FALL 2018 Vol. 6, No. 3
Reality Therapy for Persons with Substance Use Disorders
By Robert Wubbolding, EdD, LPCC, BCC, CRT
PLUS: • New Reasons Counselors Should Address Smoking in Their Patients • Protect Patient Confidentiality and Access to Treatment • Self Disclosure: To Do or Not to Do?
NAADAC’s celebrated three-module Basics of Addiction Counseling Desk Reference has been updated! The Basics of Addiction Counseling Desk Reference, 11th Edition – Buy all three! • Module I: Pharmacology of Psychoactive Substance Use Disorders • Module II: Addiction Counseling Theories, Practices and Skills • Module III: Ethical and Professional Issues in Addiction Counseling
Updates include: • DSM-5 diagnostic criteria and newest ASAM criteria • 2016 NAADAC/NCC AP Code of Ethics • Current terminology • Support for evidence-based practice and theory by research published since last edition
The Basics of Addiction Counseling Desk Reference, 11th Edition, is a three-module set that has aided many addiction professionals in attaining their state and national credentials with its thorough and easy-to-understand descriptions of counseling concepts. Basics can also be used as a quick reference tool for clinicians to use throughout their careers and students preparing for addiction counseling careers.
Purchase as a three-module set or buy each module individually! Available as independent study courses to obtain nationallyapproved continuing education hours (CEs) or as manuals only. • Module I: 11 CEs • Module II: 7.75 CEs • Module III: 11 CEs
Three-Module Set MANUALS ONLY: INDEPENDENT STUDY COURSES: NAADAC Members $158 NAADAC Members $324 Non-members $225 Non-members $428
Order your copies today at www.naadac.org/bookstore.
44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 P: 703.741.7686 F: 703.741.7698 E: naadac@naadac.org
FALL 2018 Vol. 6 No. 3 Advances in Addiction & Recovery, the official publication of NAADAC, is focused on providing useful, innovative, and timely information on trends and best practices in the addiction profession that are beneficial for practitioners. NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 100,000 addiction counselors, educators, and other addictionfocused health care professionals in the United States, Canada, and abroad. NAADAC’s members are addiction counselors, educators, and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education. Mailing Address
■ FEAT U R ES
Telephone Email Fax
44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 703.741.7686 naadac@naadac.org 703.741.7698
Managing Editor
Jessica Gleason, JD
Associate Editor
Kristin Hamilton, JD
Graphic Designer
Elsie Smith, Design Solutions Plus
Editorial Advisory Committee
Kirk Bowden, PhD, MAC, NCC, LPC Rio Salado College
22 New Reasons Counselors Should Address Smoking in Their Patients
Kansas Cafferty, LMFT, MCA, CATC, NCAAC True North Recovery Services National Certification Commission for Addiction Professionals (NCC AP)
24 Alcohol & Women’s Health: Studies Reveal Problems
Thomas Durham, PhD NAADAC, the Association for Addiction Professionals
By Jack B. Stein, PhD, MSW and Eric M. Wargo, PhD, National Institute on Drug Abuse
By National Institute on Alcohol Abuse and Alcoholism
Deann Jepson, MS Advocates for Human Potential, Inc.
26 Reality Therapy for Persons with Substance Use Disorders
James McKenna, MEd, LADC I McKenna Recovery Associates
By Robert Wubbolding, EdD, LPCC, BCC, CRT
29 NHSC Substance Use Disorder Workforce Loan Repayment Program – Do You Qualify?
Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP NAADAC, the Association for Addiction Professionals
By Health Resources and Services Administration (HSRA)
■ DEPA R T M EN TS 4
President’s Corner: Executive Interview: Meet Your New President, Diane Sevening, EdD, LAC, MAC By Jessica Gleason, JD, Deputy Director
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From The Executive Director: The Legacy of a NAADAC President By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director
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Certification: NCC AP Update: The Importance of Quality Assurance By Jerry Jenkins, MEd, MAC, NCC AP Chair
11 Ethics: Self-Disclosure: To Do or Not to Do?
By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair
12 Advocacy: Protect Patient Confidentiality and Access to Treatment
By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director and Tim Casey, Policy Advisor, Polsinelli
13 Membership: Reflections on a NAADAC Presidency
By Gerard J. Schmidt, MA, LPC, MAC, NAADAC Immediate Past-President
Donald P. Osborn, PhD, LCSW, LMFT, LCAC, MAC Indiana Wesleyan University Article Submission Guidelines We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Please submit story ideas and/or articles to Jessica Gleason at jgleason@naadac.org. For more information on submitting articles for inclusion in Advances in A ddiction & Recovery, please visit www.naadac.org/advances-in-addiction-recovery. Disclaimer It is expressly understood that articles published in Advances in Addiction & Recovery do not necessarily represent the view of NAADAC. The views expressed and the accuracy of the information on which they are based are the responsibility of the author(s) and represent the wide diversity of thought and opinion within the addiction profession. Advertise With Us For more information on advertising, please contact Irina Vayner, NAADAC Exhibits & Ad Sales Manager, at ivayner@naadac.org. Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5 This publication was prepared by NAADAC, the Association for Addiction Professionals. Reproduction without written permission is prohibited. For more information on obtaining additional copies of this publication, call 703.741.7686 or visit www.naadac.org. Printed December 2018
16 Membership: NAADAC Honors 2018 National Award Winners
By Kristin Hamilton, JD, NAADAC Sr. Communications Manager
20 Conference: 2018 Annual Conference Highlights
STAY CONNECTED
30 NAADAC CE Quiz 31 NAADAC Leadership
ALL IMAGES FROM SHUTTERSTOCK UNLESS OTHERWISE NOTED
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■ PR ES ID ENT ’S CORN E R
Executive Interview: Meet Your New President, Diane Sevening, EdD, LAC, MAC By Jessica Gleason, JD, NAADAC Deputy Director At the close of NAADAC’s 2018 with grandparents and other relatives. Annual Conference in October, Diane I came to the realization that not evSevening, EdD, LAC, MAC started her eryone lives like this, so decided it was two-year term as NAADAC’s President. my responsibility to create a better life Currently an Assistant Professor in the for me and others like me and make a Addiction Counseling and Prevention difference. There were many mentors Department at the University of South in my life who saw potential in me Dakota School of Health Sciences, Dr. and encouraged me to pursue higher Sevening has over 35 years of teaching education. My first interests were to beexperience and ten years of clinical excome a teacher of elementary students perience in the addiction profession. She or a high school English teacher. These serves as a member of the South Dakota studies were not satisfying to me, but Board of Addiction and Prevention I then heard about the University of Professionals (BAPP), Treasurer of the South Dakota that offered a Bachelor’s International Coalition for Addiction degree in Addiction Studies. It was Studies Education (INCASE), and there that I found my niche. member of the National Addiction Studies Accreditation Commission GLEASON: How did you (NASAC) Board of Commissioners. become involved with As a clinician, Sevening spent seven NAADAC and decide to years as the Prevention and Treatment pursue a role in NAADAC’s Coordinator at the University of South leadership? Dakota’s Student Health Services, two SEVENING: In one of my classes, years as a Clinical Supervisor for the we discussed how can we make a University of South Dakota Counseling difference as addiction professionals. Center, and one year as a family theraThe NAADAC Advocacy in Action pist at St. Luke’s Addiction Center in First on my agenda conference was coming up and four Sioux City, Iowa. students decided they were going to A NAADAC member since 1999, as NAADAC President is attend. NAADAC was so welcoming, Sevening previously served as Regional encouraging, and supportive of our Vice-President for the NAADAC advocating for the addiction interests. These fabulous four students North Central Region and Chair of decided to create a student organithe Student Committee. As NAADAC profession at the national, state, zation on campus and as a result, I Student Committee Chair, she was vital was approached at a later NAADAC in the implementation of the NAADAC and local levels to address conference to consider becoming the William L. White Student Scholarship NAADAC student chair. During this Award in 2015. Sevening has presented the workforce shortages. same time, it was such an honor to at numerous NAADAC events, trainbe voted in as the South Dakota (SD) ings, and conferences. President of Chemical Dependency Jessica Gleason, NAADAC Deputy Association and with the support of the Director, sat down with Sevening to discuss her new role as NAADAC state Director of the Division of Alcohol and Drug Abuse, South Dakota President. became an affiliate of NAADAC. This then led to me being voted in as NAADAC Regional Vice President for the North Central Region.
GLEASON: Why did you decide to go into the addiction profession? How did you get started?
SEVENING: There is a history of alcohol use disorder in my family. While growing up, we made many geographic moves and often times lived 4
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GLEASON: What motivated you to run for NAADAC President? President, continued on page 6 ☛
■ F R O M T H E E X E C U T I VE DI RE C TOR
The Legacy of a NAADAC President By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director
Every two years in the fall, NAADAC welcomes a new NAADAC Pr esident. It has been the procedure of NAADAC for over 40 years. Two years as a NAADAC President may sound like a short term, but it is a six-year commitment that includes two years as President-Elect, two years as President and two years as Immediate Past President. Gerry Schmidt, our current Immediate Past President, stepped into this new role of Immediate Past President after the Annual Conference in October. It has been my immense pleasure to work with Gerry in his role as President. I have been fortunate to work along-side of Gerry in one capacity or other for the past thirty years. Gerry was one of our early Legislative Chairs, picking up the mantel of advocacy and working to capture the attention of local, state and federal policy makers. His passion and enthusiasm for this work grew along with his clearness of purpose. Gerry’s experience in administrating a multi-disciplinary treatment system that incorporates mental health and addiction has given NAADAC a breath of new air and insight as we moved from sequential care of addiction and mental health to an integrated model of addiction, mental health, and primary care. His experiences at Valley Health Systems has been invaluable in understanding the dynamics of integrated care from a clinical, administrative, political and billing perspective. His passion and commitment naturally led him to the role of President-Elect due to his eagerness to change from the silo systems of care to an more integrated model. Gerry also brought forth his education and experience in addiction and co-occurring disorders in the trainings that he has performed for NAADAC acorss the country and internationally. He has trained and lead groups internationally for NAADAC and brought the “good news” that treatment works and recovery is possible! Being President of NAADAC is both an honor and an obligation of a commitment of time, expertise, and energy. Gerry has met that challenge and left for NAADAC and the current President of NAADAC, Diane Sevening, a lasting legacy on which to build. NAADAC cannot continue to exist and provide support to addiction professionals without financial growth and stability. During Gerry’s term, the financial health of NAADAC has strengthened. Gerry worked hard to increase our bottom line without sacrificing quality and quantity of NAADAC programs and initiatives, and his commitment paid off. Under Gerry’s leadership, NAADAC has expanded its advocacy
efforts by entering into a consulting contract with Polsinelli, a government relations firm in Washington, DC that is rated number one in health care issues. Through this partnership, we have increased our government relations voice and presence on Capital Hill, including participating in meetings with key legislators and providing writing testimony to Congress. NAADAC has assisted in adding addiction-specific workforce language in several bills and provided input regarding the content of the recently passed SUPPORT for Patients and Communities Act (P.L. 115-271). We are excited to celebrate the passing of this bill in particular, which contains key provisions that (1) incentivize individuals to pursue substance use disorder treatment professions by offering student loan relief; (2) protect against the erosion of privacy rights of individuals with substance use disorders; and (3) remove the IMD exclusion for all substance use disorder treatment and allow Medicaid payment for eligible individuals for up to 30 days annually. We will continue to work to support addiction clients, counselors, and treatment facilities. NAADAC also held its 2018 Advocacy in Action Conference and Hill Day on November 1213, 2018, which welcomed addiction professionals from across the county and led to over a dozen meetings with Members of Congress or their staff. We are looking forward to the 2019 Advocacy in Action Conference and Hill Day on April 11-12, 2019! Thank you, Gerry, for the work that you do and the tireless hours that you work and then donate back to us! Without your support, we could not have achieved all the amazing growth over the past two years! I am also appreciative of the work of the NAADAC team and the dedicated work they so generously give to support our vision and mission. Thank you for the opportunity to serve you! Together, we are making a difference! Cyn Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years as well as an international, national and state trainer in a variety of topics. Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders, and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.
