Addiction Medicine: Closing the Gap between Science and Practice

professional work experience specific to the
eight domains and successful completion of a
written examination.^133

NAADAC, the Association for Addiction
Professionals offers three levels of certification
for addiction professionals based on experience
and education.^134 Like the IC&RC requirements
for the National Certified Addiction Counselor,
Level I (NCAC I), the focus primarily is on
clinical work experience rather than on
classroom-based education. Requirements
include: (1) a current state certificate or license
as an addiction counselor; (2) 270 contact hours
of addiction counseling training; (3) three years
of full-time work experience or 6,000 hours of
supervised experience as an addiction counselor;
and (4) successful completion of a written
examination.^135

These certification requirements reflect a great
reliance on apprenticeships as the training model
for addiction counselors.^136

CASA Columbia’s state-by-state analysis of
regulations and statutes found that 14 states do
not require addiction counselors in all settings to
be licensed or certified.* Six states do not
mandate any degree to become credentialed as
an addiction counselor;† in 14 states, an
individual may become licensed or certified as
an addiction counselor with the minimum
education requirement of a high school diploma
or a GED; an associate’s degree is required in 10

• In AR, counselors who are not licensed or certified

must register with the state; CT, FL and NY do not
require supervised staff and MA does not require
staff in licensed facilities to be licensed or certified;
ID, MS, OR, and SD require licensing or certification
of counselors only in certain facilities (e.g., licensed
facilities or those that receive public funds); HI
insurance law requires clinical licensure and
certification to qualify for reimbursement; in MO,
staff who are not licensed or certified have a limited
scope of practice; in WV, only counselors in opioid
treatment facilities must be certified or licensed; and
AK and NH do not appear to require counselors to be
licensed or certified.
† In states where no degree is required, certification

requirements typically include 270 hours of
education in addiction counseling.

states, a bachelor’s degree is required in six

states and a master’s degree is the minimum

requirement in only one state.‡

CASA Columbia’s survey of New York State

addiction treatment staff providers found that

35.0 percent had a graduate degree, 27.7 percent

had a bachelor’s degree, 29.9 percent had some

college or an associate’s degree and 6.6 percent

had only a high school or GED degree.^137

In spite of the limited education and training

requirements and the apprenticeship model of

training, the essential practice dimensions of

addiction counseling are defined as including

clinical evaluation; treatment planning; referral;

service coordination; and individual, group,

family and couples counseling^138 --practices that

would seem to require far more extensive and

structured clinical training than the field of

addiction counseling requires.

Licensure, Certification and

Accreditation Requirements for

Addiction Treatment Programs and

Facilities

Just as licensing and certification requirements

are insufficient to assure that those providing

addiction treatment have the knowledge and

skills to do so, government and professional

oversight of addiction treatment facilities and

programs is insufficient to insure that patients

receive clinically-indicated, quality care.

Regulatory oversight of health care facilities

may include state licensure, certification§ and/or

accreditation by a national accrediting

organization. Licensing and certification

standards may include:

‡ CASA Columbia reviewed the minimum education

requirements for certification/ licensure in each state.

In many states, counselors who meet only the

minimum education requirements must be

supervised.

§ In the case of opioid maintenance therapy.