Addiction Treatment Workforce

By: Linda Kaplan

June 30, 2005

Introduction

The addiction treatment workforce is comprised of many different types of staff, from specialty certified physicians to recovering staff with a high school diploma, and all levels in between. This range of staff provides an array of medical, psychological, counseling and social services. This paper provides a brief overview of the different types of staff working in the addiction treatment field and some general demographic information about them.

A recent study by Substance Abuse and Mental Health Services Administration (SAMHSA) (2003) of the addiction treatment workforce found there are about 134,000 full-time workers, including both direct care staff and support staff (clinical and administrative). Of these full-time staff, 37 percent, or 49,580, are nonclinical administrative personnel; the remaining 63 percent or 84,420, clinical staff categorized broadly as shown in table 1.

Table 1. Full- Time Staff

Type of Staff

Number

Percentage

Medical (Physicians and Nurses)

22,780

17%

Graduate Degreed Counselors

22,780

17%

Bachelors and Non-Degreed Counselors

38,860

29%

Total

84,420

63%
Source: SAMHSA 2003.

In addition, there were 44,956 part-time staff, who were more likely to have medical or graduate degrees and 22,283 contract staff. Contract staff who provide direct care usually were highly degreed and well-trained (SAMHSA 2003).

Although professionals from a number of disciplines work in the addiction treatment field, the bulk of the day-to-day treatment is performed by substance abuse counselors. Table 2 provides a breakdown of practitioners by professional discipline, other than alcohol and drug counselors, who specialize in addiction treatment. The original source of this information was a study completed by the Institute of Medicine (IOM) in 1997; however, some of the data has been updated with more current information.

Table 2. Practitioners Specializing in Addiction Treatment

Discipline

Certified Addiction Specialists

Primary care doctors

3,854 ASAM Certified *

Psychiatry

800 to 900 Addiction Psychiatrists*

Clinical psychology

2,700 APA Certified Substance Use Disorders*

Social work

1,000 ATOD certified* (29,000)**

Nursing

4,100**

Marriage/family therapy

2,500**
* Updated numbers as of 2005
** Self-described addiction specialists as of 1997
Source: IOM, 1997.

A study conducted by NAADC, the association for addiction professionals (2003), found that although almost 80 percent of their members were certified as alcohol and drug counselors, many also were licensed in their respective states in another discipline such as social work, mental health counselor or licensed professional counselor, as shown in table 3.

Table 3. Substance Abuse and Other Behavioral Health Licenses Among NAADAC Members

Certification or License

Percent of NAADAC Members

State substance abuse credential

79%

Licensed Professional Counselors

31%

Licensed Clinical Social Worker

22%

Licensed Mental Health Counselor

16%
Source: NAADAC, 2003.

Addiction Treatment Practitioners

Alcohol and Drug Abuse Counseling Professionals

Alcohol and drug counselors comprise the largest group of practitioners who provide direct services. No national database exists on alcohol and drug counselors, so the information has been compiled from a number of studies, some state or regional, and some that looked at just certain segments of the workforce. Estimates of the number of certified alcohol and drug counselors vary from state to state; however, the most recent studies put that figure at about 50 percent to 55 percent of direct counseling staff (SAMHSA 2003).

A study, by Harwood (2002) reported there were 67,000 counseling/psychosocial professionals providing services to 985,000 clients in 13,000 agencies around the country. This counseling staff was comprised of about 53 percent credentialed alcohol and drug counselors and of about 25 percent professionals credentialed in other disciplines such as social work, licensed professional counseling or marriage and family therapy. Twenty-two percent were not credentialed, but a majority of these non-credentialed staff reported being in the process of becoming credentialed.

The majority of these direct service counseling/psychosocial professionals are female, white and in their 40s; a large majority have at least bachelor’s degree (Kaplan, 2003). Most studies have found that at least 50 percent of alcohol and drug counselors possess at least a master’s degree and, in some studies, the figure is much higher (Kaplan 2003). All states have certification/licensing processes that generally require, at a minimum, 270 hours of specific addiction education and 500 hours of supervised internship; applicants also must pass a written and, in most states, an oral examination. Most states have adopted a career path that offers multiple levels of certification from an entry level with just a high school diploma or associate’s degree, to a second level that requires at a bachelor’s degree, and a third level with a master’s degree that allows for independent practice. Two independent certification bodies currently certify alcohol and drug counselors, the International Certification and Reciprocity Consortium (IC&RC) and the NAADAC’s National Certification Commission (the NAADAC NCC). However, these two organizations currently are in negotiations to merge into one credentialing body for alcohol and drug counselors. NAADAC also offers three national credentials, NCAC I, NCAC II, and the MAC for state-certified counselors with experience, a bachelor’s degree, or a master’s degree respectively.

Physicians

Physicians serve in a number of capacities in the addiction treatment field as evidenced by the SAMHSA (2003) report, although many may work part-time or as contract staff. With the ever-increasing use of medications in the treatment of substance use disorders, however, more physicians are providing services in the addiction treatment field.

