Advances in Addiction & Recovery (Fall 2016)

FALL 2016 Vol. 4, No. 3

Justice Reform for Veterans: The Rise of Veterans Treatment Courts

By Scott Swaim, USAFV, MA, LMHC, Justice for Vets Director

Breaking the Chain of Addiction’s Intergenerational Legacy

By Tian Dayton, PhD and Sis Wenger, NACoA President/CEO

NAADAC 2016 Award Winners

CONTENTS FALL 2016 Vol. 4 No. 3 Advances in Addiction & Recovery, the official publication of NAADAC, is focused on providing useful, innovative, and timely information on trends and best practices in the addiction profession that are beneficial for practitioners.

NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 85,000 addiction coun­selors, educators, and other addictionfocused health care pro­fessionals in the United States, Canada, and abroad. NAADAC’s members are addic tion counselors, educators, and other addic tionfocused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education.

Mailing Address 44 Canal Center Plaza, Suite 301

Alexandria, VA 22314 Telephone 800.548.0497 Email naadac@naadac.org Fax 703.741.7698 Managing Editor

Jessica Gleason, JD

Kristin Hamilton, JD Communications & Digital Media Coordinator

■ F EAT UR ES 14 Justice Reform for Veterans: The Rise of Veterans Treatment Courts By Scott Swaim,

Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Committee

Kirk Bowden, PhD, MAC, NCC, LPC Rio Salado College

Kansas Cafferty, LMFT, MCA, CATC, NCAAC True North Recovery Services National Certification Commission for Addiction Professionals (NCC AP)

Thomas Durham, PhD

NAADAC, the Association for Addiction Professionals

Deann Jepson, MD Advocates for Human Potential, Inc.

18 In 2017, Advocates Must Work to Build on Success of 114th Congress By Michael

James McKenna, MEd, LADC I AdCare Hospital

22 Breaking the Chain of Addiction’s Intergenerational Legacy. The Effects of Trauma: How

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP

NAADAC, the Association for Addiction Professionals

USAFV, MA, LMHC, Director, Justice For Vets

Petruzzelli, National Council for Behavioral Health

Pain From One Generation Seeps Into the Next By Tian Dayton, PhD, and Sis Wenger, President/CEO, National Association for Children of Alcoholics (NACoA)

26 Opioid Antagonist: Issue of “Over-The-Counter” Naloxone. An Interview with Darryl S. Inaba, PharmD, CADC V, CADC III Interview by Jessica Gleason, JD, NAADAC Director of Communications

28 Getting HIP in Higher Education: Using High Impact Practices When Teaching

By Margaret A. Smith, EdD, MLADC, International Coalition of Addiction Studies Education (INCASE)

■ DEPA R T M E N TS

Robert C. Richards, MA, NCAC II, CADC III Retired Article Submission Guidelines We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Please submit story ideas and/or articles to Jessica Gleason at jgleason@naadac.org.

For more information on submitting articles for inclusion in Advances in Addiction & Recovery, please visit www.naadac.org/advancesinaddictionrecovery# Publication_Guidelines.

Disclaimer It is expressly understood that articles published in Advances in Addiction & Recovery do not necessarily represent the view of NAADAC. The views expressed and the accuracy of the information on which they are based are the responsibility of the author(s) and represent the wide diversity of thought and opinion within the addiction profession.

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President’s Corner: Farewell and Thank You! By Kirk Bowden, PhD, MAC, NCC, LPC, NAADAC President

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From The Executive Director: The Legacy of a President By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

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Ethics: Cultural Humility and Sensitivity By Mita M. Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair

Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5

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Membership: NAADAC Addiction Counselor Fellows Receive Stipends Up to $18,000

By A. Ace Crawford, NAADAC Grants Manager

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This publication was prepared by NAADAC, the Association for Addiction Pro­fes­sionals.

Reproduction without written permission is prohibited. For more in­formation on obtaining additional copies of this publication, call 1.800.548.0497 or visit www. naadac.org.

Certification: Adolescent Substance Use Disorder Treatment: A Special Opportunity for Treatment By Steve Durkee, LCADC, NCAAC, NCC AP Secretary

Printed September 2016

11 Conference: NAADAC Honors 2016 National Award Winners By Kristin Hamilton, JD,

Advertise With Us For more information on advertising, please contact Elsie Smith, Ad Sales Manager at esmith@naadac.org.

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NAADAC Communications & Digital Media Coordinator

30 NAADAC CE Quiz 31 NAADAC Leadership

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■ PR ES ID ENT ’S CO RN E R

Farewell and Thank You!

By Kirk Bowden, PhD, MAC, NCC, LPC, NAADAC President

My two-year tenure as NAADAC President comes to an end with the close of the NAADAC 2016 Annual Conference in Minneapolis, MN this October. I thank you, the members of NAADAC, for giving me the opportunity to serve as your president; it has certainly been a great honor for me and the opportunity of a lifetime. I have truly loved my time as President.

I hope that during my tenure, I have had a positive influence on NAADAC and the addiction counseling profession. I leave this position knowing that NAADAC will continue to move forward as Gerry Schmidt, MA, MAC, LPC, becomes your new president and Diane Sevening, EdD, LAC, becomes your new president-elect. Gerry and Diane are outstanding people who I consider to be my personal friends, as well as great leaders, true addiction counseling professionals, and longtime NAADAC members who have served in leadership positions for many years.

Leading NAADAC requires a total team effort and the NAADAC leadership team is comprised of some of the finest and most talented people in our profession. This dedicated team includes elected members of the Execu­tive Committee, appointed committee chairs and members, the Chair and Commissioners of the National Certification Commission for Addic­ tion Professionals (NCC AP), state affiliate presidents and boards, and NAADAC’s Executive Director, directors, managers, and staff.

I take this opportunity to specifically thank our Executive Director, Cynthia Moreno Tuohy. I truly appreciate all the support and encouragement she has offered to me during my term. Cynthia has served NAADAC in various leadership position for most of her adult life, including a term as president over 20 years ago. She is one of the hardest working people I have ever met and is truly committed to NAADAC, its membership, and all addiction professionals throughout the country and around the world.

We are blessed to have her as our Executive Director.

I leave NAADAC hoping that we always remember that addiction counselling is about serving people. It is about assisting and supporting individuals in their time of great need. Regardless of whether you are a life-long NAADAC member or this is your first year of membership, I urge you to please renew your commitment to NAADAC and to the addiction

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counseling profession. Please consider running for a leadership position, whether with NAADAC or with your state affiliate board, and help shape the future of the addiction profession. Volunteer to serve on one or more of NAADAC’s committees or consider applying to serve as a NCC AP Com­missioner. NAADAC and the addiction profession need you!

I thank NAADAC members for the thousands of hours of volunteer service you provide to NAADAC and our profession each year. NAADAC is a dynamic association of dedicated and caring professionals. Thank you, NAADAC. It has been a pleasure serving you!

In addition to serving as NAADAC’s President, Kirk Bowden, PhD, MAC, NCC, LPC, serves on the Editorial Advisory Committee for Advances in Addic­tion & Recovery. While serving in many capacities for NAADAC through the years, Bowden also serves as Chair of the Addiction and Substance Use Disorder Program at Rio Salado College, consultant and subject matter expert for Ottawa University, a past-president of the International Coalition for Addic­ tion Studies Education (INCASE), and as a steering committee member for SAMHSA’s Center for Substance Abuse Treatment (CSAT), Part­ners for Recovery, and the Higher Education Accreditation and Competencies expert panel for SAMHSA/CSAT. Bowden was recognized by the Arizona Association for Alcoholism and Drug Abuse Counselors as Advocate of the Year for 2010, and by the American Counseling Asso­ ciation for the Counselor Educator Advocacy Award in 2013, the Fellow Award in 2014, Outstanding Addiction/Offender Professional Award in 2015, and most recently the California Association for Alcohol/Drug Educators’ Lifetime Achievement Award in 2015.

■ F R O M T H E E X E C U T I VE DI RE C TOR

The Legacy of a President

By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

Every president of NAADAC hopes to leave a legacy that will be remembered as a positive influence on the people and the causes that he or she serves. Like a ring on a tree, each president leaves his or her mark during his or her two-year term. President Kirk Bowden will leave a very visible positive mark on NAADAC and its members.

Through his own special talents as a counselor and an educator, he has lead NAADAC through a new era of increased visibility and vitality, increased awareness of the importance of standardized addiction education and a national addiction education accreditation process, and greater financial security. NAADAC has grown under Dr. Bow­ den’s leadership and his legacy will be passed onto the next President of NAADAC, Gerry Schmidt.

NAADAC does more than represent and support the interests of its members and the over 85,000 addiction focused professionals in the United States. In the past two years, we have expanded across the globe, bringing addiction education and certification to countries suffering from similar addiction issues, while simultaneously working to strengthen our affiliates and their influence in their states. Here in the United States, our National Certification Commission for Addiction Professionals (NCC AP) has made strides to increase the number of those nationally certified and build a national credentialing system based on national standards. Dr. Bowden has greatly influenced and supported NCC AP in its efforts to build the vision of a national credentialing system recognized and supported by government, payors, and educators. Today, NCC AP credentials are recognized in more states and by more third party payors than ever before.

Over the past two years, NAADAC’s public image has continued to grow and NAADAC’s views and positions have received more media atten­tion than ever. NAADAC will continue to advocate for addiction counselors and professionals as the medical and human service professionals who treat addiction best and for recognition of addiction professionals’ vital role as part of an integrated medical team

and the continuum of care. Public rec­og­nition of this discipline’s specific knowledge, skills and competencies continues to increase as we work to create healthier individuals, families and communities.

Finally, the last two years have brought us a formal recognition of the discipline of addiction counseling by the U.S. Government-fund­ ing of a Minority Fellowship Program for Addiction Counselors through the Substance Abuse and Mental Health Services Admi­ nistration (SAMHSA). Funding for the NAADAC Minority Fel­low­ ship Program for Addiction Counselors (NMFP-AC), which started in Fall 2015, was the result of eight years of hard advocacy work by NAADAC and its partners. Dr. Bowden’s guidance and support during the creation of this important program cannot be forgotten.

Each one of us hopes to leave a positive legacy that moves our profession. Each one of us who carries a passion and dedication for this work finds ways to make a difference. I applaud the efforts that each of you has made to serve communities, states, and the nation, and I encourage you to be the next person to add influence in your state to build the addiction profession and workforce! Together we can turn the tide to support and create healthier individuals, families and communities. Together we make a difference!

Blessings, Cynthia Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years as well as an international, national and state trainer in a variety of topics. Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.

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■ Et h i cs

Cultural Humility and Sensitivity

By Mita M. Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair

As the providers of co-occurring treatments and services to clients who struggle with both substance and behavioral addictions, we find ourselves living and working in a precarious time.

The concept of “multicultural humility and sensitivity” has been attacked and put aside while one definition of “to discriminate” has been elevated in numerous regions of our country. Cultural affiliation represents and celebrates the beliefs, customs, practices, historical frames, experiences and ways of being that are unique and vital to a group’s identity. According to the Merriam-Webster dictionary, culture is the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations.

From an ethical multicultural point of view, to discriminate is to recognize, appreciate, and value difference. From a positive counseling point of view, to discriminate is to engage in dialogue and provide prevention, assessment, treatment planning, treatment, and recovery services that embraces and incorporates cultural diversity.

Clinicians and other service providers intentionally recognize and incorporate areas of difference and need because that’s what we do to help our clients engage, participate, succeed, thrive, and grow. Communities and cultural groups across our nation are endorsing a negative definition of “discrimination” as a viable option for mental health/addic­tion service providers. These groups are allowing and rationalizing the unjust and prejudicial treatment of clients who are different based on race, ethnicity, sexual orientation, gender identification, age, and socioeconomic status — by endorsing the attitude that counselors do not have to treat those who have beliefs, values, and behaviors to which they themselves do not adhere. This selection process cuts into the core of the ethic of helping people. As clinicians, we are called to higher standards ethically and professionally. Most clinicians enter our profession to help people. We understand and abide by the words “do no harm.” As professionals, we are called to separate ourselves from society; we cannot carry society’s prejudices and stigmas into our work with clients. Our clients have already been pushed 6

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down and harmed by society’s definitions of addiction and addict. Addicts are “those” people; various communities now endorse not working with “those” people on professional and personal grounds. How did we get here?

As clinicians, we are taught in school to be respectful of all differences (i.e., ethnic and racial identity, developmental stage, trauma, family background, religion and spirituality, socioeconomic status, sexual identity, psychological maturity, unique physical characteristics, and geographical location). There are three stages to developing ethical multicultural skills: exploring, understanding, and acting.

Ethically and holistically — with regard to the issues at hand — we take the time to learn about the client, understand what happened or is happening to him or her, and help him or her plan and act in a manner that is empowering and individualized. Clinicians and service providers appreciate and accommodate clients from diverse cultural groups. We use our education, skills, training, and supervised experience to provide meaningful, respectful, realistic and culturallyrelevant services. “It’s not about us.” We serve clients responsibly and ethically — “it’s about them.” As a profession we are being called to develop practical and relevant approaches that address and adapt counseling practices to meet the unique and diverse needs of the particular demographics we serve.

NAADAC and the Ethics Committee provide direction for clinicians and services providers who work with people, families, and communities struggling with abuse and addiction, who would normally be the target of discriminatory philosophies and practices. Specifically, these include: • Addiction Professionals and service providers shall not practice, condone, facilitate, or collaborate with any form of discrimination against any client on the basis of race, ethnicity, color, religious or spiritual beliefs, age, gender identification, national origin, sexual orientation or expression, marital status, political affiliations, physical or mental handicap, health condition, housing status, military status, Ethics, continued on page 8 ☛

■ M EM B ER S H I P

NAADAC Addiction Counselor Fellows Receive Stipends Up to $18,000 Join the President’s Plan to Help the Addiction Workforce!

By A. Ace Crawford, NAADAC Grants Manager

Overview NAADAC Minority Fellowships for Addiction Counselors (NMFP-AC) are federally funded awards designed to increase the number of culturally competent Master’s-level addiction professionals serving underserved communities, including minority populations, LGBTQ populations, and transition age youth (ages 16–25), in an effort to increase access to and quality of behavioral health care.

