Advances in Addiction & Recovery (Winter 2015)

WINTER 2015 Vol. 3, No. 4

Transforming and Modernizing Our Nation’s Addiction and Mental Health System

By NAADAC and 2015 Hill Day Partners

NCC AP Welcomes Its New Testing Company The Counselor and Social Media

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CONTENTS WINTER 2015 Vol. 3 No. 4 Advances in Addiction & Recovery, the official publication of NAADAC, is focused on providing useful, innovative, and timely information on trends and best practices in the addiction profession that are beneficial for practitioners.

NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 85,000 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 addictionfocused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education.

Mailing Address 1001 N Fairfax Street, Suite 201

Alexandria, VA 22314 Telephone 800.548.0497 Email naadac@naadac.org Fax 703.741.7698 Managing Editor

Jessica Gleason, JD

Graphic Designer

Elsie Smith, Design Solutions Plus

Editorial Advisory Kirk Bowden, PhD, MAC, LISAC, NCC Committee Rio Salado College

■ FE ATURES 16

Transforming and Modernizing Our Nation’s Addiction and Mental Health System: Comprehensive and Mental Health Reform By NAADAC and 2015 Hill Day Partners

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Working Together to Tackle the Opioid Epidemic By Jack B. Stein, PhD, MSW, National Institute on Drug Abuse (NIDA)

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President Barak Obama Holds Public Forum in Charleston, WV, By Patrice Pooler, MA, ADC, WVAADC President

23 The Counselor and Social Media Technologies By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

26 The Field That Was Ashamed (and Proud) of Itself By William L. White, MA 28 Addressing the Future of Addiction Studies in Higher Education By Peter L. Myers, PhD

■ DEPAR TMENTS 5

President’s Corner: Addiction Counseling Credential Standardization and Portability Problem By Kirk Bowden, PhD, MAC, NCC, LPC, NAADAC President

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From The Executive Director: A Week of Advocacy, Hope, and a Historic Event

By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

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Affiliates: Meet Your 2015–2017 Regional Vice President for the Southeast: Angela Maxwell By Jessica Gleason, NAADAC Director of Communications

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Membership: NAADAC 2015 Annual Conference and Hill Day Recap

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Certification: NCC AP Welcomes Its New Testing Company By Kathryn Benson, LADC, NCAC II, QCS, NCC AP Chairperson

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Ethics: The Ethics Committee: What is Its Role – How Does It Serve NAADAC Members By Mita M. Johnson, EdD, LAC, MAC, SAP, NAADAC Ethic Committee Chair

Alan K. Davis, MA, LCDC III Bowling Green State University

Carlo DiClemente, PhD, ABPP University of Maryland, Baltimore County

Rokelle Lerner, MA Cottonwood de Tucson

Cynthia Moreno Tuohy, NCAC II, CDC III, SAP

NAADAC, the Association for Addiction Professionals

Robert Perkinson, MD Keystone Treatment Center

Robert C. Richards, MA, NCAC II, CADC III Willamette Family Inc.

William L. White, MA Chestnut Health Systems

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

For more information on submitting articles for inclusion in Advances in Addiction & Recovery, please visit www.naadac.org/advancesinaddictionrecovery# Publication_Guidelines Disclaimer It is expressly understood that articles published in Advances in Addiction & Recovery do not necessarily represent the view of NAADAC. The views expressed and the accuracy of the information on which they are based are the responsibility of the author(s) and represent the wide diversity of thought and opinion within the addiction profession.

Advertise With Us For more information on advertising, please contact Elsie Smith, Ad Sales Manager at esmith@naadac.org.

Advances in Addiction & Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5 This publication was prepared by NAADAC, the Association for Addiction Pro­fes­ sionals. Reproduction without written permission is prohibited. For more in­ formation on obtaining additional copies of this publication, call 1.800.548.0497 or visit www.naadac.org.

Printed December 2015 STAY CONNECTED

30 NAADAC Leadership ALL IMAGES FROM SHUTTERSTOCK UNLESS OTHERWISE NOTED

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Thank You to All of Our Sponsors, Exhibitors, and Partners at the NAADAC 2015 Annual Conference & Hill Day PLATINUM SPONSOR

GOLD SPONSOR

American Professional Agency, Inc.

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■ PRESIDENT’S CORNER

Addiction Counseling Credential Standardization and Portability Problem

By Kirk Bowden, PhD, MAC, NCC, LPC, NAADAC President

The lack of addiction counseling credential standardization and portability is an issue that our profession needs to address now! Addiction counselor credential r equir ements var y greatly from state to state. About half of the states offer counselor certification and the other half requires addiction counselor licensing. Most states’ credentialing boards are government entities. Some states’ addiction counseling credentialing is handled by public or private corporations.

Academic requirements for addiction counselor credentialing also varies greatly from state to state. Some states only require a GED or a high school diploma and 250 clock hours of online or in-person seminar training to be credentialed. On the other extreme, some states require a master’s or higher degree in a behavioral health field with very specific addiction counseling university course work. Requirements for internships/practicums and/ or supervised work experience hours also vary greatly from state to state — often by hundreds of hours.

I have often witnessed the credential portability problem first hand. I served on my state’s licensing board, the Arizona Board of Behavioral Health Examiners, for more than a decade. In that time, I frequently witnessed extreme frustration by addiction counselors’ credentialed in their previous state of residence being denied a license by our regulatory board. Unfortunately, this issue is not a problem specific to Arizona. This same counselor frustration happens across the nation in credentialing and regulatory board meetings every month. Why? Because there is a lack of educational and credential standardization in our profession which creates this portability problem.

Having a credential from another state and years of experience as an addiction counselor doesn’t always translate into meeting the very specific regulations of a new state. Keep in mind that regulatory board members cannot and do not randomly reject applications. Applications are rejected because the applicant is missing one or more of a state’s specific credentialing requirements.

If an addiction counseling applicant does not meet a state’s requirements, then board members do not normally have the authority to make an exception and grant the applicant a license.

This is the case even when board members personally believe the applicant is a qualified candidate. Licensing board members are mandated by law to enforce the regulatory rules and statutes of their state as they are written. Often even veteran addiction coun­selors may need to secure additional university course work and/or supervision hours when they seek to ­obtain a license in a new state of residence.

As addiction counseling matures as a profession, it is important that our profession works to incorporate standardized educational and licensing requirements in every state. Not only will this standardization provide greater portability, it will also strengthen our identity as a profession. To be viewed as a profession by the public I believe requires that we start working now to obtain standardization of addiction counselor educational and licensing requirements in every state.

