SUMMER 2013 Vol. 1, No. 2
The Official Publication of NAADAC, the Association for Addiction Professionals
Spirituality:
Can It Help You in Your Practice? PAGE 18
Recovery-oriented Practice:
A Systems Perspective PAGE 22
Healing
the Addicted Brain PAGE 24
What is a Substance Abuse Professional?
What are the requirements? In order to be a SAP, you need to have certain credentials, possess specific knowledge, receive training and achieve a passing score on an examination. There is also a continuing education requirement.
A U.S. Department of Transportation Substance Abuse Professional (SAP) operates as a “gatekeeper” of the returnto-duty process and provides an important service to the employee, the employer and the traveling public. Specifically, Substance Abuse Professionals (SAPs) evaluate workers who have violated a U.S. Department of Transportation (DOT) drug and alcohol program regulation and make recommendations concerning education, treatment, follow-up testing and continuing care.
Each of these requirements is discussed below and is easily accomplished through NAADAC’s Substance Abuse Professional’s U.S. DOT Alcohol and Drug Testing Regulation Qualification Independent Study Course. 1
The applicant must have one of the following credentials: • Alcohol and drug abuse counselor national level certification through the NAADAC Certification Commission (NCC) or the International Certification & Reciprocity Consortium (IC&RC). Note: State level certification does NOT meet DOT requirements. • Alcohol and drug abuse counselors with MAC certification through the National Board of Certified Counselors (NBCC) • Licensed physician (Doctor of Medicine or Osteopathy) • Licensed or certified psychologist • Licensed or certified social worker • Licensed or certified employee assistance professional (EAP) • Licensed or certified Marriage and Family Therapist (MFT)
SAPs provide the following services for their clients: • Conduct comprehensive face-to-face assessment and clinical evaluation to determine what level of assistance the employee needs in resolving problems associated with alcohol use or prohibited drug use; • Recommend a course of education and/or treatment with which the employee must comply prior to returning to DOT safety-sensitive duty; • Serve as a referral source to assist the employee’s entry into an acceptable program; • Conduct a face-to-face follow-up evaluation with the employee to determine if the individual has demonstrated successful compliance with recommendations of the initial evaluation and has made appropriate clinical progress sufficient to return to duty; • Develop and direct a follow-up testing plan for the employee returning to work following successful compliance; and • Provide the employee and employer with recommendations for continuing care.
2
SAP applicants must possess knowledge of: • Clinical experience in the diagnosis and treatment of substance abuse-related disorders. • Understanding how the SAP role relates to the special responsibilities employers have for ensuring the safety of the traveling public.
Bookmark our website and use it as a professional resource!
www.naadac.org/SAP
• The nine required components laid out in Section 281 (c), Part 40 of the U.S. Department of Transportation’s agency regulations, SAP guidelines and any significant changes to the SAP guidelines. Note: Degrees and certificates alone do not confer to you these knowledge requirements. 3
SAP applicants must receive SAP training and pass a validated examination administered by a nationally recognized professional or training organization.
4
SAPs must complete 12 hours of professional development relevant to performing SAP functions during each subsequent three-year renewal period.
Mandated by the Department of Transportation (DOT) Generate new revenue Expand your services and clientele Free webinars on how to build your business and market yourself
Obtain this training through NAADAC’s Substance Abuse Professional’s U.S. DOT Alcohol and Drug Testing Regulation Qualification and Requalification Independent Study Course Substance Abuse Professional’s U.S. DOT Alcohol and Drug Testing Regulation Qualification Independent Study Course • Course includes a bound Learner’s Guide that covers all required information in an easy to learn style and includes sample forms to use in your practice. The initial qualification course includes a 100-item written examination, and subsequent re-qualification examinations are 25 questions and can be taken online. • Read the training materials at your convenience and submit the completed written examination or pass the online requalification exam anytime within 90 days of your receipt of the materials. • Upon passing the exam, receive: - A new Substance Abuse Professional (SAP) Qualification Certificate that affords you 3 years of maintenance-free ability to practice as a SAP - Certificate of Completion for 12 CEs that can be used towards renewing other professional credentials or licenses at the state and/or national level - A free listing on our website to help advertise your services
member
non member
$307
$407
Request an order form:
Call NAADAC at
800.548.0497
Email: naadac@naadac.org SAP Services on www.naadac.org/SAP
SAP Services on www.naadac.org/SAP
• Read detailed instructions and requirements for a Substance Abuse Professional (SAP) • becoming Read detailed instructions and requirements for or renewing your qualification
becoming a Substance Abuse Professional (SAP) or
• Search foryour SAPs by state through an interactive US map renewing qualification • Apply for your name to be listed on our website as • aSearch for free, SAPs or by for state through interactive U.S. map SAP for a fee if youan did not receive your qualification through NAADAC ($100 for members of • NAADAC; Browse a listing Employment–Agencies $150 of forSAP non-members contact NAADAC to apply)
• Read U.S. Department of Transportation
• Browse a listing of SAP Employment Agencies Regulatory Updates • Read U.S. Department of Transportation Regulatory Updates
Contents DEPARTMENTS
FEATURES
10
NAADAC 2013 Annual Confer-
ence Preliminary Program
5
Advocacy & Regulatory Change
Health Care Exchanges
6
Certification
NCC AP Moves to Monthly Testing
Advances in Addiction and Recovery, the official publication of NAADAC, is focused on providing useful, innovative and timely information on trends and best practices in the profession that are useful and beneficial for practitioners.
16
We Can Work It Out Leading
Addiction Organizations Talk Collaboration, Commitment to the Profession
18 7
Letters to the Editor Readers
Speak Out on NAADAC’s Position Statement on Medical and Recreational Marijuana
8
States News From
Around the Nation: Education, Awards and Community Action
9
Membership Your
Best Resource for Networking, Education, News and Support
The Spiritual ity of Connectedness as a Response to the Stress Reac tions in Substance Abuse Counselors
20
Clinical ConConsultations
Addressing Dilemmas in Ethics, Supervision and Treatment
22
Recovery oriented Prac- tice and the Addictions Professional: A Systems Perspective
Recovery is the Very Soul of Our Profession
24
Healing the Addicted Brain
31
NAADAC
Board of Directors
Welcome to the latest issue of Advances in Addiction and Recovery! We hope you enjoy it. Donovan Kuehn, Managing Editor
Addiction is a Chronic, Multifactorial — and Lifelong — Medical Disease of the Brain
28
Effective Inte grated Treat- ment Model for Military Based Trauma and Addiction Critical
Factors to Consider for Counseling Wounded Warriors and Their Families
Comments?
Send to Donovan Kuehn at dkuehn@ naadac.org
4 Advances in Addiction & Recovery | SUMMER 2013
SUMMER 2013 Vol. 1 No. 2
30
Mastering Essential Business Operations Learn-
ing Networks Attract More Than 800 Organizations Focused on Preparing for Health Care Reform
NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 75,000 addiction coun selors, educators and other addiction-focused health care pro fessionals in the United States, Canada and abroad. NAADAC’s members are addiction counselors, educators and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support and education. Mailing Address Telephone Email Fax
1001 N Fairfax Street, Suite 201 Alexandria, VA 22314 1.800.548.0497 naadac@naadac.org 703.741.7698
Managing Editor Donovan Kuehn Graphic Designer Elsie Smith, Design Solutions Plus Editorial Advisory Kirk Bowden, PhD Rio Salado College Committee
Alan K. Davis, MA, LCDC III Bowling Green State University
Carlo DiClemente, PhD, ABPP University of Maryland, Baltimore County
Rokelle Lerner Cottonwood de Tucson
Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP NAADAC, the Association for Addiction Professionals
Robert Perkinson, PhD Keystone Treatment Center
Robert C. Richards, MA, NCAC II, CADC III Willamette Family Inc.
William L. White, MA Chestnut Health Systems
We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Have a story idea or article that you’d like to submit? Contact Donovan Kuehn at dkuehn@naadac.org and share your story idea. Publication Guidelines ● Articles must be the work of the author(s) and not subject to copyright. ● Articles must not contain information that promotes unethical activities or business practices. ● Submissions can be from 500 to 3,000 words. Longer articles can be submitted in consultation with the editor. ● Submitted works must include citations and a bibliography, or be clearly marked as an opinion piece. ● Authors must submit a biography and photo to be appended to the article. Photos need to be at least 300 KB in size and in JPG or PNG format. NAADAC reserves the right to edit or condense any articles. Advertise With Us NAADAC accepts advertising placements. For more information on advertising, please contact Donovan Kuehn at dkuehn@naadac.org. Advances in Addiction and Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5 This publication was prepared by NAADAC, the Association for Addiction Professionals. Reproduction without written permission is prohibited. For more information on obtaining additional copies of this publication, call 1.800.548.0497 or visit www.naadac.org. Printed June 2013
Cover: monkey business | photospin.com
Health Care Exchanges You Can Help Your Uninsured Clients Get Coverage
Advocacy & Regulatory Change Essential Health Benefits 1 Ambulatory patient services 2 Prescription drugs 3 Emergency services 4 Rehabilitative and habilitative services and devices 5 Hospitalization 6 Laboratory services 7 Maternity and newborn care 8 Preventive and wellness services and chronic disease management 9 Mental health and substance use disorder services, including behavioral health treatment, and 10 Pediatric services including oral and vision care.
B y C ynthia M oreno Tuohy, NAADAC E xecutive D irector
The Substance Abuse and Mental Health Services Administration (SAMHSA), an operating division of the U.S. Department of Health and Human Services (HHS), has estimated that nearly a third of the people who lack health insurance are individuals with mental and sub stance use disorders. Expanded eligibility for Medicaid and the new health insurance exchanges may offer many of these individuals an opportunity to receive cov erage for the first time and access affordable, effective services to support treatment and recovery. There are challenges in enrolling individuals who have been uninsured because they are less informed about health coverage, its benefits and knowledge of how and where to enroll. NAADAC is working with the Centers for Medicare and Medicaid Services (CMS) and SAMHSA in disseminating marketing and educational materials that will be targeted to the newly eligible uninsured. Your connections to the treatment and re covering communities, and to the community at large, can help make a difference in enrolling these uninsured individuals.
Enrolling in Health Insurance Marketplaces (or Insurance Exchanges) ■ Enrollment starts October 1, 2013 ■ Coverage begins January 1, 2014 ■ Even working families can get help through the Mar
ketplaces (or Insurance Exchanges)
erwin wodicka | photospin.com
■ The Marketplaces are aimed at individuals and small
business as a tool to compare health insurance op tions, provide choices in affordable health insurance and pay lower costs. The plans are written in terms that are understandable to the individuals they are intended to serve. These insurers will be a “Qualified Health Plan” and will cover a core set of benefits called “Essential Health Benefits.” There are ten cat egories of “Essential Health Benefits” which include addiction treatment and recovery services as a part of the essential health benefits (see sidebar). ■ Individuals will have guaranteed coverage and renewability, regardless of pre-existing conditions (like cancer, substance use disorders or diabetes), gender or age. ■ Plans may be re viewed online and participants can sign up — through one application — via the internet.
■ Help will be available through a website, a call center,
community groups or individuals specifically desig nated as “navigators” to help the consumer. ■ As a small business employer (100 employees or less and, in some states, 50 employees or less) your program may be eligible to purchase insurance cov erage for your employees at a competitive rate. These programs are called “SHOP” administered by a qualified health plan in the Marketplace (Insurance Exchanges). ■ Some states are establishing and operating their own Marketplace, some states are working through the Federal Government and others are a hybrid. Connect with your local Secretary of State office to learn how the Marketplace is being set up in your state. ■ Consider having a “navigator” designated at your treatment and/or recovery program to help enroll in dividuals, provide outreach and raise awareness. Navigators will play a role in all types of market places, be funded through state and federal grant programs and must complete comprehensive train ing. Check with your state’s office of addiction and mental health to learn what the process is to enroll and be trained to be a “navigator.” ■ There will be “in-person assistance personnel” who will be funded through separate grants or contracts administrated by your state. In-person assistance personnel must also complete comprehensive train ing and will serve essentially the same role as a nav igator until those systems are in place. NAADAC will continue to be part of the SAMHSA Enrollment Coalitions Initiative and will be disseminat ing information through the NAADAC state affiliates. If you are not yet connected with your state affiliates, you can locate your state on the NAADAC website at www. naadac.org/affiliates. For information on the Affordable Care Act and enroll ment, please visit www.healthcare.gov/marketplace. Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals. She previously served as the Executive Director of Danya Institute and the Central East Addiction Technology Transfer Center and as Program Director for Volunteers of America Western Washington. In addition, she has over 20 years of experience serving as the administrator of multi-county, publicly funded alcohol/drug prevention/intervention/treatment centers with services ranging from prenatal care to the serving the elderly.
SUMMER 2013 Advances in Addiction & Recovery 5
NCC AP Moves to Monthly Testing Exams Will Occur More Frequently in Response to Your Requests B y S hirley B eckett M ikell , D irector
Certification
of
C er tification
The National Certification Commission for Addiction Professionals (NCC AP) and its partner the Professional Testing Corporation (PTC) have heard your concerns and are responding to your requests that we offer the NCC AP examinations at more frequent periods during the year. It is our hope that by offering the examinations monthly, you will be able to more quickly and effectively review applicants for your credentials and licenses. Over the past few years, this has been of major concern for many boards. As of October 1, 2013, all NCC AP examinations will be offered once each month during the first full week of each month. The new schedules for the remainder of 2013 are October 5 through October 12, November 2 through November 9 and December 7 through December 14. In conjunction with monthly examinations, we will also be instituting an online application process and payments by credit cards to provide faster and easier access for your candidates. For those state boards who wish to continue paying by check, this will be possible as well. The NCC AP will provide further information
Special course for those treating our Military! Special course for those treating our Military!
Unfortunate Hero: The Soldiers Path From Trauma nd and Addiction book 2 edition By Dr. Katie Evans, book only $20. Independent Home Study Course, NAADAC and NASW approved 40 CEUs, cost $179. Includes: Author autographed book, 2 client videos, open book true/false post quiz. To order this book or course, make checks payable to Dr. Katie Evans, Inc. Mail to Dr. Katie Evans, Inc, 19943 SW Jette Ln, Beaverton, OR 97006-2789, use debit or visa and fax form to 503-524-3778, email form to drkatieevans@yahoo.com. For more information or to order by phone, call 503-756-6117. All major credit cards accepted Visit www.drkatieevans.com for other NAADAC & NASW approved home studies. 30 CEU Dual Diagnosis Counseling the Mentally Ill Substance Abuser 30 CEU Treating Addicted Survivors of Trauma 15 CEU 5-Stage Recovery Model for PTSD and Addiction Include: name, address, city, state, zip, day phone, evening phone, credit card number, expiration date, and credit card verify number.
6 Advances in Addiction & Recovery | SUMMER 2013
about the online application system once it has been finalized later this year. We thank you for your patience and for your contin ued trust in our examination products as we work to implement this new process. There are more changes that we will be notifying you of in the near future. We are developing new examina tions and credentials that may be of use to your creden tialing and licensing processes. Thank you for your support and use of the NCC AP ex amination and credentialing products. For more information on credentialing, please visit www.naadac.org/certification. Shirley Beckett Mikell serves as the Director of Certification for NAADAC and has worked in the addiction profession for over 33 years. She began as a counselor in Charleston, S.C., where she also served as trainer, manager and mentor for fellow addiction professionals. Beckett Mikell is particularly skilled in the areas of ethics, confidentiality and group and individual counseling skills.