Funded by the Substance Abuse and Mental Health Ad­mini­ stration (SAMHSA), the NMFP-AC’s ultimate goal is to reduce health disparities and improve behavioral health care outcomes for diverse populations by addressing current challenges in the addictions profession pertaining to human infrastructure development, cultural misalignment between addiction professionals and the populations they serve, and insufficient training of addiction professionals in cultural humility concepts. As the second year of the four-year grant comes to an end, much has been accomplished.

NMFP-AC Eligibility Requirements To be eligible for the fellowship, an applicant must: • Be a U.S. Citizen or Legal Permanent Resident; • Be enrolled full time in either an addiction counseling Master’s program or a Master’s program with a concentration in addiction counseling from an accredited institution; • Agree to complete an orientation training and six required NAADAC educational webinars on cultural humility concepts; • Agree to work with a NMFP-AC provided mentor; • Commit to providing at least six months of post-graduation addiction counseling services to underserved populations, defined as minority populations, LGBTQ populations, and/or transition age youth (ages 16–25); • Submit a complete application that includes all required supporting documentation; and • Not have been previously notified of ineligibility for the fellowship by the NFMP-AC. Students do not need to be a minority or LGBTQ to qualify for the fellowship. Students of all backgrounds are encouraged to apply.

Now Open to Social Work and Nursing Students In 2016, NAADAC was awarded the Now is the Time: Minority Fellowship Program for Addiction Counselors Supplemental Grant, which provides funds to expand the NMFP-AC to include fellowships for Master’s students in social work and nursing programs with an emphasis in addiction/substance use disorders.

Program Benefits & Highlights Awarded Fellows each receive tuition stipends of up to $18,000, specialized education in cultural humility concepts and working with underserved populations, professional support and development, a NAADAC-assigned mentor, an annual NAADAC membership including the opportunity to earn up to 75 continuing education hours for free, and the prestige of being a NMFP-AC Fellow.

The Program also provides funds for Fellows to either attend the NAADAC Annual Conference or another NAADAC conference in their area to increase their knowledge base and network with others in the field.

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Last year’s NMFP-AC Fellows have completed and attained their Master’s Degrees in Addiction Counseling and will strengthen our workforce with their hard work, dedication to the field, and commitment to helping underserved populations, especially transition age youth. We are excited to see what comes next for them in their careers!

NMFP-AC Fellows already selected for this award year have recently started the Program by meeting NMFP-AC staff and each other and receiving a detailed overview of program requirements and the resources currently available. They are excited to begin their specialized education programs, develop relationships with their mentors, use their NAADAC membership resources, and finish their Masters’ Degree programs with NMFP-AC funding and support.

The NMFP-AC currently has Fellows in 16 states plus the territory of Puerto Rico and hopes to have a Fellow in every state and U.S. territory by 2018.

Still Accepting Applications – Apply Today Interested in applying for the NMFP-AC or know an eligible Master’s student who should apply? You’re in luck! This year, NAADAC is accepting applications on a rolling basis and we are still accepting applications from students who will graduate from their Master’s programs by August 2017. However, as applications will be reviewed and approved on a first come, first served basis, students should apply as soon as possible before this year’s grant funds run out.

To apply, students must submit an online application, along with three required references, an essay, a current resume or CV, and an official transcript from their academic institution. If applicable, students should also include their professional certification and/or license in addiction/substance use disorder counseling. For more information or to start the appli­cation process, please visit www.naadac.org/nmfp-ac-eligibility-applicationprocess. If you have any questions, please contact NAADAC’s Grants Manager, Ace Crawford, by phone at 703.741.7686 x107 or by email at acrawford@naadac.org.

Spread the Word!

Now is the time to increase access to addiction services in America! Help NAADAC spread the word about this invaluable fellowship program and help the addiction workforce! Help us help you!

Ace Crawford is the Grants Program Manager for NAADAC. He manages the day-to-day operations of various grant programs and is responsible for development and implementation of all program components. Crawford has more than 10 years of experience in creating and managing public health and nonprofit education programs ranging from kidney disease to pharmacy research and has received a BS degree in Health Management from Howard University. Prior to joining NAADAC, Crawford served as the Education Services Manager for the National Electrical Contractors Association, a nonprofit organization based in Bethesda, MD.

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Ethics, continued from page 6

or economic status.

• Professionals and service providers shall not engage in, endorse or condone discrimination against prospective or current clients and their families, students, employees, volunteers, supervisees, or research participants based on their race, ethnicity, age, disability, religion, spirituality, gender, gender identity, sexual orientation, marital or partnership status, language preference, socioeconomic status, immigration status, active duty or veteran status, or any other basis.

• Addiction Professionals and service providers shall provide services that are nondiscriminatory and nonjudgmental. Providers shall not exploit others in their professional relationships. Providers shall maintain appropriate professional and personal boundaries.

• When Addiction Professionals become aware of inappropriate, illegal, discriminatory, and/or unethical policies, procedures and practices at their agency, organization, or practice, they shall alert their employers. When there is the potential for harm to clients or limitations on the effectiveness of services provided, providers shall seek supervision and/or consultation to determine appropriate next steps and further action. Providers and Supervisors shall not harass or terminate an employee or colleague who has acted in a responsible and ethical manner to expose inappropriate employer employee policies, procedures and/or practices.

• Addiction Professionals shall develop an understanding of their own personal, professional, and cultural values and beliefs. Providers shall recognize which personal and professional values may be in alignment with or conflict with the values and needs of the client. Providers shall not use cultural or values differences as a reason to engage in discrimination. Providers shall seek supervision and/or consultation to address areas of difference and to decrease bias, judgment, and micro­aggressions.

As ethical clinicians and service providers, we shall treat clients as we would want to be treated if we were in their shoes. We express genuine empathy and concern.

We shall not endorse society’s views on stereotyping and discrimination; as providers we do not view clients through a stigmatizing lens. Clients are not referred to other clinicians/agencies simply because they are different. We seek supervision and opportunities for professional growth and development. We seek to understand our client’s views and core beliefs without transference and counter-transference. We treat clients — all clients — with respect and consideration. We provide quality services to all clients, regardless of their cultural affiliation or ability to pay. As professionals, we have an obligation to accept clients where they are at and ensure that they receive culturally-inclusive treatment and services. We push ourselves to understand rather than “select out” those clients who do not fit our profile.

Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education and Supervision, an MA in Counseling, and a BA in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the national Master Addiction Counselor (MAC) and Department of Transportation Substance Abuse Pro­fes­sional (SAP) certifications. Johnson has two supervisory credentials (ACS and AAMFT) and is an NCC. In addition to being a core faculty member at Walden University, she maintains a private practice where she sees clients and supervisees who are working on credentialing. Johnson is the Past-President of the Colorado Association of Addiction Professionals (CAAP) and is the Ethics Chair and Southwest Regional VP for NAADAC. She speaks and trains regionally and nationally on topics specific to counseling skills, ethics, supervision, and addiction-specific services. She has been appointed by the Governor of Colorado to two committees working on behavioral health integration and transformation, is a consultant to the state regulatory agency that regulates our professions, and is a consultant and committee member at the state Office of Behavioral Health.

■ CER T IF IC AT I O N

Adolescent Substance Use Disorder Treatment: A Special Opportunity for Treatment

By Steve Durkee, LCADC, NCAAC, LPCC, NCC AP Secretary

The latest data from the National Institute on Drug Abuse’s Monitoring the Future Survey, which surveyed 44,892 students in the 8th, 10th and 12th grades from 382 public and private schools, suggests that, “[p]erhaps the most striking finding in 2015 is that across the very broad spectrum of drugs (more than 50 classes and subclasses) none exhibited a statistically significant increase.” However, this same study suggests that annual prevalence of using any illicit drug remained essentially unchanged in all three grades in 2015; annual prevalence was 14.8%, 27.9%, and 38.6% in 8th, 10th, and 12th grades, respectively (Johnston, O’Malley, Miech, Bach­ man, & Schulenberg, 2016).

As a Nationally Certified Adolescent Addiction Counselor, it has been my pleasure to work with the adolescent population for over twenty years. My training taught me to always look at my work like a scholar practitioner. In that role, I offer the following as one example of how we need to continue our education and research in order to best serve the clients with whom we are privileged to work.

Given the above information, research suggests that there is a need to explore an understanding of adolescents as a unique population when considering various possible treatment processes. When examining adolescent substance use disorder intensive outpatient treatment, research has suggested that although substance use disorder treatment is effective for adults, it has a remarkably low long-term success rate for adolescents (Cacciola, Meyers, Bates, Rosenwasser, Arria & McLellan, 2015). Length of stay in the treatment setting correlates with long-term success, but there has been a lack of information explaining why adolescents leave treatment and run into legal problems soon after leaving (King, McChaerge, 2014).

Some believe that adolescent outpatient substance use disorder treatment has not been successful because the treatment model has been based upon adult clients (E. F. Wagner, 2009).

Additional perspectives need to be considered from developmental and experiential bases that specifically consider adolescents (Knudsen,

2009). Adolescents have valuable perspectives about what is effective and what is not effective in treatment, and they need to be heard. According to King, Chung, and Maisto (2009), monthly conversations between adolescents in treatment and their treatment providers can present an oppor­ tunity for adjustments to be made to their individual treatment plans.

Adolescent developmental theory is characterized more by a developmental phase than by a set ­sequenced series of ­stages (Prout & Brown, 1999; E. F. Wagner, 2008). Piaget and Inhelder’s (1969) theory in the area of cognitive development informs adolescent developmental theory. Piaget posited that from the age of 11, most people are in the formal operational phase of cognitive development, meaning they can develop hypotheses and make conclusions about effective ways to solve problems.

Piaget and Inhelder suggested that it becomes a process of assimilation when people incorporate new information into extant knowledge and accommodation, and when people adjust to new information.

In considering adolescent developmental theory, it is important to understand the psychosocial elements of adolescent developmental stages. This theory emphasizes the importance of social relationships, as well as feelings during the course of development. The theory suggests that all people have similar basic needs and that societal and cultural expectations, as well as personal relationships, influence the way that people respond to these needs (Kaplan, 2000). Erikson (1968) asserted that adolescents generally are in Stage 5, where there is a struggle between identity and role confusion.

In this stage, adolescents are establishing a strong sense of identity and exploring alternatives about career and future plans. Adolescents are trying to find out who they are, what they are all about, and where they are going in life (Meece, 2002).

The last concept to consider in adolescent development is moral development. Kohlberg (1976) stressed that moral development, which primarily involves moral reasoning, unfolds in stages. A key understanding is internalization, the developmental change from behavior that is externally controlled FA L L 2 016 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 9

to behavior that is internally controlled (Colby, Kohlberg, Gibbs, & Lieberman, 1983). In this theory, Kohlberg stated that the stages range from preconventional reasoning to conventional reasoning to post conventional reasoning, where individuals move from doing what gets them the most rewards or the least punishment to a more developed sense of justice, equality, and fairness as the basis of determining what is right and wrong.

In using the above concepts, I have found the following to be true in working with adolescents in an intensive outpatient treatment program.

Based on research performed pursuant to a dissertation requirement for my doctorate, I offer the following observations. In asking 10 different young adults, age 18 to 25, to assist me in designing an Intensive Outpatient Program (IOP), they provided memories from their experience in IOPs as adolescents. The participants’ memories of the IOPs that they experienced were best described by five themes: relational issues, the process of IOPs, the content of the programming in IOPs, current use of techniques and process learned while in IOPs, and advice to newcomers into IOPs. The first theme dealt with relational concepts and strategies. Generally, the participants reported that being with other adolescents who were struggling with their own recovery was very important. The sense of being accepted and not judged by the group allowed the participants to relax and not feel alone or different from others. The IOPs allowed the participants to transition from being in a residential program of 30 days or more to enjoying the life of an adolescent in high school.

Some of the participants also mentioned that gender-specific groups were helpful, but another participant expressed a preference for one-on-one conferencing while still appreciating that both forums were available during this phase of treatment. Likewise, as might have been expected, the usual drama that arises in a group of adolescents was present, but it was not determined to be relevant to the process.

The participants reported that it was helpful to have staff members who were in recovery themselves and active members of AA. The reasonable proximity of age also seems to facilitate trust between staff and participants and the ability of staff to relate to the participants. It was equally important that the participants had staff members who supported their efforts but could call them out on behaviors that did not support their stated intention of becoming sober. The ability of participants, parents, and school staff to collaborate also was important to the participants.

The participants expressed an appreciation for the family sessions that were part of the IOPs. They reported that these sessions, backed up with individual and group sessions on family topics, allowed the entire concept of family communications to be viewed from fresh perspectives by participants and family members. The process of having four or five families present to discuss common issues allowed the participants and their families to benefit from tools other families used while understanding that some common communication problems existed among all of the families. It was evident from the report of one participant whose family refused to attend the sessions how much disappointment played a role in not being able to start fresh.

The participants were divided over attendance at “young people’s” AA meetings versus traditional open AA meetings. The idea of being with peers from an age perspective who had attained long-term sobriety was important to some; to others, not feeling intimidated by large crowds of older people was important. One participant found young people’s meetings an excuse to continue to think and act like an adolescent, but most of the other 10

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participants agreed that it was an important option to have available to sample and choose from. Having alumni come back and speak to the group was very important to the participants as a source of encouragement. The fact that others had been where they were as adolescents and were continuing their sobriety gave the participants hope that it was possible.

When discussing techniques and processes introduced in the IOPs but still essential to their ongoing recovery, the participants mentioned the importance of attending meetings when they were in treatment and also keeping up regular attendance and having a home group and sponsor in their ongoing recovery. All of the participants reported learning the process and discipline of committing to attending treatment and individual meetings with counselors and sponsors in addition to 12-step meetings while they were in their adolescent IOPs. The support of that initial group of participants was reported to lead to the formation of the core of their sober and supportive friends today. Coming through the process together and continuing to count on those early relationships remains part of their ongoing sober support system.

While I have been blessed to attend school with many fine colleagues and be taught by even more gifted professors, I truly believe that the wisdom and passion that these 10 individuals shared with me have contributed to a better treatment process that I and my agency colleagues deliver today.

REFERENCES Cacciola, J. S., Meyers, K., Bates, S. E., Rosenwasser, B., Arria, A., & McLellan, A. T. (2015).

Assessing Adolescent Substance Abuse Programs with Updated Quality Indicators: The Development of a Consumer Guide for Adolescent Treatment. Journal of Child & Adolescent Substance Abuse, 24(3), 142–154.

