Understanding and developing the substance abuse treatment workforce is a major priority at the global level. The United Nation’s Declaration on the Guiding Principles of Drug Demand Reduction (United Nations 1998
) states, “[This initiative] responds to the need for an international instrument on the adoption of effective measures at the national, regional and international levels against the demand for illicit drugs” (p. 1). The Declaration also emphasizes that “states should place appropriate emphasis on training policy makers, programme planners and practitioners in all aspects of the design, execution and evaluation of demand reduction strategies and programmes” (United Nations 1998
, p. 4). Therefore, it is clear that building an educated, well-trained substance abuse workforce is a high priority.
Before mounting efforts to address workforce needs, it is important to ascertain the demographic characteristics and skills of the existing workforce. Understanding the workforce is vital in determining the skills and knowledge that practitioners need and the best way of addressing those needs. Within the substance abuse treatment system in many parts of the world, a category of professionals or paraprofessionals referred to as “counselors” constitute a central component of the staffing for many treatment organizations. However, little has been documented about who these counselors are, how they are trained, and what their training needs are. Our review of the published reports on the international substance abuse treatment workforce (Home Office 2006
; National Centre for Education and Training on Addiction 2003
; Roche et al. 2004
) revealed that relatively minimal information is available on the nature of the workforce in general and even less about counselors specifically.
In the United States, counselors play a key role in delivering substance abuse care, and since the late 1990 s, attempts have been made to describe this group. Fifty to seventy percent of substance abuse treatment counselors are female, middle-aged (40–55 years of age), and White (84.5%) (Harwood 2002
; Knudsen et al. 2003
; Mulvey et al. 2003
; National Association of Alcoholism and Drug Abuse Counselors (NAADAC) 2003
; RMC Research Corporation, 2003
). Considerably diverse education levels have been found among counselors across various studies in the United States. Several studies reported that 80% of the direct care workforce had at least a bachelor’s degree (Johnson et al. 2002
). Harwood (2002
) found that 53% of direct service treatment staff had a master’s degree, and Mulvey et al. (2003
) found that in publicly funded programs, 72% had at least a bachelor’s degree, 47% a master’s degree, and 7.4% a doctorate.
Considerable diversity is also found in the academic disciplines for counselors in the United States. According to a study by the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), the most common master’s degrees among substance abuse counselors were in social work (29%), counseling (27%), and psychology (22%). In a study of the CTN direct care workers, the majority worked full-time (over 35 h a week), spending between 41% and 61% of their time seeing clients and 20% of their time doing administrative duties such as paperwork (McCarty et al. 2007
). Direct service treatment staff spent just over one-fifth of their time on paperwork (NAADAC 2003
) and about half their time counseling clients (RMC 2003
). Half the treatment professionals had worked in their current organization for 5 years or less.
New counselors entering the substance abuse treatment field in the United States tend to do so later in their career (mean age 38). Almost half indicated that they entered the field as a second career, and that their entry into the field was due to personal or family experiences with substance abuse (61%) (NAADAC 2003
; RMC 2003
). Other reasons for joining the field included the challenging nature of the work (95%), the desire to work in a helping profession (91%), and the existence of substance abuse problems in their community (78%) (NAADAC 2003
To our knowledge, only two other countries have collected information on their substance abuse treatment workforce: Australia and the United Kingdom. The data available from these countries is collected on staff and counselors alike, with no breakdown of the data by group beyond profession. Thus, specific comparisons of the counselors with other groups of counselors are limited.
In Australia, one study by the National Centre for Education and Training on Addiction (2003
) surveyed 234 managers of alcohol and other drug (AOD) treatment agencies regarding the characteristics of the agencies, the workforce, and workforce development issues (Roche et al. 2004
). Managers reported that approximately 70% of the workforce consisted of frontline therapeutic staff, with the remainder being ancillary and administrative staff as well as managers with no caseload. When asked to describe their staff by occupational group, managers indicated 26% were nurses, 19% were general AOD workers, 8% psychologists, 6% counselors, and 5% social workers. Other reported occupations included teachers, pharmacists, and health promotion officers. In the United Kingdom, the workforce that has direct contact with the substance abuse population includes nurses (17%), criminal justice workers (16%), service managers (12%), counselors (11%), outreach workers (5%), social workers (5%), doctors (3%), psychologists (1%), and other professionals such as pharmacists and teachers (Home Office 2006
). The workforce also includes practitioners who have become qualified through other pathways such as National Vocational Qualifications and, in large numbers, through volunteerism.
Besides data from the United States, Australia, and the United Kingdom, information on the substance abuse treatment workforce is minimal to non-existent. The purpose of the present report is to add to the body of knowledge about the nature of this workforce on the international level. We report on a sample of substance abuse counselors in the treatment system in the Republic of South Africa.