25 Addiction Counseling Competencies
Introduction
Counselors who treat people with substance use disorders do life-changing work on a daily basis, amid difficult circumstances that include staff shortages, high turnover, low salaries, and scant program funding. Counselors come to this important work by various paths and with vastly different skills and experience. The diversity of backgrounds and types of preparation can be a strength, provided there is a common foundation from which counselors work.
This chapter addresses the following questions: What professional standards should guide substance abuse treatment counselors? What is an appropriate scope of practice for the field? Which competencies are associated with positive outcomes? What knowledge, skills, and attitudes (KSAs) should all substance abuse treatment professionals have in common?
The Model
When creating The Competencies, the National Curriculum Committee recognized a need to emphasize three characteristics of competency: knowledge, skills, and attitudes. Many hours were spent conceptualizing a differentiated model when designing TAP 21—a model that could address general KSAs necessary for all practitioners dealing with substance use disorders while explaining the more specific needs of professional substance abuse treatment counselors.
The first section of the model addresses the generic KSAs. This section contains the transdisciplinary foundations, comprising four discrete building blocks: understanding addiction, treatment knowledge, application to practice, and professional readiness. The term “transdisciplinary” was selected to describe the knowledge and skills needed by all disciplines (e.g., medicine, social work, pastoral guidance, corrections, social welfare) that deal directly with individuals with substance use disorders.
The second section of the model specifically addresses the professional practice needs, or practice dimensions, of addiction counselors. Each practice dimension includes a set of competencies, and, within each competency, the KSAs necessary for effective addiction counseling are outlined. Many additional competencies may be desirable for counselors in specific settings. Education and experience affect the depth of the individual counselor’s knowledge and skills; not all counselors will be experienced and proficient in all the competencies discussed. The National Curriculum Committee’s goal for the future is to help ensure that every addiction counselor possesses, to an appropriate degree, each competency listed, regardless of setting or treatment model.
The relationship of the components in the competencies model is conceptualized as a hub with eight spokes (see figure 25.1). The hub contains the four transdisciplinary foundations that are central to the work of all addiction professionals. The eight spokes are the practice dimensions, each containing the competencies the addiction counselor should attain to master each practice dimension.
The Transdisciplinary Foundations
Addiction professionals work in a broad variety of disciplines, but share an understanding of the addictive process that goes beyond the narrow confines of any one specialty. Specific proficiencies, skills, levels of involvement with clients, and scope of practice vary widely among specializations. At their base, however, all addiction-focused disciplines are built on four common foundations.
This section focuses on four sets of competencies that are transdisciplinary in that they underlie the work not just of counselors but of all addiction professionals. The four areas of knowledge identified here serve as prerequisites to the development of competency in any of the addiction-focused disciplines.
The Four Transdisciplinary Foundations
- Understanding Addiction
- Treatment Knowledge
- Application to Practice
- Professional Readiness
Regardless of professional identity or discipline, each treatment provider must have a basic understanding of addiction that includes knowledge of current models and theories, appreciation of the multiple contexts within which substance use occurs, and awareness of the effects of psychoactive drug use. Each professional must be knowledgeable about the continuum of care and the social contexts affecting the treatment and recovery process.
Each addiction specialist must be able to identify a variety of helping strategies that can be tailored to meet the needs of individual clients. Each professional must be prepared to adapt to an ever-changing set of challenges and constraints.
Although specific skills and applications vary across disciplines, the attitudinal components tend to remain constant. The development of effective practice in addiction counseling depends on the presence of attitudes reflecting openness to alternative approaches, appreciation of diversity, and willingness to change.
The following knowledge and attitudes are prerequisite to the development of competency in the professional treatment of substance use disorders. Such knowledge and attitudes form the basis of understanding on which discipline-specific proficiencies are built.
Understanding Addiction
Competency 1:Understand a variety of models and theories of addiction and other problems related to substance use. |
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Competency 2: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. |
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Competency 3:Describe the behavioral, psychological, physical health, and social effects of psychoactive substances on the person using and significant others. |
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Competency 4:Recognize the potential for substance use disorders to mimic a variety of medical and mental health conditions and the potential for medical and mental health conditions to coexist with addiction and substance abuse. |
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Treatment Knowledge
Competency 5: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 problems. |
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Competency 6:Recognize the importance of family, social networks, and community systems in the treatment and recovery process. |
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Competency 7:Understand the importance of research and outcome data and their application in clinical practice. |
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Competency 8:Understand the value of an interdisciplinary approach to addiction treatment. |
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Application to Practice
Competency 9:Understand the established diagnostic criteria for substance use disorders, and describe treatment modalities and placement criteria within the continuum of care. |
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Competency 10:Describe a variety of helping strategies for reducing the negative effects of substance use, abuse, and dependence. |
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Competency 11:Tailor helping strategies and treatment modalities to the client’s stage of dependence, change, or recovery. |
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Competency 12:Provide treatment services appropriate to the personal and cultural identity and language of the client. |
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Competency 13:Adapt practice to the range of treatment settings and modalities. |
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Competency 14:Be familiar with medical and pharmacological resources in the treatment of substance use disorders. |
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Competency 15:Understand the variety of insurance and health maintenance options available and the importance of helping clients access those benefits. |
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Competency 16:Recognize that crisis may indicate an underlying substance use disorder and may be a window of opportunity for change. |
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Competency 17:Understand the need for and the use of methods for measuring treatment outcome.. |
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Uses of the Competencies
The Board of Directors of the Illinois Alcohol and Other Drug Abuse Professional Certification Association has endorsed and will be incorporating the knowledge, skills, and attitudes provided in The Competencies into all of its models for Certified Alcohol and Other Drug Abuse Counselors.
The Practice Dimensions
Professional practice for addiction counselors is based on eight practice dimensions, each of which is necessary for effective performance of the counseling role. Several of the practice dimensions are subdivided into elements. The dimensions identified, along with the competencies that support them, form the heart of this section of The Competencies.
The Eight Practice Dimensions of Addiction Counseling
- Clinical Evaluation
- Screening
- Assessment
- Treatment Planning
- Referral
- Service Coordination
- Implementing the Treatment Plan
- Consulting
- Continuing Assessment and Treatment Planning
- Counseling
- Individual Counseling
- Group Counseling
- Counseling Families, Couples, and Significant Others
- Client, Family, and Community Education
- Documentation
- Professional and Ethical Responsibilities
A counselor’s success in carrying out a practice dimension depends on his or her ability to attain the competencies underlying that component. Each competency, in turn, depends on its own set of knowledge, skills, and attitudes. For an addiction counselor to be truly effective, he or she should possess the knowledge, skills, and attitudes associated with each competency that are consistent with the counselor’s training and professional responsibilities.
License and Attribution
Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. HHS Publication No. (SMA) 15-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.