Question from the field:  How does someone maintain longevity in the addiction field?

Two people working in the addiction field recently gave me a question to respond to here on Recovery Review.  Interestingly, they both gave me the same question. 

One phrased it as a topic by saying, “I would enjoy hearing some more about risk and protective factors for SUD clinicians.”

The other phrased it as a question:  “What practices help keep long term practitioners grounded and relevant through changing terrain?”

In order to respond to this request, first I’ll provide a list of suggestions that have been given to me.  Some are from way back in graduate school and the rest were suggested over the years.  After the suggestions I’ll provide some first-hand stories and list one bottom-line takeaway for each story.  Lastly, I’ll list some suggested readings. 

Longevity is one thing. Evergreen is another.

Suggestions I’ve Been Given:

1. Find the people in your work life who hold and use theories or practices you disagree with the most.  Spend time with them and invite them to teach you their way of thinking and practicing.  Learn all about it from them.  Don’t argue against what they have to say while they teach you.  Ask questions and gather their answers.
   • You will end up gaining something useful and being more well-rounded. By listening to a strong expert in what you disagree with, you will end up knowing that model or practice better than most.  This will improve your knowledge base.Afterwards, study that area independently (read academic material, research articles, etc.).  You will gain something from that material.
   • By the end you will be able to support what’s valuable in that area of learning, and be able to refute it more effectively when needed than if you had continued to ignore it. 
2. Be open to employment (and helping, volunteering, etc.) in other kinds of SUD settings services.  Don’t limit yourself to the few you like or feel comfortable with.
3. Tour every SUD-related setting and service in your local area.  Know what’s available first-hand. 
4. Find SUD career role models and spend time with them.
5. Identify topics related to the work that you have no interest in, and learn them.  You will come away improved, more well-rounded, and with expanded interests.
6. Read material related to your SUD work for at least one hour per week for the rest of your career.
7. Read the burnout literature and make needed adjustments.
8. Become familiar with your own cognitive preferences (MBTI, Enneagram, etc.) and your personality style. 
   • Work with these factors, rather than against them.
   • While learning those materials strive to make your blind spots and your less preferred methods conscious.  Then spend years consciously developing your less-preferred approaches.  Grow outside of your preferences.
9. Receive clinical supervision for life.  Be mentored for life.
10. Mentor others.
11. Stay close to the delivery of clinical direct service.
12. Picture staying in primary SUD clinical work for your whole career. 
    • Carry this notion and nurture it. 
    • Over the years, make adjustments that accommodate and advance this plan. 
13. Read original source material from our field that is much, much older.  Also read some recent historical accounts of much earlier times in our field.  These will help you be more grateful.

Stories:

Life and Life Purpose:

When my graduate internship (1988-1989) in a 30-90 day residential program first started, all the counselors and clinical supervisors seemed like “lifers”.  As I got to know them better, I realized that some were not going to stay in SUD work for the rest of their professional lives, but many had more or less decided to do just that.  Regardless of SUD specificity, all of them were lifers in the helping professions generally.  The subset of SUD-specific lifers seemed to have a career connected to their whole life, whether they were in recovery or not.  And their SUD work was congruent with their whole life story.  For example, one was a former IV heroin user and also the ex-president of a very well-known gang in a very large and well-known city.  And another was an ACOA whose marriage slowly turned into a relationship with a person who became a severe and chronic alcoholic, but that person never had a SUD of their own.

• What’s my take on that at this point in my career?  Make your work, and your approach to the way you work, congruent with your life purpose and story.

Values of the Workplace:  Match or Mismatch?

I started my first job (1989) in a traditional 9-12 month or longer residential therapeutic community (TC) program that also had an outpatient methadone maintenance therapy (MMT) program operating in the first few offices at the front of the building.  Everyone seemed like a lifer to me.  When I arrived there the first state-approved methadone dispensing nurse in the history of the state of Illinois was still working there; she opened the clinic in about 1968.  She remained there for about my first ten years before she retired.  Those sister programs (the residential TC and the outpatient MMT clinic) were very different, of course.  And they were embedded within a huge community agency – among which a great many staff were lifers.  But guess what?  The TC and MMT programs had the lowest turnover in the whole agency.  If you entered those two programs as an employee and fit, you stayed.  When I left those programs (and that agency) after 19 years, I was a baby in those two programs compared to other staff.  Two of the nurses and one of the counselors – all of whom pre-dated my arrival there by several years – were still there.  As were a number of clinical support staff, the program secretary, and so on.  Across the agency’s primary MH programs, primary SUD programs, and administrative support services (kitchen, accounting, HR, etc.) lots and lots of employees worked there for their whole careers.