In addition to serving as NAADAC’s President, Kirk Bowden, PhD, MAC, NCC, LPC, serves on the Editorial Advisory Committee for Advances in Addic­ tion & Recovery. While serving in many capacities for NAADAC through the years, Bowden also serves as Chair of the Addiction and Substance Use Disorder Program at Rio Salado College, consultant and subject matter expert for Ottawa University, a past-president of the International Coalition for Addic­tion Studies Education (INCASE), and as a steering committee member for SAMHSA’s Center for Substance Abuse Treatment (CSAT), Part­ners for Recovery, and the Higher Education Accreditation and Competencies expert panel for SAMHSA/CSAT. Bowden was recognized by the Arizona Association for Alcoholism and Drug Abuse Counselors as Advocate of the Year for 2010, and by the American Counseling Asso­ ciation for the Counselor Educator Advocacy Award in 2013, the Fellow Award in 2014, Outstanding Addiction/ Offender Professional Award in 2015, and most recently the California Association for Alcohol/Drug Educators’ Lifetime Achievement Award in 2015.

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■ FROM THE E XECUTIVE DIREC TOR

A Week of Advocacy, Hope, and a Historic Event

By Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, NAADAC Executive Director

Now that the boxes from the 2015 NAADAC Annual Conference & Hill Day are unpacked and the debrief of five days of exciting activities is complete, I can take a breath and reflect on what an incredible time the beginning of October was for addiction professionals here in Washington, D.C. First, wow! What a powerful conference! Every five years, NAADAC combines its Advocacy in Action and Annual Con­ferences into a special Advocacy Conference and Hill Day in Washington, D.C. to allow for even more of our members and conference attendees to take part in advocating for the addiction profession. This year, our Hill Day was made all the more impactful through NAADAC’s alignment and partnership with 10 impor­ tant groups who joined forces and found consensus to create materials to educate the public and federal legislators on necessary addiction and men­tal health reforms and legislation. We thank the Association for Be­ havi­oral Health and Wellness, the Depression and Bipolar Support Alli­ ance, Faces & Voices of Recovery, Hazelden Betty Ford, the In­ter­na­tional Bipolar Foundation, Legal Action Center, Mental Health America, the National Alliance on Mental Illness, the National Council for Behavioral Health, and the Psychiatric Rehabilitation Association for their voices and work.

Our Conference rounded out a week that started with people, communities, and organizations taking

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over the National Mall first for the FedUP! Rally for a Federal Response to the Opioid Epidemic on Saturday, October 3rd, and next for the unprece­ dented UNITE to Face Addiction Rally & Concert on Sunday, October 4th, where tens of thousands of people and 700 partners, including NAADAC, joined together to bring attention to and the change the national discourse about substance use disorders.

For over a decade, it was my hope and vision to have an event like the UNITE Rally brought to Washington, D.C. to bring positive attention and support to those persons with addiction and substance use disorders and their family members. As a person in recovery, I wanted to “March on Washington,” just as the Civil Rights movement did 51 years ago to claim justice and freedom from oppression. In this case, the oppression of the stigma of addiction and co-occurring disorders. To see that vision brought to reality on October 4th was historic — a day to remember the opening of a door of public acceptance. Acceptance that people in recovery are people first, with talents, capabilities, hopes, and dreams. Entertainers shared their talents and stories, including Joe Walsh from the Eagles singing his songs of the sixties and speaking his story of recovery, the Fray and its lead singer’s personal story, Sheryl Crow stepping out as an ally, and closing with Steven Tyler from Aero­s mith shouting out that he was there to

celebrate recovery! Never before have we had a Surgeon General make a promise to publish a “Sur­geon General’s Report on Addiction,” and keep this issue in the public’s face! This move to investigate and write a report will bring unprece­ dented awareness for addictive disorders to a new level of identification and treatment as it did over 30 years ago for the issue of smoking.

My own heart was full of wonder and sorrow as I saw thousands of people walking to the event grounds, with signs and pictures of loved ones lost to addiction. Sorrow for the losses of loved ones suffered by families and friends, and sorrow for my own losses — my mother, father, aunts, uncles, grandparents and cousins. Sorrow turning to thanks that so many people were willing to open their hearts and give up their time and their person comfort to come to an event that could have literally been “blown off” due to warnings of Hurricane Joaquin. I stood in the gathering crowd, wanting to be with “my people” of recovery and opting out of being in the “VIP tent” with other event partners. I wanted to feel it — the electricity of the crowd, the roar of shouting and clapping as cogent comments came from the stage, including Dr.

Oz stating that “The Days of Silence have ended today!” The feel of the wet ground was as real as the feel of hope in those around me.

NAADAC staffers Jessica Gleason, HeidiAnne Werner, and Rhonda Britton, joined me holding NAADAC signs proclaiming that “Treatment

by Addiction Professionals = Recovery!” and distributing free NAADAC t-shirts, stickers, and baseball caps. People came up to us to thank us and tell stories of the addiction professionals that made a difference in their lives or in their family member’s lives. They wore our NAADAC logo proudly with smiles and expressions of knowing that we and our work mattered in their lives.

Gratitude for their acknowledgement of the work of the addiction profession that so many of my colleagues and myself have dedicated our lives to do swept over me and tears of joy for them, for us, and for the persons yet to come into recovery flowed uninterrupted down my face. It was an honor to have Ivette Torres from the Substance Abuse and Mental Health Ad­ mini­stration (SAMHSA) take the time to interview me at the event to speak to why the event was important and how others, not at the event,

can bring awareness to their communities that addiction is a treatable brain disease and that hope for recovery exists for both individuals and their families.

Ten hours later, the mood of the crowd moved from excitement and hope to that of love, peace, and a sweet calmness as the night and the event came to an end. People moved together to the last song, touching, and hugging, knowing that they had made a historic stand for addiction awareness and recovery!

I am proud to be a person in recovery and a person who is an addiction professional! Thank you to all addiction professionals for the work you do – you do make a difference!

Blessings, Cynthia Cynthia Moreno Tuohy, NCAC II, CDC III, SAP, is the Executive Director of NAADAC, the Association for Addiction Pro­fes­sionals, and has worked as an addiction professional for over 35 years. She has been a trainer in Domestic Violence/Anger Man­ age­ment 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 magazine. She holds a Bachelor’s Degree in Social Work and is certified both nationally and in Washington State.

