WINTER 2016 Vol. 4, No. 4
Addictive Sexuality: Diagnostic Controversies By Stefanie Carnes, PhD, LMFT, CSAT-S
U.S. Surgeon General’s Report on Alcohol, Drugs, and Health
Newly-Revised NAADAC Code of Ethics
A New Emerging Trend: College Students in in Recovery
Thank You to All Sponsors, Exhibitors, and Partners at the 2016 NAADAC Annual Conference SILVER SPONSORS
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ASAM
American Society of Addic on Medicine
CONTENTS WINTER 2016 Vol. 4 No. 4 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 95,000 addiction counselors, educators, and other addictionfocused health care professionals in the United States, Canada, and abroad. NAADAC’s members are addic tion counselors, educators, and other addic tionfocused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education. Mailing Address Telephone Email Fax
44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 800.548.0497 naadac@naadac.org 703.741.7698
Managing Editor
Jessica Gleason, JD
Communications & Kristin Hamilton, JD Digital Media Coordinator Graphic Designer
Elsie Smith, Design Solutions Plus
Editorial Advisory Committee
Kirk Bowden, PhD, MAC, NCC, LPC Rio Salado College Kansas Cafferty, LMFT, MCA, CATC, NCAAC True North Recovery Services National Certification Commission for Addiction Professionals (NCC AP) Thomas Durham, PhD NAADAC, the Association for Addiction Professionals Deann Jepson, MS Advocates for Human Potential, Inc.
■ F EAT UR ES
James McKenna, MEd, LADC I AdCare Hospital
18 Addictive Sexuality: Diagnostic Controversies By Stefanie Carnes, PhD, LMFT, CSAT-S 22 Rethinking How We Address Substance Issues in Criminal Justice Settings By Jack B.
Cynthia Moreno Tuohy, NCAC II, CDC III, SAP NAADAC, the Association for Addiction Professionals
24 Addressing Women’s Sexual Health Disparities in Substance Use Disorder Treatment
Robert C. Richards, MA, NCAC II, CADC III Retired
Stein, PhD, National Institute on Drug Abuse (NIDA) By Raven Badger, PhD
26 A New Emerging Trend: College Students in Recovery – Finding Success in RecoveryUnfriendly Environments By Scott Washburn, EdD, LADC
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President’s Corner: Executive Interview: Meet Your New President Gerard J. Schmidt, MA, LPC, MAC By Jessica Gleason, JD, NAADAC Director of Communications
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From The Executive Director: NAADAC 2016: The Year in Review By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director
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Ethics: Newly-Revised NAADAC Code of Ethics Released By Mita M. Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair
10 Advocacy: Surgeon General’s Report on Alcohol, Drugs, and Health: Key Findings, Facts, and Messages Compiled by Jessica Gleason, JD, NAADAC Director of Communications
13 Membership: Dr. Eugene Herrington Awarded 2016 NAADAC President’s Award
By Kristin Hamilton, JD, NAADAC Communications & Digital Media Coordinator
15 Certification: Musings of a NCC AP Commissioner By Kansas Cafferty, NCC AP Commissioner
Article Submission Guidelines We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Please submit story ideas and/or articles to Jessica Gleason at jgleason@naadac.org. For more information on submitting articles for inclusion in Advances in Addiction & Recovery, please visit www.naadac.org/advancesinaddictionrecovery# Publication_Guidelines. Disclaimer It is expressly understood that articles published in Advances in Addiction & Recovery do not necessarily represent the view of NAADAC. The views expressed and the accuracy of the information on which they are based are the responsibility of the author(s) and represent the wide diversity of thought and opinion within the addiction profession. Advertise With Us For more information on advertising, please contact Elsie Smith, Ad Sales Manager at esmith@naadac.org. Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5 This publication was prepared by NAADAC, the Association for Addiction Professionals. Reproduction without written permission is prohibited. For more information on obtaining additional copies of this publication, call 1.800.548.0497 or visit www. naadac.org. Printed December 2016 STAY CONNECTED
16 Conference: NAADAC 2016 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
Executive Interview: Meet Your New President, Gerard J. Schmidt, MA, LPC, MAC By Jessica Gleason, JD, NAADAC Director of Communications At the close of NAADAC’s 2016 Annual Con ference in early October, Gerard J. Schmidt, MA, LPC, MAC started his two-year term as NAADAC’s President. Schmidt has been in the mental health and addictions treatment field for the past 45 years, spending the last 36 years as the Chief Operations Officer at Valley HealthCare System in Morgantown, WV. He has a Bachelor’s of Arts Degree in Psy chology from Fairmont State University, a Master’s Degree from West Virginia University, and is a licensed professional counselor (LPC), a certified addictions counselor (CAC), and a certified Master Addictions Counselor (MAC). Schmidt started his career with the State of West Virginia working as an alcohol and drug counselor and since that time has been a prominent developer of an extensive array of addiction treatment services within north central West Virginia. He is the former president of the West Virginia Association of Alcoholism and Drug Abuse Counselors and was awarded its Distinguished Service Award in 2003. A NAADAC member since 1989, Schmidt previously served as NAADAC’s Clinical Affairs Consultant, Chair of the Public Policy Com mittee, Chair of the Certification Commission, and a member of the Advisory and Development Committee for NAADAC’s Recovery to Practice Initiative. Schmidt was a key developer of NAADAC’s Life-Long Learning Series and has been active in the coordination and delivery of the series of Practitioners Services Network (PSN) projects for the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (CSAT). He has been instrumental in the development of NAADAC’s legislative agenda over the years. Due to Schmidt’s strong efforts advocating for substance use disorders and mental health parity, he was named NAADAC’s 2010 Senator Harold Hughes Advocate of the Year. Schmidt has presented at numerous NAADAC events, trainings, and conferences, trained and consulted both nationally and internationally on behalf of the Association, and has a variety of publications to his credit. He has been active with the Mid-Atlantic Addiction Technology Transfer Center (ATTC) in establishing the State of West Virginia as a partner in the Mid-Atlantic ATTC region and currently sits on its Advisory Board in Richmond, VA.
Gleason: Why did you decide to go into the addiction profession? How did you get started? SCHMIDT: I have to be honest; I did not choose this profession, but rather feel as though it chose me. In 1971, I was fresh out of undergraduate school, the Viet Nam War was ongoing, and I was working as a meat cutter to pay my way through college. I knew I wanted to work with individuals 4
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who had problems or issues in their lives and I had a job interview with a state-run program that happened to have an opening for a Substance Abuse Counselor. As luck would have it, the gentleman who interviewed me knew little about this newly emerging treatment practice. I was eager to learn and he gave me the opportunity to do just that. I read as much as I could find about the subject, attended workshops and conferences, and quickly realized that I needed more education and counseling skills, so I began working on my counseling degree while working full time. It was at this point that I knew I found the population with whom I wanted to work, although I had no idea that 46 years later, I would still be here. I fell in love with the ability to connect with clients and their families and looking at new, innovative ways of approaching treatment while simultaneously having the opportunity to learn more and more from those who I treated. I was fortunate to have many great mentors over the years, which helped me shape my approach to treatment and gave me the opportunity to grow and expand my areas of interest within the addiction profession.
Gleason: How did you become involved with NAADAC and decide to pursue a role in NAADAC’s leadership? SCHMIDT: I first became involved with NAADAC when the newly organized West Virginia addiction membership organization became affili ated with NAADAC in 1983. I was active in West Virginia’s association and eventually became the president. As President, I attended NAADAC’s national conferences and meetings and was exposed to the work that NAADAC was doing on the national level. I was fortunate to meet and interact with some of NAADAC’s leadership at that time and was asked to serve on the newly formed NAADAC Certification Commission, now known as the National Certification Commission for Addiction Professionals (NCC AP). After serving on the commission for four years, I was asked to be the Chair. Serving in this role led to many other leadership opportunities within NAADAC, including working as the Clinical Affairs Consultant and eventually as the Chair of the Public Policy Committee, and taking an active role in advocacy within NAADAC.
Gleason: What motivated you to run for NAADAC President? SCHMIDT: Having been in the profession for the past 45 years and having had the wonderful experiences of being exposed to a variety of marvelous trainers and training opportunities myself, in the past 15 years I have felt the need to give back to the profession. I think we all have a responsibility to support and develop the future workforce to maintain the
identity of the profession. In considering my role in the NAADAC leadership, I felt that I had some ideas and strategies that would be helpful in moving the organization forward and continuing to support and grow the workforce, so I decided perhaps I could best do that as NAADAC’s president. I am blessed that the executive leadership is strong and that I will have the chance to work with a bright, articulate, and motivated group of leadership professionals over these next two years. I look forward to working with and learning from them.
Gleason: How would you describe your leadership style? SCHMIDT: I like to believe that my style is inclusive. I want input from as many people as possible. I do not believe that just because you are in a leadership role input flows only from the top down. I have learned over the years that in remaining open to input and feedback, you can experience much more growth and development and have access to many more opportunities. However, I also realize that there are times when a hard decision may need to be made and a leader has to be willing to assess the situation, make that decision, and live with that choice. Again, I feel blessed that my fellow executive committee members will provide me with the knowledge and guidance I need to succeed.
Gleason: What is first on your agenda as you settle into your new role? SCHMIDT: One of my very first agenda items was to select committee chairs for the organization. I believe these choices are critical in determining the direction and sustaining the pulse of NAADAC. The committees need to be active and have strong leadership and specific goals. We are a big organization and represent a vast array of addiction treatment professionals across a wide spectrum of care, and need to use the knowledge of these individuals to guide the different committees in doing the work of the profession we represent.
Gleason: What other goals do you hope to achieve during your term as NAADAC President? Is there an initiative you are excited to tackle during your presidency? SCHMIDT: When considering the ever expanding demand for substance use disorder treatment across the United States, another goal of mine is to grow the workforce. This includes working to obtain increased salaries at all levels, tuition reimbursement, and direct marketing of counseling professionals. If we are going to maintain the unique talents and knowledge that is needed for our profession to be successful, then we are going to have to ensure that we continue to try and attract the most qualified professionals. Another goal would be to increase advocacy efforts at the national, state and local levels. We all need to have a louder voice in this process so that increased funding, access to care, and implementation of all the rules and regulations regarding parity for treatment are enforced and fair, and that equal care is available to those afflicted with this disease. I am excited to work toward obtaining more active involvement by the membership in pushing our agenda forward at all levels. We have a responsibility to those we serve to not just be as educated as possible and current in the treatment we provide, but also to support recovery at all levels. We can encourage our members to be active within their local communities in awareness events, support local treatment programs, encourage anonymous fellowship meetings in these communities, and enlist and support mentors in recovery. I strongly encourage member engagement in all areas related to the profession. We can no longer sit back and assume someone else will do it for us. If we do not promote the need to loudly and clearly advocate
that trained, certified and licensed substance use disorder professionals are the most qualified and ethically responsible group of professionals to treat this disorder, then we will abdicate it to the other treatment disciplines.
Gleason: What are you hearing from members as their biggest concerns and challenges for the industry today and how can NAADAC support them? SCHMIDT: Three important words: parity, parity, parity! For more than 20 years, this has been the clear and most vocal cry coming from members practicing across the United States. We have carried this message to Capitol Hill and have continued to voice our concerns to the Substance Abuse and Mental Health Services Administration (SAMHSA), its Center for Substance Abuse Treatment (CSAT), and other funding entities within the addiction arena. Our message has been that we want parity for care, parity for pay, and parity for coverage. Legislation alone is not enough; we have to be vocal about the ongoing disparity and prejudice against treatment inclusion.
Gleason: What do you feel are one or two of the biggest challenges facing new addiction counselors today, and do you have any advice for overcoming these challenges? SCHMIDT: Achieving inclusion into mainstream care equal to mental health and primary care is one of the biggest challenges new addiction counselors — and experienced addiction counselors — face today. Access ing funds for continuing education and earning equal pay are also big challenges. New professionals coming into the profession need to be vocal, patient, and tireless in their efforts to work with a population of clients that often have very limited resources and support systems to encourage their long term recovery. I encourage “newbies” to find a mentor who has a history of providing treatment and glean from him or her and his or her experiences and incorporate those components in their own practices. New addiction counselors should have a constant hunger for new and innovative treatment approaches and always, always remember the road to recovery is different for each and every individual we encounter in treatment.
Gleason: Why is NAADAC membership important for addiction professionals? SCHMIDT: NAADAC is important primarily because it connects members to other treatment professionals across the United States and offers a wide variety of educational opportunities for members to grow and expand their knowledge, skills and abilities. One of the most valuable resources NAADAC offers is the connection to over 10,000 substance use disorder treatment professionals all working in very similar capacities across the world in an effort to improve the lives of those so devastated by their own involvement in the disease. NAADAC also offers professional support, treatment practice insurance, a collective advocacy voice, and educational mentoring possibilities. Finally, the conferences, as well as web-based educational opportunities, are invaluable in this time where funds for training are shrinking. Jessica Gleason 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.
