|Recovered Addicts Working in the Addiction Field: How do Substance
Abuse Treatment Agencies Work with Substance Abuse Relapse among
Addiction Counsellors who are in Recovery?
|Nick Doukas* and Jim Cullen
|Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada
||Dr. Nick Doukas
Centre for Addiction and Mental Health
Russell Street, Toronto, Ontario
M5S 2S1, Canada
|Received September 28, 2010; Accepted March 07, 2011; Published March 07,
|Citation: Doukas N, Cullen J (2010) Recovered Addicts Working in the Addiction
Field: How do Substance Abuse Treatment Agencies Work with Substance Abuse
Relapse among Addiction Counsellors who are in Recovery? J Addict Res Ther
|Copyright: © 2010 Doukas N, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
|The potential for relapse among recovered counsellors if one accepts that substance abuse is a chronic illness,
which often entails relapse, is a topic that has been neglected by the scientific community. The lack of research in this
area needs to be addressed especially when bearing in mind the possible unresolved issues motivating some "Ex addicts"
seeking employment in the field. Given that relapse among recovered counsellors is not a rare phenomena, the
research posed certain questions with regards to how agencies work with employees who have had a substance abuse
relapse. Using a case study design, the authors reviewed two diverse urban substance abuse treatment agencies with
very distinctively different ways of working with recovered counsellors who have relapsed.
|In the 1970's when the field of substance abuse treatment was
still growing as a discipline, individuals in recovery were hired on by
treatment agencies and given on the job training to help with the high
rate of people seeking treatment  This influx of ex-addicts entering
the field as addiction counsellors raised some concerns among writers.
The potential for relapse among counsellors in recovery is not a rare
phenomenon, especially when bearing in mind the possible unresolved
issues motivating some ex-addicts seeking employment in the field,
such as atoning for one's misdeeds, or eliminating past guilt  Writers
also describe the propensity for recovered counsellors to over identify
with clients [1,2] and become over involved with their work . The recovering counsellor may also be at a greater risk of burnout because
they are involved in their own recovery as well as the clients they work
with. Kinney  conducted a telephone survey of all counsellors who
graduated from a nine-month addictions training program between
1972 and 1978 . Out of the thirty-five graduates, twenty-four were
recovering alcoholics who had been abstinent for at least two years prior
to matriculation. Of the twenty-four recovering alcoholics, eight had
experienced a relapse since completing the program and one admitted
himself to a treatment program to avoid relapse.
|A counsellor's relapse threatens the credibility of the treatment
program for which they work at, places additional pressure on fellow
workers because they have to cope with the extra workload, and it causes
the counsellor to lose their credibility and maybe their credentials
[3,5]. The secondary problems which result from a substance abuse
relapse extend further than few are aware of, and are often unaddressed
by workplace policy  Wright et al.  maintain that over 30% of
employees are affected by substance use through insurance claims,
disability payments, firing and hiring, and other intangible costs, such
as friction between co-workers, damage to public image and personnel
|The literature on substance abuse in the workplace can be traced
back to the 1950s where researchers were interested in examining
the relationship between workplace factors and the development of
excessive drinking. Out of these discussions emerged the Employee
Assistance Program (EAP), which helped establish boundaries,
workplace intervention efforts and cost containment issues [1-3]. As
the topic of substance use in the workplace began to be recognized as a
major concern, research focused on policy strategies, such as workplace
drug testing, and ongoing supervisory training regarding substance
abuse identification and referral [1-5]. Despite the extensive research conducted on policy strategies to minimize substance abuse in the
workplace, the topic of relapse among recovered counsellors working
in the addiction field is an area of policy work that is extremely under
investigated, possibly because of the sensitive and stigmatizing nature
of this topic.
