Advances in Addiction & Recovery (Spring 2018)

SPRING 2018 Vol. 6, No. 1

Preparing Clinicians for the Future of Behavioral Healthcare

By Raymond Tamasi, MEd, LCSW, LADC-I

PLUS: • Identification as an Addiction Professional Matters • Licensing Board Defense Coverage • 2018 Elections

NAADAC’s celebrated three-module Basics of Addiction Counseling Desk Reference has been updated!

The Basics of Addiction Counseling Desk Reference, 11th Edition – Buy all Three!

• Module I: Pharmacology of Psychoactive Substance Use Disorders • Module II: Addiction Counseling Theories, Practice and Skills • Module III: Ethical and Professional Issues in Addiction Counseling

Updates include: • DSM-5 diagnostic criteria and newest ASAM criteria • 2016 NAADAC/NCC AP Code of Ethics • Current terminology • Support for evidence-based practice and theory by research published since last edition

The Basics of Addiction Counseling Desk Reference, 11th Edition is a three-module set that has aided many addiction professionals in attaining their state and national credentials with its thorough and easy-to-understand descriptions of counseling concepts. Basics can also be used as a quick reference tool for clinicians to use throughout their careers and students preparing for an addiction counseling career.

Purchase as a three-module set or buy each module individually!

Available as independent study courses to obtain nationallyapproved continuing education hours (CEs) or as manuals only.

• Module I: 11 CEs • Module II: 7.75 CEs • Module III: 13 CEs

Order your copies today at www.naadac.org/bookstore.

44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 P: 703.741.7686 F: 703.741.7698 E: naadac@naadac.org

CONTENTS SPRING 2018 Vol. 6 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 addiction profession that are beneficial for practitioners.

NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 100,000 addiction coun­selors, educators, and other addictionfocused 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

44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 703.741.7686 naadac@naadac.org 703.741.7698

Managing Editor

Jessica Gleason, JD

Associate Editor

Kristin Hamilton, JD

Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Committee

Kirk Bowden, PhD, MAC, NCC, LPC Rio Salado College Kansas Cafferty, LMFT, MCA, CATC, NCAAC True North Recovery Services National Certification Commission for Addiction Professionals (NCC AP) Thomas Durham, PhD NAADAC, the Association for Addiction Professionals

■ F EAT UR ES

Abimbola Farinde, PhD Columbia Southern University

20 Partnerships to Help End the Opioid Crisis By Jack B. Stein, PhD and Eric M. Wargo, PhD,

Deann Jepson, MS Advocates for Human Potential, Inc.

National Institute on Drug Abuse

22 Preparing Clinicians for the Future of Behavioral Healthcare By Raymond V. Tamasi, MEd,

James McKenna, MEd, LADC I AdCare Hospital

24 From Opioid Addiction to Recovery: Overcoming Barriers to Effective Treatment By Shareh

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

LCSW, LADC-I Ghani, MD

26 Licensing Board Defense Coverage By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

■ DEPA R T M EN TS 4

President’s Corner: Advocacy: The Voice for Recovery

By Gerard J. Schmidt, MA, LPC, MAC, NAADAC President

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From The Executive Director: Advocacy Matters! By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

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Certification: Identification as an Addiction Professional Matters By Jerry Jenkins, MEd, MAC, NCC AP Chair

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Affiliates: Meet Your 2017–2019 Mid-Central Regional Vice-President: Gisela Berger

By Jessica Gleason, JD, NAADAC Director of Communications Ethics: Ethics and Telebehavioral Health By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair

11 Education: CEs, CEHs, and CEUs: What’s the Difference? By Thomas Durham, PhD, LADC,

Article Submission Guidelines We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Please submit story ideas and/or articles to Jessica Gleason at jgleason@naadac.org.

For more information on submitting articles for inclusion in Advances in A ­ ddiction & Recovery, please visit www.naadac.org/advances-in-addiction-recovery.

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

Advertise With Us For more information on advertising, please contact Jeff Smith, NAADAC Ad Sales Manager, at jsmith@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 703.741.7686 or visit www.naadac.org.

Printed April 2018

NAADAC Director of Education

12 Membership: Meet the 2018 Candidates for NAADAC Executive Leadership Positions

By Kristin Hamilton, JD, NAADAC Communications Manager

STAY CONNECTED

18 Membership: NAADAC Annual Awards & Nominations Process By HeidiAnne Werner, NAADAC Director of Operations & Finance

30 NAADAC CE Quiz 31 NAADAC Leadership

ALL IMAGES FROM SHUTTERSTOCK UNLESS OTHERWISE NOTED

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■ PR ES ID ENT ’S CO RN E R

Advocacy: The Voice for Recovery

By Gerard J. Schmidt, MA, LPC, MAC, NAADAC President From our initial roots as a professional organization founded through and by those in recovery, NAADAC has always had as a major emphasis of its mission to advocate for those that we treat. We recognized early on that a strong voice is needed not only to advance funding agendas on a federal and state level, but also to work towards raising the standards of care for those who have addictive disorders to the same level of care as any other individual afflicted with a medical illness.

NAADAC is proud of its efforts to amplify the voice of those with have addictive disorders and those who serve people with addictive disorders.

Since it was founded in 1972 as the National Association of Alcoholism Counselors and Trainers (NAACT), efforts have included: 1972 – The National Association of Alcoholism Counselors in Trainers (NAACT) is founded to address the need for an organized constituency to represent our interests.

1977 – NAADAC joins NIAAA on a panel on national credentialing of qualified alcoholism counselors.

1978 – NAADAC establishes the National Commission for the Credentialing of Alcoholism Counselors (NCCAC).

1982 – NAADAC contributes to the landmark NIAAA-funded report

by Birch & Davis defining the work of alcoholism and drug abuse counselors for the first time.

1986 – NAADAC hosts its first legislative conference, which includes White House and Congressional Briefings and is attended by First Lady Nancy Regan.

1988 – NAADAC creates national credentialing for both alcoholism and drug abuse counselors due to the lack of credentialing for drug counselors.

1989 – Treatment Works!, later named the National Recovery Month, is launched by NAADAC in alliance with government and private treatment organizations.

1992 – NAADAC holds the first Addiction Professionals’ Day to commemorate the hard work of addiction counselors.

1994 – U.S. Department of Transportation expands it definition of Substance Abuse Profession (SAP) to include those certified by the National Certification Commission.

1995 – NAADAC works with the National Board for Certified Coun­ selors (NBCC) to establish the Master Addictions Counselor (MAC) credential.

2005 – NAADAC and NCC start work with the U.S. State Department’s Bureau of International Narcotics and Law Enforcement Affairs (INL) to create training and certification programs internationally.

2011 – NAADAC and the International Coalition for Addiction Studies Education (INCASE) join to create the National Addiction Studies Accreditation Commission (NASAC) to provide a single standard for higher education addiction studies programs.

2014 – SAMHSA awards NAADAC $3.2 million to start the NAADAC Minority Fellowship Program for Addiction Counselors to provide tuition stipends to Master’s degree students focusing on addiction.

2016 – NAADAC hosts addiction workforce development forums at colleges across the United States.

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2017 – NAADAC’s Minority Fellowship Program expands to include behavioral health professionals focusing on addiction.

In 1988, NAADAC formed the NAADAC Public Policy Committee (PPC). The PPC works to raise awareness in Congress on critical funding and policy issues surrounding addiction treatment and its objectives are to: • establish a legislative agenda that promotes the needs of the addiction professional at the state and national levels; • develop and distribute relevant position statements, white papers, legislative agenda guides, and other public policy papers for the education and advocacy of addiction focused issues; • conduct an annual public policy conference and/or workshops that promote, educate and train on the public policy agenda of NAADAC; • help educate and train at the state level advocacy and legislation that promotes addiction focused issues; • promote and advocate for public policy issues to relevant governmental and private institutions and organizations; and • give testimony on the state or national level on relevant public policy issues.

Legislative success was slow in coming, but early pioneers, including Ed Chandler and John Avery, paved the path for those coming after them and helped shape the course and direction for legislation that has led to parity, Block Grant Funding, Minority Fellowship Grants, and the development of state and national certification and licensing standards.

The PPC’s latest effort in its commitment to continually engaging the membership in their advocacy role is the development of a webinar series on the components of advocacy. These monthly webinars began in January Advocacy, continued on page 6 ☛

• establish a legislative agenda • develop and distribute relevant nformation • conduct an annual public policy conference and/or workshops • help educate and train at the state level • promote and advocate for public policy issues • give testimony

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

Advocacy Matters!

By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director In NAADAC President Gerry Schmidt’s column, he focuses on the roots of our professional organization with the major emphasis on our mission to advocate for those who we treat and those who serve. Early on in NAADAC’s organizational development, we recognized that a unified voice makes for a stronger voice and that a stronger voice is needed to be heard in our national capitol and by the Congress that meets to determine what matters and what does not. It has taken literally decades for our voice to raise to the level of “mattering” and much of that is due to the focus that the opioid crisis is bring to our state and local legislators. Now is the time to advance NAADAC’s public policy agenda and bring the focus onto those strategies that have potential to not only affect the opioid crisis, but also to affect the impending marijuana tsunami and the always present alcohol drowning of America.

Advocacy is important to the addiction profession. We must work to change systems, practices, and policies in order to create systems, practices, and policies at the local, state, and national levels that benefit the members of our profession and, most importantly, the clients we serve. As a national organization, NAADAC targets its advocacy efforts to the national level.

However, as it does so, it is always bearing in mind that policy at the highest level trickles down to the local level, so it is important to advocate for change that will benefit and work for state and local organizations and agencies.

One great example is the work that NAADAC is doing with Optum, a leading managed care organization, to recognize the credentials of the Master Addiction Counselor (MAC) and the National Peer Recovery Support Specialist (NPRSS). Both national credentials are now recognized and reimbursed in Optum’s system after several years of effort. NAADAC is now advocating to Optum’s Credentialing Department for the recognition

of all NCC AP National Credentials and the NCC AP tests used at the state level.

NAADAC’s advocacy work also includes providing education of the career ladder and scopes of practice to the Center for Medicare Services (CMS) and the addiction specific enhancement projects through Medicaid.

Pursuant to these efforts, we coordinated a presentation on addictionspecific Medicaid benefits and how to obtain reimbursement for addiction treatment at the state level. NAADAC will continue to work with CMS to share information that is relevant to our stakeholders in order to affect system change at a national and state level.

NAADAC has also worked tireless to advocate for support for and the development of the addiction workforce. We advocated to be awarded the National Minority Fellowship designated funds for more than 8 years before we were actually funded in the “Now Is The Time” Bill in 2014.

We are now advocating again for the Minority Fellowship funds due to the deletion of these funds in the President’s budget. Ace Crawford, who manages the NAADAC Minority Fellowship Program, joined leaders and lobbyists from other Minority Fellowship Programs (CESW, NBCC, ANA) to visit Capitol Hill to advocate for funding and call attention to the specific needs of the workforce in order to combat the current opioid crisis. Without raising more addiction professionals through loan forgiveness, tuition support and other supports, America will not be able to make a substantial change in the opioid or any other drug epidemic.

At the state level, we work with single state agencies who are struggling with credentialing issues. For example, we are working with lawmakers in California to correct its credentialing system that is non-functional for certain populations and does not establish a tiered career ladder with appropriate scopes of practice. We also work at the state level to pass legislature requiring those who provide addiction treatment to be qualified and competent to do so.

NAADAC works with our affiliates to understand and promote the addiction professional needs at the state level and looks for opportunities to promote it at the national level, through both legislation being introduced to Congress, and through federal agencies such as the Substance and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Office of National Drug Con­trol Policy (ONDCP). For example, NAADAC was recently asked to provide testimony on the cause and extent of the opioid crisis and was represented by member and educator Dr. Darryl Inaba. Further, in a recent letter to U.S. Senator Orrin Hatch (R-UT), NAADAC outlined how the federal government could support treatment through Medicaid funding and the need to use qualified and educated addiction professionals to effectively fight this crisis.

NAADAC’s Advocacy Webinar Series was developed to support and assist addiction professionals in their advocacy efforts by providing guidance and training on the issues that affect our practice and how to discuss these issues at the local level. Our national Advocacy in Action Conference, scheduled for November 12–13 in the Washington, DC Metro area at the Gaylord National Harbor, will be an opportunity for you to gather with like-minded professionals to learn more and discuss NAADAC’s public S P R I N G 2 018 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 5

policy agenda and the legislative bills we are supporting, as well as prepare you for visits on Capitol Hill to discuss how these issues affect your legislator’s constituency and why addiction treatment matters. This is your opportunity to be a part of the legislative process at the grass roots, the place where we all have a voice and where we can use that voice to share about the devastation of substance use disorders to individuals, families and communities.

Some of the bills that NAADAC is currently endorsing include: • H.R. 5102 – Substance Use Disorder Workforce Loan Repayment Act of 2018 • H.R. 4778/S. 2301 – Behavioral Health Coverage Transparency Act of 2018 • H.R. 3252 – Second Chance for Students Act • H.R. 3545 – Overdose Prevention and Patient Safety Act • H.R. 2938 – Road to Recovery Act • H.R. 664 – STOP OD Act of 2017 • S. 778/H.R. 1854 – Prescription Drug Monitoring Act of 2017 • H.R. 3566 – Addiction Recovery for Rural Communities Act • H.R. 3254 – Heroin and Opioid Abuse Prevention and Treatment Act of 2017

• • • •

H.R. 1354 – Stop Trafficking in Fentanyl Act of 2017 Related bill: H.R.1781 – Comprehensive Fentanyl Control Act H.R. 2731 – Stop Taxpayer-Funded Alcohol Marketing Act H.R. 774 – Medicaid Coverage of Tobacco Cessation Nonprescription Drugs Act • H.R. 3096 – Drug-Free Indian Health Service Act of 2017 • S. 658 – Illegal Synthetic Drug Safety Act of 2017 • S. 1453 – Strengthening the Addiction Treatment Workforce Act Links to the text of all bills above can be found at www.naadac.org/ take-action. Look for more information regarding our public policy initiatives on our website and register for the Advocacy webinars!