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■ F R O M T H E E X E C U T I VE DI RE C TOR
NAADAC 2016: The Year in Review By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director NAADAC continues to grow, build upon its successes, and work toward the vision set by its Board of Directors. NAADAC’s annual efforts are concentrated in four major areas: professional development, public engagement, professional services, and communication of NAADAC’s mission. These Four Pillars support NAADAC’s membership and constituents and those credentialed by the National Certification Commission for Addiction Professionals (NCC AP). Together, we form a premier global organization serving the needs of the addiction focused professional and other helping professionals. Together, we do make a difference! I am excited to share the following highlights from our busy year:
Professional Development • Education and training stand at the center of NAADAC’s efforts to ensure professional development for members and non-members alike. Our successful on-demand webinar series continues to be world class, offering up to 90 free CE credits (worth over $1,350) to our members throughout the year. Highlights from 2016 include webinars on neurobiology, co-occurring disorders, mindfulness, peer recovery, spirituality, workforce, trauma, adolescent development, treatments for older adults, and so many more. In 2016, we celebrated educating our 100,000th webinar participant! CE credits are also available through our many online independent courses, NAADAC’s magazine Advances in Addiction & Recovery, and our many trainings and conferences around the country. • NAADAC’s official publication, Advances in Addiction & Recovery, continues to be a great treatment and recovery resource for both NAADAC members and others serving in the addiction profession. Over the past year, we have partnered with experts in the field to bring you articles from the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), National Council for Behavioral Health, Smart Approaches to Marijuana (SAM), Justice for Vets, the National Addiction Studies Accreditation Commission (NASAC), the International Coalition for Addiction Studies (INCASE), and other national partners and trainers to bring readers substantive and important content, as well as to educate and update members on NAADAC initiatives. • The National Certification Commission for Addiction Professionals (NCC AP) initiated a grandparenting process for the NCAC Levels I and II and MAC national certifications. Almost 6,000 applications came in for review during the six-month application period, and we are working hard to process the last of the pending applications. 6
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• The NCC AP also welcomed Virginia and Montana and will soon welcome Maryland as the latest states to use the NCC AP standardized licensing/credentialing tests and criteria at the state level. NCC AP’s credentials remain the only national addiction-specific credentials, meaning that the same criteria is used for each level of credential and therefore, the credentials are mobile and transferable. NAADAC is working to nationalize the NCC AP credentials to promote the identity of our profession, the standardization of credentialing, and the potential for increased ease and ability of our professionals to be reimbursed. • NAADAC educated over 700 individuals with over 64 presentations and 78 presenters and panelists at its Annual Conference in Minneapolis, MN in October 2016. After several years in the making, the new NAADAC Code of Ethics was released in October and is now available on the NAADAC website. We are proud to say that it is more comprehensive and clearer than ever before. The new Code of Ethics covers new treatment approaches such a telehealth and telesupervision, client welfare in expanded circumstances, and other nuances specific to our profession. We look forward to educating our members and constituents about the new Code and the requirements to serve ethically throughout the coming months! • All three modules of our popular Basics of Addiction Counseling: Desk Reference and Study Guide are undergoing important revisions. The revised publications will be coming out in phases throughout 2017, with Module II: Addiction Counseling and Theories to be released in the new year. Module I: Pharmacology of Psychoactive Substance Use, Abuse, and Dependence and Module III: Ethical and Professional Issues in Addiction Counseling will be coming next spring and summer, respectively. NAADAC will continue to update many of its other products to stay current, including the Clinical Supervision Guide and the Co-Occurring Disorders Manual. Look for these by the end of 2017. • NAADAC continues to support the National Addiction Studies Accreditation Commission (NASAC) in its efforts to create national professional standards and improve and expand accreditation of higher education addiction studies and counseling programs. NASAC is growing and gaining recognition in the higher education accreditation world.
Public Engagement • NAADAC engages with the public through its many communication channels, including the NAADAC website, its weekly and bi-weekly e-newsletters, Professional eUpdate and Addiction & Recovery eNews, e-blasts about programs or advocacy issues to an email list of 48,000+ addiction professionals, a strong social media presence through Twitter, Facebook, LinkedIn, and YouTube, our 47 state affiliates, and our important network of federal, regional, and state organizational partnerships. NAADAC’s advocacy work at both federal and state levels is a key component of our public engagement initiatives. At the state level, we worked to build a stronger identity for our professionals by protecting and enhancing certification and licensing laws to specify that addiction counseling must be performed by those trained specifically and with addiction knowledge, skills and competencies, and supporting increased funding for addiction treatment and recovery services,
loan forgiveness, and improved support of the addiction profession as a specialized and integral part of the mental and behavioral health continuum. • We also worked to build and enhance the addiction workforce and bring stronger attention to the needs of the profession. NAADAC partnered with the SAMHSA and its Single State Authorities to develop and produce four workforce forums at colleges and universities across the country to build awareness and promote the many benefits of working in our profession, and two webinars on workforce recruitment and retention. • At the federal level, NAADAC continues to work with the White House Office of National Drug Control Policy (ONDCP), SAMHSA, NIDA, National Institute on Alcohol Abuse & Alcoholism (NIAAA), the Department of Health & Human Services, the Human Resources & Services Administration (HRSA), the Bureau of International Narcotics and Law Enforcement (INL), and other agencies to ensure that your agenda items are being addressed, especially in the workforce arena. NAADAC also participates in many national and Washington, D.C. stakeholder groups, including the Addiction Leadership Group. • NAADAC has signed onto many advocacy letters, supported various bills, and given testimony and recommendations to SAMHSA, ONDCP, members of the Congressional Committees on Veterans Affairs and the Congressional Addiction, Treatment, and Recovery Caucus, as well as various state legislators this past year. • NAADAC partnered with National Council for Behavioral Health and 13 other national advocacy organizations for National Council’s Hill Day in June. Together, we created consensus fact sheets on Comprehensive Mental Health and Addiction Reform, the Comprehensive Addiction & Recovery Act (CARA), Substance Use and Mental Health Appropriations, Mental Health First Aid, and the Mental Health Access Improvement Act.
• NAADAC created a campaign for a general public audience to promote addiction professionals as specialists with the correct training, skills, and experience to provide the support needed to find and maintain recovery. We filmed two short public service announcements (PSAs) and placed a print ad in USA Today’s Heroin Addiction Campaign insert, reaching over 750,000 readers across the country. We look forward to building this campaign and reaching more people in 2017. • Two Road to Recovery series episodes were filmed this past year that featured experts, along with myself, on issues of family and addiction and the other on criminal justice and addiction. These were televised nationally on several stations. • Through NAADAC’s Annual Conference in October, and numerous regional and affiliate conferences and trainings, NAADAC members and other addiction professionals have been able to network and share information and ideas across the nation.
Professional Services • NAADAC previously announced that after years of advocating for the inclusion of addiction professionals in SAMHSA’s Minority Fellowship Program, it has been awarded a $3.2 million multi-year grant to administer a new NAADAC Minority Fellowship Program for Addiction Counselors (NMFP-AC). Now in our third year, we are excited to announce an expansion to the program after having been awarded a Supplemental Grant for persons specializing in addiction/substance use disorders through a track with a major in another discipline such as social work, general counseling and nursing. The NMFP-AC will increase the number of culturally-competent Master’s level addiction counselors available to underserved and minority populations, and transition age youth (ages 16–25) by providing tuition stipends, training, education, and professional guidance.
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• NAADAC continues to provide technical support and professional services to its 47 state affiliates and numerous international affiliates and partners, including conferences at the state and regional levels, training sessions, curriculum development, capacity-building efforts, advocacy assistance, certification testing, and more. Our international affiliates continue to grow and build recognition in their counties, and NAADAC and NCC AP continue to be contacted by countries seeking technical support. • NAADAC partners with other organizations to provide technical assistance, training and other support. We are working with many different organizations to assist them in grant management and other delivery of services they perform. • In partnership with the American Professional Agency, Inc., NAADAC now offers members discounted malpractice insurance covering not only addiction counselors, but also clinical supervisors, students, and Peer Recovery Support Specialists! We also offer discounted coverage for agency malpractice, boards and officers, and general liability! • NAADAC’s Approved Education Provider Program includes over 350 training and education entities throughout the United States and internationally and continues to expand. Review of the Approved Provider Education Program is underway to add at least one more category and to simplify the application process. • The U.S. Department of Transportation’s Substance Abuse Professional (SAP) program has become more important as a result of the Affordable Care Act. NAADAC expects that as a result of CARA becoming law and the new 21st Century Cures Act, which includes $1 billion to combat addiction and multiple bipartisan reforms, the SAP program will become more recognized and used as a gatekeeper for employers. NAADAC’s SAP course is now available online, making it more accessible
for individuals to prepare for and take the test to become qualified to apply for the DOT’s program. • NAADAC’s international presence continues to grow, with education, training, certification and technical assistance brought to China, Egypt, Hong Kong, Indonesia, Mexico, Puerto Rico, South Korea, the six U.S. Affiliated Pacific Jurisdictions (American Samoa, the Republic of the Marshall Islands, the Federated States of Micronesia, Guam, and the Commonwealth of the Northern Mariana Islands), and the Colombo Plan’s International Center for Credentialing and Education of Addiction Professionals, which serves 43 countries in Asia and in the Pacific.
Communicate the Mission • NAADAC continued its work to promote the message of recovery through its successful Recovery to Practice (RTP) initiative, webinar series, and Certificate Program. The Recovery to Practice (RTP) Certificate Program is designed to promote awareness, acceptance, and adoption of recovery-based practices in the delivery of addiction-related services and builds on SAMHSA’s definition and fundamental components of recovery. This program is now accepted toward the required amount of training hours for the NCC AP’s National Peer Recovery Support Credential. • NAADAC staff and leadership have been interviewed and quoted across various mediums, including in print, online, on the radio, and on TV, on such important issues such the need for loan forgiveness programs, inclusion on reimbursements, employee benefits and salary issues, tuition assistance, the need for an increased and better workforce, and the need for continued specialization of the addiction profession, and the state of the opioid epidemic. • NAADAC continues be involved in national discussion and to work with Managed Care Organizations (MCOs), Preferred Provider Organi zations (PPOs), Behavioral Health Organizations (BHOs), and the Centers for Medicare & Medicaid Services (CMS) on issues of funding and reimbursements to addiction professions. In closing, I would again like to acknowledge the NAADAC Executive Committee, Board of Directors, and staff, who work tirelessly and with so much ambition to serve you, our valued members, our constituents, and the addiction profession as a whole. They deserve all of the gratitude, compliments, and positive comments we receive from members and the public on a regular basis. Please take the time to thank each and every member of our wonderful team for his or her expertise, dedication, and competence. Finally, thank you for the opportunity to serve you and our honored profession! Sincerely,
Cynthia Moreno Tuohy, NCAC II, CDC III, SAP NAADAC Executive Director Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years as well as an international, national and state trainer in a variety of topics. Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.
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■ Et h i cs
Newly-Revised NAADAC Code of Ethics Released By Mita M. Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair
Ethics is a word we throw around casually every day but what is it really? Interestingly, the term ethics is derived from the Greek word ethos, which speaks to one’s character. As professionals, we adhere to two codes of ethics — our personal ethics or morals and the Code of Ethics of our professional organization(s). NAADAC’s Code of Ethics is designed to protect two parties: the client and the reputation/character of the provider and his/her profession. Breaches of the professional Code of Ethics can incur consequences to one’s reputation and result in disciplinary action, ranging from a suggestion for corrective action or a warning to dismissal from NAADAC’s professional membership. NAADAC has a responsibility to create and maintain a realistic and relevant Code of Ethics that guides its members and others. The NAADAC Code of Ethics is intended to guide the everyday professional conduct of anyone who provides addiction-related and ancillary services. In early 2016, the NAADAC Ethics Committee decided, after discussion with the Executive Committee and National Addiction Studies Accreditation Commission (NASAC), to update the Code of Ethics to meet the needs of current addictions practice. A comprehensive draft was created, edited, and submitted to the General Board and approved by a majority vote at the General Board meeting on October 9, 2016. The new Code of Ethics is a completely new document — it was built from the ground up with major enhancements and additions to the previous version. Standards were replaced with Principles and each Principle considered clinician, supervisor, and relevant others. It was important to create a document that clearly states the standards of practice within our profession; we wanted a document that provides meaningful direction when addressing a grievance or complaint. This Code provides in-depth and clear guidance and direction to individual providers, service organizations, regulatory boards, educators and trainers, legislators, and other related parties. There will be only one document: the 2016 Code of Ethics. NAADAC will not be publishing a brochure in addition to the Code, to prevent confusion about which document to reference for studying and work, and will be updating The Basics of Addiction Counseling: Desk Reference and Study Guide – Module III: Ethical and Professional Issues in Addiction Counseling in the first quarter of 2017 to reflect the new Code. The 2016 NAADAC Code of Ethics is arranged as follows: Introduction to NAADAC/NCC AP Ethical Standards; Principle I: The Counseling Relationship; Principle II: Confidentiality and Privileged Communication; Principle III: Professional Responsibilities and Workplace Standards; Principle IV: Working in a Culturally-Diverse World; Principle V: Assessment, Evaluation and Interpretation; Principle VI: E-Therapy, E-Supervision and Social Media; Principle VII: Supervision and Consultation; Principle VIII: Resolving Ethical Concerns; and Principle IX: Publication and Communication.
The 2016 Code of Ethics places more emphasis on client safety and welfare. Each Item of each Principle was updated to reflect the current practice environment and the entire continuum of care. Enhancements and additions can be found throughout. Expect to find refinements to the language on most topics including informed consent, confidentiality, multiple relationships, abandonment, compen sation, records, credentialing, reporting, advocacy, and decision making model. There were many additions, including sections regarding virtual relationships (don’t engage), encryption, recording, multidisciplinary care, work with medical professionals, collaborative care, impairment, cultural humility, and supervisory informed consent. A new Principle was added regarding e-therapy, e-supervision and social media. It is now commonplace to find providers working in environments that utilize technology for information storage and the delivery of services. It was important to address this by emphasizing the need for competency, informed consent, verifications, knowledge of the legalities, use of local resources, and record keeping. You will also find a section specific to Friends and to Social Media. More emphasis was placed on the Supervisory and Consultation relationships. The Principle on Supervision and Consultation was enhanced to place more emphasis on the supervisory relationship, and its ultimate impact on client welfare. NAADAC, as a professional organization, has high expectations regarding the delivery of services to a client on all points of the continuum of care. The 2016 Code of Ethics sets the bar high regarding the obligations that professionals must respect when carrying out their duties. The work in which providers engage to help those struggling with substance use disorders is challenging and gratifying; the new Code provides a clear and meaningful foundation for that work. To read the newly updated 2016 Code of Ethics, please visit www.naadac.org/ code-of-ethics. 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 an NCC. In addition to being a core faculty member at Walden University, she maintains a private practice where she sees clients and supervisees who are working on credentialing. Johnson is the Past-President of the Colorado Association of Addiction Professionals (CAAP), and is currently NAADAC Treasurer and Ethics Chair. She previously served as NAADAC’s Regional Vice-President for the Southwest. In Colorado, Johnson is involved in regulatory and credentialing activities and very involved in workforce recruitment and retention activities. Johnson speaks and trains regionally and nationally on a variety of topics. Her passions include pharmacology of drugs of addiction, infectious diseases, ethics, motivational interviewing, and clinical supervision.
