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Does Minnesota really need more addiction counselors?

09:51 EDT 23 Sep 2016 | MinnPost

With opiate abuse surging nationwide, and with new health-care laws offering increased access to addiction counseling services, it only makes sense that there would be great — and growing — opportunities for licensed alcohol and drug counselors (LADCs) in Minnesota. 

Certainly, there are a number of schools in the state offering degree or certification programs in alcohol and drug counseling. And word is that a significant number of potential students are expressing an interest in these programs.  

“Anecdotally, we keep hearing that there is a shortage of LADCs,” said Kari Rechtzigel, executive director of the Minnesota Board of Behavioral Health and Therapy. “But,” she added, “we don’t regulate the workforce.” 

Rechtzigel explained that her office’s records indicate a growing number of people training to become addiction counselors: “Our number of licensees continues to steadily grow,” she said. “In the last 10 years, the number of LADCs has doubled. The numbers are growing steadily every year.”

And nationally, the outlook also looks good for graduates. The Bureau of Labor Statistics predicts a 22 percent job growth rate for substance abuse and behavioral disorder counselors between 2014-2024. 

Behind the numbers

While assertions like these do appear to point to growing employment options for LADCs, the reality, in Minnesota at least, may be a little different. 

A couple of reliable sources had recently suggested that I write a story about the growing market for LADCs in the state. So I decided to check it out. At my request, Teri Fritsma, senior research analyst for the Minnesota Department of Health Office of Rural Health and Primary Care, ran the numbers. What she found wasn’t what I expected to hear.   

“I can’t spin it any other way,” Fritsma said when we talked earlier this week. “When I look at the overall statewide numbers of LADCs that we are producing and the number that DEED (Minnesota Department of Employment and Economic Development) is projecting that we need, the numbers aren’t that great.”

In an email, Fritsma detailed her findings:

• Substance-use disorder counselors needed annually in MN: 83 (DEED)

• Total number of students completing a 4-year or graduate-level substance abuse/addiction counseling programs last year in MN: 160 (IPEDS)

“The overall quantitative picture does not appear to support the idea of a labor-market shortage,” Fritsma wrote in a note at the end of her email.

How could that be? If signs point to a growing need for addiction counselors nationwide, why doesn’t the employment market for LADCs in Minnesota appear more robust? It turns out that the answers are complicated.

Fritsma is a data person, so she understands that sometimes numbers aren’t what they look like at first glance. One way to carefully parse the numbers is to look at the reality beneath the stated percentages, she said.

“Say if you currently have one alcohol and drug counselor and next year you need one more, that would be considered a 100 percent growth rate,” she said. “But that’s just one job. That’s how it works.”  

Urban-rural need gap

The lackluster DEED numbers for Minnesota LADCs also look different when viewed from a regional perspective.

While there is a glut of treatment centers — and treatment professionals — in the Twin Cities area (it’s the Land of 10,000 Treatment Centers, after all), parts of rural Minnesota continue to experience serious need for high-quality substance-use care — and many have a hard time attracting qualified candidates.  

Teri Fritsma
Teri Fritsma

While the market for addiction treatment professionals in the Twin Cities may be less than robust, Fritsma said, “that doesn’t mean that there aren’t some pockets of severe need in rural areas or in-patient facilities.” To illustrate her point, Fritsma ran more numbers, this time on population-to-provider ratios for LADCs. “In urban areas in Minnesota, there is one LADC for every 2,200 people,” she explained. “In rural areas, there is one LADC for every 7,000 people. You do get a sense there is an unmet need in the rural areas.”

Another explanation for this seeming disconnect is that it can sometimes be hard to get a clear reading of the vitality of the health-care workforce, Fritsma added. (Predicting the future demand for nurses is a good example.) In many other industries, it is clear when there is a need for workers. 

“Take an occupation like plumbers,” Fritsma said. “The way you know if you need more plumbers is when businesses are screaming for plumbers. In health care, it can be a different story. There may be people who need addiction counseling desperately but they can’t get to it for a number of reasons. Maybe there aren’t enough in-patient beds. Maybe there are no treatment centers in their region. This may be the case in rural areas of the state.”

