Time to Up the Standards in the Addiction Treatment World!
As the holidays approach, I have been reflecting on how we can improve not only the practices of the addiction treatment industry, but also the public perception of it. On a daily basis, I hear addiction treatment centers complaining about not being taken seriously. They complain when their insurance claims are denied and insurance companies cut or limit addiction treatment from their policies. Sober homes complain that any attempt to regulate them is a violation of the American Disabilities Act. They want to be on equal footing with the real medical institutions, yelling “Addiction is a disease!” and citing the Parity Act of ’08.
The irony is that, in the addiction treatment world, the standards of professionalism are lower than any other field. First of all, anyone can own a treatment center. There are no requirements other than having the money to invest. Even convicted felons are not precluded from opening a treatment center – although they frequently put it in someone else’s name. When this happens, we see that old Sicilian proverb in action – “Pesci fet d’a testa” (in English, “The fish stinks from the head.”) The meaning is that corruption or shadiness works its way down from the top, seeping into the fabric of an organization.
As stated by Carey Davidson, “There are those in this industry who capitalize on the vulnerability in an unethical manner. It is essential that families are able to place their trust in capable, educated, and accountable specialists. However, because the behavioral health field is so vast, multi-faceted, and unregulated, it’s difficult to know where to begin.”
Setting Low Standards
The vast majority of treatment centers do not even require a college degree for hiring employees. The clinical staff, for the most part, is made up of people who are not qualified and would never be hired in a true medical setting. At least one person at the center must hold a license of some type (LMHC,LCSW, etc) in order for the facility to be properly licensed. All treatment centers must have a medical director, who is usually a licensed M.D. or D.O. In many cases, that medical director is on staff for various treatment facilities and, at most, stops by the facility to do rounds and sign off on patient charts once a week.
The majority of the day-to-day clinical staff, however, is made up of people with no qualifying education or experience. Many of them are members of a 12-step program themselves who feel that working in the recovery field is somehow their “calling” or they are taking their own recovery to the next level. While their hearts may be in the right place, it is naïve to believe that just having their own personal experience in recovery, in and of itself, makes them qualified to work in a professional setting. This may upset some people working in the field or attempting to do so – but it is the truth. There is no substitute for formal education and training; this is in large part the reason why the addiction treatment field is not given the same respect and credibility as other medical institutions.
Being a graduate of the “School of Hard Knox” just doesn’t cut it on a professional level. We are dealing with people’s lives here, not selling cars. We have a surge of consultants, patient brokers, marketers, treatment placement specialists, and other creative professions – often without formal training – for those espousing these titles. While these workers are called different names, they serve the same function: to put “heads in beds.” They are people who, through one method or another, receive kickbacks for getting a patient into a particular facility. These so-called professionals make their money directly by placing someone into a specific treatment program who pays them a bounty, a marketing fee, or reward for “placing” the person with them. “Patient brokers, in effect, broker lives for cash.” (C. Davidson, 10/31/16)
Why do these treatment facilities hire such unqualified employees to “treat” patients suffering from a disease? Some facilities are of the opinion that only people who have personally experienced addiction are in a position to help those suffering from them. This is a myth which has been repeatedly debunked. When someone you love has cancer, do you insist on sending them to a doctor who has had cancer themselves? So, the same people who are adamant that addiction be viewed in the same light as any other disease now want to make exceptions when it comes to the treating professionals? The real truth is that it comes down to the bottom line for the centers. It is definitely cheaper to hire unqualified people.
Let me ask you, in what other professional field is it okay to hire people who do not even hold a bachelor’s degree? To work in any other medical setting, this is a minimum requirement – in addition to other various degrees and training. This includes nurses who must be licensed, radiologists, medical technicians, etc. “One key difference between a trained professional and a layperson is that a layperson works solely from personal experience and a professional works from an empirically-evidenced theory.” (C. Davidson, 10/31/16)
Being a graduate of the “School of Hard Knox” just doesn’t cut it on a professional level. We are dealing with people’s lives here, not selling cars.-Myles B Schlam
Defining “Qualified” Professionals
What are the requirements to be hired as a mental health tech at an addiction treatment center? Some centers require six months of personal sobriety; some require one year. And these are the people charged with caring for your loved ones (who are patients) twenty-four hours a day, seven days a week. And we wonder why many of these addiction treatment centers have morphed into not much more than glorified daycare centers? (Daycare centers that charge upwards of $30,000 per month!)
