Advances in Addiction & Recovery (Fall 2017) by NAADAC, the Association for Addiction Professionals

FALL 2017 Vol. 5, No. 3

A Framework for Service: “Facing Addiction in America” During an Opioid Epidemic By H. Westley Clark, MD, JD, MPH, CAS, FASAM & Matthew Davis

PLUS: • Recovery Rising: An Interview with William L. White • New National Certificate in Tobacco Treatment Practice • 2017 Award Winners & Annual Conference Highlights

Just ! Released

2017 Update includes: • DSM-5 diagnostic criteria and newest ASAM criteria • 2016 NAADAC/NCC AP Code of Ethics • Current terminology • Support of evidence-based practice and theory by research published since last edition

The Basics of Addiction Counseling Desk Reference is a three-volume set that has aided many addiction professionals in attaining their state and national credentials, as a quick reference tool for various situations that arise throughout addiction professional careers, and as a college/ university text. The independent study course for Module II: Addiction Counseling Theories, Practices and Skills is designed to provide addiction counselors and other helping professionals with a thorough overview of the major theories and techniques used for addiction counseling. Newly updated in 2017, this course includes the 168-page manual and an online independent study exam that can be completed for 17 nationally-approved continuing education credits and serve as useful practice for certification/licensure exams.

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Please visit www.naadac.org/bookstore. Independent Study Course NAADAC Members $111

Non-members $150

Manual Only NAADAC Members $48

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

CONTENTS FALL 2017 Vol. 5 No. 3 Advances in Addiction & Recovery, the official publication of NAADAC, is focused on providing useful, innovative, and timely information on trends and best practices in the addiction profession that are beneficial for practitioners. NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 100,000 addiction counselors, educators, and other addictionfocused health care professionals in the United States, Canada, and abroad. NAADAC’s members are addiction counselors, educators, and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education. Mailing Address 44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 Telephone 800.548.0497 Email naadac@naadac.org Fax 703.741.7698 Managing Editor

Jessica Gleason, JD

Associate Editor

Kristin Hamilton, JD

Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Committee

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

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

Thomas Durham, PhD NAADAC, the Association for Addiction Professionals

■ F EAT UR ES 18 Recovery Rising: An Interview with William L. White By Jessica Gleason, JD, NAADAC Director of Communications

Abimbola Farinde, PhD Columbia Southern University

Deann Jepson, MS Advocates for Human Potential, Inc.

James McKenna, MEd, LADC I AdCare Hospital

20 A Framework for Service: “Facing Addiction in America” During an Opioid Epidemic

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP NAADAC, the Association for Addiction Professionals

27 U.S. Sentencing Commission Testimony on Synthetic Cathinones, Cannabinoids, and Opioids

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

By H. Westley Clark, MD, JD, MPH, CAS, FASAM and Matthew Davis By Darryl S. Inaba, PharmD, CATC-V, CADC III

■ DEPA R T M EN TS 4

President’s Corner: The Future of Health Care Reform: Shaping and Reshaping Treatment By Gerard J. Schmidt, MA, LPC, MAC, NAADAC President

From The Executive Director: Developing an Environment of Change for the Peer Recovery Support Specialist By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

Affiliates: Lessons Learned in a Year of Hurricanes By Kristin Hamilton, JD, NAADAC Communications Manager

11 Ethics: Addiction Professionals With and Without Lived Experience: Common Ethical Questions By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair

12 Education: NAADAC and ATTUD Announce New National Certificate in Tobacco

Treatment Practice (NCTTP) By Jessica Gleason, JD, NAADAC Director of Communications

14 Membership: NAADAC Honors 2017 National Award Winners

For more information on submitting articles for inclusion in Advances in A ddiction & Recovery, please visit www.naadac.org/advances-in-addiction-recovery. Disclaimer It is expressly understood that articles published in Advances in Addiction & Recovery do not necessarily represent the view of NAADAC. The views expressed and the accuracy of the information on which they are based are the responsibility of the author(s) and represent the wide diversity of thought and opinion within the addiction profession. Advertise With Us For more information on advertising, please contact Jessica Gleason, Managing Editor, at jgleason@naadac.org. Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5 This publication was prepared by NAADAC, the Association for Addiction Professionals. Reproduction without written permission is prohibited. For more information on obtaining additional copies of this publication, call 1.800.548.0497 or visit www.naadac.org. Printed November 2017

15 Certification: Reciprocity Issues Amidst a Young and Mobile Workforce: Another Argument for National Standards By Thaddeus Labhart, MAC, LPC

STAY CONNECTED

16 Conference: NAADAC 2017 Annual Conference Highlights 30 NAADAC CE Quiz 31 NAADAC Leadership

ALL IMAGES FROM SHUTTERSTOCK UNLESS OTHERWISE NOTED

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■ PR ES ID ENT ’S CO RN E R

The Future of Health Care Reform: Shaping and Reshaping Treatment By Gerard J. Schmidt, MA, LPC, MAC, NAADAC President Senator Shelley Moore Capito, R-WV, and I sat down this summer to discuss health care and health care reform. While we may not agree on all aspects of the best path to a more comprehensive and affordable method of addressing health care coverage, we do agree that the future is uncertain and that health care nationwide is a problem. Many of the current problems Senator Capito and I see our fellow citizens here in West Virginia facing are the same problems that communities are facing nationwide. Medicaid expansion in West Virginia, and in many states, has opened the door for access to health care, including addiction treatment, for hundreds of thousands of individuals previously excluded from health care coverage of any type. We, on a local level and as a nation, need to come together to identify priorities and work to provide treatment.

Don’t Lose Sight of Other Addictions One thing Senator Capito and I agree on is that an over-focus on the opioid addiction problem redirects the focus away from other equally critical addiction issues facing us nationally. Seemingly every time you turn on the news or pick up a paper, you hear about the opioid crisis. Without question, there is a huge problem with the rise in opioid addiction, opioid overdoses, and access to pain medications over the past ten years or so, and we need more local, state, and national initiatives and funding to address

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the issue. In the past two weeks alone, President Trump has declared the opioid crisis a public health emergency and his Commission on Combating Drug Addiction and the Opioid Crisis released a report making more than 50 recommendations aimed at ameliorating the opioid epidemic. However, for many of us that have been in this profession for the past 30 plus years, this current problem is just that: the current problem. That does not take away from the serious and harmful nature of what is occurring, but it does distract from the larger and more widespread and deadly problem of alcohol addiction. Alcohol addiction is still the third most serious health problem in the United States and more people die each year from this addiction and related illnesses then any other addiction. Alcohol misuse accounts for about 88,000 deaths in the United States each year and alcohol is involved in about 20 percent of the overdose related to opioids. Alcohol misuse and alcohol use disorders alone cost the United States approximately $249 billion in lost productivity, healthcare expense, law enforcement, and other criminal justice costs.1 We cannot lose sight of the serious nature of this, and in our efforts to deal with the current epidemic with opioids, pull or redirect funding away from research, prevention and treatment of alcohol addiction. Future, continued on page 9 ☛

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

Developing an Environment of Change for the Peer Recovery Support Specialist By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director The addiction profession is at a breaking point. There are more people who need addiction prevention, treatment, and recovery support in the United States than there are addiction professionals to meet those needs. This workforce shortage is serious and will only get worse. According to the U.S. Department of Labor, the need for addiction professionals will grow by 20 percent by 2026. This increased need is due to both negative factors, such as the ongoing opioid epidemic, and positive factors, such as increased public awareness, increased access due to Parity and the Affordable Care Act, and increased funding due to legislation like the 21st Century Cures Act and Comprehensive Addiction and Recovery Act. The addiction profession has longed for recognition and support for decades, and now that we are receiving it, we must work to meet the needs of consumers and families. In an effort to address part of the workforce shortage, the National Certification Commission for Addiction Professionals (NCC AP) is taking on the challenge of both setting national standards through its Nationally Certified Peer Recovery Support Specialists (NCPRSS) credential and working to cement the Peer Recovery Support Specialist (PRSS) as an integral part of the National Career Ladder. Developed by NAADAC under a contract with Advocates for Human Potential, Inc., the National Career Ladder is accepted by partner national addiction organizations, promoted through SAMHSA and, at some levels, funded by managed care organizations (MCOs) or behavioral health and wellness services.

Certified Peers should be used as one component of a comprehensive, holistic, and evidence-based system of care. The scope of practice and the range of services that this position can support is vast. A certified NCPRSS can provide one-on-one support in navigating health and mutual support systems, services, and supports, facilitate introduction to a mutual support group, and/or provide community services connections to education, employment, housing, clothing, food, transportation, child care, alumni support groups and systems. A NCPRSS can also be a part of a client services team in hospitals, clinics, and treatment centers. While not an exhaustive list, these are services that addiction counselors often do not have the time to support due to large caseloads, and are services that clients can benefit from immensely. NCC AP recognizes that it is important to gain acceptance and recognition of Peer Recovery Support Specialists within the continuum of care to ensure that funders (states, MCOs, Medicaid, and others) will not supplant Peers for other trained, credentialed, and educated addiction professionals. To prevent this, NCC AP has clearly laid out the scope of practice of the NCPRSS and works to ensure that certified Peer Recovery Support Specialists will be supported with the type of supervision and support that will protect their recovery and those that they serve. We are happy to report that behavioral health organizations as a whole are increasing the use of PRSS as part of the continuum of care. Some states are reimbursing services through publicly funded agencies for PRSS

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services, while other states also support these services through Medicaid funding. Some MCOs are also recognizing the value of the services provided by those with this credential and providing reimbursement for them. NCC AP has also received acceptance of our NCPRSS national credential for reimbursement through Optum. Optum, like many others, recognizes that: 1) the NCPRSS credential is a national credential and thereby adheres to the same criteria in every state/jurisdiction that adopts it; 2) there is a national credential portfolio kept at the NCC AP/NAADAC offices; 3) there is a national PRSS Code of Ethics that is tied to the NCPRSS credential with a national body to review ethics complaints; and 4) that NCPRSS-credentialed individuals can obtain malpractice insurance — which is important to the facilities that use Peer Recovery Support Specialist services and also important to third-party reimbursers. There is work to be done to increase the acceptance of the NCPRSS in the treatment and recovery support environment. First, we will work toward the continued and increasing acceptance of the NCC AP NCPRSS national credential to support quality education and supervision, reimbursement, and portability. Second, we will work to develop and ensure broad reimbursement systems by MCOs, state-supported programs, the VA/Tricare, and Medicaid systems for NCPRSS, as well as continued increased acceptance for addiction counselors. Third, we will work to promote internal billing systems that are able to accurately bill with service codes at each level of service. Fourth, we will work to expand access to these services throughout addiction and mental health agencies, hospitals, emergency rooms, health care clinics, and other community based service

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centers such as emergency housing, food banks, clothing/housing supports, and other relevant services. Finally, we will support studies that explore the effectiveness of NCPRSS and addiction counselors specific to their scope(s) of practice. NCC AP is working to bring more Peers into the national credentialing process for PRSS and embrace them in the continuum of care for addiction and mental health services. Together, we can build a comprehensive, standardized and qualified national Peer Recovery Support Specialist system that embraces their specific field of work and supports the health and wellness of individuals, families and communities across the national and eventually, across the globe. Blessings, Cynthia Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years as well as an international, national and state trainer in a variety of topics. Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders, and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State. (References) Peer Support Services, A Valuable Component of Behavioral Healthcare, report by Linda Kaplan, January 28, 2013. NAADAC/SAMHSA Career/Education Ladder, September 2016.

■ A F F ILIAT E S

Lessons Learned in a Year of Hurricanes By Kristin Hamilton, JD, NAADAC Communications Manager

Matt Feehery, LCDC, is the NAADAC Regional Vice-President for the Mid-South, representing Arkansas, Louisiana, Oklahoma, and Texas, and CEO of Memorial Hermann Prevention & Recovery Center (PaRC) and Behavioral Health Services in Houston, TX. He has worked in the addiction treatment field since 1979, serving as consultant and CEO for treatment organizations and hospitals throughout the country. Feehery is Chairman of the Behavioral Health Services Council for the Texas Hospital Association (THA), is an appointed member of the Behavioral Health Advisory Committee for the Texas Health and Human Services Commission (HHSC), and previously served as President of the Texas Association of Addiction Professionals (TAAP). He is a native Houstonian and holds a Master’s degree in Business Administration in Healthcare Management. NAADAC Communications Manager, Kristin Hamilton, sat down with Feehery to discuss the effects of Hurricane Harvey on the treatment provided by the addiction professionals in the region, lessons learned, and how they can be better prepared for disasters in the future.

