Advances in Addiction & Recovery (Summer 2018)

SUMMER 2018 Vol. 6, No. 2

A Person-Centered and Motivational Interviewing Approach to Discharge Planning

By Sarah A. Zucker, PsyD

PLUS: • Closing the OUD Treatment Gap • The Value of NAADAC Membership

2018 A nnual C onferen Prelimi ce nary Sc hedule

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

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

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

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

The Basics of Addiction Counseling Desk Reference, 11th Edition, is a three-module set that has aided many addiction professionals in attaining their state and national credentials with its thorough and easy-to-understand descriptions of counseling concepts.

Basics can also be used as a quick reference tool for clinicians to use throughout their careers and students preparing for addiction counseling careers.

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

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

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

Three-Module Set MANUALS ONLY: INDEPENDENT STUDY COURSES: NAADAC Members $158 NAADAC Members $324 Non-members $225 Non-members $428

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

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

CONTENTS SUMMER 2018 Vol. 6 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 100,000 addiction coun­selors, educators, and other addictionfocused health care pro­fessionals in the United States, Canada, and abroad. NAADAC’s members are addiction counselors, educators, and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education.

Mailing Address 44 Canal Center Plaza, Suite 301

Alexandria, VA 22314 Telephone 703.741.7686 Email naadac@naadac.org Fax 703.741.7698 Managing Editor

Jessica Gleason, JD

Associate Editor

Kristin Hamilton, JD

Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Committee

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

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

Thomas Durham, PhD

NAADAC, the Association for Addiction Professionals

■ F EAT UR ES

Abimbola Farinde, PhD Columbia Southern University

22 Closing the OUD Treatment Gap

Deann Jepson, MS Advocates for Human Potential, Inc.

James McKenna, MEd, LADC I AdCare Hospital

By Jack B. Stein, PhD, National Institute on Drug Abuse

26 A Person-Centered and Motivational Interviewing Approach to Discharge Planning

By Sarah A. Zucker, PhD

■ DEPA R T M EN TS 4

President’s Corner: The Value of NAADAC Membership: Intangible Benefits

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

5

From The Executive Director: The Value of NAADAC Membership: Tangible Benefits

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

7

Certification: NCC AP Update: A Focus on National Credentialing

By Jerry Jenkins, MEd, MAC, NCC AP Chair

9

Affiliates: A Conversation with Northeast Regional Vice President, William Keithcart

By Kristin Hamilton, JD, NAADAC Communications Manager

Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP

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

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

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

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

10 Ethics: What Complaints are Outside of NAADAC’s and NCC AP’s Jurisdiction

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

13 Advocacy: Sharing Your Voice: A NAADAC Advocacy Update

This publication was prepared by NAADAC, the Association for Addiction Pro­fes­sionals. Reproduction without written permission is prohibited. For more in­formation on ob­taining additional copies of this publication, call 703.741.7686 or visit www.naadac.org.

By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair

15 Membership: 2018 Annual Conference Preliminary Schedule

Printed July 2018

30 NAADAC CE Quiz 31 NAADAC Leadership

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■ PR ES ID ENT ’S CORN E R

The Value of NAADAC Membership: Intangible Benefits

By Gerard J. Schmidt, MA, LPC, MAC, NAADAC President Have you ever joined a club or an organization and after time has passed wondered, “Why am I continuing to belong here or pay these dues?” It is at these moments we reflect and begin thinking about how we — or the club or organization — benefit, either directly or indirectly, from our involvement.

I invite you all to reflect on your experiences with, the benefits you gained from, and the contributions you have made to NAADAC and the addiction profession. My own personal experiences have been gratifying and remarkable since I became a member of NAADAC in the early 1980s.

At that point I had no idea what laid ahead, including all of the marvelous and remarkable professionals I would encounter over the years and the experiences that I have had that have helped make and shape me as a professional and as a person.

One of my first memorable experiences with NAADAC was meeting an individual who had come into West Virginia from neighboring Virginia representing NAADAC to do some training for the newly-founded West Virginia Association of Addiction Professionals. That woman, Charlotte Chapman, opened up a whole new world of

addiction treatment skills and knowledge that made me hungry for more.

Little did I know that this would lead me down a path of volunteerism within the West Virginia affiliate, and eventually at the national level with NAADAC. Since that time, I have networked with and met thousands of addiction treatment professionals all over the United States, Iceland, Hong Kong, South Africa, Puerto Rico and many other places. The faces, towns, and countries may change, but the problems and effects addiction causes are global. Being able to represent NAADAC and share not only knowledge, but bring needed resources to many of these areas, has been rewarding in and of itself.

Another intangible but clear benefit I have experienced as part of my involvement with NAADAC is the ability to advocate for the addiction profession and those individuals with substance use disorders on both the state and national levels. I realize that direct contact with legislators through meetings and other forms of contact with their staff is not something everyone is capable of or comfortable with. However, through the NAADAC advocacy trainings and conferences I have been involved with over these many years, I have learned that advocacy takes on many unique President, continued on page 6 ☛

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

The Value of NAADAC Membership: Tangible Benefits

By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director One of my favorite things about my work with NAADAC is the wide range of benefits we are able to offer to addiction professionals! We have many tangible benefits that continue to grow and expand the professional development of our recovery support specialists, counselors and other professionals.

“What is a ‘tangible benefit?’ you may ask.” These are the benefits that are real, perceptible by touch, and helpful to you in your practice, in your professional growth, and in your career development.

The newest benefit NAADAC has to offer involves the addition of a government relations firm, Polsinelli. Polsinelli has a longstanding focus in the area of health care policy development and implementation. This includes substantive expertise crafting legislative and regulatory language to shape policy, working with members of Congress and administration officials within the Department of Health and Human Services (HHS), the Substance and Mental Health Services Administration (SAMHSA), Health Research and Services Administration (HRSA), the Centers for Medicare and Medicaid Services (CMS), the Department of Veterans Affairs (VA), and the National Institutes of Health (NIH). Polsinelli’s Public Policy Group is a bipartisan team that includes two former members of Congress, executive branch officials, and senior Congressional staff. Although part of a larger firm, Polsinelli’s Public Policy Group functions more like a boutique firm, working closely with clients to achieve their public policy goals. NAADAC is excited to be working with this reputable and well-known firm that has vast experience in the health care public policy arena! Already, we are working on major initiatives and setting meetings with Congress and federal agencies to build on the work that NAADAC has done over the past thirty years. Please consider joining us at the Advocacy in Action Conference on November 12, 2018 in National Harbor, MD and on November 13, 2018 for a Briefing on the Hill and Hill Day in Washington, D.C. NAADAC continues to work to generate new benefits that take advantage of evolving technology. NAADAC is excited to announce that it is working with the Telehealth Behavioral Health Institute (TBHI) to bring telehealth training and certification to NAADAC members at a discount. There are several training and education options available, ranging from general training to obtaining a TBHI Level I or Level II Professional Training Certificate. Some of you were able to attend the full-day training at the NAADAC 2017 Annual Conference in Denver last year and hear Dr. Marlene Maheu’s training on telehealth and technology. Dr. Maheu

will be with us again this year at the NAADAC 2018 Annual Conference in Houston to present another full day of telehealth information and education and a keynote presentation. As part of this initiative, we will also be offering telehealth video tips for members only on our website, with a new video clip every month.

To partner the education with the reality of service, NAADAC is partnering with a HIPPA-compliant telehealth platform, Clocktree. Clocktree was founded

by Chandan Chauhan, David Chalmers and Nanduri Ramakrishna, formerly of Microsoft. This platform is HIPPAcompliant and secure from ground up, easy to use, and combines all aspects of client communication into one platform, eliminating the need for multiple different services for video conferencing, client messaging, document sharing, and appointment scheduling and reminders.

The simplicity and convenience allow providers to spend more time actually treating clients and less time managing logistics.

NAADAC, under the direction of HeidiAnne Werner, the Director of Operations and Finance, and Jessica Gleason, the Director of Communications, has been working to implement a new Association Management System (AMS), which launched on July 16. This new, upgraded system will allow you to more easily and speedily update your member profiles, renew your membership, register for conferences and events, make bookstore purchases, track your committee activities, access your membership benefits and discounts, choose your online directory information, and choose which enewletters and emails you would like to receive. In addition, the new AMS will allow for online continuing education tracking in 2019. This means you will be able to track all of the continuing education you earn as a NAADAC member in one place online and easily download documentation as needed for certification, re-certification, and clinical supervision requirements.

Education and training opportunities are perhaps the most important NAADAC benefits for many members. These opportunities allow members to expand their professional knowledge of new evidence-based and promising practices, as well as new science and research. NAADAC continuously updates the training materials that it provides, including most recently updating the popular Basics of Addiction Desk Reference series. In the last six months, we have released updated editions of Integrating Treatment for Co-Occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know (July 2018) and the popular three-module Basics of Addiction Desk Reference – Module I: Pharmacology of Psychoactive Substance Use, Abuse, and Dependence (March 2018), Module II: Addiction Executive Director, continued on page 6 ☛

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Executive Director, continued from page 5

Counseling Theories, Practices, and Skills (January 2018), and Module III: Ethical and Professional Issues in Addiction Counseling (May 2018). We are also updating Clinical Supervision: An Overview of Functions, Processes, and Methodology, to be released this Fall. All of these manuals are great reference tools for agencies and great teaching tools for colleges/universities and training programs.

In addition to the training manuals and other products that NAADAC offers, it also offers over 150 hours of webinars covering a variety addiction and co-occurring disorder topics from the best trainers in the country! We are very proud of the education and knowledge that these trainers impart in the webinars. Each webinar is worth at least 1 CE, and all of these webinars are available on demand 24 hours per day, 7 days per week.

NAADAC recognizes that it is important for addiction professionals to carry a professional liability insurance policy and has worked to make finding and purchasing a policy easier (and less financially burdensome) on its members by partnering with the American Professional Agency, Inc. (APA). APA offers professional liability insurance policies at a discounted NAADAC-member rate for counselors, clinical supervisors, peer recovery support specialists, students and agencies/facilities. If this is something you

have not considered before, please review the information on our website at www.naadac.org/insurance.

NAADAC is continuously working to build new membership benefits, such as group discounts that will benefit you professionally. These are still being finalized but will be announced soon on the NAADAC website and in the NAADAC Professional eUpdate enewsletter.

NAADAC works consistently to increase the value of NAADAC membership and has for over 46 years! We hear your ideas and welcome them! Feel free to contact me or the NAADAC staff with other suggestions or ideas! Together we make a difference!

Cynthia Moreno Tuohy, BSW, 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.

President, continued from page 4

roles and we can all contribute in some capacity. Contributions can take the form of writing letters or emails to state and national legislators, attending community meetings, making small donations to candidates who support our causes, or just by simply stating your message at work, at home or in the community. Those who we serve experience stigma that has, at times, prevented them from receiving needed services and even caused them to experience discrimination. Our voice and our ability to stand up for them and for the addiction professionals that serve them is a privilege and part of being a NAADAC member.

Over the past thirty-five years, I have had the distinct honor and privilege as a NAADAC member to help develop and provide a variety of trainings for both NAADAC members and other addiction professionals nationwide. Having the opportunity to take the years of experience and professional interactions I have had and apply them to a training module has been remarkably rewarding. We all have a responsibility to share what we have for the betterment of our profession. All of you have unique skills and talents that those entering the profession can benefit from being exposed to. Do not pass up that experience of sharing what you have experienced as a bridge to those coming after us.

