Advances in Addiction & Recovery (Summer 2015)

SUMMER 2015 Vol. 3, No. 2

Preliminary Annual Conference Schedule The Role and Value of Nationally Certified Recovery Support Specialists New Professional Liability Insurance Program for NAADAC Members

A Scientific Perspective on Marijuana on the Eve of Its Legalization An Interview with Dr. Darryl Inaba

Help Your Business Operations Thrive (At No Cost) SAMHSA’s BHbusiness is a technical assistance program designed specifically for substance use and mental health service providers.

TAKE ADVANTAGE OF FULLY-FUNDED:

Learning Networks Self-Paced Online Courses Resource Library

Join fellow NAADAC members in a learning network starting fall 2015.

Contact BHbusiness@TheNationalCouncil.org for more information.

“Within a week’s time we were able to make a plan to ramp up our enrollment processes.

The results were immediate in that enrollments began increasing right away.”

– Deb Freed, Northern Lakes Community Mental Health, Michigan Visit BHbusiness.org to learn more.

CONTENTS SUMMER 2015 Vol. 3 No. 2 Advances in Addiction & Recovery, the official publication of NAADAC, is focused on providing useful, innovative, and timely information on trends and best practices in the addiction profession that are beneficial for practitioners.

NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 85,000 addiction coun­selors, educators, and other addictionfocused health care pro­fessionals in the United States, Canada, and abroad.

NAADAC’s members are addiction counselors, educators, and other addictionfocused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education.

Mailing Address Telephone Email Fax

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

Managing Editor

Jessica Gleason, JD

Graphic Designer

Elsie Smith, Design Solutions Plus

PS PRODUCTIONS | PHOTOSPIN.COM

Editorial Advisory Kirk Bowden, PhD, MAC, LISAC, NCC Committee Rio Salado College Alan K. Davis, MA, LCDC III Bowling Green State University Carlo DiClemente, PhD, ABPP University of Maryland, Baltimore County Rokelle Lerner, MA Cottonwood de Tucson Cynthia Moreno Tuohy, NCAC II, CDC III, SAP NAADAC, the Association for Addiction Professionals

■ FE ATURES

Robert Perkinson, MD Keystone Treatment Center

10

NAADAC 2105 Annual Conference Preliminary Schedule

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

21

A Scientific Perspective on Marijuana on the Eve of Its Legalization NAADAC Interview of Dr. Darryl S. Inaba, PharmD, CADC-V, CADC III

William L. White, MA Chestnut Health Systems

Earn Continuing Education Hours

26 INCASE: The International Coalition of Addiction Educators, Past, Present and Future

By John Korkow, PhD, LAC, SAP, President INCASE

29 Electronic Screening and Brief Intervention (e-SBI) Effective for Reducing Excessive Alcohol Consumption by Adults

By Robb Hicks, MD

■ DEPAR TMENTS 4

President’s Corner: My Big Concern for the Addiction Counseling Profession (Part II)

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

5

From The Executive Director: NAADAC: Advocating for You! By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

7

Letter to the Editor

8

Certification: The Role and Value of National Certification for Recovery Support Specialists By Kathryn Benson, LADC, NCAC II, QCS, NCC AP Chairperson

18

Membership: Professional Liability Insurance — Claims Made vs Occurrence Form Policies? By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

31

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

For more information on submitting articles for inclusion in Advances in Addiction & Recovery, please visit www.naadac.org/advancesinaddictionrecovery# Publication_Guidelines Disclaimer It is expressly understood that articles published in Advances in Addiction & Recovery do not necessarily represent the view of NAADAC. The views expressed and the accuracy of the information on which they are based are the responsibility of the author(s) and represent the wide diversity of thought and opinion within the addiction profession.

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

Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5 This publication was prepared by NAADAC, the Association for Addiction Pro­fes­ sionals. Reproduction without written permission is prohibited. For more in­ formation on obtaining additional copies of this publication, call 1.800.548.0497 or visit www.naadac.org.

Printed June 2015 STAY CONNECTED

NAADAC Leadership

COVER: DMITRIY SCHIN & OXYGEN64 | PHOTOSPIN.COM

S U M M E R 2 015 | 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 3

■ PRESIDENT’S CORNER

My Big Concern for the Addiction Counseling Profession (Part II)

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

A primary role of states’ behavioral health regulatory/licensing boards is protection of the public. I am fearful that in most states these boards do not adequately protect the public in respect to addiction counseling.

At this time, most states do not require behavioral health professionals to obtain any addiction-specific education and experience before granting them authority to independently provide addiction counseling services.

How is that protecting the public? They clearly aren’t! Especially in light of the fact that addiction and substance use disorder counseling is widely considered one of the most challenging areas of behavioral health counseling. Members of the public seeking recovery and in need of a skilled addiction counselor for themselves or for a family member should be outraged.

In Spring 2015 issue of Advances in Addiction and Recovery, I discussed my frustration over this issue and pointed out that in most states Clinical Psychologists, Clinical Social Workers, Marriage and Family Thera­pists (MFTs), Licensed Professional Counselors (LPCs), and Licensed Mental Health Counselors (LMHCs) are not required to obtain any addiction counseling-specific education, training, or supervised work experience prior to practicing addiction counseling independently. Hold­ ing one of the above listed behavioral health licenses in most states inherently includes authority to provide addiction counseling. Because of my high level of frustration surrounding this topic I know I sounded a little preachy; however, please keep in mind that I don’t believe this topic can be repeated or discussed too much.

I also have related concerns and frustration with third party re­im­ burse­ment under the Affordable Care Act (ACA). While I understand that the dust has not totally settled on the ins-and-outs of the ACA, it currently appears that the regulation and oversight of insurance companies and other third party reimbursement payers falls under the jurisdiction of individual states. Though insurance companies and other third party reimbursement payers have some authority in establishing their own rules and requirements for direct reimbursement, it’s likely that in most cases the requirements will follow states licensing rules and require a master’s degree or higher and a license in a behavioral field and at the independent level.

It appears that many, if not most of the third party reimbursement payers will reimburse for addiction counseling provided by independently licensed behavioral health professionals — even if the professional has no education, training or work experience in addiction counseling. Keep in mind that many states do not currently offer an addiction counseling license or an addiction counseling license at a master’s or higher degree level. Therefore, addiction counselors in those states may be required to obtain an independent license in a different behavioral health profession to be qualified to receive direct payment from a third party re­imbursement 4

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

provider for addiction counseling services. There is a very real pos­si­bility that many licensed and experienced master level addictions counselors whose states have certification instead of licensing will be unable to receive direct reimbursement from third party providers for their service; unless the counselor has a license in another behavior health profession.

I asked you, as an addiction counseling professional, to conduct a web search and find the website of the regulatory agency in your state that licenses the various behavioral health professionals. Study it carefully.

Normally, psychologists have a regulatory board that separates them from the other behavioral health professions. Often social workers and MFTs and LPCs are regulated by a single state board. However, regulatory boards vary from state to state. It shouldn’t be hard finding the regulatory board or boards in your state. Read the statues and rules for each of the behavioral health professions. It is likely that you will find that your state doesn’t require addiction-specific education or experience to practice addic­tion counseling independently.

Many of you, NAADAC members like myself, are licensed in one or more of the other behavioral professions. As professionals, we understand the importance of “doing no harm” and “only practicing within the scope of training and experience.” The public needs to be protected. The public needs counselors that are truly knowledgeable in addiction treatment and recovery. We need to work for the protection of the public. We need to get actively involved in writing and calling our states’ behavioral health licensing/regulatory boards. Most importantly, we need to work with and lobby our state legislators to make the needed regulatory changes in behavioral health licensing laws. Members of the public seeking recovery that are in need of a skilled addiction counselor for themselves or for a family member have the right to know that their counselor has had addic­ tion specific training and experience.

If you would like to share your thoughts and experience on this issue or share how you feel this issue is affecting you in your state, please email me at kirkbowdenphd@gmail.com.

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

■ FROM THE E XECUTIVE DIREC TOR

NAADAC: Advocating for You!

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

In the last edition of Advances in Addiction & Recovery, I wrote about some of the initiatives that NAADAC has done to develop professionalization and standardization in the addiction profession from certification and licensure to a national scope of practice to national addiction education standards, the Minority Fellowship Program for Addiction Professionals, and advocacy with the ACA and Parity regulations. In this edition, I want to focus on NAADAC’s role as an activist to lift the banner of the addiction professional in the mainstream of healthcare!

In June 2015, NAADAC’s Executive Committee convened at its Alexandria, VA offices for several days with consultant Charley Curie to hone our ideas and strategies to advance the recognition of addictions treatment as a mainstay specialty within mainstream healthcare. This will become our priority and goal as we work to educate, influence, and change policy. The clear need to build on the specialization of the addiction profession within the medical healthcare system and the integration of addiction as a specialty is vital to the continued recognition and funding of addiction prevention, intervention, treatment, and recovery support services. NAADAC proposes that addiction services are an integral medical intervention within the full medical care services continuum.

NAADAC will work with our organizations and professionals to help educate and influence how they can integrate their specific services within the medical care model. There are choices for addiction programs and pro­fes­sionals to make. Will they be: (1) stand alone with contracts to serve the medical and mental health community and coordinate care; (2) in­te­grated services within the same facility and providing services in a multidisciplinary team approach; or (3) integrated by working within a larger system yet providing separate services with referral to different de­part­ments? Or yet another model? Whatever the model, it will be vital that addiction professionals become co-occurring competent, and offer referrals to or services in their own facilities for medication-assisted treatment and recovery, recovery support, and long term continuing care with “self-health” management skills.

Yes, “self-health” management or wellness management skills need to become incorporated in the daily recovery skill plan for our clients/ patients with the goal in mind for long term recovery, health and happiness. This is what the Managed Care Organization (MCO) of today is looking for in a provider program — not the basics of addiction information alone, but the enhancement of treatment and recovery skills to include self-management through mindfulness and mediations, and learn­ing how to change the brain neuropathways to more productive and healthy thinking and thus behaviors. This includes family system work to reduce the medical, emotional, and psychological needs and illnesses of each family member. It is important to bring as many of the family members into the treatment system as are willing to join, to learn communication, decision making, solution focused issue solving, conflict

resolution, and a shared vision of family responsibility to each other and to the general community they live in.

Another expansion area is medicated-assisted treatment (for those indicated) and recovery with counseling that focuses on the skill areas above as well as the more traditional methods of understanding the disease of addiction, and recovery. Medication can increase retention in treatment and recovery support programs, increase the clients’/patients’ ability to pay attention and remain cognizant of the information they are learning, and be aware and available enough in their thought process to hear, understand, process and apply the information they are learning in treatment centers. Medication-assisted treatment and recovery is not in opposition to prevention, intervention, treatment and recovery support; it is an essential tool for some that without it, they may relapse and they may die. We are seeing this in high numbers with the current opioid epidemic across the United States.

To build the vision of the addiction profession within the medical health­care system and the integration of addiction as a specialty, NAADAC is currently working with MCOs/PPOs/BHOs to broaden the base for reimbursement and panel approvals for reimbursement. The recognition of the specialized education, training, and experience of addiction professionals is building in their level of awareness. It is in all of our best interest to collaborate and work to build these systems of care.

Together, we can work to detail addiction professionals and recovery support specialists in regions that are low in numbers of providers thereby increasing the work and reimbursement levels of our addiction specialists and recovery support persons and assisting the lives covered by the MCO/PPO/BHO for a mutual benefit built on mutual understanding of what each needs to work together.

NAADAC has hired a consultant to assist us in the current and future development of the addiction profession within the medical healthcare system and the integration of addiction as a specialty within other groups of payers. Look to future issues of the magazine to learn how we are doing this and with who!

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association of 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 magazine. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.

S U M M E R 2 015 | 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

Building Recovery One Life at a Time At Memorial Hermann Prevention and Recovery Center in Houston, we offer a variety of clinically proven programs with 30 years of success stories. Our nationally recognized addiction recovery program has helped thousands of patients reclaim their lives.

We have residential and outpatient programs and counseling services that start individuals on their journey in recovery.

Programs include: Adult and Adolescent Services Aftercare Program Alumni Association Detox, Residential and Day Programs Family Services

Outpatient Programs in Houston, Austin and Dallas Pain Recovery Program Professionals and Executives Program Young Adult Program (ages 18-24)

Learn more about PaRC’s award-winning programs.

Visit parc.memorialhermann.org or call 1.877.464.7272.

3043 Gessner Houston, TX 77080

Improve the lives of others... ...prepare for a life of significance.

Enroll in Ottawa University’s

Bachelor of Science in Addiction Counseling or Master of Arts in Counseling • • • • •

Led by Subject Matter Expert Dr. Kirk Bowden Flexible and Convenient Learning Environment Personal Student Success Team of Advisors Accelerated 8-week Courses Online Generous Credit Transfer Policy

Contact us today, and prepare for a life of significance!

ottawa.edu/addiction

This program is available in an online format and is designed to meet the state board of behavioral health licensing/certification and USDOE requirements in a majority of U.S. states. Because these requirements vary by state, students should confer with their state’s licensure or certification authority to assure that this degree program meets the requirements.