Q: How did Hurricane Harvey and the resulting flooding, evacuation orders, and loss of electricity affect the treatment systems in Houston? A: Most residential treatment organizations were able to stay operational, but some evacuated due to either optional or mandatory evacuation orders in advance of the storm. Different treatment centers handled the evacuations differently, but providers from across the state came together to minimize any lapse in care being provided to the residents. One center moved its patients to treatment centers it operates in other parts of the state that were out of the storm's path. Other treatment centers further inland agreed to house patients from those closer to the coast. PaRC Memorial Hermann had agreed to accept detoxing patients from another center but at the last minute that center chose to stay open. Treatment facilities that provide medication assisted treatment, including methadone clinics, coordinated with each other to cover clients’ needs in the event their operations were interrupted due to flooding or lack of electricity. The city and county open shelters for displaced citizens and part of the services offered included behavioral health care, so care for mental health and substance use was available.

Q: What lessons were learned in the aftermath of Hurricanes Katrina, Rita, and Ike that helped with the preparation for and recovery from Hurricane Harvey? A: The experiences from Hurricanes Katrina and Rita in 2005 motivated treatment providers to plan ahead for storm events and get prepared for handling rising water and hurricane force wind. Healthcare organizations developed evacuation and storm operation plans, including plans to ensure there are enough supplies and staff on hand for riding out the storm, or having a plan in place for transferring patients, should the need arise. Managing staff coverage during a weather emergency is a challenge within itself, since employees still have to get to work while dealing with their own situations. Houston took a direct hit from Hurricane Ike in 2008, but the detrimental impact was mitigated as much as possible because the providers were more prepared as a result of their planning. Hurricane Harvey was a huge flood event spread across a wide geographic area and it lasted for almost four days in the Houston area. River and bayou flooding, which caused some roads to remain impassable, continued well into the following week. The impact on Houston area residents was widespread. More than 15% of Memorial FA L L 2 017 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 7

AVAILABLE RESOURCES Hermann’s staff had either their home or A: When a natural disaster of this magniAs an association, NAADAC is committed to doing their vehicles flooded. Continuing to serve tude happens, people move into a different what we can to support our members and treatment your patients while being sensitive to the level of response, both emotionally and providers working to rebuild and recover from the very real issues many of your employees physically. Regardless of their own personal storms in Texas, Florida, Louisiana, and Puerto Rico, are facing is a challenge, but people pulled issues, they are generally more supportive and other natural disasters in the United States. together to make both priorities. of each other and helpful. Families help If you or someone you care about needs help coping Those organizations that provide methafamilies, neighbors help neighbors and with these tragedies, please contact : done or other MAT pre-planned a response complete strangers help complete strangin the event clientele were cut off from acers. It's a beautiful thing to witness com• SAMHSA’s Disaster Distress Helpline by calling cessing designated clinic sites. Clients were munities pull together in difficult times and 1-800-985-5990 or texting TalkWithUs to 66746. supplied with additional doses in case offices support each other. When PaRC Memorial • The SAMHSA Disaster Technical Assistance Center were unable to reopen. These same providHermann intensive outpatient program pa(DTAC) also offers a hurricane-specific resource ers also contacted each other to arrange for tients came back to attend groups after the collection through the Disaster Behavioral supporting clients from other programs in storm subsided, it was great to hear them Health Information Series (DBHIS), which can be the event a program’s office was flooded share their perspectives about the previous found at www.samhsa.gov/dbhis-collections/ or there was not adequate medication on days and weeks. Patients reflected on how disaster-specific-resources?term=Hurricane-DBHIS. hand. This, in fact, happened to one of the self-absorbed they were prior to treatment, local methadone clinics and the coordiacknowledging that they were more worried nated response worked well. When Hurricane Katrina hit, many people about themselves and where their next drug or drink might come from. from Louisiana came to Houston. Methadone patients came to the city’s Being sober allowed them to have compassion and concern for others and shelters and medical sites without medication or identification and, of become helpful to their families and neighbors in these difficult times. It was course, there was no way to notify their programs to confirm participa- an eye-opening experience for many of them and provided an important tion. Regardless, Houston area addiction medicine professionals provided reassurance about being in recovery. One of the gifts of sobriety and recovcare and assistance, and addressed the need for medication and treatment. ery is that you are present and available to others. The 12-step recovering Hurricanes happen along the Gulf Coast and these storms made all pro- community also came out in force to support each other. viders aware of the need to safely and adequately serve patients in these Q: What can NAADAC or other groups do to assist the programs in the kinds of circumstances. Houston area? A: The recovery across the greater Houston area has been swift and Q: What affect do you see on the client population – particularity relapse and binge using of drugs or alcohol – during a major disaster, like quite remarkable. There are continuing needs, but each organization is working to secure the resources needed to help them get back on their Hurricane Harvey? A: People with addictions are pretty resourceful. In the general popula- feet. This hurricane certainly wasn't the community’s first but it was defition, someone actively using will prepare for a hurricane event the same nitely a historical storm in terms of duration, size and the amount of rain. way another person would prepare, but instead of just getting batteries Between 48” and 52” of rain fell across the Houston area in just three for flashlights, water and non-perishable food supplies in preparation for a days’ time. No part of the community was left untouched; that was the storm, they'll make sure they're stocked up on alcohol and their primary difference with this one. drug of use. For those with an addiction, the alcohol and/or drugs are Q: What tips would you give to others regarding preparing for and hanthe necessities, and acquiring them becomes a priority and a part of storm dling the aftermath of natural disasters? preparation. For the homeless or displaced, that preparation will be more A: Many disasters, like hurricanes or even the recent fires in northern difficult. California, tend to allow for advance warning. Take advantage of that time Q: What do you see as the long term needs or issues as a result of the to make and finalize plans and otherwise prepare. Treatment organizations should have organized Disaster Response and Emergency Preparedness hurricane? A: Hurricane Harvey impacted a large swath of Texas, including larger plans in place and drill on an annual basis, if not more often. Knowing the cities like Corpus Christi, plus many rural and small communities as far other organizations in your community that provide treatment services is away from Houston as 150 miles in any direction. Those who live farther always a good idea. Collaborate and partner with them in handling these away from major metropolitan areas experience more difficulty in accessing types of emergencies. One organization may be impacted while another is services without delay, especially those who are in MAT programs. Storm not; it’s important that we all do what we can to help our neighbor. relief shelters were set up in Dallas, Austin and San Antonio to support Kristin Hamilton is the Communications Manager for NAADAC, the Association the rural communities, and they faced some of the same challenges with for Addiction Professionals. She works on NAADAC public relations, combehavioral health. The state’s Health and Human Services substance use munications, and digital media, including the NAADAC website and social media, is editor of NAADAC's two ePublications, the bi-weekly Addiction & division utilized their response resources to meet much of this need in the Recovery eNews and weekly Professional eUpdate, and is associate editor for weeks following the storm. State-funded and private providers will conNAADAC’s magazine, Advances in Addiction and Recovery. She also contribtinue to evaluate their responses and streamline their coordination efforts. utes to the planning, organization, and administration of communication

Q: Did you hear of an up-tick in services or support groups happening in the aftermath of the hurricane, or were clients more involved in helping their families with the immediacy of the situation? 8

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campaigns, administers the PhD Candidate Survey Program, and serves as the affiliate liaison for the Communications Department. Hamilton holds a Juris Doctorate from Northeastern University School of Law in Boston, MA and a Bachelor of Science Degree in Biology and Chemistry from Roger Williams University in Bristol, RI.

Future, continued from page 4

Promote Comprehensive Systems of Care and Continuum of Care It is clear that our nation is in crisis with respect to health care from a variety of fronts. Politics aside, we as a profession need to make certain that our voices are constant and in concert with the message that treatment works and recovery is possible. We need to continue to promote systems of care that address both immediate and emergent care issues of substance use disorders like detoxification, naloxone intervention, prevention, treatment and long term recovery. It is only through this continuum of care that we can effectively deal with the staggering epidemic of alcohol and drug use disorders in the country. In my travels across the country as President of NAADAC, I have had the opportunity to talk with a variety of providers, treatment program administrators, and the public in general about what a devastating shortage of treatment professionals we have. While the demand and access for treatment continues to grow, the ever-increasing demand for qualified addiction treatment professionals continues to greatly exceed their availability. Comprehensive systems of care from intervention to treatment to long term recovery support using Peer Recovery Specialists are effective and evidence-based methods of practice that have had a profound impact on addressing the ever growing problems of substance use disorders across the United States. As a profession, we need to embrace these methods and work with systems of care in making certain that we are both open to this delivery system and supportive of education and certification and reimbursement efforts for this type of care.

the opioid epidemic dominates the headlines. However, our task is clear: we must work to provide access to evidence-based and quality substance use disorder treatment for everyone and keep our message in front of those who can make meaningful changes in both policy and practice. We are the leaders in addiction treatment nationwide and we need to join our voices and advocate for those who cannot speak for themselves but are so desperately in need of care. As the debate continues over health care coverage, and no matter how it gets reshaped, we need to make certain our message is loud and clear: Treatment works and needs to be funded because recovery is possible. Gerard J. Schmidt, MA, LPC, MAC, is President of NAADAC, the Association for Addiction Professionals and the Chief Operations Officer at Valley HealthCare System in Morgantown, WV. He has served in the mental health and addictions treatment profession for the past 45 years. Publications to Schmidt’s credit include several articles on the development of Employee Assistance Programs in rural areas and wellness in the workplace, addictions practice in the residential settings and an overview of addictions practice in the United States. He has edited Treatment Improvement Protocols for CSAT for several years and has been active with the Mid-Atlantic ATTC. Schmidt had served as Chair of the National Certification Commission for Addiction Professionals (NCC AP) and NAADAC’s Public Policy Committee, and as NAADAC’s Clinical Affairs Consultant. Awards include the Distinguished Service Award in 2003 and the Senator Harold Hughes Advocate of the Year in 2010. In addition to his national and international work, Schmidt has been active within West Virginia in advocating for and supporting State legislative issues related to addictions and addiction treatment. (Endnote) 1 U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.

Stay Abreast of Current Trends of Use As the conversation continues about health care reform and coverage for all aspects of treatment, we, as addiction treatment professionals need to stay focused on current trends of use. A prime example of this is the fallout that is occurring across the United States as a result of states legalizing medicinal and/or recreational marijuana use, and/or decriminalizing marijuana use/possession. As a result, I believe we are already seeing both an increase in diverted use and an increase in “tainted” or “doctored” marijuana coming across the border to compete with local product. While our job is to focus on treatment, we need to be keenly aware of the current trends and the impact these trends have on those we are treating or who may need to seek treatment. Furthermore, as we advocate for treatment dollars, our message needs to be uniform and consistent about the issues facing each locale.