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President, continued from page 4
SEVENING: Several of my friends, mentors, colleagues, and students encouraged me to consider the possibility of running for NAADAC President. Never in my wildest dreams did I think I was capable of taking on this role, and I initially laughed it off. They were persistent in reminding me about making a difference. Now it was a personal challenge to put my actions where my mouth is and I decided to take a chance.
GLEASON:How would you describe your leadership style? SEVENING: My leadership style is democratic or participative. My belief is that we all work as a team and with input and feedback from each member of the team, success happens.
GLEASON: What is first on your agenda as you settle into your new role? SEVENING: First on my agenda as NAADAC President is advocating for the addiction profession at the national, state, and local levels to address the workforce shortages.
Addiction professionals need to be recognized and respected for the knowledge and special skill sets they possess.
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? SEVENING: Addiction professionals need to be recognized and respected for the knowledge and special skill sets they possess. It is my hope to assist in creating a standardized credential that is recognized by all other health care providers. An initiative that is exciting to me and that I plan to tackle is to inspire students to pursue the addiction profession as a career choice. Colleges and universities need to market addiction studies as a viable degree with endless opportunities for job placement.
GLEASON:What are you hearing from members as their biggest concerns and challenges for the industry today and how can NAADAC support them? SEVENING: Many members have expressed that they are unable to find qualified addiction professionals to work in remote areas. They have also indicated it is difficult to find qualified addiction professionals who are willing to provide treatment to diverse populations, such as ethnic groups, LGBTQ, homeless, disabled, veterans, and incarcerated populations. Another major concern is portability of credentials. Credentialing standards vary from state to state, which makes it difficult for an addiction professional to make a lateral move to a different state. Some states require a Master’s degree for licensure, while other states require a Bachelor’s degree for licensure. The testing requirements also vary. Some states require the IC&RC exam and other states require the NCC AP exam. I would have to say that the biggest issue I hear about is low pay for the addiction professionals who are addressing the number one public health problem in the nation. NAADAC is very aware of these concerns
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and challenges and has incorporated the Minority Fellowship Program for Master’s level students who plan to work with diverse groups or minority populations to receive funding for their last year of graduate studies in an addiction-related field. In addition, NAADAC continues to advocate for the addiction profession in regard to both standardizing credentialing and increasing the recognition and pay that those in the addiction profession receive.
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?
SEVENING: The biggest challenge facing new addiction counselors today is being able to afford the high cost of living with the low pay scale. Sometimes the long work hours can also be a detriment and a deterrent for inspiring young people to become addiction counselors. Advocating for equal pay of addiction counselors in comparison to other professionals in the behavioral healthcare profession on the national, state, and local levels is necessary. New addiction counselors need incentives that compliment their passion for wanting to help people move into recovery. This is such a challenging and rewarding profession, and with higher education comes the knowledge and skills needed to provide evidence-based practices and the best individualized care possible.
GLEASON: Why is NAADAC membership important for addiction professionals? SEVENING: NAADAC membership provides a wealth of benefits and resources specifically for addiction professionals. Currently NAADAC offers over 150 CEs of ongoing and archived webinars that address contemporary issues by renowned presenters – all of which can be accessed for free by members. Members also receive a subscription to the quarterly NAADAC magazine, Advances in Addiction & Recovery, professional and student liability insurance at an affordable price, discounted rates for attendance at national and regional conferences, and national representation for legislative issues, just to name a few of the many benefits. NAADAC membership also provides opportunities for professional growth, leadership, and continuous updates on the latest issues through the electronic e-blasts and NAADAC news. NAADAC cares about its members and will provide the best service available in helping us make a difference. Jessica Gleason, JD, is the Deputy Director of NAADAC, the Association for Addiction Professionals. In this role, she assists the Executive Director in managing and leading the association and oversees the day to day operations and activities of the communications, marketing, public relations, exhibits and ad sales, training, and professional development departments. In addition, she assists the Executive Director in managing NAADAC’s government relations activities, sponsor recruitment and coordination, grant writing and programming, and other special projects. Gleason also serves as Managing Editor of NAADAC’s quarterly magazine, Advances in Addiction & Recovery. She joined NAADAC in October 2013 and was Director of Communications from January 2014 to November 2018.
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FA L L 2 018 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 7 OCTOBER 5 – 9 | NA ADAC 2018 ANNUAL CONF ERENCE 1
■ CER T IF IC AT I O N
NCC AP Update: The Importance of Quality Assurance By Jerry Jenkins, MEd, MAC, NCC AP Chair In the article I wrote for the last issue of Advances in Addiction & Recovery, I focused on why substance use disorder professionals need to be pursing national credentials. As noted, the U.S. Department of Labor projects employment of addiction counselors to grow by 23% in the next seven years. The demand for qualified professionals is increasing at a pace exceeding most other professions. This is one reason for advocating for accessible training and education to enable people entering the field to learn the basics of substance use disorder treatment and to continue to advance their counseling skills and work toward earning credentials. With that background, the following is a “look behind the curtain” of the National Certification Commission for Addiction Professionals (NCC AP). It is imperative that we, as a profession, adapt to and take advantage of innovations in our field. NAADAC and NC CAP have long advocated for training and education that facilitates learning the basics of substance use disorder treatment and then continuing to learn updated information or technologies as it become available. In fact, it was because of the need for a consistent and concise requirement of specialized and continued training and experience that NCC AP was founded.
A Look Back The recognition of the need in the 1980’s for national credentialing was a strategic initiative by NAADAC, resulting the sponsoring of NCC AP. The impetus was the various credentialing criteria and titles being used by states. “Alphabet soup” was often used to describe the various combinations of letters for identifying addiction professionals. Further complicating professional recognition was the approach by some states to separately credential alcoholism counselors from other psychoactive substances (White, 1998). Since 1990, NCC AP has been developing standards for national credentials. Commissioners are experienced state licensed or certified SUD professionals responsible for “developing and keeping current national standards of requisite knowledge in substance use disorder counseling and providing evaluation mechanisms for measuring and monitoring the level of knowledge required for national credentialing. . .” NCC AP recognizes that the addiction profession is in constant development, which requires reassessing the tenets underlying credentialing. In 1998, the Substance Abuse and Mental Health Ser vices Administration (SAMSA) and the Center for Substance Abuse Treatment (CSAT) published Addiction Counseling Competencies – The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) as Technical Assistance Publication (TAP) 21. TAP 21 identifies 123 competencies that are essential to the effective practice of counseling for psychoactive substance use disorders. TAP 21 presents the knowledge, skills, and attitudes (KSAs) counselors need to become fully proficient in each competency. (CSAT, 2005) Today, TAP 21 is considered the source document defining addiction counseling and the technical aspects of the profession. It was last formally updated in 2005. 8
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A Look Behind the Curtain NCC AP uses a combination of requirements to determine eligibility for national certification, including having a state credential as a SUD/ addiction counselor, supervised work experience, requisite SUD/addiction related training and passing a comprehensive exam (NAADAC, n.d.). NCC AP, as part of its strategic plan, is doing quality assurance activities related to the examination process to ensure our credential exams for our three main credentials (National Certified Addiction Counselor Level I (NCAC I), National Certified Addiction Counselor Level II (NCAC II), Master Addiction Counselor (MAC) reflect the current state of the profession. Information, technology, and best practices from ten years ago may be outdated. For example, we need to consider advances in understanding the impacts of adverse childhood events and other traumatic events on assessment techniques and counseling strategies, as well as advances in medication assisted treatment (MAT). Other examples include the expanding use of electronic clinical records, as well as increased use of electronic technologies to connect with clients through everything from texting to remote monitoring and tele-behavioral health. Further, competencies may remain the same but the tools needed may change. The quality assurance process for the NCAC I, NCAC II, and MAC started from the ground up. First, NCC AP worked to answer the question, “Why is the exam being created?” Short answers included: • To establish national professional standards for addiction professionals based on training, education, experience, and demonstrated knowledge. Credentials are part of a career ladder tied to a scope of practice, and are available for professionals to advance through the profession of addiction/SUD counseling. • To ensure professionals receiving credentials agree to a national code of ethics. • To position candidates for career advancement and increased salary potential. • To distinguish candidates as practitioners who have specialized addiction/SUD training and experience in assessment, treatment, and counseling. Next, NCC AP underwent a critical reviewing of and ultimate reaffirming of the major topics constituting critical areas to be addressed by exams. The topics are: • Clinical evaluation, including screening, assessment and diagnosis of substance use/addiction and screening for CODs • Treatment Planning for SUDs, including initial, ongoing, continuity of care and discharge and planning for relapse prevention
• Referral • Service coordination/case management in the areas of SUDs and CODs • Counseling skills and theories of counseling – therapy and psychoeducation with individuals, families and groups in the area of SUDs • Client, family and community education
• Documentation and compliance • Professional and ethical responsibilities • Clinical supervisory responsibilities for all categories of SUD counselors • Pharmacology and physiology of SUD/addictive and COD • Code of ethics & professional development The NCC AP then underwent a review of the 123 competencies outlined in TAP 21 and determined the minimally acceptable knowledge and skills to be assessed by the examination process. In the fall of 2018, NCCAP credentialed professionals were surveyed regarding job roles in terms of the job functions (i.e., responsibilities/duties) and tasks performed on a job as well as the knowledge and/or skills (i.e., competencies) required to perform those tasks. The results of the job analysis will provide evidence to the breadth and depth of knowledge and skills substance use disorder counselors should possess in 2018. In turn, NCC AP will ensure that the exams accurately reflect the updated information. This is key to insuring a quality national credentialing process reflecting what the profession considers to be the minimum standards for identifying SUD professionals. In closing, NCC AP recognizes the need for developing and maintaining current national standards of requisite knowledge in substance use disorder counseling and monitoring the level of knowledge required for national credentialing. As described above, that process is currently underway in a robust manner. All of this is in support of insuring our national credentials for recognizing SUD counseling professionals are up to date and reflective of our critical task in effectively addressing substance use disorders. REFERENCES CSAT (Center for Substance Abuse Treatment). Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice—An Update to TAP 21. Technical Assistance Publication (TAP) Series 28. DHHS Publication No. (SMA) 06-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006a. NAADAC, the Association for Addiction Professionals (n.d). About the NCC AP. Retrieved from https://www.naadac.org/about-the-ncc-ap. White, W. L. (1998). Slaying the Dragon. Bloomington, IL: Chestnut Health System/Lighthouse Institute, 275. Jerry A. Jenkins, MEd, LADAC, MAC, currently chairs the National Certification Commission for Addiction Profes sionals. He has over 35 years of experience in treating substance use disorders and mental illness and has been a member of NAADAC since the late 1980’s. He has worked in and managed community based, outpatient, halfway and residential treatment services where he has regularly hired people in recovery. He is an advocate for recovery as the expectation for behavioral health care with an emphasis on being trauma informed and substance use disorder treatment counselors having credentials to demonstrate having specialized training, experience and skills.
