Counselors who treat people with substance use disorders do life-changing work on a daily basis, amid difficult circumstances that include staff shortages, high turnover, low salaries, and scant program funding. Counselors come to this important work by various paths and with vastly different skills and experience. The diversity of backgrounds and types of preparation can be a strength, provided there is a common foundation from which counselors work.
This chapter addresses the following questions: What professional standards should guide substance abuse treatment counselors? What is an appropriate scope of practice for the field? Which competencies are associated with positive outcomes? What knowledge, skills, and attitudes (KSAs) should all substance abuse treatment professionals have in common?
The Model
When creating The Competencies, the National Curriculum Committee recognized a need to emphasize three characteristics of competency: knowledge, skills, and attitudes. Many hours were spent conceptualizing a differentiated model when designing TAP 21—a model that could address general KSAs necessary for all practitioners dealing with substance use disorders while explaining the more specific needs of professional substance abuse treatment counselors.
The first section of the model addresses the generic KSAs. This section contains the transdisciplinary foundations, comprising four discrete building blocks: understanding addiction, treatment knowledge, application to practice, and professional readiness. The term “transdisciplinary” was selected to describe the knowledge and skills needed by all disciplines (e.g., medicine, social work, pastoral guidance, corrections, social welfare) that deal directly with individuals with substance use disorders.
Figure 25.1: Competencies Hub
The second section of the model specifically addresses the professional practice needs, or practice dimensions, of addiction counselors. Each practice dimension includes a set of competencies, and, within each competency, the KSAs necessary for effective addiction counseling are outlined. Many additional competencies may be desirable for counselors in specific settings. Education and experience affect the depth of the individual counselor’s knowledge and skills; not all counselors will be experienced and proficient in all the competencies discussed. The National Curriculum Committee’s goal for the future is to help ensure that every addiction counselor possesses, to an appropriate degree, each competency listed, regardless of setting or treatment model.
The relationship of the components in the competencies model is conceptualized as a hub with eight spokes (see figure 25.1). The hub contains the four transdisciplinary foundations that are central to the work of all addiction professionals. The eight spokes are the practice dimensions, each containing the competencies the addiction counselor should attain to master each practice dimension.
The Transdisciplinary Foundations
Addiction professionals work in a broad variety of disciplines, but share an understanding of the addictive process that goes beyond the narrow confines of any one specialty. Specific proficiencies, skills, levels of involvement with clients, and scope of practice vary widely among specializations. At their base, however, all addiction-focused disciplines are built on four common foundations.
This section focuses on four sets of competencies that are transdisciplinary in that they underlie the work not just of counselors but of all addiction professionals. The four areas of knowledge identified here serve as prerequisites to the development of competency in any of the addiction-focused disciplines.
The Four Transdisciplinary Foundations
Understanding Addiction
Treatment Knowledge
Application to Practice
Professional Readiness
Regardless of professional identity or discipline, each treatment provider must have a basic understanding of addiction that includes knowledge of current models and theories, appreciation of the multiple contexts within which substance use occurs, and awareness of the effects of psychoactive drug use. Each professional must be knowledgeable about the continuum of care and the social contexts affecting the treatment and recovery process.
Each addiction specialist must be able to identify a variety of helping strategies that can be tailored to meet the needs of individual clients. Each professional must be prepared to adapt to an ever-changing set of challenges and constraints.
Although specific skills and applications vary across disciplines, the attitudinal components tend to remain constant. The development of effective practice in addiction counseling depends on the presence of attitudes reflecting openness to alternative approaches, appreciation of diversity, and willingness to change.
The following knowledge and attitudes are prerequisite to the development of competency in the professional treatment of substance use disorders. Such knowledge and attitudes form the basis of understanding on which discipline-specific proficiencies are built.
Understanding Addiction
Competency 1:
Understand a variety of models and theories of addiction and other problems related to substance use.
Knowledge
Terms and concepts related to theory, etiology, research, and practice.
Scientific and theoretical basis of model from medicine, psychology, sociology, religious studies, and other disciplines.
Criteria and methods for evaluating models and theories.
Appropriate applications of models.
How to access addiction-related literature from multiple disciplines.
Attitudes
Openness to information that may differ from personally held views.
Appreciation of the complexity inherent in understanding addiction.
Valuing of diverse concepts, models, and theories.
Willingness to form personal concepts through critical thinking.