Colby, A., Kohlberg, L., Gibbs, J., & Lieberman, M. (1983). A longitudinal study of moral development. Monographs of the Society for Research in Child Development, 48(1-2 Serial No. 200).

Erikson, E. H. (1968). Identity: Youth and crisis. New York, NY: W. W. Norton.

Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016).

Monitoring the Future national survey results on drug use, 1975–2015: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.

Kaplan, P. S. (2000). A child’s odyssey: Child and adolescent development (3rd ed.). Belmont, CA: Wadsworth.

King, K. M., Chung, T., & Maisto, S. A. (2009). Adolescents’ thoughts about abstinence curb the return of marijuana use during and after treatment. Journal of Consulting Clinical Psychology, 77(3), 554–565.

King, S., McChargue, D. (2014). Adolescent substance use treatment: the moderating effects of psychopathology on treatment outcomes. J Addict Dis. 33(4), 366–75.

Kohlberg, L. (1976). Moral stages and moralization: The cognitive-developmental approach. In T. Lickona (Ed.), Moral development and behavior. New York, NY: Rinehart & Winston.

Meece, J. L. (2002). Child and adolescent development for educators. New York, NY: McGraw Hill.

Piaget, J., & Inhelder, B. (1969). The psychology of the child. New York, NY: Basic Books.

Prout, H. T., & Brown, D. T. (Eds.). (1999). Counseling and psychotherapy with children and adolescents theory and practice for schools and clinical settings (3rd ed.). New York, NY: John Wiley & Sons.

Wagner, E. F. (2008). Developmentally informed research on the effectiveness of clinical trials: A primer for assessing how developmental issues may influence treatment responses among adolescents with alcohol use problems. Pediatrics, 121(Suppl 4), S337–S347.

Wagner, E. F. (2009). Improving treatment through research. Alcohol Research & Health, 32(1), 67–75.

Steve Durkee is the Clinical Director of Substance Use Disorder Services with Children’s Home of Northern Kentucky. Durkee holds the Licensed Clinical Alcohol Drug Counselor, National Certified Adolescent Addiction Counselor, and Licensed Professional Clinical Counselor designations. He has been in the substance use disorder profession in excess of 25 years. In that time he has been in private practice, worked in a psychiatric practice well as inpatient and outpatient treatment at a local hospital. Durkee has also taught as an adjunct for regional schools in the mental health and addiction programs for over ten years. Durkee is currently the secretary for NCC AP as well as president of the Kentucky Addiction Professionals, the Kentucky affiliate of NAADAC.

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NAADAC Honors 2016 National Award Winners

By Kristin Hamilton, JD, NAADAC Communications & Digital Media Coordinator Farrell is in private practice at Counseling For Today’s Issues, of which she has been the owner and director since 2009. Farrell holds a CDC from the Massachusetts Board of Substance Abuse Counselor Certification since 1989, a Master’s degree in Counseling & Human Services, and a Bachelor’s degree in Psychology.

Farrell has positively impacted countless clients with her caring nature, empathy, and passion for recovery. The enthusiasm and humor she brings to her work allows her to connect with her clients and she has positively contributed to the lives of many.

Mel Schulstad Professional of the Year: James Joyner, LICDCCS

Each year NAADAC honors the work of dedicated addiction professionals, organizations, and public figures during its President’s Awards Luncheon at the Annual Conference. This year NAADAC will present awards to four outstanding individuals for their extraordinary service and contributions to the addiction profession and to one outstanding organization for its strong commitment to the addiction professional and individual addiction professionals.

Lora Roe Memorial Addiction Counselor of the Year: Sandra Farrell, MS, CADC This award, renamed for Lora Roe in 1988, is presented to a counselor who has made an outstanding contribution to the profession of addiction counseling.

This year’s recipient of the Lora Roe Memorial Addiction Counselor of the Year Award, Sandra Farrell, is a motivated, confident, reliable, and humble individual with over 30 years of addiction counseling experience in a variety of counseling modalities. She specializes in substance use disorder recovery, mental health issues, and couples therapy. She has worked with individuals, agencies, prisons, boot camps, couples, families, groups, and long and short term rehabilitation programs. She has also maintained a NAADAC membership for 22 years.

After beginning her career in 1984 as an assistant counselor for Norcap, Farrell worked in Norcap’s detox unit and with long term in-patient treatment before moving on to Leonard Morse Hospital. Farrell also worked as a senior counselor in multiple correctional facilities, including Longwood Facility, Bridgewater Boot Camp, and Old Colony Prison. She went on to work in a halfway house and at an out-patient detox center. Currently,

This award recognizes an individual who has made outstanding and sustained contributions to the advancement of the addiction counseling profession.

James Joyner, the recipient of the Mel Schulstad Professional of the Year Award, has been an exemplary addiction professional over the course of his 45 year career.

Joyner was an instrumental voice in the fight against legalization of marijuana in the State of Ohio, advocating against the proposed constitutional amendment that would have legalized both recreational and medical use of marijuana. He traveled across Ohio to speak and participate in Town Hall meetings and televised debates that contributed to the defeat of the amendment.

In addition to being a Master’s level Licensed Independent Chemical Dependency Counselor Clinical Supervisor (LICDCCS) certified by the Ohio Chemical Dependency Professional Board, Joyner is the Founder and Director of Joyner and Associates LLC, which provides intervention, consultation, education, and counseling services for parents and others who are concerned about a loved one’s use of alcohol or other drugs. He is also a well-known presenter and trainer. Over the course of his career, he has provided education and consultative services for a variety of organizations, associations and institutions, Cuyahoga County Juvenile Court, The Cleveland Clinic Department of Psychiatry and Psychology, Case Western University, Guardian ad Litem Project of the Cleveland Metropolitan Bar Association, Ohio Lottery, and the Ohio Chapter American Academy of Matrimonial Lawyers. Joyner has been the guest on numerous media programs and forums and has hosted both radio and cable TV programs focusing on topics related to alcohol and other drug use.

Joyner currently serves as the President of the Ohio Association of Alcohol and Drug Addiction Counselors (OAADAC) and Chairperson for the Greater Cleveland Municipal Drug Court Advisory Council. As presi­dent of OAADAC, he has worked to secure not-for-profit status for the organization, a goal that was on the agenda for 20 years before it was accomplished by Joyner. He has also been an essential part in the organization of two very successful OAADAC conferences.

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Joyner served in his previous position as the Manager of Public Information and Training for the Alcohol & Drug Addiction Services Board of Cuyahoga County (ADASBCC) for over 15 years. In that capacity, he supervised all Training Institute sponsored events, directed and coordinated all Board Public Relations efforts, assisted service providers with their specific public relations requests, provided training on topics related to alcohol, tobacco, and other drug issues, participated in and represented ADASBCC on numerous state and local committees and initiatives, and coordinated Health and Human Services Levy campaign activities annually for the ADASBCC network provider system.

In his 45 years of professional experience, Joyner has worked in a number of other treatment and prevention settings. He has a reputation for excellence in the services he provides and a passion for assisting those impacted by a loved one’s addiction. Joyner believes that the consequences associated with the use of alcohol, tobacco and other drugs represent the single greatest negative factor of the quality of life that touches every man, woman and child in this country today. He further believes that through effective education, prevention, and low risk lifestyle choices, these problems can be arrested. He has dedicated his professional life to this belief.

Medical Professional of the Year: Phyllis Prekopa, PsyD, BSN, CARN-AP, LCADC This award is presented to a medical professional who has made an outstanding contribution to the addiction profession.

Dr. Phyllis Prekopa, recipient of the Medical Professional of the Year Award, is a highly intelligent and compassionate professional with a depth of understanding, empathy, and willingness to help those in the throes of addiction. She not only makes contributions in her daily role as a provider for patients and their families, she is also a role model and mentor to her peers and disseminates addiction counseling information to other medical professionals and the public. Because of her positive disposition, her reflective way of operating, and her willingness to go above and beyond her role, she has touched the lives of many people. As an educator, Prekopa never leaves a question unanswered and always helps those experiencing addiction discover that addiction is not just about the drug of choice but rather about behavior and making choices.

Prekopa has co-owned Drugcheck Consulting, a specialized drug testing company, since 2001. She has spent the last 10 years as facilitator to several peer support groups through the Recovery and Monitoring Program (RAMP). She also worked as a Nurse Manger of a medical detox unit for four years and as a Director of Nursing and Family Counselor for two years prior to that. Her many years of working in the addiction field, both psychologically as a counselor and medically as a nurse, has earned her professional recognition and respect as a knowledgeable colleague and specialist in her fields of expertise. She has been working with impaired nurses for over 10 years and recently was involved in initiating special mental health groups for nurses with co-occurring diagnoses through her work with RAMP. Prekopa has always been an innovator in her practice, in her business, and in RAMP. She is the only facilitator with numerous meetings spread over the weekdays and weekends to allow for the convenience of participants, and these meetings give participants the feeling of hope instead of despair, and allow them to know that they will have a good chance of being able to return to their beloved professions.

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Despite an already impressive resume and busy schedule, Prekopa earned her Doctorate in Addictions Studies when she was 70 years old.

She continues to influence political change, share innovations in patient care and inspire others in the healthcare field.

William F. “Bill” Callahan Award: Donald “Frank” Davis This award recognizes sustained and meritorious service at the national level to the profession of addiction counseling.

Donald “Frank” Davis, winner of this year’s William F. “Bill” Callahan Award, has had a significant impact on advancing the professional credential.

His work with the Texas Certification Board of Addiction Professionals is extensive and he has worked tirelessly advocating for on behalf of counselors both legislatively in the halls of Texas government as well as working closely with Texas Department of State Health Services. His work has benefited every licensed chemical dependency counselor and criminal justice addiction professional working on the state and national level to bring to light workforce issues in the behavioral health field. He has been a mentor to many in and out of the addiction counseling realm. He has and continues to be committed to the Texas Association of Addiction Professionals (TAAP), NAADAC’s Texas Affiliate, and the Texas Cer­ti­fication Board of Addiction Professionals (TCBAP) and has been the Chairman of the Board from 2005 to 2011, and then re-elected in 2012 as Chairman once again.

Davis has been a Texas delegate to the International Certification & Reciprocity Consortium (IC&RC), and currently serves on the marketing, finance, and criminal justice committees.

Currently, Davis works as an Administrative Director for the Gateway Foundation, Inc., a position that he has held since 2005. He recently was promoted to that position and is responsible for three treatment locations in the Houston area. He also continues his work as a counselor at Memorial Hermann Prevention and Recovery Center, which began in 2012. Davis has been an adjunct faculty member at Alamo College–San Antonio College, where he teaches drug and alcohol classes, since 2012. In the past, Davis worked as a Program Director, first for Correctional Medical Services and then for CiviGenics, Inc., where he directed and oversaw prison and correctional therapeutic programs from 1996 to 2004. He holds a Master’s of Education in Counseling and a Bachelor’s in Addiction Studies, as well as being a Licensed Chemical Dependency Counselor, Advanced Alcohol and Drug Counselor, and a Certified Criminal Justice Addictions Professional.

Davis is a tireless worker whose efforts with TAAP, TCBAP, and IC&RC have afforded counselors recognition, advancement, acceptance and protection as a workforce. He is selfless and humble and works diligently toward advancing the profession. Davis is known to his peers as being committed to the profession, a champion for treatment and recovery, and a kind soul who cares about all individuals who struggle with the disease of addiction and its associated challenges.

Davis has been married to the same beautiful lady for over 41 years and has three daughters and six grandchildren. He attributes all of these blessings to God and over 27 years of long term recovery with lots of help from many mentors.

Organizational Achievement Award: Sierra Tucson

William L. White Scholarship Award Winners: Kelsey Henning and Jacqlyn Stein

This award recognizes an organization that has demonstrated a strong commitment to the addiction profession and particularly strong support for the individual addiction professional.

NAADAC recognizes Sierra Tucson as its 2016 Organizational Achievement Award winner for its high level of care, support, and dedication to its staff members and the addiction professionals in the behavioral health field. Sierra Tucson has not only demonstrated a strong commitment to the addiction profession over the years, but continues to innovate programs and communication methods to keep professionals engaged and informed of their clients’ progress as they continue through residential treatment.

Sierra Tucson joins with professionals to align the mutual objectives of maximizing an individual’s opportunity to grow healthier, and views referring professionals as true partners. It has long operated with a clear mission to be inclusive and informative in a spirit of collaboration by maintaining open communication with all of its referring professionals.

For more than 32 years, Sierra Tucson’s longstanding legacy of clinical excellence and compassionate care has resulted in recovery for those struggling with substance use disorder, trauma-related issues, eating disorders, chronic pain, and mood anxiety disorders. Sierra Tucson believes that real recovery begins only after healing progresses beyond the symptomatic to embrace the whole person. Its approach to residential treatment helps residents move past underlying problems to authentic recovery with a multidisciplinary team of professionals that uses the Sierra Tucson Model® — a biopsycho-social-spiritual approach which recognizes that the mind, body, spirit, and emotions must be in synchronization for change to occur. The Sierra Tucson Model ensures accurate diagnosis and individualized treatment for each resident, combining integrative and experiential therapies with evidence-based practices to provide a full range of treatment modalities. Residents receive the recourses, support, and tools necessary for long-term change to occur, including one full year of continuing care and a lifetime of alumni services.

The team at Sierra Tucson has a reputation for being comprised of true pioneers in behavioral health treatment.

Their influence has healed many relationships and saved countless individuals and families that have found recovery amid their serene and beautiful campus in Tucson, Arizona.

NAADAC is proud to announce the 2016 winners of the William L. White Scholarship Award, created to promote student addiction studies research and develop the importance of student research projects in NASAC accredited programs, NAADAC approved programs in higher education, or an accredited addiction studies higher education program acknowledged by the Higher Learning Commission (HLC) that provides research or education to the addiction profession. It is awarded annually to one undergraduate student and one graduate student for the best student addiction research paper. This year’s assigned topic was “Recovery Oriented Systems of Care: How Research is Changing the Addiction Profession.” Winners receive a monetary award and are recognized at the NAADAC Annual Conference.

