A competency is a skilled trait that demonstrates a high standard of knowledge in a given area. Competencies include required knowledge, skills, and attitudes to perform tasks and responsibilities essential to addiction treatment (U.S. Department of Health and Human Services, 2006). Continued education and professional development are important elements of developing and refining competencies. Intentionally seeking development opportunities and keeping current on the many changes in your profession can enhance the effectiveness of the treatment you provide. It is important that addiction professionals are aware of the competencies required for addiction treatment, including their own strengths and limitations, in order to improve professional development. For this Assignment, review the resources and select three competencies that you consider most important for an addiction professional. Support your response with references to the resources and current literature. Submit a 2- to 3-page paper that addresses the following: (Use 3 APA references, be detailed in response and use sub-headings) Describe the three competencies that you selected and explain why you consider these the most important competencies for addiction professionals. Explain any competencies that you may need to further develop and explain why. Describe professional development opportunities that you might participate in to strengthen professional competencies. REferencesCapuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). New York, NY: Pearson Education, Inc.Chapter 4, “Important Professional Issues in Addiction Counseling” (pp. 66-86)Lambert, M. T. (2002). Linking mental health and addiction services: A continuity-of-care team model. The Journal of Behavioral Health Services & Research, 29(4), 433–444.
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Addiction
Counseling
Competencies
The Knowledge, Skills, and
Attitudes of Professional Practice
21
TAP 21
Technical Assistance Publication Series
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ADDICTION COUNSELING
COMPETENCIES
The Knowledge, Skills, and
Attitudes of Professional Practice
Technical Assistance Publication (TAP) Series
21
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
5600 Fishers Lane
Rockville, MD 20857
Acknowledgments
A number of people deserve recognition for their tireless and dedicated work on this document. The publication was originally conceived and written by the National Addiction Technology Transfer Center (ATTC)
Curriculum Committee. The Committee, one of six national committees designed to serve the ATTC Network,
comprises representatives from several ATTC Regional Centers and the ATTC National Office. This group was
responsible for the original 1998 publication and for the 2000 draft on which this updated edition is based
(see page v). A second Committee convened in 2005 to update and finalize the current document (see page
vi). Karl D. White, Ed.D., and Catherine D. Nugent, M.S., served as the Center for Substance Abuse Treatment
(CSAT) ATTC Project Officers. Christina Currier served as the CSAT Government Project Officer. This
publication was produced by JBS International, Inc. (JBS), under the Knowledge Application Program (KAP)
contract number 270-04-7049.
D
The views, opinions, and content of this publication are those of the authors and do not necessarily
reflect the views, opinions, or policies of SAMHSA or HHS.
Public domAin notice
All materials appearing in this volume except those taken directly from copyrighted sources are in the public
domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the
source is appreciated. However, this publication may not be reproduced or distributed for a fee
without the specific, written authorization of the Office of Communications, SAMHSA, HHS.
E
This publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page at http://
store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).
R
Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and
Attitudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. HHS Publication No.
(SMA) 15-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
O
Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for
Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane,
Rockville, MD 20857.
HHS Publication No. (SMA) 15-4171
First Printed 2006
Revised 2007, 2008, 2009, 2011, 2012, 2013, 2014, 2015, and 2017
No substantive revisions have been made to this publication since its original printing.
C
Curriculum Committees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
1998 National ATTC Curriculum Committee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
2005 Update Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Section 1: Transdisciplinary Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
I. Understanding Addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
II. Treatment Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
III. Application to Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
IV. Professional Readiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Section 2: Practice Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
I. Clinical Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
II. Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
III. Referral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
IV. Service Coordination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
V. Counseling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
VI. Client, Family, and Community Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
VII. Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
VIII. Professional and Ethical Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Section 3: Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Cultural Competency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Internet Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Attitudes Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Recovery Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Section 4: Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
A. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
B. The Competencies: A Complete List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
C. National Validation Study: Defining and Measuring the Competence
of Addiction Counselors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
D. Complete Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
E. Other Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
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1998 nAtionAl Attc curriculum committee
Affiliations indicated below are those at the time of the work.
David A. Deitch, Ph.D. (Chair)
Pacific Southwest ATTC
University of California San Diego
La Jolla, California
Alan M. Parsons, M.S.W., ACSW
Northeastern States ATTC
State University of New York at Albany
Albany, New York
G.E. Carrier, Ph.D.
Representing the Texas ATTC
Alvin Community College
Alvin, Texas
Nancy Roget, M.S., MFT, LADC
Mountain West ATTC
University of Nevada–Reno
Reno, Nevada
Steven L. Gallon, Ph.D.
Northwest Frontier ATTC
Oregon Health and Science University
Salem, Oregon
Susanne R. Rohrer, RN, M.B.A.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
Washington, D.C.
Paula K. Horvatich, Ph.D.
Mid-Atlantic ATTC
Virginia Commonwealth University
Richmond, Virginia
Mary Beth Johnson, M.S.W.
ATTC National Office
University of Missouri–Kansas City
Kansas City, Missouri
Hendi Crosby Kowal, M.P.H.
