As we look back and remember all those who died for our country on this Memorial Day, we’re also remembering the ones who made it back home. We found it fitting to share some of their stories from our recent trip to Washington D.C. with Mid-Michigan Honor Flight as our nation celebrates 250 years.

This is Mission 25.

• Michigan ranks 38th nationally in terms of addiction counselors per person with an addiction
• Heads of treatment organizations pinpoint high turnover and low funding as perpetuating the shortage
• Many providers doubt Michigan’s addiction treatment system is sustainable in the long term 

Alyssa Montague is no stranger to being overworked.

Until recently, Montague, the community engagement manager at Ten16 Recovery Network–Midland, was taking on the work of multiple people. So was the therapist who works under her.

“He was slammed,” she said. “I was slammed.”

Now, for the first time since early 2024, her team is fully staffed. But other addiction treatment organizations across the state aren’t as lucky. 

As the opioid epidemic continues to ravage Michigan, the state’s addiction treatment workforce faces a shortage that hinders its ability to effectively respond, providers say.

Michigan ranks 38th nationally in terms of addiction treatment staffing, with 7.58 addiction treatment counselors per 1,000 people with a substance use disorder, according to the Michigan Department of Health and Human Services. Indiana sits at the top of the DHHS ranking, with 16.54 counselors per 1,000 people with a substance use disorder, and the US median is 8.79 counselors per 1,000 people with a substance use disorder.

Michigan has taken steps to alleviate counselors’ financial woes, offering $12.3 million through its behavioral health student loan repayment program through 2024 and $3.7 million to repay addiction treatment providers’ student loans. Beginning this summer, DHHS will provide internship and scholarship opportunities to incentivize new providers to become addiction treatment counselors.

Some organizations were fully staffed before the coronaviruspandemic, according to Paula Nelson, president and CEO of Sacred Heart Rehabilitation Center, which has locations across the state. 

But, during the pandemic, many addiction treatment counselors experienced burnout and left the field, and many others retired early, according to Nikki Soda, of Sodas Consulting. Providers couldn’t attract enough new counselors to fill the dearth. 

“Post-pandemic behavioral health demand increased way faster than the workforce development could, because we saw a significant spike in usage during COVID,” said Soda. 

An estimated 1.3 million Michiganders with a substance disorder including alcoholism did not receive addiction treatment in 2024, according to the most recent data from the National Surveys on Drug Use and Health. The vast majority of those people don’t seek treatment, but providers say the workforce shortage makes it hard to meet the needs of those who do. 

One Michigander dies from an opioid overdose roughly every six hours.

As Bridge has previously reported, Michigan has among the fewest behavioral health vocational programs in the nation. That substantially weakens the student-to-worker pipeline and means fewer people are being trained to help alleviate the worker deficit. 

The shortage means that, instead of receiving dedicated attention from their providers, people in addiction treatment often feel they are told to “go figure it out,” said Josh Puckett, a peer recovery coach at Recovery Action Network of Michigan. 

High-stress demands

Multiple factors perpetuate the shortage. 

One is that working in addiction treatment isn’t easy: Counselors face high rates of burnout and secondary trauma. They deal every day with people at the lowest points in their lives. 

“It’s not for the faint of heart,” said Anthony Dondero, an addiction treatment counselor at Hegira Health, which has locations around Wayne County. “I had to really wrap my head around and really process the fact that more of my clients are going to pass away from the disease that I’m treating than if I were treating just general mental health.”

High stress contributes to the high rates of turnover treatment organizations see.

Nelson said Sacred Heart saw 39% turnover of therapists and counselors over the past fiscal year, while its residential treatment program saw 62% turnover. 

High turnover has affected the addiction treatment field for years, with average national rates above 30%. The turnover rate for all industries in the US was 3.4% in March, according to the Bureau of Labor Statistics.

“We’re constantly having to retrain people,” said Nelson. 

A visual of the 12-step program hangs on the wall at the Ten16 Recovery Network-Midland. (Nate Miller for Bridge Michigan)

However, finding qualified staff is extremely difficult, especially in Michigan’s rural areas.

“Ten years ago, when we’d advertise a clinical position in some of our rural communities … we still would get a handful of resumes,” said Sam Price, president and CEO of Ten16, which has locations across central Michigan. “Now, the competition is so fierce we can run an ad for three weeks and not even get a qualified applicant.”