|Given that relapse among recovered counsellors working in the
addiction field is not a rare phenomena, our research posed certain
questions with regards to how agencies work with employees who have
had a substance abuse relapse: Are potential staff screened during the
interview process prior to being hired with regards to their recovery
and what are the requirements? Do substance abuse treatment agencies
have a policy in place to work with staff that have had a substance abuse
relapse? Is there any support in place for staff who has relapsed, or who
feel they are at risk for relapse? This paper uses a content analysis method
and telephone interview to answer the above questions by analysing the
policies of two diverse substance abuse treatment agencies with very
distinctively different ways of working with recovered counsellors who
|The chosen design of research was a case study, where we examined
the substance use policy of two substance abuse treatment organizations,
using telephone interview and content analysis methodology. We
reviewed the written policy that was supplied by one agency and
interviewed the Executive Director of the second agency to obtain the
information because they did not have anything in writing. The website
of both organizations was reviewed to obtain a background history
and approaches most frequently used in their plan of treatment. The written content was categorized into three essential questions and these
questions were asked in the telephone interview with the Executive
Director: (1) Are potential staff screened during the interview process
prior to being hired with regards to their recovery and what are the
requirements? (2) Do substance abuse treatment agencies have a policy
in place to work with staff that have had a substance abuse relapse? (3)
Is there any support in place for staff who has relapsed, or who feel they
are at risk for relapse? We chose this design because it presents with an
opportunity to analytically compare two policies and how they might
differently affect individuals and larger social structures within the field
|The two agencies being reviewed are quite different in the number
of employees it staffs, approaches to treatment and background history.
The larger of the two agencies is an urban centre, public hospital,
providing outpatient and inpatient care for those seeking help for
mental health and addiction services in Ontario, Canada. With over
ninety-three addiction counsellors on staff, it provides client-centred
service, using a harm reduction model in its delivery of care. The
other privately run, urban centre agency staffs twenty-two addiction
counsellors and was founded by an individual from Ontario, Canada
who attended a substance abuse treatment centre in the United States
that was based on the Minnesota model of recovery. This individual
found this 12-step based model so helpful to his own recovery that he
established one in Ontario, Canada several decades ago.
|How do we know we've hired the right person for the job?
|The agency that maintains a harm reduction philosophy and applies
a holistic approach to therapy does not have any screening process to
identify whether potential employees have a past history with substance
abuse. The other agency that maintains a 12 - step model of care is
known for hiring counsellors that are in recovery. The harm reduction
based agency provides opportunities for potential employees in
recovery to work alongside recovered and non-recovered counsellors,
but staff are at their own discretion to disclose or not a past history with
substance abuse. Unlike the harm reduction based agency's absence in
inquiring about length of "clean time", or how sobriety was achieved
and presently maintained, the 12 - step agency requires all employees
to have a minimum of three years "clean time", with 12 - step programs
for achieving sobriety being an asset. Addiction counsellors are also
expected to maintain 12 - step meeting attendance while being employed
with the agency (Executive Director. personal communication, January
|How do we work with the counsellor who has relapsed?
|During an interview with the Executive Director of the 12- step
based agency, he stated that there was no written policy in place to deal
with staff having had a substance abuse relapse. He continued by stating
that if a counsellor has relapsed, then their employment is terminated,
because the individual has failed to meet the minimum three year
of sobriety requirement to be employed with the centre (Executive
Director. personal communication, January 31, 2011). This implies
that the staff member represents his or her place of employment even
outside of work hours. After being asked about counsellors who have
been terminated as a result of relapse, the interviewer replied that in the
twenty years that he has been working with the agency only one person
has ever been terminated. He also added that there have never been
any challenges from staff with regards to this policy because this rule is
discussed in the interview process.