• What’s my take on that at this point in my career?  Find a place that’s congruent with your values and purpose; settle, dig in, and be helpful no matter what is needed.

“Just don’t quit.  Be the person that doesn’t quit.”

Here’s a story I’ll never forget and have told dozens and dozens of times.  Back in the early 1990’s I was at a CE event where Bill White was giving a CE presentation.  One major focus area he discussed in that talk was burnout among addiction counselors.  At one point in his presentation he calmly said, “The average career length, not length of employment in any one particular job, but average career length of an addiction counselor…” and then he named the national survey/study he was giving the data from “…is three and a half years.”  He paused and said, “Three and a half years.”  The room was super quiet.  He then said, “Our work is so difficult, and so painful, that the average amount of time an addiction counselor can do the work is only three and a half years.”  He continued by saying, “And now I’ll give you a secret.  I’ll give you some inside information on how to make it in this field.  How to have a career, and eventually move up, and more or less succeed.”  He paused again.  And leaning in toward the mic, lowering his voice he said, “To make it in this field, just don’t quit.  The work is so difficult and so painful, all you have to do is just not quit.  When you just don’t quit, you’re there.  And then, other people do quit – mainly because the work is so difficult and painful.  And then they hire a new person. And when the place needs someone to show the new person the ropes, they ask you to do it, because you’re there.  They can’t ask someone who isn’t there.  And then…one day…they use the word… ‘supervisor’.  So that’s how to make it in this field.  Just don’t quit.  And when you do want to quit, don’t.  And then you’ll still be there.  And eventually you’ll move up.”  Honestly, that was one of the funniest, and at the same time saddest things, I’ve ever heard. 

• What’s my take on that at this point in my career?  Find a way to “sit with the pain”, just as we advise our patients to do.

Trying to control the patient, making my work unmanageable?

In my graduate training program we had to do a 32 hr/week 10-month long internship in the second year.  I chose a 30-90 day residential addiction treatment program.  It was a classic “Minnesota Model” program in that big community agency.  The Executive Director of the program, Tom Murphy, was a very seasoned, smart, and wise individual deeply and intimately connected with alcoholism, addiction, and recovery.  One unremarkable day he gently stopped me in the hallway while we were walking in opposite directions.  He said, out of the blue, “I think you should take the first step.  You should take step one.”  This was so unexpected and without context I literally had no idea what he was talking about.  He was calm and polite, but just kept looking me in the eyes.  I finally said, “Pardon me?”  He said, “I really do think you should take the first step.  Step one.”  It’s impossible for me to tell you, the reader, how overly awkward this felt.  I finally did politely tell him so.  At that point he said one of the most profound and beneficial things I’ve ever heard.  He literally said, “We admitted we were powerless over our client – and to the extent we try to control the client, our work becomes unmanageable.”  After he said that he expounded it so clearly and so well that it only took him a couple of minutes to hand me the wisdom that sentence contains and how to apply it. That one sentence has remained with me from that time to this, and has helped me tremendously over the years to find calm and clarity.

• What’s my take on that statement from Tom Murphy at this point in my career?  Let go while retaining the responsibility of your role; it’s a mindfulness skill that might help you sit with the pain while you diminish one source of the pain.

Two key decisions:  reading and clinical supervision

The Behavioral Health Recovery Management project (BHRM) had a steering committee during its entire 10-year lifespan (1997-2007).  I sat on that steering committee for the entire length of the project.  The committee consisted of our CEO, 2 vice presidents, and senior-level directors and managers of key service areas.  We met every other Friday on an open schedule with most meetings lasting 2-3 hours.  We were decisive about change.  Not only did we contract the writing of practice guidelines by subject matter experts on a wide range of best practices and promising practices, but we also learned and applied specific change-management strategies.  Those change management strategies started at the organizational level, not just the clinical-applied level.  Early in those ten years we made two key decisions both related to clinical supervision, employee development, and setting organizational culture and priorities. 

