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Who can afford to stay?

May 1, 2007
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Addiction services professionals face low compensation and high credentialing and education costs

Those who spend their time helping, counseling, and advising the 22.2 million Americans who struggle with addictions constitute a unique and special group of people. But some disturbing trends are leading us to question whether we will continue to be able to attract the most talented people to the addiction services profession.

As a member of the staff for NAADAC, The Association for Addiction Professionals, I'm privileged to work for the largest membership organization serving addiction counselors, educators, and other addiction-focused healthcare professionals who specialize in addiction prevention, treatment, and education. In working so closely with these dedicated professionals, NAADAC has been able to identify major issues and trends that impact our members.

One of those trends was indicated by the 2003 Practitioner Services Network. The PSN, supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), contacted 1,275 clinicians to assess their demographics and attitudes on the issues that faced them. The results were quite revealing. When asked what influenced them to join the addiction services profession, 95% said that they were attracted by work that was “challenging or interesting,” while 91% claimed that they had a “desire to work in a helping profession” (figure 1). Almost 80% identified “substance abuse problems in the community” as a factor in their decision to work as a clinician. More than 60% cited a family/personal connection as a motivation for joining the addiction services profession.1 These results revealed a highly motivated, passionate, and engaged workforce.

Figure 1. The proportion of NAADAC members who indicated a factor was influential “to a great extent” or “to a very great extent” in their decision to work in the substance abuse field is shown.


But one of the challenges we face is the imminent need to add to this workforce. According to a study by the Lewin Group in 2004, “5,000 new addiction professionals are needed each year just to replace those leaving” the profession.2 That is coupled with SAMHSA's estimate that if “current drug use initiation rates continue, demand for treatment will double by 2020.”2 However, trends indicate that people are leaving the profession for a number of reasons.

Since credentialing of addictions counselors began more than 25 years ago, the issues of which credential is required to practice within a state or region, the cost of maintaining credentials, and questions about which board should someone apply to have created concern and confusion. Today, most addiction services professionals hold at least two certificates to practice: a license in an allied profession (e.g., social work) and an addiction-specific credential usually obtained from the state. According to the NAADAC PSN, more than 75% of members are state certified or licensed as substance abuse counselors, and a majority (60.6%) holds memberships in other professional organizations.1

Yet the cost of obtaining and maintaining licenses and credentials has risen so high that in many instances professionals have trouble covering the costs of obtaining and/or maintaining licenses and credentials. These costs can range from $100 to $400 per credential or license. For those who hold a number of credentials or licenses, these costs can quickly become prohibitive. And it's difficult to find low or no-cost training/education that licensing/credentialing bodies require.

In addition to navigating the requirements to practice, addiction services professionals face compensation issues. We can again look to the NAADAC PSN for insight. Counselors were asked what kept them satisfied or very satisfied with their work. More than 75% of those surveyed mentioned the nature of tasks, the work environment, and the fact that they see an impact from their efforts (figure 2). On the other hand, only 45% of respondents said that they were satisfied with their workloads, and only 20% were satisfied with their salaries.1

Figure 2. Addiction services professionals' satisfaction with aspects of their current job.


The federal Center for Substance Abuse Treatment's Environmental Scan indicated in 2003 that average starting salaries in the addiction services profession are in the low $30,000s. The majority of new counselors' salaries range from $15,000 to $34,000.3 When these low salaries are coupled with the costs of maintaining multiple licenses and credentials, general costs of living (i.e., supporting a family), and student loan repayment obligations, the economic pressures can be overwhelming.