BILL ANALYSIS
----------------------------------------------------------
|Hearing Date: April 30, 2001 |Bill No:SB |
| |537 |
----------------------------------------------------------
SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: SB 537Author:Vasconcellos
As Amended:April 3, 2001 Fiscal: Yes
SUBJECT: Alcohol and drug abuse counselors.
SUMMARY: Creates state licensing and regulation for
persons who provide alcohol and drug dependency counseling
services for compensation by a new Board of Alcohol and
Drug Abuse Counselors within the Department of Consumer
Affairs.
Existing law:
1)Provides for the licensing and regulation of by various
healing arts practitioners, including those who provide
counseling-related services, such as psychologists
licensed by the Board of Psychology, and social workers
and marriage and family therapists licensed by the Board
of Behavioral Science.
2)Provides for the licensing and regulation of narcotic
treatment programs (NTPs) by the California Department of
Alcohol and Drug Programs (DADP).
3)Does not require the licensing or regulation of persons
who provide alcohol and drug dependency-counseling
services for compensation.
This bill:
1)Licensing Board . Creates within the Department of
Consumer Affairs, the California Board of Alcohol and
Drug Abuse Counselors (Board), composed of nine members
as follows:
SB 537
Page 2
(a) Eight licensees: two of whom are to be voting members
of the National Association of Alcoholism and Drug Abuse
Counselors, two of whom are to be alcohol and drug abuse
counseling educators, two others of whom are to have a
background in social model recovery programming, and the
remaining two licensees are not specified to have any
other particular background.
(b) One consumer of alcohol or drug abuse counseling
services who is not a licensee or employed in the alcohol
or drug abuse counseling field.
2)Registration and licensing authority . Provide for the
registration and licensing by the Board of persons who
render alcohol and drug dependency counseling services,
or related services , for compensation, to an individual,
group, organization, corporation, institution, or the
general public.
3)Registration and Licensing categories and qualifications .
Specifies one category of registration and three
categories of licensing, and specifies the criteria
required for issuance of a registration or a license as
follows:
(a) Registration - if the applicant is a California
resident, at least 18 years old, has completed a
professional ethics and orientation class, and has signed
a code of ethics approved by the Board.
(b) Licensed Addiction Counselor I : if the applicant is a
California resident, at least 18 years old, has graduated
from high school or possesses a general education
development equivalent (GED), has at least 2080 hours of
experience working with chemically dependent persons in a
supervised setting, and has completed 90 hours of
classroom education or training in a Board approved
curriculum; OR has current certification as a Certified
Addiction Specialist by the California Association of
Addiction Recovery Resources; OR has certification as a
Certified Addiction Specialist by the California
Association of Addiction Recovery Resources
(c) Licensed Addiction Counselor II : if the applicant is
a California resident, at least 18 years old, has a high
school degree or a general education development
SB 537
Page 3
equivalent, has completed 315 hours of classroom
instruction in a Board-approved curriculum, has 4000
hours of experience working with chemically dependent
persons in a clinically supervised setting, has completed
300 hours of field work in a clinically supervised
setting, has submitted two letters of reference from
licensees, and has passed a Board-approved oral and
written exam; OR has current certification as an alcohol
and drug abuse counselor by the National Association of
Alcoholism and Drug Abuse Counselors, the California
Association of Alcoholism and Drug Abuse Counselors, the
International Certification and Reciprocity Consortium,
or by the California Association of Alcohol and Drug
Educators;
(d) Licensed Addiction Practitioner : if the applicant
meets all of the requirements for licensing as a Licensed
Addiction Counselor II (Item(c) above) and has a master's
or doctorate degree in alcohol and drug counseling or a
related human services field from a Board-approved
college; OR who meets all of the requirements for
licensing as a Licensed Addiction Counselor II (Item (c)
above) and who has a bachelors degree in addiction
counseling or a related human services field, and five
years of counseling experience.
4)Grandfather licensing clauses . Limits the duration of
the alternate "grandfather" provisions for license
qualification for a Licensed Addiction Counselor I or II
and a Licensed Addiction Practitioner (i.e., the "OR "
alternative qualifications in paragraphs (c), (d) and (e)
above) to one year, until January 1, 2003.
5)Provisional Licenses . Authorizes the Board to issue a
five (5) year "provisional license" for a Licensed
Addiction Practitioner to an applicant who meets all of
the licensing criteria for a Licensed Addiction Counselor
II and who is currently enrolled in a bachelor's or
master's degree program that satisfies the requirements
for licensing as a Licensed Addiction Practitioner.
