Advances in Addiction & Recovery (Summer 2016) by NAADAC, the Association for Addiction Professionals

SUMMER 2016 Vol. 4, No. 2

Translating Coverage into Quality Treatment By Kimberly A. Johnson, PhD, Director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration

Preliminary Annual Conference Schedule Changing the Way We Think About Appearance and PerformanceEnhancing Drugs By Jack Stein, PhD, National Institute on Drug Abuse

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

CONTENTS SUMMER 2016 Vol. 4 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 addic tion counselors, educators, and other addic tionfocused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education. Mailing Address 44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 Telephone 800.548.0497 Email naadac@naadac.org Fax 703.741.7698 Managing Editor

Jessica Gleason, JD

Kristin Hamilton, JD Communications & Digital Media Coordinator Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Committee

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

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

Thomas Durham, PhD NAADAC, the Association for Addiction Professionals

■ F EAT U R ES 15 Translating Coverage into Quality Treatment By Kimberly A. Johnson, PhD, Director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration

18 Changing the Way We Think About Appearance and Performance-Enhancing Drugs By Jack B. Stein, PhD, MSW, National Institute on Drug Abuse (NIDA)

20 Insurance Coverage, Breaches of Confidentiality and HIPPA By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

Deann Jepson, MD Advocates for Human Potential, Inc.

James McKenna, MEd, LADC I AdCare Hospital

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP NAADAC, the Association for Addiction Professionals Robert C. Richards, MA, NCAC II, CADC III Retired

23 Recovery and Relapse: An Interview with Darryl S. Inaba, PharmD, CADC V, CADC III

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.

25 Substance Use Disorder Treatment: The Good, the Bad, and the Ugly By Harry Nelson, JD

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

Interview by Ashley Johnson

28 Social Science to Service: Successes and Disconnects By Peter L. Myers, PhD

■ DEPA R T M E N TS 4

President’s Corner: Do Your Part in Building the Addiction Workforce By Kirk Bowden, PhD, MAC, NCC, LPC, NAADAC President

From The Executive Director: Calling All Students! Join the Effort to Grow the Addiction Profession Workforce By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

Ethics: Standards of Practice By Mita M. Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair

Membership: Spreading the News About Student Membership By Diane Sevening, EdD, LAC, NAADAC North Central Regional Vice President and NAADAC Student Committee Chair

Annual Conference: Preliminary Schedule

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 Professionals. Reproduction without written permission is prohibited. For more information on obtaining additional copies of this publication, call 1.800.548.0497 or visit www. naadac.org. Printed July 2016 STAY CONNECTED

30 NAADAC CE Quiz 31 NAADAC Leadership

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■ PR ES ID ENT ’S CO RN E R

Do Your Part in Building the Addiction Workforce By Kirk Bowden, PhD, MAC, LISAC, NCC, LPC, NAADAC President We have all read the reports that our profession has a serious shortage of well-trained addiction professionals. The shortages have been attributed to numerous causes, including infrastructures that are inadequately prepared to recruit, retain, and develop the needed numbers of addiction professionals, a rapidly aging workforce, high rates of new counselors leaving the profession, and a low number of well-trained addiction counselors entering the profession. This workforce shortage is further being exacerbated by the increased duties and pressure on the existing workforce. The shortage limits the services that can be provided to current clients and reduces the number of clients that can be treated. Our professional field has a serious workforce crisis. Because the cost of not treating addiction is indisputable, both individually and to the nation, our workforce crisis is a human crisis. I know our profession has many challenges, including an increasingly complex client population, increasing accountability in client care, a workforce that is over worked and under paid, a pervasive negative stigma associated with our profession and clients, and insufficient support for professional development. In spite of all of the challenges, most of us truly love this profession. We wouldn’t want to do anything else with our lives. While NAADAC continues its national workforce lobbying and recruitment efforts everyday, NAADAC needs your assistance to be successful in these important efforts. We need our profession to grow and the nation needs our profession to grow. I ask each of you as an addiction professional to make an effort to recruit one new person into our profession this year. We, as addiction professionals, need to share our love for the profession with our friends and associates. We need to make them aware of the many outstanding benefits with which our profession provides us. I love my work as an addiction professional. Prior to entering this profession, I was a Certified Financial Planner and a licensed stockbroker. The

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opportunity for financial reward was certainly great; however, I didn’t feel personally rewarded. I did not enjoy my work. I was earning a living for myself and my family but I didn’t feel that I was making a positive impact on the world. It is important to me to have a career that I feel makes a difference. I decided I need to change my life’s direction and find a renewed sense of purpose. I spent two years working days in financial services to support my family and earning a Master’s degree in counseling in the evenings. For me, the sacrifices I made to become an addition counselor were worth the effort. I have now worked as an addiction counselor and counselor educator for more than 25 years and have no regrets. I love my work and I have high job satisfaction. I feel my work has made a positive impact on the lives of people I have served, and I feel that my work has made a positive impact on my own life. Please join our effort to recruit others into our worthy profession. Share your own story and your own love of the addiction counseling profession. Though the financial rewards may not be significant, the personal, professional, and social rewards are worth the effort. In addition to serving as NAADAC’s President, Kirk Bowden, PhD, MAC, NCC, LPC, serves on the Editorial Advisory Committee for Advances in Addic tion & 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 Asso ciation for the Counselor Educator Advocacy Award in 2013, the Fellow Award in 2014, Outstanding Addiction/Offender Professional Award in 2015, and most recently the California Association for Alcohol/Drug Educators’ Lifetime Achievement Award in 2015.

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

Calling All Students! Join the Effort to Grow the Addiction Profession Workforce By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

SAMSHA has tasked NAADAC with working to grow the addiction professional workforce. NAADAC and SAMHSA are calling on SAMHSA’s Regional Administrators and Single State Authorities (SSAs), as well as NAADAC’s 10,000+ members, 41,000+ constituents, and 47 State Affiliates, to join forces to reach out to freshman and sophomore college and university students across the country to build awareness of the the addiction workforce shortage, and the many benefits and opportunities available by joining the substance use and mental health disorder professions. This collaboration between SAMHSA, its SSAs, and NAADAC is a workforce recruitment and retention effort and will work to create a national picture of the addiction professional workforce, identify the gaps in the current workforce, and work to address the needs identified. The program includes identifying and qualifying state-specific needs, evaluating strategies currently in place and strategies being developed, identifying gaps in the current resources, and creating content and resources to address these needs. This workforce program addresses two of SAMHSA’s key strategic initiatives: Healthcare and Health Systems Integration, and Recovery Support. Due to the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA), employment opportunities for new professionals to find and maintain employment in the substance use and mental health disciplines are on the rise and addiction professionals are gaining credibility in the overall health care world. This program will highlight the opportunities for advancement, creativity, professional devel opment, and personal development in our rewarding profession with the goal to increase the number of college and university students that choose to join the substance use and mental health disorder professions. A major focus of this program is the development of four onsite forums at college or university locations in Ohio, Louisiana, Colorado, and New England to reach out directly to freshman and sophomore students who are likely at the beginning stages of choosing a career or specialization in the behavioral health and mental health fields, and educate them on the benefits and opportunities involved in specializing in substance use disorders. The forums will be led by national trainers, persons in recovery who have joined the addiction profession, and/or addiction treatment providers that are making a difference in their communities. In addition, trainers will work with students to evaluate their potential career paths to take advantage of the 22% growth in employment opportunities for substance use and behavioral disorder counselors between 2014 and 2024 projected by the U.S. Department of Labor, and discuss funding alternatives including loans, grants, and work programs. Finally, treatment centers in the areas surrounding each forum will be invited to participate in a mini “job fair” to meet with students and discuss the potential for field placements and employment opportunities.

