Very “SAD” Facts about the Addictions Field
A recent issue of the Addictions Professional presented very disturbing news about how clinicians in the field are doing. NOT WELL! Addictions clinicians treat people with addictions but mainly people with co-occurring disorders – addictions with trauma, depression, anxiety and/or eating disorders. Often there is also a co-occurring medical condition. This is very difficult work. People suffering from these conditions often relapse into one condition when they improve in another. Trying to attain a healthier client life in this work is no easy matter, and places huge emotional strains on families and clinicians. It is a profession of the heart.
To begin with it is so sad how poorly the American public understand addictions. I think much of this wrong opinion is based on stigma, shame, and very poor public education about addictions. A recent Harris Poll of 2,184 adults, of which 692 were parents of children between the ages of 6 and 25, noted that 66% of the people polled thought addictions could 
be cured; nearly all professional groups believe it is a chronic, progressive disease/syndrome that can be managed. Recovery, of course, is quite possible; recovery, however, does not meet clinical criteria of a “cure.” 18% believed that recovery was hopeless once a person relapses after intervention. In reality, relapse is simply part of the recovery process and may indicate by its repetition how severe the addiction is (a brain-based, mind-body-spirit disorder). 55% had an opinion that a person with an addiction could not perform well at work. In reality this situation if quite variable. 42% to 47% of respondents would feel uncomfortable if a significant person (potential in-law, teacher, medical doctors) had an addiction. Well we all know how poorly informed the American public has been and still is about the realities of addictions. What is the problem here?
A recent Quality of Life survey of 650 addictions clinicians found that in 2015 71% intended to work in the field until retirement. That number was reduced in 2016, with only 68% planning to retire from their current work. In 2017 the number went down again with only 59% of current addictions professionals intending to remain in the field until they retired. That is a 12% drop in just three years. Almost 10% noted that they would most likely seek another career. Workloads have increased and salaries have not move very much. 52% of a sample of workers noted that their caseload has increased over the past two years. What about compensation? Not so good! In 2017 71% noted that their current salary DID NOT reflect their training, experience, and job requirements. 35% have quit a job in addictions work. 13%noted that their clinical supervision needed improvement or was not good at all. These numbers are dismal.
At the same time documentation requirements of state and federal government funding, as well as health insurance company funding, have increased dramatically. In my own 
experience I supervised clinicians working with very difficult addiction clients. Most of them had to spend about 51% of their time documenting the work they did, while only 49% of their time or less was actually working with clients. It was common for people to go back to work on weekends to complete overdue paper/computer documentation. I often joke that to be an addictions counselor you need to fill out more paper and/or computer screens than to transport nuclear waste across state line or to buy a house. I think this may be true! I call this “Organic Bureaucracy,” where record keeping and management functions increase to the detriment of time with clients. Is it not the goal to help client learn skills and stabilize emotions so that they may enter recovery process? This requires TIME!
How about self-care. Surely in such a “strained” field – often called the poor sister or poor brother of health care – where demand for services outpaces staff and funding availability – self-care must be seen as important. Perhaps not! Survey data suggests that only about 1/3 of addictions counselors perceive self-care as a high priority at their place of employment. 25% note that self-care receives little or no attention. 41% note that self-care is an occasional topic in the workplace. I fear that marginal supervisors may be fearful of emphasis on self-care, perhaps suggesting that the job really cannot be done in a healthy way. Lots and lots of “burn-out.”
Let’s HOPE that somewhere up the federal bean stock somebody wakes up. In not, we may see huge shortages of qualified addictions professional. Yes there are other resources, but often far less trained and experienced in helping people work their way out of their addictions and other clinical conditions. Then what?
For more information refer to Addiction Professional (Fall, 2016), pp. 16-18, 20, 40.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness
Here I will continue my posts about the common characteristics of happiness. Here is the list.
suggested that life’s purpose is not happiness but being compassionate, useful, and honorable. Leonardo Da Vinci equated work with purpose and purpose with work. The Buddha advised that ultimate purpose is to work toward ultimate truth.