|The centre that maintains a harm reduction philosophy does
have a written policy in place and states that if staff, volunteers or
students are in possession of, under the influence of, or using drugs
while performing their duties they must provide an explanation to the
Director of the facility. If this explanation is found unsatisfactory, the
Director will encourage the staff member to seek help from the Centre
Employee Assistance Program (EAP), a substance abuse treatment
program, or other appropriate resources. The staff member is provided
with a written documentation of the warning and a copy will be put into
the staff's file. Staff will be permitted to return to work if they have fully
complied with the treatment program's requirement and a certificate
from a health professional indicating the staff's ability to return to
work. During our past work with this agency we have been witness to
the relapse of two staff members who were eventually dismissed. One
individual declined when the agency offered to put him on sick leave
until he successfully completed a substance abuse treatment program
of his choice. The second co-worker whose incident was taken to the
media by the client he chose to use substances with was not offered the
same option because of the policy and taboo associated with becoming
personally involved with clients of the centre. This incident had serious
repercussions for the agency, which led to an agency representative
having to give a public statement.
|The harm reduction agency's substance use policy only refers
to when individuals are on duty, unlike the 12 - step focused agency that
expects their employees to abstain from all substance use whether at work
or at home. This written policy continues by stating that if the Director
does not feel that the staff member's work performance is maintained
at an acceptable level in a specific period of time, management will take
steps to deal with the unsatisfactory performance. In the event that a
subsequent incident occurs again, then this could result in dismissal.
|How do we support our recovered counsellors and help
|The harm reduction based organization does have a support group
for recovered counsellors who meet regularly whether they have had
a relapse or not. This agency also has an EAP available that employees
can access, which offers specialized counselling in a variety of areas,
including substance abuse problems. The 12 - step agency does this as
well by insisting that each employee regularly attend 12 - step meetings,
which acts as their support group.
|The philosophy and culture of a substance abuse treatment
organization will play a major role with individuals it attracts for hire
and how ex-addicts seeking employment will feel about their past
within the agency. The 12-step run agency will openly welcome the
recovering addict in 12 - step fashion, fostering a sense of belonging,
where there is no need for hiding one's past, because "the man [or
woman] who is making the approach has had the same difficulty."(p.
18) . It is also understandable why this 12 - step focused agency will
attract people in recovery who might have been positively affected in
their recovery by the 12 - step approach [1-3]. However, for those in
recovery who choose to be employed in an organization alongside nonrecovered
counsellors, the experience could be quite different. They
may be viewed as inferior by their non-recovered counter-parts because
of their past association with substance use. This has forced many to go
underground with their past and drop all reference to former addiction
and recovery to avoid the potential of being stigmatized .
|Finding suitable candidates to work in a substance abuse treatment
setting is not an easy task, and quite often an inadequate screening process later reveals that the hired counsellor lacks the suitable
emotional fibre to perform their job in an appropriate manner .
McInerney  states that the suitability of addiction counsellors is
measured based on the reputation of the institution that trains them
and that agencies need to develop their own criteria in determining
the suitability of employee candidates . Kinney  believes that
agencies have to screen out those recovering individuals seeking
employment as substance abuse counsellors whose sense of self-esteem
is tied to helping others, or making restitution, or those who have little
capacity for reflecting on their own experience or differentiating it from
that of others . Developing better screening tools, such as improved
and validated survey instruments to use in assessing the attitudes of
counsellors with more accuracy can be helpful in these areas . Taking
these measures might seem intrusive, but addiction therapists are in
some way intruding into the lives of clients by virtue of the therapeutic
power they posses that has been bestowed upon them by the institution
they graduated from and by the agency that supports the application of
|In comparison, the two agencies have varying approaches when
attending to expectations of substance use among their employees.