The four forums will take place in September 2016 as part of NAADAC and SAMHSA’s National Recovery Month activities. NAADAC is working with a Workforce Planning Committee with members from the individual states or regions for help develop each of the forums. We are also working with each region’s Addiction Technology Transfer Center (ATTC) as part of the well-rounded collaborative effort to reduce the workforce shortage crisis. In addition, each of the forums will expand its reach through satellite forums throughout their state and region, and, in some states, outreach to area high schools. Finally, in coordination with the forums, NAADAC is developing two national online webinars that will address the availability of opportunities in the substance use and mental health disorder professions, the need behind the expansion of opportunities in these professions, the requirements necessary to join the workforce within each of the major discipline categories, and ideas for current workforce retention. The whole nation is invited to participate in the National Workforce webinars and for those who are close to a forum, to come and join inperson. For those not close to a forum, each forum will be live-streamed by its college or university and recorded for posting on NAADAC’s YouTube channel for on-demand watching. NAADAC will be announcing the dates and times of the live-streams and notify the public of the availability of the on-demand recordings through its communication channels. Here’s where you come in! We need ideas regarding both workforce recruitment and workforce retention. How do you currently recruit people? How would you have liked to have been recruited? What incentives would you have liked to have been offered? What do you believe to be the most effective ways to retain a workforce in the addictions and mental health fields? If you have read research, papers, conducted your own agency survey, or want to share your own experiences, opinions, ideas or thoughts, please send those as well! Please send your thoughts, ideas, and opinions to jgleason@naadac.org. NAADAC, SAMHSA and the SSAs are working to raise the workforce of tomorrow! Together, we can all play a part in that effort! Blessings, Cynthia Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years, as well as an international, national, and state trainer in a variety of topics. Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.

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■ Et h i cs

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

Realistically, common sense is not as common as we would like. The art and business of providing addictionspecific counseling services has changed over the last decade; addiction counseling is not business-as-usual any more. Discrimination, judgment, aggression, and stigma are on the rise. Addictions have become more sophisticated and accessible. The costs of doing business are high and cumbersome. Burn-out is a reality. Our work is misunderstood by colleagues in other specialty areas. And, as clinicians, we have an obligation to be advocates on behalf of our clients. As advocates, we influence decisions made regarding our clients’ care within political, economic, and social systems and institutions. Our work as advocates and service providers is governed by laws, rules, ethics, and policies and procedures. There is often confusion amongst advocates regarding personal versus professional versus organization ethics. In addition, there is confusion about professional ethical codes versus organizational policies and procedures. Personal ethical codes are specific to one’s personal values and morals, and concern right, wrong, good, bad, etc. They are developed through a lifetime of experience and modeling, and are taught by family, friends, and society. Personal ethics include honesty, genuineness, responsibility, and commitment. Not adhering to a high standard of personal ethics can harm self and others. Professional ethics include rules, values, and morals imposed on a practitioner by their employer and/or by their professional membership organization. Professional ethics are learned through education, training, and experience. Ethical codes for addiction professionals, service providers and others working in our profession include confidentiality, record keeping, and delivery of services. Not adhering to professional ethical codes can result in harm to the client as well as jeopardizing one’s career and reputation. Professional ethics often build on personal ethics; professional ethics do not supersede personal ethics and often have greater authority over a person’s scope of practice. Organizational ethics study the decisions and actions taken by an organization/institution internally and externally. Organizations are governed by policies and procedures. Policies provide direction for an organization and influence decisions made; policies guide decision making and frame business mission, objectives, goals, and management philosophies. Typically, you will see policies referring to employees’ conduct and procedures related to organizational mission. Procedures delineate how to accomplish a task within the organization. 6

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As advocates and service providers we have to hold our work and ourselves accountable; we are responsible for our work and how we conduct ourselves within both clinical and organizational circles. A professional Code of Ethics defines acceptable behaviors, promotes high standards of practice, provides a benchmark for self-evaluation, establishes professional boundaries, specifies professional identity, and offers a standard of professional maturity. “A Professional Code of Ethics” cannot be totally prescriptive as it cannot address every potential ethical violation; however, Code of Ethics offer clinicians and service providers standards of practice to adhere to or extrapolate for their situation. Why have a Code of Ethics? Because our clients deserve the best available service delivery, and a Code of Ethics governs the specific work and practice of the clinician. A professional Code of Ethics allows a professional to understand and emulate acceptable standards for practice. The client’s perspective matters. Change happens when a therapeutic relationship is established through connection, empathy and active listening. Confidentiality and accurate record keeping matters. Collaboration is the vehicle for addiction counseling. Agendas are agreed upon that are realistic and attainable. We know addiction prevention, treatment, and recovery services help people heal. A Code of Ethics is a realistic and accessible reminder of what it means to have common sense. In a world that wants to loudly proclaim one philosophy or another at will, a Code of Ethics keeps us grounded in the reality that our work is about the client first and us second. When’s the last time you read and/or considered your professional Code of Ethics? The NAADAC/NCC AP Code of Ethics is available online at www. naadac.org/code-of-ethics. Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education and Supervision, an MA in Counseling, and a BA in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the national Master Addiction Counselor (MAC) and Department of Transportation Substance Abuse Pro fessional (SAP) certifications. Johnson has two supervisory credentials (ACS and AAMFT) and is an NCC. In addition to being a core faculty member at Walden University, she maintains a private practice where she sees clients and supervisees who are working on credentialing. Johnson is the PastPresident of the Colorado Association of Addiction Professionals (CAAP) and is the Ethics Chair and Southwest Regional VP for NAADAC. She speaks and trains regionally and nationally on topics specific to counseling skills, ethics, supervision, and addiction-specific services. She has been appointed by the Governor of Colorado to two committees working on behavioral health integration and transformation, is a consultant to the state regulatory agency that regulates our professions, and is a consultant and committee member at the state Office of Behavioral Health.

■ M EM B ER S H I P

Spreading the News About Student Membership By Diane Sevening, EdD, LAC, NAADAC North Central Regional Vice President and NAADAC Student Committee Chair

Exciting things continue to happen at NAADAC — not only has NAADAC moved, now benefits for student membership are expanding. As the chair of the NAADAC Student Committee and an Assistant Professor at the University of South Dakota (USD), along with the great works of members on the committee, we have worked to develop a full student membership strategy from recruitment to retention. College and university students majoring in addiction/alcohol/drug studies programs will be the future leaders for the addiction profession. As students advance in their studies, there comes a time for them to make the transition from student to professional. The NAADAC Student Committee is encouraging colleges/universities to require student membership in their curriculum to make this transition a reality. For example, the USD Addiction Studies (ADS) program has required all students enrolled in the field experience (internship) course to become a member of NAADAC. As a course/program requirement, financial aid is available to assist the student. A NAADAC student membership provides a professional identity of a national addiction-focused organization that provides education, advocacy, networking, national credentialing, and mentorship, along with many other benefits, including: Liability Insurance: Malpractice risk starts in school. Students can be sued for malpractice while performing duties in field placement, college/ university practicum, or internship upper-level classes and are required by most schools to obtain liability insurance. While some schools provide coverage for students under a school policy, students might be sharing a liability limit with many other students and/or the school coverage might have gaps that do not fully protect the student. In addition, some school’s policies might only cover the liability of the college or university, and not the student. For these and other important reasons, students should be encouraged to get their own liability coverage. To help its student members, NAADAC has partnered with the American Professional Agency, Inc. to provide special professional liability coverage for students enrolled in an accredited degree program or a program approved for candidacy. Policies

start at as low as $23 per year with occurrence form coverage limits ranging from $1,000,000/$1,000,000 to $2,000,000/$4,000,000 and cover the performance of duties in field placement. For more information, please visit www.naadac.org/student-insurance. William L. White Scholarship Award: NAADAC undergraduate and graduate student members are eligible to compete for a $1,000–$2,000 award by submitting a research paper on an assigned topic by May 31st of each year. This year’s topic was “Research-Oriented Systems of Care: How Research is Changing the Addiction Profession.” The 2016 awards will be presented at NAADAC Annual Conference in Minneapolis on October 10. For more information, please visit www.naadac.org/whitescholarship-award. NAADAC Minority Fellowship Program for Addiction Counselors (NMFP-AC): The NMFP-AC aims to reduce health disparities and improve behavioral health outcomes for underserved populations by increasing the number of c ulturally-competent Master’s level addiction counselors qualified to serve minority and LGBT populations, and transition age youth (ages 16–25). The NMFP-AC provides stipends of $15,000 per student, as well as additional training, professional development and mentoring to students in their final year of a Master’s program in addiction/substance use disorder counseling at an accredited instituion. While students do not need to be a minority or a member of the LGBT community to qualify, they must commit to providing addiction counseling services to the aforementioned underserved groups for six-months post-graduation. For more information, please visit www.naadac.org/NMFP-AC. NAADAC Publications: All NAADAC student members will receive and have access to NAADAC’s quarterly magazine, Advances in Addiction & Recovery, and will receive its weekly Professional eUpdate newsletter and bi-weekly Addiction & Recovery eNews newsletter by email. NAADAC’s magazine provides information on NAADAC initiatives and evidencebased articles and columns providing useful information for the addiction profession. Students are encouraged to submit evidence-based scholarly