Get Involved with Local, State, and National Advocacy As most of you know, advocacy is near and dear to me and has been over the course of my career. We treat a population of individuals who are less represented than any other health group in the United States. We, as treatment professionals, have a responsibility to be the voice for recovery and to promote legislation and encourage funding at all levels for substance use disorders treatment. While NAADAC can take the lead, we cannot do it without you! We need your help at the local, state, and national levels to advocate for prevention, treatment and recovery resources and funding. Visit NAADAC’s “Take Action” webpage at www.naadac.org/takeaction and learn about current federal legislation that you can support. Call, email, or text your local, state, and federal representatives and use your voice. The current state of health care is up in the air as politicians debate and FA L L 2 017 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 9

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■ E T H ICS

Addiction Professionals With and Without Lived Experience: Common Ethical Questions By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair There are two questions that are posed regularly: (1) does a potential clinician/service provider have to have addiction and recovery in his or her story to be effective helping others struggling with addictive substances and behaviors, and (2) how long “should” a person be sober before accepting employment as a helper/service provider to others struggling with addictive substances and/or behaviors? The answer to the first question is easier to explain than the second question. No, you do not have to have a personal history with addictions (directly or indirectly) to be effective in our profession. Understandably, clients may have the idea that we cannot relate to them or be empathetic to the hurdles of their recovery journey if we have not walked a similar journey to theirs. We all want someone who can relate to us — helping us. However, that similarity may not always work to the client’s advantage. The client is the expert on his or her own addiction-related experiences. Their stories and histories are uniquely theirs. We cannot compare where we have been to where they are. As clinicians and service providers we are here to collaborate with the client. The client brings the issues, concerns, and compulsions; the clinician/service provider brings a unique perspective and appropriate therapeutic and recovery tools to the professional relationship. The clinician/service provider is able to see the forest for what it is without being blinded by the individual trees. The clinician/service provider does not need to be clouded by his or her own experiences, nor does he or she need to measure their client’s successes and setbacks based on his or her own journey, regardless of how similar the stories are. When we are using our story to help a client, we are operating more from a counselor-centered than a client-centered agenda. The most effective clinician/ service providers are those who are able to connect with and establish rapport with their clients. The most effective providers listen with the intent to understand and collaborate with the intent to support meaningful positive change towards functionality, health and wellness. Clients benefit from an unbiased collaboration that is respectful, honest, and client-focused. To answer the second question, we consider the client who does really well in his or her treatment journey. That client has learned a lot about him- or herself, has tasted success in treatment and early recovery, and now wants to help others along their journey. How long should he or she be in recovery before seeking employment in our profession, treating addictions and supporting recovery? That is a valid question that is difficult to answer. Every treatment and recovery story is unique and complicated. No two people recover in the same way; a person in recovery has to discover what it means to be functional and/or sober, and has to hold him- or

herself accountable to his or her treatment and recovery goals. We know that one’s recovery journey is a factor influencing potential employment. There are other guidelines to consider. One of the primary reasons a client recidivates or relapses is stress. Life in early and sustained recovery can be very stressful physiologically, psychologically and socially. PAWS (post-acute withdrawal syndrome) includes symptoms of anxiety, depression and cravings that persist for months to years after last use. Working in a treatment and recovery-oriented environment is stressful. Clients relapse, clients are suicidal, and clients are dealing with significant co-occurring disorders. Clients are sharing intimate details about their use and behavior patterns, as well as the cravings and triggers they are being bombarded with. There are moments when clients can be rude, angry and disrespectful. There are moments when you will hear and see things you do not want to remember, but will. We have all struggled with wanting to make sure we are saying the right things and using the right tools to make a meaningful difference in a person’s life — but we are doubting our thoughts and actions. On top of these factors, if we want to work at the agency from which we graduated we have the additional layers of having been a client at that facility. Just because a person succeeded as a client in a specific agency does not mean that he or she will make a great employee of that agency. There are unspoken expectations of the client hired by the agency that he or she graduated from — by the staff, clinicians and active clients. Those expectations and the office politics around those expectations can cause a great deal of stress on the client hired as staff. There are also dual relationship concerns that would have to be addressed that could be avoided by working at another agency. So, what are the recommendations for when a person in recovery can start working in the addictions-specific profession: right after they graduate from treatment, after several months or several years of recovery without any relapses, after several months or several years after last relapse, never … ? Across our profession, the answer ranges from immediately after graduation to five years post-graduation from treatment and in recovery. The most consensus is around a minimum of one to two years of recovery time. This allows the client-turningservice provider time to work his or her recovery, address triggers and cravings, and allow his or her brain to heal and mature. The brain needs time and resources to create new neural pathways and heal. During this time, the individual should be working on addressing any trauma that has been fueling the addictive behaviors and/or substance use, and learning essential life skills in deficient areas. If a client-turning-service provider wants to start Ethics, continued on page 13 ☛

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■ ED U C AT IO N

NAADAC and ATTUD Announce New National Certificate in Tobacco Treatment Practice (NCTTP) By Jessica Gleason, JD, NAADAC Director of Communications Tobacco use remains the single largest preventable cause of death and disease in the United States. In addition, smoking tobacco causes more deaths among clients in substance use disorder treatment than the alcohol or drug use that brings them to treatment. In an effort to give more attention to the importance of smoking cessation and access to evidence-based tobacco treatment, NAADAC is pleased to be partnering with the Association for Treatment of Tobacco Use and Dependence, Inc. (ATTUD) and the Council for Tobacco Treatment Training Programs (CTTTP) to launch a new National Certificate in Tobacco Treatment Practice. The National Certificate in Tobacco Treatment Practice (NCTTP) was created to standardize and unify tobacco competencies, knowledge, and skills on a national level and provides national, unified recognition of professionals who obtain this prestigious certificate. The NCTTP represents a game changer for the tobacco treatment field and is the culmination of many years of effort. By obtaining the NCTTP, tobacco treatment professionals are demonstrating to employers, third-party payers, and clients their advanced education in evidence-based tobacco competencies, skills, and practice and ensures the tobacco dependent will receive the highest level of professional care. To apply for the certificate, candidates must provide evidence of specific education and experience, including successful completion of a CTTTP-accredited Tobacco Treatment Specialist training program and hours of tobacco treatment practice experience following completion of the training. In addition, candidates must be tobacco-free for a minimum of six months and must agree to adhere to the Tobacco Treatment Provider Code of Ethics. See sidebar for specific eligibility and application requirements. A list of accredited Tobacco Treatment Specialist training programs may be found at http://ctttp.org/accredited-programs/. The initial test-exempt offering of this Certificate will be available until April 15, 2018. Applications postmarked after April 15, 2018 will require successful completion of an examination to be awarded the certificate. For more information or to apply for your NCTTP, please visit www.naadac.org/ncttp. Jessica Gleason, JD, is Director of Communications for NAADAC, the Association for Addiction Professionals. She manages all communications, marketing, public relations, and informational activities of the Association, the NAADAC website, and all digital media, marketing, and communications. Gleason is the Managing Editor for NAADAC’s Advances in Addiction & Recovery magazine, and oversees the publication of NAADAC’s two digital publications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate. Gleason holds a Juris Doctorate from Northeastern University School of Law in Boston, MA and a Bachelor of Arts Degree in Political Science from the University of Massachusetts at Amherst in Amherst, MA. (Endnote) Substance Abuse and Mental Health Services Administration, Tobacco Use Cessation During Substance Abuse Treatment Counseling, March 2011, Volume 10, Issue 2.

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Eligibility & Application Requirements Candidate must: 1. Provide evidence of one of the following: • High School diploma plus 4,000 hours (2 years full-time) of human services work experience. • Associate’s Degree plus 2,000 hours (1 year full-time) of human services work experience. • Bachelor’s Degree or higher. 2. Provide a certificate of successful completion of a CTTTP-accredited Tobacco Treatment Specialist training program. 3. Acquire 240 hours of tobacco treatment practice experience following the completion of training within a two-year period. 4. Be tobacco-free (including use of electronic nicotine delivery devices such as vaping and e-cigarettes) for a minimum of the six months prior to submission of this application, and must attest to this in the application. 5. Sign a statement that he or she has read and adheres to the Tobacco Treatment Provider Code of Ethics. 6. Mail application and all supporting documents with the non-refundable application fee of $150 to NAADAC. c/o NCTTP 44 Canal Center Plaza, Suite 301 Alexandria, VA 22314

Ethics, continued from page 11

working immediately away after graduation, it is advised that he or she consider working at an agency that is not connected to the agency where he or she graduated. This keeps expectations realistic and avoids unnecessary dual relationships or conflicts of interest. NAADAC promotes the need for clinicians and service providers to invest in their self-care, which includes self-care in recovery. NAADAC, through its Code of Ethics, encourages all clinicians and service providers to seek clinical supervision that is meaningful and relevant. This is especially critical for a person newly in recovery who is also applying to work in our profession. Clinical supervision will serve a vital monitoring and gatekeeping function, alongside empowering and teaching the supervisee. A potential clinician, who is actively managing his or her recovery journey and doing the hard work of maintaining his or her recovery, will be in the best mindset to be valuable and relevant to the clients he or she wants to help. Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education and Supervision, a Master’s Degree in Counseling, and a Bachelor’s Degree in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the national Master Addiction Counselor (MAC) and Department of Transportation Substance Abuse Professional (SAP) certifications. Johnson has two supervisory credentials (ACS and AAMFT) and is a NCC. She is a core faculty member at Walden University, and she maintains a private practice where she works with supervisees who are working on credentialing. Johnson is the Past-President of the Colorado Association of Addiction Professionals (CAAP), and is currently NAADAC Treasurer and Ethics Chair. She previously served as NAADAC’s Southwest Regional Vice-President. In Colorado, Johnson is involved in regulatory and credentialing activities as well as workforce recruitment and retention initiatives. She speaks and trains regionally and nationally on a variety of topics. Her passions beyond workforce retention include pharmacology of drugs of addiction, infectious diseases, ethics, motivational interviewing, and clinical supervision.

Call for NAADAC Leadership Nominations

DEADLINE: January 31, 2019 at 5:00 pm EST. Let your voice be heard! Make a difference by nominating a passionate, skilled, and dedicated addiction professional to serve as an Officer or Regional Vice-President on the NAADAC Executive Committee. NAADAC is accepting nominations for the following positions:

• President-Elect • Secretary • Treasurer • Mid-Atlantic RVP • Mid-South RVP • Northeast RVP • Northwest RVP

Only NAADAC members in good standing who have been actively engaged in work in addiction counseling or as an addiction professional for at least two years immediately prior to the nomination shall be eligible for an elected office with the Association. Visit www. naadac.org/nominations-for-executive-leadership-team to view eligibility requirements for all positions and download a n omination form to submit today! Candidate statements will be published in the Spring 2018 issue of Advances in Addiction & Recovery to help inform your vote in May. All 2019 terms begin October 9, 2018, after the NAADAC Annual Con ference in Houston, TX. If you have any questions about the nomination process, please email NAADAC Executive Director, Cynthia Moreno Tuohy at cynthia@ naadac.org, or call 800.548.0497 x102.

Call for Presentations NAADAC invites you to submit a proposal to present at its 2018 Annual Conference: Shoot for the Stars in Houston, TX. The 2018 Annual Conference will be held at the Westin Galleria Houston from October 5–9, including pre-conference training sessions on October 5 and post-conference training sessions on October 9. Regular conference sessions will take place October 6–8. NAADAC members and non-members are invited to submit presentation proposals for 1.5 hour breakout sessions. NAADAC encourages young investigators, researchers, and addiction and co-occurring professionals from diverse organizations and disciplines to submit.

Submission Deadline: January 15, 2018

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■ M EM B ER S H I P

NAADAC Honors 2017 National Award Winners

As part of its National Addiction Professionals Day celebration, NAADAC honored its 2017 National Award Winners. This year, NAADAC presented awards to four outstanding individuals and one organization for their extraordinary service and contributions to the addiction profession. Lora Roe Memorial Addiction Counselor of the Year: Cherylene Tucker, MA, MAC, LCDC, ADC This award, renamed for Lora Roe in 1988, is presented to a counselor who has made an outstanding contribution to the profession of addiction counseling. This year’s recipient of the Lora Roe Memorial Addiction Counselor of the Year Award, Cherylene Tucker, is a passionate, highly skilled and empathetic community leader with 30 years of experience as an addiction counselor. She specializes in cognitive treatment for substance use disorder, program development, and coaching, and has worked tirelessly to provide treatment and support to individuals in the criminal justice system with substance use disorder.

Mel Schulstad Professional of the Year: Leigh Kolodny-Kraft, LCADC, CSAT, CCTP, SAP, CCGC, ICADC This award recognizes an individual who has made outstanding and sustained contributions to the advancement of the addiction counseling profession. Leigh Kolodny-Kraft, recipient of the Mel Shulstad Professional of the Year award, is a compassionate, dedicated, and gifted therapist with unwavering ethics who inspires hope and motivation in her clients. With over a decade of experience, she exudes the utmost professionalism and creativity, utilizing multiple modal ities of treatment rather than a one size fits all approach. She specializes in individual, couples and family therapy with a focus on addictions and codependency.

