Implications of Personal Recovery History for Training and Development

of Addiction Treatment Workers

Bruce K. Barnard

The following is a summary of data from surveys administered to the clinical staff of community addiction treatment agencies in central Illinois. The purpose of the study was to identify, compare, and contrast competencies perceived as most important by addiction treatment workers with a personal history of recovery and competencies perceived as most important by workers with no personal history of recovery.

Response Rate

Distributed Returned Response

94 89 94.6%

For purposes of comparison, the data is reported on the survey instrument. Data is reported for each of five groups. A mean score was calculated for the responses from each group and reported according to the following validity scale.

Validity Scale

Numerical Scale Description Average

1 Very low 1 to 1.5

2 Low 1.51 to 2.5

3 Neither high nor low 2.51 to 3.5

4 High 3.51 to 4.5

5 Very high 4.51 to 5

Group A Addiction treatment workers, eligible for licensure, who have a personal history of recovery. n=11

Group B Addiction treatment workers, not eligible for licensure, who have a personal history of recovery. n=18

Group C Addiction treatment workers, eligible for licensure, who have no personal history of recovery. n=30

Group D Addiction treatment workers, not eligible for licensure, who have no personal history of recovery. n=28

Group E All addiction treatment workers. N=87

Weighting

Responses to questions regarding the most important competency were weighted as follows:

Most Important 3 points

2^nd Most Important 2 points

3^rd Most Important 1 point

The highest score was reported as most important. If scores were identical, the competency with the highest mode score in the “most important” category was reported.

Q-1 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill

No.

____________ Description of Skill___________________

VERY

LOW

NEITHER HIGH

NOR LOW

HIGH

VERY

HIGH

Understand a variety of models and theories of addiction and other problems related to substance use.

E

A,B

Able to recognize the social political, economic, and cultural context within which addiction and substance abuse exist, including risk and resiliency factors that characterize individuals and groups and their living environments.

E

A.C

Able to describe the behavioral, psychological, physical health, and social effects of psychoactive substances on the user and significant others.

E

A,B

C,D

Able to recognize the potential for substance use disorders to mimic a variety of medical and psychological disorders and the potential for medical and psychological disorders to co-exist with addiction and substance abuse.

E

A,D

B,C

Q-2 Of the skills listed in Q-1 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important 3 3 1 2 3

Second most important 2 2 3 3 2

Q-3 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill No.	____________ Description of Skill___________________	VERY LOW	LOW	NEITHER HIGH NOR LOW	HIGH	VERY HIGH
1	Able to describe the philosophies, practices, policies, and outcomes of the most generally accepted and scientifically supported models of treatment, recovery, relapse prevention, and continuing care for addiction and other substance-related disorders.				E A,B C,D
2	Able to recognize the importance of family, social networks, and community systems in the treatment and recovery process.					E A,B C,D
3	Understand the importance of research and outcome data and their application in clinical practice.				E A,B C,D
4	Understand the value of an interdisciplinary approach to addiction treatment.				E A,B C,D

Q-4 Of the skills listed in Q-3 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important. 2 2 2 2 2

Second most important 1 1 1 1 1

Q-5 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill

No.

________________ Description of Skill_______________

VERY

LOW

NEITHER HIGH

NOR LOW

HIGH

VERY

HIGH

Understand the established diagnostic criteria for substance abuse disorders and describe treatment modalities and placement criteria within the continuum of care.

E

A,B

Able to describe a variety of helping strategies for reducing the negative effects of substance use, abuse, and dependence.

E

A,B

Able to tailor helping strategies and treatment modalities to the client’s stage of dependence, change, or recovery.

E

A,C

Able to adapt practice to the range of treatment settings and modalities.

E

A,B

C,D

Familiarity with medical and pharmacological resources in the treatment of substance use disorders.

E

A,B

C,D

Understand the variety of insurance and health maintenance options available and the importance of helping clients access those benefits.

E

A,B,C,D

Able to recognize that crisis may indicate an underlying substance use disorder and may be a window of opportunity for change.

E

A,B

C,D

Understand the need for and the use of methods for measuring treatment outcome.

A

E

B,C

Q-6 Of the skills listed in Q-5 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important 3 3 1 1 3

Second most important 2 1 3 3 1

Third most important 7 2 2 2 2

Q-7 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill No.	______________ Description of Skill_______________	VERY LOW	LOW	NEITHER HIGH NOR LOW	HIGH	VERY HIGH
1	Able to monitor the client’s behavior for consistency with preferred treatment outcomes.				E A,B C,D
2	Able to present inconsistencies between client behaviors and goals.				E B,C D	A
3	Able to re-frame and redirect negative behaviors.				C,D	E A,B
4	Abilities in conflict resolution, decision making, and problem solving skills.				A	E B.C D
5	Able to recognize and address underlying client issues that may impede treatment progress.					E A,B C,D

Q-8 Of the skills listed in Q-7 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important 4 4 5 5 5

