STATE OF WEST VIRGINIA





SUNRISE REPORT

ON THE

LICENSING OF ADDICTION COUNSELORS





Separate Licensing Board for Addiction Counselors not Recommended



OFFICE OF LEGISLATIVE AUDITOR

Performance Evaluation and Research Division

Building 1, Room W-314

State Capitol Complex

CHARLESTON, WEST VIRGINIA 25305

(304) 347-4890



July 1999



INTRODUCTION

The West Virginia Association of Alcoholism and Drug Abuse Counselors (WVAADC) has submitted an application proposing licensure of addiction counselors. The applicant is presently the only association for addiction counselors in the state. Its membership is approximately 190.



The statute allows an applicant to propose either licensure or certification to regulate a profession. Licensure protects an occupation by making it illegal for anyone to engage in an occupation without a license. Certification establishes a title of certain expertise that can only be used by those who have met the qualifications of the certification process. However, certification does not prevent uncertified individuals from engaging in the occupation.



The Performance Evaluation and Research Division of the Legislative Auditor's Office is required under WVC 30-1A-3 to analyze and evaluate the application of professional and occupational groups who seek to be regulated. The analysis must be submitted to the Joint Standing Committee on Government Organization no later than the first day of July following the date the proposal is submitted to the Committee.



The report required by WVC 30-1A-3 shall include evaluation and analysis as to:



Whether the unregulated practice of the occupation or profession clearly harms or endangers the health, safety or welfare of the public, and whether the potential for harm is easily recognizable and not remote or dependant upon tenuous argument;



Whether the public needs, and can reasonably be expected to benefit from, an assurance of initial and continuing professional or occupational competence; and



Whether the public can be adequately protected by other means in a more cost-effective manner.



Background



Addiction counselors are professionals who have specific training in counseling individuals that are chemically dependent. These professionals have received addiction training by voluntarily becoming certified by the West Virginia Certification Board of Addiction and Prevention Professionals (WVCBAPP). The certification process involves training and testing that demonstrate an individual's competency in the special knowledge of addiction counseling. According to the applicant, this certification process is recognized as the standard by which substance abuse professionals are measured.



The applicant recently surveyed its members for the purpose of this report. The education level of its members vary from high school diploma to doctorate level (See Table 1). The applicant indicates in its application that there is a trend that places a premium on individuals having the highest level of licensure. After surveying its membership, the WVAADC recommended that 95 individuals or half of its membership upgrade their education in some manner.



Table 1

Level of Education of Certified Addiction Counselors in the State

Education

Number of Certified Addiction Counselors

MA in Counseling or related field 79
Masters in Social Work (MSW) 31
MA in Psychology 9
MS in Nursing 1
MS or MA not counseling related 10
PhD in related field 8
Medical Doctor (MD) 1
Registered Nurse (RN) 1
BS, BA or Bd. of Regents Bachelors 36
High School Diploma or Associates Degree 13
Unknown 1

TOTAL

190





There are currently no masters degree programs specializing in addiction counseling in the state. Marshall University Graduate College is the only institution with a plan to offer a master's degree in counseling with a specialization in addictions. West Virginia University also offers graduate programs in counseling, but does not have specializations in addictions. West Virginia State College and some other state colleges offer some undergraduate course work in addictions. Therefore, the availability of specialized education at the Masters level in the field of addictions counseling in this state is virtually non-existent.



Currently, approximately 75% of certified addiction counselors (CAC) are also under licensure by one of the West Virginia boards for counselors, social workers, psychologists or other related professions (see Table 2). Half the number of CAC's (95) have obtained the highest licensing level. Of the remaining 25%, or 48 CAC's that are not licensed, 21 have a masters degree, and 27 have education below a masters degree.



Table 2

Breakdown of Licensure of Addiction Counselors already in West Virginia

License Type

Number Within Classification

Licensed Professional Counselor (LPC) 56
Licensed Certified Social Worker (LCSW) 13
Licensed Independent Clinical Social Worker (LICSW) 16
Licensed Psychologist - Masters 3
Licensed Psychologist - Doctoral 4
MD 1
RN 2

Subtotal

95
This subtotal represents those who have the highest level of licensure to match a masters degree or above. These individuals do not need further licensure at this time.
Licensed Graduate Social Worker (LGSW) 6
LSW with a Masters Degree 12

Subtotal

18
This subtotal reflects those who may practice in some HMO networks but have not reached the highest level of licensure.

