Commentary: The Substance Abuse Workforce After Health Care Reform

Andrew Kessler- 3-2-12

As implementation of the Affordable Care Act (ACA) moves forward, states must ensure that people being treated for substance abuse are cared for by credentialed professionals.

All of us in the substance abuse treatment and prevention community have tracked the conception, birth and growth of the Affordable Care Act. Those who work with and as treatment and prevention professionals are no exception. Now, as treatment for addiction and abuse will be more accessible, the professionals who provide it must find a way to fit into the new world order.

Treatment for substance abuse is now mandated by the ACA, but to what degree remains to be determined. In addition, there is no simple answer for who will—or can—provide it. Policymakers who are “in the know” about substance abuse treatment, as well as substance abuse counselors, are a truly rare breed. It is also rather hard to find insurance executives with this knowledge. Add into the mix the recent curveball thrown by the Department of Health and Human Services, which will allow states to design their own essential health benefit package (rather than establishing a federal standard), combined with each state’s Medicaid system already wielding vast power under the law in terms of coverage and reimbursement, and the reimbursement waters cloud still further.

Many bodies responsible for reimbursement of health professionals look to whether a professional is licensed. In most health professions, and in most states, a license is contingent upon education in a specific pursuit. For instance, a doctor must attend an accredited medical school. Physicians, nurses, social workers, mental health counselors and many other health professionals are licensed by their respective states, or at least by bodies recognized by the state. Not every state offers licensing for substance abuse counseling, and many that do offer a license that can be obtained by virtue of a degree. Even in those states that do license substance abuse counselors, the education requirement is more often than not a degree in social work, psychology or other pursuit, with no guarantee that the licensed individual has been educated specifically in substance abuse counseling.

When setting standards for who can provide treatment, states need to look to a professional’s expertise. In the substance abuse treatment field, that is best judged by whether they are credentialed. Just as a doctor or nurse can be board certified in a specialty, a counselor can also be (and often is) certified. Not only are substance abuse counselors certified, but depending on the state, they can be certified in different specialties (for example, criminal justice, co-occurring disorders, prevention specialist) and at different levels (clinical supervisor, masters level, etc.). A very large majority of substance abuse counselors are certified by a state certification board that provides testing and standards of practice guidelines. As in any other medical specialty, a patient being treated for substance abuse or addiction may encounter different professionals with different degrees and different areas of expertise, no different than a cancer patient or HIV patient.

Those who have a stake in the treatment of substance abuse need to engage in advocacy at the state level to assure that consumers are treated by competent, educated professionals who have been trained in evidence-based practices. The days of policymakers who work off the assumption that a psychologist, social worker or even physician is competent to treat addiction by virtue of their degree must end.

As we move forward, we must illustrate that those in need of substance abuse treatment must be cared for by those trained in that pursuit, and these professionals must be compensated at a level worthy of their expertise. If Americans are to receive more competent, cost-efficient care, which is the whole point of the ACA, states would be wise to learn more about the highly trained, highly skilled workforce that provides substance abuse treatment to its citizens.

Andrew D. Kessler is IC&RC’s Federal Policy Liaison and Founder of Slingshot Solutions, LLC.

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