Competency 2:
Recognize the social, political, economic, and cultural context within which addiction and substance abuse exist, including risk and resiliency factors that characterize individuals and groups and their living environments.
Knowledge
Basic concepts of social, political, economic, and cultural systems and their impact on drug-taking activity.
The history of licit and illicit drug use.
Research reports and other literature identifying risk and resiliency factors for substance use.
Statistical information regarding the incidence and prevalence of substance use disorders in the general population and major demographic groups.
Attitudes
Recognition of the importance of contextual variables.
Appreciation for differences between and within cultures.
Competency 3:
Describe the behavioral, psychological, physical health, and social effects of psychoactive substances on the person using and significant others.
Knowledge
Fundamental concepts of pharmacological properties and effects of all psychoactive substances.
The continuum of drug use, such as initiation, intoxication, harmful use, abuse, dependence, withdrawal, craving, relapse, and recovery.
Behavioral, psychological, social, and health effects of psychoactive substances.
The effects of chronic substance use on clients, significant others, and communities within a social, political, cultural, and economic context.
The varying courses of addiction.
The relationship between infectious diseases and substance use.
Attitudes
Sensitivity to multiple influences in the developmental course of addiction.
Interest in scientific research findings.
Competency 4:
Recognize the potential for substance use disorders to mimic a variety of medical and mental health conditions and the potential for medical and mental health conditions to coexist with addiction and substance abuse.
Knowledge
Normal human growth and development.
Symptoms of substance use disorders that are similar to those of other medical and/or mental health conditions and how these disorders interact.
The medical and mental health conditions that most commonly exist with addiction and substance use disorders.
Methods for differentiating substance use disorders from other medical or mental health conditions.
Attitudes
Willingness to reserve judgment until completion of a thorough clinical evaluation.
Willingness to work with people who might display and/or have mental health conditions.
Willingness to refer for treating conditions outside one’s expertise.
Appreciation of the contribution of multiple disciplines to the evaluation process.
Treatment Knowledge
Competency 5:
Describe the philosophies, practices, policies, and outcomes of the most generally accepted and scientifically supported models of treatment, recovery, relapse prevention, and continuing care for addiction and other substance-related problems.
Knowledge
Generally accepted models, such as but not limited to:
pharmacotherapy
mutual help and self-help
behavioral self-control training
mental health
self-regulating community
psychotherapeutic
relapse prevention.
The philosophy, practices, policies, and outcomes of the most generally accepted therapeutic models.
Alternative therapeutic models that demonstrate potential.
Attitudes
Acceptance of the validity of a variety of approaches and models.
Openness to new, evidence-based treatment approaches, including pharmacological interventions.
Competency 6:
Recognize the importance of family, social networks, and community systems in the treatment and recovery process.
Knowledge
The role of family, social networks, and community systems as assets or obstacles in treatment and recovery processes.
Methods for incorporating family and social dynamics in treatment and recovery processes.
Attitudes
Appreciation for the significance and complementary nature of various systems in facilitating treatment and recovery.
Competency 7:
Understand the importance of research and outcome data and their application in clinical practice.
Knowledge
Research methods in the social and behavioral sciences.
Sources of research literature relevant to the prevention and treatment of addiction.
Specific research on epidemiology, etiology, and treatment efficacy.
Benefits and limitations of research.
Attitudes
Recognition of the importance of scientific research to the delivery of addiction treatment.
Openness to new information.
Competency 8:
Understand the value of an interdisciplinary approach to addiction treatment.
Knowledge
Roles and contributions of multiple disciplines to treatment efficacy.
Terms and concepts necessary to communicate effectively across disciplines.
The importance of communication with other disciplines.
Attitudes
Desire to collaborate.
Respect for the contribution of multiple disciplines to the recovery process.
Application to Practice
Competency 9:
Understand the established diagnostic criteria for substance use disorders, and describe treatment modalities and placement criteria within the continuum of care.
Knowledge
Established diagnostic criteria, including, but not limited to, current Diagnostic and Statistical Manual of Mental Disorders (DSM) standards and current International Classification of Diseases (ICD) standards.
Established placement criteria developed by various states and professional organizations.
Strengths and limitations of various diagnostic and placement criteria.
Continuum of treatment services and activities.
Attitudes
Openness to a variety of treatment services based on client need.
Recognition of the value of research findings.
Competency 10:
Describe a variety of helping strategies for reducing the negative effects of substance use, abuse, and dependence.
