A lot can happen in a couple of years.
Back in September 2016, the last time I talked to Teri Fritsma Mogen, senior research analyst for the Minnesota Department of Health Office of Rural Health and Primary Care, about the job market for licensed alcohol and drug counselors (LADCs), she told me that her research revealed that there wasn’t a pressing need for more LADCs, despite growing rates of addiction in the state.
“The overall quantitative picture does not appear to support the idea of a labor-market shortage,” Fritsma Mogen said at the time.
Looking at data collected in 2015 by the Minnesota Department of Employment and Economic Development (DEED), Fritsma Mogen saw that the projected number of new job openings that year for substance-use disorder counselors was just 83. Combine that with an IPEDS report that that said that some 160 new LADCs would graduate that year, Fritsma Mogen felt that the numbers didn’t add up to a shortage.
“When I look at the overall statewide numbers of LADCs that we are producing and the number that DEED is projecting that we need,” she said, “the numbers aren’t that great.”
Since then the outlook has changed dramatically.
“When we talked about this issue before,” Fritsma Mogen told me the other day, “the data that I had at my disposal was job vacancy data. It is a leading indicator, the first whiff we have at overall economy changes.” In the years since my story was published, that whiff has become a more persistent scent: “Between 2105-2016 the number of vacancies for LADCs almost doubled,” Fritsma Mogen said. “That continued into 2017. To me it’s a leading indicator that something is going on here.”
What’s going on, Fritsma Mogen said, is a rapidly growing demand for LADCs in Minnesota and nationwide. The growth took her by surprise.
Fristma Mogen recalled our 2016 interview.
“I remember taking a look at the numbers. I remember saying, ‘I’m not seeing a lot of evidence for a huge shortage. The data doesn’t bear it out.’ Now, a couple of years later, I pulled a chart together and I was like, ‘Whoa! Demand for these workers has gone through the roof in the last three years.’” The number of open LADC positions has more than tripled in the state, she said, and there are more jobs than can be filled by the current LADC supply, with even more positions to become available in coming years.
What’s behind this LADC boom/shortage?
Fritsma Mogen theorizes that public awareness of the national addiction crisis and its larger societal impact has spurred policymakers to act. Part of that action has included creating jobs for substance-use counselors.
“We’ve been talking about the opioid crisis and drug and alcohol addiction for a long time, but finally the hiring demand is catching up to the need,” Fritsma Mogen said. People struggling with addiction need mental health support, and society is waking up to that reality. “Money is coming in to create the positions, so demand is now catching up to the need.”
The only problem with this newfound awareness of the importance of addiction counseling is that there aren’t enough LADCs to fill all the open positions that exist today, Fristma Mogen said. And even more jobs will be created in years to come.
“DEED is projecting an annual statewide need for 320 alcohol and drug counselors over 2015-2026,” she said. “We are not even coming close to producing the supply we need.”
Part of the reason for the shortage of LADCs may have to do with the stress that’s baked into the job. Providing mental health services for people struggling with addiction can be hard, even painful work — with limited resources and support from insurers. Successful client outcome rates are disappointingly low.
The work can feel frustrating for people who have dedicated themselves to helping others build a life free of addiction: Fritsma Mogen said she spoke with LADCs who told her that the work can feel like “moving a huge pile of bricks one day and then coming back the next day to find the pile back in its original spot.”
Many LADC students witness this frustrating reality of the job while completing the required internship portion of their degrees, something that may be reflected in the fact that only 88 percent of the current licensed workforce is working in the field.
That number, especially in a job market that’s hungry for qualified workers, can be seen as an indicator of dissatisfaction, Fritsma Mogen said: “That’s definitely different from other mental health professions.”
Take marriage and family therapists, for instance. A higher percentage — 95 percent — work in the field they have trained for, Fristma Mogen explained: “So the that LADC number is actually fairly low.”
To paint a clearer picture of why Minnesota is struggling to keep up with demand for LADCs, Fritsma Mogen dug into state data on job satisfaction.
What she found was a segment of the workforce that wanted to help people find freedom from addiction but struggled with factors like low pay and job-related stress.
“Of those LADCs who are licensed but are not working, one in five say they are not looking for a position,” Fritsma Mogen said. “They are licensed but they have no interest in doing that work.” Of LADCs now working in the profession, 14 percent say they plan to leave within the next five years.