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Letters to the Editor Readers Speak Out on NAADAC’s Position Statement on Medical and Recreational Marijuana
Letters
Dear editor, Re: article “NAADAC Leadership Opposes Recrea tional Marijuana.” How is this for an analogy? Begin “prescribing” smoking cigarettes for tobacco’s nicotine stimulating effect for those with poor sleep, lethargy or mild depression? Peter C. Venable, MEd, LPC, LCAS Daymark Recovery Services Mt. Airy, N.C. Dear editor, You might consider changing the name of the magazine to Advances in Job Security. Both of your articles on mari juana were a repeat of the same emotional arguments that have been thrown out there for 50 years. I am a recovering addict and have not used for well over 25 years. I feel that I am able to be fairly objective on this issue. My main concern is that you are applying a different set of stan dards to so called “legitimate medicine.” “People who use marijuana are endangering their health” (p.5) OK, I can accept that. However, one could make the same statement about the psych meds that most of this pro fession supports, even though the risks are profoundly greater than for marijuana and the good they do is actu ally far less. The idea that the medical profession needs to study marijuana because they don’t know all of the risks in volved is hypocritical. Marijuana has been around for thousands of years and we do know the risks, which are minimal. And yet this same profession hands out SSRIs like candy when the risks of these drugs are definitely not known as some of them are less than 20 years old. Given the absence of any tissue pathology in any of the so called psychiatric “diseases,” the best we can go on is self-report. Who are we to doubt someone who says they get relief from depression, anxiety, etc. from marijuana? You might want to check out Kirsch’s study on SSRIs and their efficacy (http://psychrights.org/ Research/Digest/CriticalThinkRxCites/KirschandSapir stein1998.pdf ) “No sound scientific studies support medical use of marijuana… ” (p.6) If one critically examines the re search for psych meds, one cannot help but come to
the same conclusion. However, Big Pharma keeps this a secret and puts billions into the “Chemical Im balance” myth. I work with college students and 20 percent of the students at my university have smoked marijuana in the last two weeks. Three to four times that many have consumed alcohol, which no one could argue is more harmful. Why shouldn’t NAADAC be on the side of legal ization? Do we really want to keep putting these kids in jail for this? Other addiction professionals have told me that we should not be putting them in jail as they need treatment. The vast majority do not need treatment. These kids are not stupid and can see past the emo tional arguments we give them. I had one kid who point ed out that after being arrested twice in Montana for Possession of DANGEROUS DRUGS (cannabis) that he was told that he had a “disease.” He said that at home in Massachusetts, he would have had to pay two $25 fines and in Montana he had a disease that needed treatment. We are a joke to these kids and for good reason. I wonder what would happen if we were to stop lying to these people for a change? They then might not resent coming to us when they actually do develop a problem. Name Withheld Montana Dear editor, Referring to your article on NAADAC Leadership Op poses Recreational Marijuana (under Advocacy in Ad vances in Addiction and Recovery, Spring 2013 issue): I must commend NAADAC on the position you are taking on the increasing liberalization of marijuana use along with your position statement. Although it seems like an uphill battle, I believe that we in the addiction field need to stay true to the science, which shows minimal benefit from using mari juana. Over my years of working in the field, I have seen too much beginning with teenagers, all the way to older adults. I have seen the medical marijuana docs sign off on cards without really doing any type of real assess ments on those applying for the cards. Although now retired, I continue to advocate from a volunteer status. Again, good job and keep up the pressure. Ray Wilson, MS, NCAC-II (Retired) Keizer, Ore. What do you think about this or any other issue? Send your thoughts to Donovan Kuehn, Managing Editor, at dkuehn@naadac.org.
SUMMER 2013 Advances in Addiction & Recovery 7
News From Around the Nation Education, Awards and Community Action Come to the Fore
States
C ompiled B y D onovan K uehn , M anaging E ditor
NEVADA: NAADAC Member Elected President of IAAOC Former Nevada NAADAC affiliate President Larry Ashley, EdS, LCADC, CPGC, is the newly elected president of the International Association of Addiction and Offender Counselors (IAAOC). The IAAOC is an organization of professional counselors and other interested in dividuals who work in the addictions or forensic/criminal justice fields and advocate for the appropriate treatment for such client populations. ARIZONA: Bowden Receives Award From the American Counseling Association Dr. Kirk Bowden, director of Coun seling and Addiction Studies at Grand Canyon, NAADAC PresidentElect and a memb er of the Ad vances in Addiction and Recovery Editorial Adv iso ry Board, was re cently honored by the American Counseling Ass ociation (ACA) as winner of the Counselor Educator Advocacy Award. This award is giv en to an ACA member or members who have been involved in legis lative advocacy training and development. Dr. Bowden founded the counseling program at Grand Canyon in 2007, is concurrently the chair of the Addiction and Substance Use Disorder Program at Rio Salado College and is the chair of the Arizona Board of the Behavio ral Health Examiners (AzBBHE). The Award was presented at ACA’s annual conference in Cincinnati, Ohio. INDIANA: Affiliate President Lauds Educational Experience Indiana Association for Addiction Professionals (IAAP) President C. Albert Alvarez, LMHC, LCAC, MAC, CGP, reported that participants in the affiliate’s 2013 Spring conference called the meeting “Fantastic,” “Wonderful Presentation,” “Best Conference Ever” and a “Great Educational Experience.” The Spring conference highlighted the latest in brain research and provided a foundational understanding of what the addiction recovery profession can do today in conflict resolu tion in recovery. Cynthia Moreno Tuohy was the trainer for this session. OHIO: Opioid Death Rate Slows; Much Work Remains The Ohio Departments of Health (ODH) and Alcohol and Drug Addiction Services (ODADAS) announced that while the percent of in crease in deaths tied to opioid drug overdoses in 2011 was cut in half from 2010 (from a 26 percent increase in 2010 to a 13 percent in crease in 2011), the total number of unintentional poisoning deaths in 2011 — 1,765 — is still unacceptably high. “The slowed increase provides a ray of hope but underscores just how much work still needs to be done to free Ohio from the prescrip tion drug overdose epidemic and the resulting growth of heroin use and overdoses,” said Dr. Ted Wymyslo, Director of the Ohio Depart ment of Health. “Prescription drug abuse is a complex substance abuse issue and we are attacking on several different fronts.” In 2011, the year represented by the new data release, Ohio laid the framework for slowing the abuse of prescription drug abuse by 8 Advances in Addiction & Recovery | SUMMER 2013
closing the “pill mills” in southern Ohio and expanding addiction treat ment options, including accessibility of medication-assisted treat ment. Other major strategies were implemented in 2012, including the development of emergency room and urgent care opiate prescrib ing guidelines; a pilot Naloxone education and distribution program in Scioto County and drug drop box projects in conjunction with ODH, ODADAS and the Ohio Attorney General’s office. For the full analysis of Ohio’s drug overdose death data from 2011, visit www.healthyohiopro gram.org/vipp/data/rxdata.aspx. NORTH CAROLINA: NAADAC Affiliate Works With Community Organizations to Block “Stout 21” Various North Carolina organi zations and citizens, including members of the Addiction Pro fessionals of North Carolina, suc cessfully urged the ABC (Alcoholic Beverage Control) Commission to reject the approval of the alcohol product, Stout 21, described as a “shot in a tube.” Wanda Boone of Durham Together for Resilient Youth (T.R.Y) described the concerns: “These products put our low-wealth com munities in great harm. These communities that already have high concentrations of alcohol outlets (convenience stores), increased rates of crime and chronic disease [and] do not need another dan gerous alcoholic product to worsen the myriad problems that exist.” Reports Ezzell, “This was a seminal moment for APNC. Thanks to Phil Mooring and others, we were notified of the issue and quickly became part of an effective coalition that went up against the Stout 21 manufacturers and their team of attorneys. This is how an effec tive advocacy effort is supposed to work. With this victory, I think APNC begins to establish itself as the effective and informed advo cacy voice of North Carolina substance abuse professionals.” FLORIDA: WestBridge Summit Leads to the Development of a New Co-occurring Disorders Resource In March, Shirley Beckett Mikell and Cynthia Moreno Tuohy pre sented a report on co-occurring initiatives to the Learning Community on Co-occurring Integration (COSIG Learning Community), a voluntary collaboration among states that includes the Substance Abuse and Mental Health Services Administration (SAMHSA), leaders in the field of co-occurring disorders and individuals invested in systems level change processes. The report’s recommendations were developed at a two-day summit of national thought leaders on Co-occurring Disorders, hosted by WestBridge in March 2012, in an effort to formu late a co-occurring disorders scope of practice, competencies and future innovations to guide professionals in the delivery of services to people who experience co-occurring mental illness and substance use disorders. This initiative was co-sponsored by NAADAC, Dart mouth Psychiatric Research Center, Hazelden and SAMHSA.
Enhancing Your Professional Identity NAADAC Membership can be Your Best Resource for Networking, Education, News and Support
Membership
B y K atie K rieger
In an economy with continuous budget cuts, minimal job security and unpredictable changes in the ad dictions workforce, professional identity is more im por tant than ever. Staff retention, turnover and education continue to be concerns in the addictions community. NAADAC, the Association for Addictions Professionals, aims to address these issues by creat ing an outlet for professionals to be supported, grow and build an identity.
National Connections A major part of maintaining professional identity is belonging to a network and making connections. Having the support of a national organization is key to standing out. A student member who joined NAADAC says, “I feel like I have somewhere to go if I have any questions. By being active in my local chapter I have far more contacts then I would have if I was not a mem ber.” NAADAC members not only have an outlet for support, but they also have opportunities for actively participating in their affiliate by becoming a board mem ber, a guest speaker or a contributor to NAADAC’s pub lications. Each of these qualifications will enhance your professional identity or create an opportunity for growth in the field.
The Education Advantage The field is constantly evolving with new research, studies and findings. Especially with new healthcare laws initiating in 2014, it is important to stay up-to-date on the most current information related to the profes sion. NAADAC offers a quarterly magazine, Advances in Addiction and Recovery, weekly email updates and a newsletter, all of which provide information on new studies and updates. NAADAC member Ashley says, “I love the ‘breaking news’ and latest research informa tion sent to me electronically. It keeps me updated on all of the hard work and dedication of the professionals in this field.” In addition to news updates, NAADAC offers mem bers continuous online education with notable speak ers and researchers. NAADAC member Joe says, “NAADAC’s webinars have given me a national perspec tive and invaluable resources for a fast evolving sec tor.” If you are working toward your license or maintain ing your credentials, you will need to continue earning a certain number of CE credits annually. Members can view webinars for free and earn over 75 CE credits on line. Webinar topics include neurochemistry, adoles cents, ethics, spirituality, peer recovery, CBT and many more issues relevant to addiction-focused profession
als. If you fall behind on education and updates in the field, you may lack the knowledge you need to support your clients, so staying informed is crucial.
We Fit Where You Are Addictions professionals at any level of practice are welcome to join NAADAC. A NAADAC student member says, “I joined NAADAC because I am just starting out in the field. I am a student member and actually joined my first semester in college. I am about to finish my third semester and my practicum and apply for my counselor intern license.” Those seeking certification can receive discounts on materials and tests, and guid ance through the certification process. Veterans of the field who become members will stay connected through events, networking and other available opportunities in the organization.
Eventful Networking Networking outlets are also available through undreds of events and conferences around the h nation. Annually, NAADAC invites members and nonmembers to the Advocacy Leadership Summit and the NAADAC National Conference, offering discounts on flights to this year’s location, Atlanta, Ga. Other events that may appear in your state include retreats, conferences and workshops related to professional addictions education. A well-rounded professional identity entails staying up-to-date on research in the field, maintaining con nections within the addictions profession and being knowledgeable for clients. A NAADAC membership is your best resource for networking, education, news and support. Katie Krieger is the Training and Professional Development Coordinator at NAADAC. Krieger combines her experience with addiction professionals and with media by managing social media, including Facebook, Twitter and Linkedin, for the organization. After receiving her Bachelor’s degree in psychology, Katie worked in the field of child welfare for two years in Florida. As a Child Welfare Case Manager, she worked alongside substance abuse counselors, addictions professionals and clients battling substance addiction and mental health issues. Krieger also works in journalism in Northern Virginia where she assists with promotions, event planning and photography. Contact her at kkrieger@naadac.org.
SUMMER 2013 Advances in Addiction & Recovery 9
REG I S T E R TO DAY ! E A RLY B I R D R AT E E N D S AU G U S T 1 2 , 201 3
NAADAC Annual Conference
Preliminary Program October 11–14, 2013
Atlanta, Georgia
InterContinental Buckhead Atlanta Ready to be Seen?
Connecting the Profession: Building a Healthier Future
A T L NAADAC 2013 N T A
The NAADAC annual conference is the perfect place to highlight your business. To download the conference prospectus, please v isit www.naadac.org/conferences. To exhibit and participate in other marketing prog rams please cont act Leslie R inge, Account Executive for the NAADAC Annual Conference Marketing Program. Phone 215.343.7363 Fax 215.249.4741 or send an email to leringe@verizon.net. For full details on exhibiting at the 2013 NAADAC conference, visit www.naadac.org/ conferences#exhibit.
Educational Tracks Clinical Supervision Clinical Techniques Co-occurring Disorders / Dual Diagnosis Cultural Competence / Special Populations Education and Professional Development Management and Administration Ethics Prevention Trauma and Addiction
10 Advances in Addiction & Recovery | SUMMER 2013
nation and an evening event for the NAADAC Political Action Committee (admission by donation). Also included will be optional evening events, to allow you to earn more education credits or to enjoy your time in Atlanta.
Continuing Education Credit Approval All continuing education provided by NAADAC at the 2013 Annual Conference has the following approval and acceptance: NAADAC Approved Provider #189 NBCC Approved Provider #5703 OASAS Approved Provider #380 Social Work Approved #d-5098 CAADAC approval (under application) American Probation and Parole Association Full details at www.naadac.org/conferences.
