Advances in Addiction & Recovery (Winter 2019)

WINTER 2019 Vol. 7, No. 1

Addressing the Syndemic of Opioid Use Disorder, HIV, and HCV

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

PLUS • Culturally Responsive Peer Recovery • What International Providers Can Teach the U.S. About Accreditation • NAADAC Looks to Build on Success in New Congress • Alcohol and the Aging Brain

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WINTER 2019 Vol. 7 No. 1 Advances in Addiction & Recovery, the official publication of NAADAC, is focused on providing useful, innovative, and timely information on trends and best practices in the addiction profession that are beneficial for practitioners.

NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 100,000 addiction coun­selors, educators, and other addictionfocused health care pro­fessionals in the United States, Canada, and abroad. NAADAC’s members are addiction counselors, educators, and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education.

Mailing Address 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)

■ FEAT U R ES

Samson Teklemariam, MA, LPC, CPTM

NAADAC, the Association for Addiction Professionals

14 Addressing the Syndemic of Opioid Use Disorder, HIV, and HVC

Deann Jepson, MS Advocates for Human Potential, Inc.

James McKenna, MEd, LADC I McKenna Recovery Associates

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

16 What International Providers Can Teach the U.S. About Accreditation

By Michael W. Johnson, Managing Director of Behavioral Health, CARF International

18 Culturally Responsive Peer Recovery

By Masica Jordan, PhD, LCPC & Joseph T. Hackett, PhD

20 Alcohol and the Aging Brain

By the National Institute on Alcohol Abuse and Alcoholism (NIAAA)

■ DEPA R T M EN TS 4 President’s Corner: Spring of Hope

By Diane Sevening, EdD, LAC, MAC, NAADAC President

6 From The Executive Director: 2018 NAADAC in Review

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

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

NAADAC, the Association for Addiction Professionals Donald P. Osborn, PhD, LCSW, LMFT, LCAC, MAC Indiana Wesleyan University

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 Irina Vayner, NAADAC Exhibits & Ad Sales Manager, at ivayner@naadac.org.

8 Certification: NCC AP Update: Meeting the Challenges in Credentialing

By Jerry Jenkins, MEd, MAC, NCC AP Chair

10 Ethics: Would the Accurate Representation of You Please Stand Up?

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

11 Membership: Remembering Roger Curtiss

By Kristin Hamilton, JD, NAADAC Sr. Communications Manager

Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5 This publication was prepared by NAADAC, the Association for Addiction Pro­fes­sionals. Reproduction without written permission is prohibited. For more in­formation on ob­taining additional copies of this publication, call 703.741.7686 or visit www.naadac.org.

Printed February 2019

12 Advocacy: Presence, Progress, Momentum, Opportunity – NAADAC Looks to Build on Success in New Congress

By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director and Tim Casey, Policy Advisor, Polsinelli

STAY CONNECTED

22 NAADAC CE Quiz 23 NAADAC Leadership

ALL IMAGES FROM SHUTTERSTOCK UNLESS OTHERWISE NOTED

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■ PR ES ID ENT ’S CO RN E R

Spring of Hope

By Diane Sevening, EdD, LAC, MAC, NAADAC President Charles Dickens stated it very well in A Tale of Two Cities: “It was the best of times, it was the worst of times...” For the addiction profession today, it truly is the best of times and the worst of times. The National Institute on Drug Abuse (NIDA) reported that in 2016, synthetic opioids were involved in nearly 50% (19,413) of opioid related deaths, which is up from 14% (3,007) in 2010. In 2016, 42,429 drug overdose deaths involved opioids. Among the 42,249 opioid-related overdose drugs in 2016, 19,413 involved synthetic opioids (primarily illegal fentanyl), 17,087 involved prescription opioids, and 15,469 involved heroin (NIDA, 2018). As a result of these devastating statistics, the federal government declared an opioid epidemic and grant monies became available for treatment services, education, trainings, and recovery management.

However, drug use goes in cycles. In the 1930s, alcohol was the drug of choice. The 1940s saw a rise in stimulants like amphetamines, and in the 1950s, sedatives and barbiturates topped the list. The early 1960s brought a resurgence of amphetamines, followed by a rise in marijuana and LSD in the late 1960s, heroin in the 1970s, and cocaine/crack in the 1980s.

By the time the 1990s arrived, synthetic heroin (fentanyl), sedatives, MDMA (ecstasy) and inhalants were the drugs of concern. In the 2000s, there was a rise in methamphetamines made from pseudoephedrine, synthetic marijuana (K2), and synthetic stimulants (bath salts). Today, common drug use concerns include the abundance of opioids/synthetic opioids, the legalization of marijuana, and the resurgence of methamphetamines. It seems as though when a particular drug is identified as creating an epidemic by the media and federal government, emphasis is taken away from the other drugs that are being used.

For example, alcohol use and problems associated with alcohol use always remain a constant concern.

The addiction profession today is changing and evolving at a rapid rate in an increasingly complex and challenging world. Addiction professionals are dealing with the need for constant communication and challenges associated with social media and the internet, as well as an increasingly mobile workforce. There are funding 4

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cuts, changes in law (particularly with regard privacy protection laws), states legalizing marijuana, synthetic drug use, vaping, low pay, legislative issues, telehealth, Medicaid concerns, the opioid crisis, increasing methamphetamine use, continued concerns regarding alcohol use, and workforce shortage issues to contend with. Modern technology and social media have made drug use more appealing and accessible, but also often fail to provide sufficient information and education regarding the addictive

properties and associated health hazards, such as with respect to vaping. In order to address all the issues surrounding drug addiction today, advocacy, research, higher education, credentialed addiction professionals, and peer recovery specialists are necessary.

Individuals diagnosed with substance use disorders tend to have more complexities today than in the past. Today more than ever, addiction professionals are needed for their expertise and experience and play a vital role in addressing these challenges and our current national crises. The amount of individuals who are seeking treatment is increasing (SAMHSA, 2017), but our workforce is not.

Between 2005 and 2015, there was more than a 17% increase in individuals seeking treatment for substance use disorder and co-occurring disorder (SAMHSA, 2017). In September 2018, Health Resources and Services Administration (HRSA) presented a factsheet on the national-level supply and demand projections for addiction counselors from 2016–2030 using HRSA’s Health Workforce Simulation Model (HWSM)(HRSA, 2018). Two scenarios were simulated. Scenario One assumed supply and demand were in equilibrium in 2016, and Scenario Two adjusted current and projected demand based on estimates of unmet need from recent ­studies. In Scenario One, the demand for addiction counselors is expected to increase 21% by 2030, demand exceeding supply and leading

to a deficit of addiction counselors of approximately 13,600 full-time equivalents (FTEs). In Scenario Two, adjusting for the 20% of the population reporting unmet behavioral health needs due to barriers in receiving care, demand is projected to exceed supply by 38% in 2030, with demand increasing by over 22,000 FTEs. NAADAC and the Substance Abuse & Mental Health Services Administration (SAMHSA), with the support of other professional associations, developed a career ladder identifying criteria for all levels of entry for care to individuals with substance use disorders. As leaders in the field, we need to address the addiction workforce shortage from all angles and at all levels—attracting people into the field, helping those in the field to grow and stay in the field, developing true portability through national credentialing, raising wages, and raising the profile of and need for properly trained addiction professionals in the continuum of care. While addiction professionals are recognized and respected for their knowledge and skills today more than ever before, there is so much more work to be done.

In positive news, after years of NAADAC advocating for loan forgiveness for addiction professionals, substance use disorder treatment providers with a higher education degree now have the opportunity to apply for student loan repayment through two separate government programs.

The new 2019 National Health Service Corps (NHSC) Substance Use Disorder Workforce Loan Repayment Program (SUD Workforce LRP) expands access to evidence-based substance use disorder treatment in underserved, high-need communities across the country by providing up to $75,000 in loan repayment for professionals willing to commit three years of full-time work at a NHSC-approved site. Professionals committed to working half-time for three years can get up to $37,500. In addition, the successful 2018 passage of the SUPPORT for Patients and Communities

Act (commonly known as H.R.6) included the Substance Use Disorder Workforce Loan Repayment Act which will provide up to $250,000 in student loan repayment for those who work as substance use disorder treatment professionals in areas of need.

As Dickens’ Tale of Two Cities says, “Nothing that we do, is done in vain.

I believe, with all my soul, that we shall see triumph.” Addiction professionals are working hard every day to be able to see triumph and now is the time to raise our voices, mentor, recruit, and share our passion with future, career-seeking individuals. To borrow another phrase from Tale of Two Cities, I believe there is nothing better in this world than the faithful service of the heart – it is the spring of hope.

REFERENCES Behavioral Health Workforce Projections, 2016-2030: Addiction Counselors. Health Resources and Services Administration (HRSA) September 2018.

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS), 2005-2015.

Fentanyl and Other Synthetic Opioids Drug Overdose Deaths. National Institute on Drug Abuse (NIDA) 2018.

