Addiction Counselor Turnover: What’s up?

It’s no secret that our field has seen its fair share of counselor turnover. We’ve all run into it, and personally known and waved good-bye to good people. The big questions are: what’s up with that and what can your program do about it?

For our purposes, counselor turnover refers only to counselors who voluntarily leave their job, not the ones asked to leave. In an attempt to answer the first question, it looks like the existing literature does not have one definitive answer. The turnover reasons, like much else in our field, are complex. As to question two, there is enough information out there that a few practical suggestions can be crafted to assist those who want to reduce their addiction counselor turnover rates.

Among other things, the existing research revealed that counselor turnover does not come without consequences. Some of those consequences include impacts on client care (Ducharme, Knudsen, & Roman, 2007) and staff morale, not to mention the training of new staff and a certain level of financial costs (Alexander, Bloom, & Nuchols, 1994). Turnover also puts demands on management resources, which are often stretched thin to begin with, as is often the case in our field. 

Previous turnover literature estimates rates vary from a low of 16 percent (McNulty, Oser, Johnson, Knundsen, & Roman, 2007) to a high of 50 percent (McLellen, Carise, & Kleber, 2003). These wide variations make it difficult to come to clear reasons why counselors leave their job. That difficulty takes us to the extant literature that has examined this issue, and there is a fair amount of it. 

Specific turnover reasons have included the following: low pay relative to other health care professions (Bureau of Labor Statistics, 2014) and scarce opportunities for professional development (Gallon, Gabriel, & Knudsen, 2003). Other studies have found that burnout also plays a role in turnover. One study has indicated that the dropout rate of addiction clients may contribute to the feelings of counselor burnout and reduce a counselor’s feeling of professional efficacy (Garner, Knight, & Simpson, 2007). 

This last finding ties in with a concept called secondary traumatic stress (STS) (Bride & Kintzie, 2011). Secondary traumatic stress is defined as caring for people who have experienced highly stressful events, which then puts the caregiver at risk for developing similar stress-related symptoms (Stamm, 1995). Surveying some 216 substance abuse counselors, Bride and Kintzie found that indeed there was a significant correlation between STS and job satisfaction, occupational commitment, and hence retention. However, the good news was that job satisfaction reconciled some of the STS influence. 

Still another turnover study conducted by Knudsen, Ducharme, and Roman (2006) surveyed just a bit over eight hundred counselors from 253 therapeutic communities with the intent of uncovering the effects of centralized decision making (where employees are not free to make applicable work decisions, and nearly all decisions are made in the higher levels chain of command), distributive justice (refers to perceptions about how fairly the workload of the program and rewards are spread across all members of a program), and procedural justice (the extent to which decisions and process of those decisions are perceived to be fair), on emotional exhaustion and turnover intention of the counselors in those programs. Controlling for counselor demographics and credentials, among other things, they found that centralized decision making was positively associated with emotional exhaustion and turnover intention. They also found a positive correlation between exhaustion and intention to quit. Surprisingly, distributive and procedural justice was negatively associated with exhaustion and intent to quit. 

Rothrauff, Abraham, Bride, and Roman (2011) surveyed 929 substance abuse counselors from 225 different programs. The main findings of their survey centered on the perceptions of procedural justice (again, the degree to which decisions and practice of those decisions are perceived to be fair) and distributive justice (again, the sensitivities about how equally the workload of a program and rewards are spread across all members of a program), with a sense of the counselor’s own status. All findings negatively predicted occupational turnover intention or intent to leave a position. Yet, an additional finding was that the intent to leave a position was reconciled somewhat by one’s occupational commitment. That is, the stronger one’s job commitment the less the intent to leave. 

All of the research just cited was of a type called cross-sectional research. This kind of research takes a snapshot of a particular sample and reports on the results. It’s a one-time thing, and the findings are prone to change in a year or two. But a research project conducted by Eby and Rothrauff-Laschober (2012) did something a little different. They surveyed nearly six hundred substance abuse counselors over a three-year period. This is called a longitudinal approach, arguably better than cross-sectional methods in that this method gathers information on a sample over a period of time, which is a bit more stable. In the Eby and Rothrauff-Laschober study, the idea was to measure possible snowballing effects over three years. A second big goal was to assess a counselor’s perception of the organizational environment and leadership from year one of the study and any possible effects at year three, and trace the sample’s turnover patterns in that time frame. Cross-sectional studies can’t do that.