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works for publication. The Professional eUpdate newsletter provides students with the latest news from NAADAC and its partner organizations, including educational events, trainings, resources, and career opportunities around the country. The Addiction & Recovery eNews delivers trending and breaking news, innovations, research, and trends impacting the addiction profession. For more information, please visit www.naadac.org/ publications. Webinars: All NAADAC student members have access to the NAADAC Institute Webinar Series and the 75 free continuing education hours provided to all NAADAC members. NAADAC provides bi-monthly live webinars and a comprehensive on-demand webinar archive available for viewing 24/7. All webinars are taught by experts in the field. The webinars cover a wide variety of topics for various skill-levels and are very helpful for both undergraduate and graduate students, especially when preparing a paper or presentation. The webinars are also helpful for educators, who might choose to utilize a webinar in class as a substitute for having an expert guest lecturer for the day. Members can obtain the free CEs by watching the webinars and successfully passing an accompanying online quiz. The free CEs are very useful and cost-efficient for students when accumulating CEs for a state credential/license or a national credential. For more information, please visit www.naadac.org/webinars.

Thank You to the Conference Partners and Supporters SPONSOR Nebraska Department of Health and Human Services www.dhhs.ne.gov ORGANIZERS NAADAC, the Association for Addiction Professionals www.naadac.org Orion Healthcare Technology www.orionhealthcare.com PLATINUM SUPPORTER Mid-America ATTC/University of Missouri – Kansas City www.mattc.org BRONZE SUPPORTERS Bellevue University www.bellevue.edu

Starlite Recovery Center www.starliterecovery.com

Keystone Treatment Center www.keystonetreatment.com

University of South Dakota www.usd.edu

Nebraska Total Care www.centene.com PARTNERS CNS Productions www.cnsproductions.com

Sheila Raye Charles www.sheilarayecharles.com

Fresh Hope for Mental Health www.freshhope.us

The Orchard www.wellbeinginitiatives.org

Lincoln Medical Education Partnership – Training for Addiction Professionals www.lmep.com/TAP

Valley Hope Association www.valleyhope.org

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Discounts on Educational Products: By visiting the NAADAC online bookstore, all NAADAC student members can receive reduced rates on NAADAC independent courses and products, including manuals for cooccurring disorders, advocacy, conflict resolution in recovery, examination study materials, medication-assisted treatment and recovery, SBIRT, and more! In addition, NAADAC members receive a 20% discount on digital copies of Dr. Darryl Inaba’s book, Uppers, Downers, and All-Arounders, a 20% discount on all Hazelden Publishing and Educational Services resources, and a 50% discount on subscriptions to Alcoholism & Drug Abuse Weekly (ADAW). For more information, please visit www.naadac.org/ benefits. Discounted Educational Trainings & Conferences: Many states offer free or reduced rates to student members attending an educational training or conference in their area and NAADAC offers a reduced rate to student members attending the annual conferences. Students are encouraged to apply for a NAADAC scholarship to attend the annual conference that assists with registration fees. The USD ADS department pays the registration fee for senior majors to attend the by-yearly South Dakota Association of Addiction and Prevention Professionals (SDAAPP) conferences. For more information, please visit www.naadac.org/annualconference. Voting Privileges: Student members have the opportunity to vote for their state officers, regional vice presidents, and NAADAC officers.

Upcoming Initiatives The NAADAC Student Committee is currently in the process of developing criteria for the National Student Chapter Initiative. This initiative will focus on development of student chapters/associations/organizations with emphasis on growing student membership within state affiliates and NAADAC. NAADAC student chapters/associations/organizations will be established with elected officers (students) and faculty sponsorship (college, university, or training programs) to support the succession of the addiction workforce and the development of future state and national leaders while supporting the student to grow in their professional development. Retention is an issue as students’ transition from university/college/ training programs to working in the addiction profession and this system will help support their retention in the workforce. Materials have been developed and are available to assist university/college/training programs in the development of student chapters/associations/organizations. Indiana, Minnesota, Nevada, and South Dakota have active student chapters/associations/organizations that are utilizing the NAADAC materials and making the addiction profession known on their college/university campuses. We, as seasoned addiction professionals, have the opportunity and privilege to mentor, inspire, and encourage students to become the emerging new leaders of NAADAC. Let’s keep spreading the news and sharing our expertise about the rewards of being an addiction professional and NAADAC member. Diane Sevening, EdD, CDC III, is a faculty member in the Department (USD) of Alcohol and Drug Studies at the University of South Dakota (USD) and has a long and continued commitment to the association and support for the addiction profession. Sevening has served as the NAADAC Student Committee Chair since 2006 and assisted in the development of councils of students for state affiliates, guidebook (bylaws) for college and university student organizations. She has also been a faculty advisor to the local student organization, the Coalition of Students and Professionals Pursuing Advocacy (CASPPA), since 2005. In addition to her academic credentials, Sevening has presented at the 2010 National Conference on Addiction Disorders (NCAD), the 2007 Advocacy in Action Conference and the 2006 Workforce Development Summit. She served as an addiction family therapist at St. Luke’s Addiction Center for one year and as the alcohol and drug counselor at the USD student health services for seven years.

Early Bird Rate Ends September 2

Embracing Today, Empowering Tomorrow Join NAADAC for its 2016 Annual Conference at the Hyatt Regency Minneapolis in Minneapolis, MN from October 7–11. Learn about the latest trends and issues that impact all addiction-focused professionals, connect and network, take your national certification test, and build your business all while taking advantage of the beauty of Minneapolis.

Earn Up to 34 Continuing Education Hours This year’s conference will feature a broad array of topics and formats, including four all-day pre-conference seminars on October 7, a two-day SAP/DOT Qualifica tion/Requalification Course on October 7–8, daily keynote speakers in plenary sessions, breakout workshops, special evening events on October 7–10, and three all-day post-conference seminars on October 12. The conference will offer unique educational experiences for addiction-focused professionals within the following eight tracks: Practice Management & Technology Co-Occurring Disorders Psychopharmacology Process Addictions

Recovery Support Clinical Skills Cultural Humility Education/INCASE

The Annual Conference will also feature an Awards Luncheon to honor outstanding addiction-focused professionals from around the nation, an evening event to support the NAADAC Education & Research Foundation (NERF), and, for the first time, onsite NCC AP national credential testing. In the evenings, attendees can earn more education credits with an optional movie night or enjoy their time in Minneapolis with a tour of Hazelden or Augsburg College’s StepUP Program’s facilities, or exploring on their own.

