A qualitative study of recovering and nonrecovering substance abuse counselors' belief systems.(Report)

This study investigated recovering and nonrecovering substance abuse counselors' beliefs about the etiology and treatment of substance abuse disorders. Qualitative methods were used to investigate these variables. Analysis of the data revealed several key findings with implications for future research.

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Substance abuse (SA) counseling, as a specialization within the mental health field, is distinct from other specialty areas (e.g., career counseling). A main difference between the SA counseling field and other specialty areas pertains to provider characteristics (Culbreth, 2000). Historically, there has been a preference in the SA field for professionals who are themselves in recovery from an SA disorder over those professionals who are not in recovery (Culbreth, 2000; Shaffer, 1987). Oftentimes, recovering counselors lack specific training in counseling skills and techniques and hold their recovery status as their primary credential to provide treatment (Culbreth & Borders, 1999; Juhnke & Culbreth, 1994; Thombs & Osborn, 2001). In recent years, however, an increasing number of graduate degreed counselors who are not in recovery are entering the SA treatment field. This, along with a growing body of research on the effectiveness of different treatment approaches, has led to a debate among SA counselors about how best to conceptualize and treat SA disorders (Culbreth, 2000). The purpose of this study was to assess both recovering and nonrecovering counselors' belief systems regarding SA etiology and treatment, how those belief systems were formed, and the degree to which SA counselors are willing to change their beliefs. A brief review of the related literature and the rationale for the present study is presented as follows.

Beliefs systems regarding SA etiology and treatment can be described as either traditional or nontraditional in nature (Thombs & Osborn, 2001). For the purposes of this study, beliefs described as traditional support the disease model of addiction and purport treatment based on the principles of Alcoholics Anonymous (AA) and other 12-step groups as the only effective path to recovery. Nontraditional belief systems call into question the disease concept of addiction and treatment based on AA and the 12 steps. Counselors with nontraditional belief systems may use some of the principles of AA in treatment, but they also include a variety of other treatment methods. It is commonly thought that counselors with traditional beliefs are themselves in recovery from an SA disorder, whereas those with nontraditional belief are not in recovery from an SA disorder. However, little research has been done to substantiate this assumption.

In 2000, Culbreth reviewed 16 studies that investigated differences based on counselors' status as either recovering or nonrecovering. He concluded from this review that (a) clients' perceptions about counselors and the effectiveness of treatment are not related to counselor recovery status, (b) counselors who are in recovery view SA problems in different ways and use different treatment methods than do their nonrecovering peers, and (c) recovering and nonrecovering counselors have different personality traits and attitudes that may affect the treatment environment. None of the studies reviewed by Culbreth specifically addressed how SA counselors form their belief systems about the etiology and treatment of SA disorders.

Several authors have noted the need to understand the impact of SA counselors' belief systems about the treatment of SA disorders and how those belief systems were formed. For example, Thombs and Osborn (2001) described a gap in the SA field between research and the delivery of treatment services. Likewise, Reeves, Culbreth, and Greene (1997) noted that research efforts in the field of SA counseling "have received very little attention, and more often than not, have been ignored" (p. 76). Some have suggested that this gap is related to the within-group differences between counselors in the SA field (Culbreth & Borders, 1999). Specifically, counselors who have personal experiences with SA and who lack formal training may be less open to advances in research and hold on to the belief that all clients can recover from SA disorders in the same manner that they themselves did. The gap between research and practice may be detrimental to the SA treatment field. If practitioners continue to ignore research advances in the field, it may hinder their ability to be more effective in the treatment of SA disorders.

The purpose of this qualitative study was to examine the belief systems of both recovering and nonrecovering SA counselors. Specifically, we were interested in examining how SA counselors form their beliefs about SA, how those beliefs have an impact on treatment planning, and the extent to which SA professionals are willing to change their beliefs about SA and treatment. We also sought to determine if there are differences between recovering and nonrecovering counselors in the way that they form their beliefs regarding treatment, whether recovering counselors maintain more traditional beliefs, and whether recovering counselors are more resistant to a change in beliefs than their nonrecovering peers are. Because little research has been conducted on this topic, the study was exploratory in nature, with the overall goal of developing hypotheses for further study.