Advances in Addiction & Recovery (Spring 2014)

SPRING 2014 Vol. 2, No. 1

The Official Publication of NAADAC, the Association for Addiction Professionals

Beyond Opiates: Addiction: Conditioning the Brain for Reward PAGE 23

ANNOUNCEMENT:

Certification One-Time Test Acceptance Offer PAGE 12

Recovery Support: Collaborating With Other Professions, Professionals, and Communities PAGE 20

V0–OMaTy 3E0, 2014

April 3

ments Candidate State ns, tio for NAADAC Elec Page 13

ARCHIVED ARCHIVED

ARCHIVED

ARCHIVED

Contents DEPARTMENTS

5

LETTERS: Ten Years Well Spent

NAADAC Magazine Editor is Moving on; Thankful for Memories

7

LEGISLATIVE/ ADVOCACY: Parity Regulations Final Rule – What You Need to Know Compiled

from the Parity Implemen­ tation Coalition Release

FEATURES

20

Recovery Support:

Collaborating With Other Professions, Professionals, and Communities

23

Beyond Opiates Addiction: Condi-

tion­ing the Brain for Reward

8

LEGISLATIVE/ ADVOCACY: 27th Annual Advocacy in Action Conference Recap Putting Addiction

and the Needs of AddictionFocused Professionals on the Agenda

11

AFFILIATES: Meet NAADAC’s Regional Vice Presi­ dent for the South­ west Mita M. Johnson

12

CERTIFICATION: Announcement: One-Time Test Accep­ tance Offer for National Certification

13

MEMBERSHIP: Meet the 2014 Candidates for NAADAC Executive Leadership Positions

24

Healing Invisible Wounds: An Action Plan Research Efforts

Improve Our Understanding of Trauma

25

NAADAC Pro­duces a Workforce Situational Analysis for Addic­ tion – and Recovery

27

Suicide Making Peace

With Death

Candidates Bring a Rich Breadth of Talent

17

MEMBERSHIP: NAADAC Annual Awards Process

31

NAADAC LEADERSHIP

29

The Art and Science of Healing Successfully

Living With Any Chronic Illness Requires a Change of Worldview

SPRING 2014 Vol. 2 No. 1 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 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 addiction-focused health care pro­fessionals in the United States, Canada, and abroad. NAADAC’s members are addiction counselors, educators, and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education.

Mailing Address

Telephone Email Fax

1001 N Fairfax Street, Suite 201 Alexandria, VA 22314 800.548.0497 naadac@naadac.org 703.741.7698

Managing Editor

Jessica Gleason, JD

Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Committee

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

Alan K. Davis, MA, LCDC III Bowling Green State University

Carlo DiClemente, PhD, ABPP University of Maryland, Baltimore County

Rokelle Lerner, MA Cottonwood de Tucson

Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP NAADAC, the Association for Addiction Professionals

Robert Perkinson, MD Keystone Treatment Center

Robert C. Richards, MA, NCAC II, CADC III Willamette Family Inc.

William L. White, MA Chestnut Health Systems

We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Have a story idea or article that you’d like to submit? Please contact Jessica Gleason at jgleason@naadac.org.

Publication Guidelines ● Articles must be the work of the author(s) and not subject to copyright. ● Articles must not contain information that promotes unethical activities or business practices. ● Submissions can be from 500 to 3,000 words. Longer articles can be submitted in consultation with the editor. ● Submitted works must include citations and a bibliography, or be clearly marked as an opinion piece. ● Authors must submit a biography and photo to be appended to the article. Photos need to be JPG or PNG format and at least 500 KB. NAADAC reserves the right to edit or condense any articles.

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

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

Comments?

Send to Jessica Gleason at jgleason@naadac.org

Printed April 2014 STAY CONNECTED

Cover: benoit daouse | PhotoSpin.com

USD ADS_Advances in Addiction ad.pdf

C

M

Y

CM

MY

CY

CMY

K

1

2/19/14

12:14 PM

Making a Difference at the University of South Dakota.

We are a national leader in offering addiction, co-occurring and prevention education that emphasizes state-of-the art evidence-based approaches to addiction/prevention, giving students the skills and knowledge they need to meet the changing needs of the clients and the communities they live in.

Choose an affordable online program that meets your needs.

• Undergraduate Certificate in Addiction Studies • Bachelor of Science in Addiction Studies • Graduate Certificate in Addiction Studies • Master of Arts in Addiction Studies

APPLY TODAY For more information contact:

DIVISION OF CONTINUING & DISTANCE EDUCATION 414 East Clark Street • Vermillion, SD 57069 605-677-6240 • 800-233-7937 www.usd.edu/cde

Ten Years Well Spent Letters

NAADAC Magazine Editor is Moving on; Thankful for the Memories B y D onovan K uehn After ten years at NAADAC, I have moved on to a new opportunity at the National Institutes of Health, working at the Clinical Center, the nation’s research hospital. Jessica Gleason, the new Managing Editor of Advances in Addiction & Recovery was gracious enough to let me write a farewell message, which I really appreciate.

It was my privilege to be a part of many innovations at NAADAC: helping to re-establish the NAADAC annual conference and making it to grow; re-launching a NAADAC-produced magazine after an almost 15 year hiatus; and collaborating with the American Mental Health Counselors on a set of conferences focused on strategies to address co-occurring disorders, a precursor to the federal government’s focus on multidisciplinary teams.

While I’m proud of these accomplishments, what I treasure the most are the experiences NAADAC has af-

NAADAC CAS Spring 2014 Ad.pdf

1

2/18/2014

forded me: chasing down the contents of a cash box through forceful winds in Corpus Christi, TX; a wolf howling outside my open hotel window in West Yellow­ stone, MT; meeting at the South African embassy in Washington, D.C. with leaders who had participated in a cultural exchange in the African nation; being left behind by my tour bus at a NAADAC-sponsored recovery month event in Baltimore, MD (thank goodness for back­up plans!).

I’d like to express my sincere thanks to all the contributors to NAADAC’s publications, to the presenters at NAADAC’s conferences and to the NAADAC members whose enthusiasm and dedication is infectious and helps bring out the best in the NAADAC staff.

There is no way to repay the people who have been generous enough to share their time and their patience with me. All I can say is I am richer for the experience.

Thanks again for the opportunity to work for and with you. I wish you all the best!

3:15:32 PM

C

M

Y

CM

MY

CY

CMY

K

SPRING 2014 | Advances in Addiction & Recovery 5

NCC AP Announces New Credentials/Endorsements Nationally Certified Adolescent Addiction Credential A nationally recognized standard of competencies and effective clinical practice utilized in treating adolescent Substance Use Disorders (SUDs).

Nicotine Dependence Specialists Credential (NDS) A nationally recognized standard of competencies that demonstrates foundational knowledge of nicotine dependence, develops skills and strategies for tobacco addiction counseling and examines related recovery and wellness issues.

Nationally Endorsed Student Assistance Professionals (NESAP) A nationally recognized endorsement developed to address the need for professional competencies for practitioners treating adolescent Substance Use Disorders (SUDs). Over the past ten years there has been an emerging necessity to distinguish a unique set of skills for this practice when addressing adolescent issues in a school setting; identify an adequate awareness of adolescent development and differentiate issues related to co-occurring disorders that practitioners need to understand when working with adolescents.

MATT ANTONINO| photospin.com

The NCC AP’s newest credentials and endorsements provide national recognition of a professional’s current knowledge and competence. We encourage you to continue to learn for the sake of your clients which provides assistance to employers, health care providers, educators, government entities, labor unions, other practi tioners, and the public in the identi fication of quality counselors who have met the national competency standards.

For details, including requirements for credentialing, recredentialing and exam schedule and fees, go to

www.naadac.org/certification

6 Advances in Addiction & Recovery | SPRING 2014

SVETLANA FOOTE | PHOTOSPIN.COM

Legislative/ Advocacy

Parity Regulations Final Rule – What You Need to Know C ompiled from the Parity I mplementation C oalition NAADAC E xecutive D irector

release by

Through NAADAC’s involvement with the Parity Im­ple­ men­tation Coalition, we have learned more specifics regarding the final rule that was issued on November 8, 2013 through the Departments of Treasury, Labor, and Health and Human Services. These rules govern the im­ ple­mentation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) that NAADAC aggressively advocated for, along with many other organizations. The following is a brief summary of key provisions of this 200-page document. The final regulations are available in full at www.dol.gov/ ebsa/pdf/mhpaeafinalrule.pdf.

The final plan is effective for insurance plan years beginning on or after July 1, 2014. The reality is that the bulk of the insurance plans end on December 31st, thereby making the effective date for most insured to be January 1, 2015.

The final rule clarified the scope of service eligibility as follows: A) the six classifications of benefits (in­ patient in and out-of-network, outpatient in and out-ofnetwork, emergency care, and prescription drugs) were never intended to exclude intermediate levels of care (in­tensive outpatient, partial hospitalization, residential); therefore, expect these to be covered in insurance plans; B) the language in the final rule on scope makes it clear that each classification and sub-classification has to meet all parity tests within each classification.

It further states that “the classifications and subclas­sifications are intended to be comprehensive and cover the complete range of medical/surgical benefits and mental health or substance use disorder benefits offered by health plans and issuers.” This language, coupled with the new specific examples around intermediate levels of care, makes it clear that mental health/substance use disorders (MH/SUD) services have to be comparable to the range and types of treatments for medical/surgical within each class; and C) although neither the Interim Final Rule (IFR) nor the final rule mandate specific services required to be offered by plans under the six classifications, the final rule clarifies that plans must assign intermediate services in the behavioral health area to the same classification as plans or issuers assigned intermediate levels of services for medical/surgical conditions.

For example, if a plan or issuer classifies care in skilled nursing facilities or rehabilitation hospitals as inpatient benefits, then the plan or issuer must likewise treat any covered care in residential treatment facilities for mental health or substance user disorders as an inpatient benefit. In addition, if a plan or issuer treats home health care as an outpatient benefit, then any covered intensive outpatient mental health or sub-

C ynthia M oreno Tuohy, NCAC II, CCDC III, SAP,

stance use disorders services and partial hospitalization must be considered outpatient benefits as well.

The net effect of this provision is that parity requirements (as clarified by the FAQs issued by the De­part­ ment of Labor) extend to intermediate levels of MH/ SUD care and that such services must be treated comparably under the plan.

The final rule strikes the provision included in the Interim Final Regulations that permitted plans to apply discriminatory limits on MH/SUD treatment if there was a “clinically recognized standard of care that permitted a difference.”

Under the final rule, parity requirements for nonquan­t itative treatment limitations (NQTLs) are ex­ panded to include restrictions on geographic location, facility type, provider specialty and other criteria that limit the scope or duration of benefits for services (including access to intermediate levels of care). The net effect of this is plans will no longer be able to require a patient to go to a MH/SUD facility in their own state if the plan allows plan members to go out-of-state for ­other medical services.

The improvement in the final rule is that plan participants or those acting on their behalf will now be able to request a copy of all relevant documents used by the health plan to determine whether a claim is paid.

MHPAEA requires that the criteria for medical necessity determinations be made available to any current or potential enrollee or contracting provider upon request.

MHPAEA also requires that the reason for the denial of coverage or reimbursement must be made available upon request. New disclosure requirements in the final rule will require plans to provide written documentation within 30 days of how their processes, strategies, evidentiary standards and other factors used to apply an NQTL were imposed on both medical/surgical and MH/ SUD benefits.

The final rule clarifies, as codified in federal and state law, states have primary enforcement authority over health insurance issuers. As such, states will be the primary means of enforcing implementation of MHPAEA. The Department of Health and Human Serv­ ices, through its Centers for Medicare and Medicaid Services (CMS), has enforcement authority over issuers in a state that do not comply. The Department of Labor has primary enforcement authority over selfinsured ERISA plans.

These final rules do not apply to Medicaid Managed Care Organizations, Children’s Health Insurance Pro­ gram (CHIP) or Alternative Benefit Plans (i.e. Medicaid Parity, continued on page 8 ☛

SPRING 2014 | Advances in Addiction & Recovery 7

Legislative/ Advocacy

27th Annual Advocacy in Action Conference Recap Putting Addiction and the Needs of Addiction-Focused Professionals on the Agenda B y J essica G leason , NAADAC C ommunication A ssociate Addiction-focused professionals from around the countr y descended on Washington, D.C. to join NAADAC, the Association for Addiction Professionals, for its 27th Annual Advocacy in Action Conference from March 2–4, 2014. Attendees received up-to-date in­ formation from top federal officials and industry ­experts on the critical issues that impact the addictionfocused profession, and then met with national lawmakers to share their rare insight and knowledge base regarding the true day-to-day issues created by recent healthcare reforms, and a shrinking and undersupported workforce.

“This year marks NAADAC’s 40th year of working to advance the interests of addiction-focused profes­ sionals and organizations and our 27th Annual Advo­ cacy Conference. Our advocacy conference provides a vehicle for addiction-focused professionals from across many different disciplines to advocate on a national level with a strong, united voice,” said Gerry Schmidt, NAADAC Public Policy Chair. “We addressed funding for services and research, workforce development, improved technology for the treatment of all addic­tions, the implementation of parity and healthcare reform, and government initiatives to support the profession and ensure access to services.”

“With the onset of the Affordable Care Act and re­ lated healthcare reform initiatives, over 25 million ­people are newly eligible for substance use and mental disorders services. Now more than ever, we need to address the dramatic need for workforce development in the medical specialty of addiction prevention, intervention, treatment and recovery support with a strong unified push for funding for services, minority fellowships,

and tuition reimbursement for those wanting to pursue a career in addiction treatment,” said Cynthia Moreno Tuohy, NAADAC Executive Director.

“Addiction is one of America’s most serious public health challenges. With less than 10 percent of those needing addiction services receiving them, this health disparity is costing America over $600 billion a year and so much more in family and community losses! At­ tention to this health epidemic is crucial for the health of this generation and generations to come. We need Congress to clearly understand not just the need for con­tinued funding, but the severity of addiction as a major healthcare issue,” said Rober t Richards, NAADAC President. “Almost one-in-four deaths in the United States can be attributed to alcohol, tobacco, or other drug use. Our work to prevent substance use disorders, treat the disease, and support recovery ­hastens people back to work, reunites families, and cre­ates safer communities. Our work helps people get their lives back.”

Presentations from this year’s conference, as well as pictures and advocacy materials, are available at www. naadac.org/advocacyconference. Hope you will join us next year!

Jessica Gleason is the Communications Associate for NAADAC, the Association for Addiction Professionals. She is the Managing Editor for Advances in Addiction & Recovery and compiles NAADAC’s two ePublications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate. She is also responsible for the NAADAC website’s content, social media, and communications. Gleason holds a Juris Doctorate from Northeastern University School of Law in Boston, MA and a Bachelor of Arts Degree in Political Science from the University of Massachusetts at Amherst.

