Potpourri: Thoughts and Ideas

As we begin a new year I want to look at some current trends from the past year or two that will impact our work in the future. Therefore, this column will be a collection of recent events about our work in addiction and behavioral health as well as some of my thoughts and ideas about these events and the issues they will raise. 

The majority of counselors are white, female, and over age forty-five (US Department of Labor, 2014). Obviously we need more diversity among alcohol and drug counselors. Our current population in the United States consists of 62.7 percent white, 16.4 percent Hispanic or Latino, 12.2 percent black, 4.7 percent Asian, 0.7 percent American Indian/Alaskan Native and 2.3 percent other identity (US Census, 2010).   

Additionally, our population growth will reflect a growing rate of minorities in the United States. We have more males in treatment than females, but this does not mean that we are reaching the appropriate number of females that need treatment and recovery. We will need to make treatment more female-friendly in the future. The median age of the US population is 36.8 years. A positive change for those needing treatment for addiction in the US is that people are coming into treatment at younger and younger ages. Currently, 27.3 percent of the population is under twenty years of age (US Census, 2010). At the same time our older population is growing and so are addiction problems for the older adult. We need to be prepared for the coming changes and develop clinical professionals who are representative of our clients.

Additionally, 29 percent of counselors are in recovery (US Department of Labor, 2014). Although this is a significant number of clinicians, this number represents a change from previous levels. Thirty to forty years ago overwhelming numbers of addiction counselors were recovering themselves. Recovery in and of itself does not qualify someone to be a counselor. In fact, as requirements and demands to become qualified as an addiction counselor have escalated, more and more people have entered the field by way of meeting the required degrees and training as well as continuing professional certifications relating to their degrees. The demand for these qualifications has opened the field beyond personal experiences. Currently, 36 percent of addiction counselors have master’s degrees and 24 percent have bachelor’s degrees (US Department of Labor, 2014). Again, change is occurring.

The US Department of Labor indicated that from 2012 to 2022 there would be a 31 percent growth in the number of addiction counselors in the US (2014). In 2012, there were a total of 89,600 addiction counselors and by 2022 there will be a need for 117,700 addiction counselors. However, I think the counselors need a raise! In 2012, the median annual wage was $38,520 (US Department of Labor, 2014). Hopefully, things will improve.

A few months ago I wrote about the use of the internet and its potential use in therapy with alcohol- and drug-abusing clients. At that time, online utilization was focused on aftercare as a method of continuing contact with clients completing inpatient or intensive outpatient treatment. It was based on the assumption that addiction is a chronic disease and thus required lifelong follow-up. The use of online contact therefore would support the fact that addiction is a chronic disease, allow for another method of interaction with clients, provide easier access for the client to the treatment agency, and provide a method for staying in touch with a greater number of clients. Thus as I said earlier, the supporters of online therapy saw it primarily beneficial as a method of aftercare. They did not see it as taking the place of initial face-to-face therapy. However will “talk therapy” be replaced by “word therapy”?

An interesting study in Ireland was recently completed comparing the effectiveness of online therapy to previously conducted face-to-face therapy. The focus of this study was using cognitive behavioral therapy for the treatment of anxiety and depression. The reason for the study was not only the efficacy of online therapy, but also because Ireland has a shortage of qualified counselors. It was believed that the online method would allow them to reach a greater number of people suffering from depression. The study utilized a randomized control trial wherein clients participated for eight weeks. The Beck Depression Inventory was used. The results of the study indicated that “those who had access to the program demonstrated the same results one would expect to see in a similar face-to-face trial with clinicians” (“Technology helps,” 2014). 

Undoubtedly, the use of the Internet is here to stay. The role of it in clinical treatment for addiction will continue to develop, whether for aftercare, information for those seeking help or even primary care. However, many questions remain:

• Will it replace face-to-face therapy?
• Will it have a supporting role or a primary role?
• Will it be accepted for third party payment?
• Will it be as effective as group work? 

This last issue seems to be very important since the effectiveness of group work and the strength of community plays a significantly positive role in achieving sobriety and wellness.

In October of 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued the following definition of recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (Sack, 2014). Their definition is based on four dimensions of recovery: health, home, purpose, and community. Additionally, they offer ten guiding principles to expand their definition. Although many of their ideas support the traditional understanding of recovery, there are several issues that might be of concern to some members of the recovering community. For example, SAMHSA’s statement also states that “abstinence is the safest approach for those with substance abuse disorders” (Sack, 2014). Does this challenge medication-assisted treatment? What about nicotine replacement therapy? On the other hand, SAMSHA’s definition is very encompassing and supportive. It definitely goes beyond being “drug free” and endorses a life of health, wellness, and human potential. 

TV has often been characterized as the “plug-in drug,” whereby viewers become addicted to watching television or certain favorite shows. Recently however, television has introduced a variety of new shows with drug-related titles and themes. For example, MSNBC has introduced a new six part series titled Pot Barons of Colorado, which portrays attempts at turning the sale of marijuana in Colorado into big business. A web competition series follows suit with and episode of The Marijuana Show with a similar theme. The Travel Channel introduced a group of alcohol-related shows, with its first episode titled Booze Traveler. Although not a show about addiction, it focuses on the variety of alcoholic beverages from different cultures. Finally, we have Barmageddon from truTV which was introduced in November 2014. I’m glad that alcohol and drug use or abuse is becoming mainstream on American television, but at the same time I hope that it doesn’t become so blasé that we merely view addiction as an unfortunate byproduct of American society. 

These are only a few of the recent issues about alcohol and drug abuse in our society during 2014. Obviously, there will be many more in 2015 and we look forward to the research, program developments, and clinical breakthroughs in our efforts to help more and more people achieve sobriety and wellness.

Sack, D. (2014). New definition of recovery leaves questions unanswered. Retrieved from http://blogs.psychcentral.com/addiction-recovery/2012/01/definition-recovery/

“Technology helps bridge the gaps in mental health.” (2014). Retrieved from http://www.aware.ie/wp-content/uploads/2014/02/Aware-Press-Release-Final-Nov-5th-2014.pdf

US Census. (2010). 2010 census data. Retrieved from http://www.census.gov/2010census/data/

US Department of Labor. (2014). Occupational outlook handbook: Substance abuse and behavioral disorder counselors. Retrieved from http://www.bls.gov/ooh/community-and-social-service/substance-abuse-and-behavioral-disorder-counselors.htm