Abstract
Nominal career ladders for alcohol and drug treatment positions have been outlined by the Substance Abuse and Mental Health Services Administration and professional organizations. In theory, workers can move along a nominal ladder by gaining experience, education and licensure/certification. However, it is not clear that the ladders function well, given high turnover rates, recruitment difficulty, and a lack of diversity. Further, there are factors which affect career ladders’ impact on career decisions, such as structural influences on job availability and quality, and social network influences on career choices. The lack of a perceived career path has been associated with increased turnover from behavioral health organizations providing substance use services.The purpose of this dissertation is to inform policy and practice in career path implementation for the alcohol and drug treatment workforce, by focusing on extant career paths. Social Cognitive Career Theory informed understanding of individual career choice-making given personal, social and environmental influences. Ecosocial Theory enhanced understanding of structural influences on those choices. The research characterized career patterns in a state-licensed specialty alcohol and other drug treatment system and examined related factors, by (1) delineating actual career pathways and exploring predictors, and (2) identifying barriers and facilitators for entering, staying, and progressing in the field. This study also surfaced aspects of career paths which differ for some marginalized workers, such as those in entry-level positions and under-represented racial groups.
This was a mixed methods study. Secondary data stem from a single state agency responsible for licensing addiction treatment services, comprised of information on licensed and non-licensed staff in positions required by regulations. Group-based Trajectory Modeling was used to identify patterns in worker transitions, and multivariate analyses identify related factors. Survey and interviews of the specialty workforce provided primary data to inform interpretation of quantitative data, and to help identify barriers and facilitators through workforce members’ descriptions of their career path experiences.
Despite wide variation in individual career paths, the dissertation found discrete career patterns with 15-20% of workers in rising paths, and 75-80% in low, medium or higher-level stable paths. Having a bachelor’s degree or above, and having licensure or certification, were independently correlated with being in rising versus stable paths. Those who are Black had about half the likelihood of being in a rising path from entry-level, compared to those who are White. Entering the field was most frequently due to personal experience of one’s own or another’s addiction (70%). Most workers report little or no training on cultural beliefs and practices related to alcohol or other substances, but believe such knowledge is important to improve engagement of under-represented communities in treatment, which they in turn believe would help increase diversity in the field. Jobs which provide conditions for thriving versus feeling stuck, and opportunity for growth, were perceived as strengths, and organizations which implement workforce diversity practices were more attractive to both represented and under-represented racial groups. Compensation from a given job varies in perceived ability to support an individual or provide primary income for a household, or to pay for education needed to progress professionally. Stigma against addiction was perceived as a barrier to recruitment. Despite these challenges, respondents reported intense passion for the field, a desire to help others, and commitment to learn more and grow their skills.
National, state and organizational policy and practice efforts to address chronic addiction workforce shortages on many of these points continue to evolve, but so far the challenges remain. Focusing on career path implementation, and adapting existing workforce development approaches to some of the unique combination of factors affecting the addiction workforce may help increase effectiveness. This dissertation is the first to follow extant career paths in addiction services, examine the proportions who rise or remain in stable paths, and characterize factors which support or hinder the identified paths.