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PRELIMINARY SCHEDULE*

FRIDAY (OCTOBER 7) Up to 7 CEs Available on Friday

7:00 pm – 9:00 pm Welcome Reception

10:00 am – 11:30 am BREAKOUT SESSIONS

7:30 am – 7:00 pm Registration

7:00 pm – 9:00 pm Exhibit Hall Open

TRACK: RECOVERY SUPPORT

7:30 am – 8:30 am Continental Breakfast

9:00 pm – 10:00 pm Mutual Support Meeting

8:30 am – 5:00 pm PRE-CONFERENCE SESSIONS

SATURDAY (OCTOBER 8)

Application of Dialectical Behavioral Therapy to Substance Use & Mental Health Disorders Kevin McCauley, MD and Eric Schmidt, MBA, MSW

7:00 am – 4:30 pm Registration

Understanding Marijuana: Pharmacology and New Findings Darryl S. Inaba, PharmD, CATC V, CADC III The Quality Imperative: The Lean Way to Improving Patient Care Corin Hammitt, BS, MHA SAP/DOT Qualification and Re-Qualification (Part I) Wanda McMichael, CAC II, NCAC II, SAP 10:00 am – 10:15 am Morning Break 12:00 pm – 1:00 pm Lunch 3:30 pm – 3:45 pm Afternoon Break 6:00 pm – 7:00 pm New Member & Student Reception

Up to 7 CEs Available on Saturday

7:00 am – 8:00 am Continental Breakfast in Exhibit Hall 7:00 am – 8:00 am Exhibit Hall Open

8:30 am – 5:00 pm Pre-Conference Part II : SAP/DOT Qualification and Re-Qualification (Part 2) Wanda McMichael, CAC II, NCAC II, SAP 8:00 am – 9:45 am Keynote: Behind the Shades – Hope Beyond the Darkness Sheila Raye Charles

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Substance Use Disorder and the LGBT Individual: Improving Outcomes in the 21st Century Jody Forter, MS, LMFT TRACK: PSYCHOPHARMACOLOGY

The Intersection of Physics, Opiates and Recovery Judi Kosterman, PhD Because I Care: Preventing and Dealing with Burnout, Compassion Fatigue, and Vicarious Trauma Noé Vargas, DBH, LPC, FT, NCC TRACK: CO-OCCURRING

Integrated Treatments of Approach: Substance Use Disorders, Mental Health and Cognitive Challenges Rick Krueger, MA, LPCC, LADC, CBIS TRACK: PROCESS ADDICTIONS

State of NAADAC Cynthia Moreno Tuohy, NCAC II, CDC III, SAP and Kirk Bowden, PhD, MAC, NCC, LPC

Sex and Pornography Addiction: Neuroscience, Trauma and More Stefanie Carnes, PhD, LMFT, CSAT S

9:45 am – 10:00 am Morning Break in Exhibit Hall

TRACK: CLINICAL SKILLS

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: ■ American Society of Addiction Medicine (ASAM) ■ International Coalition for Addiction Studies Education (INCASE) ■ Great Lakes ATTC ■ Minnesota Addiction Professionals (MNAP) ■ 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 Council for Responsible Gaming (NCRG) ■ NIATx Learning Collaborative

TRACK: CULTURAL HUMILITY

TRACK: PRACTICE MANAGEMENT/TECH

7:30 am – 4:30 pm Poster Presentation Display

Endorsing and Collaborating Partners

* Schedule subject to change without notice. For the most up-to-date schedule, please visit www.naadac.org/annualconference.

Innovative Strategies to Empower Parents of Teens and Young Adult Addicts in Continuuim of Care Barbara Krovitz-Neren, MA

The Importance of Achieving Goals in Clinical Outcomes: Research and Practice of I-IMR Tanya Line, MPS, LADC TRACK: EDUCATION/INCASE

Accreditation of Addiction Studies Programs Vicki Michels, PhD NCC AP TEST PREP

New in 2016! NCC AP On-Site Testing Do you need to take the NCC AP test for the NCAC I, NCAC II, or MAC credentials? This year we will be offering onsite testing at the Annual Conference October 8–10. There will be two opportunities each day to take the exam. In addition, test prep sessions will be offered on October 8th and 9th. Look out for a special email outlining the steps to register for the test coming soon!

PRELIMINARY SCHEDULE 11:30 am – 12:30 pm NAADAC Regional Caucus Meetings Mid-Atlantic Regional Caucus Mid-Central Regional Caucus Mid-South Regional Caucus North Central Regional Caucus Northeast Regional Caucus Northwest Regional Caucus Southeast Regional Caucus Southwest Regional Caucus International Regional Caucus

TRACK: EDUCATION/INCASE

12:30 pm – 2:30 pm NAADAC Membership Lunch in Exhibit Hall

TRACK: PRACTICE MANAGEMENT/TECH

12:30 pm – 2:30 pm Exhibit Hall Open 2:30 pm – 4:00 pm BREAKOUT SESSIONS TRACK: PROCESS ADDICTIONS

Yogic Science for Addictive Habits and Behaviors Mukta Kaur Khalsa, PhD TRACK: CLINICAL SKILLS

The Gender Factor in Addiction Prevalence, Assessment, and Treatment An-Pyng Sun, PhD, LCSW TRACK: CULTURAL HUMILITY

Beyond Belief: Sensible Spirituality in Treatment and Recovery John P. McAndrew, MA, MDiv and Joe Chisholm TRACK: CO-OCCURRING

Opiate Abuse and Trauma Margaret Nagib, PsyD TRACK: PSYCHOPHARMACOLOGY

Opioid Use Disorders and Their Treatment Pamela Shultz, MD, FASM

The Hotel Hyatt Regency Minneapolis 1300 Nicollet Mall Minneapolis, MN 55403 Main: 612.370.1234 Website: http://minneapolis.hyatt.com/ en/hotel/home.html

Addiction Studies Programs: Establishing Competency in Education of Addiction Counselors Sandra Valente, PhD, LADC, LPC, CCS TRACK: RECOVERY SUPPORT

Let’s Compliment Not Compete: How Addiction Counselors Can Embrace Recovery Support Specialists Sherri Layton, LCDC, CCS Making a Case for Clinical Supervision Amanda C. Richards, MA, LPCC, LADC, MT-BT and Cindy Meyer, MA, LMFT, LADC NCC AP TEST PREP 4:00 pm – 4:15 pm Afternoon Break in Exhibit Hall 4:15 pm – 5:30 pm Afternoon Keynote Session: Federal Update Kim Johnson, PhD, Director of SAMHSA/CSAT 6:00 pm – 10:00 pm Saturday Evening Activities 6:30 pm – 8:30 pm Movie Night 9:00 pm – 10:00 pm Mutual Support Meeting Located on Nicollet Mall in the heart of the downtown business district, the Hyatt Regency Minneapolis provides spectacular views of the city skyline and convenient access to the light rail system. NAADAC Annual Conference attendees are able to reserve rooms at the discounted price of $159 a night (plus applicable taxes) until September 13, 2016. To receive this special rate, use https://aws.passkey.com/ g/52647690 or call 888.421.1442 and reference “NAADAC” by September 13, 2016. Reservations are available on a first-come, first-served basis for the limited number of rooms being held at the dis counted rate. Please book your room early as space is limited and will sell out!

SUNDAY (OCTOBER 9) Up to 6 CEs Available on Sunday 6:30 am – 7:00 am Sunday Religious Services 7:30 am – 4:30 pm Registration 7:30 am – 8:30 am Continental Breakfast in Exhibit Hall 7:30 am – 8:30 am Exhibit Hall Open 8:00 am – 5:00 pm NAADAC Board of Directors Meeting 8:30 am – 10:00 am Morning Keynote Seesion: Thriving in a Future Full of Changes, Disruption and Challenges Mark Mishek, JD 10:00 am – 10:15 am Morning Break 10:15 am – 11:45 am BREAKOUT SESSIONS TRACK: PROCESS ADDICTIONS

“What’s Love Got to Do With It?” – Addiction, Attachment and the 13th Step Michael G. Bricker, MS, CADC II, LPC

Explore Minneapolis, MN Join NAADAC in Minneapolis, Minnesota — the “City of Lakes”! The perfect blend of natural beauty and urban sophistication, Minneapolis is home to thousands of acres of parks, twenty lakes and wetlands, miles of trails, natural attractions like the Chain of Lakes, Minnehaha Falls, and the Mississippi River, award-winning restaurants, Broadway theater, high-end shopping, and world-class museums.

