What percentage of psychologists' clients are diagnosed with a substance abuse disorder? What kinds of treatment do practitioners provide to them? Do psychologists seek out special training in substance abuse? How do clients pay for these services?
These are a few of the questions that APA's Practice Directorate and the Substance Abuse and Mental Health Administration's Center for Substance Abuse Treatment (CSAT) are beginning to answer with the results of their first survey of practicing psychologists.
"Substance abuse is an important area of practice for psychologists, and, before now, we haven't had good data on how psychologists address it," explains Russ Newman, PhD, JD, APA's executive director for practice. "This survey will help us begin to understand the experience of practitioners in relation to substance abuse. That knowledge will enable us to create more effective policies and programs that will meet practitioners' needs."
The APA survey was conducted as part of a multidisciplinary effort initiated by CSAT and designed to gather information about how mental health professionals are working with clients with substance abuse problems. The effort includes several other professional associations that are conducting parallel surveys: American Counseling Association, American Psychiatric Institute for Research and Education, National Association of Social Workers, American Association for Marriage and Family Therapy and the National Association of Alcohol, Drug and Addiction Counselors.
"We're hoping that the coalition brought together by CSAT in conducting this project will lead to the development of other multidisciplinary, collaborative projects that will generate information that is useful to providers and of interest to funders and policy-makers," says Geoffrey M. Reed, PhD, the Practice Directorate's assistant executive director for professional development.
Through the associations' surveys, CSAT hopes to learn about the practices that mental health professionals use when they encounter substance abuse disorders, including how often patients are diagnosed with a substance abuse problem and another disorder.
To conduct its survey, APA randomly selected 400 members who were licensed psychologists providing direct health or mental health services, and sent them a paper-and-pencil questionnaire about the substance abuse-related treatment they provide.
Of those who returned the APA survey (about 55 percent), most were clinical or counseling psychologists, the mean age was 53, 89 percent were white, about half were female and the average time in practice was 22 years.
Here's what they reported:
In the past 12 months, 62 percent indicated they screened clients for substance abuse disorders, 46 percent diagnosed or conducted a formal assessment of substance abuse, 35 percent treated clients diagnosed with substance abuse as a primary disorder, 76 percent treated clients diagnosed with substance abuse as a secondary disorder and 80 percent reported referring patients to treatment for substance abuse disorders.
Independent practitioners reported treating fewer patients with a primary or secondary substance abuse diagnosis than psychologists in organizational settings such as hospitals or clinics. Overall, clients were more likely to have substance abuse as a secondary diagnosis.
Psychologists who work in independent settings reported they spend more hours providing direct clinical services and saw more patients per week than those in organizational settings.
The majority of clients treated in both organizational and independent practice are white. In general, however, organization-based psychologists saw more minorities than independent practitioners.
Practitioners reported that they are typically reimbursed by private insurance or clients' self-payment, although the majority of respondents declined to answer this particular survey item.
APA will continue studying substance abuse treatment by using the questionnaire's results to design future surveys, which will be conducted via PracticeNet, a new online data-collection tool that will examine all kinds of interventions by psychologists. Its goal is to better understand psychologists' practice patterns, work settings and training needs.
"The future PracticeNet surveys will assist in finding how substance abuse is being treated in private practice and how it's presenting in psychologists' offices," explains Stefanie Klein, PhD, PracticeNet's director.
Percentage of respondents holding substance abuse certification:
State certification 3.5%
Certificate of proficiency, APA College of Professional Psychology 7.0%
Certified drug abuse or drug and alcohol abuse counselor 1.5% Source: APA's Practice Directorate.
Percentage of respondents who reported providing substance abuse-related treatment in the past 12 months
Screened clients for a substance abuse disorder 62%
Diagnosed or formally assessed substance abuse in clients 46%
Treated substance abuse as a primary disorder 35%
Treated substance abuse as a secondary disorder 76%
Referred patient to other treatment for substance abuse 80% Source: APA's Practice Directorate.
Average percentage of time spent in practice
Substance abuse clients........................................All clients
Screening and assessments
Note: 1st column numbers represent Organizational setting and the second column of numbers represents Independent practice.