Lifetime Honorary Membership Award: Larry Ashley, EdS, LCADC, CPGC The Lifetime Honorary Membership Award recognizes an individual who has established outstanding service through a lifetime of consistent contributions to the advancement of NAADAC, the addiction profession and its professionals. This year’s recipient of the Lifetime Honorary Membership Award is Larry Ashley, a leading international authority on the relationship between addiction and combat trauma. He has been a leader in the substance use disorder field for over 40 years as a researcher, therapist, university professor and advocate for those suffering from addiction and trauma. He has been invited to consult with the United States military in Germany and at a Medical Teaching Center in Vietnam, and he has testified before the British House of Commons and the United States Congress. His valuable contribution to the field, particularly by military personnel with substance use disorder, is respected and honored by this award. 14

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Addiction Educator of the Year: John D. Massella, EdD, LPC, CAADC, NBCC, CCS-PCB, CCPG The Addiction Educator of the Year Award is presented to the educator who has made an outstanding contribution to addiction education. John D. Massella is this year’s recipient of the Addiction Educator of the Year Award. With over 30 years of experience, he has acted as a professor, clinician, advocate, therapist, and clinical supervisor, and lifelong mentor. He is currently is a faculty member at the California University of Pennsylvania, where he is acclaimed by student and peers for teaching by example with thoughtful humor and unabated passion.

Emerging Leaders Award: Metropolitan State University Alcohol and Drug Counseling Student Association Recipients have demonstrated innovative think ing, a commitment to the advancement of the public’s understanding of addiction, exemplary leadership qualities and a significant impact on the local, state or national community. Minnesota’s Metropolitan State University Alcohol and Drug Counseling Student Association (ADCSA) received NAADAC’s 2017 Emerging Leaders Award for its significant impact on its community, innovative thinking, commitment to the advancement of the public’s understanding of addiction, and exemplary leadership. This vibrant program serves addiction counseling students at all levels through the work of enthusiastic students and advisors and has engaged in advocacy work at the campus, state, and national levels. It provides a peer support environment focusing on good communication and empowerment, enhances students’ educational experiences to help promote the addiction profession, provides leadership and community service opportunities, and recruits and supports students from under-represented backgrounds. Over the past several years, ADCSA has co-sponsored on-campus Recovery Advocacy Seminars and held naloxone trainings on campus. In addition, its members have participated in state public policy briefings and visited their state legislators to support such efforts as “Good Samaritan” protection, naloxone availability, funding for recovery schools and the recent Department of Human Services effort to reform the substance use disorders service delivery system.

■ CER T IF IC AT I O N

Reciprocity Issues Amidst a Young, Mobile Workforce: Another Argument for National Standards By Thaddeus Labhart, MAC, LPC The majority of us have heard or talked about workforce challenges pertaining to younger addiction counselors, often referred to as the “millennial generation.” One of those challenges is the fact that younger workers tend to job hop more often. LinkedIn reports over the past 20 years, the number of companies people worked for in the five years after they graduated has nearly doubled.1 Millennials are often viewed as mobile, entitled and tech-obsessed, but study after study show millennials prefer work/life balance and flexibility options over financial incentives. It’s incumbent upon our field to try and meet those needs. The often referenced 2006 Institute of Medicine (IOM report)2 and the 2013 Substance Abuse and Mental Health Services Administration (SAMHSA)3 report both showed significant shortages in the addiction workforce nation-wide. The Addiction Technology Transfer Center Net work (ATTC) cites a study showing an annual turnover rate of addiction professionals at 18.5 percent nation-wide.4 While the SAMHSA report showed an aging addiction workforce, it also projected a 21 percent increase in the total workforce by 2018. The addiction workforce need is present and growing. Most of us in the addiction field recognize the addiction workforce is aging out. A third of the workforce now is 50 years or older.5 Whatever your beliefs and feelings are concerning the younger workforce, if the field is to survive and strengthen its own identity, it is incumbent upon us to ensure future generations of addiction counselors have barriers removed for them to both enter and remain in the field. Wikipedia describes labor mobility as, “The geographical and occupational movement of workers… best gauged by the lack of impediments to such mobility.” One of those impediments for a mobile addiction workforce is reciprocity, sometimes referred to as endorsement. I was compelled to bring attention to this subject after I had the unfortunate experience of attempting to pursue licensure by reciprocity/ endorsement in a state I was moving to. Despite having a graduate degree in the field, the highest level of addiction certification in my former state, a MAC, and 20 years in the field, I was denied licensure in my new state. After countless hours of research, consulting attorneys, endless un-returned phone calls from the new state’s Board and going through an appeals hearing, I was denied a second-time. At the end of the day, I was denied reciprocity because the certification in my former state was through an independent, albeit state sanctioned, certification board. The new state argued only certification or licensure from a state-ran certification/licensure board

would be accepted. The frustration was mind-boggling. I luckily have a strong resume and other licenses to lean on. And I’ll also likely have the ability to purse addiction licensure in the new state through traditional means which may necessitate another internship and new classes. But if I was a new addiction counselor, this would all likely be a deal-breaker, plain and simple. I strongly believe that we, as leaders in the addiction profession, find a way to mitigate this issue of reciprocity, especially for the younger generation. While states will likely retain the ability to make independent certification and licensure decisions, the Substance Abuse and Mental Health Administration’s Single-State Agencies (SSAs) for substance abuse services in each state have significant influence on this issue. Through groups such as the National Association of State Alcohol and Drug Abuse Directors (NASADAD) and through local legislative rule changes, SSAs can influence their respective certification/licensure boards to adopt a national set of standards and criteria for reciprocity/endorsement. This would mitigate a barrier for addiction counselors, particularly younger, more mobile counselors, in pursuing a long career in the field. The National Certification Commission for Addiction Professionals (NCC AP), through NAADAC, will advocate for such an agenda. Please contact NAADAC or NCC AP for more information or to find out ways you can become involved. Thad Labhart, MAC, LPC, serves as the Clinical Director for Community Counseling Solutions, which provides behavioral health and addiction services in numerous counties throughout Oregon. Labhart was a longstanding board member of the Addiction Counselor Certification Board of Oregon and currently serves as treasurer for the National Certification Commission for Addiction Professionals (NCC AP). Labhart is a current NAADAC member and has been working in the addiction field for 19 years. (Endnotes) Berger, G. (2016, April 12). Millennials Job-Hop More Than Previous Generations, & They Aren’t Slowing Down. Retrieved from https://www.linkedin.com. 2 Institute of Medicine. (2006). Improving the quality of health care for mental and substanceuse conditions. Washington, DC: National Academies Press. 3 Substance Abuse and Mental Health Services Administration. (2013). Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues. Washington, DC: Author. 4 Knudsen, H., Johnson, J.A., & Roman, P. (2003). Retaining counseling staff at substance abuse treatment centers: The effects of management practices. Journal of Substance Abuse Treatment, 24, 129-135. 5 Mitra Toossi, “Labor Force Projections to 2022: The Labor Force Participation Rate Continues to Fall,” Monthly Labor Review (December 2013). Accessed at http://www.bls.gov/opub/ mlr/2013/article/labor-force-projections-to-2022-the-labor-force-participation-ratecontinues-to-fall.htm. 1

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■ CO NF ER EN C E

NAADAC 2017 Annual Conference Highlights With over 1,000 participants, 78 exhibitors, 60 presentations, and 93 presenters, the NAADAC 2017 Annual Conference: Elevate Your Practice in Denver, CO from September 22–26 was a huge success! NAADAC members and other addiction professionals from across the country received up-to-date information from the top industry experts on the latest trends, practices, and critical issues that impact addiction professionals, built their businesses and networks, and had fun! NAADAC would like to extend its gratitude to all of the presenters, speakers, sponsors, and partners who contributed to make this year’s conference a success.

Missed Denver? You can still learn from the best of the best on your own time! Materials and handouts from over 54 sessions are available at www.naadac.org/ac17-presenter-materials.

Hope to See You in Houston! The NAADAC 2018 Annual Conference: Shoot for the Stars will take place at The Westin Galleria Houston from October 5–9, 2018, including pre-conference training sessions on October 5, post-conference training sessions on October 9, and a two-day U.S. Department of Transportation Substance Abuse Professional (SAP) Qualification/Requalification course on October 9–10. Regular conference sessions will take place October 6–8. For more information, please visit www.naadac. org/2018annualconference. We look forward to seeing you next year!

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Recovery Rising: An Interview with William L. White

By Jessica Gleason, JD, NAADAC Director of Communications

ecovery Rising: A Retrospective of Addiction Treatment and Recovery Advocacy is the professional memoir of William (Bill) White, who over the span of five decades evolved through the diverse roles to emerge as the addiction field’s preeminent historian and one of its most visionary voices and prolific writers. Recovery Rising contains more than 350 stories, reflections, and lessons learned within one man’s personal and professional journey. The vignettes convey many of the ideas, methods, people, and organizations that shaped the modern history of addiction treatment and recovery. Bill’s many past involvements with NAADAC include webinars, magazine articles, and authorship of The History of Addiction Counseling in the United States.

Q: How did you first become involved in the addictions field? A: I entered the field in the late 1960s at a time most people did so out of personal or family recovery experience. These were the days before the National Institute on Alcohol Abuse (NIAAA), National Institute on Drug Abuse (NIDA), and the Center for Substance Abuse Treatment (CSAT); before the founding of most state addiction treatment authorities; and before creation of NAADAC and its predecessors. The field, if you could even then call it that, was then made up of impassioned people in recovery and renegade professionals who shared the vision of forging a national system of community-based addiction treatment — well, actually community-based alcoholism and “drug abuse” programs as the emerging field was then cleaved along alcohol and drug lines.

Q: You may have set a record for the number of roles you have served in the field. What are the many hats you have worn? A: This was all pretty organic. I started out as a streetworker — an outreach worker in today’s vernacular and evolved through the roles of community organizer, counselor, clinical director, planner, trainer, organizational consultant, administrator, and research scientist. Over a span of nearly five decades, the roles of field historian, journalist, and recovery advocate came to eclipse all others.

Q: After authoring numerous other books, what motivated you to write Recovery Rising? A: I was aware that many long-tenured addiction treatment professionals and recovery advocates, including many of my mentors, were, or soon would be, retiring from this work. I wanted to find a way to honor their contributions and to acknowledge the role they had played in my life. I wanted to find a way to inform and inspire a new generation of people to carry on this work by offering insights and lessons I had drawn from this work. I saw the book as both a heartfelt thank you and a passing of the torch to a new generation of leaders. Recovery Rising was also my own attempt to weave the threads of decades of activity into a meaningful whole. There was a random quality to how all this unfolded as I lived it, but when I looked back on it, there was a peculiar order to it all, with each unexpected opportunity leading in unforeseen ways to the next. Finally,

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addiction professionals are creatures of action and the spoken word, leaving few professional memoirs through which future scholars could reconstruct the history of our field. I wanted to leave Recovery Rising as an artifact for future historians of addiction treatment and recovery in the United States.

Q: How did you decide on the story format for the book? A: Conveying lessons through stories seemed the ideal way to share my life’s journey given the role storytelling has long played in the addiction recovery experience. Most of the stories are accompanied by reflective questions that allow readers to explore their own thoughts and past experiences on the most challenging issues faced on the frontlines of addiction treatment and recovery support. Some might characterize Recovery Rising as a memoir, but it is ultimately more about the reader than about me.

A: In the Introduction to Recovery Rising, why do you compare yourself to the movie character, Forest Gump? A: Without conscious intent, this character participated in some of the most important historical milestones of the late 20th century. There is a Forrest Gump quality to my professional career and the stories I shared. Due to the many roles I occupied in the addictions field and my attraction to the field’s pioneers, I occupied a Gump-like bystander role to critical events in the modern history of addiction treatment and recovery. I have worked in the arenas of addiction treatment, recovery research, and recovery advocacy for nearly half a century and have been blessed with opportunities to work with some of the leading policymakers, research scientists, clinicians, and recovery advocates of my generation. At this late stage of my life, it seemed a worthy effort to try to pass on some of what we discovered within our collective experiences.