Total

113

This total is the maximum number who may currently practice independently under HMO rules.
Temporary Social Worker (TSW) with a Masters Degree 7
Non MA with LCSW, LSW, or TSW 20
Non MA with LPC 1
No license with MA 21
No license non-MA 27
Unknown 1

Subtotal

77
This subtotal does not meet criteria to practice independently under HMO rules.

TOTAL

190



Those professionals who are certified but not licensed do not practice at the independent level. These individuals are working in supervised settings within structured organizations such as hospitals or behavioral health centers. It is not known why these individuals do not become licensed. Some obviously must upgrade their education. For example, some may have masters degrees in fields unrelated to counseling or social work. These individuals would have to supplement their education to meet the qualifications for either of these boards. Others may qualify for licensure but choose not to become licensed for whatever reason.





The Applicant's Argument for Regulation



A major concern for the applicant is that:



Currently, anyone with a professional license in counseling, social work and psychology can claim that substance-abuse problems are within their scope of practice, even if they have not had any or minimal training and/or experience in the addictions area. Additionally, WVAADC is concerned about the increasing expansion of managed care in West Virginia, and the organization wants CACs to have as much credibility as possible to continue to practice their profession.(1)





The application also asks the question "Indicate how the public would be protected by regulation of this occupational group." The applicant answered:



Current legal remedies protect the public from being treated by individuals who have no training or demonstrated expertise in general behavior health treatment. However, there are no current mandates requiring licensed professionals to hold a specific certification in addictions. The public would be protected by having access to specific individuals who have clearly demonstrated competency by fulfilling certification requirements in addictions counseling....





Finally, the applicant indicates that:



Currently there are adequate numbers of CACs who are licensed primarily as Social Workers and/or Licensed Professional Counselors. However, as expenses increase for fees to be licensed as well as certified there is a growing concern that fewer people will opt for certification as a specialist in addictions, because licensure alone affords one the ability to practice with all populations.



Regulation by Other States



According to the National Association of Alcoholism and Drug Abuse Counselors, there are 11 states that have practice act licensure, three states with title act licensure and two states with mandatory certification. Practice act licensure is where an individual must be licensed to practice an occupation. Title act licensure is where an individual must be licensed if they wish to hold a certain title. Mandatory certification is fundamentally equivalent to licensure in that it sets a standard enforceable by the state.





Finding 1: Since the majority of current addiction counselors are already under state licensure, the Applicant's proposal for regulation weighs heavily towards providing an economic benefit to addiction counselors compared to providing additional protection to the public.





The primary intent of the Sunrise legislation is to ensure the protection of the public by determining the need to regulate a profession. The litmus tests in this process of evaluation is to determine the following:



1) Is the profession currently unregulated?



2) If the profession is unregulated, does the unregulated activity clearly endanger public health and safety?



3) If the profession is regulated, is there any concern that the public is still at risk?





Since 75% of addiction counselors are licensed, and the remaining 25% generally are under the supervision of individuals who are licensed, there is no current obvious harm to the public. The applicant has not provided documentation of abuses that have occurred due to the lack of regulation. Most of the applicant's argument is based on potential risks.



The applicant made the argument that anyone with a license in counseling, social work or psychology can practice addiction counseling with minimal training in the specialty area. This could lead potentially to fewer people pursuing certification if it is not perceived as necessary to practice addiction counseling. This argument is defeated in that the applicant has indicated that the certification process for addiction counseling is the nationally recognized standard, and that the expansion of managed care is moving towards requiring CAC's to have as much credibility as possible. This suggests that the certification title has value by itself and that its value is enhanced when combined with one of the available licenses. A person with only a license is not as credible as someone who also is a CAC. Therefore, it does not stand to reason that the state risks losing licensed CAC's.



The applicant also argues that licensure and certification provides the greatest protection to the public. This is true and it is the case for most of the practicing CAC's. The issue becomes more of a concern for CAC's that are unlicensed. These individuals should be encouraged to become licensed. However, to provide a provisional license under an existing licensing board for unlicensed CAC's so that they can be licensed while they attempt to meet the licensing qualifications gives no additional protection to the public until they actually become licensed. Furthermore, providing a provisional license is unfair to those who were not given such a provision, and it is an unnecessary administrative burden to impose on an existing board when unlicensed CAC's should be pursuing a license without the provision. Therefore, a provisional license is more of an economic benefit for unlicensed CAC's than it is providing additional public protection.



