Credentialing Around the World

By David Powell, PhD, International Center for Health Concerns, Inc.  

Addiction treatment is growing worldwide, particularly in Asia, from Beijing to Istanbul. Addiction professionals are being trained, as institutes and other educational opportunities are developing. As individuals are trained, they are asking vital questions:  What is the “end-product” of the training? Is there any credential available for trained addiction professionals? Also, they want to know where they can apply their knowledge and education in treatment centers.

The answer to the last question is more complex than the first two. As treatment centers are developed, there are many political, regulatory and systemic issues that arise. In some countries, such as China, the medical and psychiatric community sees itself as the main site for treatment. Physicians remain the primary, if not sole, provider of services. Establishing free-standing, non-hospital affiliated treatment programs in such environments will be difficult.

Considering the Questions

The first two questions, about credentialing, though is long overdue. Although several certification organizations (NAADAC, IC&RC, NBCC, etc.) have established footholds internationally, credentialing remains a patchwork quilt that will only grow more complex and confusing as time goes on.

From my perspective, here is what countries seek:

  • An internationally-recognized “good housekeeping seal of approval” for trained addiction professionals;
  • A country-specific process that addresses their unique legal, ethical, and cultural issues; and,
  • A certification process that is affordable, in their language, and fits into their health care credentialing process.

The United States has led the way in credentialing of addiction professionals. There is reluctance, though, on the part of many countries to accept in total what is seen as an “Americanized” process. Whether because of politics or geocentrism, other countries want to gain from the American experience in credentialing but want it to be “their” process as well. As Thomas Freidman in The New York Times reminds us, the world may look more like America, but globalization will mean an international slant to all that’s done. We shouldn’t be fooled by the Starbucks in the new Beijing airport. They are modernizing, not necessarily westernizing.

I want to focus on three countries as examples of what is happening throughout Asia.

Lessons from the Road

First, Turkey. A 120-bed, adolescent, substance abuse treatment center began three years ago in Gaziantep, in southern Turkey, on the Syrian/Iraq border. At the time, there were no addiction counselors providing treatment in the country. Services were offered primarily by psychiatrists and psychologists, in traditional mental institutes. The Gaziantep center trained all 50 staff members over a two-year period. Most staff would now qualify for certification by most international standards. However, there is no credentialing available, approved by the government, in Turkey. As we shall see below in other countries, what is needed now is an internationally-recognized process, approved by the Turkish government, available in Turkish, with an examination that addresses the unique issues of Turkey. Also, the process needs to be affordable for the average addiction counselor who may earn the equivalent of $10,000 USD/year.

Vietnam is a similar example. The U.S. government has invested significantly in the development of addiction treatment programs, specifically methadone maintenance and addiction counseling. Over the past five years, hundreds of counselors have been trained in the Matrix Model, family counseling, and clinical supervision, and many would qualify for certification at this time. Although the Vietnamese government is prepared to offer a credential through their Ministry of Health, there is no certification process available to them. The cost per person for this process would have to be significantly reduced to make certification affordable to these counselors. Further, as a nominally Communist country, the examination would need to reflect many country-specific issues. Duty-to-warn questions take on a totally new meaning in such an environment.

China is the awakening giant in Asia in health care. Although addiction remains a “back-burner” issue for the government, trailing far behind issues of economic growth, it is slowly taking root. China, if the current trajectory remains, will have the highest per capita rate of alcohol consumption in the world in the next twenty years. A small but growing number of individuals have been trained in addiction counseling over the past ten years through the International Center for Health Concerns, Inc. Jobs for these trained professionals will not become available until there is a viable credentialing organization in China. Although several organizations have tried to make headway into China, to date, no certification process is in place. Frustration is growing among the trained professionals, asking, appropriately, “So what is the pay off for all that training I have received?”

It is imperative at this point that the credentialing organizations in the addiction field be unified in their efforts so as to not foster a patchwork quilt of certification on the world.  This means, we need to offer countries the option to develop their own policies and procedures, as well as examination questions that reflect their country-specific issues, and we need to do so in a way that is affordable for developing countries. This may mean regional certification bodies are established, such as an Asia-Pacific Certification Organization, a European organization, and a Latin American organization.

The timing is right now for the U.S. to work with other nations in offering this growing body of addiction professionals the credentials they urgently need.

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