SPRING 2021 Vol. 9, No. 2
Welcoming Transgender and Gender Non-Conforming Clients into SUD Treatment By De’An Roper, PhD, LCSW-S, Mark Sanders, LCSW, CADC, Troy Weeldreyer, LMSW, Nathaniel Mason, MEd, NCC, Deniele Fleming, MS, SUDP, and Karl Bolton, LADAC II
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SPRING 2021 Vol. 9 No. 2 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
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Welcoming Transgender and Gender Non-Conforming Clients into SUD Treatment By De’An Roper, PhD, LCSW-S, Mark Sanders, LCSW, CADC, Troy Weeldreyer, LMSW, MSW, MPH, Nathaniel Mason, MEd, NCC, Deniele Fleming, MS, SUDP, and Karl Bolton, LADAC II
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44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 703.741.7686 naadac@naadac.org 703.741.7698
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Kristin Hamilton, JD
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Editorial Advisory Committee
Deann Jepson, MS Advocates for Human Potential, Inc. EAC Chair Kansas Cafferty, LMFT, MCA, CATC, NCAAC AToN Center National Certification Commission for Addiction Professionals (NCC AP)
Peer Recovery Support Impacts Outcomes for Incarcerated Mothers By Dana Simons, LCSW, LCAC and Robyn Lugar, MSW
Roy Kammer, EdD, LADC, ADCR-MN, CPPR, LPC (CD), NCC Hazelden Betty Ford Graduate School of Addiction Studies
24 Customizing Recovery Coaching Training – One Size May Not Fit All By Courtney Kibble, PsyD, LP, LPC, CADC and Mary McClure, EdD, LPC
Donald P. Osborn, PhD, LCSW, LMFT, LCAC, MAC Indiana Wesleyan University
28 NIDA Fosters International Research and Collaborations
Joseph Rosenfeld, PsyD, CRADC, HS-BCP Elgin Community College
By Jack Stein, PhD, National Institute on Drug Abuse, and Steven W. Gust, PhD, National Institute on Drug Abuse
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Researching the Ecology of Addictive Behavior Change for Nicotine By Nancy A. Piotrowski, PhD, MAC, NCC AP Commissioner
■ DEPA R T M EN TS 5 President’s Corner: We Are Called to Be Advocates By Mita M. Johnson, EdD, LPC, MAC, SAP, CTHP-II, NAADAC President
6 From The Executive Director: Our Vision for the Workforce: 2021 Update By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director
8 Certification: NCC AP at Home and Around the World By James “Kansas” Cafferty, LMFT, MAC, NCAAC, NCC AP Chair
9 Ethics: Is Your Organization Ethically Oriented? By Rose Maire, MAC, LCADC, CCS, NCSE, NAADAC Ethics Committee Co-Chair
10 Advocacy: Overview of Latest Federal Substance Use Disorder Investments By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director, Julie Shroyer, MSW, Senior Policy Advisor, Polsinelli and Robert Daley, Legislative Director, Polsinelli
Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP NAADAC, the Association for Addiction Professionals Margaret Smith, EdD, MLADC Ottawa University & Keene State 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 Features Editor, Samson Teklemariam at steklemariam@naadac.org. For more information on submitting articles for inclusion in Advances in Addiction & 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 Marketing 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 ob taining additional copies of this publication, call 703.741.7686 or visit www.naadac.org. Published May 2021
12 Membership: Meet the 2021 Candidates for NAADAC Executive Leadership Positions 15 Events: Engagement in the Black Community: A Virtual Summit
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32 NAADAC CE Quiz 33 NAADAC Leadership
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Master of Social Work
■ P R ESID EN T ’S CO RN E R
We Are Called to Be Advocates By Mita M. Johnson, EdD, LPC, MAC, SAP, CTHP-II, NAADAC President I made it through two graduate programs without ever discussing advocacy in action. It never occurred to me that as a professional working in the helping professions, I would be required to draw attention to the work we do and the clients we serve. Uncomfortable with the idea of politics and government influencing my career aspirations, I would have shied away from any discussion that would require me to consider engaging legislators and other decision-makers about addictions and mental health. I would have told you that I am not articulate enough to talk to legislators – surely, they will talk circles around me without listening to my head or heart. I just want to serve clients and the people who serve clients. Let those who are called to be advocates do what they do best. Well, we can all see how well that worked out for me! What have I learned, since graduate school, along this career journey I have been on? My clients didn’t wake up this morning and decide they wanted to have a substance use or mental health disorder. My clients didn’t want to have an alcohol or heroin or meth use disorder. They didn’t seek out anxiety and depression. They needed the pain to stop. They sought connection. They wanted a way out of their trap. They found a means to cope. Stigma, shame, society, family systems, criminal justice systems, race, age, trauma – all of these and so much more have silenced the voices of our clients. They are not being seen or heard by those who could help change the systems they find themselves in. An advocate is, according to the Merriam-Webster Dictionary, a person who pleads the cause of another. An advocate educates and defends. An advocate supports or promotes the interests or needs of a group or a cause. Advocates demand equal treatment of all people. What I am learning is that I cannot use my lack of confidence or experience in advocacy as an excuse for remaining silent. I cannot make excuses for not advocating for our clients. Our clients need us to be their voice when they cannot be their own voice. They need us to advocate on their behalf, by bringing attention to their biopsychosocial-spiritual-emotional-relational needs. Stigma is real and it comes from all levels of education and all walks of life. Stigma is a barrier to accessing the treatment and recovery support resources our clients so desperately need. Stigma is a barrier to seeing our clients as individuals with a name and not as “those people.” Working in the trenches with co-occurring disorders, we see how our clients are perceived and treated by the criminal justice system, healthcare system, and societal and political systems. Our clients continue to have access to no care or substandard care. They continue to get blamed and rejected. Funding continues to go to other causes deemed more important than the hurting members of our communities. What drew me to NAADAC so many years ago was not only its mission but its people. The people who work for and with NAADAC – all the employees, volunteers, members, and allies – understand, care, and are willing to put themselves out there if it will promote scientific research and clinical practices that benefit clients. NAADAC is not afraid to put
a spotlight on the compelling challenges we face around polysubstance use and co-occurring mental health and addictive behavior disorders. NAADAC willingly and unceasingly speaks out for appropriate allocation of federal and state funding that supports the entire continuum of care from prevention to treatment to recovery support services. NAADAC actively and unabashedly bends the ear of any person who is in a position of influence, who can help us help those who cannot help themselves by themselves. If you are reading this article and thinking, like I did, that you have no idea what to do or where to start, or do not know how to articulate what needs to be said – you are not alone. I am grateful that NAADAC has a Public Policy Committee led by seasoned professionals who can help us learn how to influence emerging policy at the federal and state levels. As professionals and service providers, we are called to be advocates. We may not realize it, but we are advocating for our clients on a regular basis with our colleagues, peers, supervisors, employers, funding sources, referral sources, and educators. We are advocating at the individual, group, institutional, and societal levels. We are advocating within systems – political, professional, and legal. Whenever we are talking about clients and their needs – we are advocating. Whenever we are talking about the issues and the barriers – we are advocating. So, while I may have thought early in my career that advocacy is best left to those who are passionate about being advocates, I no longer have the luxury of thinking that way. As all of us progress in our careers we enter more and more spheres of influence. To remain silent in those spheres of influence – to not give voice to the problems and barriers that we see and encounter on behalf of our clients daily – is to contribute to the stigma and problem. I truly believe it is our ethical and professional responsibility to advocate for those we serve whenever the opportunity arises. Please join NAADAC and me in raising up the needs and concerns of our clients, whenever and wherever you can. Reference “Advocate.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/advocate. Accessed 12 Apr. 2021. Mita M. Johnson, EdD, LPC, LMFT, LAC, MAC, SAP, CTHP-II, has been practicing in the world of mental health, marriage and family, and addictions counseling for the past 30 years. She earned her Doctorate in Counselor Education and Supervision degree and is a core faculty member in the School of Counseling program at Walden University. In addition, she has a thriving private practice where she provides clinical supervision, counseling services to our military, and addiction-specific training and education. She has been providing telebehavioral health services to individuals and groups for several years and is a board-certified telehealth practitioner. She is involved in regulatory and credentialing activities in Colorado and regional workforce recruitment and retention initiatives. Her areas of specialization include pharmacology, co-occurring disorders, ethics, culturally-responsive care, and clinical supervision. She has been an active member of NAADAC for over 15 years, has served as the Ethics Chair, and began her term as NAADAC’s President in October 2020.
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■ F R O M T H E E X E C U T I VE DI RE C TOR
Our Vision for the Workforce: 2021 Update By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director NAADAC has a vision to re-establish and in some cases, establish and expand the addiction workforce. The thirteen months of struggle during the pandemic yielded loss or reduced client connection, infrastructure beguilement, and workforce deterioration while at the same time, the needs of addiction and co-occurring services increased ever so quickly. Now, more than ever, we need to take steps and petition our lawmakers and government agencies to provide supports to strengthen this vital workforce. Developing a stronger, more robust addiction workforce is one of NAADAC’s highest priorities, and we have identified various avenues and means to provide support and action to initiate growth and developent.
Behavioral Workforce Capacity Increasing and strengthening the workforce is critical and new initiatives need to be employed in order to sustain a forward momentum. Underserved areas are only going to be addressed if workers are incentivized to join and remain in the workforce for significant periods of time. This can be accomplished in a number of ways, including raising the salaries of those working in publicly funded agencies, paying salaries for those who are not yet credentialed in their state system and need to accrue their hours of experience, increasing technology available (particularly in public funded agencies), and providing relocation opportunities at the end of
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college programs or employment contracts. In addition to this, second career opportunities need to be made more attractive to those individuals seeking a change in either lifestyle or career.
Non-Traditional Workforce: Peer Support Specialists, Navigators, Health Educators, and Veterans and Their Spouses There has always been a need for non-traditional workers in the workforce. From the very beginnings of this profession, recovering individuals, as well as those directly affected by addiction, have had an adjunctive role in the long-term recovery success of clients. Now more than ever, recovery support specialists and other supportive personnel are considered critical once more traditional services are no longer needed. More training opportunities need to be developed for individuals seeking this type of work experience. Currently, there are not enough qualified individuals in the workforce to fill roles that currently exist—and that does not account for the need to expand the roles for non-traditional partners in recovery. By expending the available training opportunities with quality supervision, more qualified and trained individuals will be able to join the workforce and assume these important and needed roles. Further, the current workforce needs to be educated and trained and taught how to support this alliance of the peer to the professional counselor. Education regarding the non-traditional workforce is vital so the existing workforce does not feel threatened or feel as though they are being eased out of the continuum of care. Education of administrative staff regarding the scopes of practice for each level of service is necessary to discourage the use of peers in profession positions. Instead, the current workforce should be encouraged to buy in to the use of the nontraditional workforce, in appropriate levels of care, leading to the development of a longer and more successful continuum that will benefit the client. NAADAC has worked to conceptualize and build programs to create and develop the non-traditional workforce. One such model developed by NAADAC and funded initially by the Substance and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) built the workforce in parts of the Pacific Jurisdiction where college programs in addiction education do not exist. NAADAC has also worked with prison programs in California to support an educational and credentialing model that prepares inmates in addiction counseling education to meet the hours of education to meet the state requirements; the inmates are even able to take the required credential tests while in prison to prepare them to enter the workforce. NAADAC has presented to SAMHSA a model to develop the workforce among returning military and their spouses. This model would educate and train veterans and their spouses in a 282-hour addiction education course that would satisfy the education requirements at the state and national levels for
a position as a Level 1 addiction counselor; only their work experience hours would remain outstanding to complete the requirements. NAADAC’s National Certification Commission for Addiction Professionals (NCC AP) is developing a national credential, based on the work in the prison programs in California, to add a level to the career ladder for a person with at least 270 training hours who has passed the test and is working toward their experiential hours. This could dramatically build the workforce and employ the veterans returning to civilian service. This model is transferrable to other populations as well. NAADAC has also proposed several other workforce initiatives to SAMHSA that can be undertaken in partnership. These initiatives include: • Recruitment of and mentoring students interested in the addiction workforce by creating a national strategy using the foundation laid by the efforts of the Addiction Technology Transfer Center (ATTC) Network and NAADAC for recruitment and mentoring students and interns. • Training the current addictions workforce to transition to working within the primary and mental health care fields, and the mental health workforce to transition to working within the substance use disorder workforce. This would include education and clinical supervision. NAADAC is currently working with the American Mental Health Counselor Association (AMHCA) on a series of webinars to educate the mental health workforce in substance use disorders as well as build a bridge between both disciplines. This could be expanded to develop each discipline’s workforce and to develop transition initiatives within states for credentialing and licensing toward a nationally recognized credential for co-occurring disorders. • Training the addiction workforce in the development of systems (clinical and IT billing, data collection and reporting) for Medicaid and MCO reimbursement and quality assurance. • Creating a national professional assistance hotline that would include clinical supervision and a referral system for the addiction workforce.
Training and Education Needs The existing workforce is faced with the dilemma of reduced funds available for new training experiences. With increased caseloads, an increased emphasis on productivity, and shrinking funding for education and professional and personal growth within treatment agencies, many providers are locked out of new and innovative trainings. To counter this, more web-based and online trainings need to be made available, and funds need to be allocated and earmarked for agencies for specific and targeted trainings that are evidenced-based, and skills based. NAADAC is an effective national, regional, state, and local distributor of trainings and other initiatives, and is providing this education. It has training and education programs that are steeped in skill and competency development, including a robust webinar series with now over 300 continuing education hours of addiction and mental health webinars available on demand.
Data Needs and Collection Processes The problem with data collection is that it is as diverse as the agencies and programs collecting it. There needs to be some type of standardized data collection process to reduce the duplication that often occurs between the federal and state requirements and local entities. Data collection is just collecting data if nothing is done with it. Meaningful and timely use of all data collected is essential when trying to determine trends in the
population being treated as well as the success of the outcomes of the care being provided. Systems for data collection are essential to reduce the technical assistance needs of the workforce. Funds for technical assistance and training are essential to meet the expectation of electronic health records (EHR) as well as funds to help support EHR development within the publicly funded agencies.