© 2013, kevin c. rose | atlantaphotos.com
© 2013, kevin c. rose | atlantaphotos.com
Education You Need The NAADAC annual conference will provide a well-balanced Explore Atlanta! educational experience focusing Atlanta is a world-class, modern city with a on the needs of addiction-focused rich, passionate history. It is one of only two cities in the world to lay claim to two Nobel professionals. Peace Prize winners — Martin Luther King, Innovative sessions and cuttingJr. and former President Jimmy Carter. The Olympic Park, the Martin Luther edge presenters will provide education Earn Up to 32 Continuing Education Centennial King Jr. National Historic Site and the excityou need to get ahead in your job and Credits ing arts and entertainment spots are just a few The NAADAC Annual Conference will inof the attractions to take advantage of while clude keynote speakers, daily plenary sessions provide the hours you need for your in Atlanta to earn your education credits and breakout workshops. October 11 will feacertification or license. from the profession’s thought leaders. With ture several all-day, pre-conference seminars. October average temperatures in the range The conference will also feature an Awards You can pick a track or attend the of 53 to 74 degrees, Atlanta’s summer heat is Dinner which will honor outstanding addicsessions that are the best fit for you. gone and a lovely fall should be in swing. tion-focused professionals from around the
Preliminary Agenda*
SATURDAY, OCTOBER 12, 2013
FRIDAY, OCTOBER 11, 2013
6:30 am Fun Run/Walk
(Up to six continuing education credits) 7:30 am to 7 pm Registration 8:30 am to 5 pm Pre-conference Sessions PRE-CONFERENCE: De-mystifying Health Reform, Managed Care and Joining Insurance Panels: How Behavioral Health Funding Works and How to Make it Work for You Track: Management and Administration Presented by Jim Clarkson This presentation will offer administrators, managers, clinicians and front line staff a behind-the-scenes look at how managed care and insurance companies work and will provide concrete strategies to maximize provider opportunities in the current behavioral health landscape and with the advent of the Patient Protection and Affordable Care Act. We will provide an understanding of the health reform law along with various models of reimbursement, partnership strategies, evidence-based practices, performance incentives as well as describing how innovative community partnerships, engagement of clients, clinical practice, data collection/EHRs and billing practice can all align for sustainability and financial strength. We will walk through an actual application to join a behavioral health provider panel and provide strategies for addressing barriers and overcoming common negative responses from managed care’s provider relations departments regarding new provider applications. Each participant will have the opportunity to discuss their unique questions and curiosities in a safe environment about a topic that is often confusing and ever-changing — with a former managed care executive who also has a background as an addiction professional — and get help developing an “action plan” to implement strategies discussed in the seminar. Although the topic is serious and often detailed — the presenter always tries to inform, engage, inspire and describe examples of how recovery and wellness both personally and professionally are key signposts to how well an agency can grow and thrive fiscally. PRE-CONFERENCE: Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know Track: Co-occurring Disorders Presented by Mary Ryan Woods, RNC, LADC, MSHS This skill-based training program will help addiction counselors improve their ability to assist clients who have co-occurring disorders, within their scope of practice. This educational program will introduce the integrated model of mental health and addiction treatment services, outlining how to utilize current substance abuse treatment best practices when working with this population. Through the use of case studies and interactive exercises, participants will feel more comfortable and competent in addressing mental health issues with clients who have co-occurring disorders. 5:30 to 7:30 pm Welcome Reception
*Agenda subject to change without notice For full workshop descriptions, visit www.naadac.org/conferences
(Up to eight continuing education credits)
8 am to 5 pm Registration Open 8:30 to 10 am OPENING KEYNOTES: Effective Prevention and Treatment of Substance Abuse Track: Prevention Presented by Frances Brisbane, PhD, MSW and Vincent “Peter” Hayden, PhD Effective prevention and treatment of substance abuse and addiction responds best when culture is factored into the process. Being aware and respectful of cultural differences among individuals as well as their sameness, in many ways, makes for good medical and social outcomes. While most people develop the disease of alcoholism in a general progression medically, the prevention and treatment need to respond to individual and group cultural behaviors, mores, beliefs and other historical and legacy determinants. Social service, human service, alcoholism and drug prevention and treatment agencies, which have as a goal the practice of culturally competent care, can effect ively meet the needs of their multicultural clients/patients. 10 am Exhibit Hall Kick Off 11 am to 12:30 pm MORNING BREAKOUT SESSIONS Track: Clinical Techniques Utilization of the Prescription Drug Monitoring Program (PDMP) by Addiction Professionals to Combat the Prescription Drug Abuse Epidemic: An Argument for Direct Access – Kurt Snyder, MMGT, LAC, LSW Track: Clinical Techniques Treatment of Chronic Pain: Establishing the Mind-body Connection – Del Worley, MC, LPC, LISAC
Where You’ll be Staying InterContinental Buckhead Atlanta 3315 Peachtree Rd., NE, Atlanta, GA 30326 Toll free: 1.888.424.6835 A landmark of sophisticated luxury and warm southern hospitality, the InterContinental Buckhead Atlanta offers the premier hotel experience in Atlanta and a heritage of excellence, which has been recognized with the distinguished AAA Five Diamond Award. The InterContinental Buckhead Atlanta is only seven miles to Atlanta and close to shopping, dining, entertainment and top city attractions, including Centennial Olympic Park, Lenox Mall, Phipps Plaza, the Georgia Aquarium, the CNN Studio Tour and the New World of Coca-Cola. If people back at the office need you, the hotel includes a full service business center and free Internet is included with your room reservation. Rooms are $149 per night plus applicable taxes for rooms booked by September 16, 2013. Register online by visiting www. na adac.org/con ferences or cont act t he Reser v at ions Department at 404.946.9191 or 1.877.422.8254 toll-free and let them know you are with the NAADAC meeting in order to receive your special group rate.
SUMMER 2013 Advances in Addiction & Recovery 11
Track: Clinical Supervision When We Get Behind Closed Doors. Clinical Supervision Practice for Client Protection and Clinician Growth – Alan Lyme, LCSW, ICCS, ICADC Track: Clinical Supervision Transformational Supervision: Investing in the Next Generation – Mita Johnson, LPC, LMFT, ACS, AAMFT-approved Clinical Supervisor, LAC, MAC and Anne M. Hatcher, EdD, CAC III, NCAC II Track: Education and Professional Development Moodle, MOOCs and Mobile Applications: It Is Your Turn to Discover the Power of Learning Online – Laurie Krom, MA Track: Special Populations Adult Felony Drug Court Programs: A Community’s Experience – Andrew A. Cox, MSW, EdD, MAC, CRC Track: Management and Administration A New Legacy for Addiction Professionals – Diane Sevening, EdD and Vena Schexnayder, MA Track: Special Populations Student Assistance Programs: Help and Healing Through the Educational System, Thirty-three Years Later 1980–2013. Who Will Take Our Place? – Cheryl Watkins, MD
Getting to Atlanta The nearest airport, Hartsfield-Jackson Atlanta International Airport (ATL), is only 19 miles to the hotel. To contact the airport, call 404.530.6600 or visit www.atlanta-airport.com. Nearly 80 percent of the country is within a two-hour flight of the Hartsfield-Jackson Atlanta International Airport, which has nonstop service to 151 U.S. destinations. Airlines that serve the airport include AirTran Airways, Air Canada, American Airlines, Alaska Airlines, Delta Air Lines, Frontier Air Lines, GeorgiaSkies, Southwest Airlines, Spirit Airlines, United Airlines and US Airways. Save Money on Your Airfare To help reduce costs, NAADAC has negotiated discounts with two national airlines: American and United. A m e r ic a n A i r l i n e s : NA A DAC has partnered with American Airlines to provide our attendees with a 5% discount off ANY published airfare on www.aa.com for the conference in Atlanta. The valid travel dates for this discount are October 7 to 17, 2013. Apply this discount by going to www.aa.com to book your flight. Place the code 695H3BI in the promotion code box and your discount will be calculated automatically. This special discount is valid off any applicable published fares listed for American Airlines, American Eagle and American Connection. United A irlines : Earn a 2–10% discount (depending on the type of ticket) when coming to the NAADAC conference in Atlanta on United Airlines between October 8 and 17, 2013. Book online at www.united.com and enter ZNF5582220 in the Offer Code box when searching for your flights. For full details, visit www.naadac.org/conferences. Renting a Car? Save With Your Avis Conference Discount If you’re renting a car during your stay in Atlanta, use this Avis Worldwide Discount (AWD) Number: D016314 when calling them directly at 1.800.331.1600. Or if you plan to book online, visit www.naadac.org/conferences for more information.
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2:30 to 4 pm AFTERNOON BREAKOUT SESSIONS Track: Trauma and Addiction Shame, Addictions and Post Traumatic Stress Disorder (PTSD) – Stefan J. Malecek, PhD, CADC III, MAC Track: Special Populations The Circle of Strength – Yvonne Fortier, MA, LPC, LISAC Track: Ethics The Ethical Self: Who Am I Now? – Anne M. Hatcher, EdD, CAC III, NCAC II, and Mita Johnson, LPC, LMFT, ACS, AAMFT-approved Clinical Supervisor, LAC, MAC Track: Education and Professional Development SUD Counselors on the Job: A Bi-directional Workshop on New Data on Job Satisfaction and Utilization of Medication-Assisted Treatment – Paul M. Roman, PhD, and Dail L. Fields, PhD Track: Education and Professional Development Recovery to Practice – Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP Track: Management and Administration Adapting to New Funding and Regulations Under the Affordable Care Act – Kim Johnson, MBA Track: Special Populations and Prevention Delivering High Quality Student Assistance Services: The Introduction of a National Credential – Andrew Finch, PhD and Carol Nixon, PhD Track: Education and Professional Development NASAC: Academic Accreditation Update – Don Osborn, PhD 4:30 to 5:05 pm AFTERNOON KEYNOTE: Through a Child’s Eyes and a Special Presentation by Chris Herren Track: Special Populations Presented by Jerry Moe, MA, MAC, CET II Kids have a unique perspective in viewing the world. While it’s long been held that alcoholism and other drug addiction are a family disease, there are few opportunities for young children to be an integral part of the treatment and recovery process. Come learn how children see addiction in their families. More importantly, witness how they embrace the healing process. There is much hope when we treat the whole family. 5:05 to 5: 30 pm Basketball Junkie Track: Special Populations Presented by Chris Herren Chris Herren has struggled with substance abuse for much of his basketball career. He shares his harrowing story of abuse and recovery in his memoir, Basketball Junkie, as well as in numerous interviews throughout the Emmy Award nominated ESPN documentar y Unguarded. Herren will draw on his own history to show that it is never too late to follow your dreams and overcome your setbacks and start making the right choices. 5:45 to 7:45 pm Political Action Committee Reception Come support the largest and oldest Political Action Committee dedicated to the education and working for the interests of addictionfocused professionals. The PAC Reception will feature candid remarks from former NBA player Chris Herren. Suggested donation: $35. 7 to 9 pm Movie Night Watch films and videos dealing with the critical issues of prevention, treatment and recovery from addiction.
For full workshop descriptions, visit www.naadac.org/conferences
SUNDAY, OCTOBER 13, 2013 (Up to six continuing education credits) 6:30 am Fun Run/Walk 7:30 am to 5 pm Registration Open 7:30 to 8:30 am Continental Breakfast 7:30 am to 8:30 am Regional Caucuses 8:30 am MORNING PLENARIES: Marijuana: What the Internet Won’t Tell You Track: Clinical Techniques Presented by Allan Barger, MSW This presentation addresses the new reality in which professionals find themselves with the renewed acceptance of marijuana use, including legalization. While the public has come to view marijuana as harmless, a growing body of research suggests otherwise. This presentation will cover five areas of risk supported in the research and thoughts will be added on two policy issues that impact clinical work: medical marijuana and legalization. Based on the research presented earlier, some thoughts on addressing these issues will be considered. 10:30 am to noon Track: Education and Professional Development Presented by David Mineta, Deputy Director of Demand Reduction (invited), Office of National Drug Control Policy Mr. Mineta oversees ONDCP Office of Demand Reduction which focuses on promoting drug prevention and drug treatment programs, as well as the agency’s newly created focus on programs for individuals in recovery from addiction. MORNING BREAKOUT SESSIONS Track: Trauma and Addiction The Interplay of Trauma and Addiction in the LGBTQI Community – Jeff Zacharias, LCSW, CAADC, RDDP Track: Clinical Techniques Denormalizing Tobacco Use: Improving Quality of Care in Addiction Services – Anthony (Tony) Klein, MPA, CASAC, NCAC II Track: Co-occurring Disorders Diagnosing and Treating Co-occurring Substance Use and Mental Disorders – Frances Patterson, PhD, LADAC, MAC, BCPC, CCJAS, QSAP, QCS Track: Management and Administration Developing Leadership in Your Organization Through Mentoring – Sherri Layton, MBA, LCDC, CCS Track: Special Populations Latino Behavioral Health: Cultural Challenges and Solutions – Pierluigi Mancini, PhD, NCAC II, CCS Track: Education and Professional Development Creating Challenging Learners: Helping Students Evaluate Their Substance Abuse Biases/Myths and Becoming Open to Scientific Learning – Stephanie Elias Sarabia, PhD, LCADC, LCSW Track: Special Populations HIV and AIDS – Rosamuel Dawkins, Jr., MD Track: Management and Administration Leadership Orientation – Robert C. Richards, MA and Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP Noon to 1:30 pm Regional Caucuses
1:30 to 3:30 pm AFTERNOON BREAKOUT SESSIONS Track: Clinical Techniques The Young Adult: Yes, We Know, They Don’t Get It – Allison L. Hilborn, CADC, Marriage and Family Therapist Intern Track: Education and Professional Development Eating Disorders and Brain Neurochemistry – Rebecca Cooper, MFT, LPCC, CEDS Track: Ethics Ethics and Boundaries (part 1 of 2) – Jim Seckman, MAC, CACII, CCS Track: Education and Professional Development Kick Butts, Take Names: A Multi-Faceted Response to the Challenge of Tobacco Cessation – Joanna Cummings, MEd, LMHC, LADAC Track: Trauma and Addiction Dancing Mindfulness: A Community Practice for Enhancing Body-Based Coping Skills (part 1 of 2) – Jamie Marich, PhD, LPCC-S, LIDCD Track: Special Populations and Prevention Expanding Services to Children and Families in FDCs: Lessons Learned from the Children Affected by Methamphetamine Grant Program – Nancy K. Young, PhD Track: Education and Professional Development Addiction Instruction and the Recovering Student – Kathy A. Elson, MS, PCC-S., LICDC, SAP Track: Clinical Techniques A New Model in the Addiction Recovery Spectrum...Recovery Residence Levels: Effective Discernment, Assessment and Placement – Beth Fisher, LCSW, LCAS, MAC, CCS, and George Braucht, LPC 1:30 to 3:30 pm AFTERNOON BREAKOUT SESSIONS Track: Education and Professional Development A Holistic Approach to Coping With Professional Stress Reactions in Addiction Professionals – Christopher Shea, MA, CRAT, CAC-AD Track: Clinical Techniques How to Engage Highly Resistant Adolescents in the Process of Treatment and Recovery – Elizabeth Driscoll Jorgensen, CADC Track: Ethics Ethics and Boundaries (part 2 of 2) – Jim Seckman, MAC, CACII, CCS Track: Trauma and Addiction Dancing Mindfulness: A Community Practice for Enhancing Body-Based Coping Skills (part 2 of 2) – Jamie Marich, PhD, LPCC-S, LIDCD Track: Co-occurring Disorders Treating Eating Disorders: Addiction or Mental Illness? – Marty Lerner, PhD, Licensed Clinical Psychologist Track: Prevention The Strategic Prevention Framework: An Integrated Model for Substance Abuse Prevention Planning – Janice Petersen, PhD Track: Education and Professional Development NCC AP: What Does it all Mean? An Introduction to the World of Certification – Kathryn Benson, LADC, NCAC II, QSAP, QSC Track: Education and Professional Development The Gatekeeper vs Student Assistance Role of Addiction Studies Educators – Alan Cavaiola, PhD, LCADC, Kirk Bowden, PhD, and Joan E. Standora, PhD, LADC, CASAC 5:30 to 7:30 pm NAADAC Awards Dinner Track: Education and Professional Development Invited guest speaker: H. Westley Clark, MD, JD, MPH, CAS, FASAM, Director, Center for Substance Abuse Treatment (CSAT) Join us as we celebrate the best of the profession! NAADAC will recognize professionals from around the nation as it presents the NAADAC awards for outstanding contributions to the profession.
For full workshop descriptions, visit www.naadac.org/conferences
SUMMER 2013 Advances in Addiction & Recovery 13
MONDAY, OCTOBER 14, 2013 (Up to six continuing education credits) 6:30 am Fun Run/Walk 7:30 am to 5 pm Registration Open 7:30 to 8:30 am Continental Breakfast 8:30 to 10 am MORNING PLENARY: The New ASAM Criteria – What’s New and How the ASAM Criteria Helps You Re-Form for Healthcare Reform Track: Management and Administration Presented by David Mee-Lee, MD The ASAM Criteria are the most widely used and comprehensive set of guidelines for assessment, service planning, and placement in the treatment of addictive disorders. A new edition will be released October 24, 2013. This presentation will inform participants of what is new since the last edition ASAM PPC-2R, 2001. With the Affordable Care Act (ACA), there will be many more people eligible for addiction treatment in both treatment programs, but even more, in general healthcare settings where the customers really are. This presentation will also suggest how clinicians, programs and systems can use The ASAM Criteria to re-form and respond to the clinical, financial and administrative demands for change. 10:30 am to noon MORNING BREAKOUT SESSIONS Track: Co-occurring Disorders Addiction: It’s a Brain Disease...and It Gets Complicated – Navjyot Singh Bedi, MD Track: Clinical Techniques Marijuana: Does it Have to be Toxic to be Debilitating? Teasing out Marijuana Fact from Fiction, a 2013 Health Perspective – Pete Katz, BA, LCDC, ADC Level III Diplomate, ICADC Track: Special Populations Employment Issues and Trends Affecting Veterans, Persons in Recovery, the Mentally Ill and Ex-Offenders – Cheryl A. Brown, MHR, SPHR, CM; Certified Recovery Support Specialist (CRSS) Track: Clinical Techniques The Spiritual Platform – Jeff Georgi, MDiv, MAH, LPC, LCAS, CCS, CGP Track: Education and Professional Development The Hidden Dynamics of Addiction – Johnny Patout, LSAC, LCSW, CEO Track: Education and Professional Development Thinking Out of the Box: Thoughts on Teaching Group Counseling Skills – Lisa K. Ray, MS, LADAC, ADC, CCS, CCDP-D, CPS, CCGC 1:30 to 3 pm AFTERNOON BREAKOUT SESSIONS Track: Education and Professional Development A Second Chance at College: How On-Campus Recovery Programs Are Changing the Face of Addiction Treatment – Robert Ferguson, Founder and CEO of Jaywalker Lodge Track: Education and Professional Development A Comprehensive Model of Addiction Treatment – Philip Herschman, PhD Track: Trauma and Addiction Establishing Safety: Addressing Trauma in Patients in Early Recovery – Neera Gupta, MD Track: Trauma and Addiction Powerful Solutions for Addictions Treatment: The Intersection of Addictions Medicine and Energy Medicine – Mary Hammond, MA, LPC, DCEP, EMDR Adv.