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■ E T H ICS
Self-Disclosure: To Do or Not to Do? By Mita Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair The topic of self-disclosure is a thought-provoking subject, especially in the addictions counseling profession. The questions typically revolve around: (a) how much I can or should tell a client about myself, and (b) whether my self-disclosure will help the client in his or her recovery, especially if I have a recovery history myself. These are both valid questions that need to be examined because the answer is not always a neatly-defined “always” or “never.” Whenever you are considering a self-disclosure, you should be intentional rather than impulsive about that decision, and base your decision on the answers to the following four questions: 1. W h y a r e y o u wanting to selfdisclosure personal information to your client(s)? 2. What will your information mean to the client? How will this information help the client? 3. Is it okay for your self-disclosure to be made public to everyone the client encounters? 4. How would you defend this self-disclosure to your clinical supervisor, a grievance board, or a regulatory-licensure board? Self-disclosures have a purpose in the helping professions when they are used ethically, thoughtfully, and pragmatically. Self-disclosures have the potential to let the client know that they are not alone, and that you can empathize with their situation based on your own story. For some clients, knowing that others have made it through similar journeys can be motivating and hope-inspiring. Why you are disclosing personal information is key to this conversation. What is your goal or intent in self-disclosing to your client? How is your self-disclosure addressing a specific need of the client versus meeting your needs? Is there any chance that the intent of the self-disclosure was to make an easy connection with the client where the client accepted you more because of the self-disclosure? All of these questions would have to be examined to make sure that the self-disclosures are for the client’s benefit and not the clinician’s benefit. Most clients are curious about their clinician’s story. There are also clients who need to know more about their therapist in order to connect
with and trust them. Timing of self-disclosures is important to consider. We do not want our disclosures to in any way influence the screening, intake assessment, treatment planning, or treatment of the client. When a client begins asking questions that are not necessarily timed well, you have several options: • Re-direct the conversa tion back to the client. • Deflect the client away from their question to other questions. • Answer another question. • Speak in general or third person terms/ voice rather than us ing “I” language. A final thought for you to consider is the release of information to your client about your own substance use history. This can be tricky because there will be clients who compare their drugs of choice to your drugs of choice and it can become a competition of who used harder or more intense substances and/or expressed more addictive behaviors. Again, the timing of this self-disclosure is very important to the treatment process and must be judiciously determined. Most clients do not need to know your substance use history, age, marital status, or other personal information in order to work effectively with you. What they do need to know is that you have empathy, care about them, and can listen nonjudgmentally to their stories and life journey. Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education and Supervision, a Master’s Degree in Counseling, and a Bachelor’s Degree in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the national Master Addiction Counselor (MAC) and Department of Transportation Substance Abuse Professional (SAP) certifications. Johnson has two supervisory credentials (ACS and AAMFT) and is a NCC. She is a core faculty member at Walden University, and she maintains a private practice where she works with supervisees who are working on credentialing. Johnson is the Past-President of the Colorado Association of Addiction Professionals (CAAP), and is currently NAADAC Treasurer and Ethics Chair. She previously served as NAADAC’s Southwest Regional Vice-President. In Colorado, Johnson is involved in regulatory and credentialing activities as well as workforce recruitment and retention initiatives. She speaks and trains regionally and nationally on a variety of topics. Her passions beyond workforce retention include pharmacology of drugs of addiction, infectious diseases, ethics, motivational interviewing, and clinical supervision.
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■ A D V O C AC Y
Protect Patient Confidentiality and Access to Treatment: Maintain Newly Created Privacy Protections By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director and Tim Casey, Policy Advisor, Polsinelli
We ask all addiction professionals to contact their legislators to urge support to allow HHS to fulfill its mandate in the SUPPORT for Patients and Communities Act while maintaining the privacy protections of individuals living with SUD.
Addiction professionals remain committed to ensuring the privacy of individuals living with substance use disorders (SUDs). Unfortunately, stigma surrounding addiction still exists and it is critical that our privacy laws protect those seeking treatment. NAADAC believes that efforts to amend confidentiality laws must be carefully crafted to avoid any unintended consequences for those seeking SUD treatment or the addiction professionals and treatment and recovery support agencies that serve them. Congress recently passed the SUPPORT for Patients and Communities Act (P.L. 115-271), a landmark response to the opioid crisis that advances treatment and recovery initiatives, improves prevention efforts, and bolsters research. The new law also takes steps to better coordinate care for individuals with substance use disorders by directing the Department of Health and Human Services (HHS) to: • Evaluate appropriate circumstances in which patient SUD history should be displayed in medical records; • Identify how a patient may issue a formal request to include his/her SUD history in records and what constitutes such a request; • Consider the benefits of displaying SUD information in the same way that other potentially life-threatening information, like drug allergies or contraindications, appear; and • Assess the importance of patient privacy and consent requirements for SUD history disclosure. This initiative, known as Jessie’s Law, represents a responsible approach to delivering care to patients with a history of SUD while preserving patient confidentiality. 12
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During the broader debate, many sought to advance a full overhaul of privacy protections for substance use treatment records by advocating for the Overdose Prevention and Patient Safety Act (H.R. 6082). H.R. 6082 would align regulations governing the confidentiality of SUD treatment records (42 CFR Part 2, or “Part 2”) with HIPAA standards. This approach is detrimental because HIPAA does not require patient consent to share medical records for the purposes of securing healthcare treatment or payment. The bill ultimately was not adopted in the final bipartisan package that became law, but efforts to pass the bill in the remainder of the 115th Congress continue. NAADAC remains concerned that H.R. 6082 would weaken protections for individuals with SUD treatment and recovery history and may discourage individuals from seeking SUD treatment due to the perceived risks associated with exposing patient records and other sensitive information. We ask all addiction professionals to contact their legislators to urge support to allow HHS to fulfill its mandate in the SUPPORT for Patients and Communities Act while maintaining the privacy protections of individuals living with SUD. It is vital to reject any last-minute efforts to advance legislation that seeks to align 42 CFR Part 2 with HIPAA standards. Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Professionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 25 years as well as an international, national and state trainer in a variety of topics. Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders, and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State. Tim Casey is a policy advisor at Polsinelli. He has a proven record of leadership in advancing the federal priorities of national associations, corporations, consumer organizations, and nonprofits. On Capitol Hill, Casey is a trusted resource to Members of Congress and their staff. Casey’s experience in the House and Senate combined with his time as a senior lobbyist for prominent health care organizations offers clients sound policy advice, strategic political counsel, and a keen instinct for delivering on key priorities before Congress and the Administration.
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Reflections on a NAADAC Presidency By Gerard J. Schmidt, MA, LPC, MAC, NAADAC Immediate Past-President As I sit here thinking about composing my final article as President of NAADAC, I am full of emotions and thoughts. I have to say that these past two years serving as President have gone by quickly and it is hard to believe that by the time this goes to print, I will have turned the position over to the very capable hands of Diane Sevening. When I reflect on these past two years, it is difficult to point to any one event, meeting, or experience that meant more to me than any other. I was most pleased to have had the opportunity to travel the country meeting and interacting with all of the wonderful addiction treatment professionals involved in a variety of program and services. I was always energized and felt blessed to be in their presence as they described their work and the passion and dedication with which they approached it each and every day. One particularly unique, fun, and remarkably refreshing experience I had during my tenure was attending the conference held by the Montana Association of Alcoholism and Drug Abuse Counselors (MAADAC), NAADAC’s Montana affiliate. Attending this conference provided me with an opportunity to get to a part of the country that probably feels forgotten at times because of its location. Having the chance to go there, meet the members, and have the opportunity to train was wonderful. The MAADAC members were so enthused by what they did and so anxious for new information and the time to be able to talk and connect with me as the representative of NAADAC. Malcolm Horn, the Northwest Regional Vice President, has done a magnificent job of organizing and growing the Montana affiliate. Another set of experiences worth noting were the trainings that were done last year in Maui and Oahu, Hawaii. Again, I had the opportunity to engage with a part of our membership that is separated by distance but certainly not forgotten. NAADAC’s Executive Director, Cynthia Moreno Tuohy, and I, along with other trainers, provided trainings for and interacted with individuals from several of the Hawaiian islands and from across the continental United States. The attendees’ enthusiasm and desire to learn more about this process, as well as about NAADAC and membership, was energizing and rewarding. These interactions are always so valuable because they give us at NAADAC a chance for direct feedback on their needs and the needs of those they serve that are unique to their region. Finally, it was exciting being able to visit Jackson, Mississippi,
to represent NAADAC at the Workforce Forum hosted by NAADAC, the Substance and Mental Health Services Administration (SAMHSA), and the Mississippi Department of Mental Health, Bureau of Alcohol and Drug Services. The organization, involvement, and overall breadth and depth of those in attendance was overwhelming. They had representation from schools of nursing, social work, counseling, and pharmacy, as well as strong attendance from local high school juniors and seniors. The agenda and presentations were hearty and my experience of being able to be an active participant, as well as an attendee, was exciting. During my tenure I have enjoyed being an active member of a variety of national committees and having the opportunity to represent NAADAC and provide input that reflects the realities of the profession. I must admit, there are times when representing our position can be a tenuous one and can be met with some resistance because as we all know, everyone does not agree or conform to how treatment can and needs to be provided and determining the priorities for care. Rest assured, our voice is being heard and it is making a difference! My involvement in the ongoing cohorts of the NAADAC Minority Fellowship Program has been incredible. To have the opportunity to work with and mentor these young, and sometimes not so young, students as they prepare themselves through their addiction training and education to enter the profession has been rewarding. I found that while these students look towards us for guidance and answers for direction, I am always enthralled by their energy, thirst, and enthusiasm for knowledge, skills, and experience. I would have to say that based on the quality and caliber of the cohorts, we are in very capable hands going into the future. There are so many people I need to thank for all of their constant support and commitment to the process over these past few years. I have to start with the wonderful Executive Committee, with whom I am blessed to have worked and shared experiences. Our countless calls, meetings, and conversations have been invaluable. I am always impressed and amazed at the depth of knowledge and skills sitting around the table or on the calls. As a member, you need to know these individuals give countless hours of their own time to lead and direct the work of the organization. I cannot begin to thank them enough. Words cannot express my gratitude to the staff at the NAADAC office. Their patience with me, as well as their guidance and direction and their willingness to get information to me, has been exceptional. HeidiAnne, Jessica, Ace and my West Virginia girl Donna are all so special to me, and many thanks again. FA L L 2 018 | A d va n ce s i n A d d i c t i o n & R e c o v e r y 13
Call for Presentations
Learn more and apply at www.naadac.org/ ac19-call-for-presentations NAADAC invites you to submit a proposal to present a breakout session at its 2019 Annual Conference: Navigating the Addiction Profession in Orlando, FL. The 2019 Annual Conference will be held at the Renaissance Orlando at SeaWorld from September 28 – October 3, with concurrent morning and afternoon breakout sessions occurring on September 29 – October 1. NAADAC members and non-members are invited to submit presentation proposals for 1.5 hour breakout sessions to fit
Submission Deadline: January 15, 2019
within 10 different tracks, including specific tracks for Peers and Addiction Educators. NAADAC encourages young investigators, researches, and addiction and co-occurring professionals from diverse organizations and disciplines to submit.