See you in D.C. in November at the Advocacy in Action Conference!

Together, we can and do make a difference!

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years as well as an international, national and state trainer in a variety of topics.

Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders, and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.

Advocacy, continued from page 4

and will culminate in the 2018 Advocacy in Action (AiA) Conference in Washington, DC, on November 11–13, 2018. This webinar series will help anyone engaged in advocacy work at the local, state, or national level, as well as heighten their awareness of the current issues, legislation, and roles in advocacy. The webinars, which are free to attend and available on NAADAC’s website for viewing on demand, will cover: • Medicaid • 42 CFR Part 2 (Confidentiality) • State Advocacy • Budget/Appropriations • Advocacy for Veterans/Military • Workforce Advocacy • Current Legislation and NAADAC Priorities • Preparation for the AiA Conference Another integral component of advocacy is being able to articulate those issues that are of national interest and importance to the profession.

Each year, the PPC works to identify bills, agendas, and issues that are most likely to impact the addiction profession and the people who it serves and to provide relevant and useful information about these bills, agendas, and issues on NAADAC’s website under the Advocacy section. Some of the legislative issues are ongoing and need to be in the forefront each year when meeting with our representatives and senators.

Current Legislative Priorities: • Current Fiscal Year Block Grant Appropriations • Strengthening the Addiction Treatment Workforce Act • Improving Access to Behavioral Health Information Technology Act • Funding for the Comprehensive Addiction and Recovery Act (CARA) • Medicaid Coverage for Addiction Recovery Expansion Act While there is a cadre of other bills related to addiction treatment, these bills have the most impact in the day-to-day delivery of services. Without question, with Medicaid expansion and the graying-out effect of qualified treatment providers, it is imperative to increase the number of professionals coming into the profession. All of us need to encourage and mentor 6

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young professionals and students alike about the benefits and rewards of working within this profession. Without our encouragement and active involvement, we will abdicate the quality delivery of addiction treatment services to less qualified providers.

Finally, each of us has a role at a variety of levels where we can and need to advocate for those we serve. As NAADAC members and addiction treatment professionals, we have an ethical responsibility to advocate where and when we can. I challenge and encourage each of you to: • Stay informed – reading NAADAC’s website is a great place to start.

• Become involved in NAADAC’s Public Policy Committee or your NAADAC State Affiliate’s.

• Attend state public policy conferences.

• Attend NAADAC’s Advocacy in Action Conferences.

• Attend NAADAC’s ongoing Advocacy Webinar Series.

• Follow NAADAC on social media (Facebook, Twitter, LinkedIn).

• Read the eProfessional Update for advocacy news.

• Take Action! Call, write and meet with your local, state, and national representatives.

Those who have come before us have paved the way for us to do the good work that we do. It is now our turn to enhance and light the way for those coming after us as we strive to provide the best quality treatment for those afflicted with this disease.

Gerard J. Schmidt, MA, LPC, MAC, is President of NAADAC, the Association for Addiction Professionals and the Chief Operations Officer at Valley HealthCare System in Morgantown, WV. He has served in the mental health and addictions treatment profession for the past 45 years. Publications to Schmidt’s credit include several articles on the development of Employee Assistance Programs in rural areas and wellness in the workplace, addictions practice in the residential settings and an overview of addictions practice in the United States. He has edited Treatment Improvement Protocols for CSAT for several years and has been active with the Mid-Atlantic ATTC. Schmidt had served as Chair of the National Certification Commission for Addiction Professionals (NCC AP) and NAADAC’s Public Policy Committee, and as NAADAC’s Clinical Affairs Consultant. Awards include the Distinguished Service Award in 2003 and the Senator Harold Hughes Advocate of the Year in 2010. In addition to his national and international work, Schmidt has been active within West Virginia in advocating for and supporting State legislative issues related to addictions and addiction treatment.

■ CER T IF IC AT I O N

Identification as an Addiction Professional Matters

By Jerry Jenkins, MEd, MAC, NCC AP Chair Have you ever thought about how you identify yourself and how you like for others to identify themselves to you in the addiction profession?

During my Army basic training I was taught to identify rank and follow that by the last name.

That information was quickly available simply by looking at the chevron of enlisted personnel or collar for rank of officers and name tag of someone in uniform. I could also see other information such as if they were a paratrooper (those who jump out of perfectly good aircraft), were Special Forces, or had been an Infantryman with a Combat tour. All of that information was displayed on any uniform a soldier wore.

As addiction professionals, we usually use letters after our names to indicate our educational level and professional credentials. If you have read my previous columns, I have a constant theme that addiction professionals need to have readily identifiable credentials. I consider the NCAC I, NCAC II, and MAC the most consistent and identifiable credentials because National Certification Commission for Addiction Professionals (NCC AP) credentials are nationally and internationally recognized, and are the same in Alabama as they are Wyoming or any other state, territory or international country that uses our credentials. Those letters indicate at a glance that you have met a state as well as a national standard and have agreed to follow an ethical standard established by the profession.

NCC AP focuses on keeping its standards high in order to increase our credibility as professionals who strive to deliver the most effective substance use disorder treatment available and do so in an ethical manner. NCC AP currently is undergoing an update on all our basic tests (NCAC I, NCAC II, and MAC), and the test for the National Certified Peer Recovery Support Specialist (NCPRSS) credential in order to maintain those high standards and continue to build on the verification of knowledge and competency of addiction counselors globally. NCC AP Commissioners and other subject matter experts review the current test questions for relevancy, current research, and current practices and submit the revisions along with references for each test question to our testing company. At that point, the testing company psychomatricians review each of the questions, analyze the wording and sentence structure, and recommend any changes. NCC AP Commissioners and/or clinical staff review those recommendations for final approval before adding to the “test question pool.”

From there, a “job analysis” is conducted to determine the scope of the practice and knowledge level required for each level of practice and the results are used to develop the test blueprint (including test specifications, test content outline). The test blueprint ensures that topic areas are weighted

according to their importance (i.e., how often a knowledge and/or skill is used or the potential consequence for not applying a knowledge and/ or skill properly) to practice as a certified professional at each level. The test blueprint defines the structure and format of the exam in terms of the percentage of exam items allocated to each topic area, knowledge and skills measured in each topic area, and types of items to be included.

Once this process is complete, NCC AP will be announcing a call for currently NCC APcertified professionals to participate in beta testing of the new test formats for NCAC I, NCAC II and MAC. The purpose of beta testing is to collect enough response data on each test question (item) to statistically analyze its performance and determine whether it should be retained, discarded, or revised and beta tested again. In addition, in between the above larger steps are smaller technical steps related to technical accuracy, scoring accuracy, clarity, importance to practice, the plausibility of incorrect options (i.e., distractors), and how a cut score (i.e., passing score) is determined. Needless to say, this is a time intensive and detailed process to ensure NCC AP’s national credentials continually reflect the profession’s highest standards.

Remember the earlier question: “Have you ever thought about how you identify yourself and how you like for others to identify themselves to you?” I hope you use your NCAC I, NCAC II or MAC professional designation if you have the credential. If you don’t have one, please consider getting one as they are the most consistent and identifiable way of showing your professionalism and ethics at a glance. For more information, see www.naadac.org/types-eligibility.

(References) NAADAC, the Association for Addiction Professionals. (2016). NAADAC/NCC AP Code of Ethics (2016). Available at https://www.naadac.org/code-of-ethics.

Substance Abuse and Mental Health Services Administration. (2011). Scopes of Practice & Career Ladder for Substance Use Disorder Counseling. Available at https://store.samhsa. gov/shin/content/PEP11-SCOPES/PEP11-SCOPES.pdf.

Jerry A. Jenkins, MEd, MAC, has been the Chief Executive Officer of Anchorage since 2003, adding Fairbanks Community Mental Health Services in 2013.

He is in his third year as the President of the Alaska Behavioral Health Association. Anchorage/Fairbanks Community Mental Health Services provides behavioral health services across the span of life from ages 2 to 100.

As an addiction treatment professional, Jenkins has over 34 years of experience in treating substance use disorders and mental illness. He has worked in and managed community based, outpatient, halfway and residential treatment services. He is an advocate for safe, affordable and accommodating housing for consumers as well as recovery as the expectation for behavioral health care with particular emphasis on being trauma informed. He has been the Chair of NAADAC’s National Certification Commission for Addiction Professionals (NCC AP) since 2016.

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■ A F F ILIAT ES

Meet Your 2017–2019 Mid-Central Regional Vice-President: Gisela Berger

By Jessica Gleason, JD, NAADAC Director of Communications Gisela Berger, PhD, MAC, LPC, NCC, spent several years on the Board of Directors and then as President of Recovery & Addiction Professionals of Wisconsin (RAP-WI), NAADAC’s Wisconsin affiliate. During her tenure as President, she facilitated a leadership retreat and contributed to the growth of the now vibrant and flourishing state affiliate organization. Under Berger’s leadership, the affiliate received over $30,000 in donated funds, enabling state-wide trainings and low-cost, high-value conferences. As an educator, training the next generation of counselors and substance use disorder treatment specialists has allowed Berger to work with some exceptional young leaders. Her philosophy of inclusion has also been recognized at several levels of university leadership. When Berger first began her journey, she chose to specialize in substance use disorder treatment and has been grateful ever since.

Q: What goals do you hope to accomplish during your time as Mid-Central RVP? A: I have a number of goals, listed in no particular order. I tend to favor one goal over another depending on the situation and the individual circumstances and priorities of each state in my region.

1. Enable each affiliate to function at its best. This might include helping each affiliate with board development, succession planning, and board education, encouragement, and selection, etc.

2. Work with each affiliate to ensure state licensure/certification boards are run by said affiliate rather than governor appointees or commissions.

3. Promote NAADAC/affiliate membership and all of its wonderful benefits with the hope of increasing membership.

4. Work on ensuring addiction workforce issues are appropriately handled by each affiliate, and not other entities hoping to gain by worker shortage, shortage of appropriate training/education, etc. This also includes making sure that other professions are appropriately trained in addiction treatment and vetted by the affiliate.

5. Work to make affiliates the go-to for all addiction professional issues in the state. This includes not only treatment but also prevention and peer recovery services.

6. Create a sense of cohesiveness and unity within the region.

Q: What are the major issues or challenges happening in your region?

How can NAADAC help overcome them?

A: One major issue facing the Mid-Central Region is apathy. The new generation of individuals coming into the field are concerned not only with helping others but also with making a living wage. Often there is debt from educational endeavors as well as a family to support. We no longer have people in recovery working in this field as a second or third career, for example. We can’t ask people to join an organization that isn’t seen as relevant to earning a decent living. So, overcoming this stereotype is a huge project! But, I have every confidence in each state affiliate being up to the challenge. We are a vibrant, energetic organization working with entities on all levels to create something larger than each individual.

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Representing Illinois, Indiana, Kentucky, Michigan, Ohio, and Wisconsin

That is our strength!

Another issue facing our region is workforce development. There are few institutes of higher education offering Bachelor’s degrees, much less Masters’ degrees, in addiction studies. Yet, third party payers are requiring this level of education for reimbursement. Added to this is the problem of concentration: we have many professionals in most suburban areas. But, there are few to none in outlying areas and small, farming communities.

Also, some urban areas are underserved but in dire need of services. It is a catch-22.

Finally, capacity building is challenging for different reasons within each affiliate. Working together, we can use each affiliate’s unique strengths to assist with their unique concerns. Helping each affiliate find useful resources to meet this challenge will be a long process.

NAADAC can help by continuing to be a resource and keeping lines of communication open between affiliates, regions, institutes of higher education, third-party payers, and governmental entities at all levels. NAADAC’s discussions with third-party payers as well as providing scholarships to attend institutes of higher education will help address concerns of apathy by showing our continued relevance. This is also helping address the many concerns around workforce development.

Q: Why is NAADAC membership important for addiction professionals?

A: Because what one person cannot do, we can all do together. Our strength is not only in our numbers but also in our willingness to give voice to those who cannot speak for themselves. People diagnosed with addiction disorders are often not heard and stigmatized. We can speak not only for ourselves but also for those we serve.

Q: What are your hopes for the future of NAADAC? A: My hopes include making NAADAC the unifying voice for all addiction professionals, no matter what degree or license/certification they hold.

This includes unification for education as well as portability of licenses/ certifications. Portability is seen as key to having unified standards for each state to ensure optimal service to our clients.

Another hope I have is that NAADAC will urge appropriate reimbursement for services at all levels. Finally, I hope to see NAADAC as the powerful influence to end the stigmatization of all people with addiction disorders.

Realizing that my hopes are big dreams and won’t happen soon, I will continue to serve to the best of my ability. Whatever I can do to help, I will.

Jessica Gleason, JD, is Director of Communications for NAADAC, the Asso­ci­ a­tion for Addiction Professionals. She manages all communications, marketing, public relations, and informational activities of the Association, the NAADAC website, and all digital media, marketing, and communications.

Gleason is the Managing Editor for NAADAC’s Advances in Addiction & Recovery magazine, and oversees the publication of NAADAC’s two digital publications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate. 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 in Amherst, MA.

■ E T H ICS

Ethics and Telebehavioral Health

By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair As behavioral health professionals and services providers, we are exploring new frontiers in the delivery of co-occurring services to include telebehavioral health (which also includes telemental health and tele-SUD/ addictive behavior) services, hereinafter referred to as TBH. TBH is the delivery of addiction and co-occurring mental health services across electronic and digital platforms. TBH delivers behavioral healthcare services to individuals who are separated from their provider by space and/or time by allowing for the provision of services from a distance. There are two types of TBH delivery: synchronous and asynchronous. Synchronous services occur in real time at the same time – the provider is communicating with the client directly in a live, real-time interaction, using a landline, mobile phone, home monitoring, instant messaging or video conferencing, or other device/platform. Asynchronous services do not occur in real time; rather the provider and client interact with each other at different times

when each of them is available (e.g. email and secure messaging, secure file exchanges). TBH can be made available in a wide variety of settings, including private practice office, outpatient clinics, primary care, hospitals, corrections, colleges and universities, mobile crisis centers, homes, nursing homes, assisted living centers, and VA/military installations. Ongoing research has demonstrated the efficacy and safety of using telemedicine/ TBH for behavioral health services.