My favorite benefit that comes from my association with NAADAC is the opportunity to mentor and shape professional growth and development of those now coming into our profession. We all are aware of the dramatic shortage of qualified and trained addiction treatment professionals across the United States. Each of us needs to be able to provide mentoring, guidance, and consultation to those in either educational programs with a focus on addiction or to those who have addiction-specific degrees and are entering the profession. Our remarkable skill sets and experiences, as well as the needed insights to guide and shape professional development, is invaluable. We all had mentors in our own professional development, and these experiences were an important part of shaping our growth and development and leading us to be the addiction professionals we are today.

When called upon or if you perceive a need to mentor, please do not pass up that opportunity. You will find it truly rewarding and a way for you to grow as well. Remember: we are a link to the future!

Being part of NAADAC offers many opportunities for involvement for you to share your talents and skills in leadership roles at a variety of 6

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levels. From volunteering as a member of one of the many NAADAC committees or running for office to offering your own unique talents as a trainer, NAADAC affords you the opportunity to become as involved as you would like to be. Don’t sit back and assume that someone else can and will do it. Don’t rob the profession of your talents and skills. We need you and we need your involvement. I know from my own personal experience that you will find it to be rewarding! The opportunity to help shape the face of treatment and to help develop and move forward legislative agendas that will directly affect the delivery of services is only part of the reward that comes from your commitment.

Finally, when looking at how you benefit from any organization you are a part of, you must look at what you are willing to invest of yourself, whether it be your time, skills, talents, or ideas. Our profession is one where individuals depend on our insight, commitment and skills to help them through some of the most difficult decisions and assist them in rebuilding lives devastated by addiction. NAADAC is an organization comprised of many talented and skilled treatment professionals, which makes it a marketplace for an exchange of concepts, ideas and practice models that can be effectively used in your practice. Don’t miss the opportunity to meet and share with your colleagues across the United States either directly at a conference, on a webinar, or at a training or mentoring event. Remember, those in and striving for recovery are counting on you each and every day.

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

■ CER T IF IC AT I O N

NCC AP Update: A Focus on National Credentialing

By Jerry Jenkins, MEd, MAC, NCC AP Chair The National Certification Commission for Addiction Professionals (NCC AP) continues to work hard to promote national credentialing and its many benefits to addiction professionals, third-party payors, community and government stakeholders, and the public at large.

NCC AP and NAADAC are working hand-in-hand to promote national credentialing through a multidimensional approach at both the state and the national levels. At the state level, we are reaching out to states directly to provide information about why using a system of national credentials is important and how the state, the practitioners, and the addiction community all benefit from the use of national credentials. NAADAC has also hired a top-rated health government relations firm in Washington, D.C. to assist in the promotion of NAADAC’s legislative agenda, which includes national credentialing and higher rates of reimbursement for addiction treatment services. We have also contributed to a variety of reports at the federal level regarding the need for national credentials, such as the National Workforce Report, published Fall 2017 by the Addiction Technology Transfer (ATTC) Network, and through testimony to Congress.

NAADAC’s Executive Committee supports national credentialing as a solution to the issues of transportability of credentials that is affecting our workforce and the ability for facilities to be reimbursed equally to other disciplines. Medicaid and 3rd party organizations have difficulty comparing the addiction profession and its credentials to the other counseling disciplines that they reimburse largely because there is such a diverse set of addiction/substance use disorder credentials used from state to state.

Because the credentials, and their respective requirements, vary from state to state, the funders are unclear as to the appropriate scope of practice of each practitioner. This is further complicated by the fact that states are changing their credentials and the respective requirements, both to raise and lower their standards. Reimbursors are not going to spend hours of time and effort to map out the credentialing system of each state, or to understand the nuanced differences between the various credentials.

Many reimbursors still see the addiction professional as a “paraprofessional” and will not recognize or reimburse for treatment provided; however, there are funders that recognize and reimburse for NCC AP’s Master Addiction Counselor (MAC). In 2011, the Substance Abuse & Mental Health Services Administration (SAMHSA) worked with the United Behavioral Health Care Association to conduct a survey of counseling disciplines and insurance company’s recognition and reimbursement of levels of credentials. In the addiction field, only the MAC credential was found to be recognized and reimbursed as a specific credential. When credentials are not recognized by reimbursors, this then often translates to the individual counselor not receiving sufficiently high salaries and benefits due to a reduced revenue stream at the agency level. By having national credentials that represent specific education and training, levels of care, and scope of practice, addiction professionals allow payors to easily see and understand the various levels of practitioners and provide reimbursement accordingly.

The lack of parity has greater implications than decreased revenue streams for addiction treatment providers. The largest issue is that the decreased revenue streams and the resulting limited salaries compared to other counseling disciplines causes the next generation of would-be addiction counselors to instead seek careers in other counseling fields.

According to the U.S. Department of Labor, employment of addiction counselors is projected to grow by 23% by 2026 (compared to an average growth rate of 7% for all occupations). The current system of state-specific credentialing, as opposed to national credentialing, results in lower wages and lack of portability from state to state. This is an unattractive prospect to a recent graduate. Without some other compelling reason (self, family or friend with SUD) to entice a young person to come into this profession, the workforce will simply diminish, despite the need for it to grow. There are other disciplines who would happily provide addiction treatment to those who need it; however, practitioners in these disciplines lack the specialized education and training that individuals with substance use disorders and

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co-occurring disorders need to have the best chance at maintaining recovery. There needs to be a concerted effort among the national organizations to rally around the issue of national credentials and put aside the fears and territoriality of the past and move the addiction profession into the next phase of our development.

As a result of NCC AP’s efforts to expand the reach of its credentials, Maryland, Virginia, and Wisconsin have contracted with NCC AP in the past year to use its tests at the state level, allowing the examination scores from those states to be used for NCC AP national credentialing. NCC AP has also been working in unison with two credentialing bodies in California, California Association of DUI Treatment Programs (CADPT) and California Association of Alcohol/Drug Educators (CAADE), to bring unification of the addiction counselors in California. It is exciting to see that more states are coming “on board” to build the national credential system and enjoy the benefits of both NCC AP’s menu of testing services and NAADAC’s workforce development initiatives.

NCC AP is also in discussions with several other states regarding their use of the National Peer Recovery Support Specialist (NCPRSS) credential, NCC AP’s newest national credential. Most states that permit peer recovery support have lower requirements than NCC AP’s NCPRSS credential. By adopting the NCPRSS, states can use their credential as a baseline and add the national peer credential for those peers who want to take advantages of the benefits of this higher national peer credential. The adoption of this credential by states is a great opportunity to create transportability for this credential and grow the peer support specialist workforce both state-bystate and nationally. We are excited to be working with a variety of states at this time in the preparation and implementation of this new opportunity.

We are also excited to announce a collaboration between NCC AP and

the American Psychological Association (APA)’s Division 50: Society of Addiction Psychology that has resulted in allowing the transfer of holders of APA’s Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders (APAPO) to NCC AP’s Master Addiction Counselor (MAC) national credential. Those who currently hold the APAPO certificate will be eligible to apply for NCC AP’s MAC national credential during a six-month, one-time test-exempt offer period that will close on August 31, 2018. This collaboration brings together Master’s leveled credentialed professionals in a unified effort to bring growth in the areas of reimbursement, transportability, and public recognition. A special “thanks” to Dr. Kirk Bowden, Immediate Past President of NAADAC for helping facilitate this relationship.

In closing, by working to expand the use of its national credentials, NCC AP is working hard to serve the addiction profession and protect its future. We believe the move toward national credentialing is vital to the profession’s growth, success and ability to meet the increasing needs of the public and will ultimately result in better and more accessible treatment being provided to those who need it the most.

Jerry A. Jenkins, MEd, MAC, has been Chair of NAADAC’s National Certification Commission for Addiction Professionals (NCC AP) since 2016. He retired in January 2018 as the Chief Executive Officer of Anchorage/Fairbanks Community Mental Health Services after 15 years. Jenkins currently is the Chief Operations Officer for the Alaska Behavioral Health Association, serves as Board President for the Alaska eHealth Network and does behavioral health care consulting. As an addiction treatment professional, he has over 35 years of experience in treating substance use disorders and mental illness. Jenkins has worked in and managed community based, outpatient, halfway and residential treatment services. He is an advocate for safe, affordable and accommodating housing for consumers as well as recovery as the expectation for behavioral health care with particular emphasis on being trauma informed.

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■ A F F ILIAT E S

A Conversation with Northeast Regional Vice President, William Keithcart

By Kristin Hamilton, JD, NAADAC Communications Manager

William Keithcart, MA, LADC, We also need to encourage other professionals to become dual-licensed in the field of addictions to meet the demand of client needs.

MAC, SAP, has over 18 years Living in the northeast, our geography poses a constant challenge. The of experience in direct, MAT, distance between practitioners can limit connections, and trying to find and residential services. Keith­ adequate representation for our affiliate Board of Directors membership cart is the Program Supervisor is challenging. We are exploring ways to address how to communicate of DayOne, an outpatient sub- with addiction professionals interested in becoming involved with their stance use disorder program in affiliate Board. the Department of Psychiatry at Q: Why is NAADAC membership important for adThe University of Vermont Med- diction professionals?

A: NAADAC membership for addiction professionals offers clinicians a i­cal Center. He is on the Board voice and NCC AP credentialing offers recognition for the quality of work of Directors of NAADAC’s afbeing accomplished with clients seeking recovery. By being a member, adfiliate, the Ver­mont Addiction Professionals Association diction professionals are able to network with other colleagues, learn ways (VAPA) and the Vermont Association of Mental Health to promote professional ethics, gain insight into decisions at the state and and Addiction Recovery (VAMHAR). Keithcart also federal level, and keep informed of current national standards in the field participates in Chittenden County Opioid Alliance and of substance use disorders. In addition, NAADAC members are afforded the opportunity to receive on-going continuing education courses through Co-Chairs the Treatment Access and Recovery Support a variety of methods, including webinars, independent study courses, and Action Team. conferences, for free or at a reduced cost.

Q: What goals do you hope to accomplish during your time as Northeast RVP?

A: One of my goals for the Northeast region is to continue to improve the already positive collaboration among the state affiliates. This will be accomplished by maintaining our monthly conference calls to discuss what is currently working in each state and determine how NAADAC can assist in furthering each state’s individual needs.

Another goal is to offer a coordinated multi-state training initiative that would provide clinicians in our Northeast region with more opportunities to participate in evidence-based trainings to strengthen their clinical skills.

Q: What are the major issues or challenges happening in your region? How can NAADAC help overcome them?

A: One of the major issues in our region is workforce development. We need to work to increase the number of skilled addiction professionals by both providing opportunities for current addiction professionals to improve and enhance their skills to meet the complex needs of our clients, and also by encouraging and supporting mental health professionals as they move into the field of addiction treatments.

Q: What are your hopes for the future of NAADAC?

A: My hope for the future of NAADAC is that we can work to continue its mission to provide leadership and advocacy in to advance our profession at the state and national level. NAADAC is in the unique position to advance the field of addictions by setting the standards with our Code of Ethics. This is the foundation for upholding the highest standards for our profession.

Another hope for the future direction of NAADAC would be continuing to offer its expertise to higher education in setting the standards at college and graduate level for credentialing and/or licensing to enter the field of addictions.

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

The Northeast Regional Vice President represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont.

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■ E T H ICS

What Complaints are Outside of NAADAC’s and NCC AP’s Jurisdictions?