Diane Sevening, EdD, LAC, MAC, is an Assistant Professor at the University of South Dakota (USD) School of Health Sciences Addiction Counseling and Prevention Department (ACP), has over 35 years of teaching experience, and is a faculty advisor to CASPPA. In addition to serving as NAADAC President, Sevening is also a member of the SD Board of Addiction and Prevention Professionals (BAPP) and Treasurer of the International Coalition for Addiction Studies Education (INCASE). Her clinical experience involves 7 years as the Prevention and Treatment Coordinator Student Health Services at USD, Family Therapist at St. Luke’s Addiction Center in Sioux City, IA for 1 year, and 2 years as clinical supervisor for the USD Counseling Center. Sevening has been the Regional Vice President for NAADAC North Central Region, the Chair of the Student Committee for NAADAC, an evaluator for the National Addiction Studies Accreditation Commission (NASAC), and currently a member of the NASAC board of commissioners.

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

2018 NAADAC in Review

By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director Over the past year, NAADAC worked hard toward the vision set by its Board of Directors and recognized many accomplishments. I am excited to share the following highlights in the areas of advocacy and influence, education and professional development, certification, and membership and affiliates. For a full list of NAADAC’s 2018 accomplishments, please visit www.naadac.org/2018YearinReview.

Advocacy & Influence • In mid-2018, NAADAC entered into a consulting contract with Polsinelli, a top-rated government relations firm in D.C. Through this partnership, we have increased our voice and presence on Capitol Hill, visited key legislators, written testimony, and hosted a successful Advocacy in Action Conference, Hill Day, and briefing on the Hill.

• NAADAC has given testimony, supported national bills, and submitted recommendations to SAMHSA, ONDCP, NIDA, and Congressional offices and committees this past year, including providing input on numerous provisions of the SUPPORT for Patients and Communities Act. Specifically, we contributed to provisions that (1) incentivize individuals to pursue substance use disorder treatment professions by offering student loan relief; (2) protect against the erosion of privacy rights of individuals with substance use disorders; and (3) remove the IMD exclusion for all substance use disorder treatment and allow Medicaid payment for eligible individuals for up to 30 days annually, among others.

• NAADAC is often contacted by journalists to give our views on issues relating to the opioid crisis, addiction in the United States, treatment and recovery issues, and other topics related to addiction. In the past year, NAADAC leadership has been interviewed many news outlets, including National Public Radio, Fox News (Local DC), Circa News, Drug Topics, Nexstar Media Group, Health.com, ADAW, ModernHealthcare, Reuters, and The Boston Globe. We even supported HBO and John Oliver’s Last Week Tonight show with background for a segment on the opioid crisis.

• NAADAC works at the Federal level with ONDCP, SAMHSA, NIDA, HRSA, NIAAA, HHS, INL and other Federal agencies to ensure that your agenda items are being addressed, especially in the workforce arenas. NAADAC also participates in other Washington, D.C. groups such as the Addiction Leadership Group to pull more funds into treatment and recovery. NAADAC continues to build your voice and recognition at the state, national and international levels.

• NAADAC is also on the Optum Advisory Council, where it serves to to inform on national issues affecting addiction services and the way in which our professionals can assist in the prevention, education, intervention, treatment and recovery of the millions of lives those services cover across the United States. NAADAC continues to work with other MCOs, PPOs, BHOs and CMS to assist in seeking funding or other regulations to support the work of our providers and counselors.

• NAADAC’s social media strategy has led to increased followers and reach throughout its three main platforms: Facebook, LinkinedIn, and Twitter. Since 2013, we have increased our followers by 294% 6

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(Facebook), 339% (Twitter), and 6409% (LinkedIn). In April 2018, our Facebook messages were seen over 170,000 times!

Education & Professional Development Education and training stand at the center of NAADAC’s efforts to ensure professional development for all addiction professionals at every stage in their careers. NAADAC is continuously working to update and improve the educational offerings that it provides, and 2018 was no exception.

• NAADAC added 39 webinars to its on-demand webinar library to now provide over 145 Continuing Education (CE) hours of free addiction-specific education. In addition to its regular 2018 Webinar Series, NAADAC launched a new Advocacy Webinar Series, an Ethics Webinar Series, and a HIV/Bloodborne Pathogens Webinar Series. All of the CEs earned through webinars are free for NAADAC members, while non-members can receive the education for free or pay for CEs per webinar.

• Our most popular products received content updates and cover redesigns, including Integrating Treatment for Co-Occurring Disorders and all three modules of The Basics of Addiction Counseling Desk Reference: Pharmacology of Psychoactive Substance Use Disorders; Addiction Counseling Theories, Practices, and Skills; and Ethical and Professional Issues in Addiction Counseling. Our new manual on Clinical Supervision is in its final stages and will be released in the Spring. We are also working with William White to update our popular The History of Addiction Counseling in the United States book.

• Our 2018 Annual Conference was a big success, with over 950 participants, over 80 exhibitors, and over 90 presentations. Attendees were able to earn up to 43 CEs across the five day conference!

• In coordination with Single State Agency (SSA) offices and other partners, NAADAC implemented SAMHSA-funded Workforce Forums at colleges/universities in Mississippi, New Mexico, Minnesota, and Illinois. These were held to build awareness of the discipline of addic­tion and mental health professionals, inform students of the career ladder and resources to achieve the education necessary to become an addictions and/or mental health professional, and provide resources and other connections.

• The NAADAC Minority Fellowship Program for Addiction Counselors (NMFP-AC) program recognized 42 Fellows in 2018. The program is a major SAMHSA-funded initiative to build the addiction specific workforce that provides tuition stipends and professional development opportunities, including education and mentorship, to individuals who are committed to working with underserved populations. In addition, the MFP got additional funding to expand to include Behavioral Health Professionals (BHP). Through the NMFP-BHP, we are able to expand the program to welcome another 12 Fellows.

• NAADAC continues to support the National Addiction Studies Accreditation Commission (NASAC) for higher education addiction accreditation. NASAC is continuing to grow and is increasingly gaining recognition in the higher education accreditation world.

• NAADAC’s magazine, Advances in Addiction and Recovery, has

become well known as a great treatment and recovery resource for both those who serve in the addiction and other helping professions.

NAADAC works with outside groups for regular contributions, including NIDA and SAMHSA. • NAADAC’s Approved Education Provider Program continues to grow, representing more training and education entities throughout the United States and internationally.

• In partnership with the Association for the Treatment of Tobacco Use and Dependance (ATTUD), and the Council for Tobacco Treatment Training Programs (CTTTP), NAADAC offerred the National Certificate in Tobacco Treatment Practice (NCTTP), which has been more successful than what we projected. Over 1,300 CTTTP-trained professionals have availed themselves of the NCTTP Training Certificate since its launch in October 2017.

• The U.S. Department of Transportation’s Substance Abuse Pro­fes­ sionals (SAP) Qualification/Requalification training continues to grow.

We will see this educational program expand to online education as well as the home-study and face-to-face methods that we currently offer.

Certification NAADAC’s National Certification Commission for Addiction Professionals (NCC AP) worked to expand, promote national credentialing, and improve its current national credential, tests, and testing processes.

• NAADAC’s continued work in the Pacific Jurisdiction to build training systems and successful certification, with the Pacific Jurisdiction now organizing its own Pacific-wide training and planning to use NCC AP’s certification system.

• NCC AP welcomed Maryland, Pennsylvania, Virginia, Wisconsin, and Wyoming as the latest states to use the NCC AP standardized licensing/ credentialing tests and criteria at the state level.

• NCC AP completed a very successful test-exemption offer period for the Nationally Certified Peer Recovery Support Specialist (NCPRSS) credential, including special offers for addiction professionals in Puerto Rico, New Jersey, and the Pacific Jurisdiction that are still ongoing. In addition, NCC AP partnered with Oxford House to help all qualified peer Oxford House employees nationwide obtain the NCPRSS. • In April, NCC AP announced the new testing alternative of online proc­toring through the use of a computer with a cameria. People can now take NCC AP examinations from the comfort of their homes or offices.

• The American Psychological Association (APA) Division 50: Society of Addiction Psychology transferred the holders of its Certificate of Pro­ ficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders to NCC AP’s Master Addiction Counselor national credential.

• NCC AP Commissioners spent countless hours updating the certification exams for the National Certified Addiction Counselor Level I (NCAC I), National Certified Addiction Counselor Level II (NCAC II), and Master Addiction Counselor (MAC).

regional conferences, such as the third Annual Alaska Training Institute, the 2018 Northwest Regional Conference, and numerous Conflict Resolution in Recovery (CRR) trainings. We also support affiliate conferences with trainers, logistical and communcations support, and promotion.

• The 2018 March to Membership Campaign has been successful and added to the rolls of new members. NAADAC staff continues to look for ways to enhance membership benefits and thereby, membership.

• NAADAC announced two strategic telehealth partnerships: (1) with the Telebehavioral Health Institute (TBHI) to bring telehealth training and certification to NAADAC members at a discount; and (2) with Clocktree, a HIPAA-compliant telehealth platform, to provide free and discounted services to NAADAC members.