Benefits and Disadvantages There are benefits and disadvantages to the use of TBH. One primary disadvantage of TBH is the lack of face-to-face interaction that would typically allow the provider to assess the client’s verbal and nonverbal communications. Another disadvantage of TBH is the potential isolation of the client from live interactions with others. From a practice standpoint, there

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NAADAC endorses the sound quality of the technology as needed. Providers may not be the same level of collaborative care and will have to address complications that arise, includstaffing amongst providers when using TBH. There use of evidence-based ing the loss of an internet connection or other unare, however, numerous benefits to using TBH. TBH technologies that are at expected interruptions of service, and have a backup brings the provider and his or her services directly to for contacting the client should that happen. the client. Expanding access to care is important in the forefront of our next plan Providers should be familiar with the strengths and so many communities, especially in rural and frontier areas. Travel time and costs associated with travel are generation of care, and is weaknesses of the software programs they plan to use for clinical services. It is incumbent upon providers reduced for both the provider and the client. There is working with its members to research and utilize a secure video platform that is increased satisfaction with the services delivered and and partners to ensure compliant with the Health Insurance Portability and an increased ease of delivery once everything is setAccountability Act (HIPAA). Only products that are up correctly. Lengthy waiting lists are avoided, and that the client is always HIPAA-compliant and meet federal requirements for loss of prospective clients are significantly diminished protecting the clients’ privacy should be used. in those practices that utilize TBH. As we know in kept in focus when the world of addictions-specific services, delays in considering, choosing, and Clients First engaging in treatment can result in a scenario where the client feels helpless, hopeless, and triggered to re- adopting the use of TBH. Clients take priority over platforms and technollapse. Evidence-based practices and outcome-driven ogy. Providers should carefully consider the apdata point to the need for continuity of care, which propriateness of each TBH option for each client’s is assisted by the use of TBH. Engagement with the prospective client individualized needs. Demonstrating competence requires providers to while he or she is feeling motivated towards change is crucial to long-term determine which TBH services and treatment modalities may be appropristabilization and recovery. For treatment to be effective, we as a profession ate in any specific context with each client. While some clients may benefit have to use the latest evidence-based practices that are innovative, outcome- from counseling services offered using phone or email, others will need oriented, and engaging. TBH is flexible, creative, engaging, and affordable services using videoconferencing or even in-person treatment, and still oth– which enhances the client’s overall experience with the provider and his ers may benefit from a combination of services. The decision regarding the or her agency. Finally, TBH reduces stigma by making care accessible to technology utilized must be made after carefully screening each potential any person struggling with co-occurring disorders, regardless of his or her TBH client to determine the scope of his or her diagnosis, the context location in relation to providers. within which the client lives, whether the client is in crisis, the level of rapport established, and the client’s motivation for therapy. Screening should also explore whether the client has a support system, whether the client Ethical, Legal & Clinical Considerations While TBH brings a great deal of flexibility to a provider’s practice, it can find competent clinician services, and whether the client has access to a also brings up questions of ethical, legal, and clinical competence. Engaging secure and private space for participating in the telemental health services.

We, as a profession, are witness to amazing developments within our in TBH using an electronic/digital platform requires commitment, competence, and self-management skills. While TBH can be a helpful tool for industry. The need for innovative, evidence-based, outcome-focused tools many individuals, how it is applied requires careful forethought. Providers that reach persons struggling with substance use and addictive behavior must understand that all requirements of their profession’s Code of Ethics disorders is evidenced every day in every community. TBH provides access apply to the provision of TBH. NAADAC/NCC AP’s Code of Ethics ap- to healing relationships where access might otherwise not exist. TBH is plies to all professional services delivered by clinicians and other providers, a logical next chapter in a world that is so technology-driven. We have a regardless of the therapeutic modality and whether it is delivered in person, professional obligation to use tools that can help our clients find healing, over the phone, via the internet, or through any other means. NAADAC wellness, relationship, support, and functionality. We have an ethical obligaincluded principles specific to the use of technology in its most recent Code tion to reach out to the clients who have the hardest time accessing services. of Ethics (2016) update and has partnered with the Telebehavioral Health We also have a legal obligation to use TBH in a manner that does not cause Institute to offer discounted education, training, and resources geared real or perceived harm. NAADAC endorses the use of evidence-based technologies that are at the forefront of our next generation of care, and is towards increasing TBH competency as a new member benefit.

A provider demonstrates clinical competence by possessing the working with its members and partners to ensure that the client is always knowledge and skills needed to ensure he or she meets, and hopefully kept in focus when considering, choosing, and adopting the use of TBH. exceeds, the minimum standards required for the delivery of relevant and Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education meaningful professional services. Before offering TBH to any client, the and Supervision, a Master’s Degree in Counseling, and a Bachelor’s Degree provider should familiarize him or herself with the relevant guidelines for in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the each practice area he or she engages in, including those guidelines available national Master Addiction Counselor (MAC) and Department of through the Telebehavioral Health Institute. The guidelines do not contain Transportation Substance Abuse Pro­fes­sional (SAP) certifications. Johnson enforceable standards; rather, the guidelines illuminate evidence-based has two supervisory credentials (ACS and AAMFT) and is a NCC. She is a core faculty member at Walden University, and she maintains a private practice clinical practice standards specific to TBH best practices. In addition to where she works with supervisees who are working on credentialing. Johnson clinical competence, providers must be knowledgeable about the various is the Past-President of the Colorado Association of Addiction Professionals (CAAP), and is curtechnologies used in TBH (e.g., hardware, software, Internet connections, rently NAADAC Treasurer and Ethics Chair. She previously served as NAADAC’s Southwest Regional privacy safeguards, security protocols). Providers work diligently to protect, Vice-President. In Colorado, Johnson is involved in regulatory and credentialing activities as well as workforce recruitment and retention initiatives. She speaks and trains regionally and nationto the best of their ability, their clients’ rights to confidentiality and privacy. ally on a variety of topics. Her passions beyond workforce retention include pharmacology of It is important that providers take the time to familiarize themselves with drugs of addiction, infectious diseases, ethics, motivational interviewing, and clinical supervision. the technologies they are going to use so they can adjust the visual and 10

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■ ED U C AT IO N

CEs, CEHs and CEUs: What’s the Difference?

By Thomas Durham, PhD, LADC, NAADAC Director of Training The terminology for continuing education credits can be confusing, misunderstood, and often (and innocently) misused. Each state credentialing or licensing board may have its own unique terminology and guidelines for continuing education (CE) credit. In most cases, hour-for-hour educational credit is referred to as either a “contact hour” or a “continuing education hour.” This type of credit is typically known as one of the following acronyms: CEHs, CE hours, or simply CEs. At NAADAC, we typically refer to the credit hours we offer as CEs, but to be clear, when we use the term CE we mean hour-for-hour credit (1 CE equals 1 continuing education hour). Training programs that provide continuing education are sometimes referred to as continuing education or CE programs and, in most cases, provide hour-for-hour credit. In fact, most certification or licensing boards that credential addiction professionals require a certain number of direct contact hours (CEs or CEHs) for certification and recertification.

The acronym that is most often misused when referring to contact hours is CEUs, which stands for Continuing Education Units. However, a single CEU is not the same as a single contact hour. A Continuing Education Unit is most often used with a structured educational experience (such as a class, seminar or retreat) and is based on a formula that equates to 10 contact hours for each CEU. According to The College Board, “one CEU equals ten contact hours of participation in organized continuing education classes and/or training conducted by a qualified instructor” (Source: https:// professionals.collegeboard.org/prof-dev/workshops/ceu-credits).

To confuse things further, some credentialing boards use the term CEUs on their website when they are actually referring to contact hours and I am aware of at least one training organization that includes the acronym CEU in their name (but looking at their website, it appears that they provide contact hours).

NAADAC offers continuing education hours (referred to as CEs) calculated as direct contact hours, to professionals who participate in our national conferences, affiliate conferences, workshops, webinars, self-study guides and any other form of education that would qualify for education hours toward an addiction professional credential. Those who attend NAADAC’s conferences can also receive business hours (BHs) for attending NAADAC business meetings, such as Board of Directors meetings, regional caucuses and general membership meetings. Business hours are not typically recognized by credentialing boards, so we carve these out as separate hours of attendance and keep them separate from continuing education hours in the certificates provided to participants. Although these hours may not count toward credentialing, they might be worth something to a participant’s employer in recognition of overall time spent in conference attendance.

So, which is it – CE, CEH or CEU? Technically, contact hours are continuing education hours (CEs or CEHs). However, many in our field use these terms interchangeably with CEUs. So, when you hear someone talk about CEUs, make sure you find out what they are referring to. They may, in fact, be referring to contact hours, even though (technically) a CEU means something quite different.

Thomas Durham, PhD, LADC, has been in involved in the field of addiction treatment since 1974 as a counselor, clinical supervisor, program director, and educator. As Director of Training at NAADAC, he is responsible for the assessment, coordination, curriculum development, and delivery of training Prior to joining NAADAC, he worked in government contracting under SAMHSA (while at JBS International) and the Department of Defense (while at Danya International). He also served as the Executive Director of The Danya Institute and Project Director of the Central East Addiction Technology Transfer Center. A seasoned curriculum developer and trainer, Durham has been conducting training for over 25 years on a variety of topics on the treatment of addictions including motivational interviewing, co-occurring disorders, and clinical supervision. He holds a PhD in Psychology from Northcentral University, a Master of Arts degree in Counseling Psychology from Adler University, and a Bachelor of Arts degree in psychology from DePauw University.

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■ M EM B ER S H I P Help choose the future leaders of NAADAC! It’s election time again, and we are seeking new leadership to help us determine the direction of the Association. NAADAC holds elections every two years to select its Officers and four Regional Vice-Presidents (the other four Regional Vice-Presidents are selected on alternate years). This year, nine

C A D A A N r fo s te a id d n a C 8 Meet the 201 ns o ti si o P ip h rs e d a e L e v ti u Exec ge r tio ns Ma na , NA AD AC Co mm un ica

By Kr ist in Ha mi lto n, JD

well-qualified addiction-focused professionals have been nominated as candidates for NAADAC Executive Leadership. All 2018–2020 terms will begin on October 11, 2018, immediately following the 2018 NAADAC Annual Conference in Houston, TX. This spring, NAADAC received two nominations for President-Elect and two nominations for Secretary. Please find each candidate’s statements below in order to inform your vote.

NAADAC only received one nomination each for the positions of Treasurer and Mid-Atlantic, Mid-South, Northeast and Northwest Regional Vice-Presidents. Therefore, these five nominees will be seated in their nominated roles for the 2018–2020 term without an election. The winning candidates’ statements are listed below for your review. Congratulations to our five winners!

Voting starts on May 1, 2018 and ends May 31, 2018. All NAADAC members are eligible and encouraged to vote. Instructions for voting will be emailed to members and can be found at www. naadac.org/2018-leadership-elections. Members may vote online by logging into their naadac.org account or by mail. To request a paper ballot to vote by mail, please email HeidiAnne Werner at hwerner@naadac.org.

Please read the following statements by and for the candidates in order to help inform your vote this spring.

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C A N D I D AT E S F O R P R E S I D E N T - E L E C T PRESIDENT-ELECT CANDIDATE: Mita M. Johnson, EdD, NCC, LPC, LMFT, ACS, LAC, MAC, SAP Evergreen, CO mitamjohnson@gmail.com Summarize the nominee’s NAADAC activities: It has been a pleasure to serve NAADAC through various activities. I have had the privilege of being: a General Board member representing the Colorado State Affiliate CAAP, Regional Vice-President for the Southwest Region, member of NAADAC’s Executive Committee, and current Treasurer. I am the current Ethics Chair for NAADAC. It was an honor to go to Hong Kong with Gerry Schmidt several years ago, to provide NAADAC trainings related to NCC AP testing. There have been several opportunities to provide webinars for NAADAC related to HIV and other infectious diseases that our clients are exposed to while struggling with a substance use disorder. NAADAC’s annual conferences have been an opportunity for me to share current data and information related to drug trends, ethics, and clinical supervision as well as provide a SAP training Day 1. In 2017, I had the opportunity to work on rewriting NAADAC’s Basics of Addiction Counseling Desk Reference on Module I: Pharmacology of Psychoactive Substance Use Disorders and Module III: Ethical and Professional Issues in Addiction Counseling. I helped with test questions. I have participated on the Clinical Issues Committee, Ethics Committee (Chair), Finance and Audit Committee (Chair), National Education and Research Foundation (NERF) Committee, and Personnel Committee.

Philosophy statement of the nominee on the future of NAADAC: More than 21 million Americans age 12 and older struggle with a substance use disorder (SUD). Many of these individuals have other co-occurring behavioral health disorders. Nationally we are experiencing an unprecedented workforce crisis. Many states have 66% of the workforce they need to help persons and families struggling with SUDs. The human, social and economic costs of not treating SUDs are undeniable. Lack of qualified workers (recruitment concerns), inadequate compensation (retention concerns), insufficient professional development, and ongoing stigma/discrimination challenge the health of our profession. NAADAC’s mission is to unify, lead and empower addiction-focused professionals and the behavioral health profession. NAADAC is strategically positioned to understand our unique concerns and needs. NAADAC advocates for the delivery of the best, current science-based services. NAADAC is actively working with major insurance payers to recognize NCC AP national credentials and address compensation issues. NAADAC is purposefully involved in state/national government policy development, advocating on behalf of all providers along the entire continuum of care. NAADAC spearheads discussions and perceptions related to stigma. NAADAC is uniquely and tactically positioned to be the voice for the addiction profession and providers. I truly believe that NAADAC is committed through personnel and resources to promote and guard our profession.