Q: How does this book differ from your earlier books Slaying the Dragon: The History of Addiction Treatment and Recovery in America and The History of Addiction Counseling in the United States? A: The books you mention were a product of years of historical research and interviews with leaders in the field. In contrast, Recovery Rising tells the modern history of addiction treatment and recovery and the new recovery advocacy movement through my own direct experiences. The former were based on archival documents and interview transcripts; the latter was based on years of journaling and a rigorous dredging of my memory. What these books share in common is an effort to heighten the historical consciousness of people working on the front lines of addiction treatment, recovery support, and recovery advocacy. I have loved working in this field and researching its history. I wish I had another lifetime to devote to it. Jessica Gleason, JD, is Director of Communications for NAADAC, the Associ ation for Addiction Professionals. She manages all communications, marketing, public relations, and informational activities of the Association, the NAADAC website, and all digital media, marketing, and communications. Gleason is the Managing Editor for NAADAC’s Advances in Addiction & Recovery magazine, and oversees the publication of NAADAC’s two digital publications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate. Gleason holds a Juris Doctorate from Northeastern University School of Law in Boston, MA and a Bachelor of Arts Degree in Political Science from the University of Massachusetts at Amherst in Amherst, MA.

Vignettes from Recovery Rising Wounded Healer

What Would Mel Do? (Keeping My Eyes on the Prize)

One of the foundational concepts within the history of recovery support is that of the wounded healer — the notion that people who have survived a particular illness or trauma might use that experience as a foundation to help others in similar circumstances. This idea, first introduced by psychoanalyst Carl Jung and later amplified by Henry Nouwen and others, provides a rationale for the legions of recovering people working in addiction treatment organizations and filling service roles within addiction recovery mutual aid and recovery advocacy organizations. Carried to extreme, it was posited that only an addict could help another addict. Through the course of my career, that proposition was challenged by my experience of people in recovery who were not effective healers and people who lacked personal or family recovery experience who were exceptional healers. All humans are wounded, but only those who find ways to transcend such wounds seem to possess these healing qualities. In his history of Alcoholics Anonymous, Ernie Kurtz noted many non-alcoholics who had played important roles in the history of AA — Dr. Silkworth, Sister Ignatia, Sam Shoemaker, Willard Richardson, Frank Amos, Dr. Harry Tiebout, and Father Ed Dowling, to name a few. Ernie described how these individuals did have something in common. Each, in his or her own way, had experienced tragedy in their lives. They had all known kenosis; they had been emptied out; they had hit bottom....whatever vocabulary you want. They had stared into the abyss. They had lived through a dark night of the soul. Each had encountered and survived tragedy (Not-God: A History of Alcoholics Anonymous, p. 143). Wounded healers, regardless of recovery status, enter helping relationships with others with conscious awareness of their own healed and healing wounds. Such awareness allows us to serve others from a position of emotional authenticity, learned humility, and moral equality. Over the course of the last half century, I was at my best when I maintained that awareness and at my worst when I lost it. We are indeed all wounded, and what we can bring to the most wounded among us is our presence, our compassion, and our testimony that survival is possible and that a life of meaning and purpose can be found on the other side of such experiences.

I have met some remarkable human beings in my more than four decades working in the addictions field, and many of them have helped shaped my own character. One of the most important of these individuals is Mel Schulstad. Mel got sober in the early 1970s and entered the alcohol ism field a few years later. He went on to become a co-founder of the National Association of A lcoholism Counselors in 1974, the precursor to NAADAC, the Association for Addiction Professionals. He was a central figure in the professionalization of the role of the addiction counselor in the United States. Mel served as a friend and mentor for many years. Having just passed his 92st birthday as I write this, Mel only recently retired and remains an astute observer of the addiction treatment field. We just finished co-authoring an article, so even now he is not exactly retired. Mel has long been one of the key people who kept me grounded during the high and low points of my career. It was a complex relationship in many ways. There were days he felt like a father to me, days we were brothers and comrades in arms, and days he served as professional role model and mentor. At other times, he felt like an all-in-one confessor/teacher/sponsor/guide. Perhaps more than anything, he exemplified how to work in this field as a person in recovery and how to stay focused on the recovery mission when a thousand distractions compete for our attention. I can’t count the number of times I have asked myself, “What would Mel do?” Do you have a Mel in your life? If so, cherish and nurture that relationship. If not, begin your search for such a person. We all need a guiding star. Postscript: Mel Schulstad died January 6, 2012, at the age of 93. A tribute to his life and work is posted at www.williamwhitepapers.com. Recovery Rising is available at Amazon.com.

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A Framework for Service: “Facing Addiction in America” During An Opioid Epidemic

By H. Westley Clark, MD, JD, MPH, CAS, FASAM & Matthew Davis

n October 26, 2017, the President of the United States addressed the issues of combatting drug demand and the opioid crisis. In his speech, he noted that this country was dealing with the worst drug crisis in American history.1 The President recited key

public health statistics, noting that in 2016 at least 64,000 Americans died from overdoses. He emphasized this number by asserting that 64,000 deaths converted to losing 175 lives lost per day or 7 lives lost per hour. With that, he announced that the federal government was officially declaring the opioid crisis a national public health emergency under federal law and that he was directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis. Although the focus of most of the President’s speech was on the opioid crisis, he shifted into another area of concern to those addressing substance use disorder issues: alcohol. The President talked about his brother, Fred, who had “a problem with alcohol.” He reflected on Fred’s advice to him not to drink alcohol and not to smoke. In short, the President noted that he had “somebody that guided me.”As a result, the President noted that he did not drink alcohol or smoke.2

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The heartfelt juxtaposition of alcohol and opioids points to the need for a larger framework for addressing substance use in America, a framework that could be converted into a toolkit to be used by substance use disorder professionals. That framework can be found in the Surgeon General’s Report, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.” The Surgeon General’s Report (SG Report) functions as a complement to the opioid public health emergency, because it offers a public health model for addressing substance misuse and related consequences.

A Public Health Model for Addressing Substance Misuse and Related Consequences A public health systems approach to substance misuse and its consequences, including substance use disorders, aims to: • Define the problem through the systematic collection of data on the scope, characteristics, and consequences of substance misuse; • Identify the risk and protective factors that increase or decrease the risk for substance misuse and its consequences, and the factors that could be modified through interventions; • Work across the public and private sector to develop and test interventions that address social, environmental, or economic determinants of substance misuse and related health consequences; • Support broad implementation of effective prevention and treatment interventions and recovery supports in a wide range of settings; and • Monitor the impact of these interventions on substance misuse and related problems as well as on risk and protective factors.

Counselors and other clinicians can play a major role in helping communities in their prevention efforts.

By taking this public health approach, counselors and other clinicians can play a key role in addressing the full spectrum of strategies necessary to address the opioid epidemic, substance misuse, and substance use disorders. The SG Report acknowledges that alcohol misuse, illicit drug use, misuse of medications, and substance use disorders are estimated to cost the United States more than $400 billion in lost workplace productivity (in part, due to premature mortality), health care expenses, law enforcement and other criminal justice costs (e.g., drug-related crimes), and losses from motor vehicle crashes. While the President reminds us about the number of people dying from overdoses associated with opioids, other substances like alcohol, cocaine, and benzodiazepines are also associated with overdoses and overdose deaths.

A Prevention Toolkit for Counselors and Other Clinicians Counselors and other clinicians can play a major role in helping communities in their prevention efforts. While counselors bring their wealth of clinical expertise to the community dialogue about prevention strategies, the SG Report offers tangible, plain English documentation of evidence based strategies, culturally sensitive, and available to communities concerned about the adverse effects of alcohol misuse and drug misuse. In situations where simple advice from heartfelt family members does not work, the SG Report Chapter on Prevention offers resources for the counselor to discuss with the community in general and with specific at risk audiences in particular. It is often said that no one sets out to become someone who has a substance use disorder. However, because some people do develop substance use disorders, it is helpful to be able to present the tables in Chapter 3 as concise examples of the evidence of what puts an adolescent or young adult at risk. In using the health and moral authority of the Surgeon General, a clinician can make it clear that despite risk factors there are protective factors can be enhanced in order to decrease the chances of a young person experimenting with alcohol or drugs or developing a substance use disorder, should they experiment. The Prevention Chapter of the SG Report highlights interventions from elementary school-based prevention programs such as “The Good Behavior Game and ClassroomCentered Interventions” or the “Raising Healthy Children” program. The Prevention Chapter also contains content matter to address substance use across the lifespan. While the training of most clinicians is short on prevention strategies, the SG Report provides information to the Counselor to augment what information a counselor has previously learned. Policies to Reduce Alcohol Misuse and Related Problems are also discussed. Clinicians can work with community-based organizations, local policy makers and legislators to address environmental policies centered on alcohol use. The Prevention Chapter identifies those policies, putting them at the fingertips of the Counselor so that the clinician moves beyond the one-to-one therapist role or the group therapist role into the realm of a population level intervener. In short, using these population level environmental strategies can help counselors play not only a treatment role in the community but also an advocacy role, broadening the reach and influence of messages about non-harmful drinking and reducing inappropriate access to alcohol. Using environmental prevention strategies doesn’t just apply to underage drinking or alcohol misuse. The recently declared opioid public health emergency calls upon Counselors to make sure state prescription drug monitoring programs (PDMPs) are adequately addressing the issue of clinician facilitated prescription drug misuse. Key elements of effective PDMP programming are spelled out in the SG report. Now that all 50 states have some variant of PDMPs, it is important for counselors and other clinicians to check to see if their state mandates clinicians writing prescriptions for controlled substances to query the database beforehand. As the SG Report suggests, unless prescribers are required to query the PDMP, the utility of this strategy is mixed. Using the information in the SG Report, Counselors can participate with community members to insist that all community prescribers enroll in the PDMP program and use the PDMP each and every time a controlled substance prescription is written. Counselors working with patients experiencing prescription drug use disorders, who get their prescription drugs from local prescribers, will be able to use that information to remind local prescribers of the