Undergraduate: Kelsey Hennig is a senior Addiction Studies and Psychology student at the University of South Dakota. Hennig is known to her professors as being a very mature, responsible and personable young woman. She demonstrates intellectual curiosity, works hard, and shows a general interest in learning new material. Hennig has served as a student representative for the University of South Dakota Addiction Studies Department at last year’s NAADAC Conference and she worked to lobby for addiction legislation during the 2015 Hill Day. She serves as the Vice President of the Coalition of Addiction Students and Professionals Pursuing Advocacy (CASPPA), a student organization whose mission is to advocate for the addiction profession on a state and national level, and is a member of the Psychology Club.

During her time at the University of South Dakota, Hennig has been a member of a research team conducting research on how personality and mental health conditions are related to substance use concerns. She was responsible for conducting experimental sessions with individuals who experienced traumatic stressors and core characteristics of posttraumatic stress disorder. Hennig also participated in a research project regarding the cognitive, emotional and developmental impact of family substance use disorder and addiction on children, and presented the findings at the 2016 South Dakota Association of Addiction and Prevention Professionals Conference and the 2016 School of Health Science Research Day. After graduation, Hennig plans to begin working towards obtaining a Master’s degree in Mental Health Counseling, as well as her LAC credential.

Graduate: Jacqlyn Stein is working toward obtaining her Master’s degree in addiction counseling from Grand Canyon University and her certification as a recovery life coach. Her professors have described her as an exemplary student always striving to succeed and producing excellent work that is above and beyond what is required.

Stein spent over 20 years in the legal field before starting down the path to become an addiction professional. She plans to use her legal background to engage in advocacy for those in need of support.

In addition to working toward obtaining her Master’s degree, Stein is participating in a coaching program called Be A Loving Mirror (BALM), which asserts that the family is their loved one’s best chance at recovery. Stein has been described as a critical thinker about the issues related to addiction treatment, and has demonstrated an astute understanding of theory and counseling, as well as co-occurring disorders.

Further, she exudes warmth and a caring nature that is essential for an addiction professional. After completing her degree, Stein plans on working with individuals with substance use disorders and their family members. She feels very strongly that addiction is a family disease and the family members need treatment as much as their loved one.

Kristin Hamilton, JD, is the Communications and Digital Media Coordinator for NAADAC, the Association for Addic­ tion Professionals. She works on NAADAC public relations, communications, and digital media, including the NAADAC website and social media, and is editor of NAADAC’s two ePublications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate. She also contributes to the planning, organization, and administration of communication campaigns. Hamilton holds a Juris Doctorate from Northeastern University School of Law in Boston, MA, and a Bachelor of Science Degree in Biology and Chemistry from Roger Williams University in Bristol, RI.

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Justice Reform for Veterans: The Rise of Veterans Treatment Courts

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By Scott Swaim, USAFV, MA, LMHC, Director, Justice For Vets

n 2007, a judge in Buffalo, New York, named Robert Russell began seeing an increase in the number of veterans appearing before him clearly struggling with substance use disorders, mental health conditions, and trauma.

One day during his Mental Health Court docket, Judge Russell called the case of a Vietnam veteran who, to that point, had not responded to the help being offered by the court, and seemed to struggle to communicate with the court team. In a moment of exasperation, Judge Russell asked two members of his court staff, themselves Vietnam veterans themselves, to go out in the hall and talk to him. The three met for over an hour, and when Judge Russell recalled the case, the man walked up to the bench, stood at parade rest, and held his head high.

The 10 Key Components of Veterans Treatment Courts 1. Veterans Treatment Courts integrate alcohol/ drug treatment and mental health services with justice system case processing.

2. Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants’ due-process rights.

3. Eligible participants are identified early and promptly placed in the veterans treatment court program.

4. Veterans treatment courts provide access to a continuum of alcohol, drug, mental health, and other related treatment and rehabilitation services.

5. Abstinence is monitored by frequent alcohol and other drug testing.

6. A coordinated strategy governs veterans treatment court responses to participants’ compliance.

7. Ongoing judicial interaction with each veteran is essential.

8. Monitoring and evaluation measure the achievement of program goals and gauge effectiveness.

9. Continuing interdisciplinary education promotes effective veterans treatment court planning, implementation, and operations.

10. Forging partnerships among the veterans treatment court, U.S. Department of Veterans Affairs, public agencies, and community-based organizations generates local support and enhances veteran treatment court effectiveness.

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Judge Russell asked him if he was ready to accept the treatment that was being offered. He looked Judge Russell in the eye and said yes.

This small moment of two veterans helping another in crisis was the spark that ignited a movement that is transforming how the justice system identifies, assesses, and connects veterans to treatment rather than putting them behind bars. By January 2008, Judge Russell and his team had created a veterans-only docket where service men and women were surrounded by their peers and offered treatment and services specific to their unique needs. While maintaining the traditional partnerships and practices found in his drug court and mental health courts, Judge Russell brought to the table Department of Veterans Affairs health care networks, the Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA), volunteer veteran mentors from the community, and veterans’ family support organizations. The resulting program was the nation’s first veterans treatment court, one of over 260 in operation today.

There are more than 21 million veterans in the United States (National Center for Veterans Analysis and Statistics, n.d.).

Some of us may struggle with adjusting to the civilian world after active duty military life, but we are all instilled with the values of service, sacrifice, and honor. Veterans treatment courts give veterans the chance to re-group, dust off the foundation of integrity and commitment their military service gave them, and move forward to be the leaders they are destined to be. The road to recovery may be long, but the early success of veterans treatment courts is a testament to the resiliency and fortitude of those who serve. This success allows them to man the bridge for others who need support to return to society and once again be productive citizens.

Veterans and the Justice System It is important to note that veterans are incarcerated at significantly lower rates than non-veterans, and the number of veterans in jails and prisons decreased between 2004 and 2012 (Bureau of Justice Statistics [BJS], 2015). There is a startling lack of data on the intersection of veterans and the justice system, but what we do know suggests that mental health is a significant factor. Incarcerated veterans have higher rates of mental health issues than non-veterans, and while less than a third of veterans behind bars experienced combat, those who did report higher rates of mental health conditions (BJS, 2015).

In March 2014, The Washington Post released a report finding that more than half of the 2.6 million American veterans of the wars in Iraq and Afghanistan struggle with physical or mental health problems stemming from their service and feel disconnected from civilian life (Chandrasekaren, 2014). The RAND center estimates that about 1 in 5 veterans of the wars

in Iraq and Afghanistan has post traumatic stress disorder (PTSD) or significant mental health needs (Tanielian & Jaycox, 2008). The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates 1 in 15 veterans had a substance use disorder in 2014 (SAMHSA, 2015).

Left untreated, these issues put veterans at significant risk for involvement with the justice system. Historically, there has been no comprehensive effort to ensure the justice system responds sufficiently to the unique clinical needs some veterans face. Veterans treatment courts are alternatives to incarceration for veterans whose justice system involvement is linked to a substance use disorder, mental health condition, and/or trauma. Like drug courts, veterans treatment courts strike a balance between accountability and the need to treat underlying conditions that affect behavior. This innovation has gained national recognition because it demonstrates that veterans can be held accountable while also being connected to the benefits, treatment, and mentoring necessary to address the underlying causes of their criminal behavior.

Veterans treatment courts involve cooperation and collaboration with traditional partners found in drug courts and mental health courts, such as the prosecutor, defense counsel, treatment provider, probation, and law enforcement. Added to this interdisciplinary team are representatives from the Department of Veterans Affairs — including the Veterans Health Administration and the Veterans Benefit Administration — as well as State Department/Commission of Veterans Affairs, et Centers, community mental health and substance use treatment providers,Veterans Service Organizations, and volunteer veteran mentors.

One Stop Shop Traditionally, justice-involved veterans have been scattered throughout the justice system, making it difficult to coordinate effective treatment interventions. Veterans treatment courts economize resources by clustering veterans onto a single docket and linking them with resources uniquely designed for the distinct needs that can arise from military service. This approach allows jurisdictions to bring to bear the myriad of local, state, and federal resources exclusive to veterans. For example, a representative from the local Department of Veterans Affairs medical center is present during the court docket with a laptop computer able to quickly access confidential medical records, schedule treatment appointments, and communicate this vital information to the court. In addition, veterans treatment courts have had great success liaising with the VBA, VHA, accredited service officers from Veterans Service Organizations, Vet Centers, County Veterans Service Officers, State Department/ Commission of Veterans Affairs, DOL DVOP/LVER, State/ County Bar Associations, and congressional offices. These team members are not employed by the criminal justice system and normally would not be present at the courthouse. Consolidating justice-involved veterans onto a single docket makes it possible for these individuals and groups to actively support those most in need of help.

Therapeutic Camaraderie From the camaraderie during military service to the isolation many veterans experience transitioning to the home front, veterans experience a dramatic change in environment than can magnify mental health issues and substance use. Without the support of other veterans, some struggle to accept help. In veterans treatment court, those who served in our ­nation’s Armed Forces participate in the treatment court process with their fellow veterans, re-instilling a sense of solidarity that they experienced while in the military.

One of the keys to veterans treatment court success has been the use of volunteer veterans from the community who act as mentors to veterans involved in the program.

By pairing struggling veterans with a volunteer veteran mentor, veterans treatment courts give both parties the chance to reclaim a sense of honor, duty, and leadership — values that make our veterans the backbone of American society. In serving as mentors, volunteer veterans find a sense of fulfillment that can only be achieved when one veteran comes to the aid of another. Veterans treatment courts transform the bond of military service into healing and empowerment.

The Impact Recently, Community Mental Health Journal released the first published study on veterans treatment courts and concluded that participating veterans experienced significant improvement with depression, PTSD, and substance use, as well as with critical social issues including housing, emotional well-being, relationships, and overall functioning. The study further concluded that veterans who receive trauma-specific treatment and mentoring not only experienced better clinical outcomes, they reported feeling more socially connected (Knudsen & Wingenfeld, 2016).

Veterans treatment courts are modeled after drug courts, which have more evidence supporting their efficacy than any other justice system strategy. Today, there are over 3,000 drug courts in the United States; they are the most successful, cost-effective program in the justice system for people struggling with addiction.

Research shows that drug courts reduce crime by as much as 45% com­pared to traditional sentences (Aos, 2006). This success translates directly to cost-savings. Drug courts return $2.21 for every $1 invested when considering only direct and measurable offsets such as reduced re-arrests, law enforcement contact, court hearings, and the use of jail or prison beds. When considering other benefits, including reduced foster care placement and healthcare utilization, drug courts benefit the economy by as much as $27 for every $1 invested. As a result, drug courts save up to $13,000 per participant (Aos, Miller & Drake, 2006). In veterans treatment courts, treatment is generally delivered through the Department of Veterans Affairs, generating even more significant savings than drug courts for the communities they serve.

In addition to providing freedom from addiction, trauma, and other mental health disorders, veterans treatment courts benefit veterans, their families, and their communities in several key ways: • Freedom from homelessness: Veterans treatment courts provide an effective stop-gap to prevent future homelessness by connecting justice-involved veterans to housing services and providing wrap-around support to ensure stability and long-term success.

• Freedom from unemployment: Veterans treatment courts have emerged as a vital tool in the fight against veteran unemployment by connecting veterans to Department of Veterans Affairs education and training benefits, as well as to other local, state, and federal resources aimed at putting veterans back to work.

• Freedom from a felony record: For those veterans who get caught up in the legal system, one of the most damaging long-term effects is having a felony on their record. Veterans treatment courts offer a reduction in charge(s), dismissal of the case, and/or expungement of the criminal record for those veterans who successfully complete the program.

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Justice For Vets Justice For Vets leads the national effort to put a veterans treatment court within reach of every veteran in need, and proudly offers the following training: • Veterans Treatment Court Implementation – The Bureau of Justice Assistance at the U.S. Department of Justice provides funding for Justice For Vets to offer this comprehensive, three-day training for new or planned veterans treatment courts. By the end of 2016, Justice For Vets will have trained 205 veterans treatment courts teams, including 2,050 personnel. Learn more at: www.justice forvets.org/2016-vtcpi • Veterans Treatment Court Site Visits – The Center for Substance Abuse Treatment (CSAT) at SAMHSA provides funding for Justice For Vets to identify four national veterans treatment court “mentor courts” to serve as learning sites for communities interested in creating a program of their own. Individuals and court teams can apply to visit and learn from one of these mentor courts at: www.justice forvets.org/veteran-mentor-courts.

• The National Mentor Corps – The two-day Justice For Vets Mentor Corps Boot Camp provides critical training for volunteer veteran mentors who want to be of service to their fellow veterans participating in veterans treatment court. The training includes examining the roles, responsibilities, and boundaries of veteran mentors; the unique issues facing combat veterans; and how to swiftly connect mentee veterans to the local, state, and federal services and benefits they have earned. Learn more at: www.justice forvets.org/Mentor-Corps.

In addition to providing ongoing training and technical assis­ tance to the veterans treatment court field, Justice For Vets annually hosts Vet Court Con, the nation’s only training conference dedicated to justice-involved veterans. The next Vet Court Con will be held just outside of Washington, DC from July 9-12, 2017.

For more information, visit www.JusticeForVets.org.

REFERENCES Aos et al. (2006). Evidence-based public policy options to reduce future prison construction, criminal justice costs, and crime rates. Olympia: Washington State Institute for Public Policy; Lattimer (2006). A meta-analytic examination of drug treatment courts: Do they reduce recidivism? Canada Dept. of Justice; Lowenkamp et al. (2005). Are drug courts effective: A meta-analytic review. Journal of Commu­ nity Corrections, Fall, 5–28; Shaffer (2006). Reconsidering drug court effectiveness: A meta-analytic review. Las Vegas, NV: Dept. of Criminal Justice, University of Nevada; Wilson,et al. (2006). A systematic review of drug court effects on recidivism. Journal of Experimental Criminology, 2, 459–487.

Aos, S., Miller, M., & Drake, E. (2006). Evidence-based public policy options to reduce future prison construction, criminal justice costs, and crime rates. Olympia, WA: Washington State Institute for Public Policy; Carey, S. M., Finigan, M., Crumpton, D., & Waller, M. (2006). California drug courts: Outcomes, costs and promising practices: An overview of phase II in a statewide study. Journal of Psychoactive Drugs, SARC Supplement 3, 345–356; Finigan, M., Carey, S. M., & Cox, A. (2007). The impact of a mature drug court over 10 years of operation: Recidivism and costs. Portland, OR: NPC Research; Loman, L. A. (2004). A cost-benefit analysis of the St. Louis City Adult Felony Drug Court. St. Louis, MO: Institute of Applied Research; Barnoski, R,. & Aos, S. (2003). Washington State’s drug courts for adult defendants: Outcome evaluation and cost-benefit analysis. Olympia, WA: Washington State Institute for Public Policy; Logan, T. K., Hoyt, W., McCollister, K. E., French, M. T., Leukefeld, C., & Minton, L. (2004). Economic evaluation of drug court: Methodology, results, and policy implications.