Other qualifications of the nominee for this office: I have had the privilege of being a clinician, clinical supervisor, trainer, and educator for many years; I still maintain a clinical practice. I am of the strong opinion that our clients deserve the best services available, in stigma-free, bias-free environments. When we encounter stigma and discrimination we have an obligation to use our voices to address the situation, advocating for SUD clients and their families. I also have a passion for workforce development, including recruitment and retention. Recruitment needs to begin early

PRESIDENT-ELECT CANDIDATE: Thurston S. Smith, MPA, CCS, NCAC I, CADC Arlington, TN teesmith1@hotmail.com Summarize the nominee’s NAADAC activities: Thurston has served faithfully on both the NAADAC executive committee and state affiliate levels for over 15 years. More specifically, the nominee has served 2-terms as Southeast Regional Vice President, 1-term as National Membership Chair, 2 terms as NAADAC Secretary, and 1-term as SCAADAC Regional Representative.

Additional service activities include appointments to the following NAADAC and state affiliate committees: Peer Assistance Committee; International Committee; Veterans and Military Sub-Committee; Personnel Committee; and Credentialing Committees. Additionally, Thurston has passionately represented the interests of NAADAC, in both official and unofficial capacities, within the domestic and international healthcare arenas, while articulating the organization’s mission in an effective and meaningful way.

Philosophy statement of the nominee on the future of NAADAC: As the premier global organization for addiction-focused professionals, NAADAC must remain a visible, vocal, and viable force within the healthcare industry. With an emphasis on advocacy, parity, credentialing, and public education, NAADAC must ensure its members are both well trained and well positioned to address the growing needs of individuals and families impacted by addiction. While these ideals underscore the organization’s pledge to its members and other stakeholders, NAADAC should forever maintain a proactive stance within the public sphere. These goals should thoughtfully include a rigorous public policy program that candidly speaks to the skills and competencies of addiction professionals before Congress, while highlighting their indispensable contributions to the field. To these ends, the attainment of 100% parity for addictions treatment, including the professional licensure of addictions treatment providers should never be abandoned. As each precept effectively captures the organization’s “Four Pillars” and “key priorities”, the future of NAADAC will always be found within the constructs of a thriving member-driven workforce.

Other qualifications of the nominee for this office: As an Executive Career Field (ECF) employee within the U.S. Government, Thurston S. Smith currently serves as the Congressional Liaison for the Veterans Health Administration (VHA) in Memphis, Tennessee and has received a number of other public service appointments on the municipal, county, and state levels. A few of these include: 3 Mayoral appointments to the Shelby County Juvenile Justice Consortium (CJJC), 1 state appointment to the Tennessee Community Resource Board for the Department of Corrections; 1 gubernatorial appointment to the Charleston/Dorchester Mental Health Board; 1 gubernatorial appointment to the Charleston County Foster Care Review Board; and 1 State of South Carolina appointment as Liaison to Morehouse School of Medicine Addiction Technology Transfer Center (SEATTC). Thurston has been honored for his outstanding public service on two separate occasions through Proclamation by the Tennessee House of Representatives. Thurston has been awarded the designation of Senior Fellow by the American Leadership Forum (ALF)/ Leadership Memphis, and is a graduate of Leadership Beaufort and the Veterans Health Administration VISN-7 Leadership Program. Having worked in the addictions and mental health treatment field for over 25 years, Thurston has earned the reputation as sought after trainer within

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C A N D I D AT E S F O R S E C R E TA R Y Candidate for Secretary: Susan Coyer, MA, AADC-S, MAC, CCJP Huntington, WV susancoyer@outlook.com Summarize the nominee’s NAADAC activities: I have had the privilege of being involved in NAADAC and the West Virginia affiliate for 25 years. For the last 4 years, I have been honored to serve as the Mid-Atlantic Regional Vice President.

Prior to that, I was on the NCC AP for six years and chaired the ethics committee. I have also served on the NAADAC Membership, Conference, Bylaws, and Public Policy Committees. I am a past president of the West Virginia affiliate (WVAADC) and a delegate to the NAADAC Board of Directors for 4 years. With WVAADC, I also held the positions of secretary and conference, membership, awards, nominations and bylaws committees.

Philosophy statement of the nominee on the future of NAADAC: NAADAC’s membership and advocacy efforts are vital to support and grow our workforce. Workforce development and strong advocacy efforts are essential in ensuring the quality of prevention, treatment and recovery support services as well as improving treatment for individuals across the nation. Advancing legislation at both local and national levels is imperative to continue to support and enhance our profession. Established partnerships and new ventures allow NAADAC to have a meaningful impact on legislation and lead our membership into new horizons. NAADAC remains the voice of addiction professionals and the leader in advancing addition recovery. I see our organization growing and continuing as the leader in the growth and strengthening of our profession. Expanding our partnerships with other organizations relevant to NAADAC’s mission as well with our representatives in our States on Capitol Hill will allow us to continue the exceptional work that makes NAADAC the leader in our field.

Other qualifications of the nominee for this office: I have a master’s degree in counseling with an emphasis in addiction counseling. I have held a number of clinical and management positions in outpatient, intensive outpatient, residential, community housing and medication assisted treatment programs. My credentials include Master Addiction Counselor (MAC), Advanced Alcohol and Drug Counselor (AADC), Certified Clinical Supervisor (CCS) and Certified Criminal Justice Professional

(CCJP). I am currently a Regional Director with Acadia Healthcare in the Comprehensive Treatment Centers Division specializing in the treatment of opioid addiction. I have facilitated numerous workshops and training in Motivational Interviewing, Motivational Interviewing Assessment: Supervisory Tools to Enhance Proficiency (MIA:STEP), clinical supervision, Serious and Violent Offender Reentry Initiatives (SVORI) and ethics for addiction and prevention professionals. I have participated in numerous legislative activities at the State and National level.

Candidate for Secretary: Christopher Taylor, DBA, CASAC, LMHC, MAC Avon, NY candwtaylor@yahoo.com Summarize the nominee’s NAADAC activities: I have been involved in NAADAC since the late 1990’s, first as a Board Member of the New York Affiliate, NYFAC, then as a Board Member and eventually the President of the Association of Addiction Professionals of New York (AAPNY). I have served in a variety of capacities on behalf of AAPNY and NAADAC, including representation on the State Clinical Advisory Panel and, more recently, as a member of the Per Advocate Advisory Board of the The New York Certification Association (NYCA).

Philosophy statement of the nominee on the future of NAADAC: I believe that the future of NAADAC is brighter than ever. NAADAC is uniquely positioned to help shape the future of care that is provided to those who suffer from substance use disorders. Whether through strategic partnerships, National and International representation and collaboration, advocacy, continuing education, access to professional liability insurance, or professional certifications, our NAADAC is the preeminent “one stop shop” for addiction professionals. Coming from a state that is not a “NAADAC State”, I see the tremendous value that NAADAC offers and share this with others as often as I can.

Other qualifications of the nominee for this office: I have served in the capacity of Secretary for AAPNY in the past. I would sincerely appreciate the opportunity to do so for NAADAC.

C A N D I D AT E F O R T R E A S U R E R Candidate for Treasurer: Gregory J. Bennett, LAT, MAC Powell, WY 180degreedifference@gmail.com Summarize the nominee’s NAADAC activities: Executive Committee Member acting as: Northwest Regional Vice President 2011-2016. Wyoming Association for Addiction Professionals President 2006-2010. Wyoming Association for Addiction Professionals Past President 2010-2012. NAADAC Committees: PAC, Student Advisory and conference Committees.

Attendance to all Executive Committee Conference meetings. Attendance to every NAADAC Conference from 2009 to present. NAADAC Board of Directors 2006-2016 Philosophy statement of the nominee on the future of NAADAC: I see the behavioral health workforce growing exponentially in the coming

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years. NAADAC plays a vital role in many areas: Clinical, Professional, Certification, Political, Educational, Treatment Access, Third Party Payers, Organizational Development, Leadership and Governmental Relationships. I see NAADAC as being the Organization that, “Speaks for those who believe they have no voice.” NAADAC is a vital piece to the ever changing Behavioral Health System. NAADAC’s future is to cultivate a plethora of relationships with a variety of Stakeholders as a means to be the Leading Organization for Addiction Professionals striving to survive an ever changing Behavioral Health space.

Other qualifications of the nominee for this office: Gregory has many years of dedicated service on the NAADAC Board of Directors and Executive Committee Board. Gregory is highly ambitious, knowledgeable, passionate and dauntless in his endeavors.

C A N D I D AT E S F O R R E G I O N A L V I C E P R E S I D E N T MID -ATL ANTIC

MID -SOU TH

NOR THEAST

NOR THWEST

Candidate for Mid-Atlantic Regional Vice President: Ron Pritchard, CSAC, CAS, NCAC II Virginia Beach, VA ronpritchard@verizon.net Summarize the nominee’s NAADAC activities: While serving in the US Navy I served as a Drug Alcohol Program Advisor, SA Counselor, and a Counseling and Assistance Center Director.

I was first certified as a Virginia Addiction Counselor in 1986 and I have been a NAADAC Member since 1992. I have served three times as the Affiliate President of Virginia. I completed an unserved

Candidate for Mid-South Regional Vice President: Matthew Feehery, LCDC Houston, TX mattfeehery@comcast.net Summarize the nominee’s NAADAC activities: Matt is currently serving as Mid-South RVP and is helping to organize the 2018 NAADAC Conference. He has previously served as President of the Texas Affiliate, TAAP, and is TAAP’s current Finance Committee Chair.

Matt has been a member of TAAP and NAADAC since 1982. As MidSouth RVP he has worked with the non-active states to develop a stronger presence for NAADAC

Candidate for Northeast Regional Vice President: William A. Keithcart, MA, LADC, MAC, SAP Essex Junction, VT william.keithcart@uvmhealth.org Summarize the nominee’s NAADAC activities: I am currently completing my first term as the Northeast Regional Vice President for NAADAC. In this role, I implemented a monthly northeast affiliate conference call to provide support and guidance in how NAADAC can be of assistance to increase our influence in the northeast and on a national scale. On a monthly basis, I also

Candidate for Northwest Regional Vice President: Malcolm Horn, LCSW, MAC, LAC, SAP, NCIP Billings, MT mhorn@rimrock.org Summarize the nominee’s NAADAC activities: Current RVP for Northwest Region (10/2016 through 10/2018); focus on building state affiliates for states without leadership or active board; previous state president for Montana (10/2015 through 10/2017; president elect for 2 years prior to that; presenter (2017 Annual Conference, 2017 and 2018 Webinar series).

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term as Mid Atlantic RVP. I am currently the NAADAC Mil/Vet Advisory Committee Chair. I have served on NERF, PAC, and now on the NMFPAC Scholarship panel. I organize and provide membership recruitment events on military installations and college/university campuses. I am an advocate for increased recognition of certified addiction counselors and all addiction professionals within the behavioral healthcare community.

In particular I advocate for increased recognition of certified addiction counselors and all addiction professionals within the behavioral healthcare community. In particular I advocate for standardization of civil service pay grades commensurate with scope of practice within the workforce. I have written and presented a number of White Papers/Point Papers on the pay grade parity topic to pertinent authorities in both HHS and DOD training and discussion forums. I have collaborated with several MidAtlantic institutions of higher learning to foster development of Student and Veteran Student campus chapters for those seeking a SUD treatment provider career path.

Philosophy statement of the nominee on the future of NAADAC: I believe NAADAC will prevail as the single-most powerful advocate for the continued viability of well trained, well-paid and well-motivated addiction professionals who provide evidence-based and culturally appropriate SUD prevention, treatment and recovery to those in need. From a position of financial stability and with the technology to remain in the forefront in provision of education, training and information pertinent to the workforce, NAADAC will insure its membership is informed, trained and aware of developments affecting our profession. We must renew, develop and expand collaborative partnerships with organizations that share our common goals so we may speak with a unified voice regarding legislative issues pertinent to our membership and our clients. NAADAC must intensify advocacy with insurance providers and state SUD Treatment administrators to insure fair compensation for addiction professionals. NAADAC must initiate dialogue with OPM, TRICARE, DOD, VA and other entities regarding recognition and acceptance of standardized pay grades and scopes of practice within the DOD and VA organizations. I believe NAADAC must welcome Certified Peer Recovery Specialists/Coaches and ensure they are offered appropriate mentorship and supervision. NAADAC also must be vigilant for opportunities to offer our collective wisdom to any development adjunct services for the treatment of SUD. Other qualifications of the nominee for this office: As a trainer, speaker and advocate for the profession and the field, I have developed and delivered a number of advocacy and educational presentations to promote current best practices in prevention, treatment and recovery of SUD. I worked eight years as the SUD outreach and treatment navigator for the medically indigent in Norfolk, Virginia. I also have extensive active duty and civil service experience with the military and have developed and presented several training sessions on military culture, policies, procedures, and techniques of SUD treatment, obstacles, and expected outcomes in the Military/Veteran and family community. I have appeared at local HHS, CSB, Foreign Legion, and American Legion and on SAMHSA webinars to discuss the topic of SUD from a Military/Veteran perspective. I serve on three Governor’s Advisory Boards as the SUD advisor. I have provided editorial commentary and advice to Virginia’s Certified Peer Recovery Specialist Program. I was one of the developers of the Virginia Summer

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Institute for Addiction Studies (VSIAS) which will again host one of the premiere SUD conferences — the seventeenth — in the Mid-Atlantic this year. I continue to serve on the VSIAS Faculty/Board.

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and has planned a conference for counselors in Arkansas.

Philosophy statement of the nominee on the future of NAADAC: NAADAC should continue to focus on advancing and protecting the addiction counseling profession, helping to strengthen the credential, and improve opportunities for reimbursement.

Other qualifications of the nominee for this office: Matt has served in executive leadership positions in addiction treatment for the past 35 years. He currently is CEO of a large treatment facility that employs over 300 people. He understands the needs of addiction professionals from both a counselor and administrator point of view.

