Avoid Burnout


There’s a high turnover in the field of addiction treatment. That’s not good, because people with the most experience leave the field for more attractive work environments. I’d like to offer some ways of avoiding undue stress that leads to burnout.

Before we get to stress, it’s important to talk about why there’s burnout in this field. Many people think it’s all from patient behaviors, but that’s not the only reason.

True, it’s not always easy to work with patients in treatment for drug addiction. Addiction can cause all sorts of behaviors that can interfere with treatment, and trigger anger on the part of treatment providers. In patients with addiction, old behaviors don’t disappear overnight, and we have no right to expect them to do so. For humans, change takes time.

Program administrators can cause stress for program workers. Administrators who aren’t familiar with what happens on the front lines of addiction treatment may make unworkable changes to how treatment is to be provided. As an example, I once worked for an opioid treatment program who instructed a nurse to operate three dosing windows at the same time, by herself, to reduce wait time for patients to dose. I am not making this up. Obviously this was unworkable and unwise, yet the nurse was required to “prove” the unworkability before this lame idea was discarded.

Addiction treatment providers don’t make a great deal of money. Addiction treatment professionals earn an average income of $38,000 per year, with a range of $24,000 to $60,000 per year depending on experience, credentials and and treatment setting.

Counselors at OTPs have tremendous workloads. State and federal regulations say OTPS can have no more than fifty patients assigned to each counselor. Even within that limit, there’s not enough time to attend to all patient needs. And besides time spent with the patients, the time spent on documentation and paperwork is overwhelming.

In the past, addiction counselors tended to be in recovery themselves, with their personal experience as their only credential. Now there’s a push for the substance abuse treatment field to become more professionalized. The pressure to prove competency causes ever-increasing paperwork to pop up like mushrooms after a rain. And the documentation forms change all of the time. Just as workers get used to one form, it’s changed again.

To paraphrase Terri Moyers, a world-renowned addiction treatment professional, the substance abuse field is addicted to documentation and they are in denial.

OK, so there are stresses working in the field. Maybe the field will improve someday. Until then, here are some ideas about dealing with burnout:

1. Take care of your physical health. We tell patients to do this, but are we setting good examples? Eat right, go to the doctor for routine medical health screens, get to the dentist periodically, and get enough sleep. We all know what to do.
2. Have a life outside of work. This is big. I have to remind myself of this one frequently. Don’t let work become your whole identity. When you are at home, is your mind also at home, or are you thinking about a work situation? Try to keep your mind and your feet in the same place.
3. Have a creative outlet. Right now, I’m weaving rugs. I love it; it’s creative and I enjoy the process of making a rug. It’s fun to give them as gifts, too. Right now I buy old ratty leather items at the local thrift stores, cut them into strips and weave them into rugs. In times past, I’ve made quilts. I seem to be drawn to the textile arts. What is your artistic outlet? It could be a non-traditional art form, like cooking or decorating your house.
4. Don’t take things personally. We all have bad days, and another person’s nasty response to you may have nothing to do with you. Make allowance and let it roll off.
5. Don’t stuff your feelings, either. If there’s a situation at work that you don’t like, don’t wait until you explode in anger to say something about it. Go to your supervisor or other appropriate person and state your feelings about what’s going on. You’re more likely to be heard if you’re calm and logical and not spew-y.
6. Don’t have unrealistic expectations. Drug addicts use drugs. Expect this to happen during the treatment of the disease. Relapse is never OK, but if the patient is lucky enough to live through it, help them figure out why it happened so they can avoid a similar situation in the future.
7. Do some kind of aerobic exercise if your physical condition permits. Besides health benefits, exercise can make a huge difference in my ability to handle stress. It doesn’t have to be heavy exercise; even going for a walk can reduce stress.
After I broke my leg last spring, I couldn’t exercise like I was used to, and I really missed it. I felt much better after my leg healed enough to do some of my normal activities.
8. Nurture your spiritual health. This doesn’t necessarily mean participation in an organized religion, although for some people it may. For me, anything that connects me to other people and to the God of my understanding is spiritual. I feel better and more centered when I regularly make time for prayer and meditation. Obviously people find different things that nurture them spiritually.