Decision one: Schedule time to read during your work week

One decision related to each clinical employee’s annual performance review, personal and long-term career goals, the clinical supervision they received, and development of their growth goals in the clinical supervision context.  First of all, we decided every clinician needed to be in formal and scheduled clinical supervision regardless of their credentials, length of service, and so forth.  And we decided that every person in clinical supervision needed a personal learning plan (analogous to the treatment plan of a patient) co-developed by both the supervisor and the supervisee.  And within that context we made this decision:  that every clinical employee should be required, as an administrative oversight matter, to shut their door, put out “don’t disturb” on the outside of the door, push the “do not disturb” button or shut off the ringer on their phone, close email and…read for one hour per week on a regular part of their schedule, as a regular part of their job.  Put “reading” on your appointment calendar as a recurring appointment, and let your clinical supervisor and administrative manager see that it’s scheduled.

• What’s my take on that decision?  I followed that mandate for those ten years, and I’ve followed it or exceeded it for most of the following years to the present.  I don’t have the words to convey the many positive impacts of sustaining that priority over time.  But I can say this:  it has helped keep me relatively more green and growing. 

Decision two: Prioritize attendance of clinical supervision

Another decision from the steering committee had to do with priorities.  For several weeks we wrangled with the idea that clinical supervision might be a higher priority than almost all others. I’ll spare you all of the “what-ifs” we discussed and all the scenarios we discussed that might cause someone to have to miss a clinical supervision meeting.  Eventually someone on the steering committee blurted out a question:  “Should providing patient care be a priority over attending clinical supervision?”  The meaning of the question was discussed.  Once the meaning of the question (which did not pertain managing an emergency) became clear, the room more or less turned very quiet.  Ultimately, we decided that attending clinical supervision was actually more important than, and superseded, some patient care scenarios.  This was strenuously debated and objected to.  What it came down to was this.  If you are scheduled for clinical supervision at a certain hour, you should attend, and a routine emergent need should not be an excuse to miss clinical supervision.  You should not be able to get away with the excuse that you “had to miss” clinical supervision “because of patient care”.  Because almost everyone in the agency worked within a clinical team, most emergent needs could easily and routinely be addressed by a teammate – similar to if the employee in question was away sick.  And the clinician should thus attend their clinical supervision.  We literally decided, and worded it this way to all the clinicians in the agency, that providing care at the “treatment as usual” level was literally worse than missing the growth opportunity of clinical supervision and letting a teammate attend to the emergent need.  In our agency at that time we were moving the agency’s culture.  Toward that end we pressed the point about the primacy of importance of clinical supervision by saying, rhetorically, “How valuable is it to continue to provide routine care, rather than learn best practices and promising practices?”  In our agency we made it explicit that everyone was required to be in clinical supervision for life.    

• What’s my take on that decision at this point?  My thoughts about it are similar to the one about reading.  But receiving clinical supervision adds the hugely significant human factor of being with a mentor. When sustained, this arrangement becomes a very potent upstream location with gigantic downstream impacts for the patient, our colleagues, and our career.  To say nothing of staying in learner mode, growing, and staying green. 

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Suggested Resources

Carroll, D.  (2012).  The 9 And 12 Workbook.  William Donald Carroll, Jr. 

Coon, B. Clinical Supervision of Clinical Supervision.

Coon, B. Essays on Addiction Counseling

NIATx

White, W. L.  (2007).  Counselor Magazine’s Addition Professional’s Reference Guide.  Health Communications, Inc.  Deerfield, FL.

White, W. L. (2014).  The history of addiction counseling in the United States:  Promoting personal, family, and community recovery.  NAADAC.

White, W. L. Recovery advocacy is not a recovery program.

White, W. L. Stigma-Busting: Sharing The Good News Of Recovery At A Professional Level.