Predicting Substance Recovery Service Trends: Best Practices, Reimbursement, and Employment – Part I

In my role as a substance recovery clinician and educator, it’s essential to be mindful of macro and micro shifts in our field. This is the first in a 2-part series which predicts trends you may see in the delivery of recovery services in the near future. In this blog, we cover Outpatient Counseling. In Part 2, we discuss Inpatient Detoxification Centers and Driver Alcohol Education Programs.

I believe there will be an explosion in jobs specifically for CADAC professionals, and within the substance recovery field as a whole.

Outpatient Counseling

For as long as I’ve been in the field, a black cloud has hung over Outpatient Counseling Clinics and their ability to be fiscally viable: the black cloud known as the “no-show”.

In this scenario, a client scheduled to attend an OP (outpatient) appointment “no-showed” for the session. This currently results in the clinic paying the clinician $20 – $35 for the hour without generating revenue for the clinic. As a result, most local clinics have shifted to a high percentage of “fee-for-service” clinicians.

In the fee-for-service model, clinicians are only compensated for completed, documented sessions. If a client does not attend the scheduled session, the clinician has donated an hour of his or her time and receives no compensation. In substance recovery outpatient clinics, there are a high percentage of CADACs serving as clinicians.

On the positive side of the equation, the fee-for-service model usually offers clinicians a better rate of reimbursement for billed services; however, the agency often classifies clinicians as “contractors” and does not provide benefits. Over time, research has shown this has a negative impact on the quality of services. It attracts younger, inexperienced clinicians (recent grads and interns) and encourages practices like double-booking and punitive clinic policies towards clients who miss sessions.

I envision a two-fold solution in the future:

1) It seems logical that Insurance Companies (3rd party reimbursement) should provide a reduced payment for a “no-show,” a policy that currently exists under other behavioral and medical populations with third-party reimbursement.

2) Additionally, clinics that utilize best practices within substance recovery often employ a group-heavy approach that incorporates positive, pro-sober peer supports and healthy modeling facilitated in a therapeutic environment. Groups are not for everyone, but research shows they produce results for most clients. They also significantly reduce the “no-show” rate. Consider the benefits identified by the Substance Abuse and Mental Health Service Administration (SAMHSA): “The natural propensity of human beings to congregate makes group therapy a powerful therapeutic tool for treating substance abuse, one that is as helpful as individual therapy, and sometimes more successful. One reason for this efficacy is that groups intrinsically have many rewarding benefits—such as reducing isolation and enabling members to witness the recovery of others—and these qualities draw clients into a culture of recovery. Another reason groups work so well is that they are suitable especially for treating problems that commonly accompany substance abuse, such as depression, isolation, and shame.”

Substance Recovery Counselors can expect continued growth in mandated inpatient (Court, Corrections, Probation, DCF, Employment, Detox) points of service. It’s likely that traditional outpatient counseling will continue to trend toward group psychotherapy as a best practice model. Individuals new to the field should develop this skill set.

Third-party billing for psychotherapy groups will probably require an advanced degree and/or license for billing in the near future. Currently, a counselor with lesser credentials receives a reduced reimbursement rate.  The reimbursement difference can be as much as $25.00 per group participant for a licensed clinician with an advanced degree vs. $10.00 per participant for a bachelor’s level CADAC clinician.


FOR REFERENCE: the O*Net Resource Center is the premier source of employment skills and trends, offered under the sponsorship of the US Department of Labor/Employment and Training Administration (USDOL/ETA).

O*Net Summary: Substance Abuse and Behavioral Disorder Counselors
O*Net Summary: Mental Health Counselors
O*Net Summary: Mental Health and Substance Abuse Counselors
O*Net Summary: Substance Abuse and Behavioral Disorder Counselors

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