Although the 12-step agency's approach might be found intrusive
to some who prefer that their work and personal life remain separate,
this full-time commitment to work and recovery allows all staff to be
on the same page with recovery. It also provides clear and consistent
expectations, and helps build cohesion because "having shared in a
common peril is one element in the powerful cement which binds us"
(p. 17) . The agency maintaining the harm reduction policy does
express its leniency when working with a staff member's substance
use problem and makes attempts to support the individual's return to
duty, but it also implies that the individual's performance and pace is
based on the Director's view. Not only does the staff member have to
face the embarrassment of the stigma associated with this incident,
which might lead to a social distancing by co-workers, but also be aware
that his or her actions may be monitored by both management and
staff. This creates the scenario often spoken about by addicts seeking
treatment who describe their friends and family as being watchful of
their behaviours, or expressing a lack of trust in the individual.
|Reducing stigma by fostering a supportive, non-judgemental
environment is paramount to an agency if it wants to encourage staff
who are struggling with substance use issues to raise these concerns
with their supervisor without the fear of being the topic of gossip. Many
workers with substance use issues resist seeking help because they fear
gossip, or distrust confidentiality at work [1,2]. This is mainly due to a
lack of knowledge about policy and an organization's EAP . Despite
studies that report the availability and effectiveness of EAP, this lack of
information can lead to low trust in EAP confidentiality and stigma for
seeking help [1-3].
|Lack of information about an organization's substance use policies
has raised concerns in the literature, especially with today's reliance on
the Internet. An evaluation of college online alcohol policy information
was conducted by Faden et al.  to see how difficult it was to
locate this information . They found that many colleges failed to
provide their alcohol policies in a web friendly, accurate and complete
descriptive manner. One cannot draw conclusions without conducting
a similar investigation to see if substance abuse treatment agencies were
also limited in this area, but it is important to note that the written
policy in the harm reduction agency that we examined led us to contact
their human resource department for a copy of the policy because
we were unable to locate it by Internet. When staff are not aware that
this information exists and is not easily accessible, the individual may draw conclusions based on their perception of mistrust in the agency
and/or their EAP. The 12-step agency on the other hand does not have
a written policy on this topic, but all employees are aware and clear
of the unwritten rule of having their employment terminated if they
have relapsed. This increases the reluctance of an employee disclosing
any substance use issues for fear of losing their job, unlike the harm
reduction agency where a staff member can resume their work after
they have successfully completed their rehabilitation and given a 'clean
bill of health' from their doctor. Having a policy or procedure in place
to deal with a staff member's inappropriate substance use is a sensible
necessity, but having a support group in the workplace for recovered
counsellors to meet speaks to an organization being proactive in
reducing the possibility of recovered counsellors relapsing.
|Another difference between the two is that one insists on the use
of a support group that you are free to choose from across the city, and
the other offers only one support group that you are not obliged to
attend. Furthermore, in belonging to a 12-step group that your place of
employment supports, the individual has no fear of being exposed as an
ex-addict because self-disclosure of one's past is supported. Attending
a support group in an organization with non-recovered counsellors
might be difficult for the recovered counsellor to disclose, because
exposing their past association with substance abuse might be difficult
among colleagues - if someone identifies us as someone in recovery,
this may result in stigma within the work community.
|Research and policy
|In the introduction of this paper we expressed the need to
address the lack of research on the topic of relapse among recovered
counsellors. And while this paper focuses primarily on a substance
use treatment agency's policy for relapse, research is inextricably
linked to this matter. Martin et al.  explain this link quite well by
illustrating how scientific research feeds the framework of social policy:
"Just as the truth of a criminal confession depends upon the system of
criminal justice that frames its meaning, so the data of social scientists
is collected, interpreted and communicated in a broader institutional
framework of social policy. The more controversial the issue, the more
importance accrues to the facticity of the data" (p. 396, 397) .
|Bennett  advocates administering anonymous and confidential
surveys for the evaluation and strategic planning of policy . This
will help increase the confidence of those who fear exposing their
views more openly because of anticipated repercussions. In addition,
aggregating survey data across groups of individuals can be used to
study sensitive topics, such as the potential for relapse .
