Burning Out the Gaslight: Addiction Psychologists and Rehab Culture
Chairing Outreach and Dissemination for Division 50 means bringing Professors, Students, Researchers, Clinicians/Clinical Supervisors, and Treatment Facility Executives across the United States together in hopes of collaboratively translating research into practice and practice into research. The current range of professional and public opinions regarding substance use may result in coursework and supervised professional experience varying significantly. This incompatibility can leave students questioning themselves (i.e., feeling gaslit) in unhelpful ways that increase risk of burnout and negatively impact patient experiences.
If students fail to follow the direction of their supervisor or their professor, they are at risk of disciplinary action that could lead to expulsion. The stakes are high, the power dynamics are palpable, and the path forward is not always clear for trainees.
As an Adjunct Professor, I currently teach Issues in Chemical Dependency and Treatment, Advanced Ethics and Professional Issues, and Clinical Supervision and Consultation in the PhD program at the California School of Professional Psychology (CSPP). Students from CSPP are a large provider of mental health services for substance use disorders across treatment facilities in San Diego. While hearing about student experiences in these classes, I observe many students experiencing burnout, because they must engage in code switching between their clinical supervisors at abstinence-only drug rehabs and professors teaching evidence-based practices like harm reduction. There are substantial disagreements between our long-established rehab culture in the United States and the progressing scientific views in addiction psychology.
If you practice clinical psychology, you likely treat addictive disorders at some point in your practice either knowingly, or unknowingly. Trainees in counseling and clinical psychology are likely to encounter individuals with diagnosable substance use disorders (SUDs) well before they receive coursework on how to diagnose and treat corresponding symptoms. Clinical psychology trainees make up the bulk of the clinical workforce at many facilities treating SUDs because student labor is either steeply discounted or free.
In hopes of starting a broader discussion within the Division about preventing graduate student burnout in addiction psychology, I offer three potential solutions.
Increase Clinical Translation Efforts in Addiction Psychology
- A recurring round table discussion that includes all those involved in the treatment of addictive disorders could allow our outreach and dissemination efforts to reach more corners of our field.
- Programming and continuing education efforts focused on translational science could decrease the lag time between research base establishment and clinical integration.
Bring Treatment Facilities into the Discussion
- Increased Division 50 conversations with the executive directors, founders, and other important leaders at the treatment facilities across the United States could contribute to the dissemination of newly established research with the direct care providers at the front lines of addiction treatment.
- Facilitate bidirectional conversations between providers and researchers. Listening to one another may lead to the field of addiction psychology progressing in a direction that meets the unique needs of all people receiving substance use treatments.
Develop Co-Led and Panel Led Programming
- Include a researcher/professor, a clinician, a treatment program owner/founder/other representative, and at least one person with relevant lived experience in discussions about programming for addiction treatment.
- Exposure to differing opinions will help us think creatively about how to work together within the boundaries of our field as it stands today. More voices will support the discovery of a sustainable balance.
Invest in Collaborative Community Spaces
- Developing programing, events, and online spaces that facilitate interaction around the round table of people working in addiction psychology can improve the ease of information dissemination.
Invest in Graduate Students to Improve Patient Care
Acknowledge the Gaps & Lag Time Between Research and Practice
- The lag time between research and practice can last years. Student ambitions and aspirations are at risk of becoming frustrated so learning to accept the pace at which things change is essential.
- Sharing this information in practical ways to facility owners may further the development of this relationship.
Normalize Grievance Procedures and Create Effective Follow Up
- Schools and training programs with an accreditation are likely to have a grievance process. It is important for trainees to feel comfortable about offering feedback through these processes without fear of retaliation
- Focus research efforts on common grievances in SUD treatment program training experiences.
- Code switching is exhausting and can contribute to burnout because people tend to feel inauthentic when they cannot speak in a consistent, familiar, and honest way. It is important to validate and normalize code switching fatigue during grievance procedures.
- Variation between classrooms and training sites likely contributes to unpredictability, which can increase stress levels. Normalizing these experiences is important when trainees share about these experiences with professors, site liaisons, and supervisors.
Diplomacy and Networking “Across the Aisle”
- Develop programming on behavioral ethics to increase compassion and understanding for opposing opinions within the division and at SUD treatment facilities across the United States.
- Researching the experience of graduate students in psychology programs who receive supervised clinical experience at SUD facilities will provide clarity on how addiction psychologists and US rehabs can work together more effectively and collaboratively. This collaboration could facilitate the provision of community defined care with quality supervision that aligns with curriculum in courses teaching evidence-based treatments for addiction.
Offer Trainings to Local Treatment Facilities
Accessibility to evidence based, community defined treatments is essential. Many treatment programs are working with limited budgets, staffing challenges, and large yet essential marketing costs. Budgets for education and training are limited, so volunteers can make a big difference. As a division, we could organize an effort to disseminate our expertise to the treatment facilities helping people with addictive problems.
Harm Reduction and Moderation Management
Harm reduction and moderation management treatments are important to share with clients to help them make informed decisions about treatment options. Two primary points to keep in mind are:
- Sharing information that could save a life by decreasing risk is imperative.
- Helping people set realistic, self-defined goals that create room for self-respect is ethical.
Family and Friends Resources and Support
- Support families with the inevitable challenges that come with navigating the current mental health care systems in the United States.
- Knowledge of different approaches to family support for problematic substance help providers make individualized referrals.
Medication Assisted Therapies
- People in the United States are gaining more access to medication assisted therapies than ever before.
- Many programs in the United States still do not offer these treatments.
Dissemination of current research on the use of these and other interventions that show promise in the treatment of addictive problems is critical. The research is ever evolving, yet the infrastructure for dissemination we create can change and save the lives of people struggling with addictive problems.
Resources are available for those struggling with addiction and numerous effective treatments exist. Whether you are looking for help for yourself or a loved one, we encourage you to seek out help.