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Track: Special Populations Cultural Competency Training: Providing Affirmative Services to Lesbian, Gay, Bisexual, Transgender and Orientation Questioning Clients – Phil McCabe, CSW, CAS, CDVC, DRCC Track: Clinical Techniques Sexuality and Substance Abuse: Connections to Women’s Recovery – Raven James, PhD 3:30 to 5 pm CLOSING KEYNOTE: Uppers, Downers, All Arounders: Current Trends in Substance Abuse and/or Evolving Science of Addiction and Recovery Track: Education and Professional Development Presented by Darryl S. Inaba, PharmD, CADAC III Dr. Inaba will discuss the wide variety of new synthetic and natural chemicals that are recently being abused. This will include synthetic cannabinoids, “Bath Salts,” prescription opiates, Kratom, “shake and bake” methamphetamine and others. The discussion will include the toxic and addiction characteristics of these substances, including how they impact recovery and treatment. Evolving science of addiction and recovery will discuss the neuro-scientific developments in understanding the processes of addiction and recovery including craving and relapse.
TUESDAY, OCTOBER 15, 2013 POST-CONFERENCE WORKSHOPS Half-day Session: 8:30 am – noon; three continuing education credits Medication Assisted Treatment and Recovery (MATR) Track: Clinical Techniques Presented by Misti Storie, MA Disulfiram (Antabuse), oral naltrexone (ReVia/Depade), acamprosate (Campral) and injectable naltrexone (Vivitrol) are diverse medications that have different purposes and ways of working in the brain. This course provides a comparison of the four FDA-approved pharmacotherapies to help treat alcohol dependence and presents strategies for overcoming treatment obstacles, matching patients to the most appropriate therapy, motivating patients in treatment and building cooperative relationships between addiction professionals and prescribers. Full-day Session: 8:30 am – 4:30 pm; Six continuing education credits Screening, Brief Intervention and Referral to Treatment (SBIRT) Track: Clinical Techniques Presented by Gerry Schmidt, MA, MAC Substance use is associated with physical and emotional health problems, alcohol-related traffic crashes, alcohol- and drug-impaired driving, accidents and violence. Addiction professionals can identify and intervene early before substance use results in adverse consequences or they become alcohol or drug dependent. SBI uses a brief, valid, scientific, screening (five minutes or less) to identify whether substance use places an individual at risk for negative consequences. Depending on the results from the screening questions, the addiction professional may provide health education, simple advice, motiva tional counseling, help with an action plan or a referral for treatment. Full-day Session: 8:30 am – 4:30 pm; Six continuing education credits Conflict Resolution in Recovery Track: Clinical Techniques Presented by Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP This seminar has been designed to provide an effective, costefficient, feasible model for improving clients’ conflict resolution knowledge, attitudes and skills and to help reduce relapse and sustain recovery of clients. This session will provide resources that are easy to use and integrate into existing community residential, intensive in patient and outpatient substance abuse treatment facilities, school and faith-based counseling groups.
NAADAC 2013 ANNUAL CONFERENCE Registration Form Pre-conference Registration Fees: October 11 Member
❑ $150
Non-Member
❑ $200
Student/Associate Member/ Active Military Member Student/Associate Member/ Active Military Non-Member
Attendee Information (please print clearly)
❑ YES, I want to join NAADAC now! Please consult www.naadac.org for membership fees or call 800.548.0497 to enroll.
❑ $150
❑ Please send me additional information about membership. ❑ $200
Please check which session you plan to attend: ❑ De-mystifying Health Reform, Managed Care and Joining Insurance ❑ Integrating Treatment for Co-occurring Disorders
Total Amount Enclosed_ ______________________________ ❑ This is my first NAADAC Training/Conference NAADAC/GACA, INCASE or NALGAP Member #_ ________________________ Name:_____________________________________________________________
Conference Registration Fees: October 12–14 Early Bird
Regular Fees
(register by August 12)
(register after August 12)
Member
❑ $375
❑ $425
❑ $150
Non-Member
❑ $500
❑ $550
❑ $175
N/A
❑ $250
❑ $150
N/A
❑ $400
❑ $175
Student/Associate Member/Active Military Member Student/Associate Member/Active Military Non-Member
Daily Rates Sat., Sun, or Mon.
Post-conference Registration Fees: October 15 MATR Half-day Session Full-day Sessions 8:30 am – noon 8:30 am – noon Member Non-Member Student/Associate Member/Active Military Member Student/Associate Member/Active Military Non-Member
Address:___________________________________________________________ City: ____________________________________ State: ____ Zip: _________ Phone: ( )_______________________________________________________ Fax: ( )_________________________________________________________ Email:_____________________________________________________________
Payment Options Please return check or money order by mail to: NAADAC 1001 N Fairfax Street, Suite 201 Alexandria, VA 22314 (Make checks payable to NAADAC)
❑ $75
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Or pay by credit card: ❑ Visa ❑ MasterCard ❑ American Express Fax to: 800.377.1136
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Name as appears on card_ __________________________________________ (please print clearly)
❑ $100
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Please check which session you plan to attend: ❑ Medication Assisted Treatment and Recovery (MATR) ❑ Screening, Brief Intervention and Referral to Treatment (SBIRT) ❑ Conflict Resolution in Recovery
Credit card number_ ________________________________________________ Expiration date ____________ Signature__________________________________________________________
Conference refund policy: A partial refund of 75% of registration cost is refundable 30 days before the conference. Thereafter, 50% of conference fees are refundable.
Scholarships NAADAC anticipates that there will be funding available for scholarships to the conference. All scholarship applications must be received 60 days before the first day of the conference (August 12, 2013). For full details, visit www.naadac.org/conferences.
Questions? Visit www.naadac.org/conferences or call 1.800.548.0497. SUMMER 2013 Advances in Addiction & Recovery 15
We Can Work It Out Leading Addiction Organizations Talk Collaboration, Commitment to the Profession B y D onovan K uehn , M anaging E ditor The future of the profession is at stake, and the nation’s leading addiction organizations are working to preserve it. Due to the rapid changes expected in the addiction profession through the Affordable Care Act and parity, three leading organizations in the f ield – NA A DAC, the A ssociation for Addiction Professionals, the National Certification Commission for Addiction Professionals (NCC AP) and the International Certification &
Reciprocity Consortium (IC&RC) – are discussing collaborative activities to ensure professional quality in the delivery of prevention, intervention, treatment and recovery support services. Advances in Addiction and Recovery asked Cynthia Moreno Tuohy from NAADAC, Mary Jo Mather from IC&RC and Kathryn Benson from NCC AP to outline what this initiative means and where the addiction-focused profession is heading.
The announcement of this collaboration was welcomed by many throughout the nation. What are the three things that addictionfocused professionals need to know about this initiative?
Cynthia Moreno Tuohy: All three of the collaborators understand the monumental change that health care and therefore the addiction profession will be undergoing in this next few years and recognize that in order to exercise any influence, we need to have a united voice. We are entering into this collaboration with an open mind as to how we progress in order to support the addiction profession. This collaboration is about more than any of these three groups, it is about the addiction
profession as a whole. We are looking for benefits to the whole profession and may need to sacrifice some of our individuality in order to achieve that.
provide the highest level of quality care to those individuals to whom we are committed to serving in their efforts toward healthy, balanced lives.
K athryn Benson : Our goals are to demonstrate through collaborative work, the unification of the substance use disorder treatment profession, its unique areas of prevention, intervention and treatment expertise; and to support professionally and legislatively continued research in our combined effort to
M ary Jo M ather : First, IC&RC is pursuing this collaboration because it is good for the field and for professionals. We also believe that combining efforts makes us a stronger voice for the field, while strengthening each of our organizations. However, the collaboration will take time — it is a long-term effort.
What can the field expect as the results from this discussion?
KB: The profession should reasonably expect our combined and mutually supportive efforts to promote, advocate and support the addiction disease model, the needed research and technology development to enhance the provision of prevention and treatment services and to strengthen efforts to influence a healthier work environment in support of the professional’s ability to deliver desired quality services.
MJM: A strong, united voice for the professionals in the field — that’s our primary goal. To achieve that, we want to finally put to rest the perception of rivalry between our organizations. Together, we can share resources that allow us to do more for the field.
CMT: Professionals can expect unified communication that is informative and instructive as to how to prepare, how to become in-
volved and how to remain connected to the public policy and health care reforms that are impacting the profession. We also plan to look at scopes of practice and our profes sionals’ ability to provide care in the health care and Medicaid system. As well as unified communication on ongoing initiatives and how we will strategically plan to implement impactful change.
What brought these three organizations together?
MJM: We often found ourselves at the same tables in Washington, D.C., and beyond, and it became clearer and clearer that — despite our different approaches — we shared the same goals for the addiction prevention, intervention, treatment and recovery field. It was natural for the idea of collaboration to
16 Advances in Addiction & Recovery | SUMMER 2013
surface, and now, we feel it’s more important than ever that the professionals have a unified voice.
CMT: A common goal to inform and advocate for the addiction profession and those that serve in the profession.
KB: The fact is our three organizations have always worked together in a variety of ways. We recognize the current and growing need for maximizing our efforts, resources and professional workplace development strategies to both insure continued stabilization and future enhanced growth of the profession and the professional care giver.
What are the biggest threats to the profession?
CMT: Becoming irrelevant in the bigger picture of primary care and mental health.
KB: Rather than a “threat” I believe we have a great opportunity, with significant national support, to move forward with greater emphasis on development of additional areas of treatment including, but not limited to: brain research and applying this knowledge to the
prevention and treatment experience, co-occurring disorders and their role in the development of and treatment of substance use disorders, env ironment al inf luences that enhance development of and recovery obstacles with multiple addictive disorders. We have never, in the history of addiction treatment, experienced both the understanding of the role of the brain, environment, genetics and social involvement in the development and recovery from addictions.
MJM: What IC&RC is hearing from its members in 25 countries and 45 states is that substance abuse is a low priority for federal and state agencies. Parity, integration into primary care, and extending the spectrum of recovery often seems to mask an erosion of the substance abuse field. As the workforce continues to age, we need to halt the decline with new measures to attract and retain professionals.
How does this initiative fit into the strategic plans of the IC&RC, NCC AP and NAADAC?
K B: Within the substance use isorders (SUD) prevention and d treatment profession the first and foremost focus is the informed, research based, provision of quality clinical care to all who seek our services. It is the purpose of the NCC AP to support this commitment to quality care by identifying, teaching, supporting and credentialing those professionals who are committed to providing the highest level of care to those individuals impacted by addictions. Our commitment to the population seeking care is the establishment and maintenance of knowledge and skillbased credentialing as a way of supporting and protecting the public in their efforts to receive health care. MJM: IC&RC’s strategic plans, current and past, always highlight the need for collaboration with other organizations, so this initiative fits perfectly into our strategic plan. The cost of doing business continues to rise —
from credentialing to advocacy. It makes sense to look at ways to operate smarter, eliminating duplication of efforts. I think this collaboration will, in the end, result in our respective organizations becoming stronger and more effective.
CMT : S e v e r a l y e a r s a g o , NAADAC’s leadership developed and implemented a strategic plan to focus on Four Pillars, or key a reas, to strategically move NAADAC and NCC AP forward. These pillars grow the addiction profession in four strategic areas: 1) Professional Development by focusing on education and training such as our annual conference, online education, webinars with over 80 continuing education credits and through state-level conferences with our local affiliates. 2) P ublic Engagement through NAADAC’s advocacy efforts at the national and state level with legislators and regulators and through our annual advocacy conference. 3) P rofessional Services, offering evidence-
based trainings and products with con tinuing education credits attached. Key areas we address are counseling theory and methods, pharmacology and physiology, ethics, Screening, Brief Intervention, and Refer r a l to Treat ment (SBI RT), co occurring, conflict resolution and recovery and many other products relevant to practicing professionals, and, 4) C o m m u n i c a t i n g o u r A s s o c i a t i o n’s Mission, according to NAADAC’s mission, our job is “to lead, unify and empower addiction focused professionals to achieve excellence through education, advocacy, knowledge, standards of practice, ethics, professional development and research.” To supp or t t hat end, N A A DAC ha s launched a new magazine, Advances in Addiction and Recovery, and works with the media interviews and uses social media to communicate with our members and others in the profession. This collaboration touches on all of our four focus areas.
Is there anything else you would like to add? lieve people will be impressed as we issue periodic reports to the field.
CMT: NA A DAC is excited to work with IC&RC and NCC AP in a deliberate plan to assist the addiction profession and professional to remain cogent and relevant.
In its Occupational Outlook Handbook, 2010–11 Edition, the U.S. Department of Labor (DOL) named substance abuse and behavioral disorder counselors as one of the fastest growing professions, expected to grow 21 percent by 2018. Despite this positive outlook, changes to practice legislation and funding streams make the future of the profession difficult to predict.
KB: The NCC AP is honored to be part of this strong, progressive initiative of collaborative professional work and advocacy. We anticipate a stronger unified voice in national agenda setting and implementation for the ever-growing Substance Use Disorder professional workforce development service plan.
Together, IC&RC, NAADAC and NCC AP hope to influence federal policy, including workforce development issues within Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA) and other departments to protect the addiction profession as a specialty within the primary healthcare system.
SUMMER 2013 Advances in Addiction & Recovery 17
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MJM: Personally, I want to say how honored I am to be working w it h t wo or g a n i z at ion s t h at IC &RC respects a great deal – NAADAC and NCC AP. The small workgroup we have assembled to set the agenda for our efforts is excellent, representing the best from each of our three organizations. I be-
Spirituality of Connectedness
The
as a
Response to the Stress Reactions in Substance Abuse Counselors
When People Lack Connectedness They Feel Isolated and Discouraged Earn TWO continuing education credits for reading this article. Cost $25. Take the quiz at www.naadac.org/education/ magazineces.