Room Reservation Deadline: September 13, 2016

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PRELIMINARY SCHEDULE TRACK: CLINICAL SKILLS

Clinical Intuition in Alcohol and Drug Counseling Zachary Hansen, EdD, NCC, LADC TRACK: RECOVERY SUPPORT

Recovery Issues: Public Acceptance Through National Recovery Month Ivette A. Torres, MEd, MS and Amy Smith, LPC, MAC, SAP TRACK: CO-OCCURRING

Pain Management in Clients with CoOccurring Depression and Substance Use Disorder Billy Heckle, RPh, CAC II TRACK: EDUCATION/INCASE

On-Line Fieldwork Supervision Using Powell's Four FOCI of Supervision Eileen O'Mara, EdD, LADC, NCC TRACK: CULTURAL HUMILITY

Intergenerational Trauma and the Healing Forest J. Carlos Rivera, CADC II, ICADC TRACK: PSYCHOPHARMACOLOGY

Both a ‘Science-Based’ and ‘Client Credible’ MJ Prevention/Intervention Approach Pete Katz, LCDC, ADC III, ICADC TRACK: PRACTICE MANAGEMENT/TECH

The Law of Drug Testing in the Workplace: The Minnesota Model V. John Ella, JD, CIPP TRACK: CLINICAL SKILLS

An Integrative Approach to Addiction Counseling: Theories, Practices and Skills Thomas G. Durham, PhD, LADC 11:45 am – 2:30 pm Lunch in Exhibit Hall

Ready to be Seen? Showcase your institution, product, or organization at this prestigious event by exhibiting, sponsoring, or advertising at our 2016 Annual Conference. Access not only over 600 conference attendees, but NAADAC’s membership of over 10,000, its mailing list of over 41,000, and its website, which receives over 260,000 visits per month. To explore the many promotional opportunities available, download the 2016 Annual Conference Prospectus at www. naadac.org/2016-sponsor-exhibit-oradvertise or contact Elsie Smith, Account Executive, at esmith@naadac.org or 717.650-1209.

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2:30 pm – 4:00 pm BREAKOUT SESSIONS TRACK: CULTURAL HUMILITY

What About Men? The Forgotten Gender in Trauma Informed Addiction Care Chris Dorval, MSW, LCDCS, LCDP, ICADC TRACK: PSYCHOPHARMACOLOGY

The Opioid Addiction Epidemic: Pharmacological Treatment Approaches an Evidence-Based Perspective Joseph Bebo, MA, CAGS, LADC I, LMHC TRACK: RECOVERY SUPPORT

Recovery Support Technologies: Pioneering New Models of Substance Use Disorder Recovery Services Joyce Hartje, PhD and Mark Disselkoen, LCSW, LADC TRACK: PRACTICE MANAGEMENT/TECH

Wounded Healer to Worthy Helper Maeve O'Neill, MEd, LCDC, LPC S, CDWF TRACK: CO-OCCURRING

Addressing the Challenges: Brain Injury and Substance Use Disorders Annette Pearson, MS, LADC, CBIS TRACK: EDUCATION/INCASE

Developing and Delivering a Co-Occurring Course in Higher Education Margaret Smith, EdD, MLADC and Vicki Michels, PhD TRACK: CLINICAL SKILLS

Recognizing & Overcoming Trauma & Shame Tamarah Gehlen, LMFT, LADC

TRACK: PROCESS ADDICTIONS

Assessing and Treating Gambling Disorder Christine Reilly 4:00 pm – 4:15 pm Afternoon Break 4:15 pm – 5:45 pm Keynote: Post-Traumatic Growth – Strategies in Dealing with Complicated Grief in Treatment and Recovery Rokelle Lerner, BA 6:30 pm – 8:30 pm NAADAC Education & Research Foundation (NERF) Auction 9:00 pm – 10:00 pm Mutual Support Meeting

MONDAY (OCTOBER 10) Up to 7.75 CEs Available on Monday 7:30 am – 4:30 pm Registration 7:30 am – 8:30 am Continental Breakfast 8:30 am – 9:00 am Q & A with NAADAC President and Executive Director 9:00 am – 10:30 am Keynote Speaker: From Now What to What’s Next – A View From Two Decades in the Trenches of Recovery Advocacy William Moyers 10:30 am – 10:45 am Morning Break

Visit the Exhibit Hall! On October 7–9, please be sure to visit and support the companies that are showcasing their institution, product, or organization in our Exhibit Hall 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, lunches, and morning and afternoon coffee breaks on Saturday and Sunday. Interested in exhibiting, sponsoring, or advertising at the Annual Conference? Please download the 2016 Annual Conference Prospectus at www.naadac. org/2016-sponsor-exhibit-or-advertise or contact Elsie Smith, Account Executive, at esmith@naadac.org or 717.650.1209.

PRELIMINARY SCHEDULE 10:45 am – 12:15 pm BREAKOUT SESSIONS TRACK: RECOVERY SUPPORT

Building Relationships: Integration Between Victim Service and Substance Use Disorder Providers Megan Jones, LISW, CADC and Silvia BenitezRichards, MA, CADC TRACK: EDUCATION/INCASE

TRACK: PROCESS ADDICTIONS

Gambling....The Disordered, The Responsible, and Everything in Between Daniel Trolaro, MS TRACK: CULTURAL HUMILITY

Warp Speed: Parenting and Working with Teens in a Digital Age Jessica Wong TRACK: EDUCATION/INCASE

Experiential Learning in Addiction Education Chaniece Winfield, PhD, ACS, LPC, CADC, CSAC

Building and Sustaining Your College Addiction Studies Program Kathleen Ayers-Lanzillotta, MPA, CASAC

TRACK: PSYCHOPHARMACOLOGY

The Physiology and Clinical Applications of Cannabinoids in Harm Reduction Dustin Sulak, DO TRACK: PROCESS ADDICTIONS

Co-Occurring Disorders: Improving Outcomes Through Pharmacogentics and Medication Assisted Treatment Patricia Allen, MSN, PMHNP-BC, DNP

Treating the Compulsive Over-Eating Client in Addictions Treatment Services Jeffrey Lang, MS, LCADC, CCS, CPRP

TRACK: CLINICAL SKILLS

TRACK: PRACTICE MANAGEMENT/TECH

R U Ready For Tele-Medicine, Tele-Health? Jessica Rodriguez, PhD, CATC V, CTRTC, CIP, GIP TRACK: CO-OCCURRING

Food Addiction – Process Addiction or Substance Use Disorder? Marty Lerner, PhD TRACK: CULTURAL HUMILITY

The Paradox That Works: Looking Within as a First Step to Becoming Culturally Competent Bridget Rivera, PsyD TRACK: CLINICAL SKILLS

Planning for Today and Tomorrow: A Reality Therapy Approach Robert Wubbolding, EdD TRACK: RECOVERY SUPPORT

What’s the Big Deal About ROSC & What Does It Mean for the Addiction Professional Lonnetta Albright, BS, CPEC TRACK: PRACTICE MANAGEMENT/TECH

The Struggle to Recover – Payer Perspective on the Opiate Epidemic Martin Rosenzweig, MD 12:30 pm – 2:15pm President’s Award Luncheon

Understanding and Managing Anger Peter Suski, PhD, MAC, CASAC Song-Poetry as an Expression of Responding to and Coping with Addiction Counselor Stress Timothy Conley, PhD, LCSW, CAS TRACK: PRACTICE MANAGEMENT/TECH

Tools You Can Use to Enhance Your Practice Today! Laurie Krom, MS

4:00 pm – 4:15 pm Afternoon Break 4:15 am – 6:00 pm Keynote Speaker Closing Ceremony Federal Research Panel 9:00 pm – 10:00 pm Mutual Support Meeting

TUESDAY (OCTOBER 11) Up to 6.5 CEs Available on Tuesday 7:00 am – 8:00 am Continental Breakfast 7:00 am – 11:00 am Registration 8:00 am – 4:30 pm POST-CONFERENCE SESSIONS HIV/AIDS & Bloodborne Pathogens for Professionals Mita Johnson, EdD, LAC, MAC, SAP Romancing the Brain Cynthia Moreno Tuohy, NCAC II, CDC II, SAP Not the Usual Ethics Training: Navigating Difficult and Challenging Situations Frances Patterson, PhD, LADAC, MAC, BCPC and Kathy Benson, LADAC, NCAC II

Special Events Movie Night: Can telling your story save your life? “How I Got Over” follows 15 formerly homeless women as they craft an original play, based on their harrowing true-life stories, to be performed one-night-only at The Kennedy Center. The women of N Street Village — a community for addiction recovery — have never performed on stage in their lives. Yet, guided by teachers from the Theater Lab School of the Dramatic Arts, they discover their untapped artistic talents and reckon with their traumatic histories. Courage is found; a leap of faith is taken. Sharing their pasts to release the potential in their futures, these 15 emboldened women take the stage in front of a packed house, illuminating the transformative power of arts education. Directed by Academy Award nominated and Peabody Award winner, Nicole Boxer. Hazelden & StepUP Tours: Want to see what two highly respected facilities and programs are doing? Visit Hazelden or Augsburg College’s StepUP on the evening of October 9 to tour their facilities, ask questions, and learn about best practices.