The Need for National Standards and Credentials Licensure and credentialing requirements for addiction professionals vary greatly from state to state and serve as a barrier to entry, advancement, and retention for this key segment of the workforce. The COVID-19 pandemic has also accelerated the advancement of telehealth as an acceptable form of assessment and treatment, so it is more important than ever that we have standardized credentials that are able to cross state boundaries and offer the support that a mobile society of people in recovery needs to have in their lives. Further, new members of the addiction profession have historically been forced to navigate without a distinct roadmap or career ladder to guide their development. In response to this issue, NAADAC, SAMHSA, and other key stakeholders developed a model scope of practice and career ladder for the addiction workforce in 2011. The model outlines reasonable and realistic scopes of practice for each level and provides clear gateways into the profession’s ranks. Adopting a standard, recognizable set of addiction professional credentials would provide clarity for providers and payers, as well as assurance to individuals seeking quality, effective treatment and recovery services for themselves or their loved ones. While licenses are state-issued authorizations to practice in a specific field, credentials are the standard-bearers for experience and levels of education. Some states require credentials in order to attain a license while others do not grant licenses, and instead rely on various certifications to permit a provider to practice within the state. National credentials would set uniform standards for education, experience, and competency, and could be portable at both state and national levels. These standards of knowledge and competency for treating SUDs was supported by the work of SAMHSA and other key stakeholders and published by SAMHSA in the TAP 21 and 21A. Enacted together, these elements would create new generations of treatment providers capable of addressing the full range of SUDs and support individuals, families, and communities in the treatment and recovery continuum to address the current opioid crisis and the next addiction crisis yet to come. We know that these visions and changes will not happen overnight, but we will continue to work to grow and strengthen our workforce so that we can better support and serve those who are in need of our services. 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 48 years. She has been a trainer in Domestic Violence/Anger Management and Conflict Resolution for over 30 years as well as an international, national, and state trainer. Moreno Tuohy is also a curriculum writer in addiction screening and evaluation, counseling methods, conflict resolution, co-occurring disorders, ethics, documentation, and medicated assisted treatment and recovery, and has written articles published in national and other trade magazines. Her book, Rein in Your Brain; from Impulsivity to Thoughtful Living in Recovery, was released May 2014 through Hazelden Publishers. She has served as President of NAADAC, Certification Board Commissioner, International Chair, Treasurer and Legislative Chair for NAADAC.
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NCC AP at Home and Around the World By James “Kansas” Cafferty, LMFT, MAC, NCAAC, NCC AP Chair It is no secret that today, the National Certification Commission for Addiction Professionals (NCC AP) is a significant arm of NAADAC, and responsible for credentialing tens of thousands of addiction professionals across the country. When NCC AP began in 1989, it was formed to credential counselors to treat both alcohol use disorder and drug use disorders under the same credentialing. Out of that development came to be what we now know as the National Certified Addiction Counselor (NCAC) Level I and Level II. Soon thereafter, in 1994, in cooperation with the National Board of Certified Counselors (NBCC) and the Commission on Rehabilitation Counselors Certification (CRCC) came the Master Addiction Counselor (MAC) credential. This completed the core suite of credentials that saw the careers of counselors as evolving, growing, and developing into masters of their professions. Since the beginning, it has been a primary part of NCC AP’s mission to achieve national credentials for our field. It really is to the benefit of our entire profession to find our way there, and we are still working diligently toward the day when payors recognize our credentials as equal and appropriate for reimbursement regardless of which state they are in. We are working hard for the day to come when a counselor who is relocating has to do nothing more than let their new jurisdiction know they are setting up shop and file “transfer paperwork.” Are addiction professionals really studying something better or more evidence-based in one state than another? With varying degrees of certainty, we can say it is unlikely as we all draw our professional tools from the same research. If by some chance there is a discrepancy in the training, the exams work to bring forward the qualified professionals and to send the clear message to those who are not ready that they simply have some more work to do. Our primary focus remains on national credentialing, and over the years we have grown, and our exams are now being used multi-nationally and in multiple languages. While this was not necessarily the original mission NCC AP set out on, it is a challenge we have excitedly embraced. Going back to 2005, NCC AP Commissioners and NAADAC staff and leadership have been working internationally as trainers and consultants in many foreign countries. Often, we were helping them to create their own infrastructure to start the actual field of addiction counseling in their home countries. If you have been to one of the NAADAC Annual Conferences, you may have noticed as you wandered the halls and attended sessions that there is always an international presence. It is not uncommon to find yourself at lunch with some of my longest standing friends in NAADAC, the “Icelandic Contingency” as I like to call them. Not only have they become my dear friends, they are our colleagues and they are studying what we study here—and passing the same tests we are here! Notably, our NCAC I, II, and MAC have been slightly adapted for the International community. If you are abroad, it would be unfair to be asked to answer a question about HIPAA. In addition to the aforementioned Icelandic counselors, NCC AP and NAADAC have also made significant contributions to several other countries and territories, such as Cyprus, Kenya, Egypt, South Korea, Hong Kong, and several of the American Territories such as the Pacific Jurisdiction and Puerto Rico. In fact, our presence is currently growing 8
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considerably as we have formed a deepened relationship with the Global Credentialing and Certification Commission (GCCC), the counseling credentialing arm of the International Society of Substance Use Professionals (ISSUP). These groups get a substantial amount of their funding from the U.S. State Department and have created significant documents to further the field of substance use disorder treatment internationally including the Universal Treatment Curriculum and the Universal Prevention Curriculum. These two highly impressive pieces of work are available and used in countries all over the world and are freely accessible to those of us in the United States, including through the ISSUP website. In fact, NCC AP materials were scrutinized and meticulously reviewed and cross referenced methodically by the GCCC and others, and what has eventually transpired is truly humbling for NCC AP. The meeting of the minds led down a path where our exams have actually been adopted for use by the GCCC! NCC AP, having such a well-developed infrastructure and depth and breadth of testing administration and experience was the perfect fit for an organization that is concerned with finding a way to get people trained and tested even in third world countries. If you take an exam today in Kenya for example, it will be an NCC AP exam. There is so much happening in the world of substance use disorder counseling and NCC AP is at the forefront, leading the way arm-in-arm with the other vital leaders in our profession. Whether it is finding a way to get our exams translated into Arabic with our friends in Egypt, which is complete now, or setting up a proctoring site in American Samoa, you will find NCC AP is serving all of you as proudly as we can. If you feel compelled to be part of something like this, feel free to contact us. There is plenty of work to go around and we need all of you, at all career levels, to do what is right. James “Kansas” Cafferty, LMFT, MAC, NCAAC, serves as the Chair to the National Certification for Addiction Professionals. He has been in the field of substance use disorder treatment since 1997, a year after he entered into recovery himself. He currently serves as the Clinical Director at the Aton Center, a residential treatment center based in the suburbs of San Diego, CA. He has been an active member of NAADAC for 15 years.
■ E T H ICS
Is Your Organization Ethically Oriented? By Rose Maire, MAC, LCADC, CCS, NCSE, NAADAC Ethics Committee Co-Chair Do organizations and agencies need organizational ethics? Does NAADAC’s Code of Ethics apply to organizational members as well as individual members? Foundational to both questions is this question: what is an organization or agency? An organization or agency is an entity of like-minded individuals who share a common vision and purpose. Organizations and agencies can have one employee or thousands of employees. They can be privately or publicly funded, governmental or nongovernmental, and for profit or not-for-profit. Organizations providing addictions-related services have credentialed and noncredentialled professionals and service providers working for them. Most organizations are expected to operate within the scope of a professional Code of Ethics, like NAADAC’s. Most organizations have their own internal ethical philosophy or code of ethics in addition to a professional Code of Ethics such as that published by NAADAC. The organization’s ethics are the values and standards of practice embedded within the framework and mission of their agency that are then carried out by the individuals and professionals employed there. Organizations need ethical principles to guide its operational decisions including its policies and procedures, financial management, marketing, and programming. An organization’s ethical philosophy and adherence to external codes is communicated from the top down – from leadership to its managers, professionals, employees, and support staff. The leadership’s ethical philosophy is communicated internally and externally and can influence the organization’s productivity and reputation, and ultimately its viability. That ethical philosophy translates into an ethically oriented organization. What are the attributes of an ethically oriented organization? At the top of the list is a desire to be an ethical organization that goes above and beyond legally and ethically to demonstrate its commitment to integrity, honesty, and responsibility. An ethically oriented organization has a mission and vision that drives its culture and values. Operational decisionmaking is based on ethical principles and values. All communication – internally and to the public – is ethical, honest, sensitive, professional. Communication including advertising and marketing materials, proposals and applications, and clinical documentation – online, in person, and in writing – is factual, person-sensitive, and client-focused. An investment is made by the agency to maintain an ethical workplace through training, socialization, and leadership engagement. The rights of individuals (employees and clients) are honored and respected. There is concern for one another, as individuals with value and worth. Morale amongst employees is monitored often; employee and client feedback about how the organization is doing is solicited regularly. Employees and others who express concerns to the agency’s leadership about their ethics are not retaliated against. Destructive behaviors, including inappropriate use of power, is
prohibited. There is low tolerance for unethical, immoral and/or illegal behavior; procedures exist to address unethical and/or illegal behavior. The agency takes responsibility for what goes on in its organization and makes amends as needed. Addiction professionals want to work in agencies that value their contribution to the agency, community, and profession. They want a safe workplace that is not driven by ego and power. The need to be respected and valued is understandable. At NAADAC, we value our organizational members for their commitment to our profession. Organizational members have been assaulted on so many fronts, including confusing legislation, billing and reimbursement nightmares, lack of parity, shortage of qualified workforce, credentialing and licensing concerns, scarcity of funding opportunities, employee retention concerns, expensive infrastructure needs, and COVID-19 setbacks. In the midst of all of these issues, it can be hard to monitor the organization’s ethics and hold leadership and the organization accountable for any lack of ethics and professionalism. However, the times call for the organizational member to remain true to its ethical compass; this is not the time to become ethically disoriented. NAADAC understands the struggles our agencies face, and NAADAC encourages its organizational members and its employees to adhere to the most current version of the NAADAC Code of Ethics. We want to stand with you as you strive to do the best you can with what you have. NAADAC’s and NCC AP’s Ethics Committee and your organizational professional liability insurance carrier will make themselves available to answer questions and provide guidance when organizational members are faced with an ethical dilemma. NAADAC is here to support its organizational members who are working to live up to their core values and highest ethical standards. Rose Maire, MAC, LCADC, CCS, NCSE, has worked in the addiction treatment field for over 30 years and is currently the Clinical Director of COPE Center in Montclair, NJ. She holds a Master’s degree in Counseling and is licensed in New Jersey as a Clinical Alcohol and Drug Counselor. She is also certified as a Master Addiction Counselor and a Certified Clinical Supervisor, and holds the National Clinical Supervision Endorsement. Maire has worked in outpatient, intensive outpatient, and short-term residential levels of care. She has also taught graduate level counseling courses and has worked as a Student Assistance Counselor. She is currently a member of the NJ Professional Advisory Committee. She also serves as Secretary to the newly formed New Jersey affiliate of NAADAC. Although she has held many different positions in the field, her first love remains working directly with clients. Maire was a commissioner on the National Certification Commission for Addiction Professionals (NCC AP) for 10 years. She found working with professionals dedicated to maintaining competency standards for addiction treatment professionals to be an honor and a highlight of her career. She currently serves as Co-Chair of the NAADAC Ethics committee.
Want to learn more about becoming a NAADAC organizational member? Visit www.naadac.org/organizational-membership.
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■ A D V O C AC Y
Overview of Latest Federal Substance Use Disorder Investments By Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, NAADAC Executive Director, Julie Shroyer, MSW, Senior Policy Advisor, Polsinelli, and Robert Daley, Legislative Director, Polsinelli This has been a historic time for public recognition of substance use disorders (SUD), as well as new federal investments to increase access to SUD prevention and treatment. In an effort to help NAADAC members navigate and access these newly established funding opportunities, we are providing an overview of those made available at the Substance Abuse and Mental Health Services Administration (SAMHSA), the Federal Communications Commission’s (FCC) telehealth grants, and the American Rescue Plan’s emergency funding for substance use and mental health programs, as well as the Office of National Drug Control Policy’s (ONDCP’s) priorities to address the country’s overdose and addiction epidemic. Of note, the Department of Health and Human Services Secretary Xavier Becerra announced a 90-day extension of the Public Health Emergency on April 7th due to the continued consequences of the opioid crisis affecting our nation.
SAMHSA Funding Since the beginning of the COVID-19 pandemic, Congress has passed a series of relief bills that have provided billions of dollars in emergency funding for SAMHSA. On March 11, 2021, the Biden-Harris Administration announced the allocation of $1.65 billion in emergency funding for the Substance Abuse Prevention and Treatment (SAPT) Block Grant for states and territories. These funds were made available by Congress at the end of 2020. The SAPT Block Grant provides infrastructure support for publicfunded facilities. Each state may distribute funds to local government entities, administrative service organizations, and prevention and treatment service providers in accordance with each state’s plan. The SAPT Block Grant system of selection and payments are well established with a distribution plan in place. Since states have flexibility to implement their own distribution plans, NAADAC recommends that interested entities stay engaged with their 10
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state agencies to determine current and future funding opportunities related to emergency COVID-19 funding. SAMHSA has detailed information on its website to highlight where funds have been allocated for both Fiscal Year (FY) 2020 and FY 2021, with additional funds from the American Recovery Plan yet to be allocated. NAADAC is available to assist our Affiliates in working with their Single State Authority (SSA), the state level authority that oversees the SAPT Block Grant. Those of you who are treatment owners, directors and clinical supervisors will want to connect with your SSA and attend their regular meetings to learn the direction your state is heading regarding the use of this unprecedented funding. You may want to meet with your SSA or others in your state authority’s office to discuss ways you can assist in program development. NAADAC is working at the national level, providing input and making proposals. (NAADAC Executive Director Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP, discusses this work more fully in her article in this issue of Advances in Addiction and Recovery.) NAADAC also advocates that these additional funding dollars not be too restricted in specific categories of funding, such as opioid services, as each state has its own priorities and needs related to other drugs of use. However, all the funds need to be used for SUD related services, infrastructure building and support and workforce building and support.
Telehealth Grants The COVID-19 pandemic has also accelerated the advancement of telehealth. In the past year, Congress has passed legislation to allow for greater use of telehealth. This also included funding for broadband and adoption of telehealth platforms. The FCC announced on March 30, 2021, that the agency would begin accepting applications in late April for a second round of telehealth grants. Congress provided nearly $250 million for the FCC’s COVID-19 Telehealth Program to support provider’s telehealth
applications. Additional information and application instructions will be available on the FCC’s website. The COVID-19 Telehealth Program is intended to provide grants to support the purchase of “telecommunications services, information services, and devices necessary” to provide telehealth and connected care in response to the COVID-19 pandemic. Funding is limited to nonprofit and public eligible health care providers, including: 1. post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools; 2. community health centers or health centers providing health care to migrants; 3. local health departments or agencies; 4. community mental health centers; 5. not-for-profit hospitals; 6. rural health clinics; 7. skilled nursing facilities; or 8. consortia of health care providers consisting of one or more entities falling into the first seven categories. NAADAC recognizes that telehealth is increasingly being utilized in SUD treatment, and began working with Clocktree Telehealth Platform approximately four years ago to make discounts on telehealth services and technical support available to members. More information can be found on the NAADAC website at www.naadac.org/clocktree-telehealth-platform.