T
oday’s modern society, aside from all of the futuristic prom ises, appears to be more stressful and complex than ever before. We are continually inundated with data, be they from text messages, social networking, RSS feeds, phone calls, etc. The “promise” that technology would enable us more free time to spend with family and friends does not appear to be a reality. Instead, the time we do spend with family and friends involves checking our smart phones as we are continually and everywhere in touch with the office. In the addiction field where healthcare reform is changing our business practices while the latest research is changing our clinical practices, increases in stress and burnout are being felt by clinicians and administrators alike (Shea, C., 2012). There are no easy answers or solutions to stress, but one approach I encourage is to focus on the spiritual aspect of the clinician and situation. Stress reduction through an appreciation of the spiritual is an effective approach since the spiritual “can enhance inner strength and enable individuals to find meaning in stressful situations, provide people with an optimistic perspective and positive purpose in life, and subsequently reduce anxiety.” (Langman, Louise; Chung, Man Cheung, 2012) A recent study, funded by a NIDA grant, “the first to examine the link between staff stress and client engagement within the field of substance abuse treatment” (Landrum, B.; Knight, D. K.; and Flynn, P. M., 2012) indicates that “Burnout is higher in high-stress organizations and workload and staff influence moderate the stress-burnout relationship.” (Landrum, B. et al, 2012) My years of experience in the addict ion field confirm this research. Shocking, though, is their next conclusion: “Specifically, stress and burnout appear to be more strongly linked when caseloads are lower and opportunities for staff to influence program practices are few.” (Ibid.) Caseload size is, therefore, a factor in stress and burnout reactions, yet it is the lower case loads which seem to bring about more frequent instances of burnout versus clinicians carrying higher caseloads. The “relationship between stress and burnout suggests that when caseloads are large, stress may act as a motivator and buffer against burnout. ...(I)ncreased stress does not necessarily lead to feelings of being overwhelmed and ex-
18 Advances in Addiction & Recovery | SUMMER 2013
hausted; instead, it may provide motivation to work harder as the stress is perceived as a “challenge” rather than an obstacle.” (Ibid.) Stress is a complex set of emotional and physical reactions to the world around us, either enabling us to confront our challenges, or paralyzing us into inaction (referring to the “fight or flight” reactions which are hard-wired in the recesses of brain). This NIDA-funded study finds that when clinicians are under stress, the perceived “challenge” motivates them to succeed. We need a balance of stress in our lives; a balanced level of stress motivates while too much stress paralyzes. Where do we find the balance? When does stress reach the level of burnout and paralysis? Comparing burnout in the addiction field to other professions, the authors of the article “Causes, Consequences, and Prevention of Burnout Among Substance Abuse Treatment Counselors: A Rural Versus Urban Comparison” posit the theory that the “emotional connection is what differentiates burnout from occupational stress … burnout is tied to work that is demanding and involves emotional investment.” (Oser, C. B., Biebel, E. P., Pullen, E., & Harp, K. L., 2013) Substance abuse counselors tend to become emotionally involved with their clients since “their clients many times deny their problems, lack the motivation to change … have significant health problems … and many times have co-occurring mental health disorders.” (Oser, C. B., et al, 2013) An intense investment of clinician time and resources is needed in order to guide such a client to a return of a healthy lifestyle. It is precisely in this emotional connection wherein we need to infuse the spiritual into the addiction field. If we are to make the case that it is in the “emotional investment” wherein clinicians find their stress, than we need to discover a means whereby we can reduce this stress to a manageable level. As the clinician meets the client on the emotional level, it is therefore on the emotional level where we need to meet the clinician. “While it may not be impossible to measure spirituality in an empirical sense, it may be possible to clarify what role spirituality plays in aiding sustained recovery and prevention … We will suggest connectedness as an integral component in defining spirituality … as gaining knowledge through connectedness to others.” (Tonigan, J. Scott, 2007) In treatment sessions clinicians are trained to re-connect clients to healthy people in healthy relationships. Therefore, in the same vein, clinicians need a sense of connectedness to themselves, their peers and the organization for which they work. “… (P)eople with addiction tend to be concerned with spirituality, forgiveness, and guilt, each relating to the human conscience as the
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B y C hristopher W. S hea , MA, CAC-AD, CRAT
person struggles with who they are, who they ought to be and the meaning of life. These are the existential aspects of living with addict ion.” (L a ng ma n, L ou ise, et a l, 2012) Abraham Maslow (1908–1970), famed for his 1943 work entitled A Theor y of Human Motivation, speaks of a “hierarchy of needs” which when followed lead a person to the pinnacle of self-actualization, namely a deep and personal existential view of themselves in relation to the world. A sense of one’s connectedness to self and others. “Maslow himself recognized a motivational force higher than self-actualization, an inner drive to place the needs of others above a person’s own needs. Some have called it self-transcendence. Others have called it personal integration. Still others have called it holiness.” (Ferder, 1986) The clinician’s drive to place the needs of others above their own leads to an emotional connectedness with their clients, but at the same time brings about a high degree of stress if the clinician does not see positive results from their efforts. And in a field with a high rate of recidivism, many counselors tend to become discouraged. “Similar to stress, burnout is also a complex phenomenon, and past research has divided it into several components, including emotional exhaustion, depersonalization, and lower sense of personal accomplishment.” (Landrum B., et al, 2012) When a clinician no longer feels a connectedness to their mission, to their clients, they can feel isolated. This isolation is but one of the factors which can tip the balance of stress away from the benefits of a motivating stress, to those of a detrimental and paralyzing stress. Since we live in a stressful society, stress in and of itself is not the issue. Stress is inevitable, and, in manageable portions, can be a motivating factor challenging a person to perform at their greatest potential. Recent research indicates that when a person feels an emotional connectedness to others, stress reactions remain at healthy and workable levels. Yet, when people lack this level of connectedness they feel isolated and discouraged. This is true for both our clientele as well as our clinicians. Therefore, as mentioned above, an enhanced spiritual sense is encouraged since the spiritual “can enhance inner strength and enable individuals to find meaning in stressful situations, provide people with an optimistic perspective and positive purpose in life, and subsequently reduce anxiety.” (Lang man, L., et al, 2012) As previously mentioned, burnout consists of three major components: emotional exhaustion, depersonalization, and a lower
sense of personal accomplishment. Utilizing these components as our guide, how can we infuse a sense of the spiritual into each component so as to reduce the stress reaction to healthy levels. For the purposes of this article, I chose to use Tonigan’s definition of spirit ual: “gaining knowledge through connectedness to others.” (2007)
E motional E xhaustion : Working long hours or having large caseloads can lead to a clinician feeling tired, but to be emotionally exhausted affects one’s emotional connectedness to others. To feel emotionally exhausted one no longer has the emotional capacity to cope, in a healthy manner, with the stressors of life. To counter this on the spiritual level, an agency needs to allow their staff time for self-care. According to Oser, C. B. “Self-care includes meditation, taking a vacation, taking the time to debrief with a coworker, or just engaging in other tasks besides therapy.” (2013). In my career as an administrator and clinical supervisor, I encouraged all my clinicians to have active hobbies which had no relation to their daily duties or career. Encourage your staff and peers to engage in hobbies which interest them, encouraging them to discuss, as appropriate, their h obbies in the workplace with their co workers. These interactions with coworkers offer a sense of connectedness and camaraderie which will offset the stressors of the work day whereby reducing the chances for emotional exhaustion.
Depersonalization: The degree to which a clinician feels connected to the overall structure of the agency for which they work has a direct effect on the degree to which they feel valued by that same agency. “(T)he degree to which members of the organization perceive themselves as having influence can moderate the relationship between stress and staff burnout. When influence is higher within a program, stress is not related to burnout. However, when influence is low, higher stress is associated with higher burnout. Thus, influence serves as a buffer against burnout. Programs where staff report more knowledge sharing, influence in the decisions made by the program, and are being viewed as a leader by their peers have lower organizational burnout even when stress was high.” (Lan drum B., et al, 2012) To counter depersonalization on the spiritual level it is important for an agency to include clinicians and other staff in the planning and decision making of the agency. If you haven’t yet tried this approach you may be surprised; I was.
Questions to consider while reading this article
?
Stress reduction through an appreciation of the spiritual is an effective approach to what?
? ?
What is Tonigan’s definition of spiritual?
A recent study funded by a grant by the National Institute on Drug Abuse (NIDA) concluded that which factors links stress and burnout?
?
True or false, the NIDA funded study found that when clinicians are under stress, the perceived “chal lenge” motivates them to succeed.
? ?
What differentiates burnout from occupational stress?
What is one of the factors that can tip the balance of stress away from the benefits of a motivating stress to those of a detrimental and paralyzing stress?
?
What factor leads the clinician’s drive to place the needs of others above their own?
?
Which programs have lower orga nizational burnout even when stress was high?
? ?
What does the author say about stress?
The author recommends that agencies, administrators and clinical supervisors foster a sense of personal accomplishment in clini cians and staff by doing what? Earn two continuing education credits for reading this article. Cost $25. Take the quiz at www.naadac.org/ education/magazineces.
P ersonal Accomplishment : I am not aware of many people who enter and stay in the field of addiction counseling who do not wish to achieve their goals and personal best within the profession. A sense of personal accomplishment needs to be encouraged by agencies, administrators and clinical super visors. Encourage the clinicians and staff to obtain, beyond the local requirement, certifications in advanced study or clinical skills. Encourage them to author articles, white pap er s , or g i ve le c t u re s a nd s em i n a r s . Encouraging one’s personal accomplishSpirituality, continued on page 21 ☛ SUMMER 2013 Advances in Addiction & Recovery 19
Clinical Consultations
Addressing Dilemmas in Ethics, Supervision and Treatment B y K athy B enson , NCAC II, QCS, Tom D urham , P h D, LADC,
and
Frances Patterson , P h D, MAC, SAP, QCS
Clinical Consultations aims to address real questions and dilemmas that practitioners encounter in their daily practice. Have a question or advice to share? Send your thoughts to Donovan Kuehn, Managing Editor, at dkuehn@naadac.org.
Resource Applying the Substance Abuse Confidentiality Regulations 42 CFR Part 2 (REVISED), published by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, December 2011. Online at www.samhsa.gov/about/laws/ SAMHSA_42CFRPART2FAQII_Revised.pdf
Disclosing information when a client has a communicable disease. I took an Essential Learning course on Ethics and in this course it said the following: “When consumers disclose that they have a communicable disease that is also lifethreatening, counselors may be justified in informing third parties who are known to be at high risk of contracting the disease.” I have never heard this before. Is this something the State Licensing Boards tell us to do or is this an error? If this is correct, under what circumstances would we break confidentiality?
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Thomas Durham: I agree. 42 CFR does not mandate such a report (i.e. this type of release of information) and, as noted, this doesn’t seem to qualify as a Duty to Warn as no one has threatened to do harm. On the other hand, what about a client who is intending to delibera tely transmit harm through a communicable disease? So, is there ever a Duty to Warn when it comes to communicable diseases, such as HIV? Each state regulates Duty to Warn with respect to HIV infection. Again, this is regulated by each state. But, the need to warn must be limited to risk. For example, c asual contact, such as sharing eating utensils and kissing doesn’t seem to qualify as Duty to Warn, but exchange of bodily fluids through needle sharing or sexual contact may fall under mandated reporting. It is important that treatment a gencies/providers know their state law regarding this issue and consult an attorney who is familiar with 42 CFR Part 2 when a legal question arises.
F rances Patterson : When I worked at our local public health department there were diseases that had to be reported to the Health Department by doctors, labs and hospitals for tracking and surveillance — HIV, TB or other STIs (sexually transmitted infections) to mention a few. As counselors, we have a different relationship with clients. We are given information in confidence. We are under strict guidelines about exceptions to confidentiality. The licensure board does not tell us to do this. It would fall under other state or federal notification laws. Always remember that the most stringent of the confidentiality laws is the one to follow. For instance, if a law says you have to notify, but 42 CFR Part 2 says you cannot notify, then you have to follow 42 CFR. There are options to resolving the dilemma. Of course, if there is a written release of information from the client to comply with 20 Advances in Addiction & Recovery | SUMMER 2013
K a t h r y n B e n s o n : It wou ld be my posit ion w it h t his amount of information that it does not meet the criteria for Duty to Warn, as in threat of harm to self or others. As a therapist, my approach would be to explore with identified client their sharing info with other person, reasons for doing so and not doing so, f acilitate that conversation if deemed helpful, etc. If in the course of this exchange I became aware that the identified client intended deliberate transmission as a way of harming the other person(s) than I would respond according to Duty to Warn with additional communication with health department, etc. Of course, my determination would be based on more than my inference, speculation and would be supported by actual statements of intent. state-mandated reporting and follow up, a report can be made. Anonymous reporting is permitted in some states. This is often done with codes rather than client names. A report could include a client name if it is not disclosed that the client is in an addictions treatment program. If the program has entered into a Qualified Service/Business Organization Agreement (QSO/BA) with a medical provider that is a mandated reporter, the health care provider can make the report when it is learned, through testing, that the client has a communicable disease. This does not allow the outside medical provider to redisclose information that identifies the client as being in an addictions program. This can also be achieved by entering into a QSO/BA directly with the local public health department where preventing, treating, and controlling communicable disease is Patterson, continued on page 21 ☛
Patterson, continued from page 20 within their responsibil ity. Under this agreement, the agency would refer clients to the health department for testing, monitoring, possible treatment and follow up, thus allowing the treatment agency to comply with mandatory reporting of communicable diseases. The QSO/BA must specify services to be provided by the public health department. Again, redisclosure of information by the health department identifying persons as substance abuse treatment clients is prohibited without the client’s consent. When the communicable disease creates a medical emergency then it becomes necessary to report to medical personnel. Keep in mind that it must be an immediate threat to the client’s personal health. An example would be a person with untreated TB. If the client is already under medical care for the condition, this does not constitute a medical emergency. And, last but not least, if a court order is obtained by a program that authorizes reporting, the court can only issue an order when it is for good cause and is executed according to 42CFR Part 2. Reference: Confidentiality and Communication: A Guide to the Federal Drug & Alcohol Confidentiality Law and HIPPA: Legal Action Center, N.Y., N.Y. 2012 Frances Patterson, PhD, MAC, SAP, QCS, is board certified as a professional counselor with the American Psychotherapy Asso ciation (APA) and is a NAADAC, the Association for Addiction Professionals certified Masters Addictions Counselor and Qualified Substance Abuse Professional. She is certified by the State of Tennessee as a Clinical Supervisor for A&D licensure and serves as an oral examiner for people seeking licensure. Dr. Patterson has worked as a counselor and program administrator in treatment programs in Virginia and Tennessee over the past 24 years and is the owner of Footprints Consulting Services, LLC in Nashville, Tenn. Thomas Durham, PhD, LADC, brings more than 35 years of experience in behavioral health treatment and has been an educator and trainer for over 20 years delivering a variety of training topics for behavioral health professionals on topics such as clinical supervision, motivational interviewing, co-occurring disorders, ethics, medicated assisted treatment, compassion fatigue and leadership. Dr. Durham is Program Manager of the Prescription Drug Abuse and Overdose Prevention Program at JBS International where he develops curricula and coordinates training programs for physicians and other healthcare professionals. Kathryn Benson, NCAC II, QCS, SAP, has worked in the counseling profession since 1972, with an initial emphasis on domestic violence, intervention and re-parenting of abusive parents. She has specialized in addiction issues since 1978. She maintains a clinical consulting practice in Nashville, Tenn., where she provides therapeutic services, clinical and program development and supervision services. She currently serves as the Chair of the National Certification Commission for Addiction Professionals (NCC AP) — the NAADAC Certification Board — and has received numerous professional awards.
Looking for more information? Check out the archived webinar Understanding NAADAC’s Code of Ethics, available at www.naadac.org/education/webinars.
Spirituality, continued from page 19
ments allows them to feel a connectedness to advancing the field, v icariously connecting on an emotional level with a wide range of clients through those clinicians who may learn from their work.
Conclusion “Despite the many challenges that substance abuse counselors … voiced and the impact that burnout can have on client outcomes, … {counselors} recognized that burnout is not an inevitable outcome
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of their work. … (T)he counselors identified a positive working atmosphere can also help them to cope with these strains, thereby protecting them from burnout.” (Oser, C. B., 2013) Christopher Shea is a nationally and state certified addiction counselor in Maryland. Shea has worked for almost 20 years in the addiction field as a counselor, case manager, clinical director and administrator. Shea presents seminars and conferences across the country and is published in medical and peer-reviewed journals. Shea is currently the Director of Campus Ministry at St. Mary’s Ryken high school as well as an adjunct professor at Towson University. He is also the founder and author of Life’s Journey blog at www.lifesjourneyblog.com. Bibliography Ferder, F. (1986). Words Made Flesh: Scripture, Psychology & Human Communication. Notre Dame: Ave Maria Press. Greene, G., & Nguyen, T. D. (2012). The Role of Connectedness in Relation to Spirituality and Religion in a Twelve-Step Model. Review Of European Studies, 4(1), 179-187. Landrum, B.; Knight, D. K.; and Flynn, P. M. (2012). The impact of organizational stress and burnout on client engagement. Journal of Substance Abuse Treatment 42(2), 222–230. Langman, Louise; Chung, Man Cheung. (2012). The Relationship Between Forgiveness, Spirituality, Traumatic Guilt and Posttraumatic Stress Disorder (PTSD) Among People with Addiction. Psychiatric Quarterly, 10.1007/ s11126-012-9223-5. Oser, C. B., Biebel, E. P., Pullen, E., & Harp, K. L. (2013). Causes, Consequences, and Prevention of Burnout Among Substance Abuse Treatment Counselors: A Rural Versus Urban Comparison. Journal of Psychoactive Drugs, 45(1), 17-27. Shea, C. (2012). Unintended Consequences of the ACA – Workforce Development Issues in Addiction Treatment Services. Healthcare Reform Magazine, August. Retrieved from http://www.healthcarereformmagazine.com/article/unintendedconsequences.html Tonigan, J. Scott. (2007). Spirituality and Alcoholics Anonymous. Southern Medical Journal 100(4), 437-440.