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■ AFFILIATES

Meet Your 2015–2017 Regional Vice-President for the Southeast: Angela Maxwell

Representing Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee

By Jessica Gleason, NAADAC Director of Communications Angela Maxwell, MS, CSAPC, is currently the Director of Prevention and Early Intervention Serv­ ices for Alcohol and Drug Services, where she oversees services in 10 counties and has served for over 14 years.

She began her work as an addiction professional over 20 years ago as a program facilitator for youth deemed “at-risk” for substance use disorders and other risky be­haviors. She has served as an adjunct professor at Guil­ford Technical Community College, and a Cer­ ti­fied Nonviolent Crisis Intervention Instructor, and is a statewide trainer in the areas of substance use disorder prevention, workforce development, strategic planning, coalition development, and workplace well­ ness. Angela has facilitated numerous workshops on substance use disorders and their impact on the family and is an authority in the field of prevention. She cur­ rently serves on numerous boards in North Carolina, including the North Carolina Substance Abuse Prevention Providers’ Association, the Guilford County Partners for Healthy Youth, the Cone Health Foundation Prevention and Best Practices Committee, and as Board Immediate Past President for NAADAC’s affiliate, the Addiction Pro­ fessionals of North Carolina (APNC). Angela has received two statewide awards: the Art of Prevention Award by APNC in 2008 and the 2010 Johnnie H. McLeod Exemplary Service Award. She has Bachelor’s Degree in English from the University of North Carolina at Chapel Hill, a Master’s of Science Degree in Agency Counseling from North Carolina A&T State University, and is currently working on her Doctorate in Leadership Studies.

Angela lives in North Carolina and can be reached at aet.maxwell@gmail. com. The Managing Editor was able to catch up with Angela to learn about her thoughts and plans for NAADAC during her two-year term.

Q: What goals do you hope to accomplish during your time as Southeast RVP? My initial goal is to gain a strong working knowledge of the role and responsibilities of a NAADAC Regional Vice-President to ensure that I am able to provide the most effective leadership for the Southeast. I want to get to know each affiliate within the Southeast region in an effort to identify needs, work collaboratively with each affiliate to develop a plan of action to address the identified needs, and service as a collective voice for the region within NAADAC’s national business affairs. I also hope to bring forth a platform that acknowledges that there are many pathways to recovery and that supports a community of professionals who represent diverse levels of substance use services (including primary prevention).

Q: What are the major issues or challenges happening in your region? How can NAADAC help overcome them?

As the new Southeast RVP, my initial goal is to meet with each affiliate

within my region to identify critical needs in the region. I expect to work with affiliates on developing a clear plan of action to address needs, fill gaps, and strengthen current resources and assets.

Q: Why is NAADAC membership important for addiction professionals?

NAADAC membership is important for addiction professionals for three major reasons: Networking: NAADAC serves as an ideal venue for addiction professionals to network through national conferences and state-level affiliate conferences and networking events. Membership also provides members access to a dynamic team of staff at NAADAC that is able to link professionals to other addiction professionals within their state, nation­wide, and even internationally.

Professional Development: Addiction professionals have few opportunities to get high-quality trainings. NAADAC is a valuable educational resource through its conferences, as well as its numerous education products and free online trainings. Membership provides access to over 75 FREE online CE credit trainings. This alone is worth the membership.

Legislative Advocacy and Support: In an ever-changing legislative landscape, it is imperative that addiction professionals have representatives at the federal level advocating on our behalf. This often overlooked benefit makes it possible for addiction professionals to continue our work. From parity to federal funding, NAADAC’s advocacy work has touched all of our careers.

Q: What are your hopes for the future of NAADAC? I hope that NAADAC continues to sustain its efforts into the future.

One key factor will be to ensure that NAADAC remains connected and relevant to the mission of state affiliates by continuing to assess the needs of its affiliates and working collaboratively with affiliates to meet those needs. I also hope that NAADAC continues to examine how it represents the full continuum of substance use disorder services (from primary prevention to medication-assisted treatments to aftercare services, etc.).

Jessica Gleason is the Director of Com­mu­nications for NAADAC, the Asso­ ciation for Addiction Professionals. She is responsible for NAADAC communications, marketing, public relations, and all digital media, including the NAADAC website and social media. She is the Managing Editor for NAADAC’s official publication, Ad­vances in Addiction & Recovery magazine, and editor of NAADAC’s two ePublications, the bi-weekly Addiction & Recovery eNews and weekly Professional eUpdate. Gleason holds a Juris Doctorate from Northeastern University School of Law in Boston, MA and a Bachelor of Arts degree in Political Science from the University of Massachusetts at Amherst in Amherst, MA.

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NAADAC 2015 Annual Conference & Hill Day Highlights

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Call for NAADAC Executive Leadership Nominations Let your voice be heard! Make a difference by nominating a passionate, skilled, and dedicated addiction professional for a 2016–2018 NAADAC Executive Leadership position.

Nominations are open until January 31, 2016 at 5:00 pm ET. NAADAC is accepting nominations for the following Executive Committee positions: • President-Elect • Secretary • Treasurer Nominations are also being accepted for the following Regional Vice-President positions: • Mid-Atlantic • Mid-South • Northeast • Northwest Candidate statements will be published in the Spring 2016 issue of Advances in Addiction & Recovery to help inform your vote in May. All 2016 terms begin October 12, 2016, after the NAADAC Annual Con­ ference in Minneapolis, MN. Only NAADAC members in good standing who have been actively engaged in work in addiction counseling or as an addiction professional for at least two years immediately prior to the nomination shall be eligible for an elected office with the Association.

Visit www.naadac.org/nominationsforexecutiveleadershipteam to view eligibility requirements for all positions and download a

­nomination form to submit today!

If you have any questions about the nomination process, please email NAADAC Executive Director, Cynthia Moreno Tuohy at cynthia@ naadac.org or Director of Operations, Heidi­Anne Werner at heidianne@ naadac.org, or call 800.548.0497 x102.

NCAC I & II, MAC Grandfather Credential Offer This one-time offer for a NCAC I, NCAC II, or MAC national credential is only available for a limited time!

NCAC I & II Deadline: April 30, 2016 • MAC Deadline: May 31, 2016 The NCC AP announces an opportunity for all currently state credentialed/licensed addiction professionals to apply for the National Certified Addiction Counselor Level I or Level II, or Masters Addiction Counselor credentials based on their already demonstrated competence, skill, training, and experience.

