Addiction treatment workforce: Counselor credentials, training and innovation J. Aaron Johnson, Ph.D. Lori J. Ducharme, Ph.D. Sarah Henderson, M.A. Center for Research on Behavioral Health and Human Services Delivery The University of Georgia Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Professionalization of Addiction Treatment Workforce Traditionally addiction treatment counselors were recovering addicts, often graduates of program in which they were employed Numerous factors led to professionalization of workforce Today, nearly half have Master’s degrees More than half are either certified and/or licensed as addictions counselors Significant differences in level of professionalization in publicly funded and privately funded programs Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Professionalization and Evidence-based Practice Addiction treatment traditionally based on the 12-step model. Research suggests adherence to 12-step model may impede innovation. Many new techniques, including FDA approval of several pharmacotherapies, have recently emerged. Educating and training clinical staff on new techniques may remove barriers to innovation by changing attitudes. Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976 Research Question To what extent are there differences between publicly and privately funded centers in regards to counselor credentials and training? What impact does counselor credentials and training have on perceived effectiveness and acceptability of selected new treatment techniques? What are the implications for adoption of new treatment techniques? Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976 Data and Methods The National Treatment Center Study Nationally representative samples of publicly and privately funded addiction treatment programs (N=763) Counselor data via mail questionnaire from counselors employed in these programs (N=2296) Counselor Response rate = 61% Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Counselor Demographics Public Centers Private Centers Gender (% Female) 63.9%** 57.6% Race - White 81.9% - Black 22.4%** 10.5% - Hispanic 8.1%** 3.4% Average Age 44.4 Yrs** 46.4 Yrs In Recovery 48.9% 47.7% Salary (% > $40K) 8.9%** 24.3% Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Counselor Credentials and Training Public Centers Private Centers Education(% MA or Higher) 37.9%** 47.7% Ave. Annual In-service Training (Hours) 23.9* 20.6 Ave. Annual External Training (Hours) 35.9* 32.0 Certified (%) 53.4%* 58.6% Licensed (%) 24.2% 27.0% Experience (Yrs in Field) 8.3Yrs** 10.3Yrs Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Specific Training on Select Evidence-based Practice (Scale = 1 to 7) Public Centers Private Centers Buprenorphine 1.85** 2.18 Naltrexone 2.09** 2.72 SSRIs 2.65** 3.32 Motivational Enhancement Therapy 3.43 3.26 Motivational Incentives 2.37** 1.94 Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976 Relationship b/w Training and Perceived Effectiveness/ Acceptability of Therapies (Bivariate Regression Coefficients) Perceived Effectiveness of Technique Perceived Acceptability of Technique Buprenorphine .599** .369** Naltrexone .567** .344** SSRIs .667** .425** Motivational Enhancement Therapy .494** .311** Motivational Incentives .568** .366** Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976 Relationship b/w Education and Perceived Effectiveness/ Acceptability of Therapies (Bivariate Regression Coefficients) Perceived Effectiveness of Technique Perceived Acceptability of Technique Buprenorphine .074* .283** Naltrexone .127** .293** SSRIs .600** .481** Motivational Enhancement Therapy .068 .191** Motivational Incentives -.063 .095** Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976 Conclusions Significant differences b/w counselors employed in public and private treatment programs. Public Centers Demographics - more racially diverse, employ higher proportion of females, have significantly lower salaries Credentials – lower % with MA or certification, fewer years of experience in field Training – more training hours, but less training on pharmacotherapies Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976

Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976 Conclusions (cont.) Both training on specific techniques and overall levels of education shown to increase perceptions of effectiveness and acceptability for new techniques, particularly pharmacotherapies. Significant differences in education levels and training in public centers could make it more difficult to move research into practice in these settings. Funded by NIDA Grants: R01-DA13110, R01-DA14482, R01-DA14976