More substance use disorder (SUD) professionals will be needed over the next few years, especially in 2014 when the Affordable Care Act (ACA) takes effect, according to a long-awaited five-year study from the Addiction Technology Transfer Center (ATTC) network. The report also found that the workforce will have to change — be more diverse (it’s currently mostly white, female and over 45) and better trained (in terms of degrees and licensing). Meanwhile, the federal agency that funded the report is moving toward a “behavioral” workforce that can treat both SUDs and mental health conditions.

The 145-page report, “Vital Signs: Taking the Pulse of the Addiction Treatment Profession,” was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), which funds the ATTC network. SAMHSA provided guidelines for conducting the study, which was done by a survey of clinical directors, telephone interviews with clinical directors, telephone interviews with “thought leaders” and a review of literature and data sets. SAMHSA asked the ATTC to find the answers to these three questions:

  • What are the basic demographics of the SUD workforce?
  • What are the common strategies and methodologies to prepare, retain and maintain the workforce?
  • What are the anticipated workforce development needs in the next five years?

There is not enough data to “track the projected growth, retraction, and composition of the SUD workforce over the next five years,” the report said. But the ACA will mean there will be more patients seeking treatment in a variety of healthcare settings.

Laurie Krom, director of the ATTC Network central office in Kansas City, Missouri, pointed to the technology deficiencies as one of the most important — and surprising — findings. “I believe it is significant that almost one-third of clinical directors in a nationally representative sample reported being only somewhat proficient in web-based technologies, and that almost half of SUD facilities do not have an electronic health record system in place,” she told ADAW. “These results suggest that SUD treatment practitioners need to increase their technological competency in order to thrive in the larger healthcare system.”

Asked what the study showed about the SUD workforce that distinguished it from the “behavioral” or mental health workforce, Krom said she could not make a comparison because “we did not study the mental health workforce.”

Krom said the findings that most SUD treatment facility direct care staff are either currently licensed or seeking licensure is “good news,” but she warned that “I think it will be important for SUD treatment practitioners to continue to earn degrees in higher education as well as professional credentials in the future.”

Results

The report shows that a perfect storm is brewing in recruitment of SUD professionals — more will be needed, but even now, there aren’t enough qualified applicants to fill open positions.

Most direct care staff workers are licensed/certified or seeking licensure/certification, according to the report. Most of the SUD workforce that is licensed or credentialed comes from social work, with others coming from nursing, general and specialty medicine, psychiatry, and clinical psychology. Slightly less than a third of direct care staff are in recovery from SUDs.

Almost half of SUD facilities don’t have an electronic health record (EHR) system, with the main reason being cost. There was also a lack of proficiency in web-based technology.

Retention is also a problem, as it has been in the past, with a turnover rate of 18.5 percent reported. The best ways to retain SUD staff are to provide healthcare benefits and access to ongoing training, the report found.

The mega-trends the ATTC identified for the next five years:

  • changes to healthcare and treatment delivery;
  • push for enhanced pre-service training, professional development and uniform credentialing;
  • increased use of evidence-based and recovery-oriented methods of SUD treatment targeted for a changing client population and emerging drugs of abuse;
  • workforce recruitment and retention efforts;
  • the recognition of substance use disorders as a valid health issue; and
  • implementation and use of health information technology.

Recommendations

Some key recommendations from the report:

  • SUD treatment facilities should consider recruiting professional or pre-professional individuals in their 20s and 30s from diverse backgrounds to the workforce. Policymakers and stakeholder groups should promote the SUD treatment field, and treatment facilities should have relationships with colleges and universities so they can have access to professionals. Facilities should also continue to draw from the recovery community.
  • SUD treatment practitioners should continue to earn degrees in higher education as well as professional credentials.
  • SUD treatment practitioners should increase their technological competency. Facilities should have access to training opportunities, and educational programs for SUD treatment practitioners should include training on computer skills and the use of EHR systems. SUD treatment practitioners should also learn how to navigate e-learning software.
  • As healthcare reform changes the reimbursement structure for SUD treatment services, advocates for the field should consider mounting a concerted effort to ensure that SUD treatment practitioners are reimbursed on an equal level with other healthcare professionals.
  • SUD treatment facilities need to better understand evidence-based practice implementation models.
  • SUD treatment facilities must adopt and implement EHR systems in order to survive. Current and future SUD treatment practitioners need to have the skills to operate EHR systems in order to continue working in healthcare. Federal and state policymakers should consider supporting programs that assist SUD treatment facilities to utilize health information technology.

Data sets

Very little concrete current data lists the number and type of SUD counselors and staff. The data sets used for the report are Census 2000, the National Survey of Substance Abuse Treatment Services, National Survey on Drug Use and Health (treatment gap projection), the Treatment Episode Data Set (TEDS), the Bureau of Labor Statistics (BLS), and Annapolis Coalition data (behavioral health workforce). The BLS data show that behavioral/SUD counselors increased from 56,080 in 2000 to 77,940 in 2010. Projecting to 2020, there could be an increase in up to 30,000 more counselors.

Data from the 2005 to 2009 TEDS show a 4 percent increase in SUD treatment admissions. But the ACA combined with parity may mean an additional 6 to 10 million (11 million according to SAMHSA’s data released last week) newly insured people with untreated mental or substance abuse problems will seek treatment. This, of course, is mental and SUD, not just SUD.

‘Behavioral’ workforce

The report did not address the question of the need for a behavioral health workforce, because it was only supposed to look at the SUD workforce. But at SAMHSA, the watchword is “behavioral,” according to H. Westley Clark, M.D., director of SAMHSA’s Center for Substance Abuse Treatment, which guided the ATTC study.

“We’re still digesting the contents,” said Clark. “We’re aware that there are workforce issues.” SAMHSA did not publicize the report. A press release was issued October 10 after we indicated we would be writing about it. But Clark did point to the need for better technology, better training (he referred to a master’s degree and licensure) and the need to be part of a “behavioral” workforce.

“We know that with health reform in the offing there will be a need to provide more services to about 11 million people will have behavioral issues,” said Clark. Asked about how the SUD workforce would be affected — how many of the 11 million would have SUD issues — Clark refused to make that distinction. “With the degree of co-occurring (SUD and mental illness) that is out there, the workforce has to be able to assess both,” he told ADAW. “So rather than dissect this as an either-or proposition, our concern is dealing with behavioral health issues as part of a continuum.”

Even though SAMHSA is now talking about a “behavioral” workforce, the ATTC report is still relevant, said Clark. “The report can inform our work,” he said. “But the ultimate focus on workforce is not on workforce. It’s on helping the patient, whether it’s an SUD workforce, a behavioral workforce or a physical workforce.”

“This is a good report,” said Clark. “It raises solid issues; it is something that we need to keep in mind because we need to prepare substance abuse providers and to work in an integrated paradigm.”

And “integrated” is key. “We don’t want someone saying, ‘I’m only a substance abuse provider,’ or ‘I’m only a mental health provider,’” Clark said.

For the report, go to www.attcnetwork.org/documents/VitalSignsReport.pdf.

Editor’s note: Both NAADAC and IC&RC, the two membership organizations representing SUD counselors, were both having national meetings this week, so neither was able to comment on this report. Watch for their response in next week’s issue.