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importance of consulting with the PDMP each and every time. Pointing other clinicians can find a comprehensive summary of treatment strategies to the PDMP findings in the SG Report may help reduce any objections in the SG Report. Research shows that the most effective way to help someone with a and complaints that counselors may encounter when addressing this issue. The SG Report can also help program or facility administrators understand substance use problem, who may be at risk for developing a substance use why monitoring by counselors and other non-prescriber clinicians can help disorder, is to intervene early, before the condition can progress. With this recognition, screening for substance misuse is increasingly being provided prescribers and programs. in general health care settings, so that emerging Counselors working in primary care settings “It should be noted that while p revention problems can be detected and early intervention with people whose use of controlled substances policies have shown impacts for the entire provided if necessary. The addition of services to prescription is being questioned can use the SG population, and a number of p revention address substance use problems and disorders Report and the CDC Guideline for Prescribing programs at each d evelopmental period in mainstream health care has extended the Opioids for Chronic Pain, which the SG Report have shown positive outcomes with a mix of continuum of care, and includes a range of efreferences. The combination of these two docupopulations, most studies have not s pecifically fective, evidence-based medications, behavioral ments can help people being treated for pain unexamined their differential effects on racial and therapies, and supportive services. Chapter 4 derstand the need for a “start low and go slow” ethnic subpopulations.” of the SG Report provides a framework for the approach to using pain medications, including SG Report range of treatment strategies necessary to help non-opioid or non-medication strategies. People in pain, who are denied opioids of choice, may require help understanding reduce the burden of the disease of substance use disorders. In light of an evolving national policy that includes focusing on dethe importance of avoiding misuse of opioid medications, including the mand reduction, a comprehensive framework provides for addressing the risk of overdose. Of course, not all prevention programs work for all people, in every spectrum of disorders associated with the use of substances that alter mind, context. Keeping this in mind can be helpful, particularly in explaining to mood, and behavior. Readers of the SG Report will find in Chapter 2 an the community and people in need of services. Working with prevention explanation of the underlying neurobiology of substance use disorder. specialists and some form of local adaptation may be possible when a certain That neurobiology lends support for the idea of a more comprehensive feature of the selected evidence-based intervention fails to engage a specific framework of intervention. In other words, vulnerable people don’t just do group within a local community. However, not all EBIs, as the SG Report one type of drug. The reward system that underlies substance use disorders notes, may work with all community subgroups. Nevertheless, a partner- is triggered by a number of psychoactive substances. Thus, in order for ship between intervention developers, persons delivering the intervention, a laudable national strategy focused on opioids to have population level and potential program participants, who can represent the concerns of impact, early intervention and treatment efforts must be entertained and specific populations, such as Blacks or African Americans, Hispanics or employed. It is in the arena of this national framework that counselors and Latino/as, Asians, American Indians or Alaska Natives, Native Hawaiians other clinicians can have a substantial impact. Mild substance use disorders can be identified quickly and reliably in or other Pacific Islanders, veterans, or lesbian, gay, bisexual, and transgender many medical and social settings. These common but less severe disorders (LGBT) populations group’s concerns, is recommended for developing often respond to brief motivational interventions and/or supportive well-reasoned solutions to remedy specific features of the original evidencebased interventions that may not be working as intended. The ultimate aim monitoring, referred to as guided self-change. In contrast, severe, complex, is to craft needed adaptive adjustments that aptly remedy these emerging and chronic substance use disorders often require specialty substance use problems and that also enhance the efficacy of the intervention in attaining disorder treatment and continued post-treatment support to achieve full the intended outcomes with local community residents; it is in this arena remission and recovery. To address the spectrum of substance use probwhere the observations and suggestions of trained counselors and other lems, the treatment-oriented information found in Chapter 4 can be used to educate communities, families, treatment providers, health systems and clinicians may be helpful. local policy makers as to the need for a continuum of care that provides individuals an array of service options, based on need, including prevention, A Treatment Toolkit for Counselors and Other early intervention, treatment, and recovery support. Clinicians The SG Report reminds us that substance use and substance use care In his October 26, 2017 speech, the President noted: occurs across a continuum and uses a plain graphic to highlight the spec“In addition, we understand the need to confront reality, right trum of issues that are captured by that continuum. Reproduced below smack in the face, that millions of our fellow citizens are already adthe reader can see the need for different intervention strategies at different dicted. That’s the reality. We want them to get the help they need. points in time. We have no choice but to help these people that are hooked and In order to address the continuum of use and continuum of care shown are suffering so they can recover and rebuild their lives with their in the accompanying graphic, Chapter 4 focuses on the following: families. We’re committed to pursuing innovative approaches that • Early intervention; have been proven to work, like drug courts. Our efforts will be based 3 • Treatment engagement and harm reduction interventions; on sound metrics, and guided by evidence and guided by results” • Substance use disorder treatment; and The important idea of evidence-based, outcome-oriented treatment, • Emerging treatment technologies. highlighted by the President’s comments, is one that is promoted by the Early intervention services can be provided in a variety of settings (e.g., SG Report. As resources pour into communities to address the opioid school clinics, primary care offices, mental health clinics) to people who epidemic from a treatment perspective, the psychosocial needs of those have problematic use or mild substance use disorders. experiencing substance use disorders will have to be met. Counselors and 22

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Clinicians, of course, need to be familiar with various screening tools that can be useful in determining whether problem with alcohol or drugs exists. These screening tools are evidence based. Alcohol and Drug Use Screening Tools for Adolescents Brief Screener for Tobacco, Alcohol, and Other Drugs (BSTAD) CRAFFT

CRAFFT (PART A) S2BI

For adults, the NIDA Drug Use Screening Tool and the NIDA Drug Use Screening Tool: Quick Screen will allow for screening both alcohol and drugs. If opioid use is a perceived risk, for adults there is the Opioid Risk Tool. For screening for drugs only in adults, the Drug Abuse Screen Test (DAST-10) is another screening tool. For alcohol only in adults, there is the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol Use Disorders Identification Test-C (AUDIT-C). Using validated screening will assist the counselor in determining whether or not there is a possible problem with psychoactive substances. Counselors working in settings that serve a primary purpose other than specialty substance use disorder treatment are in an ideal position to benefit from the respect or legitimacy of those environments to facilitate inquiry. Using the respect that the office of the Surgeon General garners, counselors and other clinicians can promote screening as an essential component of the function of these non-specialty settings. The SG Report stresses that positive screening results should be followed by brief advice or counseling tailored to the specific problems and interests of the individual and delivered in a non-judgmental manner, emphasizing both the importance of reducing substance use and the individual’s ability to accomplish this goal. Later follow-up monitoring should assess whether the screening and brief intervention was effective in reducing the substance use below risky levels or whether the person needs formal treatment. The President described

his brother Fred as advising him not to drink or smoke. Fred, as a person with lived experience, had legitimacy in the eyes of the President. However, given the apparent gravity of Fred’s alcoholism, it is clear that mere advice alone would not and did not help him. It is this recognition that needs to be extolled in communicating with communities, families, and patients themselves. It is here that a provider should be making a referral for a more formal clinical assessment followed by a clinical treatment plan developed with the individual that is created to meet the person’s needs. It is here that a well-trained counselor can employ motivational interviewing to address person’s ambivalence to change. The main purpose of Motivational Interviewing is to examine and resolve ambivalence, and the counselor is intentionally directive in pursuing this goal.4 While the literature is clear that SBIR and SBIRT work for those with alcohol use problems, the literature on the effectiveness of drug-focused brief intervention in primary care and emergency departments is less clear. It is in this situation that counselors and other clinicians can help advance our knowledge of the utility of SBIR and SBIRT by carefully following the behavior of those who present to them. Incidentally, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers free SBIRT continuing education courses for providers. Another important observation in the Treatment toolkit of the SG Report is the realization that substances, such as opioids, alcohol, sedatives and tranquilizers can produce significant physical withdrawal upon abrupt discontinuation. Counselors and other clinicians must always keep in mind that rapid or unmanaged withdrawal from alcohol, sedatives, and tranquilizers can produce seizures and other complications. While withdrawal symptoms vary in intensity and duration based on the substance(s) used, the duration and amount of use, and the overall health of the individual, counselors should make sure that a physician, nurse-practitioner, physician assistant, nurse or other experienced clinician knowledgeable about

Substance Use Status and Substance Use Care Continuum Positive Physical, Social, and Mental Health A state of physical, mental, and social well-being, free from substance misuse, in which an individual is able to realize his or her abilities, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to his or her community.

Substance Misuse Substance Use Disorder The use of any substance in a manner, situation, Clinically and functionally significant impairment amount, or frequency that can cause harm to the user caused by substance use, including health problems, and/or to those around them. disability, and failure to meet major responsibilities at work, school, or home; substance use disorders are measured on a continuum from mild, moderate, to severe based on a person’s number of symptoms.

SUBSTANCE USE STATUS CONTINUUM SUBSTANCE USE CARE CONTINUUM Enhancing Health Promoting optimum physical and mental health and wellbeing, free from substance misuse, through health communications and access to health care services, income and economic security, and workplace certainty.

Primary Prevention Addressing individual and environmental risk factors for substance use through evidence-based programs, policies, and strategies.

Early Intervention Screening and detecting substance use problems at an early stage and providing brief intervention, as needed.

Treatment Intervening through medication, counseling, and other supportive services to eliminate symptoms and achieve and maintain sobriety, physical, spiritual, and mental health and maximum functional ability. Levels of care include: • Outpatient services; • Intensive Outpatient/ Partial • hospitalization Services; • Residential/ Inpatient Services; • and • Medically Managed Intensive • Inpatient Services.

Recovery Support Removing barriers and providing supports to aid the long-term recovery process. Includes a range of social, educational, legal, and other services that facilitate recovery, wellness, and improved q uality of life.

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significant withdrawal effects associated with drugs and alcohol examine any person contemplating cessation of psychoactive substance use involving alcohol, sedatives, tranquilizers, and opioids. While most counselors will not be providing medication-assisted withdrawal management, they can play a major role in helping to prepare individuals for treatment; in addition, they can assist in involving the individual’s family and other significant people in the person’s treatment process. The role of the counselor in withdrawal management, whether medication assisted or not, is of critical importance. Between 50 and 75 percent of individuals who receive medically-assisted withdrawal management do not become engaged in subsequent treatment.5 If a counselor can successfully intervene during the withdrawal management process, and assist a person in beginning substance use disorder treatment within 14 days of discharge from withdrawal management, a reduction in readmission is likely to occur.6 Withdrawal management, whether medication-assisted or psychosocially facilitated, should not be regarded as treatment. The goals of substance use disorder treatment are similar to those of treatments for other serious, often chronic, illnesses: reduce the major symptoms of the illness, improve health and social function, and teach and motivate patients to monitor their condition and manage threats of relapse. As a part of the Treatment Toolkit component of the SG Report, the 13 evidence-based principles of effective treatment for adults7 and the 13 evidence-based principles of adolescents promoted by the National Institute on Drug Abuse8 was reproduced. Counselors should review these principles to inform both their basic understanding of treatment principles and to help community members, policy makers and family about effective treatment. Whether the clinical issue is one of prescription drug misuse, opioid misuse, alcohol misuse, marijuana misuse, or any other psychoactive substance that produces clinically significant impairment of function, counselors should conduct a clinical assessment. This is essential to understanding the nature and severity of the patient’s health and social problems that may have led to or resulted from the substance use. This assessment is important in determining the intensity of care that will be recommended and the composition of the treatment plan. The SG Report gives a brief overview of several validated clinical assessment tools that a counselor can use to acquire key information about an individual’s substance use disorder. The following tools are highlighted: (1) Addiction Severity Index (ASI); (2) Substance Abuse Module (SAM); (3) the Global Appraisal of Individual Needs (GAIN); and (4) the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). The reader is encouraged to review the key points in the SG Report about these assessment tools. As counselors and other clinicians know, treatment of substance use disorders is delivered in programs that differ in their setting (hospital, residential, or outpatient), frequency of care, range of treatment components, and/or duration of care. Chapter 4 provides brief summaries of the major levels of the treatment continuum: (1) medically monitored and managed inpatient care; (2) residential services; (3) partial hospitalization and intensive outpatient services; and (4) outpatient services. Counselors and other clinicians working in freestanding programs should have an idea of where their programs fit in the continuum of care. With an increased focus on opioid misuse and inappropriate management of pain with opioid medications, having a list of medications used for the treatment of opioid use disorders is helpful. The SG Report’s Treatment

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section provides such a list. Currently, there are three medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid use disorders (methadone, buprenorphine and naltrexone); one of which, naltrexone, is also approved for the treatment of alcohol use disorders. In addition, two other medications (disulfiram and acamprosate) have been approved for alcohol use disorders. Currently, no approved medications are available to treat marijuana, amphetamine, or cocaine use disorders. While most counselors will not be prescribers of the five FDAapproved medications, they should be aware that all of these medications have side effects; two (methadone and buprenorphine) have the potential to be misused, and methadone (and to a lesser extent buprenorphine) has the potential for overdose. Since the maximum number of patients who can be on a buprenorphine prescribing physician’s case load is 275, appropriately trained counselors should be able to assist such prescribers in providing needed behavioral health care. The use of opioid agonist medications to treat opioid use disorders has been criticized by some policymakers, criminal justice agents, treatment providers, as well as some people in the recovery community. Counselors and other clinicians who realize that scientific evidence supports the use of medication-assisted treatment can use the SG report to inform those who question medication-assisted treatment about the research that demonstrates better treatment outcomes compared to behavioral treatments alone. Furthermore, particularly during this period of climbing overdose deaths, withholding medications increases the risk of relapse to illicit opioid use and overdose deaths. Chapter 4 of the SG Report provides counselors and other clinicians with a list of behavioral therapies that have been shown to be effective in treating substance use disorders. Counselors and other clinicians seeking to expand their treatment skill set can use this list to guide them in their continuing education efforts. Many counselors and therapists working

in substance use disorder treatment programs have not been trained to provide evidence-based behavioral therapies; in order for evidence-based behavioral therapies to be delivered appropriately, they must be provided by trained providers. Evidence-Based Behavioral Therapies • Cognitive Behavioral Therapy • Contingency Management • Community Reinforcement Approach • Motivational Enhancement Therapy • The Matrix Model • Twelve-Step Facilitation Therapy • Family Therapies

In Pursuit of Recovery — A Demand Reduction Imperative: The approach to be taken by the federal government under a public health declaration and under the auspices of different Departments and agencies of the federal government, is to mobilize a number of aggressive activities to address the demand of opioids. However, an important area raised by the SG Report was overlooked in the President’s speech, i.e., recovery and its many paths to wellness. In order to be “the generation that ends the opioid epidemic,” as the President indicated in his speech, the efforts of the recovery community should not be overlooked. Chapter 5 of the SG Report focuses on recovery and the many paths to wellness. Here, the SG Report documents that mutual aid groups and newly emerging recovery support programs and organizations are a key part of the system of continuing care for substance use disorders in the United States. Recovery support services can be found all over the United

States, including in schools, health care systems, housing, and community settings. Counselors and other clinicians can make use of this blossoming movement by assisting patients in engaging in recovery-oriented assistance, by educating family members and professionals about the importance of recovery, and by encouraging local policies to embrace recovery housing as a part of their support for recovery efforts.

