By Helen Buttery
Summer 2005, Vol 8 No 4
A pioneering study of Canada’s addiction treatment workforce is shedding light on this neglected health care sector and laying the groundwork to improve services to Canadians with substance use issues. Conducted by the Canadian Centre on Substance Abuse (CCSA) in Ottawa, this is the first-ever survey of its kind. “Why it’s taken so long to do such a survey is a good indication that we’re not taking the profession of addictions treatment as a nation as seriously as we should,” says Jeff Wilbee, executive director of the Canadian Addiction Counsellors Certification Federation in Kitchener, Ontario.
But the renewal of Canada’s drug strategy, which saw the injection of $245 million over five years (starting in 2003) by the federal government to reduce the harm associated with substance use and abuse, has brought new attention and resources to the addiction field.
Historically, substance abuse problems were seen as a moral issue to be dealt with by the legal system. However, as societal attitudes have changed around substance use, and weighty issues such as the spread of hiv through intravenous drug use have come into play, substance abuse has shifted from a legal issue to a health issue. “With growing recognition of substance abuse disorders as a health issue comes an increased need to have professionals to deal with treatment,” says Dr. David Marsh, physician leader of Addiction Medicine with Vancouver Coastal Health and Providence Health Care in British Columbia. “Substance abuse disorders are just starting to get that recognition.”
Professionals in the addiction field are responding enthusiastically to the recent attention: Almost half of the 2,720 surveys mailed to staff working at 281 substance abuse treatment agencies across the country were completed; executive directors and service heads had a 60 per cent response rate. “The workforce is really interested and engaged in this topic of becoming more professional and finding ways to do their jobs better,” says co-author of the study Greg Graves, who is also co-ordinator of Training and Workforce Development with the CCSA.
Ten recommendations emerged from the survey findings, divided into three key areas: leadership and supportive strategies, training and education and research (see sidebar). Reflected in several of the recommendations is the desire to professionalize the workforce; for example, creating a professional designation for addiction workers so they can represent themselves as a body, similar to other health care workers like mental health counsellors, nurses and physicians. “The workforce is really looking for a professional network or a way to represent itself,” says Graves. “Comparing themselves to other primary health care workers, addiction professionals see they have the same kinds of credentials but don’t have the same recognition.”
Such professionalization requires an over-haul and evolution of the system, starting with the development of a national treatment network, national education standards and national standards and competencies for addictions workers. “What stuck out the most were standards and competencies – the need to develop knowledge and skills that would most likely facilitate effective service delivery in the field,” says Graves.
Illustrating this need is confusion over certification. Many survey respondents did not distinguish between having a certificate from a university or college and being certified as an addiction counsellor. Although overall education of substance abuse workers is very high, with many being certified by other professional bodies (such as those for nursing and social work), less than three per cent of respondents were certified as addiction counsellors by a sanctioned certifying body such as the Canadian Addiction Counsellors Certification Board or the Canadian Counselling Association. For Graves, this points to the need for a professional designation for addiction workers based on national standards and competencies.
Wilbee agrees: “This is an opportune time for the addictions field to come of age,” he says. Still, he worries that unless development in education standards is accompanied by adequate investment in the overall system, it won’t help to recruit or retain addictions workers. “The bottom line, like everything in life, comes down to dollars,” says Wilbee. “What are we prepared to invest?”
A paradoxical discovery in the study confirms Wilbee’s worker retention fears: Although there is overwhelming job satisfaction in the field (92 per cent among program mangers and front-line staff and 95 per cent among executive directors and agency heads), 40 per cent of respondents failed to respond to a question about how many years they planned to stay in the field. Of those who did answer, 39 per cent indicated they intend to leave the field before age 55; among those 40 and younger, 30 per cent said they plan to leave the field in the next five years. The survey reports an overall concern about the lack of financial resources and opportunities for professional development.
