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Does Minnesota really need more addiction counselors?

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.

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Comments (3)

  1. Submitted by Paul Udstrand on 09/23/2016 - 12:49 pm.


    A number of realities the article fails to mention:

    a) Many people seek help at a variety of “Anonymous” groups that LADC’s don’t facilitate.

    b) Successful treatment models may not yet exist, so whatever we’re training LADC’s to do, may be of limited value. Current treatment models only have 10% – 30% success rate (in other words 70%-90% of patients relapse, and that’s within a year). This contributes to the LADC burnout rates and turnover AND means that users are looking elsewhere for treatment.

    c) The number of patients can increase without a corresponding demand for LADC’s because there’s no set LADC to patient ratio, groups can be bigger and more patients can be seen by existing LADCs or OTHER mental health professionals. Again, LDAC’s aren’t the only ones treating addiction.

    d) Matching “use” to treatment is always dicey because not all users will actually “need” treatment, the majority of user never end up in court or jail because of their drug use. Drug use can cause all kinds of problems for people but they don’t necessarily get treatment because those problems. Drug use doesn’t necessarily translate into drug treatment. You can see increases in drug use but since there are a variety of pathways to or around treatment you can’t assume that big increases in drug use will lead to big increases in drug treatment, and any additional treatment you see won’t all be picked up by LADC’s.

  2. Submitted by Joel Stegner on 09/23/2016 - 04:30 pm.

    Mental health under service

    Those who suffer from chronic mental health problems and addiction benefit from treatment, but this area is the single largest area of under service in healthcare. Failure to treat harms not just the individual, but fractures families and causes countless legal, financial and social problems. Poor mental underlies most chronic disease as it underlies poor lifestyle choices. And total abstinence is not the only goal, but as with cancer and heart disease, remission and improved quality of life is a more realistic goal and the illusiveb”cure.”

    Does everyone who heavily used or addicted to drugs and alcohol need to reduce use or quit? Is it easy? Of course not, as the behavior is both physically addictive and socially reinforced, a way to conform to others’ expectations. Recovery is an anonymous, lonely path where people need continuous support to move forward. Getting into treatment can be incredibly difficult, with employers often not understanding and insurers despite parity laws, providing less card than effective to save a buck, in a way they don’t do with cancer.

    If whether as a professional or a friend, you helped someone on their path to recovery, you understand how important services are and how effective they can be. As with other health issues, there is no guaranteed but if you look at risk reduction and days nothing is used, treatment is much more effective than the “only total abstinence counts” crowd would suggest. Sobriety means one less drunk driver on the road, another routine day at work or another person safe from a drunken spouse. The good days make it worthwhile.

  3. Submitted by Greg Kapphahn on 09/26/2016 - 10:11 am.

    The Human Person is a System

    something akin to a super computer.

    What we experience of ourselves and what we present to the world is nothing close to the totality of that system,…

    but is far more like the sound and display produced by our computers.

    A great deal more is going on beneath our awareness,…

    and invisible to others,…

    than we currently comprehend.

    Although lately we’ve become quite fascinated with the observations we’re newly capable of,…

    regarding how the brain rebuilds and rewires itself in response to new learning and experiences,…

    we still have ZERO knowledge and understanding of the system which is controlling those responses.

    In our computers that system is the Basic Input Output System (B.I.O.S.), which controls what the computer does with everything connected to it;…

    how it uses the inputs which arrive via the touchpad, keyboard, mouse, and network connections,…

    to create the output which we see on the display screen and hear through the speakers, ear buds, or headphones.

    For a human person, there is a dynamic system which serves the same function,…

    and continuously re-programs itself and rebuilds/rewires the brain,…

    according to current circumstances.

    Just as in our computers, this dynamic B.I.O.S. within a human person operates by a set of rules,…

    but we do not yet recognize that those rules exist, nor what they might be.

    Furthermore, just as with a computer, those rules are stored in the deepest, least accessible part of the psyche.

    What’s most problematic is that those rules were written eons ago in ways designed to protect our preverbal ancestors from repeating experiences that caused them life-threatening pain or stress.

    (It appears, however, that most animals share the same or very similar rules with us and each other.)

    The addictive use of chemicals, experiences, or people appears to be a MISpogramming of the human psyche created in response to an experience (or multiple experiences) that the addicted individual has had.

    To that internal control system, pursuing the addiction makes perfect sense,…

    (which is why the urge to continue the addiction is so strong–

    that addiction has been wired into the person’s psyche as a normal and predictable response to what they have experienced).

    Addictions are not a thing, in and of themselves, therefore,…

    they are the displays created by the underlying MISprogramming of the psyche.

    Almost all current treatments for addiction fail to address this misprogramming nor seek to erase it,…

    and therefore fail to address the underlying motivations of the addict,…

    seeking, instead, to address the displayed behaviors.

    In computer parlance, this would be like trying to force your computer to work better by turning up the sound and brightness,…

    while ignoring that its internal RAM, hard drive, or cooling fan was failing,…

    or setting up another computer next to it in the hopes that it would somehow learn to work around it’s internal issues by watching the other computer work;…

    not likely to be very successful.

    Because so much of chemical dependency treatment doesn’t address the deeper issues that need to be addressed,…

    the misprogramming of the psyche and the healing of the painful experiences which created that misprogramming,…

    the counselors who do that work have very frustrating and difficult jobs.

    Far too often, what they’re doing doesn’t work well for many of their clients,…

    and there doesn’t seem to be anyone who can teach them techniques, approaches, and perspectives that WILL work.

    This leads to a very high burnout rate among ChemDep counselors,….

    which is part of the reason we constantly need new ones.

    I don’t believe the concepts I’ve expressed, here, are original with me,…

    though I have used them successfully,…

    but surely there must be others with better certification and qualifications that I,…

    who can and will, (or are already) developing ChemDep treatment programs that will work better,…

    based on them.

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