• NAADAC released a new marketing brochure “NAADAC for Treat­ ment Providers” in an effort to provide treatment organizations with information about how NAADAC can help organizations build business and brand recognition, keep staff up-to-date on the latest addictionrelated education offerings, news, and events, improve recruitment and retention, develop leadership, and save money on individual professional liability expenses and professional development costs.

Thank you to our NAADAC leaders for the work that you do and the tireless hours that you work and then donate back to us! Without your support, we could not have achieved all the amazing growth over the past year! I am also appreciative of the work of the NAADAC Team and the dedicated work they so generously give to support our vision and mission.

Thank you for the opportunity to serve you!

Together, we are making a difference! Cyn 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.

Membership & Affiliates • NAADAC supports it 50 state affiliates and international affiliates with technical and professional services, from training and curriculum development, to speakers, technical assistance, certification testing and advocacy. We have worked this year to support state licensure bills, state support of addiction treatment services and support for the addiction professional being seen as the professional to treat and be paid for addic­ tion services and other workforce initiatives.

• NAADAC continues to work with its affiliates to co-host state and W I N T E R 2 019 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 7

■ CER T IF IC AT I O N

NCC AP Update: Changing to Meet Challenges in Credentialing

By Jerry Jenkins, MEd, MAC, NCC AP Chair In the last issue of the Advances in Addiction and Recovery, I provided an update on national credentialing. In my opinion, national credentialing will become even more important due to the mobility of the workforce, increased credentialing requirements from payors, and the expansion of tele-behavioral health. These three factors are subtexts to the challenge of the shortage of qualified substance use treatment workforce.

NAADAC has historically recognized the need for identifying a qualified workforce.

NAADAC formally addressed this in 1990 by creating the National Certification Commission for Addiction Professionals (NCC AP), which in turn developed the National Certified Addiction Counselor, Level I (NCAC I) credential and the National Certified Addic­tion Counselor, Level II (NCAC II) credential. These credentials require specific training related to substance use counseling and supervised experience, along with a passing score on an exam, to demonstrate that the national standard for education, training, and awareness of best-practices is met. This national credentialing system provides a level playing field, as opposed to navigating respective states’ credentialing requirements and titles that vary greatly. The credentials also require adherence to a national code of ethics. The Masters Addiction Counselor (MAC) credential was developed in 1994 to recognize professionals with graduate and other advanced degrees who also meet the required standards of education, training, and experience at that level and successfully pass the associated exam.

NCC AP Commissioners, the individuals who set the standards for the certifications NCC AP offers, consist of experienced practicing professionals from around the United States. They come from varied treatment backgrounds and varied educational levels and have all been through the NCC AP certification process. The Commissioners develop and keep current the national standards of requisite knowledge in substance use disorder (SUD) counseling and the evaluation mechanisms for measuring and monitoring the level of knowledge for each credential.

Keeping the standards current can be challenging at times and the focus is always on ensuring a qualified SUD workforce. The following are some of the challenges addressed in the past months and the outcomes.

Test Taking Up until 2017, individuals were required to go to a testing center to take certification exams. While this was simple for those who lived in close proximity to a testing center, individuals living in rural areas faced significant challenges. Rural test takers were faced with having to travel significant distances, which could include an overnight stay depending on the distance and the testing start time. Individuals who lived in Fort Yukon, Alaska had to fly to Anchorage via Fairbanks or Bethel! Each of these scenarios is time consuming, expensive and potentially increased the stress of test taking.

8

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Technology provided an alternative and testing can now be monitored remotely. As a result, tests can now be administered from any location where an individual has sufficient internet capacity with a computer with a camera—including the comfort of home. This approach to testing was piloted in 2017 and is now available to all applicants.

Recognizing Peers As previously noted, the workforce shortage is a critical issue for the addiction profession. The addiction profession has long recognized the added value of including peers in the continuum of care for addiction treatment. For those not familiar with the concept, peers are persons in recovery with lived experience with substance use disorders that provide non-clinical support to individuals with substance use and co-occurring mental health disorders. NCC AP recognized the need for having a national standard of knowledge, skills, and competencies for peers and developed the National Certified Peer Recovery Support Specialist (NCPRSS) credential to address that need. In addition, NAADAC and NCC AP created a Peer Recovery Support Specialist Code of Ethics that outlines basic values and principles of peer recovery support practice. NCC AP refined and fully implemented the process in 2018.

Training Hours Traditionally, NCC AP has requied that at least 50% of training hours required for the various NCC AP credentials be attained face-to-face. In the past, this meant that the individual had to be in the room with the presenter.

In today’s world, this requirement posed more and more a challenge with the rise of distance learning and online colleges and universities. Distance learning happens now across many platforms and is accessible for anyone with an internet connection. In addition, the advancement of distance learning technology now allows people to interact together and have a more synergistic learning experience. As a result of this new technology and in order to adapt to the current training and educational delivery approaches being used, NCC AP no longer requires 50% of training to be face-to-face.

State Test Acceptance for NCC AP Credentials NCC AP has been asked why it required the successful completion of a NCC AP-specific exam despite an applicant having already successfully completed an exam at the state level. NCC AP considered the issue and made the determination that comparable state credentialing exams will now be accepted for purposes of national NCC AP credentialing.

Quality Assurance & Staying Current An important part of providing quality healthcare is quality assurance.

The same holds true for credentialing. NCC AP has been engaged since

early 2018 in maintaining and updating our processes and materials. Some of the process updates included the aforementioned test taking changes, as well as redefining what is acceptable training. The requirements related to the candidate’s knowledge and skills are also maintained and updated.

Since NCC AP establishes national professional standards for addiction professionals based on training, education, experience and demonstrated knowledge, it is imperative that we recognize and incorporate the fields’ advancements and best practices. Ultimately, each level of exam certifies that the successful candidate has the knowledge and skills necessary to screen, assess, evaluate, diagnosis, and treat individuals and their family members regarding/with substance use and co-occurring disorders (CODs). Since knowledge and skills are being refined constantly, commissioners must periodically perform a formal review of each exam—examining the purpose of each exam, to whom each exam applies, and the associated requisite knowledge, competencies and skills—and re-evaluating each exam’s blueprint to ensure that the exam questions properly correspond to required knowledge and skills for that appropriate level. As this is a long and very complex process, I will address it fully in my next column.

All this work takes time and commitment and I am very thankful for the efforts of Commissioners Christina Migliara (FL), Rose Maire (NJ), Elda Chan (Hong Kong), Kansas Cafferty (CA), Kirk Bowden (AZ), and Mick Meagher (CA), as well as former commissioners Joan Standora (PA), Kathy Benson (TN), and Thad Labhart (OR/AZ). NAADAC President Diane Sevening, NAADAC Immediate Past President (and former NCC AP Commissioner) Gerry Schmidt and NAADAC Executive Director (and former NCC AP Commissioner) Cynthia Moreno Tuohy have significantly contributed to these efforts as well.

On the Horizon NCC AP is recruiting new commissioners. We attempt to have geographical diversity, so the focus will be finding qualified candidates from the Mid-Central, Mid-South and North Central regions. NCC AP needs a diversity of credentials as well. We are currently in need of people with a NCAC I and/or NCAC II credential. Applications can be found at www. naadac.org/about-the-ncc-ap.

Also, on the horizon for NCC AP are discussions about problem gambling and prevention, as well as assisting various states, territories, and international organizations with credentialing for recognizing substance use disorder professionals.

In closing, thank you for your professionalism and what you do. As I stated in the beginning, I think national credentialing will become even more important due to the mobility needs of the workforce, increased credentialing requirements from payors, and the expansion of tele-behavioral health. NCC AP addresses these factors through process improvements as described earlier and insuring thoroughly vetted credentials for the professionals making up the substance use treatment workforce.

Jerry A. Jenkins, MEd, LADAC, MAC, currently chairs the National Certification Commission for Addiction Pro­fes­sionals. He has over 35 years of experience in treating substance use disorders and mental illness and has been a member of NAADAC since the late 1980s. He has worked in and managed community based, outpatient, halfway and residential treatment services where he has regularly hired peo­ple in recovery. He is an advocate for recovery as the expectation for behavioral health care with an emphasis on being trauma informed and substance use disorder treatment counselors having credentials to demonstrate having specialized training, experience and skills.

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■ E T H ICS

Would the Accurate Representation of You Please Stand Up?

By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair The addictions and behavioral health professions rely heavily on credentials (i.e., diplomas, degrees, certificates, certifications and licenses) that attest to: (1) attendance and completion of specialized education and training; (2) successful completion of credentialing or certification exams; and (3) an individual possessing the knowledge, skills, and work experience necessary to practice competently. Credentials are meant to accurate portray one’s scope of practice to other members of one’s profession and the public. In addition, credentials delineate specific specialty areas and attest to continued adherence to NAADAC/NCC AP’s Code of Ethics and other codes of ethics and regulatory statutes. There are many contexts within which credentials are displayed: business cards, informed consent documents, contracts, email signature blocks, and letterhead. These credentials also represent experience working in the profession and pathways within which one’s career has ventured.