Conclusion In order to address the broad spectrum of issues associated with drug and alcohol misuse in America, it will take what the President called “the resolve of our entire country.” While addressing the opioid crisis is of major importance, addressing substance use in the broader context is also necessary. The Surgeon General’s Report on Alcohol, Drugs, and Health offers a comprehensive framework and toolkits to help counselors and other clinicians mobilize around evidence-based practices to promote prevention, treatment and recovery in America. H. Westley Clark, MD, JD, MPH, CAS, FASAM, is currently the Dean’s Executive Professor of Public Health at Santa Clara University in Santa Clara, CA. He is formerly the Director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Service, where he led the agency’s national effort to provide effective and accessible treatment to all Americans with addictive disorders. Clark received a Bachelor's degree in Chemistry from Wayne State University in Detroit, MI; he holds a Medical degree and a Master’s degree in Public Health from the University of Michigan, Ann Arbor and a Juris Doctorate from Harvard University Law School. Clark received his board certification from the American Board of Psychiatry and Neurology in Psychiatry. He is ABAM certified in Addiction Medicine. Clark is licensed to practice medicine in California, Maryland, Massachusetts and Michigan. He is also a member of the Washington, DC, Bar. Matthew Davis is currently finishing his Bachelor of Arts in Psychology at Santa Clara University, located in the heart of Silicon Valley. His emphasis is on understanding the psychological underpinnings of substance use dis orders, as well as their effective treatment methods. Davis is also in long-term recovery , which has contributed to his passion for these issues.

(Endnotes) 1 Trump, D. J. (n.d.). Remarks by President Trump on Combatting Drug Demand and the Opioid Crisis. Speech. Retrieved from https://www.whitehouse.gov/the-press-office/2017/10/26/ remarks-president-trump-combatting-drug-demand-and-opioid-crisis. 2 ibid. 3 ibid. 4 Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press. 5 Mark, T. L., Dilonardo, J. D., Chalk, M., & Coffey, R. M. (2002). Trends in inpatient detoxification services, 1992-1997. Journal of Substance Abuse Treatment, 23(4), 253-260. 6 Lee, M. T., Horgan, C. M., Garnick, D. W., Acevedo, A., Panas, L., Ritter, G. A., . . . Reynolds, M. (2014). A performance measure for continuity of care after detoxi cation: Relationship with outcomes. Journal of Substance Abuse Treatment, 47(2), 130-139. 7 National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A researchbased guide. (NIH Publication No. 12–4180). Rockville, MD: National Institutes of Health, U.S. Department of Health and Human Services. 8 National Institute on Drug Abuse. (2014). Principles of adolescent substance use disorder treatment: A research-based guide. (NIH Publication No. 14-7953). Rockville, MD: National Institutes of Health, U.S. Department of Health and Human Services.

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U.S. Sentencing Commission Testimony on Synthetic Cathinones, Cannabinoids, and Opioids By Darryl S. Inaba, PharmD, CATC-V, CADC III

n September 26, 2017, Dr. Darryl Inaba, PharmD, CATC-V, CADC III, was invited by the U.S. Sentencing Commission to give testimony on synthetic cathinones, cannabinoids, and opioids in this capacity as an expert in the field and as a NAADAC member. Here is his testimony.

Thank you for this opportunity to share my clinical interactions and concerns regarding the continuous growth in the trafficking and abuse of illicit “designer drugs,” internationally known as “new psychoactive substances.” I am Dr. Darryl Inaba, Director of Clinical and Behavioral Health Services at the Addictions Recovery Center and Director of Education and Research at CNS Productions, Inc. both in Medford, OR. I am a Lifetime Fellow of the Haight-Ashbury Free Clinics where I served as the Director of its Drug Detoxification and After Care Services from the late 1960s through 2006. I am also speaking today as a member of NAADAC, the Association for Addiction Professionals. During the 1960s and 1970s I witnessed what some have described as the largest uncontrolled human drug experiment in the world that had its epicenter in the United States. Synthetic drugs like PCP, 2-CB, LSD and many others were unleashed on our streets with very little to no preliminary research on their toxic or addictive effects. This had devastating consequences for many who were exposed to these substances. These people were in fact, unknowingly human “guinea pigs” for rogue street chemists and illicit drug traffickers to determine the effects and dosage range for the substances that were trafficked. Now I believe America is in a much more serious situation with bigger operations releasing a deluge of synthetic cathinones, cannabinoids and opioids into our communities again. The traffickers use those who experiment with these new psychoactive substances as test subjects to determine dosing parameters and toxic or side effects of such illicit drugs to sell on the internet as well as in head shops or street drug outlets.

Cathinones: “Bath Salts,” “Psychoactive Bath Salts,” “Psycho-Stimulants” By the latter part of the last decade, chemical modifications of cathinone, the active chemical in the Catha edulis bush chewed as Khat, Qat, Miraa, et al. in East Africa and the Arabian Peninsula, begin to appear throughout the United States. Modifications were needed to traffic this drug because it quickly degraded once the leaves of the plant were removed from the bush. Chemically redesigning cathinone as mephedrone, methylone, MDPV, et al. resulted in a more stable compound and provided increased potency and effects (as well as toxic effects) than what resulted from taking cathinone itself. First sold as “bath salts — Not For Human Consumption” these cathinone analogues resulted in toxic and addictive effects but they continued to

be sought because they were available (especially on the internet), produced powerful often times overwhelming effects resulting in a “zombie-like” affect in the user and were non-detectable in standard urine drug test or other body fluid testing until the specific molecule is identified and an appropriate standard anolyte is developed for it to be tested. These and other new synthetic substances are marketed as household or other non-drug products to avoid FDA, DEA and other legal scrutiny. Thus, these and other new psychoactive drugs can circumvent legal and clinical interaction processes when they first appear in the substance abusing subculture. Note that since “bath salts” became an easily recognized ploy in the trafficking of “psychoactive bath salts” for abuse purposes, traffickers quickly moved on to market them differently as jewelry or glass cleaner, plant food, energy powder, insect repellent, stain remover, ladybug attractant, et al. most with the strong admonition of “Not For Human Consumption” on their package. Although 10 or so different synthetic cathinone molecules are now banned in the U.S., several more continue to replace those and are available to be sold until they are identified and separately legislated against which will only result in other newer designer cathinone-like drugs replacing them. This is dangerous as even slight chemical modifications in the parent molecule can result in massive changes in the potency and toxic effects of each specific molecule. For example, MDPV, methylene dioxypyrovalerone, a now banned “designer” cathinone, has been found to be 10 times more powerful than cocaine or methamphetamine in animal testing. It would be difficult to determine the cathinone equivalencies with such diverse potency ranges and effects even when the effects of each specific street cathinone molecule are known and many are still unknown at this time. “Psychoactive Bath Salts” were created to be methamphetamine substitutes but have been found to possess a wider range of physical, behavioral and mental effects including an unusual “zombie-like” affect in the user and a unique “growl” vocalization when one is under their influence. Current “bath salt” using clients enrolled for treatment at the Addictions Recovery Center in Medford, OR were admitted for amphetamine use disorder treatment and some for polydrug, stimulant/opioid use disorders treatment, known as “speed balling.” Management of this “psychoactive bath salt” addiction follows the same clinical interventions as employed in methamphetamine addiction. The term “psycho-stimulants” occasionally used for some synthetic cathinones accurately described how some of these substances manifest psychedelic (hallucinogenic) effects as well as stimulant effects. New substances FA L L 2 017 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 27

also appear every year and many are not technically cathinones though they may possess the molecular structure activity like that of cathinoes. “Benzo Fury” (6-APB or 6-aminopropyl benzofuran), “Flakka” (alpha-PVP or alpha-pyrrolidinovalerophenone), and “Serotoni” (4,4-DMAR or 4,4-dimethyl aminorex) are some of the newer ones to hit the illicit drug market. My major concern with the synthetic cathinones is really a wider concern about the renewed era of synthetic psychoactive substance abuse brought on by the evolution of chemical sophistication among national and international street chemists. They can continue to modify molecules to stay ahead of identification, legal prohibition and drug testing procedures using the drug abusing subculture to test out their new psychoactive substance often unknowingly. For example, “Molly” is usually a street name for purer forms of “Ecstasy” (methylene dioxy-methamphetamine). Many samples of “Molly” sold at “rave” dance gatherings and elsewhere have been analyzed to actually contain a synthetic cathinone molecule as its active ingredient. Because of continual modification of these molecules, they are initially able to circumvent legal processes but more importantly, this also hampers good clinical practices that are used to assist individuals with substance use disorder recover from their nightmare of addiction and overdoses.

Tetrahydrocannabinol (THC) and Synthetic Cannabinoids As a clinician, my greatest concern regarding this class of abused substances is that their toxic and addictive properties continue to be ignored or worse, totally denied. Eight to ten percent of marijuana and cannabinoid abusers will meet medical diagnostic criteria for cannabis use disorder and many more will suffer toxic medical or mental health problems from their use. The THC (tetrahydrocannabinol) concentration in phytocannabinoids continue to increase while CBD (cannabidiol) concentrations that can moderate the psychoactive effects of THC decrease in recreational marijuana. Dabbing and other THC extraction processes result in “wax,” “shatter,” “honey oil,” “hash oil,” and more. These substances can have a concentration as high as 95 percent THC. Manufacturers also produce “edibles,” “vapes,” “gel caps,” and other forms of potent THC products. Marijuana equivalency of one gram of THC = 167 grams of marijuana may have fair validity for phytocannabinoids but there is a problem with the continued hybridization of marijuana creating varying strains of the plant that will have great variability in the 60 or more cannabinoid molecules in cannabis, each with their own effects and interactive properties with the main psychoactive substance, THC. As previously mentioned, CBD will mitigate some THC effects while THCV (tetrahydrocannabivarin) intensifies the effects of THC. There are now at least nine totally different chemical families used to produce synthetic cannabinoids. Thus, each specific synthetic cannabinoid can have different potencies and diverse behavioral and mental effects from a similar weight dose of the different substance abused. The current identified range in potency of these substances range from 5 to even 800 times more potent than THC. Originally introduced as herbal incense (“Spice,” “K2,” “Kush,” “Kronic,” “Zohai,” et al.) with the false admonishment “Not For Human Consumption,” synthetic cannabinoids are now sold as potpourri, aromatherapy, and vape fluid. Many different families of chemicals are used to make synthetic marijuana resulting in almost an endless number of cannabinoids that can be produced. This enables traffickers to stay a step ahead of legal restrictions and drug testing technologies. New cannabinoid molecules continually replace older synthetic cannabinoids that have been made illegal and/or become detectable by testing. 28

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Clients in treatment for cannabis use disorder demonstrate a withdrawal syndrome, psychosis, intense paranoia and even cannabinoid hyperemesis syndrome in addition to the more commonly seen effects of marijuana.

