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Workforce Crises and Health Reform

114th Congress


Our country is on the verge of a crisis. There is an inadequate supply of workers trained in substance abuse treatment, including those specializing in the therapeutic community philosophy of treatment. This crisis is not unlike the nursing shortage, addressed by Congress. Treatment Communities of America (TCA) believes the substance abuse treatment workforce shortage must be addressed this year to avert the loss of effective programs accessible to those suffering from addictive disorders.

The Crisis

The substance abuse treatment community experiences both high turnover and a low rate of newly trained workers entering the field. Retention problems lead to overworked staff and difficulty in training. Low pay, a high stress work environment and burdensome regulations restricting time spent on direct patient care plague the substance abuse field.

What is at Stake

  • Addiction is a true health crisis, impacting the addicted individual, his or her family, workplace, and the entire community.
  • Costs – Alcohol and drug abuse costs $346 billion a year due to direct health care costs, lost productivity and other societal costs. (Source: National Institutes of Health)
  • Crime – According to the Center for Substance Abuse Treatment, 1.2 million correctional inmates are addicts.
  • The Treatment Gap - SAMHSA’s 2002 National Household Survey on Drug Abuse found that only 18.2 percent of Americans over the age of 12 who needed substance abuse treatment received treatment.
  • Treatment Works – A Senate committee report concluded: “Studies have shown that substance abuse treatment is effective at reducing primary drug use by nearly 50%, criminal activity by 80%, and alcohol- and drug-related medical visits by 50% while increasing individual financial self-sufficiency.”

Possible Solutions

Millions of addicted individuals will continue to suffer if the decline in the numbers of available qualified substance abuse treatment staff is not addressed. Health reform should include the substance abuse counselor shortage as any other primary health workforce shortage remedies.

TCA believes the substance abuse treatment community would benefit from an array of incentive programs to recruit and retain counselors and other staff trained specifically in alcohol and drug abuse. These programs include:

  • Career ladders for advancement within the field
  • Loan repayments
  • Scholarships and other collaborative efforts with the education community
  • Public service announcements and utilization of other marketing tools
  • Mentoring programs
  • Training of other caregivers specifically in evidence-based substance abuse treatment
  • Apprenticeship programs

TCA Recommends

  • Inclusion of specific substance abuse counselor training funds within HHS that are responsive to the needs of the substance abuse community. Secure funding and leadership for career development activities for substance abuse workforce shortages.
  • Assessment of present opportunities within federal agencies and State grant programs to dedicate specific federal funds for loan guarantees and other programs.
  • Development of demonstration projects within the Department of Labor and/or the Veterans Administration to develop training institutes and career ladder opportunities for veterans and service corps members to become qualified addiction counselors and other innovative demonstrations to stimulate and sustain pipeline career development opportunities for new youth populations to be recruited and trained as counselors.
  • Introduction of legislation specifically addressing the substance abuse treatment workforce issue including a grant program to state governments and the territories to develop and implement specific remedies.