NAADAC’s celebrated Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know has been updated! Integrating Treatment for Co-occurring Disorders is a skill-based training manual to help addiction counselors improve their ability to assist clients who have co-occurring disorders. This introductory educational program is designed for those who do not have a significant background with co-occurring disorders and discusses: Updates include: • DSM-5 diagnostic criteria and newest ASAM criteria • Current terminology • An expanded list of medications • Treatment Strategies • Support for evidence-based practice and theory by research published since last edition
INDEPENDENT STUDY COURSE: 160-page manual + online exam with 8 nationally approved CEs. NAADAC Members $116 Non-members $155
• The many myths related to mental illness treatment, • Barriers to assessing and treating co-occurring disorders, • Relevant research and prevalence data, • Commonly encountered mental disorders, • Applicable screening and assessment instruments, and • Issues surrounding medication management and coordinating with other mental health professionals.
MANUAL ONLY: NAADAC Members $37 Non-members $50
Order your copy today! Visit www.naadac.org/bookstore for more information. 14
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I want to personally and publically thank Cynthia for all she has done for me during these past two years. I often kidded her that I spend more time talking to her than I do to my wife, Nancy! Our relationship goes back nearly 30 years but working with her in this capacity has shown me such a different side of her. I have always known she was a high energy person but trust me, until you have a chance to sit in this seat, you have no idea! Whether it’s an early morning call from the West Coast or a late night call for an emergent issue, she always made herself available. I marvel at not only her energy but the volume of work that she can turn out in such a brief period of time. Thank you, Cynthia, not only for your leadership and the skills you bring us, but more importantly for your friendship and the pleasure of enjoying this ride together. Finally, to all of you, as members and providers who step up and meet the challenges inherit in this profession: there is no greater satisfaction as your President then having the honor and the privilege of representing such a fine group of professionals. I have traveled throughout the world and met so many wonderful people but none finer than those who are proud to call themselves substance use disorder treatment professionals. We are unique and we all know that treatment works! Recovery is possible! Blessings to you all and thank you for all that you do. Gerard J. Schmidt, MA, LPC, MAC, is Immediate Past-President of NAADAC, the Association for Addiction Professionals and the Chief Operations Officer at Valley HealthCare System in Morgantown, WV. He has served in the mental health and addictions treatment profession for the past 45 years. Publications to Schmidt’s credit include several articles on the development of Employee Assistance Programs in rural areas and wellness in the workplace, addictions practice in the residential settings and an overview of addictions practice in the United States. He has edited Treatment Improvement Protocols
for CSAT for several years and has been active with the Mid-Atlantic ATTC. Schmidt had served as Chair of the National Certification Commission for Addiction Professionals (NCC AP) and NAADAC’s Public Policy Committee, and as NAADAC’s Clinical Affairs Consultant. Awards include the Distinguished Service Award in 2003 and the Senator Harold Hughes Advocate of the Year in 2010. In addition to his national and international work, Schmidt has been active within West Virginia in advocating for and supporting State legislative issues related to addictions and addiction treatment.
Join NAADAC & National Council for Behavioral Health in Kosovo Connect with addiction and mental health professionals in Kosovo on the NAADAC and the National Council for Behavioral Health delegation from May 18 – 25, 2019. Led by NAADAC Executive Director Cynthia Moreno Tuohy and the National Council for Behavioral Health President and CEO Linda Rosenberg, the program will give you a unique opportunity to learn about the state of addiction and mental health programs in this developing country, the Balkan region, and Eastern Europe.
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NAADAC Honors 2018 National Award Winners By Kristin Hamilton, JD, NAADAC Sr. Communications Manager Each year, NAADAC honors the work of dedicated addiction professionals, organizations, and public figures during its President’s Awards Luncheon at the Annual Conference. This year, NAADAC presented awards to five outstanding individuals for their extraordinary service and contributions to the addiction profession and to one outstanding organization for its strong commitment to the addiction profession and individual addiction professionals.
ADDICTION EDUCATOR OF THE YEAR AWARD: Donald P. Osborn, PhD, LCSW, LMFT, LCAC, MAC This award is presented to an educator who has made an outstanding contribution to addiction education. This year’s recipient of the Addiction Educator of the Year Award, Donald P. Osborn, PhD, LCSW, LMFT, LCAC, MAC, is a kind, compassionate, and generous educator with over 26 years of experience guiding students along the path to education and employment in the addiction profession. Osborn received his Bachelor of Arts degree in Christian Ministries from Lincoln Christian University, his Master of Science degree in Counseling from Indiana State University, his Master of Arts degree in Theology from Saint Mary-of-the-Woods College, and his Doctor of Philosophy degree in Guidance and Psychological Services with a Specialization in Counselor Education and Clinical Supervision from Indiana State University. Osborn has served as the President of NAADAC, as Regional Vice President, and as Chairman of the National Addiction Studies and Standards Accreditation Committee (NASAC). He has also served as a member of the American Society of Addictions Medicine’s (ASAM) Diagnostic and Addiction Treatment Criteria Committee. In 2011, Osborn was selected to lead the first United States delegation of addiction and mental health treatment professionals and educators to Cuba to review treatment facilities and practices. In 2014, Osborn was appointed to the Indiana Behavioral Health and Human Services Licensure Board (BHHSLB), of which he became the Chair and President in 2016. Osborn has served the addictions profession in various settings, including outpatient mental health, correctional settings, and his current capacity as Director of Graduate Clinical Addictions Counseling with Indiana Wesleyan University (IWU). He is credited with playing a primary and supportive role in the design and implementation of the undergraduate and graduate addictions counseling programs at IWU. Throughout his years in the addiction profession, Osborn worked with educators in Indiana to create a standardized curriculum for an Associate degree in Addictions. He then went to educators across the country to create standardized curriculum for Bachelor’s, Master’s, and Doctoral degrees in Addiction. Osborn has worked diligently to support the addiction profession and to create an academic career ladder for aspiring and existing addictions counselors in Indiana and nationally. As a mentor to many, he is affectionately known as “Dr. O” by his students. Students who graduate from Osborn’s programs emerge ready to lead the profession, not merely to work in it. Osborn is uniquely qualified to lead students down the path to education and licensure in Indiana because he helped create it. 16
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LIFETIME HONORARY MEMBERSHIP AWARD: Ralph Edward Jones, Sr., PhD, LCDC, LPC This award recognizes an individual who has established outstanding service through a lifetime of consistent contributions to the advancement of NAADAC, the addiction profession, and its professionals. This year’s recipient Ralph Edward Jones, Sr., PhD, LCDC, LPC, of the Lifetime Honorary Membership Award is a dedicated and active advocate for persons with substance use disorders. His passion for serving the recovery community extends to his willingness to guide, mentor, educate, and make lifelong friends with other professionals in the addiction field. Jones is a long-time member of NAADAC and the Texas Association of Addiction Professionals (TAAP), a founding member of the Valley Association of Addiction Professionals, and Vice Chairman of the Governor’s Texas State Independent Living Council (SILC). He was instrumental in Texas legislative efforts to increase funding for substance use disorder services and mental health and was one of the leading advocates for the development and implementation of the Licensed Chemical Dependency Counselor licensure program in the State of Texas. Jones began his career serving in the Airforce and was selected to enter into its relatively new Social Actions Program. Through this program, he became an Alcohol and Drug Counselor and Technician, and he was eventually responsible for the implementation of an ambitious training program in human relations for over 3,000 personnel and personally counseled, administered, and managed over 400 personnel in the Drug and Alcohol Rehabilitation Program. During this time, Jones played a key role in establishing the Air Training Command Alcohol Evaluation Program, which is now used throughout the Air Force. After 22 years of serving both his country and the addiction community, Jones retired from the military and assumed the role of the Director and Substance Abuse Program Administrator of the Del Rio Mental Health Clinic, followed by the role of Chemical Dependency Administrator at the Rio Grande State Center. He has also been on the faculty at five different colleges and universities throughout Texas. During this time, Jones published hundreds of articles, books, essays, and other publications to promote education and awareness, and has been the recipient of dozens of awards, including TAAP’s Counselor of the Year, the U.S. Airforce Meritorious Service Metal, and induction into TAAP’s Hall of Fame. Throughout his career, Jones has proven himself to be an excellent counselor, administrator, leader, and advocate within the addiction profession. He has been described by his peers as a “grassroots organizer,” “role model,” “servant for the betterment of others,” and “the best one-on-one counselor [the writer has] ever seen.” Jones has lived his life in service of others and his impact on the addiction profession and those it serves is immeasurable. NAADAC is honored to award him the Lifetime Honorary Membership Award.
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LORA ROE MEMORIAL ADDICTION COUNSELOR OF THE YEAR: Robert L. Nutt, MSW, LICSW, CADAC, LADAC, SAP, CAS, BCD, EMDRIA This award, renamed for Lora Roe in 1988, is presented to a counselor who has made an outstanding contribution to the profession of addiction counseling. Robert L. Nutt, MSW, LICSW, CADAC, LADAC, SAP, CAS, BCD, EMDRIA, the recipient of this year’s Lora Roe Memorial Addiction Counselor of the Year award, is a committed, caring, and skilled counselor. He has made valuable contributions to the treatment of addiction and has consistently and diligently worked to provide his clients with specialized and cutting-edge evidence-based treatment to treat their substance use and mental health disorders. Nutt has a reputation for being both compassionate and frank, and for being highly skilled in treating clients from all walks of life. He is held in high esteem by peers and clients alike and is known for forming caring and meaningful relationships with his clients. Nutt has spent his career in the greater Boston area and is a member of NAADAC’s Massachusetts affiliate, the Massachusetts Association of Alcoholism & Drug Abuse Counselors, Inc. (MAADAC). After graduating from the Boston College School of Social Work, Nutt worked at a mental health and substance use disorder outpatient clinic for many years before beginning his sub-specialty work in couples and family therapy. Nutt completed a three-year post-graduated training program in couples and family therapy at the Kantor Family Institute, headed by David Kantor, author of Inside the Family. While attending the Kantor institute, Nutt joined a group practice with twelve other clinicians, forming Access For Change. This group practiced as a behavioral health and consultation group for almost twenty years. Nutt is also the recipient of MAADAC’s Counselor of the Year Award. Nutt has spent his career striving for and often attaining excellence. He is sought after for his work and frequently has clients who return to his care decades after their original treatment or refer their spouses, children, or friends to him for treatment. His compassion for his clients is evident and his passion for his work is extraordinary. He has clients who are fiercely loyal to him, peers who hold him in the highest esteem, and a reputation for continuously working to better himself and those around him.