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■ A D V O C AC Y
Surgeon General’s Report on Alcohol, Drugs, and Health: Key Findings, Facts, and Messages Compiled by Jessica Gleason, JD, NAADAC Director of Communications On November 17, 2016, the Office of the U.S. Surgeon General released its historic Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. The release of this landmark 400page report marks the first time a U.S. Surgeon General has dedicated a report to substance misuse and substance use disorders, and presents substance misuse and substance use disorders as public health challenges. Written by leading scientists and researchers, it discusses the latest science, describes evidence-based programs, policies, and strategies to address substance misuse, and makes recommendations for the future. NAADAC hopes the report will mark a critical moment in the fight against addiction, much like the 1964 Surgeon General’s report on smoking and tobacco use that catalyzed a half century of work on tobacco control. NAADAC shares below key findings, facts, and messages written and compiled by the Surgeon General from the Report. The key findings highlight what is currently known from available research on that main topic, as well as the strength of the evidence. As with the rest of the Report, the key findings are not intended to be exhaustive, but are instead considered the important “take-aways” from each chapter. NAADAC encourages all constituents to read the Report in its entirety for a fuller discussion of the topics. The full report, executive summary, and supplementary materials are available online and to order at http://addiction.surgeongeneral.gov.
Neurobiology of Substance Use, Misuse, and Addiction • Well-supported1 scientific evidence shows that addiction to alcohol or drugs is a chronic brain disease that has potential for recurrence and recovery. • Well-supported evidence shows that the addiction process involves a three-stage cycle: binge/intoxication, withdrawal/negative effect, and preoccupation/anticipation. This cycle becomes more severe as a person continues substance use and it produces dramatic changes in brain function that reduce a person’s ability to control their substance use. • Well-supported scientific evidence shows that disruptions in three areas of the brain are particularly important in the onset, development, and maintenance of substance use disorders: the basal ganglia, the extended amygdala, and the prefrontal cortex. These disruptions: 1. enable substance-associated cues to trigger substance seeking (i.e., they increase incentive salience); 2. reduce sensitivity of brain systems involved in the experience of pleasure or reward, and heighten activation of brain stress systems; and 3. reduce functioning of brain executive control systems, which are involved in the ability to make decisions and regulate one’s actions, emotions, and impulses. • Supported scientific evidence shows that these changes in the brain persist long after substance use stops. It is not yet known how much these changes may be reversed or how long that process may take. 1
• Well-supported scientific evidence shows that adolescence is a critical “at-risk period” for substance use and addiction. All addictive drugs, including alcohol and marijuana, have especially harmful effects on the adolescent brain, which is still undergoing significant development.
Prevention Programs and Policies • Well-supported scientific evidence exists for robust predictors (risk and protective factors) of substance use and misuse from birth through adulthood. These predictors show much consistency across gender, race and ethnicity, and income. • Well-supported scientific evidence demonstrates that a variety of prevention programs and alcohol policies that address these predictors prevent substance initiation, harmful use, and substance use-related problems, and many have been found to be cost-effective. These programs and policies are effective at different stages of the lifespan, from infancy to adulthood, suggesting that it is never too early and never too late to prevent substance misuse and related problems. • Communities and populations have different levels of risk, protection, and substance use. Well-supported scientific evidence shows that communities are an important organizing force for bringing effective EBIs to scale. To build effective, sustainable prevention across age groups and populations, communities should build cross-sector community coalitions which assess and prioritize local levels of risk and protective factors and substance misuse problems and select and implement evidence-based interventions matched to local priorities. • Well-supported scientific evidence shows that federal, state, and community-level policies designed to reduce alcohol availability and increase the costs of alcohol have immediate, positive benefits in reducing drinking and binge drinking, as well as the resulting harms from alcohol misuse, such as motor vehicle crashes and fatalities. • There is well-supported scientific evidence that laws targeting alcohol-impaired driving, such as administrative license revocation and lower per se legal blood alcohol limits for adults and persons under the legal drinking age, have helped cut alcohol-related traffic deaths per 100,000 in half since the early 1980s. • As yet, insufficient evidence exists of the effects of state policies to reduce inappropriate prescribing of opioid pain medications.
Early Intervention, Treatment, and Management of Substance Use Disorders • Well-supported scientific evidence shows that substance use disorders can be effectively treated, with recurrence rates no higher than those for other chronic illnesses such as diabetes, asthma, and hypertension. With comprehensive continuing care, recovery is now an achievable outcome.
The Centers for Disease Control and Prevention (CDC) summarizes strength of evidence as: “Well-supported”: when evidence is derived from multiple controlled trials or large-scale population studies; “Supported”: when evidence is derived from rigorous but fewer or smaller trials; and “Promising”: when evidence is derived from a practical or clinical sense and is widely practiced.
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• Only about 1 in 10 people with a substance use disorder receive any type of specialty treatment. The great majority of treatment has occurred in specialty substance use disorder treatment programs with little involvement by primary or general health care. However, a shift is occurring to mainstream the delivery of early intervention and treatment services into general health care practice. • Well-supported scientific evidence shows that medications can be effective in treating serious substance use disorders, but they are underused. The U.S. Food and Drug Administration (FDA) has approved three medications to treat alcohol use disorders and three others to treat opioid use disorders. However, an insufficient number of existing treatment programs or practicing physicians offer these medications. To date, no FDA-approved medications are available to treat marijuana, cocaine, methamphetamine, or other substance use disorders, with the exception of the medications previously noted for alcohol and opioid use disorders. • Supported scientific evidence indicates that substance misuse and substance use disorders can be reliably and easily identified through screening and that less severe forms of these conditions often respond to brief physician advice and other types of brief interventions. Well-supported scientific evidence shows that these brief interventions work with mild severity alcohol use disorders, but only promising evidence suggests that they are effective with drug use disorders. • Well-supported scientific evidence shows that treatment for substance use disorders—including inpatient, residential, and outpatient—are costeffective compared with no treatment. • The primary goals and general management methods of treatment for substance use disorders are the same as those for the treatment of other chronic illnesses. The goals of treatment are to reduce key symptoms to non-problematic levels and improve health and functional status; this is equally true for those with co-occurring substance use disorders and other psychiatric disorders. Key components of care are medications, behavioral therapies, and recovery support services (RSS). • Well-supported scientific evidence shows that behavioral therapies can be effective in treating substance use disorders, but most evidencebased behavioral therapies are often implemented with limited fidelity and are under-used. Treatments using these evidence-based practices have shown better results than non-evidence-based treatments and services. • Promising scientific evidence suggests that several electronic technologies, like the adoption of electronic health records (EHRs) and the use of telehealth, could improve access, engagement, monitoring, and continuing supportive care of those with substance use disorders.
Recovery – The Many Paths to Wellness • Recovery from substance use disorders has had several definitions. Although specific elements of these definitions differ, all agree that recovery goes beyond the remission of symptoms to include a positive change in the whole person. In this regard, “abstinence,” though often necessary, is not always sufficient to define recovery. • Remission from substance use disorders—the reduction of key symp toms below the diagnostic threshold — is more common than most people realize. “Supported” scientific evidence indicates that approximately 50 percent of adults who once met diagnostic criteria for a substance use dis order — or about 25 million people — are currently in stable remission (1 year or longer). Even so, remission from a substance use disorder can take several years and multiple episodes of treatment, RSS, and/or mutual aid. • There are many paths to recovery. People will choose their pathway based on their cultural values, their socioeconomic status, their psychological and behavioral needs, and the nature of their substance use disorder.
• 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. A range of recovery support services have sprung up all over the United States, including in schools, health care systems, housing, and community settings. • The state of the science is varied in the recovery field. • Well-supported scientific evidence demonstrates the effectiveness of 12-step mutual aid groups focused on alcohol and 12-step facilitation interventions. • Evidence for the effectiveness of other recovery supports (educational settings, drug-focused mutual aid groups, and recovery housing) is promising. • Many other recovery supports have been studied little or not at all.
Health Care Systems and Substance Use Disorders • Well-supported scientific evidence shows that the traditional separation of substance use disorder treatment and mental health services from mainstream health care has created obstacles to successful care coordination. Efforts are needed to support integrating screening, assessments, interventions, use of medications, and care coordination between general health systems and specialty substance use disorder treatment programs or services. • Supported scientific evidence indicates that closer integration of substance use-related services in mainstream health care systems will have value to both systems. Substance use disorders are medical conditions and their treatment has impacts on and is impacted by other mental and physical health conditions. Integration can help address health disparities, reduce health care costs for both patients and family members, and improve general health outcomes. • Supported scientific evidence indicates that individuals with substance use disorders often access the health care system for reasons other than their substance use disorder. Many do not seek specialty treatment but they are over-represented in many general health care settings. • Promising scientific evidence suggests that integrating care for substance use disorders into mainstream health care can increase the quality, effectiveness, and efficiency of health care. Many of the health home and chronic care model practices now used by mainstream health care to manage other diseases could be extended to include the management of substance use disorders. • Insurance coverage for substance use disorder services is becoming more robust as a result of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act. The Affordable Care Act also requires non-grandfathered individual and small group market plans to cover services to prevent and treat substance use disorders. W I N T E R 2 016 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 11
• Health care delivery organizations, such as health homes and accountable care organizations (ACOs), are being developed to better integrate care. The roles of existing care delivery organizations, such as community health centers, are also being expanded to meet the demands of integrated care for substance use disorder prevention, treatment, and recovery. • Use of Health IT is expanding to support greater communication and collaboration among providers, fostering better integrated and collaborative care, while at the same time protecting patient privacy. It also has the potential for expanding access to care, extending the workforce, improving care coordination, reaching individuals who are resistant to engaging in traditional treatment settings, and providing outcomes and recovery monitoring. • Supported evidence indicates that one fundamental way to address racial and ethnic disparities in health care is to increase the number of people who have health insurance coverage. • Well-supported evidence shows that the current substance use disorder workforce does not have the capacity to meet the existing need for integrated health care, and the current general health care workforce is undertrained to deal with substance use-related problems. Health care now requires a new, larger, more diverse workforce with the skills to prevent, identify, and treat substance use disorders, providing “personalized care” through integrated care delivery.
Five Key Messages The following five general messages described within the Report have important implications for policy and practice. 1. Both substance misuse and substance use disorders harm the health and well-being of individuals and communities. Addressing them requires implementation of effective strategies. 2. Highly effective community-based prevention programs and policies exist and should be widely implemented. 3. Full integration of the continuum of services for substance use disorders with the rest of health care could significantly improve the quality, effectiveness, and safety of all health care. 4. Coordination and implementation of recent health reform and parity laws will help ensure increased access to services for people with substance use disorders.
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5. A large body of research has clarified the biological, psychological, and social under pinnings of substance misuse and related dis orders and described effective prevention, treatment, and recovery support services. Future research is needed to guide the new public health approach to substance misuse and substance use disorders.
Conclusion NAADAC is committed to efforts to ensure that the Report has a lasting impact. As your professional association, NAADAC has a responsibility to support high-quality care for substance use disorders and will continue its efforts to set workforce guidelines, advocate for curriculum changes in professional schools, promote professional continuing education training, and develop evidence-based guidelines and educational materials that outline best practices for prevention, screening and assessment, brief interventions, diagnosis, and treatment of substance-related health issues. As addiction professionals, the Surgeon General and NAADAC urge you to play a major role in addressing substance misuse and substance use disorders, not only by directly providing health care services, but also by promoting prevention strategies and supporting the infrastructure changes needed to better integrate care for substance use disorders into general health care and other treatment settings.
How Can You Learn More? For more information on the Surgeon General’s Report, including the full report, executive summary, and supplementary materials, please visit at http://addiction.surgeongeneral. gov. REFERENCE 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. Jessica Gleason is Director of Communications for NAADAC, the Associ at ion 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.
■ M EM B ER S H I P
Dr. Eugene Herrington Awarded 2016 NAADAC President’s Award By Kristin Hamilton, JD, NAADAC Communications & Digital Media Coordinator Eugene Herrington, PhD, MSW, MDiv, LCSW, was awarded the 2016 NAADAC President’s Award by outgoing NAADAC President Kirk Bowden. The NAADAC President presents this award to an individual or entity in recognition of a long and continued commitment to NAADAC and in appreciation for support of the addiction profession. Dr. Bowden chose Dr. Herrington for this year’s award because Dr. Herrington is truly committed to helping people improve their lives. “He is personable, a gifted relationship builder and a genuinely good person,” said Dr. Bowden. Dr. Herrington is an Associate Professor of Clinical Psychiatry at Morehouse School of Medicine, where he teaches first and third year psychiatric residents. He holds a Doctor of Philosophy Degree in Clinical Psychology and a Master’s Degree in Social Work. Dr. Herrington previously worked as a Professor of Clinical Psychiatry & Behavioral Sciences at the University of Arkansas at Pine Bluff where he was actively engaged in both addiction counselor education and research and was honored as a Distinguished Professor in the Master’s Degree Addiction Studies Program. He was a founder of the first addiction studies honor society, Delta Phi Beta Addiction Studies Honor Society International. Dr. Herrington is a very committed longtime member of NAADAC and a founding member of the NASAC Advisory Committee. He has served on multiple Center for Substance Abuse Treatment (CSAT) and Substance Abuse and Mental Health Services Administration (SAMHSA) committees and workgroups and is the recipient of the Distinguished Service Award from the National Historically Black Colleges and Universities (HBCU) Substance Abuse Consortium. Congratulations to Dr. Herrington on this well-deserved honor. Kristin Hamilton, JD, is the Communications and Digital Media Coordinator for NAADAC, the Association for Addiction Professionals. She works on NAADAC public relations, communications, and digital media, including the NAADAC website and social media, and is editor of NAADAC’s two ePublications, the biweekly Addiction & Recovery eNews and weekly Professional eUpdate. She also contributes to the planning, organization, and administration of communication campaigns. Hamilton holds a Juris Doctorate from Northeastern University School of Law in Boston, MA, and a Bachelor of Science Degree in Biology and Chemistry from Roger Williams University in Bristol, RI.
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Call for NAADAC Regional Vice-President Nominations Let your voice be heard! Make a difference by nominating a passionate, skilled, and dedicated addiction professional to serve as a Regional Vice-President on the NAADAC Executive Committee.
DEADLINE: January 31, 2017 at 5:00 pm EST. NAADAC is accepting nominations for the following Regional VicePresident positions: • North Central • Mid-Central • Southeast • Southwest 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/nominationsforexecutiveleadershipteam to view eligibility requirements for all positions and download a nomination form to submit today! Candidate statements will be published in the Spring 2017 issue of Advances in Addiction & Recovery to help inform your vote in May. All 2017 terms begin September 26, 2017, after the NAADAC Annual Con ference in Denver, CO.
If you have any questions about the nomination process, please email NAADAC Director of Operations & Finance, HeidiAnne Werner at heidianne@naadac.org, or call 800.548.0497 x102.
Save the Dates!