Some of that mass exit has to do with the age of the state’s LADC workforce, explained Therissa Libby, associate professor and director of the Masters of Science in Co-Occurring Disorders Recovery Counseling Program at Metro State University and immediate past-president of MN Addiction Professionals.
“We are now seeing a significant graying out of the workforce,” Libby said. “A lot of LADCs who came into the profession a few years ago are now in their 50s, 60s and 70s,” she said. “Many of these workers have retired or are looking to retire in the next few years.”
Pay is also an issue in LADC job retention, Fritsma Mogen said. Before 2008, the education requirement for licensure was a two-year associate of arts degree. Bumping the educational requirement to a four-year bachelor’s degree raised the investment required for licensure, but average pay did not increase to reflect that investment.
Other health care professions that require four-year degrees earn higher salaries. Registered nurses, for instance, make a median hourly wage of $37.67 per hour. Fristma Mogen said that substance-abuse counselors earn a median hourly wage of $22.50 per hour.
Roy Kammer, dean of Hazelden Betty Ford Graduate School of Addiction Studies, agreed that low pay relative to other helping professions like nursing make addiction counseling positions harder to fill.
“It is not an extremely high-paying field,” he said. “If you look at bachelor’s level you are looking at $40,000 a year, give or take. At a master’s level, you are looking at $50,000 a year give or take, depending on where you are getting hired.”
Newly minted LADCs sometimes struggle to make ends meet even after landing a job, he said. “People have student loans.” Sometimes the decision to stay in the field comes down to practicality. “There are other helping professions that may not require the same amount of education and have lower stress levels. These are factors that people going into the field have to consider.”
Another factor that can make LADCs think twice about continuing in the profession is the financial burden of completing the unpaid internship that is required to earn certification.
Completing two 30- to 35-hour-a-week internships are a key part of LADC education, Libby allowed, but the fact that the vast majority of those internships are unpaid makes it hard for her students, many of whom are working adults, to make ends meet.
“What would be helpful is paid internships,” she said. “At Metro State we cater to adult students, typically working, often with families. They are asked to do a 30- to 35-hour internship for two consecutive semesters that doesn’t pay a dime. Unpaid internships are a real bugaboo in a number of professions, a particular barrier to nontraditional students like ours.”
Libby said she is impressed by her students’ commitment to meeting all the requirements of the degree, even if it means serious personal sacrifice.
“Our students are my heroes,” she said. “Somehow they find a way to manage it. They find ways to make it work, but by and large [unpaid internships are] definitely a barrier for people who are looking at the profession.”
Once a person takes a job as an LADC, workplace stress can be a factor in determining how long they stay in the profession. Libby said that people can find great satisfaction in the work, but when a workplace feels dysfunctional or disorganized, she explained, “people will tend to feel used up. Even in the best workplace it is very challenging. So many people with substance use disorder have trauma histories.”
Trying to make a difference for people with deep pain is wearing, Libby said. “They may love the work, but it has a high rate of burnout and compassion fatigue. If they discover they can make more money doing something else, some may decide to do that.”
‘Very few people were pleased with their job.’
Waseca resident Stephanie La Due is one of those LADCs who experienced compassion fatigue. She came to the field in midlife, with a personal passion to help others struggling with addiction.
“I have a lot of alcoholism in my family, a number of loved ones who struggled with drinking,” she said. “The one relative who went into treatment ended up doing better than the ones who didn’t. I was inspired by that relative.”
Going into the field, La Due did her research and learned that the average annual salary for LADCs in the state was between $40,000 and $45,000. That didn’t hold her back, she said. As a former lab assistant, “That was quite a bit more than what I was making at the time.”
Plus, La Due added, she was committed to helping others, not to getting rich.
“I don’t know anyone who went into this job for the money,” she said.
La Due completed the Alcohol and Drug Studies program at Minnesota State Mankato. She completed the internship requirement of the program (880 hours) over five months, living on her savings, because her position was unpaid.
After earning her degree, La Due took a job at a clinic and later at a halfway house for individuals who had completed addiction treatment programs. At those jobs, she felt frustrated by what she saw as a “high workload” that focused on the completion of paperwork over client interaction.
“We have deadlines,” she said. “We have paperwork we need to comply with for the state.” She said she saw clients cycle in and out of her program, with few achieving lasting sobriety. Insurance rarely paid for them to stay long enough to fully recover.