6

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

■ LE T TER TO THE EDITOR In the article “Licensing Addiction Pro­fes­ sion in All Fifty States: The Process Begins” by Dr. Don Osborn, published in the last issue of Ad­vances in Addiction & Recovery, the In­ter­ na­tional Association of Addic­tion and Offender Counselors (IAAOC), a division of the Ameri­ can Counseling Association, was characterized as follows: “…the American Counseling Association as a professional body sees ‘counseling’ alone as the profession, and addiction counseling as a spec­ialty of the counseling profession. Hence, the International Association of Addiction and Of­fender Counselors (IAAOC) is one of 20 spec­ialty divisions within the American Coun­ seling Association. It does not see the primacy of addiction-specific practice, training, and education.” (Osborn, 2015, p. 20) A number of the IAAOC members and leaders, including the current NAADAC President Kirk Bowden, discussed this statement and de­termined that a letter of clarification would be appropriate to correctly char­a cterize IAAOC’s position. It is correct that IAAOC is a division of the American Counseling Asso­ci­ a­tion and that we focus on the specializations of addiction and offender counseling. However, we absolutely believe and advocate for addictionspecific education, training, and practice. We are a group of professional counselors and coun­selor educators who have worked in the addic­tion counseling profession and join this

Editor Correction A final edit done by NAADAC for publication spacing to a paragraph in last issue’s article “Licensing Addiction Profession in All Fifty States: The Process Begins” by Dr. Don Osborn resulted in a change of context and perceived mischaracterization of the International Association of Addiction and Offender Counselors (IAAOC), a division of the American Counseling Association, and its stance on addiction-specific practice, training, and education. NAADAC regrets this error. Further, NAADAC offers to clarify any negative perception that may have resulted to IAAOC. NAADAC recognizes that both the IAAOC and NAADAC are committed to advancing addiction counseling as a standalone profession, possessing rigorous addiction studies and training in higher education.

or­gani­zation because we believe that our clients and work contexts are unique within the mental health counseling field and that they require unique specialized training and supervised prac­tice. We all have at least a master’s degree in a counseling field and are therefore able to treat co-occurring disorders for dual diagnosed clients, which is crucial to working as an addiction counselor.

IAAOC members and leaders have a history of consistently advocating within the counseling profession for addiction-specific education and training standards. For examples, the addi­ tion of addiction-specific education standards as part of the minimum standards for accreditation from the Council for Accreditation of Coun­seling & Related Educational Programs (CACREP) was largely due to the work of the IAAOC Executive Board in the late 2000’s.

Addi­tionally, we have advocated for the creation of a specialty track of Addictions Counseling accreditation under the CACREP accreditation umbrella, which includes specialized addiction educational and training standards.

Finally, IAAOC supports a number of addiction-specific committees where professional counselors who are addiction specialists are actively carrying out advocacy activities and research projects, presenting training, and publishing articles related specifically to addiction issues.

We believe that IAAOC and NAADAC have much in common and can work together to strengthen our research, education, and advocacy efforts to raise awareness about professional and client-specific issues and enhance addiction-specific education and training. We believe that NAADAC is recognized as the premier association for addiction professionals in our country, whereas IAAOC is recognized as the premier organization for masters-level counselors specializing in addiction. It is our hope that we are able to work toward finding common ground, rather than dividing these organizations into competing factions.

Sincerely, Leigh Falls Holman, PhD, NCC, RPTS IAAOC President

Sierra Tucson Where Change Begins For over 31 years, SIERRA TUCSON has helped to navigate the path of hope and healing.

You can take comfort that your patients are at the center of a recovery program that is world renowned. Within a natural healing environment, their journey will be with others who are experiencing a similar process, yet tailored to their individual needs.

CALL TODAY TO LEARN ABOUT OUR INDIVIDUALIZED PROGRAMS: • Addictions/Co-Occurring Disorders • Trauma Recovery • Mood & Anxiety • Complex Pain • Eating Recovery • Continuing Care

844-227-7292 SierraTucson.com

Sierra Tucson is accredited by The Joint Commission and licensed as both a special hospital and a behavioral health residential treatment center.

S U M M E R 2 015 | 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 7

■ CER TIFIC ATION

The Role and Value of National Certification for Recovery Support Specialists

by Kathryn Benson, LADC, NCAC II, QCS, NCC AP Chairperson

Role of Peer Recovery Support Specialists In 2011, as SAMHSA anticipated and prepared for the creation of the Affordable Care Act (ACA), much attention was given to the fundamental need to integrate substance use disorder (SUD) treatment services into the full spectrum of a behavioral health care model.

In 2012, a national committee was convened to begin the process of identifying consumer needs, healthcare resources, and the possibility of creating a new level of service delivery through a Peer Recovery Specialist (PRS) approach.

Peer Recovery Support Specialists were defined as individuals who are in recovery from life altering substance use disorders or mental health dis­orders which have caused life disruption. Their life experiences allow them to provide recovery support in such a way that others can benefit from their experiences.

First and foremost, in the course of this developmental process, a clear delineation of roles was established. Everyone understood the fundamental goal was to have service delivery be more immediate and cost effective, while supporting SUD counselors in their role of patient clinical care­giver.

Crosswalks were established to best identify the scope of activities that the PRS would provide the consumer vs. the scope of practice of the SUD counselor. Distinctions were made in the role and provision of services, which included planning, resource utilization, illness management, medication management, employment, housing, and educational service. It was crucial that the role of the PRS be understood to be a non-clinical role with the focus in this integrated system to be one of recov­ery support.

Role delineation was essential in order to then establish the components of an effective PRS and to insure appropriate and quality consumer service delivery. Identified components included eligibility criteria, training and education, supervision and integration into SUD continuum of care. Ethical standards and codes of conduct were established along with the recognition of need for a credentialing process. Additional policy and procedures were developed to assist service providers in the effective use of this PRS service.

8

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

With the support of SAMHSA, these components came into existence through individual state authorities. It also became clear that the National Certification Commission for Addiction Professionals (NCC AP) needed to move forward with creating a national credential to help consolidate the best of all identified factors.

NCPRSS Credential NCC AP was committed to standardize on a national level, the competency of peer support to individuals with substance use — and co-occurring mental health — disorders and created the Nationally Certified Peer Recovery Support Specialist (NCPRSS) credential. This experience-based credential focuses on the individual and provides a formal indicator of the current knowledge and competence needed at the national level. NCC AP successfully established formal PRS national eligibility criteria, educational and training requirements, code of ethics, and core competencies for this new level of care. This national standard encourages Peer Specialists to continue to enhance their skills for the welfare of consumers and establishes, measures, and monitors requirements for required knowl­edge. The NCPRSS credential provides assistance to employers, health care providers, government entities, other practitioners, and the public in the identification of quality individuals who have met national competency standards.

It was understood a formal testing instrument was necessary for individuals and state authorities for use in determining and reflecting a basic level of knowledge to best insure protection of consumer and public welfare. NCC AP, through the nationwide involvement of professionals and peer support specialists, has created a national certification process that provides the path for individuals to follow in order to demonstrate their knowledge and skill in their role as a primary peer support provider.

Through this standardized testing and portfolio review, NCC AP is able to set a benchmark for recognition of Peer Recovery Support Specialists and monitor the skills and abilities of those providing peer recovery support services.

Candidates for the Peer Recovery Support Specialist Credential must meet the following criteria: • High school diploma or GED or higher; • Minimum of one year of direct practice (paid or volunteer);

• 125 hours education and training in addiction with a minimum of six hours training in addiction-specific ethics and three hours training in HIV/AIDS/ communicable diseases. Training must be within the past five years; • Minimum one year of recovery from substance use/co-occurring mental health and substance use disorders (selfattestation), if applicable; • Read and sign a statement on the Application affirming adherence to the NA A DAC Peer Recover y Support Specialist Code of Ethics; • Complete all sections of the online test Application.

• Take and pass the Peer Recovery Support Specialist examination. Upon passing the exam, contact the NCC AP and submit any additional required fees and documentation required; and • Receive final approval of the NCC AP to obtain the credential.

Make hope real

It is imperative that the consumer be served

by Peer Support Special­ists who have received consistent training and serve under formal qualified supervision.

as an addiction counselor Study with today’s leading practitioners at the nation’s largest nonprofit addiction treatment center.

Residential and online degree programs available. Three convenient start dates throughout the year.

Support for Credential We are very pleased to report the growing support for and recognition of the value of the NCPRSS within the system of care. Most recently, Optum, Inc., which operates one of the nation’s leading managed behavioral health care organizations, has expressed strong interest in recruiting individuals who have completed the NCPRSS to be part of its behavioral network of providers’ system of care in order to expand the range of services available to consumers. We hope other MCOs and BHOs will follow suit and embrace the NCPRSS credential as an essential path for both the providers and the insurers of these treatment services to instill confidence that the service activities that will best benefit the consumer are being provided by knowledgeable and skilled specialists.

Kathryn Benson, NCAC II, LADC, QSAP, QSC, serves as Chair of the National Cer­ ti­fication Commission for Addiction Pro­ fessionals (NCC AP), and has worked in the counseling profession since 1972, specializing in addiction issues since 1978. She may be contacted at lightbeing@aol.com with your thoughts or questions.

Hazelden Graduate School of Addiction Studies Master of Arts programs available in addictions and co-occurring disorders counseling

hazelden.edu

5216-1 HGSAS Ad Resize 4.9375x10_F.indd 1

651-213-4617

2/12/15 AM S U M M E R 2 015 | A d va n ce s i n A d d i c t i o n & R e c o 8:10 v e r y 9

REGISTER NOW! EARLY BIRD RATE ENDS AUGUST 28TH

2015 Annual Conference October 9 – 13  Washington, D.C. (Exhibit dates October 9 – 11)

LEARN  CONNECT  ADVOCATE  SUCCEED Join NAADAC for its 2015 Annual Conference & Hill Day at the Bethesda North Marriott Hotel & Conference Center, outside of Washington, D.C. from October 9 – 13, 2015. Learn about the latest trends and issues that impact all addiction-focused professionals, connect and network, build your business, and advocate for the addiction profession, all while taking advantage of the beauty and excitement of Washington, D.C.

This year’s conference will feature a broad array of topics and formats, including four all-day pre-conference seminars on October 9, a two-day SAP/DOT Qualification/Re­qual­i­ fication Course on October 9 – 10, daily keynote speakers in plenary sessions, breakout workshops, and events on October 10 – 12, and a visit to Capitol Hill to meet with congressional leaders and advocate for the addiction profession on October 13. The conference will offer unique educational experiences for addiction-focused professionals within the following eight tracks:  Practice Management & Technology Practice  Advocacy  Co-Occurring Disorders  Clinical Skills  Psychopharmacology  Cultural Humility  Process Addictions  Educators The Annual Conference will also feature an Awards Lun­ cheon to honor outstanding addiction-focused professionals from around the nation and an evening event to support the NAADAC Education & Research Foundation (NERF). In evenings, attendees can earn more education credits with an optional movie night or enjoy their time in Washington, D.C. with a Monu­ment Night Tour, a show by Capitol Steps in the Ronald Regan Building, or exploring on their own.

MATHISWORKS & SEAMARTINI | PHOTOSPIN.COM

10

Earn Up to 30 Continuing Education Hours

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

PRELIMINARY SCHEDULE* FRIDAY, OCTOBER 9 7:30 AM -- 7:00 PM Registration

Marijuana Impact on the Developing Adolescent Brain (Part I) and the Evolving Science of Relapse and Recovery (Part II) Darryl S. Inaba, PharmD, CATC-V, CADC III

7:30 AM -- 8:30 AM Continental Breakfast

SAP/DOT Qualification and Re-qualification Wanda McMichael, CAC II, NCAC II, SAP

8:00 AM -- 5:00 PM NAADAC Executive Committee Board Meeting

The Business of Addiction Treatment: The Impact of ACA Kim Johnson, MBA, PhD

8:00 AM -- 5:00 PM NCC AP Meeting

6:00 PM -- 7:00 PM New Member/Student Reception

8:30 AM -- 5:00 PM PRE-CONFERENCE WORKSHOPS: PART I

7:00 PM -- 9:00 PM Welcome Reception

The Ins and Outs of Medication-Assisted Treatment and Recovery for Alcohol and Opioid Dependence Misti Storie, MS, NCC

9:00 PM -- 10:00 PM Mutual Support Meeting

SATURDAY, OCTOBER 10

What Using The ASAM Criteria Really Means: Skill-Building and Systems Change David Mee Lee, MD

7:00 AM -- 6:00 PM Registration

Up to 7 CEs Available on Friday

* Schedule subject to change without notice.

For the most up-to-date schedule, please visit www.naadac.org/annualconference.

Up to 6.5 CEs Available on Saturday

7:00 AM -- 5:00 PM Exhibit Hall Open

7:00 AM -- 8:00 AM Continental Breakfast 8:00 AM -- 9:45 AM Keynote & Kick-Off Ceremony Embracing the Changing Environment with NAADAC Kirk Bowden, PhD, MAC, LISAC, NCC, LPC Cynthia Moreno Tuohy, NCAC II, CDC III, SAP H. Westley Clark, MD, JD, MPH, CAS, FASAM (invited) 8:30 AM -- 5:00 PM PRE-CONFERENCE WORKSHOPS: PART II SAP/DOT Qualification and Re-qualification Wanda McMichael, CAC II, NCAC II, SAP 10:30 AM -- 12:00 PM MORNING BREAKOUT SESSIONS ICD-10/DSM-5 in Graphics to Facilitate Differential Diagnosing Jerry Mobley, PhD, LPC, MAC Addiction Within Families Jona Olafsdottir, MSW, PhD(c) Process Addiction, Why Can’t I Stop?

John Gordon, Jr., MHS, CASAC, ICADC

Endorsing and Collaborating Partners

Explore Washington, D.C.

Part of what makes NAADAC’s Annual Conference unique is the depth and breadth of NAADAC’s partnerships. NAADAC is proud to have 11 national and local partners joining us, including:

Washington, D.C. is filled with exciting, iconic, and memorable places to visit during your time at the conference.

There is no place that matches the assortment and quality of free attractions that await you in D.C., from the mag­nificent memorials, parks, and monuments on the National mall to must-see sights lie the National Gallery of Art and the museums of the Smith­sonian Institution.

Beyond national treasures and historic buildings, Wash­ ing­ton, D.C. is also home to world-class and lively restaurants, deep-rooted culture, diverse neighborhoods, the nation’s zoo, and music of all kinds.

October is a wonderful time of year to visit our nation’s capital, when the summer crowds have thinned, the temperatures have cooled, and the leaves are beginning to change in the many green spaces throughout the city.

Don’t miss out on this “monumental” experience!