DC/Delaware ATTC
Danya International, Inc.
Silver Spring, Maryland
Linda Nicholas
Great Lakes ATTC
University of Illinois–Chicago
Jane Addams School of Social Work
Chicago, Illinois
Anne Helene Skinstad, Psy.D.
Prairielands ATTC
University of Iowa
Iowa City, Iowa
Patricia L. Stilen, LCSW, CADAC
Mid-America ATTC
University of Missouri–Kansas City
Kansas City, Missouri
Susan A. Storti, RN, M.A.
ATTC of New England
Brown University
Providence, Rhode Island
Elleen M. Yancey, Ph.D.
Southeast ATTC
Morehouse School of Medicine
Atlanta, Georgia
v
Addiction Counseling Competencies
2005 uPdAte committee
Paula K. Horvatich, Ph.D. (Chair)
Mid-Atlantic ATTC
Virginia Commonwealth University
Richmond, Virginia
Carol Davidson, M.S.W., CDP
Evergreen Treatment Services
Seattle, Washington
Steven L. Gallon, Ph.D.
Northwest Frontier ATTC
Office of Alcohol and Drug Abuse Programs
Salem, Oregon
Michael Hoge, Ph.D.
Annapolis Coalition
Yale University
New Haven, Connecticut
James Holder, M.A., LPC-S, MAC
National Association for Alcohol and
Drug Addiction Counselors
McLeod Behavioral Health
Florence, South Carolina
Mary Beth Johnson, M.S.W.
ATTC National Office
University of Missouri–Kansas City
Kansas City, Missouri
Linda Kaplan, M.A.
National Association for Children
of Alcoholics
Rockville, Maryland
Captain Florentino (Tino)
Merced-Galindez, M.S.N., RN
Center for Substance Abuse Prevention
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Randolph Muck, M.Ed.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Paul D. Nagy, M.S., LCAS, LPC, CCS
Duke Addictions Program
Duke University Medical Center
Durham, North Carolina
Nancy Roget, M.S., MFT, LADC
Mountain West ATTC
University of Nevada–Reno
Reno, Nevada
Gerard J. Schmidt, M.A., LPC, MAC
NAADAC–The Association for Addiction
Professionals
Valley HealthCare System
Morgantown, West Virginia
Michael Shafer, Ph.D.
Pacific Southwest ATTC
Tucson, Arizona
James L. Sorensen, Ph.D.
San Francisco General Hospital
University of California–San Francisco
San Francisco, California
Patricia L. Stilen, LCSW, CADAC
Mid-America ATTC
University of Missouri–Kansas City
Kansas City, Missouri
Deborah Stone, Ph.D.
Center for Mental Health Services
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Pamela Waters, M.Ed., CAPP
Southern Coast ATTC
Florida Certification Board
Tallahassee, Florida
vi
F
Counselors who treat people with substance use disorders do life-changing work on a daily
basis, amid difficult circumstances that include staff shortages, high turnover, low salaries,
and scant program funding. Counselors come to this important work by various paths and
with vastly different skills and experience. The diversity of backgrounds and types of
preparation can be a strength, provided there is a common foundation from which counselors
work. This publication addresses the following questions: What professional standards should
guide substance abuse treatment counselors? What is an appropriate scope of practice for
the field? Which competencies are associated with positive outcomes? What knowledge,
skills, and attitudes (KSAs) should all substance abuse treatment professionals have in
common?
Workforce development is essential to the field of substance use disorder treatment.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has included
workforce development in its Matrix of Priority Programs. A major focus of this workforce
development strategy is improving the competencies of professionals in the field. This updated
edition of Technical Assistance Publication (TAP) 21: Addiction Counseling Competencies:
The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) is a key
component of that strategy.
In 1998, in cooperation with its Addiction Technology Transfer Center (ATTC) Network,
SAMHSA published TAP 21, a comprehensive list of 123 competencies that substance abuse
treatment counselors should master to do their work effectively. TAP 21 has been used to
develop and evaluate addiction counseling curricula, advise students, and assess counseling
proficiencies.
The overarching competencies in this updated version of TAP 21 remain largely unchanged
from the original TAP 21. The KSAs have been changed from those in the 1998 edition when
necessary, in light of new thinking in the field. The competencies and the KSAs in practice dimensions that address clinical evaluation and treatment planning have been revised to reflect
changes in the field. The competencies are defined by sublists of the KSAs needed to master
each competency. Bibliographies have been supplemented with new publications through 2005.
The format has been improved to make the information more accessible and useful.
SAMHSA’s TAP series provides a flexible format for the timely transfer of important technical
information to the substance abuse treatment field. This updated version of TAP 21 exemplifies
the flexibility of the TAP format. We are grateful to the members of the ATTC Network and staff
and to all those who participated in the validation and updating of these competency lists.
Kana Enomoto, M.A.
Acting Deputy Assistant Secretary
Substance Abuse and Mental Health Services Administration
Kimberly A . Johnson, Ph.D.