Allows one five (5) year renewal of a five (5) year
provisional license (thereby allowing 10 years of
provisional licensure), and terminates the Board's
authority to issue provisional licenses in four years, on
January 1, 2006.
SB 537
Page 4
6)Authorized Licensed Practices .
(a) Authorizes a Licensed Addiction Counselor I or II to
perform screening, intake, orientation, assessment,
treatment planning, treatment, case management, substance
abuse, dependence crisis intervention, client education,
referral activities, recordkeeping, and consultation with
other healing arts professionals and in connection with
alcohol or drug abuse counseling, either while under the
supervision of a Licensed Addiction Practitioner or other
licensed medical or mental health professional, or while
employed in an alcohol or drug treatment program licensed
or certified by the state, a Department of Corrections
facility, or a hospital or clinic licensed by the State
Department of Health Services.
(b) Authorizes a Licensed Addiction Practitioner to perform
all of the above functions without any supervision in any
setting and to supervise, direct or instruct others who
provide alcohol and drug abuse treatment services.
7)Title protection . Makes it a misdemeanor for an
unlicensed person to use license titles or related
initials, or practice or attempt to practice alcohol and
drug abuse counseling. Exempts from these prohibitions:
(a) persons who are licensed to perform alcohol and drug
abuse counseling who does not use a license title or
representation that he or she is licensed, (b) members of
peer or self-help groups who do not use a license title
or representation, or (c) a student enrolled in an
accredited school of alcohol and drug abuse counseling
providing services under qualified supervision.
8)Fees and repealer . Requires the Board to assess an
unspecified fee for registration and license issuance and
renewal, and provides an unspecified date for repeal of
all of the bill's licensing provisions.
FISCAL EFFECT: Unknown. Legislative Counsel has keyed
this as a fiscal bill.
COMMENTS:
1.Purpose. This bill is sponsored by the California
Association of Alcoholism and Drug Abuse Counselors
(CAADAC) to provide for the licensure of alcoholism and
SB 537
Page 5
drug abuse counselors at three tiers or levels to reflect
the training, experience and educational level of
counselors employed in a wide range of settings, and to
provide for registration for new counselors entering the
field.
The purpose of the new proposed state regulation is to
assure that persons who are counseling alcoholics and
drug addicts are competent and ethical.
2.Background. Current California law provides for the
licensing and regulation of alcoholism or drug abuse
recovery or treatment program, including narcotic
treatment programs, by the Department of Alcohol and Drug
Programs (ADP). However, state law does not mandate any
specific education or training to assure the minimum
competency or ethical behavior of persons who are
providing alcoholism or drug abuse counseling or
treatment within those programs.
There appear to be a number of private professional
certifying organizations, including but not limited to
this bill's sponsor, who have established their own
educational, training, and experience standards for
counselors. Materials provided by the CAADAC indicate
that there are approximately 1300 persons with valid
certification by CAADAC. Further, the sponsor states
that it has certified over 2500 people over the past 20
years, many of who continue to work without maintaining a
current certification.
Last year the voters passed Proposition 36 which provides,
effective July 1, 2001, that: (1) a person convicted of
a nonviolent drug possession offense shall receive
probation with completion of a drug treatment program as
a condition of probation; and, (2) a person's parole may
not be suspended or revoked for commission of a
nonviolent drug possession offense, or for violating a
drug-related condition of parole, and that an additional
condition of parole for those offenses or violations
shall be completion of a drug treatment program. As a
result of the passage of Prop. 36, it is anticipated that
there will be an increased demand for drug treatment
programs and counselors. According to the sponsor, there
have been over 200 new applications for drug program
certification/licensure since the passage of Prop. 36,
without a corresponding increase in the number of
SB 537
Page 6
certified counselors.
According to the sponsor, there are about 20 other states
that currently have some form of state licensure for
alcohol and drug abuse counselors. The education,
training and experience requirements in those states vary
from no educational requirement, to a high school diploma
or up to a master's degree; to no minimum number of
educational hours up to 270 hours; and from 880 hours of
supervised experience up to 6,000 hours, or 18 months of
training.
3.Arguments in Support. The author and sponsor argue, that
except for criminal penalties for sexual exploitation of
clients, there are no controls or regulations placed on
alcohol and drug abuse counselors to assure that they are
competent or ethical. They argue that the lack of
standards in the treatment of addicts borders on
discrimination, in that no other life-threatening disease
is treated by lay persons whose only qualification is
that they have had the disease (were addicts.) The
expectation that recovering addicts, who are the primary
source of new counselors, are unable to become educated
and tested for competency has resulted in the current
shortage of treatment providers according to proponents.