We also invite sponsorships, exhibitors, and advertisers. Exhibit hall will sell out. Don’t be left out in 2017!
Registration opens January 3rd! www.naadac.org/2017annualconference
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■ CER T IF IC AT I O N
Musings of a NCC AP Commissioner By Kansas Cafferty, NCC AP Commissioner It has been quite an adventure serving NAADAC and the National Certification Commission of Addiction Professionals as of late. With a fantastic annual conference in Minneapolis, a landmark report from the U.S. Surgeon General, and the unprecedented success of the grandfathering opportunities for our NCAC I, NCAC II, and MAC national credentials, our small but very busy group of Commissioners has been working diligently to meet all of the needs of those certified by the NCC AP. I would like to reflect a bit on some of these experiences and how profound they have really been for me.
Facing Addiction in American: The Surgeon General’s Report on Alcohol, Drugs, and Health
NCAC I, NCAC II, and MAC Grandfathering Update
Get Involved
On November 17th, I was fortunate to attend and represent the NCC AP at the national summit to launch the U.S. Surgeon General’s highly anticipated report on substance misuse and substance use. At the Summit, the U.S. Surgeon General Dr. Vivek Murthy and colleagues from SAMHSA, NIDA, and NIAAA presented on the report’s key findings and messages. I was deeply moved by Dr. Murthy’s passion and the force in which he and his team put our current epidemic of substance use disorders in the national spotlight. This report validates what we have been saying NAADAC 2016 Annual Conference: Embracing Today, to all who would hear for years: prevention works, treatment is effective, Empowering Tomorrow and recovery is possible. I was taken with the personal and collective sense The NAADAC Annual Conference is always a reminder of NAADAC’s of the duty the NCC AP, NAADAC leadership, and NAADAC members professionalism, the professionalism of its presenters, the breadth and depth have to respond to Dr. Murthy’s call to healthcare professionals to support of the trainings offered, and how extremely proud I am of my membership high quality care and the professional and educational standards to ensure and involvement with NAADAC and the NCC AP. Perhaps being a psycho Americans are getting the best care we can give them. We have such an therapist and addictions specialist in Southern California has skewed my incredible responsibility as clinicians, professional leaders, and for me, as a view of some of the directions our field has moved into, but it was refreshing commissioner who is active in daily clinical practice to educate ourselves to be at a large scale conference that was not dominated by the vendors, and our colleagues to ensure that we are offering our clients the best care exhibitors, and marketing arms of the industry’s private sector. Many of and options for recovery. This is a watershed moment. Never before has the conferences I have attended recently are filled with laboratory- our work and the potentially catastrophic consequences of inaction and sponsored events and sponsors brokering services not built on the ethical inadequate treatment been given a federal voice and spotlight as they have integrity we as a profession adhere to. now!
At the Annual Conference, the NCC AP Commissioners had their semi-annual in-person meeting to discuss current credentials and processes, and strategic planning for 2017. On the agenda was a review of our wildly popular grandfathering opportunities for our NCAC I, NCAC II, and MAC credentials. We opened the door to grandfathering to bring in some of the best in our profession and to advance the field with a strong set of national credentials that are easily recognizable, standardized, and accepted by managed care organizations and other payors. The MAC credential is, and has long been, our most coveted credential, as it is the most recognized and reimbursed addiction credential. It represents our professional elite and is the highest form of professional distinction available in our profession. Truly no other credential for addiction excellence even compares to the MAC. Even so, we did not expect to be buried by the volume of qualified and hungry applicants for the grandfathering opportunities, and have spent significant time this year analyzing and refining our reviewing processes to employ a more effective and efficient way to review applications and issue credentials, all while maintaining the high quality of our credentials. Grandfathering is always risky to the value of a credential. Knowing the high stakes involved in grandfathering, we worked very hard to ensure the level of quality that has become synonymous with the NCC AP brand while processing over 5,600 applications and issuing new credentials to over 4,000 professionals. Our work was made easier by enormous contributions from NAADAC Executive Director Cynthia Moreno Tuohy and our Certification Manager Donna Croy and her incredible Certification team.
If there is anything I hope to impart during “my turn in the barrel” as the voice of NCC AP for our beloved magazine, it is that collectively this organization is not only capable, but qualified to meet the challenges put before us by the Surgeon General. The surge of NCAC I, NCAC II, and MAC applicants only concretes the truth that we have the will, the capability, and the skills to meet the needs of this growing profession and the needs of those who suffer from the deadly brain disease that is addiction. I believe it is time for all of us to rise to the occasion. Contribute to our profession by applying to serve on the NCC AP Commission, the NAADAC Exec utive Committee, your State Affiliate Board, or on one of NAADAC’s many committees! Each and every component of our beloved organization is ready for you to step forward. We have so much to do, and for once in our careers, the wind is at our backs. In addition to serving the NCC AP as a Commissioner, Kansas Cafferty, LMFT, CATC, NCAAC, is also the owner and operator of both the Cafferty Clinic and True North Recovery Services, an intensive outpatient treatment center in Encinitas, CA. He can be contacted through either of his websites www. sandiegoaddictions.com or www.caffertyclinic.com.
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■ CO NF ER EN C E
NAADAC 2016 Annual Conference Highlights
CHRIS TUOHY
ANDY GARCIA-RUSSE
With over 700 participants, 80 exhibitors, 64 presentations, and 78 presenters, the NAADAC 2016 Annual Conference: Embracing Today, Empowering Tomorrow in Minneapolis, MN from October 7–11, 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 and speakers who contributed to make this year’s conference a success, including our Pre-Conference, Post-Conference, and Plenary Session speakers: Kathryn Benson, LACD, NCAC II, QSAP, QSC, Sheila Raye Charles, Darryl S. Inaba, PharmD, CATC V, CADC III, Kimberly Johnson, PhD, MBA, Mita Johnson, EdD, LAC, LPC, LMFT, ACS, MAC, SAP, Rokelle Lerner, Kevin McCauley, MD, Wanda McMichael, CAC II, NCAC II, SAP, Mark Mishek, JD, Cynthia Moreno Tuohy, NCAC II, CDC II, SAP, William C. Moyers, Frances Patterson, PhD, LADAC, MAC, BCPC, and Eric Schmidt, MBA, MSW.
You can still learn from the best of the best on your own time! Materials and handouts from over 64 sessions are available at www.naadac.org/2016-presenter-materials.
Hope to See You in Denver! The 2017 NAADAC Annual Conference: Elevating Your Practice will take place at Denver Marriott Tech Center from September 22–26, including pre-conference training sessions on September 22 and post-conference training sessions on September 26. Regular conference sessions will take place September 23–25. For more information, please visit www.naadac.org/annualconference. We look forward to seeing you next year!
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GROUP BELOW: JESSICA GLEASON; RIGHT: CHRIS TUOHY
Missed Minneapolis?
CHRIS TUOHY
ORLESHA FAIRGOOD CHRIS TUOHY
CHRIS TUOHY
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Addictive Sexuality: Diagnostic Controversies
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By Stefanie Carnes, PhD, LMFT, CSAT-S
s of this writing, there is no “official” diagnosis for sexual addiction in the United States. This despite a painstakingly researched and brilliantly argued 2010 position paper, commissioned by the American Psychiatric Association (APA) and written by Harvard’s Dr. Martin Kafka, recommending hypersexual disorder (as Kafka prefers to label the issue) for inclusion in APA’s diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). In his position paper, Kafka examined the then-extant research and concluded, clearly and definitively, that sexual addiction is a very real and treatable disorder. He also proposed a set of diagnostic criteria. Kafka wrote: The data reviewed from these varying theoretical perspectives is compatible with the formulation that hypersexual disorder is a sexual desire disorder characterized by an increased frequency and intensity of sexually motivated fantasies, arousal, urges, and enacted behavior in association with an impulsivity component — a maladaptive behavioral response with adverse consequences. ... Hypersexual disorder is associated with increased time engaging in sexual fantasies and behaviors (sexual preoccupation/sexual obsession) and a significant degree of volitional impairment or “loss of control” characterized as disinhibition, impulsivity, compulsivity, or behavioral addiction. ... [Hypersexual disorder] can be accompanied by both clinically significant personal distress and social and medical morbidity.1 In simpler terms, after considering literally hundreds of peer-reviewed studies and articles, one is left to conclude that sexual addiction, except for the fact that the “drug of choice” is sex rather than an addictive substance, develops and manifests in the same basic ways, with the same basic consequences, as alcoholism, drug addiction, and all other addictive behaviors. Despite this significant evidence, the APA chose to not include hypersexual disorder in the DSM-5. Moreover, they refused to list it as a condition worthy of further study. This, of course, left hundreds of sexual addiction treatment specialists and countless thousands of sex addicts scratching their heads and asking, “What gives?” With or without an official diagnosis, of course, many sex addicts still (eventually) self-assess as sexually addicted and seek treatment based on this knowledge. However, when they seek insurance-funded clinical assistance they can be stonewalled — because insurance companies usually refuse to fund treatments not backed a DSM-5 diagnosis. Thus, sex addicts and the clinicians who treat them often find themselves working around the APA’s decision, usually by listing a symptomatic or co-occurring issue as the primary reason for treatment. Many sex addicts also present with depression, anxiety, eating disorders, and/or a cross or co-occurring addiction — all of which are “officially diagnosable” DSM disorders. However, this type of partially accurate diagnosis is less than ideal, and neither therapists nor addicts should be forced to play this little game. NOTE: Some psychotherapists think it is possible to diagnose sexual addiction more directly via the DSM-5. For instance, Dr. Richard Krueger2 of Columbia University and the New York State Psychiatric Institute suggests that a pair of generalized disorders, Other Specified Sexual Dysfunction (302.79) and Unspecified Sexual Dysfunction (302.70), may work, even though the criteria are largely unrelated to the diagnostic criteria used to identify sexual addiction.3 In addition to issues with insurance funding, without an official diagnosis sexual addiction can be misunderstood and misrepresented by certain clinicians. Some seem to think that without an official diagnosis, sexual addiction does not exist. However, this is akin to saying there were no alcoholics prior to the 1970s, when the APA finally adopted an official diagnosis. Even worse, as we saw with alcoholism prior to its “legitimization” by the APA, sex addicts are sometimes stigmatized and written off as immoral people behaving badly, rather than people suffering from a treatable psychiatric condition. So why did the APA choose to exclude sexual addiction from the DSM-5? The only explanation ever given is the “lack of supportive research.” This rationale is provided in the introduction to the Addictive Disorders section, which states: [Groups] of repetitive behaviors, which some term behavioral addictions, with such subcategories as “sex addiction,” “exercise addiction,” or “shopping addiction,” are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.4 18
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However, as Kafka notes in his position paper, there is more than enough evidence for the APA to officially recognize sexual addiction. In fact, many of the disorders currently included in the DSM-5 (particularly the sex-related disorders) have significantly less supportive evidence. About this, Kafka writes, “The number of cases of hypersexual disorder reported in the peer reviewed journals greatly exceeds the number of cases of some of the codified paraphilic disorders, such as fetishism and frotteurism.”5 Sadly, this is not the first time the APA has ignored both research and clinical realities when it comes to addictions. In fact, as mentioned above, alcoholism was a generally accepted disorder for decades before the APA finally relented and provided an official diagnosis. With sexual addiction, we are seeing a similar progression. Worldwide, for several decades, people all over the world have self-identified as sexually addicted, seeking both clinical and 12-step recovery as available. Meanwhile, countless studies confirm the existence of and our ability to both diagnose and successfully treat sexual addiction. Again, despite this evidence, the APA has been unwilling to change its position. In addition to the hundreds of studies analyzed by Kafka, dozens of more recent studies also support sexual addiction. For example, a group of researchers led by UCLA’s Rory Reid conducted a field study testing the clinical utility, reliability, and validity of Kafka’s proposed diagnostic criteria, as outlined in his position paper, and concluded that his proposed benchmarks (which coincide nicely with the criteria generally in use by properly trained and certified sex addiction therapists6) are both accurate and well thought out—more so, in fact, that most other sets of DSM diagnostic criteria.7 Other research has considered the neuroscience of sexual addiction. One significant study looked at “cue reactivity,” a hallmark of addiction disorders. (For example, research tells us that when a cocaine addict sees a line of cocaine, his or her brain “lights up” in a very specific way, and that response is quite different than in the brain of a non- addict.8) The sex addiction cue reactivity study, conducted at the University of Cambridge by Dr. Valerie Voon, a leading authority on addiction in the brain, produced parallel results: in self-identified sex addicts (but not in a non-addicted control group) neurobiological cue reactivity to sexual stimuli mirrors that of drug addicts when exposed to drug-related stimuli.9 A second neurobiological study examined “attentional bias,” another hallmark of addiction disorders. Here, the research team, again led by Dr. Voon, used attention-distraction techniques — specific tasks measuring the degree to which addicts will focus their attention on an addiction-related image as opposed to a neutral image. Once again, there were significant parallels between self-identified sex addicts and drug addicts.10 Additionally, researchers led by Dr. Simone Kuhn from the Max Planck Institute in Berlin have linked compulsive sexual behaviors to changes in brain structure.11 In short, they found that compulsive viewing of pornography correlates with a reduction in gray matter in the brain’s rewards circuitry. This means that porn addicts, over time, tend to develop a sluggish or numbed pleasure response. The study found that “regular consumption of pornography more or less wears out your reward system,” and that “subjects with a high porn consumption need increasing stimulation to receive the same amount of reward.” This, of course, mirrors the tolerance and escalation that we commonly see with substance use disorders. Other post-Kafka sex addiction research finds parallels between sexual addiction and other forms of addiction regarding: characteristics and motivations of addicts,12 diagnosis,13 consequences,14 and desire for clinical assistance,15 among other issues. Individually, of course, none of these studies definitively proves the existence of sexual addiction, just as no single study proves the existence of alcoholism or drug addiction. However, taken together, along with the hundreds of studies Kafka analyzed, we start to see a pattern. And that pattern tells us that sexual addiction is a very real disorder. Regardless, we have no official diagnosis. Perhaps the issue is not, as the APA intimates, a lack of research. One fairly obvious sticking point with many sex addiction critics involves terminology. Over the years, numerous labels have been proposed, including (but by no means limited to) the following: sexual addiction,16 impulsive sexual behavior,17 sexual compulsion,18 and hypersexual disorder.19 In some ways, this mostly spurious nomenclature issue stems from the fact that some people seem to think the word “addiction” is shaming and W I N T E R 2 016 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 19
