White Paper

Full Report



I. Background

In response to the escalating societal and economic consequences of addictions, the ATOD field began in the early 1970’s with public recognition of and government funding for treatment and prevention programming. Early efforts at alcoholism treatment and prevention were integrated into traditional mental health systems, while separate substance abuse treatment and prevention programming developed in specific modalities and environments. The early workforce consisted of people who were recruited from related social service agencies or people who achieved recovery through a particular program.

As the ATOD field consolidated and matured, government regulations, funding sources, and third party payers mandated credentialing programs for counselors and the creation of addictions specialties in professions such as nursing, social work, psychology, psychiatry, medicine, and rehabilitation counseling. Subsequently, these professions developed their own standards and certifications related to the addictions field, and professional associations arose to provide vehicles for advocacy, standardization, and advanced education. In spite of these efforts, fewer people have chosen to work in the ATOD field, and there has been an increase in people leaving it.

The current focus on research-to-practice models, the integration of evidence-based findings into service delivery, and the challenge of maintaining existing staffing levels are critical issues facing the addictions field. Success in addressing these issues is dependent upon organizations that can readily adapt to change and a workforce that is able to accept and implement new protocols.

The growing crisis in the addictions workforce has been recognized at local, state and national levels. In recent months, in response to this crisis, descriptive information about the nature and make up of the addictions workforce has been collected and disseminated via the Addiction Technology Transfer Centers (ATTC) and its prime funding source, the Center for Substance Abuse Treatment (CSAT), and other behavior health care groups. This information supports observations that the field is “in transition, primarily [from] one that has relied on experientially trained counselors to one that emphasizes graduate training.”

This crisis, which exists in the entire workforce – among direct care counselors, professionals with specialized credentials, and those who provide education and training – underlines the need for several key initiatives. Substantial change requires new attitudinal perspectives toward clients, an interdisciplinary approach to the nature and delivery of services, increased education and training opportunities (including an enhanced curriculum), innovative methods of recruitment and retention, and more effective ways to advocate for and secure funding.