|The limited and outdated quantitative research conducted thus
far on recovered counsellors has helped identify associations between
variables, but this area of research can benefit greatly from a qualitative
approach. This narrative approach would create a communicative
understanding of the participants' experiences, meanings and
interpretations as recovered counsellors, while data gathered can raise
compelling arguments with real life immediacy . Allowing recovered
counsellors to participate through open dialogue can be taken one
step further as was done by Bennett and et al.  who used these
collaborative techniques in a focus group format to explore employee
insights on the affects of socially constructed policies .
|In our research we also contacted another substance abuse treatment
agency to add to the comparison. When we asked if they had a policy
in place to work with substance use issues among their staff, we were
told that they did not have one. It is not our intention to promote one
agency's policy over another, because it is important for agencies to have their own unique culture of dealing with this type of issue. However, we
do believe that all agencies should have some clear and concise way
of acting when confronted with these challenges in the work place,
whether it is written or expected through the agency's culture. Making
policy easily accessible, accurate and complete encourages employees to
look up information and helps address problems. In addition, the policy
should clearly include information explaining the rules / requirements,
consequences, and referrals, such as EAP and substance abuse
counselling centres . Many organizations today do have an EAP
to consult regarding these matters, but in a field where organizations
entrust staff who are in recovery and are responsible with the personal
lives of clients who depend on them on so many levels, it would be
prudent to invest more energy in developing policies that are guided
by research so that the field can maintain accountability to both staff
|A more comprehensive search is needed to identify substance
abuse treatment agencies that have a procedure / policy in place that
works with substance use issues among staff. Their guidelines should
then be made public so that agencies can compare their procedures
with that of others, and try to determine what guidelines would
fit best with their agency's culture and principles. Agencies should
conduct ongoing evaluation of these procedures and make their results
available to fellow treatment agencies so that each organization can
draw its own conclusions of what might work best for them. Sharing
information will also identify the prevalence of the issue on a province wide,
substance abuse treatment agency level. It seems as if the topic of
relapse in this field is avoided because it is embarrassing for both staff
and the organization, and often "becomes elevated to the unspeakable
and cannot then be seen as a part of a chronic disease process which
requires an appropriate therapeutic response, not embarrassment and
hushed silence (p. 746) .
|Examining the policy of two uniquely different agencies sheds light
on how addiction counsellors in recovery are worked with regarding a
relapse to substance use. These findings should not be generalizable
to other agencies in Ontario, Canada, or anywhere else because other
agencies may act on these issues in various unique ways specific to the
culture of their organization. This is why a follow up-study should be
conducted with several more agencies involved. Future research should
also include the influence played by government and the political arena
with regards to policy's developed on this topic.
|The literature examining the topic of relapse among recovered
counsellors is limited, outdated, and deserves to be addressed.
Research will help inform policy making strategies, while ongoing
evaluation will examine the strengths and limitations of the policy.
Making the evaluated data available to all substance abuse treatment
agencies will cast a wider scope on the prevalence of this issue, allow
for an exchange of ideas, build cohesion across the field and reduce
the stigma associated with recovered counsellors by giving voice to a
taboo topic that deserves to be addressed. In addition, institutions and
agencies have to take more responsibility to insure that the appropriate
students graduate and suitable candidates are hired.
|Policy can come from many ideologies, biases and prejudices and
cannot be neutral because one group will benefit more than another. At
the same time, to do nothing when an issue clearly demands addressing
can also be seen as a policy that might serve a particular group. In this
paper we hope to give voice and create discussion regarding a topic that
has been dormant in the system for far too long.
- Mann M (1973) The para-professional in the treatment of alcoholism. (2nd edn)
Charles C Thomas Publisher: Springfield. Illinois, USA.
- Ellis D (1984) Essentials of chemical dependency counseling. Aspen
- Blume S (1977) The biology of alcoholism, treatment and rehabilitation of the
chronic alcoholic. (1st eds), Plenum Press. New York.
- Valle S (1979) Alcoholism counselling for an emerging profession. Charles C
Thomas Publisher: Springfield. Illinois, USA.
- Kinney J (1983) Relapse among alcoholics who are alcoholism counsellors. J
Stud Alcohol 44: 744-748.
