by: David Jensen, former Staff Attorney
The Therapist
(November/December 2006)

Are you looking to add another dimension to your private practice? If so, you should consider becoming a substance abuse professional for drug and alcohol programs connected with the Department of Transportation (·DOT·). Why? Because as of September 22, 2006, licensed marriage and family therapists are now eligible to be reimbursed for such work. This is an extraordinary development for the profession. Substance abuse professionals were first utilized by the DOT in 1994, however, only licensed physicians, licensed or certified social workers, licensed or certified psychologists, licensed or certified employee assistance professionals, and certain drug and alcohol counselors have been allowed to be such professionals. Becoming a substance abuse professional for DOT drug and alcohol programs involves getting over four hurdles: The initial credential hurdle; a minimum knowledge hurdle; a mandated training hurdle; and an examination hurdle. Once qualified as a substance abuse professional for DOT drug and alcohol programs, there are two on-going requirements: Continuing education and documentation of qualifications.

First, a Bit About the DOT
The DOT is a federal government agency that employs 60,000 individuals in agencies all across the United States,including:

1. Federal Aviation Administration;
2. Federal Highway Administration;
3. National Highway Traffic Safety Administration;
4. Federal Motor Carrier Safety Administration;
5. Federal Railway Administration;
6. Federal Transit Administration;
7. Maritime Administration;
8. National Highway Traffic Safety Administration;
9. Office of the Inspector General;
10. Pipeline and Hazardous Materials Safety Administration;
11. Research and Innovative Technology Administration; and,
12. Surface Transportation Board.

The DOT uses substance abuse professionals to evaluate, refer, and treat DOT employees who have engaged in prohibited drug and/or alcohol related conduct.1 The obligations of a substance abuse professional include making face-to-face clinical assessments and evaluations of employees; referring employees to education and/or treatment programs; performing follow-up evaluations to determine whether the employee has complied with the assessment and evaluation requirements; devising follow-up plans; and, providing the employer and employee with recommendations for continuing education and treatment. 2 Substance abuse professionals play an important role in deciding whether employees who have violated a drug and/or alcohol regulation may be returned to safety- sensitive duties.3 Thus, substance abuse professionals play an important public safety role.

However, part of the analysis as to whether becoming a substance abuse professional for DOT drug and alcohol programs is right for you is whether the DOT has employees in your area, and, if so, how many. In this regard, the larger population centers of the state, i.e., San Diego, Los Angeles, and San Francisco, because of their proximity to airports, ports, and interstates, will undoubtedly have the majority of opportunities. If you are interested in this subject, you should determine if one or more of the agencies listed above has an office in your area. Keep in mind that the DOT is a federal government agency, not a state one, so you will need to check in the federal government section of the phone book and not the state or county government sections.

Credential
Getting over the first hurdle is easy; all that is required is possession of a valid California license as a marriage and family therapist. Unfortunately, neither trainees nor interns, just by virtue of being trainees or interns, are eligible to be substance abuse professionals for DOT drug and alcohol programs.

A trainee or intern could, theoretically at least, qualify as a substance abuse professional if he or she were a drug and alcohol counselor certified by the National Association of Alcoholism and Drug Abuse Counselors Certification Commission (NAADAC); by the International Certification Reciprocity Consortium/Alcohol and Other Drug Abuse (ICRC); or, by the National Board for Certified Counselors, Inc. and Affiliates/Master Addictions Counselor (NBCC).4 Of course, should a trainee or intern desire to gain hours of experience for such work, he or she would have to be supervised by someone who is competent to provide such supervision.

Knowledge
Getting over the second hurdle is a bit more difficult. It necessitates having knowledge of three general areas pertaining to substance abuse professionals. The first area is knowledge about and clinical experience in the diagnosis and treatment of alcohol and controlled substances- related disorders.5 Unfortunately, the regulations do not give us any criteria for judging whether one has the minimum or requisite amount of knowledge or experience in diagnosing and treating alcohol and substancesrelated disorders. It seems clear, however, that the practitioner should be able to document some type of experience.