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participate in the NAADAC executive committee conference calls. I look forward to continuing with my current responsibilities in my second and final term in this position.

Philosophy statement of the nominee on the future of NAADAC: NAADAC is the voice of the addiction professional. As our profession continues to evolve, NAADAC serves a critical role in establishing the standards and credentials necessary to work in the field of addictions. Our discipline is currently going through a lot of changes. NAADAC can and should be leading the way for us to be recognized by other professional organizations for the quality of our work.

Other qualifications of the nominee for this office: I have had the pleasure of working in field of addictions for over eighteen years.

My first five years was as a clinician at Phoenix House Mountain View Treatment Center, 90-day residential program, followed by three plus years at the Chittenden Clinic, a methadone program, and the past ten years at DayOne, an outpatient substance use disorder program. As Program Supervisor of DayOne at the University of Vermont Medical Center in Burlington, Vermont, the academic setting allows an opportunity to supervise graduate students and train colleagues and medical personnel on the latest advances of best practice in our field. I currently sit on the Board of Directors of VAPA, Vermont Addiction Professionals’ Association and VAMHAR, Vermont Association of Mental Health and Addiction Recovery and Co-Chair the Chittenden County Opioid Alliance, Treatment Access and Recovery Support Action Team.

Kristin Hamilton is the Communications Manager for NAADAC, the Association for Addiction Professionals. She works on NAADAC public relations, communications, and digital media, including the NAADAC website and social media, is editor of NAADAC's two ePublications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate, and is associate editor for NAADAC’s magazine, Advances in Addiction and Recovery. She also contributes to the planning, organization, and administration of communication campaigns, administers the PhD Candidate Survey Program, and serves as the affiliate liaison for the Communications Department. Hamilton holds a Juris Doctorate from Northeastern University School of Law in Boston, MA and a Bachelor of Science Degree in Biology and Chemistry from Roger Williams University in Bristol, RI.

C A N D I D AT E S F O R R E G I O N A L V I C E P R E S I D E N T S (co ntin ued ) Horn, continued from page 15

Using leadership and educational roles, I have promoted the field of SUD treatment with the end goal of improving client care through reducing stigma and changing policy. By engaging stakeholders and constituents, I believe I am poised to continue the work that I have begun.

Philosophy statement of the nominee on the future of NAADAC: Improve access to care by reducing stigma and legislative actions; address workforce shortage issues by promoting national credential/licensure and portability NAADAC has the history and resources to truly change the face of SUD treatment on a micro and macro system; by pooling knowledge, skills and

connections NAADAC has the power to truly maximize impact and, thus, improve client care. No other organization is poised to do so and, as this is something I believe must happen in order to effectively care for our clients, I want to contribute to and be involved in the process.

Other qualifications of the nominee for this office: Malcolm has served as Rimrock’s Director of Learning for the past five years. She advocates for client’s rights and supports staff in personal and professional development. There is no one more suited to represent our region.

C A N D I D AT E S F O R P R E S I D E N T - E L E C T (co ntin ued) Johnson, continued from page 13

Smith, continued from page 13

and be ongoing, as a rewarding profession to pursue. Career ladders need to include educational and noneducational tracks. As a prominent health specialty, we need to define and defend what is within the addiction’s scope of practice. Our workforce needs diversity of providers, to appropriately represent the diverse populations served. We need to promote peer recovery services. Compensation is a huge problem that is not easily addressed; efforts must be directed here if we are going to retain the providers we recruit. Given the current workforce crisis, my intentions at NAADAC are to support and promote our workforce. I would like the opportunity to serve you as President, working actively on your workforce concerns and needs.

the profession and is modestly published.

Most recently, Thurston was appointed to the Shelby County Opioid Task Force by the Chairman of the Shelby County Commission.

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■ M EM B ER S H I P

NAADAC Annual Awards & Nominations Process

By HeidiAnne Werner, NAADAC Director of Operations & Finance Each year NAADAC and its members celebrate and honor people and organizations that have achieved excellence in the treatment, recovery, prevention, medical and educational sectors of our addiction profession over the past year.

Awards are given in seven categories and will be presented during NAADAC’s Annual Conference in Denver, Colorado at the President’s Awards Luncheon. It is important to recognize and honor the distinguished services, accomplishments, and contributions of individuals and organizations to continue to elevate and motivate the profession. Make sure to get your nominations in by May 31st!

AWARD C ATEGORIES ■ T h e ADDIC TION EDUC ATOR OF THE YEAR AWARD recognizes an adjunct or full-time ­college/university professor who has contributed through academia to the addiction profession through mentoring students/student chapters, colleagues or addiction professionals and/ or by providing ongoing research or other contributions that grow, enhance, advocate and educate for the addiction profession.

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■ The LIFETIME HONORARY MEMBERSHIP AWARD recognizes an individual or entity who/that has worked in the addiction profession for at least 25 years, has established through research, publications, presentations or by other means the significance of the addiction profession and its professionals, had demonstrated leadership, service, and contributions to addiction profession, and has supported NAADAC’s mission, vision and Code of Ethics.

■ The LORA ROE MEMORIAL ADDICTION COUNSELOR OF THE YEAR recognizes a counselor who has made an outstanding contribution to the profession of addiction counseling. To be eligible for this award, nominees must be currently employed as an addiction counseling professional and actively working as a counselor for not less than three years prior to receiving the award; be an active NAADAC member in good standing (the individual must be a voting member as opposed to an honorary or nonvoting member); have worked with clients (patients) for a sustained period with individual or group contact that fosters recovery from addiction disorders; preferably, be certified, registered or licensed as an addiction professional, although these qualifications are not mandatory; and have demonstrated to the satisfaction of one’s peers full compliance and support of NAADAC’s Code of Ethics.

■ The MEDICAL PROFESSIONAL OF THE YEAR recognizes a medical professional who has made an outstanding contribution to the addiction profession. To be eligible for this award, nominees must be currently employed in the addiction profession and actively working as such for a minimum of three years prior to receiving this award; hold licensure as a Medical Doctor, Registered Nurse, Licensed Practical/Vocational Nurse in their respective state; be an active NAADAC member in good standing (i.e., the individual must be a voting member as opposed to an honorary member or nonvoting member); be working with clients/patients for a sustained period with individual or group contact that fosters recovery from addiction disorders; and have demonstrated to the satisfaction of one’s peers full compliance and support of NAADAC’s Code of Ethics.

■ The MEL SCHULSTAD PROFESSIONAL OF THE YEAR AWARD r­ ecognizes an individual who has made outstanding and sustained contributions to the advancement of the addiction counseling profession.

■ The ORGANIZATIONAL ACHIEVEMENT AWARD recognizes an organization that has demonstrated a strong commitment to the addiction profession and particularly strong support for the individual addiction professional. To be eligible for this award, nominees must have been in existence for at least five years and cannot be affiliated with any other organization or company that sells, distributes or supports the consumption of alcoholic spirits or illicit substances.

■ The WILLIAM F. “BILL” CALLAHAN AWARD recognizes sustained and meritorious service at the national level to the profession of addiction counseling. To be eligible for this award, nominees must have a minimum of fifteen years in the addiction counseling profession or related administration, and possess a strong dedication to the addiction profession as demonstrated by involvement in and commitment to a variety of key organizations.

Nominating Information Any NAADAC member in good standing may nominate any eligible individual NAADAC member for any of the above individual awards.

Current members of the NAADAC Executive Committee are ineligible for all awards.

To nominate an eligible addiction professional for a NAADAC award, please submit: (1) a letter of recommendation stating how the nominee fulfills the award criteria; (2) at least three letters of support from three different sources (individuals, organizations, or agencies); (3) the nominee’s resume; and (4) a completed NAADAC Recognition and Awards Nomination Acknoweldgement Form.

To nominate an eligible organization for the NAADAC Organizational Achievement Award, please submit (1) a letter of recommendation including a detailed description of the nominated organization and how the organization has supported the addiction profession; (2) at least three letters of support from three different sources (individuals, organizations, or agencies); and (3) a completed NAADAC Recognition and Awards Nomination Acknowledgement Form.

The NAADAC Recognition and Awards Nomination Acknolwedgment Form requires the nominee to sign a statement acknowledging that he/she meets all of the eligibility 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 Acknowledgement Form and the specific eligibility criteria for each award, please visit: www.naadac.org/recognition-and-awards.

All award nomination packets must be received by May 31, 2017 for consideration by the NAADAC Awards Committee.

To nominate an individual or organization, please send the required documentation to: NAADAC, the Association for Addiction Professionals Attn: Awards Committee Chair 44 Canal Center Plaza, Suite 301 Alexandria, VA 22314

Materials may also be faxed to the NAADAC Awards Committee (Attn: Director of Operations) at 703.741.7698 or sent by e-mail 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.

Questions?

For more information, please visit www.naadac.org/awards. For further questions, please email NAADAC at naadac2@naadac.org or call 703.741.7686.

HeidiAnne Werner is the Director of Operations & Finance for NAADAC, the Association for Addiction Professionals. Werner has had an extensive career in association management. After starting out as a meeting planner with The American Association of School Administrators, she worked on tradeshows for VNU Expositions, and was the Registration Manager for The Consumer Electronics Association (CEA), where she was responsible for managing all registration for the largest annual tradeshow in the United States. After spending three years at CEA, Werner moved to the vendor side to work with Integrated Software Solutions, Inc. (ISSI), where she eventually became the Executive Vice President, Sales and Administration. During her time at ISSI, Werner consulted with over 100 different associations, advising on business practices and implementation and better use of association management software system and accounting system to run their organizations more efficiently. Werner holds a Bachelor’s Degree in Economics from Denison University.

NAADAC is now accepting submissions for the

William White

Student Scholarship This award was created to promote student addiction studies research and develop the importance of student research projects in NASACaccredited programs, NAADAC-approved programs in higher education, or an accredited addiction studies collegiate program acknowledged by the Higher Learning Commission (HLC). It is awarded to one graduate NAADAC Student Member and one under­graduate NAADAC Student Member with the best addiction research paper on one of the assigned yearly topics.

Award benefits: Students will receive a monetary award ($2,000 for graduate; $1,000 for undergraduate), and will be recognition at the 2018 NAADAC Annual Conference in Houston, Texas on October 8.

Application submission: The completed application form, academic transcript, letters of reference, and the research paper must be submitted electronically to naadac@naadac.org, Attention: William White Scholarship.

Submission Deadline: May 31, 2018 For complete information, including the 2018 research paper topics, eligibility and application requirements, please visit:

www.naadac.org/white-scholarship

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Partnerships to Help End the Opioid Crisis

T

By Jack B. Stein, PhD, and Eric M. Wargo, PhD, National Institute on Drug Abuse

he escalating rates of opioid misuse and addiction in the U.S. have many causes, including overprescribing of opioid analgesics starting in the late 1990s and later an influx of high-quality heroin and now fentanyl. But the epidemic of deaths that has resulted from this crisis is partly a symptom of our society’s sluggishness to recognize substance use disorders as medical conditions and people with these disorders as patients needing and deserving of medical care rather than punishment. A positive effect of the enormous attention now being given to the opioid crisis — however belated — is that these attitudinal barriers are finally breaking down, and medical treatments for opioid use disorders are becoming more accepted and understood and utilized in a wider range of healthcare contexts (such as emergency departments) as well as in the criminal justice system.

Unfortunately, the range of available treatments for opioid addiction remains limited. Buprenorphine, approved in 2002, has proven extremely successful, with numerous studies showing effectiveness on par with the only medication available until then, methadone. And because buprenorphine is a partial rather than full agonist at the mu-opioid receptor, it has a slightly better profile for safety and misuse risk: it is hard for an opioidtolerant individual to obtain euphoria from this drug. But as with methadone, many factors have made it hard to administer and utilize, especially for people in rural areas without frequent access to a health-care provider who is waivered to prescribe it and who can continuously monitor the treatment.

The approval in 2016 of Probuphine, a buprenorphine implant, was a first step toward greater versatility of buprenorphine treatment, although it delivers a low dose and thus is not appropriate for the majority of patients. In November 2017, the FDA approved Sublocade, a once-monthly buprenorphine injection that delivers a sufficient dose to treat patients with moderate to severe opioid use disorder; other depot formulations of buprenorphine are also in the drug-approval pipeline. These medications could potentially greatly extend the reach of maintenance treatment.

Naltrexone, the third currently approved medication for opioid addiction, faces its own challenges in proving itself, in part because of compliance

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issues — unlike methadone and buprenorphine, it does not minimize cravings or withdrawal symptoms but instead blocks the effects of opioids at the mu-opioid receptor. The approval of extended-release naltrexone (Vivitrol) in 2010 went a long way to address compliance, as the patient only needs to make the right decision once a month, instead of once a day. Still, a lack of head-to-head comparisons with other medications left uncertainty in providers’ minds as to its effectiveness. Two recent trials however, one in Norway1 and one in the United States2, compared extended-release naltrexone to buprenorphine and found the drugs equally effective at preventing relapse and retaining patients in treatment once they could be successfully inducted. The “detoxification hurdle” — the need to detoxify the patient initially and thus face the risk of noncompliance with the treatment plan in the induction phase — needs to be addressed, but from these trials we now have reason to believe that extended-release naltrexone is as effective as buprenorphine once this hurdle is cleared. However, more research is needed, including research on the safety of naltrexone during pregnancy.

Even though three effective medications are FDA approved to treat opioid use disorders, new medications as well as non-pharmacological interventions are needed. Not all opioid-addicted patients respond to the medications currently available, and each of the medications has drawbacks associated with it. Thus, a broader treatment toolkit comparable to the range of treatments available for other chronic conditions is essential.

Likewise, a wider range of overdose-prevention tools is needed, partly because overdoses on new powerful synthetic opioids like fentanyl are requiring multiple naloxone administrations. And because opioid addiction is so entangled with pain, addressing opioid addiction and overdose means developing new, non-addictive pain treatments.

