Improving the Recruitment and Retention of Counselors in Rural Substance Use Disorder Treatment Programs

• Date: 01 July 2022
• DOI: 10.1177/00220426221080204
• Author: Jennifer Murphy
• Published date: 01 July 2022
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(3) 434–456

© The Author(s) 2022

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DOI: 10.1177/00220426221080204

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Improving the Recruitment and

Retention of Counselors in

Rural Substance Use Disorder

Treatment Programs

Jennifer Murphy

1



Abstract

While access to drug treatment has increased in recent years, there is still a shortage of substance

use disorder (SUD) treatment counselors in the United States, especially in rural areas. This study

examined recruitment and retention issues for counselors in rural substance use disorder

treatment programs. Qualitative interviews were conducted with 26 program, clinical, and/or

human resource directors of SUD treatment programs. Almost all interviewees had problems

recruiting high-quality counselors although only a small number saw retention as a signif‌icant

issue. Improving educational opportunities and training related to addictions counseling could

result in more people entering the SUD treatment f‌ield. Strategies for improving reten tion of

counselors include more supportive and inclusive management practices. The stigma of SUD also

contributed to recruitment and retention problems.

Keywords

counselors, recruitment, retention, stigma, substance use disorder treatment

Introduction

The Bureau of Labor Statistics (2019) predicts that the number of jobs related to behavioral health

counseling, which includes substance use disorder (SUD) treatment, will increase by 23% by the

year 2026, an increase higher than the average job growth. Yet, the per capita supply of behavioral

health providers in non-metropolitan counties is signif‌icantly less than the supply in metropolitan

counties (Larson, Patterson, Garberson, & Andrilla, 2016). Similarly, the Health Resources and

Services Administration (2020) projects that the supply of addiction counselors is not suff‌icient to

meet the future demand for substance use services in the United States.

A national sample of clinical directors in drug treatment programs found that almost half of the

facilities surveyed had diff‌iculty f‌illing open positions, most often due to a lack of qualif‌ied

1

Penn State Berks, Reading, PA, USA

Corresponding Author:

Jennifer Murphy, Penn State Berks, PO Box 7009, Reading, PA 19610, USA.

Email: Jxm1192@psu.edu

applicants (Ryan, Murphy & Krom, 2012). Research suggests that recruitment problems for SUD

treatment counselors are worse in rural areas. Challenges to recruiting SUD treatment staff in rural

areas include low pay compared with their urban/suburban counterparts, social isolation, and

fewer educational opportunities (SAMHSA, 2016;Snell-Rood, Pollini, & Willging, 2021). Given

the shortage in mental health/SUD treatment providers in rural areas, some states have im-

plemented programs to encourage college students to enter careers in behavioral health, including

loan repayment programs and “pipeline”projects that educate rural students about related careers

(Baum & King, 2020).

Because of this shortage, rural residents have less access to drug treatment services than people

in urban areas (Borders & Booth, 2007). They also experience disparities in mental health

outcomes even though rates of mental illness are similar in rural and metropolitan areas (Morales,

Barksdale & Beckel-Mitchener, 2020). The recruitment and retention of high-quality counselors is

important to improve rural mental health and SUD treatment.

Substance Use Disorder Treatment Turnover

In addition to a shortage of workers, the SUD treatment f‌ield faces the additional challenge of high

turnover among clinical staff. Research consistently shows high voluntary turnover rates among

counselors, typically ranging from 25 to 35%, with some studies showing rates as high as 50%

(Eby, & Rothrauff-Laschober, 2012;Gallon, Gabriel & Knudsen, 2003;Garner, Hunter,

Modisette, Ihnes, & Godley, 2012;Garner & Hunter, 2013,2014;McLellan, Carise &

Kleber, 2003;McNulty, Oser, Aaron Johnson, Knudsen & Roman, 2007). SAMHSA esti-

mates that the annual turnover rate is about 33% (Sherman, Lynch, Greeno & Hoeffel, 2017),

although these rates have likely increased since the beginning of the COVID-19 pandemic

(Akinyooye & Nezamis, 2021). Turnover rates are also high for clinical supervisors (Eby, Burk &

Maher, 2010;Knight, Broome, Edwards & Flynn, 2011). These rates are substantially higher than

the annual turnover rate for all health and human services occupations reported by the Bureau of

Labor Statistics (White & Garner, 2011).

High turnover rates are problematic because they can have negative impacts on the organi-

zation as well as those receiving treatment (Hyde, 2013). One issue is f‌inancial; it costs more to

recruit and hire a new employee than to retain an existing one (Cascio, 2000). Programs with high

turnover rates also show low employee morale and increased work demands (Johnson & Roman,

2002;Knight et al., 2012). Counselor turnover can also be disruptive to the treatment process.

Research has found that clients stay in treatment longer and do better when they remain in contact

with the same therapist (McCarty, Greenlick, & Lamb, 1998;McCaul & Svikis, 1991). There is a

general lack of research, however, on the direct impacts of turnover on treatment outcomes. One

study found that counselor and clinical supervisor turnover actually had positive impacts on

treatment outcomes, such as reduced illegal activity (Garner et al., 2012). Another study linked

poor job performance ratings to future turnover, suggesting that those who voluntarily leave their

counseling positions might not be the highest quality (Laschober, & de Tormes Eby, 2013).

Some research suggests that facilities in rural areas may experience greater retention issues than

urban facilities. For example, a study of treatment providers in Tennessee found that rural

programs had higher turnover rates (Knudsen, Williams, & Perry, 2005). Other research on mental

health providers f‌inds higher rates of burnout and exhaustion in rural areas, suggesting that SUD

treatment staff in rural areas might also experience higher stress and turnover than their urban

counterparts (Hargrove & Curtin, 2012;Kee, Johnson & Hunt, 2002). A recent study examining

physician bias toward people with opioid use disorder found higher levels of bias in rural areas

(Franz, Dhanani, & Miller, 2021). Clearly, more research is needed to better understand the

recruitment and retention issues for rural treatment workers and the impact they have on treatment.

Murphy 435