The second and third general areas of knowledge are somewhat commingled. The second area requires knowledge about substance abuse professionals and their function as related to employer interests in safety-sensitive duties,6 and the third area requires knowledge about applicable federal regulations and substance abuse professional guidelines.7 The unifying thread seems to be knowledge about substance abuse professionals and their work within the DOT milieu, which is special, unique information. You would not likely have received this more specialized information in your degree program. This information will undoubtedly be part of the training that substance abuse professionals in DOT drug and alcohol programs are required to receive, which takes us to the next hurdle.

Training
This is a moderately difficult hurdle to surmount because it is going to involve an investment of time and money. To become a substance abuse professional, an individual must get training in the following areas:

1. The background, rationale, and coverage of the DOT·s drug and alcohol testing program;
2. The DOT·s drug and alcohol testing rules;
3. Key DOT drug and alcohol testing requirements;
4. Substance abuse professional qualifications, obligations, and prohibitions; and,
5. Reporting and recordkeeping requirements.8

Examination
Following completion of the mandated training, the individual must pass an examination administered by a nationally- recognized professional or training organization.9 Please see the chart to the right for a list of organizations that can provide the necessary testing.

Having passed the examination, the practitioner is now ready to contact DOT agencies in his or her area and get on a list of substance abuse professionals. It is important to realize, however, that DOT does not certify anyone to be a substance abuse professional; in essence, an individual certifies himself or herself by complying with the requirements set forth above.

On-Going Requirements
To maintain one·s status as a substance abuse professional, there are two things that the practitioner must do: The first is fulfill a mandatory continuing education requirement, which is twelve hours every three years, beginning on the date the individual passed his or her substance abuse professional examination.10 Note that this is a three year time frame; whereas, the California MFT license is, in most cases, renewed every two years. This coursework must relate to substance abuse professional functions. As long as it pertains to substance abuse work, there is nothing in the federal regulations that would prohibit a licensee from using CE coursework completed to keep one·s California license current to meet this DOT requirement. However, the flipside of the situation may not be true. Keep in mind that coursework completed in furtherance of California licensure must come from an accredited or approved post-secondary institution meeting applicable requirements of California law, or from a provider approved by the BBS.11

The second thing to be done is to maintain documentation evidencing that you meet the requirements for being a substance abuse professional.12 This documentation could be requested by DOT agency representatives and employers, as well as by third party administrators who are using or contemplating using your services.13

Conclusion
Although probably not a major event in terms of generating a large volume of referrals, the inclusion of MFTs in DOT alcohol and drug programs as substance abuse professionals does represent a step forward for the profession, as well as a professional opportunity for individual practitioners. It is entirely possible that meeting the criteria for becoming a substance abuse professional in DOT drug and alcohol programs may also open up other opportunities with other government agencies or private insurers. For more information concerning substance abuse professionals in DOT drug and alcohol programs, see The Substance Abuse Professional Guidelines, which is available at www.dot.gov.

David G. Jensen, J.D., is a staff attorney at CAMFT. David is available to answer member calls regarding business, legal, and ethical issues.

References
149 CFR 40.291(a)
249 CFR 40.291(a)
349 CFR 40.291(b)
449 CFR 40.281
549 CFR 40.281(b)(1)
649 CFR 40.281(b)(2)
749 CFR 40.281(b)(3)
849 CFR 40.281(c)(1)
949 CFR 40.281(c)(2)
1049 CFR 40.281(d)
1116 CCR 1887.6
1249 CFR 40.281(e)

This article appeared in the November/December 2006 issue of The Therapist, the publication of the California Association of Marriage and Family Therapists, headquartered in San Diego, California. The information contained in this article is intended to provide guidelines for addressing legal dilemmas. It is not intended to address every situation that could potentially arise, nor is it intended to be a substitute for independent legal advice or consultation. When using such information as a guide, be aware that laws, regulations and technical standards change over time, and thus one should verify and update any references or information contained herein.