The High Cost of Varying Standards for Certification and Licensure of Addiction Counselors in the United States

This article originally appeared in the Spring 2016 issue of NAADAC’s official publication, Advances in Addiction & Recovery.

By John Korkow, PhD, LAC, SAP

The complex and inconsistent licensure of addiction professionals has become a much discussed topic, and licensure guidelines are only getting more confusing.  Currently, the country is split: 27 states and the District of Columbia have addition-specific licensure, and the remaining 23 states do not.  The American Counseling Association (ACA) is working to have all of 23 states currently without addiction-specific liensure under their licensure umbrella by 2020.  However, the ACA plan’s guidelines require a degree from a master’s program accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP).  This means that counselors practicing in almost half of the states in the country will not be eligible for an addiction professional license unless they hold a master’s degree from a CACREP accredited master’s program.

An exhaustive review of the addiction counselor licensure and certification standards on a state-by-state basis reveals a crazy quilt of different titles, different standards, different levels, different educational requirements, and differentexperienceial requirements. There is, surprisingly, not even a common thread running through all programs.  This state of affairs places states lacking addiction-specific licensure in a position that will readily allow outside groups to seize the profession out of addiction-specific stakeholders’ grasps and remake it into something new and different.  I cannot overstate the damage this will do, not only to addiction counselors, but to the addiction profession and our clients.

Only California, Mississippi and Ohio have implemented the SAMHSA career ladder, though some other states have partially done so.  The SAMHSA career ladder provides addiction counselors at all educational levels a method to enter and remain in the profession, along with the ability to move to higher levels of the ladder should the counselor wish to gain additional education.1  This is where the National Addiction Studies Accreditation Commission (NASAC)  standards for accreditation intersect with existing certification and licensure standards. A primary first step for states wishing to move toward licensure is a joint incorporation of the NASAC standards within the SAMHSA Career ladder.  The NASAC accreditation model adopts the Practice Dimensions from SAMHSA publication TAP 21, Addiction Counseling Competencies. The Knowledge, Skills, and Attitudes of Professional Practice. These dimensions include: clinical evaluation, treatment planning, referral, service coordination, counseling, client-family-community education, documentation, and professional-ethical responsibilities.2  With the exception of Category 5, Independent Skills Supervisor (covered in TAP 21-A), these competencies very neatly dovetail with the existing educational standards for licensure and certification in ALL states.3

Even states which specify certain addiction courses could easily incorporate the Practice Dimension into their existing requirements without sacrificing the education the state has deemed appropriate. The true basis of a national licensure standard, which allows state-by-state flexibility, and simplifies reciprocity, lies within the Practice Dimensions, as utilized in the NASAC accreditation standards. These standards were developed by INCASE over many years, and as we reviewed TAP 21, it became apparent that we now had a universal standard that could apply to a wide range of programs in many states with differing requirements for licensure and certification.

The lack of a flexible and accommodating national standard has left 23 states in a position that opens the addiction profession to an aggressive takeover by other professions. While we, as addiction professionals, are very open to working with outside professions, we should not be open to working for these other professionals who do not fully understand our ethics, standards, competencies, diagnoses, skills, business, and, most importantly, our clients. In one particular state that has achieved licensure within the last five years, there are four levels of the SAMHSA ladder in place.  The categories, which I have renamed so as to avoid identifying the state, are as follows: (1) Entry Category: Addiction Technician, which requires a high school diploma and 60 hours of education including ethics, HIV, education and recovery support; (2) Category 1: Certified Addiction Counselor, which requires a bachelor’s degree or master’s degree with 270 hours of education covering the 12 core functions and ethics along with HIV and domestic violence classes; (3) Category 2: Licensed Addiction Counselor, which requires 180 education hours in addiction (again, very similar to the 12 core functions) with a master’s degree or PhD; and (4) Category 3: Licensed Clinical Addiction Counselor, which requires 180 hours of addiction education, and the ability to do mental health diagnosis. The Practice Dimensions neatly cover this state’s standards, and when placed within the career ladder, allow for the addition of Category 4, Administrator with a master’s degree, and Category 5, Supervisor.

Currently, there is little to no consistency amoung the states.  Several states have a lengthy list of required trainings, several states have a listing of required college coursework, and several merely state a required number of hours in addiction counseling workshops.  Regardless, the Tap 21 Compentencies would fit as an umbrella over all states.  Utilizing this simple and comprehensive eight competency listing is the key to a universal standard that fits all existing models in all states, and meets the high level of accreditation standards set by NASAC.

Universal, and understandable competency standards that are the foundation of our profession, leading us into a position of safe leadership via national licensure with regional flexibility, or a patchwork quilt of 23 states at high risk of takeover by external professionals who truly do not understand our profession: the choice is before us.


References:

  1. SAMHSA Career Ladder, http://store.samhsa.gov/product/Scopes-of-Practice-and-Career-Ladder-for-Substance-Use-Disorders-Counseling/PEP11-SCOPES
  2. SAMHSA TAP 21, http://store.samhsa.gov/product/TAP-21-Addiction-Counseling-Competencies/SMA15-4171
  3. SAMHSA TAP 21-A, http://store.samhsa.gov/product/TAP-21-A-Competencies-for-Substance-Abuse-Treatment-Clinical-Supervisors/SMA13-4243

John Korkow, PhD, LAC, SAP, received his PhD in Educational Psychology
from the University of South Dakota in 2008. He completed an MA in
Community Agency Counseling, and a BS in Addiction Studies, and has
worked as an addiction counselor since 1999. He is a board member and
conference committee planning chair of SDAAPP, member of NAADAC,
President of INCASE, and board member of NASAC. He is currently an assistant
professor in Addiction Studies at the University of South Dakota.
 

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