Skip to main content

Supervisory Turnover in Outpatient Substance Abuse Treatment


Staff turnover is a significant issue within substance abuse treatment, with implications for service delivery and organizational health. This study examined factors associated with turnover among supervisors in outpatient substance abuse treatment. Turnover was conceptualized as being an individual response to organizational-level influences, and predictors represent aggregate program measures. Participants included 532 staff (including 467 counselors and 65 clinical/program directors) from 90 programs in four regions of the USA. Using logistic regression, analyses of structural factors indicated that programs affiliated with a parent organization and those providing more counseling hours to clients had higher turnover rates. When measures of job attitudes were included, only parent affiliation and collective appraisal of satisfaction were related to turnover. Subsequent analyses identified a trend toward increased supervisory turnover when satisfaction was low following the departure of a previous supervisor. These findings suggest that organizational-level factors can be influential in supervisory turnover.

This is a preview of subscription content, access via your institution.


  1. 1.

    Ben-Dror R. Employee turnover in community mental health organizations: A developmental stages study. Community Mental Health Journal. 1994;30:243–256.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Alexander JA, Bloom JR, Nuchols BA. Nursing turnover and hospital efficiency: An organization-level analysis. Industrial Relations. 1994;33(4):505–520.

    Google Scholar 

  3. 3.

    Mor Barak M, Nissly JA, Levin A. Antecedents to retention and turnover among child welfare, social work, and other human service employees: What can we learn from past research? A review and metanalysis. Social Service Review. 2001;75(1):625–661.

    Article  Google Scholar 

  4. 4.

    Glisson C, Schoenwald SK, Kelleher K, et al. Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research. 2008;35:124–133.

    Article  PubMed  Google Scholar 

  5. 5.

    Klein KJ, Knight AP. Innovation implementation: Overcoming the challenge. Current Directions in Psychological Science. 2005;14(5):243–246.

    Article  Google Scholar 

  6. 6.

    Simpson DD, Flynn PM. Moving innovations into treatment: A stage-based approach to program change. Journal of Substance Abuse Treatment. 2007;33(2):111–120.

    Article  PubMed  Google Scholar 

  7. 7.

    Equal Employment Opportunity Commission. Enforcement guidance: Vicarious employer liability for unlawful harassment by supervisors. 1999. Retrieved October 8, 2009 from

  8. 8.

    Alcoholism & Drug Abuse Weekly. Special report: Workforce issues. 14(15); ISSN:1042-1394; April 15, 2002.

  9. 9.

    Gurel O, Carise D, Kendig C, et al. Developing CASPAR: A computer-assisted system for patient assessment and referral. Journal of Substance Abuse Treatment. 2005;28(3):281–289.

    Article  PubMed  Google Scholar 

  10. 10.

    Institute of Medicine. Bridging the gap between practice and research: Forging partnerships with community-based drug and alcohol treatment. Washington: National Academy Press; 1998.

    Google Scholar 

  11. 11.

    Knudsen HK, Johnson JA, Roman PM. Retaining counseling staff at substance abuse treatment centers: Effects of management practices. Journal of Substance Abuse Treatment. 2003;24(2):129–135.

    Article  PubMed  Google Scholar 

  12. 12.

    Gallon SL, Gabriel RM, Knudsen JRW. The toughest job you’ll ever love: A Pacific Northwest Treatment Workforce survey. Journal of Substance Abuse Treatment. 2003;24(3):183–196.

    Article  PubMed  Google Scholar 

  13. 13.

    McLellan AT, Carise D, Kleber HD. Can the national addiction infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment. 2003;25(2):117–121.

    Article  PubMed  Google Scholar 

  14. 14.

    Pinder CC, Das H. Hidden costs and benefits of employee transfers. Human Resource Planning. 1979;2:135–145.

    Google Scholar 

  15. 15.

    Bloom JR, Alexander JA, Nuchols BA. The effect of the social organization of work on the voluntary turnover rate of hospital nurses in the United States. Social Science and Medicine. 1992;34(12):1413–1424.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    McNulty TL, Oser CB, Johnson JA, et al. Counselor turnover in substance abuse treatment centers: An organizational-level analysis. Sociological Inquiry. 2007;77(2):166–193.

    Article  Google Scholar 

  17. 17.

    Neal MJ, Johnson A, Knudsen H, et al. National Treatment Center Study: Third wave on-site results. Athens, GA: The University of Georgia, Institute for Behavioral Research; 2002.

  18. 18.

    Fuller BE, Rieckmann T, Nunes EV, et al. Organizational readiness for change and opinions toward treatment innovations. Journal of Substance Abuse Treatment. 2007;33(2):183–192.

    Article  PubMed  Google Scholar 

  19. 19.

    Lake ET. Advances in understanding and predicting nurse turnover. Research in the Sociology of Health Care. 1998;15:147–171.

    Google Scholar 

  20. 20.

    Broome KM, Knight DK, Edwards JR, et al. Leadership, burnout, and job satisfaction in outpatient drug-free treatment programs. Journal of Substance Abuse Treatment. 2009;37:160–170.

    Article  PubMed  Google Scholar 

  21. 21.

    Knudsen HK, Ducharme LJ, Roman PM. Counselor emotional exhaustion and turnover intention in therapeutic communities. Journal of Substance Abuse Treatment. 2006;31:173–180.

    Article  PubMed  Google Scholar 

  22. 22.