View from the inside

Professionals with years of experience in addiction counseling also say that the DEED numbers may not fully explain one tough reality that helps newly trained LADCs continue to find work in a tight market: high turnover.

“This field will always be perceived to be a growth industry, because, like social work and teaching, the LADC is the bottom-feeder of the mental-health field when it comes to compensation,” said Howard McMillan, a veteran LADC who works at Professional Counseling Centers in St. Louis Park. “A typical salary is going to be in the low-to-mid 40s. And the work is hard, so the burnout rate is high. That means that there is a lot of turnover in the profession — and there are always jobs available for people who are eager to fill them.”

“It can be a tough job,” added Peter Oesterreich, director of recovery services for Silver Sobriety, an alcohol treatment center for seniors. “It’s not for everyone, and not everyone sticks with it.”

McMillan, who has been working in the industry for nearly a decade, said that while many Americans struggle with drug and alcohol addiction, only a small percentage actually seek help. 

“The number I’ve always heard and still hear is that 10 percent of the people who would meet the criteria for substance-use disorders are in fact actually currently seeking help for those disorders,” McMillan said. “That means that 90 percent of people who could use help with their addictions aren’t getting help.”

When McMillan decided to leave a job in the financial industry and train to become a LADC, he was under the impression that he would never have a hard time finding a job. So far that’s been true.

“Back then they were saying that there would be a huge growth opportunity for licensed drug and alcohol counselors,” McMillan said. “The numbers may not be reflecting that at this point, but reality speaks for itself. There are so many people who are in need of recovery help and cannot get it.”

And with growing public awareness of the life-and-death perils of drug abuse, McMillan believes that the market for his services will continue to grow.

“We will never have enough LADCs for all the people who are trying to get past drug and alcohol abuse,” he said.

Fritsma is more than willing to buy the argument that the need for LADCs in rural Minnesota may be great — perhaps the numbers just haven’t caught up yet.

“The numbers have led me wrong before,” she said. “You often get a different story at the ground level. It takes time for the numbers to catch up with reality. “

Training in-demand graduates

In Center City, administrators at Hazelden Betty Ford’s Graduate School of Addiction Studies have seen no slowing in the demand for the LADCs they train. Dean Roy Kammer said that while many of his graduates do find work in Minnesota, his program is nationally focused, and many of his students take job in other parts of the country. 

“When we look at the numbers, we do look at the national market,” Kammer said. “We see our students getting hired.”

Hazelden Betty Ford’s graduate school was founded in 1999, and received full regional accreditation in 2007. The school offers three different graduate programs, available in-person on the Center City campus, or online. Students come from across the country — and around the world.

Roy Kammer
Roy Kammer

“We have three different degrees,” Kammer said. “A 44-credit master of arts in addiction counseling, a master's-level addiction counseling program and a 60-credit advanced practice degree, which adds a mental health component.”

In the not-so-distant past, educational requirements were less stringent for addiction counselors, Kammer said, but today most states (including Minnesota) require a bachelor’s, or even a master's, degree for certification. “For so long our field had been an experience-based field,” Kammer said. “Many counselors' qualifications were personal experience and an associate's degree.”

As educational requirements for LADCs have changed, so has the perspective on the profession.

“A profession is a science,” said Kammer, who formerly served as program director of the Alcohol and Drug Studies Program at Minnesota State University, Mankato. “You have to understand what works. Sometimes life experience is valuable, but from a professional standpoint, this kind of training gives you the science of knowing what works. We have an ethical obligation to use practices that have evidence behind them. That’s what comes with good degrees.” 

What also comes with a good degree, Kammer said, are jobs: Employers nationwide are interested in hiring his graduates.

“The name carries weight for some people,” Kammer said. “We’re known as a pioneer in addiction treatment. The Hazelden Betty Ford name is known across the world. We are the largest nonprofit provider of addiction treatment and largest publisher of behavioral health curriculum. We consistently hear from treatment centers that contact us and tell us, ‘We want more of your graduates.’ They like our students and can’t wait to hire them.” 

Kammer’s experience may point to a larger trend: The need for qualified LADCs is growing everywhere — and the rest of the world is finally catching up with Minnesota.

Original Article: Does Minnesota really need more addiction counselors?

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