BILL ANALYSIS                                                                                                                                                                                                    







           ---------------------------------------------------------- 
          |Hearing Date:  April 30, 2001  |Bill No:SB                |
          |                               |537                       |
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                    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:






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          (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  





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            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.






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           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  





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            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  





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            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  





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            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  





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            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  





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            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  





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            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  





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            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)





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           California Association of Addiction Recovery Resources  
                     (CAARR - Oppose unless Amended)
           California Association for Alcohol/Drug Educators (CAADE -  
                     Oppose unless Amended)



          Consultant:  Jay J. DeFuria