Donna Woods rocked and sobbed, trying to find courage. She considered herself a sorry drunk and methamphetamine addict and an even sorrier mother. Her hand shook as she held the pistol up to her head. She fired once and missed. "I pulled that trigger again. I missed again,” she said. With that turning point 15 years ago, she got extensive help from drug and alcohol counselors and began helping other substance abusers. But now such counselors face proposed regulations that could limit their services and reduce substance abusers’ access to counseling, Woods said. "It’s a matter of life and death. How many people will die because of these decisions?” said Woods, executive director of Oklahoma Citizen Advocates for Recovery and Treatment Association. "I’ve got people crying on the phone, ‘Please help me!’ How can I help if I have no place to put them?” The state’s 900 certified counselors and counselors in training would be required to get a master’s degree to provide those services. They currently need a bachelor’s degree. Larry Gaines, with Norman Addiction Information and Counseling, called the plan disastrous. Like many certified counselors, Gaines battled his own addictions and then decided to help other substance abusers. He’s now in his 27th year of counseling drug and alcohol abusers, but figures he’ll probably retire rather than going for his master’s degree. "If they go through with this deal, it will really hurt alcoholics and addicts. People won’t have a place to get services and there’s already not enough facilities to get the services. If this passes, it will be devastating to all the communities,” he said. About $17 million in budget cuts already have closed more than 195 beds used for substance abuse and mental health patients. More cuts are expected. In light of those cuts, diminishing experienced counselors’ services doesn’t make a lot of sense, said Andy Dean, a former client of Norman Addiction Information and Counseling. He said substance abusers like to polish up a lie and use it to gain the sympathy of a counselor. But the farce usually won’t sneak past someone who’s been an abuser. "I think a master’s degree is great. However, if you don’t have any experience, yourself, in substance abuse to be able to identify when a client is being honest and when a client is in denial ... I don’t think you can learn that at a university at any level,” Dean said.
Experience, educationBut the idea is simply to raise state standards and ensure therapists have a master’s degree, while preserving services to substance abusers, said Terri White, Mental Health and Substance Abuse Services commissioner. "Life experience is incredibly important,” White said. Under the proposal, assessing people, diagnosing and therapy would be handled by licensed professionals with master’s degrees, White said. But certified counselors would still give 23 of the 26 services they now do, including case management. PatientsFirst Coalition, representing the Oklahoma State Medical Association and other groups, sent White a letter applauding the proposal, saying it would help ensure that substance abusers get the best assessments and treatment. But Oklahoma already requires some of the nation’s most rigorous training of certified counselors, said Ric Pierson, executive director of the state board of Licensed Alcohol and Drug Counselors. He said many counselors are upset. "We’ve got a lot of old-time counselors out there who have been doing a whale of a job for us for years and years and they’re being told, ‘You don’t count,’” he said. He said some certified counselors will not get their master’s degree because of cost or travel or because they’re too near retirement. "It could cost the state more,” he said. "If people aren’t getting treatment for substance abuse, we could see rises in crime rates, domestic violence, homelessness, divorce, child abuse.”
Who’s paying?The shrinking state budget motivated the state Mental Health Department and the Oklahoma Health Care Authority to develop the plan, said Rep. Kris Steele, R-Shawnee. "Currently, Medicaid will pay for CADC (certified alcohol and drug counselor) treatment services, but they are in the process of changing their rules to not do that anymore,” Steele said. He said the departments want to make sure they meet Medicaid requirements so the state can get federal matching dollars. Steele’s House Bill 2999 is designed to ensure that Medicaid continues to reimburse drug and alcohol counselors until June 2013 so they will have time to get their master’s degrees. It passed a House committee and Steele said he expects a House of Representatives vote this week.
In the worksState agencies have been discussing how to improve Oklahoma’s behavioral health system for 10 years, said Debbie Spaeth, behavioral health director for the state Health Care Authority. They looked closely at the lower-paid certified counselors. "Over time we didn’t want them to be doing assessment and developing these treatment plans,” Spaeth said. Instead, the state agencies wanted certified counselors to do rehabilitation and teach living skills and social skills. She said other states are looking at requiring more stringent training, too.
• 250 licensed
• 650 under supervision Requirements:
• Bachelor’s degree in behavioral science
• 4,000 hours of supervision
• 135 hours in drug and alcohol specific continuing education
• 45 hours in co-occurring disorders continuing education Licensed alcohol and drug Counselors:
• 600 licensed
• 600 under supervision Requirements:
• Master’s degree in behavioral science
• 2,000 hours of supervision
• 90 hours in alcohol and drug specific continuing education