Clinical staff turnover is high in addiction treatment programs and is associated with disrupting the clinical relationship and lowering the quality of care. Efforts to implement evidence-based practices may be hampered by staff turnover, and replacing personnel is costly. The relationship between substance abuse counselors' perceptions of clinical supervision and their intent to leave employment was studied among community treatment programs participating in the National Institute of Drug Abuse Clinical Trials Network. A total of 1643 questionnaires were mailed, and 1001 were returned (response rate, 60.9%). Of these, 823 met inclusion criteria. Results indicated that high-rated clinical supervision was associated with:

• Less intention on the part of counselors to leave their jobs.
• Less emotional exhaustion.
• Greater feelings of autonomy.
• Higher perception of procedural justice (i.e., fairness of decision making within their organization).
• Higher perception of distributive justice (i.e., fairness of job demands and rewards).

Comments by Michael G. Boyle, MA
Training clinical supervisors and reviewing the quality of clinical supervision is time-consuming and expensive. However, opening the “black box” of supervision to observe its impact and modifying it as necessary may be worth this investment. The counselors surveyed in this study were part of a unique research network, and their situation may not be representative of other programs in the United States. Nonetheless, high-quality clinical supervision can improve the quality of addiction treatment while simultaneously reducing the financial costs that result from staff turnover. Addiction counselors should advocate for it within their organizations.