Why Addiction Training is Essential for All Mental Health Professionals

All mental health professionals will work with addiction in one form or another, so they need to be able to recognise and respond to addiction effectively.

Related article: Assessing and Treating Substance Abuse.

Introduction

There has been a longstanding belief that a separation exists between mental health professionals and addictions professionals. This belief purports that some clinicians deal with mental health issues while others address substance use concerns: that these two areas of clinical practice are mutually exclusive. It is time for this false dichotomy to end. Regardless of setting, if you are in the mental health field, you will work with addiction. You will see clients who are in active addiction, in long-term recovery, in relationship with someone with addiction, or living in a home with active addiction. So, as clinicians, the question we should be asking is, are we prepared to recognise and respond to addiction effectively?

Addiction does not discriminate and can affect individuals across demographic categories and over the course of the lifespan. Whether you work in a community agency, school, college/university, hospital, faith-based organisation, or private practice, it is imperative that you can assess for and respond effectively to clients who use drugs of abuse and/or engage in addictive behaviours. In this article, we explore some of the contexts where mental health professionals may encounter addiction.

Play Therapists and Clinicians Who Work with Children/Youth

Play therapists and those practitioners who work with children/youth likely will encounter clients who live in homes with active addiction. Parental substance use can be traumatic for a child. It could be a condition influencing child removal to out-of-home-care, it may be a factor involved in child maltreatment, and it is considered an Adverse Childhood Experience (ACE). Additionally, a sibling’s substance use can have a major impact on the client and their entire family system. It is imperative that practitioners who work with children are trained in addiction so as to accurately conceptualise their clients’ experience. Furthermore, there is a robust relationship between early trauma and adult addiction. Thus, as play therapists and clinicians who work with children/youth address trauma among their clients and foster posttraumatic growth, they are doing preventative work against future addictive behaviours.  

School Mental Health Professionals

School counsellors and practitioners who work in schools are in prime positions to recognise and intervene with students’ substance use and addictive behaviours early. Many addictive behaviours begin in adolescence (e.g., drinking, vaping, cannabis use, disordered gaming, digital media addiction, pornography misuse, or nonprescription stimulant misuse). School counsellors must be trained in addiction so they can engage in both prevention efforts (e.g., school-wide campaigns, large group guidance, classroom lessons) and effective early intervention strategies with regard to students’ addictive behaviours. School practitioners can employ empirically supported interventions like SBIRT (Screening, Brief Intervention, and Referral to Treatment) and motivational enhancement interventions to connect students who have initiated substance use to effective community resources.

College Mental Health Professionals

Colleges and universities are considered “abstinence-hostile environments” in light of the social norms promoting experimentation, partying, and substance use. Moreover, the availability and access to drugs of abuse in collegiate settings (e.g., number of bars per square mile) contributes to the high prevalence rates of addictive behaviours among this population. Counsellors and mental health professionals who work in college settings must be familiar with the intoxication and withdrawal symptoms of various drugs of abuse to distinguish between substance-induced symptomology and symptoms of mental health concerns among their clients. Additionally, college counsellors trained in addiction can contribute to the development of effective prevention programming on their campuses and support collegiate recovery programs.

Community Mental Health Professionals

Counsellors and therapists who work in the community must also be prepared to assess addictive behaviours among all clients. In light of the stigma associated with substance use and behavioural addictions, individuals with these issues may seek clinical services for other, seemingly “safer”, presenting concerns, like marital conflict, depression, anxiety, family issues, or occupational struggles. If clinicians fail to recognise addiction, they may not see treatment gains in their work with these clients as they address only the symptoms, rather than the root cause of the distress. Additionally, substance use is greater among those with mental health concerns. This means that clients who come to counselling for mental health-related issues (e.g., depression, anxiety, PTSD, disordered eating) are at higher risk of using substances than those without mental health concerns. Providing integrated treatment (where both the mental health concern and addictive behaviours are addressed simultaneously) is the gold standard for treating co-occurring disorders.

Conclusion

Clients in active addiction, in long-term recovery, living with someone with addiction, or in a relationship with someone with addiction, need mental health professionals who are knowledgeable and trained in addictive behaviours. They need advocates who are familiar with the aetiology, neuroscience, progression, and effects of addiction. They need practitioners who know about relapse prevention, levels of addiction treatment, effective clinical strategies for addiction (e.g., motivational interviewing, SBIRT, CRAFT), and peer support groups. Let’s make it our personal responsibility to become trained in addiction (and stay up to date on new research and practice approaches) so we can provide effective, empathetic care to clients with addiction, wherever they present for services.   

Key Takeaways

• All mental health professionals, regardless of setting, need to be prepared to recognise and respond effectively to clients’ substance use and addictive behaviours.
• Play therapists and child counsellors likely will encounter clients who live in a home with active addiction and must be prepared to support the child and family system.
• Given that many addictive behaviours begin in adolescence, school counsellors and mental health practitioners in schools are in prime position to intervene early with students who initiate substance use and connect them with helpful community resources.
• Colleges and university settings are called “abstinence-hostile environments” and practitioners on college campuses must be prepared to assess substance use and behavioural addictions with all clients as well as differentiate between substance-induced symptoms and symptoms of mental health concerns.
• Given the prevalence of co-occurring disorders, community mental health professionals must be prepared to treat both mental health issues and addiction simultaneously to provide integrated care.

References

• American College Health Association. (2023). American College Health Association-National College Health Assessment III: Reference group executive summary spring 2023. American College Health Association.
• Burke Harris, N. (2018). The deepest well: Healing the long-term effects of childhood adversity. Bluebird.
• Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258. https://doi.org/10.1016/s0749-3797(98)00017-8
• Giordano, A. L., Morey, A. W., Kim, I. K., Song, J., & Kim, O. (2023). School counselors’ experiences with student vaping and internet gaming: A report from the field. International Journal for the Advancement of Counselling, 45, 441-457
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• National Center on Substance Abuse and Child Welfare (2023). Prevalence of parental alcohol or drug abuse as a condition associated with removal. https://ncsacw.acf.hhs.gov/research/child-welfare-statistics/interactive-statistics-series/1-2-prevalence-aod-removal/
• Substance Abuse and Mental Health Services Administration. (2013). Systems-level implementation of Screening, Brief Intervention, and Referral to Treatment. Technical Assistance Publication (TAP) Series 33. HHS Publication No. (SMA) 13-4741. Substance Abuse and Mental Health Services Administration.
• Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders. Treatment Improvement Protocol (TIP) Series, No. 42. SAMHSA Publication No. PEP20-02-01-004. Substance Abuse and Mental Health Services Administration.
• Substance Abuse and Mental Health Services Administration. (2023). Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.