The lack of a "career ladder" and the scourge of abusive
counselors who are allowed to continue "treating" clients
are believed to have made the profession one in which the
pay is traditionally slightly higher than minimum wage.
This is said to lead counselors to pursue licensure by
other licensing boards or to move into administrative or
teaching positions to obtain better salaries, thereby
draining the talent from the profession and reducing its
capacity to serve the needs of the addicted. The
proponents believe that the bill would create a career
path that will lead to an increase counselors, both in
the short term and the long term.
The proponents argue that it is difficult to quantify
consumer harm because, unlike other medical conditions,
when poor treatment is received, the client is unaware
and inherently vulnerable to accepting responsibility for
failed treatment outcomes. Proponents also state that in
cases of abuse, particularly of women, the victims are
reluctant to speak out since their word as an addict is
SB 537
Page 7
likely to be discounted. It is argued that private
certification and the threat of revoking professional
credentials is ineffective because there are many certify
organizations and treatment programs for counselors to
circulate through, without being confronted with any
repercussions from their incompetent or unethical
actions.
According to the author, the inadequacy of the current law
has been exacerbated by the passage of Prop 36 and the
influx of $150 million in new funding each year for drug
treatment that will generate a great potential for fraud
and abuse. Because a drug abuse treatment program can
consist of a single individual of unproven
qualifications, it is argued that the potential of
referring addicts to unqualified persons is a grave one.
According to the author, the Department of Alcohol and
Drug Programs has conducted meetings on this subject for
over 10 years - but efforts to establish minimum
counselor requirements have been thwarted by the economic
stakeholders of the industry (the drug programs).
4.Arguments in Opposition. The California Association of
Marriage and Family Therapists (CAMFT) opposes the bill
unless it is amended to specify a "scope of practice"
that clearly delineates the limited services that may be
provided by alcohol and drug abuse counselors. CAMFT
believes that the bill should make it clear that it is
outside the scope of practice for such counselors to
diagnose and treat mental, emotional or nervous
disorders, and that the proposed licensing act
specifically should exempt persons who are appropriately
licensed, certified, or registered as physicians,
psychologists, marriage and family therapists, and
clinical social workers.
The California Psychological Association (CPA) opposes the
bill stating that it would allow "counselors" with
minimal education to work with critically ill drug and
alcohol abusers. The CPA notes that a substantial
portion of drug and alcohol addicted individuals also
suffer from co-occurring mental illness that can compound
the difficulties in treating the patient. The
SB 537
Page 8
psychologists argue that there are no requirements in the
bill that the proposed new counselor licensees have
training to recognize these types of conditions, nor does
the bill prevent undereducated counselors from treating
these more clinically complicated cases via the authority
for counselors to provide "related services."
The California Organization of Methadone Providers (COMP),
and organization composed of narcotic treatment programs
(NTPs) licensed by the State Department of Alcohol and
Drug Programs (DADP), also opposes the bill stating that
it does not believe the licensure of counselors will
improve the quality of care that patients receive in
state treatment programs. COMP states that opiate
addiction is significantly different from others kinds of
addictions and that counselors in state licensed NTPs
work with physicians and licensed nurses to provide
fairly specialized counseling services.
COMP points out that its experience in other states, which
require alcohol and drug counselor licensure, is that
most counselors do not receive specialized training in
opiate counseling. In those situations the methadone
clinics have had to provide counselors with that
specialized training and sometimes instruct counselors to
forget the inapplicable alcohol abuse training emphasized
by most licensure training programs. At a minimum, COMP
believes that the bill's licensure requirements should
not apply to NTPs that are licensed and regulated by the
state.
The California Society for Clinical Social Work opposes the
bill arguing that it would exclude professionals who are
already licensed to treat these addiction problems and
who have proven themselves to be the most effective in
doing that counseling.
The California Coalition of Addiction Certifying and
Credentialing Organizations (CCACCO), the California
Association of Addiction Recovery Resources (CAARR), and
the California Association for Alcohol/Drug Educators
(CAADE) are also all opposed to this bill. These three
organizations state that for the past six years they have
been working together with other organizations, including
the sponsor, which are interested in advancing the
concept of certification of persons who work in the
SB 537
Page 9
alcohol and drug program field. These opponents have
been working to try and reach some consensus on
legislation that would establish minimum standards for
workers and meet the needs of a diverse client
population, assure public safety, establish a career
ladder, honor the hard work and dedication of workers,
meet the needs of employers and be inclusionary of a very
diverse work force. To that end, these organizations
have developed their own working draft language for
establishing standards for alcohol and drug counselor
personnel. They believe that their proposal is a better
approach than that being put forward in the bill, and
would like to see it amended into the bill as a
substitute. One aspect that is different is that their
alternative would leave out private practice provisions
to be addressed separately.