Findings included that by the end of year one of this study 25 percent of the sample had turned over. By the end of year two 39 percent of the sample had voluntarily left their programs. And, by the end of year three 47 percent of this sample had voluntarily turned over. There were a number of hypotheses stated for this study, and three were found to be supported. First, counselors who had a higher level of perceived procedural justice were less likely to leave their job. Second, counselors with greater perceived organizational support (as in “My program cares about my opinion”) were less likely to leave their jobs. And third, counselors with a greater level of job satisfaction were less likely to leave their jobs. No support between leadership and turnover rates was found. 

If one were to extract some practical information from the above findings, what might be a brief list of suggestions for existing substance abuse programs to utilize? Note that this information is not solely directed at administrators and supervisors. Counselors who wish to raise valid issues can employ them as well.

In no particular order, the suggestions consist of:

• Programs may reduce turnover if their counselors’ perception is one where managers listen to counselor opinions and apply decisions fairly across the program workforce. 
• As to a program’s sense of procedural justice and turnover rates, if counselors can clearly perceive that program decisions are seen as fair, turnover rates might well decrease.
• As to a program’s sense of distributive justice turnover rates, they might decrease if the counselors see that the workload of a program and rewards are equally spread across all members of a program.
• To improve a program’s organizational support turnover rates, administrators and supervisors should show appreciation for a counselor’s work and value employees from diverse backgrounds.
• Programs need to attend to counselor burnout and emotional exhaustion. There is a vast literature base on these subjects, which is beyond the parameter of this particular column. Just punch in “counselor burnout” in a good browser and have at it. 

All of these elements could well improve one’s job satisfaction, and in turn decrease counselor turnover rates.

Alexander, J. A., Bloom, J. R., & Nuchols, B. A. (1994). Nursing turnover and hospital effinency: An organizational-level analysis. Industrial Relations, 33(4), 505–20.

Bride, B. E., & Kintzie, S. (2011). Secondary traumatic stress, job satisfaction, and occupational commitment in substance abuse counselors. Traumatology, 17(1), 22–8.

Bureau of Labor Statistics. (2014). Occupational outlook handbook: Substance abuse and behavioral disorder counselors. Retrieved from http://www.bls.gov/ooh/community-and-social-service/substance-abuse-and-behavioral-disorder-counselors.htm. 

Ducharme, L. J., Knudsen, H. K., & Roman, P. M. (2007). Emotional exhaustion and turnover intention in human service occupations: The protective role of coworker support. Sociological Spectrum, 28(1), 81–104.

Eby, L. T., & Rothrauff-Laschober, T. C. (2012). The relationship between perceptions of organizational functioning and voluntary counselor turnover: A four-wave longitudinal study. Journal of Substance Abuse Treatment, 42(2), 151–8.

Gallon, S. L., Gabriel, R. M., & Knudsen, J. R. (2003). The toughest job you’ll ever love: A Pacific Northwest treatment workforce survey. Journal of Substance Abuse Treatment, 24(3), 183–96.

Garner, B. R., Knight, K., & Simpson, D. D. (2007). Burnout among corrections-based drug treatment staff: Impact of individual and organizational factors. International Journal of Offender Therapy and Comparative Criminology, 51(5), 510–22.

Knudsen, H. K., Ducharme, L. J., & Roman, P. M. (2006). Counselor emotional exhaustion and turnover intention in therapeutic communities. Journal of Substance Abuse Treatment, 31(2), 173–80. 

McLellen, A. T., Carise, D., & Kleber, H. D. (2003). Can the addiction infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment, 25(2), 117–21.

McNulty, T. L., Oser, C. B., Johnson, J. A., Knudsen, H. K., & Roman, P. M. (2007). Counselor turnover in substance abuse treatment centers: An organizational-level analysis. Sociological Inquiry, 77(2), 166–93.

Rothrauff, T. C., Abraham, A. J., Bride, B. E. & Roman, P. M. (2011). Occupational turnover intentions among substance abuse counselors. Journal of Substance Abuse Treatment, 40(1), 67–76.

Stamm, B. H. (1995). Preface. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. xxiii). Baltimore, MD: The Sidran Press.