Second most important 2 3 4 4 4

Third most important 5 5 2 3 3

Q-9 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill No.	_______________ Description of Skill_______________	VERY LOW	LOW	NEITHER HIGH NOR LOW	HIGH	VERY HIGH
1	Understand diverse cultures and incorporate the relevant needs of culturEy diverse groups, as well as people with disabilities, into clinical practice.				E A,B C,D
2	Understand the importance of self-awareness in one’s own personal, professional, and cultural life.				E A,B D	C
3	Understand the addiction professional’s obligations to adhere to ethical and behavioral standards of conduct in the helping relationship.					E A,B C,D
4	Understand the importance of ongoing supervision and continuing education in the delivery of client services.				E A,C D	B
5	Understand the obligation of the addiction professional to participate in prevention as well as treatment.				E A,B C,D
6	Understand and apply setting-specific policies and procedures for handling crisis or dangerous situations, including safety measures for clinical staff.				E A,B D	C

Q-10 Of the skills listed in Q-9 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important 3 2 3 3 3

Second most important 2 3 2 1 2

Third most important 1 1 1 6 1

Q-11 Listed below are some areas of knowledge that have been identified in addiction treatment workers. Please indicate how you rate the importance of knowledge in each area: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill No.	_________ Description of Knowledge_______________	VERY LOW	LOW	NEITHER HIGH NOR LOW	HIGH	VERY HIGH
1	Pharmacotherapy (combining medical and pharmacological interventions with counseling)			D	E A,B C
2	Mutual help and self-help. (AA, NA, Alanon)				E A,C,D	B
3	Behavioral self-control training				E A,B,C,D
4	Mental health				E B,C,D	A
5	Self-regulation community (therapeutic community)				E A,B,C,D
6	Psychotherapeutic				E A,B,C,D
7	Relapse prevention					E A,B,C,D
8	Multimodality				E A,B,C,D

Q-12 Of the knowledge areas listed in Q-11 which do you believe is most important for addiction treatment workers? Please write the knowledge number in the appropriate area.

A B C D E

Most important 7 2 7 2 7

Second most important 2 7 4 7 2

Third most important 3 4 2 4 4

Q-13 Listed below are some clusters of skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each cluster of skills: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill No.	_______________ Description of Skills______________	VERY LOW	LOW	NEITHER HIGH NOR LOW	HIGH	VERY HIGH
1	Screening, the process through which a counselor, client and available significant others determine the most appropriate initial course of action, given the clients needs and characteristics, and the available resources within the community.				E A,B	C,D
2	Assessment, an on-going process through which the counselor collaborates with the client and others to gather and interpret information necessary for planning treatment and evaluating client progress					E A,B C,D
3	Implementing the treatment plan.				E A,B,C,D
4	Consulting (case presentation and staffing).				E A,B,C,D
5	Continuing assessment and treatment planning					E A,B,C,D
6	Individual counseling				B	E A,C,D
7	Group Counseling					E A,B,C,D
8	Counseling families, couples, and significant others				E A,B,D	C
9	Client, Family, and Community Education				E A,B,C,D
10	Documentation. The recording of the screening and intake process, assessment, treatment plan, clinical reports, clinical progress notes, discharge summaries, and other client-related data				E A,B,C	D
11	Professional and Ethical Responsibilities					E A,B,C,D

Q-14 Of the skill areas listed in Q-13 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important 2 2 2 2 2

Second most important 6 11 11 11 11

Third most important 7 6 1 1 1

Q-15 Listed below are some clusters of skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each cluster of skills: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill No.	_______________ Description of Skills______________	VERY LOW	LOW	NEITHER HIGH NOR LOW	HIGH	VERY HIGH
1	Able to establish a helping relationship with the client characterized by warmth, respect, genuineness, concreteness, and empathy.					E A,B C.D
2	Able to facilitate the client’s engagement in the treatment and recovery process.				E A,B D	C
3	Able to work with the client to establish realistic, achievable, goals consistent with achieving and maintaining recovery.					E A,B C,D
4	Able to promote client knowledge, skills, and attitudes that contribute to a positive change in substance abuse behaviors.					E A,B C,D
5	Able to encourage and reinforce client actions determined to be beneficial in progressing toward treatment goals.				B,C	E A,D
6	Able to work appropriately with the client to recognize and discourage E behaviors inconsistent with progress toward treatment goals.				E A,B C,D
7	Able to recognize how, when, and why to involve the client’s significant others in enhancing or supporting the treatment plan.				E A,B C,D
8	Able to promote client knowledge, skills, and attitudes consistent with the maintenance of health and prevention of HIV, TB, STDs, and other infectious diseases.				E A,B C,D
9	Able to facilitate the development of basic and life skills associated with recovery.				E C,D	A,B
10	Able to adapt counseling strategies to the individual.					E A,B,C,D
11	Able to make constructive therapeutic responses when the client’s behavior is inconsistent with stated recovery goals.				E A,B	C,D
12	Able to apply crisis management skills.				A,C,D	E B
13	Able to facilitate the client’s identification, selection, and practice of strategies that help sustain the knowledge, skills, and attitudes needed for maintaining treatment progress and preventing relapse.				A,B D	E C