STEVE HEAP | PHOTOSPIN.COM

• American Society of Addiction Medicine (ASAM) • American Association for the Treatment of Opioid Dependence, Inc. (AATOD) • International Coalition for Addiction Studies Education (INCASE) • NALGAP: the Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies • National Addiction Studies Accreditation Commission (NASAC) • National Addiction Technology Transfer Network (ATTC) • National Association for Children of Alcoholics (NACoA) • National Association of Addiction Treatment Providers (NAATP) • National Council for Behavioral Health • National Center for Responsible Gaming • NIATx Learning Collaborative

S U M M E R 2 015 | 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 11

PRELIMINARY SCHEDULE* SATURDAY, OCTOBER 10 MORNING BREAKOUT SESSIONS (CONT.) HIPAA-HITECH Compliance 2015 Jay Ostrowski, MA, LPC-S, NCC, DCC, ACS Treating the Emerging Young Adult Alcoholic and Addict Cardwell C. Nuckols, PhD Extreme Love Addiction: The CoDependent and The Borderline Cheri DeMoss, MA, LCPC, CAADC, MAC, NCAC II, NCRS Energy Psychology: A New Paradigm for Trauma-Informed Care Michael DeMolina, MS, LPCS, CDCS, MAC, DCEP The MEPS Mobile, a Paradigm for Recovery Mark Loftis, PhD, LADAC, SPE, LPC, MHSP Using a Clinical Decision Support Tool to Match Patients to Treatment for Opiate Dependence Peter Luongo, PhD, LCSW-C Developing Self-Efficacy: Addiction Counseling Interns in Field Experiences Joan Standora, PhD & Monica Joseph, PhD Treating the “T” in LGBT Marsha Partington, MA, LADC 12:15 PM -- 1:45 PM NAADAC Membership Lunch Boxed Lunches with NAADAC Regional Caucuses

2:00 PM -- 3:30 PM AFTERNOON BREAKOUT SESSIONS Relapse Prevention Planning: Findings from an Investigation of SMART Recovery Participants Deirdre O’Sullivan, PhD, CRC

The ACA and Why Prevention Is Health Reform Jane Goble-Clark, MPA, CSAPC Navigating Information in Addiction Science with SALIS Judit Ward, PhD, MLIS

Eating on the Edge: A Study of Dietary Habits and Nutritional Status Among Street Drug Addicts Mone Eli Saeland

NCC AP Certification: Being the Star of Your Own Show Kathryn Benson, LADC, NCAC II, QSAP, QSC & Shirley Mikell, NCAC II, CAC II, SAP

Technology-Based Clinical Supervision Thomas Durham, PhD, LACD

Affiliate Leadership Meeting: What NAADAC Can Do for You Kirk Bowden, PhD, MAC, LISAC, NCC, LPC Cynthia Moreno Tuohy, NCAC II, CDC III, SAP HeidiAnne Werner, Director of Operations & Finance Jessica Gleason, JD, Director of Communications Rhonda Britton, CMP, Affiliate & Events Coordinator

Contingency Management: An EvidenceBased, Family Therapy Approach to Treating Teen Substance Abuse Jaime Houston, PsyD The Action Distraction Addiction: Sexual Addiction Sadie Sheafe, PhD, LCSW, BCD, ABS Dip Bipolar Borderline and Substance AbuseTreating the Most Difficult Cases Debra Meehl, DD, MSW Opioids — Friend or Foe? Billy Heckle, Rph, CAC II

4:15 PM -- 5:30 PM KEYNOTE Understanding and Changing a “Habit” Called Addiction Cardwell C. Nuckols, PhD

Addition Vulnerability and Psychiatric Disorders are Primarily Genetic – Exactly What is Inherited?

Rhonda McKillip, MEd, LMHC, MAC, CDCIII, CDP

The Venue Where You’ll be Staying Bethesda North Marriott Hotel & Conference Center 5701 Marinelli Road, North Bethesda, MD 20852 Main: 301-822-9200 | Fax: 301-822-9201 Website:http://www.marriott.com/hotels/hotel-photos/wasbn-bethesda-north-marriott-hoteland-conference-center

Attendees can book their hotel rooms online at https://resweb.passkey.com/go/518be9ed or by calling 800.859.8003. Please make sure to reference the NAADAC Conference to receive our special group discount. Reservations are available on a first-come first-served basis for the limited number of rooms being held at the discounted rate. Please book your room early as space is limited and will sell out!

Room Reservation Deadline: September 21, 2015 12

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

COURTESY OF HOTEL

Just outside of Washington, D.C., the Bethesda North Marriott Hotel & Conference Center is offering rooms for the discounted price of $149 a night (plus applicable taxes) for reser­ vations made by September 21, 2015. The hotel offers convenient public transportation access to Washington, DC and surrounding areas. The White Flint Metro Station (on the Red Line) is just a short walk away from the hotel (within 1/3 of a mile). In addition, there are a number of restaurants and shops within walking distance of the hotel.

PRELIMINARY SCHEDULE* 7:00 PM -- 10:00 PM INCASE Membership Meeting

11:00 AM -- 12:30 PM MORNING BREAKOUT SESSIONS

6:00 PM OPTIONAL TOURS: Washington, D.C. Night Tour; See “The Capital Steps”; Explore Washington, D.C. & Bethesda, MD on your own (See tour descriptions on page 14.)

Spirituality And Recovery Robert “Bob” Richards, MA NCACII (Ret.)

9:00 PM -- 10:00 PM Mutual Support Meeting

SUNDAY, OCTOBER 11 Up to 5.75 CEs Available on Sunday 7:30 AM -- 5:00 PM Registration 6:30 AM -- 7:00 AM Sunday Religious Services 6:30 AM -- 7:00 AM Zumba/Yoga 7:30 AM -- 4:30 PM Exhibit Hall Open 7:30 AM -- 8:30 AM Continental Breakfast 8:00 AM -- 5:00 PM NAADAC Board of Directors Meeting 8:30 AM -- 10:00 AM KEYNOTE Epidemic of Opioid Pain Medication Abuse Ushering in a New Cycle of Heroin Addiction Darryl S. Inaba, PharmD, CATC-V, CADC III

“Warning: Take Only As Directed”: Using Social Media to Advocate for Teen Prevention Elizbeth Donnellan, MEd, ABD FT

12:45 PM -- 1:45 PM Lunch on Your Own 2:00 PM -- 3:30 PM AFTERNOON BREAKOUT SESSIONS

“I did not choose him, he did not choose me”: Families, Young Adult Addiction and Resistance Jevon Rice, MS, LMHC

The Intersection of SBIRT and Wellbriety: A Tribe First Research Project John Korkow, PhD, LAC, SAP & Leon Leader Charge

Hazardous Duty: Gambling Addiction and the Military Keith Whyte, BA

Disordered Eating: Implications for Midlife and Beyond Connie Ducaine, MA, LPC, LCADC, ACS, BCPC, NCC

When We Get Behind Closed Doors: Clinical Supervision for Client Safety and Clinician Growth Alan Lyme, LISW, ICCS, ICADC

Opioid Addiction, Pharmacological Treatment Approaches, and Comorbid Conditions Joseph Bebo, MA, CAGS, LADC1

The Trifecta: Treating Addiction Interactions and Complex Trauma Jan Beauregard, PhD, CSAC, CSAT

Alternative Peer Group Techniques…The Research is In! John Cates, MA, LCDC

The Interface of Drug and Alcohol Addiction, Suicide, and Surrender: Implications for Treatment Ford Brooks, LPC, NCC, CADC

Law and Ethics: Past, Present and Future Hayley Lake, MS, CDP

Understanding Trauma in Addiction Treatment Noe Vargas, DBH, LPC, NCC

Urine Drug Testing in Addiction Medicine: A New Paradigm to Improve Outcomes and Reduce Costs Andrea Barthwell, MD, FASAM & Michael Barnes, Esq.

Process Addiction and the Addictive Brain Chris Tuell, EdD, LPCC-S, LICDC-CS

Travel Information: Getting to Washington, D.C. Save Money on Your Flight to Washington, D.C.!

To help reduce costs, NAADAC has negotiated discounts with Delta and United Airlines when flying into Washington, D.C. between October 5 and October 17, 2015 for the 2015 Annual Conference. Learn more at www.naadac.org/annualconference.

Washington, D.C. Metro Area Airports The Washington, D.C. metro area is served by three major airports: Ronald Reagan Washington National (DCA) (recommended), Dulles International Airport (IAD), and Baltimore/Washington International Thurgood Marshall Airport (BWI).

VLADIMIR PADALKO | PHOTOSPIN.COM

Connecting the Classroom and Clinic: Training Innovations in Counselor Preparation Julie Rohovit, PhD

Ground Transportation • Attendees can take the DC Metro from Ronald Regan National Airport directly to the conference hotel. The hotel is a short walk (.3 miles) from the White Flint Metro Station on the Red Line.

• All three airports have taxis and rental car facilities.

• All three airports are serviced by the SuperShuttle shared van service. To book, please visit http://www.supershuttle.com.

Parking Registered hotel guests and conference attendees may park at the conference hotel for free.

Serving Our Veterans in Addiction Treatment Christina Catalano, BS, CASAC

Ready to be Seen?

Highlight your business by exhibiting, sponsoring, or advertising at our 2015 Annual Conference. Access not only over 700 conference attendees, but NAADAC’s prestigious membership of over 9,500, its mailing list of over 37,000, and its website, which receives over 185,000 visits per month. Showcase your institution, product, or organization at this prestigious event!

To explore the many promotional opportunities available, please visit www.naadac.org/2015-sponsor-exhibit-oradvertise to download the 2015 Annual Conference Prospectus or contact Elsie Smith, Account Executive, at esmith@naadac.org or 717.650.1209.

S U M M E R 2 015 | 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 13

PRELIMINARY SCHEDULE* SUNDAY, OCTOBER 11 AFTERNOON BREAKOUT SESSIONS (CONT.) New Ethical Dilemmas in the Digital Age: Telehealth Technologies and Treatment Mark Disselkoen, LCSW, LADC What is Everyone Talking About: The Real Deal on Cultural Competence Philip T. McCabe CSW, CAS, CDVC, DRCC & Laura Fenster Rothschild, PhD Mindfulness-Based Relapse Prevention: An Overview Therissa Libby, PhD 4:30 PM -- 5:45 PM Federal Panel: NIDA & NIAAA Emerging Research Moderator: David Mineta, MSW; Panelists: Jack Stein, PhD (NIDA), NIAAA Representative 6:30 PM -- 8:30 PM NAADAC Education & Research Foundation (NERF) Auction 9:00 PM -- 10:00 PM Mutual Support Meeting

Optional Saturday Evening Events Washington, D.C. Night Tour Join NAADAC aboard a luxury motor coach for a three-hour tour of Washington, D.C. and its beautifully lit memorials and monu­ ments after dark. Your tour guide will hop off with you at each attraction and share important details of each memorial with you. The fee for this experience includes a tour ticket and all ticketholders will be picked up and dropped off at the conference hotel. Participant Fee $50.

The Capitol Steps at the Ronald Regan Building Join NAADAC for a performance by The Capitol Steps, an American political satire group, at the Ronald Regan Building Am­ phi­theater. The fee for this experience includes a ticket to the show. Participant Fee $50.

Explore Washington, D.C. & Bethesda, MD Jump on the metro a few block from the conference hotel and explore Bethesda, MD or Washington, D.C. on your own! Free.

For full details on these evening events, visit www.naadac.org/annualconference.

14

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

MONDAY, OCTOBER 12 Up to 8.75 CEs Available on Monday 7:30 AM -- 5:00 PM Registration 7:30 AM -- 8:30 AM Continental Breakfast 7:30 AM -- 8:15:00 AM Q&A with the NAADAC President & Executive Director Kirk Bowden, PhD, MAC, LISAC, NCC, LPC & Cynthia Moreno Tuohy, NCAC II, CDC III, SAP 8:30 AM -- 10:00 AM KEYNOTE SPEAKER The ASAM Criteria and Addiction Treatment Matching David R. Gastfriend, MD 10:45 AM -- 12:15 PM MORNING BREAKOUT SESSIONS TrueTalk: Advocating for the Expansion of Youth SBIRT Tera Bianchi, MSW, Neil Campbell, MS & Mary Simon Treatment of the Relapse Process Using Mindfulness and Meditation as Viable Techniques Christopher Shea, MA, CAC-AD, CRAT RISE TOGETHER – Bringing a Face and Voice to Recovery Anthony Alvarado & Douglas Darby The Family in Early Recovery: Pitfalls & Hazards: An Indepth Look Oyen Hoffman, LMFT, LAC, MAC Effective Alcohol and Other Drug Interventions with the College-Aged Population Using the DSM-5 Matthew Shupp, NCC, DCC Military Culture: Bridging the Gap to Assist those Who Have Served Sharon Foley, MA, NCC, ACS, CADC Preparing for the Future: Treating Older Adults with Substance Use Disorders Randall Webber, MPH, CADC Pain in the Brain: Studying the Entanglements of Pain, the Brain, and Drugs Mita Johnson, EdD, LPC, LMFT, ACS, AAMFTApproved Clinical Supervisor, LAC, MAC, SAP Managing Pain Without Suffering: The Unmet Need Del Worley, MC, LPC, LISAC Ethical Considerations in Diagnosis John Lisy, LICDC-CS, OCPS II, LISW-S, LPCC-S

Creating Meaningful Learning Experience in Substance Abuse Courses Stephanie Sarabia, PhD, LCADC, LCSW 12:30 PM -- 2:15 PM President’s Award Luncheon 2:30 PM -- 4:00 PM AFTERNOON BREAKOUT SESSIONS Minority Fellowship Program–Addiction Counselors Grants Paula Horvatich, PhD, NMFP-AC Program Manager Addiction: Is It Ever Too Late To Hope?

