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Understanding the Graduate-Level Addiction Counselor Workforce: Differences in Educational Standards, Scope of
Maria Gaiser1, Lisa de Saxe Zerden1,2, Libby Daberko1
1Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, USA.
Background:
Graduate-level licensed addiction counselors are a critical component of the substance use disorder workforce, yet their scope of practice, education and training requirements, and credentialing varies in the U.S.
Objectives:
To better understand the roles and functions of the graduate-level addiction counselor workforce across the U.S., this state-by state analysis sought to identify the titles, minimum education and training requirements, scope of practice, and supervisory opportunities for graduate-level addiction counselors.
Design:
This project conducted systematic abstraction and descriptive analysis of U.S. state Practice Acts, certification board rules, materials from behavioral health professional organizations, and state Medicaid plans, fee schedules, and provider manuals.
Methods:
Descriptive summaries were produced to describe trends across states. Tables synthesized aggregated data across the workforce domains of education and training, regulation and credentialing, supervision, and payment for graduate-level addiction counselors only.
Results:
Forty-one states offer a graduate-level addiction counselor credential, 18 of which offer multiple credentials for a total of 69 credentials. States varied in services permissible by scope of practice definition, including assessments (41 states), psychotherapy (28 states), telehealth (28 states), and diagnosis (16 states). Only 26 states allow for independent practice. States required an average of 2,887 practice hours and 143 post-graduate supervision hours. Sixteen states permitted all tiers of graduate-level addiction counselors to supervise others, and 10 states specifically offer a graduate-level supervisory credential.
Conclusion:
State graduate-level addiction counselor credentials widely vary, suggesting that states utilize this workforce differently based on differing training criteria, required competencies, scope of practice, and supervision. Strategies to support growth of this workforce include alignment of training competencies, additional substance use disorder training in behavioral health graduate programs, and expansion of supervisory pathways and credentials.
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