Like many public health and human services issues, it takes a village to provide effective and compassionate substance abuse treatment in America today.
That’s true not just at the process level, where coordination, funding, and policy provide support, but out in the wild lands of clinical treatment as well. Not everyone experiencing addiction shows up on the doorstep of a trained and qualified substance abuse counselor. Many of them may not even realize they need to see one.
And even if that were the case, the sad reality is that there simply aren’t enough drug and addiction treatment therapists to go around in the U.S. today. According to a 2024 report on the Behavioral Health Workforce from the Health Resources and Services Administration (HRSA), there are substantial shortages of addiction counselors across the country today… and projections show the situation getting even worse, with a shortfall of 60 percent expected by 2037.
So a lot of the slack in addiction treatment has to be picked up by individuals in other healthcare, mental health, and social services professions. But it can be a real struggle for those professionals to get the training they need to be effective in the role.
Addiction Therapy Is a Field That Has Always Drawn on Other Specialized Professions
Fortunately, it’s not usually a huge stretch to adapt skills and knowledge in these fields to real-world SUD (Substance Use Disorder) treatment competencies. Substance abuse and addiction counseling is already an interdisciplinary field that exists in the intersection of many psychology and social science professions.
From the world of social work, it looks at the cultural and community enablers of addiction, and for resources and support for reconciliation from those same areas.
From clinical psychology, it draws on evidence-based practices for understanding and treating the psychopathology of addictions.
From marriage and family therapy, it draws lessons in understanding personal support systems and the importance of involving friends and family in recovery efforts.
From mental health counseling, it takes practical techniques in behavioral therapy and coaching to nudge patients back onto a healthy track in life.
From healthcare and nursing, it uses scientific research and deep understanding of the biological bases of addiction to help treat physiological forces that tie people to illicit substances.
So it isn’t surprising that individuals in any and all of those various professions also have a role to play in delivering direct treatment for substance use disorders. In many cases, they have their own sub-specialties and licensing tracks. In many states, they have separate, but often equivalent, practice authority to treat substance abuse patients.
Yet in many cases, they also have challenges in finding training that is specifically designed to make them better addiction counselors.
The Tradition of Substance Abuse Counseling Runs Through Many Healthcare, Psychology, and Social Services Professions
While addiction counselors are the go-to choice for focused professional treatment of substance use disorders today, that’s a relatively recent development. The first professional licensing or certification programs for addiction treatment didn’t even begin to emerge until the 1970s.
The problems of addiction, and the need to care for those experiencing it, are timeless, and addiction treatment in some form has been around since at least the 18th century.
Before addiction counseling even existed as an independent profession, physicians, psychologists, counselors, and others working in the social and healthcare services field were doing their level best to help bring solace and recovery to people experiencing addiction. Each of those fields developed its own approaches to offering that treatment, creating traditions and sometimes credentials that are still available for training today.
Although professional training, certification, and licensure for addiction counseling are broadly available today, that doesn’t mean that these professions have dropped their own responsibilities in therapy and treatment. But it does mean that it can be challenging for those professionals to get the latest training in substance use disorders.
Training Options Can Depend on Tradition and Practice
Some of these professions have more options for substance use disorder training baked into the credentialing pipeline than others.
It’s quite common, for example, to find degree specializations in addiction or substance abuse treatment associated with psychology or counseling majors. There are also a lot of BSW (Bachelor of Social Work) and MSW (Master of Social Worker) programs that offer concentrations dealing with substance use disorders.
At the master’s degree level, many of the options for specialized addiction counselors will actually be programs in mental health counseling with an addiction science specialization.
On the medical side of addiction therapy, there are actual requirements in place through the Drug Enforcement Administration (DEA) that mandate some types of training.
On the whole, though, if you’re coming to addiction counseling from a field other than these, you’ll need to put in considerably more effort to find the training you need to be an effective SUD therapist.
Confronting the Professional Challenges of Specializing in Addiction Counseling When You Aren’t an Addiction Counselor
The most natural way to develop the knowledge and skills you need to specialize comes through the degrees you are likely to earn on your way to licensing or certification. In most cases, these are as highly specialized as a master’s degree in addiction counseling, so not particularly well-suited to professionals in other areas of healthcare, mental health, or social services.
It’s also the case that continuing education course materials, professional publications, and major conferences in healthcare, mental health, and social services fields outside of addiction counseling probably don’t zero in on substance abuse education specifically. Each field has its own concerns, and those, naturally, soak up most of the continuing education hours on offer.
Finally, it’s often harder to find peers to network with who have the same concerns, interests, or issues to talk over. The bulk of the workforce will be drawn to the more immediate interests in the field, leaving anyone focused on substance abuse issues in the backseat.
Specialty Credentials in Addiction Counseling Are Available To Many Professionals in Mental Health and Healthcare
Not all is lost, though. All of these are well-established professions, and, as you know, each has a history of involvement in substance abuse treatment. So there are strong foundations to build your practice on, if you can find them.