Thomas Estis, PhD, NCC, LPC, LMFT, LAC Smart Approaches to Marijuana (SAM) Kevin Sabet, PhD Managing Workplace Risks: Legal Trends in Medical Marijuana and Other DisabilityRelated Topics Kathryn Russo, Esq. Personal Values and the Counseling Relationship Frances Patterson, PhD, LADAC, MAC, BCPC, CCJAS, SAP, QCS Neuropsychological Education and the 12 Steps: Reclaiming a Viable Recovery Option for Adolescents Daniel Fishburn, LCSW Enhanced Illness Management & Recovery: Practice & Recovery Implications of CoOccurring Disorders Piper Meyer-Kalos, PhD, LP & Roxanne Kibben, MA

Exhibit Hall Please be sure to visit and support the companies that are exhibiting this year.

Exclusive time to interact with the exhibitors in the Exhibit Hall has been set aside during the Welcome Reception on Friday evening, and during the Continental Breakfasts and morning and afternoon coffee breaks on Saturday and Sunday.

Interested in exhibiting, sponsoring, or advertising at the Annual Conference?

Please download the 2015 Annual Conference Prospectus at www.naadac. org/2015-sponsor-exhibit-or-advertise or contact Elsie Smith, Account Executive, at esmith@naadac.org or 717.650.1209.

PRELIMINARY SCHEDULE* Solution-Focused Substance Misuse Treatment Teri Pichot, LCSW, MAC, LAC Romancing the Brain into Recovery Cynthia Moreno Tuohy, NCAC II, CDC III, SAP The Wellbriety Movement and Celebrating Families!™: Bringing Back Cultural Teachings Don Coyhis BHbusiness: Where Healthcare Change Meets Business Success Kim Johnson, PhD, MBA Addiction Medicine: What Works for Whom?

Kenneth Martz, PsyD, CAS Now That You Know It….How Do You Do It? Kathy Elson, MS, PCC-S, LICDC-CS, SAP

4:30 PM -- 6:00 PM KEYNOTE & CLOSING CEREMONY Bath Salts, Spice, Khat, Ecstasy, Rophies, K2, DXM, PCP, GHB, MDMA, E-cigarettes etc.

Robert Perkinson, PhD, LAC, LMFT, NCGC II 6:30 PM -- 8:30 PM Movie Night 9:00 PM -- 10:00 PM Mutual Support Meeting

TUESDAY, OCTOBER 13 Up to 2 CEs Available on Tuesday 7:00 AM -- 12:00 PM Registration 7:00 AM -- 8:00 AM Breakfast

8:00 AM -- 10:00 AM Pre-Hill Advocacy Briefing Presented by Kirk Bowden, PhD, MAC, LISAC, NCC, LPC, Jim Macrae, MA, MP, Acting Administrator for the Health Resources and Services Administration (HRSA), Tom Coderre, Senior Advisor to the Administrator, Substance Abuse and Mental Health Services Administration (SAMHSA), Kevin Sabet, PhD, President of Smart Approaches to Marijuana (SAM) & Rob Morrison, Executive Director of The National Association of State Alcohol and Drug Abuse Directors, Inc. (NASADAD) 3:00 PM -- 6:00 PM Advocacy – Debrief Kirk Bowden, PhD, MAC, LISAC, NCC, LPC, Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, Gerry Schmidt, MA, MAC, LPC & Michael Kemp, ICS, CSAC, CSW

Capital Hill Day: October 13th Let Your Voice Be Heard!

Every five years, NAADAC combines its Advocacy in Action and Annual Conferences into a special Annual Conference and Hill Day in Washington, D.C. On Tuesday, Oc­to­ ber 13th, NAADAC members and other addiction-focused professionals from across the country will participate in a special Advocacy briefing and then convene on Capitol Hill to meet with their congressional representatives to advocate for the addic­tion profession.

ROSTISLAV AGEEV | PHOTOSPIN.COM

Hill Day is an opportunity for addiction professionals to meet face-to-face with lawmakers to share their expertise and put a human face to decisions about issues such as: the fair and effective implementation of the Affordable Care and Parity Acts; the growth and development of the addiction professional workforce; and federal and state funding for addiction prevention, treatment, and recovery efforts.

These meetings lay the groundwork for getting lawmakers into treatment centers and facilities, meeting with them when they return to their districts, and becoming a resource for their staff when they make important decisions that might impact your work as addiction professionals. Join NAADAC to help make Hill Day the hallmark advocacy event of 2015!

S U M M E R 2 015 | 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 15

LEARN  CONNECT  ADVOCATE  SUCCEED Pre-register now for the best rates!

Early Bird (ends 8/28)

Registration Fees

Regular (ends 10/3)

Full Conference: October 10–13 (3 days + Hill Day) Member ❑ $425 ❑ $475 Non-Member ❑ $550 ❑ $600 Student/Military Member ❑ $350 ❑ $400 Student/Active Military Non-Member ❑ $475 ❑ $525 Premium Conference: October 9–13 (Pre-Conference + 3 days + Hill Day) Member ❑ $525 ❑ $575 Non-Member ❑ $700 ❑ $750 Student/Military Member ❑ $450 ❑ $500 Student/Military Non-Member ❑ $525 ❑ $575

Late/On-site (starts 10/4) ❑ $525 ❑ $650 ❑ $450 ❑ $575 ❑ $625 ❑ $800 ❑ $650 ❑ $625

Pre-Conference: October 9 Member ❑ $150 ❑ $175 Non-Member ❑ $225 ❑ $250 Daily Please check day(s) you will attend: ❑ Oct. 10 ❑ Oct. 11 ❑ Oct. 12 Member (rate per day) ❑ $150 ❑ $175 Non-Member (rate per day) ❑ $225 ❑ $250

❑ $225 ❑ $275 ❑ $225 ❑ $275

Hill Day: October 13 Member Non-Members

❑ $50 ❑ $75 ❑ $100 ❑ $75 ❑ $100 ❑ $125 Special Events: October 11 Space is limited; sign up early. Minimum registrations required.

Night Tour of the Monuments ❑ $50 ❑ $50 ❑ $50 Capitol Steps Show at the Ronald Reagan Building ❑ $50 ❑ $50 ❑ $50

FEE TOTAL SUMMARY Full Conference: October 10–13 Premium Conference: October 9–13 Pre-Conference: October 9 Daily ( _____ days at $ _____ per day) Hill Day: October 13 Evening Events: October 11 ❑ Night Tour ❑ Capitol Steps Show

TOTAL AMOUNT ENCLOSED

Attendee Information

(please print clearly)

❑ YES, I want to join NAADAC! Please consult www.naadac.org for membership fees or call 800.548.0497 to enroll. ❑ Please send me additional information about membership. ❑ This is my first NAADAC Training/Conference.

NAADAC, INCASE, or NALGAP Member #:______________________________________________ Name:________________________________________________________________________ Address:______________________________________________________________________ City: ____________________________________ State: Zip: _ Phone: ( )___________________________ Fax: ( )_________________________ Mobile: ( )__________________________ Email:________________________________ If you or an accompanying person require special accommodations to fully participate, please describe your needs:_____________________________________________________________

Payment Options

(please print clearly) MATHISWORKS & SEAMARTINI | PHOTOSPIN.COM

❑ Check payable to NAADAC Please charge my credit card: ❑ Visa ❑ MasterCard ❑ AmEx Name as appears on card_________________________________________________________ Credit card number______________________________________ Exp. date ________________ Signature_____________________________________________________________________ Email form to naadac@naadac.org. Fax to NAADAC at 800.377.1136 or mail to 1001 N. Fairfax St., Ste. 201 Alexandria, VA 22314. Keep a copy for your records.

Conference refund policy: A partial refund of 50% of registration cost is refundable for cancellations received prior to September 8, 2015. Thereafter, no refunds are given.

Questions? Visit www.naadac.org/conferences or call 1.800.548.0497.

REV.1 05202015

1001 N. Fairfax Street, Suite 201, Alexandria, VA 22314 P: 703.741.7686 F: 703.741.7698 E: naadac@naadac.org

Write for NAADAC

We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals.

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

PHOTOSPIN | LEV DOLGACHOV

Please submit your story ideas and/or articles to Jessica Gleason at jgleason@naadac.org.

New Credentials/Endorsements Announcement National Certified Peer Recovery Support Specialist (NCPRSS) The NCPRSS is a credential for those who desire to support those in obtaining and maintaining recovery.

Nationally Endorsed Clinical Supervisor (NECS) The NECS recognizes a national standard of competencies and effective clinical supervision in the addiction treatment process.

For more information about the NCC AP and its substance use disorder counselor certification and specialty endorsement opportunities at the national and international level, visit www.naadac.org/certification.

MATT ANTONINO| PHOTOSPIN.COM

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

national competency standards.

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

www.naadac.org/certification

S U M M E R 2 015 | 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 17

■ MEMBERSHIP

Professional Liability Insurance – Claims Made vs Occurrence Form Policies?

Not better, not worse, but..... Different

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

DREAMSTIME

At some time in their professional career, a counselor will usually look into purchasing an individual professional liability policy to defend them for claims brought by unhappy clients. As an addiction counselor, you will see that two different types of policy forms are offered: a Claims Made form and an Occurrence Form.

Of course, wanting the best protection you can get, you will wonder, “Which form is best?” An agent only offer­ing Claims Made coverage may say Claims Made coverage is the better form.

The agent offering only an Occurrence Form coverage may feel the opposite.

18

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

When Claims Made form policies began appearing more regularly during the 1970s and 1980s, they were often compared unfavorably with the long-standing Occurrence Forms.

Over time, the Claims Made prod­uct was improved and is now mainstream and better understood by the insurance industry and the public. With today’s enhanced policy forms and provisions, neither form is better or worse than the other on an overall basis. But they are “different” and it is important that professionals are aware of the differences. Most of the largest insurers of professional liability offer excellent

coverage regardless of the policy form and both forms are offered for one year terms. Both forms are accepted by state regulatory authorities, governmental agencies, employers, or clients that may require a counselor to have professional liability coverage.

The difference is apparent when it comes time to report a claim. An Occurrence Form policy will cover an incident that occurs during the policy term, regardless of how many years later a suit is actually brought, while a Claims Made Form policy will cover all claims reported to the insurance company during the

The difference is apparent when

Claims Made Form PROS • Less costly: Claims Made premiums are less expensive than Oc­cur­rence Form premiums. The premium is lowest the first year the policy is issued and gradually increases over a 5- or 6-year period, then levels off. This works very well for the first few years of a counselor’s career when money is tightest.

• Greater flexibility: If you have a Claims Made policy for 5 years with $1/3 million limits, and you increase limits to $2/4 million for the 6th year, all claims brought after your limits are increased will be covered at the higher $2/4 million limits, even if the incident happened 3 or 4 years ago when the policy had lower limits.

• Broader coverage for past incidents: Generally, policies get broader in coverage over time, which means you will enjoy the benefits of your current broader coverage, even if the incident happened several years ago when coverage was more restrictive.

• Less uncertainty regarding an insurance company’s financial sta­bil­ity: An insurance company may have been financially secure 5 years ago when a policy was first written, but less financially stable today.

Claims Made policyholders are much less affected by the prospect of an insurance carrier becoming insolvent.

CONS • Planning needed when coverage is no longer needed: If you no longer choose to renew a Claims Made Form, you need to investigate with your insurance agent as to whether you will need to purchase an Extended Reporting Period endorsement. This endorsement is needed to cover incidents that are reported to the insurance company after the last Claims Made policy has expired.

• Possible additional costs: There may be an additional cost to purchase the Extended Reporting Period ­endorsement. Some insurance carriers do not charge an additional premium as long as certain conditions are met.

• Group Policy provided by employer could cause potential lapse: If you do not have your own coverage, but are relying on coverage provided by your employer’s group Claims Made liability policy, you may not know if your employer has allowed the insurance to lapse or non-renew. With some Claims Made carriers, you may be able to purchase coverage to cover a potential gap in coverage due to this type of situation, but only if you are aware that a lapse has occurred. To protect against this happening, employees may decide to purchase their own individual coverage so they have more peace of mind of knowing they have their own policy and limits to protect them.

it comes time to report a claim.

An Occurrence Form policy will cover an incident that occurs during the policy term, regardless of how many years later a suit is actually brought, while a Claims Made Form policy will cover all claims reported to the insurance company during the policy term, regardless of the incident date as long as the incident occurred after the first Claims Made policy was issued or the retroactive date of the policy.

policy term, regardless of the incident date as long as the incident occurred after the first Claims Made policy was issued or the retroactive date of the policy.

So, if these two forms are just “different,” what are the pros and cons of each form? Both forms continue to have advocates and detractors, but the difference often comes down to what is important to you, the purchaser of insurance.

Why does the insurance industry even have two different policy forms?

The Occurrence Form for liability form had been part of the insurance landscape since the first forms of liability policies were offered in the United States in the early 1900s. The Oc­ currence form initially worked well because liability claims were more predictable in these early years. The insurance industry would establish liability rates based on the mathematical and statistical predictions of what future claim costs would be for a policy issued in a given year.

This ability to predict adequate rates for liability policies came to a crash­ing halt in the 1970s and 1980s

Occurrence Form PROS • More familiar type of form: Policy­ holders generally understand the principles of an Occur­rence Form since their auto liability and home liability insurance is also on an Occur­rence Form. The policy written for a given policy period will be there to protect you for future claims that may be brought against you as long as the incident occurred during the policy period.

• Less planning: No need to plan to purchase an Extended Reporting Period endorsement once you no longer need insurance coverage. These endorsements are not needed on Occurrence Form policies.

CONS • Need to track: Policyholders need to keep track of past Occurrence Form policies to know which policy period applies should a claim arise. This is very important if you have changed agents or insurance carriers one or more times over the years.

• Cannot be endorsed after expiration: After an Occurrence policy expires, it cannot be endorsed to give broader coverage or higher limits. The policy terms in effect at the time the incident occurs determines coverage that will apply.

• More expensive: Occurrence forms cost more for the first several years of coverage than a Claims Made form. The cost difference disappears gradually over time.

• Insufficient limits: A past policy may no longer have sufficient limits to pay for a claim made today. Awards and settlements always trend higher over time.