    Blankertz LE, Robinson SE. Recruitment and retention of psychosocial rehabilitation workers. Administration and Policy in Mental Health. 1997;24(3):221–234.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Cotton JL, Tuttle JM. Employee turnover: A meta-analysis and review with implications for research. Academy of Management Review. 1986;11(1):55–70.

    Article  Google Scholar 

  24. 24.

    DeCotiis TA, Summers TP. A path analysis of a model of the antecedents and consequences of organizational commitment. Human Relations. 1987;40(7):445–470.

    Article  Google Scholar 

  25. 25.

    Bannister BD, Griffeth RW. Applying a causal analytic framework to the Mobley, Horner, and Hollingsworth (1978) turnover model: A useful reexamination. Journal of Management. 1986;12(3):433–443.

    Article  Google Scholar 

  26. 26.

    Eby LT, Freeman DM, Rush MC, et al. Motivational bases of affective organizational commitment: A partial test of an integrative theoretical model. Journal of Occupational and Organizational Psychology. 1999;72:463–483.

    Article  Google Scholar 

  27. 27.

    Maslach C, Jackson SE. The measurement of experienced burnout. Journal of Occupational Behaviour. 1981;2:99–113.

    Article  Google Scholar 

  28. 28.

    Jenaro C, Flores N, Arias B. Burnout and coping in human service practitioners. Professional Psychology: Research and Practice. 2007;38(1):80–87.

    Article  Google Scholar 

  29. 29.

    Kirk SA, Koeske GF, Koeske RD. Changes in health and job attitudes of case managers providing intensive services. Hospital & Community Psychiatry. 1993;44(2):168–173.

    CAS  Google Scholar 

  30. 30.

    Ellis BH, Miller KI. Supportive communication among nurses: Effects on commitment, burnout, and retention. Health Communication. 1994;6(2):77–96.

    Article  Google Scholar 

  31. 31.

    Shirey MR. Authentic leaders creating healthy work environments for nursing practice. American Journal of Critical Care. 2006;15(3):256–267.

    PubMed  Google Scholar 

  32. 32.

    Gentry WA, Kuhnert KW, Mondore SP, et al. The influence of supervisory-support climate and unemployment rate on part-time employee retention: A multilevel analysis. Journal of Management Development. 2007;26(10):1005–1022.

    Article  Google Scholar 

  33. 33.

    Broome KM, Flynn PM, Knight DK, et al. Program structure, staff perceptions, and client engagement in treatment. Journal of Substance Abuse Treatment. 2007;33(2):149–158.

    Article  PubMed  Google Scholar 

  34. 34.

    Knight DK, Broome KM, Simpson DD, et al. Program structure and counselor–client contact in outpatient substance abuse treatment. Health Services Research. 2008;43(2):616–634.

    Article  PubMed  Google Scholar 

  35. 35.

    Flynn PM, Broome KM, Beaston-Blaakman A, et al. Treatment Cost Analysis Tool (TCAT) for estimating costs of outpatient treatment services. Drug and Alcohol Dependence. 2009;100:47–53.

    Article  PubMed  Google Scholar 

  36. 36.

    Lehman WEK, Greener JM, Simpson DD. Assessing organizational readiness for change. Journal of Substance Abuse Treatment. 2002;22(4):197–209.

    Article  PubMed  Google Scholar 

  37. 37.

    Rowan-Szal GA, Joe GW, Simpson DD, et al. During-treatment outcomes among female methamphetamine-using offenders in prison-based treatments. Journal of Offender Rehabilitation. 2009;48:388–401.

    Article  PubMed  Google Scholar 

  38. 38.

    US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Survey of Substance Abuse Treatment Services (N-SSATS), 2005 [United States]. 2006. Retrieved October 8, 2009 from

  39. 39.

    Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services (N-SSATS): 2006 (Data on substance abuse treatment facilities, DASIS Series: S-39, DHHS Publication No. SMA 07-4296). Rockville, MD: Office of Applied Studies; 2007.

  40. 40.

    Flynn PM, Simpson DD. Adoption and implementation of evidence-based treatment. In: Miller PM, ed. Evidence-based addiction treatment. San Diego: Elsevier; 2009:419–437.

    Google Scholar 

  41. 41.

    Judge TA, Piccolo RF. Transformational and transactional leadership: A meta-analytic test of their relative validity. Journal of Applied Psychology. 2004;89:755–768.

    Article  PubMed  Google Scholar 

  42. 42.

    Vandenberg RJ, Nelson JB. Disaggregating the motives underlying turnover intentions: When do intentions predict turnover behavior? Human Relations. 1999;52(10):1313–1336.

    Google Scholar 

  43. 43.

    Podsakoff PM, LePine JA, LePine MA. Differential challenge stressor—Hindrance stressor relationships with job attitudes, turnover intentions, turnover, and withdrawal behavior: A meta-analysis. Journal of Applied Psychology. 2007;92(2):438–454.

    Article  PubMed  Google Scholar 

Download references

Funding source

This work was funded by the National Institute on Drug Abuse (Grant R01 DA014468). The interpretations and conclusions, however, do not necessarily represent the position of the NIDA, NIH, or Department of Health and Human Services. More information (including data collection instruments that can be downloaded without charge) is available on the Internet at, and electronic mail can be sent to

Author information



Corresponding author

Correspondence to Danica K. Knight PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Knight, D.K., Broome, K.M., Edwards, J.R. et al. Supervisory Turnover in Outpatient Substance Abuse Treatment. J Behav Health Serv Res 38, 80–90 (2011).

Download citation


  • Substance Abuse Treatment
  • Emotional Exhaustion
  • Revolving Door
  • Parent Organization
  • Staff Satisfaction