About the Substance Use and Addictions Workforce

The substance use and addiction workforce is made up of people at all levels of experience and education, from all types of backgrounds, working in a wide range of settings, from schools to doctor’s offices, residential treatment programs to peer recovery support centers, syringe service programs to mobile health vans, outpatient treatment programs to inpatient hospitals.

Substance use and addiction workers provide harm reduction counseling, outreach, case management, recovery coaching, prevention services, residential, community, and home-based treatment services, medication, individual and family counseling, support groups, trainings and technical assistance, and much more.

According to the most recent data collected on the BSAS-licensed treatment system workforce alone, at any given time, about 7000 people are working in positions required by regulations.

People who choose to work in the field of substance use and addiction (SU/A) services are passionate about serving some of the most marginalized and stigmatized residents of the Commonwealth. 

Reasons to choose work in this field:

  • Opportunities for Growth – the US Bureau of Labor Statistics predicts the field is and will keep growing, particularly given changes in the healthcare industry and ongoing need, and the fact that addressing the negative effects of SU/A can reduce future health and other societal costs for individuals
  • Chances to Make a Difference Every Day – changing the life of one person affects their family, community, workplace
  • Rewarding Teamwork – SU/A providers are working in multidisciplinary teams to address multiple facets of clients’ lives and needs
  • Expanding Understanding of the Brain– every day we understand more about the complex biological interactions, such as epigenetic changes which result from short term use, long term use, withdrawal, overdose, and also the ways in which the brain can repair itself once the unhealthy use has stopped
  • Increasingly Effective Social Interventions – new understandings of social components which support and reinforce recovery are adding to our growing understanding of social factors which relate to first use, risky use, and dependence
  • Complex Challenges – professionals in this field are continually looking for new ways to understand how physiology and medications, individual psychology, and family and community violence, racism, and trauma affect the people we are serving
  • Growing Emphasis on Equity, Inclusion, and Diversity – people who work in the field recognize the role the system of SU/A  services has played in creating and upholding barriers to services for members of marginalized communities. Black, Indigenous and other People of Color (BIPOC), individuals in the LGBTQIA+ community, folks with disabilities, and others have made it clear that the majority of services offered are not set up to meet their needs, or, worse, have contributed to their experiences of trauma.

For those who want to know more see additional topics below.

The field of addiction work spans many roles and professions, all working toward the goal of supporting people experiencing substance use and addiction, and those who want to enter into and sustain recovery. While the work may be organized in different ways across different organizations, in all cases it is important that every worker understand and be effective in at least these five areas:

  1. The basics of addiction;
  2. How to provide person-centered treatment (particularly with cultural humility and deeply well-implemented trauma-informed approaches);
  3. The ways their organization approaches addiction;
  4. The teamwork, coordination and technology needed; and
  5. The elements of a system of care.

At any given time, there are about 7000 people working in regulation-required positions in Massachusetts addiction treatment programs, from Recovery Specialists and Aides to Counselors, Nurses and Physicians. There are even more employed in positions which support or enhance those required positions, as well as in other recovery, prevention, and harm reduction work. In addition, many professions engage with addiction even if it is not their prime focus – for example, primary care physicians, first responders, oral health professionals, and teachers. The Bureau of Labor Statistics, the Center for Healthcare Workforce and other major national groups all predict the ongoing need for workers in addition-related fields.

Yet all those professions also face workforce shortages of their own. At a national level, there is a shortage of people working in addiction in total, in geographic distribution, and a lack of diversity (see the Surgeon General’s report from 2016 for an overview). In Massachusetts we face the same challenges – between one 2-year program licensure period and the next, about 50% of regulatorily required staff leave; and the workforce has historically been primarily white. However, this is changing: from one source, we see 50% of the people with 4 or fewer years of experience are over 40 years old, bringing their life and work experience into the field and renewing energy; at the same time, a third of the workforce is in their 30’s and a quarter in their 20s. So, there is age diversity in the workforce. There is also growing racial and ethnic diversity in the workforce in total, and in particular in those entering the field. This is a good trend, which Careers of Substance aims to help support.

There are also expansions of the type of roles, including new roles for peers (for example Recovery Coaches and Recovery Navigators). Peer supports can help people enter and sustain recovery, whether embedded in treatment programs or in non-clinical community settings, helping people engage in treatment or sustain treatment gains after treatment. There are many pathways of recovery, some of which involved clinical treatment and some of which do not. Peers can provide support along all of them.

Peer-to-peer service is a profoundly important part of the history of the field. There is an historic tension between professionalization of roles and the peer nature. The nature of service also may lead people who work in the field to accept lower compensation, because the personal reward is so great and the tradition of giving back is contrary to the idea of being compensated for providing support and care for others. Nevertheless, development of the roles of licensed alcohol and drug counselor, and requirement of certification for peer supports, is valued by many as demonstrating that people with experience of addiction have learned how to use that personal experience in service of another person’s needs, rather than imposing their own ideas. That training is vital to the success of professionals, whether or not they have lived experience.

At the same time, scientific understanding of addiction has leaped forward, both in terms of physiological and genetic mechanisms, medications which can support recovery, as well as improved understanding of real-world implementation challenges and successes for evidence-based practices, and practice-based evidence for new ways to treat addiction. It is an exciting time to be a researcher working on addiction from a physiologic or public health approach, or a nurse, physician or other medical professional implementing new treatments.

Unfortunately, stigma against people experiencing addiction is also an important part of the history. This has led to criminalizing and paternalistic approaches to addiction, some of which still impact care. It has also led to stigma against people working the addiction field. Support for the field must always include the shoring up of both those working in the field and those receiving care to advocate for the field. The state government supported an anti-stigma campaign, State without Stigma.

Care provision takes individuals trained in their role, even if their presence is enhanced by technology like apps. If there are not enough workers, there is not enough care, and not enough assessment of quality of care. Approving evidence-based practices and erecting buildings does not mean that care is provided, if there is no one to deliver care.

In addition, if people do not see care providers who look or sound like themselves, they are less likely to engage in treatment. While programs cannot always match caregivers to people seeking care on the basis of demographic, religious or philosophical life stances, just seeing people like themselves on staff can make a difference. How an organization relates to its community, hires from the community and represents that community with the organization both visibly, in trainings its workers, and in its practices – all those aspects matter.

In sum: the workforce matters, there is a need to both recruit and retain workers in the field, and to grow along career paths. This website is meant to support you in whatever way you engage in the work to grow and sustain the addictions workforce, whether you are a reporter, legislative aide, advocate, program director, clinical provider or recovery aide. Let us know what you need and we will try to help.