Parity, continued from page 7

Expansion Plans under the ACA) even though the rule states the statute applies to these entities. As stated, the January 2013 CMS State Health Official Letter will continue to govern implementation of Medicaid managed care parity. The final rule states more guidance on this will be forthcoming. The PIC will be requesting this additional Medicaid guidance be issued within 180 days.

Under the final rule, regulations under the ACA and FAQs issued by the Department of Labor, plans and issuers must provide the claimant, free of charge, during the appeals process with any new additional evidence considered relied upon or generated by the plan or issuers in connection with a claim.1 The final rules give clear direction for plan parity requirements. It will be vital that the clients/patients you are planning to serve understand the provisions in their health benefit coverage, what the limits are for medical/surgical benefits and that the substance use dis­ order/mental health benefits are on par. If they are not, the State In­ 8 Advances in Addiction & Recovery | SPRING 2014

sur­ance Commissioner or the Department of Health and Human Services are the departments with primary responsibility to enforce.

As more information becomes available, visit www.naadac.org/ advocacy for updates.

Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Profes­sionals.

She previously served as the Executive Director of Danya Institute and the Central East Addiction Technology Transfer Center and as Program Director for Volunteers of America Western Wash­ing­ton. In addition, she has over 20 years of experience serving as the administrator of multi-county, publicly funded alcohol/drug prevention/ intervention/treatment centers with services ranging from prenatal care to the serving the elderly.

REFERENCES 1 For more resources, please refer to: U.S. Department of Health and Human Services’ Study: Consistency of Large Employer and Group Health Plan Benefits with Require­ ments of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, available at www.dol.gov/ebsa/pdf/hhswellstonedomenici mhpaealargeemployerandghpbconsistency.pdf

PHOTOS BY JESSICA GLEASON | NAADAC.ORG

NAADAC Executive Board and the National Certification Commission for Addiction Professionals (NCC AP) Texas delegation in Senator Ted Cruz’s office

Opening Reception Briefing with Michael Boticelli, Deputy Director, White House Office of National Drug Control Policy (ONDCP)

Members of Texas Association of Addiction Professionals (TAAP) Jamie Schmitt, President of Waco Chapter, and Teresa Sawyer

Bob Richards, NAADAC President

U.S. Capitol Building in March’s snowstorm

NAADAC Education & Research Foundation (NERF) Reception and Auction Lunch sponsored by National Association of Drug Court Professionals (NADCP)

Gerry Schmidt, NAADAC Public Policy Chair, speaking about the Recovery to Practice (RTP) Initiative 2014 NAADAC Emerging Young Leaders of the Year Award recipient – Young People in Recovery 2014 Senator Harold E. Hughes Advocate of the Year Award recipient – Sherri Layton, NAADAC Mid-South Regional Vice President Screening of “The Anonymous People” and Panel Discussion

SPRING 2014 | Advances in Addiction & Recovery 9

Thank You to Our 2014 Advocacy in Action Conference Partners and Sponsors!

GOLD SPONSOR

PLATINUM SPONSOR

PREFERRED VENDORS

SUPPORTERS

F O U N D A T I O N

PARTNERS

NARR

National Alliance for Recovery Residences

10 Advances in Addiction & Recovery | SPRING 2014

Meet NAADAC’s Regional Vice-President for the Southwest:

Affiliates

Mita M. Johnson

Representing Arizona, California, Colorado, Hawaii, Nevada, New Mexico, and Utah Mita M Johnson, EdD, LPC, LMFT, ACS, AAMFT-approved Clinical Supervisor, LAC, SAP, has worked in the behavioral health field as a mental health and substance abuse clinician, educator, trainer and supervisor for over 25 years. She has a ­private practice in Golden, CO where she works with clients, families, and supervisees. Mita is a faculty member of Metropolitan State University of Denver and Argosy University Denver. She provides live and online CAC trainings across the state. Mita has provided content-specific trainings for NAADAC and several NAADAC State Affiliates.

Mita is a retained consultant for the Colorado Department of Regulatory Affairs, advising the marriage and family and the addic­tion professionals sections; Mita is a behavioral health consultant to the Mental Health Center of Denver. Mita is the immediate Past-President of the Colorado Association of Addiction Professionals (CAAP), is a Governor’s appointee to the Behavioral Health Transformation Council, has been an expert witness and case consultant to the state attorney general’s office, has been a member of the Advisory Committee that provides input regarding CAC training through the Office of Behavioral Health, and is the NAADAC Southwest Regional Vice President encompassing seven states. Mita received the 2013 CAAP Leadership Award, the Therapist of the Year by the Colorado Association of Marriage and Family Therapists, and received the Dr. James R. Beck Coun­ seling Excellence Award from Denver Seminary. Mita has a Bach­ elor’s degree in Biology, a Master’s degree in Counseling, and her EdD in Counselor Education and Supervision.

There are important passions that drive Mita, including: ■ clients deserve the best clinical care available to them, regardless of their situation ■ counselors deserve the best supervision, guidance and support always ■ the fields of mental health and substance abuse treatment requires ongoing advocacy, and ■ leaders have a mandate to serve everyone equally and to collaborate generously.

There is much work to be done to promote the behavioral health field!

Contact Information: Behavioral Health Resources, LLC Mailing Address: PO Box 4297, Evergreen, CO 80437 Office Address: 14143 Denver West Parkway, Suite 100, Golden, CO 80401 Phone: 303.808.8466 Fax: 303.674.6958 Email: mitamjohnson@comcast.net

SPRING 2014 | Advances in Addiction & Recovery 11

Certification

Announcement: One-Time Test Acceptance Offer for National Certification B y K athr yn B enson , NCAC II, LADC, QSAP, QSC, NCC AP C hair The National Certification Commission for Addiction Professionals (NCC AP), a department of NAADAC, the Association for Addiction Professionals, is proud to announce that, for a limited time, it is waiving its requirement that all national credential applications be submitted within four years of receiving a passing NCC AP test score. The NCC AP invites you to apply for the level of national credential you tested for when you obtained your state-issued credential/license, no matter how old your test score!

This one-time offer to apply for an NCC AP national cre­dential with a test score older than four years will begin April 1 and end September 30, 2014. No applications will be accepted after September 30, 2014.

The NCC AP is making this one-time test acceptance offer to acknowledge and honor your hard work and professional dedication, and aid in your professional growth. The upcoming addiction workforce shortage needs people like you who can validate competence and experience with a national level of credentialing to enhance your professional viability.

To qualify, you must: 1. Have a passing NCC AP test score; 2. Be able to document that score, the date you tested and which NCC AP test (NCAC I, NCAC II, MAC) was taken (NCC AP staff will be able to help find missing information); 3. Hold a current state issued credential/license and be able to verify your active status; 4. Be currently practicing as a Substance Use Dis­ orders Professional or a professional in a related discipline; and 5. File a completed NCC AP Test Acceptance application and submit all required documentation between April 1, 2014 and September 30, 2014.

How does the NCC AP Credential assist me in my profession?

■ Obtaining a national credential demonstrates a high level of competence in your chosen profession.

■ The NCC AP MAC credential will enhance your ability to bill third party payees. The following survey finding was released by SAMSHA and the Association of Behavioral Health and Wellness (ABHW):

A survey by Pam Greenberg with SAMHSA and the Association for Behavioral Health and Wellness (ABHW) found that SUD counselors were required to be state licensed as an alcohol and drug abuse counselor in the provider’s state OR certified by NCC AP as a Master Addiction Counselor (MAC).1 ■ The U.S. Department of Transportation recognizes

all three levels of NCC AP national credentials as means to qualify for the Substance Abuse Pro­fes­ sional (SAP) qualification.

■ Acceptance/portability within states where the NCC AP testing products are recognized.

■ Evidences your skills, knowledge and competence at a national credentialing level. This is important to Fed­eral Agencies who promote the use of national cre­dentials to lessen the confusion of who is eligible to treat Substance Use Disorders.

The NCC AP works very closely with your state credentialing/licensing boards to offer a sound testing product that is used in the United States and in many countries. We hope you will take advantage of this onetime offer to apply for a national credential even if your NCC AP test score is more than four years old. Please pass this announcement on to anyone you know who may be eligible for this professional offer.

We thank you for your many years of support of the NCC AP and look forward to your attainment of a highly valued NCC AP national credential as you continue to enhance your professional career.

For more information on this offer, please visit www. naadac.org/testacceptanceoffer.

Kathryn Benson, NCAC II, LADC, QSAP, QSC, serves as Chair of the National Certification Commission for Addiction Professionals (NCC AP).

Contact her at lightbeing@aol.com with your thoughts or ­questions. Every effort will be made to respond to your inquires in either this publication or a personal reply.

REFERENCES 1 Association for Behavioral Health and Wellness (ABHW). (2011).

Managed Behavioral Health Care Organization: Provider Credential and Information.

12 Advances in Addiction & Recovery | SPRING 2014

Meet the 2014 Candidates for NAADAC Executive Leadership Positions Membership

Candidates Bring a Rich Breadth of Talent B y J essica G leason , NAADAC C ommunications A ssociate We are seeking future NAADAC leaders! This year, 11 well-qualified addiction-focused professionals have put their names forward as candidates for NAADAC leadership. All 2014 terms begin on October 1, 2014, after the NAADAC Annual Conference in Seattle, WA. Every two years, NAADAC members have the opportunity to select officers who will determine the direction of the Association. Voting starts April 30, 2014 and ends May 30, 2014. All members of NAADAC are eligi-

ble and encouraged to vote. Voting can be done easily online by logging into your naadac.org account or by mail. All members eligible to vote will receive email instructions for voting on April 29, 2014. For anyone who prefers to receive a paper ballot in the mail, please email Autumn Kramer at akramer@naadac.org or call 800.548.0497.

Please read the following candidate statements to help inform your vote in May.

CANDIDATES FOR PRESIDENT-ELECT PRESIDENT-ELECT CANDIDATE: John Lisy, LICDC-CS, OCPSII, LISW-S, LPCC-S Cleveland Heights, OH jlisy@msn.com Summary of NAADAC Activities: John currently serves as the NAADAC Treasurer. In that capacity he has worked with staff to improve the fiscal planning, reporting and accountability of the Asso­ciation. This critical quality improvement process has taken place over the last year and a half and is nearing completion.

He currently serves on the NAADAC Executive, Finance, and Personnel Committees. John also represents NAADAC on the National Addiction Studies Accreditation Committee. John served two terms as the Mid-Central Regional Vice President (September 2007–September 2011). He has also served on the Mentoring Committee and the NAADAC Public Policy Committee from 2000 to 2007. In 2005, John was awarded the NAADAC Advocate of the Year at the Leadership Conference in Washington, D.C. John helped secure national funding for workforce development for the State of Ohio in a collaborative project with NAADAC. He chaired the Workforce Development Committee, a statewide coalition representing all segments of the Addictions Prevention and Treatment Community from March 2004 to January 2008. On the state level, John was President of OAADAC from September 2011 to September 2003. He has served as State Legislative Chair since September 1995. In 1998, John received the OAADAC August Martin Meuli Humanitarian Award.

Philosophy Statement on the Future of NAADAC: I believe the future of NAADAC is tied to how well we represent and serve our members. I also ­strongly believe that NAADAC’s ability to grow and thrive is essential to the ­addictions field. The Four Pillars have served to focus NAADAC on our core mission and provide a roadmap to achieve our mission and increase membership. I believe my experience in professional development through the workforce development project, public engagement through my advocacy and professional serves through numerous NAADAC/OAADAC projects will enable me to clearly communication the mission through actions. NAADAC has made significant steps in the last two years addressing the two major challenges that NAADAC has been facing: membership and finances. Board and staff have worked tirelessly to reverse the decline in membership. In fact, we are currently seeing membership grow. NAADAC has also made significant progress in stabilizing our finances. Better reporting has allowed us to better understand and address fiscal issues. We have also made significant progress in addressing the budget and cash flow issues. This is not to say that all issues are behind us, but is to say that NAADAC is heading in the right direction.

Other Qualifications for President-Elect: John is Executive Director of the Shaker Heights Youth Center. While serving in this position since 1996, he has been responsible for a 300 percent increase in funding and a 450 percent increase in services. More important than the increase in services is the excellent quality of services the Center provides to its consumers. Under John’s leadership, the Center received the Exemplary Prevention Award from the Ohio

Department of Alcohol and Drug Addiction Services three times. The Center also received the Matthew Dunlop Prevention Services Award and John received the Calvin Thomas Community Leadership Award. John’s education includes a Master’s in Social Work from Case Western Reserve University (CWRU). He was Co-Chair of the Social Welfare in Jamaica Conference celebrating the 30th Anniversary of collaboration between CWRU and the University of the West Indies. He is currently on the faculty of CWRU’s School of Medicine.

PRESIDENT-ELECT CANDIDATE: Gerald (Gerry) Schmidt, MA LPC, MAC Fairmont, W.V. gschmidt@valleyhealthcare.org Summary of NAADAC Activities: Gerry has served in a num­ber of past and current capacities within NAADAC. He served on NAADAC’s then newly formed Certification Com­mis­ sion in the 1990s and then for four years as Chair of the Com­ mis­sion. He is the current Chair of NAADAC’s Public Policy Committee, a ­former member of NAADAC’s PAC, as well as the Clinical Affairs Consultant for NAADAC. Gerry has presented at numerous NAADAC events, trainings and conferences and has trained both nationally and internationally and acted as a consultant in many capacities over the years. While chairing the Certification Commission, he consulted on certification and treatment in Puerto Rico and Iceland. In 2003, he represented NAADAC and co-led a group of 25 addiction treatment professionals to South Africa. Recently, he traveled to Hong Kong where he led the training of local addiction treatment professionals on a variety of ­topics including assessment, clinical supervision and co-occurring disorders and pharm­acology. Over the past eight years, he was part of a team of addiction treatment professionals that developed five Life-Long Learning Series of trainings on a variety of addiction topics for NAADAC. He is currently serving on the Advisory and Development Committee for the Recovery to Practice initiative for NAADAC. Philosophy Statement on the Future of NAADAC: As a long term member of NAADAC who has been actively involved in many aspects of the organization for over 25 years, I believe that in order to best serve the membership NAADAC needs to continue to strive to be the leader in advancing recovery. As the past Chair of the NAADAC Certification Commission, I strongly believe and support competency-based treatment providers as the hallmark in the delivery of quality services to the addicted population. NAADAC’s continued role in recognizing and developing quality training experiences for its members as well as the treatment community at large is critical to the profession. NAADAC has taken the lead nationally in organizing a work group to specifically strategize and develop a plan to address the ever growing need for more addiction treatment professionals. This is more critical now as the implementation of the Affordable Care Act has begun as well as the graying of the current addiction treatment profession. NAADAC also leads the way in terms of advocacy

Ready to vote? Go to www.naadac.org/2014Elections SPRING 2014 | Advances in Addiction & Recovery 13

for funding for addictions treatment and educational stipends for the advancement of treatment professionals. NAADAC needs to continue to be “the voice” of advocacy as it has been for 40 years.

