The recent AOD counselor certification regulations in California were intended to standardize the education, experience, conduct, and complaint investigation for AOD counselors. Because nicotine addiction is prevalent among those with other substance abuse and dependence, we used the enactment of the regulation as an occasion to evaluate the degree to which nicotine addiction is addressed in the California counselor certification process.
Our findings reveal two main points. First, the text of the California AOD Counselor Certification regulations and supporting documents make no mention of cigarettes, nicotine, smoking, or tobacco, and thus do not mandate or recommend they be addressed in the counselor certification process. Nicotine and tobacco are not unique in this regard, as most other drugs excluding alcohol are also not specifically mentioned in these documents. Fact sheets posted on the California ADP Web site, however, distinguish among alcohol, cocaine, and methamphetamine, but mention tobacco only in the context of sales to minors and not as a target of treatment or intervention. Second, although nicotine or tobacco were not mentioned in regulatory or supporting documents, four of the 10 certifying organizations mentioned nicotine or its synonyms at least once in handbooks, program books, continuing education topics, or other materials. One organization offered specialization in smoking and nicotine addiction as separate tracks within its certification training program.
Smoking continues to be the leading preventable cause of death in the U.S., the prevalence of smoking is elevated among persons entering drug abuse treatment, and many treatment programs do not address smoking even in the presence of practice guidelines encouraging them to do so (Fuller et al. 2007
; Fiore, Bailey & Cohen 2000
; Sees & Clark 1993
). Consequently, addressing smoking in substance abuse treatment systems represents a public health concern, a health disparities concern, and a clinical best practice concern. Based on this review of the California counselor certification regulation and related documents, we conclude that smoking and nicotine addiction are not adequately addressed in regulations governing the training of California AOD counselors. Systematic inclusion of training on smoking and nicotine addiction in counselor training offers one strategy to better address smoking in drug treatment settings, and collaboration between state departments of alcohol and drug treatment and national and professional organizations can support in the development of policy guidelines in this area (Walsh et al. 2005
; Hahn, Warnick & Plemmons 1999
The work reported here concerns AOD counselor certification in California only, and may not generalize to certification in other states. It is limited by reliance on Web-based materials, which represent publicly available information through which counselors would investigate the certification process and education requirements. With regard to certifying organizations, our methods may result in a distorted view of how well these same topics are covered. A more comprehensive review of program brochures, handbooks in hardcopy, or interviews with representatives of certifying organizations may have resulted in a different perspective of the degree to which nicotine is addressed by certifying organizations. Further, study procedures did not attempt to correct for variation in the quantity of information posted on individual Web sites, which ranged from less than 10 pages to multi-tier site structures and downloadable handbooks, and nicotine or tobacco mentions may increase commensurate with the amount of information posted. Finally, we cannot comment on the degree to which smoking and nicotine addiction are or are not included in actual counselor training in California. Among the 10 certifying organizations, some provide training directly while others accredit training programs offered in California college and university settings; there are approximately 70 such training programs throughout the state. Systematic study of curricula in each of these programs would be needed to further assess the degree to which nicotine addiction is, or is not, incorporated into counselor training.
These limitations notwithstanding, the nationally promulgated Addiction Counselor Competencies (in TAP 21), on which the California regulation bases its certification training content, the language of the regulations themselves, and associated documents on the state ADP Web site were silent with regard to nicotine, smoking, and tobacco. Publicly available and accessible materials describing certification agencies and approved training programs did mention these topics, but infrequently. Given the comorbid nature of smoking and nicotine addiction with other substance abuse, and the relevance for public health in general as well as the individual health of persons involved in drug abuse treatment systems, we recommend that training in assessment and intervention for nicotine addiction be included in AOD counselor certification and training requirements in California.