MEL SCHULSTAD PROFESSIONAL OF THE YEAR: Shelly Dutch, CSAC, ICS This award was created in November 1979 by Jay Lewis, former editor and publisher of The Alcoholism Report, and a select group of his peers and colleagues, to recognize an individual who has made outstanding and sustained contributions to the advancement of the addiction counseling profession. This years’ recipient of the Mel Schulstad Professional of the Year award, Shelly Dutch, CSAC, ICS, has demonstrated a lifelong commitment to successfully enhance opportunities for individuals with substance use disorders. She has been an innovator in creating successful group dynamics, personal connectivity, and methods for recovering individuals to give back to stay actively engaged in recovery and multiply their own recovery gift. Dutch was an early pioneer of mentorship in the outpatient setting. She is the founder, owner, and director of Connections Counseling, LLC (“Connections”) a Madison, WI, outpatient clinic for substance use and mental health disorders. Under Dutch’s leadership, Connections developed an active mentor program and has forged a relationship to provide services to students at the University of Wisconsin Madison. Dutch is credited with being exemplary at finding the best in each person and connecting him or her with other individuals and supports to leverage their recovery efforts. 18
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Dutch is a co-founder of Horizon High School (HHS), a non-profit recovery high school in Madison, WI. HHS has continuously operated since January 2005, and is one of an estimated 35 recovery focused high schools in the United States and the only one in Wisconsin. Dutch also founded the Recovery Foundation, Inc., a 501(c) non-profit organization to raise funds for outpatient substance use disorder treatment scholarships, mentorship, and education around long term recovery in 2005. Dutch has actively served on the volunteer board of directors of Recovery Foundation 13 years since its founding. Directly and indirectly through staff development, policy, and energetic board-level activism, Dutch has touched countless individuals and families in Wisconsin. Her humble “worker among workers” attitude endears her to clients, staff, families, collaborative partners, and community members. She has worked tirelessly to advance the addiction counseling profession and to improve resources for those it serves.
MEDICAL PROFESSIONAL OF THE YEAR: Davida Coady, MD, PhD This award is presented to a medical professional who has made an outstanding contribution to the addiction profession. NAADAC is honored to posthumously award this year’s Medical Professional of the Year Award to Davida Coady, MD, PhD. Coady devoted her life to doing the greatest good for the greatest number of people and serving those who needed it the most. She was both a physician and an activist, and believed, as she wrote in her memoir, that, “[i]f you’re a doctor, you’re every kind of doctor.” Coady completed medical school at Columbia University, spending a semester in Africa and subsequent stints in Haiti and Guatemala. Though she trained as a pediatrician, her experiences abroad led to a commitment in public health and international health. Coady was among the first responders to humanitarian crises in Biafra, Bangladesh, Cambodia, India and Central America. She earned a Master’s degree in public health from Harvard University and worked to establish medical services in Bangladesh and in India before becoming involved in efforts to resist repressive regimes in Central America. Coady served as Medical Director for the Peace Corps, and while in India, she worked with Mother Teresa, who invited Davida to become her medical director — and a nun. Coady considered both options, but decided her long-term future lay elsewhere. By the mid-90s, Coady was working as an Emergency Room pediatrician at Oakland’s Children’s Hospital. She treated many abused children and observed that she never saw a physically abused child where alcohol or drugs were not involved. This realization led her to begin her transition to working in the addiction profession. Coady worked as a drug and alcohol counselor for the Berkeley Mental Health Department and in 1997, she founded Options Recovery Services (Options). Options began as a diversion treatment program for the Berkeley Court, but grew to offer a variety of evidence-based treatment, including sober living opportunities, that has helped more than 10,000 people get sober. Options expanded its work to the California prison system in 2006, preparing several hundred inmates over the years to become state-certified addiction treatment counselors through the Offender Mentor Program. A week after celebrating her 80th birthday on April 15, 2018, Coady and her husband, Tom Gorham, decided that she would not seek further treatment for her ovarian cancer. Coady passed away peacefully on May 3, 2018, in Alamo, CA, in the company of her loved ones. Coady will be remembered as a force for good and for her vision of reaching out to the poor and imprisoned in finding the path to lifeaffirming sobriety and service.
ORGANIZATIONAL ACHIEVEMENT AWARD: Tung Wah Group of Hospitals This award is presented to organizations that have demonstrated a strong commitment to the addiction profession and particularly strong support for the individual addiction professional. The Tung Wah Group of Hospitals (TWGH), located in Hong Kong and this years’ recipient of the Organizational Achievement Award, has demonstrated a strong commitment to the direct services of addiction prevention and treatment, as well as to the development of the addiction profession. TWGH is home to addiction treatment centers that provide treatment and prevention services for substance use disorder, smoking addiction, gambling disorder, internet and gaming disorder, and multi-expressions of addiction and serve over 33,000 people in their treatment and prevention programs each year. These centers utilize a multi-disciplinary team model that includes treatment and intervention from medical doctors, psychiatrists, therapists, psychiatric nurses, clinical psychologists, social workers and counsellors. Regular supervision by local and overseas renowned experts provide support and guidance in case management and treatment. TWGH is directly responsible for improving the quality of treatment provided to individuals with substance use disorders and co-occurring disorders in Hong Kong, which lacked formal training institutions and had no professional standards or accreditation bodies for addiction professionals. Instead, most people working in the addiction field relied solely on on-the-job training and did not receive professional recognition. To remedy this, TWGHs has actively pursued the establishment of professional accreditations for addiction professionals in Hong Kong.
Since 2013, TWGH has been actively promoting the specialization status of addiction professionals through the establishment of a local credentialing body, the Asia Pacific Certification Commission for Addiction Professionals (APCC AP), which is affiliated with the National Certification Commission for Addiction Professionals (NCC AP), and the establishment of a local membership association, Asia Pacific Association for Addiction Professionals (APAAP), which is affiliated with NAADAC. TWGH has also facilitated increased and improved training and education opportunities for practitioners treating those with substance use disorders and co-occurring disorders by organizing and providing evidence-based and internationally recognized conferences and trainings. The effort and diligence put forth by the staff and leadership at TWGH has improved and increased the treatment available to individuals with substance use disorder and co-occurring disorders in Hong Kong. TWGH has demonstrated great commitment to the training of and knowledge sharing among local helping professionals that greatly benefits the community and will continue to do so in years to come. Kristin Hamilton, JD, is the Senior Communications Manager for NAADAC, the Association for Addiction Professionals. She works on NAADAC public relations, communications, and digital media, including the NAADAC website and social media, is editor of NAADAC’s two ePublications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate, and is asso ciate editor for NAADAC’s magazine, Advances in Addiction and Recovery. She also contributes to the planning, organization, and administration of communication campaigns, administers the PhD Candidate Survey Program, and serves as the affiliate liaison for the Communications Department. Hamilton holds a Juris Doctorate from Northeastern University School of Law in Boston, MA and a Bachelor of Science degree in Biology and Chemistry from Roger Williams University in Bristol, RI.
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2018 Annual Conference Highlights With over 950 participants, 85 exhibitors, 70 presentations, and 95 presenters, the NAADAC 2018 Annual Conference: Shoot for the Stars in Houston, TX from October 5 – 9 was a huge success! NAADAC members and other addiction professionals from across the country and around the globe received up-to-date information from the top industry experts on the latest trends, practices, and critical issues that impact addiction professionals, built their businesses and networks, and had fun! NAADAC would like to extend its gratitude to all of the presenters, speakers, sponsors, and partners who contributed to make this year’s conference a success.
Missed Houston? You can still lear n fr om the best of the best on your own time! Materials and handouts from sessions are available at www.naadac.org/ ac18-presenter-materials.
Hope to See You in Orlando! The 2019 NAADAC Annual Conference: Navigating the Addiction Profession will take place at the Renaissance Orlando at SeaWorld from September 28 – October 3, 2019, including pre-conference training sessions on September 28, post-conference training sessions on October 2, and a two-day U.S. Department of Transportation Substance Abuse Professional (SAP) Qualification course and two-day Conflict Resolution for Recovery Course on October 2 – 3. Regular conference sessions will take place September 29 – October 1. For more information, please visit www. naadac.org/annualconference. We look forward to seeing you next year!
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New Reasons Counselors Should Address Smoking in Their Patients By Jack B. Stein, PhD, MSW and Eric M. Wargo, PhD, National Institute on Drug Abuse
S
moking goes hand in hand with mental illness and substance use disorders. Although roughly a quarter of the U.S. population has a mental illness or substance use disorder, people with these conditions account for 40 percent of the cigarettes sold (SAMHSA, 2013). A recent study found that people with mental illness or substance use disorders die five years earlier than the rest of the population on average—often from cardiovascular diseases, cancer, and other conditions associated with smoking (Druss, Zhao, Von Esenwein, Morrato & Marcus, 2011). Drug users who smoke are four times more likely to die prematurely than those who don’t smoke (Centers for Disease Control and Prevention, 2018).
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In the past, treatment providers have tended to ignore smoking in patients with addiction or other psychiatric disorders due to the mistaken belief that there are bigger fish to fry in their treatment and even that smoking may serve as a form of self-medication, with that benefit outweighing the health risks. Tobacco companies themselves worked to foster these beliefs, along with the argument that encouraging smoking cessation in people with mental illness is ill-advised (Prochaska, Hall, & Bero, 2008). But as we learn more about the mutually reinforcing role of multiple substances in drug addiction (polypharmacy), these outworn and discredited notions must be set aside in favor of a comprehensive treatment philosophy that incorporates smoking cessation along with other aspects of treatment. In fact, continuing nicotine use may play an important role in maintaining an individual’s other addictions. Nicotine has long been suspected to be a “gateway” substance potentiating or fostering other kinds of drug misuse, yet the reasons users of “harder” drugs typically begin with tobacco have been debated. The simple fact that cigarettes are legal and widely available means that it is much more likely that an individual will initiate drug use with nicotine and not, say, heroin or cocaine. But recent research has shown that there really is something unique about nicotine in the way it fosters other addictive behaviors. Ironically, it may have a lot to do with the relatively milder pleasure or euphoria produced by nicotine compared to other drugs. Although nicotine does not produce the extreme reward (pleasure) associated with other drug highs, smoking a cigarette is highly reinforcing—a crucial distinction. Like most other drugs, inhaling nicotine produces bursts of dopamine in circuits linking the limbic reward circuits (nucleus accumbens and striatum) with the areas like the amygdala that govern mood and with the prefrontal cortex, the seat of judgement and self-control. These dopamine bursts tie mood and judgment to the pleasure of the puff on a cigarette, strongly “teaching” the brain to repeat the experience of obtaining and smoking cigarettes. The fact that any single puff is only mildly rewarding means that the act is repeated—over the few minutes of smoking a cigarette and then from cigarette to cigarette over the course of the day. It adds up to a lot of opportunities to reinforce the act of smoking as a central, deeply reassuring part of the individual’s life. It was not known until relatively recently that nicotine can also potentiate the enjoyment of other behaviors, including other drug-taking behaviors. Animal research has shown that nicotine primes individuals to self-administer cocaine, whereas cocaine will not make them more likely
to self-administer nicotine—effectively supporting the hypothesis that nicotine is special as a gateway substance. Research by Denise B. Kandel and Eric R. Kandel at Columbia University has elucidated the underlying mechanisms for this effect: in the reward circuit, nicotine encourages the expression of a gene that underlies the dopamine teaching (reinforcement) signal mentioned previously (Levine et al., 2011). Consistent with the stereotypical use of a cigarette to accompany other pleasurable activities, recent research by Joshua A. Karelitz and Kenneth A. Perkins at the University of Pittsburgh School of Medicine shows that nicotine also makes other, non-drug-related activities more enjoyable. Karelitz and Perkins showed that nicotine enhances the pleasure obtained from music and visual stimuli (videos) and that it made smokers become habituated to (that is, bored by) a visual reinforcer more slowly (Perkins, Karelitz, & Boldry, 2017; Karelitz & Perkins, 2018). These secondary reinforcing effects of nicotine go a long way to helping explain why smokers have such a hard time quitting. Besides contending with the cravings and withdrawal symptoms produced by nicotine addiction, smokers also have difficulty enjoying other activities without the presence of nicotine. These reinforcement-enhancing effects of nicotine apply also when using e-cigarettes (Perkins, Karelitz & Michael, 2015). The ability of nicotine to enhance the pleasure of other activities and encourage other forms of drug use highlights the importance of addressing nicotine addiction in patients with other substance use disorders. Smoking is not a substitute for other drugs or a useful way to self-medicate; instead, it may be contributing to the intractability of other addictions. Although less is known about e-cigarettes and their nicotine content may be variable, these devices too may be detrimental to individuals undergoing drug addiction treatment, even if the long-term impact of vaping on lung health turns out to be less dire than smoked tobacco. Nicotine addiction, like other addictions, is eminently treatable both behaviorally and pharmacologically, and as with the brain changes wrought by other forms of chronic substance use and misuse, the brain’s reward circuitry can restore some or all of its original balance after prolonged abstinence from nicotine. This process can be a crucial part of helping addicted individuals regain the ability to live without the support of other substances (e.g., opioids, stimulants, or alcohol) that may be the more explicit focus of their addiction treatment.