No testing necessary!

MATT ANTONINO| PHOTOSPIN.COM

For more information about the NCC AP and its substance use disorder counselor certification and specialty endorsement opportunities at the national and international level, visit www.naadac.org/certification.

For details, including requirements for credentialing, recredentialing and exam schedule and fees, go to

www.naadac.org/certification

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■ CER TIFIC ATION

NCC AP Welcomes Its New Testing Company

By Kathryn Benson, LADC, NCAC II, QCS, NCC AP Chairperson

The NAADAC/National Certification Commission for Addiction Professionals (NCC AP), in servicing our substance use disorder professionals and our many professional credentialing boards, requires a mature, robust, flexible secure technology to manage our ever-evolving cuttingedge programs. As the addiction profession evolves and becomes ever more specialized, everyone, from government entities to the public, is demanding accountability of our national and international substance use disorder professionals. More and more national and international certification boards are turning to NCC AP to help them manage their certification programs and ensure that practitioners have the skills and required knowledge to practice in the addiction profession.

NCC AP, following 18 months of selection criteria-based assessment interviews, is proud to announce that we are now in partnership with Kryterion, a well-established, innovative international testing company.

With its principal offices located in Phoenix, AZ, Kryterion offers an array of services that meet the need of the NCC AP, our test candidates, and our state boards.

Offering test development services along with a variety of test delivery options, Kryterion also provides additional features for the benefit of our professionals including: • On-demand Testing • Lower Test pricing • Additional technology of systems that includes immediate test results • Direct access to data for the NCC AP for knowledge, best practices testing enhancement, and NAADAC’s work with workforce development initiatives • Testing at colleges and universities as part of the educational component of degreed programs • Testing at special venues, such as the NAADAC Annual Conference or other State Conferences. Test preparation workshops may be taught the day before testing to allow for greater support in the testing process.

This new partnership allows you, our valued customers, to have closer and easier access to the NCC AP staff, and to the information you may choose to relay to your constituents. The developing changes in the appli­ cation process, fee collection, and test availability will provide test candidates a value-added product.

Kryterion uses the latest technology and security to develop, deliver, and manage NCC AP’s testing programs while providing the test taker on-demand access to the exam process along with their immediate test results.

NCC AP supports the intent of credentialing to standardize the quality of substance use disorders prevention, intervention, treatment, continuing care, and recovery support services. Through our standardized testing, the Commission is able to set and maintain a benchmark for professionals to demonstrate knowledge and competence while providing ongoing resources for those who treat substance use disorders. It is, and always has been, our commitment to continue to improve and enhance the quality

of the test question item bank and testing process. It is in this effort to meet the needs of our maturing profession that we are so proud to be collaborating with Kryterion.

In NCC AP’s commitment to be and maintain our connection to the profession and to those who are using the credential on a day-to-day basis, all of our tests are evaluated annually to ensure they address the latest information on treating addictive disorders.

The NCC AP Commissioners and our every-growing pool of expert advisors look forward to having new online test development tools including best practices methodologies available to us. This new system will allow us to more quickly and cost effectively develop, regularly review, and therefore continue to deliver high-quality evidence-based certification testing products and processes.

Our partnership with Kryterion also gives us more ways to assist our substance use disorders professionals in their pursuit of national and international credentialing by allowing the NCC AP staff to more assist with specific customer services issues that may arise in a more efficient manner.

As NCC AP Chair, I am fully committed to enhancing the recognition and acceptance of NCC AP national credentials for third party reimbursement by our efforts to: (1) provide a formal indicator of the professionals’ current knowledge and competence; (2) renewal-mandated continuation of learning to ensure professionals are using the most current best practices; (3) assist in establishing, measuring, and monitoring the ever changing requirements for the profession; and (4) provide assistance to employers, health care providers, educators, government entities, labor unions, other practitioners, and the public in the identification of quality counselors who have met the national competency standards.

Another step of streamlining NCC AP’s quality testing system requires, as of July 1, 2015, that all candidates seeking to test with an NCC AP exam product must first submit a completed application directly to NCC AP in order to be pre-approved for testing. Once approved, the individual will be directed to Kryterion for testing. This procedural change will better ensure that all candidates will be formally in our NCC AP system, allowing us to be of assistance throughout their entire testing experience.

We thank you for your trust in us, our test products, and our testing process and appreciate your continued use of our services. We encourage you to review our website at www.naadac.org/nccap for more information and contact NCC AP at nccap@naadac.org with all questions.

NCC AP is grateful to be here to serve you!

Wishing all a Joyful Holiday and a Very Peaceful New Year!

Kathryn Benson, NCAC II, LADC, QSAP, QSC, serves as Chair of the National Cer­ti­fication Commission for Addiction Pro­fessionals (NCC AP), and has worked in the counseling profession since 1972, specializing in addiction issues since 1978. She may be contacted at lightbeing@aol.com with your thoughts or questions.

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■ E THICS

The Ethics Committee: What is Its Role – How Does It Serve NAADAC Members

By Mita M. Johnson, EdD, LAC, MAC, SAP, NAADAC Ethics Committee Chair

Being “ethical” is complicated; professional ethics are not based on societal norms of the day, nor are they based on feelings or law. Ethical codes are standards of practice and standards of competence that guide what we as providers of services ought to do. There is an expectation that addiction professionals and other service providers have personal morals, ethics, and values that they examine and hold themselves accountable to. Professional and organizational ethical codes prescribe specific obligations towards nonmaleficence while promoting beneficence. As an institution, NAADAC is committed to reviewing and updating its Code of Ethics on a regular basis to reflect advances in the delivery of addictions services that promote client-centered, evidencebased, outcome-driven, culturally-sensitive, trauma-informed, genderresponsive care.

The NAADAC Ethics Committee works diligently to develop, publish, and update clear, understandable, pragmatic standards of care for cooccurring addiction and mental health services. The NAADAC Code of Ethics is meant to guide clinicians towards excellence in the delivery of services. The Ethics Committee drafts annotations to the Code on a regular basis. The Committee establishes protocols for responding to grievances brought forth by a member of NAADAC, a member of a state regulatory board, a consumer, or other interested person. The members of the Ethics Committee ensure that complaints are handled in accordance with procedures for handling complaints of unethical conduct. The Committee provides consultative services to members who are inquiring about ethical concerns and conflicts, and their options. The Committee offers educational opportunities specific to ethical practice for its members, affiliates, and other interested individuals, organizations or committees. NAADAC is committed to providing resources to its Ethics Committee as the Committee meets its mission of case review, code and policy development, and education.