By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair “Why bother filing an ethics complaint? Nothing will probably come of it anyways!” I hear questions and statements like this often. NAADAC firmly supports the principle that we have an obligation to our clients and our profession to engage in the delivery of services that are individualized, relevant, evidence-based, and driven by outcomes data. Most difficulties between clients or colleagues/professional peers and service providers/ clinicians result from misunderstandings, miscommunication, lack of appropriate policies and procedures, and/or unethical and/or illegal clinical and/or administrative practice. Clients and colleagues may not be offered the opportunity to engage in constructive dialogue, practices, or actions that work towards resolving questions, concerns, or differences, thereby eliminating the need for further action.

When clients and colleagues/professional peers are not satisfied with how a clinician is delivering care, they can turn to a state or national entity, like NAADAC, for assistance. NAADAC has a formal complaint process for filing an ethics complaint, which can be found at: www.naadac.org/ assets/2416/naadac-nccap-ethics-complaint-form-122016.pdf. The ­ability to file an ethics complaint is available to anyone who feels compelled to do so. Initially, ethics complaints are read by the NAADAC and NCC AP Ethics Chairs and NAADAC Executive Director to determine if the complaint falls within NAADAC’s and NCC AP’s jurisdictions, and if it has been filed with the appropriate local and state authorities first. Their job is to review complaints to determine if the allegations made, if taken as fact, might indeed amount to the violation of the NAADAC/NCC AP Code of Ethics cited in the complaint.

There are complaints filed with NAADAC that do not fall within NAADAC’s jurisdiction and are returned to the Complainant (the person filing the complaint) with suggestions for alternative remedies. Examples of complaints that do not fall within our scope of oversight and Code of Ethics include: • NAADAC Nonmember or NCC AP Non-Credentialed Complaints: NAADAC does not have jurisdiction over individual clinicians or service providers who are not individual or organizational members of NAADAC or are not credentialed by NCC AP, and therefore cannot process complaints made against them. The most we can do with nonmembers is send them a letter notifying them that a complaint was filed against them (we do not share who sent the complaint) and that there is an expectation that they are delivering the highest level of care within our profession. It is our hope that nonmembers will look at their practices to see what needs to be addressed. The Complainant is notified that, because the person who they are filing a grievance against is neither a NAADAC member nor credentialed by NCC AP, his or her complaint falls outside of our jurisdiction. We do recommend that the Complainant contact his or her state licensing board, state grievance board, state regulatory agency, or Single State Authority to determine if the complaint would fall under one of their jurisdictions.

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• Licensure and Right-to-Practice Complaints: NCC AP can and will remove or restrict a credential holder’s certification or endorsement based on the facts of an investigation. However, NAADAC/ NCC AP is ultimately unable to restrict a clinician, member or nonmember, from practicing in the Complainant’s state. NAADAC/ NCC AP does not provide a license to practice and cannot fully restrict a clinician from practicing. Ultimately, restricting a clinician’s ability to practice falls under the state’s regulatory jurisdiction/licensing board where the individual is certified or licensed to practice.

When NAADAC/NCC AP determines that a credential holder’s credential (NCAC I, NCAC II, MAC, NDS, NCAAC, or NCPRSS) or endorsement (NESAP, NCSE, NECODP) will be formally revoked, NAADAC/NCC AP notifies the state regulatory agency/licensing board and Single State Authority of its decision. NAADAC/NCC AP does not otherwise have any influence on the state’s decision to revoke or restrict the state license of a member or credential holder.

The highest sanction NAADAC can impose on a member is to expel that member from the association with notifications to other entities.

The highest sanction NCC AP can impose on a credential holder is to revoke that member’s credential with notifications to the appropriate state entities. State regulatory agencies/licensing boards are separate entities from NAADAC/NCC AP. • Financial Complaints: NAADAC/NCC AP cannot resolve financial disputes. NAADAC/NCC AP cannot obtain a refund or monetary award for a Complainant or compel a member or credential holder “to do something” that the Complainant has requested. NAADAC/ NCC AP does not have jurisdiction over fees charged by a clinician or agency. Complaints that involve financial issues are referred back to the Complainant. The Complainant is notified that he or she needs to file a complaint with his or her state licensing board, Single State Authority, or Attorney General’s office. The Complainant is also notified that he or she might want to seek legal counsel to determine potential legal courses of action.

• Civil Complaints: NAADAC/NCC AP cannot resolve civil disputes. A civil complaint initiates a civil lawsuit by setting before a court a claim for monetary or other relief from damages caused by, or wrongful conduct engaged in by, someone. Examples of civil complaints include: wrongful business practices, fraud, copyright infringement, negligence and liability, and malpractice concerns.

When NAADAC receives a civil complaint, the Complainant is notified that his or her complaint falls outside of NAADAC/NCC AP’s jurisdiction. He or she is advised to seek legal counsel to determine if there is a valid civil complaint and to explore all options for resolving the issues and concerns.

Other situations where a complaint may not be processed include, but are not limited to: • Second-Hand Knowledge: NAADAC/NCC AP does not recommend that any individual file a complaint on behalf of another person. This can lead to a situation of hearsay and it is very difficult, if not impossible, to conduct a formal investigation without the involvement of and signed releases from the individual who has direct knowledge of the situation in question.

• Incomplete Application: NAADAC/NCC AP cannot process a complaint that is illegible, incomplete, or incoherent. It is important that complaint forms are filled out completely, and that they are legible. It is also equally important that the complaint include as much supporting documentation as possible in order for NAADAC/NCC AP to fully understand the nature and scope of the complaint. Finally, NAADAC/NCC AP will not accept a complaint that is not signed and dated by the Complainant.

• Out-of-Order: Many complaints are referred back to the Complainant.

NAADAC/NCC AP’s Ethics Chairs want the Complainant to submit his or her complaint to the appropriate authorities governing their state first (e.g., regulatory agency, licensing board, Single State Authority, attorney general’s office, insurance board, etc.) for review, investigation and determination. Many states throw out cases because they do not fall under their jurisdiction. NAADAC may then decide to investigate those cases if there is a clear violation of the Code of Ethics.

When a state determines that the complaint warrants investigation, NAADAC will wait until the Complainant sends the formal findings to NAADAC/NCC AP to determine if NAADAC/NCC AP also needs to act regarding membership and certification.

NAADAC and NCC AP wants their members and credential holders to know that all complaints are reviewed thoroughly. Each complaint is taken very seriously. NAADAC/NCC AP’s mission is to enhance the health and recovery of individuals, families and communities — through prevention, intervention, quality treatment, and recovery support. Clients deserve the best care available to them, without risk of exploitation or damaging practices. NAADAC’s and NCC AP’s Ethics Chairs and Committee Members, Executive Director and Board of Directors appreciate the diligence of those who care enough about our practices in the profession to file a complaint when a principle within the Code of Ethics has been violated.

Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education and Supervision, a Master’s Degree in Counseling, and a Bachelor’s Degree in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the national Master Addiction Counselor (MAC) and Department of Transportation Substance Abuse Pro­fes­sional (SAP) certifications. Johnson has two supervisory credentials (ACS and AAMFT) and is a NCC. She is a core faculty member at Walden University, and she maintains a private practice where she works with supervisees who are working on credentialing. Johnson is the Past-President of the Colorado Association of Addiction Professionals (CAAP), and is currently NAADAC Treasurer and Ethics Chair. She previously served as NAADAC’s Southwest Regional VicePresident. In Colorado, Johnson is involved in regulatory and credentialing activities as well as workforce recruitment and retention initiatives.

She speaks and trains regionally and nationally on a variety of topics. Her passions beyond workforce retention include pharmacology of drugs of addiction, infectious diseases, ethics, motivational interviewing, and clinical supervision.

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■ A D V O C AC Y

Sharing Your Voice: A NAADAC Advocacy Update Whether you live in a red state, a blue state, or somewhere in between, the significance of the opioid crisis has permeated our nation’s consciousness and awakened a bipartisan streak in an otherwise divided Congress.

Addiction professionals have long understood the need for our nation to invest more resources into prevention, treatment, and recovery services for those living with substance use disorders. Advocacy plays a central role in shaping the policies that impact our profession and practice, and NAADAC is committed to ensuring that your voice and experience as addiction professionals resonate through the halls of Washington. Our industry has led the call at the federal level to enhance these vital services and we are pleased that lawmakers are taking notice and responding.

In the spirit of this commitment, NAADAC has partnered with a government affairs firm with a longstanding track record of developing, implementing, and shaping health care policy at the federal level. Led by former Congressman Alan Wheat (D-MO), Polsinelli Public Policy Group members Tim Casey, Julie Shroyer, and Sylvia Kornegay have already begun working closely with NAADAC to elevate our presence and amplify our members’ voices on Capitol Hill and across federal agencies.

Collectively, Polsinelli has extensive experience and bipartisan relationships on Capitol Hill, with the Administration, and across the federal agencies, including within the Department of Health and Human Services (HHS), the Substance and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), the Centers for Medicare and Medicaid Services (CMS), the Department of Veterans Affairs (VA), and the National Institute of Health (NIH). In addition to Polsinelli’s advocacy capabilities, its legal practice was named ‘Best Health Care Law Firm’ in 2018 by U.S. News & World Report.

Importantly, Polsinelli’s Public Policy Group leverages the resources of its firm while working hand-in-hand with its clients as an integrated part of the team. NAADAC is thrilled to partner with Polsinelli to advance and complement our critical mission on behalf of addiction professionals in the public policy arena.

Already, we are seeing exciting momentum for key priorities, including support for the addiction workforce in the form of student loan forgiveness. The Substance Use Disorder Workforce Loan Repayment Act (H.R.

5102), which would incentivize students to pursue substance use disorder treatment professions by providing student loan relief, passed the U.S. House of Representatives on June 13th.

NAADAC endorsed the legislation in advance of the vote and rallied support for its passage with an action alert to members.

This legislation, championed by Representatives Katherine Clark (D-MA) and Hal Rogers (RKY), garnered strong bipartisan support and, at the time of publication, awaits Senate action.

NAADAC also weighed in on the House’s recent push to pass a large package of opioidrelated provisions, known as the SUPPORT for Patients Communities Act (H.R. 6).

NAADAC supported the effort by encouraging members to call their U.S. Representatives. The legislation passed with overwhelming bipartisan support in a 396–14 vote.

In addition to proactively shaping legislation, beating back potentially harmful legislation is a critical function of a strong advocacy operation.

With that in mind, NAADAC took swift action to oppose a bill that could undermine the privacy rights of those with substance use disorders, prior to its consideration by the House. NAADAC believes the Overdose Prevention and Patient Safety Act (H.R. 6082) would have unintended consequences for individuals with substance use disorders. The bill would permit the disclosure of patient records without written consent, under certain conditions, and could make these individuals subject to discrimination and legal consequences in the event that their information is improperly used or discussed. While the bill ultimately passed the House on June 20th, NAADAC offered valuable contributions to a contentious and complicated debate. The Senate next will consider this proposal and NAADAC will educate lawmakers about the unintended consequences of passing this harmful bill.

As you can see, our partnership with Polsinelli is already extending our reach, amplifying our voice, and helping us to better monitor and shape federal policy that impacts addiction professionals and the people we serve.

The fight to expand prevention, treatment, and recovery services in the 115th Congress continues, and we hope you’ll join us. Stay tuned for more information about our Advocacy in Action Conference on November 12, 2018 in National Harbor, MD and our November 13, 2018 Capitol Hill Day.

