Addiction Medicine: Closing the Gap between Science and Practice

Detoxification Specialists (ADS) and has its
own set of training guidelines.* 121

Addiction Counselors.................................................................................................

Addiction counselors, also known as Substance
Abuse Counselors (SACs), Credentialed
Alcoholism and Substance Abuse Counselors
(CASACs) or Alcohol and Drug Counselors
(ADCs), make up the largest share of full-time
addiction treatment provider staff in facilities
providing addiction treatment in the United
States.^122

Addiction counselors can be licensed, certified
or both.^123 CASA Columbia’s review found that
37 states require addiction counselors either to
be licensed or certified, although even these
states may provide important exemptions.†

The review also found that to become a licensed
addiction counselor in a given state, generally
one must meet the state’s minimum education
and training requirements and pass a designated
exam. There is no one national licensing exam
used to measure competencies.^124 The state
education qualifications for licensure vary
greatly.‡ 125 According to CASA Columbia’s
review, more than half of states that offer
licensing require a master’s degree for the

• The NADA training guidelines include 30 hours of

didactic classroom training (e.g., history of the
profession; the NADA protocol which defines the
five points where needles are to be applied;
techniques; clean needle; integration with larger
treatment program; ethics) and 40 hours of hands-on
clinical work (content not specified), supervised by a
licensed acupuncturist.
† Such as supervised students engaged in practicum,

licensed health care professionals (e.g., MDs, RNs,
psychologists) working within their scope of
profession, religious leaders working within the
scope of their ministerial duties, government
employees working within the scope of their
employment, and short-term services provided by
non-residents who are certified in another state.
‡ There are several tiers of addiction counselors--such

as Certified Alcohol and Drug Abuse Counselor
(CADAC) or Substance Abuse Counselor (SAC)--
each with its own proficiency requirements (based on
education and experience). The highest level usually
requires a master’s or doctorate degree.

highest level of licensure, although several states

offer the highest level of licensure to individuals

who only have a bachelor, associate or high

school degree. A 1998 survey similarly found

that 56 percent of licensed addiction counselors

have at least a master’s degree.^126

A variety of state boards and non-governmental

organizations are designated with responsibility

for certifying addiction counselors.^127 Similar to

the licensure process, certification recognizes

that addiction counselors have met what the

organization deems to be minimum standards of

education and clinical experience.^128 In some

states addiction counselors must be certified

while in other states certification is voluntary.^129

Some state certification boards defer to

standards established by professional

membership or credentialing organizations, such

as the International Certification and Reciprocity

Consortium (IC&RC) or NAADAC, the

Association for Addiction Professionals,§ 130

which do not stipulate a particular required

degree for the entry level certification.^131

The IC&RC establishes minimum education and

training standards for the credentialing of

addiction counselors--each state certification

board that is a member of the IC&RC

consortium either may follow the minimum

standards or impose higher standards.^132 The

focus of the minimum requirements for the

IC&RC Alcohol and Drug Counselor (ADC)

certification is more on clinical work experience

than on classroom-based education:

requirements include 270 hours of education in

the eight domains of addiction counseling,** 300

hours of supervised practical experience in the

eight domains, 6,000 hours of supervised

§ The National Association for Alcoholism and Drug

Abuse Counselors (NAADAC) changed its name in

2001 to NAADAC, the Association for Addiction

Professionals to reflect the increasing number of

addiction professionals who address forms of

addiction involving behaviors other than substance

use, such as gambling.

** The eight domains include: clinical evaluation;

treatment planning; referral; service coordination;

counseling; client, family and community education;

documentation; and professional and ethical

responsibilities.