A long wait for help: Addiction counselor shortage lengthens wait for treatmentFARGO - Ask Kenny Lamb how long he and his wife waited for substance abuse treatment, and he’ll quickly give an exact answer: “33 days.”
By: Archie Ingersoll, INFORUM
FARGO - Kenny and Jennifer Lamb lost custody of their four children in 2012 after police caught the couple with meth paraphernalia and ill-gotten prescription pills. To get their kids back, the Lambs needed to get clean.
Ask Kenny Lamb how long he and his wife waited for substance abuse treatment, and he’ll quickly give an exact answer: “33 days.”
For the couple, that time was a bleak one. Not only had they lost their children, but also their home.
“You don’t get hope when you’re losing everything,” the 34-year-old father said. “Somebody who’s addicted, all they can think about is using at that point.”
As the Lambs waited, they found support from a church and weathered those 33 days. They eventually received treatment from addiction counselors at the state-run Southeast Human Service Center in Fargo and regained custody of their children, ages 5 to 14.
“There’s not really a lot of married couples that go through treatment the way we did, but it really made us stronger and brought us closer together,” said Jennifer Lamb, 40.
The couple’s ending was happy, but their wait for treatment reveals a real-life consequence of the shortage of addiction counselors in North Dakota – a need created by an aging workforce and a rising demand for treatment.
Health officials say the situation is straightforward: If North Dakota had more counselors, waiting lists for treatment programs would be shorter, and addicts who’ve made the crucial decision to seek a sober path would be helped before they can change their minds.
“Sometimes people’s desire is very strong one day, and they want to get in, and they want to get services, but their waiting list is a month,” said Christy Anderson, past president of the North Dakota Addiction Counselors Association. “Well, then by the time the appointment comes along, they might not have that same desire anymore, you know. They might be on a bender.”
One reason for the shortage is a wave of retirements. “Basically, two-thirds of our counselors are 50 years or older,” said Kristie Spooner, president of the North Dakota Board of Addiction Counseling Examiners.
Attracting new counselors is tricky. Spooner said many people aren’t aware that addiction counseling is a career option.
“I really would like to figure out a way to get people to understand what a rewarding career this is and look at this as a possibility,” said Spooner, who noted she was not speaking on behalf of the state board.
While addiction counseling can be a satisfying career, it also can be a stressful one. And with a shortage of counselors, caseloads are greater for those who are working and so is the chance for burnout, Anderson said.
Plus, the pay is not exceptionally high. In 2012, a survey showed that annual salaries for counselors in Fargo ranged from $41,000 to $51,000, said Connie Stevens, director of clinical services at ShareHouse, a nonprofit treatment center in the city.
Regardless of the downsides, counselors have the upper hand in the job market these days. “I have to be pretty aggressive as an employer to catch those coming out of training,” said Kurt Snyder, executive director of the Heartview Foundation in Bismarck. “It’s just a very competitive market right now.”
The growing need for addiction counselors is not isolated to North Dakota. A study by the Education Advisory Board, a consulting firm based in Washington, D.C., shows the number of postings for jobs that involve counseling and addiction treatment in Montana and the Dakotas spiked 194 percent between the first half of 2010 and that of 2013. The same study counted 24 such job postings in Fargo between October 2012 and September 2013.
According to the U.S. Department of Labor, nationwide there were 89,600 jobs for substance abuse and behavioral disorder counselors in 2012. That figure is expected to increase 31 percent by 2022, while the average growth rate for all jobs is forecast at 11 percent.
There are many pathways to sobriety, but addiction counselors are the only professionals specifically trained to treat substance abuse problems. North Dakota has about 350 licensed counselors, Spooner said.
It’s not exactly clear how many more counselors the state needs, but one gauge is the Department of Human Services, North Dakota’s largest employer of addiction counselors.
Alex Schweitzer, the department’s director of field services, said the state has budgeted for 87 addiction counselor positions, but only 76 are filled. He said having 11 open positions is not a crisis situation, but in response to the shortage, the department is considering using federal grants to contract with private treatment providers until the state can find more counselors.
Schweitzer said his department, which runs treatment centers around the state, tries hard to limit wait times for addicts who want treatment. Still, the average wait time more than doubled for adults last year, jumping from 11.8 days in January to 28 days in October. During the same time, the average wait for adolescents went from 5.6 days to nine days.
State treatment centers, which are open to all comers, give priority to pregnant women and addicts who inject drugs. In those cases, the goal is to have them start treatment within 48 hours, said Brad Brown, director of addiction services at the state treatment centers in Fargo and Jamestown.
With the rush for oil fueling population growth in western North Dakota, state treatment centers, particularly those in Williston and Minot, have faced an increasing demand for addiction counseling in the past couple of years, Schweitzer said.
“We’re seeing a lot more IV users. We’re seeing people that are abusing opiates,” he said, adding that alcohol abuse continues to be the No. 1 problem.
Snyder said much of the state’s population growth has been among younger people, a group more prone to addiction. He said half of the addicts his organization treats are 25 or younger.
The Affordable Care Act, which requires coverage for substance abuse treatment and allows people to stay on their parents’ health insurance until they are 26, has also influenced the number of patients seeking addiction counseling, Snyder said.
Training without pay
To become a licensed addiction counselor in North Dakota, you have to earn a bachelor’s degree, pass two written tests and train for 1,400 hours. That training usually takes the form of an unpaid internship that lasts nine months. Snyder said the lack of pay during training often creates a roadblock for people interested in the field.
Stevens said a challenge she faces when hiring counselors to work at ShareHouse is the lack of reciprocity between North Dakota and Minnesota when it comes to licensing. Minnesota only requires counselors to receive 880 hours of training; a counselor looking to take a job in North Dakota has to meet the state’s requirement of 1,400 hours.
To make the switch easier, North Dakota credits out-of-state counselors with 150 hours for each year worked, up to 900 hours. Spooner pointed out that other states have more stringent requirements. In Wisconsin, for instance, counselors need 4,000 hours of experience.
North Dakota could shorten its training period, but not everyone believes that’s the best route.
“To lower the requirements lowers the ability for us to treat a very difficult, complicated illness, and I don’t know that that’s the answer,” Snyder said.
Readers can reach Forum reporter Archie Ingersoll at (701) 451-5734