2:30 pm – 4:00 pm BREAKOUT SESSIONS

Explore Minneapolis and St. Paul: Jump on the subway and explore Minneapolis or St. Paul. on your own! Free.

TRACK: CO-OCCURRING

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

Co-Occurring Trauma and Substance Use Disorders: The Incest Connection Alberta Montano-DiFabio, ScD, LCADC, CCS TRACK: RECOVERY SUPPORT

Trauma-Sensitive Mindfulness-Based Recovery Maintenance Angela Thomas Jones, LCMHC, MLADC, RYT

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Pre-register now for best rates!

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Pre-Conference Only: October 7 Member Non-Member Organizational Member Staff** Student/Military Member Student/Military Non-Member

Full Conference: October 8–10 Member Non-Member Organizational Member Staff** Student/Military Member Student/Military Non-Member

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❑ YES, I want to join NAADAC! Please visit www.naadac.org/join or call 800.548.0497 to enroll. ❑ Please send me additional information about membership. ❑ This is my first NAADAC Training/Conference. NAADAC or INCASE Member #: _______________________ Name: _____________________________________________________________ Address: ___________________________________________________________ City: ________________________________ State:

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❑ $150 ❑ $175 ❑ $225 ❑ $225 ❑ $250 ❑ $275 ❑ $175 ❑ $200 ❑ $250 One Day Only* Please check day you will attend: ❑ Oct. 8 ❑ Oct. 9 ❑ Oct. 10

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Post-Conference Only: October 11 Member Non-Member Organizational Member Staff**

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Two-Day SAP Training Only: October 7–8 Member Non-Member Organizational Member Staff**

❑ $307 ❑ $407 ❑ $307

Full Conference + SAP Training: October 7–10 Member Non-Member Organizational Member Staff**

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Special Events: October 8 Space is limited; sign up early. StepUP Tour Hazelden Tour Movie Night

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Prices determined by date of payment. Please send payment and form together. Email form to naadac@naadac.org. Fax to NAADAC at 800.377.1136 or mail to 44 Canal Center Plaza, Suite 301, Alexandria, VA 22314. Keep a copy for your records. Conference refund policy: All cancellations received prior to September 7, 2016 will receive a 75% refund. Thereafter, no refunds are given.

Questions? Visit www.naadac.org/annualconference or call 800.548.0497.

**For a complete list of NAADAC Organizational Members, visit www.naadac.org/orgmembersdirectory

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

V1 06172016

Translating Coverage into Quality Treatment By Kimberly A. Johnson, PhD, Director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration

or most Americans, access to treatment for substance use begins with health insurance coverage. The combination of the Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act (MHPAEA) have been positive steps to open access to equitable insurance coverage for substance use and mental disorders. However, coverage is only the first step in providing access to quality care. For coverage to work, there have to be providers who accept the coverage and can provide the right care in the right place at a convenient time. The challenge for the behavioral health community as we go forward is two-pronged: first, ensuring that treatment is available and, second, that it is effective — preferably evidence-based. It’s a tall order that requires a collaborative effort between payers, regulators, providers and advocates. If we accept that only 10 percent of those identified as needing substance use disorder (SUD) treatment actually receive it1, then we have a long way to go to reach the goals of health care reform. If 20 million more people decide to use the current specialty care treatment to address their SUD, the system will not be able to accommodate them. As it is, many locations have waiting lists for all levels of care. The ACA and MHPAEA have set the stage for a brighter future, but it is now our responsibility to make that future an achievable reality.

Increasing Access It’s important to remember that expanding access to insurance does not necessarily mean expanding access to treatment. To achieve that we need to have a sufficient provider workforce and have the members of that workforce placed in high need, underserved communities. Attracting a dedicated, qualified behavioral health workforce is not a new concern; however, the ACA and MHPAEA have created a greater sense of urgency. In its 2013 Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that high turnover, an aging workforce, and lack of diversity continue to plague the behavioral health workforce.2 In addition, according to a 2012 report conducted by the Addiction

Technology Transfer Center Network (funded by SAMHSA), approximately a third of clinical directors at the time were only somewhat proficient in web-based technologies, and almost half of substance use disorder facilities did not have an electronic health record (EHR) system in place.3 Based on this data, it is clear that one important focus needs to be attracting and retaining highly qualified, and ethnically and culturally diverse behavioral health workers who are comfortable with utilizing technology to increase access to care. With this in mind, SAMHSA included Workforce Development in its six strategic initiatives for 2015–2018 to develop training, guidance, and competencies for behavioral health workers. We need to continue developing and expanding the behavioral health workforce in racial and ethnic minority communities, which are underrepresented in the workforce and over-represented in the treatment population compared to their prevalence rates. Since its inception in 1973, SAMHSA’s Minority Fellowship Program (MFP) has helped to enhance services for racial and ethnic minority communities. Through stipends given to post-graduate students, the program seeks to increase culturally competent behavioral health professionals who often then serve in key leadership positions in their communities. In 2014, President Obama enacted the “Now is the Time” initiative in response to the Sandy Hook Elementary School tragedy. Activities funded under the initiative include training for behavioral health professionals and paraprofessionals, as well as teachers and other adults who interact with youth. Under the initiative, SAMHSA received $5.2 million to expand the Minority Fellowship Program to support Master’s level trained behavioral health professionals in the fields of psychology, social work, professional counseling, and other areas that serve children, adolescents, and transitional youth. Of course, the challenge remains of how to keep behavioral health pro fessionals in communities with the highest need when salaries and working conditions are often inferior to those in resource-rich communities. With a large number of the behavioral health workforce aging out, qualified graduates have their choice of jobs. Those of us in positions of leadership need to develop mechanisms to distribute the available workforce in a way that reaches those most in need. Models to consider are those that have been used in other areas of medicine and in education.

Reaching Rural Communities Slightly more than 57 million people live in rural or frontier counties in the U.S. — that accounts for approximately 18 percent of our total population.4 Rural communities have had historic shortages in health professionals, and this shortage is particularly evident in the distribution of the behavioral health practitioners.5 Seventy-five percent of those counties have no advanced behavioral health practitioners.6 To add to what is already a disturbing situation, the southern and western states with the least access to treatment are also the ones with the highest rates of mental and substance use disorders. SAMHSA is looking to the effective use of technology to expand access to areas where the population size may limit the ability of organizations to support regular specialty care staff. Telehealth is not new, but it is finding an increasingly vital role in the post-ACA world. In rural communities, the use of technology has increased the ability of providers S U M M E R 2 016 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 15