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2019 Call for Webinar Presentations

NAADAC in Washington, DC:

Conflict Resolution for Recovery

Development of the NAADAC’s

September 5–7, 2018

2019 Webinar Series is underway!

Gaylord National Resort & Convention Center at National Harbor

If you are a subject-matter expert on a topic relevant

Join NAADAC's Executive Director, Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, for a two-day training on Romancing the Brain: Conflict Resolution for Recovery (CRR) on September 5–6, 2018.

Earn 14 CEs!

to addiction professionals, apply today for a chance to present on a nationally-broadcasted webinar. All webinars are presented live and recorded to be posted on NAADAC’s website for future free on-demand viewing.

Submission Due Date:

Tuesday, Sept. 4, 2018 Learn more at: www.naadac.org/call-for-webinar-presentations

Learn how to use this multi-component, multi-media tool for assis­ting adults and youth in improving their life traumas and conflict through an intensive set of psycho-emotional-social-spiritual Cognitive Behavioral Therapy (CBT) treatments.

Do you want to learn how to provide CRR training to other qualified individuals? Join us for the full-day Train the Trainer training on September 7, 2018. Earn an additional 7 CEs!

Learn more at www.naadac.org/CRR-washington-dc

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r Registe Now! d Early Birds Rate En 5th!

1 August

Join NAADAC for its 2018 Annual Conference: Shoot for the Stars at The Westin Galleria Houston in Houston, Texas from October 5–9, 2018.

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 against the backdrop of vibrant Houston.

Earn up to 42 CEs!

The three-day Annual Conference will take place on October 6–8 and feature daily keynote speakers in plenary sessions, breakout workshops, and unique addiction-specific educational experiences within the following 10 tracks: ■ ■ ■ ■ ■

Pharmacotherapy Clinical Skills Practice Management Cultural Humility Education/INCASE

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Recovery Support Co-occurring Disorders Process Addictions Peer Recovery Professional Development

The main conference will also include an Awards Luncheon to honor outstanding addiction-focused professionals from around the nation, an exhibit hall with over 100 exhibitors, and special evening events, including an opening reception, comedy night, and an auction with entertainment to support the NAADAC Education & Research Foundation (NERF).

In addition, attendees may register to attend one of five full-day pre-conference sessions on October 5, one of three full-day post-conference sessions on October 9, and/or a two-day U.S. Department of Transportation Substance Abuse Professional (SAP) Qualification/ Re-Qualification training on October 9–10.

www.naadac.org/annualconference REV.1 062017

SCHEDULE 10 Reasons

Preliminary

NAADAC’s 2018 Annual Conference: Shoot for the Stars is a few short months away.

Here’s why YOU should attend:

★ FRIDAY (OCTOBER 5)

TO ATTEND 1

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Earn up to 42 CEs. Five days of education, training, networking, and capacity building. Get the full schedule online.

Two-day SAP Course. Get your U.S. Department of Transportation Substance Abuse Professional (SAP) Qualification/Re-Qualification.

SCHEDULE* Up to 7 CEs Available 7:30 am – 7:00 pm Registration 7:30 am – 9:00 pm PaRC’s Carry the Message Books & Gifts Open 7:30 am – 8:30 am Continental Breakfast 8:30 am – 5:00 pm PRE-CONFERENCE SESSIONS Understanding Medication-Assisted Treatment in Recovery Darryl S. Inaba, PharmD, CATC V, CADC III

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Nine Tracks & Over 58 Breakout Sessions. This year’s conference features over 58 breakout sessions in ten different subject tracks.

4

Network, Connect and Reconnect.

Make professional relationships and long-lasting friendships.

Basics of Addiction Counseling: Pharmacology of Psychoactive Substance Use Disorders Deborah Fenton Nichols, EdD, LPC, LAC, NCC

5

Learn from Industry Leaders. Experts and leading academics, practitioners, and clinicians are on the stage and in the audience.

Clinical Supervision: A Relational and Individualized Approach Thomas Durham, PhD

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Get Inspired. Our speakers and attendees are not only brilliant professionals, but are inspirational in their passion to make long-term positive impacts.

Celebrate Your Peers. Join NAADAC in honoring outstanding addiction professionals and organizations from across the U.S. Professional Development. Develop your skills and make yourself more valuable to your employer and clients.

Have Fun! Attend receptions, watch an inspiring movie, meet new friends, and re-energize in beautiful Houston.

*Schedule subject to change without notice.

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

Wholehearted Journey to Ethics Maeve O’Neill, MEd, LCDC, LPC-S, CDWF Telebehavioral Health Legal & Ethical Best Practices: Dos and Don’ts Marlene Maheu, PhD 10:00 am – 10:15 am Morning Break 12:00 pm – 1:00 pm Lunch (for Pre-Conference attendees only) 3:30 pm – 3:45 pm Afternoon Break 5:00 pm – 8:00 pm Welcome Reception in Exhibit Hall 9:00 pm – 10:00 pm Mutual Support Meeting

Endorsing and

COLLABORATING PARTNERS Part of what makes the 2018 Annual Conference unique is the depth and breadth of NAADAC’s partnerships. NAADAC is proud to have 10 national and local partners joining us, including:

IMAGES: SHUTTERSTOCK & NAADAC FILES

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American Society of Addiction Medicine (ASAM) Faces & Voices of Recovery International Coalition for Addiction Studies Education (INCASE) National Addiction Studies Accreditation Commission (NASAC) National Addiction Technology Transfer Network (NATTC) National Association for Children of Alcoholics (NACoA) National Association of Addiction Treatment Providers (NAATP) National Center for Responsible Gaming (NCRG) National Council for Behavioral Health NIATx Learning Collaborative

SCHEDULE ★ SATURDAY (OCTOBER 6) Up to 8 CEs Available 7:00 am – 4:30 pm Registration 7:00 am – 5:00 pm PaRC’s Carry the Message Books & Gifts Open 7:00 am – 8:00 am Continental Breakfast in Exhibit Hall 7:00 am – 4:15 pm Poster Presentations 7:00 am – 4:15 pm Exhibit Hall Open 8:00 am – 9:45 am MORNING KEYNOTE Welcome Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, Matthew Feehery, LCDC, MBA, & Commander Karen Hearod, LCSW Music and the Brain in Recovery John McAndrew State of NAADAC Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP & Gerard Schmidt, MA, LPC, MAC 9:45 am – 10:00 am Morning Break in Exhibit Hall 10:00 am – 11:30 am BREAKOUT SESSIONS TRACK: PHARMACOTHERAPY

America Wakes Up – The Opioid Crisis and Its Impact on Our Country Matthew Feehery, LCDC, MBA

TRACK: CULTURAL HUMILITY

TRACK: PROCESS ADDICTIONS

How Cultural and Linguistic Competence Can Help Reduce Disparities in Behavioral Health Pierluigi Mancini, PhD

Eating Disorders 101 Malcom Horn, LCSW, LAC, MAC

TRACK: PEER RECOVERY

Ethical Considerations for Recovery Community Organizations Donald McDonald, MSW, LCAS TRACK: INCASE/EDUCATION

Project-Based Learning in Research Courses Therissa Libby, PhD TRACK: PRACTICE MANAGEMENT

Impacting National Addiction & Recovery Policy & Legislation – What You Can Do at Home & in D.C. Sherri Layton, MBA, LCDC, CCS & Michael Kemp, NCAC I, ICS, CSAC, CSW 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 Caucus Military Caucus 12:30 pm – 2:30 pm Lunch in the Exhibit Hall 2:30 pm – 4:00 pm BREAKOUT SESSIONS

TRACK: CLINICAL SKILLS

TRACK: PHARMACOTHERAPY

Behavioral Approaches For Substance Use Disorder Group Process Deborah Harkness, MS, LAADC, CATC

Improving Opioid MAT Prescribing Readiness Todd Molfenter, PhD

TRACK: RECOVERY SUPPORT

TRACK: CLINICAL SKILLS

Military/Veterans SUD Resources and Rationale Ron Pritchard, CSAC, CAS, NCAC II

Worlds Apart – What Works in Adolescent Treatment and Why James Campbell LPC, CAC II, MAC

TRACK: CO-OCCURRING DISORDERS

TRACK: RECOVERY SUPPORT

ADHD and Substance Use Disorders: Practical Steps to Understanding and Improving Treatment Laura Walsh, PsyD

Resilient Families: How Communities Can Cultivate Adaptability Within Family Systems Karyl Sabbath, PhD, LICDC, LAC

TRACK: PRACTICE MANAGEMENT

TRACK: CO-OCCURRING DISORDERS

What is the Value of Accreditation to my Organization?

Michael W. Johnson, MA, CAP

Neuroscience Introduces Physiological Brain Treatment to SUD and Addiction Judi Kosterman, PhD

TRACK: PROCESS ADDICTIONS

TRACK: PRACTICE MANAGEMENT

Adolescent Sexual Behaviors in Cyber Age Michael Dunn, LMFT, MAC, CSAT

Grant Writing 101 Bruce Reed, PhD, LCDC, CRC & Miranda Lopez, PhD(c), MA

TRACK: CULTURAL HUMILITY

Harm Reduction: Are We Ready For It? Lessons from Portugal Eluterio Blanco, Jr., MAC, LADC & Rachita Sharma, LPC-S, CRC TRACK: PEER RECOVERY

Novel Approaches to Peer Support Services: Incorporating Peers into a Hospital Medicine Unit Elizabeth Shilling, PhD, LPC & Laura Veach PhD, LPC, LCAS, CCS TRACK: INCASE/EDUCTION

Teaching Anti-Oppression: Constructing Experiential Exercises to Teach About Oppression Deborah Mosby, MS, LADC, CPP, MAC & Theodore Tessier, MA, LMFT, LADC, MAC

Ready to be

SEEN? Showcase your institution, product, or organization at this prestigious event by exhibiting, sponsoring, or advertising at our 2018 Annual Conference.

Access not only over 1,000 conference attendees, but also NAADAC’s membership of over 10,000, its mailing list of over 48,000, and its website with over 220,000 monthly visits.

To explore the many promotional opportunities available, download the 2018 Annual Conference Prospectus at www.naadac.org/ac18-exhibitsponsor-advertise or contact Jeff Smith, Exhibit and Ad Sales Manager, at jsmith@naadac.org or 703.741.7686 x140. We will sell out!

Hurry and book your booth today!

S U M M E R 2 018 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 17

SCHEDULE About the

CITY

Home to world-class museums and attractions, NASA, Fortune 500 companies, the largest medical center in the world, and over 10,000 restaurants, Houston is a diverse metropolis brimming with personality.

TRACK: PROFESSIONAL DEVELOPMENT

Affiliate Leadership Training HeidiAnne Werner, CAE, Jessica Gleason, JD, & Diana Kamp 4:00 pm – 4:15 pm Afternoon Break in Exhibit Hall 4:15 pm – 5:30 pm AFTERNOON KEYNOTE SESSION Update on the Neuroscience of Addiction Darryl S. Inaba, PharmD, CATC V, CADC III

10:00 am – 10:15 am Morning Break in Exhibit Hall 10:15 am – 11:45 am BREAKOUT SESSIONS TRACK: PHARMACOTHERAPY

Breakthrough Innovations in Opioid Use Disorder Treatment – New Medical Treatment Standards for OUD Wiley Patterson, MD TRACK: CLINICAL SKILLS

HOTEL

6:30 pm – 8:00 pm MOVIE NIGHT Letters to My Mother Documentary Film & Panel

In It to Win It: Helping Families Heal From Addiction Through Family Therapy Christiana Migliara, PhD, LMFT, CCTP, MAC, CAP, CASAC

The Westin Galleria Houston 5060 West Alabama Houston, TX 77056 USA www.westingalleriahoustonhotel.com

7:00 pm – 8:00 pm International Coalition for Addiction Studies Educators (INCASE) Membership Meeting

TRACK: RECOVERY SUPPORT

About the

The Westin Galleria Houston is offering rooms for a discounted rate of $149 a night (plus applicable taxes) for reservations made by September 19, 2018.