“For many years, the level of funding for addiction treatment has not kept pace with inflation, which shows that staff are very dedicated and enjoy their work, but are unfortunately underpaid,” says Marsh, who is also president of the Canadian Society of Addiction Medicine. “Agencies tend to make cuts that are not directly linked to service, so the money for staff education, staff travel to conferences and so forth has been eliminated from many agency budgets, and those sort of cuts erode staff morale and retention.” Predictably, many of these sidelined items are found in the 10 survey recommendations, including workforce development initiatives and an expansion of the CCSA’s National Summer Institute on Addictions, a professional development series for addiction workers.
Also prevalent among the recommendations is the need to develop and implement best practices to enhance service delivery. The problem, as the survey discovered, is that although many in the field are informed by Health Canada best practices reports, they aren’t able to integrate this knowledge into a service-delivery model. Currently, best practice is being implemented in a piecemeal fashion, without the transfer or sharing of information among agencies; many respondents were not even aware of these best practice documents.
“The irony is that a lot of these best practice elements are being put into action in the field,” says Graves. “We need to take what we know works and find pragmatic ways to connect to the field and help implement services that have been demonstrated to work. An electronic or written newsletter could have a huge influence in sharing information.” Respondents surveyed on 14 initiatives to help service delivery were supportive of programs to encourage best practices such as a Canadian web site, print and electronic bulletins and an association for staff.
“We need to build knowledge in the area of best practices and work on knowledge transfer in the field,” says Graves. “There’s strong evidence in this survey that there’s a hunger and a thirst for developing and implementing services according to empirical standards.”
Although Marsh believes the survey was a good effort, he would have liked to see a broader survey of the substance abuse landscape. “The survey looked at addiction treatment agencies, but not at all the places in the health care system where people with substance use disorders receive treatment,” says Marsh. “For example, methadone maintenance treatment in Canada is overwhelmingly delivered through physicians’ offices and pharmacies, but neither of those settings was included in this survey. We need a more comprehensive picture of how the health care system deals with people with substance use disorders.
The survey has taken an important step in propelling the field forward. Representatives from the addictions workforce across Canada came together in Ottawa this spring for a two-day workshop on workforce development, hosted by the CCSA. The meeting focused on areas identified by the survey, especially professionalizing the workforce in the areas of standards and competencies and education and training. Graves hopes the survey is just the beginning of what’s to come in improving service delivery to Canadians with substance use issues.
Professionalization requires an overhaul and evolution of the system, starting with the development of a national treatment network,national education standards and national standards and competencies for addictions workers.
“Comparing themselves to other primary health care workers, addiction professionals see they have the same kinds of credentials but don’t have the same recognition.”
Support the formation of a Canadian treatment network of front-line addiction treatment providers that will, among other things, promote and support workforce development in the field.
Provide leadership in the creation and ongoing maintenance of an interactive web site that
promotes best practices, encourages and supports ongoing learning and promotes Canadian and international content.
Host a national conference on substance abuse treatment that includes presentations and workshops on workforce development.
Promote a wide range of workforce development activities that match the varying needs of treatment agencies, including low-cost activities (e.g., web-based learning).
Continue to deliver and expand on the National Summer Institute series, but extend these sessions throughout the fiscal year and across regions.
Promote the development of national standards and competences for the addiction workforce that can be tailored to meet the needs of provincial-territorial jurisdictions.
Work toward the design of education and training curriculum that is responsive to the needs of the addiction workforce in Canada and translates into best practices across core competencies, including records management, professional ethics, screening and assessment, conceptual models of addictions, individual and group counselling, treatment planning and evaluation.
Monitor and evaluate academic curriculum and professional training services.
Continue to conduct research on and create awareness about the workforce development need of substance abuse treatment providers, including further analysis of the data from this survey and future investigations.
Continue to conduct research on best practices in the substance use field.
The results of the study are published in the report Optimizing Canada’s Addiction Treatment Workforce, available on the CCSA’s web site. Follow the “Training and Workforce Development” link.