To these ends, the National Institutes of Health (NIH) has embarked on an ambitious strategy of leveraging public-private partnerships to find and implement solutions to the crisis. At the National Rx Drug Abuse and Heroin Summit in Atlanta last April, NIH Director Francis Collins announced an initiative to cut in half the time it takes to develop new therapeutics, and since then NIDA has convened several meetings bringing together experts and representatives from government, the pharmaceutical

industry, and academia3. The partnership is still taking shape, but initial action steps will likely include accelerating the development of new formulations and combinations of existing opioid-addiction medications and overdose-reversal tools, as well as identifying ways to repurpose existing or abandoned medications for addiction or pain or to reverse overdose. Over the longer term, the partnerships will work toward goals that may include the development of new, safer and more effective treatments for pain and the development of new, objective pain assessments and biomarkers.

There are many areas where our efforts could produce novel drugs and treatment strategies in a shorter-than-usual timeframe; NIDA Director Nora Volkow and NIH Director Francis Collins outlined several possibilities in the New England Journal of Medicine last July4. Within a few years, we could see stronger formulations of naloxone for addressing fentanyl overdoses, for instance, as well as additional depot formulations of approved addiction medications and misuse-resistant formulations of existing pain medications. Also, various existing medications show potential to be repurposed to treat addiction. For example, lorcaserin, an FDA-approved diet drug that acts at a serotonin receptor, has been found to reduce opioid seeking in rodents and could be studied in humans; lofexidine, a hypertensive drug currently being used in the UK for opioid detoxification, is being studied for its ability to control opioid withdrawal symptoms.

In addition, our rapidly increasing scientific understanding of the mechanisms of pain and addiction point to a wide range of novel pain treatments that could appear over the longer term. One of the many drug development strategies that looks promising is the use of so-called biased agonists at the mu-opioid receptor. Studies of that receptor have shown that the signaling pathway that causes pain relief is conveniently distinct from the one that causes reward and respiratory depression, raising the possibility of a compound that could decouple the desired effects from the harmful side effects. Phase 2 trials of one biased agonist successfully produced pain relief without producing reward and respiratory depression, and thus this could, if successful in further trials, spur accelerated development of a new, truly safe generation of opioids.

Compounds that target other receptor systems such as the endocannabinoid system are also actively being studied for possible therapeutic benefit both in pain and in addiction treatment. Alternative approaches such as vaccines that recruit the body’s immune system to neutralize drug molecules and transcranial magnetic stimulation for pain and addiction are other areas for research, as are technologies such as wearable devices that might detect an overdose and automatically administer naloxone.

Of course, new medications and technologies alone will not cure opioid addiction or solve the overdose epidemic. We also need better delivery of existing evidence-based treatments (both behavioral treatments and medications) to people with opioid use disorders, most of whom currently do not receive any form of care. NAADAC members are well-poised to ensure that quality treatment is supported by evidence and is delivered with fidelity. As addiction treatment becomes increasingly integrated with the general healthcare system, many of these challenges can be addressed.

NIDA has always supported research on addressing opioid addiction; partnerships between NIDA and industry led to the development and approval of buprenorphine and some of the newer tools poised to make an impact on the problem. We are currently taking, as Volkow and Collins put it, an “all scientific hands on deck” approach5, and the combined will of government and industry to work together to end this health crisis provides much reason for optimism. Science can and will provide solutions.

(References) Tanum L, Solli KK, Latif ZE, et al. “The effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial.” JAMA Psychiatry 74(12):1197-1205. (2017).

Lee JD, et al. “Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial.” The Lancet (2017). [epub ahead of print]. doi: 10.1016/ S0140-6736(17)32812-X. U.S. Department of Health and Human Services. “NIH Initiative to Help End the Opioid Crisis.” (2017). Available at: https://www.nih.gov/research-training/medical-researchinitiatives/opioid-crisis/public-private-partnership Volkow ND, Collins FS. “The role of science in addressing the opioid crisis.” New England Journal of Medicine 377:391-394. (2017).

Volkow ND, Collins FS. “All scientific hands on deck to end the opioid crisis.” NIH Director’s Blog. https://directorsblog.nih.gov/2017/05/31/all-scientific-hands-on-deck-to-end-theopioid-crisis/ Jack Stein, PhD, MSW, joined the National Institute on Drug Abuse (NIDA) in August 2012 as the Director of the Office of Science Policy and Communications (OSPC). He has over two decades of professional experience in leading national drug and HIV-related research, practice, and policy initiatives for NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.

Eric M. Wargo, PhD, is a science writer in the Science Policy Branch of the Office of Science Policy and Communications at the National Institute on Drug Abuse (NIDA). Before coming to NIDA in 2012, he was Editorial Director at the Association for Psychological Science (APS) in Washington, DC. He received his Ph.D. in Anthropology from Emory University in 2000.

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Preparing Clinicians for the Future of Behavioral Healthcare

By Raymond V. Tamasi, MEd, LCSW, LADC-I

A

s we continue to move closer to the integration of behavioral health with general medical care, there is concern that Behavioral Health (BH) clinicians are ill prepared to work in a medical environment. Those who contend that “we’ve heard this before” should think twice before assuming that integration is just another “thing of the day.” As data mining has become more sophisticated and as health systems dig deeper into the healthcare cost drivers, few can continue to ignore the cost disparities caused by behavioral health disorders. It is generally accepted that costs for patients with a medical condition who have a substance or mental health co-morbidity are 2½–3 times higher than for those without these disorders.1 A 2014 analysis by the Massachusetts Center for Health Information and Analysis (CHIA) on hospital readmission rates revealed striking disparities in seven major medical conditions between patients with and without a BH co-morbidity.2 (Figure 1) READMISSION RATES & BH COMORBIDITY Arrythmia

13.2%

Kidney Disorders

13.2%

21.5%

21.5% 18.1%

Renal Failure 12.7%

Pneumonia

21.0% 15.4%

COPD Septicemia & Infections

26.4%

15.8%

23.2% 18.9%

Heart Failure 0.0%

22

27.0%

5.0%

10.0%

15.0% 20.0% ■ W/O BH ■ With BH

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29.4% 25.0%

30.0%

35.0% CHIA-2014

In addition to these facts, it is reported that upwards of 70% of primary care visits are related to psychosocial issues but only 20–30% of these ­patients inform their Primary Care Physician (PCP) about their concerns.3 Even when a PCP identifies an issue, it is well documented that few patients follow through and keep appointments with addiction or mental health professionals.4 The evidence is clear and the opportunity to make a difference awaits.

Practice Methods in the Integrated Care Model There are several variations on the models of integrated care as delineated by the Center for Integrated Solutions at the Substance Abuse and Mental Health Services Administration (SAMHSA) (Figure 2).

LEVELS OF “INTEGRATION” ➢ LEVEL 1: Minimal Collaboration – Separate Systems, little communication ➢ LEVEL 2: Distance Collaboration – Separate Systems, periodic communication ➢ LEVEL 3: Onsite Collaboration – Co-location, still separate; frequent communication ➢ LEVEL 4: Partial Integration – Same site, common scheduling/charting, but BH and medical still seen as separate entities ➢ LEVEL 5: Full Integration – Same site, same vision, same team, a full unified practice

These range from totally separate systems with a loosely defined referral arrangement to a fully integrated system where the BH clinician functions as a member of the medical team. The latter is the most effective and the one that requires a modification of traditional clinician skill set and practice methods. This skill set requires a new way of thinking about the clinician’s role and purpose — more of a population health view than that of a specialty provider. The following table identifies these contrasting approaches.

Integrated Practice Model

Current Practice Model

Barriers and Challenges

15–20 minute visits

45–60 minute visits

No limit on # of patients per day

5–7 scheduled appointments

Open Access — Same Day Visits

Waiting Lists

Interruptible

Do Not Disturb

Instruct, Guide, Enhance

Diagnose and Treat

Minimal Stigma

Stigma Usually Very High

Patient “Ownership” is Shared

Clinician “Owns” the Patient

PCP Always Involved

PCP Rarely Involved

Interventions Support Medical Staff

BH Issues Addressed Independently

Documentation in a Unified Record

Documentation Stands Alone

Referrals from Medical Staff

Referrals from the Community

It’s one thing to advance a theoretical model and while there are many demonstrations of integrated care in the country, several challenges remain.

Significant Training Gaps On both sides, the BH provider side and the primary care side, there is still insufficient understanding and appreciation for reciprocal value.

Because this is a new approach, clinicians need in-depth understanding of what it means to work in a medical setting. And medical providers need to better understand that behavioral health issues are not always defined by the most extreme severity level.

Reimbursement and Regulatory Challenges Because historically reimbursement for medical treatment and reimbursement for behavioral healthcare have been in two separate buckets based on separate systems of care, getting these services paid for remains a thorny issue. Sure, co-located BH provides can bill insurers but only as a mutually exclusive provider and that’s not full integration.

Privacy and Confidentiality Understanding the great concern with the privacy of sensitive behavioral health issues, I think this obstacle will ultimately be more perceived than real. The laws and regulations governing access to records of substance use disorder patients have been understandably restrictive. But, I believe that stigma can be greatly reduced through integration and, let’s face it, treatment of the whole person in a unified system requires that there be information exchange.

Clinician moves rapidly between patients

Clinician focused on 1:1 Interaction

No Cancellations

Frequent Cancellations or No Shows

These differences will require a considerable adjustment for clinicians who have spent years in specialty addiction or mental health clinics. Not everyone will be able to function in the fast-paced environment of a medical practice where visits are brief, solution oriented, and primarily supportive of a medical intervention. Are you willing to be a member of a team and do you have the political and personal skills to function in a busy medical practice? How comfortable are you moving between patients or being called into an exam room on a moment’s notice to assist a medical provider? Can you adapt to a model that relies more on lifestyle modification guidance or instruction than on diagnosis and therapy? Does your skill set enable you to “share” the patient or are you more comfortable in an exclusive therapeutic relationship? These are just a few of the questions to consider.

The Advantages of Integrated Care There are many rewarding aspects of doing clinical work in a medical setting and for those who take the time to enhance their skills, the task will be well worth it. Think of the opportunity this model presents — engaging with individuals before their condition becomes so acute that they have to go to a specialty behavioral health provider. Our current model sits back and waits for patients to get sick or desperate enough to finally pick up the phone and make that call. And then, when they finally do, often they are given an appointment several days or weeks out — enough time for them to decide they don’t really need counseling. How much better is it for the patient to visit his/her PCP in a setting that has no stigma, in a waiting room with other patients none of whom know why the others are there?

This is how care should be provided for most patients. And for those who may need something more than can be provided via a brief intervention in the PCP office, there is always the referral to specialty addiction or mental health care. It’s not unlike what the physician might do when other health problems rise to the need for specialty care. If the EKG doesn’t look right, your doctor may, at some point, determine that you need to see a cardiologist. It’s the same with behavioral health — if the condition requires more intense intervention, the referral is made to specialty care. But, this time the collaborative relationship is established between the PCP and specialty BH care, with feedback loops on both ends. It starts to look more and more like a unified approach to healthcare, all to the patient’s benefit.

The Dawning of a New Age For some, the prospect of a new approach will be threatening. For others, it will be the opening of doors that have long been shut to behavioral health providers. I think about it this way. The number of diagnosable addiction cases in the USA is about 25 million; about 15% of those receive treatment, mostly from specialty addiction providers (detox, rehab, outpatient). That leaves about 21 million untreated. There’s another cohort of about 60 million people identified as substance misusers. That’s about 80 million people affected by alcohol or other drugs who don’t get clinical attention. Where are they? Most of them go to their doctor for physicals or treatment for illnesses. This is where we need to be; this is where we can make a real difference; and this is where behavioral healthcare is going. It’s time for clinicians to embrace the future.

(Notes) 1 Melek, S., Norris, D., Paulus J., (2014), The Economic Impact of Integrated Medical-BehavioralHealthcare; Page 4, Milliman American Psychiatric Association Report.

2 Center for Health Information and Analysis, August 2016, Behavioral Health and Readmissions in Massachusetts Hospitals.

3 Croze, C., (2015), Healthcare Integration in the Era of the Affordable Care Act, Prepared for the Association for Behavioral Health and Wellness.

4 Slay, J.D., & McCleod, C. (1997) Evolving an integration model: The Healthcare Partners experience. In N.A. Cummings, J.L. Cummings, and J. Johnson (Eds.) Behavioral health in primary care: A guide for clinical integration (pp 121-144). New York: International Universities Press.

Raymond V. Tamasi is the former President and CEO of Gosnold on Cape Cod, a provider of addiction and mental health prevention, treatment, and management. He is currently the President and Founder of the Gosnold Innovation Center, a division devoted to the development of new approaches to addiction care. He is a frequent speaker on issues of policy and practice.

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From Opioid Addiction to Recovery: Overcoming Barriers to Effective Treatment

By Shareh Ghani, MD

D

eaths from prescription opioid abuse have more than quadrupled since 1999, prompting President Donald Trump to declare the opioid epidemic a national public health emergency.1 But while discussions around opioid abuse prevention have intensified, numerous barriers to recovery continue to exist.

For example, one of the most effective ways to combat opioid addiction is through medication-assisted treatment (MAT), an evidence-based approach that combines medication with psychosocial intervention. MAT empowers those suffering from opioid use disorder (OUD) to recover from their addiction while rebuilding their lives.

However, the stigma often related to MAT — on the part of both the medical community and addiction support professionals, as well as patients’ family members — continues to limit its use across the industry. Further, the need to educate communities and legislators about the complex issues surrounding addiction treatment cannot be overstated. Addiction should be considered a chronic condition, and such treatments need to be viewed the same way.

The Complexities of Opioid Recovery Recognized to lower rates of opioid addiction and overdose as well as reduce the potential for relapse, MAT works by decreasing opioid cravings and mitigating the effects of withdrawal. In one study, more than half of patients treated with MAT reported opioid abstinence 18 months after beginning treatment. Further, abstinence rates rose to 61 percent three and a half years after beginning MAT.2 However, in spite of the value of MAT in supporting successful OUD recovery, it has not yet seen widespread adoption from the medical, mental health, and behavioral health communities. Across the nation, waitlists for MAT exist — not due to a shortage of MAT drugs, but rather a lack of professionals who are certified or willing to prescribe treatment.