Other Qualifications for President-Elect: Gerry’s skills not only as a leader but as an addiction treatment professional for 42 years reflect an individual who has contributed a great deal to the recovering community during his tenure. His ability to quickly assess a situation and assist in developing a strategy to resolve issues is a hallmark of his abilities, talents and service. He embraces the profession and has long been an advocate for the addicted. He has been recognized numerous times and in 2010 was awarded the Senator Harold E. Hughes Advocate of the Year Award for outstanding work both in his state and nationally regarding addiction. In 2003, the West Virginia Asso­ci­a ­ tion of Addiction Professionals recognized him for his lifetime of commitment and dedication to the addiction profession by awarding him the Distinguished Service Award. Gerry has been published both within NAADAC and in national journals and publications on a variety of addiction treatment-related topics.

He has presented webinars, workshops and been involved in a variety of training within his state, nationally and internationally on various addiction issues, especially medication assisted treatment.

PRESIDENT-ELECT CANDIDATE: Diane Sevening, EdD, LAC Vermillion, SD diane.sevening@usd.edu Summary of NAADAC Activities: Diane has been a NAADAC member since 1999 and currently serves as the Regional Vice President of the North Central Region. She has served as the NAADAC College and University Student Committee Chair since 2006, where she has assisted NAADAC in the development of State Affiliate’s council of stu­dents, guidebook (bylaws) for college and university student organizations, and has been the Faculty advisor to the local NA ADAC student organization, the Coalition of Students and Professionals Pursuing Advocacy (CASPPA), since 2005. Diane has presented at the 2010–2013 National Conferences, the 2007 Advocacy in Action Conference and the 2006 Workforce De­vel­op­ment Summit. In 2010, she received the NAADAC President’s Award as an edu­cator and advocate for the addiction profession.

Philosophy Statement on the Future of NAADAC: Dr. Diane Sevening is motivated by compassion and believes in the NAADAC mission to lead, unify and empower addiction focused professionals to achieve excellence through education, advocacy, and knowledge, standards of practice, ethics, professional development and research. She also wants to focus on the recruitment of addiction studies students who will enhance the health and recovery of individuals, families, and communities and help strengthen NAADAC by emerging as future leaders.

Other Qualifications for President-Elect: Diane is an Assistant Professor in the Department of Addiction Studies at the University of South Dakota. She serves on the Board of Directors of INCASE, a professional association of college\university professors specializing in addiction studies counselor education. She has also served as an addiction family therapist at St. Luke’s Addic­ tion Center and as an alcohol and drug counselor at the University of South Dakota student health services. Diane presented at the 2011–2013 NAADAC conferences, the 2010 National Conference on Addiction Disorders (NCAD), the 2007 Advocacy in Action Conference and the 2006 Workforce Devel­ opment Summit.

CANDIDATES FOR SECRETARY SECRETARY CANDIDATE: Margaret A. Smith, EdD, LADC Newport State, N.H. msmith@keene.edu Summary of NAADAC Activities: Margaret has been a NAADAC member since 1998. She is a current member of the Board of Directors of the New Hampshire NAADAC Affiliate, NHADACA, and is an accreditation evaluator for the National Addiction Studies Accreditation Commission (NASAC).

Philosophy Statement on the Future of NAADAC: In the future, I see NAADAC as THE international organization for alcohol and other drug professionals of all levels and generations. In this role, NAADAC promotes the use

of science — as well as — evidence based practices, in academia, training, prevention, education, intervention, treatment, aftercare, and life-long recovery services. Further, NAADAC is seen as a strong political leader in representing alcohol and other drug professionals, who in turn represent their states, organizations/institutions, clients, and their families. Additionally, as a strong political force, NAADAC can work to educate leaders with regards to the disease of addiction and the importance of effective education, policies, and serv­ices in dealing with this public health problem. I also see NAADAC committed to diversity in its leadership, workforce and policies, recognizing the harm of discrimination, prejudice and stigma among clients, professionals, organizations, institutions, states and countries.

Other Qualifications for Secretary: Margaret is an Associate Professor in Health Science/Addictions at Keene State College in Keene, NH and an Ad­ junct Professor of Addiction at Rio Salado College in Arizona and Washburn University in Kansas. As a licensed alcohol and other drug counselor in her cur­rent jobs, she is invested in teaching the next generation of counselors.

She is a member of the National Association of Alcohol and Other Drug Professionals, the International Coalition of Addiction Studies Education, Partnership for a Drug Free New Hampshire and several other committees.

Margaret’s prior work includes prevention, intervention and treatment in such places and programs as substance abuse counselor in a hospital setting, a treatment team member of an elder recovery program, a college alcohol and other drug educator and an Associate Professor in Health Science/Addictions.

Her specialties include addiction, elder substance abuse, women, gerontology, Gay/Lesbian/Bisexual culture and Heterosexism reduction, diversity, and higher education. She lives with her two dogs in an old (and drafty!) farm house in New Hampshire.

SECRETARY CANDIDATE: Thurston Smith, CCS, NCAC I, CADC Memphis, TN teesmith@hotmail.com Summary of NAADAC Activities: Thurston has served NAADAC credibly for nearly two decades and was a former candidate for President-Elect. He has served on the organization’s Peer Assistance and International Committees, has fulfilled two terms on NAADAC’s Executive Committee in the role of Southeast Regional Vice Presi­dent, one term as Secretary, and has fulfilled a prior service obligation as the organization’s National Membership Committee and Southeast Regional Conference Chair. He’s been frequently sought after to represent the organization at various symposiums and legislative events throughout his service tenure and has had an extensive record of service on the Board of Directors of the South Carolina Association of Alcoholism and Drug Abuse Counselors, and historically has maintained dual NAADAC memberships, encompassing the states of Georgia and South Carolina. Notably, his experienced tenure as a NAADAC officer also includes service on a variety of special projects, sub-committees, and training initiatives.

Philosophy Statement on the Future of NAADAC: Since its inception, NAADAC has maintained its commitment to the field of addictions, ensuring advocacy, access to treatment, and excellence through professional development, ethics, and education remain its top priorities. In its mission to lead, unify and empower addiction focused professionals, NAADAC is continuously challenged to maintain its position as leader amongst allied health care asso­ ciations, as well as improve the visibility and status of its members.

Considering these ideals, my vision for NAADAC encompasses the following strategies.

NAADAC must make every effort to advocate for, and protect the individuality of addiction-focused professionals as viable experts in the treatment of addictive disorders; thereby, ensuring adequate compensation and thirdparty reimbursement for services are realized.

Given the enactment of the Affordable Healthcare Act, NAADAC should do all it can to ensure addictions treatment is given equal prioritization in comparison with other healthcare illnesses and conditions. Herein, efforts of both education and advocacy should be utilized collaboratively in these instances.

With professional ethics in mind, NAADAC must continue to develop its membership through training, workforce development, and legislative initiatives that emphasize the value of credible research, prevention and evidenced-based practices in behavioral health treatment.

Other Qualifications for Secretary: Thurston has been in civil service for nearly 16 years and is employed by the Veterans Health Administration as an

Ready to vote? Go to www.naadac.org/2014Elections 14 Advances in Addiction & Recovery | SPRING 2014

outpatient chemical dependency center program manager. He has held numer­ ous leadership roles within his community and in the addictions profession.

He is the former Director for Client and Prevention Services for the ACCESS Net­work, is a 1998 graduate of Leadership Beaufort, a civic program of Beaufort, South Carolina’s Chamber of Commerce, and 2013 Executive Class graduate of Leadership Memphis. Thurston received the Key to the City from the late Mayor Larry Abernathy of Clemson, S.C., was appointed to the Nancy Moore Thurmond Alcohol and Drug Abuse Policy Initiative and has provided oral testimony before the U.S. Congressional Black Caucus Political Education and Leadership Institute. He has served as a field reviewer and technical consultant for the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA–CSAT); the S.C. Department of Alcohol and Other Drug Abuse Services (SC-DAODAS); and the Institute for Research, Education and Training in Addictions – the Northeast Addiction Technology Transfer Center; and was appointed as South Carolina Liaison to the Southeast Addiction Technology Transfer Center (SEATTC – Morehouse School of Medicine).

CANDIDATE FOR TREASURER TREASURER CANDIDATE: Terrance Lee Newton, BAS, CADC Petoskey, MI terryn@harborhall.com Summary of NAADAC Activities: Terry Newton serves on the Michigan Association of Alcoholism and Drug Abuse Coun­ selors (MAADAC) board as the Vice President and has helped to put together numerous statewide conferences. He has served on numerous boards including Rotary and just completed being President of the club after being a member for 16 years, on the NCADD Board as their treasurer, on the Charlevoix/Emmet County Community Corrections Advisory Board, on Charlevoix-Emmet County Human Services Coordinating Body as a member agency and chairperson for four years, on the Provider Alliance of the Michigan Association of Community Mental Health Boards, on an opiate replacement task force in Northern Michigan. Terry was a founding member of Communities Offering Alternatives to Substance Abuse and SAFE; both community coalitions designed to prevent underage drinking, drugging, and tobacco use with adolescence. Terry has been in the field of substance use disorders for the past 35 years and served as the executive director of Harbor Hall in Petoskey, Michigan for 23 years. Prior to Harbor Hall he worked at The Betty Ford Center and Hazelden in his long career. Terry is a great asset to MAADAC as well as being a fantastic networker in the field of addiction.

Philosophy Statement on the Future of NAADAC: I believe that the future of NAADAC holds much promise with a potential merger of all certification boards. This is our biggest challenge and promise. We are serving in the field dur­ing one of the most interesting times with the implementation of the Afford­ able Care Act, Parity and the recognition of mental health issues and how these have been underfunded and modestly treated for several years.

Other Qualifications for Treasurer: Terry is a dedicated (work-a-holic) gentlemen with stellar character and a work ethic we all hope to have on our teams. He would be a great asset to NAADAC and I am confident he would meet the needs and exceed your expectations.

CANDIDATES FOR REGIONAL VICE-PRESIDENTS

MID-ATLANTIC RVPs MID-ATLANTIC RVP CANDIDATE: Susan Coyer, MA, AADC-S, MAC, SAP, CCJP Huntington, W.V. susan.coyer@prestera.org Summary of NAADAC Activities: Susan has been a member of NAADAC for 20 years. For the past five years, Susan has served on the NCC AP. She is currently secretary and ethics committee chair and has chaired the policies and procedures and co-chaired strategic planning/marketing committees. Susan has served on the NAADAC membership, conference, bylaws and public policy committees. As affiliate president Susan represented the West Virginia Association of Alcohol and Drug Abuse Counselor on the NAADAC Board of Directors for

four years. Prior to becoming President of WVAADC, Susan chaired the affiliate’s conference, regional training seminar, membership, nominations and awards committees.

Philosophy Statement on the Future of NAADAC: I believe that the future of NAADAC lies in the strength of membership and advocacy efforts. NAADAC members are being challenged by changes in service delivery, reductions in revenue streams, increased workloads and lower salaries than other healthcare professions. We are lacking individuals needed to meet the increased need for qualified treatment providers. Continued workforce development is needed to attract and maintain a professional, well-trained workforce.

Competitive salaries and solid benefits including tuition reimbursement are vital to increasing the number of practicing addiction professionals. This goes hand-in-hand with advocacy efforts to support our workforce and continue to decrease stigma associated with addictive disorders. Advocacy is essential in ensuring the quality of addiction prevention, treatment and recovery support services as well as improving access for individuals across the United States. Advancing legislation at the national and state levels is imperative to continue to support and enhance addiction prevention and treatment. Estab­ lished partnerships with other stakeholders allows NAADAC to have a meaningful impact on these areas and lead our members through these exciting times. NAADAC remains the premiere organization dedicated to individuals work­ing in addiction prevention and treatment and will continue to serve as the most relevant voice for the addictions field.

Other Qualifications for RVP – Mid-Atlantic: Susan has over 25 years of experience in the addictions field in direct practice, clinical and administrative management of outpatient and residential addiction treatment programs. She is active with WVAADC; coordinated training for WVAADC and with the ATTC. She has participated in a number of ATTC Training of Trainers events including the Buprenorphine blending products and Motivational Inter viewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA:STEP) providing training across the region. She was a mentor in the ATTC Leadership Institute in West Virginia. In 2001, Susan was the recipient of the West Virginia Certification Board for Addiction and Prevention professionals Lisa Grossi Award for inspiring dedication in the field of addiction prevention and treatment. She is a former surveyor with CARF (Behavioral Health Division) and is currently serving on a number of committees and task forces.

MID-ATLANTIC RVP CANDIDATE: Ron Pritchard, BS, CSAC, CAS Virginia Beach, VA ronpritchard@verizon.net Summary of NAADAC Activities: Point of contact in helping to revive N.J. affiliate and vocal advocate for Mid-Atlantic States. Trainer in medium and small venues regarding topics per­tinent to treatment of addiction and related disorders.

Unhesitatingly finds time to travel to meetings across region to sit in strategic planning and board develop­ment meetings. Constantly seeking additional resources and contact persons to further the NAADC purpose and to broaden NAADAC and N.J. membership.

Philosophy Statement on the Future of NAADAC: I believe NAADAC’s future is directly related to the degree all addiction professionals actively participate in a professional organization that provides advocacy for its constituents, oppor­tunities for training, and professional development to meet the dynamic behavioral healthcare environment. Parity, licensure, effective representation and collaboration with other professionals are paramount. NAADAC, with regional, and State Affiliate membership that has responsive and forwardlooking leadership, is positioned to remain relevant and achieve these goals.

Addiction is a brain disorder that cannot be treated with only one modality.

Addiction professionals must have a wide variety of skills/techniques and be willing to accept the positive outcomes of a multitude of strategies. The addic­ tion professional comes to the fore with their ability to successfully encompass positive aspects of the client’s past treatment interventions and lifetime lessons into a comprehensive, dynamic, and long range treatment plan.

Successful treatment plans depend on the client’s motivation. Motivation is enhanced by therapeutic rapport, provider training, absence of bias, and consideration for the self-worth of each individual. Addiction professionals must be willing to address, or have addressed, all of the basic needs of a client. We must seek to engage in multidisciplinary treatment teams and other helping resources at every reasonable opportunity.

Ready to vote? Go to www.naadac.org/2014Elections SPRING 2014 | Advances in Addiction & Recovery 15

Other Qualifications for RVP – Mid-Atlantic: Active in seeking to unite the NAADAC Mid-Atlantic Region to become a cohesive and professional significant force that will be able to represent the NAADAC constituents and in various venues. Strives to encourage State Affiliate leadership to become educated and proactive in pursuing advocacy for those issues pertaining to parity and proficiency in the addiction prevention, treatment and recovery fields.

