Trauma Training, Practice, and Secondary Traumatic Stress among Substance Abuse Counselors

Background and Purpose: High rates of comorbid substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are well-documented in treatment-seeking substance abusers. Clinical researchers recognize that SUD and PTSD symptoms are interwoven and emphasize the need for concurrent treatment. However, it is believed that PTSD is underassessed, underdiagnosed, and undertreated in many substance abuse treatment centers, decreasing the effectiveness of substance abuse treatment services. The high rate of comorbid SUD-PTSD also places counselors at risk for secondary traumatic stress (STS). STS has yet to be empirically studied in substance abuse counselors. The purpose of this study was to determine to what extent substance abuse counselors are trained to and, in fact, do assess and treat trauma and PTSD; and to determine to what extent substance abuse counselors experience STS.

Methods: A total 242 (24% response rate) members of the National Association of Alcohol and Drug Addiction Counselors (NAADAC) completed a survey that included measures of demographic and professional characteristics, trauma-specific education and training, trauma assessment and treatment practices, and secondary traumatic stress.

Results: Most counselors make at least limited inquiries regarding clients' trauma histories, though some traumas are assessed more consistently than others. Between 2/3 and 3/4 of counselors indicated that they always screen for childhood sexual and physical abuse, sexual assault in adulthood, and domestic violence. However, clients' experiences with violent crime, disaster, and PTSD symptoms were assessed less frequently. Approximately half of counselors reported that they address trauma/traumatic stress on clients' treatment plans or in individual counseling. On the other hand, more than a third of counselors rarely address trauma in treatment plans or individual counseling. Only a third of counselors regularly address clients' trauma issues in group counseling and nearly half rarely do so. Nearly all (97%) of the counselors in this study had traumatized clients on their caseload and more than three-quarters of counselors indicated that at least 25% of their caseload had experienced trauma in their lives. 75% of counselors experienced at least one symptom of STS in the previous week, 56% met the criteria for at least one of the core symptom clusters, and 19% met the core criteria for a diagnosis of PTSD.

Conclusions: The results indicate that most substance abuse counselors are not being prepared for practice with traumatized populations in their formal academic or internship/practicum training, though they are receiving some training through continuing education. In addition there is a great deal of variance in the degree to which trauma and PTSD are assessed and treated in substance abuse settings. As such, strategies to increase the implementation of trauma-focused services should be identified and implemented. These findings also highlight the need to attend to the issue of STS among substance abuse counselors. STS is believed to be one reason why many counselors leave the field prematurely. Given the high rate of turnover in the substance abuse field and its negative impact on service delivery, it is important to identify and address factors that may contribute to counselor attrition.