The man's favorite drug was the painkiller Dilaudid, but he would use any opiate he could get his hands on. As his addiction escalated, so did the illegal activities he engaged in to support his increasingly desperate habit.
The man had sought help from a social worker, psychologist and psychiatrist, in inpatient and outpatient settings. But because they weren't specialists, they simply didn't know how to treat his addiction appropriately. In fact, none of them had even bothered to assemble a history of his drug use--a standard first step in treating substance abuse.
Then the man landed in the office of psychologist Meyer D. Glantz, PhD, a private practitioner in Rockville, Md., and associate director for science in the division of epidemiology, services and prevention research at the National Institute on Drug Abuse. Glantz began using proven treatment techniques like allowing the man to see his children in exchange for drug-free urine samples. Glantz also worked with a psychiatrist to get the man on medication that would help him tolerate withdrawal. Now reunited with his family and working full time, the man is well on his way to recovery.
Glantz is just one of about 1,000 psychologists who have earned APA's Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders. Launched by the APA College of Professional Psychology in 1996, the certification program represents the first uniform, national credential for psychologists in this booming field. According to Glantz and other recipients, certification has improved the quality of care they offer, enhanced their credibility and opened new markets.
"There have been a lot of developments in drug abuse treatment, and not everyone has kept up," says Glantz. "Certification sets standards for what expertise psychologists need in order to treat substance abuse appropriately."
To earn the APA certificate, psychologists must meet the following criteria:
Possess a current state or provincial license in good standing.
Have treated alcohol and other psychoactive substance use disorders for at least one of the last three years.
Provide health services in psychology.
Pass an APA College of Professional Psychology examination.
To stay certified, recipients must then take 18 hours of continuing education during each three-year certification period.
General psychologists may not know about the latest behavioral treatment options, explains Glantz, who helped write examination questions. They may not be aware of new medications that reduce craving or block the pleasurable effects of drugs or know how to find a psychopharmacologist to work with. They may not even understand substance abuse itself.
Linda J. Dubrow, PhD, also certified by the college, a private practitioner with the Verree Psychology Group in Philadelphia and director of counseling at Manor College in Jenkintown, Pa., agrees.
Without specialized training, she says, psychologists may not realize all the special issues that arise in treating substance abusers. For one thing, generalists may not even recognize that clients have substance abuse problems. Denial that a problem exists is a hallmark of substance abuse. Substance abuse typically occurs alongside depression and other psychopathologies. And clients in outpatient settings typically don't match the stereotype of skid row addicts, Dubrow explains, noting that most of her clients still have jobs, families and homes.
Generalists may also fail to understand how difficult substance abuse treatment is, says Dubrow, noting that inexperienced treatment providers often view clients' relapses as signs of their own failure. Psychologists treating substance abuse also have to consider the ethical issues associated with what is often mandated treatment, she adds. The college where Dubrow works, for instance, requires students whose alcohol or drug problems disrupt dormitory life to receive counseling if they wish to remain in college housing.
Although Dubrow began treating substance abuse when veterans brought heroin and other addictions home from Vietnam, she welcomed the opportunity to update her knowledge by preparing for certification.
"I may be a nerd, but I enjoyed studying for the certification exam," she says. "If you're not in an academic setting, it's hard to stay on top of everything. Studying for the exam forced me to learn about all the current research, which has been very helpful in my practice."
The certification does more than just ensure that psychologists have an appropriate knowledge base, however. In some cases, it has helped them tap new markets.
Take New Hampshire's impaired driver intervention program, for example. Until a few years ago, only certified or licensed alcohol and drug counselors could provide treatment to people caught driving under the influence. Now the state accepts psychologists holding the APA certificate as well.
"That opened up a whole new population for us," says Manchester, N.H., practitioner Eric G. Mart, PhD, who rejected the idea of earning a counseling certificate out of loyalty to his professional identity as a psychologist. "Psychologists are chasing fewer patient dollars, so anything that increases the availability of patients is going to be good for our practices."
Certification has also added to his credibility when he's doing more general forensic work, says Mart, whose interest in substance abuse treatment evolved out of his work evaluating juveniles for substance abuse for the local child protective services department.
Having the certificate also gives recipients added credibility with third-party payers. When insurers ask for proof of his ability to treat substance abusers, for instance, Meyer Glantz simply sends them a copy of his proficiency certificate.
Brian D. Wener, PsyD, a private practitioner in Portsmouth, N.H., and Newburyport, Mass., highlights his certification in the marketing materials he distributes to potential referral sources. Wener, who also participates in New Hampshire's impaired driver program, has a brochure featuring the credential. He also runs ads mentioning his certification in the New Hampshire Bar directory.
"I'm one of only a dozen or so psychologists in the whole state who has the certification," says Wener, whose family-oriented practice has been increasingly pulled toward a substance abuse specialty as his clients wrestle with issues like teenage marijuana use or parental drinking. "It helps me stand out."
A growth field
As Wener's experience suggests, substance abuse treatment is a growth field.
For psychologist Grady Dale Jr., EdD, who holds the college's certificate, the pervasiveness of substance abuse has shaped his career.
"I happen to work in an urban area, so I see substance abuse all around me," says Dale, now the administrator for mental health and substance abuse policy and services at the Maryland Department of Juvenile Justice in Baltimore. "But the need to be aware of and treat substance abuse is becoming more and more important everywhere. We have a whole cadre of kids coming up who are using drugs."
It isn't just psychologists who specialize in substance abuse treatment who need to keep up with the latest research, however. Although obviously not every psychologist needs certification, all need to know at least the basics of diagnosing and treating alcohol- and drug-related problems, emphasizes Steve K. Dubrow-Eichel, PhD, who runs the Verree Psychology Group along with ex-wife Linda Dubrow.
"I've had a lot of psychologists say to me, 'I don't want to work with substance abuse,'" says Dubrow-Eichel. "I say, 'Well, how do you intend to avoid it?' It's like a physician saying, 'I don't want to work with people who have influenza.' It's just so pervasive."
Rebecca A. Clay is a writer in Washington, D.C.