The art of “representing” one’s academic and professional accomplishments can be an invaluable tool in securing employment, internships/ externships/fellowships, scholarships and grants, awards, and other professional recognition. Masterful wording can reveal depths of critical thinking that are necessary for one’s work, and can add extra padding or significance to otherwise minor professional accomplishments. There is not always a clear distinction between stating and overstating or misrepresenting one’s professional qualifications. When a professional/provider goes beyond negligible overstating of one’s certifications and credentials to intentional or unintentional deception, it is evident that ethical principles and licensing laws have been violated. Misrepresentation of credentials misrepresents education, training, skills and supervised experience—all factors in one’s scope of practice.

In addition to the misrepresentation of one’s credentials, certifications, and skills to one’s profession, there is the public side of this problem.

Clients and the general public expect counselors and other service providers to represent themselves accurately so they can determine as to whether this counselor/provider is suitable to their needs. Clients expect providers to operate ethically and morally—with values that promote honesty and integrity. To misrepresent one’s professional credentials, certifications, and work experience is to lie to the general public and/or a client.

Intentionally or unintentionally lying to a client can cause a great deal of harm. Unintentional lying occurs when the provider does not correct his or her peer’s or client’s understanding of his or her credentials when it comes to light that the provider has misrepresented himself/herself. It is vital that counselors and allied professions accurately represent their credentials—in all contexts written and verbal—for the sake of the profession and to do no harm to clients who are already struggling with psychosocial concerns.

So you may be wondering what examples there are of misrepresenting one’s credentials. One example is on business cards, where a person adds letters after their name that they did not earn or only put letters but 10

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not l­evels (i.e., CAC rather than CAC I, II or III). Not including levels as required by the certifying/licensing body is unethical and intentionally deceptive. Another example is website marketing information about one’s agency and services provided. When a person who is not a NAADAC Approved Education Provider puts on his or her website that he or she is a NAADAC-approved trainer, that is deceptive, unethical, and sanctionable.

Yet another example is stating that one provides services that he or she is not qualified to provide as part of his or her scope of practice. The client looking at all these materials is expecting providers to represent themselves accurately. The client does not know the difference between levels or how a person applies to become an approved training/education provider—he or she is taking the information presented at face value. To prevent harm towards a client—whether actual or perceptual—it is important that we clearly state what our qualifications are and how we achieved them. It is always helpful to clients for them to understand what you had to accomplish to earn your certifications and licenses. By carefully explaining what each credential means and what it allows in practice, we are being open, genuine, and transparent.

NAADAC’s and NCC AP’s Ethics Committees encourage all NAADAC members, NCC AP credential holders, and other allied pro­ fes­sionals, to step into the public’s shoes and scrutinize all materials and information put into the public domain. Take time to critically think about what information or credentials are being presented that could cause harm to the profession and/or public. Take time to consider what values are on display when erroneous information is provided in the public domain. Take time to consider what Principles of the NAADAC Code of Ethics are being violated by offering inaccurate information. Take time to consider what state regulatory statutes are being broken by endorsing erroneous information without correcting it. With the opioid crisis and surge of other substance use disorders, we are being scrutinized more intensely by the public.

How will you fare if your credentials and practices are carefully analyzed?

Mita M. Johnson, EdD, LAC, MAC, SAP, has a Doctorate degree 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 NAADAC President-Elect, NAADAC Ethics Chair, and a Board Member of the Colorado Association of Addiction Professionals (CAAP).She previously served as the NAADAC Treasurer, the CAAP President, and the NAADAC Southwest Regional Vice-President. In Colorado, Johnson is involved in regulatory and credentialing activities as well as workforce recruitment and retention initiatives. She speaks and trains regionally and 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.

■ M EM B ER S H I P

Remembering Roger Curtiss

By Kristin Hamilton, JD, NAADAC Sr. Communications Manager

On November 8, 2018, long-time NAADAC member Roger Allan Curtiss passed away at the age of 79 years.

Curtiss will be remembered as a dedicated addiction professional, NAADAC leader, mentor, and friend.

Curtiss was born and spent his youth in Coldwater, MI. He joined the U.S. Army in 1959, served as part of the 3rd Armored Division, and was honorably discharged in 1962. In 1969, Curtiss moved to Billings, MT, where he built a life and eventually a career.

In April of 1979, Curtiss became a “friend of Bill W.,” and began his journey into helping others with addiction. For the next 30 years he worked first as a counselor and then as director in addiction treatment facilities throughout Montana, Wyoming, and Idaho. Curtiss served in many roles over the years, including as Director at Alcohol and Drug Services of Gallatin County in Bozeman, MT, and as CEO of The Walker Center, a large inpatient treatment facility, in Gooding, ID. Over the years, Curtiss also served as NAADAC leadership in numerous capacities, including serving as President from 2002–2004. He also represented the Northwest Region as the Northwest Regional Vice President and served as Secretary, Membership Chair, Leadership Circle Chair, President-Elect, and Immediate Past President.

Curtiss was a well-respected addiction counselor who was committed to improving supporting other addiction counselors and improving the lives of those they serve. He was described by former NAADAC President Mary Woods as “a friend, mentor, and all around good guy.”

“What struck me most [about Curtiss] was the tone of his voice and that look in his eyes of confidence and warm acceptance,” remembered NAADAC Immediate Past President Gerard Schmidt. “I can truly say I connected with Roger the very first time I met him,” Schmidt continued.

He recalled a particular anecdote about joining Curtiss to co-lead a group of addiction professionals to South Africa for two weeks in 2003. Schmidt noted that “it was a trip of a life time and an experience that I cherish to this day,” but recalled that before the trip, “Roger mentioned that he snored a little.” According to Schmidt, that was quite an understatement. “It sounded like an express train coming through the room each night for those two weeks,” laughed Schmidt. “We would kid about that for years and in fact the last time we spoke, it was part of our conversation,” he continued.

NAADAC President Diane Sevening also described Curtiss as “a wonderful person and friend.” “Upon my first meeting of Roger, I was awestruck and hoped someday I could demonstrate his compassion and conviction to the addiction profession,” Sevening reflected. “He was a great mentor and inspired me to never lose sight of the importance of being a genuine, dedicated addiction professional,” she continued.

NAADAC Executive Director Cynthia Moreno Tuohy will remember Curtiss as her “friend, debater, mentor, and cheerleader.” She recollected that he was also her ringleader—quite literally. At the NAADAC 2009 Annual Conference in Utah, “it was Roger’s great idea to have a carnival at the opening,” recalled Moreno Tuohy. “He decided he would wear a ringleader costume and I would be his assistant and wear a costume to match,” said Moreno Tuohy. “It was so much fun to work the carnival alongside Roger. He made it special and fun and a bit crazy,” she continued. “Roger was amazing and he brought that to his world, my world, and the world of NAADAC!” said Moreno Tuohy.

Curtiss will also be remembered for his leadership within both NAADAC and the addiction profession. Moreno Tuohy remembers him “as dedicated and as influential as any addiction professional can aspire to be.” Woods recalled that he “was an advocate for our profession, for treatment, and for NAADAC.” Northwest Regional Vice President Malcolm Horn fondly described learning from Curtiss. “He was instrumental in helping me learn the ropes of NAADAC and “Robert’s Rules of Order”—which should have maybe been called “Roger’s Rules of Order!” said Horn. “He was passionate about our cause and passed that on to me,” said Horn. “[Curtiss’] belief in the mission of NAADAC made me want to be a part of this great association and emulate his leadership style,” said Sevening.

“What I loved about Roger was his direct approach of letting you know if you were slacking off or not meeting your potential while remaining humble,” she related.

Curtiss will be missed by NAADAC and the addiction profession. “He will always have a special place in my heart and will be sorely missed,” said Sevening.

“I was blessed in my life and became a better man, professional, and friend because of my friendship with Roger,” said Schmidt. “His impact will forever be felt by those that got to not only know and experience him but to truly love and be loved by him.”

Kristin Hamilton, JD, is the Senior 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.

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■ A D V O C AC Y

Presence, Progress, Momentum, Opportunity – NAACAC Looks to Build on Success in New Congress

By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director and Tim Casey, Policy Advisor, Polsinelli NAADAC’s commitment to elevating the voice and experience of addiction professionals helped shape critical legislation in the 115th Congress. In 2019, NAADAC will continue building on its work to expand prevention, treatment, and recovery services, forge new relationships with the new faces of the 116th Congress, and host another engaging Advocacy in Action Conference and Hill Day in Washington.

Last year, lawmakers worked together in bipartisan fashion to deliver a comprehensive response to the nation’s opioid crisis by passing the SUPPORT for Patients and Communities Act (Public Law No: 115-271). NAADAC played an important role in advocating for its passage and ensuring that key provisions were included in the final bill, including student loan forgiveness for the addiction workforce, partial repeal of the Medicaid IMD Exclusion, expansion of SUD telehealth services, grants to states to help support SUD workforce shortages, and much more.

With NAADAC’s help, the Substance Use Disorder Workforce Loan Repayment Act, championed by Representatives Katherine Clark (D-MA) and Hal Rogers (R-KY), was adopted in the broader legislation. NAADAC endorsed the legislation in advance of the vote and rallied support for its passage in the House and Senate with action alerts to members and letters to Congress. The legislation marks a significant victory for NAADAC members and the next generation of addiction professionals.