Constantly seeking state and regional partners and sponsors for events and initiatives pertinent to professional growth and increased membership.

MID-SOUTH RVP MID-SOUTH RVP CANDIDATE: Sherri Layton, LCDC, CCS Hunt, TX slayton@lahacienda.com Summary of NAADAC Activities: Sherri is currently serving her first term as the RVP for the Mid-South Region. Her commitment and service to NAADAC and its State Affiliates have been exemplary. Sherri has represented the region well by coordinating a NAADAC-sponsored training event in Texarkana last summer to bring addiction professionals together from Arkansas, Louisiana, Oklahoma and Texas. She has reached out across the region to help organize individuals who are interested in establishing affiliates, but also making sure they receive the support and benefits associated with being a member of NAADAC. Sherri has also organized and led the national legislative advocacy efforts for the region in an admirable fashion during this time, collaborating with state and local affiliates to advance the NAADAC agenda. Sherri is an active, productive contributor to the profession and to our association. She continues to serve as a most effec­tive representative for our region, looking out for the interests of the affiliates and NAADAC as a whole.

Candidate’s Philosophy Statement on the Future of NAADAC: I am excited that NAADAC is recognized as the leader in addiction prevention, treatment, and recovery. I believe we are experiencing the fruit of many, many years of patient, diligent work addressing the concerns of addiction professionals and those we serve. NAADAC’s leadership, and our members, are sought out for input and direction on relevant issues. I believe the advocacy work we do is of great importance and will continue to position us as the go-to organization for input and direction on addiction related policy and activities. Consequently, it should remain one of our highest priorities. Additionally, ongoing professional development for our members, as well as the development and growth of our workforce, is of great importance. We face significant workforce shortages and that will only increase as Affordable Care Act provisions are fully implemented. We must work to enact policies that will recruit new people into our field and retain the valuable folks we already have. Growing our membership and building collaborative relationships with other organizations will be key to strengthening our advocacy position, as well as growing our workforce. I look forward to those opportunities.

Other Qualifications for RVP – Mid-South: Sherri has worked exclusively in the treatment field for over 36 years, serving as both a licensed addiction counselor and treatment program administrator. She remains in tune with the times, navigating the changes taking place in the addiction treatment field (the Affordable Care Act, Insurance Parity) and monitoring those aspects that impact our professional licenses and certifications. Sherri has a MBA and has been quite supportive in bringing her knowledge and skills about leadership and organizational change to the forefront, thereby helping counselors and associated organizations to improve their effectiveness. Sherri’s experience and dedication were instrumental in helping the Texas affiliate advance its state legislative agenda during the 2013 legislative session. Among those major legislative accomplishments was a 66 percent increase in funding for substance abuse services, the first state increase in over 15 years.

NORTHEAST RVP NORTHEAST RVP CANDIDATE: Catherine Iacuzzi, PsyD, LADC Hinesburg, VT catherineiacuzzi@catelenaconsulting.com Summary of NAADAC Activities: Catey began her work with NHADACA (the NH Affiliate of NAADAC) as the Student Repre­ sen­tative on the Board of Directors in 2005 and served for two and a half years. She rejoined the NHADACA Board in 2010 and became President-Elect later that year. She served as President of NHADACA from 2011–2012. As Board President, she worked to improve communication with members, strengthen the organization, and build an organizational structure that will be sustainable. During her tenure, NHADACA hired its first Executive Director and expended training opportunities to include more national trainers, a year-long DSM-5 training series, and online trainings.

In 2013, Catey was appointed to the Northeast Regional Vice President position and has continued her active role on the NAADAC Board.

Philosophy Statement on the Future of NAADAC: The Addiction Profession is facing a critical moment in history that will determine the future place of Addiction Professionals in the human services. I believe that NAADAC will be an instrumental force in ensuring that Addiction Professionals are heard by those in positions to affect the profession and those we serve. Additionally, I believe that NAADAC, and the membership, has a responsibility to make certain that effective addiction prevention, treatment, and recovery services are readily available for those struggling with the disease of addiction.

Other Qualifications for RVP – Northeast: Catey has 15 years of experience in the addiction prevention, treatment, and recovery profession. She holds two Master’s degrees (in Counseling Psychology and Clinical Psychology) and a Doctorate of Clinical Psychology. Catey has worked in a range of settings including outpatient and residential treatment, psychiatric hospitals, community mental health centers, and jails. Her areas of interest include integrated co-occurring disorder treatment, organizational development and non-profit capacity building, and clinician supervision and training. She owns Catelena Consulting & Grant Services, providing nonprofit capacity building, grant services and clinical supervision/consultation. She has presented at state and national conferences on topics ranging from supervision to systems change, from trauma-informed services to multicultural counseling. Catey is an adjunct faculty member at the NH Technical Institute and Granite State College. She has also served on the NH Board of Licensing for Alcohol & Other Drug Use Professionals.

NORTHWEST RVP NORTHWEST CANDIDATE: Gregory Bennett, MA, LAT Powell, WY 180degreedifference@gmail.com Summary of NAADAC Activities: Greg has been a NAADAC member since 2005. He has served on the Political Action Com­mittee and Student Committee. Greg has been on the Board of Directors since 2008, filled the Northwest RVP position in 2010 for Pete Formaz of Montana and has served one full term on the Executive Committee. Greg has attended all Board meetings and Executive Board meetings since being in office.

Philosophy Statement on the Future of NAADAC: I believe NAADAC to be “the Association for Addiction Professionals.” Through NAADAC’s efforts, we will be the voice that is heard on many different levels. NAADAC’s efforts will provide us, as individuals, an identity and respected reputation for the work we provide to our patients.

Other Qualifications for RVP – Northwest: Extensive work on boards and committees. Greg was one of the co-founders of the student organization CASPPA, which assisted in the development of the student recruitment ­package.

Ready to vote? Go to www.naadac.org/2014Elections 16 Advances in Addiction & Recovery | SPRING 2014

NAADAC Annual Awards Process B y Tricia S app , BSW, CCJP, CPS, NAADAC A wards C ommittee C hair

PHOTOSPIN.COM

Membership NAADAC celebrates and honors the individuals and organizations that have achieved excellence in the treat­ment, recovery, prevention, medical and educational sectors of our addiction profession over the past year. Six awards will be presented at an awards event during the 2014 NAADAC Annual Conference in Seattle, WA. It is important to recognize and honor addiction professionals and organizations their accomplishments and contributions through accolades from colleagues to continue to elevate the profession. To be considered for a NAADAC Recognition and Award, current membership in NAADAC is required.

NAADAC is proud to announce the addition of a new award this year, the Addiction Educator of the Year Award, developed by the Awards Committee and approved by the Board of Directors in 2013. This award was designed to elevate and honor the work of a pro­ fessor who contributes through academia to the addic­ tion profession through mentoring students/student chapters, colleagues or addiction professionals and/ or provides ongoing research or other contributions that grow, enhance, advocate and educate for the addic­tion profession.

Additional awards include the following: ■ Lifetime Honorary Membership Award, recognizing an individual or entity who has established outstanding service through a lifetime of consistent contributions to the advancement of NAADAC, the addiction profession and its professionals; ■ Medical Professional of the Year, recognizing a medical professional who has made an outstanding contribution to the addiction profession. Members of NAADAC’s Executive Committee are not eligible for this award; ■ Lora Roe Memorial Alcoholism and Drug Abuse Counselor of the Year, recognizing a counselor who has made an outstanding contribution to the profession of addiction counseling; ■ William F. “Bill” Callahan Award, recognizing sustained and meritorious service at the national level to the profession of addiction counseling.

■ Mel Schulstad Professional of the Year, recognizing an individual who has made outstanding and sustained contributions to the advancement of the addiction counseling profession; and the ■ NAADAC Organizational Achievement Award, recognizing an organization that has demonstrated a strong commitment to the addiction profession and particularly strong support for the individual addiction professional.

Nominating Information NAADAC’s awards process involves State Affiliates submitting excellent candidates for consideration. If a State Affiliate does not currently have an annual State Recognition and Awards program in place, its president should contact the Chair of NAADAC Award Committee, Tricia Sapp at tsapp716@yahoo.com or NAADAC at naadac@naadac.org for assistance in the development of the NAADAC awards process to recognize affiliate mem­bers’ contributions to the addiction profession.

Each NAADAC affiliate is encouraged to submit a nomi­nee, although only one nominee per State Affiliate will be considered. To nominate an individual for an award, nominators should submit: a letter of recommendation stating how the nominee fulfills the award criteria; a resume from the nominated individual; three letters of support; and the new NAADAC Recognition and Awards Nomination Form, which requires the nominee to acknowledge and sign a statement acknowl­ edging that he/she has met all of the criteria for the particular award and has “demonstrated to the satisfaction of one’s peers full compliance and support of NAADAC’s Code of Ethics throughout [his/her] professional career.” For access to the NAADAC Recognition and Awards Nomination Form and eligibility criteria for each award, please visit www.naadac.org/recognitionand-awards.

All award nomination packets must be received by April 30, 2014 for consideration by the NAADAC Awards Committee.

To nominate an individual, please send a letter, ­supporting documentation and the NAADAC Recog­ nition and Awards Nomination Form signed by the Nominee to: NAADAC, the Association for Addiction Professionals Attn: Awards Committee Chair, Tricia Sapp 1001 N. Fairfax Street, Suite 201 Alexandria, VA 22314 Materials may also be faxed to the NA ADAC Awards Committee (Attn: Director of Operations) at 800.377.1136 or sent by email to naadac2@naadac. org (please put “NAADAC Awards” in the subject line).

NAADAC does not pay for travel to the venue of acceptance. If the award winner cannot attend the presentation, the award will be sent to the recipient. For additional information, please contact NAADAC by email naadac2@naadac.org (please put “NAADAC Awards” in the subject line) or contact the Awards Committee Chair, Tricia Sapp at tsapp716@yahoo.com or 817.308.7896.

SPRING 2014 | Advances in Addiction & Recovery 17

NAADAC, the Association for for Addiction AddictionProfessionals, Professionals, of more more than than75,000 75,000 represents the professional interests of addiction counselors, counselors, educators and other other addiction-focused addiction-focused addiction health care care professionals, professionals, who specialize specialize in inaddiction addiction health prevention, treatment, treatment, recovery recoverysupport supportand andeducation educationinin prevention, the United UnitedStates, States, Canada the Canada and and abroad. abroad.

Why Join NAADAC, the Association for Addiction Professionals

NAADAC Membership Tailored to you:

NAADAC Members Receive Reduced Rates:

• Professional, Associate and Student membership levels available.

• Payment plans available to help with your budget.

• NAADAC membership dues include membership in NAADAC and your state affiliate.

• Save $100 on national certification and re-certification of the National Certified Addiction Counselor (Levels I and II), Master Addiction Counselor (MAC) and other credentials.

• Receive members-only pricing on all NAADACproduced publications, independent study courses and continuing education units (CEUs).

• Members save $75 to $100 on NAADACsponsored conferences and public policy events.

NAADAC members also save on regional meetings, workshops and conferences.

• Malpractice and comprehensive professional liability insurance for individuals and agencies.

• 20% discount on all Hazelden resources.

• 25% discount off new subscriptions to Substance Abuse Funding News.

Earn Free Online Education and CEs: • Over 75 online continuing education credits (CEs), including three online courses and over 70 hours of webinars available to members for free.

• Simply watch the webinar/online course of your choice, complete the online CE quiz, and receive a free CE certificate to use towards your license/credential – all online, at your convenience.

Join NAADAC online at www.naadac.org/join or by calling 1.800.548.0497!

www.naadac.org 18 Advances in Addiction & Recovery | SPRING 2014

Be a part of the NAADAC community! www.facebook.com/Naadac @NAADACorg

Why Join NAADAC, the Association for Addiction Professionals Gain Free Access To: • The NAADAC online Find a Professional listing, a comprehensive list of NAADAC members and certification holders searchable by zip code.

• Advances in Addiction and Recovery, the journal of NAADAC. AAR is focused on providing useful, innovative and timely information on trends and best practices in the profession that are useful and beneficial for practitioners in the field.

• The NAADAC Calendar of Events to view events throughout the US and online.

• Notifications about hot topics, events, opportunities, and important announcements about the addiction profession through mail, email and/or social media.

• The NAADAC Career Center, where you can look through NAADAC's national and international job listings and post openings with your organization.

• The electronic Legislative Alert Network (e-LAN), which provides up-to-date information on policy developments in Washington, D.C.

Support Your Profession: • NAADAC members are bound by a nationally recognized Code of Ethics to promote professional ethics.

• NAADAC members contribute to maintain a professional identity and association that helps preserve and honor the unique talents of addiction professionals.

Join NAADAC online at www.naadac.org/join or by calling 1.800.548.0497!

www.naadac.org

• NAADAC is an influential and effective voice for addiction professionals before Congress and the federal administration, the key governmental bodies that determine how addiction treatment is funded and administered in America.

• Networking opportunities through national and state conferences and workshops.

Be a part of the NAADAC community! www.facebook.com/Naadac @NAADACorg

SPRING 2014 | Advances in Addiction & Recovery 19

Recovery Support:

Collaborating With Other Professions, Professionals, and Communities B y G erald J. S chmidt , MA, LPC, MAC

Earn TWO continuing education credits for reading this article. $25 for NAADAC members and for non-members.

MONKEY BUSINESS IMAGES | PHOTOSPIN.COM

Take the quiz now at www.naadac.org/ magazineces.

As these times are changing in the ever growing and expanding health care picture on a national level, the treatment of those with addic­t ions clearly comes into focus and becomes a critical factor that cannot be over­ looked. With the implementation of the Affordable Health Care Act and the expansion of Medicaid serv­ ices within most states, those not only eligible for health care services but the subset of those with addictions will increase dramatically.

With a workforce already stretched and in dire short­ age nationally, the injection of additional individuals perhaps previously not eligible for treatment will now have access and a method of reimbursement for those services available. The addiction treatment profession is making strides towards addressing this critical mass issue, however, it will be years before effective method­ ologies are in place to enhance the addiction treatment workforce, as well as augment it to a status even greater than it currently is.

To this end, new and creative methods of effectively addressing the treatment needs and looking at strate­ gies and interventions that can assist the current treat­ ment professionals, and, at the same time, augment and enhance treatment methodologies is already occur­r ing. In fact, these interventions and disciplines have been in place in many parts of the country for years, but because of the increased demand and the ­evidence of it as an effective method of practice, it is ­becoming not only more popular, but seen as an ad­ junct to current levels of care being used in many treat­ ment communities across the United States.