counterproductive. The APA, for instance, almost completely removed that term from the DSM-5, rebranding alcoholism and drug addiction as substance use disorders and gambling addiction as gambling disorder. However, most of the people who struggle with out-of-control, life- destroying behaviors choose to self-identify as addicted and to seek help accordingly. One could posit that this APA alteration may be why Kafka opted for the term “hypersexual disorder” rather than other, more commonly accepted terminology. In a recent issue of the Journal of Addiction Medicine, Dr. Patrick Carnes compares the various conceptualizations of sexual addiction.20 (See chart below.) Interestingly, the only real difference between the conceptualizations is that researchers using the addiction model sometimes include tolerance, escalation, and withdrawal among their criteria, while the others do not. More importantly, all of the conceptualizations mesh with language adopted in 2011 by the American Society of Addiction Medicine (developed over the course of four years with input from more than eighty neuroscientists). ASAM writes: Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral engagement in addictive behaviors.21
Hypersexuality: Sex Addiction Theory of (Carnes, 1983, 191) Dependence (Orford, 1978, p. 308)
With this statement, the scientists at ASAM drew a line in the sand — clearly stating that food, sex, and other behaviors can be addictive. Despite this declaration and the abundance of neuroscientific research to support it, the APA nevertheless refuses to accept the concept of sexual addiction. Another of the more common anti-sex addiction arguments is that sex addiction treatment is shaming, sex negative, and based on morality rather than sound scientific principles. In reality, nothing could be further from the truth. Properly trained and certified sex addiction therapists do not pathologize consensual and legal sexual activity of any kind. Qualified sex addiction therapists are not the sex police, nor do they want to be the sex police. In fact, as a rule, they are wonderfully sex positive, encouraging any and all sexual activities, as long as they are not obsessive, out-of-control, and creating problems. A similar concern centers on the fact that a few unethical religious/ moralistic clinicians offer reparative (gay conversion) therapy but call it sex addiction therapy — even though their “treatment” has nothing whatsoever to do with sexual addiction. This approach is NEVER condoned by properly trained and credentialed sex addiction therapists. In fact, the largest training organization for certified sex addiction therapists (CSATs) has a clear guideline in its ethics policy stating that CSATs may not, under any circumstances, attempt reparative therapy. From CSATs perspective, reparative therapy is not only ineffective,22 its unethical. Rather than being moralistic and sex negative, true sex addiction treatment, as provided by properly trained and certified sexual addiction therapists, is sex positive in every respect. To this end, each client creates a plan for sexual health that is tailored to his or her individual background, goals, and sexual arousal template. As with eating disorders treatment, where the endgame is a healthy and life-affirming relationship with food, sex addicts Sexual Addiction (Goodman, 1998, pp. 233-234)
Hypersexual Nonparaphilic Sex Addiction Hypersexual Disorder Compulsive (Carnes, 2005) Disorder (Stein et al., 2001, Sexual (Kafka, 2010) pp. 1592-1593) Disorder
Criteria Recurrent failure (pattern) to resist sexual impulses to engage in specific sexual behavior Frequent engaging in those behaviors to a greater extent Persistent desire or unsuccessful efforts to stop, to reduce, or to control behaviors Inordinate amount of time spent in obtaining sex, being sexual, or recovery from sexual experiences Preoccupation with the behavior or preparatory activities Frequent engaging in the behavior when expected to fulfill occupational, domestic, or social obligations Continuation of behavior despite knowledge of having persistent or recurring social, financial, psychological, or physical problem that is caused or exacerbated by the behavior Need to increase the intensity, frequency, number or risk of behaviors to achieve the desired effect or diminished effect with continued behaviors at the same level of intensity Giving up or limiting social, occupational, or recreational activities because of their behavior Distress, anxiety or restlessness, or irritability if unable to engage in the behavior
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(Coleman, 2003)
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focus on the development of a healthy and life-affirming relationship with sex, however they might define that. As such, every recovering sex addict, working in conjunction with his or her therapist, creates a unique plan for sexual sobriety, with non-compulsive sex positive behaviors being a “go,” and only destructive sexual behaviors being a “no.” In short, properly trained sex addiction therapists are sex positive and supportive of all sexual orientations and behaviors as long as the related behaviors are consensual, legal, and do not cause problems for the addict. That said, certified sex addiction specialists recognize that not all sexual behaviors are benign, non-destructive, and non-distressing. Some sex can become compulsive, and over time these behaviors can and often do result in negative life consequences. Ignoring this reality makes it harder for the individuals who are suffering to reach out for and find the assistance they desperately need. Instead of getting help, these struggling sex addicts feel stigmatized, ashamed, abnormal, and hopeless. This shaming will continue to varying degrees until the APA relents and reverses its outdated stance, legitimizing sexual addiction in the DSM. Is the APA likely to amend the DSM and officially recognize sexual addiction in the near future? Most likely not. After all, when it comes to making significant changes to the ways in which clinicians view psychiatric disorders, it looks like the APA will be the last to arrive at the party. That said, the organization will eventually have to reverse its position because the scientific evidence in favor of sexual addiction is rapidly mounting. Until the APA yields, however, we cannot hope to see any meaningful change. Sex addicts hoping to heal will still seek sex addiction treatment, insurance companies will refuse to pay for it, and sex addiction clinicians will continue to help these addicts as best they can. ENDNOTES 1 Kafka, M. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of sexual behavior, 39(2), 377-400. 2 Dr. Krueger served as a member of the American Psychiatric Association’s Sexual and Gender Identity Disorders Workgroup, and he is a member of the World Health Organization’s Sexual Health and Disorders Committee, charged with making recommendations for changes to the next version of the ICD (the ICD-11), scheduled for release in 2018. 3 Krueger, R. B. (2016). Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD‐10 and DSM‐5 despite rejection of this diagnosis by the American Psychiatric Association. Addiction. 4 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, p 481. Washington, D.C.: American Psychiatric Association. 5 Kafka, M. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of sexual behavior, 39(2), 377-400. 6 Weiss, R. (2015). Sex addiction 101: A basic guide to healing from sex, porn, and love addiction, 233-38. Deerfield Beach, FL: Health Communications. 7 Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., ... & Fong, T. (2012). Report of findings in a DSM‐5 field trial for hypersexual disorder. The journal of sexual medicine, 9(11), 2868-2877. 8 Carter, B. L., & Tiffany, S. T. (1999). Meta‐analysis of cue‐reactivity in addiction research. Addiction, 94(3), 327-340. 9 Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., Mitchell, S., ... & Irvine, M. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS one, 9(7), e102419. 10 Mechelmans, D. J., Irvine, M., Banca, P., Porter, L., Mitchell, S., Mole, T. B., ... & Voon, V. (2014). Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours. PloS one, 9(8), e105476. 11 Kühn, S., & Gallinat, J. (2014). Brain structure and functional connectivity associated with pornography consumption: the brain on porn. JAMA psychiatry, 71(7), 827-834. 12 Wéry, A., & Billieux, J. (2016). Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men. Computers in Human Behavior, 56, 257-266. 13 Kraus, S. W., Martino, S., & Potenza, M. N. (2016). Clinical characteristics of men interested in seeking treatment for use of pornography. Journal of Behavioral Addictions, 5(2), 169-178. 14 Mattebo, M., Tydén, T., Häggström-Nordin, E., Nilsson, K. W., & Larsson, M. (2013). Pornog raphy consumption, sexual experiences, lifestyles, and self-rated health among male adolescents in Sweden. Journal of Developmental & Behavioral Pediatrics, 34(7), 460-468.
Gola, M., Lewczuk, K., & Skorko, M. (2016). What Matters: Quantity or Quality of Pornography Use? Psychological and Behavioral Factors of Seeking Treatment for Problematic Pornography Use. The journal of sexual medicine, 13(5), 815-824. 16 Carnes, P. (2001). Out of the shadows: Understanding sexual addiction. Hazelden Publishing. 17 Barth, R. J., & Kinder, B. N. (1987). The mislabeling of sexual impulsivity. Journal of Sex & Marital Therapy, 13(1), 15-23. 18 Coleman, E., Raymond, N., & McBean, A. (2003). Assessment and treatment of compulsive sexual behavior. Minnesota Medicine, 86(7), 42-47. 19 Kafka, M. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of sexual behavior, 39(2), 377-400. 20 Carnes, P. J., Hopkins, T. A., & Green, B. A. (2014, November/December). Clinical Relevance of the Proposed Sexual Addiction Diagnostic Criteria. Journal of Addiction Medicine, 8(6), 450-461. 21 American Society of Addiction Medicine, Definition of Addiction: Public Policy Statement. (2011). Retrieved 11/18/16 from www.asam.org/quality-practice/definition-of-addiction. 22 American Psychological Association, Sexual orientation and homosexuality. (n.d.). Retrieved 11/18/16 from web.archive.org/web/20070928051520/http:/www.apahelp center.org/articles/article.php?id=31. Chart: From JAMA article 15
Stefanie Carnes, PhD, is the President of the International Institute for Trauma and Addiction Professionals, a training institute and professional organization for addiction professionals, and a national clinical consultant for Elements Behavioral Health. She is a licensed marriage and family therapist and an AAMFT approved supervisor. Her area of expertise includes working with patients and families struggling with multiple addictions such as sexual addiction, eating disorders and chemical dependency. Carnes is also a certified sex addiction therapist and supervisor, specializing in therapy for couples and families struggling with sexual addiction. She presents regularly at conferences at both the state and national levels. She is also the author of numerous publications including her books, Mending a Shattered Heart: A Guide for Partners of Sex Addicts, and Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts, and Facing Addiction: Starting Recovery from Alcohol and Drugs.
Bridging the Gaps is an integrative addiction treatment center providing quality, compassionate, and comprehensive treatment for adults with substance use disorders. Since 2000, we have been helping individuals transform their lives and find health and happiness free of drug and alcohol dependence. Using an innovative approach that promotes the healing of the whole person – mind, body, and spirit – our programs combine proven psycho-social-spiritual therapies and “12 step” approaches with some of the most progressive modalities available to restore physical and neurological health and enhance spiritual and emotional well-being. We offer full residential treatment in up to 3 core phases, as well as an extended transitional phase to facilitate clients’ adjustment back into the demands of daily life. We also provide rigorous, yet cost-effective, Intensive Outpatient (IOP) and Day Treatment programs for individuals whose clinical needs and life circumstances may allow them to realize positive outcomes in a more flexible, non-residential setting. Our small size and intimate setting ensure that clients receive the personal attention and individualized treatment they deserve.
Visit www.bridgingthegaps.com, call 866-711-1234, or email admissions@bridgingthegaps.com
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Rethinking How We Address Substance Issues in Criminal Justice Settings
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By Jack B. Stein, PhD, National Institute on Drug Abuse (NIDA)
ubstance misuse, addiction, and associated physical and mental health problems are particularly concentrated among people involved in the criminal and juvenile justice system. According to U.S. Department of Justice data, half of state and federal prisoners meet DSM-IV criteria for a substance use disorder1; yet only 11 percent receive treatment while
in prison.2 Research conducted as part of NIDA’s Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJTRIALS) has shown that over half of justice-involved youth present with substance use problems, but only 64% of agencies serving them screen for these problems, and in more than a third of localities, residential treatment, detoxification, and medication assisted treatment are not available.3 Since most substance use disorders go untreated in prison, inmates are at greatly increased risk of relapse upon their release, even if they have been abstinent during their prison stay. A former inmate’s risk of death within the first two weeks of release is more than 12 times that of other individuals, with the leading cause of death being a fatal drug overdose.4 Untreated substance use disorders also make a return to criminal activity and re-incarceration more likely and raise the risk of behavior that can result in contracting or transmitting HIV and hepatitis B and C. Although the intersection of substance use and criminal justice involvement presents many problems and challenges, it also presents a unique opportunity to intervene in many individuals’ lives with needed treatment and prevention interventions. The new Surgeon General’s Report, Facing Addiction in America, outlines a broad public health vision for addressing substance misuse and substance use disorders, including shifting from a punitive, criminal justice based model to a public-health model for facing the problem.5 This includes providing evidence-based treatments such as medications in prisons, and offering treatment as an alternative to incarceration for individuals who could benefit. Addiction counselors and others in healthcare can facilitate the needed shifts through education and outreach with the law enforcement community and other social service and healthcare organizations. Research shows that providing evidence-based addiction treatment while in prison and across the transition to the community can make an enormous difference. For prisoners with alcohol or opioid addiction, this should include medications in addition to behavioral counseling. Starting buprenorphine or methadone treatment along with counseling prior to release increases the likelihood that individuals will enter treatment after release and lowers their risk of relapse, overdose, and continued criminal involvement.6,7 Positive results have also been shown for the antagonist medication naltrexone.8 Unfortunately, many prison systems currently do not offer appropriate access to or utilize these treatments, and even where medications are permitted, their use remains inconsistent due to variable acceptance by corrections officers. A recent study found that acceptance of these treatments was related to officers’ knowledge about addiction and their direct experience seeing medications be effective. Even those who saw the benefits of medications were generally opposed to using them long-term.9
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Among the reasons for reluctance to provide medication is the continued widespread belief that doing so substitutes a new addiction for an old one. This is based on misconceptions about the nature of addiction. Addiction is a chronic brain disorder that impairs the function of multiple brain circuits involved in reward, stress, decision making, learning, and other functions. Buprenorphine and methadone help reduce cravings and withdrawal symptoms but they do not produce euphoria in people dependent on opioids; instead they restore balance to the affected brain circuits to allow the patient to function while they work towards recovery. Another concern is diversion. While this is a risk with any prescription drug, studies have shown that when buprenorphine and methadone are diverted they are most commonly used to control cravings and withdrawal symptoms, not to obtain a high,10,11 often because the individual cannot access treatment.12 As has been emphasized in numerous recent initiatives at the federal level and underscored in the recent Surgeon General’s Report, much wider utilization of FDA-approved medications is crucial for bringing the opioid crisis under control, and this applies as much in criminal justice settings as elsewhere. Making medications available to prisoners is also part of the World Health Organiza tion’s Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence.13 In 2015, the White House Office of National Drug Control Policy (ONDCP) announced that State drug courts receiving federal grants may not deny par ticipation by individuals being prescribed medications to treat their addiction.14 NIDA is supporting implementation science research to develop strategies to increase the adoption of evidence-based prevention, screening, and treatment interventions in prisons and to increase acceptance of these interventions within the justice system. In 2015, NIDA launched a randomized controlled trial (RCT) as part of JJ-TRIALS, comparing two data-driven interventions aimed at improving the adoption of evidence-based practices in 39 juvenile justice agencies. Another JJ-TRIALS study is examining partnerships between justice organizations and public health agencies to improve the delivery of HIV screening and prevention services for youth in the juvenile justice system.