to “see” their clients without requiring them to travel long distance to their facilities. SAMHSA’s Targeted Capacity Expansion program’s Technology Assisted Care in Targeted Areas of Need (TCE-TAC) grants are designed to assist practitioners in expanding their reach through the use of smart phones, tablets, web-based technologies, and applications. Of course, providing the technology is only helpful if the providers and the clients make beneficial use of it. Telehealth programs need to include technical assistance and education as part of their plans to be truly effective. Where telehealth is used properly, however, it cannot only save time but also reduce cost. In West Virginia, Prestera Center, a TCE-TAC grantee, has significantly increased productivity of its psychiatrists while at the same time reducing “no-shows” by adopting telehealth technologies. Prestera doctors make virtual appointments with patients living in remote areas, making it easier to keep appointments, refill medications, and provide more effective care to all patients, regardless of where they live. As more treatment providers experiment with integrating technology into their treatment models, the demand for resources to help use the technology effectively and efficiently is rising. SAMSHA’s Addiction Technology Transfer Centers offer Telehealth Tuesdays on the second Tuesday of each month to discuss models and address issues in the delivery of SUD treatment and recovery services via telehealth and other electronic media. An archive of previous webinars is also available on their website. Topics are diverse and are not limited to only the tech-savvy. SAMHSA is supporting a pilot project with the American Society for Addiction Medicine and Project Echo at the University of New Mexico to train and support rural physicians in the use of buprenorphine, a medication approved by the Food and Drug Administration for the treatment of opioid use disorder. The Echo model links highly trained specialists with physicians practicing in the field and via webinar training, case consultation and mentoring. Research has demonstrated that patients that receive care from generalists who are supported by Project Echo have care that is as safe and effective as care by a specialist7 and that participation in Project Echo improves the skills and confidence of general practitioners to provide specialty care in rural areas that cannot support full time specialists.8 Peer support workers can fill in many of the gaps created by the lack of trained clinical workforce. In addition to the special level of social support and systems navigation that can be provided by peers, peer specialists and other para-professionals can act as clinician extenders much as physician assistants (PAs) and nursing staff work with physicians. To ensure the success of such delivery models, however, two challenges need to be addressed: first, what competencies are required to ensure quality care, and second, what reimbursement models best support this team based care. Building on the Peer Support Policy guidance issued in the August 15, 2007, State Medicaid Director Letter (SMDL #07-011), the Center for Medicare and Medicaid Services (CMS) has continued to encourage states to develop behavioral health models of care under the Medicaid program that offer peer support services as a component of a comprehensive mental health and substance use service delivery system. SAMHSA, working with CMS, continues to review state Medicaid waivers as part of the interagency review board that makes suggestions and offers guidance to states on effectively providing services through their Medicaid delivery systems. These efforts to encourage effective use of peer support services have the potential to expand the reach of treatment, but the challenge of ensuring quality standards remains. The challenge of creating quality standards for peer support workers is compounded by the inconsistencies in requirements state-to-state. Generally, a peer support provider has a determined amount of time in recovery and some type of training, but deciding on standard requirements 16

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for each of these areas is difficult. Just as not all subject matter experts make good teachers, not all people with “lived experience” and training make good peer support providers. It is essential to find consensus on a set of basic skills, knowledge, and attitudes that each peer support provider should possess. In response to this need, SAMHSA, in conjunction with subject matter experts, conducted research to identify core competencies for peer workers in behavioral health and later posted the draft competencies developed with these stakeholders online for comment. Over 120 stakeholders, including treatment providers, peer organizations, and family and youth organizations, participated in the summits. They include: recovery-oriented, person-centered, voluntary, relationship-focused, and trauma-informed. Although they are not binding, the competencies can be used by providers to integrate peer recovery services into their treatment programs, while ensuring a level of program quality and integrity. As the behavioral health field looks further into how closely to regulate peer support providers, it is important that we remember the goal of increasing access and avoid creating barriers for those wishing to enter the peer workforce or utilize peer support services in their treatment programs. Peer support providers have a role alongside other treatment providers; they do not and should not replace them. Each brings unique knowledge, experience, and perspectives that result in a more comprehensive treatment approach.

Ensuring Quality Offering effective, quality treatment should be the goal of every treatment program. Individuals come to treatment with a myriad of issues and experiences; they are vulnerable and dependent on the skills and compassion of the treatment providers. With the increased access offered by expanded Medicaid and newly offered coverage through post-ACA insurance programs, ensuring quality treatment and identifying a standard of care that is evidence-based and sustainable are key components of a successful future for providers and clients. The ACA very clearly puts an emphasis on evidence-based treatment programs, particularly for cost-reimbursement of services. For some in the behavioral health industry this is a new requirement, and one that may seem overwhelming. Resources such as SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP) can provide a good starting point for those who are seeking to integrate evidence-based programs into their treatment models. In response to the increased emphasis on evidence-based programs, SAMHSA is in the midst of improving the content and structure of NREPP to better reflect users’ needs and more clearly reflect evidence-based treatment criteria.

Access and Quality for Opioid Treatment No discussion of quality and access would be complete without touching upon medication-assisted treatment (MAT) and, in particular, opioid treatment programs (OTPs). In March 2015, Health and Human Services Secretary Sylvia Burwell announced a targeted initiative to address the nation’s opioid crisis. In support of the initiative, SAMHSA launched a new grant program called Medication-Assisted Treatment-Prescription Drug and Opioid Addiction (MAT-PDOA). The goal of MAT-PDOA is to assist states in increasing access to MAT in their communities of most need. Although still in its early days, MAT-PDOA is already showing results. The Washington State Department of Social and Health Services, for instance, is funding three providers who are using a number of evidencebased treatment models to facilitate collaboration between OTPs and primary care clinics, making MAT part of the regular service menu provided

through primary care. Not only does this increase access in high risk, underserved areas, it allows providers to share information, lessons learned, and resources. In Missouri, the Department of Mental Health, Division of Behavioral Health, is providing funding to two providers who are integrating the use of MAT-trained peer specialists to help new clients develop support networks. The providers are also using telehealth services to provide MAT to rural clients. Building on the early success of MAT-PDOA, SAMHSA plans to expand the program to an additional 23 grantees in FY 2016, which will bring the total number of states with grants to expand access to quality MAT to 45. Under the Drug Addiction Treatment Act (DATA) of 2000, SAMHSA is responsible for approving physician applications for a waiver to treat opioid dependency with approved buprenorphine products in any settings in which they are qualified to practice. While the waiver process ensures a level of quality, there have been concerns expressed about its client limits and how that might limit access. In response to those concerns, new regulations are being created that would increase the 100 limit to 200, under certain conditions. The proposed change in rules is

designed to increase access while assuring quality.

Building for the Future In 2015, the Institute of Medicine issued a report, “Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards,”9 out lining a framework and strategy for better incorporating evidence based practices in counseling services. They recommend changes in research, translation, training and implementation processes. SAMHSA has begun to discuss how to incorporate this guidance into our efforts regarding improving the quality of care. We are eager to engage the field in a discussion of how to better measure patient outcomes, provide services that reach those outcomes, and ensure that the cycle of research to practice addresses the questions that are of most concern to patients and families. In addition, to further establish and expand alcohol screening and brief counseling as a permanent component of primary care services, SAMHSA is currently collaborating with the National Committee on Quality Assurance to conduct additional field testing of the “Unhealthy Alcohol Use: Screening and Brief Counseling”

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measure to include it in the Healthcare Effectiveness Data and Information Set (HEDIS) core measure set. This work is a high priority for SAMHSA and will build the foundation for a more comprehensive approach to measuring treatment access and improving the quality of care and health outcomes for individuals with substance use disorders. As more medical treatments for SUDs become available and service delivery becomes more integrated, we need to continue to recognize and support the critical role that behavior change therapies and social supports play in helping patients achieve recovery. While we have reached a milestone in access to insurance coverage, translating coverage into access to quality treatment remains a work in progress. ENDNOTES 1 Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data. 2 Substance Abuse and Mental Health Services Administration (April 2013). Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues. (Report ID PEP13-RTC-BHWORK), Rockville, MD. 3 Ryan, O, Murphay, D, Krom, L. (2012). Vital Signs: Taking the Pulse of Addiction Treatment Workforce, A National Report – Executive Summary, Kansas City, MO: Addiction Technol ogy Transfer Center National Office in residence at the University of Missouri-Kansas City. 4 Meit, M, et al. (2014). The 2014 Update to the Rural-Urban Chartbook. Rural Health Reform Research Policy Center. Retrieved from: https://ruralhealth.und.edu/projects/ health-reform-policy-research-center/pdf/2014-ruralurban-chartbook-update.pdf. 5 Miller, BF, et al. (2014). Colocating Behavioral Health and Primary Care and the Prospects for an Integrated Workforce. American Psychiologist, 69:443–451. 6 Herron, A (n.d.) Behavioral Health Workforce: Challenges, Opportunities, and Initiatives. (PowerPoint Slides). 7 Arora, S, Thornton, K, Murata, G, Deming, P, Kalishman, S, Dion, D, ... & Kistin, M. (2011). Outcomes of treatment for hepatitis C virus infection by primary care providers. New England Journal of Medicine, 364(23):2199–2207. 8 Arora, S, Kalishman, S, Dion, D, Som, D, Thornton, K, Bankhurst, A, ... & Komaramy, M. (2011). Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Affairs, 30(6):1176–1184. 9 England, MJ, Butler, AS, & Gonzalez, ML. (Eds.). (2015). Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards. National Academies Press. Dr. Kimberly A. Johnson, Director, Center for Substance Abuse Treatment, has an extensive career in behavioral health that has earned her numerous awards, including the Federal DHHS Commissioner’s Award for Child Welfare Efforts and the National Association of State Alcohol and Drug Abuse Directors’ Recognition for Service to the field of Substance Abuse Treatment and Prevention. Before joining SAMHSA’s leadership team, Dr. Johnson had served as Deputy Director for Operations of CHESS/NIATx at the University of Wisconsin, Madison; as Director of the Office of Substance Abuse in Maine; and as Executive Director of Crossroads for Women, a women’s addiction treatment agency.