American Rescue Plan On Thursday, March 11, 2021, President Joe Biden signed the $1.9 trillion American Rescue Plan Act into law. NAADAC and substance use disorder and mental health stakeholders have been engaging with policymakers for the last year advocating for federal investments to adequately support the prevention, treatment, and recovery support of SUD in communities across the country. Although more investments will be needed both during and after the pandemic, NAADAC is pleased that the American Rescue Plan includes nearly $4 billion in additional emergency funding for substance use and mental health programs. The law also extends unemployment insurance programs, provides assistance to individuals and families, expands health insurance programs, funds public health efforts, and provides aid to small businesses, states and local governments. NAADAC is closely following the implementation of the law and will be keeping our members apprised of agency guidance to ensure that addiction professionals are able to access the substance use disorder program funds to better serve your clients and communities. SAMHSA announces grant applications through Funding Opportunity Announcements (FOAs), which are posted on their website.
President Biden’s Drug Control Priorities On April, 1, 2021, the White House Office of National Drug Control Policy (ONDCP) issued the Biden-Harris Administration’s Statement of Drug Policy Priorities, which includes details on the administration’s first year priorities to address the country’s overdose and addiction epidemic. Moreno Tuohy attended a call with the ONDCP staff to learn the scope of the seven priorities identified. The administration’s priorities range from expanding evidence-based approaches in prevention, treatment, recovery support, and harm reduction services, racial equity, reducing
the supply of illicit substances, and building and advancing the addiction workforce and workplaces. In the coming year, the ONDCP will be working with federal agencies and state and local partners to implement these priorities. NAADAC stands ready to support and build the addiction infrastructure for workplaces and the addiction workforce, and to expand on all seven policies addressed by the Biden-Harris Administration. The addiction pandemic is not resolving – it is only growing and we want to get ahead of the devastating effects on individuals, families, and communities. President Biden will also send his first budget request to Congress in the coming weeks. Presidential budget requests outline an administration’s top spending and legislative priorities for the coming year. While the preliminary Fiscal Year 2022 overview was released just before publication of this issue of Advances in Addiction & Recovery, NAADAC was pleased that President’s new budget will build on ONDCP’s drug policy priorities with increased funding to support research, prevention, treatment, and recovery services to help end the opioid epidemic. NAADAC is working with our stakeholder partners to ensure the administration continues to focus on enforcement of substance use and mental health parity laws, along with proposing a significant investment to expand prevention, treatment and recovery services for those impacted by addiction. You can stay engaged by following NAADAC’s Advocacy Updates and Action Alerts webpage at www.naadac.org/advocacy-blogand-action-alerts for policy updates and grass roots action alerts. Your voices make a difference! We look forward to working with you as we continue to advocate for federal policies that support those in need of addiction and mental health prevention, intervention, treatment, and recovery support! 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 the State of Washington. Julie Shroyer, MSW, is Senior Policy Advisor in the Washington, DC, office of Polsinelli, a national law and public policy firm. She has more than 30 years of federal health policy experience, including service on Capitol Hill as committee staff and in senior positions in both the non-profit and private sector. A respected advisor to congressional and presidential campaigns, she is sought after for her recognized expertise in health care and public policy. Shroyer serves on the Board of Directors of House of Ruth, a DC-based nonprofit organization that empowers women, children, and families to rebuild their lives and heal from trauma, abuse, and homelessness. She graduated from Western Michigan University with a Bachelor’s degree in social work and earned a Master’s degree in social work from the University of Michigan. Robert Daley is a Legislative Director in the Washington, DC, office of Polsinelli, a national law and public policy firm. He has over a decade of public policy experience, including serving as an aide to Members of Congress. Daley works with a wide range of health care clients to develop legislative strategies, craft policy solutions and represent their interests before policymakers in Washington. He has worked to secured favorable client outcomes on federal appropriations, as well as legislation to modernize Medicare reimbursements, and reduce opioid prescribing. He is a graduate of American University in Washington, DC.
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■ M EM B ER SHI P
Meet the 2021 Candidates for NAADAC Executive Leadership Positions The time has come again to help us determine the future of NAADAC! Elections give us the opportunity to allow new leaders to represent NAADAC with the purpose of continuously advancing and growing the addiction profession. NAADAC holds elections for its Officers and/or Regional Vice Presidents every year for the two-year terms; Officers and four Regional Vice Presidents are elected on even years, and the remaining four Regional Vice Presidents are elected on odd years. This year, the positions of Mid-Central, North Central, Southeast, and Southwest Regional Vice President are up for election. All 2021-2023 terms will begin in October 2021, immediately following the NAADAC 2021 Annual Conference. NAADAC received one nominee each for the positions of Mid-Central, North Central, and Southwest Regional Vice President. Therefore, these three nominees will be seated in their nominated roles for the 2021-2023
Candidate for MidCentral Regional Vice President & Uncontested Winner Representing Illinois, Indiana, Kentucky, Ohio, and Wisconsin
Raynard Packard, MAed, PsyD (candidate), LICDC-CS (Ohio) Akron, OH Summarize the nominee’s NAADAC activities: Member since 90s (with a hiatus in 2000s). Former NAADAC Public Policy Committee. Former OAADAC Akron, Ohio Chapter President, Former OAADAC Ohio Vice President, Current OAADAC President. Philosophy statement of the nominee on the future of NAADAC: As addiction professionals we must move towards the big-tent of inclusivity. Current needs require skilled providers in the trenches equipped to fight the addiction epidemic within the pandemic. We must recruit, provide the continuing guidance, and retain those who bring their passion to the field – at all levels. Other qualifications of the nominee for this office: Former military leader, and spearheaded Ohio’s Recovery Oriented Systems of Care revolution from the 90s on.
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term without an election. Congratulations to our three winners! NAADAC received two nominations for the position of Southeast Regional Vice President, so an election will be held for these two candidates. Please find all candidates’ statements below in order to inform your vote and get to know your 2021-2023 representatives. The voting period will begin on May 1, 2021 and end on May 31, 2021. All NAADAC members are eligible and encouraged to vote for the candidates within their region and will receive emailed instructions for voting. These instructions can also be found at https://www.naadac. org/2021-leadership-elections. Members may vote online by logging into their Member Portal or by mail. To request a paper ballot to vote by mail, please email Kristin Hamilton at khamilton@naadac.org. Please review each candidate’s information below, cast your vote, and congratulate the future leaders of NAADAC!
Candidate for North Central Regional Vice President & Uncontested Winner Representing Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota
ark Young, LAC; M Master of Arts/ Community Counseling Sioux Falls, SD Summarize the nominee’s NAADAC activities: Currently President (2017-2021) of South Dakota Addiction + Prevention Professionals (SDAAPP) the NAADAC affiliate. SDAAPP East River Representative (2013-2017). NAADAC Board since 2017, Delegate to annual conferences in Orlando (2017), Houston (2018), and virtual (2020). Joined NAADAC International Delegation to Greece, (March 6-13, 2020). SDAAPP By-Laws Revision Workgroup Member, (2016). Philosophy statement of the nominee on the future of NAADAC: I see the Association for Addiction Professionals standing on pillars of teamwork, advocacy, training, and service. Our vision should be expansive: becoming a louder voice of advocacy by continuing our growth in membership; pursuing the ongoing work for state-to-state standards seeking consistency in professional practice; and continuing to grow our international presence through delegations, personal contacts, and provision of support & growing expertise through training.
Other qualifications of the nominee for this office: Work experience in addictions: 1993-1997, First Step Counseling; 1998-2001, Charter Hospital; 2002-2004, First Step Counseling Clinical Director; 2005-Present, VA. Experience in lobbying: South Dakota State Government, 19711984 included management level 1973-1984 including Acting Director of Tourism Department presenting budget in legislative hearings, 1981. Lobbying congressional offices for AFGE Local 1509 as Legislative Officer, seven trips to Washington between 2009-2017. Serve on MPATTC Treatment & Treatment Provider Workgroup.
Candidate for Southwest Regional Vice President & Uncontested Winner
Representing Arizona, California, Colorado, Hawaii, New Mexico, Nevada, & Utah
homas Gorham, LMFT, T SUDCC IV Berkeley, CA Summarize the nominee’s NAADAC activities: I am currently the Southwest Regional Vice President. I have been a NAADAC member since 2001. I was the founding president of the Addiction Professional Association of California. I spent over 8 years organizing the California affiliate. I organized the workforce by collaborating with the existing certifying entities, including NAADAC, to give the Addiction Professional a
voice in California. I have also partnered with NAADAC for the past 5 years to train and certify inmates in 35 California prisons. Options Recovery Services was honored in 2005 with the Outstanding Organizational award while I was the Clinical Director there. Philosophy statement of the nominee on the future of NAADAC: My philosophy for the future of NAADAC is to continue to support the Addiction Professional workforce in a number of ways. 1) Training the workforce in the science for effective treatment is one thing we do well and should continue that effort. 2) I also see NAADAC’s role as political in nature. We need to continue to advocate for and affect change in government policy and law. The discrimination of those that suffer from Substance Use Disorders must stop and treatment must be made available on demand. 3) Finally, NAADAC should continue to address the many social justice issues present in our society total. We must be the voice of reason concerning how those challenges affect the population that we serve. Other qualifications of the nominee for this office: I am a licensed Marriage and Family Therapist and a Certified Substance Use Disorder IV through CADTP. I have a track record in leadership having been an Executive Director of Options Recovery Services. I was the President of APAC for almost 10 years and am currently serving as Regional Vice President for the Southwest region. I have shown the ability, passion and willingness to continue to serve the membership as S.W. Regional Vice President.
Candidate for Southeast Regional Vice President
Representing Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee
at Sandifer, LCSW, M LCAS, CSI Greensboro, NC Summarize the nominee’s NAADAC activities: I have had the honor of serving on NAADAC’s Executive Board for the past two years as the South East Regional Vice President. During this time as the South East VP, the state affiliates have taught me about their challenges and successes. As the COVID Pandemic has increasingly disrupted service delivery, the free flow of communication and information between NAADAC and our affiliates is crucial to support and meet the challenges that COVID has imposed on the profession and, most notably, those we serve.
With the new administration and legislative initiatives that NAADAC will propose, NAADAC must understand each state’s environment to best support SUD professionals. I see the job of the Regional VP as instrumental in that understanding. Finally, I have served, as all Regional VP’s do, on the membership committee. This service allows me to understand the SUD profession’s broader challenges to engage and retain new NAADAC members and cultivate new professionals keeping NAADAC and the SUD profession invigorated and growing. Philosophy statement of the nominee on the future of NAADAC: NAADAC is the national voice for SUD professionals. During the current unstable national environment, NAADAC’s role in supporting professionals with policy and legislative agendas, while historically essential, is crucial today as SUD professionals face fiscal and policy obstacles. NAADAC’s dedication to understanding each affiliate’s unique situation informs NAADAC’s initiatives and policies. SUD and MH disorders are increasing during this time of health and political crisis. NAADAC’s leadership through legislative and educational advocacy positions NAADAC as a leader supporting our profession’s work during a challenging time. Other qualifications of the nominee for this office: I have worked as a SUD professional since 1992. Like many of you, I have seen the evolution of our profession. Experiencing the numerous service delivery reforms, reimbursement approaches, and shifting political policies taught me the value of flexibility and open-mindedness while maintaining a dedication to foundational principles. As a community advocate, I helped form a local community advocacy group, CURE Triad. CURE Triad’s mission is to reduce systemic barriers to accessing services and advocating for evidence-based best practices. CURE partnered with local and state leaders and public and private providers to identify and address service access obstacles. I also currently serve on NAADAC’s North Carolina affiliate, APNC’s Board. I have served on the APNC Board for six years. I am the co-chair of the Social Justice Committee. This committee is addressing the necessary and challenging topic of racism, identifying systemic barriers to access respectful and responsive services. These experiences collectively give me a broad view of the challenges ahead for SUD. If elected to serve as the South East Region VP, I will bring my experiences, open ears, and a willing spirit to support SUD professionals in the South East Region.
Candidate for Southeast Regional Vice President
Representing Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee
Terry Kinnaman, LADAC 11, CAADAC, MAC, QCS Spring Hill, TN Summarize the nominee’s NAADAC activities: I have been an active member of NAADAC for twenty years. During this time, it has been an honor to serve as the president of the Tennessee Association of Addiction Professionals for the last two years. In my tenure with NAADAC I have served as the president of the Middle Tennessee Region of Addiction Professionals, I have served as president of the state of Tennessee Licensure Board, and I have been awarded honors as Counselor of the Year, Professional of the Year, and the Lifetime Achievement Award from both the Middle Tennessee and the state association of NAADAC. I have held regional and state trainings in addiction counseling and supervision. I am a Certified Qualified Clinical Supervisor by the state of Tennessee for those preparing to enter this profession. Philosophy statement of the nominee on the future of NAADAC: NAADAC represents the profession for the Addiction Professional and is the standard barrier for those in this position. As Addiction Professionals we have been entrusted with caring for those who are suffering from one of the most horrific and deadly diseases of our lifetime. NAADAC sets professional standards and provides quality and excellent trainings to ensure the best of care is provided to save the lives of others. NAADAC must continue efforts to see that only the best and most qualified continue in this service to others. It is my intention to continue to represent the people in this profession and continue to develop standards of professional care for others. Other qualifications of the nominee for this office: I have been involved in multiple program start-ups. In doing this, I have relied on the standards of NAADAC and the Code of Conduct for those that I have brought into this profession. I believe that addiction counseling does save lives and improves the lives of others whose lives have been impacted by this disease. This has been my mission for thirty years and I intend to continue this belief in all I am entrusted to care for. S P R I N G 2 021 | 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
Introducing the Arkansas Peer Specialist Program By Kyle Brewer, BS, PRPS, NAADAC Peer Specialist Program Manager
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or the first time in the State of Arkansas, individuals with lived experience have direct involvement in the development and administration of a peer support credentialing program. The Arkansas Peer Specialist Program (APSP) is a collaborative effort between NAADAC, the Association for Addiction Professionals, and the State of Arkansas that streamlines each step of the credentialing process for peers, producing highly trained and knowledgeable peer specialists and creating a one-stop shop for all peer credentialing needs. APSP is an innovative three-tiered credentialing process developed with involvement of peers at every level of the application and certification process that provides peers the opportunity to progress through the core, advanced, and supervision levels of the Arkansas Model. Through this model, peers can climb the career ladder hold the Arkansas Core Peer Recovery Specialist (PR) credential, the Arkansas Advanced Peer Recovery Specialist (APR) credential, and the Arkansas Peer Recovery Peer Supervisor (PRPS) credential. Each level of this career ladder has its own training, education, experience, and supervision requirements designed to produce highly trained and knowledgeable peer specialists. Before 2017, peer recovery for substance use disorders was virtually non-existent in Arkansas. Peers generally only found available work in treatment centers where they were met with the lack of understanding of the non-clinical role, leading to improper job descriptions and the underutilization of peer services. Within a year, as the opioid epidemic exponentially grew, the peer recovery field also grew. Arkansas used federal funding that was provided to help combat the opioid epidemic and overall rise in substance use and misuse to support development of the Arkansas Peer Model, which was developed by a small group of recovering individuals who envisioned dynamic change within our behavioral health system. Over the course of one year, peer specialists—with a range of experience in recovery and knowledge of the behavioral health system—gathered with other professionals to develop a training manual for required core peer training. The manual was adapted from the Appalachian Consulting Group and includes many of the same stories and strengths. In November 2018, 18 peer specialists became certified as trainers. Subsequently, the first core training for the Arkansas Model was offered in March 2019 and included two separate classes for a total of 50 participants. However, since substance use peer services were relatively new, the need for appropriate supervision became evident; the unique, nonclinical role based off of a relationship of equality and mutuality needed a supervision counterpart. In July 2020, 10 seasoned peer specialists—who had progressed through the core and advanced levels of the Arkansas Model—completed the Arkansas Peer Supervision training and became the first 10 Peer Recovery Peer Supervisors in Arkansas. Currently, peer at each level of the Arkansas Model are required to have experience and supervision hours approved by a Peer Recovery Peer Supervisor (PRPS).