Evaluation & Program Planning, 27, 381–396.

The Bureau of Justice Statistics. (2015, December 7). Veterans in Prison and Jail, 2011–2012. Retrieved from http://www.bjs.gov/index.cfm?ty=pbdetail&iid=5479 Chandrasekaren, R. (2014, March 29). Pain and Pride: A nationwide poll of Iraq and Afghanistan veterans reveals the profound and enduring effects of war on the 2.6 million who have served. The Washington Post. Retrieved from http://www.washingtonpost.com/sf/national/2014/03/29/a-legacyof-pride-and-pain/ Knudsen, K. J. & Wingenfeld, S. (2016) A Specialized Treatment Court for Veterans with Trauma Exposure: Implications for the Field. Community Mental Health Journal, 52:127.

National Center for Veterans Analysis and Statistics. (n.d.). Veteran Population. Retrieved from http:// www.va.gov/vetdata/veteran_population.asp Substance Abuse and Mental Health Administration. (2015, May 7). 1 in 15 veterans had a substance use disorder in the past year. Retrieved from http://www.samhsa.gov/data/sites/default/files/ report_1969/Spotlight-1969.pdf Tanielian, T. & Jaycox, L. H. (2008) Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Retrieved from http://www.rand.org/pubs/monographs/MG720.html Scott Swaim is a U.S. Air Force, Gulf War Veteran, and licensed mental health counselor.

He is the Director of Justice For Vets in Alexandria, VA. During his military service, he was stationed overseas in Germany and traveled to 32 different countries as a Loadmaster Crewmember on the C-5 Galaxy out of Dover AFB, DE. He earned both his Bachelor’s and Master’s while serving on Active duty in the Air Force and then transferred to the reserves.

In the civilian sector, he has managed and directed programs in community mental health for 20 years in Florida and Washington State. Most recently, he served as Senior Director of Veteran Services at Valley Cities Counseling, Clinical Supervisor of the Veterans Court Liaison for the Seattle Veterans Treatment Court, the Regional Veterans Treatment Court, and contractor with the Washington Department of Veterans Affairs, PTSD and War Trauma program.

He has served on the joint DOD/VA workgroup on Military Culture training for clinicians, and authored the Quickseries guide on Military and Veteran Culture. He is a life member of the Veterans of Foreign Wars, and Disabled American Veterans.

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In 2017, Advocates Must Work to Build on Success of 114th Congress

By Michael Petruzzelli, National Council for Behavioral Health

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ipartisan legislation was passed, key hearings were held, and a new Medicaid demonstration project began.

Congress — long deemed a “do-nothing” body — made important strides for the addictions treatment community in 2016. Legislators did not solve all of the problems; some areas they barely touched. But in all, Congress focused more on addictions treatment in 2016 than in the last few decades combined. In the hearings held, bills introduced and compromises made, Congress gave important attention to the issues facing our field and the many potential proposals to make them better. This attention was due in large part to the organized advocacy and education of legislators by providers, professionals, consumers and family members across the nation.

So as we come to the end of the 114th Congress and the end of a presidential administration, what should the addictions and mental health community be looking forward to in 2017? What should we be looking to achieve? Harnessing the bipartisanship of this last year, our community must continue advocating and organizing, building on a message of unity and progress to bring action to Capitol Hill.

Let’s take a look back over the last year and see how we, as a community, can continue making strides.

Passing Legislation in the United State Congress In July, President Obama signed the Comprehensive Addiction and Recovery Act: a momentous occasion for advocates across the country. The signing of CARA was the culmination of years of hard work, grassroots advocacy and organization, and tireless efforts from providers, consumers and family members to inform Congress of policies that will help save lives. Three years after its initial introduction by Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI), CARA had become law.

Chief among its many provisions, CARA increases access to medication-assisted treatment by expanding the eligible prescriber pool to include nurse practitioners and physicians’ assistants. These professionals are allowed to prescribe medication under the same cap restrictions as other practitioners. In July, the Substance Abuse and Mental Health Services Administration (SAMHSA) finalized an increase to the patient cap to as much as 275 patients per practitioner. Moreover, the law requires a report to Congress exploring the effectiveness of this expansion, ensuring access to and use of these services.

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CARA creates grant programs to help communities reach those in need and fight the epidemic with innovative prevention, treatment and recovery programs. These programs establish incentives to achieve outcomes everyone wants to see: fewer people becoming addicted to opioids; more access to a comprehensive range of services and supports, including medication-assisted treatment; and more individuals living in recovery from addiction. CARA incentivizes Prescription Drug Monitoring Programs to help identify illegal activity and intervene for those in need of addiction treatment by tracking opioid prescriptions. CARA brings behavioral health providers, law enforcement officers, criminal justice systems, state agencies and others together as key partners in the collaborative efforts that are needed to stop the opioid crisis.

Yet, CARA does not solve all of the field’s problems. CARA — while expansive — does not include the funding necessary to properly carry out its many provisions. In 2017 and beyond, advocates must turn their attention to securing the needed funding to make the promise of CARA come to fruition. They must continue fighting for additional resources, working to repair decades of financial neglect.

Despite this legislative achievement, current funding still supports only a fraction of the total amount of care that is needed in America. With 9 in 10 Americans unable to access lifesaving addiction treatment, professionals, advocates, consumers and families must to continue fighting to build the capacity of the addiction treatment delivery system. The President, Members of Congress, and presidential candidates from both sides of the aisle have called for additional funding for this field. They have all identified the necessity for greater resources in the addictions community. Together, we must recognize that maintaining the progress to date is of great importance, but CARA alone is not enough.

Financing Treatment in Communities Across the Country As we look ahead to 2017, we see the beginning of a new presidential administration, the start of the 115th Congress and — perhaps most importantly for community addiction providers — the launch of a new provider type in Medicaid known as Certified Community Behavioral Health Clinics (CCBHCs).

What are CCBHCs? For starters, let’s look at the statistics: each year, more than one in five Americans experience a mental health condition and more than 22 million struggle with addiction. The growing need for treatment and prevention services is straining the already limited resources of our behavioral health system, and the lack of ready access to addiction and mental health services is having a profound impact across American life.

In 2014, Congress worked to address these issues and passed the Protecting Access to Medicare Act, which included a demonstration ­program based on the Excellence in Mental Health Act. The Excellence Act — first introduced years before by Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO) — aimed to increase Americans’ access to community addiction and mental health services while improving Medicaid reimbursement for these services.

The Excellence Act provides specific requirements and metrics, answering the question of what it means to deliver comprehensive, high-quality behavioral health care. These certified clinics must provide evidence-based outpatient addiction and mental health services, 24-hour crisis care, primary care screening and monitoring, psychiatric rehabilitation services, and care coordination across health care settings. They will work with law enforcement officers, criminal justice systems, veterans’ organizations, child welfare agencies, schools, and others to ensure no one falls through the cracks. Through outcome monitoring and quality bonus payments, clinics are going to be held accountable for patients’ progress. CCBHCs will be supported by a sustainable Medicaid payment rate that — unlike current grant funding and dismally low reimbursement rates — supports their anticipated costs of care: expanding evidence-based services, engaging patients outside the four walls of the clinic, and leveraging technology for improved outcomes.

Addictions pro­viders are crucial to the success of CCBHCs. They will work with CCBHCs to provide a robust array of required services, ensuring that when someone is in need of crisis care, the community systems around them are prepared and able to meet their needs. The strong emphasis on these partnerships reflects the fact that in the health care world of the future, policymakers and stakeholders will have little to no patience with siloed systems that cannot work together to demonstrate concrete health outcomes and high-value care. Addiction and mental health providers around the country are already engaging in these partnerships; with the advent of the Excellence Act, they will become part and parcel of the usual scope of care.

But how do we pay for this coordinated care? The Excellence Act answers that question too. Recognizing that current payment models are insufficient to support the kind of comprehensive and coordinated care envisioned by the Excellence Act, the law requires states to establish a payment system based on CCBHCs’ anticipated costs — a giant step forward in a health system that until now has drastically underfunded community addiction and mental health services.

Expanding the Excellence Act The demonstration program passed in 2014 only funded CCBHCs in eight states for two years. In 2015, SAMHSA awarded 24 states planning grant funding to prepare states to apply to participate in the demonstration. As of right now, only one-third of interested states will have an opportunity to participate, and see their hard work come to fruition.

In February of 2016, Senators Blunt and Stabenow introduced legislation to expand the CCBHC demonstration program to all 24 planning grant states. By funding all 24 states, Congress would ensure that every state that is working towards reforming and revitalizing its behavioral health safety net has the opportunity to do so through CCBHCs. FA L L 2 016 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 19

Ex­panding the Excellence in Mental Health Act is paramount to ensuring communities and providers across the nation have the resources they so desperately need to improve the lives of those living with addiction or mental illness.

Expanding this program did have movement on Capitol Hill during the 114th Congress. In 2017, ad­vocates will continue working to turn this legislation into law, ­securing the full funding of CCBHC demonstration states across the nation.

Securing Funding for the Future Despite concerted efforts to move appropriations legislation one-by-one through both the House and Senate, neither chamber of Congress was able to ­approve spending legislation before leaving for a long summer recess. When Congress reconvenes in September, approving a funding plan should be at the top of the priority list to avoid a government shutdown on October 1.

Looking back at previous election cycles, each of the last four presidential election years has ended in Congress approving a spending package that maintains government spending across the board for a specific period of time. This year, we can expect more of the same with Congress likely to approve a spending package level-funding the government through the November elections.

What does this mean for addiction providers? What can they expect for the future?

Much will depend on who wins the White House and control of Congress in November and the policy agendas they look to put forth.

Fiscal Year 2017 To start the year, President Obama submitted his budget priorities to Congress, outlining his vision for the country over the next year. Obama requested $1.1 billion in new money to be appropriated to fight the opioid and heroin abuse epidemic.

If implemented, this request would expand access to medication-assisted treatment, bolster the addictions and mental health workforce by supporting new providers, and implement state-level prescription drug overdose prevention strategies.

Build Up Your Teen

Treatment

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Evidence-based prevention and treatment for youth How can we better serve this vulnerable population?

Through a series of webinars, learn more about innovative research outcomes and how to incorporate those findings into treatment for adolescent substance use.

Learn more and register at

www.TeenTxIQ.org The Build Up Your Teen Treatment IQ campaign is made possible through funding from the NIDA/SAMHSA-ATTC Blending Initiative 2.0.

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In July, the House and Senate Appropriations Committees approved funding bills for all health and education programs. Both committees approved funding to combat the opioid and heroin epidemic, including an additional $581 million in the House-approved bill to address use and abuse. $500 million of that appropriation would create the first-ever comprehensive state grant program to curb the growing epidemic nationwide. The Centers for Disease Control and Prevention’s budget would also increase by $90 million. The money would expand efforts for prescription drug abuse prevention and treatment services.

Other important line items saw level funding amidst cuts to the overall budget. The Substance Abuse Prevention and Treatment Block Grant would see level funding of $1.8 billion in the House-approved bill. And criminal justice related activities would see level funding, specifically $60 million for drug courts.

Maintaining level funding for these and other programs should be seen as victories for the addictions and mental health community. Overall, Republican leadership has looked to rein in federal spending but has continually supported increases in addictions prevention, treatment and recovery supports. Moving forward in 2017, advocates will look to maintain these increases to make clear the impact this spending is having on communities across the country.

Looking Ahead to 2018, Stopping Sequestration While many policymakers are focused on Fiscal Year 2017, there is a growing chorus of advocates and legislators turning their eyes toward Fiscal Year 2018 and the dramatic cuts that await. In October of 2015, leaders from both parties came together to pass the Balanced Budget Act. This bipartisan, two-year budget deal provided limited relief from mandated spending cuts that would have taken effect. The deal added $80 billion in discretionary funding over two years and helped avoid a government shutdown. However, when that deal runs out, Congress will be faced with the full weight of these spending cuts yet again.

What is sequestration? Sequestration refers to the automatic, across-the-board spending cuts imposed by the Budget Control Act of 2011.

This law required Congress to cut spending below a certain threshold — or else all discretionary spending programs would be slashed by an equal amount to bring the top-line numbers in line with predetermined budget caps. When the deal from 2015 runs out, sequestration will return in full force.

While sequestration was originally designed to ignite bipartisan action on the budget, recent history shows that some appropriators are more comfortable with the cuts remaining in place, allowing them to pursue a strategy of re­prioritizing funding from programs of lesser to greater importance. Programs at risk of losing substantial funding under sequestration include: Substance Abuse Prevention and Treatment Block Grant, the Center for Substance Abuse Prevention, and PrimaryBehavioral Health Care Integration, among many others.

Beginning now, advocates should be educating their legislators on the disastrous impact of sequestration cuts. In Washington, DC, staff may not yet be focused on the years ahead and the potential budgetary hurdles they will have to maneuver. Instead, they are focused on the here and now and working to make things better for their constituents in the moment. It is the job of advocates nationwide to ensure legislators and staff know what sequestration would mean for their organizations, their consumers and their communities.

The year 2016 was important for the addictions and mental health community. Years of hard work have resulted in many successes and opportunities for continued growth and greater achievement. As we look ahead to 2017 and the possibilities in a new presidential administration, we must be mindful of how far we have come as a field and where we must continue to speak up. Providers, consumers and family members must all continue and enhance their advocacy efforts, speaking up for addictions and mental health. Speaking up for more funding, greater access and more comprehensive services. By building relationships and sharing stories with legislators, we can effect change in Washington.

In his role as a Policy Associate for the National Council for Behavioral Health, Michael Petruzzelli monitors and executes the National Council’s public policy and grassroots advocacy initiatives to support the mental health and addiction safety net. He works closely with advocates, em­powering them to connect with their elected officials and join the discussion on behavioral health. He also serves as the primary author of the Capitol Connector, the National Council’s public policy news­letter and blog. Before joining the National Council, Petruzzelli managed grassroots advocacy campaigns on social and politi­cal issues, including the 2012 general election. Petruzzelli earned his Bachelor’s of Arts Degree from Rutgers University and his Master’s of Public Ad­mini­stra­tion from George Washington University.