Addiction treatment has developed dramatically over the past 40 plus years and has become more refined and inclusive in the overall physical treatment of an indi­ vidual. Strategies for care now include a more compre­ hensive and inclusion method of care that is structured

20 Advances in Addiction & Recovery | SPRING 2014

and overseen by multi-disciplinary teams of treatment individuals. The individualized needs, and therefore the more individualized care, of each person seeking help have emerged. This more broad-based level of care has not only enhanced the delivery of care to those ­addicted, but research supports that this engagement and subsequent oversight focused on total care of the individual has been successful in more long term and successful recovery.

The addiction treatment professional is no longer isolated into a specialized care sector, but in many in­ stances, merged with other health professionals focus­ ing on a variety of aspects of care for the total wellbeing of the client. These other professionals might include mental health professionals, including a psy­ chologist or psychiatrist, as upwards of 50–75 percent of all those with substance use disorders have cooccurring mental health disorders.1 In addition to this, a physician or physician’s assistant may be monitor­ ing their physical care, diet and related health issues.

Non-medical staff such as a care coordinator, attorney, or education/vocational specialist may also be attend­ ing to other facets of the individual’s care. We can no longer treat individuals in silos but must look at a com­ prehensive system of care that addresses the many dif­ ferent areas of need for these individuals. Furthermore, more and more clients are either directly coming from the prison system, or they are currently involved in drug courts or some type of day report system within the criminal justice system. This alone has injected a totally new, and in some instances, overwhelmingly large number of individuals into the treatment system.

Working within these multi-disciplinary teams re­ quires a unique need for open and honest communica­ tion of ongoing care in all ­aspects. Team members need to be aware of and agree to methods ­being employed and understand the interaction and impact each team member plays in the total delivery of care to the client.

They need to have rapid and open access to each other, discuss problem ­areas such as relapse or potential for other interferences, and discuss with each other the im­ pact that successful or not so successful interventions are having.

A visual representation of what potential compo­ nents and facets of care involved in a multi-disciplinary team is best exhibited in NIDA’s Principles of Drug Addiction Treatment. This brief publication clearly ­outlines the different roles of direct care as well as an­ cillary treat-ment services and the participants that could be involved with the ­client’s care.

Modern addiction treatment came of age in the 1960s and 1970s as a community-based phenomenon.

You began to see the representation of recovering indi­ viduals and their families on agency boards and advi­

sory committees, as well as the recruitment of staff from local communities of recovery.

More and more vibrant recovery volunteer programs began to spring up and you started to see regular meetings between the treat­ ment organization and the service communi­ ties of the local recovery support fellowships.

Currently there is a paradigm shift that is occurring between the addiction treatment professional and peer recovery specialists. To this end, there is more of a focus on what ­occurs both before and after primary care and the transition from the professionally ­directed treatment plan to client developed recovery plans. The greater the physical, psy­ chological and cultural distance between the treatment organization and the client’s natu­ ral environment, the greater the problem of transferring the learning that has occurred.

Treatment organizations must resemble more and more the surrounding community and the post treatment environment. Fur­t her­ more, they must promote client ­access to both pro-social and pro-recovery activities that take place within these environments.

Recovering communities take different shapes and forms and they will all address multiple issues in recovery for the client.

There are the spiritual, religious, and secular communities of recovery that include the ever rapidly growing online support communities which are increasing in both number as well as diversity across the United States. A more popular recovering community is the recover­ ing schools, colleges and universities that are all an integral part of a specialized recovery environment addressing the needs of this spe­ cial population of recovering individuals.

Cur rent ly, t here a re t hree essent ia l ­t reatment-related strategies to assist in en­ hancing supportive healing power of the community in the long term recovery process: 1) outreach, 2) inreach and 3) recovery com­ munity building. Let’s take a look at these three strategies.

Outreach is the extension of professional addiction treatment services into the every­ day life of the community at large, including supporting clients in their own natural envi­ ronment. This occurs after the client has completed some form of primary care treat­ ment. Generally addiction professionals, alumni from treatment, as well as volunteers, are involved as you extend core treatment and recovery support beyond the walls of the pri­ mary care. Activities that you would typically see taking place are: recovery-focused educa­ tion programs, promotion of screening and brief intervention, conducting assertive street and institutional engagement as well as in­

creasing home-based service delivery. This Questions to consider while approach is true outreach to the client within reading this article their homes and other social and living envi­ hat percentage of all those with ronments. sub stance use disorders have The next strategy, inreach, is the inclusion co-o ccur ring mental health disorders? of indigenous community resources within the professionally directed addiction treat­ hat is required when working with in ment. The kind of strategies that are em­ multi-disciplinar y teams? ployed here can include engaging family as hich resource outlines the different well as social network members and the de­ role s of direct care as well as ancilvelopment of alumni groups. Organizations lary trea tme nt services and the particiare more proactive in increasing recovery pan ts that coul d be involved with the community representation on treatment clien ts’ care ? boards of directors and/or advisory com­ mittees. With more and more focus on peer hen did modern addiction treatrecovery coaching, some professional treat­ ment come of age? ment organizations are now contracting hat is the definition of outreach? ­directly with specialized recovery special­ ists to work with clients once they are dis­ charged from direct care treatment. At this hat is the definition of inreach? time, there are many variations of how these recovery specialists are being em­ hat is the definition of recovery ployed. There are many instances where com munity building? these individuals are integrated as part of the multi-disciplinary team within the hat kinds of activities involve outtreatment organization or contracted reach, inreach, and recovery com with­in the community at large. Either way, munity building? the inclusion of these recovery specialists an recovery mutual aid groups serv creates a continuum of care that reaches e as an alternative to professional out past the professional addiction treat­ help? ment provider.

The final strategy, recovery community articipation in what generates bett er building, includes activities that nurture long term recovery outcomes? the development of cultural institutions Earn two continuing education cred in which persons that are recovering from its for reading this article. $25 for NAADAC addiction can find relationships that are members and for non-members. supportive to recovery, reciprocal in na­ Take the quiz now at www.naadac.org/ ture, and promote long-term recovery. mag azin eces.

These are usually representing knowl­ edge and skills that are not dominated by First, professional treatment can be viewed a particular clinical practice or discipline and where the community is seen as the client in as an adjunct to recovery mutual aid groups that it draws upon the knowledge from public rather than just seeing such groups as an ad­ health, social movement and community junct to treatment. In the past, mutual aid ­development and other organizations sup­ groups have often been looked upon as sec­ portive of recovery. The addicted individual ondary aid measures to be employed after is embraced by a community that both under­ professional treatment has either been ex­ stands, supports, and encourages recovery, hausted, tried and been unsuccessful, or sim­ and creates an environment of support for ply as an adjunct to care. Research has sup­ ported since the mid-1950s that mutual aid this recovery.

When looking at the development of a sys­ groups have been tremendously successful in tem of care that rolls out into the community aiding and augmenting professional care and from the professional treatment organiza­ that, in many cases, addicted individuals tions, there are several issues that need to be maintain much longer and protracted in­ closely regarded. It is generally believed that volvement and commitment to this process there are three critical points in shaping a and group than they ever did in professional philosophy of linkage between organizations care. In many instances when asked, individu­ and/or professionals and recovery mutual aid als will state that their current recovery status groups and recovery community organiza­ is based on their long-time commitment to a particular mutual aid group. tions. Let’s look at each of these.

W

W W

W W W W W

C

P

SPRING 2014 | Advances in Addiction & Recovery 21

A second point to be considered is that re­ covery mutual aid groups can serve as an al­ ternative to professional help. As stated above, this process has proven to be success­ ful even for those that have long finished be­ ing actively involved in professional help. In many instances, individuals will opt out of professional help, strictly become involved in some type of mutual aid group, and maintain themselves and an improved lifestyle through this involvement without any formal profes­ sional help. This cannot be overlooked as a successful method for these individuals de­ spite attempt from the treatment organiza­ tions believing and adhering to the tenet that the combination of both is indeed more ben­ eficial to the individual.

A final point to consider is that participa­ tion in professional treatment and recovery support groups generates better long term ­r ecovery outcomes as opposed to just in­ volvement in either professional treatment or recovery support groups by themselves. The synergistic effect of both the professional treatment in conjunction with some form of mutual aid group enhances and augments an individual’s chances of more long term recov­ ery because of the combination and approach to care. Furthermore, the mutual aide groups

are a combination of both short-term and long-term individuals who can bring a unique form of insight and understanding for the ad­ dicted client as they begin their road to recov­ ery. In addition to this, the system of support that exist professionally can assist the client in greater insight and understanding of cooccurring problems and disorders that when addressed in a therapeutic setting further en­ hance their long term recovery.

We do know that a large number of individ­ uals that are being discharged successfully from treatment never transition to recovery support groups in the weeks and months fol­ lowing their discharge. This lack of linkage to a community-based recovery support system plays a large part in the lack of long term suc­ cess for these clients in recovery.

Rapid entry into involvement with a recov­ ery support group and continued involve­ ment in these increase the probability of long term recovery. Treatment organizations need to embrace this alliance, not feel threatened by their presence, and rather see them for the mutual aid and support that these individuals and groups can bring towards the establish­ ment of long term recovery for the addicted individual.

Gerard J. “Gerry” Schmidt, MA, LPC, MAC is the Chief Operations Officer at Valley HealthCare System in Morgan­ town. Gerry has been in addictions treatment profession for over fortytwo years and has been instrumental in developing a comprehensive system of outpatient and residential addiction services in north central West Virginia. He has served on a variety of national committees and has trained both nationally and internationally on addiction treatment. Gerry served as Chair of the NAADAC Certification Commission for ten years and consulted with NAADAC in the development of the Life Long Learning Series of educational programs focusing on the integration of counseling skills with medicated assisted treatment strategies for treatment professionals. Gerry is the Chair of NAADAC’s Public Policy Com­ mittee and NAADAC’s Clinical Affairs Consultant.

REFERENCES 1 White, W. & Kurtz, E. (2006). Linking Addiction Treat­ ment and Communities of Recovery: A Primer for Addic­tion Counselors and Recovery Coaches.

Pittsburgh, PA: IRETA/NeATTC. 1&2 White, W. & Kurtz, E. (2005). The Varieties of Recovery Experience. Chicago, IL: Great Lakes Addiction Technology Transfer Center.

1 “Varieties of Recovery Experience: A Primer for Addiction Treatment Professionals and Recovery Advocates” by William White, MA, and Ernest Kurtz, PhD (2005).

2 “Building Resiliency, Wellness and Recovery — A Unified Vision for the Prevention and Management of Substance Use Disorders, — A Shift from an Acute Care to a Sustained Care Recovery Management Model,” edited (2006) by Michael Flaherty, PhD, Executive Director of The Institute for Research, Education and Training on Addictions.

KAPLAN UNIVERSITY Kaplan University offers psychology degrees and specializations designed to provide you with the knowledge and skills to advance your career as an addiction professional.

One degree.

Infinite impact.

Kaplan University is a NAADAC-approved education provider. Students who complete the addictions-focused specialization within the bachelor’s or master’s degree in psychology will meet the coursework requirements to take the NCAC, Level I and II, and MAC certification examinations.

Make a difference in other people’s lives and your own with the right degree. You have the power.

LEARN MORE:

NAADAC.KAPLANU.EDU 877.680.2331 (Toll Free) For comprehensive consumer information, visit www.kaplanuniversity.edu/student-consumer-information.aspx.

Additional requirements must also be completed to take the examination(s). Refer to www.NAADAC.org and www.NBCC.org for full eligibility requirements. Kaplan University cannot guarantee a student will pass the exams.

Kaplan University cannot guarantee employment or career advancement. The professional practice of psychology is regulated by each state, and the requirements in this program do not prepare graduates for state licensure.

KPU203D_PsychMosiacAd_7.5x4.875_07.indd 1 22 Advances in Addiction & Recovery | SPRING 2014

2/24/14 5:38 PM

Beyond Opiates

Addiction: Conditioning the Brain for Reward B y A ndy M endenhall , MD It is estimated that there are 1.7 million heroin, and 3 to 4 million prescription opiate addicts in America.1 Recent data inform us that in this current era of opiate abuse more people are dying from these drugs than are dying from highway accidents.2 To better understand what we in the treatment and recovery field are facing it is useful to consider the science of pain and reward.

Endorphins are the natural opioids that give us a feeling of con­ tented well-being in the world. Endorphins are released when we eat, exercise, or have sex. Our brains are used to release small amounts of endorphins and other neurotransmitters in response to these sur­v ival related activities. When people are exposed to ‘exogenous,’ or outside of the body opioids, the brain responds by releasing very large or un­ natural levels of dopamine. This tidal wave of dopamine is rewarding and reinforcing for many individuals. In addition to creating a downregulation of opioid and dopamine receptors, the brain imprints this profound experience of reward.

BENOIT DAOUSE | PHOTOSPIN.COM

CNS Productions, Inc.

Evidence within the pain management field reveals the brain and nervous system start down-regulating opioid receptors immediately after exposure to opioids. This down-regulation leads to tolerance to opioid therapy for pain treatment. Tolerance leads to the need to take more medication to achieve the same level of pain relief, and leads to deeper levels of physical dependency on the opioid pain medication.

We know that opioids amplify pain in many patients, independent of whether they suffer from addiction. A type of nerve cell called a mi­ croglial cell activates in response to opioid medication and changes the way in which the brain receives pain information. Chronic expo­ sure to opioids leads to microglial cell activation and pain amplifica­ tion. It is proposed that the experience of pain amplification or “hy­ peralgesia” may lead patients into the spiral of opioid misuse and abuse in an attempt to achieve the prior states of analgesia associated with early use of these powerful medicines. Further evidence suggests microglial cell activation within the brain may lead to permanent de­ struction of reward neurons and/or signal pathways between neurons in response to unnaturally elevated levels of dopamine from exposure to high-doses of heroin or opioids.

I have observed clinically, that many patients suffering from chron­ ic pain become deeply tolerant and physically dependent to opioids, and begin to misuse and abuse their medication as a direct result of these unanticipated side effects of the opiate medication. Many of these patients demonstrate abuse and or addictive behaviors, and are

at great risk of dying due to their attempt to achieve analgesia and/or avoidance of withdrawal that has become the main driver for the risky accelerated use of prescription opiate medications.

In the United States there are upwards of 14 million patients receiv­ ing daily prescription opioid therapy for pain.3 It is estimated that four out of ten patients regularly misuse or abuse their medication.4 For people who have been abusing opiates who are successful in completing a detoxification to an opioid-free state, it takes upwards of two years for the brain to restore itself from a synaptic and receptor basis. Some addicts may require periods of medication assistance with buprenorphine or methadone to reduce cravings and withdrawal symptoms to a point where behavior change from the compulsive use of opioids or other drugs is achieved. There is an abundance of medi­ cal evidence that supports the clinical utility of providing buprenor­ phine or methadone to patients. While this issue remains deeply con­ troversial within the context of abstinence-based recovery, the evidence is clear that the use of medication assisted treatment saves lives, reduces relapse, and reduces drug use-associated medical and criminal justice costs.

