As the holidays approach, I have been reflecting on how we can improve not only the practices of the Addiction Treatment industry, but also the public perception of it. On a daily basis, I hear the addiction treatment centers complaining about not being taken seriously. They complain when their insurance claims are denied and when insurance companies cut or limit Addiction Treatment from their policies. They want to be on equal footing with the real medical institutions yelling “Addiction is a disease!” and citing the Parity Act of ’08. Similarly, the sober homes complain that any attempt to regulate them is a violation of the ADA and Fair Housing Act.
The irony is that in the Addiction Treatment world, the standards of professionalism are lower than any other field. First of all, ANYONE can own a Treatment Center. There are no requirements other than having the money to invest. Even convicted Felon’s are not precluded from opening a Treatment Center- although they frequently put it in someone else’s name. When this happens we see that old Sicilian proverb in action – “Pesci fet d’a testa” (in English, “The fish stinks from the head.”) The meaning is that corruption or shadiness works its way down from the top seeping into the fabric of an organization. As stated by Carey Davidson, “There are those in this industry who capitalize on the vulnerability in an unethical manner. It is essential that families are able to place their trust in capable, educated, and accountable specialists. However, because the behavioral health field is so vast, multi-faceted, and unregulated, it’s difficult to know where to begin.” (An Ethical Compass: Navigating the Maze of Addiction Treatment, 10/31/16).
I want to preface this by saying there are many good, reputable treatment centers but I urge all families to do your due diligence when selecting a treatment center for your loved one. Do not be afraid to ask questions.
The vast majority of treatment centers do not require a college degree for hiring employees. The clinical staff for the most part
is made up of people who are not qualified and would never be hired in a true medical setting. At least one person at the center must hold a license of some type (LMHC, LCSW, etc.) in order
for the facility to be properly licensed. All treatment centers must have a medical director, who is usually a licensed M.D. or D.O. In many cases, that Medical Director is on staff for various treatment facilities and at most, stops by the facility to do rounds and sign off on patients chart once a week.
The majority of the day to day clinical staff however, is made up
of people with no qualifying education or experience. Many of them are members of a 12-step program themselves who feel that working in the recovery field is somehow their “calling” or they
are taking their own recovery to the next level. While their hearts may be in the right place, it is naïve to believe that just having their own personal experience in recovery in and of itself makes them qualified to work in a professional setting. This may upset some people working in the field or attempting to do so – but it is the truth. There is no substitute for formal education and training and this is in large part the reason why the Addiction Treatment field is not given the same respect and credibility as other medical institutions.
Being a graduate of the “School of Hard Knox” just does not cut it on a professional level. We are dealing with people lives here, not selling cars. We now have “Consultants, patient brokers, marketers, treatment placement specialists, and other creative professions surged, often, without formal training for those espousing these titles. While these workers are called different names, they serve the same function: to put “heads in beds.” They are people who, through one method or another receive kickbacks for getting a patient into a particular facility. These so-called professionals make their money directly by placing someone into a specific treatment program who pays them a ‘bounty’, a ‘marketing fee,’ or ‘reward’ for ‘placing’ the person with them. ‘Patient Brokers, ‘in effect, broker lives for cash.” (Carey Davidson, An Ethical Compass: Navigating the Maze of Addiction Treatment, 10/31/16)
Why do these Treatment facilities hire such unqualified employees to “treat” patients who suffer from a disease? Some facilities are of the opinion that only people who have personally experienced Addiction are in a position to help those who suffer from them. This is a myth which has been repeatedly debunked. When someone you love has Cancer, do you insist on sending them to a doctor who has had Cancer themselves? So, the same people who insist that Addiction be viewed in the same light as any other disease now want to make exceptions when it comes to the treating professionals. The real truth though is that it comes down to the bottom line for some centers. It is definitely cheaper to hire unqualified people.
Let me ask you, in what other professional field is it ok to hire people who do not even hold a bachelor’s degree? To work in any other medical setting, this is a minimum requirement in addition to other various degrees and training. This includes nurses, who must be licensed, radiologists, medical technicians, etc. “One key difference between a trained professional and a layperson is that a layperson works solely from personal experience and a professional works from an empirically-evidenced theory.” (C. Davidson, 10/31/16)
What are the requirements to be hired as a Mental Health Tech at an Addiction Treatment Center? Some centers require 6 months of personal sobriety and some are 1 year. And these are the people who are charged with caring for your loved ones who are patients, 24 hours a day 7 days a week. Many Treatment Centers spend major and extravagant amounts of dollars on marketing – TV commercials, street signs, website optimization, etc. If they cut some of the enormous spending on such marketing campaigns and instead put that money into paying for clinical staff that are qualified and competent, we may not be in the position we are presently in.
