Wednesday, May 20, 2009

Class war in California counseling

In California you need a license to fix cars, cut hair, paint fingernails, give massages, and much else. But not to provide addiction treatment. You can be a high school dropout with a history of petty crime and mental hospital stays, and you may find work as a counselor treating people who suffer from addiction. There are in fact a substantial number of high school dropouts working as front-line counselors in the field today.

Yet, at the same time, the addiction counseling industry insists, almost with one voice, that addiction is a disease. Just like diabetes, atherosclerosis, hypertension, and the rest. Now, if addiction is a disease, then addiction treatment must be a branch of medicine. No?

How many other branches of medicine do you know where the front-line treatment providers -- the physicians and RNs who hold the patient's recovery in their hands -- are high school dropouts? Or high school graduates, without more? Or have junior college degrees, only? There are none. Addiction treatment is way out of line, far, far below the standard of the rest of medicine -- if in fact it deserves the name "medicine" at all.

To be sure, there are quality treatment programs where addiction professionals are held to the same high standard as other providers. At the Kaiser Chemical Dependency Recovery Programs, for example, there is supervision by an MD, and each of the counselors has a professional license or certification as a Licensed Clinical Social Worker, Marriage and Family Therapist, Registered Nurse, or a similar qualification that requires graduate level education and thousands of hours of supervised training. But these islands of quality are, unfortunately, just islands.

Several organizations in California have been trying for years to pass legislation that would require standards of training, education, licensure and certification for addiction counselors comparable to those in other clinical professions. The current effort is Senate Bill 707. It is a complex piece of legislation and I won't try to analyze it here in detail. What's most interesting about it, really, is the controversy that surrounds it.

On the one hand, there are voices crying that it doesn't go far enough. Today's email, for example, brings a post from Dennis W., a member of the board of one of the counselors' organizations, complaining that the draft bill is so watered down as to be useless. It puts counselors with a GED and 350 hours of counseling experience on the same level as those who have a master's degree in addiction studies. He says that the bill in this form "will continue to keep the addiction service profession in California the sub-standard field that all other states in the US look down upon."

On the other hand, the bill has been the target of a barrage of attacks charging that it goes too far. If it passes, say these voices, program costs will rise, programs will go out of business, and counselors by the thousands will be out of jobs. What's that about?

The current newsletter of one of the other addiction professionals' organizations explains:
Simply put, associations representing program owners are attempting to defeat the measure by “scaring” counselors from supporting it. The truth is, they’ve opposed every bill put forward to recognize your professionalism. More than half of the states have licensure and none of their treatment systems were shut down due to licensure or certification. Standards for counselors improves salaries, raises treatment outcomes and reduces the strains on public sector treatment as addicts seek treatment from private practitioners.

So there you have it. It's class war. On one side, the counselors who aspire to professional status and to the salaries, benefits, and respect that come with it. On the other side, associations representing owners of treatment programs whose profit rate depends on filling their staff rosters with people who have little education, training, or other claims to professional advancement.

Now you can begin to understand a little more clearly why much of the addiction industry is so heavily invested in the 12-step approach. The 12-step approach does not require much in the way of professional education. If you've done the steps and you can repeat a basic set of slogans for any occasion, you're qualified to "carry the message" to others. Of course, you're not supposed to be getting paid for doing that, but you're being paid so little as a counselor that you might as well be doing it for free. If Karl Marx were looking at this, he might say that the 12-step organizations continuously generate a "reserve army of labor" for the treatment industry -- a flood of workers willing to work for substandard wages and under substandard conditions. And this "reserve army" necessarily depresses the wages and conditions of the whole labor force. No wonder, then, that the owners' associations oppose the counselors' campaign to pass laws that would upgrade professional standards.


Anonymous said...

Your arguments are plausible but you make the mistaken assumption that everyone supports, or should support, the disease concept of alcoholism and/or "addiction".
Everyone does not and that certainly includes a good number of doctors and researchers in the medical industry. So long as we live in what's left of a free society, so long as we are free to make our own decisions and make our own mistakes, bad, nasty, degrading, even dangerous habits will NEVER be diseases. You cannot force something to be what it is not. Bad habits are not diseases. Even a first grader understands this. And all the legal jargon in the world can't change a bad, nasty, awful habit into a "disease". Anthro

Salina said...

Anthro, why are the 12-step groups still using the term "disease"? Please educate me! Pretend I'm a first grader.