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As this comprehensive peer career ladder developed, it became clear that it required an innovative and well-developed system to certify and supervise each level. So, in January 2021, the State of Arkansas partnered with NAADAC to develop and provide the application and certification process—as well as implement a supervision system and peer ethics review process—for all three levels of the Arkansas Model. This partnership led to the birth of the Arkansas Peer Specialist Program as it is known and utilized today. APSP is currently offering peers in Arkansas the one-time opportunity to transfer their current training, education, work experience and supervision hours directly to the APSP and become appropriately credentialed without additional testing through June 30, 2021. NAADAC is excited about the growth of qualified, credentialed, and supervised peers in Arkansas, and looks forward to help expand the program so that it can be replicated in other states to better standardize and develop a high level of training, education, and state credentialing structures for peers across the country.
To learn more about the Arkansas Peer Specialist Program, including information about test waiver and test acceptance offers, please visit www.naadac.org/arkansas-peer-specialist-program or contact Kyle Brewer, BS, PRPS, NAADAC Peer Specialist Program Manager, at kbrewer@naadac.org.
Kyle Brewer, BS, PRPS, is the Peer Specialist Program Manager for NAADAC, the Association for Addiction Professionals. He works for NAADAC remotely from Little Rock, AR, managing the Arkansas Peer Specialist Program Grant. He oversees the development and implementation of an innovative threetier credentialing process (Core, Advanced, Supervision) for the Arkansas Peer Support Model. Brewer earned a Bachelor of Science degree in Addiction Studies from the University of Central Arkansas in 2013. He went on to use his lived experience with drug and alcohol addiction to become a Certified Peer Recovery Support Specialist, where he led the implementation of this position in an emergency department at the University of Arkansas for Medical Sciences. Most recently, he became one of the first ten Certified Peer Support Supervisors in Arkansas. He also serves on numerous committees and boards to develop and strengthen the Arkansas Model and improve peer support services across the United States.
On February 25-26, 2021, NAADAC hosted the Engagement in the Black Community Summit, organized by NAADAC’s Critical Issues in the Black Community Committee. The summit highlighted critical issues within the Black community as they relate to addiction treatment, recovery, and healing. Over 1,300 people attended the virtual event during Black History Month, and attendees all joined together to foster a greater sense of diversity, open-mindedness, and inclusion within the addiction community. Thank you Samson for validating what I have been feeling, I could not put my finger on it. Real talk! Love this panel! Excellent questions and excellent discussions from all! This panel is actively affecting the change...thanks NAADAC for confronting the demon!!! Absolutely amazing! Thank you for the inspiration you provide. Im going to be watching this entire presentation as many times as I am allowed. This WILL become a part of my curriculum. PERIOD! If allowed.
On Friday, presenters focused their topics on music as treatment, critical issues within the Black community, and the journey of the Black helping professional. NAADAC thanks all who spoke and participated in this powerful event and looks forward to more like it in the future.
Two in one session-Self-care and tools to help consumers The summit’s featured speakers included Grady Anthony Austin, Raven Freeborn (née Dickerson) LCSW, CNP, Angele Moss-Baker, LPC, LMFT, MAC, EAS-C, DCMHS-COD, and O.T. Porter, PhD, LCDC. These renowned speakers brought their insights and experiences to life with their presentations, and worked alongside panelists from NAADAC’s Critical Issues in the Black Community Committee, including Committee Co-Chairs Bakahia Madison, PsyD, LCPC, CADC, and Katina Palmer, MA, LPC, as well as panelists Helena Washington, MEd, LCDC, ICADC, MAC, Shevel Mavins, MS, Peter Mott, MA, LCDC, ICPS, Karla L. Sapp, EdD, LPC, LMHS-S, MAC, Carmela Drake, PhD, LPC, NCC, CAADP, ACGC-III, Joe Powell, LCDC, and Thurston S. Smith, MPA, LAC, CCS. Key topics of discussion from the Thursday presentations included equity solutions for the Black community, advocacy and policy reform, and addiction in Black LGBTQ+ identifying individuals.
Join NAADAC’s Critical Issues in the Black Community Committee! Visit www.naadac.org/naadac-committees to join and help provide a voice and platform for the Black community.
It has been an awesome 2 days I have learned so much I cant wait to use the information I have gained Most definitely will listen again to recordings...lot to digest, but most valuable...Thank all presenters/ moderators/funders. Blessed event. Stay SAFE. GREAT presentations
Did you miss the Engagement in the Black Community Summit? Watch it on demand! Visit the NAADAC website to watch all of the training sessions and earn CEs (free for NAADAC members!). www.naadac.org/engagement-in-the-black-community-webinars S P R I N G 2 021 | 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 15
Welcoming Transgender and Gender Non-Conforming Clients into SUD Treatment By De’An Roper, PhD, LCSW-S, Mark Sanders, LCSW, CADC, Troy Weeldreyer, LMSW, MSW, MPH, Nathaniel Mason, MEd, NCC, Deniele Fleming, MS, SUDP, and Karl Bolton, LADAC II
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A
lthough transgender and gender non-conforming (TGNC) people represent less than 1% of the population, they experience disproportionate discrimination, mental health concerns, substance use, and violence when compared to other groups (James et al., 2016; Valentine & Shipherd, 2018). According to a national study conducted by the National Center for Transgender Equality, TGNC people experience hate and violence at epidemic levels (James et al., 2016). The report indicated up to one-third of participants had been fired or experienced employment discrimination, including verbal, physical, or sexual harassment or assault in the last 12 months. Survey participants reported an unemployment rate three times higher than the general U.S. population, poverty rates were more than doubled, and up to one-third had experienced homelessness at some point (James et al., 2016). Almost 40% of the more than 27,000 survey respondents indicated significant mental distress within the last 30 days; the rates of suicide attempts were almost nine times higher than the general population (James et al., 2016). These discrimination and mental health disparities were disturbingly higher when examined among TGNC people of color (James et al., 2016). Despite these disparities, limited research exists to explain these differences in TGNC populations (Connolly & Gilchrist, 2020). Minority stress theory is a commonly proposed model for explaining disparities among TGNC people, although the theory is predominately supported in research among lesbian, gay, and bisexual groups (Hendricks & Testa, 2012). The theory posits that rates of substance use and mental health disorders result from the unique and distinctive experiential stress related to chronic and daily discriminatory experiences of sexual and gender minority individuals (Meyer, 2003). The theory proposes that the sexual or gender minority person is exposed to cultural and social experiences that increase personal stress and tax coping responses, and that these stressors are chronic, unique, and occur above and beyond everyday stressors (Blosnich, Farmer, Lee, Silenzio, & Bowen, 2014; Frost, Lehavot, & Meyer, 2015; Hsieh, & Ruther, 2016; Meyer, 2003). Meyer (2003) states the stressful experiences are persistent and also are stigmatizing experiences that continue to be entrenched in the social and cultural fabric of the wider environment (Blosnich, Farmer, Lee, Silenzio, & Bowen, 2014; Frost, Lehavot, & Meyer, 2015; Meyer, 2003). Key constructs supporting the minority stress model include internalized stress of social stigma, daily discrimination, concealment of minority identity, and anticipation of social rejection (Meyer, 2003). Accordingly, coping with minority stigma, discrimination, and stress may contribute to substance use risk and substance use disorders (SUD).
Prevalence of Substance Use Disorders SUD studies focused on TGNC populations have generally been limited to smaller samples and have utilized various methodologies. This insufficiency in research makes it difficult to accurately understand and illustrate the prevalence rates of substance use disorders in the TGNC population as compared to those in the general population who identify as cisgender. Gonzalez et al. (2017) report 90-day substance use at rates of up to 40% among a population of TGNC people. Overall, 21.5% of participants reported excessive alcohol use, 24.4% reported cannabis use, and 11.6% reported illicit drug use (Gonzalez et al., 2017). Within the sample group itself, they found transgender women are one and half times more likely to use cannabis, and transgender men—when compared to S P R I N G 2 021 | 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 17
transgender women—consumed excessive alcohol at a higher rate: 22.3% versus 20.5%, respectively (Gonzalez et al., 2017). Similarly, in a Canadian study, transgender men reported almost double episodic alcohol use compared to transgender women (Scheim, 2016). Another study found among a cross-sectional sample of transgender men, self-reported substance use rates were more than 27% and related to coping with stigmatizing experiences within the medical care system (Reisner et al., 2015). Lastly, a study with 452 transgender adults found that 10% reported a lifetime prevalence rate of SUD treatment (Keuroghlian et al., 2015).
Critical Issues for Treatment Providers Qualitative research with TGNC clients indicates that they are less likely to feel supported by the therapeutic program and feel less connected to their service providers than heterosexual, lesbian, gay, or bisexual clients (Senreich, 2011). Transgender clients have also reported ending treatment prematurely due to stigma, shame, misunderstandings, ignorance, harassment, and even violence directed towards them by treatment professionals and other clients (Lyons et al., 2015). Moreover, a recent study indicates an inverse relationship between transphobia and gender minority knowledge; in other words, clinicians with less TGNC cultural knowledge demonstrated higher rates of transphobia (Powell & Cochran, 2020). Additionally, the study indicated training for mental health professionals around TGNC individuals’ issues helps to decrease personal biases that may interfere with treatment decisions (Powell & Cochran, 2020). These few studies point to the critical need for creating welcoming environments and specialized training in engagement skills with TGNC individuals who present for SUD treatment. First, treatment programs should make every effort to train all staff on TGNC-specific issues and terminology, such as the importance of pronouns, to refraining from using a client’s “deadname” (Knutson et al., 2019), and how to avoid microaggressions. Most larger cities have at least one organization that provides “Transgender 101” training to organizations and individuals, and many excellent resources for providing transgender-affirmative care are available online. Finally, treatment programs should offer regular and comprehensive psychoeducation to all clients regarding sexual health, financial literacy, and other life skills that are potentially compromised by chaotic substance use and an intersecting marginalized status within society.
Creating a Welcoming Environment Creating a welcoming environment is a significant step toward engaging all clients in SUD treatment (Mueser, Noordsy, Drake & Fox, 2015). Engaging clients can be a challenge as nearly half of clients with substance use disorders miss their second outpatient session (Duncan, Miller & Sparks, 2007), and nearly half drop out of residential treatment prematurely (Sanders, 2011). A comprehensive review of the literature reveals a paucity of research regarding factors that create a welcoming environment for TGNC individuals seeking SUD treatment (Gylnn & van den Berg, 2017). Nevertheless, it is reasonable to surmise that SUD treatment can be unpredictable, inconsistent, and traumatic for TGNC individuals. In an effort to increase the knowledge base of SUD treatment providers, the authors incorporated their real-world practice wisdom and knowledge of the literature, and have identified the following areas to create a welcoming and engaging SUD treatment environment for TGNC individuals: • Diversification of Staff - A research study of a San Francisco-based 18
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residential SUD treatment facility found that hiring TGNC individuals and conducting staff training played a key role in the program achieving an 81% nine-month retention rate for TGNC clients. The research also found that linkage to support groups, housing, and landlords who were friendly toward TGNC individuals also contributed to the program’s success (Oggins & Eichenbaum, 2002). • Provision of Staff Training - In a qualitative study of TGNC individuals’ experiences in substance use disorder treatment, clients who reported that they felt stigmatized, experienced transphobia, or experienced violence perpetration in treatment were more likely to leave treatment prematurely. Clients who felt included and respected in treatment reported more positive outcomes (Lyons et al., 2005). Thus, training should provide information about creating a welcoming environment, identifying the specific needs of TGNC individuals seeking SUD treatment, cultural humility, staff transphobia, homophobia, examining personal bias, creating a trauma-informed system of care, and stigma reduction. Training should also include the intersectionality of multiple marginalized identities and an understanding that not all TGNC individuals have the same experiences. It is imperative that non-clinical staff should participate in the training. TGNC clients entering treatment will likely interface first with nonclinical staff prior to admission. • Examination of the Organization’s Decor, Audiovisual Elements, and Programmatic Reading Materials - Examine all media utilized by the facility, including wall posters and brochures. Ensure materials include pictures of diverse persons. Incorporate and utilize TGNC symbols (e.g., pink and blue flag). Ensure there are recovery stories in assigned readings or audiovisual materials that describe TGNC individuals’ experiences or tell TGNC individuals’ stories in recovery. • Medical Paperwork - Ensure that the organization’s paperwork includes preferred name, legal name, preferred pronouns, and options for transgender and non-conforming for marking gender demographics. • Provision of Gender-Neutral Bathrooms - The use of unisex, singlestall, or gender-neutral bathrooms provides choice and safety. • Respect of TGNC Individual’s Right to Disclose at Their Own Pace - Beginning with the initial intake experience and throughout SUD treatment, TGNC individuals have the right to discuss their identity and sexual orientation at their own pace. The individual is in charge of all disclosures. Never force a disclosure or ask someone to conceal their gender identity or sexual orientation. • Careful Listening and Mindfulness of Language - It is often helpful to use the words that clients use to describe themselves instead of imposing predetermined terminology. Ensure that staff understands the importance of explaining why they might be asking sensitive questions; furthermore, staff should be trained not to ask sensitive questions such as “have you had surgery” or ask about gendered body parts unless it is absolutely pertinent to treatment. • Sharing of Pronouns - Unprompted sharing of pronouns by staff and clinicians early in the therapeutic relationship can help create emotional safety and comfort. • Visible Anti-discrimination Statement - The statement should address inclusivity regarding race, ethnicity, disabilities, gender identity, and sexual orientation. Creating a welcoming environment for TGNC individuals seeking SUD treatment can go a long way to decrease stigma, increase engagement,
and yield successful treatment outcomes. By no means are these recommendations exhaustive. Listen to and believe what TGNC clients say they want. While many practitioners may strive for cultural competence to understand TGNC culture, cultural humility should be a consistent goal. Cultural competence suggests an endpoint. The attainment of discrete knowledge indicates competency; however, cultural humility suggests that complete knowledge is unattainable, but there is a willingness to be open and continue learning. More thoughtful ongoing work involves organizations asking several essential questions: Are TGNC staff hired at all organization levels, including leadership and the Board of Directors? Does the organization retain and promote TGNC staff? Is the organization a trauma-informed system of care? Do policies and procedures reflect the inclusivity of clients who are TGNC? Does the program enjoy the trust of TGNC communities? When these questions are answered with “yes,” the organization will likely improve its ability to successfully and respectfully serve TGNC individuals with substance use disorders. References Blosnich, J. R., Farmer, G. W., Lee, J. G., Silenzio, V. M., & Bowen, D. J. (2014). Health inequalities among sexual minority adults: evidence from ten US states, 2010. American journal of preventive medicine, 46(4), 337-349. Connolly, D., & Gilchrist, G. (2020). Prevalence and correlates of substance use among transgender adults: A systematic review. Addictive Behaviors, 106544. Duncan, B. L., Miller, S. D., & Sparks, J. (2007). Common factors and the uncommon heroism of youth. Psychotherapy in Australia, 13(2), 35. Frost, D. M., Lehavot, K., & Meyer, I. H. (2015). Minority stress and physical health among sexual minority individuals. Journal of behavioral medicine, 38(1), 1-8. Glynn, T. R., & van den Berg, J. J. (2017). A systematic review of interventions to reduce problematic substance use among transgender individuals: A call to action. Transgender Health, 2(1), 45-59. Girouard, M. P., Goldhammer, H., & Keuroghlian, A. S. (2019). Understanding and treating opioid use disorders in lesbian, gay, bisexual, transgender, and queer populations. Substance Abuse, 40(3), 335–339. https://doi.org/10.1080/08897077.2018.1544963 Gonzalez, C. A., Gallego, J. D., & Bockting, W. O. (2017). Demographic characteristics, components of sexuality and gender, and minority stress and their associations to excessive alcohol, cannabis, and illicit (non-cannabis) drug use among a large sample of transgender people in the United States. The journal of primary prevention, 38(4), 419-445. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender non-conforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460. Hsieh, N., & Ruther, M. (2016). Sexual minority health and health risk factors: Intersection effects of gender, race, and sexual identity. American Journal of Preventive Medicine, 50(6), 746-755. James, S., Herman, J., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. A. (2016). The report of the 2015 US transgender survey. Keuroghlian, A. S., Reisner, S. L., White, J. M., & Weiss, R. D. (2015). Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug and alcohol dependence, 152, 139-146. Knutson, D., Koch, J. M., & Goldbach, C. (2019). Recommended terminology, pronouns, and documentation for work with transgender and non-binary populations. Practice Innovations, 4(4), 214. Lyons, T., Shannon, K., Pierre, L., Small, W., Krüsi, A., & Kerr, T. (2015). A qualitative study of transgender individuals’ experiences in residential addiction treatment settings: stigma and inclusivity. Substance abuse treatment, prevention, and policy, 10(1), 1-6. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674. Mueser, K. T., Noordsy, D. L., Drake, R. E., & Smith, L. F. (2015). Integrated Treatment for Dual Disorders: A Guide to Effective Practice. Guilford Publications. Oggins, J., & Eichenbaum, J. (2002). Engaging transgender substance users in substance use treatment. International Journal of Transgenderism, 6(2), 1-16. Powell, H. A., & Cochran, B. N. (2020). Mental health providers’ biases, knowledge, and treatment decision making with gender-minority clients. Psychology of Sexual Orientation and Gender Diversity. Reisner, S. L., Pardo, S. T., Gamarel, K. E., Hughto, J. M. W., Pardee, D. J., & Keo-Meier, C. L. (2015). Substance use to cope with stigma in healthcare among US female-to-male trans masculine adults. LGBT health, 2(4), 324-332.
