Addiction counseling is like walking a tightrope from a dizzying height. One mis-step, one mis-statement, and you can lose the trust of the client, lose their commitment to their recovery, or lose your job.
In this day and age we have the added burden of HIPPA and privacy that undermines all our efforts with those who struggle with addiction because until a client has reached the stage of acceptance, is working a program of recovery, they will do anything to manipulate the counselor, staff, doctors, family and others to get their own way.
The treatment models used back in the 1950’s employed harsh and some would say abusive techniques; the models from the 80’s into the 90’s used a bit more humane approaches – and today in the 2015’s we are inundated with such a hodgepodge of approaches that it is hard to say what we are using. Everything from “harm reduction” to “religious based” from “cognitive-behavioral” to “recovery coaching” and from “community support” to “rational recovery.”
According to the CASAColumbia’s 2012 report “Addiction Medicine: Closing the Gap” (Columbia University, New York City), There are no national standards of care for addiction, which is an alarming fact. Addiction is not treated like other diseases – and marginalizes the patient in need of care.
Most doctors are not educated in the parameters of addiction as a disease – if they were they would not have contributed to the opioid addiction pandemic that is ravaging this country. Medical schools do not engage in curricula that give medical practitioners the tools to offer a diagnosis or provide treatment, much less refer patients to resources.
Our insurance system varies so widely and in many ways is so punitive that most treatment centers won’t take insurance. This leaves millions of people suffering from the disease without options for care, left to their own devices, relapsing, or death.
The substance abuse counselor is caught between numerous systems – the facility that seeks to make a profit, the family desperate to get help for their loved one, the debilitating co-pay required by the insurance company, and standards and practices that constrain us from engaging in anything that would appear sympathetic to the plight the client is faced with.
It is perhaps why this profession has such a high burnout rate and turnover, and why so many talented but disgruntled counselors who are not heard by administrators, leave organizations for more mediocre employees to take their place.
The solutions to these problems can not be implemented by one person, but rather many. One counselor may find themselves struggling against a tidal wave of opposition when trying to update methods or approaches at a clinic, treatment center or outpatient facility. But when more than one counselor begins to speak the same words, solutions are around the corner.
The biggest solution is for counselors to get involved outside their work in advocacy, volunteering, education, and prevention in the community. That’s a tall order when you are worked to the bone with little to no time off for self-care. But small steps like printing off articles from professional journals, or reports from the National Institute for Drug Addiction (NIDA) or CASAColumbia, to name two of the top organizations working to advance this field, and sharing with co-workers and sympathetic ears, is a good beginning.
There are organizations like “FedUp Rally,” “Shatterproof,” “Faces and Voices in Recovery” and there are local opportunities at churches, police stations and schools as our cities and states try to deal with the overwhelming problems that drugs and alcohol are bringing to their doorsteps.
If you are a counselor, these places need your knowledge. If time is limited, show your support to the work being done by the larger organizations by visiting their sites, liking them on Facebook, and talking about it. Get pamphlets. Share the knowledge.
Above all, don’t give up hope. We are not a perfect profession, by far – and we have a long way to go. But raising your voice, and your knowledge base will go a long way to raise the standards, raise awareness, and raise the national bar.
After all – what do you have to lose – other than devolving into mediocrity?