- Kohut G, Geurin V (1991) Attitudes of personnel managers toward substance
abuse policies. Journal of Drug Issues 21: 493-503.
- Wright R, Wright D (1993) Creating and maintaining the drug-free workforce.
New York: McGraw-Hill, Inc.
- Roman P (1990) Alcohol problem intervention in the workplace: Employee
assistance programs and strategic alternatives. Quorum Books.
- Grimes C (1986) At Elkridge: A discussion of EAP objectives. The Almacan
- Googins B (1986) EAPs and cost containment. The Almacan 16: 18-19.
- Carpenter CS (2007) Workplace drug testing and worker drug use. Health Serv
Res 42: 795-810.
- French M, Roebuck M, Alexandre P (2004) To test or not to test: Do workplace
drug testing programs discourage employee drug use? Social Science
Research 33: 45-63.
- Hoffmann J, Larison C (1999) "Worker drug use and workplace drug-testing
programs: Results from the 1994 National Household Survey on Drug Abuse"
Contemporary Drug Problems 26: 331.
- Bayer GA, Gerstein LH (1988) An adaptation of model of prosocial behaviour
to supervisor interventions with troubled employees. Journal of Applied Social
Psychology 18: 23-37.
- Trice HM, Belasco JA (1968) Supervisory training about alcoholics and other
problem employees: A controlled evaluation. Q J Stud Alcohol 29: 392-398.
- Neuman W (2001) Social research methods: Qualitative and quantitative
Approaches. (5th edn), Pearson Education, Inc.
- Alcoholics Anonymous (2001) The Anonymous Press.
- Timko C, DeBenedetti A, Billow R (2006) Intensive referral to 12-Step self-help
groups and 6-month substance use disorder outcomes. Addiction 101: 678-
- Trice H, Staudenmeier W (1989) Recent developments in alcoholism treatment
research. New York, NY: Plenum Press.
- Zenmore S (2007) A role for spiritual change in the benefits of 12-Step
involvement. Alcohol Clin Exp Res 31: 76s-79s.
- Strachan J (1973) The para-professional in the treatment of alcoholism. (2nd
edn), Charles C Thomas Publisher, Springfield. Illinois, USA.
- McInerney J (1973) The para-professional in the treatment of alcoholism. (2nd
edn), Charles C Thomas Publisher: Springfield. Illinois, USA.
- McGovern T, Armstrong D (1987) Comparison of recovering and non-alcoholic
alcoholism counsellors: A survey. Alcoholism Quarterly 4: 43-60.
- Bennett J, Lehman W (1997) From dual policy to dual attitudes: The social
construction of substance use policy. Review of Public Personnel Administration
- Hood J, Duphorne P (1995) To report or not report: Nurses' attitudes toward
reporting co-workers suspected of substance abuse. Journal of Drug Issues
- Bennett J, Lehman W (2001) Workplace substance abuse prevention and helpseeking:
Comparing team-oriented and informational training. J Occup Health
Psychol 6: 243-254.
- Blum T, Roman P (1995) Cost-effectiveness and preventative implications of
Employee Assistance Programs. Rockville, MD: Substance Abuse and Mental
Health Services Administration, Centre for Substance Abuse Prevention.
- Conlin P, Amaral T, Harlow K (1996) The value of EAP case management.
EAPA Exchange: 12-15.
- Beidel B (1999) The employee assistance handbook (edn), New York: Wiley
- Faden VB, Baskin ML (2002) An evaluation of college online alcohol-policy
information. J Am Coll Health 51: 101-107.
- Martin A, Stenner P (2004) Talking about drug use: What are we (and our
participants) doing in qualitative research? International Journal of Drug Policy
- Lee RM (1993) Doing research on sensitive topics. London, Sage.
- Mason J (2006) Mixing methods in a qualitatively driven way. Qualitative
Research 6: 9-25.