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Breaking the Chain of Addiction’s Intergenerational Legacy The Effects of Trauma: How Pain From One Generation Seeps Into the Next

By Tian Dayton, PhD, and Sis Wenger, President/CEO, National Association for Children of Alcoholics (NACoA)

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uch attention has been paid by the media to chronicling the dark side of addiction; images of celebrities hiding behind sunglasses on the way in to or out of treatment are commonplace. But this is not where the story begins or ends. If only the same rapt attention was paid to the family members whose hearts, minds, and lives have been turned and twisted by the daily chaos and confusion that addiction engenders, the story would be more complete. It’s easy to capture drunkenness. It wears a certain disheveled look that grabs our attention. But how do you photograph a broken heart or the shattered sense of self of the wife, husband, or child who lives in addiction’s wake? The kind of neglect and pain endured by the loved ones of someone with a substance use disorder is hard to capture in a photo and the story of his or her pain just doesn’t sell newspapers. This hidden pain can be much harder to identify, but its effects are nonetheless tenacious and long term. That churning angst can be concealed beneath the surface of a resigned smile or buried inside a quiet kid who doesn’t make trouble. It can be what drives the acting out of a child or teenager or what vibrates beneath the surface of the overachiever who works double time trying to restore the family dignity and ward off shame. It’s the trauma that is the direct result of relationship neglect, abuse, and emotional abandonment and it can wear many faces.

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According to the Center on the Developing Child at Harvard University (2015), “[t]oxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity — such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship — without adequate adult support. This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.”

Growing up with parental addiction and the chaos and stress that surround it has emerged through research as being a primary cause of toxic stress. The child who grows up with addiction is often encircled by additional behaviors occurring in the home that also qualify as risk factors for toxic stress, according to the Adverse Childhood Experiences (ACE) studies performed by Robert Anda and Vincent Feletti (2006) and their team at the Center for Disease Control and Kaiser Permanente’s

Health Appraisal Clinic in San Diego. Adverse childhood experiences (“ACEs”) tend to occur in multiples. Once a home environment is disordered by addiction, for example, the risk of witnessing or experiencing emotional, physical, or sexual abuse rises dramatically (Anda, et al., 2006). During one of his lectures, Dr. Anda described why on­going traumatic experiences, such as growing up with addiction, abuse, or neglect in the home, can have such lasting effects. “For an epidemic of influenza, a hurricane, earthquake, or tornado, the worst is quickly over,” says Anda, “treatment and recovery efforts can begin. In contrast, the chronic disaster that results from ACEs is insidious and constantly rolling out from generation to generation.” If the effects of toxic stress are not understood well enough so that the children in these situations can receive some sort of appropriate understanding and support from home, school, and community, these children simply “vanish from view … and randomly reappear — as if they are new entities — in all of your service systems later in childhood, adolescence, and adulthood as clients with behavioral, learning, social, criminal, and chronic health problems” (Anda, et al., 2010, p. 3). In other words, when childhood trauma goes unidentified and unattended, it re-emerges as other emotional, psychological, health and behavioral problems.

The Biology of Trauma Our bodies can’t tell the difference between a charging elephant or an abusive parent; our physiological reaction to either will be relatively the same. Nature has evolved in us a “fight or flight” ­response designed to allow us to get out of harm’s way and stay alive. When we feel terror, whether from an attacking beast or a drunken or raging parent, in just a split second our fear causes us to spurt adrenaline, our hearts pump faster and we get increased supply of blood to our muscles so that we can flee for safety or stand and fight. However, children trapped in

homes where an addicted parent is the person in charge of their welfare can often do neither, so they do what they can; they stand there and take it, their bodies remain in the situation but they disappear on the inside. They collapse and withdraw into themselves (Van der Kolk, 1987); they freeze and those fight/flight stress chemicals boil up inside of them, undermining their overall health and well-being.

Their fear/adrenaline driven urge to act on their own behalf to stay safe becomes thwarted and they are left with an underlying sense of pain, discomfort, resentment and even rage. This shutting down, dissociating or “freezing,” can be a barely visible reaction to trauma. We shut down our extreme emotional reactions, whether fear, anxiety or simmering rage, in order to keep from burning up inside, similar to how a dangerously hot circuit breaker flips to the “off” position to keep from overheating.

For hurting children, it’s a double whammy. The very people to whom they’d normally go to for re­ assurance and to let them feel safe and to help them calm down are the ones who are causing their pain and fear. They lose access to their most immediate source of support and emotional regulation and their support people become people who cause deep pain that all too often does not get acknowledged and worked through.

The Child’s Dilemma Picture the child facing his or her drunk parent. The child is small and has limited reasoning skills, and the parent is physically larger with a more developed mind. When a parent is in a state of anger or rage, he or she is likely looking for someone on whom to pin his or her mood. Children are sitting ducks and can easily become the container of pain and blame. They absorb it and often wind up feeling somehow responsible for it.

They make sense of the situation with only the developmental equipment available to them at that particular stage of maturity. They feel abandoned by those people on whom they should be allowed to depend.

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needs because they have not received the kind of consistent and reliable responses that allow them to learn to solidify the communication loop that would teach them what it feels like to be seen and heard. They do not learn good interpersonal skills, such as how to expect or need something from another human being, how to give back, and how to regulate their neediness and deep desire for connection within both themselves and their intimate relationships. This can lead to a loss of ability to find emotional middle ground. They lose their ability to “self regulate” or to easily “right” themselves when they get off balance, which can lead to the sort of black and white thinking and feeling that characterizes addiction.

Some of the factors that sear trauma in place and make it more likely that a child of a parent suffering from an addiction (COA) will develop PTSD include whether or not escape is possible, whether or not there is a power imbalance, and the length of time that the COA spends in a numbed out or dissociated state. The power imbalance between an adult and child is clear. The child is dependent and the parent is the one who has created the home and who is, or is supposed to be, in charge. (Dayton 2015) The parent has the keys to the house, drives the car, and supplies food and shelter. The child is trapped in a world created, run and paid for by the parent, with limited access to other resources or sources of support. He or she can try to fight back, but will eventually lose. Children quickly learn that if they fight back, they risk humiliation and hurt, getting into trouble, being hit or punished, or having their allowance taken away. Instead, they learn to comply, withdraw and shut down. They freeze and hold their pain, hurt, and tension in the musculature of their little bodies.

The combination of the power imbalance, the length of time spent in a dissociated state, and the inability to escape are factors that can contribute to PTSD or pain from childhood resurfacing in adulthood. When the trauma is relational and occurs at the hand of those who are meant to love and protect us, the loss of trust can be profound. The pain can lie dormant for days, weeks, years or decades. It becomes intergenerational when that COA grows up, becomes an adult (ACoA), and creates a family of his or her own. The very feelings of innocence, vulnerability and dependence that are a part of falling in love, raising children and creating a family can act as triggers for the unresolved pain they carry from childhood. The ACoA parent is “yesterday’s child” who never unwound his or her pain and got the help that was needed to understand himself or herself, and self in relation to others, so cannot bring to parenting what was never received or learned. In a classic seesaw pattern, ACoA parents may overreact or underreact to the emotional pressures of partnering and parenting; remember it is emotional middle ground that eludes the person who has been traumatized. Over reaction or under reaction characterize the trauma response.

Changing the Legacy But these very triggers can also light a path into the unconscious, revealing to us what was once too painful to look at. What triggers us sends up a red flag as to where our buried pain lies. Once we can understand why we get triggered, we have a choice to re-enact and pass pain down to the next generation or to understand, work through and resolve lives; we do have a choice about how we play that hand. ACoAs need treatment as surely as anyone suffering from a substance use disorder needs treatment.

ACoAs need to treat their trauma so that it does not engender pain, confusion and alienation in the next generation, and so that the trauma they pass on does not lead to a desire to self medicate in those close to them and contribute to the insidious, intergenerational pattern of addiction.

Because this pain can be hard to see, hidden under veil after veil of denial, repression and dissociation, it often goes untreated. At least with addiction, you have something to point at, and the problem is only too 24

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visible. But the all too often silent suffering of those traumatized by growing up with ACEs can go unidentified both by the ACoA who does not wish to revisit his or her painful past and those close to the ACoA. However, it’s the responsibility of the ACoA to get the help he or she needs to become emotionally sober just as surely as the addict needs to become physiologically sober. PTSD is treatable, and experiential forms of group therapy have proved very successful in bringing an inner frozenness back to life and in giving pain a voice and safe space to express itself. Twelve step programs such as Al-Anon, CODA and ACoA groups provide a safe and ongoing container for pain to surface in an atmosphere of support and understanding alongside a new sense of good and orderly living.

The idea of growth through suffering is not a new one, but it has only recently been studied. Post-traumatic growth (PTG), a phrase coined by Drs. Richard Tedeschi and Lawrence Calhoun — editors of The Handbook of Post Traumatic Growth — describes the positive self-transformation that people undergo through meeting challenges head on. It refers to a profound, life altering response to adversity that changes us on the inside as we actively summon qualities like fortitude, forgiveness, gratitude, and strength that enable us to not only survive tough circumstances but also thrive. Twelve step programs have long operated with just these principles.

Recovery offers an opportunity to transform personal pain into personal growth and to take the bold and self-affirming steps we need to take to save our children and grandchildren from the legacy of pain, and to break the chain of trauma and addiction.

A Call to Action from NACoA: Finding Freedom for Hurting Kids – What You Can Do The first line of defense in a child’s life are teachers, pediatricians and clergy, as well as friends, family and neighbors. Those who touch the children’s lives on a daily basis are in a position to have the strongest impact in their lives.

Passing the pain of trauma through the generations doesn’t need to happen. We know that when children at early ages are provided with the education to understand what is happening in their family and have the nurturing support of even one caring adult, they can develop the capacity to become resilient and thrive despite the chaos at home. About the same time that the devastating findings of the ACE Study, and the trauma and PTSD that followed, were becoming known, the Substance Abuse and Mental Health Services Administration (SAMHSA) made available The Children’s Program Kit, an extraordinary and effective tool for educational support groups to help impacted children from early childhood through high school age. Thousands of kits were distributed and have been used in student assistance programs with the children of clients in addiction treatment, in Native American family education programs, and by other youthserving agencies. Awareness of the devastating results of ignoring the study’s truth are increasingly apparent across our systems. Many of the program kits are still used in weekend camps, in treatment programs, and where student assistance programs still function. The ACE Study’s conclusions cry out for clinicians to become advocates for services for the children of their clients. Such programs provide curriculum based educational support groups with children of a similar age. In these programs, the children learn that their parents are trapped by a disease, that it is no one’s fault, and that there are people whom they can trust and who could help them to heal. Such experiences can change the trajectory of a child’s life. However, when the silence in the addicted family carries into the offices of the pediatrician and family doctor, and into schools, faith communities and youth organizations, the trauma from the chronic emotional stress remains invisible and unaddressed.

The potential is immeasurable for the enlightened clinician to impact both the healing of the client who is an adult traumatized in childhood (often an ACoA) and the client’s children. Without that intervention, the client is likely to pass the pain onto their children and set the next generation up for mental health problems.

Imagine what could happen if a handful of doctors, teachers, treatment administrators and local faith communities all decide to break the silence they have supported for too long and name the pain and confusion being suffered by the 1 in 4 children (Grant, 2000; 2006) within their reach. Breaking the chain of addiction and trauma that locks generations into cycles of repeated pain can start with one committed and compelling clinician who advocates with their clients to find recovery support services for their children and with the schools and courts to look deeper into troubled children and families and find treatment and support for their core issues rather than expulsion or incarceration.

REFERENCES Anda, R. F., V. J. Felitti, J. Walker, C. L. Whitfield, J. D. Bremner, B. D. Perry, S. R. Dube, and W. H. Giles.

2006. “The Enduring Effects of Abuse and Related Adverse Experiences in Child­hood: A Convergence of Evidence from Neurobiology and Epidemiology.” European Archives of Psychiatry and Clinical Neuro­sciences 256(3):174–86.

Anda, R. F., V. J. Felitti, D. W. Brown, D. Chapman, M. Dong, S. R. Dube, V. I. Edwards, and W. H. Giles.

2006. “Insights into Intimate Partner Violence from the Adverse Childhood Experi­ences (ACE) Study.”

In P. R. Salber and E. Taliaferro, eds., Physician’s Guide to Intimate Partner Violence and Abuse, Volcano, CA: Volcano Press.

Dayton, T. 2000. Trauma and Addiction. Health Communications, Deerfield Beach, FL. Health Communications.

-------------2007, Emotional Sobriety: From Relationship Trauma to Resilience and Balance, Health Communications, Deerfield Beach, FL. Health Communications.

-------------2012, The ACoA Trauma Syndrome, The Impact of Childhood Pain on Adult Relation­ships, Health Communications, Deerfield Beach, FL. Health Communications.

-------------2015, Neuropsychodrama in the Treatment of Relational Trauma, Health Com­muni­ca­tions, Deerfield Beach, Fla. Health Communications.

Schore, A. N. (1991), Early superego development: The emergence of shame and narcissistic affect regulation in the practicing period. Psychoanalysis and Contemporary Thought, 14: 187–250.

------------- (1994), Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Mahwah, NJ: Erlbaum.

Tedeschi, R. G. & Calhoun, L. G. (1996). The post-traumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–471. Retrieved from http://link.springer.com/article/10.1007/BF02103658.

Van der Kolk, B. (1994). The body keeps the score: Memory and the evolving psychobiology of post-traumatic stress. Harvard Review of Psychiatry, 1(5), 253–65.

------------------ 1994. The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-Traumatic Stress. Boston: Harvard Medical School.

Dr. Tian Dayton is the author of 15 books including , The ACoA Trauma Syndrome: How Childhood Trauma Impacts Adult Relationships and Emotional Sobriety: From Relationship Trauma to Resilience and Balance, and is the Director of The New York Psychodrama Training Institute and creator of www.InnerLook. com, an online self-help website.