In the State of Florida, there is a definition for “Qualified Professional” under Sec. 397.311. It reads: A “Qualified Professional” “means a physician or a physician assistant licensed under chapter 458 or chapter 459; a professional licensed under chapter 490 or chapter 491; an advance registered nurse practitioner having a specialty in psychiatry licensed under part I of chapter 464; or a person who is certified through a department-recognized certification process for substance abuse treatment services by a state-recognized certification process in another state at the time of employment with a licensed substance abuse provider in this state may perform the functions of a qualified professional as defined in this chapter but must meet certification requirements contained in this subsection no later than 1 year after his or her date of employment.”
So, as you can see, the State Legislature has been quite specific about who is considered an Addiction Professional. Yet many people employed by these centers are NOT Addiction Professionals. Also, let me give a bit of clarity to the state-recognized certification process mentioned above as a Qualified Addiction Professional.
There are only three certifications recognized as Professionals in the State of Florida: A CAP (Certified Addictions Professional), A CCJAP (Certified Criminal Justice Addictions Professional) and CMHP (Certified Mental Health Professional). All three of these certifications require a minimum of a Bachelor’s Degree in a related field in addition to approximately 6000 ours of in the field training (300 of which must be supervised). There are other requirements such as domestic violence and HIV training as well as a written exam which must be passed. There are other intermediate certifications that can be obtained by people who have not met all these requirements such as the (CAC, CCJAC, CAS, CCJAS). These are NOT Qualified Addiction Professionals under the law – and people should be aware of that. If someone were falsely holding themselves out as a Doctor or an Attorney or a Police Officer they would be arrested and prosecuted for a Felony- no questions asked. Yet people are holding themselves out as Addiction Professionals who are not, and this is acceptable?
Then we have people in the field who are calling themselves
“Interventionists” or “Case Managers”. While a Treatment Center can give a title such as Case Manager to an employee, in reality they are licensable components under Chapter 65D-30 of the Florida Rules (DCF). Case Management is actually a subcomponent of General Intervention. The definition of Case Management is: “A process which is used by a provider to ensure that clients receive services appropriate to their needs and includes linking clients to services and monitoring the delivery and effectiveness of those services”. Intervention “includes activities and strategies that are used to prevent or impede the development or progression of substance abuse problems.” The fact that these are licensable by DCF means that people who are doing so without a license, are doing so illegally and committing a crime in the process.
It has become more and more prevalent for people in the community who are working in the capacity of marketers or brokers to hold themselves out as “Interventionists” without the necessary licensure or credentials. My intent is not to discredit the challenging and indispensable work of interventionist (or anyone else working in the field). After all, I am one. However, it is crucial to know that there are individuals without any formal behavioral health education, certification, license or clinical training who claim to be “interventionists” or “addiction specialists” that “work” in the addiction field. This is dangerous. “Just because a person has been through recovery and/or has watched every season of Intervention on A&E, it does mean they are qualified to be an Interventionist. This is as reckless as watching Grey’s Anatomy, buying an ambulance, and calling oneself an EMT.” (C Davidson, 10/31/16)
The above mentioned are all major concerns, and issues which are presently being addressed by the Task Force which I serve on, and eventually by the State Legislature. Certification and Accreditation has extended to Sober Homes and Legislation is now pending on that front. There needs to be more oversight into the day to day practices of both Treatment Centers and Sober Homes and this is something we are currently working hard on.
In addition, all the additional enforcement and regulation will require funding. DCF is stretched very thin and can only do so much. The tax payers are not going to be enthusiastic about footing the bill
-which is why most of it may fall upon the Treatment Centers (which is something many reputable centers may be in favor of so proper policing of this industry is possible). The number of people dying from this disease has increased ten-fold in the last few years and its only getting worse. It’s time to demand accountability, stand up and take action.
Happy Holidays and New Year!
Mr. Schlam graduated from St. Thomas University School of Law in ’02. He is a Certified Addictions Professional (CAP) and Criminal Justice Addiction Professional (CCJAP). Mr. Schlam is the founder and CEO of Advocare Solutions, Inc., which was the first agency in South Florida specifically licensed for Case Management and General Intervention. Mr. Schlam also serves on the 15th Judicial Circuit Sober Homes Task Force as well as the Mental Health task force. For more info on Myles B. Schlam, go to www.drugtreatmentpro.com