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Spirituality
of Connectedness
The
as a
Response to the Stress Reactions
in Substance Abuse Counselors
When People Lack Connectedness They Feel Isolated and Discouraged
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magazineces.
T
oday’s modern society, aside from all of the futuristic promises, appears to be more stressful and complex than ever
before. We are continually inundated with data, be they from
text messages, social networking, RSS feeds, phone calls, etc. The
“promise” that technology would enable us more free time to spend
with family and friends does not appear to be a reality. Instead, the
time we do spend with family and friends involves checking our
smart phones as we are continually and everywhere in touch with
the office.
In the addiction field where healthcare reform is changing our business practices while the latest research is changing our clinical practices, increases in stress and burnout are being felt by clinicians and
administrators alike (Shea, C., 2012). There are no easy answers or
solutions to stress, but one approach I encourage is to focus on the
spiritual aspect of the clinician and situation. Stress reduction
through an appreciation of the spiritual is an effective approach since
the spiritual “can enhance inner strength and enable individuals to
find meaning in stressful situations, provide people with an optimistic
perspective and positive purpose in life, and subsequently reduce anxiety.” (Langman, Louise; Chung, Man Cheung, 2012)
A recent study, funded by a NIDA grant, “the first to examine the
link between staff stress and client engagement within the field of
substance abuse treatment” (Landrum, B.; Knight, D. K.; and Flynn,
P. M., 2012) indicates that “Burnout is higher in high-stress organizations and workload and staff influence moderate the stress-burnout
relationship.” (Landrum, B. et al, 2012) My years of experience in the
addiction field confirm this research. Shocking, though, is their next
conclusion: “Specifically, stress and burnout appear to be more
strongly linked when caseloads are lower and opportunities for staff
to influence program practices are few.” (Ibid.) Caseload size is, therefore, a factor in stress and burnout reactions, yet it is the lower caseloads which seem to bring about more frequent instances of burnout
versus clinicians carrying higher caseloads. The “relationship between
stress and burnout suggests that when caseloads are large, stress may
act as a motivator and buffer against burnout. …(I)ncreased stress
does not necessarily lead to feelings of being overwhelmed and ex-
18
Advances in Addiction & Recovery | SUMMER 2013
hausted; instead, it may provide motivation to work harder as the stress
is perceived as a “challenge” rather than an obstacle.” (Ibid.)
Stress is a complex set of emotional and physical reactions to the
world around us, either enabling us to confront our challenges, or
paralyzing us into inaction (referring to the “fight or flight” reactions
which are hard-wired in the recesses of brain). This NIDA-funded
study finds that when clinicians are under stress, the perceived “challenge” motivates them to succeed. We need a balance of stress in our
lives; a balanced level of stress motivates while too much stress paralyzes. Where do we find the balance? When does stress reach the level
of burnout and paralysis?
Comparing burnout in the addiction field to other professions, the
authors of the article “Causes, Consequences, and Prevention of
Burnout Among Substance Abuse Treatment Counselors: A Rural
Versus Urban Comparison” posit the theory that the “emotional connection is what differentiates burnout from occupational stress …
burnout is tied to work that is demanding and involves emotional investment.” (Oser, C. B., Biebel, E. P., Pullen, E., & Harp, K. L., 2013)
Substance abuse counselors tend to become emotionally involved with
their clients since “their clients many times deny their problems, lack
the motivation to change … have significant health problems … and
many times have co-occurring mental health disorders.” (Oser, C. B.,
et al, 2013) An intense investment of clinician time and resources is
needed in order to guide such a client to a return of a healthy lifestyle.
It is precisely in this emotional connection wherein we need to infuse the spiritual into the addiction field. If we are to make the case
that it is in the “emotional investment” wherein clinicians find their
stress, than we need to discover a means whereby we can reduce this
stress to a manageable level. As the clinician meets the client on the
emotional level, it is therefore on the emotional level where we need
to meet the clinician. “While it may not be impossible to measure spirituality in an empirical sense, it may be possible to clarify what role
spirituality plays in aiding sustained recovery and prevention … We
will suggest connectedness as an integral component in defining spirituality … as gaining knowledge through connectedness to others.”