SUMMER 2013 Advances in Addiction & Recovery 21
C O M M E N TA R Y
Recovery-oriented Practice and the Addictions Professional:
A Systems Perspective Recovery is the Very Soul of Our Profession W illiam L. W hite , MA
and
C ynthia M oreno Tuohy, NCAC II, CCDC III, SAP
Modern addiction treatment as a system of care emerged in the e arly 1970s. This birthing process was followed by sustained and t urbulent processes of professionalization, commercialization and bureaucratization. New specialized addiction treatment programs were a godsend for people with alcohol and other drug problems and their families who in earlier years faced few if any resources, contempt from mainstream helping professionals, and all too often, harmful interventions masked as help. Today, hundreds of thousands of people in long-term recovery owe their lives to modern addiction treatment. So why in the past decade have we witnessed repeated calls from people in recovery and from long-tenured addiction professionals for greater recovery orientation in addiction treatment? Aren’t addiction treatment and addiction counseling already recovery-oriented? In this brief essay, we will offer some historical perspectives and systems performance data to answer these questions.
Lost Connection to Recovery
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There are remarkable milestones in the rise of a national infrastructure of addiction treatment, each worthy of a detailed recounting: discovery of replicable models of addiction treatment, expansion of public and private funding for addiction treatment, explosive growth of community-based treatment programs, development of program accreditation and counselor certification standards, birth of professional associations and addiction studies programs, and increased rigor addiction research, to name just a few. Yet, by the mid-1990s, as addiction treatment episodes became ever-briefer, there were warning voices suggesting that something important was being lost in the professionalization and industrialization of addiction treatment. One could hear at national conferences and read in the field’s professional journals fears that addiction treatment was becoming disconnected from the larger and more enduring process of addiction recovery and that recovery initiation in institutional settings was disconnected from processes of recovery maintenance within natural community environments (Elise, 1999; Morgan, 1994; White, 2004). A growing recovery advocacy movement also challenged that an addiction treatment field that once viewed itself as an adjunct to recovery was now viewing recovery as an adjunct (afterthought) to itself (White, 2001).
22 Advances in Addiction & Recovery | SUMMER 2013
Key System Performance Measure The opening decade of the 21st century witnessed two additional shifts that exerted a profound influence on addiction treatment. The first was the refined conceptualization of addiction as a chronic condition (McLellan, Lewis, O’Brien, & Kleber, 2000) and discussions of the implications of such an understanding to clinical practices in addiction treatment (Dennis & Scott, 2007; White, Boyle, & Loveland, 2002). The second shift involved an intensified analysis of what addiction treatment was and was not achieving as a system of care. Critiques of key system performance measures (e.g., White, 2008a) concluded that there were major problems with addiction treatment in such key areas as 1) attraction and access (only 10% of those with a substance use disorder enter treatment each year), 2) engagement and retention (less than 50% successfully complete treatment, 3) clinical practices (significant gaps between clinical research and clinical practices), 4) linkages to communities of recovery (use of passive rather than assertive linkage procedures), 5) service duration (less than optimum 90 days across levels of care), 6) continuing care (only 20–36% of adolescents and adults receive post-treatment monitoring and support), 7) post-treatment substance use outcomes (more than 50% of persons leaving treatment resume substance use within year of discharge, with most occurring within 90 days of leaving treatment) and 8) treatment recycling (64% of persons entering addiction treatment have a prior treatment; 19% have five or more prior treatment episodes).
Recovery as an Organizing Paradigm These processes of professional self-inventory and systems per formance evaluation triggered calls to: 1) shift the field’s organizing center to one focused on recovery rather than addiction pathology or clinical/social intervention, 2) extend the design of addiction treatment from one focused almost solely on acute biopsychosocial sta bilization (recovery initiation) to one that encompassed support for long-term personal and family recovery (recovery maintenance and enhanced quality of life in recovery) and to 3) nest these models of sustained addiction recovery management (ARM) within larger recovery-oriented systems of care (ROSC; White, 2005, 2008a,b). The calls for this conceptual shift in the field were not without challenges.
Some countered that the recovery concept was amorphous (“Is it like pornography? You can’t define it but you know it when you see it?”), redundant (“We’re already recovery oriented.”), faddish (“a flavor of the month”), impractical (“No one will fund long-term recovery support.”) and dangerous (“Recovery is a political Trojan horse aimed at de-professionalizing, delegitimizing, and defunding science-based treatment and harm reduction services.”). Such were the challenges that faced early ARM/ROSC pilot settings (e.g., the State of Connec ticut and the City of Philadelphia) and recovery-focused policy shifts within the Substance Abuse and Mental Health Services Administra tion/Center for Substance Abuse Treatment and the White House Office of National Drug Control Policy.
Defining Recovery and Recovery-oriented Practice The emergence of recovery as a new (or renewed) organizing framework for addiction treatment and the larger alcohol and other drugs policy arena sparked efforts to reach a consensus definition of recovery (Betty Ford Institute Consensus Panel, 2007), develop recoveryoriented practice guidelines (Abrahams et al., 2012; Tondora et al., 2008) and forge a recovery-focused research agenda (Laudet, Flaherty, & Langer, 2009) that could collectively guide the future design of addiction treatment and peer recovery support services. These efforts, led by addiction professionals and people in recovery, point to a future of more person- and family-centered care and the increased involvement of addiction professionals in pre-treatment and post(acute) treatment stages of addiction recovery. They also point to a future in which addiction professionals will be working in an everexpanding variety of service settings and providing an expanded menu of clinical and non-clinical recovery support services. They portend a future in which addiction treatment and addiction recovery are inseparable and in which the physical, psychological, and social barriers separating the treatment institution from indigenous recovery supports in the community no longer exist (a move toward “treatment without walls”). That redesign process is already underway — pushed by recovery advocates, visionary professionals and the cumulative findings of scientific research.
A Time for Activism NAADAC’s founding generation spent their lives widening the doorways of entry into addiction recovery. They fought to create a treatment system and a new profession (addiction counseling) to achieve that vision. The present call for increased recovery orientation within the field is in many ways a call to renew that founding vision. Many things diverted this recovery focus over the years. There were days when addiction counselors found themselves working in systems that seemed to care more about progress notes than the real progress of those being served. Yes, at times it seemed like the “new profession” would, in its worship of regulatory compliance, drown itself in a sea of paper. There were days when addiction counselors found themselves in systems that seemed more preoccupied with money management than recovery management. Yes, fixations on funding and profit have sometimes obscured the ultimate goal such resources were to serve. And yes, there were times preoccupations with our own professional status also served as a distraction from our founding recovery vision. But addiction counselors and NAADAC have always found ways to renew this vision and add our voices to those of our founders who challenged us to keep our eyes on the ultimate prize of this profession: the long-term recovery of individuals, families, and communities. Addiction treatment as a cultural institution (as well as the role of the addictions professional) remains on probationary status within the United States and other countries of the world. The future of the
field is by no means assured. It is our contention that the fate of the field will rest upon the degree of optimism — or pessimism — in which addiction recovery is viewed by the larger culture. In a culture awash with media coverage of celebrities constantly recycling in and out of “rehab,” it is our voices that must help convey two messages: 1) long-term recovery is a reality in the lives of millions of individuals and families, and 2) professionally directed addiction treatment can be a critical adjunct in recovery initiation, recovery maintenance, and enhancement of quality of personal and family life in long-term recovery. Our charge is to now renew, and never again lose, this recovery vision. In the midst of all manner of health reform and service integration initiatives, that vision cannot be lost. Recovery is not a new innovation, nor is it a passing fad. It is the very soul of our profession. William L. White is a Senior Research Consultant at Chestnut Health Systems/Lighthouse Institute and past-chair of the board of Recovery Communities United. White has a Master’s degree in Addiction Studies and has worked full time in the addictions field since 1969 as a street-worker, counselor, clinical director, researcher and well-traveled trainer and consultant. He has authored or co-authored more than 400 articles, monographs, research reports and book chapters and 16 books. His book, Slaying the Dragon — The History of Addiction Treatment and Recovery in America, received the McGovern Family Foundation Award for the best book on addiction recovery. His collected papers are posted at www.williamwhitepapers.com. Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals. She previously served as the Executive Director of Danya Institute and the Central East Addiction Technology Transfer Center and as Program Director for Volunteers of America Western Washington. In addition, she has over 20 years of experience serving as the administrator of multi-county, publicly funded alcohol/drug prevention/intervention/treatment centers with services ranging from prenatal care to serving the elderly. References Abrahams, I. A., Ali, O., Davidson, L., Evans, A. C., King, J., Poplawski, P., & White, W. (2012). Practice guidelines for recovery and resilience oriented treatment. Philadelphia: Philadelphia Department of Behavioral Health. Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33, 221–228. doi:10.1016/j.jsat.2007.06.001 Dennis, M. L., & Scott, C. K. (2007). Managing addiction as a chronic condition. Addiction Science & Clinical Practice, 4(1), 45–55. Elise, D. (1999). Recovering recovery. Journal of Ministry in Addiction and Recovery, 6(2), 11–23. Laudet, A., Flaherty, M., & Langer, D. (2009). Building the science of recovery. Pittsburgh, PA: Institute for Research, Education and Training and Northeast Addiction Technology Transfer Center. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association, 284(13), 1689–1695. doi:10.1001/jama.284.13.1689 Morgan, O. J. (1994). Extended length of sobriety: The missing variable. Alcoholism Treatment Quarterly, 12(1), 59-71. doi:10.1300/J020v12n01_05 Tondora, J., Heerema, R., Delphin, M., Andres-Hyman, R. O’Connell, M. J., & Davidson, L. (2008). Practice guidelines for recovery-oriented care for mental health and substance use conditions (2nd ed.). New Haven, CT: Yale University Program for Recovery and Community Health. White, W. L. (2001). The new recovery advocacy movement: A call to service. Counselor, 2(6), 64–67. White, W. L. (2004). Recovery: The next frontier. Counselor, 5(1), 18–21. White, W. L. (2005). Recovery: Its history and renaissance as an organizing construct concerning alcohol and other drug problems. Alcoholism Treatment Quarterly, 23(1), 3-15. doi:10.1300/J020v23n01_02 White, W. L. (2008a). Recovery management and recovery-oriented systems of care: Scientific rationale and promising practices. Pittsburgh, PA: Northeast Addiction Technology Transfer Center, Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health & Mental Retardation Services. White, W. L. (2008b). Recovery: Old wine, flavor of the month or new organizing paradigm? Substance Use and Misuse, 43(12&13), 1987–2000. doi:10.1080/10826080802297518 White, W. L., Boyle, M., & Loveland, D. (2002). Alcoholism/addiction as a chronic disease: From rhetoric to clinical reality. Alcoholism Treatment Quarterly, 20(3/4), 107-129. doi:10.1300/J020v20n03_06
SUMMER 2013 Advances in Addiction & Recovery 23
Healing the Addicted Brain Addiction is a Chronic, Multifactorial – and Lifelong – Medical Disease of the Brain B y H arold C. U rschel III, MD, MMA
Introduction Researchers estimate that some 20 million Americans who could benefit from treatment are not getting it. Additionally, for those patients who are receiving treatment, the majority of our industry still treats alcohol and drug addiction with only behavioral and psychosocial approaches. While traditional, 12-step based programs have certainly helped countless people achieve sobriety, the long term sobriety failure rate is estimated at 70 percent, a figure most would consider unacceptable, as alcoholism is the third leading cause of death in the United States. Also, the majority of patients do not have the funds or the time to commit to residential treatment or intensive outpatient counseling. The bottom line is that until we stop treating alcohol and drug addiction insufficiently in the U.S., we will continue to see countless people die unnecessarily, as many of them will give up hope if they can’t get well. Fortunately, we now have scientific evidence that concludes addiction is a chronic, progressive disease of the brain with many similarities to other chronic medical diseases such as diabetes, hypertension and asthma and needs to be treated with a combination of behavioral therapy and a medical approach. The American Medical Association (AMA), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), World Health Organization (WHO), American Psychiatric Association (APA), as well as many other organizations in the scientific and medical fields, now recognize alcohol/drug addiction as a chronic and progressive physical disease that attacks the brain, damaging key parts of the limbic system and cerebral cortex causing lasting changes in the brain. These changes don’t go away, sometimes for months or years, even after recovering patients stop using. Although an individual’s initial choice to drink alcohol or use another substance is a voluntary one, over time the substance physically changes the brain to where the individual truly cannot stop his or her addictive behavior, even though the desire to do so might be high. In chronic, multi-factorial conditions such as cardiovascular disease, the standard of care involves front-line physiological interventions through surgery or medication, followed by environmental and behavioral modifications. Hypertension and high cholesterol are often controlled by medication, but modifying dietary habits and exercise are necessary steps as well. Addiction treatment is no different, 24 Advances in Addiction & Recovery | SUMMER 2013
and with the proper treatment it too can be managed and more importantly, give substance use disorders patients realistic hope that they can be healed and live a clean or sober life.
Psychopharmalogical Component of Addiction Treatment Since addiction is a chronic, multifactorial — and lifelong — medical disease of the brain, no one medical treatment alone can serve as a “cure.” However, used in combination with behavioral treatments and other psychosocial interventions, pharmacologic treatments have shown effectiveness in countering the effects of alcohol/drugs on the brain and behavior, relieving withdrawal symptoms, and helping overcome cravings. For some patients, this is a “ jump start” for their recovery — relief from cravings allows them to concentrate on the behavioral and psychosocial aspects of recovery, often progressing sooner or faster in those activities. Additionally, the use of pharmacological treatments that also seem to accelerate recovery of the brain systems controlling memory and concentration can allow a patient to more effectively participate in a behavioral treatment program or group. With their memory and concentration systems back “on line,” these patients can actually learn the new coping skills that they will need to be able to successfully navigate their own particular daily life stressors, while simultaneously maintaining a sober life style. In figure 1, talking therapy is designed to influence the cells in the higher cognitive centers of the cortex. It can and does work, but only if the brain is willing and able to pay attention, listen and remember. Yet most addicted brains are physically incapable of generating the focus and cooperation necessary for this type of therapy to work. Until the damage has been at least partially repaired, most brains are in no condition to absorb and digest these new ideas. A great deal of the alcohol- or drug-induced brain damage takes place in the limbic region, an area deep inside the brain that is responsible for powerful, primal drives such as hunger, thirst, the need to bond and the need for sexual contact. Talking therapy can help correct problems in the cortex, but it cannot influence the limbic system or other structures found deeper within the brain. This means that even if the substance use disorders patient is able to listen to and understand the therapy, that nearly irresistible emotional drive to get high will remain intact. That’s why so many substance use disorders patients relapse early in the recovery process — they simply cannot “get” what their wellintentioned counselors want them to understand. A key component of the new addiction treatment is the new anti-addiction medications designed to rebalance the brain’s biochemistry. They help correct imbalances in dopamine and other essential neurotransmitters and accelerate healing of the physical damage in both the limbic region and the cortex. Once this damage has been repaired, a person with monkey business images | photospin.com
Last issue, Dr. Harold Urschel addressed the issues of Treatments for Alcohol Dependence, opiates and stimulants. Dr. Urschel also outlined the costs of medical problems caused by addiction, along with lost earnings, accidents and crime. These issues were estimated to have cost Americans more than $500 billion, with state and federal governments spending more than $15 billion per year, and insurers another $5 billion more annually, on substance abuse treatment services for about four million people.