Over the last decade, organizations in the field have seen complete paradigm shifts in how services are delivered. Traditional roles are being redefined by the Affordable Care Act, moving us towards collaborative care teams and comprehensive health care. With such paradigm shifts come appropriate concerns about how to best serve the needs of the client.

The Ethics Committee acknowledges its role in promoting sound ethical practice by endorsing values-driven ethical client-centered care.

NAADAC’s Ethics Committee supports and strengthens ethical leadership behaviors by examining the values that underlie macro- and micro-decision making, stressing the need for an ethical view of organizational activities, and promoting transparency in decision making. Ethics committees can

assist anyone who has a question about professional behaviors, privacy and confidentiality, and workplace practices.

For individual clinicians, an ethics committee can help with ethical dilemmas by providing case-related consultation services as well as feedback specific to organizational practice.

An ethics committee can help a member and others look at contextual concerns such as con­flicts of interests professionally, interprofessionally, and institutionally. It can be useful to receive guidance on confidentiality concerns, the role of family members in clinical decisionmaking, financial conflicts, workplace harassment, sub-standard care, etc. All of these concerns affect clinical decisions and client welfare. At NAADAC, the Ethics Committee seeks to provide guidance, support, and case-review related to a grievance.

The Ethics Committee values the contributions that addiction professionals like you make to individuals, families, and communities. We value your hard work and the efforts that you made towards professional credentialing. The Ethics Committee is here to serve NAADAC and its mem­bers by publishing a Code of Ethics and supporting policies to act as guides for practice and competency. NAADAC holds its members accountable for delivering the best in client care while acting as an esteemed professional within the addiction counseling and allied disciplines. The Committee seeks to be a resource to its members when ethical dilemmas arise that could use neutral discussion and guidance. The Committee seeks to be a resource to you whenever there is an ethical concern or question.

You entered the profession of addictions counseling and services because you want to make a real difference in peoples’ lives. The mission of NAADAC’s Ethics Committee is to serve you in your work while promoting excellence in clinical care.

Visit www.naadac.org/code-of-ethics for the full version of the NAADAC Code of Ethics.

Mita M. Johnson, EdD, LAC, MAC, SAP, has a doctorate in Counselor Education and Supervision, an MA in Counseling, and a BA in Biology. She is a licensed professional counselor, licensed marriage and family therapist, and licensed addiction counselor, along with earning the national Master Addiction Counselor (MAC) and Department of Transportation Substance Abuse Pro­ fessional (SAP) certifications. Johnson has two supervisory credentials (ACS and AAMFT) and is an NCC. In addition to being a core faculty member at Walden University, she maintains a private practice where she sees clients and supervisees who are working on credentialing. Johnson is the PastPresident of the Colorado Association of Addiction Professionals (CAAP) and an the Ethics Chair and Southwest Regional VP for NAADAC. She speaks and trains regionally and nationally on topics specific to counseling skills, ethics, supervision, and addiction-specific services. She has been appointed by the Governor of Colorado to two committees working on behavioral health integration and transformation, is a consultant to the state regulatory agency that regulates our professions, and is a consultant and committee member at the state Office of Behavioral Health.

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Transforming and Modernizing Our Nation’s Addiction and Mental Health System: Comprehensive and Mental Health Reform

By NAADAC and 2015 Hill Day Partners

E

very five years, NAADAC combines its Advocacy in Action and Annual Conferences into a special Annual Conference and Hill Day in Wash­ing­ton, D.C. On October 13, 2015, NAADAC members and other addiction-focused professionals from across the country convened on Capitol Hill to meet with their congressional representatives to advocate for the addiction profes­ sion. This article is one of the handouts attendees discussed with their legislators, and reviews impor­ tant provisions and issues for readers to look out for when reviewing any potential addiction and/ or mental health legislation.

NAADAC, the Association for Addiction Pro­fes­sionals, and Hill Day partners commend Congress for its attention to comprehensive addiction and mental health reform. Patients, family members, providers, local communities and states have waited far too long for the necessary policy reforms that will improve prevention, facilitate treatment, and ensure healthy communities. The time for action is now.

Four approaches to this issue are reflected in legislation currently before Congress: the Helping Families in Mental Health Crisis Act (H.R. 2646), the Mental Health Reform Act (S. 1945), the Mental Health Awareness and Improvement Act (S. 1893), and the Mental Health and Safe Com­munities Act (S. 2002).

While their details have received varying reactions from stakeholders and advocacy groups — including the Hill Day partners — all four bills have prompted important national conversations about our treatment system’s shortcomings and the need for reform.

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Recognizing a Diversity of Perspectives: Beyond the areas of consensus articu­lated here, NAADAC and Hill Day partners recognize and embody a diversity of perspectives on how to balance privacy, patient rights, and family engagement. Our groups look forward to sharing our indi­vidual views and working with the bill sponsors, committee staff, and congres­sional leader­ship to ensure that the needs of consumers, families, and providers are fully met through any comprehensive reform legisla­tion that moves forward.

We encourage all members of Congress to contact the leadership of the Senate HELP Com­mittee and the House Energy & Com­ merce Committee to urge them to mark-up comprehensive legislation to reform our nation’s public mental health and addiction treatment systems. We urge legislators to include the following provisions within any final legislation:

Reauthorizing Key SAMHSA Programs H.R. 2646, S. 1893, and S. 1945 include language reauthorizing important programs funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).

These include (but are not limited to): the

Garrett Lee Smith Memorial Act suicide prevention activities (H.R. 2646, Sec. 208(c); S. 1893, Sec. 2); the National Child Traumatic Stress Network (H.R. 2646, Sec. 208(a); S. 1893, Sec. 4); Projects for Assistance in Transition from Homelessness (S. 1945, Sec. 804); comprehensive community mental health services for children with serious emotional disturbances (S. 1945, Sec. 805); jail diversion programs (S. 1945, Sec. 803); and more. These are longstanding, successful programs providing important sources of assistance and support to Americans considering suicide, those who are homeless or involved with the criminal justice system, and children with serious emotional disturbances.

Strengthening Parity Enforcement The landmark 2008 mental health and addiction parity law was further strengthened by provisions in the Affordable Care Act extending parity’s protections to millions of additional consumers. Parity is a critical tool in ensuring Americans have access to the full range of medically necessary mental health and addiction care.