Attendees may book their rooms online at https://book.passkey.com/ event/49583364/owner/49240811/ home or by calling 713.960.8100.

Please make reference to the “NAADAC Conference” to receive our special group rate.

Reservations are available on a firstcome, 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 19, 2018

8:00 pm – 10:00 pm International Coalition for Addiction Studies Educators (INCASE) Reception 9:00 pm – 10:00 pm Mutual Support Meeting

★ SUNDAY (OCTOBER 7) Up to 6 CEs Available 6:30 am – 7:00 am Sunday Religious Services 7:30 am – 4:30 pm Registration 7:30 am – 4:30 pm PaRC’s Carry the Message Books & Gifts Open 7:30 am – 2:00 pm Poster Presentations & Exhibit Hall Open 7:30 am – 8:30am Continental Breakfast in Exhibit Hall

Visit the

EXHIBIT HALL On October 5–7, 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 breakfasts, lunches, and morning and afternoon coffee breaks on Saturday and Sunday.

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8:00 am – 5:00 pm NAADAC Board of Directors Meeting 8:30 am – 10:00 am MORNING KEYNOTE SESSION Mechanisms of Addiction and Recovery: Treatment Implications Carlo DiClemente, PhD, ABPP

Medicine Wheel & 12 Steps: A Cultural Approach to Personal Recovery J. Carlos Rivera, CADC II TRACK: CO-OCCURRING DISORDERS

Co-Occurring Disorders & the Criminal Mind Julie Otis, BS, CADAC II TRACK: PRACTICE MANAGEMENT

Caring for the Caring: Organizational Policies to Support Providers Working with Trauma Survivors W. David Holden, LPC, LPCS, LCAS, CCS TRACK: PROCESS ADDICTIONS

Sex, Drugs, and Interactions Brian Lengfelder, LCPC, CAADC, SAP, CSAT TRACK: CULTURAL HUMILITY

Minority Stress Considerations in Substance Use Treatment for LGBTQ People Kate Lehmann, MA, LADC, SAP, ADCR-MN TRACK: PEER RECOVERY

Peer Recovery During Incarceration John Shinholser TRACK: INCASE/EDUCATION

Experiential Learning in Addiction Education Chaniece Winfield, ACS, LPC, MAC, CAADC 11:45 am – 2:00 pm Lunch in Exhibit Hall 2:00 pm – 3:30 pm BREAKOUT SESSIONS TRACK: PHARMACOTHERAPY

Tobacco Use Disorder and E-Cigarettes: Are They Good for Patients to Quit Smoking?

Maher Karam Hage, MD, CTTS

SCHEDULE TRACK: CLINICAL SKILLS

SBIRT Skill Building Training - Are You Ready For It? Stephen Vega, MAC, LPC, LCDC & Eluterio Blanco, MAC, LCDC TRACK: RECOVERY SUPPORT

Opening a Recovery High School...What a Trip!

Sasha McLean, LMFT, LPC & John Cates, MA, LCDC TRACK: CO-OCCURRING DISORDERS

Implementing Effective Delivery of Clinical Services for the Complexities of CoOccurring Disorders Hal Baumchen, PsyD, LP, LADC TRACK: PRACTICE MANAGEMENT

Ethics and Social Media Kelly Scaggs, LCSW, LCAS, CCS, MAC TRACK: PROCESS ADDICTIONS

The Fear of Missing Out: Dimensions of Personality and Psychopathology in Smartphone Overuse Errol Rodriguez, PhD, CRC, MAC TRACK: CULTURAL HUMILITY

No God No Problem: Accommodating A Growing Appetite for Secular 12 Step Facilitation Joe Chisholm

★ MONDAY (OCTOBER 8) Up to 6.75 CEs Available 7:30 am – 4:15 pm PaRC’s Carry the Message Books & Gifts Open 8:00 am – 4:30 pm Registration 8:00 am – 9:00 am Continental Breakfast in Foyer 8:00 am – 5:00 pm National Certification Commission for Addiction Professionals (NCC AP) Meeting 8:30 am – 9:00 am Q&A with NAADAC President & Executive Director Gerard Schmidt, MA, LPC, MAC & Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP 9:00 am – 10:30 am MORNING KEYNOTE SESSION Behavioral Care at the Crossroads: Serving Clients/Patients with 21st Century Technologies Marlene Maheu, PhD 10:30 am – 10:45 am Morning Break 10:45 am – 12:15 pm BREAKOUT SESSIONS

TRACK: PEER RECOVERY

TRACK: PHARMACOTHERAPY

Peer Recovery Supports: Are You Ready for a Fully Integrated System of Care?

Kimber Falkinburg, PRSS-S & Annie Powell, PRSS-S

Neurotransmitter Balance: The Key to Understand Addiction Jeff Sandoz, PhD, LPC, LMHC, MAP

TRACK: INCASE/EDUCATION

Clinical and Ethical Issues in Managing Suicide Risk in Substance Users John O’Neill, EdD, LCSW, LCDC, CAS

“But What Do We Tell the Children?”

Cannabis Teaching Pedagogy in an Era of Change Vanessa Alleyne, PhD & Sue Seidenfeld, MS, LCADC, MAC, CCS 3:30 pm – 4:00 pm Afternoon Break in Foyer 4:00 pm – 5:30 pm AFTERNOON KEYNOTE SESSION Federal Panel 6:30 pm – 8:30 pm NAADAC Education & Research Foundation (NERF) Auction Entertainment by John McAndrew & hosted

by Gerard Schmidt, MA, LPC, MAC 9:00 pm – 10:00 pm Mutual Support Meeting

TRACK: CLINICAL SKILLS

TRACK: RECOVERY SUPPORT

RISE-UP! (Recovery In Supportive Environments-Updated Practices) Kenneth Roberts, MPS, LADC, LPCC, Monique Bourgeois, MPNA, LADC & Kris Kelly, BA, CPRS TRACK: CO-OCCURRING DISORDERS

Integrated Treatment of Co-occurring PTSD Stephen Wiland, LMSW, ICADC TRACK: PRACTICE MANAGEMENT

Measuring Outcomes to Improve the Delivery of Care, Treatment and Services Megan Marx-Varela, MPA TRACK: PROCESS ADDICTIONS

Similarities and Differences Between Substance Use Disorder and Disordered Gambling Ken Litwak, II, ICGC-1, CCTP

Special

EVENTS Saturday, October 6 NAADAC is excited to welcome Letter to My Mother to the NAADAC 2018 Annual Conference.

In addition to a special exhibit that will be available throughout the three-day conference, we invite you the Letter to My Mother film viewing and panel on Saturday evening, October 7.

Letter to My Mother is a visual and literary body of work created by artist Branislav Jankic that reveals an impactful look into the lives of mothers suffering from addiction in the Untied States.

The project strives to lift the stigma of addiction and create an international support system for those suffering from this disease, particularly mothers.

When the artist’s mother, a former prescription drug and alcohol addict, was diagnosed with lung cancer in November 2012, Jankic, who had experienced his own struggles with addiction throughout his teenage years, began writing a letter to his mother expressing his regrets for their dismantled relationship and his misunderstanding of her struggles, hoping to show both love and forgiveness.

Monday, October 8 On Monday, October 8, join comedian Mark Lundholm for his hilarious and hopeful, controversial and caring show “Perfekty Broken.” Hang onto your seats as this quickly-paced, all original, PG-35 rated comedy will enlighten, entertain, and inspire.

Lundholm has performed in all 50 states and 10 foreign countries. From worldrenowned musicians, heads of state, Fortune 500 companies to rehabilitation centers and convicted felons, Lundholm has truly entertained on the world’s stage.

He’s appeared on Comedy Central, Showtime, A&E, CBS, and NBC. Lundholm wrote and performed his own one-man show off-Broadway in New York City reaching critical acclaim, and in his spare time created the now staple DVD series ‘Humor in Treatment’ and the Recovery Board Game. We’re excited to have him join us in Houston!

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SCHEDULE TRACK: CULTURAL HUMILITY

TRACK: CULTURAL HUMILITY

Women Only: Could this be the Secret?

Darlene Walker, MA, CATC IV, NAC & Lynda Sanchez, MA, CATC

“Why Does Grandma Fall So Much?” Substance Use Disorders in the Elderly Michael Bricker, MS, CADC-2, NCAC II, LPC

TRACK: PEER RECOVERY

TRACK: PEER RECOVERY

SUD Peer Supervision Eric Martin, MAC, CADC III, PRC, CPS & Anthony Jordan MPA, CADC III, CRM

Taking Stock: Comparing Probation and Treatment Systems on Recovery-Oriented Characteristics Stacy Conner, PhD, LMFT, LMAC & Melissa Lubbers

TRACK: INCASE/EDUCATION

Preparing Addictions Counselors to Work in Integrated Treatment Setting Cheryl Mejta, PhD, Nancy Burley, EdD & Shannon Dermer, PhD TRACK: PHARMACOTHERAPY

Opioid Treatment Panel: Addressing Controversy with MAT, Abstinence vs Replacement Therapy and Pain Management Interventions Matt Feehery, MBA, LCDC (Moderator), Wiley Patterson, MD, Rick Green, LCDC, & James Lai, MD (Panelists) 12:30 pm – 2:15 pm President’s Awards Luncheon Michael Botticelli 2:30 pm – 4:00 pm BREAKOUT SESSIONS TRACK: PHARMACOTHERAPY

Initial Results From a Study of MAT in a 12 Step Model Treatment System Marvin Seppala, MD TRACK: CLINICAL SKILLS

The Wounded Griever: Grief Competency for Counselors Treating Substance Use Disorders David Chastain, PhD, CSAC TRACK: RECOVERY SUPPORT

Addressing Religious and Spiritual Abuse Within LGBTQ+ Recovery Steven Kelly, LPC, CSAT TRACK: CO-OCCURRING DISORDERS

How Brain-Gut Health Supports Addiction and Mental Health Recovery Judith Magnon, BS, RN-BC, CAC TRACK: PRACTICE MANAGEMENT

Compassionate Culture Shift for Recovery Services Megan Fisher, LCAC, LMHCA, CADAC IV TRACK: PROCESS ADDICTIONS

Understanding the Course of Recovery Over Time for Sexual Addiction Kathy Kinghorn, LCSW, CSAT-S

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TRACK: INCASE/EDUCATION

University, Community & Medical School Collaboration Solving Youth Substance Misuse/Addiction Lori Holleran Steiker, PhD, ACSW, Julie McElrath LMSW, LCDC-I & Hannah Milne TRACK: PROFESSIONAL DEVELOPMENT

National Certificate in Tobacco Treatment Practice: First Step Toward Uniform Certification Thomas Payne, PhD, Denise Jolicoeur, MPH, CHES & Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP 4:00 pm – 4:15 pm Afternoon Break 4:15 am – 6:00 pm AFTERNOON KEYNOTE & CLOSING CEREMONY Forgiveness: Part of the Therapeutic Process or Unfinished Business?