Figure 1: Psychosocial Treatment and Medication
Cortex Limbic Region Cortex Role: • Decision making • Thinking • Reasoning • Rationalizing
Limbic Region Role: • Drive generation
– Psychosocial treatments – 12-step fellowships – Faith-based support addictions will find it much easier to learn, remember and focus on the cognitive and behavioral changes used in talking therapy to achieve longer-lasting sobriety.
Comprehensive Approach Once the brain is physically on its way to healing through the use of the anti-addiction medications, we can focus on getting to the core psychological issues that originally triggered and/or fed the addictive cycle. And as we uncover and identify those issues through behavioral therapies, we are able to resolve some and/or provide coping mechanisms and life skills to help manage others. With more than 12 to 15 different types of alcoholism and 12 to 25 types of narcotic addiction, and various stages to each type, it’s no wonder that the traditional treatment models don’t work for everyone. It is definitely not a “one treatment fits all” disease. Research shows that the 70 percent of substance use disorders patients who are in the seemingly constant cycle of treatment-recovery-relapsetreatment-recovery-relapse really need a 90-day residential stay, followed by months of comprehensive outpatient programs, behavioral therapies and social support in order to have the optimal chance for lasting recovery. Depending on how severely an substance use disorders patient’s brain has been injured, it can take 45 to 90 days or more for the brain’s chemistry to “reboot.” Beyond that, it takes four to 12 months for an alcoholic brain to heal and get back to normal, and often longer for someone with an addiction to narcotics and/or other drugs. People sometimes want to avoid residential treatment because it’s disruptive to their family, their job and their everyday but an substance use disorders patient’s brain needs disrupting in order to
– Vivitrol
Dual diagnosis is not simply one disease added to another. It is one disease multiplied by another. break the harmful patterns. The first 45 to 90 days are critical to achieving that goal. In other words, a comprehensive approach to alcohol and drug addiction treatment (defined by the NIH research-based findings) incorporates treatments for many different components of a patient’s life including: psychiatric care, anti-addiction medication, wellness/ nutrition programs, family therapy, stress management, skill building, individual and group psychoeducational components and therapy, spirituality and 12-step fellowships. It takes all of these components individualized to a specific patient’s life experience, to be able to approach that 90 percent long term sobriety success rate.
Dual Diagnosis For many suffering from addiction, treatment is only half the battle. It is estimated that 50 percent of alcohol abusers and 53 percent of drug abusers also have at least one cooccurring mental illness. These substance use disorders patients have what is called a dual diagnosis, a term used to describe coexisting conditions of a person suffering from a psychiatric illness and a substance addiction problem. A wide variety of psychiatric ill nesses can accompany addiction. The most common co-occurring psychiatric illnesses are bipolar disorder, anxiety disorders, de-
pressive disorders, post-traumatic stress disorder (PTSD) and schizophrenia. Dual diagnosis is not simply one disease added to another. It is one disease multiplied by another. The two illnesses can interact, each mak ing t he ot her worse, complicating treatment and increasing the risk of relapse. At times, the symptoms of one may overlap and even mask the symptoms of the other, making diagnosis and treatment much more difficult. The presence of cooccurring illnesses also can slow the recovery process, weakening an individual’s resolve to stay sober. Even if the co-occurring illnesses are correctly identified, it is extremely difficult to get an individual suffering from addiction plus emotional distress to actively engage in and cooperate with the treatment process. The addiction and the psychiatric illness must be managed simultaneously to insure that one illness does not cause a relapse of the other. The combined treatment plan must be comprehensive, coordinated, integrated and flexible. It must include treatment for the psychiatric illness, treatment for the alcohol or drug addiction, participation in a 12-step based program, appropriate non-addicting medication for each illness, as well as family education and participation in treatment for both component illnesses. A prolonged period of abstinence (30 days or more) from the abused substance is ideally recommended before beginning to treat the psychiatric illness of co-occurring disorders with indicated medications. In some cases, however, psychiatric medications can be crucial to reduce depression, anxiety, paranoia and craving. Any psychiatric medication treatment plan should be prescribed by a physician specifically trained in treating dual diagnosis. Appropriate anti-depression and anti-anxiety medications, including SSRIs or SNRIs, may be appropriate to relieve the symptoms of depression or anxiety without risking an additional addiction. While there are some general patterns seen in many dual diagnoses — such as depressive disorders are often linked to both alcohol and sedative use, while bipolar disorder is often seen with stimulant and opiate use — there is no solid formula for how these diseases occur. Substance abuse or addiction can be found in conjunction with any psychiatric illness, and vice versa. At times, problems can begin with substance use, abuse or addiction, which grow severe to trigger depression, rage, hallucinations or suicide attempts. But, problems also can start with a psychiatric illness, where SUMMER 2013 Advances in Addiction & Recovery 25
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an individual tries to self-medicate with alcohol or drugs. Or perhaps, an individual uses alcohol or drugs recreationally, but because of the preexisting psychiatric illness, he or she is more susceptible to becoming addicted. Whichever way the problems begin, once you have both illnesses, you have to treat both illnesses effectively in a coordinated fashion.
Family Therapy
ety disorders; depression; frequent medical illnesses; difficulty in forming and maintaining relationships; martial problems and divorce; and even their own addictions. The effects of addiction are not limited to only the family members living in the same household of the substance use disorders patient. The consequences of addiction are felt by all of an substance use disorders patient’s loved ones, and although the family members need a different type of treatment from what the substance use disorders patient is receiving, they still need treatment. Family members need to learn how to recognize the problems caused by the addiction, understand the roles they have unwittingly played in the addiction, assess the psychological damage they have suffered and develop new interpersonal skills. One of the most common problems seen in families with substance use disorders patients is codependency, a complex relationship between the substance use disorders patient and a family member, or in some cases a friend, that appears to be loving, but is actually dangerous and damaging to all involved. Codependency is a habitual pattern of self-defeating coping mechanisms. Typically, the codependent offers help to the substance use disorders patient, but it is too much help and is often inappropriate. The substance use disorders patient learns to depend on the codependent to help “fix” his or her problems and what begins as a kind gesture, become an enabling mechanism for the addiction. Because the codependent protects the substance use dis orders patient from the negative consequences of the addiction, the substance use disorders patient can continue drinking or using. While the codependency is a dysfunctional behavior that family members adopt in order to survive the emotional pain and stress caused by the addiction, in the long run it can be counterproductive and detrimental to an substance use disorders patient’s recovery process. Both parties involved, the substance use disorders patient and the codependent family member, should be involved in therapy to understand how to form a healthier relationship. Helping an substance use disorders patient engage in a comprehensive addiction treatment program is never a codependent action, however. At times, families separate from their loved-ones as the physical, emotional and financial stress of the addiction becomes overwhelming. But, it is important to remember that substance use disorders patients who have encountered such family dynamics are not without support resources. There are a variety of sober support systems that substance use disorders patients can utilize, including but not limited to community groups (e.g., 12-step programs, Recovery Inc., Families Anonymous, etc.), religious and spiritual programs, and even online e-lessons (www.enterhealth.com) and recovery blogs. A substance use disorders patient’s family support system does not have to be bloodrelated relatives, or even the individuals he or she live with. Whether it is a patient’s parents, significant other, children, close friends, coworkers or a sober support group, the ability to build a solid system of recovery resources is essential to a patient’s ability to sustain his or her life without alcohol or drugs.
Family involvement has long-term
benefits for the patient and family: sustained recovery, increased
marital satisfaction and even family and job stability.
Addiction is never just one person’s problem; it affects the entire family system. As recently as 2008, researchers argued that family therapy was among one of the most underutilized methods of treatment for drug and alcohol addiction. This is because substance abuse and addiction are no longer considered an individual issue, but instead are viewed as a broader issue that impacts the entire family, a ffecting the family’s health, happiness and wellbeing. In fact, it has been found that addiction treatment approaches that include and focus on the family, significantly increase a patient’s engagement and retention in the treatment process, resulting in improved outcomes for the entire family. When an substance use disorders patient is in the throes of addiction, family members can feel abandoned, anxious, fearful, angry, embarrassed, guilty and a host of other emotions. The damage extends throughout the family as family members struggle to cover up the problem, work around the substance use disorders patient, deal with their own negative emotions and cope with the responsibilities the substance use disorders patient has left unattended and the roles that are unfilled. Many times the family members can unwittingly become enablers to the substance use disorders patient, allowing the substance use disorders patient to continue their damaging behavior and keeping the addiction in play. For this reason, it is important that family members be involved in the treatment process from the beginning, participating in family therapy sessions for the benefit of both the substance use disorders patient and the family member. When an substance use disorders patient’s family is involved in the recovery process, the family members gain a better understanding of the addiction and the underlying issues. This gives the patient a stronger network of support during and after treatment. He/she is more likely to remain engaged in the recovery process, utilize healthier and broader methods of coping when faced with stressors, and successfully return to employment, school or parenting. Research also has found that family involvement has long-term benefits for the patient and family, such as sustained recovery, increased marital satisfaction and even family and job stability. Also, because the substance use disorders patient’s brain is so injured by the substance use, most of the time it is up to the family to help the substance use disorders patient put together a comprehensive treatment approach that is specific for them. So the more science based education that the family has about alcohol and drug addiction, the better they can help guide their loved one to a higher chance of success. I wrote Healing the Addicted Brain specifically to educate the families of substance use disorders patients about the new comprehensive approach to alcohol/ drug addiction treatment. Family members can and do suffer from a wide variety of problems related to their loved one’s addiction, including: physical, emotional and sexual abuse; anger management issues; poor self-esteem; anxi-
Continuum of Care When an individual completes one phase of addiction treatment, Healing, continued on page 29 ☛ SUMMER 2013 Advances in Addiction & Recovery 27
Effective Integrated Treatment Model for Military Based Trauma and Addiction
Critical Factors to Consider for Counseling Wounded Warriors and Their Families B y K atie E vans K elley, P h D, CADC III, NCAC II Our soldiers coming home from the battlefields overseas are in c risis. Suicide rates in the U.S. Army doubled in 2010, and then doubled again in 2011.i The military is trying to find a way to stop the epidemic of suicide among veterans suffering from the cluster of posttraumatic stress disorder (PTSD), addiction and depression. There is a stigma in the military in asking for help.ii Saying you are “sick” can be seen as the equivalent of being “weak.” To compound the problem, there are limited benefits available to veterans to pay for treatment and the process to apply for these benefits can be frustrating, bureaucratic and time consuming.iii My book, Unfortunate Hero, is both a counselor handbook and a workbook for soldiers that includes client work sheets at the end of each chapter. It is written as if it is speaking directly to the soldier to address one of the biggest obstacles in helping this population. The following is an excerpt:
ps productions | photospin.com
Unfortunate Hero: The Soldiers Path From Trauma and Addiction (2011) 2nd Edition. The therapists and healers among us who are dedicated to helping our veterans recover from their military PTSD have to allow history to judge the “right” and “wrong” of the wars in Iraq and Afghanistan. Our job is to help our warriors heal from the trauma of their service, to help them rebuild their lives outside the military, and to “wash out” the brainwashing that turned them into full-time warriors. To do that, we have to help them understand what happens psychologically when the military runs (or is it ruins?) their lives. In order to transform them into the warriors/killers they needed to be, their previous lives had to be erased and new ones created. That is the job of the boot camp drill sergeant or company commander. The good ones are masters of “psychological orientation,” the military euphemism for brainwashing.iv It is their job to traumatize recruits into being killers-on-command. Their motives are laudable — to protect
28 Advances in Addiction & Recovery | SUMMER 2013
our soldiers from the enemy so they can survive to carry out the mission, but their “psychological orientation” techniques can leave psychic scars on the toughest recruit.v At some point in boot camp, for example, all enlistees realize that they are going to survive and will be warriors — trained killers.iv,v Self-confidence soars and a part of them begins to believe they will never feel victimized by anyone ever again.v,viii Sadly, almost every belief with a magical “never” or “forever” attached to it is actually just another trance state: you have lost the ability to think logically and clearly. This is how I explain it to my clients: “Your military trance state begins on the boot camp bus, when that screaming Non-Commissioned Officer’s (NCO) threats and verbal attacks make you feel completely isolated, utterly helpless and generally victimized: painful symptoms of PTSD, but absolutely necessary for a good brainwashing.v,vi,vii,viii,ix Because of the abuse, you quickly develop hyper-vigilance, staying constantly alert to your environment, which is critical if you are to survive on a battlefield, but this is also another symptom of PTSD.viii These are just a few examples of how your military brainwashing also instills in you the basic building blocks of military PTSD.” The seven components of military brainwashing discussed below have been drawn from military training materials as well as other sources on brainwashing.iv,v,vi,vii,viii When you read the following section, you’ll understand why being isolated in boot camp for six or more weeks is necessary to program in the automatic reactions our warriors will need when they go into battle — the same reactions that later lead to the trance states inherent in and indicative of military PTSD. If you entered the military with other traumatic events in your past (complex military PTSD), you were already very “tranceable.”viii If you were mistreated as a child, you might hear a parent’s voice in this list and quickly slip back into the trance state that helped you survive that early abuse. In addition to possible strong emotional reactions, you are likely to have a deep and intense learning experience as
you consider the brainwashing you may have endured in your childhood and definitely endured in your military service. The goal of the therapist is to help these soldiers “de-trance,” or “wash out” the brainwash. The military spent months preparing soldiers to go to war.iv,v A two-hour talk in a gym with two hundred other soldiers while returning their guns and uniforms, however, does not prepare them to come home. They are now different people, unfortunate heroes suffering from the trauma-related symptoms of military PTSD. Furthermore, their families, jobs (if they have jobs) and friends have all changed and moved on with their lives. If you are a therapist, the following discussion will probably be painful for your clients. Nevertheless, it is also the first step on the road to recovery. What are their expectations now home from battle? Do they expect special treatment, a party and gratitude for their service? How about basic respect? Sadly, this is not the experience of most soldiers. A final note; I have spent the last decade married to a retired veteran wounded warrior who contributed a great deal to this book. I am also the stepmother of a son who after allowing me to tape his story of addiction and PTSD, and receiving my PTSD workbook said, “Before we met I felt like a wounded dog, now I know I am an unfortunate hero.” Healing, continued from page 27
they do not walk out completely sober and free of the challenges that they once had. Their brain is still injured by the chronic medical disease of addiction. The triggers, people and places that challenged and caused their addictions are still there, the same as before they entered treatment. The only difference is that the individual now has the tools and information to defeat or manage those influences. Historically, the leading cause for relapses is failure to follow the prescribed, on-going outpatient addiction treatment plan set up at discharge. To reduce the risk of relapse, it is important that substance use disorders patients have the continuum of care plan that provides consistent touch points to support positive future recovery. Recovered substance use disorders patients should participate in Life Care counseling and focus on true friends, using people for support when experiencing negative feelings and avoiding people, places and activities that were strongly associated with their addiction. They also should continue all of their medications and therapies started in the previous treatment phase. One key part of the continuum of care is Relapse Prevention Therapy (RPT), a behavioral self-control program that teaches individuals with substance addiction how to anticipate and cope with the potential for relapse. RPT can be used as a stand-alone substance use addiction treatment program or as a Life Care (aftercare) program to sustain gains achieved during initial substance use addiction treatment. Coping skills training is the cornerstone of RPT, teaching patients strategies to: ■ Understand relapse as a process ■ Identify and cope effectively with high-risk situations such as negat ive emotional states, interpersonal conflict and social pressure ■ Cope with urges and craving ■ Implement damage control procedures during a lapse to minimize negative consequences ■ Stay engaged in recovery even after a relapse ■ Learn how to create a more balanced lifestyle
Katie Evans Kelley, PhD, CADC III, NCAC II, wrote Unfortunate Hero: The Soldiers Path From Trauma and Addiction, which is now in its 2nd edition. Unfortunate Hero was a 2011 Pinnacle Book Achievement Award Winner for Best Book in the Category of Non-Fiction. Dr. Evans has been a NAADAC trainer and offers NAADAC-approved independent home study courses and is a contributor to the Hazelden Co-occurring Disorder Series. She has a PhD in psychology from Capella University and is well known for her excellent trainings nationally and internationally. More information is available at www.drkatieevans.com. (Endnotes) i Army, Navy, see record year for suicides, By Gregg Zoroya, USA Today, Nov. 20, 2012, www.armytimes.com/apps/pbcs.dll/article?AID=2012211200385 ii Ending the stigma of seeking help in the Army, James W. Cartwright, PhD, Sept. 4, 2012, www.army.mil/article/86622 iii A suicidal veteran and a call for help, unanswered, Leo Shane III, Stars and Stripes, April 24, 2012, www.stripes.com/a-suicidal-veteran-and-a-call-for-help-unanswered 1.175397 iv Gray, Glenn, The Warriors (1996), Bison Books v Grossman, David, On Killing, 2nd edition (2006), Bay Books vi Chang, Mathias, Brainwashing for War: Programmed to Kill (2006) vii Taylor, Kathleen, Brainwashing: The Science Of Thought Control (2004), Oxford Press viii Evans, K. and Sullivan, J. M. Treating Addicted Survivors Of Trauma (1995), Guilford Press, New York ix Sergeant, W., Battle for the Mind: A Physiology of Conversions and Brainwashing (1957). London
Coping skills training strategies include both cognitive and behavioral techniques. Cognitive techniques provide patients with ways to re-frame the habit change process as a learning experience with errors and setbacks expected as mastery develops. Behavioral techniques include the use of lifestyle modifications such as meditation, exercise and spiritual practices to strengthen a patient’s overall coping capacity. By implementing the most advanced, science-based treatment protocols and incorporating pharma cotherapy into patient-centered treatment plans that address the psychological, relational and spiritual aspects of addiction, we, as an industry, can move beyond traditional approaches that have struggled for the past 40 years to show improved outcomes. We now have the tools to do more than just get substance use disorders patients clean or sober. We can get them well. Harold C. Urschel III, MD, MMA, a board-certified addiction psychiatrist, is chief medical strategist of Enterhealth, LLC, an addiction disease management company based in Dallas, and author of the New York Times best seller, Healing the Addicted Brain. Dr. Urschel is responsible for overseeing and implementing all addiction psychiatric treatments delivered through traditional clinical outlets, telemedicine support and online coaching services for Enterhealth. For more information on Dr. Urschel and Enterhealth, please visit www.enterhealth.com.
References TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice, Pub id: SMA12-4380; Publication Date: 5/2009, http://store.samhsa.gov/product/ TIP-49-Incorporating-Alcohol-Pharmacotherapies-Into-Medical-Practice/ SMA12-4380. TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, Pub id: SMA12-4214; Publication Date: 11/2008, http://store. samhsa.gov/product/TIP-43-Medication-Assisted-Treatment-for-OpioidAddiction-in-Opioid-Treatment-Programs/SMA12-4214 TIP 39: Substance Abuse Treatment and Family Therapy, Pub id: SMA12-4219; Publication Date: 7/2008, http://store.samhsa.gov/product/TIP-39-SubstanceAbuse-Treatment-and-Family-Therapy/SMA12-4219 TIP 33: Treatment for Stimulant Use Disorder, Pub id: SMA09-4209; Publication Date: 6/2009, http://store.samhsa.gov/product/TIP-33-Treatment-for-StimulantUse-Disorder/SMA09-4209 Urschel, H. C., Healing the Addicted Brain, Sourcebooks, Inc, 2009
Want to learn more from Dr. Urschel on healing the addicted brain? Check out the archived webinar the Addicted Brain: Cutting Edge Science and Brain Neurochemistry at www.naadac.org/education/webinars.
SUMMER 2013 Advances in Addiction & Recovery 29
Mastering Essential Business Operations Learning Networks Attracts More Than 800 Organizations Focused on Preparing for Health Care Reform B y K im J ohnson , MBA
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More than 800 addiction treatment providers across the country are participating in the first round of learning networks offered through BHBusiness: Mastering Essential Business Operations. The learning networks focus on the business skills organizations need to be fully prepared for the changes anticipated — and in some cases, already underway — with the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act. This SAMHSA-funded initiative is administered by the State Associations of Addiction Services (SAAS) in partnership with NIATx, Advocates for Human Potential (AHP), and the National Council. The four organizations have pooled their expertise, training materials, consultants, and mailing lists to offer the field top-notch training that participants can apply in their organizations while they’re ramping up for 2014. Experienced coaches and consultants from each of the four organizations serve as faculty for the learning networks. Key components of the BHBusiness program include: Strategic Business P lanning : learning about how the new reimbursement methods, expanded access to coverage, accountable care organizations, redesigned systems of care and other aspects of the changing health system affects your organization. Participants will walk away with a business plan that incorporates knowledge gained in market and organizational assessments. Third Party/Billing and Compliance : learning how to i mplement third-party billing systems, how to improve existing s ystems and to identifying core compliance measures and ways to design systems that reduce risk to your organization. Third Party/Contract Negotiations : understanding the payer’s perspective, demonstrating the value of your services and attracting new payers using sales and marketing strategies. Eligibility Determination : learning how to address issues in your enrollment process that reduce access to care and reduce potential revenue. Organizations will develop processes for assessing patient eligibility and enrolling patients in plans.
Meaningful Use of Health Information Technology:
expanding your knowledge of Health Information Technology, including how HIT and Electronic Health Record systems can help improve patient care and business management. Twenty groups of 30 providers (representing more than 1,200 individuals) have enrolled in the learning networks that launched in early March: Strategic Business Planning and Third-party Billing and Compliance. Three other learning networks that launched in May include Third-Party/Contract Negotiations, Eligibility Determination and Meaningful use of Health Information Technology. The first round of learning networks will run through September 2013, with the second round beginning shortly after. Designed to accommodate the schedules of busy professionals, the learning networks combine online learning, individual and group coaching via telephone and in-person consulting. Curriculum developers created the training modules using the latest distance 30 Advances in Addiction & Recovery | SUMMER 2013
learning technology that allows for student-teacher interaction in real time, as well as other lessons and required readings that participants can complete at their convenience. Peer sharing plays an important role in the learning networks. Treatment providers are so consumed with the day-to-day operations of their organizations that they often feel isolated. To offset that, the BHBusiness learning networks draw from the success of other projects that gave participants a chance to connect with each other, brainstorm and solve problems. K atharine K irchmeyer, Director of A dm ini strative Services for Alcohol and Drug Dependency Services, Inc. in Buffalo, New York, welcomes the peer sharing. Kirchmeyer is participating in one of the BHBusiness Strategic Business learning networks. “This exercise has been such a great opportunity for our agency,” she says. “It’s allowed us to work with and get feedback from a number of agencies across New York State. We always tend to think we’re alone when dealing with difficult internal and external factors, especially when it comes to government regulations and insurance and managed care companies, so it’s nice to be reminded that we’re not. These types of forums are also good to discover solutions that you’d never think of on your own.” Nancy Crean, Director of Program Development and Contracts of Transitional Living Services of Northern New York in Watertown is also participating in the Strategic Business Planning learning network. “The timing of this training could not be better, as our agency is starting a new strategic planning cycle. The knowledge and perspective we are gaining is incredibly empowering.” “As we move forward in this new health care environment, it is critical that addiction-focused professionals understand the opportunities and challenges that we face,” said Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP, Executive Director of NAADAC. “The BHBusiness program can help our agencies thrive as we move forward and help forge relationships with Preferred Provider, Managed Care and Behavioral Health organization (PPO/MCO/BHO) third party payers for reimbursement of health care services.” For more information visit http://saasnet.org/bhb/index.php or e-mail info@bhbusiness.org. Kim Johnson, MBA, is the deputy director for operations of NIATx, a research center at the University of Wisconsin-Madison that focuses on systems improvement in behavioral health. She is also director of the ACTION (Adopting Changes to Improve Outcomes Now) Campaign, a national campaign to improve access to and retention in treatment. Johnson has also been an executive director of a treatment agency, managed intervention and prevention programs and been a child and family therapist. She has a Master’s degree in counselor education and an MBA.
Want to learn more on billing and preparing for the changes in the health care environment? Check out the archived webinars at www.naadac.org/education/webinars.
NAADAC BOARD OF DIRECTORS REGIONAL VICE PRESIDENTS
Organizational Representative Philip L. Herschman, PhD
Mid-Atlantic (Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)
PAST PRESIDENTS
Mid-Central (Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)
Stewart Turner-Ball, LMFT, LCSW, LCAC, MAC
NAADAC
Mid-South (Represents Arkansas, Louisiana, Oklahoma and Texas)
NAADAC OFFICERS
Sherri Layton, MBA, LCDC, CCS
Updated 5/7/13
North Central (Represents Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota)
President Robert C. Richards, MA, NCAC II, CADC III
Diane Sevening, EdD, CDC III
President Elect Kirk Bowden, PhD
Northeast (Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)
Secretary Thurston S. Smith, CCS, NCAC I, ICADC Treasurer John Lisy, LICDC, OCPS II, LISW-S, LPCC-S
Catherine Iacuzzi, PsyD, MLADC, LCS Northwest
Past President Donald P. Osborn, PhD (c), LCAC
(Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)
Greg Bennett, MA, LAT
National Certification Commission for Addiction Professionals (NCC AP) Kathryn B. Benson, LADC, NACAC II, QSAP, QSC Executive Director Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP
(Represents Arizona, California, Colorado, Hawaii, Nevada, New Mexico and Utah)
National Addiction Studies and Standards Collaborative Committee Chair Donald P. Osborn, PhD (c), LCAC
Adolescent Specialty Committee Chair Christopher Bowers, MDiv, CSAC, ASE
NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP) Kathryn B. Benson, LADC, NCAC II, QSAP, QSC, NCC AP Chair Nashville, Tenn. lightbeing@aol.com
William S. Lundgren Denver, CO lund1365@msn.com Rose M. Maire Glen Rock, NJ rmmaire@aol.com
Christopher C. Bowers Powhatan, VA chriscbowers@comcast.net
Loretta Tillery, Public Member Lanham, MD ltillery99@yahoo.com
Susan L. Coyer Huntington, WV susan.coyer@prestera.org
Ricki Townsend Fair Oaks, CA ccrtowns@aol.com
Carmen L. Getty Alexandria, VA carmen.getty@alexandriava.gov
James Holder Past Chair Effingham, SC james.holder10@yahoo.com
Tay Bian How Sri Lanka bian.howtay@colomboplan.org
Clinical Issues Committee Frances Patterson, PhD, MAC
Gloria Boberg, LSAC, CAC
Student Committee Chair Diane Sevening, EdD, CDC III
Awards Sub-Committee Chair Tricia Sapp, BSW, CCJP, CPS
Bylaws Committee Chair Ronald A. Chupp, LCSW, LCAC, NCAC-II, ICAC-II
Southwest
Political Action Committee Chair Nancy Deming, MSW, LCSW, CCAC-S
NAADAC AD HOC COMMITTEE CHAIRS
NAADAC STANDING COMMITTEE CHAIRS
Frances Patterson, PhD, MAC
Product Review Committee Chair Philip L. Herschman, PhD
NAADAC Public Policy Committee Chair Gerry Schmidt, MA, LPC, MAC
Southeast (Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)
Leadership Retention & Membership Committee Chair Roger A. Curtiss, LAC, NCAC II
Personnel Committee Chair Robert C. Richards, MA, NCAC II, CADC III
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
Ron Pritchard, CSAC, CAS
International Committee Chair Paul Le, BA
Nominations and Elections Co-Chairs Donald P. Osborn, PhD (c), LCAC
Ethics Committee Chair Anne Hatcher, EdD, CAC III, NCAC II Finance Committee Chair John Lisy, LICDC, OCPS II, LISW-S, LPCC-S
Thaddeus S. Labhart John Day, OR tlabhart@hotmail.com
Robert C. Richards, MA, NCAC II, CADC III (ex-officio)
MID-CENTRAL
NORTHEAST
Beverly Jackson, Illinois C. Albert Alvarez, LMHC, LCAC, MAC, CGP, Indiana Michael Townsend, MSSW, Kentucky Shannon Rozell, MPA, Michigan Leon Collins, LICDC, ICADC, ICCS, Ohio Gisela Berger, PhD, Wisconsin
Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Susan O’Connor, Massachusetts Peter DalPra, LADC, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, DOT SAP, New York William Keithcart, MA, LADC, Vermont
NAADAC REGIONAL BOARD REPRESENTATIVES
NORTH CENTRAL
AK
James P. Johnson, BS, LADC, ICS, Minnesota Gloria Nepote, Kansas/Missouri Jack Buehler, LADC, Nebraska Kurt Snyder, MMGT, LSW, LAC, North Dakota Jack Stoddard, MA, CCDC III, South Dakota WA
NORTHWEST MT
Steven Sundby, PhD, Alaska Julie Messerly, LAC, Montana Christine Stole, Oregon Greg Bauer, CDP, NCAC I, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming
OR
ME
ND VT
MN
Northwest
SD
ID
North Central
WY
NJ
Mid-Central IL
CO
Southwest
KS
CT
NH MA RI
PA
UT CA
NY
MI IA
NE
NV
Northeast
WI
IN
MO
MD
OH
MidAtlantic
DE
WV
KY
VA NC
TN
SOUTHWEST
HI
AZ
OK
NM
Del Worley, MC, LPC, LISAC, Arizona Thomas Gorham, MA, CADC II, California Mita Johnson, LPC, LMFT, LAC, MAC, ACS, Colorado Mark C. Fratzke, MA, MAC, CSAC, CSAPA, Hawaii Kimberly Landero, MA, Nevada Michael Odom, LSAC, Utah
Mid-South TX
AR
AL LA
Matthew Feehery, MBA, LCDC, Texas
GA
MS
SOUTHEAST MID-SOUTH
SC
Southeast
FL
MID-ATLANTIC Jevon Hicks Sr., Delaware Johnny Allem, MA, District of Columbia Moe Briggs, NCC, LCPC, MAC, SAP, Maryland Patrice Porter, LPC, Virginia Susie Mullens, MS, LPC, ALPS, AADC-S, West Virginia
Eddie Albright, MS, Alabama Bobbie Hayes, LMHC, CAP, Florida Diane Sherman, PhD, NCAC II, Georgia Martha Wittig, PhD, CAADC, CCS, Mississippi Angela Maxwell, MS, CSAPC, North Carolina Ernie Kirkland, South Carolina Toby Abrams, LADAC, Tennessee
SUMMER 2013 Advances in Addiction & Recovery 31
NCC AP Announces New Credentials/Endorsements The NCC AP’s newest credentials and endorsements provide national recognition of a professional’s current knowledge and competence. We encourage you to continue to learn for the sake of your clients which provides assistance to employers, health care providers, educators, government entities, labor unions, other practi tioners, and the public in the identi fication of quality counselors who have met the national competency standards.
Nationally Certified Adolescent Addiction Credential A nationally recognized standard of competencies and effective clinical practice utilized in treating adolescent Substance Use Disorders (SUDs). Nicotine Dependence Specialists Credential (NDS) A nationally recognized standard of competencies that demonstrates foundational knowledge of nicotine dependence, develops skills and strategies for tobacco addiction counseling and examines related recovery and wellness issues.
Nationally Endorsed Student Assistance Professionals (NESAP) A nationally recognized endorsement developed to address the need for professional competencies for practitioners treating adolescent Substance Use Disorders (SUDs). Over the past ten years there has been an emerging necessity to distinguish a unique set of skills for this practice when addressing adolescent issues in a school setting; identify an adequate awareness of adolescent development and differentiate issues related to co-occurring disorders that practitioners need to understand when working with adolescents.
For details, including requirements for credentialing, recredentialing and exam schedule and fees, go to
www.naadac.org/certification