Despite the stresses, many of us prefer to work in the field of addiction treatment, for various reasons. For those people, working in the field of addiction treatment is an avocation, not just a vocation.

For me, I love to see the positive changes in patients’ lives, and to feel like I had some small part in that. In this field when addicts find recovery it isn’t just their lives that improve; families and then communities benefit, too. I didn’t see that when I worked in primary care.

I have the best job in the world.

12 responses to this post.

  1. Posted by desiree on December 26, 2013 at 7:52 pm

    Thank you tremendously for this ever important and needed reminder. It has occurred to me in the past, that it would be great to have a sort of support group for clinicians, to allow for debriefing (complaining if needed) a place to get support,advice,resources, guidance, etc. My schedule is demanding as is my case load, it seems I only have time to eat sleep once I am home. I would love to have a place to “dump” my stuff, and know that it is being heard by others who have been there. Any suggestions?


    • You can go to alanon, but you would have to share in a general way about the issues, so as to respect patient privacy. I don’t know if your communtiy has an organization for therapists/clinicans to get support, but maybe you could start one!
      I know doctors have their own recovery groups, but that’s only for doctors in recovery.


  2. “In the past, addiction counselors tended to be in recovery themselves, with their personal experience as their only credential” I would take these credentials over MDs, etc..I’ve had both and believe me there’s nothing like soemone who’s been there.


    • And if you take someone who has been there and then teach them about ways to be a better counselor, you have the best of both worlds. Teach that person how to do cognitive-behavioral therapy and motivational interviewing, and you’ve got an impressive mix of experience and education.
      I’ve seen excellent counselors in recovery, but I’ve also met excellent counselors who have never had a problem with addiction.
      If all you want is to talk to someone who’s been there, consider going to 12-step meetings…they are free. Patients who pay for treatment at treatment programs have the right to expect their counselors have training as well as experience.


  3. I have been in the field of Addictions and Mental Health since 1988= 25 years of experience, seen the good the bad and the ugly side of healthcare, one thing that I despise in the substance abuse field is haw management treats their staff. If a staff member is equal or even better knowledgeable in the field of addictions, don’t move them from your direction, encourage them and learn from them, don’t offer false promises. The experience clinician is employable at any time.

    Angel L. Perez, MBA

    Sincerely Yours


  4. @desiree re Support-I echo your remarks and wonder why providers do not include good clinical supervision from someone not doing personnel within your organization as a way to support clinicians and actually Prevent Burnout. While it would not be free, it certainly would help support staff and their stress levels. What a great investment for the people who actually drive much of the revenue in OTP’s! I know a great many exceptional clinicians who did not get what they needed at their agency for support and moved on. Myself included!


  5. Posted by Jason on January 1, 2014 at 4:49 am

    Doc, Obviously you are not following # 4 on your list. You must be burnt out


  6. Posted by Jason on January 1, 2014 at 8:57 pm

    Me too. Happy New Year and thank you for all you do!


  7. Thankyou Dr Burson.Moved the treadmill today, Great article to start the. New Year


  8. I fully agree with the views expressed. I have been counselling users and their families in my practice as a family physician in addiction to offering mental health service for over 20 years.
    I love the field because outcomes are so unpredictable. I have learnt not to have high expectations of my clients. I make it clear that with out the client’s full cooperation little can be achieved.
    I have seen the same clients for over ten years at varying intervals.
    These clients appreciate the fact that I am never judgmental and very open minded.
    I find general practice offers me the variety not to get too bogged down with addiction.

    I attend a support group that I started as a member and not as a counsellor.
    Sadly, far too many counsellors live in a flase world that they do not need any help.
    I am willing to forward anyone interested in starting a support group can contact me and I will gladly email them a copy of my simple hand book to start up a support group.
    Counselling is and art that is developed over years and not rocket science that can be taught in the confines of lecture halls.
    DR robert Rapiti


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