Most treatment centers spend major and extravagant amounts of dollars on marketing – TV commercials, street signs, website optimization, etc. If they cut some of the enormous spending on such marketing campaigns and instead put that money into paying for clinical staff that are actually qualified and competent, we may not be in the position we are presently in. I would dare say that the majority of today’s addiction treatment centers spend the lion’s share of their operational budget on marketing expenses instead of on providing better treatment like they should.
In the State of Florida, there is a definition for “Qualified Professional” under Sec. 397.311. It reads:
“A ‘Qualified Professional’ means a physician or a physician assistant licensed under chapter 458 or chapter 459; a professional licensed under chapter 490 or chapter 491; an advanced registered nurse practitioner having a specialty in psychiatry licensed under part I of chapter 464; or a person who is certified through a department-recognized certification process for substance abuse treatment services by a state-recognized certification process in another state at the time of employment with a licensed substance abuse provider in this state may perform the functions of a qualified professional as defined in this chapter but must meet certification requirements contained in this subsection no later than 1 year after his or her date of employment.”
So, as you can see, the state legislature has been quite specific about who is considered an addiction professional. Yet the majority of people employed by these centers are not addiction professionals. Also, let me give a bit of clarity to the state-recognized certification process mentioned above as a qualified addiction professional:
There are only three certifications recognized as “professionals” in the state of Florida: A CAP (Certified Addictions Professional), A CCJAP (Certified Criminal Justice Addictions Professional) and CMHP (Certified Mental Health Professional). All three require a minimum of a bachelor’s degree in a related field, in addition to approximately 6,000 hours of in the field training (300 of which must be supervised). There are other requirements, such as domestic violence and HIV training, as well as a written exam that must be passed.
There are other lower certifications that can be obtained by people who have not met all these requirements such as the (CAC, CCJAC, CAS, CCJAS). These are not “Qualified Addiction Professionals” under the law – and people should be aware of that. If someone was falsely holding themselves out a doctor or an attorney or a police officer, they would be arrested and prosecuted for a felony – no questions asked. Yet people are holding themselves out as addiction professionals who are not…and this is acceptable??
Then we have people in the field who are calling themselves “interventionists” or “case managers.” While a treatment center can give a title such as “case manager” to an employee, in reality, they are licensable components under Chapter 65D-30 of the Florida Rules (DCF). Case management is actually a subcomponent of General Intervention. The definition of “case management” is: “A process which is used by a provider to ensure that clients receive services appropriate to their needs and includes linking clients to services and monitoring the delivery and effectiveness of those services”. Intervention “includes activities and strategies that are used to prevent or impede the development or progression of substance abuse problems.” The fact that these are licensable by DCF means that people who are doing so without a license are doing so illegally and committing a crime in the process.
It has become more and more prevalent for people in the community who are working in the capacity of marketers or brokers to hold themselves out as “interventionists,” without the necessary licensure or credentials. My intent is not to discredit the challenging and indispensable work of an interventionist (or anyone else working in the field). After all, I am one. However, it is crucial to know there are individuals without any formal behavioral health education, certification, license or clinical training who claim to be “interventionists” or “addiction specialists” that “work” in the addiction field. This is dangerous.
“Just because a person has been through recovery and/or has watched every season of Intervention on A&E, it does not follow they are qualified to be an interventionist. This is as reckless as watching Grey’s Anatomy, buying an ambulance, and calling oneself an EMT.” (C Davidson, 10/31/16)
Providing Oversight and Enforcement
The above mentioned are all major concerns and issues presently being addressed by the task force I serve on, and eventually by the state legislature. Certification and accreditation has extended to sober homes, and legislation is now pending on that front. There needs to be more oversight into the day-to-day practices of both treatment centers and sober homes – and this is something we are also currently working hard on.
In addition, all the additional enforcement and regulation will require funding. DCF is stretched very thin and can only do so much. Taxpayers are not going to be enthusiastic about footing the bill, nor should they be. That is why treatment centers should bear the financial burden. It is only just that they contribute to the extra policing of their industry, which has become necessary due to the low bar they have set for themselves.
The number of people dying from this disease has increased tenfold in the last few years and it’s only getting worse. It’s time to demand accountability, stand up and take action.
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