Establishing a separate licensing board for CAC's provides no added public protection for the same reason given above. However, it would restrict services for chemically dependent people to be provided primarily by professionals that are licensed and are CAC's. This is the applicant's goal as indicated in its application:



...CAC's are - or should be - the primary group of professionals in West Virginia who focus their practice and professional training in the addictions arena. Without their efforts and specialization, individuals suffering from the debilitation of alcoholism and/or drug dependency are left with professionals who spend minimal, if any, time learning about the intricacies of addictions. WVAADC believes that CAC's should be the primary practice group who is afforded the right to provide treatment in any setting where alcoholics, drug addicts or their families may benefit from their services.(2)



Given that there would be no additional public protection from a separate licensing board, and that certain professionals would benefit from becoming primary providers in addiction counseling, providing licensure specifically for addiction counselors does more for the economic well-being of the professionals than it provides additional safety to the public. Furthermore, with such small numbers that are not yet licensed, 25% or 48, it would be financially unfeasible that such a licensing board, if created, would be able to support itself. There is no guarantee that addictions counselors that are part of the 75% that are licensed under other boards would be willing to switch licensure boards.





Finding 2: It is already the common practice of state licensing boards to not license specialties of a general occupation or profession.



Other state licensing boards in West Virginia have many areas of specialization in the occupations that they oversee. However, they do not issue licenses for each specialization. An excellent example of this is the Board of Medicine which issues a license to practice medicine and surgery or podiatry in the state. The Board does not issue licenses on specific specialties such as radiology, cardiology, and the like. Doctors who specialize receive certification from the national association that oversees that medical specialty.



Another example is the Board of Examiners in Counseling which offers a license as a professional counselor (LPC). This board does not license specialties separately which is what the licensing addiction counselors would be. However, the board asks that its members display a disclosure statement alongside their licenses, identifying their specialties such as school counseling, marriage counseling and the like.



This same argument can be used in regard to addiction counselors, many of whom are already licensed by the state as counselors, social workers and psychologists. Addiction counseling can already be considered a field of specialty of any of the three previously mentioned state-licensed occupational groups. Just as in the board of medicine, individuals who wish to become addiction counselors can become licensed to be counselors, social workers, psychologists or the like and can be certified by either the West Virginia Certification Board of Addiction and Prevention Professionals or the International Consortium for Alcoholism and Other Drug Addictions as a Certified Addictions Counselor (CAC).



Basically, if you have a licensing board that oversees people who have the responsibility of doing medical diagnoses that are at times life-threatening, or do surgery that is also often life-threatening, on patients and does not require licensure of specializations it can be argued that not licensing addictions counselors, who can already be licensed by other boards, by no means poses a greater harm to the public by not creating their own licensing board.



Finding 3: Mandatory Certification within the Board of Examiners in Counseling Is Not Necessary to Protect Public Health and Safety.



An alternative to full licensure of addiction counselors has been mandatory certification under the Board of Examiners in Counseling. Presently, addiction counselors can seek voluntary certification from the West Virginia Certification Board of Addiction and Prevention Professionals. The Board of Examiners in Counseling only issues a license to be a licensed professional counselor. The Board does not require mandatory certification of any counselor specializations which is what addiction counseling would be considered. Counselors voluntarily get certification in their areas of specialization from the appropriate certifying board. However, the Board of Examiners in Counseling requires that counselors must display their license in their place of practice as well as a disclosure statement that identifies what areas of counseling they are experienced in doing.





Conclusion



The Legislative Auditor finds that there is no need to create a separate licensing board for the profession of addictions counselors. The Sunrise criteria is established for professions that are currently not being regulated in some manner. Without such regulation, it must be determined that the well-being of the public is at risk. In this particular case, all addiction counselors are certified and most are licensed; therefore, the public is protected to a large extent. Consequently, the proposed licensure would be more of an economic benefit to the addiction counselors than additional protection for the public.



The addictions counselors who are not licensed, which is approximately 50 individuals, do not have sufficient numbers to financially support a separate licensing board which are considered to be self-supporting. Those who have yet to be licensed can get the necessary education and follow the licensing procedures of one of the existing licensing boards that already have addiction counselors in them. Of course these individuals will have to be supervised until they are licensed, but that is normal procedure with any individual who is seeking licensure under one of these boards. There is no reason why unlicensed individuals who are currently doing addictions counseling be treated differently than anyone else with regard to being licensed.









RECOMMENDATIONS



Recommendation 1



The Performance Evaluation and Research and Research Division recommends that a separate licensing board for addictions counselors not be created.





Recommendation 2



The Performance Evaluation and Research Division recommends that any provisional licensure or mandatory certification by an existing state licensure board not be allowed for addictions counselors.





Recommendation 3



The Performance Evaluation and Research Division recommends that unlicensed addictions counselors be encouraged to become licensed through an existing licensing board.

1. 1Sunrise Application, answer to question number ten.

2. Within the applicant's answer to question 7 of its application.