American Society of Addiction Medicine (ASAM)

ASAM, with approximately 3,200 members, is a specialty medical society founded in the early 1950’s, to serve to educate, advocate and promote research in addictions. The ASAM-developed certification program has certified more than 3,800 candidates who are graduates of accredited medical schools, hold a valid state license, submit three letters of recommendation from fellow physicians, and pass a rigorous day-long examination.

American Academy of Addiction Psychiatrists (AAAP)

AAAP, started in 1985, has a membership of about 1,000 psychiatrists whose interests are to promote quality addiction treatment, strive for excellence in clinical practice, and disseminate information about addictions. The organization publishes the American Journal on Addictions.

Nurses

Nurses in the addictions field work in methadone maintenance programs, other outpatient programs, and residential and inpatient settings. In addition, there is an organization of nurses who specialize in treating addictions.

International Nurses Society on Addictions (IntNSA)

IntNSA is a group of nurses that has members in every state and a number of countries overseas. IntNSA has a certification program with two levels of credentials, the Certified Addictions Registered Nurse (CARN) and the CARN-Advanced Practice (CARN-AP). To be eligible for the CARN, a nurse must have a minimum of three years of experience as an RN and must have worked 4,000 hours (equivalent of two years) in the addictions field within the past five years. In addition, candidates must pass a written examination. To be qualified for the CARN-AP, the candidate must possess or be eligible for the CARN, have a master’s degree, and have 500 hours of supervised work in addictions treatment.

Social Workers

As demonstrated by the membership figures in table 3 and by the work of Harwood (2002), among others, social workers are an integral part of the addiction treatment workforce. Some may be dually credentialed in their respective state as both a licensed social worker and as a certified addiction counselor; however, many do not seek the addiction counseling credential. The National Association of Social Workers (NASW), a large membership organization, offers a specialty certificate for members who are interested in this specialty. The Certified-Clinical Alcohol, Tobacco and Other Drugs Social Worker (C-CATODSW) certificate requires that a candidate be a member of NASW; have an MSW degree from an accredited school; have 180 hours of education specifically in alcohol, tobacco and other drugs; have 3,000 hours (two years) of supervised post MSW paid supervised experience; have 3,000 hours (two years) of supervised post-MSW experience working in alcohol, tobacco and other drug field; have an evaluation from an approved supervisor; and have references from a colleague.

Psychologists

The American Psychology Association (APA) also offers a special certificate in substance use disorders. The Proficiency Certificate in Substance Use Disorders is for licensed, independent practitioners who provide health services in psychology. It requires passing a three-hour, 150 multiple choice exam, letters of recommendation from a fellow psychologist, and at least three years of work providing psychological services, with at least one year in addiction treatment.

Mental Health and Licensed Professional Counselors

Mental health and licensed professional counselors also play a part in providing services to people with substance use disorders. These practitioners have master’s degrees and, in many states, must pass licensure requirements that include both work experience and passing a national examination. The National Board of Certified Counselors (NBCC) has a national certification—the Master Addiction Counselor (MAC)—for those interested in working primarily in addiction treatment settings. The MAC requires that the candidate be a National Certified Counselor or have passed the national counselor examination, have12 semester hours in addiction-specific education, and have three years of supervised experience working in addictions at least 20 hours per week, with two of those years post degree. In addition, the candidate must pass the MAC examination.

For More Information

American Academy of Addiction Psychiatry – http://www.aaap.org/
American Psychological Association – http://www.apa.org/
American Society of Addiction Medicine – http://www.asam.org/
International Certification and Reciprocity Consortium/AODA – http://www.icrcaoda.org/
International Nurses Society on Addiction – http://www.intnsa.org/
NAADAC, The Association for Addiction Professionals – http://www.naadac.org/
National Association of Social Workers – http://www.naswdc.org/
National Board of Certified Counselors – http://www.nbcc.org/

References

Harwood, H.J. Survey on Behavioral Health Workplace. Frontlines. Washington, D.C.: Academy Health, November 2002.
Institute of Medicine (IOM). Managing Managed Care: Quality Improvements in Behavioral Health. Washington, D.C.: National Academy Press, 1997.
Kaplan, L. Substance Abuse Treatment Workforce Environmental Scan. Bethesda, Md.: Abt Associates, Inc., 2003.
National Association for Addiction Professionals (NAADAC). The Association for Addiction Professionals’ Year Two Final Report: A Survey of Early Career Substance Abuse Counselors. Alexandria, Va.: NAADAC, 2003.
Substance Abuse and Mental Health Services Administration (SAMHSA). Alcohol and Drug Services Study (ADSS): The National Substance Abuse Treatment System: Facilities, Clients, Services and Staffing. Rockville, Md.: Office of Applied Studies, 2003.

Back arrow, return to previous page Back to Main Site

National Conference of State Legislatures logo NCSL Home Page