For example, to prescribe buprenorphine, physicians must take an eighthour course and then apply for a license supplement. As such, resistance to meeting these requirements is strong: while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine. Sixty percent of rural counties in the U.S. do not have a physician who is certified to prescribe buprenorphine.3 And even among physicians who are licensed to prescribe buprenorphine, the majority do not prescribe buprenorphine.

The factors that limit access to MAT are complicated. Often, physicians who treat OUD patients cite a lack of care management staff, space and psychosocial support services.4 Additionally, patients who suffer from opioid addiction can also be considered “difficult patients,” and this stigma makes physicians reluctant to commit to prescribing MAT, which may require care for a year to 18 months or longer.

There is also the stigma that use of MAT simply enables patients to replace one addiction with another. It’s a belief held not only by clinicians but also by peer support groups and family members of those suffering from addiction.

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Additionally, lack of understanding around how to administer MAT contributes to low adoption rates. For example, some physicians mistakenly believe patients must withdraw from MAT before receiving treatment for other conditions.

Supporting a Successful Recovery How can physicians, other medical professionals, and addiction professionals more effectively support patients suffering from OUD to increase their chances for a successful recovery? There are five strategies addiction professionals should consider.

• Commit to MAT education and training. In-depth education around evidence-based MAT protocols is critical to addressing preconceived notions about MAT, which impact both access to treatment and recovery outcomes. By providing MAT education for physicians, addiction professionals and the community, healthcare leaders not only will support improved outcomes for OUD patients, but also help to erase the stigma associated with prescribing such treatment. Consider lunch-and-learn sessions for physicians, nurses and staff, addiction professionals, community education programs offered at local centers, libraries and churches, and one-on-one education for loved ones supporting the patient’s recovery journey.

• Combine MAT with supportive psychosocial interventions.

Research shows that patients who receive MAT combined with psychosocial interventions have better outcomes than those who are treated with drugs or behavioral therapy alone. Additionally, treatment that includes individual counseling, family therapy and peer-to-peer support groups increases adherence to patient care plans.5 Screening and treatment for behavioral health conditions such as depression and post-traumatic stress disorder — conditions that contribute to the experience of pain — also are essential.

One approach to psychosocial intervention is contingency management, an evidence-based approach to therapy that rewards patients for positive behaviors such as submitting a clean urine sample, attending counseling sessions or meeting weekly goals. Another approach is motivational interviewing, a type of behavioral therapy in which counselors help patients understand how addiction is keeping them from achieving their life goals. These approaches help patients move from denial to acceptance and, ultimately, to action.

• Actively address the stigma related to addictions treatment, including MAT, with patients, their families and their peers.

Removing the stigma associated with MAT requires ongoing dialogue and awareness not only within the medical community, but also among those who will support a patient’s recovery — including addictions professionals and support groups. Often, use of MAT is viewed as replacing one drug with another. When any member of the patient support team questions the validity of MAT, this weakens the patient’s access to or commitment toward this evidence-based, life-saving approach.

Look for ways to leverage waiting room and lobby posters, brochures, and materials on your website to explain why MAT is the right approach for some patients with opioid use disorders. Seek opportunities for in-person dialogue with family members and support group leaders to dispel myths and solidify support for patients in need.

• Look for ways to assess patients’ risk for relapse in real time. For example, some tools use comprehensive claims data to help identify individuals who face increased risk for persistent opioid use in real time, at the point of care. By analyzing prescription fill behaviors, such tools flag individuals who exhibit persistent use of opioids and help target interventions for inappropriate opioid use. Examine ways to leverage these tools to monitor MAT patients’ risk of straying from their treatment plan and putting their recovery in jeopardy.

Look for opportunities to actively collaborate with providers across the continuum of care in support of the patient’s recovery.

Moving Past the Stigma When it comes to opioid addiction recovery, the potential for relapse is high, especially in the early stages of recovery when patients’ resolve is fragile.

Evidence-based approaches to opioid treatment, such as MAT, are critical to patients’ successful transition toward becoming fully functional members of society. But MAT alone is not enough to aid this transition.

Support from all key stakeholders in the recovery process — from physicians to addictions professionals to peer support specialists to family members and peers — is critical to achieving the best possible outcomes.

Take the time to dispel the myths about addictions treatments, including MAT, and to investigate their potential to make a difference for the communities you serve. Ultimately, an informed approach to treatment for patients suffering from opioid addiction will provide patients with the tools needed to live addiction-free lives.

(Endnotes) 1 Opioid Overdose. (2017, August 30). Retrieved from https://www.cdc.gov/drugoverdose/ epidemic/index.html 2 Sarlin, E. (2015, November 20). Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields “Cause for Optimism”. Retrieved from https://www.drug abuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatmentaddiction-to-pain-relievers-yields-cause-optimism 3 Andrilla, C. H., Coulthard, C., & Larson, E. H. (2017). Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder. The Annals of Family Medicine, 15(4), 359-362. doi:10.1370/afm.2099 4 Andrilla, C. H., Coulthard, C., & Larson, E. H. (2017). Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder. The Annals of Family Medicine, 15(4), 359-362. doi:10.1370/afm.2099 5 Medication-Assisted Treatment Improves Outcomes for Patients With Opioid Use Disorder.

(2016, November 22). Retrieved from http://www.pewtrusts.org/en/research-andanalysis/fact-sheets/2016/11/medication-assisted-treatment-improves-outcomes-forpatients-with-opioid-use-disorder Shareh Ghani, MD is the vice president and medical director for Magellan Healthcare. A diplomate of the American Board of Psychiatry and Neurology, he began his career in inpatient psychiatry and worked as a consultation and liaison psychiatrist for many years. He has worked as a psychiatrist in traditional ambulatory care settings and in urgent psychiatric care environments.

Ghani previously served as the chief medical officer for Magellan Health Services for the Maricopa Contract in Phoenix, Arizona from 2010 through 2014. He has a deep interest in quality outcomes and analytics and has published several research papers and has presented at many academic and research conferences.

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Licensing Board Defense Coverage

By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

T N I A L COMP

W

hen considering the purchase of an insurance policy to cover professional services, most counselors are legitimately concerned about lawsuits that may be brought by a dissatisfied client or family member since lawsuits are costly to defend in terms of time and money. And since the monetary values of judgments or settlements tend to increase over time, one can expect a lawsuit that is filed today to have a higher settlement amount than it would have had a decade ago. As an insurance provider for professional liability for mental health and addiction specialists, it is not surprising to hear most of our insureds say their biggest concern is a lawsuit.

However, the reality is that you are far more likely to have a complaint brought against you by a state licensing board than to have a lawsuit brought against you. In fact, after a 10-year review of all claim reports made to our office, licensing board complaints outnumber lawsuits two to one. In addition, calls to our office in which an insured seeks legal help due to the receipt of a subpoena for records or for legal guidance due to the need to attend a deposition hearing also exceeded the number of lawsuits filed.

Here is how claims or complaints reported to our office broke down over the last ten-year period: Number Board Complaints

666

Requests for legal assistance arising from the receipt of a subpoena for records or for legal representation at a deposition

469

Lawsuits

331

TOTAL:

1,466

Lawsuits are a demand for money, brought by clients or family members as a remedy for an injury they feel was caused by the actions of a counselor.

To bring a lawsuit, the plaintiff must demonstrate that an injury occurred to them. The plaintiff has a burden of proof to demonstrate that they suffered or continue to suffer injuries, whether physical or emotional.

Complaints to licensing boards or other regulatory authorities are not demands for money. When clients file complaints to licensing boards or similar authorities, they want disciplinary action taken against the counselor.

They must demonstrate that the counselor breached legal or ethical standards or that the counselor is providing services they are not licensed or certified to provide. It must be stressed that state licensing boards exist to protect the public, not the counselor.

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Why Do More People File More Licensing Board Complaints?

So why is an unhappy or angry client twice as likely to report a counselor to a licensing board or other regulatory authority instead of bringing a lawsuit against the counselor? Mostly, it comes down to which process is easier and less disruptive to the client.

To bring a lawsuit against a counselor, a client must first find a lawyer willing to take his or her case. The client must then be able to prove that an injury has occurred. Most injuries claimed as a result of the counselorclient relationship are not physical but emotional in nature. Since emotional injuries are harder to prove than physical injuries, a client can expect a process that is more expensive and time consuming.

In contrast, the process of filing a complaint against a counselor with a licensing board is easier, less time consuming, and much less expensive than initiating a lawsuit. First, depending on the state, complaints can be filed online or mailed in for free, negating the need for a lawyer. Second, in most cases, a final disposition can be expected in a shorter period of time than it normally takes to settle a lawsuit (months vs. years), but some board complaints have been known to drag on for years as well. Third, a complainant does not have the difficult burden of showing that he or she suffered an emotional injury from an alleged offense; he or she just has to show that a counselor was practicing outside the scope of his or her practice, expertise, or the legal boundaries of his or her profession.

In addition, filing a complaint with a licensing board has at least three additional benefits: 1. Many states do not have a statute of limitations that would act as a barrier in lodging a complaint to a licensing board, allowing a complaint to be filed at any time regardless of when the alleged offense occurred. Other states give a longer statute of limitation time period for filing board complaints than for filing lawsuits.

2. Regardless if the board initially feels that there may be no merit to a complaint, the board will open an investigation to investigate all complaints.

3. Some complainants first file board complaints to test the waters.

A successful board complaint outcome will increase the chance of success with litigation so the proper defense of a board complaint is very important.

Defense Coverage: Lawsuit vs. Licensing Board Complaint Almost all insurance policies that provide professional liability for counselors will also provide a separate limit of coverage for licensing board hearings defense coverage. It is important that the counselor knows the difference between defense coverage provided for a lawsuit versus how defense costs are handled for licensing board complaints.

With a lawsuit, most insurance companies provide first dollar defense coverage. The insurance company assigns lawyers to defend the insured and the costs for defense are borne by the insurance company. In most cases, the expense to defend a lawsuit is unlimited and will not erode the limits of liability provided under the policy. The insured does not have the right to choose his or her own defense lawyer. The insurance company will either use its own in-house team of lawyers or choose a firm from an approved panel of law firms it has used in the past.

If there is a board complaint, insurance companies generally will not provide lawyers to defend the insured. The insured chooses his or her own lawyer and the insurance company will reimburse the insured for the legal costs subject to the limit provided under the policy. Some insurance companies only offer one limit to reimburse an insured for licensing

board hearings, usually $25,000. The insurance coverage provided by our policy offers a range of limits to choose for this coverage, from $5,000 to $150,000. Our 10-year review of the costs to defend licensing board complaints show 69% of complaints are resolved for under $5,000, 96% of complaints are resolved for under $25,000, and a few complaints did take up to $100,000 to defend. If the cost to defend a licensing board complaint exceeds the limits purchased under the policy, the insured bears the cost of lawyer fees that exceed the policy limit.

If a licensing board complaint is made, a counselor may feel anxiety and even anger. The prospect of a long and tedious board investigation with the likelihood of releasing records to a licensing board can be extremely disruptive. This can be a serious distraction to counselors and their practice.

The good news is that most board complaints are dismissed in the early stages of an investigation and there is no permanent record of the complaint unless sanctions are levied against the counselor.

If the complaint is found to have merit, a lengthier investigation and the counselor’s appearance before the board may be required. If the complaint is not dismissed at this stage, the board may decide on an action ranging from a reprimand to a revocation of the license. A common outcome is the suspension of the counselor’s license which is stayed if a Consent Order is signed by the counselor detailing a course of action the counselor must agree to in order to keep practicing. The courses of action can include continuing education, supervision, therapy, restrictions of the counselors practice and a monetary fine. Fines imposed by a licensing board are generally not covered by a professional liability policy.

How to Avoid a Licensing Board Complaint From the perspective of an insurance company that has handled many lawsuits and board complaints, here are our suggestions to help avoid a board complaint: 1. Know the laws that pertain to your license, both state and federal. Thorough knowledge of reporting laws in cases of suspected abuse or neglect is a must. Refresh your knowledge of these laws annually.

2. Belong to a professional coun selors association and adhere to its code of ethics. Professional associations keep you abreast of the changing environment of your profession and the rules and regulations that shape it.

Most also offer continuing education and ethics training.

Counselors that belong to professional associations are considered better insurance risks than those that do not.

3. Many board complaints that result in sanctions are directly attributable to insufficient documentation. Documentation is your best defense. It can mean the difference between board complaints being dismissed or proceeding forward. The “Less is More” theory of life S P R I N G 2 018 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 27

does not apply when it comes to documenting your files. Spotty documentation can be worse than none at all so document, document, and document!

4. Give particular attention to record keeping and reporting procedures when providing services related to child custody and fitness for duty evaluations. A large percentage of board complaints arise from these areas.

5. Have a network of professionals to touch base with when faced with questionable situations. Be pre-emptive if an incident occurs that you feel could lead to a complaint. Reach out to other professionals for guidance. This includes your insurance representative. We can provide guidance before complaints or claims are filed. Risk management departments of insurance companies can often mitigate a situation from escalating further if they are contacted early enough.

What to Do If a Board Complaint Is Filed Against You

1. Do not try to handle this alone, no matter how baseless or insignificant you consider the situation. Report this to your insurance representative immediately. Remember that all insurance policies have policy conditions that require the reporting of claims or complaints as soon as practical.

2. If your insurance company has not assigned an attorney to you, contact one right away who has experience in working with licensing boards. Your professional association or other professionals may be able to give you recommendations. Assist your lawyer in your defense. This may mean supplying the names of other professionals who may be able to corroborate that your treatment plan was correct.

3. Do your homework when looking for a professional to help you as an expert witness. Check his or her credentials. Interview him or her to determine that he or she has a strong grasp of the issues regarding your case. Your attorney and insurance company will usually play a role here also.