Robert Ackermann, PhD Closing Ceremony Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, Diane Sevening, EdD, LAC & Bobbie Hayes, MS, LMHC, CAP 6:30 pm – 8:30 pm Comedy Night with Mark Lundholm 9:00 pm – 10:00 pm Mutual Support Meeting

★ TUESDAY (OCTOBER 9) Up to 7 CEs Available 7:00 am – 11:00 pm Registration 7:00 am – 8:00 am Continental Breakfast (for Post-Conference & SAP Course Attendees only) 8:00 am – 4:30 pm POST-CONFERENCE SESSIONS Technology-Based Interventions: Exploring New Models of Care and Navigating New Ethical Dilemmas Nancy Roget, MS, MFT, LADC Integrating Treatment for Co-occurring Disorders: Myths, Realities and Effective Approaches to Care Thomas Durham, PhD Recovery to Practice: Incorporating Recovery Principles in Your Practice University of North Texas Recovery to Practice U.S. Department of Transportation’s Substance Abuse Professional Qualification/Requalification Course Day 1 Mita Johnson, EdD, LPC, LMFT, LAC, MAC, SAP 12:00 pm – 1:00 pm Lunch (for Post-Conference & SAP Course Attendees only)

★ WEDNESDAY (OCTOBER 10) Up to 7 CEs Available 7:00 am – 8:00 am Continental Breakfast (for SAP Course Attendees only) 8:00 am - 4:30 pm U.S. Department of Transportation’s Substance Abuse Professional Qualification/ Requalification Course - Day 2 Mita Johnson, EdD, LPC, LMFT, LAC, MAC, SAP 10:15am – 10:30am Morning Break 12:00 pm – 1:00 pm Lunch (for SAP Course Attendees only) 3:00pm – 3:30pm Afternoon Break

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For Pre-Conference registration, please check one session to attend: ❑ Understanding Medication-Assisted Treatment in Recovery ❑ Basics of Addiction Counseling: Pharmacology of Psychoactive Substance Use Disorders ❑ Clinical Supervision: A Relational and Individualized Approach ❑ Telebehavioral Health Legal & Ethical Practices: Dos and Don’ts ❑ Wholehearted Journey to Ethics

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Closing the OUD Treatment Gap

By Jack B. Stein, PhD, National Institute on Drug Abuse

T

he great irony of the opioid crisis that is now claiming over 115 lives in America every day is that effective treatments exist for opioid use disorder (OUD), which could avert many of these deaths. OUD is the only drug use disorder for which there are medications proven effective at reducing illicit use and improving other outcomes; as of this past spring, there is now also a medication called lofexidine that can help control withdrawal symptoms. Yet effective treatments are not consistently being delivered to those who need them.

The “treatment gap” is revealed by national data from SAMHSA. In 2015, 7.5 million people had an illicit drug use dis­order, of whom only about 31 percent (2.3 million) received any treatment. Only 1.5 million individuals received specialty treatment at a hospital, rehab facility, or mental health center.1 The percentage of those receiving the standard of care for OUD, medication-assisted treatment or MAT, was far smaller. According to SAMHSA’s Treatment Episode Data Set (TEDS), just under a third (31%) of patients in specialty treatment facilities for non-heroin OUDs and just over a third (37%) treated for heroin use disorder in 2015 had treatment plans that included medications.2 Over 80 percent of patients in treatment for OUD relapse in the absence of medications, whereas around 50 percent relapse with medications.3 However, many of those who do receive maintenance medication (buprenorphine or methadone) get it for too short a period of time or for too low a dose to be effective. Nearly half of opioid-addicted patients treated in opioid treatment programs who initiate buprenorphine treatment receive 90 days or less of continuous treatment with that medication,4 showing that many providers do not know how to administer it or are not following treatment guidelines. The already clear benefits of MAT over behavioral treatment alone (or worse, no treatment) might be even clearer if treatment protocols were more universally followed.

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“OUD is the only drug use disorder for which there are medications proven effective at reducing illicit use and improving outcomes… Yet effective treatment are not consistently being delivered to those who need them.”

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The inadequacy of current OUD care is revealed in a recent retrospective cohort study of 17,568 people in Massachusetts who had survived an opioid overdose.

Even though these individuals had already intersected with healthcare to reverse the worst potential consequence of their OUD and were clearly at high risk for a further overdose, only 30 percent received MAT in the 12 months after their overdose.5 As would be expected from the already voluminous evidence base, there were significantly fewer overdoses among those who did receive methadone or buprenorphine than among those who did not. (Too few received naltrexone to draw strong conclusions about that drug’s effectiveness.)

What can be done to deliver MAT to those who need it, and do so effectively? Research has supported several models of expanding adoption of MAT. Emergency Department (ED) Initiation of Office Based Opioid Treatment (OBOT) identifies patients with OUD after a non-fatal overdose, initiates them on buprenorphine, and connects them with a DATA-waivered provider who can continue their treatment after discharge. In a 2015 study, 78 percent of patients were engaged in buprenorphine treatment 30 days following discharge, compared with 37 percent of those referred to treatment but not initiated on buprenorphine in the ED.6 Increasing access to MAT in justice settings is also very important, since a high percentage of justice-involved 24

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“Drug addiction counselors can help lead the way toward greater acceptance of these treatment modalities as well as support patients in adhering to their medication treatment.”

individuals have OUD. Incorporating methadone or buprenorphine into criminal justice treatment programs has been shown to reduce post-release opioid use, hasten and increase duration of treatment engagement after release, and reduce both all-cause and overdose mortality rates after release.7 8 9 Giving extended-release naltrexone to offenders upon release was also shown to reduce relapse to opioid use.10 Researchers are actively seeking ways to improve compliance with MAT. The need for patients on maintenance medications to frequently visit their provider is one obstacle to retaining patients in treatment. New long-acting formulations of buprenorphine are being developed (including a 1-month depot formulation already approved last November), which will make this treatment more feasible for those who do not live near a DATA-waivered provider.

Those in rural areas are particularly at a disadvantage, but a 2017 study showed that telemedicine was more successful at retaining patients in therapy than in-person group treatment, making this a particularly appealing method for potentially widening access to effective OUD treatment.11 Several policy-level changes such as increasing the number of DATA-waivered providers of buprenorphine and further increasing MAT capacity in primary care settings such as federally qualified health centers would help increase the number of patients treated effectively with

MAT. A collaborative care model that reimbursed nurse care managers to support buprenorphine-prescribing physicians in a Massachusetts practice achieved high success rates in a five-year study—51 percent treatment retention over 12 months and 93 percent of those patients remaining opioid- and cocaine-free.12 Last year, a Health Affairs blog by Arthur Robin Williams, Edward Nunes, and Mark Olfson recommended adopting lessons learned from HIV in confronting the opioid crisis.13 They argue for applying a “cascade of care” model that identifies sequential stages of engagement in evidence-based treatment and targets interventions to increase retention at each stage, following established benchmarks to track performance of the interventions. The stages they identified in the cascade of care as it would be applied to the opioid crisis are: • Diagnosis • Linkage to care • Initiation of MAT • Retention on MAT for 6 months or more • Continuous abstinence among patients retained in treatment Such a model orients the treatment system to tracking outcomes at each of these stages. It would mean tracking patients who enter addiction treatment, tracking those who begin MAT, and tracking not only treatment but MAT retention. Although serious barriers exist at each of these stages and need to be addressed, the authors point out that those barriers were overcome in the case of HIV, leading to a halving of deaths from AIDS within two years of antiretrovirals becoming available.

Over the next several years, as part of the NIH Helping to End Addiction Long-term (HEAL) initiative, NIDA will be applying a comprehensive care delivery model in up to three hard-hit communities as a pilot project.14 The HEALing Communities Study will find the best ways of delivering coordinated, evidence-based interventions across each stage of addiction diagnosis and treatment as well as prevention and recovery supports. Other communities will then be able to take what is learned from this study and apply that knowledge in their own locales.

Even as federal agencies and healthcare systems mobilize to remove the infrastructure-related impediments to delivering effective OUD treatment (e.g., lack of health insurance coverage for treatment, low reimbursement rates, patient limits for waivered providers, etc.), addiction treatment professionals on the ground can do much to close the treatment gap.

Counselors can play an important role in supporting adherence to MAT regimens and in relapse prevention by addressing the multiple psychosocial issues often faced by individuals with OUD that may get in the way of keeping with their treatment plan.

Counselors and other treatment professionals can also work to counter the stigma that still exists against people with addiction and against medications used to treat it. Promoting non-stigmatizing language that recognizes addiction as a medical disorder rather than a moral failure remains important for changing the public mindset around substance use disorders.

So is correcting the misconceptions that linger around MAT—such as the lingering misconception that medications replace one addiction with another or that people using medications to remain abstinent from illicit opioids are not “drug free.”15 As the Surgeon General’s Report made clear in 2016, addressing addiction in America requires changing how we as a society talk about, and think about, drugs and drug use.16 The means to bring the opioid crisis under control and greatly reduce the numbers of people suffering and dying from their disorder already exist. Delivering them where they are needed requires organization and

determination, as well as a willingness to overcome outmoded attitudes that continue to marginalize those suffering from addiction, as well as MAT approaches that are proven to work. Drug addiction counselors can help lead the way toward greater acceptance of these treatment modalities as well as support patients in adhering to their medication treatment.

REFERENCES 1 Park-Lee E, Lipari RN, Hedden SL, Copello EAP, Kroutil LA. Receipt of services for substance use and mental health issues among adults: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. 2016 (September). Retrieved from: https:// www.samhsa.gov/data/sites/default/files/NSDUH-ServiceUseAdult-2015/NSDUHServiceUseAdult-2015/NSDUH-ServiceUseAdult-2015.htm.

2 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-91, HHS Publication No. (SMA) 17-5037.

Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017.

3 Bart G. Maintenance medication for opiate addiction: The foundation of recovery. Journal of Addictive Diseases. 2012;31(3):207-225. doi:10.1080/10550887.2012.694598.

4 Substance Abuse and Mental Health Services Administration. 2011 Opioid Treatment Program (OTP) Survey: Data on Substance Abuse Treatment Facilities with OTPs. BHSIS Series S-65, HHS Publication No. (SMA) 14-4807. 2013. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available at: https://www.samhsa.gov/data/sites/ default/files/OTP2011_Web/OTP2011_Web/OTP2011_Web.pdf.

5 Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study. Ann Intern Med. 2018. [Epub ahead of print]. doi:10.7326/M17-3107.

6 D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al.

Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: A randomized clinical trial. JAMA. 2015;313:1636-1644.

7 Kinlock TW, Gordon MS, Schwartz RP, O’Grady K, Fitzgerald TT, Wilson M. A randomized clinical trial of methadone maintenance for prisoners: Results at 1-month post-release.

Drug Alcohol Depend. 2007;91(2-3):220-227. doi:10.1016/j.drugalcdep.2007.05.022.

8 Gordon MS, Kinlock TW, Schwartz RP, Fitzgerald TT, O’Grady KE, Vocci FJ. A randomized controlled trial of prison-initiated buprenorphine: Prison outcomes and community treatment entry. Drug Alcohol Depend. 2014;142:33-40. doi:10.1016/j. drugalcdep.2014.05.011.

9 Marsden J, Stillwell G, Jones H, Cooper A, Eastwood B, Farrell M, et al. Does exposure to opioid substitution treatment in prison reduce the risk of death after release? A national prospective observational study in England. Addiction. 2017;112:1408–1418. doi: 10.1111/add.13779.