When we acknowledge that substance use disorders are medical illnesses and not moral weakness or willful defiance of social norms, it follows that, when possible, punishment for certain drug-related crimes should be replaced with medical intervention. New modalities replacing punishment with treatment have proven highly effective at interrupting the cycle of drug use and criminal justice involvement. This is true both for those with addiction and those whose occasional or intermittent substance misuse threatens their own or others safety. Even in the absence of the compulsive use that characterizes addiction, a single episode of binge drinking, for example, has the potential to harm others through impaired driving or interpersonal violence. In such cases, the criminal justice system has the opportunity to intervene in a teachable moment, to prevent further misuse or escalation to substance use disorder or addiction. Programs that divert people arrested for alcohol-related offenses to treatment have been tried in some states, such as South Dakota and Montana, and have shown positive results in reducing repeat arrests for DUI and intimate partner violence.15,16 For people who do have addictions and are convicted of crimes related to their drug seeking and use, drug courts can play a similar role. Random drug tests and other forms of monitoring are used in such programs along with consistent, swift sanctions for positive screens, creating a strong incentive to maintain abstinence. These programs have proven highly successful, with randomized controlled trials showing high rates of treatment completion and reduced rates of subsequent drug use and recidivism—from 50 percent to 38 percent over 3 years, according to one review of the research.17 Drug courts seem to be especially effective among nonviolent offenders. Because of their demonstrable success, use of drug courts has rapidly expanded across the country, but they still handle only a tiny percentage of the more than 1 million people with substance use disorders who become involved with the U.S. criminal justice system annually. The population engaged with the criminal and juvenile justice systems is at high risk for substance misuse and use disorders, typically at a point in the individual’s life when he or she may be more accepting of the need for treatment. Substance use disorders are medical issues, so less punitive, more health-focused approaches can have a critical impact on short- and long-term outcomes for both the individual and for public health and safety broadly. Drug addiction counselors have a crucial role to play in working with local police departments, sheriff’s offices, courts, and other social service organizations to facilitate implementation of interventions that provide alternatives to arrest and lockup that have been proven effective. As highlighted by the Surgeon General, how we respond to this crisis is a moral test for our country. We must be guided by the best available science to develop pragmatic solutions to reduce drug use, addiction, and crime.
Zaller, N., McKenzie, M., Friedmann, P. D., Green, T. C., McGowan, S., Rich, J. D. Initiation of buprenorphine during incarceration and retention in treatment upon release. J Subst Abuse Treat. 2013;45(2):222-226. doi:10.1016/j.jsat.2013.02.005. 7 Kinlock, T. W., Gordon, M. S., Schwartz, R. P., O’Grady, K., Fitzgerald, T. T., Wilson, M. A randomized clinical trial of methadone maintenance for prisoners: results at 1-month post-release. Drug Alcohol Depend. 2007;91(2-3):220-227. doi:10.1016/j.drugalcdep. 2007.05.022 8 Lee, J. D., Friedmann, P. D., Kinlock, T. W., et al. Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders. N Engl J Med. 2016;374(13):1232-1242. doi:10.1056/ NEJMoa1505409. 9 Mitchell, S. G., Willet, J., Monico, L. B., et al. Community correctional agents’ views of medication-assisted treatment: Examining their influence on treatment referrals and community supervision practices. Subst Abus. 2016;37(1):127-33. doi: 10.1080/08897077. 2015.1129389. 10 Schuman-Olivier, Z., Albanese, M., Nelson, S. E., et al. Self-treatment: Illicit buprenorphine use by opioiddependent treatment seekers. J Subst Abuse Treat. 2010;39(1):41-50. doi:10.1016/j.jsat.2010.03.014. 11 Cicero, T. J., Surratt, H. L., Inciardi, J. Use and misuse of buprenorphine in the management of opioid addiction. J Opioid Manag. 2007;3(6):302-308. 12 Johnson, B., Richert, T. Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: Patients who Regularly Sell or Share their Medication. J Addict Dis. December 2014:0. doi:10.1080/10550887.2014. 975617. 13 World Health Organization, International Narcotics Control Board, United Nations Office on Drugs and Crime, eds. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva: World Health Organization; 2009. 14 Substance Abuse and Mental Health Services Administration. Grants to Expand Substance Abuse Treatment Capacity in Adult and Family Drug Courts: RFA no. TI-15-002. January 2015. http://www.samhsa.gov/sites/ default/files/grants/doc/ti-15-002.doc. 15 Kilmer, B., Nicosia, N., Heaton, P., & Midgette, G. (2013). Efficacy of frequent monitoring with swift, certain, and modest sanctions for violations: Insights from South Dakota’s 24/7 sobriety project. Am J Public Health. 2013;103(1):e37-e43. 16 Midgette, G., & Kilmer, B. (2015). The effect of Montana’s 24/7 sobriety program on DUI re-arrest: Insights from a natural experiment with limited administrative data. Santa Monica, CA: RAND Corporation. 17 Wilson, D. B., Mitchell, O., MacKenzie, D.L. A systematic review of drug court effects on recidivism. J Exp Criminol. 2006;2(4):459-487. 6
Dr. Jack Stein joined NIDA in August 2012 as the Director of the Office of Science Policy and Communications (OSPC). He has over two decades of professional experience in leading national drug and HIV-related research, practice, and policy initiatives for NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.
REFERENCES 1 U.S. Department of Justice (DOJ), Office of Justice Programs. Bureau of Justice Statistics Special Report: Drug Use and Dependence: State and Federal Prisoners, 2004. Washington, DC: DOJ, October 2006. 2 The National Center on Addiction and Substance Use. Behind Bars II: Substance Abuse and America’s Prison Population. February 2010. Available at: http://www.centeronaddiction. org/addiction-research/reports/substance-abuse-prison-system-2010. 3 Scott, C. K., Dennis, M. L, Funk, L., & Nicholson, L. (2016, October). Preliminary Findings from the JJ-TRIALS National Survey on Behavioral Health Services for Youth Under Community Supervision. Presented at the Addiction Health Services Research Conference. 4 Binswanger, I. A., Stern, M. F., Deyo, R. A., et al. Release from prison—a high risk of death for former inmates. N Engl J Med. 2007;356(2):157-165. doi:10.1056/NEJMsa064115. 5 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.
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Addressing Women’s Sexual Health Disparities in Substance Use Disorder Treatment By Raven Badger, PhD
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he demographics of substance use have changed dramati cally over the past 20 years. Many health issues directly linked to substance use disorder disparities include a sexual component, (e.g. STIs/HIV, sexual behaviors, reproductive health, sexual dysfunction, sexual orientation, sexual assault), yet few treatment approaches currently exist to address women’s sexual health in substance use disorder treatment. The Institutes of Medicine recommends that the National Institutes of Health implement research agendas designed to advance scientific knowledge and understanding of women’s health, including inequities in health care and research to develop and test the effectiveness of interventions that address health inequities and negative health outcomes experienced by women, minorities and by LGBT people.
increased risk for alcohol abuse and are more likely to suffer from other psychiatric disorders than women without such history (Karjane, Stovall, Berger, & Svitkis, 2011). This is based in part due to their fears of miscarriage from past infertility issues. Women with infertility diagnoses tend to present higher levels of depressive and anxiety symptoms in comparison with fertile controls and adoption candidates (Galhardo, Pinto-Gouveia, Cunh, & Matos, 2012). Infertility diagnoses and substance use disorder are linked to negative affective reactions, such as the grief and loss associated with the inability to produce children in a culture that values women for their reproductive functioning. Increases in posttraumatic alcohol usage predicts increases in posttraumatic sexual activity, suggesting that use of alcohol as a coping strategy from sexual assault may result in an increased likelihood of engaging in risky sexual behavior (Deliramich & Gray, 2008). Women with histories of sexual abuse during childhood/adolescence experience high rates of sexual dysfunction, such as desire disorders and inability to experience sexual pleasure or orgasms. Negative body image and resulting disordered eating, intimacy issues, lack of sexual desire and pleasure and sensuality issues have been correlated to relapse and substance use disorder in women (James, 2012). For some individuals who identify as lesbian, gay, or bi-sexual, social stigma associated with sexual orientation may induce psychosocial stress, leading to high risk behaviors and poorer health outcomes (Coker, Austin, & Schuster, 2009). Resulting social stigma can lead to avoidant coping strategies such as substance use disorder, disassociation, and emotional suppression (Staples, Rellini, & Roberts, 2004). One study found that minority stressors and available social-psychological resources had a significant impact on the mental health and substance use among sexual minority women (Lehavot & Simoni, 2001). These researchers recommended health care professionals assess for minority stress and coping resources and refer patients for evidence-based psychosocial treatments. However, the lack of tailored evidence-based psychosocial treatments persists.
The Meaning of Sexuality for Women in Treatment
Connections Between Sexuality and Women’s Substance Use Disorder The link between sexuality and women’s substance use disorders are well supported by research. Substance use, in and of itself, brings with it sexual health disparity risks for women (e.g., increased risk of breast cancer, and fertility-related disparities including higher infant mortality and pregnancy risks for women of child-bearing age). Women who have had multiple abortions remained at an increased risk of having a substance use disorder compared to women who had no abortions (Steinberg & Finer, 2010). Pregnant women with prior history of infertility problems are at 24
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Sexual shame has been linked to substance use disorders and subsequent relapse in women (James, 2011 & 2012). Lowering sexual shame has also been linked to increased client retention and improved treatment outcomes (Braun-Harvey, 2010). Research related to the identification of sexual shame and low sexual self-esteem (SSE) in women noted numerous themes, including: being raped, being blamed for rape or molestation, not being believed about sexual abuse, negative reactions from family and friends, religious messages that conflicted with sexuality, sexual behaviors (prostitution, multiple sex partners, etc.), not feeling comfortable about sex, feeling pleasure from sex, body loathing, infertility, getting HIV and STIs, inability to orgasm, same sex orientation, and not feeling “good enough” sexually. In a series of focus groups conducted as part of a larger study in 2010 (Badger), when asked what they would like to see included in treatment related to sexuality, women reported a desire to discuss the afore-mentioned
themes as part of their treatment process. Women also wanted validation of their feelings around abuse; some of the women had brought up sexual issues in treatment and were “shut down” by their counselors and told “we don’t talk about that here” or were met with awkward silence and shifted to another topic. Several women reported wanting permission to talk about sex and sexual abuse, stating that not being allowed to discuss their intimate sexual secrets increased the shame they had felt about their past behaviors and experiences. The outcome was essentially one of re-victimization and reportedly contributed to continued sexual shame and relapse. All of the surveyed women reported direct links to their substance use and relapse related to their sexual attitudes, feelings and behaviors. Based on this research, we have developed women’s sexual health intervention that includes the following emergent themes: REPRODUCTIVE ISSUES: This theme centers on a person’s capacity to reproduce and the behaviors and attitudes regarding reproduction issues. Critical components of substance use disorder treatment include providing accurate information about reproduction, feelings and attitudes (about condoms, abortion, etc.), sexual intercourse (oral, anal, and vaginal), and sexual reproduction (processes of conception, pregnancy, delivery, and infertility). While many women reported having some information in this area, experiences that had negative consequences, such as abortion, infertility, or disease, not only resulted in substance use and relapse, but created an expressed need to process feelings and attitudes related to those issues. SENSUALITY: Sensuality has to do with awareness and enjoyment of one’s own body and the bodies of others. Sensuality enables people to feel pleasure in a reciprocal manner and feel good about how their bodies’ look and feel and what they can do. Sensuality affects behavior in several ways, including body image, human sexual response, satisfying the need to be touched, and experiencing pleasure and fantasy. Women reported multiple links to sensuality and substance use in all of these areas; they reportedly used substances to feel better about how they looked and engaged in risky sexual behaviors in order to feel loved or be touched and to reduce feelings of sexual shame when they felt undesirable or had experienced sexual dysfunction. INTIMACY: Intimacy is the ability to be emotionally close to another human being and to accept closeness in return. Several aspects of intimacy include sharing, caring, loving and liking, emotional risk-taking, and vulnerability. Women’s intimacy was reportedly impacted by substance use. Some reported that they were unable to be close to a sexual partner due to past abuse, or were in fear of being vulnerable in a relationship. False intimacy was common among women when they shared sex for drugs, financial support or a place to stay. Being able to create a healthy sense of self can help enable women to develop intimate relationships with sexual partners. Rather than facilitate a sense of how to form healthy relationships in recovery, many treatment programs espouse the norm of relationship avoidance. SEXUAL AND GENDERY IDENTITY: Sexual identity includes an understanding of sexual attraction, sexual behaviors based on that attraction, and the sense of being male or female. Sexual identity consists of several components that, together, affect self-perception. Gender identity, gender role, gender bias, and sexual orientation comprise this theme. Internalized homophobia, transgender issues, sexism, heterosexism, and associated stigma were greatly associated with women’s subsequent substance use and potential relapse. Many women reported feeling re-traumatized or unsafe to “come out” in treatment due to provider bias around sexual and gender identity.
COERCIVE SEXUAL EXPERIENCES: Sexual experiences considered coercive range from seduction, withholding sex and sexual harassment, to sexual abuse, incest and rape. A large majority of women expressed direct links to substance use disorder in this realm by being sexually exploited and abused. Creating an environment where it is safe to process the effects of sexual coercive experiences and begin the healing process is critical to prevent relapse for affected women. SEXUAL SHAME: Women’s sexual shame was linked to internalized negative reactions and messages from family and friends, culture, religious and spiritual figures, and societal institutions regarding their sexuality. Reinforcing negative sexual beliefs can be counterproductive to the recovery process if it results in shame-based thinking. The internalization of what is deemed healthy (through societal norms, religion, politics, and education) becomes the mechanism that causes the distress in individuals as they develop and attempt to form relationships based on limited options for perceived “normal” sexual functioning.
