Is “Time in Recovery” the Right Measure to Work in the Addiction Treatment and Recovery Field?
By Kevin Doyle, EdD
NOTE: This was originally published for the Hazelden Betty Ford Foundation’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.
I’ve been thinking recently about how much recovery time is needed for individuals with an addiction history to work in the substance use treatment and recovery field. Longstanding policies, and, in some cases, actual laws have prohibited people in recovery from working as treatment professionals or clinicians for varying periods of time, often in multiples of years, with the requirement of having one or two years of uninterrupted recovery seeming to be most common.
These rules, in my view, are problematic, in that they are inflexible, equate recovery solely with the amount of time since the last use of a substance, apply only to substance use disorder diagnoses, and are not generally based on research. Additionally, they perpetuate the stigma that people in recovery from substance use disorders continue to face on a daily basis. Significantly, there do not seem to be any such requirements for people recovering from other mental health disorders, such as depression or bipolar disorder. Instead, job applicants with mental health disorders are generally evaluated on a case-by-case basis to determine if they can do the work required.
One potential solution or compromise on this matter would be for individuals in early recovery who want to work in a treatment or recovery job to participate in a structured monitoring program for healthcare professionals, such as those already available in nearly every state. Sometimes, monitoring programs are organized by profession or discipline (medicine, nursing), while other times they are multidisciplinary in nature. Consisting of elements such as formal treatment, ongoing individual and/or group counseling, random drug testing, workplace oversight, and case management, these programs are highly successful in supporting healthcare professionals in the return-to-work process (with a solid research base showing 80% and higher success rates), although they have the limitations, such as cost and stigmatization, as well. Monitoring contracts or agreements are often in place for as long as five years to provide the support needed for individuals in recovery to be successful both at work and in recovery.
One irony is that a medical doctor could conceivably be back to active practice, performing highly sensitive surgeries, in as little as four to six months after initiating treatment/recovery, while a substance use counselor or clinician might not be permitted to practice for as long as two years from the last prior use of a substance. Something seems wrong with that picture, acknowledging that the relationship with a counselor is structurally different from that with a surgeon.
Additional issues with length-in-recovery requirements include the challenges of so-called medication-assisted approaches. (I actually prefer the phrase “medications for addiction treatment,” as the word “assisted’ seems to perpetuate stigma and is not used for treatment and recovery of other mental health disorders). Medications such as methadone and suboxone, for example, are common, legitimate pathways to recovery, but are viewed by some as “replacing one addiction with another.” Automatically prohibiting anyone on one of these protocols from working, as sometimes occurs, is inherently stigmatizing and wrong.
Likewise, solely measuring recovery time treats any return to use the same, when in reality each “relapse” (a word we don’t really use anymore either) or reoccurrence should be evaluated and assessed on its own characteristics. Sometimes a return to use necessitates a referral to residential treatment. In other cases, what self-help groups sometimes refer to as a “slip” can be addressed in other, less intrusive ways, particularly if the individual comes forward immediately and discloses what has happened. It is important to incentivize the behavior we wish to see, which would be for an individual to disclose what has occurred and address it in the same manner we would if he or she had a flare-up of another mental health condition.
Finally, the rise of the peer recovery movement further illustrates that regulations should be re-evaluated. Peer recovery specialists are a growing part of the treatment and recovery workforce and have an important, non-clinical niche in the continuum, providing direct, community-based support to others in recovery after completing relevant training — while also supporting their own recovery in the mutual-help tradition. Mandating them to have rigid, aspirational recovery requirements may be well-meaning, but not essential.
Antiquated, inflexible, one-size-fits-all requirements have no place in an industry that is desperate for a strong and committed workforce and has been challenged to individualize treatment to the needs of the patient or client. Finding ways to welcome and support those in early recovery without jeopardizing patient or client safety — such as requiring a thorough, multidisciplinary assessment — would help the behavioral health field confront current workforce challenges and evolve with the times.
Kevin Doyle Ed.D., is the president and CEO of the Hazelden Betty Ford Graduate School of Addiction Studies in Center City, Minn.