4. Never sign a Consent Order without legal representation. Signing this type of agreement acknowledges that there was wrongdoing and can also open the door to a lawsuit being filed. A good lawyer may not be able to avoid a consent order being drawn up, but he or she can certainly help make sure that the terms are as favorable as possible.

Make sure your professional liability insurance policy has the added coverage of licensing board hearings defense coverage. If your policy provides this coverage, see if higher limits are available and ask your insurance representative to discuss these options and costs with you. Make sure the limit of liability for this important coverage feature is adequate based on your situation and risk tolerance.

Why Sierra Tucson? Legacy.

Pamela J. Van Cott, CPCU is Assistant Vice President with the American Professional Agency, Inc. (APA, Inc.), NAADAC’s partner and endorsed professional liability company. Van Cott has 25 years of experience insuring professional liability, with a concentration in the addiction field. APA, Inc. has been a leading writer of professional liability for mental health and other professionals for 40 years. With over 100,000 insureds, APA, Inc. has been endorsed or sponsored by many national and regional mental health associations, including NAADAC. In addition, APA, Inc. has experienced staff to provide risk management consultation services for policyholders.

“I would feel comfortable recommending Sierra Tucson to my own family members.”

-George B., psychologist

Over 33,000 individuals and their families have trusted the Sierra Tucson legacy of hope and healing.

844-227-7292 | SierraTucson.com We work with most insurances.

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Earn 1 CE by Taking an Online Multiple Choice Quiz Earn one Continuing Education hour by taking a multiple choice quiz on this article now at www.naadac.org/magazine-ce-articles. $15 for NAADAC members and non-members.

1. Raymond Tamasi, in his appeal for clinicians to prepare for the future of behavioral healthcare, discusses the potential success of integrated care.

Which of the following is an example of the treatment environment in a fully integrated program? a. A treatment environment where each counselor has an exclusive therapeutic relationship with assigned clients while physicians and other axillary staff are integrated into care when necessary b. Most treatment occurs in the primary care physician’s office where addiction counselors are integrated into the practice as axillary staff c. A fast-paced environment of a medical practice where visits are brief, solution oriented, and primarily supportive of a medical intervention d. Longer counseling sessions with a determined number of visits 2. Which of the following is not an example of a fully integrated system of care? a. Where behavioral health clinicians function as member of the medical team b. Where modification of traditional clinician skill set and practice ­methods must be made c. Where there is open access, with same day visits with no limits to the number of patients seen per day d. Where behavioral health issues are dealt with independent of the ­patients substance use disorder 3. In Jerry Jenkins’ article on identification as an addiction professional, he outlines the current process the NCC AP is undertaking in the revision of tests for all of their credentials. Which of the following is most accurate with regards to this process? a. The NCC AP Commissioners and other subject matter experts review the current test questions for relevancy, current research, and current practices and submit the revisions, along with references for each test question, to the testing company. b. The NCC AP conducts a “job analysis” prior to the review/rewrite of current test questions. c. The testing company psychometricians review the current test questions for relevancy, current research, and current practices and submit the revisions, along with references for each test question, to the NCC AP Commissioners. d. A test blueprint is created by subject matter experts to ensure that that the test fits with the “job analysis” created to determine the scope of the practice prior to creating the “test question pool.”

4. In her article on telebehavioral health (TBH), Mita Johnson notes the many benefits, disadvantages, and ethical concerns of TBH. Which of the following is not an accurate statement? a. When using TBH, there is potential isolation of the client from live interactions with others. b. TBH brings the provider and his or her services directly to the client. c. TBH reduces stigma by making care accessible to any person struggling with co-occurring disorders, regardless of his or her location in relation to providers. d. There are no ethical concerns when using TBH since NAADAC included principles specific to the use of technology in its most recent Code of Ethics.

5. In his article on the difference between continuing education units (CEUs) and continuing education hours (CEHs or CEs), Thomas Durham discusses the differences between the two. Which of the following is most accurate when comparing CEUs and CEHs? a. A CEU, according to the College Board is the same as a CEH. b. A CEH is determined by a formula that converts hours of training to credits c. A CEU is determined by a formula that converts contact hours to units. d. CEUs and CEHs are clearly understood and rarely confused.

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6. In their article on opioid disorder treatment, Jack Stein and Eric Wargo discuss two new medications recently approved by the FDA for opioid treatment that, along with others “in the drug approval pipeline,” could be beneficial in broadening the scope of opioid maintenance treatment.

These two new medications are: a. Lorcaserin and lofexidine b. Probuphine and sublocade c. Probuphine and extended release naltrexone d. Sublocade and naloxone 7. Jack Stein and Eric Wargo discuss the possibility of achieving pain relief without producing reward and respiratory depression that could lead to a “truly safe generation of opioids.” Which of the following was mentioned in the article as an example of such promising drug development strategies? a. Biased agonists at the mu-opioid receptor b. Biased agonists at cannabinoid receptor c. Reducers of hormones that cause inflammation and pain d. Reuptake blockers of serotonin and norepinephrine 8. In her article on licensing board and lawsuit defense insurance coverage, Pamela Van Cott states that a counselor is more likely to receive a complaint from a state licensing board than a lawsuit by a client. In her advice on how to avoid a state licensing board complaint, which of the following (from an insurance company’s perspective) was included? a. It’s not important to know your state’s laws as long as you have malpractice insurance. b. When it comes to documentation, follow the “less is more” theory to avoid being successfully sued. c. Belong to a professional counselors’ association and adhere to its code of ethics. d. Avoid contacting your insurance provider directly when faced with questionable situations; it is better to reach out to other professionals for guidance.

9. Shareh Ghani, in his article on effective opioid treatment, lists strategies involving medication assisted treatment (MAT) for addiction professionals to consider in support of successful recovery. Which of the following is an accurate summation of these strategies? a. MAT training; reduce waitlists for MAT; address stigma; and increase the number of physicians certified to prescribe opioid treatment medications b. Address stigma; increase the number of physicians certified to prescribe opioid treatment medications; combine MAT with psychosocial interventions; and look for ways to assess risk for relapse in real time c. Address stigma; reduce wait lists for MAT; combine MAT with psychosocial interventions; and look for ways to assess risk for relapse in real time d. MAT training; combine MAT with psychosocial interventions; address stigma; and look for ways to assess risk for relapse in real time 10. Evidence-based approaches to opioid treatment, such as MAT, are critical to patients’ successful transition toward becoming fully functional members of society. However, MAT alone is not enough to aid this transition. Which of the following was not mentioned by Shareh Ghani as being helpful in regard to this transition? a. Ensure support from all key stakeholders in the recovery process as this is critical to achieving the best possible outcomes. b. Take the time to dispel the myths about addictions treatments, including MAT. c. Ensure patients withdraw from MAT before receiving treatment for other conditions. d. Investigate its potential to make a difference for the communities you serve.

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

NAADAC COMMITTEES

Updated 04/08/2018

North Central

STANDING COMMITTEE CHAIRS

President Gerard J. Schmidt, MA, LPC, MAC

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

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

President-Elect Diane Sevening, EdD, LAC Secretary John Lisy, LIDC, OCPS II, LISW-S, LPCC-S Treasurer Mita Johnson, EdD, LPC, LAC, MAC, SAP Immediate Past President Kirk Bowden, PhD, MAC, NCC, LPC National Certification Commission for Addiction Professionals (NCC AP) Chair Jerry A. Jenkins, MEd, MAC Executive Director Cynthia Moreno Tuohy, NCAC II, CDC III, SAP

James “JJ” Johnson Jr., BS, LADC, ICS Northeast (Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)

William Keithcart, MA, LADC Northwest

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

Malcolm Horn, LCSW, MAC, SAP, NCIP Southeast (Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)

Angela Maxwell, MS, CSAPC Southwest

Mid-Atlantic

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

Susan Coyer, MAC Mid-Central

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

Ethics Committee Chair Mita Johnson, EdD, LPC, LAC, MAC, SAP Finance & Audit Committee Chair Mita Johnson, EdD, LPC, LAC, MAC, SAP NERF Events Fundraising Chair Ed Olson, LCSW, CASAC

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

Clinical Issues Committee Chair Frances Patterson, PhD, MAC

Julio Landero, PhD, MAC, MSW, LADC, LASAC Organizational Member Delegate Jim Gamache, MSW, MLADC, IAADC

Gisela Berger, PhD, MAC, LPC, NCC

Nominations and Elections Chair Kirk Bowden, PhD, MAC, NCC, LPC Personnel Committee Chair Gerard J. Schmidt, MA, LPC, MAC Professional Practices and Standards Committee Chair Kirk Bowden, PhD, MAC, NCC, LPC Public Policy Committee Co-Chairs Michael Kemp, ICS, CSAC, CSW Sherri Layton, MBA, LCDC, CCS AD HOC COMMITTEE CHAIRS Awards Committee Chair Patricia Greer, LCDC, AAC Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC Steven Durkee, NCAAC

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

International Committee Chair Elda Chan, PhD, MAC

Matthew Feehery, MBA, LCDC, IAADC

Leadership Committee Chair Gerard J. Schmidt, MA, LPC, MAC Membership Committee Chair Margaret Smith, EdD, LADC

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)

Student Sub-Committee Chair Diane Sevening, EdD, LAC

Jerry A. Jenkins, MEd, MAC NCC AP Chair Alaska

Product Review Committee Chair Jim Gamache, MSW, MLADC, IAADC Tobacco Committee Chair Diane Sevening, EdD, LAC

James “Kansas” Cafferty, MA, LMFT, MCA, CATC, NCAAC NCC AP Chair-Elect California

PAST PRESIDENTS 1974-1977 Robert Dorris 1977-1979 Col. Mel Schulstad, CCDC, NCAC II (ret’d) 1979-1981 Jack Hamlin 1981-1982 John Brumbaugh, MA, LSW, CADAC IV, NCAC II 1982-1986 Tom Claunch, CAC 1986-1988 Franklin D. Lisnow, MEd, CAC, MAC 1988-1990 Paul Lubben, NCAC II 1990-1992 Kay Mattingly-Langlois, MA, NCAC II, MAC 1992-1994 Larry Osmonson, CAP, CTRT, NCAC II 1994-1996 Cynthia Moreno NCAC I, CCDC II 1996-1998 Roxanne Kibben, MA, NCAC II 1998-2000 T. Mark Gallagher, NCAC II 2000-2002 Bill B. Burnett, LPC, MAC 2002-2004 Roger A. Curtiss, LAC, NCAC II 2004-2006 Mary Ryan Woods, RNC, LADC, MSHS 2006-2007 Sharon Morgillo Freeman, PhD, APRN-CS, MAC 2007-2010 Patricia M. Greer, BA, LCDC, AAC 2010-2012 Donald P. Osborn, PhD (c), LCAC 2012-2014 Robert C. Richards, MA, NCAC II, CADC III 2014-2016 Kirk Bowden, PhD, MAC, NCC, LPC

Rose Maire, MAC, LCADC, CCS Secretary New Jersey Elda Chan, PhD, MAC, Grad. Dip. Family Therapy Hong Kong, China Thaddeus Labhart, MAC, LPC Treasurer Oregon M. David Meagher, Esq. Public Member California Christina Migliara, PhD, LMFT, MAC, CAP, CASAC Florida Joan Standora, PhD, LADC, CASAC Pennsylvania Gerard J. Schmidt, MA, LPC, MAC (ex-officio) West Virginia

NAADAC REGIONAL BOARD REPRESENTATIVES NORTHEAST NORTH CENTRAL

MID-CENTRAL

Gloria Nepote, LAC, NCAC II, CCDP, BRI II, Kansas-Missouri Therissa Libby, PhD, Minnesota Tiffany Gormley, MS, PLMHP, Nebraska Megan Busch, LAC, LPCC, North Dakota Mark Young, South Dakota

Renee Lee, MSW, CADC, Illinois Stewart Ball, MAC, LCAC, LMFT, LCSW, Indiana Steven Durkee, NCAAC, Kentucky Shannon Rozell, MPA, Michigan Dorothy Hillaire, LSW, LCDC II, Ohio Daniel Bizjak, MSW, ICS, CSAC, Wisconsin

Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Joe Kelleher, LADC-1, Massachusetts Kelly Luedtke, MEd, CAGS, MLADC, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, SAP, New York John Mann, LADC, Vermont

NORTHWEST Diane C. Ogilvie, MAEd, Alaska Coralee Goni, MS, MBA, MAC, Montana Jennifer Velotta, MNPL, NCAC II, CDP, CPP, Washington

SOUTHWEST

MID-ATLANTIC

Yvonne Fortier, MA, LPC, LISAC, Arizona Thomas Gorham, MA, CADC II, California Agnieszka Baklazec, MA, LPC, LAC, MAC, Colorado David Marlon, CADC-1, Nevada Shawn McMillen, Utah

Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia David Semanco, MAC, CAADC, CSAC, CACAD, Virginia Mary Aldrich-Crouch, MSW, MPH, LICSW, MAC, AADC, West Virginia SOUTHEAST MID-SOUTH Scott Kelley, Texas

Sam Long IV, NCAC I, Alabama Bobbie Hayes, LMHC, CAP, Florida Ewell Hardman, MDiv, MAC, CACII, CCS, Georgia Tony Beatty, MA, LCAS, CCS, North Carolina James Wilson, NCAC II, MRC, CCS, South Carolina Michele Squires, MS, LADAC II, MAC, QCS, Tennessee

Register now to hear from these featured speakers!

NAADAC, the Association for Addiction Professionals is excited to announce the following speakers at its 2018 Annual Conference: Shoot for the Stars in Houston, TX from October 5–9 at the Westin Galleria Houston.

Darryl Inaba

Carlo DiClemente

PharmD, CATC V, CADC III

PhD, ABPP

Marlene Maheu

Robert Ackerman

PhD

PhD

Don’t miss out on learning from these knowledgeable speakers!

UP TO

REGISTER TODAY!

4CE2 s

For more information, please visit www.naadac.org/2018annualconference