Sanders, M. (2011). Strategies for engaging difficult-to-reach, multiproblem clients with substance use disorders. Alcoholism Treatment Quarterly, 29(1), 91-98. Scheim, A. I., Bauer, G. R., & Shokoohi, M. (2016). Heavy episodic drinking among transgender persons: Disparities and predictors. Drug and alcohol dependence, 167, 156-162. Senreich, E. (2011). The substance abuse treatment experiences of a small sample of transgender clients. Journal of Social Work Practice in the Addictions, 11(3), 295-299. Valentine, S. E., & Shipherd, J. C. (2018). A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clinical Psychology Review, 66, 24-38. De’An Roper, PhD, LCSW-S, worked in various systems of care for more than two decades prior to her academic career. Her early experience was shaped by working in the LGBTQ+ community during the HIV/AIDS epidemic. Later, her direct practice included working in criminal justice environments developing treatment programs for people diagnosed with co-occurring disorders. Roper’s areas of practice expertise include program development, LGBTQ+ cultural competence, service team development, and she provides advanced clinical supervision. Her research interests include sexual and gender minority health disparities, health risk behaviors, substance abuse, mental health and criminal justice systems. Mark Sanders, LCSW, CADC, is an international speaker in the addictions field whose presentations have reached thousands throughout the United States, Europe, Canada, Caribbean and British Islands. He is the author of five books on recovery and Curator of the Online Museum of African American Addictions Recovery. You can visit the museum at www.museumofafricanamericanaddictionsrecovery.org. He has also had two stories published in the New York Times Best Selling Book Series, Chicken Soup for The Soul. Sanders is the recipient of numerous awards, including The Barbara Bacon Award for outstanding contributions to the Social Work Profession as a Loyola University of Chicago alumni, Health Care Alternative Systems Leadership Award, and The Professional of the Year Award from the Illinois Addiction Counselor Certification Board. He is past Board President of the Illinois Association of Addictions Professionals and Co-Founder of Serenity Academy Chicago, the only recovery High School in Illinois. Troy Weeldreyer, LMSW, MSW, MPH (he/him), is a mental health clinician living in Albuquerque, NM. His interests include promoting and implementing micro, mezzo, and macro structural interventions aimed at eliminating healthcare disparities for people who use drugs, LGBTQ+, and racial/ethnic minorities.
Nathaniel Mason, MEd, NCC, is a Doctorate of Philosophy degree candidate in Counselor Education & Supervision at William and Mary. His clinical and research interests include connectedness and empowerment within the LGBTQ+ community, recovery for marginalized populations, and the role of spirituality in recovery. He is currently a resident counselor at a local private practice and one of the student co-directors of the Flanagan Counselor Education at William and Mary. In both roles, he uses motivational interviewing (MI) to assess client’s readiness to change in cultivating wellness, setting healthy emotional boundaries, and changing their relationship with old coping mechanisms. Deniele Fleming, MS, SUDP, has been a certified substance use disorder professional (SUDP) by Washington State Department of Health since 2003, serving youth and families at Sundown M Ranch. Fleming earned a Master’s degree in Addiction Counseling from Grand Canyon University. Her work experience includes Adjunct Professor and Administrative Lead at Yakima Valley College for the Substance Use Disorder Studies Program. In addition, Fleming has worked on forming a grassroots community coalition for an alcohol and drug-free community in Selah, Washington. Karl Bolton, LADAC II, has ten years of experience working in the substance use disorder treatment field. Bolton is a member of NAADAC’s Clinical Issues Sub-Committee on LGBTQIA issues. In addition, he has over five years of experience working with individuals who seek treatment for co-occurring substance-related and mental health issues. Bolton is a trained Dialectical Behavior Therapy (DBT) counselor and provides therapy to his clients that is adherent to full practice DBT. Additionally, he specializes in providing affordable aftercare to those who are transitioning from inpatient treatment to outpatient care.
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Peer Recovery Support Impacts Outcomes for Incarcerated Mothers By Dana Simons, LCSW, LCAC and Robyn Lugar, MSW
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convicted of a state or federal felony offense for using or selling drugs (Godsoe, 1998). Additionally, the social supports of family and friends may also have limited resources, thus making it impossible for them to offer material support. The counties in West Central Indiana are rural and once released from jail, these young mothers need money to use a nearly non-existent public transportation system to meet with their probation or parole officer, to he female offender population in Indiana is a rapidly grow- go to court, to meet with child protective services, to see their children, ing and distinctly underserved group, where seven of 10 to go to AA/NA meetings, to see a therapist, to get groceries, and to atwomen prisoners have minor children (Carson, 2014), tend medical appointments. Missing meetings with the correctional or and Indiana is not alone in facing this problem. A report child welfare systems may result in harsh consequences. This creates diffrom the Sentencing Project (November 2020) shows ficulty for young mothers who are trying to re-establish relationships, as that between 1980 and 2016, the number of women incarcerated in well as a sense of self-esteem and confidence. Reentry overwhelms the American jails and prisons increased by more than 700 percent, from coping capacity of most women. 26,378 in 1980 to 213,722 in 2016, and the In Indiana, 40% of incarcerated women proportion of imprisoned women convicted committed an offense related to having a conReceiving public assistance and of a drug offense has increased from 12% in trolled substance, 26% committed a property public housing may be impossible. crime, 18% committed a personal assault, 12% 1986 to 26% in 2018. In 2016, peer mentoring services were pro- Indiana implemented a lifetime fall into the ‘other’ category, and 2% commitvided to 232 young mothers incarcerated in six ted a sex offense (IDOC, 2014, pp. 56-57). ban on welfare benefits, such as Methamphetamines, prescription drugs, herocounty jails in West Central Indiana, though a partnership between Indiana State University in, alcohol, and marijuana are drugs commonly cash assistance or food stamps, Department of Social Work and the Next Step abused in Indiana. Vigo County (where the for persons convicted of a state prison in this program is located) is in the top Foundation, a recovery community organization, and a grant offered by the Office of 10% of the state’s 92 counties in severity of or federal felony offense for Juvenile Justice and Delinquency Prevention. SUD by its residents. In 2015, there were 331 using or selling drugs. These peer recovery coaches, who are “inpeople in the Vigo County Community Cordividuals with a history of recovery from adrections home detention program, including diction who deliver supportive services to 71 females (Vigo County Community Corothers that are going through the process of recovery from addiction” rections). The lack of services for women impact recidivism, and Vigo (SAMHSA, 2009), can often connect to individuals who are trying to Country has a 36.2% recidivism rate (Indiana Department of Correcovercome their addiction in a way that other providers cannot because tion, 2015, pp. 2-4). they can share their lived experiences and act as more of a mentor, guide, and role model. Peer recovery coaches are increasingly seen as serving a The Program vital role in the continuum of care, even in traditional settings. Not only In 2008, the Second Chance Act (SCA) was signed into law, making do they provide help in social service and health care navigation, but funding available to provide services that could impact successful reenthey also provide social support—which might not be otherwise avail- try for the general incarcerated population. In 2016, the SCA expanded able—to help facilitate recovery (Jack, Oller, et al., 2018). Introducing their funding opportunities for specific minority populations, such as peer recovery coaches to the women in West Central Indiana proved the incarcerated mothers and fathers. Indiana State University was awarded women with this needed support. a grant under this SCA program, called Strengthening Young Mothers, in order to provide mentoring services to women from ages 18 to 25. The Problem A local recovery community organization, Next Step Foundation, Inc., Criminal justice-involved women have higher rates of psychological dis- designed a mentoring program utilizing certified peer recovery coaches tress, mental illness, and substance use disorders (SUD) (Golder, Eng- for those in recovery from SUD. The program focused on providing peer strom, Hall, Higgins, & Logan, 2015). All of the women in the Next mentoring services to incarcerated mothers that had a history of SUD. Step 2 Healthy Families program were under the age of 25, 82% were The Next Step to Healthy Families (NS2HF) program connects young incarcerated for a drug related offense, and 100% stated that substance mothers with pre-release programming designed to support them in use was “a problem.” When released, the social and economic situation overcoming the many barriers they face when reuniting with their chilhas often worsened for these women. Receiving public assistance and dren and then continues that support once the women are released. The public housing may be impossible. Indiana implemented a lifetime ban program utilizes a one-to-one individual mentoring model where the on welfare benefits, such as cash assistance or food stamps, for persons incarcerated woman is matched with a mentor for a period of one year, “My parents taught me to cook meth when I was 10 and I have been involved with drugs ever since. I don’t want my kids to end up the same as me. The peer mentor I got through this program listened without judgement and not only helped me with getting sober, but she has become someone who I can rely on to help me with getting a new life. She has been through the same things as me.” —Samantha, 22, mentee in the Next Step 2 Healthy Families program
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optimally with three months mentoring pre-release and nine months mentoring post-release. The program first recruited mentors from the general community, but the mentees provided feedback indicating that they preferred to have peer mentors who had been incarcerated, were in recovery from SUD, and had reunited with their children. Based on this feedback, the program began to utilize Certified Recovery Specialists (CRS) and Certified Addiction Peer Recovery Coaches (CAPRC) to provide these mentoring services. These certifications are offered through the State of Indiana Department of Mental Health and Addictions and Indiana Counselor’s Association on Alcohol and Drug Abuse (ICAADA). For individuals to be certified, they must have lived experience in recovery from SUD, complete specific training for peer coaches, and pass a certification exam. The NS2HF project only recruited certified peer mentors and provided additional training to assist in creating services that provided gender-specific, coordinated reentry case planning, and other services. Mentees learned about recovery, child health and development, how to use positive reinforcement in parenting, skills for establishing healthy co-parenting relationships, and financial literacy. The peer mentor also acted as a resource broker to help link the mentee to community services for SUD, legal aid, housing assistance, and other community-based services.
Evaluation of Results The success of the program was assessed at several points throughout the one-year length of the program. At the initiation of each mentee into the program, her demographic characteristics, risks for future criminal activity, and needs for financial and social support were assessed utilizing the SPIN-W™ (Service Planning Instrument for Women) assessment instrument. At the conclusion of six months, the standardized SPIN-W
assessment of each mentee’s risks and needs was repeated. After a year of mentorship, each mentee also completed a survey. Each woman selfreported whether she was in recovery, had avoided recidivism, and had custody or visitation with her children. She also gave her opinions of the program, including whether her mentor had been helpful and whether the program was worthy of her recommendation to other women. After a year of participation in the mentorship program, the mentees completed a questionnaire about their experiences. Nearly all (96.1%; N = 195) of them self-reported they were in recovery. A similar percentage (91.7%; N = 188) of mentees claimed they had not been re-arrested since beginning participation in the program. A majority (79.7%; N = 157) of the mentees averred that they have custody of or visitation with their children. When asked about the value of the program to them, the mentees overwhelmingly endorsed it. Nearly all (96.6%; N = 197) of the mentees thought that their mentors had been helpful to them. They (98.0%; N = 195) would recommend the mentorship program to other women. (Rizzardini, 2019). The success of the NS2HF shows both the effectiveness of the peer recovery support provided, and the need for the services. Peer recovery support services are a growing resource in the field of addiction, and the milieus in which their services are being used is expanding. In this instance, the NS2HF program shows that the utilization of peer services, both while incarcerated and continuing after release, can help improve recidivism rates and client success in establishing and maintaining recovery from SUD. Peers can help eliminate common barriers for women in re-entry, such as helping them find support for substance use disorders, childcare, and transportation. Additionally, peers can play a role similar to a sponsor for those in rural areas where there is not a strong 12-step fellowship available.
When asked about the value of the program to them, the mentees overwhelmingly endorsed it.