Conclusion A positive women’s sexual health intervention presents a scientific framework from which to address the links between women’s sexuality and substance use disorder. When substance use disorder treatment perpetuates client shame and low sexual self-esteem, it inadvertently leads to ineffective treatment outcomes. A holistic approach to recovery incorporates a myriad of techniques that include positive sexual health messages. Recovery is about change, and in order to facilitate healthy change, clinicians must have requisite knowledge and consider variables related to the problematic use of substances, including the sexual self. REFERENCES Braun-Harvey, D. (2010). Sexual health in recovery: A professional counselor’s manual. New York: Springer. Coker, T. R., Austin, S. B., & Schuster, M. A. (2009). The health and health care of lesbian, gay, and bisexual adolescents. Addiction, 104(6), 974-81. Deliramich, A. N., & Gray, M. J. (2008). Changes in women’s sexual behavior following assault. Journal of Emergency Nursing, 32(5), 611-621. Galhardo, A,. Pinto-Gouveia, J., Cunha, M., & Matos, M. (2012). The impact of shame and self-judgment on psychopathology in infertile patients. Archives of Sexual Behavior, 41(2), 341-50. James, R. (2011). Correlates of sexual self-esteem in a sample of substance-abusing women. Journal of Psychoactive Drugs, 43(3), 220-228. James, R. (2012). Sexuality and addiction: Making connections, enhancing recovery. CA: Praeger. Karjane, N. W., Stovall, D. W., Berger, N. G., & Svikis, D. S. (2011). Alcohol abuse risk factors and psychiatric disorders in pregnant women with a history of infertility. Human Reproduction, 26(9), 2408-14. Lehavot, K., & Simoni, J. M. (2001). The impact of minority stress on mental health and substance use among sexual minority women. Journal of Women’s Health & Gender-Based Medicine, 10(10), 937-52. Staples, J., Rellini, A. H., & Roberts, S. P. (2004). Avoiding experiences: sexual dysfunction in women with a history of sexual abuse in childhood and adolescence. Archives of Sexual Behavior, 33(6), 539-548. Steinberg, J. R, & Finer, L. B. (2010). Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a commonrisk-factors model. Journal of Psychosomatic Obstetrics and Gynecology, 31(3), 130-139. Raven Badger, PhD, is an Associate Professor at Governors State University in Illinois in Addictions Studies and Behavioral Health. Badger received her PhD in Human Sexuality, and completed postdoctoral fellowships in Advanced Rehabilitation Research and Health Disparities; she has several publications to date including book chapters, research articles, and her book “Sexuality and Addiction: Making Connections, Enhancing Recovery.” She is a member of the Society for the Scientific Study of Sexuality (SSSS), and serves on the board for the International Coalition of Addiction Studies Education (INCASE) and the National Association of LGBT Addictions Professionals (NALGAP). Badger is pilot testing a sexual health intervention for women in substance use disorder treatment and editing a three-volume encyclopedia set on “Sex and Sexuality” for publication in 2017.
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A New Emerging Trend: College Students in Recovery
Finding Success in Recovery-Unfriendly Environments
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By Scott Washburn, EdD, LADC
ears ago, the prospect of a young adult new in recovery attending college seemed clinically inadvisable. The college and university social environment has historically been unfriendly at best, if not hostile, to the prospects of recovery for emerging adults with substance use disorders (Cleveland, Harris, Baker, Herbert, & Dean, 2007). For decades, researchers have found the culture of U.S. colleges and universities to engender and promote excessive alcohol and drug use among certain groups of students (Dowdall, 2013). Although campuses differ in their rates of binge alcohol and drug use, statistics regarding the consequences of excessive patterns of substance use paint a stark and alarming picture leading many to identify excessive alcohol use as the number one health threat facing college students in the U.S. (Wechsler & Wuethrich, 2002). Most clinicians who work with adolescents and young adults with substance use disorders are well aware of these facts and trends. However, what may not be as commonly known is the emerging trend of Collegiate Recovery Programs (CRPs) supporting students in recovery and helping them find success on college and university campuses. The research on the effectiveness of these programs is still emerging but points to a likely emerging evidence-based practice effective for this population.
A Unique College Counter-Culture Phenomenon Most experts agree that risky alcohol use on college campuses has been at epidemic proportions for decades. Based on the results of the Harvard School of Public Health’s College Alcohol Study, which consisted of an ongoing survey of over 50,000 students at 140 four-year colleges in forty states from 1993 to 2001, Wechsler and Wuethrich (2002) concluded that the culture of American colleges and universities is essentially the promotion of alcohol consumption. They observed, On college campuses across America, alcohol-related culture takes many forms, from revered campus traditions to fraternity initiations, football tailgating parties, twenty-first birthday ‘bar crawls’ where the celebrant ‘drinks his age’ with twenty-one shots, and more. Over many decades a culture of alcohol has become entwined in school customs, social lives, and institutions. Winked at for decades, this culture has its darker side (pp. 3–4). Others have claimed that the college years are one of the riskiest periods of development for emerging adults and risky alcohol use presents the greatest health threat to college students today (Ham & Hope, 2003; Raskin-White & Rabiner, 2012; Saltz, 2004; Wechsler & Wuethrich, 2002). The health threat of risky alcohol use by college students is clear and well-established by research. According to the SAMHSA 2014 National Survey on Drug Use and Health, approximately 60 percent of college students ages 18 to 22 consumed alcohol in the past month, and almost two out of three students engaged in binge drinking during that same timeframe. The consequences of these behaviors are alarming. Studies estimate that over 1800 college students between the ages of 18 to 24 die 26
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each year from alcohol-related injuries; over 650,000 students are assaulted each year by another student who had been drinking; about 97,000 students report having been sexually assaulted or date-raped each year with alcohol being a major factor; about one-fourth of college students report negative academic consequences (missing class, falling behind, failing grades, etc.) due to alcohol use; and, approximately 20 percent of college students meet criteria for an alcohol use disorder (NIAAA, College Fact Sheet). Colleges and universities have historically addressed the problematic culture of excessive alcohol use by means of primary and secondary prevention efforts with some notable success and identification of promising practices. After decades of investigation, development, and practice, many researchers agree that multiple prevention interventions are necessary, including environmental approaches to produce long-term effects on college student drinking (Cronce & Larimer, 2012; Ham & Hope, 2003; Saltz, 2012). However, gaps in prevention efforts across institutions remain. Supporting college students in recovery is an emerging area in both research and practice with impressively promising results. The history of organized recovery support on college campuses in the United States followed the emergence of the recovery schools movement, beginning at the secondary level with recovery high schools. White and Finch (2009) claimed that this movement arose when the need reached a tipping point resulting in the coalescence of new structures of recovery support. The history of the collegiate recovery support movement began in the mid1970s and has proliferated nationally in the 2000s. The collegiate recovery support movement began as organized but disparate efforts in various configurations. The first documented Collegiate Recovery Program (CRP) started in 1977 at Brown University in Rhode Island (White & Finch, 2006). It was followed by a second CRP at Rutgers University in New Jersey in 1983, and a third program at Texas Tech University in 1988 (Harris, Baker & Cleveland, 2010). A fourth CRP, StepUP, launched in 1997 at Augsburg College in Minnesota (Botzet, Winters, & Farnhorst, 2007). This movement has proliferated greatly in the past decade. In 2009, the Association of Recovery in Higher Education formed to support the propagation of CRPs and currently lists 140 colleges and universities with existing programs or efforts to start CRPs on campuses in the United States. Although these programs differ in their configuration and structure, they all share in common the organized effort with dedicated or trained staff to support and foster the success of students in recovery from substance use disorders on their respective campuses. In many ways these CRPs consist of small communities on college campuses forming a counter-culture to the perceived norm of excessive alcohol and drug use by college students and its disastrous consequences. These communities support the norms of remaining abstinent as a form of recovery, promoting success academically, and giving back to the community at large as a recovery entity. Several college and university administrators have recognized these communities of students as assets to the
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overall campus because of their successful recovery and academic progress (Recovery Campus, 2013).
An Emerging Evidence-Based Practice Collegiate Recovery Programs are emerging as an evidence-based practice providing impressive outcome results with their students. Although the research on these programs and their students is still relatively new, it highlights positive outcomes with students in recovery achieving notable success. Findings from several pioneering programs indicate the successful abstinence rates of students in these communities are consistently above 90% each year. Furthermore, the grade point average of students in CRPs as a community is frequently above a 3.0 on average. (Augsburg StepUP Annual Report, 2014; Harris, et al., 2008; Laitman & Stewart, 2013; Botzet, Winters, & Farnhorst, 2007). The following table illustrates these findings from three pioneering CRPs: Table 1: Sample CRP Outcomes Institution
Student Student Abstinence Rates Grade Point (Average per year) Averages
Augsburg StepUP Program
87% to 95%
3.2
Texas Tech CSAR Program
92% to 95%
3.18
Rutgers University Recovery House
83% to 95%
3.13
The significance of these findings is striking. First, these outcomes provide a strong contrast to the typical abstinence rates of adolescents and young adults. Post-treatment relapse rates for this population can range from 60% to 79% within the first year and reach as high as 90% after five years (Brown, Tapert, Tate, & Abrantes, 2000; Winters, Stinchfield, Latimer, & Lee, 2007). Second, students participating in CRPs often must overcome additional challenges resulting from their previous substance use disorders, highlighting even more the significance of their successes. For example, the first national study of students participating in CRPs (N=496 from 29 different CRPs) found that many of students reported high levels of substance use disorder severity, having used multiple substances, and, many reported recovering from multiple behavioral addictions as well (Laudet, Harris, Kimball, Winters, & Moberg, 2014). The factors helping these students find success in both their recovery and academics are varied and reflect multiple dimensions of support. Researchers have found that the social support from peers in the CRP and the community of the CRP itself provide an important protective safety net or context for them to live in as college students (Wiebe, Cleveland & Dean, 2010; Cleveland, Wiebe & Wiersma, 2010). This helps these students to meet the significant challenge of making new friends as they attend college. A friendship group is already present as a community of recovering peers. Other important identified supports include the safety of a substancefree recovery housing environment, the counseling and advocacy support of CRC staff, the availability of on-campus 12-Step meetings, academic skills support, financial assistance, and the opportunity to be of service to others (Bell, Kanitkar, Kerksiek, et al. 2009; Casiraghi & Muslow, 2010; Finch, 2007; Washburn, 2016). These findings are not surprising given the body of literature regarding student success in college. One of the best predictors of whether a student will graduate from college is the presence of the quality of persistence. The level of support the campus environment offers to its students to enable 28
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them to persist is equally important (Kuh, Kinzie, Schuh, & Whitt, 2010). Colleges and universities that provide a CRP are providing the necessary support to enable students in recovery to successfully persist in their respective college environments. Tinto (2016) framed persistence as one form of student motivation. He argued that central to motivation are the qualities of self-efficacy, a sense of belonging, and a perceived value of the curriculum. CRPs provide a milieu of services distinctly designed to generate self-efficacy and a sense of belonging. My own research in this area revealed that students in CRPs build a sense of self-confidence and efficacy through the modeling of peers within the CRP, thereby creating a positive peer influence. This combined with a sense of belonging provides a collective shared investment in a “culture of success” within the CRP (Washburn, 2016). In essence, CRPs provide an important, safe, and supportive environment for students in recovery attending college. While other campus resources and off campus recovery self-help and mutual support groups can play important role for students in recovery, the interpersonal support from peers combined with specialized professional support by trained staff knowledgeable of addiction and recovery are critical for helping these students succeed.
A New Referral Resource What remains for investigation is how CRPs on college and university campuses serve as a tertiary prevention modality affecting the greater “drinking culture” of their respective campuses. In my current role as Assistant Director of a CRP, I see anecdotal evidence of how CRP students in recovery have a positive outreach influence to other non-CRP students struggling with alcohol and drug use issues. A few studies have framed CRPs as a form of AOD prevention on college campuses and have begun to examine their impact on the greater institutional context (Smock, Baker, Harris, & D’Sauza, 2010; Watson, 2014). However, this research is seminal and ripe for much further investigation.
Conclusion CRPs provide a valuable resource of support for young adults recovering from substance use disorders wanting to attend college. Addiction and mental health professionals who work with these clients now have an important referral resource to consider if their clients are thinking of going to college while maintaining their recovery. Young people in recovery need structure, purpose, meaning, and peer support in order to do more than simply survive, but actually thrive, in their recovery. Attending college in a supportive environment with peers pursuing the same journey, provides a great opportunity to meet those needs. Colleges and universities offering CRPs provide an opportunity for young people in recovery to be successful.
Find a Collegiate Recovery Program near you at collegiaterecovery.org. REFERENCES Bell, N., Kantikar, K., Kerksiek, K., Watson, W., Das, A., Kostina-Ritchey, E., Russell, M., & Harris, K. (2009). It has made college possible for me: Feedback on the impact of a universitybased center for students in recovery. Journal of American College Health, 5(6), 650-657. doi: 10.3200/JACH.57.6.650-658. Botzet, A., Winters, K., & Fahnhorst, T. (2007). An exploratory assessment of a college substance abuse recovery program: Augsburg college’s stepup program. Journal of Groups in Addiction and Recovery, 2(2-4), 257-270. doi: 10.1080/15560350802081173. Brown, S. A., Tapert, S. F., Tate, S. R., & Abrantes, A. M. (2000). The role of alcohol in adolescent relapse and outcome. Journal of Psychoactive Drugs, 32, 107-115.
