In the early 1990s, managed care began to impact the substance abuse counseling field (e.g., increased clinical documentation requirements, shorter lengths of stay, and justifications for levels of care regarding client placement in treatment). With these and other changes brought on by managed care, the substance abuse treatment workforce came under scrutiny. Prior to this time, most substance abuse counselors were considered "paraprofessionals" with limited formal education and training. Workforce studies that focused on substance abuse counselors revealed that less than half had master's degrees and over two thirds identified themselves as being a person in recovery. Based upon data of this type, the U.S. Congress inquired about the readiness and ability of the substance abuse treatment workforce to function within a managed care ...

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