Yet, parity’s promise has been stymied by confusion over rule implementation and enforcement issues. Our groups are pleased to see improved parity compliance measures receiving attention in H.R. 2646 (in Sec. 103(a) and Sec. 901) and S. 1945 (in Sec. 901 and Sec. 902). These provisions will strengthen federal oversight of parity enforcement by commissioning annual reports on the status of federal parity investigations and a one-time report on the extent to which group health plans and Medicaid managed care plans are in compliance with the 2008 parity law.

Bolstering the Mental Health and Addiction Workforce According to the Association of American Medical Colleges, there is currently a shortage of more than 2,800 mental health and addiction professionals in workforce shortage areas across the country. S. 1945 and H.R. 2646 each support programs that strengthen and diversify the mental health and addictions health workforce, allowing for better access to needed treatment and culturally competent care for those in need.

Both bills maintain funding for the Minority Fellowship Program, which recruits minorities to the mental health and addiction workforce to aid in reducing health disparities and improving health care outcomes for racial and ethnic minority populations. Additionally, each bill maintains funding for the National Health Service Corps (NHSC) and expands the eligible provider pool to include pediatric mental health professionals. NHSC provides incentives for residents — including psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, psychiatric nurse specialists, addiction professionals and psychiatrists — to work in medically underserved communities, offering loan repayment in return for service in rural communities.

Broadening Peer Support Services NAADAC and its Hill Day partners applaud Congress’ growing recognition of the important role peers play in helping individuals along the path to recovery. Peers are individuals who use their lived experience with substance use dis­ orders or mental illness, plus skills learned in

for­mal training, to facilitate support groups, provide one-on-one support, and engage in other activities to promote patients’ health and wellness. This evidence-based model of care has been shown to reduce both expensive inpatient services and recurrent psychiatric hospitalization. Individuals utilizing peer support services are better engaged in their care and have improved relationships with their care team. These services also increase individuals’ ability to manage their symptoms and reduce their reliance on formal services. We thank Senators Murphy and Cassidy and Representative Murphy for recognizing the role of peer support services in H.R. 2646 (in Sec. 103 (b)) and S. 1945 (in Sec. 102(a)). Both bills support the collection of data to better understand the field of peer support and create a pathway to ensuring expanded opportunities for training and use in care delivery.

We look forward to working with Congress and the bill authors to improve and strengthen the bills’ definition of peer specialists so as to ensure inclusion of individuals in long-term recovery and to accommodate typical peer practice and supervision patterns.

Addressing Justice-Involved Populations People with substance use disorders and mental illness are more likely than others to be victims of crime; yet they are disproportionately represented in jails and prisons, primarily as a result of nonviolent offenses. 65 percent of inmates meet the criteria for a substance use disorder (a rate seven times higher than the general population) and more than half have a mental

health condition. Inmates with substance use disorders or mental illness often become trapped in a revolving door of arrest, release, poverty, deterioration of health, and re-arrest. Recog­ nizing that jails and prisons should not be our nation’s largest source of inpatient behavioral health care, legislators are turning to addiction and mental health reform as a means for addressing these health care needs and reducing recidivism. S. 2002 includes numerous provisions de­signed to support justice-involved individuals: grants for law enforcement crisis intervention teams; a pilot program for federal drug and mental health courts; assistance for addressing substance use disorders and mental health as part of offender reentry, mental health and drug treatment alternatives to incarceration, and much more.

S. 2002 (in Title II) also includes in its entirety the Comprehensive Justice and Mental Health Act (S. 993/HR 1854), legislation to support collaborative programs between criminal justice and addiction and mental health agencies. This bill reauthorizes and improves the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) while also: continuing support for mental health courts and crisis intervention teams; expanding services to veterans that include treatment court programs, peer-to-peer services, and appropriate services to veterans who have been incarcerated; establishing grants to provide broader training during police academies and orientation that teach law enforcement personnel how to identify and respond to incidents involving persons with mental health or substance use disorders; supporting corrections-based programs, like transitional services that reduce recidivism rates and screening practices that identify inmates with mental health or substance use conditions; and more.

Promoting Technology for Behavioral Health As the U.S. health care system moves quickly into the digital age, addiction and mental health treatment providers face major challenges to their adoption and use of health information tech­nology. H.R. 2646 (in Title VII) includes the Behavioral Health Information Technology Act, legislation that expands federal Meaningful Use incentives to previously ineligible mental health and substance use treatment providers and facilities. This change will facilitate care coordination among providers while helping to improve data collection and care quality. H.R. 2646 also authorizes grants for telehealth services provided to individuals with mental W I N T E R 2 015 | 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

illnesses, an important means of expanding access to care in areas suffering a shortage of mental health and addiction professionals. S. 1945 (in Sec. 207) also addresses telehealth by establishing telehealth child psychiatry access grants.

Funding Addiction and Mental Health Awareness Training One in five Americans will experience a mental health or substance use condition during the course of a year, but few know how to reach out and help someone in crisis. S. 1893 (in Sec. 3) authorizes funding for training programs to educate the public about signs and symptoms of substance use disorders and mental illness, including strategies for de-escalating a crisis situation and helping the person connect to appropriate treatment services that are strikingly similar to those taught in Mental Health First Aid courses around the U.S. H.R. 2646 (in Sec. 207(e)) authorizes funding to train law enforcement officers, paramedics, emergency medical services workers, and other first responders to recognize and properly intervene with individuals in crisis. S. 2002 (in Sec. 108) requires mental

health awareness and crisis de-escalation training for the federal uniformed services under the De­partments of Defense, Homeland Security, and others. These and similar initiatives before Congress — such as the Mental Health First Aid Act (S. 711/H.R. 1877) — will take great strides in helping individuals who are experiencing a mental health or substance use crisis connect with much-needed treatment.

Focusing on Early Intervention, Innovation, and Dissemination of Evidence-Based Practices NAADAC and its Hill Day partners share a deep commitment to ensuring all Americans have access to timely, high-quality care. H.R. 2646 and S. 1945 include numerous provisions designed to move identification and treatment up­stream — that is, to support prevention and intervention at an early stage before patients’ mental health or substance use conditions worsen. These two bills establish grants to support innovative approaches to treatment while dis­seminating information about proven, evidencebased interventions. Both codify the 5 percent setaside for early intervention activities in the

Men­tal Health Block Grant, an important effort for helping individuals with first-onset psychosis.