5.Regulatory Request Questionnaire Provided by Sponsor.
Pursuant to Government Code 9148 et seq., the author or
sponsor of a proposal to create a new registration
program to regulate a profession must provide a plan for
the establishment and operation of the new program and/or
justification for regulating the particular profession.
The sponsor has been working to fulfill this requirement
by providing responses to a "Regulatory Request
Questionnaire" ("sunrise questionnaire") provided by the
Business and Professions Committee. Only a partial draft
of responses to that questionnaire was completed prior to
this analysis.
6.Issues, Questions and Concerns. As is most often the
case, this proposal for new state licensing is being
proposed by the occupational group who would be
regulated, and not by the consumers of the occupation's
services. This always raises some skepticism that the
proposed licensing scheme is self-serving rather than
necessary to protect the consuming public - in this case
alcohol and drug addicts. This is particularly true when
the standards being promoted for state licensure appear
to be the same as those which proponents already have met
to obtain private certification.
The intent of the author and the sponsor to assure
competent and ethical drug counseling service to the
public is laudable. However, it seems that the evidence
SB 537
Page 10
of the existence of a problem is largely theoretical,
subjective or anecdotal. There appears to be a
significant lack of consensus among the various private
professional organizations that are involved in alcohol
and drug abuse counseling regarding what form of state
regulation is warranted, and what the particular
educational and training standards should be. The
current proposal seems to have adopted the standards of
one of the many private certifying organizations and
simply placed them in proposed statutes.
The estimate as to the potential number of licensees seems
to be indefinite. The proposed licensing Board is
weighted heavily towards licensee representation (8
licensees to 1 "public" member), and even towards one
particular private organization - contrary to the
Legislature's trend in recent years to expand the
representation of the public on state occupational
licensing Boards. There does not appear to be a clearly
defined scope of practice related to the education and
training and activities of the proposed licensees. As
such the potential for overlap with other state licensed
professions seems likely to occur and create confusion.
The criteria for licensure seems to be rather vague and
appears to be leaving it up to the proposed Board to
determine. Unlike virtually all state occupational
licensing schemes, no examination is required to test the
basic skills and abilities necessary for the performance
of the profession's services. The grandfather and
provisional licensing provisions while accommodating to
those currently performing alcohol and drug counseling
services, appear to undercut the assurance that licensed
practitioners will have the minimum education and
training that is being proposed as needed to perform with
minimum competency.
It seems that, as with other professions that are licensed
by the state, it would make sense to have an independent
expert assess the available information to determine the
need for licensure, and to perform an occupational
analysis to determine the basic core knowledge, skills
and abilities that are necessary to perform competently
in this profession. Having that study and analysis
performed would seem to provide a better basis for
determining the need and degree of state regulation that
SB 537
Page 11
is warranted. Since the proposed licensing Board would
be placed in the Department of Consumer Affairs, having
the department's Office of Examination Resources perform
the study and analysis would seem to be one viable
option.
SUPPORT AND OPPOSITION:
Support:
Boyle Heights Family Recovery Center (Los Angeles)
California Association of the Alcoholism and Drug Abuse
Counselors
(CAADAC - sponsor)
California Narcotic Officers' Association
California Paramedical and Technical College (Long Beach)
California Society of Addiction Medicine (San Francisco)
College for the Advanced Study of Addictive Disorders
(Sacramento)
Cornerstone of Southern California (Tustin)
Crutcher's Serenity House (Deer Park)
Fred Brown Recovery Services (San Pedro)
Living Proof Recovery Center (Monrovia)
National Council on Alcoholism and Drug Dependence of the
San Fernando
Valley
Nevada County Substance Abuse Treatment and Recovery
Programs
Owens Valley Career Development Center, Vocational
Education
Program Manager of the St. Joseph's Hospital Chemical
Dependence
Tibur Cio Vasquez Health Center (East S.F. Bay)
Tierra Miguel Foundation (San Diego)
One alcohol/drug counselor
Opposition:
California Association of Marriage and Family Therapists
California Society for Clinical Social Work
California Psychological Association
California Organization of Methadone Providers (COMP)
California Coalition of Addiction Certifying and
Credentialing Organizations
(CCACCO - Oppose unless Amended)
SB 537
Page 12
California Association of Addiction Recovery Resources
(CAARR - Oppose unless Amended)
California Association for Alcohol/Drug Educators (CAADE -
Oppose unless Amended)
Consultant: Jay J. DeFuria