The Substance Use Disorder Workforce Loan Repayment Program will serve as a major incentive to students pursuing substance use disorder treatment professions. The legislation will provide up to $250,000 in student loan repayment for those who work as substance use disorder treatment professionals in areas of need. To qualify, eligible health care professionals, such as addiction counselors, need to be employed in a full-time substance use disorder treatment job in a high-need area for up to six years.

In addition, after 11 years of advocating for the Human Resources and Services Administration (HRSA) to include addiction professionals in its National Health Service Corps (NHSC) loan repayment program, NAADAC was excited for HRSA to announce the 2019 Substance Use Disorder Workforce Loan Repayment Program (SUD Workforce LRP).

This new program expands access to evidence-based SUD treatment in underserved, high-need communities by offering up to $75,000 in loan forgiveness for a three-year full-time commitment at a NHSC-approved site or up to $37,500 for a three-year half-time commitment.

During the debate regarding the text of the SUPPORT for Patients and Communities Act, NAADAC also voiced concerns over provisions that could have carried significant unintended consequences for the privacy rights of individuals with substance use disorders. The Overdose Prevention and Patient Safety Act, one of the bills contained within the SUPPORT for Patients and Communities Act, would have permitted the disclosure of patient records without written consent, under certain conditions, and could have subjected individuals to discrimination if their information 12

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was mishandled. NAADAC offered valuable contributions to a contentious and complicated debate. The provision was omitted from the final bill, representing another important win for NAADAC’s advocacy efforts.

In addition to its efforts to pass the SUPPORT for Patients Communities Act, NAADAC called on Congress to fund critical programs that support the addiction workforce. In collaboration with coalition partners, NAADAC successfully advocated for increased funding for the Substance Abuse & Mental Health Services (SAMHSA)’s Minority Fellowship Program, which awards funding to Master’s degree-level graduate students in addiction studies committed to working with underserved populations.

In the fall, NAADAC took to Capitol Hill for its annual Advocacy in Action Conference and Hill Day. NAADAC members and constituents in attendance heard from key Congressional staff and some of Washington’s most influential voices on addiction, treatment, and recovery services, including the Director of the Office of National Drug Control Policy, Jim Carroll. NAADAC also hosted a successful briefing at the U.S. Capitol Building’s Visitor Center where attendees heard from a number of engaging speakers before hitting the halls of Congress for their Hill Day. NAADAC is gearing up already for its 2019 Advocacy in Action Conference and Hill Day, so be sure to stay tuned for more information and hold April 10-11th on your calendars now.

NAADAC is poised to build on its 2018 accomplishments but needs your help. In 2019, NAADAC will look to help grow the Congressional Addiction, Treatment and Recovery Caucus, demonstrate to Congress the importance of national credentials and standards for the addiction workforce, and fight for expanded treatment and recovery services for individuals with substance use disorders. Join us as we fight to ensure individuals, families, and communities across this country get access to the treatment and recovery continuum of care they deserve. Please follow www.naadac. org/take-action for more ways to stay involved.

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.

Tim Casey is a policy advisor at Polsinelli. He has a proven record of leadership in advancing the federal priorities of national associations, corporations, consumer organizations, and nonprofits. On Capitol Hill, Casey is a trusted resource to Members of Congress and their staff. Casey’s experience in the House and Senate combined with his time as a senior lobbyist for prominent health care organizations offers clients sound policy advice, strategic political counsel, and a keen instinct for delivering on key priorities before Congress and the Administration.

ADVOCACY IN ACTION CONFERENCE

Conference April 10 Hill Day April 11

NAADAC, the Association for Addiction Professionals invites you to its 2019 Advocacy in Action Conference at the Gaylord National Resort & Convention Center on April 10, 2019 and Hill Day on April 11, 2019.

Attend the conference on April 10th 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 April 11th.

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/2019-advocacy-conference

REGISTER TODAY

2019

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

Addressing the Syndemic of Opioid Use Disorder, HIV, and HCV

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

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s we focus on reducing opioid-related deaths through enhanced prevention and substance use disorder (SUD) treatment, it is crucial to realize the role opioid addiction plays in the spread of infectious disease. An estimated 6 percent of new HIV diagnoses in the U.S. in 2015 were among people who inject drugs (Centers for Disease Control and Prevention (CDC), 2017). HIV can be successfully managed with antiretroviral therapy (ART), but we must not forget that those most at risk of contracting HIV may also lack access to interventions to prevent and successfully treat it. What’s more, HIV’s spread is entangled with that of the virulent and dangerous virus, hepatitis C (HCV). Thus the “opioid epidemic” is really a set of overlapping epidemics sharing many of the same contributing factors and conditions—a syndemic (Perlman & Jordan, 2018)—and addiction counselors have a critical role to play in reducing the toll of all these conditions.

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As we focus on reducing opioid-related deaths through enhanced prevention and substance use disorder (SUD) treatment, it is crucial to realize the role opioid addiction plays in the spread of infectious disease.

Stigma against people with drug addiction continues to hinder efforts to treat and prevent the spread of infectious disease, just as it continues to limit the adoption and use of medications for opioid use disorder. Infectious disease physicians might be hesitant to treat people with SUDs, not only because they lack the necessary training but also because they may be concerned these individuals will not be adherent to their ART regimens.

Improved training of all medical providers in screening for and addressing addiction, as well as addressing stigma toward drug users, remains an area of high-priority research at National Institute on Drug Abuse (NIDA) (NIDA, 2018).

We know how to prevent transmission of HIV and, to a lesser extent, HCV; the trouble is getting communities to adopt the appropriate measures. Syringe services programs are an example of an evidence-based strategy that could be expanded. These programs have been shown to be highly effective at reducing transmission of infectious diseases while not leading to increased drug use (CDC, 2018). Not only do such programs reduce the sharing of needles among drug users, they also provide the opportunity to link people to screening for HIV/HCV and to SUD treatment. Addressing SUD reduces the risk of an individual transmitting or contracting an infectious disease—the “treatment as prevention” principle.

Educating policymakers and those working in healthcare and justice systems about the benefits of implementing evidence-based approaches— and overcoming stigma—continues to be important. Last October, Gregg Gonsalves, a MacArthur “Genius” award-winning investigator at Yale and his coauthor Forrest W. Crawford published a modeling analysis showing that faster implementation of syringe-services programs and other harm-reduction measures could have prevented the majority of the new HIV cases in the widely publicized outbreak in Scott County, Indiana in 2014-2015 (2018).

HCV is also a concern. Incidences of this extremely contagious disease increased by 133 percent between 2004 and 2014 (Zibbell et al., 2018), and HCV currently kills more Americans than all other infectious diseases combined (Page, Cox, & Lum, 2018). Along with hepatitis B, HCV is the leading cause of liver cancer in the U.S. Because it is typically asymptomatic, it often goes undiagnosed and is hard to track; thus, cases are likely underreported.

Unlike HIV, medications are available that completely cure HCV in most cases. However, the medications are expensive, and access to them is a challenge. There is no vaccine for HCV, and because of its virulence, finding one is a top public health priority. Fortunately, science is making advances and we are learning more about this disease, who it affects, and how it affects them. For example, it has recently been found that females who inject drugs are at a greatly increased risk of contracting HCV compared to males, yet they also spontaneously clear the virus at higher rates than males and show slower disease progression (Page, Cox, & Lum, 2018). Such findings could provide important guidance in developing a vaccine for HCV. Although there is no vaccine for HIV yet either, there multiple approaches have been developed to prevent transmission. Pre-exposure

prophylaxis or PrEP is available to individuals engaging in high-risk behaviors to reduce their chances of contracting HIV. Evidence shows that PrEP is effective in preventing acquisition of HIV in people who inject drugs (Choopanua et al., 2013). However, this intervention is underutilized and accessibility for people who inject drugs is limited. Research on access and adherence to ART can inform strategies to improve utilization of PrEP. One of the main factors facilitating ART adherence, according to a recent study, is receiving medication treatment for opioid use disorder (Brazzi et al., 2019), further showing that when drug addiction is addressed, it can have much wider benefits in health and healthcare engagement.

The entanglement of opioid addiction with HIV and HCV presents both a challenge and an opportunity for those who find themselves on the front lines of these public health battles. Addiction counselors are uniquely positioned to not only address SUDs but also to improve the overall health of their clients and entire community. This can be accomplished by linking people who inject drugs to screening and treatment for HIV and HCV. Ensuring appropriate care, including medications, for those struggling with opioid use disorders can greatly increase adherence to ART. Encouraging the use of PrEP and participation in syringe services programs can also reduce the risk for transmission of HIV and HCV. Finally, ensuring patients and family members have access to naloxone can save lives and help prevent opioid-related overdoses.

REFERENCES Bazzi AR, Drainoni ML, Biancarelli DL, et al. Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions. BMC Public Health.

2019;19(1):31.

Centers for Disease Control and Prevention (CDC). HIV and Injection Drug Use. 2017. https://www.cdc.gov/hiv/risk/idu.html.

