Difficulties in retaining existing staff and recruiting new staff impact the quality of care that an alcohol or other drug treatment facility is able to deliver. To date, few research studies have focused on the addiction treatment workforce (ATW). Drawing on past research from the addiction treatment field, the field of nursing, and the field of nursing home care, this study seeks to examine the counselor's work environment, taking into consideration the impact of the facility specific context on the behavior of the counselor's employed within each facility, and relating these factors to quality of care measures generated at the facility level. The questions guiding this research are: (1) how does perception of work environment vary at the individual counselor level?, (2) how do perceptions of work environment vary across facilities?, (3) do counselor perceptions of facility level work environment impact staff turnover?, and (4) is there an association between counselor perceptions of facility work environment and the quality of care produced at the facility level? The theories informing this research include: (1) Social Exchange Theory and the Norm of Reciprocity which predict the behavior of individuals within organizations;(2) Resource Dependence Theory (RDT) which predicts the behavior of an organization, in this case the outpatient treatment facility, in regards to its compensation package, organizational structure, and the provision of organizational supports to staff working within the facility;and (3) Donabedian's quality of care paradigm which recognizes the impact of structure and process measures within a facility as having a direct influence on the quality of care being generated. By focusing on the addiction treatment counselors and their workplace, this research creates an opportunity to gain new knowledge, as well as important and valuable insights about the counselors, their work environment, and the challenges and barriers they face as they seek to deliver quality care. This new knowledge could be used in the development of sustainable and reproducible interventions or strategies that can address the real-world challenges and barriers to quality care that exist, and result in improved treatment outcomes for the patients seeking care, as well as an improved quality of life for both patients and counselors.

Public Health Relevance

Difficulties in retaining existing staff and recruiting new staff impact the quality of care that substance abuse treatment facility is able to deliver. The proposed research will expand what is known about the addiction treatment workforce, and its linkage with quality. Further, this research has the potential to provide the field with an actionable set of workforce policy recommendations that will assist us in the development of a sustainable response to the core workforce issues of recruitment, retention, and stigma.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Predoctoral Individual National Research Service Award (F31)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-F16-B (20))
Program Officer
Duffy, Sarah Q
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Brandeis University
Schools of Social Work
United States
Zip Code