10 Lee JD, Friedmann PD, Kinlock TW, Nunes EV. Extended-release naltrexone to prevent opioid relapse in criminal justice offenders. N Engl J Med. 2016;374:1232-1242. doi: 10.1056/NEJMoa1505409 11 Eibl JK, Gauthier G, Pellegrini D, Daiter J, Varenbut M, Hogenbirk JC, Marsh DC. The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting. Drug Alcohol Depend. 2017;176133-138.

12 Alford DP, LaBelle CT, Kretsch N, Bergeron A, Winter M, Botticelli M, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: Five-year experience. Arch Intern Med. 2011;171:425-431.

13 Williams A, Nunes E, Olfson M. To battle the opioid overdose epidemic, deploy the ‘cascade of care’ model. Columbia University Academic Commons. 2017. https://doi. org/10.7916/D8RX9QF3.

14 National Institute on Drug Abuse. The NIH HEAL Initiative. 2018. Available at: https:// www.drugabuse.gov/drugs-abuse/opioids/nih-heal-initiative#HEALing.

15 Olsen Y, Sharfstein JM. Confronting the stigma of opioid use disorder—and its treatment.

JAMA. 2014;311(14):1393–1394. doi:10.1001/jama.2014.2147.

16 Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: US Department of Health and Human Services. 2016 (November).

Jack Stein, PhD, MSW, joined the National Institute on Drug Abuse (NIDA) in August 2012 as the Director of the Office of Science Policy and Communications (OSPC). He has over two decades of professional experience in leading national drug and HIV-related research, practice, and policy initiatives for NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.

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A Person-Centered and Motivational Interviewing Approach to Discharge Planning

By Sarah A. Zucker, PsyD

“You cannot shame or belittle people into changing their behaviors.”

T

– Brené Brown, (2007, p. 1)

he quote above is one of the most important philosophies regarding substance use disorder treatment. It speaks to the value of striving to treat people as autonomous and capable writers of their own stories. Applying this idea can be challenging as a clinician, especially as it pertains to something as critical as discharge planning. In the past, before I was taught how to connect motivational interviewing (MI) and discharge planning, I found discharge planning to be time-consuming, disappointing, and stressful. I also used to think MI was manipulative, inadequate, and meandering. Thankfully, personal and professional experiences led me to a new perspective. I now firmly believe that MI is a compassionate and client-affirming approach to facilitate an effective and value-driven discharge plan.

Discharge Planning Discharge planning is one of the most important, yet often neglected, aspects in treatment. Research on the topic is also difficult regarding substance use treatment because there is not agreement on what constitutes “recovery” or a successful treatment outcome (White, 2012). Thankfully, discharge planning seems to be receiving increased attention not only in hospital health care, but also in substance use treatment.

When we fall short in residential treatment, it appears to come down to a finite amount of time and resources, which forces us to make difficult decisions about priorities.

We end up trying to cram too much material into one treatment episode, not following-up appropriately, and not communicating with other providers. If you don’t have the time and staff to effectively discharge plan in substance use treatment, you are doing your clients an epic disservice. We know treatment is just a blip on the radar in the journey to health, and our clients need a lot of support while they transition to their next level of care. That support comes down to a solid discharge plan to which our clients will commit.

Discharge planning is defined simply by Medicare as “[a] process used to decide what a patient needs for a smooth move from one level of care to another” (Levine, 26

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2009). It involves continued and thorough evaluation of patients, extensive discussions with patients or their representatives and family members, in-depth planning for homecoming or transfer of care, appropriate referrals, follow-up scheduling, and ideally aftercare support (Levine, 2009). The research is clear: A good discharge plan can significantly improve health and reduce readmission rates (Wong et al., 2011). Wong et al. also found that increased readmissions were the result of sub-optimal assessment of preparedness for discharge, fractured discharge planning, break downs in communication, lack of sufficient followup, or some combination of these factors (2011). You can see how this specifically applies to the world of treatment since our length of stay often gets cut short by insurance denials. This uncertainty means we must implement discharge planning especially efficiently.

Why does a good discharge plan matter? Polcin, D. L., Korcha, R. A., Bond, J., and Galloway, G. (2010) studied outcomes of people residing in some form of sober living after discharge. They found that fellowship and positive social networks were strong predictors of positive outcomes.

Additionally, people residing in sober living environments were able to stay stopped more successfully, regardless of many demographic factors. The positive outcomes from sober living were often maintained well after leaving the sober living. Sober living residents also showed improvements on measures of employment, psychiatric symptoms, and arrests at 12 and 18 months.

We also know that of those who do resume use, most do it in the first days and weeks following discharge (White, 2012). White (2012) also noted that treatment effects are less durable than “enduring family and social support within one’s natural environment” (p. 4). With so much evidence indicating how important a good discharge plan is, it’s no wonder that competent clinicians feel compelled to make one happen. I have gone wrong in the past when trying to force the “perfect” discharge plan. It can be frustrating to see a client headed for disaster after all the hard work they put into treatment. I’ve inadvertently alienated clients and fallen short on treatment goals when I tried to impose my will on clients. Getting attached to outcome,

The spirit of MI is one of partnership, acceptance, compassion, and evocation.

MI is a “collaborative conversation, never a lecture or monologue” about change.

no matter how noble our intentions are, is rarely a fulfilling endeavor. Instead, we can benefit from learning how to let go of our desires and instead listen before moving forward.

We also serve our clients best when we remember that our last client is not our next client, and neither client is us.

Understanding this helps one to appreciate the collaborative, encouraging, strength-affirming approach of MI.

Motivational Interviewing (MI) In balancing out our desire to meet treatment goals, we should keep in mind that a favorable evaluation of treatment near the time of discharge has a significant positive correlation with use improvement results (Zhang, Gerstain, & Friedmann, 2008). Also relevant is that many people have more than one treatment episode, and sometimes we are planting seeds rather than making the sweeping changes we’d hope for. Making treatment a space that clients will want to return to if needed is crucial. An MI approach takes all of this into consideration.

We are taught in graduate school to listen, affirm, reflect, interpret, and support. These are important strategies, but we do not always know where we are going. In recovery fellowships, we are taught to share experience, strength, and hope and tell it like it is. The former can lack direction, and the latter can feel simplistic and sanctimonious at times. It was not until a post-doctoral position that I realized that MI is a beautiful melding of these components. It uses a “guiding” style, which is perfectly between following and directing (Miller & Rolnick, 2013). Research shows that a client’s motivation for change is significantly influenced by the therapist’s relational style (Norcross, 2002), and a therapist’s behavior can even “determine a client’s noncompliance with change suggestions.” (Lundahl & Burke, 2009, p. 1233). Hence, your helpful suggestions could be in vain if your delivery is ineffective or off-putting. Also important is that in MI, the clinician does less than half of the talking (Miller & Rolnick, 2013). Instead, he or she focuses on listening, asking open-ended questions, affirming, reflecting, and summarizing. The spirit of MI is one of partnership, acceptance, compassion, and evocation. MI is a “collaborative conversation, never a lecture or monologue” about change (Miller & Rolnick, 2013, p. 372).

MI started as a more compassionate intervention for substance use disorders, especially alcohol use disorder, and was shown to promote “positive behavioral change”

(Motivational Interviewing, 2017). Lundhal et al. (2013) reported in their meta-analysis: “The central implication of our findings is that MI can profitably be delivered by a range of professionals with a minimum investment of time in medical care settings in a variety of formats and time frames for patients of different ages, genders, and ethnicities. Our review suggests medical providers can use MI to help patients exercise more, lose weight, lower HIV viral load, blood pressure and cholesterol, reduce problematic substance use (perhaps even more effectively than in nonmedical settings), and boost self-efficacy in their ability to make health-related behavioral changes” (p. 166).

SAMHSA’s National Registry of Evidence-based Programs and Practices review found that MI also helps people with problem gambling, increases compliance with various health-related recommendations, and aids people facing academic concerns (Motivational Interviewing, 2017). It is reported that it may be especially helpful for clients who are reluctant to seek treatment (Motivational Interviewing, 2017). Also noted is that it has shown to help those with eating disorders, especially when combined with other treatments (Motivational Interviewing, 2017).

MI has also been shown to be effective in engaging clients with mood, anxiety, and psychotic disorders (Romano & Peters, 2015).

For our purposes, MI includes attuning to natural language about change in all conversations with our clients throughout treatment and seeing how we can use our clients’ own words and underlying values to increase commitment to a healthy and effective discharge plan. MI is best used when our clients are ambivalent or torn between making a change and sustaining a behavior. It can be used in short bursts throughout treatment anytime sustain talk arises in order to help the client. MI is special because we can have difficult conversations without putting our clients on the defense. It allows the clients to have and express their understandably mixed feelings (ambivalence) about making big decisions regarding discharge, while gently guiding them to act in accordance with their value of recovery. (Even the most hesitant client has typically come to treatment by making a choice, so there is almost always a kernel of underlying motivation.) MI posits that arguments for healthy change are already within us, which is in contrast to previous notions about people presenting to treatment.

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For our purposes, MI includes attuning to natural language about change in all conversations with our clients throughout treatment and seeing how we can use our clients’ own words and underlying values to increase commitment to a healthy and effective discharge plan.

Below are some client-centered and MI-congruent suggestions for discharge planning in substance use treatment.

• Examine your own countertransference and notice sources of discomfort. Your journey is not your client’s journey. Having personal experience with addiction and treatment can be very helpful to our clients, but it can also do them a disservice when we are overly identified with our path to recovery. Recovery means many different things to many different people, and we should let our clients’ definitions guide us. They will know if their plan is working or not, and we will be there for them if things go astray.

• Utilizing an MI-style does not mean that you cannot give blunt, honest feedback. This may apply if you notice problems in a discharge plan and want to express concern. That’s a very important part of our job. Being directive, at the right time and in the right manner, is inherent in MI. Being direct involves asking for permission, offering feedback, and giving non-judgmental observations.

It may look like this: “Can I give you some feedback? I’m very concerned because you’re returning to your apartment with your roommate who uses. You’ve also expressed that you want to stay sober no matter what. Can we make sure you’re thinking this through?”

An MI-consistent format for doing this is asking an open-ended question, making a brief statement, and then asking another openended question. Lastly, we must be prepared for our clients to say “no” when asked if we can provide feedback. (I have not had this happen because just asking permission has proven disarming, but if someone said no, I would ask to revisit the topic at a later time or just accept the “no” and affirm the client for being assertive. You can always look for an opening later, but chances are the rapport needs work.)

• Everyone, from the outreach team to the resident assistants, are part of treatment. Every staff member can act in the spirit of MI and influence a solid discharge plan in their own appropriate way.

All staff members can be trained in an MI-consistent, respectful approach, which facilitates an atmosphere of warmth and openness.

The clients spend a lot more time with the resident assistant staff and the nurses than they do with the therapists (even though we see our clients for four hours or more of therapy per day), and they are invaluable members of the treatment team.

• Individualize all discharge plans and respect cultural considerations.

A good discharge plan does nothing for your client if they do not plan to follow through on it. Our clients are not “just” substance users – they have various identities that intersect to create their unique place in the world. Clinicians, especially clinicians with various privileges, should always consider how being marginalized and discriminated against has affected clients. Socioeconomic status should be factored into discharge planning, and financial considerations should be strongly considered. Clients should not have to go broke to remain sober. Therefore, we do the best that we can within 28

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the confines of reality when it comes to discharge planning. We also best serve our clients when we have a keen understanding of their barriers to change.

