Counselor stress can affect a patient's commitment to recovery

Staff Stress Affects Patients' Engagement in Therapy

I don't know of anyone informed in substance abuse and drug treatment that would challenge the fact that the career of a substance abuse/treatment professional or counselor is stressful, difficult and challenging work. The problems that substance abuse counselors face with their patients on a daily basis are often difficult and multifarious; What's worse are the limited number of supplies and revenue with which professionals in the substance abuse field have to work (especially the majority of those employed in treatment centers that espouse a medication assisted modality of treatment). The National Institute on Drug Abuse (NIDA) recently co-sponsored a study which found that outpatient programs "can help substance abuse treatment professionals reduce their stress and more effectively engage patients in treatment."

Three physicians from Texas Christian University in Fort Worth, Texas, recently surveyed a variety of treatment professionals and patients from 89 outpatient programs spanning 9 different states and found...

  1. When staff members reported lower levels of stress, patients reported more active participation in treatment.
  2. Treatment programs may reduce staff stress by giving employees a voice in organizational policies and procedures.
  3. Staff with a higher level of influence in the organization within which they work displayed a better tolerance of stress and burnout than staff with lower levels of influence.
  4. **Staff stress and burnout was less prevalent in programs with higher patient caseloads than those with lower patient caseloads.**

For patients I feel that the 1st and 4th finding (as displayed in the list I put together here) are of particular interest and importance. It's interesting to note that patients who are treated by counselors with lower levels of stress tend to report a more active participation in their treatment. This shows that there is a direct correlation between a counselor's mood/attitude/visible stress and the effectiveness their therapy may have on a patient. It's always been very visible and clear to me if ANY of the staff at an opioid treatment program is in a bad mood, or seems "stressed out," and, while reflecting back while writing this blog entry, it has always had an impact on my approach while at the program on that particular day. For example, if a staff member or counselor seems upset or otherwise "stressed out," I am less likely to ask to speak to a counselor or otherwise ask or make a "non-routine" question or request regardless of how important the issue I am neglecting as a result of perceived staff stress may be to my treatment and recovery. This perception of staff stress, as the study from Texas Christian University now official documents, directly affects and impacts the level in which I participate in my treatment when reporting to the program on a scheduled treatment day. 

It also is very interesting that there are lower reports of staff stress and burnout in the treatment field for counselors who have higher patient caseloads than their counterparts with lower caseloads. This initially seemed to go against what I would have originally assumed. However, "researchers speculate that counselors who have more patients to treat can channel their stress positively into a sense of challenge that may be protective against burnout." So instead of higher caseloads, by their very nature, resulting in more stress for treatment professionals it appears that the higher caseloads may actually serve as a therapeutic channel through which counselors themselves are able to receive a type of quasi-therapy. 

Overall, though, the findings of this NIDA-supported study conducted by Texas Christian University are extremely relevant, and important, to both the staff and patients of treatment centers/clinics alike. Patients will serve themselves well to realize that the perceived stress or mood of their treatment providers can affect their approach to, or involvement in, treatment at any given time. Recognizing this trend could allow patients to acknowledge the influence stress in their OTP's staff could have on their treatment and, as a result, consciously make efforts to fully engage in their treatment notwithstanding any hesitation such perceptions might have initially caused. Treatment center/clinic staff and counselors can now fully recognize the therapeutic value for oneself work in this challenging field can procure and, as a result, come to a new understanding of and appreciation for their calling.


Landrum, B.; Knight, D.K.; and Flynn, P.M. The impact of organizational stress and burnout on client engagement. Journal of Substance Abuse Treatment 42(2): 222-230, 2012. (Abstract)

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