Centers for Disease Control and Prevention. Syringe Services Programs. 2018. https://www. cdc.gov/hiv/risk/ssps.html Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381:2083-2090.

Gonsalves GG, Crawford FW. Dynamics of the HIV outbreak and response in Scott County, IN, USA, 2011–15: a modelling study. Lancet HIV. 2018;5(10):e569-e577.

National Institute on Drug Abuse. NIDA AIDS Research Program Strategic Planning Workshops. 2018. https://www.drugabuse.gov/offices/office-nida-director-od/aids-research-program-arp/past-meeting-reports-presentations/nida-aids-research-programstrategic-planning-workshops.

Page K, Cox A, Lum PJ. Opioids, hepatitis C virus infection, and the missing vaccine. Am J Public Health. 2018;108(2):156-157.

Perlman DC, Jordan AE. The syndemic of opioid misuse, overdose, HCV, and HIV: structurallevel causes and interventions. Curr HIV/AIDS Rep. 2018;15:96.

Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014.

Am J Public Health. 2018;108(2):175-181.

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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What International Providers Can Teach the U.S. About Accreditation

By Michael W. Johnson, Managing Director of Behavioral Health, CARF International

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spend around 180 days each year traveling in the United States and internationally. The primary purpose of my travel is to help people understand what value accreditation can bring to their organization.

The conversations I have with providers are often unique (and complicated), and vary depending on the particular economic and regulatory pressures or competitive environment of each organization. But I have noticed a difference in these discussions with providers in the United States compared with those in other countries.

In the United States, many behavioral health organizations are looking at accreditation due to some sort of regulatory or payer pressure. They often feel forced to become accredited and, from time-to-time, they seem angry and resentful for this added level of accountability. Internationally, however, discussions center more frequently on accreditation as a tool for providing services of the highest quality.

Keep in mind that behavioral health organizations outside the United States often don’t have the regulatory or financial incentives pushing them to become accredited that many do in the U.S. I am not trying to diminish those things. You have to operate legally within the licensing requirements of your jurisdiction and get paid in order to be in business.

But I believe incentives and requirements for accreditation can sometimes obscure its value.

After all, what distinguishes a successful provider from an unsuccessful one if they both operate in the same regulatory and financial environment?

I think the answer is how each is managed, and where they place the value of the persons they serve. If you do those things right, which accreditation can help with, you are more likely to be successful and also address regulatory and payer requirements.

International providers, who have fewer outside pressures, help remind us of this fact.

Regulatory and payer incentives Because it seems many organizations in the U.S. are first introduced to accreditation by regulatory or payer incentives, I’d like to address those quickly. Incentives can take a couple of forms. The main versions include: Mandates • Many states have mandates that require behavioral health organizations to be accredited to participate in Medicaid or to become licensed. In these states, the decision to become accredited is not complicated. It is a cost of entry into the business.

Deemed status • Some states have incentives such as deemed status. This presents a choice for an organization to become accredited in lieu of a licensure visit from the state. I often speak to organizations in this situation that are searching for an additional incentive beyond just licensure to help push them toward accreditation. Sometimes the deemed status is enough for them to consider moving toward accreditation, but many times it’s not.

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Insurance reimbursement • In the substance use disorder treatment marketplace, many commercial insurance companies such as Aetna, Cigna, and United Health Group require accreditation for reimbursement. Often, organizations are motivated to seek an accrediting body to access certain payments.

The regulatory and insurance environments are becoming even more complicated. In much of the healthcare marketplace, independent practitioners are getting “squeezed out” and having to work in groups or independent practice associations in order to survive under increasing cost pressures. When providers join a group and share a patient population, they often face different regulatory and reimbursement complexities.

Many of the commercial insurance companies are still trying to determine who their “high value” providers are. They are creating special contracts with providers who meet certain outcomes that result in less utilization management and potentially better rates. Insurers are still in the early stages of determining the criteria for these contracts, but unquestionably being accredited is a cornerstone.

Despite all this, the best argument for accreditation is not about regulations, requirements, or getting paid.

If not outside incentives, then why accreditation?

At the end of the day, accreditation is a quality improvement activity designed to improve care to persons served. Accreditation alone does not ensure improved outcomes, but it provides a framework for organizations to be accountable and responsive to persons served and their families.

I worked in accredited organizations for many years, was an accreditation surveyor, and now work for an accrediting body. So I believe in the value of accreditation as a means to improve quality, and I’m not unbiased about that. If you work in an unaccredited organization, I am not trying to imply you do not provide a quality service. But quality is not a static dimension.

Once you achieve a certain level of quality, you can continuously push further. I frequently hear from organizations after they have been accredited for a while that they didn’t know what they didn’t know. They didn’t anticipate that becoming accredited would result in the overall organizational improvement that it did.

I often use my conversations with international organizations as anecdotes when I speak to people considering accreditation in the U.S. International providers talk about their pride in the accomplishment of meeting high standards of care. And they are open about how that translates into value for the persons they serve.

Approaching accreditation for the reason of quality improvement and rallying an organization around this cause results in improved outcomes. This is not only good for the persons you serve, but also for business sustainability. International providers understand this and pursue accreditation as a tool toward that goal, even without external incentive.

U.S. organizations also can (and frequently do) approach accreditation in this way because they have the same interest in providing quality services. Ultimately, implementing

practices aimed at being accountable to the persons you serve and your own outcomes naturally addresses what regulators and payers are looking for as well.

Michael W. Johnson joined CARF as managing director of the Behavioral Health accreditation area in 2013. A certified addictions professional, Johnson has more than 30 years of experience as a clinician, manager, and executive working in mental health, substance abuse, and intellectual disabilities fields. He was a CARF surveyor for 16 years and holds a master’s degree in communications from the University of Central Florida.

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Culturally Responsive Peer Recovery

By Masica Jordan, PhD, LCPC & Joseph T. Hackett, PhD

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Peer support services that are culturally responsive can effectively extend the reach of treatment beyond the clinical setting into the everyday environment of individuals seeking a successful, sustained recovery process.

eer support workers are people who have been successful in the recovery process who support others throughout their recovery.

Through collective understanding, respect, and communal empowerment, peer support workers help people stay active in their recovery. Peer support can also reduce the likelihood of relapse for those in recovery. Peer support services that are culturally responsive can effectively extend the reach of treatment beyond the clinical setting into the everyday environment of individuals seeking a successful, sustained recovery process (Substance Abuse and Mental Health Administration, 2018).

Cultural responsiveness is the ability to learn from and relate respectfully with people of your own culture as well as those from other cultures. In recovery, cultural responsiveness is the delivery of services that incorporate and respect the individual’s cultural beliefs.

Peer support workers engage in a wide range of activities. Peer support workers advocate for individuals in recovery, share resources and life skills, helping individuals build community and relationships, lead recovery groups and mentor individuals in recovery. The peer support worker may also provide services and/or training, supervise other peer workers, develop recovery resources, manage programs or recovery agencies and advocate for their peers by educating stakeholders and policymakers (SAMSHA, 2018).

Peer support workers must develop additional cultural competencies to provide unbiased services to specific groups who also share common recovery experiences, such as various minority groups. The shared experience of being in recovery from a mental health and/or substance use condition or being a family member is the foundation on which the peer recovery support relationship is built in the behavioral health arena.

Implicit bias is held internally. Occasions that cause it to show up externally in the delivery of peer recovery services is in decision-making, allocation of resources, sharing of resources and life skills, in the selection of appropriate community supports community and relationships, leading recovery groups and mentor individuals in recovery. Individuals receiving peer supports services will spend a significant amount of time throughout the recovery process with their peer support worker. Williams (2018) reported on environmental stress explaining that events requiring your body to respond are stressors and when those stressors are in your surroundings, then that is an environmental stressor. Peer recovery services that are not intentionally culturally responsive and inclusive foster high levels of environmental stressors. There is a relationship with stress and relapse for those in recovery.

The peer support worker’s mission is to advocate and support his or her peers, including those from marginalized communities with personcentered recovery supports. In order for peer support workers to provide this service to recipients, they need to be able to develop cultural competencies that minimize environmental stressors—namely discrimination.

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The growing landscape of the world includes people who are expressing their uniqueness. The field of recovery is no exception. However, foundations of helping professions, like counseling, social work, and peer recovery, were built on White culture. The need to make White culture explicit is significant when we realize it exists, but the correlation between it and recovery outcomes has rarely been acknowledged or investigated. Torrey (1972) suggests that we have little insight into our own culturally learned values and mores. Furthermore, he believes that those same mores sit within us quietly and unconsciously providing criteria for implicit biases. Those implicit biases diminish the effectiveness of peer recovery supports and in some instances cause harm to the individuals receiving services.

While the development of cultural competencies is a lifelong process, peer support workers should participate in ongoing professional development that endeavors to strengthen cultural competency and they should incorporate culturally responsive practices when delivering recovery supports.