Some of these professions have their own, independent professional certification paths for addiction specialists. It’s common for each of those certification paths to come with specialized training devoted to addiction assessment, diagnosis, and treatment skills.
Licensed Professional Counselors
The best known of these may be the Master Addiction Counselor credential from the National Board for Certified Counselors (NBCC), which is recognized as part of the addiction licensing pathway in many states.
Clinical Psychologists
Psychologists can pursue Board Certification in Addiction Psychology through ABPP, the American Board of Professional Psychology. The field was recognized as a specialty board in 2020 by the American Psychological Association (APA).
Clinical Social Workers
The National Association of Social Workers (NASW) developed a specialty credential in 1999 for dealing with substance abuse issues called the Certified Clinical Alcohol, Tobacco & Other Drugs Social Worker (C-CATODSW). New applications for the credential are on hold, but it requires two years of post-MSW clinical experience in substance use disorder treatment as well as 180 hours of CE in the field, making it one of the strongest paths for specific social worker training in addiction treatment.
Healthcare Providers
There are a lot of official options for substance abuse training for doctors, nurses, and other healthcare professionals considering both the technical details of medical treatments and the ultimate importance of diagnostics and assessing interactions with other medications. From APNA, the American Psychiatric Nurses Association, a free MSUD (Medications for Substance Use Disorders) offers the required DEA educational requirements for prescribing opioid treatment meds. Doctors can get the same required coursework from the American Academy of Addiction Psychiatry via the PCSS-MOUD (Providers Clinical Support System – Medication for Opioid Use Disorder) module, free of charge.
Nurses also have the option of official board certification as a Certified Addiction Recovery Nurse (CARN), or as a CARN-AP after additional experience, through the Addiction Nursing Certification Board. An extra 30 hours of CE in the field plus 2,000 hours of related experience are needed.
There’s also a Substance Use and Addictions Nursing Certificate available from the University of Maryland, the only one of its kind in the country, offering graduate-level instruction specific to addiction treatment.
Since 2016, doctors also have a board specialty available in addiction medicine, through the American Board of Preventive Medicine. Current specialists can apply to take an exam to become an addiction medicine specialist; in the future, a dedicated one-year fellowship in the field will be required. A number of other groups also have addiction medicine certifications for doctors including:
- American Board of Addiction Medicine
- American Board of Psychiatric and Neurology in Addiction Psychiatry
- International Society of Addiction Medicine
- American Osteopathic Association
There’s also the option through the American Society of Addiction Medicine (ASAM) to become a Fellow of the Society (FASAM), certifying members as addiction medicine specialists if they’ve been a member for at least two years and hold certification through any of the above organizations.
Dual Certification Is an Option That Opens up Full Access to Addiction Counselor Training
There’s nothing that precludes most counselors, therapists, psychologists, or other professionals from pursuing dual certification in addiction as well. In some states, this may even be required for providing or advertising certain addiction counseling services.
There are plenty of licensed clinical psychologists who have added to their credentials with a MAC from NAADAC, for instance, and LMFTs who pick up state-level addiction counseling certification. The underlying professional degrees are usually accepted for SUD counseling certification. It’s relatively easy to pick up required educational coursework through graduate certificate programs in addiction counseling.
Because experiential requirements for state certification can often be filled through your regular practice in related fields, all that is required on top of the mandatory coursework is passing the right tests. Both NAADAC and IC&RC, the major national organizations for addiction counselors, provide training materials to help the process.
Continuing Education Is the Most Common Way for Other Professionals To Earn Addiction Counseling Training
Continuing education is also a major pathway for professional counselors, therapists, and the like to extend their expertise in the world of addiction treatment. These professionals, like addiction counselors, are required to go through ongoing professional development by acquiring CEUs to maintain their licenses.
They can pursue substance abuse treatment courses either available through their standard approved providers, or often with specialized addiction counseling continuing ed services. For example, NAADAC is a recognized CE provider for other various national and state bodies including:
- National Board of Certified Counselors
- National Association of Social Workers
- Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
- Alabama Board of Examiners in Counseling
- Colorado Office of Behavioral Health
- California Association of Marriage and Family Therapy
That means any of the wide range of in-person trainings, webinars, certificate programs, or even conferences NAADAC offers can be used to build your expertise in addiction counseling and still count toward the continuing education you need to renew your primary license.
Since there are already huge numbers of patients that are tapping into these services, there are also frequently professional groups that have emerged to focus on the need. Like ASAM, these groups are filled with like-minded professionals and offer the kind of networking, and, frequently, continuing ed opportunities you need to hone your SUD treatment skills.
It’s going to take a combined effort from the entire behavioral healthcare workforce to get ahead in the fight to save people from addiction and dependency. Committed therapists from every sort of profession will find all sorts of organizations standing behind them as they prepare for that battle.
