The workforce is one of the critical issues confronting the substance abuse field today. The Center for Substance Abuse Treatment's (CSAT's) National Treatment Plan highlighted the importance of the workforce as well as the deficit of knowledge about this backbone of the nation's substance abuse treatment system.
In the past several years, NAADAC, The Association for Addiction Professionals has worked with CSAT to attempt to close the deficit through operation of a Practitioner Services Network. The PSN has been used to learn more about members of the association and to examine issues that are increasingly critical to NAADAC and the field, such as the training and education needs of counselors and the needs of our clients.
In the most recent PSN study the primary focus was to characterize the client mix NAADAC members encounter, their diagnoses, the treatment they receive, and their current treatment needs. The study particularly offers insight into differences in treatment practice and clients encountered between counselors who work in private practice and counselors who work in organized behavioral health facilities.
A 53-question survey was given to a representative sample of about 300 NAADAC members. The overall response rate was 63 percent. The most novel aspect of this study was the collection of data about a sample of about 400 clients.
In addition to the survey, a small, qualitative study was conducted with three focus groups of experienced substance abuse counselors who had been in the field longer than five years. The purpose was to identify and highlight issues that these counselors consider to pose the greatest challenge to the field today. Twenty counselors participated.
The PSN survey obtained information on select practitioner characteristics, including work setting, years of experience, age and education. A highlight was the capture of data on the characteristics of counselors working in private practice and of the clients they treat. Surprisingly, close to half of the counselors surveyed work to some degree in private practice. In total, 26 percent of practitioners work solely in a private-practice setting, while 18 percent work in both a private-practice setting and an organizational setting.
Counselors were largely mid-career (i.e., between five and 15 years of experience) or late-career (i.e., more than 15 years of experience), rather than early-career (i.e., less than five years of experience) professionals. Regardless of career level, the majority of counselors were between the ages of 35 and 64. This trend in early- and mid-career counselors suggests that these counselors entered the field at a later point in their life, perhaps after having made a career change.
The survey also found that the majority of the substance abuse counselors were well-educated--a finding that may reflect a new emphasis on the importance of higher levels of education. Sixty-four percent of the counselors surveyed held a master's degree and/or doctorate degree. Eighteen percent of practitioners who work solely in private practice held a doctorate.
Counselors provided individual client data for more than 400 clients. Slightly more than half of these clients (53 percent) were seen in an organized behavioral health facility (e.g., substance abuse and mental health ambulatory and residential clinics as well as public and private hospitals). A unique feature of the survey was that data were acquired on a representative sample of clients seen in a solo or group private practice. Very little has been known about clients who get substance abuse treatment from private practitioners.
The majority of clients were male, white, in their mid-30s, and single, and had attended and/or completed high school (see Table 1). There were notable differences in client characteristics across settings. …