• Insurance Company insolvency concerns: An insurance carrier that covered a prior policy period may become insolvent. If the Insurance Company has filed bankruptcy, the policyholder would have to rely on state Guaranty Funds which usually provide lower limits and services.

S U M M E R 2 015 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 19

when claims began arising from incidents that were reported many years after policies expired.

The insurance companies discovered that certain industries had a “long tail,” meaning the time between when an incident occurred and when a claim is finally reported. With a long tail, it is much harder to predict whether a rate established today will be enough to pay for claims five, ten or even more years away. Pollution claims and professional liability claims are examples of claims that can have a very long tail.

This situation caused a great upheaval in the insurance market place that caused Occurrence Form liability policy premiums to skyrocket for all industries. Therefore, the Claims Made Form was created to bring stability and predictability to the marketplace, especially for industries now identified as having a potential for delayed claim reporting.

The American Professional Agency, Inc. (APA, Inc.) Advantage As NAADAC’s new Program Administrator for Professional Liability for members, APA, Inc. has developed one of the best Claims Made

20

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

products in the industry. While the purchase of an Extended Reporting Period (ERP) form endorsement or “tail” endorsement seems to be t he biggest reason insureds opt for an Occurrence form, in practicality, it rarely needs to be purchased. There is no need for APA, Inc. insureds to purchase Extended Reporting Period coverage if: 1. You renew the policy; 2. You buy another claims-made policy going forward from another insurer with the same retroactive date; 3. You have been in the APA program 10 years claims free (the “tail” or ERP is free); 4. You became permanently disabled or died (the ERP is free); 5. You permanently retire after age 55 and have been in the APA, Inc. Program five years.

Counselors who would like more information on either form can call their insurance agent or do their own research on the Internet.

As there is vast amount of material on the Internet, some going back 20 years or more,

make sure to look at the more recent articles as they better reflect the difference of these two forms in today’s world.

APA, Inc.’s professional liability program provides coverage that is tailored to the unique exposures faced by addiction counselors.

Coverage is also available for NAADAC members who are nationally certified Peer Recovery Support Specialists, Associates working under supervision, Clinical Supervisors, Corporate Entities, and Students. For more information, please call 1.800.421.6694 ext. 2312 to speak with an agent in our Addiction Counselors De­ part­ment or visit www.naadac.org/insurance.

Pamela J. Van Cott, CPCU, is Assistant Vice President with the American Professional Agency, Inc. (APA, Inc.) and 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.

A Scientific Perspective on Marijuana on the Eve of Its Legalization

NAADAC Interview of Dr. Darryl S. Inaba, PharmD, CADC-V, CADC III In June 2015, NAADAC interviewed Dr. Inaba regarding the effects and actions of marijuana in the human body.

Earn 0.75 continuing education hours for reading this article. To learn more, visit www.naadac. org/magazineces.

D

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

NAADAC: It seems that the push for medical and legal recreational use of marijuana is reaching a tipping point, what do you think about this development?

DR. INABA: I think that people are again ignoring the science and medical community about marijuana as they did when marijuana was made illegal during the mid-1930s. As a clinician who has worked with those who experience medical, emotional and social problems from its use for the past 40 years, I am concerned about the life consequences that legalization will have on those who are vulnerable to developing problems from its use, especially youth users who are most at risk. Current data indicate that 8–10 % of people who use the marijuana will develop Cannabis Use Disorder (CUD) and will not be able to stop using it without treatment. (Borgelt, Franson, Nussbaum, & Wang, 2013; National Institute on Drug Abuse (NIDA), 2013; American Psychiatric Association, 2000). Currently over 300,000 people a year are being treated for this condition. About 17% of all those who are treated for substance-related and addictive disorders in the United States list marijuana as their primary and many list it as their secondary or tertiary drug of choice. It is, in fact, the substance most often listed by the 1.8 to 1.9 million treated for addiction each year in this country. (Substance Abuse and Mental Health Services Administration (SAMHSA), 2014). The majority of clients I have treated for CUD during the past 40 years were self-referred, not criminally-referred into treatment. They entered

treatment because marijuana was causing severe dysfunction and disruption in their lives and they desperately wanted to stop despite the great ridicule they were getting from others calling them a “wussy” who should go out and get a real addiction like heroin or meth before needing any help to stop.

Science and medicine also documents an availability of more powerful marijuana products than were generally available in the past.

“Dabs,” “Spice,” “Edibles” with a greater concentration of THC or more powerful synthetic cannabinoids are creating more health problems than during the 1960s when marijuana abuse first exploded in the general population of this country. (Center for Disease Control and Prevention (CDC), 2015; Gray, 2014). The greater availability of more potent THC, powerful and often undetectable synthetics, along with the evolving legalization of marijuana will certainly increase the number of people who will be seeking treatment. That issue is not being seriously considered by the legalization movement. Our treatment programs are already overloaded with long waiting lists for people who seek and need addiction treatment services. Further, how will the increased need for treatment services be financed?

In the late-1930s, the push was on to make cannabis an illegal drug.

Newspaper reporters from the Hearst newspaper chain and prohibitionists were looking for a new cause. In response Mayor La Guardia of New York City put a commission together to examine the problem and make recommendations. Cannabis had been recognized as a beneficial medical substance in many pharmacopeia references and it had been used for thousands of years to treat patients for a variety of ailments. So the question was: should it be banned for use in medicine as well as for recreational use? After a rigorous review, the Commission found that there was no cause for a total ban as there were viable medical applications for its use.

Science and medicine lost that battle and Congress passed the Marijuana Tax Act of 1937 prohibiting its use and availability for medical as well as recreational purposes.

Fast forward to the present day, society, and especially politics are again ignoring medicine and science regarding the general availability of marijuana. More information about both the positive and the negative effects of marijuana on the brain and body has been discovered in the past few years than the previous thousands of years of its use. We are starting to identify the great medical effects of the non-psychoactive chemicals in pot like cannabidiol (CBD) and the brain damaging effects of it psychoactive chemicals like Delta-9-tetrahydrocannabinol (∆ 9THC). All this is being ignored while influence for its legalization by BIG TOBACCO and ALCOHOL, whom William F. Buckley referred S U M M E R 2 015 | 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 21

DMITRIY SCHIN | PHOTOSPIN.COM

to as “The Merchants’ Of Death,” is winning the day. The potential financial opportunity to big business from having another addictive substance to market is probably irresistible. Society needs to be reminded that America suffers more than 500,000 deaths each year due to medical and life problems associated with its legal drugs of addiction, tobacco and alcohol and only about 40,000 annual deaths due to the abuse of illicit drugs on its streets.

NAADAC: There does seem to be a virtual flood of new studies and reports regarding marijuana, but they all seem to often contradict each other and promote more confusion than clarity about its effects.

Why does marijuana research result in such conflicting controversial reports?

DR. INABA: Marijuana is a nightmare for empirical scientists’ to study accurately. It is not a single chemical but a virtual smorgasbord of hundreds to thousands of biologically active compounds. Though there are only three species of the cannabis plant, there are vast numbers of strains, varieties, and hybrids that are in continuous development, each with varying levels of different molecules and compounds that the marijuana plant produces. Further, the varying concentrations of marijuana compounds are influenced by different growing techniques, how they are used, and even how long they have been stored after harvesting until they are used. A single marijuana plant contains some 480 or so biologically active chemicals, 66 of which are phytocannabinoids (cannabinoids produced by plant), and 80 to 100 psychoactive chemicals. (University of Washington Alcohol & Drug Abuse Institute (ADAI) and Australia National Cannabis Prevention and Information Centre, 2011). Each individual’s genetics or biology also influence the effects of marijuana.

When it is taken into the body, greater than 100 psychoactive metabolites can be produced from the body’s attempt to break down and eliminate it. Smoking marijuana creates an additional 2,000 or so chemicals from the combusted processes and most of those chemicals also have biologic impact on the brain and body. Another major concern about the chemicals present in street marijuana is that rodenticides, insecticides and other pesticides that are often used in their production usually remain in the plant and negatively impact the body. Fungi, bacteria, and residual solvents used in extraction processes are also found to contaminate marijuana products even in states that have legalize and regulate their sale.

Since much of the research done on marijuana does not or cannot control for these many variables, there continues to be tremendously conflicting and controversial results about its effects.

In 1988, scientists Devane and Howlett (1988) identified two major types of receptors for the cannabinoids in the brain and body: CB1 and CB2. CB1 receptors are responsible for the feelings of euphoria when marijuana is used. These are located the cortex and sub cortical areas of the brain, but there are no cannabinoid receptors in brain stem, the part of the brain that controls heart rate and breathing. Other psychoactive drugs like opiates and cocaine have major receptors in brain stem but not cannabis, which is why an overdose from marijuana rarely results in death as seen with other drug overdoses. I say rarely because high potency marijuana and synthetic cannabinoids are now being increasingly linked to suicides, accidents, homicides, drowning, heart attacks, seizures and even testicular cancer. CB1 receptors also activate the brain’s addiction pathway and are responsible for marijuana’s addictive properties.

22

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

Delta-9-tetrahydrocannabinol (∆9-THC) a major compound found in all marijuana plants is the primary activator of CB1 receptors. CB2 receptors are mainly outside of the brain and may be responsible for most of the medically beneficial effects reported with medical marijuana treatment. The CB2 receptors are more often activated by another major compound found in marijuana plants, cannabidiol (CBD). CBD actually opposes many of the effects of THC including the euphoric effects. CBD is not considered to be psychoactive and it interacts with the immune system, has anti-seizure, pain relief, anti-nausea and many other positive health benefits. Thus, I think that there is a real future for actual medical cannabinoids because CBD and other unique chemicals in the cannabis plant may be a treasure trove of future medicinal compounds. However, in my opinion, medical marijuana does not include rolling up some “nugs” or “shake” in a Zig Zag and smoking it as medicine, since there are also hundreds of medically harmful compound in the plant as well.

NAADAC: Why does addiction to marijuana, now classified in psychiatry as Cannabis Use Disorder, continue to be dismissed by many in both the general and even some scientific communities?

DR. INABA: Cannabis is a psychoactive substance that has been in continuous use throughout the world for longer than most other drugs.

It was used in Chinese medicine thousands of years ago and archeologists have even found still active molecules of its chemicals in Egyptian mummies. The funny thing about its long history of use is that we still barely know how it works and what it does to the brain. The most curious thing for me as an addiction treatment provider is that regular marijuana users continue an ardent denial about it even being a drug. They think of marijuana as an herb, a food, an economic entrepreneurial opportunity, or even that it is a political or constitutional right for all Americans to be able to use it. Very few, users and non-users, think of marijuana as being a drug. Opium, cocaine, alcohol, LSD and most abused psychoactive drugs come from botanical sources and no one has any problems thinking of them as drugs. Why then isn’t marijuana respected as being a drug as well?

As an addiction treatment professional and a clinical pharmacist, I know that the most psychoactive cannabinoid in marijuana is Delta-9thetrahydrocannabinol (∆9-THC). This compound, this drug, and many of the other cannabinoids in marijuana do cross the blood brain barrier to produce a long list of psychoactive effects: it impairs coordination, memory, depth perception, the ability for the eye to track movement and other abilities that decreased one’s ability to drive. ∆9-THC is an abuseable/addictive psychoactive substance that should not be used especially by adolescents, pregnant women, and people with a history of addiction and/or those who have mental health problems without careful medical supervision. Despite these issues and many current scientifically validated studies about adverse mental and physical effects of cannabinoids, many people do not believe that there are any negative problems associated with the use of marijuana or its primary psychoactive substance, ∆9-THC. They do not see it as an addictive drug despite the evidenced-based, Diagnostic and Statistical Manual of Mental Disorders specifying 11 symptoms plus 7 signs of withdrawal effects as diagnostic criteria for those experiencing Cannabis Use Disorder. (American Psychiatric Association, 2013).

NAADAC: How can chemicals produced in the cannabis plant have so many different effects on the human body and brain?

DR. INABA:To answer this key question we need to look at what is now known about phytocannabinoids found in the plant and the endocannabinoids present in the human body from a neuropharmacological perspective. It has only been about 25 years since research scientists first discovered the biological receptor sites that interact with the chemical compounds produced by the Cannabis plant, the phytocannabinoids in marijuana. It turns out that our brain and body cells have unique receptor sites known as G protein-coupled receptors for these compounds that are on the pre-synaptic axons fibers of neurons.

Within five years of that discovery, Raphael Mechoulam, who had much earlier identified CBD and ∆9-THC as active phytocannbinoids in the plant, then discovered anandamide, which is a natural biologically produced brain communication neurotransmitter that ∆9-THC and other phytocannabinoids emulated in the body. (Devane et. al., 1992).

So, all of us already have natural chemicals in our brains that produce the same effects as ∆9-THC. Very much like the opiates mimicking endorphins or methamphetamine releasing the brain natural catecholamine stimulants to produce their effects, the marijuana chemicals are mistaken for and act like natural neurotransmitters naturally produced by brain cells.

After anandamide, also known as AEA was discovered, scientists found an additional set of natural neurotransmitters (2AG, AGE, NADA, and OAE) that act like the various chemicals in marijuana. These natural brain marijuana-like chemicals are known as the endocannabinoids.

Phytocannabinoids artificially activate these same receptors that are in our brain and body for our natural endocannbinoids. Research has also discovered a vast number of CB1 and CB2 marijuana receptors throughout the human body, not just in the brain. These cannabinoid receptors are actually the most abundant receptors in the human body even more prevalent than opiate endorphin/enkephalin/dynorphin receptors. Thus, the chemical compounds found in marijuana have a very diverse range on effects on the human body. These phytocannabinoid compounds can have both positive and negative effects. Also, each individual may have different variances in the type, density and number of CB1 and CB2 receptors as well as unique biologic processes that differ from each other.

Thus, different people can have vastly different effects from the same batch and amount of marijuana used.