professional training and experience. Helpers from recovery-oriented peer counselors, state employed case managers, and licensed counselors/therapists all the way to physicians are reporting record high levels of reactive stress and compassion fatigue. Psychiatrists are worried about the possible death of their profession. Perhaps no group of helpers has more stress challenges than typical under-funded and under-staffed non-profit behavioral health care services. These are the same services that experience being swallowed up by the organic bureaucracy of state and federal busy-work as well insurance company “to-do lists.” For many, computerized systems and the electronic health record have only made matters worse. There is no end in sight; in fact pay for performance which is a good thing now simply adds one more layer of stress-inducing work pressure for helpers.
combined findings from 52 high quality studies; the final analysis was that between 30-40% of professionals experience burnout. This reality had devastating effects on the healthcare system as a whole, and all people involved in it. Here are the negative outcomes on individuals and systems:
This strange behavior continued for some time, until the robin had forced me to move within two feet of of our above-ground pool. The robin persisted by flying closer and closer to my head, to “push” me closer and closer to the pool until I reached its frame. Then I saw it. Then I realized how this intelligent bird figured out a way to get me to see its chick now having great difficulty staying afloat in the pool water. I knew I could not touch the chick, but I had to save it. So in the pool I went and netted it in an old bird nest sitting on the deck. I placed the “saved” chick in the nest on the deck just high enough to protect it from cats and allow its parents to come to its rescue. Soon they were feeding it. In a few days the chick was gone and so were the parents. I assume it flew correctly without landing in what must have seemed to be a gigantic ocean to the very small chick. I experienced very strong feelings of gratitude at that time. Gratitude for my actions, for the chick, and for its parents. Gratitude for the beautiful and mysterious Tao of nature surrounding me in life.
an adult delivered food to the nest. So what to do? I did not want to leave the chick to its fate, and I did not want robins pecking at my head in defense of their own. I grabbed a flat piece of wood and a scissors; I went out to the porch, quickly cut the plastic string and caught the chick in its fall on the board. The chick landed eventually on the porch floor. It was breathing heavy, and I think its leg had been injured in the tangle. By that time several robins were harassing me; they meant business. My good deed done, I left the chick on the floor and observed several robins flying on to the porch. When I looked out a few minutes later, the chick was gone and no adult birds were anywhere to be seen. Worried that the injured chick had fallen off the floor onto the ground below, I went out to investigate. I was unable to find the chick. Soon, however, two robins came to the porch making all kinds of noise – probably trying to communicate with the chick. Then I noticed the adult birds very cautiously (after quite some time of just hanging out) flying to the ground where I had been searching for the chick. I watched one robin go into the brush nearby, entering with an insect in its mouth and leaving empty-beaked. I guess they found their chick, and were continuing to nurse it back to health. Because I cannot disturb it, I will never know if that chick made it or not. One thing is certain, the parents were in no mood to give up; they continued to cautiously land on the ground with food. I think it is a happy ending just like story 1.
we learn to care more about others and less about ourselves. The self-centered ego gives way to compassionate tolerance. Buddhist practices and meditations may improve our interpersonal relations, both intimate and distant. Today our world, nation, regions, and families are locked in bitter conflict; the entitled view of “my ideas are right” holds sway and prevents any forward movement for negotiated co-existence of different ideas and people. If we hope to save ourselves as well as our world, we MUST practice more interpersonal mindfulness. Such practices of random acts of kindness, general compassion, taking in suffering and giving out joy, tolerance, openness to differences, general gratitude and others all support more inter-personally cooperative thoughts and behaviors. Such thoughts and behaviors will improve self, dyads, relationship, family, community, race, ethnic group, religion, state, nation, and world. The need for this shift is highly urgent! We must change our being from greed, aversion, and hate to generosity, inclusivity, and love. If not our species and our world may fail.
happening right now in this present moment. What, exactly, is it that is upsetting me? What, exactly, is it that may lead to mutual satisfaction here now? Begin your changes by starting with yourself. Notice what conflictual inner self-messages continue to play and re-play themselves over and over again in your own mind. Begin by listening to your own inner conflicts, and work at listening and reflecting deeply on both sides of this dynamic. Work on a solution, even if it is not a perfect one. First practice more radical acceptance with your own inner conflicts, then gently move to outer conflicts – begin gently with significant others. Practice, practice, practice and practice more. There cannot be a winner! Once you feel the sensations and emotions of successful compromise, begin to practice beyond intimate circles and into your general world environments. It is all about sharing your love and acceptance of self with others, and being for the betterment of others. On this path also practice good self-care.