Even though illicit drug misuse presents a clear and immediate health threat, both from overdose and from other consequences like infectious disease transmission, people with substance use disorders, like those with other mental illnesses, face a high likelihood of dying from the consequences of cigarette smoking. Since nicotine propagates other addictions, counselors and other treatment providers should not ignore smoking based on the old belief that it is an acceptable vice that possibly compensates or aids in some way the goal of kicking some more dangerous habit. Even in the era of the opioid crisis, it is the nicotine in tobacco products that remains the most quietly insidious addictive substance, and the deadliest. REFERENCES Centers for Disease Control and Prevention. Tobacco use among adults with mental illness and substance use disorders. 2018. Available at: https://www.cdc.gov/tobacco/disparities/ mental-illness-substance-use/index.htm Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Medical Care 2011;49(6):599-604. Karelitz JL, Perkins KA. Tobacco smoking may delay habituation of reinforcer effectiveness in humans. Psychopharmacology 2018;235(8):2315-2321. Levine A, Huang Y, Drisaldi B, Griffin EA Jr., Pollak DD, Xu S, Yin D, Schaffran C, Kandel DB, Kandel ER. Molecular mechanism for a gateway drug: Epigenetic changes initiated by nicotine prime gene expression by cocaine. Science Translational Medicine 2011;3(107):107ra109. Perkins KA, Karelitz JL, Boldry MC. Nicotine Acutely Enhances Reinforcement from NonDrug Rewards in Humans. Frontiers in Psychiatry 2017; 8:65. Perkins KA, Karelitz JL, Michael VC. Reinforcement enhancing effects of acute nicotine via electronic cigarettes. Drug and Alcohol Dependence 2015; 153:104-108 Prochaska JJ, Hall SM, Bero LA. Tobacco use among individuals with schizophrenia: What role has the tobacco industry played? Schizophrenia Bulletin 2008; 34:555-67. Substance Abuse and Mental Health Services Administration. Adults with mental illness of substance use disorder account for 40 percent of all cigarettes smoked. The NSDUH Report 2013 (March 20).
Jack Stein, PhD, MSW, joined the National Institute on Drug Abuse (NIDA) in August 2012 as the Director of the Office of Science Policy and Communications (OSPC). He has over two decades of professional experience in leading national drug and HIV-related research, practice, and policy initiatives for NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.
Eric M. Wargo, PhD, is a science writer in the Science Policy Branch of the Office of Science Policy and Communications at the National Institute on Drug Abuse (NIDA). Before coming to NIDA in 2012, he was Editorial Director at the Association for Psychological Science (APS) in Washington, DC. He received his PhD in Anthropology from Emory University in 2000.
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Alcohol & Women’s Health: Studies Reveal Problems
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By National Institute on Alcohol Abuse and Alcoholism (NIAAA)
ncreases in the prevalence of alcohol misuse and alcohol use disorder (AUD) among women point to a
growing adverse effect of alcohol on the health of women in the United States, according to findings by NIAAA scientists. While alcohol misuse by anyone presents serious public health concerns, women have a higher risk of certain alcohol-related pathologies compared to men. “The harms associated with alcohol misuse in women escalate more quickly, and at lower drinking levels, than in men, and the damage tends to be more severe,” says NIAAA Director George F. Koob, PhD. Alcohol resides predominantly in body water, and pound for pound, women have less water in their bodies than men. This means that after a woman and a man of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration will tend to be higher, putting her at greater risk for harm. Other biological differences may contribute as well. “The worrisome trends we’ve seen lately should make clinicians, researchers, and the public take note and spur action to improve diagnosis, prevention, and treatment of alcohol misuse among women,” Dr. Koob says. A 2015 study led by Aaron White, PhD, NIAAA’s Senior Scientific Advisor to the Director, indicates 24
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that longstanding differences between men and women in alcohol consumption and alcohol-related harms might be narrowing in the United States. The analysis of annual data from the National Survey on Drug Use and Health found that differences in measures such as current drinking, number of drinking days per month, reaching criteria for AUD, and driving under the influence of alcohol in the past year, all narrowed for females and males between 2002 and 2012. The findings suggest that while males still consume more alcohol, the differences between men and women are diminishing. In March 2017, researchers led by Rosalind Breslow, PhD, MPH, RD, of the NIAAA Division of Epidemiology and Prevention Research, reported upward trends in drinking among adults ages 60 and older in the United States, especially among women. While the analysis of data from more than 65,000 participants ages 60 and older in the National Health Interview Survey found that men continue to drink more than women, the prevalence of current drinking increased over time more significantly among women than men, narrowing the gender gap by about 5 percent between 2006 and 2014. The gender gap in binge drinking among adults ages 60 and older also narrowed. “These trends among older adults are particularly concerning, since older adults who drink are at higher risk of unintentional alcohol-related injuries, health problems exacerbated by alcohol use, and alcohol-prescription medication interactions,” says Dr. Breslow. Deidra Roach, MD, a Medical Project Officer in NIAAA’s Division of Treatment and Recovery Research, points to cultural changes as a leading explanation for the increase in alcohol misuse among women. “The culture around women’s drinking has changed dramatically over the past 50 years,” says Dr. Roach. “These days, women often go out for a night on the town with the intention of drinking heavily, and we see the evidence for this all over social media. Stress is another factor. Women experience higher rates of anxiety and depression than men do, and more often drink in response to negative mood states. But while alcohol may ‘take the edge off’ anxiety or elevate a depressed mood in the moment, over the long term, alcohol misuse only makes these problems worse.”
In May 2017, NIAAA researchers provided still more evidence of this troubling trend. Reporting online in JAMA Psychiatry, researchers in the NIAAA Epidemiology and Biometry Branch and their colleagues compared data from the 2001–2002 and the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions. They found that the prevalence of alcohol use, high-risk drinking (defined as drinking, on any day, four or more drinks for women and five or more drinks for men), and AUD increased across almost all sociodemographic groups in the United States over the period between the surveys. With few exceptions, increases in all the outcomes were the greatest among women, older adults, racial/ethnic minorities, and those with lower educational levels and family income. NIAAA is committed to better understanding the causes and consequences of alcohol misuse among women and to developing strategies for addressing it. The NIAAA Strategic Plan 2017–2021 identifies a number of research priorities spanning the Institute’s broad portfolio that are relevant to this issue. Raising awareness about the effects of alcohol on women’s health and safety is a key component of this effort. On June 22, 2017, Dr. Koob and Dr. Roach joined Carlo DiClemente, PhD (University of Maryland, Baltimore County), Barbara McCrady, PhD (University of New Mexico), and Martha Woodroof, former public radio journalist, at a congressional briefing sponsored by the Friends of NIAAA. Titled “The Changing Patterns of Women’s Drinking and Their Impact on Public Health,” the briefing discussed recent trends in alcohol misuse by women and alcohol’s effects on women’s health, as well as evidence-based practices for diagnosing, preventing, and treating alcohol-related conditions in women. “The briefing was an important opportunity to present timely information to congressional staff, an interested and influential audience, on this growing problem,” says Dr. Koob. For more information about women and alcohol use or general information about the health risks of alcohol misuse, visit www.niaaa.nih.gov. REFERENCES White, A.; Castle, I.J.; Chen, C.M.; Shirley, M.; Roach, D.; Hingson, R. Converging patterns of alcohol use and related outcomes among females and males in the United States, 2002 to 2012. Alcoholism: Clinical and Experimental Research 39(9):1712–1726, 2015. PMID: 26331879 Grant, B.F.; Chou, S.P.; Saha, T.D.; Pickering, R.P.; Kerridge, B.T.; Ruan, W.J.; Huang, B.; Jung, J.; Zhang, H.; Fan, A.; Hasin, D.S. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. Online August 9, 2017. PMID: 28793133 The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is one of the 27 institutes and centers that comprise the National Institutes of Health (NIH). NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. It is the largest funder of alcohol research in the world.
What Are the Health Risks Related to Alcohol? Alcohol Use Disorder (AUD) AUD is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe, and recovery is possible regardless of severity. Liver Damage Women who regularly misuse alcohol are more likely to develop alcoholic hepatitis, a serious acute illness, than men who drink the same amount of alcohol. This pattern of drinking can also lead to cirrhosis of the liver. Alcoholic liver disease includes a broad range of diseases, from the less severe—steatosis (fatty liver)—to end-stage liver disease, or cirrhosis (liver cell death). Heart Disease Long-term alcohol misuse is a leading cause of heart disease. Women are more susceptible to alcohol-related heart disease than men, even though they may consume less alcohol over a lifetime than men. Brain Damage Research suggests that alcohol misuse produces brain damage more quickly in women than in men. In addition, because alcohol can disrupt the development of the brain during the adolescent years, teen girls who drink may be more vulnerable to brain damage than teen boys who drink. Women also may be more susceptible than men to alcohol-related blackouts, defined as periods of memory loss of events during intoxication without loss of consciousness. Breast Cancer There is an association between drinking alcohol and developing breast cancer. Women who consume about one drink per day have a 5–9 percent higher chance of developing breast cancer than women who do not drink at all. That risk increases for every additional drink they have per day. Pregnancy Any drinking during pregnancy can be harmful. A woman who drinks during pregnancy puts her fetus at risk for physical, cognitive, or behavioral problems. Drinking during pregnancy can also increase the risk for preterm labor.
