Employee Turnover in Addiction Treatment Facilities

Employee Turnover in Addiction Treatment Facilities

No organization, maybe with the exception of a solo, owner-operator business, is immune to employee turnover.  Some organizations recognize signs and symptoms of turnover faster than others do and are quicker to adapt or implement preventative measures.  Organizations in the health care field appear particularly susceptible to employee turnover due to the high-stress nature of the work, the long hours, low funding, and traumatic encounters.  All of these factors leave organizations in the health care field at constant risk for high turnover.  Those who work in or administrate substance abuse addiction and recovery facilities are not immune to the effects of burnout and turnover.

Eby, Burk, and Maher (2010) indicated the turnover rate in the addictions treatment field ranges between 19% and 50%.  Employee turnover is costly for any organization, as it means resource expenditure to hire, train, onboard new staff, and pay overtime to those who are covering the holes in staffing (Eby et al., 2010; Flynn, Knight, Godley, & Knudsen, 2012).  A turnover problem unique to addiction treatment facilities, or any facility where residential care takes place, is the interruption to client progress. 

Clients, especially those who are in recovery, are resistant to change, often lack appropriate coping skills, and do not trust easily.  When there is staff turnover in a treatment program, clients can lose progress in their treatment, causing them to remain in treatment longer, or leave against a clinician’s advice.  Consequences to the client include potentially returning to their active addiction or losing support back in their community because of an extended recovery program.  Consequences for the organization include the interruption in client services, extra stress and workload on remaining staff, expenditures for hiring, training, and overtime.  Additionally, when the treatment facilities are not at capacity, they lose funding from the state or government. 

Challenges related to staffing and turnover in the addictions treatment field include increased stress levels that are not necessarily client or organizationally related, but which come from outside the organization.  Changes in organizations due to new healthcare initiatives, as well as changes in insurance coverages or companies have become the norm for the 21st century.  Not all organizations adapt to change at the same rate but organizations need to adapt quickly if they want to continue complying with new mandates.  However, implementing new initiatives, policies, training, and expectation increases stress levels for staffing that is generally overworked, underpaid, and underappreciated (Flynn, Knight, Godley, & Knudsen, 2011; Rieckmann, Farentinos, Tillotson,  Kocarnik, & McCarty, 2011). 

Another problem affecting staffing, treatment facilities, and clients, which research identifies, is the challenge of implementing evidence-based practices (EBPs) in facilities or organizations when there is a high level of staff turnover (Lundgren, Chassler, Amodeo, D'Ippolito, & Sullivan, 2012).  Organizations want to implement EBPs to assist with a variety of factors related to client outcomes as well as staffing and organizational challenges (Lundgren et al., 2012).  Organizations spend time and resources researching and developing the EBPs, and then training their staff.  However, when the staff are not with the organization long enough to begin implementing the EBPs the groundwork is essentially lost due to turnover (Lundgren et al., 2012). 

An organization is then caught in a quandary as to how to implement EBPs with no staff who was trained and has to start with a new batch of staff, who may or may not stay long enough to implement the EBPs.  Organizations suffer a potentially unending cycle of not being able to make necessary changes to better client outcomes and increase staff retention by implementing specifically designed EBPs because turnover constantly hinders the implementation of the EBPs.    

The effects of turnover are not always deleterious.  Benefits of turnover include bringing in new staffing who are fresh and who may be more willing and able to implement changes (Flynn et al., 2011).  In addition, oftentimes, staff and clients become compliant; therefore, changing up the staff assists with refocusing both staff and clients (Flynn et al., 2011).  New staff have new perspectives and are advantageous when organizations feel they have hit a wall regarding a new way of thinking or doing something. 

While there is no failsafe to prevent turnover, organizations can help lessen the rates of turnover several ways.  Smaller organizations have lower rates of turnover as they are better able to stay connected with their staff, educate them, communicate with them, and ensure their employee job satisfaction levels stay in the range of engagement (Eby et al., 2010).  Research results presented by Eby et al. (2010) also suggested that organizations implement programs to enhance quality of life at work for employees, and programs that lessen employee stress in order to help prevent turnover. 

As long as there are organizations, there will always be turnover.  However, when organizations take proper steps to assess and engage their workforce they have a better chance of retaining good employees.  Turnover is not always negative though, as refreshing the workforce helps with new ideas and preventing complacency in clients and staff.  The addictions treatment field and community is one in which consistency is key and when organizations take steps to promote consistency through lessening turnover, client and organizational outcomes will be more positive. 



Eby, L. T., Burk, H., & Maher, C. P. (2010). How serious of a problem is staff turnover in substance abuse treatment? A longitudinal study of actual turnover. Journal of Substance Abuse Treatment39(3), 264-271. Retrieved from http://www.sciencedirect.com/science/article/pii/S0740547210001364

Flynn, P. M., Knight, D. K., Godley, M. D., & Knudsen, H. K. (2012). Introduction to the special issue on organizational dynamics within substance abuse treatment: A complex human activity system. Journal of Substance Abuse Treatment42(2), 109-115. Retrieved from http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(11)00232-7/abstract

Lundgren, L., Chassler, D., Amodeo, M., D'Ippolito, M., & Sullivan, L. (2012). Barriers to implementation of evidence-based addiction treatment: A national study. Journal of Substance Abuse Treatment42(23), 1-238.

Rieckmann, T., Farentinos, C., Tillotson, C. J., Kocarnik, J., & McCarty, D. (2011). The substance abuse counseling workforce: Education, preparation, and certification. Substance Abuse, 32(4), 180-190. Retrieved from http://www.tandfonline.com/doi/abs/10.1080/08897077.2011.600122

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Heather Cromwell



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