Fentanyl and Fentanyl Analogues The United States is now admittedly in the grips of an opioid epidemic with daily overdose deaths exceeding deaths caused by auto accidents or guns. More than six Americans are dying each hour from an opioid overdose. Most of the opioid deaths result from illicit fentanyl analogues also known as synthetic fentanyl or designer fentanyl and sold by street names like “China white,” “gunpowder heroin,” “W-18,” “Pinky,” “U4,” “Chiclets,” “Grey Death,” “TNT,” “Apache,” et al. There are now at least 19 identified fentanyl analogues being abused on the street and only a handful of those can be tested for in body fluids. Fentanyl is 100 times stronger than morphine or 50 times stronger than heroin while Carfentanil and W-18 have been tested in animals and found to be up to 10,000 times more potent than morphine and 5,000 times more potent than heroin. Due to this huge increase in potency, narcotic officers in various states and even drug sniffing dogs are now required to wear protective gear when investigating or searching for illicit opioids. Fentanyl or its analogues are now being mixed into weaker heroin sale units to increase potency of the product sold and to disguise the presence of the fentanyl if an opioid overdose occurs. Fentanyl analogues have also been used as the main psychoactive substance in counterfeit medications especially counterfeit Xanax® bar tablets. Clinically, fentanyl and new designer fentanyls do not respond as well to Narcan overdose treatment as do heroin and other opioids. They result is severe withdrawal symptoms that are more difficult to address during detoxification and as with the other synthetics new fentanyl analogues are difficult to detect in urine and other body fluid testing techniques. New synthetic fentanyls continue to be brought in to replace previous ones that were made illegal, have become detectable in drug tests or if they are found to be either too toxic or have severe side effects that limit their marketability. Morphine equivalent dosing calculation is already in clinical use to determine dosing of medication assisted detoxification or management of pain medications and may offer some insights for sentencing parameters. Thank you once again for giving me this opportunity to share my experience and concerns about the deluge of new synthetic psychoactive substances that are all too easily finding their way to those struggling with substance-related and addictive disorders. These drugs undermine addiction treatment and drug abuse prevention efforts as well as legal processes. They pose a significant threat to all of our communities. Darryl Inaba, PharmD, CATC-V, CADC III, is Director of Clinical and Behavioral Health Services for the Addictions Recovery Center and Director of Research and Education of CNS Productions in Medford, OR. He is an Associate Clinical Professor at the University of California in San Francisco, CA, Special Consultant, Instructor, at the University of Utah School on Alcohol and Other Drug Dependencies in Salt Lake City, UT and a Lifetime Fellow at Haight Ashbury Free Clinics, Inc., in San Francisco. Dr. Inaba has authored several papers, award-winning educational films and is co-author of Uppers, Downers, All Arounders, a text on addiction and related disorders that is used in more than 400 colleges and universities and is now in its 8th edition. He has been honored with over 90 individual awards for his work in the areas of prevention and treatment of substance abuse problems.

Earn 1 CE by Taking an Online Multiple Choice Quiz Earn one Continuing Education hour by taking a multiple choice quiz on this article now at www.naadac.org/magazine-ce-articles. $15 for NAADAC members and non-members. 1. Darryl Inaba, in his testimony to the U.S. Sentencing Committee, noted that the production of synthetic cathinones resulted from which of the following? a. The conversion of over-the-counter bath salts into a mind altering drug b. The exploration of ways to minimize the toxic effect of naturally grown cathinones c. Chemically modifying the Catha edulis bush because it quickly degrades once the leaves of the plant are removed from the bush d. The limited number of strains of the Catha edulis bush due to its continued hybridization 2. According to Darryl Inaba, which of the following is most accurate regarding synthetic cannabinoids? a. The THC concentration in recreational marijuana continues to increase while the psychoactive effects of THC has remained static in synthetic cannabinoids b. The current identified range in potency of synthetic cannabinoids is 5 to 800 times more potent than THC c. Drug traffickers have difficulty staying a step ahead of legal restrictions since the different families of the chemicals used to make synthetic marijuana are finite d. There are now five different chemical families used to produce synthetic cannabinoids 3. In Darryl Inaba’s discussion on synthetic opioids, which of the following opioid or synthetic opioid drug did he point out as being thousands of times more potent than the others listed? a. Fentanyl b. Morphine c. Carfentanyl d. Heroin 4. From the article by Westley Clark and Matthew Davis on the opioid epidemic, which of the following is the most accurate statement about prescription drug monitoring programs (PDMP)? a. Prescribers of controlled substances should query the PDMP database before prescribing b. Counselors who are not prescribers are legally prevented from any effort to make sure state PDMPs are adequately addressing prescription drug misuse c. Not all 50 states have some variant of PDMPs d. Counselors and other non-prescriber clinicians have no authority to assist prescribers in preventing prescription drug misuse 5. Which of the following, according to Clark and Davis, should not be regarded as a goal of substance use disorder treatment? a. Reduce the major symptoms of the illness b. Improve health and social function c. Withdrawal management d. Manage threats to relapse 6. Which of the following, as discussed by Clark and Davis, portrays an effective approach to avoid misuse of prescription opioid pain medication? a. The “start low and go slow” approach b. Education to those in pain about misuse and risk of overdose c. Use of non-opioid or non-medication strategies d. All of the above

7. In Jessica Gleason’s article announcing the new National Certificate in Tobacco Treatment Practice (NCTTP), which of the following most accurately describes the purpose of this new certificate? a. To accredit and standardize treatment programs that treat tobacco use disorder b. To standardize and unify tobacco competencies, knowledge, and skills on a national level and provide national, unified recognition of qualified professionals c. To outline tobacco cessation strategies as an initial step in a sequential model of treatment with those who have other co-occurring disorders d. To effectively include tobacco cessation strategies in an integrated model of care for those with other substance use disorders 8. Eligibility to receive the new National Certificate in Tobacco Treatment Practice (NCTTP) requires which of the following? a. A Bachelor’s degree or specified hours of human service work experience b. Successful completion of a CTTTP-accredited Tobacco Treatment Specialist training program c. Acquisition of 240 hours of tobacco treatment practice experience following the completion of training within a two-year period d. All of the above 9. In her article on common ethical questions, Mita Johnson discusses whether an addiction professional is more effective if he or she has a personal experience with addiction. Which of the following best explains this ethical dilemma? a. An addiction professional cannot relate to a client or be empathetic to the hurdles of their recovery journey if he or she has not walked a similar journey to theirs. b. A client’s story and history is most understood by those who have been there as it helps to compare where a professional in recovery has been to where the client is. c. The addiction professional does not need to be clouded by his or her own experiences, nor does he or she need to measure the client’s successes and setbacks based on his or her own journey, regardless of how similar the stories are. d. When we are using our story to help a client, we are truly operating from a client-centered approach. 10. Johnson poses the question, “How long ‘should’ a person be sober before accepting employment as a helper/service provider to others struggling with addictive substances and/or behaviors?” Which of the following best typifies the most ethically sound answer to this question? a. Time sober is irrelevant because working in a recovery-oriented environment can be quite effective for a counselor in his or her own recovery in countering symptoms of anxiety, depression and cravings that persist for months to years after last use. b. A person who succeeded as a client in treatment means that he or she will make a great employee of the agency where he or she was treated, thus time sober need not be a factor in such cases. c. Since clinical supervision serves a vital monitoring and gatekeeping function, any counselor in recovery who is receiving ongoing supervision can work in the field regardless of time in recovery. d. Time sober ranges from immediately after graduation to five years post-graduation in recovery, as long as the recovering counselor has had the amount of time to work his or her recovery, address triggers and cravings, and allow his or her brain to heal and mature.

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Thank You to All Sponsors, Exhibitors, and Partners at the NAADAC 2017 Annual Conference SPONSORS

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

NAADAC COMMITTEES

Updated 11/01/2017

North Central

STANDING COMMITTEE CHAIRS

President Gerard J. Schmidt, MA, LPC, MAC

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

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

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

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

William Keithcart, MA, LADC Northwest

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

Angela Maxwell, MS, CSAPC Southwest

Mid-Atlantic

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

Susan Coyer, MAC Mid-Central

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

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

Gisela Berger, PhD, MAC, LPC, NCC

Finance & Audit Committee Chair Mita Johnson, EdD, LPC, LAC, MAC, SAP

Nominations and Elections Chair Kirk Bowden, PhD, MAC, NCC, LPC Personnel Committee Chair Gerard J. Schmidt, MA, LPC, MAC Professional Practices and Standards Committee Chair Kirk Bowden, PhD, MAC,. NCC, LPC Public Policy Committee Co-Chairs Michael Kemp, ICS, CSAC, CSW Sherri Layton, MBA, LCDC, CCS AD HOC COMMITTEE CHAIRS Awards Committee Chair Patricia Greer, LCDC, AAC Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC Steven Durkee, NCAAC

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

International Committee Chair Elda Chan, PhD, MAC

Matt Feehery, MBA, LCDC, IAADC

Leadership Committee Chair Gerard J. Schmidt, MA, LPC, MAC Membership Committee Chair Margaret Smith, EdD, LADC

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

Product Review Committee Chair Jim Gamache, MSW, MLADC, IAADC Tobacco Committee Chair Diane Sevening, EdD, LAC

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

NERF Events Fundraising Chair Ed Olson, LCSW, CASAC

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

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

Clinical Issues Committee Chair Frances Patterson, PhD, MAC

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)

Student Sub-Committee Chair Diane Sevening, EdD, LAC

James “Kansas” Cafferty, LMFT, NCAAC California Elda Chan, PhD, MAC Hong Kong, China

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

Steven Durkee, NCAAC Secretary Kentucky Thaddeus Labhart, MAC, LPC Treasurer Oregon Rose Maire, MAC, LCADC, CCS New Jersey Art Romero, MA, LPCC, LADAC New Mexico Gerard J. Schmidt, MA, LPC, MAC (ex-officio) West Virginia Joan Standora, PhD, LADC, CASAC Pennsylvania

NAADAC REGIONAL BOARD REPRESENTATIVES

NORTHEAST NORTH CENTRAL

MID-CENTRAL

Gloria Nepote, LAC, NCAC II, CCDP, BRI II, Kansas-Missouri Therissa Libby, PhD, Minnesota Tiffany Gormley, MS, PLMHP, Nebraska Megan Busch, LAC, LPCC, North Dakota Linda Pratt, LAC, South Dakota

James Golding, MSW, MHS, CAADC, MAC, Illinois Stewart Ball, Indiana Steven Durkee, NCAAC, Kentucky Shannon Rozell, MPA, Michigan Dorothy Hillaire, LSW, LCDC II, Ohio Daniel Bizjak, MSW, ICS, CSAC, Wisconsin

Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Gary Blanchard, MA, LADC, Massachusetts Kelly Reardon, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, SAP, New York John Mann, LADC, Vermont

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

SOUTHWEST

MID-ATLANTIC

Carolyn Nessinger, MA, LAC, Arizona Thomas Gorham, MA, CADC II, California Agnieszka Baklazec, MA, LPC, LAC, MAC, Colorado David Marlon, Nevada J.J. Azua, LADAC, CPSW, New Mexico Shawn McMillen, Utah

Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia David Semanco, Virginia Mary Aldrich-Crouch, MSW, MPH, LICSW, MAC, AADC, West Virginia

SOUTHEAST MID-SOUTH Suzanne Lofton, LCDC, ADC, SAP, Texas

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

★ NAADAC 2O18 OCTOBER 5-9 | HOUSTON, TEXAS

SHOOT FOR THE STARS

NAADAC, the Association for Addiction Professionals invites you to its 2018 Annual Conference: Shoot for the Stars in Houston, TX from October 5–9 at the Westin Galleria Houston. Home to world-class museums and attractions, NASA, Fortune 500 companies, the largest medical center in the world, and over 10,000 restaurants, Houston is a diverse metropolis brimming with personality. Don’t miss five days of education, training, networking, and capacity-building with thought leaders in the addiction profession! The conference will feature full-day pre- and post-conference sessions, a two-day SAP training, daily keynote speakers and breakout sessions, onsite bookstores, onsite NCC AP testing, an Awards Lunch, an Exhibit Hall, and exciting evening activities! Don’t miss out on this important educational event!

Registration opens February 12! For more information, please visit www.naadac.org/2018annualconference