Knowledge
A variety of helping strategies, including, but not limited to:
evaluation methods and tools
stage-appropriate interventions
motivational interviewing
involvement of family and significant others
mutual-help and self-help programs
coerced and voluntary care models
brief and longer term
Attitudes
Openness to various approaches to recovery.
Appreciation that different approaches work for different people.
Competency 11:
Tailor helping strategies and treatment modalities to the client’s stage of dependence, change, or recovery.
Knowledge
Strategies appropriate to the various stages of dependence, change, and recovery.
Attitudes
Flexibility in choice of treatment modalities.
Respect for the client’s racial, cultural, economic, and sociopolitical backgrounds.
Competency 12:
Provide treatment services appropriate to the personal and cultural identity and language of the client.
Knowledge
Various cultural norms, values, beliefs, and behaviors.
Cultural differences in verbal and nonverbal communication.
Resources to develop individualized treatment plans.
Attitudes
Respect for individual differences within cultures.
Respect for differences between cultures.
Competency 13:
Adapt practice to the range of treatment settings and modalities.
Knowledge
The strengths and limitations of available treatment settings and modalities.
How to access and make referrals to available treatment settings and modalities.
Attitudes
Flexibility and creativity in practice application.
Competency 14:
Be familiar with medical and pharmacological resources in the treatment of substance use disorders.
Knowledge
Current literature regarding medical and pharmacological interventions.
Assets and liabilities of medical and pharmacological interventions.
Health practitioners in the community who are knowledgeable about addiction and addiction treatment.
The role that medical problems and complications can play in the intervention and treatment of addiction.
Attitudes
Open and flexible with respect to the potential risks and benefits of pharmacotherapies to the treatment and recovery process.
Competency 15:
Understand the variety of insurance and health maintenance options available and the importance of helping clients access those benefits.
Knowledge
Existing public and private payment plans including treatment orientation and coverage options.
Methods for gaining access to available payment plans.
Policies and procedures used by available payment plans.
Key personnel, roles, and positions within plans used by the client population.
Attitudes
Willingness to cooperate with payment providers.
Willingness to explore treatment alternatives.
Interest in promoting the most cost-effective, high-quality care.
Competency 16:
Recognize that crisis may indicate an underlying substance use disorder and may be a window of opportunity for change.
Knowledge
The features of crisis, which may include, but are not limited to:
family disruption
social and legal consequences
physical and psychological
panic states
physical
Substance use screening and assessment methods.
Prevention and intervention principles and methods.
Principles of crisis case management.
Posttraumatic stress characteristics.
Critical incident debriefing methods.
Available resources for assistance in the management of crisis situations.
Attitudes
Willingness to respond and follow through in crisis situations.
Willingness to consult when necessary.
Competency 17:
Understand the need for and the use of methods for measuring treatment outcome..
Knowledge
Treatment outcome research literature.
Scientific process in applied research.
Appropriate measures of outcome.
Methods for measuring the multiple variables of treatment outcome.
Attitudes
Recognition of the importance of collecting and reporting on outcome data.
Interest in integrating research findings into ongoing treatment design.
Uses of the Competencies
The Board of Directors of the Illinois Alcohol and Other Drug Abuse Professional Certification Association has endorsed and will be incorporating the knowledge, skills, and attitudes provided in The Competencies into all of its models for Certified Alcohol and Other Drug Abuse Counselors.
The Practice Dimensions
Professional practice for addiction counselors is based on eight practice dimensions, each of which is necessary for effective performance of the counseling role. Several of the practice dimensions are subdivided into elements. The dimensions identified, along with the competencies that support them, form the heart of this section of The Competencies.
The Eight Practice Dimensions of Addiction Counseling
Clinical Evaluation
Screening
Assessment
Treatment Planning
Referral
Service Coordination
Implementing the Treatment Plan
Consulting
Continuing Assessment and Treatment Planning
Counseling
Individual Counseling
Group Counseling
Counseling Families, Couples, and Significant Others
Client, Family, and Community Education
Documentation
Professional and Ethical Responsibilities
A counselor’s success in carrying out a practice dimension depends on his or her ability to attain the competencies underlying that component. Each competency, in turn, depends on its own set of knowledge, skills, and attitudes. For an addiction counselor to be truly effective, he or she should possess the knowledge, skills, and attitudes associated with each competency that are consistent with the counselor’s training and professional responsibilities.
License and Attribution
Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. HHS Publication No. (SMA) 15-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