NAADAC: How does marijuana use result in Cannabis-Use Disorder as codified by the Diagnostic and Statistical Manual of Mental Disorder (DSM-5)?

DR. INABA: Marijuana is abused for its euphoric effects. The brain mistakes the infusion of its artificial phytocannabinoids as an excessive release of its natural endocannabinoids. The first endocannabinoid discovered was named anandamide which is Sanskrit for supreme joy. In response to what the brain mistakes as excessive activity of its natural endocannabinoids when marijuana is abused, it progressively shuts down production, storage and release of its natural endocannabinoids. The brain always strives to maintain balance of its neurochemical system which is known as homeostasis. Brain cells also shut down their cannabinoid receptors through a process known as “down regulation.” A pot user has to therefore continually use more and more or stronger and stronger

marijuana to fool the brain that its endocannabinoid functioning is at homeostasis. But, as they continue to use more their natural endocannabinoids continue to be depleted and they become potentially dependent on marijuana to feel functional. This unbalanced functioning of the brain is known as allostasis.

Phytocannabinoids in marijuana also cause an imbalance of other natural neurotransmitters like dopamine. Dopamine in the brain’s addiction pathway is imbalanced by all addictive drugs. Marijuana first exaggerates dopamine release to hijack the brain’s reward and survival instincts resulting in compulsion to keep using marijuana. But continued use results in its depletion similar to the allostasis that develops with abuse of other addictive substances. Dopamine depletion results in craving, obsession to use and the drive to start using again when marijuana use is discontinued. Addictive use of marijuana produces tolerance, physical dependence and even withdrawal symptoms.

Current research documents that 8% to 10% of the people who use marijuana will become addicted to it. (American Psychiatric Association, (2000); Anthony & Helzer, 1991; Anthony, Warner, & Kessler, 2004).

Since most people who use marijuana will not develop addiction, many users will vigorously deny marijuana addiction. Vulnerability for Cannabis Use Disorder is determined by a combination or genetics, environmental stresses (e.g. early childhood trauma, or even poor nutrition), and the allostasis impact of continued use. We treat several clients with Cannabis Use Disorder at my program in Oregon, and most are self-admitted to treatment complaining that they can’t stop using it though it is causing them significant consequences and disrupting their quality of life activities. The current waiting list to get into the residential treatment services of the Oregon Addictions Recovery Center where I work is four months long.

NAADAC: Has science identified any other solid health consequences from heavy use of marijuana?

DR. INABA: Marijuana interferes with a person’s ability to complete tasks requiring multiple steps to achieve a goal. It impairs depth perception, can suppress short term memory ability, and has many other detrimental mental effects when someone is under its influence. Standard deviation of lateral position (SDLP) equivalent to 0.08 level of alcohol use while driving has also been documented. These acute effects impair driving ability. (Hartman et al., 2015). Regular heavy use of marijuana has recently been shown to produce cognitive problems and even an 8 point drop in IQ — the same IQ drop experienced from lead poisoning!

This IQ loss has been shown to be chronic effects that persist into midlife even if the user stops using after their adolescent years. (Meier et al., 2012). Increased risk for heart attack, seizures, testicular cancer, acute psychosis, and even schizophrenia has been fairly well documented with early age, high-potency marijuana, edible marijuana products, or use of the synthetic marijuana compounds (Andeasson, et al., 1987; Arseneault, et al., 2002). I have even treated clients who have experienced very painful and scary uncontrolled vomiting from its use known as Cannabis Hyperemesis Syndrome (Chen & McCarron, 2013). I have also treated clients who developed Hallucinogen Persisting Perceptual Disorder (HPPD), which is a prolonged “bad trip” resulting from its use. (Halpern & Pope, Jr., 2003).

S U M M E R 2 015 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 2 3

As a health and addiction treatment professional, I am especially concerned about the increased use of marijuana along with decreased perception that its use can cause any harm by the youth population. Preadolescents who start using marijuana and other addictive substances at an age of 10 to 12 are 5 to 6 times more liable to develop some form of substance-use disorder and other health consequences in their lives than others who delay their first use until they at least graduate from high school. (Falls, 2007). The deluge of current laws legalizing unconstrained medical and recreational cannabis use has decreased the perception of marijuana as being harmful in any way to the user.

This has opened the door to increase abuse of marijuana especially in the population most vulnerable to its adverse consequences, our youth.

DREAMSTIME

NAADAC: Do you have any other major concerns about marijuana use as America seems on the verge of legalizing its recreational use?

Dr. Inaba: I have grave concerns about the rapid increase in the concentration of ∆9-THC potency of marijuana and its various commercial products available to those who use it. Back in the 1960s, street marijuana samples tested to an average of about 1–2% ∆9-THC. By the late 1980s, genetic manipulation, sinsemilla and other enhanced growing processes, resulted in an average concentration of 4–6% ∆ 9-THC. Currently the Marijuana Potency Monitoring Project at the University of Mississippi reports an average concentration of about 15% from thousands of samples seized by law enforcement throughout the United States. A recent report of 600 Colorado marijuana samples submitted for premarket testing found an average concentration of almost 19% with some containing up to 30%. This Colorado report also found toxins, rodenticides, and even heavy metals contaminants from the chemicals and fertilizers used to increase concentration of ∆ 9-THC in mari-

24

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

juana. CBD concentrations of these same samples were found to be much less than what had previously existed. Decreased CBD was accomplished via genetic modifications and was done since CBD counteracts the desired psychoactive effects of ∆9-THC. Fungi were also found to contaminate many of the Colorado commercial marijuana samples. (Briggs, 2015).

Then, there is the increasing problem of extracts with extremely high concentrations of Δ9-THC known as dabs, BHO, honey oil, or wax. Dabbing is a process of extracting and con­centrating ∆9-THC using butane, alcohol, water, or another solvent. This results in an oil or a wax-like product that can contain 80% to 95% concentrations of ∆9-THC. I have treated clients with terrible and long-lasting psychological and traumatic effects from smoking dabs. Some users have experienced a heart attack or feel like they are about to have a heart attack. A current client had six emergency room visits in a two month period suffering from painful Cannabis Hyperemesis Syndrome that could not be controlled with any emergency anti-vomiting medication when he used a high potency marijuana product.

Marijuana “Edibles” are ∆ 9-THC extract infused candies, cookies, soft drinks, energy drinks, etc. for oral use instead of smoking.

Attraction to abusing cannabis as “Edibles” has exploded across the country. These products often contain much more THC per candy bar, gummy bear, or soft drink can/bottle than is usually available when a marijuana cigarette or “joint” is smoked. A usual recreational dose of ∆9-THC is generally accepted to be 10 mg. and these products were mandated to contain that ∆9-THC concentration per serving. Purveyors of these products comply with this by labeling their “Edible” candy bar or can of soft drink to contain 10 mg. per servings but then have multiple servings per unit of sale. Thus, a single “Edible” gummy bear is listed as containing 4 servings per each individual gelatin candy and I know of no one who would slice a gummy

bear into 4 parts and only chew a single slice to satisfy their sugar or marijuana needs.

Finally, there is the uncontainable problem of synthetic cannabinoids. Street chemist can potentially create countless numbers of designer synthetic marijuana-like compounds. There are at least nine different chemical families with compounds that can be redesigned to act like super-potent THC at cannabinoid brain receptors. Disguised and sold as incense, potpourri, aromatherapy, and even as e-cigarettes cartridges, these chemicals have been tested to be anywhere from 5 to 800 times more potent than THC. Worst of all, most of these extremely potent forms of new cannabis products like dabs, Edibles and even the odorless and flavored e-cigarette cartridges appear to be marketed toward adolescents and young users who have still developing brains making them much more vulnerable to the new found toxic health consequences from exposure to chemical compounds in marijuana.

We are definitely in a new era of marijuana or cannabinoid abuse and the future doesn’t look too good. Why society continues to ignore science and medical community findings regarding the potential harm of cannabis use or even that it is a drug with potential negative as

well as positive effects is completely baffling to me. Maybe it’s all part of the addictive process that Bill W of A.A. once accurately described as: Cun­ning, Baffling, and Powerful.

REFERENCES American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, D.C.: Text Revision, DSM-IV-TR. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: 509–519.

Andeasson, S., Engstrom, A., Allebeck, P. & Rydberg, U. (1987). Cannabis and Schizophrenia: A Longitudinal Study of Swedish Conscripts. Lancet, 330 (8574): 1483–1486.

Anthony, J. & Helzer, J. (1991). Syndromes of Drug Abuse and Dependence. In L. Robins & D. Regier (Eds), Psychiatric Disorders in America (pp 116–154). New York, NY: Free Press.

Anthony, J., Warner, L., & Kessler, R. (2004). Comparative Epidemiology of Dependence on Tobacco, Alcohol, Controlled Substances and Inhalants: Basic Findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology, 2:244–268.

Arseneault, L., Cannon, M., Poulton, R., Murray, R., Caspi, A., & Moffitt, T. (2002). Cannabis use in adolescence and risk for adult psychosis: Longitudinal prospective study.

BMJ, 325: 1212–3.

Borgelt, L,. Franson, K., Nussbaum, A., & Wang, G. (2013).

The Pharmacologic and Clinical Effects of Medical Cannabis. Pharmacotherapy, 33(2):195–209.

Briggs, B. (2015, March 23). Colorado Marijuana Study Finds Legal Weed Contains Potent THC levels. NBC News.

Retrieved from http://www.nbcnews.com/storyline/legalpotlegal-weed-surprisingly-strong-dirty-tests-findn327811.

Center for Disease Control and Prevention. (2015). Increase in Reported Adverse Health Effects Related to Synthetic Cannabinoid Use – United States, January – May 2015.

Morbidity and Mortality Weekly Report, 64(22):618–619.

Chen, J. & McCarron, R. (2013). Cannabinoid hyperemesis syndrome: A result of chronic, heavy Cannabis use.

Current Psychiatry, 12(10):48–54.

Devane, W., Dysarz, F., Johnson, M., Melvin, L., & Howlett, A. (1988). Determination and Characterization of Canna­ binoid Receptor in the Brain. Mol Pharmacol, 34:605.

Devane, W., Hanus, L., Breuer, A., Pertwee, R., Stevenson, L., Griffin, G., Gibson, D., Mandelbaum, A., Etinger, A., & Mechoulam, R. (1992). Isolation and Structure of a Brain Constituent that Binds to the Cannabinoid Receptor.

Science, 258 (5090): 1946–1949.

Falls, B. (2007). The association of early conduct problems with early marijuana use in college students (Master’s Thesis). University of Maryland, College Park (Publication Number 1450222).

A Scientific Perspective on Marijuana on the Eve of Its Legalization Earn 0.75 continuing education hours for reading this article. To learn more, visit www.naadac. org/magazineces.

Earn 0.75 continuing education hours by taking a multiple-choice quiz on this article now at www.naadac.org/magazineces. $10 for NAADAC members and non-members.

1. Current data indicates what percentage of people who use marijuana will develop Cannabis Use Disorder (CUD)? a. 8–10% b. 12–18% c. 20–25% d. 50–58% 2. Congress passed the Marijuana Tax Act, prohibiting its use and availability for any purpose in what year? a. 1934 b. 1932 c. 1937 d. 1938 3. How many species of the cannabis plant exist? a. 2 b. 3 c. 6 d. Infinity

4. A single marijuana plant contains some _______ or so biologically active chemicals. a. 15 b. 220 c. 375 d. 480 5. _____ are the cannabinoid receptors that are responsible for the feeling of euphoria when marijuana is used. a. THC b. CB1 c. CB2 d. AEA 6. _____ are the cannabinoid receptors that are mainly outside of the brain and may be responsible for most of the medically beneficial effects reported with medical marijuana treatment. a. THC b. CB1 c. CB2 d. AEA

Gray, E. (2014, April 21). The Drug Threat in Plain Sight.

Time Magazine, 24–31.

Halpern, J. & Pope, Jr., H. (2003). Hallucinogen persisting perception disorder: what do we know after 50 years?

Drug and Alcohol Dependence, 69:109–119.

Hartman, R., Brown, T., Milavetz, G., Spurgin, A., Pierce, R., Gorelick, D., Gaffney, G., & Huestis, M. (2015), Cannabis Effects on Driving Lateral Control With and Without Alcohol. Drug and Alcohol Dependence. Published June 23, 2015. doi: 10.1016/j.drugalcdep.2015.06.015 Meier, M., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R., McDonald, K., Ward, A., Poulton, R., & Moffitt, T. (2012), Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences of the United States of America, 109:40.

National Institute on Drug Abuse. (2013). Marijuana Facts for Teens. Retrieved May 20, 2015 from https://www. drugabuse.gov/sites/default/files/teens_brochure_2013. pdf.

Substance Abuse and Mental Health Services Adminis­ tration. (2014). Treatment Episode Data Set (TEDS) 2002– 2012. Retrieved November 11, 2014 from http://www. samhsa.gov/data/sites/default/files/TEDS2012N_Web.pdf.

University of Washington Alcohol & Drug Abuse Institute (ADAI) and Australia National Cannabis Prevention and Information Centre. (2011). Learn about Marijuana.

Retrieved June 16, 2014 from http://adai.uw.edu/ marijuana/factsheets/cannabinoids.htm.

7. _______ is not considered to be psycho­ active and it interacts with the immune system, has anti-seizure, pain relief, antinausea and many other positive health benefits. a. CBD b. CB1 c. CB2 d. AEA 8. What are the natural brain marijuana-like chemicals known as? a. Phytocannabinoids b. Endocannabinoids c. Thetrahydrocannabinol d. Cannabinoids 9. Which receptors are actually the most abundant receptors in the human body? a. endorphin b. encephalin c. dynorphin d. CB1 and CB2 10. The Marijuana Potency Monitoring Project at the University of Mississippi reports an average concentration of about _______ from thousands of samples seized by law enforcement throughout the United States. a. 10% b. 15% c. 20% d. 25% S U M M E R 2 015 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 2 5

INCASE: The International Coalition of Addiction Educators, Past, Present and Future

By John Korkow, PhD, LAC, SAP, President INCASE

This is the first of a new quarterly column on addiction counselor education

by INCASE, the International Coalition for Addiction Studies Educators.