The first practice is to avoid projecting one’s own perceptions onto people but ask individuals how they would like to be seen by others. Andrews (Andrews, Hopkins, & Pearsons, 2013) spoke against ambiguity where people hide behind words, and rather suggested the use of more specific language. The reality is that language changes over time so it is best to ask people how they would like to be referenced. This is done by asking people to give their preferred pronoun and using that pronoun when referencing them. Then, quickly apologize whenever the wrong pronoun is mistakenly used. Also, ask people what name they want to be called. Quickly apologize whenever the wrong name is mistakenly used.

Next, peer support workers must provide unbiased and equal access and assistance as needed to make sure that everyone has access to and understands how to use resources to their advantage. One of the fundamental ethics of peer recovery is the recognition that there are multiple pathways to recovery. To that end, peer support workers should never dismiss the individual’s desire or refuse to provide the support needed to connect him or her with community supports that mirror the individual’s culture beliefs.

Peer Support Supervisors and other administrative team members often play a key role as a secondary support for individuals in treatment environments. Whenever information, assurance, and assistance is needed, supervisors should endeavor to provide support to peer support workers that allows them to have equal access to funding and other resources to avoid organizational discrimination.

Next, when working with other peer support workers and treatment team members, assume that each person means well in order to avoid unnecessary conflict. As members of a treatment team, give each other the benefit of the doubt knowing that the development of cultural competencies is a lifelong process and that the team is growing as a whole.

In addition, conflict can arise during the provision of peer recovery services throughout the various stages of recovery. Peers support workers

should give the benefit of the doubt while voicing discomforts and concerns. When experiencing discomforts and concerns, peer support workers should speak up. Let the person know that something happened making you uncomfortable and/or concerned. Dismissing such concerns do not aid in the recovery process. Nor does appropriate confrontation diminish a healthy peer-peer rapport.

It is also important to avoid cultural assumptions. Assumptions are rooted in making judgment calls without proper information and can often foster stereotypes. We know that differences exist among racial groups as well as within each group (LaFromboise, 1983). Therefore, while it is important to be familiar with cultural groups, it is also vital to take time to explore the individual’s preferences and personal recovery needs.

In conclusion, peer support workers are a vital resource in the lives of countless of individuals in recovery. In order to be effective in their roles, peer recovery workers must continue to develop cultural competencies in effort to provide unbiased services. Although the development of cultural competencies is a lifelong process, the cultural responsive practices highlighted in this article should be incorporated into peer support.

REFERENCES Andrews, W., Hopkins, E., & Persons, B. (2013). Righting Society’s Wrongs: Contextual Perspectives of EEO/AA. New York, NY: Springer Media.

LaFramboise, T. (1983). Assertion training with American Indians. Las Crues, NM: Educational Resource Information Center, Clearinghouse on Rural Education in Small Schools.

Substance Abuse and Mental Health Services Administration (2018, December 30). Peers.

Retrieved from https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers.

Torrey, E.F. (1972). The mindgame: Witch doctors and psychiatrists. New York, NY: Emergeson Hall.

Williams, Yolanda. (2018, December 31). Environmental Stressors: Definitions, Examples, and Types. Retrieved from https://study.com/academy/lesson/environmental-stressorsexamplesdefinition-types.html#transcriptHeader.

Masica Jordan, PhD, LCPC, is a licensed counselor and the CEO of Jordan Peer Recovery (JPR). JPR offers culturally responsive peer recovery trainings that have been used in various projects like Bowie State University’s (BSU) HRSA project responding to the Opioid Crisis, Volunteers of America Chesapeake’s Department of Labor project, training reentry citizens as peer support workers. She established programs for the SEED Public Charter School supporting marginalized minority students. The 2010 documentary film from director Davis Guggenheim and producer Lesley Chilcott, “Waiting for Superman” featured the school’s success. Jordan’s most recent presentation was “Peer Recovery at a Historically Black College University” at the 2018 NAADAC Annual Conference in Houston, TX. Joseph T. Hackett earned his Doctor of Philosophy degree in theology at Eli College and Seminary, and his Bachelor of Arts degree in sociology and Africana studies at the University of North Carolina – Asheville. He helps organizations develop cultural responsiveness and workforce development programs for justice involved citizens. Hackett is a subject matter expert in the field of forensic peer recovery. He uses his own experience of being incarcerated in federal prison to assist justice involved individuals and organizations that serve them. After incarceration, he designed an essential skills training program for workforce development in marginalized communities to assist participants increase their employability and economic mobility using asset-based community development. He currently serves as the Executive Director of Green Opportunities and Chief Executive Officer for Access Regional Taskforce.

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Alcohol and the Aging Brain

By National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Double trouble for the prefrontal cortex

T

h e r e ’ s r e a l l y n o w a y around it. Like all other organs and tissues of the human body, the brain is subject to the aging process and the typical structural and functional changes that go along with it.

With normal aging, the brain begins to shrink in middle age, losing volume primarily in the frontal lobes and the hippocampus, which leads to a decline in cognitive function and memory as people grow older.

It is also well-established that alcohol misuse over time can have harmful effects on brain structure and function. NIAAA is keenly interested in how alcohol misuse and normal brain aging might interact, particularly as the nexus between alcohol and aging becomes increasingly apparent.

“The evidence indicates that Americans are getting older and drinking more,” says NIAAA Director George F. Koob, PhD.

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Currently, 26 percent of men and 30 percent of women in the United States are age 55 or older, compared with 21 percent of men and 24 percent of women 10 years ago. Experts estimate that by 2050, nearly 1 in 5 people in the United States will be age 65 or older, compared with 1 in 7 now. And alcohol researchers have reported significant increases in alcohol use and misuse among older individuals. For example, recent years have seen an increase in alcohol use among men and women age 60 or older and an increase in binge drinking among women age 60 or older.

A new study supported by NIAAA provides important information about the effects of aging and alcohol on the brain. As reported in the May 2018 issue of JAMA Psychiatry, researchers led by Edith V. Sullivan, PhD, of Stanford University School of Medicine examined brain changes in individuals ages 25–75 with and without alcohol use disorder (AUD) who also received one or more magnetic resonance imaging scans over a 14-year period (222 subjects with AUD vs. 199 age-matched control subjects without AUD). The investigators also examined data collected over time from 116 participants with AUD and 96 age-matched control subjects, who were subsets of the whole group, to see how factors such as other substance use disorders and hepatitis C virus infection comorbidities might also interact with alcohol misuse and aging to affect brain structure.

Analyses revealed that adults with AUD had brain volume reductions, independent of sex, in a number of areas, including the frontal, temporal, parietal, cingulate, and insular cortices. These effects were particularly pronounced in adults age 65 or older. Accelerated aging was seen in some brain areas, including the frontal cortex. Notably, the accelerated aging was also seen in subjects who had developed AUD later in life.

“What was particularly striking about our study was accelerated aging of brain structure that was especially prominent in the frontal cortex. Even those individuals who developed severe AUD at an older age showed accelerated loss,” says Dr. Sullivan. “Although both substance use and hepatitis C infection may have exacerbated brain volume loss, these factors did not fully account for the AUD-aging interaction we identified. A take-home message of our results is that old age is not protective against developing AUD-related brain volume deficits.”

“These findings,” notes Dr. Koob, “provide compelling evidence that alcohol misuse during later adulthood could confer a greater risk of deficits in frontal lobe function beyond the deficits that typically occur with aging.”

In an editorial that accompanied the report by Dr. Sullivan and colleagues, Dr. Koob cites the “prominent alteration of frontal cortex volumes” as the most compelling aspect of the study.

“The frontal cortex controls executive function,” says Dr. Koob, “and the prefrontal area has prominent projections to the basal ganglia and amygdala, controlling impulsivity and compulsivity. Disruption of this frontal cortex control is part of the causative mechanism of AUD.” Dr. Koob explains that frontal cortex control is underdeveloped during adolescence and compromised during the aging process, thus opening the possibility of greater vulnerability to AUD early and later in life. He describes how alcohol misuse could contribute to the aging process, and that the aging process may contribute to the development of AUD. “Particularly with alcohol, the negative emotional states associated with aging may converge with the negative emotional states of alcohol withdrawal, which drives many individuals with AUD to self-medicate to avoid experiencing negative effects,” says Dr. Koob. “This convergence, in turn, could also drive the need to self-medicate. In short, alcohol misuse in the elderly population may tap into misdirected attempts at emotional self-regulation, in which an individual consumes alcohol to fix the problem that alcohol helped cause.”

A Spectrum of Concerns for Older Drinkers In addition to the specific brain-related issues that confront older people who misuse alcohol, it is important to remember that aging introduces a spectrum of other concerns for people who drink alcohol.

Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Alcohol may act differently in older people than in younger people, so some older people can feel increased effects from the same amount of alcohol they drank when younger.

This can make accidents, including falls and fractures and car crashes, more likely.

Also, for biological reasons, older women are more sensitive than men to the effects of alcohol.

Many medicines—including prescription, over-the-counter, or herbal remedies—can be dangerous or even deadly when mixed with alcohol. A lot of older people take medications every day and are more likely to take one or more medications that interact with alcohol, increasing their risk for harmful alcohol–medication interactions.

Finally, alcohol misuse by older people can contribute to, or complicate, other health problems, such as liver damage, immune system disorders, osteoporosis, diabetes, and high blood pressure.