Of equal importance, the development of deep attachment to the feeling created from opioids becomes the most potent driver of re­ lapse behavior. This reality is complicated by the associated deep lev­ els of physical dependency which yield through successful detoxifica­ tion, protracted periods of post-acute withdrawal and prolonged substance-induced mood disorders. These conditions are primary drivers for relapse behavior.

Opioid relapse after a successful period of detoxification is excep­ tionally dangerous as the patient’s tolerance to opioids is dramati­cally reduced. Use of a small fraction of the previous amount of opioid can lead to death due to unintentional overdose.

Why is relapse with opioids so common?

It is important to remember that the burden of addiction is an evo­ lutionary process turned upside down. When the brain experiences large releases of dopamine, this creates a profound and deeply exis­ tential and reinforcing experience. With opioids in particular, it is dif­ ficult for an addicted person to not return to those experiences.

Some patients report that the slightest hint of emotional or physical distress leads to deep triggering to return to the warm comfort of the opioid high. The challenge for many opioid-addicted individuals is to truly embrace the concept of ‘never-again.’

I present to my patients the concept of recovery from addiction as a pathway of ‘brain ownership.’ By this I mean, we educate to the ­n ature of the chemical brain lesion and conditioning that has ­occurred through repetitive substance use behavior, and then provide immersion in 12-Step-based treatment and fellowship along with ­medication assisted recovery support. Medication will not do the work over the long-term. It is a useful tool, but is not and cannot be the ultimate solu­tion. The support of recovery fellowship, relentless inter­ nal integrity and accountability, and a program of abstinence-based recovery represent the most powerful and free solution to the problem of addiction.

Beyond Opiates, continued on page 26 ☛

SPRING 2014 | Advances in Addiction & Recovery 23

Healing Invisible Wounds: An Action Plan Research Efforts Improve Our Understanding of Trauma B y T homas R. I nsel , MD, D irector

of the

N ational I nstitute

MONKEY BUSINESS IMAGES | PHOTOSPIN.COM

Since September 11, 2001, more than 2.5 million ser­ vice members have deployed to Iraq and Afghanistan.

In contrast to previous wars, these recent wars have been fought by an all-volunteer force that has experi­ enced multiple deployments. Many of the service mem­ bers are in reserve or National Guard units. Many wom­ en and parents of young children have served. And many have survived severe injuries that would have al­ most certainly been fatal in previous wars. Invisible brain injuries like traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) have been the signature wounds of these wars. The Armed Forces Health Surveillance Center reports more than a quar­ ter million cases of TBI occurring in the military be­ tween 2000 and 2012. The prevalence of PTSD and depres­sion in the military has been estimated to sur­ pass 20 percent.1 The rate of suicide in the military, which traditionally is lower than the civilian rate, has doubled in the Army since 2003 and now exceeds the rate of suicide in civilians matched for age, sex and race.2 Since 2009, more soldiers have died from suicide than combat.3 Recognizing these facts, President Obama issued an Executive Order last summer requesting “all hands on deck” to ensure better outcomes for those who have sac­ rificed for all of us. One of the results of this Executive Order has been the development of the National Re­ search Action Plan (NRAP). The NRAP was the result of months of plan­n ing between the Department of Defense, the Department of Vet­erans Affairs, the National Institutes of Health and the Department of Education. Together, these agencies reviewed the stateof-the-science, the current research portfolios and the opportunities for progress. Together they have commit­

of

M ental H ealth (NIMH)

ted to transforming the research landscape to acceler­ ate progress.

Each of the agencies already has a large investment in research on TBI and PTSD. The NRAP calls for a new culture of standardization, integration, and shar­ ing of data across all funding agencies. We recognize TBI and PTSD as brain injuries, but the brain tissue we need to study to understand them is in short supply.

The NRAP calls for an increased inventory of tissue, blood and cerebrospinal fluid samples with creation of virtual repositories in the interest of increasing access to these resources for scientific purposes. In contrast to most other neuropsychiatric disorders, TBI and PTSD are the result of injury. Yet, we have no way of knowing after an injury who will recover completely and who will be disabled; even mild symptoms may lead to signifi­ cant impairment. The NRAP calls for the identification of predictive or diag­nostic biomarkers for PTSD and TBI which can be evaluated in clinical trials for their potential to help us better understand treatment re­ sponse and more effectively match individuals to treat­ ments. Many service members and veterans who devel­ op PTSD respond well to treatment, but too many do not recover. The NRAP will help focus research efforts to improve our understanding of the impact of trauma and ultimately provide better treatments to improve the lives of those who have served as well as the tens of thou­ sands of civilians who are exposed to traumatic events.

We know that service members and veterans with neuropsychiatric disorders are at increased risk for sui­ cide, but we do not have useful tools with which to pre­ dict the individuals at highest risk. The Executive Order called for recruitment by the end of 2012 of 100,000 soldiers to assess risk for suicide. NIMH and the Department of the Army, collaborating on the Army Study to Assess Risk and Resilience in Serv­ice­ members (Army STARRS), completed recruitment of more than 100,000 soldiers last December and is al­ ready defining the major predictors of risk for suicide.

The NRAP calls for expanding Army STARRS into a long-term longitudinal study, similar to the Fram­ing­ ham study of heart disease, encompassing not just sui­ cide, but PTSD, TBI and other comorbid conditions.

This is the third time the President has talked about mental health in recent months. In April 2013, he an­ nounced the BRAIN initiative, in June the National Conversation on Mental Health, and now the NRAP. Taken together, these three announcements define not only the dimensions of a major national health chal­ lenge, but a potential solution based on (a) better tools for studying brain disorders, (b) better public aware­ ness and broader access to mental health care, and (c) Invisible Wounds, continued on page 26 ☛

24 Advances in Addiction & Recovery | SPRING 2014

NAADAC Produces a Workforce Situational Analysis for Addiction – and Recovery B y M ichael T. F laher ty, P h D

Background As part of the federal government’s efforts to promote recovery for all Americans affected by mental illness and/or addiction, the Substance Abuse and Mental Health Services Administration (SAMHSA) has been supporting an ongoing Recovery to Practice (RTP) Initiative. The initiative is designed to hasten awareness, ­acceptance, and adoption of recovery-based practices in the delivery of mental health and addiction-related services while building on SAMHSA’s evolving definition and increasingly identified funda­ mental components of recovery.1 The overall initiative involves: ■ Establishing a Recovery Resource Center, complete with webbased and print materials, training and technical assistance for mental health and addiction professionals; and ■ Developing and disseminating curricula and training materials on recovery-oriented practice for each of the major mental health and addiction professions.

The RTP Initiative is under the leadership of Larry Davidson, PhD, Deidra Dain, and Julie Shafer of the Development Services Group, Inc. who, while working with a National Expert Panel and SAMHSA, col­ laborate with six major professional associations — NAADAC, the Association for Addiction Professionals, the American Psychiatric Association, the American Psychiatric Nurses Association, the American Psychological Association, the Council on Social Work Education, and the National Association of Peer Specialists to: ■ Assess the current status and need for recovery-oriented princi­ ples and practices within the addiction professions; ■ Design and deliver a national Situational Analysis with informa­ tion from addiction professionals and a review of the literature; and ■ Develop an outline for recovery-based training curriculum for addiction professionals.

From this Situational Analysis, NAADAC, as an association dedicated to all addiction specialty professionals, and the other Associations for the disciplines they represent have developed Recovery to Practice (RTP) training curriculums for each discipline that will become part of a national training process on recovery-focused models of care.

NAADAC sought to represent addiction professionals that specialize in addressing substance use and addiction while promoting recovery and the competencies needed to integrate addiction recovery into pre­ vention, early intervention, treatment, continuing care and sustained recovery practice.

Situational Analysis is a Must-Read Based on several key listening sessions with members, NAADAC joined with other key collaborators to compile its “Situational Analysis” for the addiction profession. From the listening sessions, interviews and literature reviews, along with support from an Advisory Council, NAADAC has produced a guiding document not only for addiction professionals, but capable of guiding all disciplines in addressing sub­ stance use, addiction, and recovery. This must read is readily available at www.naadac.org/situational-analysis.

While documenting many of the current demographics of the addic­t ion profession (e.g. age, varied roles, salaries, licensed or non-

licensed, longevity/experience in addictions treatment, gender, etc.), the Analysis provides a rich history of a profession historically rooted in the lived experience of recovery. The Analysis suggests the profes­ sion has evolved through ebbs and flows of science, policy, prioritiza­ tion and neglect, medical understanding, and lived experience to its current recovery-based experiential recovery orientation. It defines today’s practice orientation as a focus on the facilitation of long-term personal and family recovery, adherence to recovery-linked and scientifically grounded service practices, and emphasis on the role of community recovery capital in the initiation and maintenance of personal and family recovery. This is a clear focus for the addiction professional even if still emerging and evolving.

In supporting a recovery “focus” in practice, the Analysis suggests more than a call — it offers specifics. Citing many works by William White and other experts, the Analysis offers fourteen specific changes that define a recovery-focused practice. Some of these changes include: ■ Allowing authentic and diverse personal/family representation at all levels of decision making within the addictions profession; recognizing the need to stabilize, develop and train further the addiction workforce — and all disciplines — on how to build and sustain recovery; ■ Accepting the need to recognize diverse pathways and cultures to recovery and to strengthen new areas such as assertive preven­ tion, outreach, engagement, and long-term recovery itself; ■ Addressing the need for service delivery to expand far beyond its specialty sector to broader roles in education, policy, business, military, religious, social service, sports, and media settings; and ■ Expanding the current roles for addiction counselors to roles and skills capable of strengthening family and community recovery capital and building bridges of collaboration between profes­ sional and addiction treatment organizations and the growing networks of recovery mutual aid organizations, recovery support institutions, and the community itself.

The Analysis is also clear on another critical point: the need for an expansion of the addiction profession and professional - not its de­ mise, diminution, or de-professionalization. “The addiction profes­ sion is at a point when the old-traditions as a stand-alone event will move to a more comprehensive continuum of care and support.”2 While noting that a growing number of states and Managed Care Organizations are using Medicaid waivers to pay for recovery support services and others are adding incentives for recovery-oriented prac­ tices, the Analysis offers a complete summary of funding streams and suggestions for the financial provisions of recovery support services.

The report acknowledges the workforce paradigmatic need for growth in the movement from an acute illness understanding to a chronic understanding of addiction. In this broadened understand­ ing, as with all chronic illness models, the need for prevention, inter­ vention, treatment, and sustained recovery increases across the con­ tinuum of service provided wherever the illness (substance use) might appear or is being addressed. In this modernized view of the illness, the need for a workforce will also grow at all levels — Peer to PhD/MD Situational Analysis, continued on page 30 ☛ SPRING 2014 | Advances in Addiction & Recovery 25

Beyond Opiates, continued from page 23

When we consider the existential nature of our existence as biolog­ ical creatures who experience our bodies, and our minds through the filter of our physical ‘tissue,’ a deep juxtaposition exists between the programming of biological reward states and the reinforcement of our experience of reality. A duality surrounding attachment to the il­ lusion of control and the ‘artificial’ state of intoxication could not be more profound than in the brain of the opioid-addicted person. An essential component of 12-Step recovery embraces the spiritual nature of our existence. It is interesting to see patients working personal pro­ grams of recovery informed by the perspective that we are able to ques­ tion our biological experience, see the truth and the deception of the mind relating to our attachments. It is also relevant to note that the experience of recovery fellowship provides itself a biological- tissue driven, reward relating to physical proximity, emotional intimacy and the experience of compassion and empathy.

A message of hope I think that the most important message to any person addicted to opiates is for a person must admit their powerlessness over the drug. I have seen people try to rationalize their way into their recovery. Every time I have seen that happen people seem to find a new bottom. Ego and the concept of self-will are deeply reinforced by the emotions of shame and guilt surrounding being addicted. These concepts are ubiquitous in treatment and recovery, but with opioid addicts there is such deep salience for the drug the concept of abstinence is exception­ ally difficult for many to embrace. The concept of ‘never-again’ is very difficult on both a conscious and subconscious level. I have always thought that it is critical for recovering people to ask themselves if they are ready to get the divorce from their drugs.

Recovery treatment must focus on something more than the ­provision of medication. It is essential to provide a safe context, a ­s afety net for pain recovery which includes working the 12-Steps, which includes: accepting limitations, working with a sponsor and

­ efining what ever their limitations may be, making a phone call, and d working with a group of experts such as physical therapists, physicians, and pain ­psychologists.

We strive to create a holistic approach to the mind, the body, the spirit of each of our patients. It is important to understand that the es­ sence of 12-Step recovery is essentially a spiritual and/or existential transformational process. It is important to understand the biology of pain and what is going on in the body. An appreciation of the neuro­ chemical dynamics of opioid drugs and pain informs us about how we can help heal the mind of those who are addicted. If we as health pro­ viders can create a stable platform using varying modalities enhanced with medications, I believe that we can help patients achieve the exis­ tential transformation that becomes the central core of successful treatment and recovery programs.

Andrew B. Mendenhall, MD, is Medical Director of Hazelden in Beaverton, OR. Dr. Mendenhall’s primary practice is general addiction medicine. His subspecialty is caring for addicted or chemically dependent individuals with complex pain management challenges.

His primary clinical interest is helping patients remain clean and sober through abstinence-based recovery, particularly Hazelden’s Comprehensive Opioid Response with the Twelve Steps (COR-12) program. Dr. Mendenhall supervises complex medical detoxification, and provides multidisciplinary, integrative pain management consultation. Dr. Mendenhall is a graduate of Oregon Health and Sciences University and completed Family Medicine residency at OHSU in 2003. He completed a Fellowship in Clinical Leadership at OHSU in 2004. He is board certified by the American Board of Addiction Medicine and the American Board of Family Medicine. He is also a diplomate of the American Academy of Pain Management.

REFERENCES 1 Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.

NSDUH Series H-46, HHS Publication No. (SMA) 13–4795.

2 Centers for Disease Control. (2011). Overdoses of prescription opioid pain relievers— United States 1999-2008. Vital Signs. 60(43);1487–1492.

3 Edlund, M., et al. (2007). Do users of regularly prescribed opioids have higher rates of substance use problems than nonusers? Pain Medicine, 8(8); 647–56.

4 Manchikanti, L., et al. (2006). Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables. Pain Physician. 9(3); 215–25.

Invisible Wounds, continued from page 24

better coordination of research between agencies. The NRAP will serve as a strategic plan for reducing the morbidity and mortality of PTSD and TBI. In his announcement of NRAP, the President told of the remarkable journey of an Army Ranger, Sergeant First Class Cory Remsburg, who was nearly killed by an improvised explosive device in Afghanistan.

