The Training Manual for US Addiction Counselors Is Full of Myths
The study guide for our most-used credentialing test for addiction counselors contains outdated information and debunked theories. How can professionals work effectively when they are this misinformed?
Forty-five US states use the examination conducted by the International Credentialing and Reciprocity Consortium (IC&RC) for the licensure and credentialing of their professional addiction counselors. IC&RC is a specialty corporation—they do nothing but licensure tests for chemical dependency counselors. The exam is computerized and administered by IC&RC rather than by the states themselves.
Having such a process in place for credentialing addiction counselors sounds like a really good idea. So does having a uniform test across the States and beyond—IC&RC also administers testing for addiction counselors in numerous countries in Europe, Asia and the Americas (see map below). Such procedures have the potential to ensure that addiction counselors are knowledgeable, accountable, consistent and better equipped to help their clients.
There’s just one problem: Numerous “facts” that people have to learn in order to pass these tests are demonstrably wrong.
The study guide for the IC&RC examination is called Getting Ready to Test: A Review and Preparation Manual for Drug and Alcohol Credentialing Exams (7th Edition). It is available (for $149) from ReadyToTest.com, a subsidiary of The Distance Learning Center for Addiction Studies (DLCAS.com). These companies are specialty services that do nothing but sell preparation materials for substance abuse credentialing exams. But instead of training future counselors in current evidence-based research and verified facts and practices, they frequently train them to memorize long-debunked myths originating in the 12-step-dominated treatment industry. Here are some examples.
On page 6 the study guide states:
“[F]or persons who have progressed to dependence on alcohol or other drugs the sojourn has been difficult. Once past a certain point there is no turning back. Continuing the journey, with any expectation of health and well-being, will require substance abuse treatment.”
This is false. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) tells us that over 90% of people with substance dependence overcome it, and that approximately 90% of these people do it on their own with no Alcoholics Anonymous, no meetings and no addiction treatment.
On page 4 the study guide states:
“It’s [sic] chronic and relapsing nature is also recognized as a part of the disorder of addiction. Recovery from addictive illness necessitates sobriety and abstinence, relapse prevention programs and continuing supportive intervention for those who become dependent on mood-altering chemicals.”
False. NESARC research tells us that most people who recover from alcohol dependence do so by cutting back on their drinking; less than half recover via abstinence (as outlined here by the National Institute on Alcohol Abuse and Alcoholism). Not only is a return to moderate use after a period of addictive use common among people who drink alcohol, the same phenomenon can be seen with “harder” drugs—even with heroin. Lee Robins’ classic study of heroin-addicted Vietnam veterans found that even among those ex-addicts who used heroin regularly after returning from Vietnam, only half became re-addicted. Hamish Warburton et al. (2005) also report a number of cases of civilian heroin users who moved from chaotic and addicted heroin use to controlled and non-addicted heroin use. Tom Decorte (2001) discusses controlled cocaine use in detail. And like plenty of other people, I have personally moved from being a very heavily addicted cigarette smoker to enjoying an occasional cigar; my use is so moderate that I have had only one cigar in the past year. This is in spite of the fact that scholars agree that nicotine is far more addictive than heroin.
What’s more, a survey conducted jointly by Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) in 2012 found that 23.5 million Americans are in recovery from addiction (defined as answering “yes” to the question “Did you once have a problem with drugs or alcohol, but no longer do?”) But less than 1.5 million North Americans are members of AA. This lends further support to the suggestion that roughly 90% of people who overcome substance dependence do it on their own—and that they do not require “relapse prevention programs and continuing supportive intervention.”
We are fortunate that when plumbers take licensing exams they have to learn material that is in accordance with the laws of physics. Otherwise we would all be constantly at risk from exploding boilers or gas leaks.
On page 42 of the study guide a standard drink is defined as containing 0.5 oz of ethanol. False. This definition is 20 years out of date. In the mid-1990s a standard drink was redefined by the US government as 0.6 oz of alcohol—not 0.5.
On pages 298-302 the study guide recommends the use of confrontational counseling. False. No clinical trial on confrontational counseling has shown it to be effective, and some have indicated that it is harmful.
On page 431 the study guide states:
“Making…housing contingent on abstinence has been shown to be a useful strategy.”
False. The abstinence-first housing model has been largely abandoned as a failure in this country. It is being rapidly replaced throughout the US with fully supportive housing based on the Housing First Model—which does not require abstinence from alcohol or drugs as a precondition for being housed.
Finally, overdose prevention and naloxone have become some of the hottest topics in the field because of the levels of opioid overdose in the US. Actions to address this issue nationwide include training and equipping first responders with naloxone and extensive state-level training programs on opioid overdose prevention.
But what does our study guide tell us about naloxone and overdose prevention? Not one word.
We are fortunate that when plumbers take licensing exams they have to learn material that is in accordance with the laws of physics. Otherwise we would all be constantly at risk from exploding boilers or gas leaks. It is unfortunate that addictions counselors undergo training that often teaches them the reverse of what research has demonstrated.
The IC&RC website boasts of having accredited “more than 45,000 professionals in prevention, alcohol and drug counseling, clinical supervision, criminal justice addictions, and co-occurring disorders” in the United States. Who is to say how many of the people served by all these professionals have suffered additional harm—even death—from their addictions as a direct result of the inaccurate information contained in Getting Ready to Test? It’s high time to reform the credentialing process, teach accurate information and replace mythology with science.
Kenneth Anderson is the founder of HAMS Harm Reduction for Alcohol and the author of How to Change Your Drinking: A Harm Reduction Guide to Alcohol. He has worked in the field of harm reduction since 2002, including “in the trenches” doing needle exchange in Minneapolis. He served as online director for Moderation Management and as director of development at the Lower East Side Harm Reduction Center. He hosts a harm reduction podcast and writes a blog for Psychology Today called Overcoming Addiction. His last piece for Substance.com was Guess What? Harm Reduction Is a Common Path to Abstinence From Alcohol.
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