REFERENCES Sullivan, E.V.; Zahr, N.M.; Sassoon, S.A.; Thompson, W.K.; Kwon, D.; Pohl, K.M.; and Pfefferbaum, A. The role of aging, drug dependence, and hepatitis C comorbidity in alcoholism cortical compromise. JAMA Psychiatry 75(5):474–483, 2018. PMID: 29541774 Koob, G.F. Age, alcohol use, and brain function: Yoda says, “with age and alcohol, confused is the force.” JAMA Psychiatry 75(5):422, 2018. PMID: 29541767 The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is one of the 27 institutes and centers that comprise the National Institutes of Health (NIH). NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. It is the largest funder of alcohol research in the world.

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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. What are the two separate government programs providing the opportunity for addiction professionals to apply for student loan repayment? a. The National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). b. SUPPORT for Patients and Communities Act and the National Health Service Corps (NHSC) Substance Use Disorder Workforce Loan Repayment Program (SUD Workforce LRP). c. The Health Resources and Service Administration (HSRA) and the Health Workforce Simulation Model (HSWM). d. The Community Support Act (CSA) and the Public Service Loan Forgiveness Act (PSLF).

2. Which of the following is an example of unethically misrepresenting one’s credentials? a. Only putting letters after your name but not levels, when levels apply (i.e. CAC rather than CAC I, II, or III). b. Having your certification listed behind your name on a website, when it expires in two months. c. Listing that you are certified in a clinical model, but you haven’t received a refresher on it for two years. d. Placing credentials after your name in an email.

3. The 2019 NAADAC Advocacy in Acton Conference and Hill Day is schedule for April 2019. What are some examples of what has been accomplished in previous NAADAC advocacy initiatives? a. Student loan forgiveness for the addiction workforce. b. Ethical dilemmas are reviewed. c. Expansion of SUD telehealth services. d. A and C 4. What is a syndemic? a. This occurs when an epidemic that was once considered regional or local has now spread across the world. b. An epidemic that is attacking one specific culture group or socio­ economic level. c. A set of overlapping epidemics that share many of the same contributing factors and conditions. d. One specific type of epidemic that infects a variety of communities, regardless of socioeconomic status.

5. What are the effects of adopting syringe services programs as an evidence-based strategy? a. The sharing of needles among drug users increase. b. Reduces the transmission of infectious disease while not leading to drug use. c. Keeps those diagnosed with a substance use disorder in denial. d. Aides in the support of environmental and recycling initiatives.

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6. How do discussions about accreditation differ in the United States compared to Internationally? a. In the United States, accreditation is perceived as an excellent benefit and appreciated standard whereas internationally it is resented and seen as an obligation. b. In the United States, accreditation is perceived as something to outsource to consultants whereas internationally it is only owned internally. c. In the United States, accreditation is perceived as a high mark to achieve whereas internationally it is a are minimum of achievement. d. In the United States, accreditation is about regulatory or payer pressure whereas internationally it is a tool for providing services of the highest quality.

7. Regarding accreditation, what are the primary forms of incentives for many organizations? a. Mandates, deemed status, and insurance reimbursement. b. Medicaid, Medicare, and the Affordable Care Act. c. Status, increased referrals, and increased rate-of-pay. d. Medicare, quality care achievement, and alignment with industry standards.

8. In recovery, what is cultural responsiveness? a. The delivery of services that incorporate and respect the individual’s cultural beliefs. b. The delivery of services that provides a standardized message to all in recovery that we are all the same. c. The delivery of services that avoids conversations that explore differences. d. The delivery of services that leverages perspectives held by the majority.

9. What are examples of techniques or practices that demonstrate culturally responsive care? a. Encourage assimilation for those in treatment who seem different. b. Ask individuals how they would like to be seen by others. c. Taking the time to over-emphasize similarities. d. Expect immediate participation from everyone in a group when using an experiential counseling method.

10. Regarding Alcohol and the Aging brain, which of the below statements is true? a. As the brain gets older, the effects of misusing alcohol are less severe. b. Alcohol use amongst older adults is on the decline. c. After an in-depth analysis of adults with AUD, the frontal, temporal, and parietal areas of the brain were affected but accelerated aging was not seen. d. Research revealed that those who developed severe Alcohol Use Disorder, even at an older age, still show accelerated loss in the frontal cortex of the brain.

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

NAADAC COMMITTEES

Updated 1/22/2019

North Central

STANDING COMMITTEE CHAIRS

Steven Durkee, NCAAC

President Diane Sevening, EdD, LAC, MAC

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

Awards Committee Chair Mary Woods, RN-BC, LADC, MSHS

International Committee Chair Elda Chan, PhD, MAC

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

PAST PRESIDENTS

President-Elect Mita Johnson, EdD, LPC, LAC, MAC, SAP Secretary Susan Coyer, MA, AADC-S, MAC, CCJP Treasurer Gregory J. Bennett, LAT, MAC Immediate Past President Gerard J. “Gerry” Schmidt, MA, LPC, MAC, LPC, CAC National Certification Commission for Addiction Professionals (NCC AP) Chair Jerry A. Jenkins, MEd, MAC Executive Director Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP REGIONAL VICE-PRESIDENTS Mid-Atlantic (Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)

Ron Pritchard, CSAC, CAS, NCAC II Mid-Central

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

William Keithcart, MA, LADC Northwest

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

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

Angela Maxwell, MS, CSAPC Southwest

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

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

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

Clinical Issues Committee Chair Mark Sanders, LCSW, CADC Ethics Committee Chairs Mita Johnson, EdD, LPC, LAC, MAC, SAP Rose Marie, MAC, LCADC, CCS Finance & Audit Committee Chairs Mita Johnson, EdD, LPC, LAC, MAC, SAP Gregory J. Bennett, LAT, MAC Membership Committee Chair John Korkow, PhD, LAC, SAP Student Sub-Committee Chair Deborah Fenton-Nichols, EdD, LPC, LAC, NCC Military & Veterans Advisory Committee Chair Ron Pritchard, CSAC, CAS, NCAC II Nominations and Elections Chair Gerard J. “Gerry” Schmidt, MA, LPC, MAC, LPC, CAC Personnel Committee Chair Diane Sevening, EdD, LAC, MAC Professional Practices and Standards Committee Chair Kirk Bowden, PhD, MAC, NCC, LPC

Gisela Berger, PhD, MAC, LPC, NCC Mid-South (Represents Arkansas, Louisiana, Oklahoma and Texas)

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

James C. Cates, MA, LCDC

AD HOC COMMITTEE CHAIRS

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP) Jerry A. Jenkins, MEd, MAC NCC AP Chair Alaska

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 2016-2018 Gerard J. Schmidt, MA, LPC, MAC

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 M. David Meagher, Esq. Public Member California Christina Migliara, PhD, LMFT, MAC, CAP, CASAC Florida Diane Sevening, EdD, LAC, MAC (ex-officio) South Dakota

NAADAC EDUCATION & RESEARCH FOUNDATION (NERF) NERF President Diane Sevening, EdD, LAC, MAC NERF Events Fundraising Chair Nancy Deming, LCSW, MAC, AADC-S

Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC

NAADAC REGIONAL BOARD REPRESENTATIVES NORTHEAST NORTH CENTRAL

MID-CENTRAL

Therissa Libby, PhD, Minnesota Tom Barr, LIMHP, LADC, Nebraska Megan Busch, LAC, LPCC, North Dakota Mark Young, South Dakota

Renee Lee, MSW, CADC, Illinois Stewart Ball, MAC, LCAC, LMFT, LCSW, Indiana Michael Townsend, NSSW, Kentucky Deborah Garrett, BS, CPRM, CPS, 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 Alexandra Hamel, MLADC, MAC, 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 Kerry Speed, MA, Oregon 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, MBA, MS, LADC, CAd, 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, LCDC, Texas

Sam Long IV, NCAC I, Alabama Bobbie Hayes, LMHC, CAP, Florida Donna Ritter, BT, CAC II, CCS, Georgia Tony Beatty, MA, LCAS, CCS, North Carolina James E. Campbell, LPC, CAC II, MAC, South Carolina Michele Squires, MS, LADAC II, MAC, QCS, Tennessee

Register Now!

NAADAC, the Association for Addiction Professionals invites you to its 2019 Annual Conference: Navigating the Addiction Profession in Orlando, FL from September 28 – October 3 at the Renaissance Orlando at SeaWorld.

Orlando, the “Theme Park Capital of the World,” is home to over a dozen theme parks, world-class golf courses, art galleries, shopping centers, major league sports teams, and a vibrant night life.

Don’t miss six days of education, training, networking, and capacity-building with thought leaders in the addiction profession! The conference will feature full-day preand post-conference sessions, a two-day SAP training, a two-day Conflict Resolution for Recovery training, five keynote speakers, over 60 breakout sessions, onsite bookstores, an Awards Lunch, an extensive Exhibit Hall, and exciting evening activities!

Don’t miss out on this important educational event!

REGISTER TODAY! For more information, please visit www.naadac.org/annualconference

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