After months in a coma, dozens of surgeries, and years of rehab, Sergeant Remsburg is now planning for a 42-mile bike race. As the Presi­dent said, “The war in Afghanistan may be ending, but for Cory and our disabled vets, the work has only just begun. Cory is 30 years old. His recovery — like so many of yours — will last a lifetime. But he won’t give up, because you haven’t given up. And when it comes to our work, to making sure that our nation is fulfilling its promises to the men and women who served and sacrificed, America cannot give up either.”

NIMH was founded in 1948, charged by President Truman to ad­ dress the problems of soldiers and veterans with “combat neurosis.”

Now, 65 years later, we have the same charge, to address the same ill­ nesses from a very different war. Fortunately, we have better tools and a better understanding of the problem. But it is important to acknowl­ edge that there is still much we do not know. We can provide better

26 Advances in Addiction & Recovery | SPRING 2014

a­ ccess to current diagnostics and current treatments, but for too many people this will not be enough. As the NRAP makes clear, we will need better science if we are to repay the debt owed to the more than two million men and women who have sacrificed for us all.

Thomas R. Insel, MD, is Director of the National Institute of Mental Health (NIMH), the component of the National Institutes of Health charged with generating the knowledge needed to understand, treat, and prevent mental disorders. His tenure at NIMH has been distinguished by groundbreaking findings in the areas of practical clinical trials, autism research, and the role of genetics in mental illnesses. Prior to his appointment as NIMH Director in the Fall 2002, Dr. Insel was Professor of Psychiatry at Emory University.

REFERENCES 1 Brett T. Litz and William E. Schlenger, PTSD in Service Members and New Veterans of the Iraq and Afghanistan Wars, PTSD Research Quarterly, Volume 20/Number 1, ISSN 1050-1835, Winter 2009, www.ptsd.va.gov/professional/newsletters/researchquarterly/V20N1.pdf 2 Christopher Munsey, Step up to help military families, Monitor on Psychology, May 2011, Vol 42, No. 5, page 57, American Psychological Association, www.apa.org/ monitor/2011/05/military-families.aspx 3 U.S. Military’s Suicide Rate Surpassed Combat Deaths In 2012, www.npr.org/blogs/ thetwo-way/2013/01/14/169364733/u-s-militarys-suicide-rate-surpassed-combatdeaths-in-2012, January 14, 2013.

Suicide

Making Peace With Death B y A nne S. H atcher, E d D, CACIII, NCACII

DESIGN PICS | PHOTOSPIN.COM

“Death has brought you face to face with your own mortality. You are looking at this irrational world with different eyes. You gain insights that had previously escaped you.” (Grollman, p 110) Brene Brown, in her book Daring Greatly (2012) described the atti­ tude in our society as being one of “Viking or Victim.” Surviving hard­ ships and being able to share the story is rewarded and honored.

Persons who were innocent victims are helped and often pitied. The stories of these individuals make up the content of news broadcasts and talk shows; donations are requested to help in their recovery. They are the subjects of numerous articles and books. For some people life ends in the middle of the story and as a result, no one knows how the story would have ended. In the U.S., we like to find resolution, to know how the story resolved itself and most of all we like happy (or at least logical) conclusions. Working with people who might choose to end their own lives does not fit the societal standard. When someone com­ mits suicide, the potential story is interrupted; family and friends are left to wonder if they could have done something to prevent death in this situation.

Based on many years of observing human beings, some of us have come to the conclusion that dying is probably the hardest life task most people will ever face. The human body does not give up living easily; it has been programmed to maintain organ function and keep on living in spite of accidents, diseases, aging and chemical abuse.

While there are any number of books and articles written about near death experiences, there is not one about someone who experienced death and then returned to teach others what to expect. This is truly the greatest unknown experience that no one can avoid. In addition, we cannot control the time and circumstances of death, except when suicide is the option chosen.

Some facts about suicide and attitudes towards it include the follow­ ing. At least 90 percent of the persons who commit or attempt suicide have one or more mental health diagnoses including depres­ sion, bipolar disorder, schizophrenia or alcoholism (Suicide Pre­vention, 2013). The statistics for suicide among veterans and LGBT youth who have expe­ rienced numer­ous incidents of life-altering events resulting in PTSD describe many of the people found in addiction treatment and mental heath treatment facilities. We, as a society, find the discussion of death diffi­ cult. We would rather deny the possibility of death by not talking about it. If someone dies in an accident or “after a long struggle with ______”, we are more likely to talk about the person, about the experiences we shared, and how much that person will be missed. Cards are sent to family mem­ bers, memorial services are attended, and support groups for family and friends are formed. If a death is the result of suicide, we tend to not talk about it, avoid interactions with the surviving relatives and friends, and in general ig­

nore the event (Brown, 2008). We, as clinicians seek to prevent suicide by clients because we don’t want to experience our own pain of loss, anger, and grief as the result of death, especi­ally one that could have been prevented. Clinically, we as addiction professionals think that we have failed if the client chooses ­suicide.

In our profession, we focus on hope, life changes that lead to success and ability to make a difference in the lives of others. The suicidal cli­ ent does not fit into this scenario. We often ignore the fact that we are working with people who, by their actions, are slowly killing them­ selves. One counselor observed that her work was in a hospice called detox. How many of us accept that reality and address it in the work with clients? We would do well to recognize that addiction is about control; the outcome of ingesting chemicals produces known effects that will last for a fairly predictable period of time. The symptoms of withdrawal are also known and a decision can be made to use more chemical or to “white knuckle” through the undesirable effects of not using it. In the same way, addiction professionals like control and pre­ dictability. The 12-Step programs as well as several other recovery sup­ port programs provide prescribed behaviors leading to discontinuing destructive behaviors and to finding a more desirable way of being in the world. When clients choose to not follow the treatment program, they might be described as being in denial or not having “reached bot­ tom.” Suicide is also about the client taking control by ending life and, in reality, the counselor cannot totally control the decision and the con­sequent actions. In other words, we cannot control what happens.

There is hope and joy along with frustration and the need to adapt to the client’s reality in our day-to-day work. We have learned a lot about recovery and the new life that can be on the other side of addic­ tion. When a client relapses, we support her/him in the process of giv­ ing up the drug of choice another time. If the client chooses suicide, we feel that we have failed; there should have been something we could have done. However, what we have not learned is how to talk about death and making peace with the fact that we are not in control. Statistics tell us that individuals with substance use disorders are six times more likely to report a life­ time suicide attempt than those who do not abuse chemicals (Ilgen & Kleinberg, 2011). The World Health Organization estimated that approxi­ mately one million people die each year from suicide. As a rule, the suicidal individual is in so much pain (physical, men­t ally and/or emotionally) that no other option seems vi­ able. For persons serving in the military to­ day. and for some of the addiction clients we treat, coming home/gaining sobriety might be more lethal than being in combat or “drugged out of one’s mind.” Despite the desire for the pain to cease, most suicidal people are conflicted about taking their own lives (Suicide Prevention, 2013). There­fore, sui­ cide assessment and prevention is an essential as­ pect of treatment. Dr. Charles Raison (2012), in a CNN special stated that he hated suicide and that he SPRING 2014 | Advances in Addiction & Recovery 27

“Compassionate Care, Clinical Excellence”

In-Depth Healing Through an Integrative Approach

Sierra Tucson’s unique approach to treating addiction and complex mental health disorders combines the best of neuroscience and integrative therapies to support each person’s capacity for resiliency, healing, and flourishing.

If you have a client who needs inpatient treatment, call about our internationally acclaimed programs: • Addictions/Co-occurring Disorders • Mood & Anxiety Disorders • Assessment & Diagnosis

• Eating Recovery • Pain Management • Trauma/PTSD

855-300-1541 SierraTucson.com

Member of CRC Health Group Dually Licensed • Dual Accreditation by The Joint Commission

time leading up to it are based on grieving, learning about spirituality, and lessons from the end of life. Two books reviewed recently in the New York Times Book Review offer a different perspective (Williams, 2014). In the book, Things I’ve Learned from Dying by David R. Dow, the author observed that through sharing the experience of dying with another person, one learns about the boundaries of control.

Questions addressed include: Who dies, how and when?” He states that the more important issue is, “How do we know when to let go when death is inevitable?” Another book reviewed is about a college course called Death in Perspective at Kean University in New Jersey.

The instructor included classes ranging from end of life biology to the responsibilities of survivors and decisions essential to carrying on with life when the deceased is no longer physically present. The popularity of the course demonstrates a desire for understanding this unavoid­ able aspect of our lives; some students are on a three-year wait list be­ fore being able to enroll. Erika Hayasaki enrolled in the course and wrote The Death Class: A True Story About Life, a book about her experi­ ence. The reviewer noted that the course resulted in the instructor and her students doing “messy and necessary stuff” that enhances their experience of life.

In summary, and in support of encouraging discussion of this im­ portant topic, please consider thoughts from Forrest Church about his own impending death: “Death is not life’s goal, only the end point.

The goal is to live in a way that will make a life worth dying for. The one thing that cannot be taken from us as we reach the end of life is the love we give away … When facing death, we can take care of unfin­ ished business, make peace with ourselves, reconcile where possible, and free ourselves to embrace the true meaning of life and relation­ ships” (Church, 2008).

Readings from the following were helpful in writing this article:

also understood it. He observed that some survivors of the person who committed suicide might defend the loved one’s decision while others are angry and consider it a selfish act. Likerman (2010) noted that per­ sons who have survived a suicide attempt have reported not so much a desire to die, but rather a desire to stop living. He stated that if there were an in-between state as an alternative to death, some of them might choose it. Another way of thinking about these observations is that many people fear the dying process because they do not know what to expect and how it will happen, but death (the end of life) is not feared. Perhaps the opportunity to talk openly about death and alter­ natives to suicide through finding a way to step back and help the cli­ ent consider alternatives would be a means of addressing the needs of the person for whom suicide might be a choice.

It appears that addiction professionals would be well advised to rec­ ognize that our work involves working with people who are killing themselves by choosing to abuse substances that could cause death.

Providing the option for clients to talk about death might be an open­ ing to determine whether or not the client might consider suicide as a means of ending life sooner rather than later. Frank discussion of the circumstances that might lead to taking such an action would become an opportunity to assess a client’s strengths, the options for changing life’s circumstances, and for finding meaningful opportunities lead­ ing to growth and the ability to make a difference in the world rather than choosing a way out. In addition, making our own peace with death and its impact on our lives will provide an opportunity for per­ sonal and professional growth. In the opinion of this author, forming addiction counselor discussion groups in which we discuss the ideas presented here would enhance our work with clients.

The readings listed at the end of this article could be used to begin discussion groups. Many of the books and articles on death and the 28 Advances in Addiction & Recovery | SPRING 2014

Brown, B (2012). Daring Greatly. Gotham Books. NY. pp. 152–155.

Brown, B. (2008). I thought it was just me (but it isn’t). Gortham Books. NY. pp. 148–149.

Church, F. (2008). Love and death. Beacon Press. Boston. pp. 94 and preface page x.

Flemons, D. (2013). Talking on the edge: assessing the risk of suicide.

Psychotherapy Networker. Oct. pp. 19–20.

Grollman, E. A. (1995). Living when a loved one has died. Beacon Press.

Boston. p. 110.

Ilgen, M & Kleinberg, F. (2011). The link between substance abuse, violence and suicide. Psychiatric Times. Retrieved from www.psychiatrictimes.com/ substance-use-disorder on Feb. 3, 2014.

Johnson, J. (2012). Keys for making peace with death. Huffington post blog posted on Feb. 17. Retrieved from www.huffingtonpost.com on on Feb. 5, 2014.

Lickerman, A. (2010). Six reasons people commit suicide. Retrieved from www.kevinmd.com/blog/2010/06/6 on Feb. 3, 2014.

Meszler, Rabbi J. (2013). How I made peace with death. Huffington post blog posted on Jan. 29, 2013. Retrieved from www.huffingtonpost.com on Feb. 5, 2014.

Morris, V. (2001). Talking about death. Algonquin Books. Chapel Hill.

Simmons, P. (2002). Learning to fall. Bantam Books.

Suicide prevention, how to help someone who is suicidal. www.Help.org. Retrieved Oct. 26, 2013.

Williams, P. (2014). Then we came to the end. NY Times Book Review.

Jan. 26. p. 21.

Anne Hatcher, EdD, CAC III, NCAC II, is Metropolitan State University Addiction Studies professor emeritus. She is chair of the NAADAC Ethics Committee and presents at professional conferences in Colorado.

The Art and Science of Healing

Successfully Living With Any Chronic Illness Requires a Change of Worldview B y C ardwell C. N uckols , P h D

At its inception, medicine was an art with little analytical science. Today, med­icine is science with little emphasis on the art of healing. Unfortunately, the sciences — medical and social — are not ­effective with some of the problems clinicians face in their day-to-day practice.

Take for instance an alcoholic or addict coming into treatment. It is common to ob­ serve signs of narcissism such as grandiosity and sensitivity to criticism. The narcissistic ego views the world in such a way that mis­ ery and suffering prevail. Defects of charac­ ter-envy, jealousy, greed, anger and pride come from this grandiose worldview. This patient presentation leads to the following question. Do you know of any psychothera­ py or pharmacotherapy that can adequately treat narcissism? Maybe a dose of Thorazine, but this only works for a short period of time!

Overcoming and successfully living with any chronic illness re­ quires a change of worldview. Grandiosity sees the world as limited and constantly compares and contrasts itself with others. If the person perceives themselves as better than another, he/she feels superior and tends to lack empathy. If he/she sees themselves as deficient in regard to another, there exist feelings of depression, anger and resentment.

Acceptance and surrender are not possible.

Intuitive leaps and “Ah Ha” experiences occur in the silent, non­ temporal, nonverbal, and nonanalytical right hemisphere of the brain. These insights alter worldview in a spiritual direction and might be thought of as successful recovery. These enchanting occurrences always happen in the moment accompanied by a gamma spike of en­ ergy and a conscious awareness in the next one-third of a second.

These encounters can be appreciated as they open your heart while closing your mind. At these moments, we experience the Truth. When we are ready, the Truth is a higher level of awareness made available to us by our Higher Power.

Changes in worldview are what the 12 Steps of the Big Book of ­A lco­holics Anonymous describes as “Having had a spiritual awaken­ ing.” The mind-analytical left hemisphere and all of our thoughts ­cannot get us there and no medications can make this happen. As the 6th step proclaims, “We’re entirely ready to have God remove all these defects of character.” It doesn’t say your therapist, your sponsor or your psychi­atrist will do this! It states God or your Higher Power will do this when conditions are right. This is healing and it is transfor­ mative making the world look different. However, the world has not changed; only the way that you look at it has changed. For example, acceptance and surrender allow us to view the world as perfectly

the way God planned for it to be and trying to control or change God’s plan as an exer­ cise in suffering and misery.