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Changing the Way We Think About Appearance and Performance-Enhancing Drugs

By Jack B. Stein, PhD, MSW, National Institute on Drug Abuse (NIDA)

n estimated 2.9 to 4.0 million Americans take anabolic androgenic steroids, derivatives of testosterone to build muscle, and a recent analysis suggests that roughly one million people, almost entirely men, are dependent on these substances.1 The health impacts of steroids and other substances taken to boost exercise performance and muscle mass, including poorly regulated diet and workout supplements available on the Internet or over the counter, can be very serious; yet their use remains a hidden problem, one that has gotten lost amid the myriad public health concerns related to other more classic drugs of abuse. Various factors have served to conceal the problem of steroid use and its health consequences. People are unlikely to disclose their use to healthcare providers, and since many users star t after their teens, steroid use is less likely than other kinds of drug use to be detected by parents or teachers or show up on surveys. The relative recency of the phenomenon of non-athletes using these substances also means that long-term health consequences are still somewhat unclear.2 In addition, since deaths related to steroid use may be reported as due to proximal causes like heart attack, there is likely to be an underreporting of the risk. Thus we still lack an accurate estimate of how many young lives are being claimed or put at risk by performance enhancers. Misconceptions about the way these drugs are used and who uses them have also contributed to the problem’s invisibility. Steroids are mainly associated with athletes, and the common designation “performance enhancing drugs” sends the signal that these substances are mainly problematic because they are a form of cheating in sport, not because of the risks they pose to the user’s health. High-profile cases like Lance Armstrong’s 2012 admission of doping after decades of denial or Maria Sherapova’s recent ban from tennis for using a cardiac performance enhancer give the impression that these substances are mainly used by elite athletes (of both sexes) who appear otherwise to be models of physical health and achievement, just to gain an edge in competition. The fact is, the vast majority of users are male non-athlete bodybuilders aiming to enhance their appearance. Use of performance-enhancing drugs 18

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is strongly tied to problems related to male body image.3 Users often exhibit a preoccupation with the perceived inadequate size of their muscles, a type of body dysmorphic disorder. Thus some organizations, such as the Taylor Hooton Foundation, are recommending using the term “appearance and performance enhancing drugs” or APEDs to highlight this strong link with body image.4 Most performance enhancers are different from more familiar drugs of abuse that directly affect the brain’s reward areas, like opioids. The latter can lead to dependence and addiction in part by altering the user’s sensitivity to reward and stress and reducing the brain’s ability to inhibit impulses. Steroids do not affect the same brain regions or directly produce a euphoric surge of dopamine, but dependence may come about through other pathways including a range of neuroendocrine effects and through their interaction with a user’s body image.2 Their association with the world of sports and fitness — and the fact that some performance-enhancing substances are sold legally as health supplements — gives them a misleading veneer of safety that most other drugs of abuse do not have. In fact, the consequences of steroid and other performance-enhancing drug use over time can be profound and devastating.2,5 Cardiovascular effects of regular steroid use include atherosclerotic disease and, at high doses, dangerous thickening of the heart muscle, raising risk for heart attack in users who otherwise would not be at risk. Risk may be magnified when using steroids in conjunction with stimulants, a common workout practice. Steroids are toxic to other organ systems as well, including the liver and kidneys, and liver cancer may be associated with prolonged steroiduse.5 Shrinking of male sex organs (hypogonadism) while periodically cycling off steroids to manage tolerance or following attempts to quit can also have psychologically devastating effects.2 Alterations of mood, both in response to such body changes and as a direct consequence of the neuroendocrine effects of these drugs, can be profound: Manic or hypomanic symptoms, such as the extreme aggression sometimes called ‘roid rage, are experienced by some users and contribute to a wide range of other risky behavior; con versely, steroid withdrawal can lead to depressive symptoms and thoughts

of suicide. Recent research in animal models and human users also suggests that prolonged steroid use is neurotoxic and might produce permanent deficits in brain areas involved in visuospatial memory.2 Awareness of the issue of male body-image disorders in our society has lagged behind that of corresponding issues in women. The 1983 death of singer Karen Carpenter from complications of anorexia and abuse of an over-thecounter emetic shined a spotlight on eating disorders and dangerous weight-loss practices. But just as girls’ and women’s body dysmorphia are driven by unrealistic portrayals of the female form everywhere from Barbie dolls to fashion magazines, male body-image issues underlying APED use must be viewed in the context of GI Joe and comic book and action movie heroes that have shown increasingly exaggerated physiques over the past three decades.3 Counselors and clinicians face a number of unique challenges around use of APEDs. Foremost is getting patients to admit using these substances. Commonly voiced is the view that steroid users are “cheating at life” by using steroids to help build muscle. Thus APEDs are associated with their own unique form of stigma

— different from the stigma than attaches to most other drugs. When a person has developed dependence on a drug, it is often insufficient and in some cases unsafe to simply advise abstinence without offering supports for withdrawal, and this is also true with steroids. The hypogonadism and depression that may result from steroid discontinuation contribute to risk of relapse and other potential outcomes like suicide. Hormone treatments like estrogen feedback blockers, human chorionic gonadotropin, or testosterone-replacement therapy can be used to medically manage hypogonadism,2 and antidepressant medications and behavioral therapy are available to help treat associated depression. Steroid use may also be comorbid with eating disorders and with other substance use disorders, which also need to be addressed in a comprehensive treatment plan. In a society that increasingly celebrates exaggerated male physiques, the issue of APEDs and the body-image issues that surround their use by young men remain oddly invisible. Outside of gym and athletic culture, most people simply don’t realize that enormous muscles are often obtained with the help of harmful and often illegal substances that can severely endanger the

user’s mental and physical health. It is important to remove the cloak of invisibility surrounding this issue. ENDNOTES 1 Pope, HG, Kanayama, G, Athey, A, Ryan, E, Hudson, JI, Baggish, A. (2014). The Lifetime prevalence of anabolicandrogenic steroid use and dependence in Americans: Cur rent best estimates. The American Journal on Addictions/ American Academy of Psychiatrists in Alcoholism and Addictions, 23(4):371–377. 2 Pope, HG, Wood, RI, Rogol, A, Nyberg, F, Bowers, L, Bhasin, S. (2014). Adverse health consequences of performanceenhancing drugs: An Endocrine Society scientific statement. Endocrine Reviews, 35(3):341–375. 3 Pope, HG, Phillips, KA, Olivardia, R. (2000). The Adonis Complex: The Secret Crisis of Male Body Obsession. New York, NY: Free Press. 4 Taylor Hooton Foundation. Retrieved at: http://www. taylorhooton.org. 5 Nieschlag, E, Vorona, E. (2015) Doping with anabolic androgenic steroids (AAS): Adverse effects on non-reproductive organs and functions. Reviews in Endocrine and Metabolic Disorders, 16(3):199–211. Dr. Jack Stein joined NIDA in August 2012 as the Director of the Office of Science Policy and Communications (OSPC). He has over two decades of professional experience in leading national drug and HIV-related research, practice, and policy initiatives for NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.

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.

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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

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