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Reality Therapy for Persons with Substance Use Disorders
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By Robert E. Wubbolding, EdD, LPCC, BCC, CRT
or decades, Reality Therapy has been applied to education, mental health and management, as well as to persons with a substance use disorder (Honeyman, 1990); (Wubbolding & Brickell, 2015).
This article describes the theory that supports reality therapy, components of reality therapy, and how it is compatible with stages of recovery. Over many years, the founder of reality therapy, William Glasser MD, continually developed both reality therapy and choice theory. After formulating and developing reality therapy in the 1960’s, Glasser then developed its supporting theory by encompassing and extending the internal control system theory of William Powers (1973) naming it choice theory (1998). Glasser’s choice theory contends that human behavior springs from five generic human needs: self-preservation, belonging, internal control or power, freedom, and fun as well as specific wants or desires related to each need. A central principle is that behaviors generated to fulfill wants and needs can be treated as chosen in many but not every instance. When using reality therapy with substance use disorder issues, counselors present clients with the five needs as motivators. They use the WDEP system of reality therapy to help them satisfy their motivators in positive ways as they journey along the path of recovery. Throughout the process, counselors stress current behaviors but do not pass over or ignore clients’ histories. Clients’ past behavior can be used to help them evaluate their current choices as helpful or not (Wubbolding, 2017).
The Process of Reality Therapy The formulation of reality therapy as the WDEP system serves as an easily remembered blueprint for both counselor and client to utilize in their joint efforts to navigate the waters of recovery.
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– Counselors explore the wants and desires of their clients by inquiring about what they are seeking from the world around them: families, job and many aspects of their environment especially what they wish to derive from their recovery process or from the treatment itself. A sample intervention includes the following with a client in the pre-contemplation stage of recovery. Counselor: We’ve talked a lot about your situation including how people around you disapprove of your substance use. They are very critical of you and at times scream at you in anger and even threaten you. Are you interested in turning this situation around? Client: Yes, I’d be better off if they would leave me alone. Counselor: Is that something you really, really want? Client: Yes. Counselor: Tell me if you want it to the degree that you are willing to change anything that you’ve been doing. Depending on individual circumstances, such interventions fit with any stage of recovery. But I arbitrarily use this brief exploration as useful in the pre-contemplation 26
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stage. The counselor’s application of the W is the discussion of the client’s sense of personal responsibility or locus of control. An additional effective question is, “How much of your trouble are you causing yourself and how much do other people cause?” This inquiry and in fact all reality therapy interventions are made with a compassionate and supportive attitude. Even direct confrontation can be made empathically without arguing or demeaning the client.
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– Throughout the stages of recovery, counselors help clients discuss their feelings, self-talk, and most especially their current actions. They empathize with their shame, guilt and other debilitating feelings, while asking them about their self-talk. Feelings and self-talk connect with actions and these three elements represent the D for Doing. The brief dialogue below illustrates how a counselor can connect these three elements. Keep in mind this intervention could take place
Counselor: That thought never occurred to me. And I’d like to help you substitute that kind of self-talk with what we said before. So you know what to do today and during the next week. Client:I know, I know. Talk to my sponsor, go to the meetings, read the big book, exercise. These are actions. I need to make different statement to myself. “Do what helps me and stop doing what doesn’t help me.”
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– The last comment in the above, abbreviated dialogue represents the central component of reality therapy: self-Evaluation. Throughout the process of recovery counselors employ various kinds of self-evaluation and teach clients to evaluate their actions, choices and their self-talk. Action choices receive the emphasis. The reason is that by changing actions, our thoughts and feelings change also. It is as though we have inside of us a suitcase of behaviors. The handle of the suitcase is anchored to action choices with cognition and feelings beneath. When the client changes action choices, eventually cognition and feelings are altered. Counselor: Have you ever chosen to do something that you did not feel good about doing? Client: You mean, like, getting up early in the morning, cleaning up the house, taking the kids to their soccer games, and worst of all, sitting at a swim meet for hours on end. Counselor: That’s exactly what I mean. In fact, you gave more examples than I thought of. But these examples prove that you can choose to do something that does not have an immediate emotional payoff for you. But you know it makes your relationship with your family stronger. Now I have a very important idea. Tell me how taking your kids to an athletic event is congruent with your recovery? Client: Well, it helps me repair some of the harm that I’ve done. I feel good about that and I know that I’ve done the right thing.
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in the contemplation or preparation stage of recovery. Also, such interventions apply to any stage of recovery. Counselor: You’ve said that you relapsed. It is evident from the look on your face that you’re feeling bad about this. Client: Yes, I’m very ashamed and embarrassed. I feel like I’m right back where I started. Counselor: And yet, in your recovery program the old timers told you about this possibility. And what did they say about a relapse? Client: They said that it does not take me back to the beginning. Counselor: I know you’re overwhelmed with feelings, but could you formulate that statement in a positive way and repeat it to yourself, such as, “I stumbled but I learned from the experience and I will do things that give me successful feelings.” Client: You absolutely refuse to accept that I am a slob.
– Plan of action. The counseling process often ends in the formulation of a plan: to do something better or different. At all stages of recovery, the formulation of plans frequently centers on human relationships with others or with the clients’ relationship with themselves. For example, in the maintenance stage of recovery, plans most often focus on issues other than addictive behaviors such as marriage and family harmony, career advancement, getting along with co-workers and supervisors, altruistic involvements and many others. Reality therapy is a practical system applicable to persons with substance use disorders at any stage of recovery and is eminently useful in treatment planning. Treatment goals are connected to five human needs or motivators. Specific objectives as described in the above abbreviated dialogues aim at satisfying clients’ wants and desires. Counselors assist clients in formulating attainable plans subsequent to helping them conduct a searching self-evaluation of current choices leading to positive, helpful results and productive living. REFERENCES Glasser, W. (1998). Choice theory. NY: HarperCollins. Honeyman, A. (1990). Perceptual changes in addicts as a consequence of reality therapy based on group treatment. Journal of Reality Therapy, 9(2), 53-59. Powers, W. (1973). Behavior: the control of perception. New York: Aldine. Wubbolding, R. (2017). Reality therapy and self-evaluation, the key to client change. Alexandria, VA: American Counseling Association. Wubbolding, R. & Brickell, J. (2015). Counselling with reality therapy (2nd ed.), London, United Kingdom: Speechmark Publishing. Robert E. Wubbolding, EdD, LPCC, BCC, CRT, is the Director of the Center for Reality Therapy in Cincinnati, Ohio. He has served as consultant to the U.S. Air Force social actions programs on military bases in Japan and Korea. He was the Director of Training for the William Glasser Institute (1988 – 2011) and is Professor Emeritus at Xavier University. He is a licensed counselor and psychologist and has trained counselors in North America, Asia, Europe, Middle East, and Australia. Author of 17 books on reality therapy and 42 chapters in textbooks, he continues to practice and teach recent developments in choice theory and reality therapy.
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NHSC Substance Use Disorder Workforce Loan Repayment Program – Do You Qualify? By the Health Resources and Services Administration
Getting Started Step 1: Verify your current employer is an eligible facility by searching HRSA’s Health Workforce Connector at https://connector. hrsa.gov. Step 2: While on the Connector, create your clinician profile so interested sites can search for and recruit you based on your experience and job criteria. Step 3: Network with potential employers during HRSA’s next Virtual Job Fair on November 28, 2018. Visit jobfair.hrsa.gov for more information.
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or nearly 50 years, the Health Resources and Services Administration’s National Health Service Corps (NHSC) has awarded scholarships and
loan repayment to health care providers dedicated to working in areas with limited access to care. NHSC is now building upon this tradition—providing quality care to those who need it most—with a new program to address the opioid epidemic.
The NHSC Substance Use Disorder (SUD) Workforce Loan Repayment Program (LRP) offers student loan repayment awards of up to $75,000 to qualified clinicians in exchange for three years of service at an NHSC-approved site providing SUD services. These sites are located in Health Professional Shortage Areas (HPSA) around the country in rural, urban, and frontier communities. NHSC-approved sites are generally out patient facilities providing primary medical, dental, and/or mental and behavioral health services. These facilities may be federally qualified
health centers, rural health clinics, state or federal correctional facilities, or free clinics. The full list of site types is available on the program’s web page (www.nhsc.hrsa.gov). Applicants from an NHSC-approved SUD treatment facility may receive priority for the NHSC SUD Workforce LRP if they have a DATA 2000 waiver to administer medicationassisted treatment (MAT); serve in an opioid treatment program; or are certified in substance use disorder interventions, such as Master’s-level substance use disorder counselors. HRSA is opening this loan repayment oppor tunity to a broader pool of eligible disciplines and specialties, including substance use disorder counselors, physicians, nurse practitioners, physician assistants who are eligible to administer MAT, behavioral health professionals, registered nurses, and pharmacists. Clinicians accepted to the program will ensure individuals living with the disease of addiction have access to quality health care. Without these clinicians, some individuals would not have the resources they need to recover. Even within our current field, NHSC is helping to address mental and behavioral health needs in the nation’s underserved communities. More than one-third of current NHSC clinicians are mental and behavioral health providers who help combat the opioid crisis our nation is currently facing, as well as work to address serious
The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable. HRSA programs help those in need of high quality primary health care, people living with HIV/AIDS, pregnant women, and mothers. HRSA also supports the training of health professionals, the distribution of providers to areas where they are needed most and improvements in health care delivery.
mental health issues more broadly. Moreover, one in three NHSC clinicians serve in rural communities. The NHSC builds healthy communities by providing financial awards to health care providers committed to serving in the nation’s high-need, rural, and tribal areas. NHSC has provided scholarships and loan repayment for more than 50,000 recipients, helping communities recruit and retain quality primary care clinicians committed to providing care where they are needed most. We encourage eligible addition professionals passionate about helping those with SUD to apply. For the latest information and to sign up for email updates, visit www.nhsc.hrsa.gov.