How and when do these changes in world­ view develop? They cannot be acquired and the quickest way to prevent intuitive change is to try to acquire it using one’s cognitive abilities. There is also no technique or pro­ gram that will do this for you. You already have everything. It is only a matter of reduc­ ing the impact of the ego which allows the true self (SELF) to shine through. This SELF is the Christ (Buddha nature, Atman, Tao or other spiritual view) inside all of us.

As we get more and more in touch with this SELF, acceptance, forgiveness and surren­ der come naturally and the essence of your true SELF — unconditional love and seren­ ity — shines forth. Unconditional love is not an emotion, but a way of being in the world and is a very powerful source of spiritual en­ ergy. When one recognizes the presence of Christ consciousness, this love permits us to become veritable healers. When we can see the love and beauty inside of someone who cannot see it in themselves, this constellates the healing process and reduces their pain. Love is the universal vibration that allows for the transfer of energy from one to another.

Consider if you will a red rose bent at the stem with the petals fall­ ing off. Upon seeing this flower, many would say that it is a rose well past its prime and should be thrown in the trash basket. However, ­others would see the flower as a perfect red rose right where it needs to be on its own life journey. Think of the difference it makes when, instead of seeing a patient as broken, screwed-up or deficient, we ­accept them with unconditional regard and the understanding they are perfectly where they need to be to learn the lessons they are here to learn in this lifetime.

Can you remember an experience when a patient, child or friend came to you with a problem they couldn’t solve? Have you had the experi­ence of them solving the problem while in your presence? Do you know why this happens? One word used to describe this phenom­ enon is entrainment. When someone comes into an energy field that is higher than their own, they can use this enhanced energy. It only works while they are in your energy field. An example of this might ­occur when someone goes to their first self-help meeting and starts to believe they can have what others in the room seem to possess — a ful­ filling recovery. When this person leaves the meeting, their energy falls to previous levels and all they can think about is using. This is why “keep coming back” makes a lot of sense.

There is so much more to therapeutic work than the left hemisphere oriented cognitive-behavioral approach to change. Each ­moment there is an exchange of light (photons) between the therapist and the patient. Can you relive a time when you totally resonated with a patient? The nontemporal right hemisphere of the patient and DESIGN PICS | PHOTOSPIN.COM

“The intuitive mind is a sacred gift and the rational mind is a faithful servant.

We have created a society that honors the servant and has forgotten the gift.”

– Albert Einstein

SPRING 2014 | Advances in Addiction & Recovery 29

t­ herapist can co-create an intersubjective context that facilitates the process of change (attachment communication). This attachment communication facilitates the experience dependent maturation of the right hemisphere. Within this emotional bond, what may well have been neglected in early life due to alcoholism/drug addiction, absentee parenting, or a traumatic upbringing can via neuroplasticity be maturely corrected.

As a helper, can we really hear what another has to say? Must we not first need to listen to ourselves? Listening is important only when one does not project their own desires into another. A clinician can get in their own way when listening comes from a preconception (image of another) or from a particular point of view. To really listen, one needs an inward quietness or awareness. This inner quietness allows for communion beyond the noise of words. In this state of awareness, the clinician can hear even when there are no words. In the moment in a state of connectedness with the client, meaning can come as a transformative change in worldview.

Photons are quanta of light. Light travels at 186,000 miles per second and has no resting mass or charge. At the speed of light, time stands still. It is like nothing described in classical Newtonian physics.

Everything comes from light as it is involved in everything developed in the physical universe and all of its permutations. The essence of every interaction in the universe is the exchange of quanta of energy (light). The Light of God is within you and it is called the true self (SELF), Atman, Buddha nature, soul, Tao or even the Holy Spirit. It is the Light in you that heals.

What is now called quantum physics started when Bohr, Heisen­ berg, Schrodinger, and others discovered that one could not separate themselves from the outcome of an experiment. The Heisenberg Principle and the Von Neumann Formula describe how one’s inten-

tion impacts the results of an experience. When you are with a patient your intention influences the outcome. If the clinician performs their work with integrity and unconditional acceptance (love), this will influence the clinical outcome. If this is our intention, we will never do anything wrong as love can only know truth. Here I am speaking of unconditional love which is not an emotion, but a way of being in the world. It is love without a motive. It is love without a price.

Over the years, I have read many research articles on the use of manualized cognitive-behavioral therapy for the treatment of ObsessiveCompulsive Disorder. Often the results are mixed with some therapists doing very well while other clinicians perform no better than a placebo. The results state the effectiveness of the therapy was inconclusive. I generally disagree with such a statement. It seems to me a clinician who has put great effort into their own personal growth and has attained a high degree of spiritual energy will elicit a greater healing response in their patients. In these cases, a therapeutic relationship is more readily established and the patient’s belief in the prescribed remedy and compliance are enhanced.

It is my hope this brief article and overview of the art of healing will cause you to ponder the work you do. It is my hope you will say to yourself, “So that is why I have been getting results often where others have failed.” When we commit our lives to the narrow road of the spiritual journey we give this gift to the entire world. The same hand that gives also receives.

Dr. Cardwell C. Nuckols has been describes as one of the most influential clinical and spiritual trainers in North America. His latest book is entitled “The Ego-Less SELF.” Dr. Nuckols can be reached at cnuckols@elitecorp1.com.

Situational Analysis, continued from page 25

— to work together for the shared interest of individual, family, and community recovery, and wellness. Peers will offer the experiential supports and assertive outreach and follow-up that often exceed the scope, boundaries or capacity of more traditional prevention, treatment, and recovery. The Analysis sees the increased access and ­demand for treatment economically and clinically supported by a ­united workforce where peers can work with the established disciplines to augment the opportunities for individual recovery in each treatment episode.

While more detailed than presented here, the Analysis readily recog­nizes that apprehension currently exists among many professionals surveyed. Beyond a typical resistance to change, the Analysis identifies still existing confusion over a definition of recovery itself (e.g. abstinence-based or not), a continuing sense of being de-valued as professionals, new ethical concerns, funding fears, a lack of ­understanding of addiction and education, and fear of more work ­b eing added to an already overwhelming workload as concerns ­needing to be addressed for any successful implementation. Specific concerns about peer involvement loom as to their need for training and a need to not define peer activities as equivalent or a replace-­ ment for a less expensive treatment. This concern in return then­ begs the issue of the need for further and future development of the addiction-focused profession as the specialist field it can be in today’s health care workforce.

Despite these concerns, the Analysis moves on to an exceptional comparison with citations of current practice education and training and what is missing if that focus is to have a recovery focus. In this area, special topics such as the role of a recovery focus in medication assisted treat30 Advances in Addiction & Recovery | SPRING 2014

ment, treatment of trauma, co-occurring disorders, the need for ongoing research and training on recovery-focused care, assessment of ROSC Readiness in agencies, defined roles for peers, certification and licensure for peers by states, university preparation of peers programs, etc. are all addressed with the confidence of the emerging larger role that the addiction professional will play.

This Situational Analysis is relevant to all who work with substance use and addiction wherever it may appear. It is a wonderful foundation and barometer for the profession and NAADAC’s just launched nine part Recovery to Practice Webinar series to be offered to all throughout 2014. NAADAC’s Situational Analysis should be viewed by all disciplines, peers and practitioners, policy makers, and educators so we can all evolve. The situation is … we are evolving.

Michael Flaherty is a clinical/consulting psychologist with over 35 years of practice in addictions treatment and policy. For the past 14 years, he has helped lead the national focus on recovery and to build a science of recovery practice and recovery oriented systems of care.

He was the past Director for the St. Francis Institute on Psy­chiatry and Addictions and Founder of the Institute for Research, Education and Training in Pittsburgh, PA and serves many national organizations including the Clinical Advisory Board of the CRC Health Group, the Executive Board of the Annapolis Coalition for Work­force Development, the Advisory Board of the SAMHSA funded Recovery to Practice Initiative the SAMHSA Service Awards Program. His e-mail is flahertymt@gmail.com.

REFERENCES 1 SAMHSA. (2010, April 22). SAMHSA Joins Together with National Behavioral Health Provider Associations to Promote Mental Health Recovery. Retrieved June 13, 2012, from SAMHSA News Release: http://www.samhsa.gov/newsroom/advisories/100422 behavioral10121.aspx 2 NAADAC. (2013). Situational Analysis: Recovery to Practice (RTP). (p.28). Alexandria, VA: NAADAC

NAADAC BOARD OF DIRECTORS REGIONAL VICE-PRESIDENTS

PAST PRESIDENTS

Mid-Atlantic

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

(Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)

Ron Pritchard, CSAC, CAS Mid-Central (Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)

Kevin Large, MA, LCSW, MAC

NAADAC

Mid-South (Represents Arkansas, Louisiana, Oklahoma and Texas)

Sherri Layton, MBA, LCDC, CCS NAADAC OFFICERS Updated 2/16/14

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

President Robert C. Richards, MA, NCAC II, CADC III

Diane Sevening, EdD, CDC III

President Elect Kirk Bowden, PhD, MAC, LISAC, NCC, LPC

Northeast

Secretary Thurston S. Smith, CCS, NCAC I, ICADC

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

Treasurer John Lisy, LICDC, OCPS II, LISW-S, LPCC-S

Northwest

Catherine Iacuzzi, PsyD, MLADC, LCS (Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)

Past President Donald P. Osborn, PhD, LCAC

Greg Bennett, MA, LAT

National Certification Commission for Addiction Professionals (NCC AP) Chair Kathryn B. Benson, LADC, NCAC II, QSAP, QSC

Southeast

Executive Director Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP

Southwest

Product Review Committee Chair Philip L. Herschman, PhD Professional Practices and Standards Committee Chair Donald P. Osborn, PhD, LCAC Student Committee Chair Diane Sevening, EdD, CDC III

Adolescent Specialty Committee Chair Christopher Bowers, MDiv, CSAC, ASE

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

Editorial Committee Chair TBA

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP) Kathryn B. Benson, NCAC II, LADC, QSAP, QSC NCC AP Chair Tennessee

Thaddeus Labhart, MAC, LPC Oregon Rose M. Marie, MAC, LCADC, CCS New Jersey

Susan Coyer, MAC West Virginia

Loretta Tillery, Public Member Maryland

Steven Durkee, ASE Kentucky

Ricki Townsend, NCAC I California

Carmen L. Getty, MAC Virginia

Ethics Committee Chair Anne Hatcher, EdD, CAC III, NCAC II

Mita Johnson, MAC, LPC, LMFT, ACS, LAC

Leadership Retention & Membership Committee Chair Roger A. Curtiss, LAC, NCAC II

Awards Committee Chair Tricia Sapp, BSW, CCJP, CPS

Clinical Issues Committee Frances Patterson, PhD, MAC

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

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

AD HOC COMMITTEE CHAIRS

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

Frances Patterson, PhD, MAC

International Committee Chair Paul Le, BA

NAADAC Public Policy Committee Co-Chairs Gerry Schmidt, MA, LPC, MAC Nancy Deming, MSW, LCSW, CCAC-S

STANDING COMMITTEE CHAIRS

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

Nominations and Elections Chair Donald P. Osborn, PhD, LCAC

Robert C. Richards, MA, NCAC II, CADC III (ex-officio) Oregon

Tay Bian How, NCAC II Sri Lanka

Finance Committee Chair John Lisy, LICDC, OCPS II, LISW-S, LPCC-S

Organizational Representative Philip L. Herschman, PhD NAADAC REGIONAL BOARD REPRESENTATIVES

MID-CENTRAL NORTHEAST

Mark Sanders, LCSW, CADC, Illinois C. Albert Alvarez, LMHC, LCAC, MAC, CGP, Indiana Michael Townsend, MSSW, Kentucky Shannon Rozell, ADS, MPA, Michigan Jim Joyner, LICDCCS, ICCS, Ohio Gisela Berger, PhD, Wisconsin

NORTH CENTRAL

AK

Gloria Nepote, LAC, NCAC II, CCDP, BRI II, Kansas-Missouri James P. Johnson, BS, LADC, ICS, Minnesota Jack Buehler, LADC, Nebraska Kurt Snyder, MMGT, LSW, LAC, North Dakota Jack Stoddard, MA, CCDC III, South Dakota

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

WA

NORTHWEST MT

Steven Sundby, PhD, Alaska Linda L. Rogers, NCC, MS, LAC, Montana Tom McKee, CADC II, Oregon Greg Bauer, CDP, NCAC I, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming

OR

ME

ND VT

MN

Northwest

SD

ID

WI

North Central

WY

NJ

Mid-Central IL

CO

Southwest

KS

CT

NH MA RI

PA

UT CA

NY

MI IA

NE

NV

Northeast

OH

IN

MO

MD

MidAtlantic

DE

WV

KY

VA NC

TN

SOUTHWEST

HI

AZ

Adam McLean, CIP, Arizona Thomas Gorham, MA, CADC II, California Thea Wessel, LPC, LAC, MAC, Colorado Mark C. Fratzke, MA, MAC, CSAC, CSAPA, Hawaii Kimberly Landero, MA, Nevada Art Romero, MA, LPC, New Mexico Michael Odom, LSAC, Utah

OK

NM

Mid-South TX

AR

AL LA

Paula Heller Garland, MS, LCDC, Texas

MID-ATLANTIC GA

MS

SOUTHEAST MID-SOUTH

SC

Southeast

FL

Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia Moe Briggs, NCC, LCPC, MAC, SAP, Maryland Patrice Porter, NCC, LPC, LSATP, Virginia Wanda Wyatt, MS, ADC, SAP, West Virginia

Eddie Albright, MS, Alabama Bobbie Hayes, LMHC, CAP, Florida Diane Sherman, PhD, NCAC II, Georgia Angela Maxwell, MS, CSAPC, North Carolina Marion E. Kirkland Jr., MS, LPC, CAC II, South Carolina Charlie Hiatt, LPC/MHSP, MAC, SAP, Tennessee

SPRING 2014 | Advances in Addiction & Recovery 31

Save the Date

NAADAC Annual Conference • Sept. 27–Oct. 1, 2014 • Seattle, WA

Natural Beauty, Unrivaled Education

howard frisk & tim thompson | visitseattle.org

NAADAC, the Association for Addiction Professionals is proud to invite you to celebrate its 40th Anniversary at the 2014 Annual Conference in Seattle, WA. A vibrant arts and culture scene, celebrity chef restaurants, live music, farmers markets, and an abundance of lakes, mountains, and shoreline to explore. Explore Seattle while earning continuing education credits from the profession’s thought leaders!

Interested in attending, exhibiting, or sponsoring at NAADAC’s 2014 Annual Conference? Get more information at www.naadac.org/annualconference.