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The statistical association of recovery from a substance use disorder and avoiding recidivism along with mentees’ endorsing the program support the contention that peer services can be an important part of assisting those incarcerated in local jails for drug crimes to successfully return to their communities without returning to their drug use. Nearly all the women were in recovery and had no new arrests at the conclusion of their one-year mentorships, which are important achievements that point to the need for more peer mentoring services for incarcerated mothers (Rizzardini, 2019). References Carson, E. A. (2014). Prisoners in 2013. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics. Godsoe, C. (1998). The ban on welfare for felony drug offenders: Giving a new meaning to life sentence. Berkeley Journal of Gender, Law & Justice, 13(1), 257-267. Golder S., Engstrom M., Hall M. T., Higgins G. E., & Logan T. K. (2015). Psychological distress among victimized women on probation and parole: A latent class analysis. American Journal of Orthopsychiatry, 85, 382–391. doi:10.1037/ort0000057 Jack, H. E., Oller, D., Kelly, J., Magidson, J. F., & Wakeman, S. E. (2018) Addressing substance use disorder in primary care: The role, integration, and impact of recovery coaches, Substance Abuse, 39(3), 307-314. DOI: 10.1080/08897077.2017.1389802 Rizzardini, L. (2019). Next Step 2 Healthy Families mentoring Program Evaluation. Terre Haute, IN: Next Step Foundation Sentencing project [PDF]. (2020). Washington, DC. Incarcerated Women. https://www. sentencingproject.org/publications/incarcerated-women-and-girls/ SPIN-W Service Planning Instrument for Women. https://orbispartners.com/assessment/ gender- responsive-spin-w/
Substance Abuse and Mental Health Services Administration (SAMHSA) (2009). What are peer recovery support services? U.S. Department of Health and Human Services, HHS Publication No. (SMA) 09-4454. Retrieved from https://store.samhsa.gov/shin/content/ SMA09-4454/SMA09- 4454.pdf Dana Simons, LMSW, LCAC, is the Executive Director of the Next Step Foundation, Inc., a nonprofit faith-based recovery community organization she co-founded in 2011 to provide housing and innovative programs and services for adults suffering from substance use disorder. Simons is a field instructor for Indiana State University and was awarded the Social Worker of the Year award for the Indiana Chapter of the National Association of Social Workers for 2017. Previously, Simons spent over 25 years in the computer software industry in California and was the CEO of Captura Software. She is the vice-chair of the Wabash Valley Recovery Alliance. Simons is a member of the Drug Free Vigo County Coalition; the Health and Wellness Committee of the Terre Haute Chamber of Commerce; and the Substance Use Disorders Council of the United Way of the Wabash Valley. Robyn Lugar, MSW, has taught at Indiana State University for 26 years. Her passion has been providing short-term international experiences for her students, which has included bilateral exchanges with Russian, South Korean, and Moroccan social work students and faculty. She is currently the Bachelor’s degree in Social Work Director. In 2016, Lugar became the PI for the Department of Justice Grant: Peer Recovery Support Impacts Outcomes for Incarcerated Mothers which provided the opportunity for the department of social work to work together with Next Step Foundation to develop a mentoring program for women who otherwise would not have had this type of support upon their release. Currently, Lugar is helping with the establishment of the Pride Center of Terre Haute.
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Customizing Recovery Coaching Training One Size May Not Fit All By Courtney Kibble, PsyD, LP, LPC, CADC, and Mary McClure, EdD, LPC
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T
he Recovery Coach (RC) has become a widely used resource in the treatment of and recovery from substance use disorders (SUD), as well as for many mental and physical health issues requiring long-term management. RC programs are increasingly customized to meet integrated care needs of populations with specific comorbid conditions (Myrick & del Vecchio, 2016). The RC provides non-clinical peer support that assists in removing personal and situational obstacles to recovery, links the recovering person with social and other support services, and serves as a personal mentor in the recovery process (CSAT, 2009; Kaplan, 2008). Despite continued growth and support for RC services, research into their effectiveness has been limited and research results are complicated by the lack of consistent educational requirements and role definition for RC, as their function evolves across service environments (Eddie et al., 2019; Myrick & del Vecchio, 2016). Given this dynamic context, effective utilization of RC support requires that organizations intentionally define desired RC functions and outcomes, the required RC knowledge and skills to support these, and how this RC role will be integrated within the larger organization.
autonomy in the development and promulgation of standards for testing, including who qualifies for the exams, content, administration, scoring, and appeals, as well as establishing appropriate policies for acquiring and maintaining the national credentials. The lack of national consensus on RC training or core competencies is explained in part by the 2007 Centers for Medicare and Medicaid Services directive that peer support training and certification requirements be defined by state (Myrick & del Vecchio, 2016). State requirements vary and evolve, often supporting multiple RC certifications. A 2018 compendium of RC certification requirements by state (UMASS, 2018) indicates that most states require RC applicants be high school graduates and obtain 40 to 50 hours of RC training, while a few states require 100 or more hours of RC training. Supervised RC role experience of 500 hours is often specified, as well as some type of personal experience in recovery. The nature of this recovery experience can vary; Oregon, for example, permits self-identification as receiving mental health services in the past or present, being in recovery from an addictive disorder with a two-year abstinence if substances are involved, being in recovery from problem gambling, or having a family member who received mental health services in the past or present (OHA, n.d.). What is a Recovery Coach? The Illinois Certification Board (ICB), in addition to offering variThe RC is a non-clinical peer support professional who has often received ous RC support specialist certifications, recently released Accreditation some level of training and certification. Where clinical professionals pro- Standards for a Peer Recovery Support Training Program. Organizational vide mental and physical health treatment services based primarily upon requirements for this comprehensive program include provision of 110 knowledge and expertise gained in formal education, training, and licen- topic-specified classroom training hours, 300 contact hours of supersure processes, the RC provides peer support vised internship experience, and compliance services based largely upon personal experito rigorous administrative and professional Also called Peer Recovery Support standards (ICB, 2020). This accreditation ence and knowledge gained while working through their own recovery processes. This establishes clear guidelines—, and a high Specialist, Wellness Support peer support is typically focused on establishbar—, for quality and scope of training coning a collaborative relationship, removing bar- Specialist, or similar titles, the RC tent and delivery mechanisms. For example, riers to recovery, and building connection to organizational applicants will provide educarole is often unfamiliar to community resources and activity. Also called tion, experience, and licensure credentials of organizations, resulting in role Peer Recovery Support Specialist, Wellness educators and supervisors, which will preferSupport Specialist, or similar titles, the RC ably include existing certification by ICB. In confusion and boundary issues. role is often unfamiliar to organizations, redoing this, ICB targets to ensure high quality sulting in role confusion and boundary issues recovery support training by forming part(CSAT, 2009; Eddie et al., 2019; Kaplan, nerships with the educational institutions that 2008). Upon introduction, the role should be distinguished from that of have designed training programs specifically to prepare students to work the more familiar Alcoholics Anonymous (AA) sponsor, noting that the in recovery support roles. RC maintains a collaborative and non-directive style not associated with RC role activity generally falls into four categories: emotional, inforAA’s 12 Steps. Clarification that clinical mental health, medical diagnosis, mational, instrumental, and affiliational. Emotional role activity includes or treatment – as well as spiritual or religious guidance – are all outside development of the empathic client relationship, mentoring, and inspiring the scope of RC activity is also appropriate. Educating the organization positivity and hope. Informational role activity includes sharing personal on intended RC functions and interfaces can allay concerns that it may knowledge, as well as resource connections or conducting life skills trainencroach on other positions’ responsibilities (Loveland & Boyle, 2005). ing on topics such as vocational skills, communications, and wellness. Though there is no national consensus on RC training and certifica- Instrumental role activity includes providing concrete assistance such as tion processes, the National Certified Peer Recovery Support Specialists childcare, transportation, or help gaining access to community support (NCPRSS) credential developed by the National Certification Commis- services; this may extend to family and significant others of the client. sion for Addiction Professionals (NCC AP) is increasingly supported as Affiliational role activity includes building client community contacts to a nationally recognized credential. The NCC AP, under the auspices of promote greater socialization and connectedness within organizations NAADAC, the Association for Addiction Professionals, has operated as such as recovery centers, support meetings, sports, and recreational cenan independent body for all matters involving the Association’s SUD ters (CSAT, 2009; Kaplan, 2008). counselor certification and endorsement opportunities at the national and However, specific RC role definition tends to be inconsistent as role international level. Established in 1990, the NCC AP has independent responsibilities are designed to meet the unique needs of the organization S P R I N G 2 021 | 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 2 5
and recovering individual. The RC may also fill a service gap as clients transition through levels of care. For example, an RC working with acute SUD issues in an emergency room setting may need specific training to help clients in a traumatic situation understand treatment options available to them given their diagnostics, location, and insurance situation; specific training may also be necessary when working with distraught families. In contrast, RCs working with populations seeking to maintain post-treatment long-term recovery may emphasize relapse prevention, wellness plan development, relationship building, goal setting, and problem solving (CSAT, 2009; Eddie et al., 2019).
Creating the RC Role within Your Organization
specific activities should be approached. State certification requirements can form a good starting point for content, as can the aforementioned training resources in both their content and references. Organizations can enrich training content, build their own training programs, or purchase RC training courses from one of the many organizations offering these. These differ in both breadth and depth of content coverage, as well as in delivery formats. Management can test-drive training options to determine the best fit for their organizational needs and culture. The following are some areas typically included in basic 40-hour RC training: • Substance use disorder and recovery processes/definitions • Recovery-oriented systems of care concept • Person-centered, strength-based, and collaborative relationships • Ethical practices • Wellness domains assessment and recovery plan development • Motivational interviewing • Advocacy and mentoring • Stages of change • Recovery capital • CBT model of relapse prevention, functional analysis, and problem solving • Involving family and close others • Interpersonal and communication skills • Multicultural awareness and special population considerations
As a first step in determining how a RC role could best fit organizational needs, decision makers need to gain foundational knowledge of RC approaches and roles, as discussed above. In addition to formal training programs there is a wealth of information on RC and recovery support services available through government organizations, such as the Substance Abuse and Mental Health Service Administration (SAMHSA). RC education materials developed by publicly funded agencies—such as that by Bennet & Bellack (2015), Loveland & Boyle (2005), and McShin Foundation (2017)—are also valuable resources and include references to respected source materials. Leadership must decide whether the RC position will be maintained in-house or provided in coordination with an external agency. Larger organizations offering a full scope of treatment and long-term recovery support may be in a better position to maintain an internal RC function Educational requirements related to the specific environment and that can serve clients throughout all stages. On the other hand, partner- identified roles for the RC must also be identified and satisfied. ing with a community social service agency Supervision is an important ongoing trainthat is a part of a Recovery Oriented System ing component to ensure competence and Education that encourages a of Care (ROSC) network offers the advantage well-rounded client care. A group superviperson-centered, strength-based, sion model can be particularly beneficial as of allowing for continuity of RC service, as the client may move between service facilities, and and collaborative approach is individual experiences and questions can be builds client ties to the community (CSAT, shared and resolved. As the boundaries of a critical to the overall 2009; Eddie et al., 2019). RC can sometimes appear cloudy, supervision There are different perspectives as to whethcan help clarify responsibilities and situations effectiveness of the RC. er the RC position must be filled by peers who that would call for referrals or assistance from are in recovery themselves. Coaches having others in the organizations. Ethical questions, personal experience with SUD can share their such as boundaries of client confidentiality for own recovery experience in their mentoring roles. Conversely, persons in the RC, often arise (CSAT, 2009; Eddie et al, 2019; ICB, 2020; Loverecovery may not have achieved overall wellness, or may have developed land & Boyle, 2005). paternalistic and highly directive dispositional attitudes from their own treatment. Requiring a personal lived recovery experience may prove Defining Specific Functions of the Recovery Coach difficult as RC service extends to integrated care environments (CSAT, As discussed above, the specific role of the RC will vary to be responsive 2009; Eddie et al, 2019). to specific organizational and client needs. In general, the following functions are considered basic to the RC role: Educating the Recovery Coach • Establish and maintain a trusting, supportive, collaborative, and perEducation that encourages a person-centered, strength-based, and colsonal client relationship. laborative approach is critical to the overall effectiveness of the RC. This • Utilize a participant-centered Recovery Wellness Plan model to help is difficult for some trainees who may have to change advice-giving and clients develop effective recovery and general life goals. judgmental habits. The goal is to help trainees grasp the empowering • Conduct recovery coaching services, including mentoring or coaching, impact of empathic connection, genuineness, and acceptance in client resource connecting and advocacy, leading recovery support groups, relationship building; this requires the repetition of habits until they beand building community. come second nature (Kaplan, 2008; Miller, 2000). • Provide indirect services to maintain collaborative and supporting reRC education should provide a foundational knowledge base on lationships within the organization and within the community. substance use and recovery processes, as well as guidance on how RC 26
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Detailed guidelines and expectations for performance of RC basic functions are needed. For example, how often, when, and where will the RC meet with clients? Will their role include various types of skills training or group meetings? What resource connections for clients are available? What access will they have to client records? Will they provide clients with transportation? The quality of the RC role performance will depend on articulation of specific role requirements (SAMHSA, 2015). Research findings to date provide some support for the potential RC services in SUD and other treatment settings related to reduced usage and relapse rates, enhanced satisfaction with and retention in treatment, and enhanced social supports (Eddie et al., 2019; Myrick & del Vecchio, 2016). Expanded research is needed to understand the relative impact of RC services as compared to other support services, and to consider variations in education, role definitions, and service settings utilizing RC services. References Bennett, M, & Bellack, A. (2015). On Track NY Recovery Coaching Manual. Retrieved from https://www.ontrackny.org/portals/1/Files/Resources/RecoveryCoach_2015.01.21.pdf Center for Substance Abuse Treatment (CSAT). (2009). What are Peer Recovery Support Services? HHS Publication No. (SMA) 09-4454. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Retrieved from https://store.samhsa.gov/system/files/sma09-4454.pdf Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., Weinstein, C., and Kelly, J.F. (2019). Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology. 10:1052. doi: 10.3389/fpsyg.2019.01052 Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01052/full Idaho Department of Health and Welfare (IDHW). (2020). 1.0 Certified Peer Support Specialist (CPSS) Standards. Retrieved from https://publicdocuments.dhw.idaho.gov/WebLink/ DocView.aspx?id=4039&dbid=0&repo=PUBLIC-DOCUMENTS&cr=1 Illinois Certification Board (ICB). (July, 2020). Illinois Certification Board Peer Recovery Support Training Program Accreditation Standards CRSS and CPRS. Springfield, IL: ICB. Kaplan, L., (2008). The Role of Recovery Support Services in Recovery-Oriented Systems of Care. DHHS Publication No. (SMA) 08-4315. Rockville, MD: Center for Substance Abuse Services, Substance Abuse and Mental Health Services Administration. Retrieved from http://www.pacdaa.org/SiteCollectionDocuments/SAMHSA%20White%20Paper%20 on%20The%20Role%20of%20Recovery%20Support%20Services.pdf Loveland, D. and Boyle, M. (2005). Manual for Recovery Coaching and Personal Recovery Plan Development. Springfield, IL: Illinois Department of Human Services Department of Alcoholism and Substance Abuse. Retrieved from https://bha.health.maryland.gov/ CLINICAL%20SERVICES/Documents/ROSC/RC_ManualDASAedition7_22_05.pdf McShin Foundation. (2017). Recovery Coaching Manual: Substance Use Disorder Recovery Program (2nd ed). Richmond, VA: McShin. Retrieved from https://mcshin.org/wp-content/ uploads/2019/07/RCM-2020_SML.pdf Miller, W. R. (2000). Rediscovering fire: Small interventions, large effects. Psychology of Addictive Behaviors, 14(1), 6–18. https://doi.org/10.1037/0893-164X.14.1.6 Myrick, K., & del Vecchio, P. (2016). Peer support services in the behavioral healthcare workforce: State of the field. Psychiatric Rehabilitation Journal, 39(3), 197–203. https://doi. org/10.1037/prj0000188 Oregon Health Authority Peer Delivered Services (OHA). (n.d.). Certified Peer Support Specialist Requirements. Retrieved January 15, 2021 from https://www.oregon.gov/oha/ HSD/AMH-PD/Documents/Certified-Peer-Support-Specialist-Requirements.pdf Substance Abuse and Mental Health Services Administration’s (SAMHSA). (2015). Core Competencies for Peer Workers. Retrieved from https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers/core-competencies-peer-workers Substance Abuse and Mental Health Service Administration (SAMHSA). (2016). Creating a Healthier Life: A Step-By-Step Guide to Wellness. SMA-16-4958. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Retrieved from https://store.samhsa.gov/product/Creating-a-Healthier-Life-/ SMA16-4958 University of Massachusetts Medical School (UMASS). (2018). Compendium of Recovery Coach Certification Requirements by State. Retrieved from https://rizema.org/wp-content/ uploads/2019/01/UMass-RIZE-Recovery-Coach-Certification-By-State-Final-WorkbookSubmitted.xlsx
White, W. & Kurtz, E. (2006). The varieties of recovery experience. International Journal of Self Help and Self Care, 3(1-2), 21-61. Retrieved from http://mx1.williamwhitepapers.com/ pr/2006VarietiesofRecoveryExperience.pdf Courtney Kibble, PsyD, LP, LPC, CADC, is an Assistant Professor at Governors State University (GSU) in the Department of Addiction Studies and Behavioral Health. She specializes in trauma and substance use concerns. She is also the Program Coordinator for the MHS in Addiction Studies program. She has been involved in many instructional opportunities including serving as site leader for a Suicide Assessment Training Team, providing trauma training for counselors, and assisting in the development and delivery of GSU’s recovery coaching education program. Mary McClure, EdD, LPC, is an Assistant Professor at Governors State University (GSU) Department of Addiction Studies and Behavioral Health. With 12 years of experience as a counselor educator, she has been working in this current position since 2015, developing and delivering Master’s level courses in the department’s Addiction Studies MHS programs. She currently leads GSU efforts in development and delivery of recovery coaching education and internship.