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Earn 1 CE by Taking an Online Multiple Choice Quiz Earn one Continuing Education hour by taking a multiple choice quiz on this article now at www.naadac.org/magazine-ce-articles. $15 for NAADAC members and non-members. 1. In Dr. Mita Johnson’s article on self-disclosure, which of the following is noted as the best reason to make a self-disclosure with a client? a. During screening to put an anxious client at ease b. When a self-disclosure is thoughtful, intentional, and not impulsive c. When the self-disclosure meets the counselor’s need of gaining respect by the client d. To develop an effective counseling relationship by letting a client know a counselor’s substance use history 2. Regarding Dr. Johnson’s discussion on appropriate self-disclosure, when a client begins asking questions to gather personal information about the counselor, which of the following is the least reasonable option? a. Re-direct the conversation back to the client b. Deflect the client away from their question to other questions c. Answer the question directly in order to build rapport d. Speak in general or third person terms/voice rather than using “I” language 3. In their article protecting patient confidentiality, Cynthia Moreno Tuohy and Tim Casey note that congress recently passed the SUPPORT for Patients and Communities Act (P.L. 115-271). Which of the following is a primary objective of this act? a. To advance treatment and recovery initiatives, improve prevention efforts, and bolster research b. To follow HIPAA regulations in order to share medical records for the purposes of securing healthcare treatment or payment c. To align regulations governing the confidentiality of SUD treatment records (42 CFR Part 2, or “Part 2”) with HIPAA standards d. To amend confidentiality laws in order to assist those seeking SUD treatment as well as the addiction professionals and treatment and recovery support agencies that serve them 4. In their article on the importance of addressing tobacco smoking in treatment, Dr. Jack Stein and Dr. Eric Wargo cite research showing that nicotine also makes other non-drug-related activities more enjoyable. The research showed that nicotine enhances pleasure obtained from which of the following? a. Food b. Music c. Sex d. Alcohol 5. Dr. Stein and Dr. Wargo note that the brain’s reward circuitry can restore some or all of its original balance after prolonged abstinence from nicotine and that this process can be a crucial part of helping addicted individuals regain the ability to live without the support of which of the following? a. Nicotine replacement therapy b. Family and friends c. Other substances d. Counseling 6. In the article on alcohol and women’s health by NIAAA, when comparing data from the National Epidemiologic Survey on Alcohol and Related Conditions from 2001–2002 with that from 2012–2013, which of the following was noted? a. The prevalence of alcohol use, high-risk drinking and AUD increased across almost all sociodemographic groups over the period between the surveys
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b. The prevalence of alcohol use, high-risk drinking and AUD decreased across almost all sociodemographic groups over the period between the surveys c. The prevalence of alcohol use, high-risk drinking and AUD decreased for women over that for men over the period between the surveys d. The prevalence of alcohol use, high-risk drinking and AUD increased most significantly among men, younger adults, and those with higher educational levels and family income 7. In March 2017, NIAAA researchers found that for participants ages 60 and older that: a. Drinking trends for men were in decline when compared to those of women b. The prevalence of current drinking for women increased over time more significantly than for men c. When comparing rates of drinking, the gender gap in binge drinking increased d. Cultural changes where ruled out as a leading explanation for the increase in alcohol misuse among women 8. In Dr. Robert Wubbolding’s article on Reality Therapy, he notes that Glasser’s choice theory contends that human behavior springs from five generic human needs. These five needs are: a. self-esteem, belonging, internal control or power, freedom, and fun b. self-preservation, belonging, emotional regulation, freedom, and fun c. self-preservation, belonging, internal control or power, freedom, and emotional regulation d. self-preservation, belonging, internal control or power, freedom, and fun 9. As noted by Dr. Wubbolding, which of the following is an accurate statement regarding the use of the WDEP system of reality therapy helps clients satisfy which of the following? a. Satisfy their need for change by identifying internal motivators b. Identify and minimize wants and desires for use as they journey along the path of recovery c. Satisfy their motivators in positive ways as they journey along the path of recovery d. Stress current behaviors by not focusing on clients’ histories 10. In the article by the Health Resources and Services Administration (HRSA), on the National Health Service Corps (NHSC) Substance Use Disorder Workforce Loan Repayment Program, which of the following is not an accurate statement associated with this programs? a. NHSC offers student loan repayment awards of up to $75,000 to qualified clinicians in exchange for three years of service at any site providing SUD service b. Applicants from an NHSC-approved SUD treatment facility may receive priority for the loan repayment program if they have a DATA 2000 waiver to administer medication-assisted treatment c. Applicants from an NHSC-approved SUD treatment facility may receive priority for the loan repayment program if they serve in an opioid treatment program d. NHSC will ensure individuals living with the disease of addiction have access to quality health care by providing financial awards to health care providers committed to serving in the nation’s highneed, rural, and tribal areas
■ N A A DAC L E ADE RS HI P NAADAC EXECUTIVE COMMITTEE
NAADAC COMMITTEES
Updated 11/18/2018
North Central
STANDING COMMITTEE CHAIRS
President Diane Sevening, EdD, LAC, 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 Mita Johnson, EdD, LPC, LAC, MAC, SAP Secretary Susan Coyer, MA, AADC-S, MAC, CCJP Treasurer Gregory J. Bennett, LAT, MAC Immediate Past President Gerard J. “Gerry” Schmidt, MA, LPC, MAC, LPC, CAC National Certification Commission for Addiction Professionals (NCC AP) Chair Jerry A. Jenkins, MEd, MAC Executive Director Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP REGIONAL VICE-PRESIDENTS Mid-Atlantic (Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)
Ron Pritchard, CSAC, CAS, NCAC II Mid-Central
James “JJ” Johnson Jr., BS, LADC, ICS Northeast
Clinical Issues Committee Chair Mark Sanders, LCSW, CADC
(Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)
Ethics Committee Chairs Mita Johnson, EdD, LPC, LAC, MAC, SAP Rose Marie, MAC, LCADC, CCS
Northwest
Finance & Audit Committee Chairs Mita Johnson, EdD, LPC, LAC, MAC, SAP Gregory J. Bennett, LAT, MAC
William Keithcart, MA, LADC
(Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)
Malcolm Horn, LCSW, MAC, SAP, NCIP Southeast (Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)
Angela Maxwell, MS, CSAPC Southwest
(Represents Arizona, California, Colorado, Hawaii, Nevada, New Mexico and Utah)
Julio Landero, PhD, MAC, MSW, LADC, LASAC Organizational Member Delegate Jim Gamache, MSW, MLADC, IAADC
(Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)
Membership Committee Chair John Korkow, PhD, LAC, SAP Student Sub-Committee Chair Deborah Fenton-Nichols, EdD, LPC, LAC, NCC Military & Veterans Advisory Committee Chair Ron Pritchard, CSAC, CAS, NCAC II Nominations and Elections Chair Kirk Bowden, PhD, MAC, NCC, LPC Personnel Committee Chair Diane Sevening, EdD, LAC, MAC Professional Practices and Standards Committee Chair Kirk Bowden, PhD, MAC, NCC, LPC Public Policy Committee Co-Chairs Michael Kemp, ICS, CSAC, CSW Sherri Layton, MBA, LCDC, CCS
Gisela Berger, PhD, MAC, LPC, NCC Mid-South (Represents Arkansas, Louisiana, Oklahoma and Texas)
AD HOC COMMITTEE CHAIRS
Matthew Feehery, MBA, LCDC, IAADC
Awards Committee Chair Mary Woods, RN-BC, LADC, MSHS
NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP)
International Committee Chair Elda Chan, PhD, MAC
Jerry A. Jenkins, MEd, MAC NCC AP Chair Alaska
PAST PRESIDENTS 1974-1977 Robert Dorris 1977-1979 Col. Mel Schulstad, CCDC, NCAC II (ret’d) 1979-1981 Jack Hamlin 1981-1982 John Brumbaugh, MA, LSW, CADAC IV, NCAC II 1982-1986 Tom Claunch, CAC 1986-1988 Franklin D. Lisnow, MEd, CAC, MAC 1988-1990 Paul Lubben, NCAC II 1990-1992 Kay Mattingly-Langlois, MA, NCAC II, MAC 1992-1994 Larry Osmonson, CAP, CTRT, NCAC II 1994-1996 Cynthia Moreno NCAC I, CCDC II 1996-1998 Roxanne Kibben, MA, NCAC II 1998-2000 T. Mark Gallagher, NCAC II 2000-2002 Bill B. Burnett, LPC, MAC 2002-2004 Roger A. Curtiss, LAC, NCAC II 2004-2006 Mary Ryan Woods, RNC, LADC, MSHS 2006-2007 Sharon Morgillo Freeman, PhD, APRN-CS, MAC 2007-2010 Patricia M. Greer, BA, LCDC, AAC 2010-2012 Donald P. Osborn, PhD (c), LCAC 2012-2014 Robert C. Richards, MA, NCAC II, CADC III 2014-2016 Kirk Bowden, PhD, MAC, NCC, LPC 2016-2018 Gerard J. Schmidt, MA, LPC, MAC
James “Kansas” Cafferty, MA, LMFT, MCA, CATC, NCAAC NCC AP Chair-Elect California Rose Maire, MAC, LCADC, CCS Secretary New Jersey Elda Chan, PhD, MAC, Grad. Dip. Family Therapy Hong Kong, China M. David Meagher, Esq. Public Member California Christina Migliara, PhD, LMFT, MAC, CAP, CASAC Florida Diane Sevening, EdD, LAC, MAC (ex-officio) South Dakota
NAADAC EDUCATION & RESEARCH FOUNDATION (NERF) NERF Events Fundraising Chair Nancy Deming, LCSW, MAC, AADC-S
Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC Steven Durkee, NCAAC
NAADAC REGIONAL BOARD REPRESENTATIVES NORTHEAST NORTH CENTRAL
MID-CENTRAL
Therissa Libby, PhD, Minnesota Megan Busch, LAC, LPCC, North Dakota Mark Young, South Dakota
Renee Lee, MSW, CADC, Illinois Stewart Ball, MAC, LCAC, LMFT, LCSW, Indiana Steven Durkee, NCAAC, Kentucky Deborah Garrett, BS, CPRM, CPS, Michigan Dorothy Hillaire, LSW, LCDC II, Ohio Daniel Bizjak, MSW, ICS, CSAC, Wisconsin
Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Joe Kelleher, LADC-1, Massachusetts Kelly Luedtke, MEd, CAGS, MLADC, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, SAP, New York John Mann, LADC, Vermont
NORTHWEST Diane C. Ogilvie, MAEd, Alaska Coralee Goni, MS, MBA, MAC, Montana Jennifer Velotta, MNPL, NCAC II, CDP, CPP, Washington
SOUTHWEST
MID-ATLANTIC
Yvonne Fortier, MA, LPC, LISAC, Arizona Thomas Gorham, MA, CADC II, California Agnieszka Baklazec, MA, LPC, LAC, MAC, Colorado David Marlon, MBA, MS, LADC, CAd, Nevada Shawn McMillen, Utah
Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia David Semanco, MAC, CAADC, CSAC, CACAD, Virginia Mary Aldrich-Crouch, MSW, MPH, LICSW, MAC, AADC, West Virginia SOUTHEAST MID-SOUTH Scott Kelley, LCDC, Texas
Sam Long IV, NCAC I, Alabama Bobbie Hayes, LMHC, CAP, Florida Donna Ritter, BT, CAC II, CCS, Georgia Tony Beatty, MA, LCAS, CCS, North Carolina James E. Campbell, LPC, CAC II, MAC, South Carolina Michele Squires, MS, LADAC II, MAC, QCS, Tennessee
Save the Date!
NAADAC, the Association for Addiction Professionals invites you to its 2019 Annual Conference: Navigating the Addiction Profession in Orlando, FL from September 28 – October 3 at the Renaissance Orlando at SeaWorld. Orlando, the “Theme Park Capital of the World,” is home to over a dozen theme parks, world-class golf courses, art galleries, shopping centers, major league sports teams, and a vibrant night life. Don’t miss six days of education, training, networking, and capacity-building with thought leaders in the addiction profession! The conference will feature full-day preand post-conference sessions, a two-day SAP training, a two-day Conflict Resolution for Recovery training, five keynote speakers, and over 60 breakout sessions, onsite bookstores, an Awards Lunch, an extensive Exhibit Hall, and exciting evening activities!
Don’t miss out on this important educational event! Registration Opens January 15, 2019 www.naadac.org/annualconference