(Tonigan, J. Scott, 2007) In treatment sessions clinicians are trained
to re-connect clients to healthy people in healthy relationships.
Therefore, in the same vein, clinicians need a sense of connectedness
to themselves, their peers and the organization for which they work.
“… (P)eople with addiction tend to be concerned with spirituality,
forgiveness, and guilt, each relating to the human conscience as the
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B Y C HRISTOPHER W. S HEA , MA, CAC-AD, CRAT
person struggles with who they are, who they
ought to be and the meaning of life. These
are the existential aspects of living with addict ion.” (L a ng ma n, L ou ise, et a l, 2012)
Abraham Maslow (1908–1970), famed for his
1943 work entitled A Theor y of Human
Motivation, speaks of a “hierarchy of needs”
which when followed lead a person to the pinnacle of self-actualization, namely a deep and
personal existential view of themselves in relation to the world. A sense of one’s connectedness to self and others. “Maslow himself
recognized a motivational force higher than
self-actualization, an inner drive to place the
needs of others above a person’s own needs.
Some have called it self-transcendence.
Others have called it personal integration.
Still others have called it holiness.” (Ferder,
1986) The clinician’s drive to place the needs
of others above their own leads to an emotional connectedness with their clients, but at
the same time brings about a high degree of
stress if the clinician does not see positive results from their efforts. And in a field with a
high rate of recidivism, many counselors tend
to become discouraged.
“Similar to stress, burnout is also a complex
phenomenon, and past research has divided
it into several components, including emotional exhaustion, depersonalization, and
lower sense of personal accomplishment.”
(Landrum B., et al, 2012) When a clinician no
longer feels a connectedness to their mission,
to their clients, they can feel isolated. This isolation is but one of the factors which can tip
the balance of stress away from the benefits of
a motivating stress, to those of a detrimental
and paralyzing stress.
Since we live in a stressful society, stress in
and of itself is not the issue. Stress is inevitable, and, in manageable portions, can be a
motivating factor challenging a person to
perform at their greatest potential. Recent research indicates that when a person feels an
emotional connectedness to others, stress reactions remain at healthy and workable levels.
Yet, when people lack this level of connectedness they feel isolated and discouraged. This
is true for both our clientele as well as our clinicians. Therefore, as mentioned above, an
enhanced spiritual sense is encouraged since
the spiritual “can enhance inner strength and
enable individuals to find meaning in stressful situations, provide people with an optimistic perspective and positive purpose in life,
and subsequently reduce anxiety.” (Langman, L., et al, 2012)
As previously mentioned, burnout consists
of three major components: emotional exhaustion, depersonalization, and a lower
sense of personal accomplishment. Utilizing
these components as our guide, how can we
infuse a sense of the spiritual into each component so as to reduce the stress reaction to
healthy levels. For the purposes of this article,
I chose to use Tonigan’s definition of spiritual: “gaining knowledge through connectedness to others.” (2007)
E MOTIONAL E XHAUSTION : Working long
hours or having large caseloads can lead to a
clinician feeling tired, but to be emotionally
exhausted affects one’s emotional connectedness to others. To feel emotionally exhausted
one no longer has the emotional capacity to
cope, in a healthy manner, with the stressors
of life. To counter this on the spiritual level,
an agency needs to allow their staff time for
self-care. According to Oser, C. B. “Self-care
includes meditation, taking a vacation,
taking the time to debrief with a coworker, or
just engaging in other tasks besides therapy.”
(2013). In my career as an administrator
and clinical supervisor, I encouraged all
my clinicians to have active hobbies which
had no relation to their daily duties or career.