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NIDA Fosters International Research and Collaborations Jack Stein, PhD, MSW, National Institute on Drug Abuse, and Steven W. Gust, PhD, National Institute on Drug Abuse
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isk factors for substance use, as well as government policies and resources for prevention and treatment of substance use disorders (SUD), vary widely among countries. But substance use and its health consequences occur everywhere, in every culture, environment, and government system. Addressing drug use and the health problems that stem from it depends upon multinational cooperation. As one of the world’s largest funders of research on drug misuse and addiction, the National Institute on Drug Abuse (NIDA) has recognized from its beginning that it has an important role to play in raising international awareness about these issues and even in supporting international research to address them. In 1990, we established our first fellowship program to address the lack of sufficient research capacity in low-to-middle-income countries (LMICs) to help address the global public health challenge of drug misuse. NIDA’s International Program helps address public health issues related to SUDs around the globe and promotes evidence-based policies, prevention interventions, and treatments. It builds partnerships with countries, organizations, and individual researchers to promote new research initiatives, build international research capacity, and disseminate knowledge.
Research Initiatives Even in the challenging economic climate of the COVID-19 pandemic, NIDA remains committed to supporting innovative research to expand scientific knowledge that leaders and policymakers everywhere can use to deliver more effective prevention and treatment interventions in their countries. NIDA-funded research has greatly expanded science’s understanding of SUDs. We know that substance use disrupts the brain circuits involved in reward, decision-making, learning, and self-control and that complex biological, social, environmental, and developmental factors dynamically interact to influence risk, trajectory, and treatment outcomes. NIDA-funded scientists have developed effective prevention and treatment interventions. But much more is needed, such as the need to develop a wider array of treatment options as well as new service delivery mechanisms to address SUDs from detoxification to recovery support and relapse prevention. Research has documented how diversity is a boon to science by 28
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increasing creativity as well as improving decision making. Consequently, there are many scientific advantages to examining SUDs with varying cultural and national perspectives and scientific approaches. About 7% of the NIDA research budget supports projects conducted in other countries. More than 90% of those international grants are awarded to teams of U.S. and international researchers who take advantage of unusual opportunities outside the United States to access talent, resources, populations, or environmental conditions not available domestically. For example, different countries’ drug policies—marijuana legalization in Canada or France’s expanded access to buprenorphine, for instance—create natural experiments from which we can learn a great deal through multinational collaborative research. Like NAADAC, the NIDA International Program has been an active partner with the U.S. Department of State Bureau of International Narcotics and Law Enforcement Affairs, the International Society of Substance Use Prevention and Treatment Professionals (ISSUP), the Colombo Plan, the Global Centre for Credentialing and Certification, and the Society for Prevention Research to train addiction professionals around the world. NIDA staff, grantees, and former fellows joined with NAADAC members and international experts to draft, review, and launch universal treatment and prevention curricula. This global effort led the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) to issue the International Standards for the Treatment of Drug Use Disorders in 2020. NIDA grantees and former fellows lead ISSUP national chapters and are members of the newly formed ISSUP Quality in Treatment Network, which shares best practices and promotes quality assurance in SUD treatment programs. Highly trained international scientists and treatment providers whose backgrounds and training opportunities differ from those of their American colleagues bring a unique perspective to NIDA’s research efforts. This spring, NIDA will issue a Notice of Special Interest (NOSI) encouraging international collaboration on SUD research using an expanded number and type of research grants. The goal is to encourage researchers to form partnerships that develop knowledge jointly that neither partner could have discovered independently. These kinds of collaborative research projects have improved pharmacological and behavioral treatment options by demonstrating how
differences in policies and treatment practices can promote treatment seeking and improve access to services and outcomes. For instance, NIDA-supported researchers in the U.S. and Russia conducted studies that led to FDA approval of extended-release naltrexone to treat opioid use disorder. Animal studies by U.S. and French researchers are shedding new light on the sex-specific behavioral effects of adolescent cannabis use and developmental delays caused by perinatal cannabis exposure. And NIDAsupported researchers in Argentina, Chile, United States, and Uruguay conducted natural experiments on the effect of marijuana legalization, providing empirical evidence to guide future policy decisions.
Building International Research Capacity The NIDA International Program builds international research capacity through four postdoctoral fellowship programs, a fellowship for midcareer substance use professionals from eligible countries, and two professional development programs for senior scientists. Since 1990, the NIDA International Program has supported more than 530 postdoctoral, midcareer, and senior scientist fellows from 114 countries. NIDA International Program fellows form the core of local, regional, national, and international networks that extend the reach of NIDA’s research and implement evidence-based interventions around the world. Former fellows now work with governmental, academic, and nongovernmental organizations conducting and publishing peer-reviewed research, teaching, and administering addiction treatment and prevention programs. Former NIDA fellows also shape global drug policies by serving on expert panels or working for international organizations such as the Colombo Plan Drug Advisory Programme, European Union, United Nations, and WHO. The NIDA International Visiting Scientists and Technical Exchange Program (INVEST) Drug Abuse Research Fellowships provide 12 months of mentored postdoctoral research training for scientists from other countries. There are four types of INVEST Fellowships: one for scientists working in any area of NIDA-supported research and three focused on clinical trials, prevention, or neuroscience, respectively. NIDA Hubert H. Humphrey Drug Abuse Research Fellowships are a component of a State Department program that provides ten months of academic study for young and midcareer professionals from eligible countries. NIDA Humphrey Fellows are most often treatment providers or prevention program administrators. Fellows study at Virginia Commonwealth University and participate in professional development activities such as short-term affiliations with researchers or treatment professionals, meetings with NIDA officials, and connections with NIDA grantees interested in collaboration. Senior scientists from other countries use the Distinguished International Scientist Collaboration Award (DISCA) to support short-term exchange visits to launch or complete joint research projects. Their American partners use the companion USDISCA program.
Disseminating Knowledge The International Program disseminates information to the international scientific community through scientific meetings and a variety of electronic and print media. The International Program’s premier scientific meeting, the NIDA International Forum, is held annually in June in conjunction with the annual meeting of the College on Problems of Drug Dependence (CPDD).
This meeting highlights the range and quality of drug misuse and addiction research conducted around the world and helps participants build research partnerships across geographic borders and scientific disciplines. This year’s event will be held virtually June 22-24, 2021. The International Program website is our primary source of information for researchers and the general public. It has innovative databases to help identify international researchers, including their locations and research areas. An interactive fellowship map allows users to identify NIDA fellowship alumni from a particular country or fellowship program and to link from individual fellows to their journal articles indexed in the National Library of Medicine’s PubMed database. The NIDA International Drug Abuse Research Abstract Database allows users to search for abstracts of presentations from meetings hosted by the NIDA International Program since 2003. Additionally, the NIDA International E-News provides information about recent Institute activities, funding opportunities, International Program fellowships, and NIDA-supported scientific meetings. Research findings from any particular country may have important implications for best practices in drug use and addiction policy, prevention, and treatment elsewhere. NIDA’s international research into implementation of evidence-based prevention and treatment interventions in settings with limited resources is applicable to both international settings and those U.S. regions that face similar structural, legal, or fiscal constraints—and vice versa. Leveraging the global network of scientific experts and treatment providers will help NIDA ensure that we all learn from one another’s successes and failures, advance science on the causes and consequences of substance use, and apply that knowledge to improve individual and public health. As NAADAC has been expanding globally in recent years, NIDA’s International Program is excited about the prospect of potential collaboration, to help further dissemination and to inform research. We invite NAADAC members to share their priorities with NIDA and participate in the NIDA International Forum, where we can share priorities and develop strategies to promote global adoption of evidence-based interventions. Reference Phillips, K.W. (October 2014). How Diversity Works. Scientific American 311(4): 42-47. doi:10.1038/scientificamerican1014-42. Steven W. Gust, PhD, has directed the National Institute on Drug Abuse (NIDA) International Program since 1999. He is responsible for the Institute’s efforts to foster collaborative and peer-reviewed international research and promote cooperation between NIDA and other U.S. and foreign agencies, governments, and non-governments organizations. Gust also leads the Institute’s efforts to support international research and training. He joined NIDA in 1986. In 1993, Gust received a prestigious appointment as a congressional fellow, where he worked with the U.S. Senate Labor and Human Resources Committee. In addition to receiving numerous Public Health Service and National Institutes of Health awards, Gust has been honored by the National Institutes of Health, College on Problems of Drug Dependence, Society for Prevention Research, and National Hispanic Science Network. Gust holds a Doctoral degree in Psychology from the University of Minnesota. 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). In addition to this position, Stein was appointed the NIDA Chief of Staff in March 2019. He has over two decades of professional experience in leading national drug and HIV-related re-search, practice, and policy initiatives for NIDA, The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.