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
vii
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I
In 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the
Center for Substance Abuse Treatment (CSAT) published Addiction Counseling Competencies:
The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) as Technical
Assistance Publication (TAP) 21. Developed by the National Curriculum Committee of the
Addiction Technology Transfer Center (ATTC) Network, TAP 21 identifies 123 competencies
that are essential to the effective practice of counseling for psychoactive substance use
disorders. TAP 21 also presents the knowledge, skills, and attitudes (KSAs) counselors need
to become fully proficient in each competency.
TAP 21 has been widely distributed by SAMHSA’s Public Engagement Platform (PEP) and the
ATTC Network. It has become a benchmark by which curricula are developed and educational
programs and professional standards are measured for the field of substance abuse treatment
in the United States. In addition, it has been translated into several languages.
Because the ATTC Network is committed to technology transfer, after the initial publication
of TAP 21, the National Curriculum Committee began exploring ways to enhance the document for future printings. Successful technology transfer requires more than presenting good
information. It entails transmitting scientific knowledge in a way that makes it understandable,
feasible to implement in a real-world setting, and supportable at a systematic level—in other
words, getting the right information across in a way that makes it useable. The National
Curriculum Committee examined how best to package and present TAP 21 to help people
learn key elements and adopt new strategies. The result was a revision of TAP 21—a process
that was begun in 2000, was completed in 2005, and resulted in the current publication.
History of The CompeTenCies
In 1993 CSAT created a multidisciplinary network of 11 ATTC Regional Centers geographically
dispersed across the United States and in Puerto Rico and the U.S. Virgin Islands. Since its
inception, the ATTC Network has collaborated with diverse international, national, State,
regional, and local partners from multiple disciplines to recruit qualified addiction treatment
practitioners and enhance academic preparation and professional development opportunities
in the substance abuse treatment field.
The National Curriculum Committee, composed of ATTC Directors, was established at the
Network’s inaugural meeting. The committee’s initial charge was to collect and evaluate
existing addiction educational and professional development curricula and establish future
priorities for ATTC curriculum development. This effort led to researching existing practice
and professional literature and defining an extensive list of addiction practice competencies
determined to be essential to effective counseling for substance use disorders. These initial
competencies would serve as benchmarks to guide future ATTC curriculum design, development, and evaluation.
1
Addiction Counseling Competencies
In addition to its own work, the National Curriculum Committee reviewed and incorporated
other publications on the work of addiction counselors.1 In 1995 the committee’s work
resulted in the ATTC publication Addiction Counselor Competencies. Subsequent to this
publication, the ATTCs conducted a national survey to validate the competencies (see appendix
C). Results supported virtually all of the competencies as being essential to the professional
practice of addiction counseling.
In 1996, the International Certification and Reciprocity Consortium (ICRC) convened a national
leadership group to evaluate the need for model addiction counselor training. After careful
deliberation, the group concluded that much of the work to define such a curriculum standard
had already been accomplished by the ATTC National Curriculum Committee and the ICRC in
the National Curriculum Committee’s Addiction Counselor Competencies and the ICRC’s 1996
Role Delineation Study,2 respectively.
Soon after, CSAT agreed to fund a collaborative effort to finalize a document that could be used
as a national standard. CSAT convened a panel—The National Steering Committee for Addiction
Counseling Standards (NSC)—that comprised representatives from five national educational,
certification, and professional associations. The NSC was successful in achieving unanimous
endorsement of the Addiction Counselor Competencies—a milestone in the addiction
counseling field.
Based on this foundation, the National Curriculum Committee began to delineate the KSAs
that undergird each competency statement. Input was solicited from a number of key national
organizations and selected field reviewers. In 1998 CSAT published the results of this groundbreaking work as TAP 21 (The Competencies).
After TAP 21 was published, the National Curriculum Committee systematically conducted
focus groups and a national survey to elicit feedback from the field about the impact of TAP 21.
Although feedback was uniformly positive and thousands of copies of TAP 21 were disseminated
through SAMHSA’s PEP and the ATTC Network, refinements were needed to improve the utility
of the publication and enhance its effect in both the addiction practice and educational systems.
Feedback obtained from the survey and the focus groups indicated a need for additional information to help the field incorporate the competencies into daily practice. Feedback also suggested
that there was no need to change the competencies. The most common suggestions were to
refine the 1998 publication by presenting the content in a more user-friendly fashion and linking
it to professional literature and specific applications. The National Curriculum Committee revised
TAP 21 in 2000 based on the feedback of dedicated addiction practice and education professionals;
however, this revision was never published.
A new Update Committee was convened in 2005 to update the revised 2000 edition with literature
published between 2000 and 2005. The Update Committee consisted of some of the original members from the National Curriculum Committee; representatives from NAADAC—The Association for
Addiction Professionals, CSAT, the Center for Mental Health Services, the Center for Substance
Abuse Prevention, the National Association for Children of Alcoholics, and the Annapolis Coalition;
treatment providers; and experts in addiction research. The current updated edition retains
all of the feedback-based improvements of the 2000 revised version and adds relevant literature
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