Encourage your staff and peers to engage in
hobbies which interest them, encouraging them to discuss, as appropriate, their
hobbies in the workplace with their co workers. These inter actions with coworkers
offer a sense of connectedness and camaraderie which will offset the stressors of the work
day whereby reducing the chances for emotional exhaustion.
DEPERSONALIZATION: The degree to which
a clinician feels connected to the overall
structure of the agency for which they work
has a direct effect on the degree to which they
feel valued by that same agency. “(T)he degree to which members of the organization
perceive themselves as having influence can
moderate the relationship between stress and
staff burnout. When influence is higher within a program, stress is not related to burnout.
However, when influence is low, higher stress
is associated with higher burnout. Thus, influence serves as a buffer against burnout.
Programs where staff report more knowledge
sharing, influence in the decisions made by
the program, and are being viewed as a leader
by their peers have lower organizational
burnout even when stress was high.” (Landrum B., et al, 2012) To counter depersonalization on the spiritual level it is important for
an agency to include clinicians and other staff
in the planning and decision making of the
agency. If you haven’t yet tried this approach
you may be surprised; I was.
Questions to consider while
reading this article
?
Stress reduction through an
appreciation of the spiritual is an
effective approach to what?
?
?
What is Tonigan’s definition of
spiritual?
A recent study funded by a grant
by the National Institute on Drug
Abuse (NIDA) concluded that which
factors links stress and burnout?
?
True or false, the NIDA funded
study found that when clinicians
are under stress, the perceived “challenge” motivates them to succeed.
?
?
What differentiates burnout from
occupational stress?
What is one of the factors that
can tip the balance of stress away
from the benefits of a motivating
stress to those of a detrimental and
paralyzing stress?
?
What factor leads the clinician’s
drive to place the needs of others
above their own?
?
Which programs have lower organizational burnout even when
stress was high?
?
?
What does the author say about
stress?
The author recommends that
agencies, administrators and
clinical supervisors foster a sense of
personal accomplishment in clinicians and staff by doing what?
Earn two continuing education credits
for reading this article. Cost $25.
Take the quiz at www.naadac.org/
education/magazineces.
P ERSONAL ACCOMPLISHMENT : I am not
aware of many people who enter and stay in
the field of addiction counseling who do not
wish to achieve their goals and personal best
within the profession. A sense of personal accomplishment needs to be encouraged by
agencies, administrators and clinical supervisors. Encourage the clinicians and staff to
obtain, beyond the local requirement, certifications in advanced study or clinical skills.
Encourage them to author articles, white pap er s , or g i ve le c t u re s a nd s em i n a r s .
Encouraging one’s personal accomplishSpirituality, continued on page 21 ☛
SUMMER 2013 Advances in Addiction & Recovery
19
Patterson, continued from page 20 within their responsibility. Under this agreement, the agency would refer clients to the
health department for testing, monitoring, possible treatment and
follow up, thus allowing the treatment agency to comply with
mandatory reporting of communicable diseases. The QSO/BA
must specify services to be provided by the public health department. Again, redisclosure of information by the health department
identifying persons as substance abuse treatment clients is prohibited without the client’s consent.
When the communicable disease creates a medical emergency
then it becomes necessary to report to medical personnel. Keep in
mind that it must be an immediate threat to the client’s personal
health. An example would be a person with untreated TB. If the client is already under medical care for the condition, this does not
constitute a medical emergency.
And, last but not least, if a court order is obtained by a program
that authorizes reporting, the court can only issue an order when it
is for good cause and is executed according to 42CFR Part 2.
Reference:
Confidentiality and Communication: A Guide to the Federal Drug & Alcohol
Confidentiality Law and HIPPA: Legal Action Center, N.Y., N.Y. 2012
Frances Patterson, PhD, MAC, SAP, QCS, is board certified as
a professional counselor with the American Psychotherapy Association (APA) and is a NAADAC, the Association for Addiction
Professionals certified Masters Addictions Counselor and Qualified
Substance Abuse Professional. She is certified by the State of
Tennessee as a Clinical Supervisor for A&D licensure and serves as
an oral examiner for people seeking licensure. Dr. Patterson has
worked as a counselor and program administrator in treatment
programs in Virginia and Tennessee over the past 24 years and is
the owner of Footprints Consulting Services, LLC in Nashville, Tenn.