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Researching the Ecology of Addictive Behavior Change for Nicotine By Nancy A. Piotrowski, PhD, MAC, NCC AP Commissioner
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ormally, when folks hear the word “ecology,” they think In the area of smoking studies, EMA is teaching us about variations in of biology and studying animals in the wild. The truth is, smoking behavior by population group and the different situations they however, that ecology is a perspective that applies even to encounter. For example, Nguyen, Nguyen, and Thrul (2020) reviewed humans. It is about understanding the behavior of any or- co-use of marijuana and cigarettes and report that EMA data show that ganism in context, which includes both other humans and the place they there are diverse patterns of co-use. For instance, some users smoke the are located. Perhaps this reminds you of the “people, places, and things” drugs separately, while some are combining them into a single blunt or refrain. Indeed, basic processes of learning in addiction are sensitive to cigarette. These patterns may demand different treatment approaches. place (O’Brien, Childress, McLellan, & Ehrman, 1992). And certainly, Another EMA study by Shiffman and colleagues, who have been using we have seen the utility of understanding experience sampling methods in addiction the effects of “place” in treatment, such as studies for decades, also looked at smoking When many people think about through classic and effective approaches of (Shiffman, Scholl, Mao, Ferguson, Hedeker, phones and addiction, they first helping clients manage risky situations via re& Tindle, 2020). They examined EMA of lapse prevention (Marlatt & Gordon, 1985). and lapses in non-daily smokers; think of addiction problems. But temptations In fact, the behavioral ecology of addiction these are individuals who are generally not dethe reality is that these devices offer pendent on nicotine, but still have a hard time is a booming field of research. It is helping us understand how things interact in real time in The researchers used EMA to study many possibilities for both research quitting. real situations, providing the possibility of an 130 initially abstinent individuals, capturing and intervention, extending a integrated perspective on how to better help over 11,000 randomly timed assessments, our patients. To date, we have seen benefits and learned that cues to smoke (e.g., others rich tradition of human ecology of using these methods across diverse probsmoking, alcohol consumption, lax smoking studies in addiction. lems such as understanding how symptoms restrictions) may indicate more conditioned develop, how emotions may vary in real time, psychological dependence than was realized. identifying internal and situational determiIn another EMA study, Livingston, Flentje, nants of psychopathology, understanding stress in person-environment Heck, Szalda-Petree, and Cochran (2017) studied sexual and gender interactions, examining social interactions, and in evaluating treatment minority individuals (N=50) for 14 days, taking measurements six times in real world circumstances (Myin-Germeys, Kasanova, Vaessen, Vachon, a day between 10 a.m. and 10 p.m. They found that discrimination exKirtley, Viechtbauer, & Reininghaus, 2018). In this article, I would like periences had both immediate and delayed association with subsequent to share about ecological momentary assessment (EMA), or what we call use of nicotine and other substance use. Further, relative to other misexperience sampling. The collection of cell phone data, telehealth, and treatment, discrimination effects became stronger throughout the day the use of apps is skyrocketing. Estimates as of 2014 suggest that 93% of and evening and were consistently larger in magnitude. Again, these finepeople in the world owned cell phones, with 100% of residents of devel- grained details would be hard to capture with a static questionnaire or oped countries having at least one phone (Birenboim & Shoval, 2016). even an interview, as recall for such nuances are not necessarily evident in The benefits of this method of data collection are that it allows for rela- the moment for the person experiencing these things, thus highlighting tively unobtrusive automatic observations, highly specific programming, one of the benefits of EMA. minimal expenses, and the ability to yield data to remote researchers with When many people think about phones and addiction, they first think ease (Raento, Oulasverta, & Eagle, 2009; Harari, Lang, Wang, Crosier, of addiction problems. But the reality is that these devices offer many posCampbell, & Gosling, 2016). sibilities for both research and intervention, extending a rich tradition of 30
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human ecology studies in addiction. Smart phones are but one area where we are growing our ability to improve our ecological understanding (and treatment) of addiction. E-health programs and web-based interventions, machine learning, computerized adaptive testing, wearable devices and digital phenotyping, biofeedback, and virtual reality (Ferreri, Bourla, Mouchabac, & Karila, 2018) all join with EMA to improve what we do. And for smoking in particular, this is very important as smoking is still one of the costliest addictions out there in terms of public health impact. So, as you think about your clients, reflect on how evolving technology such as smart phones can help you in your work. What else do we need to know about the ecology of nicotine use and related smoking? EMA is one way we can get those answers. References Birenboim, A., & Shoval, M. (2016). Mobility research in the age of the smartphone. Annals of the American Association of Geographers, 116(2), 283-291. Ferreri, F., Bourla, A., Mouchabac, S., & Karila, L. (2018). E-Addictionology: An overview of new technologies for assessing and intervening in addictive behaviors. Frontiers in Psychiatry, 01 March 2018. https://doi.org/10.3389/fpsyt.2018.00051 Harari, G.M., Lang, N.D., Wang, R., Crosier, B.S., Campbell, A.T., & Gosling, S.D. (2016). Using smartphones to collect behavioral data in psychological science: Opportunities, practical considerations, and challenges. Perspectives on Psychological Science, 11(6), 838-854. Livingston, N. A., Flentje, A., Heck, N. C., Szalda-Petree, A., & Cochran, B. N. (2017). Ecological momentary assessment of daily discrimination experiences and nicotine, alcohol, and drug use among sexual and gender minority individuals. Journal of Consulting and Clinical Psychology, 85(12), 1131–1143. https://doi.org/10.1037/ccp0000252
Marlatt, G.A., & Gordon, J.R., Eds. (1985). Relapse prevention. New York, NY: The Guilford Press. Myin-Germeys, I., Kasanova, Z., Vaessen, T., Vachon, H., Kirtley, O., Viechtbauer, W. & Reininghaus, U. (2018). Experience sampling methodology in mental health research: new insights and technical developments. World Psychiatry, 17(2), 123-132. Nguyen, N., Nguyen, C. & Thrul, J. (2020). Digital health for assessment and intervention targeting tobacco and cannabis co-use. Current Addiction Reports, 7, 268–279. https://doi. org/10.1007/s40429-020-00317-9 O’Brien, C.P., Childress, A.R., McLellan, A.T., & Ehrman, R. (1992). Classical conditioning in drug-dependent humans. The Neurobiology of Drug and Alcohol Addiction, 654(1), 400415. https://doi.org/10.1111/j.1749-6632.1992.tb25984.x Raento, M., Oulasverta, A., & Eagle, N. (2009). Smartphones: An emerging tool for social scientists. Sociological Methods & Research, 37(3), 426-454. Shiffman, S., Scholl, S.M., Mao, J., Ferguson, S.G., Hedeker, D., & Tindle, H.A. (2020). Ecological momentary assessment of temptations and lapses in non-daily smokers. Psychopharmacology, 237, 2353–2365. Nancy A. Piotrowski, PhD, MAC, is a clinical psychologist with more than 35 years of experience working in addictions. Piotrowski is a past president of the Society of Addiction Psychology and serves as its Federal Advocacy Coordinator in their work with the American Psychological Association (APA). She maintains an active consultancy, teaches for University of California – Berkeley Extension, and regularly advocates for continued improvements to addictions and mental health training, treatment quality, access to care, and enforcement of mental health and addiction parity. Piotrowski serves as a Commissioner for the National Certification Commission for Addiction Professionals (NCC AP).
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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. Free for NAADAC members and $15 for non-members.
1. The lack of national consensus on RC training or core competencies is explained in part by the Centers for Medicare and Medicaid Services 2007 directive that peer support training and certification requirements be defined by _________. A. the federal government B. the medical system C. the state government D. individual schools
6. All of the following may be ways to create a more welcoming environment for TGNC individuals seeking SUD treatment, except: A. Diversify staff at your facility B. Provide staff training C. Ensure wall posters and brochures include pictures of diverse persons D. Have only male and female bathrooms
2. The role of the recovery coach includes all of the following areas, except: A. Medication prescription B. Emotional role activity C. Informational role activity D. Instrumental role activity
7. A report by the Sentencing Project (November 2020) showed that between 1980 and 2016, the number of women incarcerated in American jails and prisons increased by more than _____ percent. A. 700% B. 100% C. 50% D. 75%
3. All of the following are areas typically included in basic 40-hour recovery coach training, except: A. Recovery oriented systems of care concept B. Person-centered, strength based, collaborative relationships C. Ethical practices D. Administering buprenorphine 4. According to a national study conducted by the National Center for Transgender Equality, up to _______ of TGNC participants had been fired or experienced employment discrimination, including verbal, physical, or sexual harassment or assault in the last 12 months. A. one-half B. two-thirds C. one-third D. one-eighth 5. What theory is a commonly proposed model for explaining disparities among TGNC people (although the theory is predominately supported in research among lesbian, gay, and bisexual groups)? A. Attachment theory B. Minority stress theory C. Social learning theory D. Sociocultural theory
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8. What year was the Second Chance Act (SCA) signed into law? A. 2000 B. 2008 C. 2010 D. 2020 9. The Next Step to Healthy Families (NS2HF) connects incarcerated young mothers with a ______ for a period of one year. A. therapist B. friend C. mentor D. coach 10. Since 1990, the NIDA International Program has supported more than ______ postdoctoral, midcareer, and senior scientist fellows from 114 countries. A. 110 B. 530 C. 50 D. 1000
■ NA A DAC L E ADE RS H I P NAADAC EXECUTIVE COMMITTEE
NAADAC COMMITTEES
Edited 04/15/21
North Central
STANDING COMMITTEE CHAIRS
AD HOC COMMITTEE CHAIRS
President Mita Johnson, EdD, LPC, MAC, SAP, CTHP II
(Represents Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota)
Awards Committee Chair Mary Woods, RN-BC, LADC, MSHS
President-Elect Angela Maxwell, PhD, CPS
Northeast
Adolescent Specialty Committee Co-Chairs Chris Bowers, CSAC, NCAAC Steven Durkee, NCAAC
Secretary Susan Coyer, MA, AADC-S, MAC, CCJP
James “JJ” Johnson, Jr., BS, LADC, ICS (Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)
Treasurer Jerry A. Jenkins, MEd, LADAC, MAC
Christopher J. Taylor, MAC, CASAC, DBA, LMHC
Immediate Past President Diane Sevening, EdD, LPC, MAC
Northwest
National Certification Commission for Addiction Professionals (NCC AP) Chair James “Kansas” Cafferty, LMFT, NCAAC
Sharon “Shari” B. Rigg, LAC
Executive Director Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP
(Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)
Ethics Committee Co-Chairs Kirk Bowden, PhD, MAC, NCC, LPC Rose Marie, MAC, LCADC, CCS
Southeast (Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)
Marvin “Mat” M. Sandifer, LCSW, LCAS Southwest
Mid-Atlantic
(Represents Arizona, California, Colorado, Hawaii, Nevada, New Mexico and Utah)
Ron Pritchard, CSAC, CAS, NCAC II Mid-Central (Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)
Clinical Issues Committee Co-Chairs Malcolm Horn, PhD, LCSW, MAC, SAP Thea Wessel, MA, LPC, LAC, MAC, NCAAC Critical Issues in the Black Community Co-Chairs Bakahia Madison PsyD, LCPC, CADC Katina Palmer, LPC
REGIONAL VICE-PRESIDENTS (Represents Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia and West Virginia)
Bylaws Committee Chair Ronald A. Chupp, LCSW, LCAC, NCAC II, ICAC II
Thomas P. Gorham, LMFT, CADC II
ORGANIZATIONAL BOARD REPRESENTATIVE Organizational Member Delegate Jim Gamache, MSW, MLADC, IAADC
Gisela Berger, PhD, MAC, LPC, NCC Mid-South
Finance & Audit Committee Chair Jerry A. Jenkins, MEd, LADAC, MAC International Practices and Standards Committee Co-Chairs Kirk Bowden, PhD, MAC, NCC, LPC Don Osborn, PhD, LCAC, LMHC, LMFT, LCSW Membership Committee Chair John Korkow, PhD, LAC, SAP Military & Veterans Advisory Committee Chair Ron Pritchard, CSAC, CAS, NCAC II Nominations and Elections Chair Diane Sevening, EdD, LAC, MAC Personnel Committee Chair Mita Johnson, EdD, LPC, MAC, SAP, CTHP II
(Represents Arkansas, Louisiana, Oklahoma and Texas)
Public Policy Committee Co-Chairs Michael Kemp, ICS, CSAC, CSW Sherri Layton, MBA, LCDC, CCS
John C. Cates, MA, LCDC
Student Committee Chair Jeff Schnoor, MA, LICDC (pending), CCSTA, QMHP-CS, Certified Interventionist
NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP) James “Kansas” Cafferty, LMFT, NCAAC NCC AP Chair California Kirk Bowden, PhD, MAC, LPC Arizona
International Committee Chair Ehab El kharrat, PhD
Gary Ferguson, BS, ND 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 2018-2020 Diane Sevening, EdD, LPC, MAC
Nancy A. Piotrowski, PhD, MAC California Michael Kemp, NCAC I Oregon Ehab El kharrat, PhD Egypt Tiffany Irvin, NCPRSS, CPRS Minnesota Mita Johnson, EdD, LPC, MAC, SAP, CTHP II (ex-officio) Colorado
NAADAC EDUCATION & RESEARCH FOUNDATION (NERF) NERF President Mita Johnson, EdD, LPC, MAC, SAP, CTHP II NERF Events Fundraising Chair Nancy Deming, LCSW, MAC, AADC-S
NAADAC REGIONAL BOARD REPRESENTATIVES NORTHEAST MID-CENTRAL NORTH CENTRAL Gloria Nepote, Kansas Rik Lundgren, MAPL, LADC, Minnesota Ryan Carruthers, PhD, MAC, LADC LMHP, CPC, Nebraska Megan Ekran, LAC, LPCC, North Dakota Mark Young, South Dakota
Renee Lee, MSW, CADC, Illinois Phillip W. Schortgen, Indiana Geoff Wilson, LCSW, LCADC, Kentucky Deborah Garrett, BS, CPRM, CPS, Michigan Raynard Packard, Ohio Rachel Feller, BA, Wisconsin
Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Joe Kelleher, LADC-1, Massachusetts Linda Brewer, MSW, LICSW, MLADC, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, SAP, New York William A. Keithcart, MA, LADC, MAC, SAP, Vermont
NORTHWEST Courtney Donovan, PhD, Alaska Monica Forbes, NCPRSS/CPRC, Idaho Tim Warburton, BS, LAC, Montana Ray Brown, CADC II, Oregon David Woldtvedt, BA, SUDP, Washington Frank Craig, Wyoming
SOUTHWEST
MID-ATLANTIC
Yvonne Fortier, MA, LPC, LISAC, Arizona Justin Phillips, LMFT, CATC-IV, California Jonathan DeCarlo, CAC III, Colorado David Marlon, MBA, MS, LADC, CAd, Nevada Brian Serna, New Mexico Richard Nance, MSHHA, MSW, LCSW, Utah
Cyril M. Scovens, MS, CAC-AD, Maryland Michele Williams (Stambaugh), MSS, Pennsylvania Connie S. Ducaine, PhD, LPC, LCADC, ACS, NCC, New Jersey Denise D. Cooper, LSATP, CRC, MAC, CSAC, Virginia Heather Sharp-Spinks, MSW, ADC, CCS, West Virginia
SOUTHEAST MID-SOUTH Sherri Layton, LCDC, CCS, Texas Abby Willroth, BA, RDS, ADC, IADC, PR, SAP, MATC, Arkansas
Bobbie Hayes, LMHC, CAP, Florida Donna Ritter, BT, CAC II, CCS, Georgia Jessica Holton, MSW, LCSW, LCAS, North Carolina Nicole Deems, LMFT, LAC, CCS, South Carolina Terry Kinnaman, LADAC II, MAC, QCS, Tennessee
ADVANCING AWARENESS IN LGBTQ CARE A FREE NAADAC WEBINAR SERIES
Part I: History of Specialized Treatment for LGTBQ+ Clients Friday, June 18, 2021 @ 12:00-2:00pm ET Earn 2 CEs! Presented by Joe Amico, MDiv, LADC I, CAS, with panelists Anne Helene Skinstad, PhD, Kristina Padilla, MA, LAADC, ICAADC, CGS, Philip T. McCabe CSW, CAS, CDVC, DRCC, Pamela E. Alexander, MSA, MUP, Dana G. Finnegan, PhD, CAC, and Emily B. McNally, PhD, CAP
Part II: LGBTQ Youth, Community & Alcohol Misuse EVERY THIRD FRIDAY OF THE MONTH AT 12:00PM ET FROM JUNE - SEPTEMBER NAADAC is excited to present our new free webinar series: Advancing Awareness in LGBTQ Care. Earn up to 6.5 CEs! This four-part webinar series was developed by NAADAC along with our LGBTQ+ Clinical Issues Sub-Committee and will launch during Pride Month 2021. Register now and learn about the issues that affect your LGBTQ+ clients from experts in the addiction treatment field! While viewing the education is free, non-members must pay to receive CEs ($20 for 1.5 CEs and $25 for 2 CEs). NAADAC members can earn those CEs for free! (Join NAADAC now and save!)
NAADAC, the Association for Addiction Professionals 44 Canal Center Plaza, Suite 301 Alexandria, VA 22314 P: 703.741.7686 | F: 703.741.7698 E: naadac@naadac.org
Friday, July 16, 2021 @ 12:00-1:30pm ET Earn 1.5 CEs! Presented by Mike Freeman (he/him/his) and Valentina D’Alessandro (she/her)
Part III: Working with LGBTQ2S+ Native American Clients Friday, August 20, 2021 @ 12:00-1:30pm ET Earn 1.5 CEs! Presented by Troy Weeldreyer, LMSW, MSW, MPH (he/him), and Jennifer Nanez, LMSW, MSW (she/ her)
Part IV: Shaping Affirming Responses for Historically “Invisibilized” LGBTQIA+ Populations Friday, September 17, 2021 @ 12:00-1:30pm ET Earn 1.5 CEs! Presented by Raven E. Freeborn, LCSW, CNP
WWW.NAADAC.ORG/ADVANCING-AWARENESS-IN-LGBTQ-CARE