“When clients come and go so quickly,” La Due said, “there’s a very high unsuccessful discharge rate due to relapse or to just not following the rules.”
La Due felt that outside financial pressures led to a rapid cycle of clients in and out of the programs. “There is a priority placed on keeping beds filled. More so it seemed than for client well-being,” she said. “People were coming and going. It made it difficult for the counselors to make enough time for the clients. They are so busy doing paperwork.”
She also felt that the traditional 12-Step model of treatment didn’t work for many of her clients, even though most programs still rely heavily on its tenets.
“Myself as well as other people I’ve talked to are disappointed about the high relapse rate,” La Due said. “With opioids in particular, the relapse rate is over 80 percent. By and large our field continues to hang on to the 12-Step program: It is not backed by science. I’ve also seen that it is offensive to a lot of people, especially the religious aspect of it.”
La Due worked as an LADC for almost five years. When her license came up for renewal this past July, she did not renew. The stress of the job outweighed any satisfaction she got from helping others, and she decided to look for other work.
She feels that she is not alone in her feelings about the profession. She’s disappointed because she went in with such high hopes of helping others but left when she felt that she was only making herself miserable.
“I would say the majority of people I worked with were frustrated,” La Due said. “Very few people were pleased with their job.” She’d like to keep helping others heal from addiction, but she’s decided to step out of the job, at least for now.
If the perfect position materialized, she might rethink her decision, La Due said, but until that happens, she’s removing herself from the role. “I’m not going to renew my license unless things change,” she said.
Because demand is so high for LADCs, the industry has been making some changes to attract workers.
One clear indicator is a wage hike. “I’m seeing the average wage offer for LADCs increase in the state, which is what should happen,” Fritsma Mogen said. “When there is a shortage of workers, wages should also go up.”
In this hot jobs climate, LADC program graduates have no problem finding a job, Libby said. Demand for trained substance-use counselors in the state is so high that, “Everybody is snapped up. Internship sites will typically offer a job.”
This didn’t used to be the case. “In the past, my colleagues would say to students, ‘Don’t get attached to your internship site. There is no promise of a job.’ Now students get hired immediately out of an internship all the time.”
Competition for trained LADCs is so tight that Kammer said he’s aware of students getting job offers during Hazelden’s job and internship fair.
“We’ve heard about students getting multiple offers right out of the gate,” he said. “Most of our students are hired before they graduate. Qualified counselors are in high demand.”
Another way to sweeten the deal for students is to find ways to make completing the internship requirement more affordable, Kammer said. “What we are starting to see and hear is that various organizations are starting to pay interns, or at minimum provide some sort of financial incentive.” The incentives include gas cards, signing bonuses or other incentives.
And once LADCs are hired, employers are developing ways to make their jobs feel more attractive.
“I see more and more organizations looking at flexibility in schedules, like four 10- hour days,” Kammer said. “Some employers are also allowing more liberal work-at-home policies.”
To help reduce the cost of adding education, Minnesota LADCs with AA degrees have been grandparented into the four-year degree requirement with something called a “temporary permit,” Libby explained: “A counselor with an associate’s degree who meets all of the board requirements can practice under direct supervision. There is a limitation to how long they can to that. It is a two-year permit. You can renew it two or three times for a maximum of six years.”
In Minnesota, peer support specialists (PSS) provide limited support and assistance to people struggling with addiction. Libby said there have been discussions about developing a “laddering” program at the state level that would provide financial assistance to PSSs seeking work their way up to LADC licensure: “They are trying to work this career ladder to bring more people into the field.”
On the national level, another initiative that feels hopeful for attracting more workers to the field is H.R.6, SUPPPORT for Patients and Communities Act, a bipartisan bill passed by Congress that’s aimed at addressing the nation’s opioid epidemic. The bill includes provisions for loan repayment for substance-use disorder treatment providers working in high-need areas.
While the details of a workforce loan repayment program are still being sorted out, Kammer said, “This has been a big win for us. We are moving forward, and close to having this happen.” Under the program, LADC graduates will be eligible for up to $75,000 in repayment for student loans over three years.
Helping to defray the cost of education could make LADC careers attainable for a larger segment of the population.
“It’s about creating access, about making substance-use counseling available to more people nationwide,” Kammer said. “I’m excited about that.”