Educational hurdles, low wages

To obtain their full license, counselors must be certified by the Michigan Certification Board for Addiction Professionals. While many organizations require their addiction treatment counselors to have master’s degrees, counselors can legally practice with less formal education if they are certified by the state board. 

Counselors can practice without being certified as long as they are working toward their full license, which can take up to three years. 

However, Nelson said, “Typically, after they get their full license, they move on to other opportunities.” 

Many leave to provide mental health services, which often require less administrative work. 

That leaves addiction treatment centers short-staffed, counselors overworked and patients in need of more attention than they can get. Because of high turnover rates, the attention they can get often comes from counselors new to the field, who can be ill-equipped to manage the complex needs of patients in addiction care, said Greg Toutant, CEO of Great Lakes Recovery Centers, which is based in the Upper Peninsula. 

Dealing with the multifaceted needs of patients in addiction treatment is something, he said, “these newer counselors, (who) are making up the majority of the field, maybe don’t have all the expertise to handle.”

Also contributing to the shortage is low salaries.

While some private, for-profit therapy settings can pay up to $120,000 a year, said Montague, addiction treatment nonprofits, which are funded by both Medicaid and private insurance, can pay much less. The average base annual salary of addiction treatment counselors is $50,506, according to Payscale.

Providers struggling nationally 

According to Thuy Nguyen, director of the Michigan Public Health Substance Use Policy and Economic Research Network, while staffing numbers at outpatient office-based mental health specialists bounced back from reductions during the coronavirus pandemic, intensive mental health facilities, such as those for addiction treatment, “struggled to rebuild their workforce.” 

That is because, compared to before the pandemic, “the lasting strain on the health care system has unfortunately made becoming a health care provider less attractive than it had been,” said Dan Schwartz, vice president of public policy at the National Association for Behavioral Healthcare.

That might have been because outpatient settings are lower-risk environments in terms of COVID-19 transmission, or because they are less stressful compared to intensive settings like inpatient addiction treatment. 

Additionally complicating the shortage, said Schwartz, is that too few people are being trained to work in addiction treatment, across the board. 

And because of broad Medicaid cuts spelled out in the One Big Beautiful Bill Act that Congress passed last year, Schwartz said he doesn’t anticipate the national shortage improving anytime soon. The National Center for Health Workforce Analysis projects that, by 2038, the US will be short more than 77,000 addiction counselors. 

Medicaid cuts also greatly affect who can receive access to care. 

“One of the most significant challenges is access to care for uninsured Michigan residents, who remain the most underserved population,” DHHS said in a statement. “Federal and state funding to support uninsured individuals has not kept pace with demand.”

Some support has come from the federal level in the form of the Opioid Workforce Expansion Program, which provides funding to train students in addiction treatment settings. 

Some states have dealt with the shortage better than others. Nguyen cited Massachusetts as a role model for other states recovering from pandemic-era reductions. Since 2022, the state has provided more than $270 million to repay loans of direct care providers including addiction treatment professionals, alleviating some of their financial strain.

‘Wake up’

Ten16 Recovery Network-Midland offers food-themed group therapy sessions on every weekday. (Nate Miller/Bridge Michigan)

Treatment organizations across Michigan have trouble imagining a future for addiction treatment centers without an overhaul of the existing system.

“A couple years ago, I said we can’t continue this for any more than five years, and I still believe that,” Nelson, of Sacred Heart, said. 

Toutant, of Great Lakes Recovery Centers, said addiction treatment providers across the state must unite to move away from the current reimbursement model.

“I don’t think there’s been enough voices to rise up in opposition to say to the state of Michigan, … ‘Wake up,’” he said. “The workforce problem will not change unless the financing model changes.”

“We recognize the challenges providers are facing, which is why the state continues to invest in recruitment, retention and provider capacity efforts to strengthen Michigan’s addiction treatment workforce,” DHHS said in a statement. 

If provider facilities close, and Michiganders who need addiction treatment are increasingly unable to access it, the state will see “more hospitalizations and deaths,” said Kenneth Hammond Jr., a board member of MAADAC, the Michigan Association for Addiction Professionals.  “More individuals will be incarcerated without these services being available to them.”

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