Q-16 Of the skill areas listed in Q-15 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important 1 1 1 1 1

Second most important 3 10 3 10 10

Third most important 5 3 10 3 3

Q-17 Listed below are some clusters of skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each cluster of skills: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Skill No.	_______________ Description of Skills______________	VERY LOW	LOW	NEITHER HIGH NOR LOW	HIGH	VERY HIGH
1	Able to describe, select, and appropriately use strategies from accepted and culturEy appropriate models for group counseling with clients with substance abuse disorders.				E A,B C,D
2	Able to carry out actions necessary to form a group, including, but not limited to: determining group type, purpose, size, and leadership; recruiting and selecting members; establishing group goals and clarifying behavioral ground rules for participating; identifying outcomes; and determining criteria and methods for termination or graduation form the group.				E A,B C,D
3	Able to facilitate the entry of new members and the transition of exiting members.				E A,B C,D
4	Able to facilitate group growth within the established ground rules and movement toward group and individual goals by using methods consistent with group type.				E A,B C,D
5	Understand the concepts of process and content, and shift the focus of the group when such an intervention will help the group move towards its goals.				D	E A, B C
6	Able to describe and summarize client behavior within the group for the purpose of documenting the client’s progress and identifying needs and issues that may require a modification in the treatment plan.				E A,B C,D

Q-18 Of the skill areas listed in Q-17 which do you believe is most important for addiction treatment workers? Please write the skill number in the appropriate area.

A B C D E

Most important 2 5 2 2 2

Second most important 5 2 5 6 5

Third most important 1 6 4 4 4

Q-19 Below are brief descriptions of some addiction treatment philosophies and approaches. Please identify those statements that most closely resemble your personal treatment philosophy.

(1) Successful treatment of addiction requires an understanding of and working with the social systems within which the client operates.

(2) Successful treatment of addiction requires engaging the client wherever he or she is and embracing any change that reduces the harm caused by addiction.

(3) Successful treatment of addiction requires following a 12-step program and bonding to a recovery community.

(4) Successful treatment of addiction requires helping the client identify destructive thinking and emotional patterns and working with the client to change those patterns.

(5) Successful treatment of addiction is based on the belief that each client has the strength, skills, and resources necessary to overcome addiction. Treatment involves helping the client identify his or her own strengths, skills, and resources and use them to create a successful recovery plan.

(6) Successful treatment of addiction requires educating the client as to the nature of addiction and providing him or her with a toolbox of skills including, but not limited to, problem solving, anger management, relapse prevention, and relaxation.

(7) Successful treatment of addiction requires the client to make a long-term commitment to change. Treatment involves providing a supportive drug-free community where the client can develop new skills and coping strategies in real world situations.

A B C D E

Most important 5 2 5 6 6

Second most important 6 5 6 5 5

Third most important 4 6 2 7 2

Q-20 Are you licensed as a Professional Counselor (LPC), Clinical Professional Counselor (LCPC), Social Worker (LSW), Clinical Social Worker (LCSW), Psychologist, Physician, or will you be licensed within two years? YES 41 NO 47

Q-21 Are you a Registered Nurse (RN), a Licensed Practical Nurse (LPN), or Emergency Medical Technician (EMT). YES 6 NO 80

Q-22 Are you certified as an Alcohol and Drug Counselor (CADC) or Assessment and Referral Specialist (CARS), or will you be certified within two years. YES 66 NO 22

Q-23 Do you consider yourself to be recovered or recovering from alcohol or substance abuse?

YES 29 NO 58

Q-1 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

E

E

E

E

Q-3 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

E

E

E

E

Q-5 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

E

E

E

A,C

E

E

E

E

A

E

Most important 3 3 1 1 3

Second most important 2 1 3 3 1

Third most important 7 2 2 2 2

Q-7 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

Q-9 Listed below are some skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each skill: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

1

Understand diverse cultures and incorporate the relevant needs of culturEy diverse groups, as well as people with disabilities, into clinical practice.

E

2

Understand the importance of self-awareness in one’s own personal, professional, and cultural life.

E

3

E

4

Understand the importance of ongoing supervision and continuing education in the delivery of client services.

E

5

Understand the obligation of the addiction professional to participate in prevention as well as treatment.

E

6

E

Q-11 Listed below are some areas of knowledge that have been identified in addiction treatment workers. Please indicate how you rate the importance of knowledge in each area: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

D

Q-13 Listed below are some clusters of skills demonstrated by addiction treatment workers. Please indicate how you rate the importance of each cluster of skills: VERY LOW, LOW, NEITHER HIGH NOR LOW, HIGH, or VERY HIGH.

1

E

2

Assessment, an on-going process through which the counselor collaborates with the client and others to gather and interpret information necessary for planning treatment and evaluating client progress

E

3

Implementing the treatment plan.

E

4