• Affirm strengths. Too many times, a client walks through the door crestfallen after resuming substance use. They consider their previous period of sobriety an abject failure because it was not perfect and infinite. Anytime clients are more functional, more content, healthier, and living how they wish to be living, we can see strength. So much had to go right for the client to maintain a period of abstinence or reduced use, and there is much to affirm about returning to treatment after a lapse. We try to encourage clients to see things in shades of grey and we want them to be able to identify what they did right after previous treatment episodes. This also allows them space to see where they fell short and what needs to be different this time in order to maintain their recovery. Clients will need to draw on an internal reservoir of strength when making tough decisions after discharge, and authentic affirmations during treatment can build resilience. Recovery and addiction is more fluid than previously thought, so we can serve our clients by honoring their progress, not perfection.

• The language you use matters. MI does not label clients as “in denial” or “oppositional.” It looks at client “resistance” within the context of the therapist putting the client on the defense via their confrontational delivery. A client-centered approach advocates for person-first, professional language. Labeling clients as “addicts” or “alcoholics” or “substance abusers” can force an unwanted label on a client. Clients should be given the opportunity to self-identify. Just as we no longer call people with Borderline Personality Disorder “Borderlines,” we can use person-first language by referring to our clients as people “with substance use disorders” or “ineffective behaviors.” Destigmatizing our clients helps them in the larger community and lends validity to the idea that a substance use disorder is a condition someone has, not what they are. Using professional language is important not only in front of clients and in the community, but also amongst colleagues in private meetings.

• Practice good self-care. Sometimes I think we forget just how hard it is to be new in recovery. Our clients need our compassion, knowledge, and unconditional positive regard. We highlight the importance of self-care to our clients, and we often neglect ourselves.

This leads to decreased empathic bandwidth. Discharge planning and investing in our clients is inherently stressful, and consulting and supporting one another is imperative to doing good work. Don’t neglect your own therapy or fellowships. We need a lot of our own support in order to avoid burnout.

Finally, it really helps to continue your education and keep up with current research. Be curious. We needn’t be afraid of change and what works will prove itself over time. If we all work collaboratively, we can add to the legitimacy of our field, continue to improve our interventions, and be of maximum service.

REFERENCES Britton, P. C., Conner, K. R., & Maisto, S. A. (2012). An open trial of motivational interviewing to address suicidal ideation with hospitalized veterans. Journal of Clinical Psychology, 68(9), 961–971. https://doi.org/10.1002/jclp.21885 Brown, B. (2007). I thought it was just me (but it isn’t): Making the journey from “What will people think?” to “I am enough.” New York: Penguin Group Inc. Levine, C. (2009). Hospital Discharge Planning: A Guide for Families and Caregivers.

Retrieved from https://www.caregiver.org/hospital-discharge-planning-guide-familiesand-caregivers.

Lundahl, B. and Burke, B. L. (2009), The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. Journal of Clinical Psychology, 65, 1232–1245. doi:10.1002/jclp.20638 Lundahl, B., Moleni, T., Burke, B. L., Butters, R., Tollefson, D., Butler, C., & Rollnick. S. (2013).

Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials. Patient Education and Counseling, 93(2), 157–168. doi: 10.1016/j.pec.2013.07.012 Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press.

Motivational interviewing for behavioral health conditions. (2017). Evidence summary retrieved on June 6, 2018, from the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices, https://nrepp-learning.samhsa.gov/sites/default/files/documents/Topics_Behavioral_ Health/pdf_07_2017/Motivational%20Interviewing__7.2017.pdf Norcross, J.C. (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.

Polcin, D. L., Korcha, R. A., Bond, J., & Galloway, G. (2010). Sober Living Houses for Alcohol and Drug Dependence: 18-Month Outcomes. Journal of Substance Abuse Treatment, 38(4), 356–365. http://doi.org/10.1016/j.jsat.2010.02.003 Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 47, 1102-1114. PMID: 1329589.

Romano, M., & Peters, L. (2015). Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: A review and meta-analysis.

Clinical Psychology Review, 38, 1-12. https://doi.org/10.1016/j.cpr.2015.02.008 White, W. L. (2012). Recovery/remission from substance use disorders: An Analysis of reported outcomes in 415 scientific reports, 1868 –2011. Philadelphia, PA: Philadelphia Department of Behavioral Health and Intellectual Disability Services and Chicago, IL: Great Lakes Addiction Technology Transfer Center.

Wong, E. L., Yam, C. H., Cheung, A. W., Leung, M. C., Chan, F. W., Wong, F. Y., & Yeoh, E.-K. (2011). Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Services Research, 11, 242. http://doi.org/10.1186/1472-6963-11-242 Zhang, Z., Gerstein, D.R., & Friedmann, P.D. (2008). Patient satisfaction and sustained outcomes of drug abuse treatment. Journal of Health Psychology, 13(3):388-400. doi: 10.1177/1359105307088142.

Sarah Zucker , PsyD, works at the AToN Center and in private practice. Her primary passion is helping clients resolve substance use concerns and supporting clients in achieving long-term recovery. She believes that treatment and recovery must be tailored to the individual. Zucker studied psychology and LGBT studies at UCLA. After graduating from UCLA, she attended the California School of Professional Psychology at Alliant International University and obtained her doctorate in clinical psychology. Prior to the AToN Center, she worked at Counseling & Psychological Services at San Diego State University. There she utilized a grant to build the university’s first collegiate recovery program. A particularly important part of that role was developing a recovery ally training to educate the SDSU community on how to reduce stigma and be recovery allies on campus. Zucker has a passion for recovery, mindfulness, intersectionality, healing shame, and empowering people.

NAADAC’s celebrated Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know has been updated!

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

1. According to Mita Johnson, what action can NAADAC take when it finds that an ethical violation has been committed? a. Assess financial penalties b. Revoke licensure issued by states c. Revoke NAADAC membership d. Issue a civil judgment

7. What does Sarah Zucker identify as issues that lead to a poor discharge plan? a. Limited time and resources b. Failure to follow up with the client c. Failure to communicate with other providers d. All of the above

2. Which of these complaints falls within the NCC AP and NAADAC scope of oversight? a. A complaint that a clinician’s fee is too high b. A complaint that a clinician violated the NAADAC/NCC AP Code of Ethics c. A complaint against a clinician who is not a member of NAADAC and does not hold any NCC AP credentials d. A complaint based on a financial dispute

8. In her article, Sarah Zucker asks, “Why does a good discharge plan matter?” Which of the following is a reason that Zucker provides? a. People who have a good discharge plan are more likely to pay their outstanding bills. b. People residing in sober living environments are able to stay sober more successfully than those who are not. c. People receiving continued medication assisted treatment are more likely to relapse. d. People are more likely to relapse as more time passes after discharge.

3. According to Jack Stein’s article, which drug use disorder is the only drug use disorder for which there are medications proven effective at reducing illicit use and improving outcomes? a. Alcohol use disorder b. Marijuana use disorder c. Opioid use disorder d. Cocaine use disorder 4. What has incorporating methadone or buprenorphine into criminal justice treatment programs been shown to do? a. Reduce post-release opioid use b. Hasten and increase duration of treatment engagement after release c. Reduce both all-cause and overdose mortality rates d. All of the above 5. Arthur Robin Williams, Edward Nunes, and Mark Olfson recommended adopting lessons learned from what other epidemic to confront the opioid crisis? a. HIV epidemic b. Alcohol epidemic c. Violence epidemic d. Heroin epidemic 6. How can counselors and other treatment professionals work to counter the stigma that still exists against people with addiction and medications used to treat substance abuse disorders? a. By prescribing medication assisted treatment to each client they treat b. By promoting non-stigmatizing language that recognizes addiction as a medical disorder rather than a moral failure c. By taking the position that medication assisted treatment replaces one addiction with another d. By only providing one type of treatment to a client at any given time

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9. Which of the following does Sarah Zucker identify as being true about motivational interviewing? a. Motivational interviewing should only be used once during the course of treatment. b. When using motivational interviewing, the practitioner should be speaking at least two thirds of the time. c. Motivational interviewing is a collaborative process. d. The goal of motivational interviewing is to put the client on the defensive.

10. Sarah Zucker identifies research that shows that using motivational interviewing can lead to which result? a. Boosting self-efficacy in clients’ ability to make health-related behavioral changes b. Preventing clients from continuing with medication assisted treatment c. Suppressing feelings about making changes or sustaining behaviors d. Increased likelihood of relapse

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

NAADAC COMMITTEES

Updated 07/17/2018

North Central

STANDING COMMITTEE CHAIRS

President Gerard J. Schmidt, MA, LPC, MAC

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

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

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

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

William Keithcart, MA, LADC Northwest

Clinical Issues Committee Chair Frances Patterson, PhD, MAC Ethics Committee Chair Mita Johnson, EdD, LPC, LAC, MAC, SAP Finance & Audit Committee Chair Mita Johnson, EdD, LPC, LAC, MAC, SAP Nominations and Elections Chair Kirk Bowden, PhD, MAC, NCC, LPC

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

Malcolm Horn, LCSW, MAC, SAP, NCIP Southeast

Personnel Committee Chair Gerard J. Schmidt, MA, LPC, MAC

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

Professional Practices and Standards Committee Chair Kirk Bowden, PhD, MAC, NCC, LPC

REGIONAL VICE-PRESIDENTS

Southwest

Mid-Atlantic

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

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

Executive Director Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP

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

Susan Coyer, MAC Mid-Central

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

Angela Maxwell, MS, CSAPC

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

Gisela Berger, PhD, MAC, LPC, NCC

AD HOC COMMITTEE CHAIRS Awards Committee Chair Patricia Greer, LCDC, AAC Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC Steven Durkee, NCAAC International Committee Chair Elda Chan, PhD, MAC

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

Leadership Committee Chair Gerard J. Schmidt, MA, LPC, MAC

Matthew Feehery, MBA, LCDC, IAADC

Membership Committee Chair Margaret Smith, EdD, LADC

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)

Student Sub-Committee Chair Diane Sevening, EdD, LAC

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

Tobacco Committee Chair Diane Sevening, EdD, LAC

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

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

NAADAC EDUCATION & RESEARCH FOUNDATION (NERF) NERF Events Fundraising Chair Ed Olson, LCSW, CASAC

NAADAC REGIONAL BOARD REPRESENTATIVES NORTHEAST NORTH CENTRAL

MID-CENTRAL

Therissa Libby, PhD, Minnesota Tiffany Gormley, MS, PLMHP, Nebraska Megan Busch, LAC, LPCC, North Dakota Mark Young, South Dakota

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

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

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

SOUTHWEST

MID-ATLANTIC

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

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

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

Conference November 12 Hill Day November 13

2018 Gaylord National Resort & Convention Center Washington D.C. 201 Waterfront Street National Harbor, MD 20745

NAADAC, the Association for Addiction Professionals invites you to its 2018 Advocacy

in Action Conference at the Gaylord National Resort & Convention Center on November 12, 2018 and Hill Day on November 13, 2018.

Attend the conference on November 12th and hear from leaders in the addiction profession and from government agencies on a variety of topics including: •

Federal budget issues affecting addiction treatment

•

Addiction reimbursement platforms

•

Legislative update and analysis

•

Addiction workforce

Learn about advocacy techniques and important issues affecting the addiction profession and those it serves.

Join NAADAC on Capitol Hill on November 13th.

Begin the day with a briefing on the Hill with NAADAC leadership and Congressional leaders before visiting your legislators to advocate for the addiction workforce.

For more information, please visit: www.naadac.org/advocacy-conference