Sis Wenger has been the President and CEO of the National Association for Children of Alcoholics (NACoA) for most of the last 21 years. At NACoA, Wenger has written numerous articles published across disciplines, edited, co-authored or contributed to books, journals, and program materials, in addition to her advocacy and leadership roles at NACoA. She has directed The Clergy Education and Training Project® which has created training manuals, handbooks and a seminary curriculum, and one-day seminars for over 4,000 clergy in over 30 states. Her specialty is children and families impacted by parental addiction and she currently directs the evidence-based Celebrating Families! Wenger has been the recipient of multiple honors for her volunteer and professional contributions across multiple fields, including two major presidential awards.

FA L L 2 016 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 2 5

Opioid Antagonist: Issue of “Over-The-Counter” Naloxone

An Interview with Darryl S. Inaba, PharmD, CADC V, CADC III Interview by Jessica Gleason, JD, NAADAC Director of Communications receptor to block other opioids or endorphins from activating that site.

Opioids can fit into some of the different receptors and not others, resulting in partial effects. As a result, small doses of an opioid can fit into an endorphin receptor as an agonist but larger doses cause the receptor to hyperpolarize or “freeze up” like a lock that has been jammed. It then becomes an antagonist. This type of receptor site activity is known as an inverse agonist. (Inaba and Cohen, 2014; Brunton, L. L., et al., 2011; Lowenson, J. H., 2011)

T

his column’s questions on the recovery and relapse were submitted by Advances in Addiction & Recovery readers.

Some questions were edited for length and clarity. Submit your questions for Dr. Inaba to jgleason@naadac.org.

NAADAC: What is the best way for me to explain to my clients the difference among opioid agonists, antagonists, and partial agonist?

DR. INABA: Opioids like oxycodone and heroin affect the brain by attaching to specific sites on neurons known as receptors. These receptors activate, modify or stop actions that the brain processes through a process known as a synapse. This is how brain cells communicate to each other and to the rest of the body. Opioids bind to endorphin receptors that are present in the brain. The brain has different types of receptors for different types of endorphin molecules and when these receptors are activated, the result is decreased pain, altered mood, mitigated stress, suppressed cough, and other effects. You can think of this like different padlocks on brain cells that are opened, partially opened, closed or plugged up when an opioid slips into a specific lock and is mistaken for one of the brain’s natural endorphin molecules.

An opioid agonist is a drug that binds to a receptor site and acts like or mimics the effect usually achieved by the brain’s natural endorphin molecule. An antagonist binds to the endorphin receptor site, does not activate it, and sits in the receptor to block it from the action of opioids or endorphins. The antagonist is like a condom that covers the receptor site to prevent it from being activated. A partial agonist/antagonist only activates a portion of the receptor site resulting in partial effects and sits in the 26

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NAADAC: How do naltrexone, naloxone and buprenorphine differ?

DR. INABA: Both naltrexone and naloxone are opioid antagonists and are often referred to as “pure antagonists” as they only block the opioid receptors without having any partial agonist activity. The chemical properties of naloxone make it poorly absorbed if taken orally or sublingually but it is absorbed effectively when snorted into the nasal passages and lungs.

Naloxone is also very short-acting in the brain (45 minute to 1 hour) and, as a result, can be used as an antidote for opioid overdose. Naltrexone can be absorbed by oral and sublingual routes of administration, is much longer acting (24 hours or longer), has some toxicity to the liver, and may block some opioid receptors that naloxone fails to block. Naltrexone is used as a prophylactic to block opioid addiction relapse by preventing the effects of the drug if an individual slips during recovery. It has also been shown to decrease craving and is approved for both alcohol and opiate addiction treatment. Naltrexone has also been used to decrease cravings in pathological gambling, stimulant, and nicotine use disorders. Even behavioral disorders like trichotillomania and kleptomania have responded to naltrexone therapy. (Aboujaoude, E., Salame, W. O., 2016; Lahti, T., et al., 2010) Buprenorphine is an opioid inverse agonist. This means that it has both opioid-like properties and can also be a blocker of opioids, whereas naloxone and naltrexone only block opioid effects. At low doses, it is a powerful opiate agonist (even more powerful than morphine or heroin), but as its dosage is increased, it deactivates and blocks the opioid receptors in the brain to act as an opioid antagonist. This action makes it safer to use both for the treatments of pain and opioid use disorder. By 2012, the Wall Street Journal reported on IMS (Inventory Management System) Health National Disease and Therapeutic Index that U.S. prescriptions for buprenorphine in the treatment of pain greatly outnumbered methadone prescriptions. (WSJ, 2012) NAADAC: Why is there a move to have opioid antagonists be allowed to be sold as “over the counter” medication?

DR. INABA: Our nation is in the midst of a major opioid addiction and overdose death epidemic. The very grim evidence of such is incontrovertible: • U.S. has 4.6% of the world’s population and consumes 80% of the worlds opioids, yet there is no or little evidence for their efficacy in the long-term treatment of chronic pain.

PURERADIANCEPHOTO / SHUTTERSTOCK.COM

• Prescriptions for opioids have more than tripled in the past 20 years.

• By 2010, prescription overdose deaths, primarily from the consumption of opioids, were greater than auto accident deaths in the U.S. • The 2016 United Nations reports that the U.S. has the highest drug overdose death rate in the world with a growing incidence of illicit fentanyl analogs laced heroin overdoses.

(Reuben, D. B., et al., 2015; UNODC 2016) The tragedy of this is that an effective, easy to administer antidote with few side effects exists to counteract the lethal effects of opioid overdose.

Particularly in its newer nasal administration form, naloxone serves as a powerful antidote. When sprayed into the nostrils, it will bring an opioid overdosed victim back into consciousness in a matter of seconds. When an accidental overdose occurs, it often takes several minutes to get the victim to an emergency room or for medical professionals to arrive with naloxone to treat the overdose. Many cities now provide their police officers and other first responders with naloxone kits since they are more likely to arrive on the scene of an overdose before other medical help can arrive and this change has resulted in many deaths being averted. In my small city of Medford, Oregon, police officers were provided with these kits last year and have been credited with saving several dozen lives in the first few months of the new program being implemented. The detox unit of the Addictions Recovery Center where I work has begun to train and provide clients coming through our unit with these kits, and in the two weeks since this training began, two lives have been saved. Needless opioid deaths continue to increase throughout the nation and making naloxone kits available to everyone “over the counter” (non-prescription) so that anyone can purchase them and have one on hand when they come upon an opioid

overdose will work to save lives. California (AB 1535 signed into law 2014) and other states have legislated availability of “over the counter” naloxone to combat the rash of opioid overdose death.

I believe that allowing naloxone to be sold over the counter is good common sense, though there are some caveats to keep in mind. First and foremost, one should always make the 911 call to get emergency medical help intervention when using naloxone. Its duration of action is much shorter than that of most opioids, so the overdosed victim may only temporarily come out of their coma only to go back into one when the naloxone wears off since the longer acting opioid will still be in their system. The victim may also have other medical problems or complication that can be addressed by getting formal medical assistance. Some of the illicit fentanyl analogs that are used to lace heroin are so powerful that naloxone may not effectively reverse their toxic effects. This also occurs when the user combines opiates with other drugs, particularly with benzodiazepines and heavy consumption of alcohol. Another thing to consider is the potential of precipitating opioid withdrawal symptoms when naloxone is used in a person who has developed physical addiction to opioids. Finally, even when used in someone not physically addicted, one should expect and be prepared for an angry and somewhat belligerent victim when he or she comes back to consciousness after the reversal of opioid effects. (Inaba and Cohen, 2014; Brunton, L. L., et al., 2011; Lowenson, J. H., 2011) Those who struggle with substance related and addictive disorders do not fully engage in recovery until they come to desire recovery more than just about anything else. Naloxone has made it possible for thousands of individuals to have a second chance to come to that understanding.

Sobriety is a change that can be accomplished before a person with addictive disorder experiences the ultimate consequence (death) from this powerful medical disorder. In many instances, naloxone has even hastened this understanding by bringing those with an opioid use disorder back from the very edge of that consequence to provide them with a new sense of meaning and value for their future potential contributions to their families and communities.

REFERENCES Aboujaoude, E., & Salame, W. O. (2016). Naltrexone: A Pan-Addiction Treatment? CNS Drugs, 30(8):719–33.

Brunton, L. L., Chabner, B. A., & Knollmann, B. C. (2011). Goodman & Gillman’s The Pharma­co­ logi­cal Basis of Therapeutics, 12th Edition. New York: McGraw-Hill.

Inaba, D. S., & Cohen, W. E. (2014). Uppers, Downers, All Arounder: Physical and Mental Effects of Psychoactive Drugs, 8th Edition. Medford, OR: CNS Productions, Inc. Lahti, T., Halme, J. T., Pankakoski, M., Sinclair, D., & Alho, H. (2010). Treatment of pathological gambling with naltrexone pharmacotherapy and brief intervention: a pilot study. Psycho­ pharmacol Bull, 43(3):35–44.

Lowinson, J. H., Ruiz, P., Millman, R. B., & Langrod, J. G. (2011). Substance Abuse – A Com­pre­ hen­sive Textbook, 5th Edition. Philadelphia, Pa: Lippincott Williams & Wilkins.

Reuben, D. B., Alvanzo, A. A. H., Takamura, A., Bogat, G. A., Callahan, C. M., Ruffing, V., & Steffens, D. C. (2015). National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. Ann Intern Med. Retrieved from https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/ opioids-chronic-pain/workshop-resources#finalreport.

UNODC (2016). World Drug Report 2016. Retrieved from http://www.unodc.org/wdr2016.

Painkiller Relief (2012). Wall Street Journal, p. B3.

Dr. Darryl Inaba is Director of Clinical and Behavioral Health Services for the Addictions Recovery Center and Director of Research and Education of CNS Productions in Medford, OR. He is an Associate Clinical Professor at the University of California in San Francisco, CA, Special Consultant, Instructor, at the University of Utah School on Alcohol and Other Drug Dependencies in Salt Lake City, UT and a Lifetime Fellow at Haight Ashbury Free Clinics, Inc., in San Francisco, CA. Dr. Inaba has authored several papers, award-winning educational films and is co-author of Uppers, Downers, All Arounders, a text on addiction and related disorders that is used in more than 400 colleges and universities and is now in its 8th edition. He has been honored with over 90 individual awards for his work in the areas of prevention and treatment of substance abuse problems.

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Getting HIP in Higher Education: Using High Impact Practices When Teaching

By Margaret A. Smith, EdD, MLADC, International Coalition of Addiction Studies Education (INCASE)

S

ome of us in the addiction profession are educators in institutions of higher education such as colleges and universities.

We develop, teach, and revise courses on such topics as funda­ mentals of alcohol and other drugs, families, counseling, prevention, and cultural competency. Others are students in undergraduate or graduate programs who are preparing for careers as addiction professionals or people interested in continuing their higher education and looking into college and university-level addiction studies programs. Whatever your role or interest in higher addiction studies education, it is good to be HIP! HIP, or High Impact [Educational] Practices, include first-year seminars and experiences, learning communities, writing-intensive courses, collaborative assignments and projects, undergraduate research, diversity/global learning, service learning/community based learning, internships, and capstone courses and projects. HIPs have been shown to increase rates of student retention and engagement. Further, students from underserved

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populations tend to perform better in school when engaged in HIPs. (Kuh, 2008, p. 14) First-year seminars and experiences for students majoring or concentrating in addiction studies include an emphasis on “critical thinking, frequent writing, information literacy, collaborative learning and other skills that develop students’ intellectual and practical competencies.” (Kuh, 2008, p.

9) Such a seminar or experience could be invaluable for first-year students to allow them to engage in learning about the fundamentals of alcohol and other drugs. The seminar or experience could ask students, in small groups, to explore a myth they heard about alcohol and other drugs by using peerreviewed, scholarly literature. This allows students to actively participate in finding accurate, research-based information to prove or disprove their theories and will involve the students in critical thinking, information literacy, and collaborative learning!

The use of learning communities is another HIP. Generally known as living and learning communities (LLCs), these communities offer “a variety

Resources of opportunities for students to pursue their academic and social goals in a safe, supportive and dynamic environment.” (Keene State College, 2016, para. 1) Colleges and universities should consider creating a LLC devoted to addiction or prevention of alcohol and other drug use disorders!

Another HIP is to offer writing intensive courses throughout the curriculum. Writing intensive courses in addiction studies can include the use of case studies, theory application papers, and research papers. In one class that I teach, I have students watch a video of a case study. After studying the theories of addiction, they “diagnose” the main character using the DSM 5 criteria and apply the theories to the case study in a paper. This practice offers students an opportunity to diagnose and use the addiction theories, organize their thoughts, and to express what they have learned through writing.

Collaborative assignments and projects provide students with an opportunity to use team work skills. Assignment and projects involve study groups within courses, team-based assignments and writing, and cooperative projects and research. (Kuh, 2008, p. 10) In one of my courses, I have students study a drug independently and then work in teams based upon the category of drug (e.g. opiates, psychedelics).

After discussing the similarities and differences among the drugs in a group, the students post their findings, allowing their information to become public and viewed by other classes in that classroom.

Undergraduate research involves inviting students to engage in faculty research. For example, we facilitated an Appreciative Inquiry study that required our students to take leadership roles in conducting the Appreciative Inquiry groups. Through this process, the students learned about Appreciative Inquiry, how to conduct the necessary group, and the general research process.

Diversity/global learning “helps students explore cultures, life experiences, and worldviews different from their own.” (Kuh, 2008, p. 10) Many students take a class about counseling culturally diverse patients. In the counseling ­diversity portion of our Advanced Treatment class, students research a culturally diverse group and provide a PowerPoint presentation to their class. Additionally, this class can also incorporate community involvement with diverse groups of people, which can encourage students to help people with diverse backgrounds in their community.

More information on HIPs can be found at the Association of American Colleges and Universities: www.aacu.org/ resources/high-impact-practices Information related to course development at: http://store.samhsa.gov/ product/TAP-21-Addiction-CounselingCompetencies/SMA15-4171 National Addiction Studies Accreditation Commission: https://nasacaccreditation.org International Coalition of Addiction Studies Education (INCASE): www.incase.org Service learning and community-based projects provide students with direct experience in the field and profession. According to the National Service Learning Clearinghouse, it is “a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities.” (Generator School Network, 2016, para. 1) Community-based projects are “undertaken by departments and/or faculty and students in collaboration with community organizations that respond to community-identified needs and promote civic engagement.”

(University of Miami, 2016, para. 1) This type of project can involve activities in homeless shelters, building projects, and prevention activities.

Internships are generally one of the final experiences of most academic addiction programs.