Casiraghi, A., & Muslow, M. (2010). Building support for recovery into an academic curriculum: Student reflections on the value of staff run seminars. In H. Cleveland, K. Harris & R. Wiebe (Eds.), Substance abuse recovery in college: Community supported abstinence (pp. 113-143). New York: Springer Science + Business Media. Cleveland, H. H., Harris, K. S., Baker, A. K., Herbert, R., & Dean, L. R. (2007). Characteristics of a collegiate recovery community: Maintaining recovery in an abstinence-hostile environment. Journal of Substance Abuse Treatment, 33, 13-23. Cleveland, H., Wiebe, R., & Wiersma, J. (2010). How membership in the collegiate recovery community maximizes social support for abstinence and reduces risk of relapse. In H. Cleveland, K. Harris & R. Wiebe (Eds.), Substance abuse recovery in college: Community supported abstinence (pp. 97-111). New York: Springer Science + Business Media. Cronce, J., & Larimer, M. (2012). Brief individual-focused alcohol interventions for college students. In H. Raskin White & D. Rabiner (Eds.), College drinking and drug use, (pp. 161187). New York: The Guilford Press. Dowdall, G. (2013). College drinking: Reframing a social problem/changing the culture. Sterling, VA: Stylus. Finch, A. (2007). Authentic voices: Stories from recovery school students. Journal of Groups in Addiction and Recovery, 2(2-4), 16-37. doi: 10.1080/15560350802080779. Harris, K., Baker, A., & H. Cleveland. (2010). Collegiate recovery communities: What they are and how they support recovery. In H. Cleveland, K. Harris & R. Wiebe (Eds.), Substance abuse recovery in college: Community supported abstinence (pp. 9-22). New York: Springer Science + Business Media. Kuh, G., Kinzie, J., Schuh, J., Whitt, E., & Associates. (2010). Student success in college: Creating conditions that matter. San Francisco: Jossey-Bass Publications. Laitman, L., & Stewart. (2012). Campus recovery programs. In H. Raskin-White & D. Rabiner (Eds.), College drinking and drug use (pp. 253-271). New York: The Guilford Press. Laudet, A., Harris, K., Kimball, T., Winters, K., & Moberg, P. (2015). Characteristics of students participating in collegiate recovery programs: A national survey. Journal of substance abuse treatment, 51, 38-46. doi: 10.1016/j.jsat.2014.1 1.0040740-5472. Laudet, A., Harris, K., Kimball, T., Winters, K., & Moberg, P. (2014). Collegiate recovery communities programs: What we know and what we need to know? Journal of social work and addictions, 14(1), 84-100. doi: 10.1080/1533256X.2014.872015. NIAAA. (2013). College drinking. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
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Saltz, R. (2012). Community and environmental prevention interventions. In H. Raskin White & D. Rabiner (Eds.), College drinking and drug use, (pp. 221-234). New York: The Guilford Press. Smock, S. Baker, A., Harris, K., & D’Sauza, C. (2010). The role of social support in collegiate recovery communities: A review of the literature. Alcoholism Treatment Quarterly, 29(1), 35-44. doi: 10.1080/07347324.2010.511073. Terrion, J. (2012). The experience of post-secondary education for students in recovery from addiction to drugs or alcohol: Relationships and recovery capital. Journal of Social and Personal Relationships, 30(3), 3-23. doi: 1177/0265407512448276. Washburn, S. (2016). Trajectories, transformations, and transitions: A phenomenological study of college students in recovery finding success. Retrieved from http://ir.stthomas.edu/ caps_ed_lead_docdiss/76/. Watson, J. (2014). How does a campus recovery house impact its students and host institution? Journal of social work practice in addictions, 14(1), 101-112. doi: 10.1080/1533256X. 2013.872933. Wechsler, H., & Wuethrich, B. (2002). Dying to drink: Confronting binge drinking on college campuses. Emmaus, PA: Rodale Publishers. White, W., & Finch, A. (2006). The recovery school movement: Its history and future. Counselor, 7(2): 54-58. Retrieved from http://mx1.williamwhitepapers.com/pr/2006The RecoverySchoolMovement.pdf. Winters, K. C., Stinchfield, R., Latimer, W. W., & Lee, S. (2007). Long-term outcome of substance-dependent youth following 12-step treatment. Journal of Substance Abuse Treatment, 33, 61-69. Dr. Washburn’s career focus and passion for over 25 years has been supporting adolescents and emerging adults in establishing meaningful productive lives in recovery. He has worked in residential treatment, outpatient mental health, school prevention, and a collegiate recovery program at Augsburg College. He is a Licensed Alcohol and Drug Counselor in MN. His educational background includes an MA in Counseling Psychology and an EdD in Education. His research focus has analyzed dynamics that facilitate success for college students in recovery. He is dedicated to teaching the next generation of counselors how to provide high quality care to persons suffering from addiction and mental health disorders.
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Earn 1 CE by Taking an Online Multiple Choice Quiz
Earn one Continuing Education hour by taking a multiple choice quiz on this article now at www.naadac.org/magazineces. $15 for NAADAC members and non-members. 1. In Scott Washburn’s article on college age recovery, he introduces Collegiate Recovery Programs (CRPs). Which of the following best articulates the primary goal of these programs? a. CRPs are communities that support remaining abstinent as a form of recovery and promote academic success. b. CRPs are the college-age equivalent to Alcoholics Anonymous. c. CRPs can best be described as off-campus recovery self-help and mutual support groups for college students. d. CRPs are campus treatment programs that uniformly follow a treatment curriculum that has been empirically researched and is an evidencebased practice. 2. According to Scott Washburn, which of the following is an accurate statement about drinking and drug use on college campuses? a. Colleges and universities have historically addressed the problematic culture of excessive alcohol use by means of tertiary prevention efforts. b. The history of organized recovery support on college campuses in the United States emerged from the recovery schools movement at the secondary level. c. The first documented CRPs emerged in the 1990s. d. All CRPs follow the same configuration and structure and share the common organized goal to support and foster the success of students in recovery. 3. According to Stefanie Carnes, neurological research on sex addiction has determined which of the following? a. Research has supported the decision not to include sex addiction in the DSM-5 due to inaccuracy when compared to most other sets of DSM diagnostic criteria. b. Other disorders currently included in the DSM-5 have significantly more supportive evidence for diagnostic criteria than that of sex addiction. c. Research measuring the degree to which addicts will focus their attention on an addiction-related image as opposed to a neutral image showed no parallels between self-identified sex addicts and drug addicts. d. For self-identified sex addicts, neurobiological cue reactivity to sexual stimuli mirrors that of drug addicts to drug-related stimuli. 4. Stefanie Carnes noted that scientists at the American Society of Addiction Medicine drew a “line in the sand,” stating which of the following? a. The APA is correct in their hesitation to support the concept of sexual addiction. b. Neuroscience has not shown evidence to support sexual addiction. c. Food, sex, and other behaviors can be addictive. d. Since sexual addiction does not involve ingesting a substance, it cannot be classified as an addiction. 5. In Jack Stein’s discussion on addressing substance use disorders in criminal justice settings, which of the following are deemed most significant in transitioning inmates with substance use disorders into the community? a. Provide behavioral counseling with no medication since prescribed drugs can be abused or sold to others. b. Avoid the use of the antagonist medication naltrexone as it can be counter-productive in preparing inmates for release. c. Mutual support groups are the best means of preparing inmates for community living. d. Prescribe approprate medication in addition to behavioral counseling.
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6. According to Jack Stein, making medications available to prisoners are supported by which of the following? a. The World Health Organization, the Office of National Drug Control Policy, and the National Institute on Drug Abuse. b. American Probation and Parole Association, the World Health Association, and NAADAC. c. The Office of National Drug Control Policy, NAADAC, and the National Association of Parole Executives. d. The National Institute on Drug Abuse, the American Probation and Parole Association, and the North American Association of Wardens and Superintendents. 7. In Raven Badger’s article on Women’s Sexual Health Disparities in Substance Use Disorder Treatment, which of the following were reportedly desired by women but discounted or not permitted by treatment staff? a. Permission to talk about sex and sexual abuse, and validation of their feelings. b. Involving their partner in treatment. c. Permission to blame their partners on their low sexual self-esteem. d. Working to gain an understanding of the link between sexuality and substance use disorder. 8. According to Raven Badger, which of the following is a significant challenge for women with regards to sexual health disparities in addiction treatment? a. Religious messages that conflicted with sexuality. b. Not being believed about sexual abuse. c. Shame about past behavior and experiences. d. All of the above. 9. In the article on the U.S. Surgeon General’s report by Jessica Gleason, it was concluded that scientific evidence shows that the following brain disruptions frequently occur at the onset, development, and maintenance of substance use disorders: a. Disabled substance-associated cues that trigger substance seeking (i.e. a decrease in incentive salience). b. Increased sensitivity of brain systems involved in the experience of pleasure or reward, and heightened activation of brain stress systems. c. Reduced functioning of brain executive control systems, which are involved in the ability to make decisions and regulate one’s actions, emotions, and impulses. d. Both a and b. 10. Jessica Gleason reported (in her review of the U.S. Surgeon General’s report) that well-supported scientific evidence shows that adolescence is a critical “at-risk period” for substance use and addiction. Which of the following is most accurate about adolescent substance abuse? a. Behavioral therapies with adolescents are not as effective in treating substance use disorders as they are with adults because they are underused and there is limited fidelity in their effectiveness. b. All addictive drugs, including alcohol and marijuana, have especially harmful effects on the adolescent brain, which is still undergoing significant development. c. Only alcohol abuse has significant effects on brain development of adolescents. d. Scientific evidence exists for robust predictors (risk and protective factors) of substance use and misuse only after one moves into adulthood.
■ N A A DAC L E ADE RS HI P NAADAC EXECUTIVE COMMITTEE
NAADAC COMMITTEES
Updated 11/30/2016
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 Kathryn B. Benson, LADC, NCAC II, QSAP, QSC Executive Director Cynthia Moreno Tuohy, NCAC II, CDC III, SAP REGIONAL VICE-PRESIDENTS Mid-Atlantic (Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)
Susan Coyer, MAC
James “JJ” Johnson Jr. BS, LADC, ICS Northeast (Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)
William Keithcart, MA, LADC Northwest
Clinical Issues Committee Chair Frances Patterson, PhD, MAC Ethics Committee Chair Mita Johnson, EdD, LPC, MAC, SAP
Malcolm Horn, LCSW, MAC, SAP, NCIP Southeast (Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)
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
Southwest
Public Policy Committee Co-Chairs Michael Kemp, ICS, CSAC, CSW Sherri Layton, MBA, LCDC, CCS
(Represents Arizona, California, Colorado, Hawaii, Nevada, New Mexico and Utah)
AD HOC COMMITTEE CHAIRS
Angela Maxwell, MS, CSAPC
Julio Landero, PhD, MAC, MSW, LADC, LASAC Organizational Member Delegate Matt Feehery, MBA, LCDC, IAADC
Mid-Central (Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)
Awards Committee Chair Jamie Durham Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC Steven Durkee, NCAAC International Committee Chair Sandra Jones, MS
Kevin Large, MA, LCSW, MAC
Leadership Committee Chair Gerard J. Schmidt, MA, LPC, MAC
Mid-South (Represents Arkansas, Louisiana, Oklahoma and Texas)
Membership Committee Chair Margaret Smith, EdD, LADC
Matt Feehery, MBA, LCDC, IAADC
Student Sub-Committee Chair Diane Sevening, EdD, LAC Product Review Committee Chair Matt Feehery, MBA, LCDC, IAADC
Kathryn B. Benson, NCAC II, LADC, QSAP, QSC NCC AP Chair Tennessee
Tobacco Committee Chair Diane Sevening, EdD, LAC
James “Kansas” Cafferty, LMFT, NCAAC California
PAST PRESIDENTS
NERF Events Fundraising Chair Ed Olson, LCSW, CASAC
(Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)
NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)
Professional Practices and Standards Committee Chair Donald P. Osborn, PhD, LCAC
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 Tay Bian How, NCAC II Sri Lanka Thaddeus Labhart, MAC, LPC Treasurer Oregon Rose Maire, MAC, LCADC, CCS New Jersey Art Romero, MA, LPCC, LADAC New Mexico Sandra Street, MAC, SAP West Virginia Loretta Tillery, MPA, CPM Public Member Maryland Gerard J. Schmidt, MA, LPC, MAC (ex-officio) West Virginia
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 Steven Stone, Indiana Steven Durkee, NCAAC, Kentucky Shannon Rozell, MPA, Michigan James Joyner, LICDCCS, ICCS, 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 William Keithcart, MA, LADC, Vermont
NORTHWEST Diane C. Ogilvie, MAEd, Alaska Malcolm Horn, LCSW, MAC, SAP, NCIP, Montana Greg Bauer, CDP, NCAC I, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming
SOUTHWEST
MID-ATLANTIC
Carolyn Nessinger, MA, LAC, Arizona Thomas Gorham, MA, CADC II, California Thea Wessel, LPC, LAC, MAC, Colorado Kimberly Landero, MA, Nevada J.J. Azua, LADAC, CPSW, New Mexico Shawn McMillen, Utah
Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia Ron Pritchard, CSAC, CAS, Virginia Patrice Pooler, MA, ADC, 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 Charles Stinson, MS, South Carolina Lori McCarter, LADAC, QCS, Tennessee
NAADAC, the Association for Addiction Professionals, invites you to submit a proposal to present at its 2017 Annual Conference: Elevating Your Practice in Denver, CO at the Denver Marriott Tech Center from September 22–26. NAADAC members and non-members are invited to submit presentations for pre-conference sessions, breakout sessions, and plenary sessions. NAADAC encourages young investigators, researchers, and addiction professionals from diverse organizations and fields to submit.
CALL FOR PRESENTATIONS
We are seeking current and relevant information within these eight topics: ● Practice Management & Technology: Health Information Technology (HIT), Electronic Health Records (EHR), Certification/Licensure, Patient Retention, Billing/Insurance, Social Media, Teletherapy, Policy/Regulatory Issues, Affordable Care Act (ACA), and Ethical, Legal, and Liability Issues. ● Co-Occurring Disorders: Integrated Treatment, DSM-5, Mental Health Disorders, Trauma Informed Care, and ICD 10. ● Psychopharmacology: Neurobiology of Addiction, Pharmacotherapy/ Medication-Assisted Treatment, Opioids, Alcohol, Marijuana, Sedatives, Stimulants, Synthetic Drugs, Tobcacco/Nicotine, and Designer Drugs. ● Clinical Skills: Evidence-based Practices, Case Studies, Relapse Prevention, Treatment Planning, Screening & Assessment, Counseling Theories, The ASAM Criteria, Substance Use Prevention, and Promising Practices. ● Cultural
Humility: Introduction to Cultural Humility, Addiction-Specific Issues Involving LGBTQ, Racial/Ethnic Groups, Gender, Spirituality, Low-Income/ Homeless, and Veterans/Military. ● Process Addictions: Gambling Addiction, Sexual Addiction, Internet Addiction, and Eating Disorders. ● Recovery Support: Community Navigation, Individual & Community Capital, Family Support, and Treatment Coordination. ● Education/INCASE: Presentations with a post-secondary educational focus, designed for an audience of college level faculty who are seeking to enhance the quality of training and education in addiction studies, to disseminate professional knowledge and share ideas regarding addiction studies, students and scholarship in the field of addiction studies with a creative evidence-based focus.
Submission Deadline: January 17, 2017 To apply and for more information on the submission and selection processes, conference information, timelines, and presenter resources, please visit www.naadac.org/ac17-call-for-presentations.
www.naadac.org/annualconference