Expanding the Excellence in Mental Health Act Demonstration Program Section 223 of the Protecting Access to Medicare Act — also known as the Excellence in Mental Health Act demonstration — established a federal definition for Certified Com­ munity Behavioral Health Clinics that provide a comprehensive range of evidence-based outpatient and crisis care while meeting defined quality standards. In return, clinics receive reimbursement that reflects their actual cost of care, supporting them in expanding services to Americans with unmet need. These changes also support states and providers in reducing high hospital emergency room utilization among individuals with behavioral health conditions and ease the burden on hard-pressed law enforcement agencies in urban and rural areas. Yet, with 28 states having applied for planning grant funds to participate in the demonstration, this 8-state, 2-year program is too narrow to meet existing needs. H.R. 2646 (in Sec. 505) extends the Excellence Act demonstration by two years and adds two states, an important first step in bringing these reforms to benefit all Americans.

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H.R. 2646 (in Sec. 501(a)) and S. 1945 (in Sec. 601(a)) each include an important provision clarifying that providers may bill Medicaid for mental and physical health services provided on the same day. This small but far-reaching clarification will remove a common barrier to the integrated care initiatives now burgeoning throughout the country; it ensures providers may receive reimbursement for primary and behavioral health services that are co-located within the same clinic. In addition, S. 1945 (in Sec. 301) reauthorizes and modifies existing grant funding to support states in scaling up their integrated care activities, including authorizing integrated care training and technical assistance provided through a national Technical Assistance Center.

NAADAC thanks its 2015 Hill Day Partners: the Association for Behavioral Health and Wellness, the Depression and Bipolar Support Alliance, Faces & Voices of Recovery, Hazelden Betty Ford, the International Bipolar Foundation, Legal Action Center, Mental Health America, the National Alliance on Mental Illness, the National Council for Behavioral Health, and the Psychiatric Rehabilitation Association.

Working Together to Tackle the Opioid Epidemic

By Jack B. Stein, PhD, MSW, National Institute on Drug Abuse (NIDA)

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n estimated 1.9 million people in the United States suffered from substance use disorders related to pre scription opioid pain medicines in 2014.1 Treatment admissions linked to these medications nearly qua drupled between 2002 and 20122, although only a fraction of people with opioid use disorders receive treatment (18 percent in 2014).3 Overdose deaths linked to these medicines more than tripled (from 1.5 to 5.1 per 100,000 Americans) from 2000 to 2013.4 We are now also seeing a rise in heroin use and heroin addiction as people shift from prescription opioids to their cheaper and often easier-to-obtain street relative; 586,000 people had a heroin use disorder in 2014.5 Besides overdose, consequences of the opioid epidemic include a rapidly rising incidence of newborns born dependent on opioids because their mothers used these substances during pregnancy and increased spread of infectious diseases including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.

Federal and State agencies and private stakeholders are taking action.

This past year, an initiative of the Secretary of Health and Human Services to address the complex problem of prescription opioid and heroin abuse began coordinating federal efforts to improve education of healthcare providers in managing pain and prescribing opioids appropriately; increasing availability and adoption of the effective overdose-reversing drug naloxone, which research has shown to be a life-saver in communities where it has been distributed to opioid users and potential bystanders; and expanding implementation of evidence-based prevention and treatment strategies. The Centers for Disease Control and Prevention also launched its Prescription Drug Overdose: Prevention for States Program, providing $20 million to states to support these goals. And in October, President Obama renewed the Admin­-

is­tration’s commitment to com­bat­ting the prescription drug and heroin epidemic by announc­ing a large number of public and private sector partnerships to improve prescriber training and access to treatment.

The overprescription of opioid medications has been a major driver of the abuse epidemic. The link between opioid misuse and addiction and the rise of chronic pain in America over the past 20 years is complex.

Opioids began to be increasingly prescribed for chronic pain in the late 1990s, but evidence supporting the effectiveness of long-term opioid therapy for most types of chronic noncancer pain is lacking, and there is even evidence that opioids may worsen pain (hyperalgesia) in some cases.6 Unfortunately, American medical school students only receive, on average, about 9 hours of training in pain management7; and virtually no training on screening their patients for substance abuse, which has contributed to the perfect storm of opioid overuse, misuse, and addiction over the past 20 years. As part of the President’s initiative, over 40 provider groups have pledged to have more than 540,000 of their members complete training in opioid prescribing in the next two years and to double the number of providers using state prescription drug monitoring programs to help identify patients who may be abusing or diverting their prescriptions.

The partnering organizations are also pledging to double the number of providers who prescribe naloxone for overdose reversal. Naloxone is a very safe drug that blocks opioid receptors in the brain and can quickly reverse an overdose that might otherwise be fatal. Studies of pilot programs issuing naloxone and overdose education to opioid users and their friends and family members have shown that wide availability of this drug can save many lives without (as critics fear) increasing the rates of opioid abuse. Lay-administered naloxone has reversed over 26,000 overdoses in the past two decades.8 In November, the FDA approved an intranasal formulation of this drug, developed by NIDA

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Dr. Jack Stein joined NIDA in August 2012 as the Director of the Office of Science Policy and Communications (OSPC). He has over two decades of professional experience in leading national drug and HIV-related research, practice, and policy initiatives for NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) where, before coming back to NIDA, he served as the Chief of the Prevention Branch.

REFERENCES Center for Behavioral Health Statistics and Quality. (2015). 2014 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Adminis­ tration, Rockville, MD. Table 5.2A. http://www.samhsa.gov/data/sites/default/files/ NSDUH-DetTabs2014/NSDUH-DetTabs2014.pdf 2 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2002–2012. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-71, HHS Publication No. 1

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(SMA) 14-4850. Rockville, MD: Substance Abuse and Mental Health Services Adminis­tra­ tion, 2014.Table 1.1a. http://www.samhsa.gov/data/sites/default/files/2002_2012_TEDS_ National/2002_2012_Treatment_Episode_Data_Set_National_Tables.htm#Tbl1.1a 3 Center for Behavioral Health Statistics and Quality. (2015). 2014 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Adminis­ tration, Rockville, MD. Table 5.42B. http://www.samhsa.gov/data/sites/default/files/ NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab5-42a 4 Centers for Disease Control, National Center for Health Statistics. Multiple cause-ofdeath data, 1999–2013. CDC WONDER 2014. http://wonder.cdc.gov/mcd.html. Accessed February 26, 2015.