Internships provide direct experience in a work setting and provide students with supervision from and direct contact with other professionals.

(Kuh, 2008) It is important to have a course/ class that partners with the internship so that students gain professional and academic information from the college/university while also gaining supervision and training workshops through their internships.

The last of the HIPs is capstone classes or projects. These classes or programs commonly take place at the end of the academic experience.

(Kuh, 2008, p. 11) At my college, students enroll in a capstone course that will allow them to thoroughly study a topic that they have wanted to explore in greater depth than through their general courses.

Recognizing and incorporating HIPS into our academic addiction programs is important to strengthen the skills of those vital new professionals entering the addiction workforce and strengthen the addiction profession overall.

Whether developing or revising a new addictions program, searching for an undergraduate or graduate program, or wanting to improve retention and engagement rates, be HIP! REFERENCES Generator School Network. (2016). National Service Learn­ ing Clearinghouse. Retrieved from https://gsn.nylc.org/ clearinghouse.

Keene State College. (2016). Living/Learning Communities.

Retrieved from http://www.keene.edu/office/reslife/llc.

Kuh, G. (2008). High-Impact Educational Practices: What They Are ,Who has Access to Them, and Why They Matter.

Washington, DC: Association of American Colleges and Universities.

University of Miami (2016). Community Based Projects.

Retrieved from http://www.miami.edu/index.php/civic_ community_engagement/projects.

Dr. Margaret Smith is Professor in Health Science/Addictions at Keene State College.

She is a member of NAADAC, the Asso­ci­a­ tion for Addiction Professionals, a prior member of the New Hampshire Alcohol and Drug Abuse Counseling Association (NHADACA), and the president-elect for the International Coalition of Addiction Studies Education (INCASE). Dr. Smith’s prior work includes prevention, intervention and treatment in such positions a substance use disorder counselor in a hospital setting and a college alcohol and other drug educator. Her specialties include addiction, co-occurring disorders, elder sub­ stance abuse, women, gerontology, gay/lesbian/bisexual culture and heterosexism reduction, diversity, and higher education.

FA L L 2 016 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 2 9

Earn 1 CE by Taking an Online Multiple Choice Quiz

Earn One Continuing education credit by taking a multiple choice quiz on this article now at www.naadac.org/magazineces. $15 for NAADAC members and non-members.

1. According to Tian Dayton and Sis Wenger, children who experience adverse childhood experiences (“ACEs”): a. Quickly learn that if they fight back, they risk humiliation and hurt, getting into trouble, and being hit or punished. b. Quickly learn to “self-regulate” and “right” themselves when they get out of balance. c. Rarely experience PTSD later in life because the pain never lies dormant. d. Develop good parenting skills as adults because they learn from their parents’ mistakes.

2. In Mita Johnson’s column on cultural humility and sensitivity, she discusses three stages to developing ethical multicultural skills. These stages are: a. Sharing one’s own ethnicity to promote mutual understanding, exploring mutual similarities, and promoting change. b. Serving the client responsibly, sharing one’s own ethnicity to promote mutual understanding, and use approaches that are evidence-based. c. Learning about the client, understanding what is happening to them, and empowering them to plan and act. d. Appreciate who the client is, share mutual similarities, and provide mean­ ing­ful, respectful, realistic and culturally-relevant services.

3. In Steve Durkee’s discussion of adolescent outpatient SUD treatment, which of the following statements most accurately reflects the theme of this article with regard to the lack of success in treating adolescents? a. Infrastructures are inadequately prepared to recruit, retain, and develop addiction professionals in adolescent development theory. b. The field includes a rapidly aging workforce that lacks understanding of today’s youth. c. Adolescents have valuable perspectives about what is effective and what is not effective in treatment, and they are not being heard. d. Counselors entering the profession have not been well trained in adolescent development theory by their academic institutions.

4. In his article on treatment courts for military veterans, Scott Swain noted which of the following as a significant factor in their success? a. They are successful at allowing addicted veterans to “man the bridge” for others who need support to return to society and once again be productive citizens. b. They are successful at building resiliency and fortitude, since many addicted combat veterans have lost such capability. c. They are only successful with veterans who have not been diagnosed with PTSD or other co-occurring disorders. d. They provide a military-like regimen that is most effective with those who served.

5. In Michael Petruzzelli’s discussion on The Excellence Act, which of the following is most accurate about this legislation? a. Since each program serves a unique population, it allows each program to develop its own specific requirements and metrics as means of ensuring high-quality behavioral health care. b. It encourages treatment programs to work with law enforcement officers, criminal justice systems, veterans’ organizations, child welfare agencies, schools, and others to ensure no one falls through the cracks. c. It allows clinics to be independently accountable for patients’ progress. d. It allows certified clinics to develop their own evidence-based outpatient addiction and mental health services as long as they include primary care and care coordination across health care settings.

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6. In the interview with Darryl Inaba, which of the following best depicts the action of naloxone? a. It has been shown to decrease craving and is approved for ongoing treatment in alcohol and opiate recovery. b. It is an opioid inverse agonist, meaning that it has both opioid-like properties and can also be a blocker of opioids. c. With increased dosage, it deactivates and blocks the opioid receptors in the brain to act as an opioid antagonist. d. When sprayed into the nostrils, it will bring an opioid overdosed victim back into consciousness in a matter of seconds.

7. In Margaret Smith’s article on High Impact (Educational) practices (or HIP), which of the following is an accurate example of using HIP in higher education? a. First-year seminars, learning communities, and writing-intensive courses. b. Undergraduate research, diversity/global learning, and community based learning. c. Internships, capstone courses, and special projects. d. All of the above.

8. Darryl Inaba said that when an accidental overdose occurs, it often takes several minutes to get the victim to an emergency room or for medical professionals to arrive to provide treatment. In an effort to prevent overdose deaths, which of the following is most accurate? a. Naloxone can be absorbed by oral and sublingual routes of administration, and is much longer acting (24 hours or longer) than naltrexone. b. Many police officers and other first responders are given naloxone kits since they are more likely to arrive on the scene of an overdose before other medical help can arrive. c. Since naloxone can only be administered by licensed medical professionals who are certified to administer it, it is important to get appropriate medical care immediately. d. The U.S. is in the midst of a major opioid addiction and overdose death epidemic and thus there are vast differences between each person who experiences an accidental overdose. Therefore, it is important to assess each case of overdose for the drug that most effectively addresses their unique physiological needs.

9. In the article by Tian Dayton and Sis Wenger, which of the following best fits their description of toxic stress response? a. It can occur when a child experiences strong, frequent, and/or prolonged adversity. b. It most commonly occurs when there is a lack of adequate adult support. c. It can lie dormant for many years, but never disrupts the development of brain architecture or other that of other organ systems. d. It decreases the risk for stress-related disease and cognitive impairment.

10. In Mita Johnson’s article on cultural humility and sensitivity, which of the following was not recommended as a means of gaining cultural sensitivity? a. We shall treat clients as we would want to be treated if we were in their shoes. b. We shall express genuine empathy and concern. c. We shall not endorse society’s views on stereotyping and dis­­crimination. d. We shall gain a complete understanding of each client’s culture.

■ N A A DAC L E ADE RS HI P NAADAC EXECUTIVE COMMITTEE

NAADAC COMMITTEES

Updated 9/13/2016

North Central

STANDING COMMITTEE CHAIRS

President Kirk Bowden, PhD, MAC, NCC, LPC

(Represents Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota)

Bylaws Committee Chair Ronald A. Chupp, LCSW, LCAC, NCAC II, ICAC II

President Elect Gerry Schmidt, MA, LPC, MAC Secretary Thurston S. Smith, CCS, NCAC I, ICADC Treasurer John Lisy, LICDC, OCPS II, LISW-S, LPCC-S Immediate Past President Robert C. Richards, MA, NCAC II, CADC III National Certification Commission for Addiction Professionals (NCC AP) Chair Kathryn B. Benson, LADC, NCAC II, QSAP, QSC Executive Director Cynthia Moreno Tuohy, NCAC II, CDC III, SAP REGIONAL VICE-PRESIDENTS Mid-Atlantic (Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)

Susan Coyer, MAC

Clinical Issues Committee Chair Frances Patterson, PhD, MAC

Diane Sevening, EdD, LAC Northeast

(Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)

Catherine Iacuzzi, PsyD, MLADC, LCS Northwest

Ethics Committee Chair Mita Johnson, EdD, LPC, MAC, SAP Finance & Audit Committee Chair John Lisy, LICDC, OCPS II, LISW-S, LPCC-S

Nominations and Elections Chair Robert C. Richards, MA, NCAC II, CADC III

Greg Bennett, MA, LAT Southeast

(Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)

Personnel Committee Chair Kirk Bowden, PhD, MAC, LISAC, NCC, LPC

Southwest

Public Policy Committee Co-Chairs Michael Kemp, ICS, CSAC, CSW Sherri Layton, MBA, LCDC, CCS

(Represents Arizona, California, Colorado, Hawaii, Nevada, New Mexico and Utah)

AD HOC COMMITTEE CHAIRS

Angela Maxwell, MS, CSAPC

Mita Johnson, EdD, LPC, LAC, MAC, SAP Organizational Member Delegate Matt Feehery, MBA, LCDC, IAADC

Mid-Central

Awards Committee Chair Jamie Durham Adolescent Specialty Committee Chair Steven Durkee, NCAAC International Committee Chair Paul Le, BA

(Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)

Kevin Large, MA, LCSW, MAC

Leadership Committee Chair Robert C. Richards, MA, NCAC II, CADC III

Mid-South

Membership Committee Chair Margaret Smith, EdD, LADC

(Represents Arkansas, Louisiana, Oklahoma and Texas)

Sherri Layton, MBA, LCDC, CCS

Student Sub-Committee Chair Diane Sevening, EdD, LAC

Kathryn B. Benson, NCAC II, LADC, QSAP, QSC NCC AP Chair Tennessee

Tobacco Committee Chair Diane Sevening, EdD, LAC

James “Kansas” Cafferty, LMFT, NCAAC California

PAST PRESIDENTS

NERF Events Committee Chair Nancy Deming, MSW, LCSW, CCAC-S

(Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)

Professional Practices and Standards Committee Chair Donald P. Osborn, PhD, LCAC

1974-1977 Robert Dorris 1977-1979 Col. Mel Schulstad, CCDC, NCAC II (ret’d) 1979-1981 Jack Hamlin 1981-1982 John Brumbaugh, MA, LSW, CADAC IV, NCAC II 1982-1986 Tom Claunch, CAC 1986-1988 Franklin D. Lisnow, MEd, CAC, MAC 1988-1990 Paul Lubben, NCAC II 1990-1992 Kay Mattingly-Langlois, MA, NCAC II, MAC 1992-1994 Larry Osmonson, CAP, CTRT, NCAC II 1994-1996 Cynthia Moreno NCAC I, CCDC II 1996-1998 Roxanne Kibben, MA, NCAC II 1998-2000 T. Mark Gallagher, NCAC II 2000-2002 Bill B. Burnett, LPC, MAC 2002-2004 Roger A. Curtiss, LAC, NCAC II 2004-2006 Mary Ryan Woods, RNC, LADC, MSHS 2006-2007 Sharon Morgillo Freeman, PhD, APRN-CS, MAC 2007-2010 Patricia M. Greer, BA, LCDC, AAC 2010-2012 Donald P. Osborn, PhD (c), LCAC 2012-2014 Robert C. Richards, MA, NCAC II, CADC III

Steven Durkee, NCAAC Secretary Kentucky Tay Bian How, NCAC II Sri Lanka Thaddeus Labhart, MAC, LPC Treasurer Oregon Rose Maire, MAC, LCADC, CCS New Jersey Art Romero, MA, LPCC, LADAC New Mexico Sandra Street, MAC, SAP West Virginia Loretta Tillery, MPA, CPM Public Member Maryland Kirk Bowden, PhD, MAC, LISAC, NCC, LPC (ex-officio) Arizona

Product Review Committee Chair Matt Feehery, MBA, LCDC, IAADC

NAADAC REGIONAL BOARD REPRESENTATIVES

NORTHEAST NORTH CENTRAL

MID-CENTRAL

Gloria Nepote, LAC, NCAC II, CCDP, BRI II, Kansas-Missouri Ted Tessier, MA, LAMFT, LADC, Minnesota Tiffany Gormley, MS, PLMHP, Nebraska Megan Busch, LAC, LPCC, North Dakota Linda Pratt, LAC, South Dakota

James Golding, MSW, MHS, CAADC, MAC, Illinois Angela Hayes, MS, LMHC, LCAC, Indiana Michael Townsend, MSSW, Kentucky Terrance Lee Newton, BAS, CADC, Michigan Jim Joyner, LICDCCS, ICCS, Ohio Daniel Scoville, MSW, ICS, CSAC, Wisconsin

Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Gary Blanchard, MA, LADC, Massachusetts Lori Ford-Magoon, MLADC, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, DOT SAP, New York William Keithcart, MA, LADC, Vermont

NORTHWEST Diane C. Ogilvie, MAEd, Alaska Malcolm Horn, LCSW, MAC, SAP, NCIP, Montana Arturo Zamudio, Oregon Greg Bauer, CDP, NCAC I, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming

SOUTHWEST

MID-ATLANTIC

Yvonne Fortier, LPC, LISAC, Arizona Thomas Gorham, MA, CADC II, California Thea Wessel, LPC, LAC, MAC, Colorado Kimberly Landero, MA, Nevada J.J. Azua, LADAC, CPSW, New Mexico Michael Odom, LSAC, Utah

Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia Ron Pritchard, CSAC, CAS, Virginia Patrice Pooler, MA, ADC, West Virginia

SOUTHEAST MID-SOUTH Suzanne Lofton, LCDC, ADC, SAP, Texas

Sam Long IV, NCAC I, Alabama Bobbie Hayes, LMHC, CAP, Florida David A. Burris, CAC II, NCAC II, CCS, Georgia Tony Beatty, MA, LCAS, CCS, North Carolina Charles Stinson, MS, South Carolina Lori McCarter, LADAC, QCS, Tennessee

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Credible Behavioral Health, v.9.1 was certified as an ONC HIT 2014 Edition Complete EHR by ICSA Labs.

For certification details, please visit www.credibleinc.com/meaningful-use

Mission: Improve the quality of care and lives in Behavioral Health for clients, families, providers and management.

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