Thomas Durham, PhD, LADC, brings more than 35 years of experience in behavioral health treatment and has been an educator and
trainer for over 20 years delivering a variety of training topics for
behavioral health professionals on topics such as clinical supervision, motivational interviewing, co-occurring disorders, ethics,
medicated assisted treatment, compassion fatigue and leadership.
Dr. Durham is Program Manager of the Prescription Drug Abuse and
Overdose Prevention Program at JBS International where he develops curricula and coordinates training programs for physicians and
other healthcare professionals.
Kathryn Benson, NCAC II, QCS, SAP, has worked in the counseling
profession since 1972, with an initial emphasis on domestic violence, intervention and re-parenting of abusive parents. She has
specialized in addiction issues since 1978. She maintains a clinical
consulting practice in Nashville, Tenn., where she provides therapeutic services, clinical and program development and supervision
services. She currently serves as the Chair of the National Certification Commission for Addiction Professionals (NCC AP) — the NAADAC
Certification Board — and has received numerous professional awards.
Looking for more information? Check out the archived
webinar Understanding NAADAC’s Code of Ethics, available
at www.naadac.org/education/webinars.
Spirituality, continued from page 19
ments allows them to feel a connectedness to advancing the field,
vicariously connecting on an emotional level with a wide range of
clients through those clinicians who may learn from their work.
Conclusion
“Despite the many challenges that substance abuse counselors …
voiced and the impact that burnout can have on client outcomes, …
{counselors} recognized that burnout is not an inevitable outcome
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s
of their work. … (T)he counselors identified a positive working
atmosphere can also help them to cope with these strains, thereby
protecting them from burnout.” (Oser, C. B., 2013)
Christopher Shea is a nationally and state certified addiction
counselor in Maryland. Shea has worked for almost 20 years in
the addiction field as a counselor, case manager, clinical director
and administrator. Shea presents seminars and conferences
across the country and is published in medical and peer-reviewed
journals. Shea is currently the Director of Campus Ministry at St.
Mary’s Ryken high school as well as an adjunct professor at
Towson University. He is also the founder and author of Life’s
Journey blog at www.lifesjourneyblog.com.
Bibliography
Ferder, F. (1986). Words Made Flesh: Scripture, Psychology & Human
Communication. Notre Dame: Ave Maria Press.
Greene, G., & Nguyen, T. D. (2012). The Role of Connectedness in Relation to
Spirituality and Religion in a Twelve-Step Model. Review Of European Studies, 4(1),
179-187.
Landrum, B.; Knight, D. K.; and Flynn, P. M. (2012). The impact of organizational
stress and burnout on client engagement. Journal of Substance Abuse Treatment
42(2), 222–230.
Langman, Louise; Chung, Man Cheung. (2012). The Relationship Between
Forgiveness, Spirituality, Traumatic Guilt and Posttraumatic Stress Disorder (PTSD)
Among People with Addiction. Psychiatric Quarterly, 10.1007/
s11126-012-9223-5.
Oser, C. B., Biebel, E. P., Pullen, E., & Harp, K. L. (2013). Causes, Consequences, and
Prevention of Burnout Among Substance Abuse Treatment Counselors: A Rural
Versus Urban Comparison. Journal of Psychoactive Drugs, 45(1), 17-27.
Shea, C. (2012). Unintended Consequences of the ACA – Workforce Development
Issues in Addiction Treatment Services. Healthcare Reform Magazine, August.
Retrieved from http://www.healthcarereformmagazine.com/article/unintendedconsequences.html
Tonigan, J. Scott. (2007). Spirituality and Alcoholics Anonymous. Southern Medical
Journal 100(4), 437-440.
SUMMER 2013 Advances in Addiction & Recovery
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