As current president, I hope to introduce myself and give a brief account of INCASE, including its history and current priorities for the future of the addiction profession, as we prepare to celebrate INCASE’s 25th anniversary at the 2015 NAADAC Annual Conference in Washington, D.C. this fall.

F

AUREMAR | PHOTOSPIN.COM

ounded in 1990, INCASE is a professional association of professors, teachers, professionals, and programs specializing in addiction studies, including the use and abuse of alcohol and other drugs, other addictions, counselor preparation, prevention and treatment, research, and pub­l ic pol ic y.

Our purpose is to provide a global forum for the examination and debate of issues concerning post-secondary education in addiction studies, and to enhance the quality of training and education in addiction studies, to disseminate professional knowledge and share ideas regarding addiction studies and scholarship in the field of addiction studies, and to develop standards and implement an accreditation process for addictions studies programs within and between nations, states and provinces. INCASE members keep abreast of the developments in the field via annual conferences and regional meetings, the INCASE newsletter, our listserv, the INCASE professional journal now merging with the Association for Medical Education and Research in Substance Abuse (AMERSA), and through participation in standing and ad hoc committees, and issues oriented task forces.

The availability of undergraduate and graduate Ad­ diction Studies programs has increased tremendously in the past decade or so. The educa­-

26

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

cational search database, Petersons.com showed 194 undergraduate Addiction Studies programs in 2015, up from 125 programs in 2003. A similar search showed 161 schools offering some type of graduate level training in addictions, up from only 35 schools in 2003 and 55 schools in 2008. Many of these programs are housed within other departments, such as Social Work, Criminal Justice and Psychology. Several are now stand-alone departments.

Prior to INCASE, set educational accreditation standards for addiction and prevention programs at the post-secondary level did not exist.

Coursework often was based around those books which were available, many of which were not “evidence-based” — a term just coming into our professional vocabulary. The 1980s had brought us an era of insurers paying for any treatment prescribed, and then the fall from grace when third party payers began examining every client record under a microscope.

It was in this atmosphere that in 1990, INCASE began to examine the standards of college level addiction and prevention programs to initiate an accred itat ion prog ra m. Not surprisingly, it found a wide range of standards, and in the majority of cases, no standards, for addiction counselor training and education. However, many programs had begun the process of creating realistic and rigorous curric­ulum standards through trial and error. INCASE members real­ized that the future of the profession rested upon the shoulders of these academic pro­ grams and hoped to raise these standards, and reduce or eliminate the trial and error process which many programs had st r ug­g led t hrough as t hey birthed brand new professional ad­d ic­tion and prevention prog r a m s f o r t he i r s t ude ntcounselors.

Accordingly, INCASE members worked very hard to create educational standards with the primary goal of providing highly

educated professionals to existing treatment and prevention programs and creating new generation of addiction and prevention professionals who both understood and helped to create evidence-based therapies. Prior to 1998, INCASE based accreditation standards on existing addiction and prevention education programs which displayed high levels of academic rigor and excellence. In 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) published TAP 21: Addiction Counseling Competencies, which covers the knowledge, skills, and attitudes of professional practice, and INCASE piloted usage of TAP 21 as the standard for addiction studies programs nationwide.

NASAC Accreditation In 2011, after urging from federal agencies, INCASE partnered with NAADAC to create a new academic accreditation organization for higher education addiction studies programs called the National Addiction Studies Accreditation Commission (NASAC). By doing so, we hoped to create a single standard for higher education addiction studies programs. NASAC is a single higher education addiction studies accreditation body commissioned to assess U.S. academic programs in addiction studies at regionally accredited institutions of higher education (not including workshop and continuing education programs). It is the only accrediting organization that represents addiction-focused major and minor programs, educators, and practitioners at the association, bachelor’s, master’s, post-graduate, and doctoral levels.

INCASE members are still active in the accreditation process, with three of six Commissioners, appointed from among INCASE leadership, and an additional INCASE Board Member/ Accreditation Committee Chair sitting on the NASAC Advisory Committee. INCASE members also serve as evaluators for the NASAC Accreditation Process and on the INCASE Accreditation Committee. INCASE continues to offer accreditation to international non-U.S. based colleges and universities using similar standards as the original INCASE Accreditation with some integrated modifications made by NASAC.

The Importance of Quality Education from Accredited Institutions As the professionalization process of addiction counseling has accelerated over the past decades, the growth of graduate-level academic programs in addiction studies has become more rapid and we have more counselors with graduate degrees than ever before.

In response to many the changes happening in our field and the increase in the demand for services, SAMHSA, in collaboration with key stakeholders including NAADAC, released a Model Scope of Practice and Career Ladder for substance use disorder treatment workers in 2011.

SAMHSA’s Career Ladder, includes four different categories of substance use disorder counselors: (4) Independent Clinical Substance Use Disorder Counselor/Supervisor; (3) Clinical Substance Use Disorder Counselor; (2) Substance Use Disorder Counselor; and (1) Associate Substance Use Disorder Counselor; and a fifth category: Substance Use Disorder Technician. While all of these categories require some level of education, the requirements range from that of a high school diploma or GED for the Substance Use Disorder Technician to a Master’s or other post-graduate degree for categories (3) and (4).

This career ladder should not be misinterpreted as a method of shutting out those without college diplomas, but rather as reasonable scopes of practice for each level of education that provide gateways into the profession for everyone with a commitment to assist our clients. During a licensing panel forum at the 2015 California Association for Alcohol and Drug Educators Conference, I made the assertion that licensure (i.e. the career ladder) is not about reducing the number of people inside the tent of addiction counseling, but rather is about deciding who is in charge inside this “tent of recovery.”

I personally can speak to those who do not wish the commitment in time, money and effort of an advanced degree. My career plan was to complete a Bachelor’s degree in Addiction Studies, and begin my counseling career. I found myself dissatisfied with the job opportunities at that level, and moved on to more advanced degrees, but that choice was personal, and required the commitment of several personal resources which others simply may not be in a position to make. Part of our professional balance is deciding which level of the career ladder fits within the lives we wish to lead.

If we lack that balance, we cannot be the best counselors for our clients. The “tent” surrounding this career ladder is meant to have a place for everyone who has a commitment to assisting our clients S U M M E R 2 015 | 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

suffering from substance use disorders. Assisting clients can and does occur at every level, beginning with recovery coaches and including counselors holding graduate degrees.

I personally cannot imagine the addiction profession, which grew out of the 12-step movement, ever shunning its extensive roots in that soil.

Those who discuss the dichotomy between “experience” and “education” are really involved in a false comparison. The research and clinical experiences of people such as William White, James Prochaska, Terrence Gorski, Don Coyhis, William Miller, David Mee-Lee, Darryl Inaba, David Powell and many, many others are the shoulders we stand upon when we teach our students about practices that result in successful client outcomes.

When supervisors talk to clinicians about their own work, they are providing knowledge to that new clinician. It has always been, and will always be about our clients, first and foremost. Many skilled counselors have both given and devoted their lives to creating knowledge that assists our clients in ways that were unimaginable as little as twenty years ago.

Therefore, taking into account the value of both education and experience, INCASE utilized an educational ladder in its initial accreditation package, and a very similar ladder (which includes programs from the Associate’s level through PhD levels) has been maintained by NASAC.

HELPING YOUto

HELP OTHERS

Why Join NAADAC, the Association for Addiction Professionals?

• Up to 75 free CEs • Joint membership in your state affiliate • Reduced rates for NAADAC & NAADAC-affiliate conferences, trainings, and events • Reduced rates on NAADAC publications • Reduced rates on national NCC AP Certification • Reduced rates on malpractices & liability insurance • Free subscription to Advances in Addiction & Recovery • And much more!

www.naadac.org 28

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

It is important to stress caution when researching undergraduate or graduate addiction studies programs online. There are several online resources designed to assist student in finding college programs which fit their needs. However, many online searches will turn up addiction or prevention education programs that merely exist as a brief track within another helping professional program. Oftentimes, these tracks would not meet the NASAC accreditation standards, and should be avoided by the serious addiction or prevention counselor student.

Many students have been misled by non-accredited institutions in the past, and the addiction profession is not immune to programs attempting to lure our students with the promises of a cheaper and quicker route to licensure or certification. There truly are no quick and easy paths that exist to advancing our skills as addiction and prevention professionals. I urge counselors seeking education to seek programs which have met the rigorous test of the NASAC accreditation process.

Looking to the Future The future of the addiction and prevention profession is supervised care under a trained addiction/prevention professional holding the appropriate addiction or prevention licensure. This is, as stated above, not a matter of kicking people out of the tent, but rather of deciding who is in charge of the “tent of recovery.” Based on my research, as of April 30, 2015, there are twenty-seven states (Arizona, Arkansas, Colorado, Delaware, Indiana, Kansas, Louisiana, Maine, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming) and the District of Columbia that require licensure, and twenty-four states without licensure in the addiction and prevention professions. Each state has very different requirements and standards, thus it would behoove the student to look at the requirements to practice in each state before making a decision concerning coursework and career ladder placement.

My hope is that we are able to achieve a single set of addiction and prevention licensure standards adopted in every state, making reciprocity a simple and fast process, and that no one has a question concerning the status of addiction and prevention counselors as professionals in their own right. I hope to work towards no longer having a patchwork quilt of numerous standards and licensure requirements across the United States, and no longer worry that our profession will no longer be considered a specific profession and will rather only be considered a subset of other professions who don’t fully understand the important and specific work that we do.

The existential question is always, “What is right for me?” The profession will always need folks at all levels of intervention, and I, for one, am thankful that I could enter our profession and earn a living with a B.S. degree, even though I went on to later earn higher degrees. Education, as provided by our INCASE educators under the auspices of NASAC accreditation, is the single best route to assure an excellent future in this profession, a future which includes everyone!

John Korkow, PhD, LAC, SAP, received his PhD in Educational Psychology from the University of South Dakota in 2008. He completed an MA in Community Agency Counseling, and a BS in Addiction Studies, and has worked as an addiction counselor since 1999. He is a board member and conference committee planning chair of SDAAPP, member of NAADAC, President of INCASE, and board member of NASAC. He is currently an assistant professor in Addiction Studies at the University of South Dakota.

Electronic Screening and Brief Intervention (e-SBI) Effective for Reducing Excessive Alcohol Consumption by Adults

T

By Robb Hicks, MD

he rapid development and accessibility of technology have made it possible for individuals to actively participate in their health care and treatment plans. More American adults (61%) than ever before are going online to find and share health-related information and advice, according to findings by the Pew Research Center (2009). Mobile access to the Internet allows individuals and clinicians to connect at any time or in any place.

Alcohol addiction specialists in particular are capitalizing on this technological acceptance by supplementing traditional medical practices with automated behavioral therapies. More formally known as electronic screening and brief intervention (e-SBI), these computerized tools (also known as computer-assisted treatments or therapies) are administered to patients who have tested positive for excessive alcohol consumption patterns on prior screening. The questions asked are supported by ­empirically-validated instruments like the AUDIT (Alcohol Use Disorders Identification Test) and the Rutger’s Alcohol Problem Index.

They are delivered via the Internet, telephone or mobile phone. Upon completion, a patient receives personalized feedback to determine their level of risk. The intervention portion of the tool includes suggestions for additional resources for reducing problem drinking (Carroll, 2014).

As with the introduction of any pioneering therapy, there are advantages and disadvantages to consider before implementing the tool into a patient’s care plan.

Computer-Assisted Treatments Serve as an Extension of Clinicians Excessive alcohol use is one of the leading contributors to preventable deaths in the United States. It significantly increases the likelihood of an individual experiencing morbidity, violence, and even death. Yet, only 1 in 6 adults who misuse alcohol say they talk with a healthcare professional about their drinking patterns (Bouchery, Harwood, Sacks, Simon & Brewer, 2011 & Centers for Disease Control and Prevention, 2014). This unwillingness to seek help may be prompted by myriad reasons, including but not limited to: difficulties accessing treatment; the time required to complete a traditional screening and brief intervention (SBI); dislike of how and/or where the treatment is administered; or the failure of clinicians to identify their problem. A shortage of staff, time, money, and other resources may pose an additional barrier for many in underserved populations (The Guide to Community Preventive Services, 2014).

The widespread use of computers and smartphones has inspired the development of e-SBIs to address some of the aforementioned obstacles preventing face-to-face SBIs. These computerized treatments can serve as an economical alternative that achieves the same outcome — help people stop their problem drinking. E-SBIs can be anonymously disseminated in various settings to more patients in less time, which in turn free up clinicians for other functions. Additionally, tailored feedback and the use of multi-media effects, games, and virtual simulations make eSBIs more appealing and engaging to many patients (Donoghue, Patton, Phillips, Deluca, & Drummond, 2014).

IGOR TEREKHOV | PHOTOSPIN.COM

Computer-Assisted Treatments Reflect Current Theory of Change Due to e-SBIs’ self-paced and self-directed nature, they can be accessed when individuals are most motivated to change their unhealthy behaviors. This demonstrates a vital step towards ending the cycle of problem drinking and other alcohol-related harms, as it relates to the ‘Stages of Change’ (SCM) model (Prochaska, 2014). Recognizing these five sequentially progressive stages of change — precontemplation, contemplation, preparation, action, and maintenance — allows us to better appreciate the potential effectiveness of e-SBIs for treating excessive alcohol consumption.

For example, the screening portion of the tool could impact patients in either the precontemplation or contemplation stage. Precontemplators have been blaming their drinking and the damage it has caused on anything other than themselves, such as genetic predisposition, family of origin, karma, societal mores, religion, or the police. As correctly noted in Motivational Interviewing: Preparing People To Change Addictive Be­havior, “We cannot make precontemplators change, but we can help S U M M E R 2 015 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 2 9

motivate them to move to contemplation” (Miller & Rollnick, 1991).

