Substance abuse treatment is stressful work. Treatment professionals must deal with problems that are complex and urgent, often with limited resources. A NIDA-supported study suggests that outpatient drug-free programs can help substance abuse treatment professionals reduce their stress and more effectively engage patients in treatment.

Dr. Brittany Landrum, Dr. Danica K. Knight, and Dr. Patrick M. Flynn of Texas Christian University in Fort Worth surveyed staff and patients in 89 outpatient drug-free programs in nine states. Staff who had direct contact with patients filled out the Survey of Organizational Functioning. Patients completed the Client Evaluation of Self and Treatment questionnaire.

engagementprogramsThe survey results revealed that when staff members reported lower levels of stress, patients reported more active participation in treatment (see figure). The results also suggested treatment programs can reduce staff stress by giving employees a voice in organizational policies and procedures. Staff who rated their influence within their programs as relatively high tolerated stress with fewer symptoms of burnoutemotional exhaustion and low sense of personal accomplishment—than staff who rated their influence as relatively low.

Surprisingly, the link between staff stress and burnout was weaker in programs with higher patient caseloads than those with lower caseloads. The 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.


One way to think of self-care is to remember the instructions from flight attendants: “If the cabin loses air pressure, oxygen masks will drop from the ceiling. Please put on your own mask before assisting others.” In other words, you will be of no help to people around you if you pass out from oxygen deprivation. Help yourself first and then you can help others. Given this air travel imagery, it is fitting that the first two dictionary definitions of “burnout” have to do with rocket engine failure (American Heritage Dictionary of the English Language, 1992; Felton, 1998) due to excessive heat or friction. While “excessive heat” and “friction” may be good metaphors for what we experience at work some days, the third definition speaks specifically to our purposes: “Physical or emotional exhaustion, especially as a result of long-term stress.”

There are three main components to burnout (Maslach and Jackson, 1986):

* Feelings of being emotionally exhausted and overextended by the work

* Feelings of depersonalization which result in negative, cynical attitudes toward clients

* Diminished personal accomplishment, reflecting a sense of lowered competence and a lack of successful achievement in work with clients.


If we’re feeling burned out, it is likely that our nerves are jagged and our job performance slips. As this happens, we blame our clients and ourselves.


Compassion Fatigue and Vicarious Trauma

Just as an untreated cold can turn into something more serious, burnout that is not attended to may turn into compassion fatigue. Formally defined, compassion fatigue is “a state of tension and preoccupation with individual or cumulative trauma of clients, manifested in various ways:

* Re-experiencing the traumatic events,

* Avoidance/numbing of reminders of the traumatic event,

* Persistent arousal,

* Combined with the added effects of cumulative stress (burnout)” (Figley, 2002, p.125).

Compassion fatigue refers to negative changes in the way we make meaning of ourselves and of the world. It is also referred to as vicarious trauma, which is defined as “the transformation or change in a helper’s inner experience as a result of responsibility for an empathic engagement with traumatized clients” (Saakvitne, Gamble, Pearlman, and Lev, 2001). As human beings, we have core psychological needs that include safety, trust, esteem, control, and intimacy. Compassion fatigue and vicarious trauma affect these core needs. Consider these examples:

* A female case manager working with women who have been sexually assaulted assumes that all the men she encounters are unsafe.

* A counselor finds himself thinking, “Yeah, right – whatever,” in response to a story told by a friend/client/colleague with whom he has always had a trusting relationship.

* Someone you’ve supervised for years has developed a recent habit of checking in with you before making any decisions, questioning whether his actions have any value to the clients he once felt confident working with.

* A social worker whose favorite way to relax is to spend time with her children finds herself wishing they would go away.

If we are burned out, we feel emotionally depleted. If we are experiencing compassion fatigue, however, we may experience changes in our ability to trust, have difficulty with intimacy, be concerned about our own safety, and experience intrusive imagery related to the traumatic stories to which we have listened.

Source: NIDA and SAMHSA

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