The objective facts provided by the validated e-SBI screening questions could break through the extant denial, and may therefore be the only such motivator available in the middle of the night.

Persons with an alcohol use disorder in the contemplation stage may similarly benefit. Contemplators acknowledge they have a problem, but they are spending enormous time and energy trying to figure out the cause, rather than trying to solve it. Heralding their movement into the preparation stage is the ability to look forward and want a solution, rather than staying hopelessly focused on the past. Again, e-SBIs may be the unique tool that brings a desperate contemplator hope in the middle of the night as it provides suggestions to solve the problem.

Heavy drinkers in the preparation stage are the third group who can most benefit from e-SBIs. They have already acknowledged they have a problem, and they are thinking of ways to solve it. Again, one can easily imagine how the screening portion of the tool could help overcome their residual ambivalence, followed by the brief intervention that could propel them into action. Thus, we can see that an environment conducive to accurate reporting of personal behaviors can be established within the progressive movement from stage to stage within the SCM. Critics of the implementation of computer-assisted treatments argue that they do not provide any of the potential benefits of in-person interactions, such as rapport, empathy or non-verbal communication (Dono­ ghue, Patton, Phillips, Deluca, & Drummond, 2014).We would never attempt or want to replace the counsel of trained substance use disorder professionals. However, it is vital we continue making effective treatment options available to patients when and where they are most likely to access them.

Research Shows Adults Receiving Web-based Treatments Drink Less Alcohol In a systematic review of 31 studies conducted from 1997 to 2011, the United States Department of Health and Human Services’ Com­mu­ nity Preventive Services Task Force recently concluded that e-SBIs are indeed effective in decreasing self-reported excessive alcohol consumption and problems. They found e-SBIs yielded favorable outcomes for all indicators of alcohol misuse, e.g., risky drinking behaviors, overall consumption, and binge drinking, throughout post-intervention periods lasting up to one year. These favorable outcomes were defined by decreases in the number of drinks consumed per occasion, the overall number of alcoholic drinks consumed per month, and the frequency of binge drinking occurrences.

It should be noted that the web-based interventions were found effec­ tive across a wide-range of age and gender populations and settings.

Never­the­less, additional research will likely be needed to determine the efficacy of e-SBIs among individuals from different sociodemographic groups (The Community Guide, 2014).

Donoghue and colleagues (2014) also conducted a systematic review and meta-analysis of 40 studies and found nearly identical evidence of the efficacy of Internet-based interventions. Many of the adult participants drank at least two standard-sized drinks less per week in the followup post intervention periods lasting up to one year. Given that e-SBIs have been demonstrated to be safe and effective for use, it remains im­ per­a­tive for clinicians to receive the training, monitoring, and feedback needed to properly administer them. Computer-assisted therapies should be carefully distributed using the same methodological standards required for evaluating clinician-delivered therapies.

30

A d va n c e s i n A d d i c t i o n & R e c o v e r y | S U M M E R 2 015

The Future of Technology Provides Accountability and Support for Problem Drinkers The advancement of e-SBIs will pave the way for more uses of technology in alcohol use disorder treatments, specifically mobile phone text messaging-based interventions (Haug, Kowatsch, Castro, Filler & Schaub, 2014). This cutting-edge resource could help us to educate a greater number of adolescents about the risk of over-consuming alcohol.

We would be able to send customizable, supportive advice directly to their smartphones, especially when they are most likely to drink.

As the Internet continues to progress, the range of help-seeking options will increase. We’ll see even more acceptance of downloadable ap­ pli­cations (apps), podcasts, videos and more to manage individuals’ health. Clinicians, too, will have more opportunities to take treatment to problem drinkers rather than bringing the problem drinkers to treatment. Technology significantly lessens restrictions to information based on traditional organizational practices.

Lastly but not least, computer-assisted treatments allow family members and outside mentors a way to provide constructive accountability as part of their loved one’s treatment plan. The road to developing better drinking habits is only a click away!

REFERENCES Bouchery, E.E., Harwood, H.J., Sacks, J.J., Simon, C.J., Brewer, R.D. (2011). Economic costs of excessive alcohol consumption in the U.S., 2006. American Journal of Preventive Medicine, 41(5):516–24.

Carroll, K. (2014). The brave new world of behavioral therapies for alcohol use disorders.

Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/special-reports/ brave-new-world-behavioral-therapies-alcohol-use-disorders/page/0/1?GUID= 7E9C163B-B8B6-4B77-92D4-AEC47D4420BF&rememberme=1&ts=17072014 Centers for Disease Control and Prevention. (2014, January). Alcohol screening and counseling. Vital Signs. Retrieved from http://www.cdc.gov/vitalsigns/alcohol-screeningcounseling/index.html Donoghue, K., Patton, R., Phillips, T., Deluca, P. & Drummond, C. (2014, June). The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: A systematic review and meta-analysis. Journal of Medical Internet Research. 16 (6). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060043/ Haug, S., Kowatsch, T., Castro, R.P., Filler, A. & Schaub, M.P. (2014). Efficacy of a web- and text messaging-based intervention to reduce problem drinking in young people: study protocol of a cluster-randomized controlled trial. Biomedcentral Public Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25099872 Miller, W.R. & Rollnick, S. Motivational Interviewing: Preparing People To Change Addictive Behavior. New York: Guilford Press, 1991. Print.

Pew Research Internet Project. (2009, June). Sixty-one percent of American adults look online for health information. Pew Research Center. Retrieved from http://www.pew internet.org/2009/06/11/61-of-american-adults-look-online-for-health-information/ Prochaska, J. (2014). Understanding the stages of change. SMART Recovery. Retrieved from http://www.smartrecovery.org/resources/library/Articles_and_Essays/Stages_of_ Change/stages_of_change.htm The Guide to Community Preventive Services. (2014). Preventing excessive alcohol consumption: Electronic screening and brief intervention (e-SBI). Retrieved from http:// www.thecommunityguide.org/alcohol/eSBI.html The Community Guide. (2014). Preventing excessive alcohol consumption: Electronic screening and brief intervention (e-SBI). (2014). Retrieved from http://www.the communityguide.org/alcohol/RReSBI.html Robb Hicks, MD, created the Intentional Sobriety Institute in St. Louis to help parents prevent their young-adult children from relapsing after returning home from treatment. Dr. Hicks is a Missouri physician and surgeon who has devoted 25 years to healing the physical, emotional and spiritual maladies of his patients. Dr. Hicks graduated magna cum laude with a BA in Psychology from Wheaton College, then matriculated to the University of Southern California School of Medicine. He completed a general surgery internship at St. Louis University Hospitals, and began his ENT Surgery residency in 1988. Intentional Sobriety Institute provides guidance and accountability to kids as they learn to create sober lives, so they face life successfully, grow confident in their sobriety, and become happy, joyous, and free.

■ NA ADAC LE ADERSHIP NAADAC OFFICERS

NAADAC BOARD OF DIRECTORS

Updated 6/15/15

President Kirk Bowden, PhD, MAC, LISAC, NCC, LPC President Elect Gerry Schmidt, MA, LPC, MAC

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

Susan Coyer, MAC

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

Mid-Central

Treasurer John Lisy, LICDC, OCPS II, LISW-S, LPCC-S Immediate Past President Robert C. Richards, MA, NCAC II, CADC III National Certification Commission for Addiction Professionals (NCC AP) Chair Kathryn B. Benson, LADC, NCAC II, QSAP, QSC Executive Director Cynthia Moreno Tuohy, NCAC II, CDC III, SAP

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

Kevin Large, MA, LCSW, MAC Mid-South

(Represents Arkansas, Louisiana, Oklahoma and Texas)

Sherri Layton, MBA, LCDC, CCS North Central

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

Diane Sevening, EdD, LAC Northeast

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

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

Greg Bennett, MA, LAT Southeast

Organizational Member Delegate Matt Feehery, MBA, LCDC, IAADC

Ethics Committee Chair Mita Johnson, EdD, LPC, LPC, MAC, SAP

PAST PRESIDENTS

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

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 STANDING COMMITTEE CHAIRS

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

Southwest

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

Kirk Bowden, PhD, MAC (ex-officio) Arizona

Public Policy Committee Co-Chairs Gerry Schmidt, MA, LPC, MAC Nancy Deming, MSW, LCSW, CCAC-S Michael Kemp, ICS, CSAC, CSW

James “Kansas” Cafferty, NCAAC California Steven Durkee, NCAAC Secretary Kentucky

AD HOC COMMITTEE CHAIRS Awards Committee Chair Jamie Durham

Carmen Getty, MAC, SAP Virginia

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

Tay Bian How, NCAC II Sri Lanka Thaddeus Labhart, MAC, LPC Treasurer Oregon

International Committee Chair Paul Le, BA Leadership Committee Chair Robert C. Richards, MA, NCAC II, CADC III

Rose Maire, MAC New Jersey

Membership Committee Chair Margaret Smith, EdD, LADC

Sandra Street, MAC West Virginia

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

Loretta Tillery, Public Member Maryland Ricki Townsend, NCAC I California

Student Committee Chair Diane Sevening, EdD, LAC

Clinical Issues Committee Frances Patterson, PhD, MAC

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

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

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

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

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

Frances Patterson, PhD, MAC

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)

Tobacco Committee Chair Diane Sevening, EdD, LAC

Mita Johnson, EdD, LPC, LAC, MAC, SAP

NAADAC REGIONAL BOARD REPRESENTATIVES

NORTHEAST AK

NORTH CENTRAL

MID-CENTRAL

Gloria Nepote, LAC, NCAC II, CCDP, BRI II, Kansas-Missouri Ted Tessier, MA, LAMFT, LADC, Minnesota Jack Buehler, LADC, Nebraska John Wieglenda, LAC, North Dakota Linda Pratt, LAC, South Dakota

Mark Sanders, LCSW, CADC, Illinois Angela Hayes, MS, LMHC, LCAC, Indiana Michael Townsend, MSSW, Kentucky Terrance Lee Newton, BAS, CADC, Michigan Jim Joyner, LICDCCS, ICCS, Ohio Tyler Luedke, SAC, Wisconsin

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

WA MT

Northwest

OR

VT

MN

NORTHWEST

SD

ID

Diane C. Ogilvie, MAEd, Alaska Linda L. Rogers, NCC, MS, LAC, Montana Arturo Zamudio, Oregon Greg Bauer, CDP, NCAC I, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming

ME

ND

North Central

WY

IL

CO

Southwest

KS

CT

PA

UT CA

NY

MI

IA

NE

NV

North-NH east MARI

WI

Mid-Central OH IN

MO

KY

NJ MD WV

MidAtlantic

DE

VA

NC TN

SOUTHWEST

HI

AZ

Carolyn Nessinger, MS, NCC, BHT, Arizona Thomas Gorham, MA, CADC II, California Thea Wessel, LPC, LAC, MAC, Colorado Kimberly Landero, MA, Nevada Art Romero, MA, LPC, New Mexico Michael Odom, LSAC, Utah

OK

NM

Mid-South TX

AR

AL LA

SC

Southeast GA

MS

FL

SOUTHEAST MID-SOUTH Paula Heller Garland, MS, LCDC, Texas

MID-ATLANTIC Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia Moe Briggs, NCC, LCPC, MAC, SAP, Maryland Ron Pritchard, CSAC, CAS, Virginia Wanda Wyatt, MS, ADC, SAP, West Virginia

Eddie Albright, MS, Alabama Bobbie Hayes, LMHC, CAP, Florida David A. Burris, CAC II, NCAC II, CCS, Georgia Angela Maxwell, MS, CSAPC, North Carolina Charles Stinson, MS, South Carolina Charlie Hiatt, LPC/MHSP, MAC, SAP, Tennessee

S U M M E R 2 015 | 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 31

NAADAC Webinar Series NAADAC Offers over 75 Hours of Free Continuing Education www.naadac.org/webinars

DESIGNED TO MATCH YOUR SCHEDULE

NAADAC, the Association for Addiction Professionals now provides free addiction-related seminars through your computer!

The NAADAC Institute includes over 75 hours of free continuing education on a wide range of topics that will enhance your knowledge and skills of addictionrelated topics most in demand by the profession.

Join NAADAC to receive all CEs for free! www.naadac.org/join

DESIGNED TO MATCH YOUR NEEDS

Live events held monthly: Easy online registration and instructions to join the webinar

Renew your professional license/certification with NAADAC nationally approved CE credits

On Demand Viewing: All webinars are recorded for later viewing on our website

Participate from work, home, or on the go!

Only need a computer/internet connection or a smartphone (compatible with PC, Mac, iPad, iPhone, Android)

1 to 2 hours in length: Conveniently fits in between clients, during lunch, after a long day of work, or on the weekend

DESIGNED TO MATCH YOUR BUDGET Education is free for everyone: Participate live or download to watch later CE credit for NAADAC members: Free by passing an online quiz CE credit for Non-members of NAADAC: Ranging from $15 for 1 CE to $35 for 3 CEs and passing an online quiz

New topics premiered each month: Wide range of current topics based on results of the NAADAC membership survey Expert presenters: Addiction professionals who have the experience, knowledge and tips that you need Who should attend: Addiction professionals, social workers, mental health counselors, professional counselors, psychologists, employee assistance professionals, and other helping professionals that are interested in learning about addiction-related matters Watch together: Use as a component of clinical supervision or watch with your colleagues

Webinar Topics: - 21st Century Street Drugs - Adolescents - Advocacy - Annual Conference - ASAM Placement Criteria - Billing & Insurance - CBT - HIV/AIDS

- Certification/Licensure - Clinical Supervision - Co-occurring Disorders - Conflict Resolution - DSM-5 - Ethics - Recovery-Oriented Practice - Veterans

- Families - History of Recovery - Medication-Assisted Treatment - Messages from NAADAC Leadership - Mutual Support Groups - Peer Recovery Supports - Trauma

- PTSD - DOT/SAP - SBIRT - Science & Neurochemistry - Spirituality - Trends in the Profession