5 Center for Behavioral Health Statistics and Quality. (2015). 2014 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Adminis­ tration, Rockville, MD. Table 5.42A. http://www.samhsa.gov/data/sites/default/files/ NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab5-2a 6 National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain, September 29–30, 2014, Executive Summary. https://prevention.nih.gov/docs/programs/p2p/ODPPainPanelStatementFinal_ 10-02-14.pdf 7 Mezei, L., Murinson, B. Pain education in North American medical schools. J Pain. 2011; 12:1199–208 8 Wheeler, E., Jones, T. S., Gilbert, M. K., Davidson, P. J. Opioid overdose prevention programs providing naloxone to laypersons – United States, 2014. MMWR Morb Mortal Wkly Rep. 2015; 64(23):631–5.

9 Knudsen, H. K., Abraham, A. J., Oser, C. B. Barriers to the implementation of medicationassisted treatment for substance use disorders: the importance of funding policies and medical infrastructure. Eval. Program Plann. 2011; 34:375–81.

10 Sees, K. L., Delucchi, K. L., Masson, C., et al. Methadone maintenance vs 180-day psycho­socially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA. 2000;283(10):1303–1310.

11 Kakko, J., Svanborg, K.D., Kreek, M.J., Heilig, M. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. The Lancet. 2003;361:662–8.

Write for NAADAC

We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals.

Please submit your story ideas and/or articles to Jessica Gleason at jgleason@naadac.org.

For more information on submitting articles for inclusion in Advances in Addiction & Recovery, visit www.naadac.org/advancesinaddictionrecovery# submissions

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in partnership with Lightlake Pharmaceuticals and Adapt Pharma, which will make administration of naloxone by laypeople much easier. Saving a life from overdose is a critical op­portunity to engage someone in addiction treatment to potentially restore them to full health.

The medication-assisted treatments (MAT) that now exist for opioid addiction are very effective, but they are grossly underutilized. Agonist or partial agonist medications — methadone or buprenorphine — reduce the negative affects of withdrawal and craving but without producing the euphoria that the original drug of abuse caused. Another effective treatment is the antagonist drug naltrexone, which blocks opioids’ effects at receptor sites, and is now available in a long-lasting depot formulation.

Ample research has shown these drugs reduce drug use, increase social functioning, and reduce associated behaviors like criminality, violence, and infectious disease transmission. Unfortunately, systemic problems of poor insurance coverage and a lack of certified providers have limited the reach of MAT, as has stigma against treating with opioid compounds.

Fewer than half of treatment programs offer MAT, and only a third of patients in those programs receive it.9 Many people — even, unfortunately, many treatment providers — still think that maintenance treatment just substitutes one addiction for another, and thus fail to adopt these treatments, or they prescribe them for insufficient duration or at too low a dose to be effective.

Misconceptions about MAT result from failure to understand the nature of addiction as a brain disease and what is needed to heal the brain so that recovery can occur. Just as body tissues require prolonged periods to heal after injury, reward, impulsivity, and decision-making circuits in the brain that have been severely compromised by prolonged drug use can only return to normal functioning gradually. People with opioid addic­ tion who do not follow detoxification with MAT are more likely to relapse10,11 — which is not only a setback on the goal to recovery, but also dangerous, raising the risk for fatal overdose. Among other measures, the groups partnering in Obama’s initiative have pledged to double the number of physicians qualified to prescribe buprenorphine over the next three years, and the Department of Health and Human Services is working to expand access to MAT services.

It is a time to be optimistic about our prospects of tackling the opioid epidemic. Communities and federal and state agencies are pulling together in a concerted nationwide effort and raising awareness among the public.

We have great resources at our disposal, and if we continue to work together in a coordinated way, there is great potential to reduce the number of Americans suffering with and dying from prescription opioid and heroin addictions.

President Barak Obama Holds Public Forum in Charleston, WV

By Patrice Pooler, MA, ADC, WVAADC President

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est Virginia has the highest drug overdose mortality rate in the United States. Ac­ cording to a 2013 report, the number of drug overdose deaths in my state, a majority of which are from prescription drugs, has increased by 605 percent since 1999.1 On October 21, 2015, these staggering statistics brought President Barack Obama to Charleston, WV to host a community forum at The Roosevelt Neighborhood Center to announce public and private sector efforts to address prescription drug abuse and heroin use.

As the President of the West Virginia Association of Alcoholism and Drug Counselors (WVAADC), I was invited to the forum.

President Obama’s wish to discuss with local, State, and Federal leaders how to handle the growing prescription drug abuse and heroin use epidemic in West Virginia and across the United States brought a table of experts to the forum, including Sylvia Burwell, Secretary of Health and Human Services, Michael Botticelli, Direc­tor of National Drug Control Policy, Carrie Dixon, a parent, Dr. Michael Brumage, Ex­ecutive Director of the Kanawha Charleston Health Department, and Brent Webster, City of Charleston Chief of Police.

President Obama addressed the audience with a spirited demeanor: “Well Hello, West Virginia…Go Mountaineers!” He discussed how prescription drug abuse and heroin use are not “top-down solution” type of problems; they require everyone to work together and understand what families, law enforcement, and our health systems are going through in order to find solutions.

He remembered exploring this issue when he began his terms of office and being stunned by the statistics: that more Americans now die every year from drug overdoses than they do from motor vehicle crashes and that the majority of those overdoses involve legal prescription drugs. That in 2013 alone, overdoses from prescription drugs killed more than 16,000 Americans. He stated that he knows that behind these numbers is incredible pain for families and that West Virginians understand these facts better than anyone.

He pointed out that the U.S. Center for Disease Control (CDC) reported 259,000,000 prescriptions were given in 2012, which is enough to give every American adult their own prescription bottle of medicine.

As the use has increased so has the misuse, with a rise in heroin use and 4 out of 5 heroin users starting out by using prescription drugs. He acknowledged that this addiction is taking lives, destroying families, and shattering communities across our Nation.

President Obama asserted that substance use disorders do not discriminate and stigma prevents people from getting the help they need, causing families to suffer in silence. He suggested that we replace those stereotypes of “junkie” with words such as “father,” “daughter,” “son,” “friend,” and “sister,” and begin to understand that substance abuse can happen to any of us. He believes we cannot fight this epidemic without reducing stigma.

President Obama pointed out that he has made substance use disorders a priority within his administration. In 2010, he released the first National Drug Control Policy, followed by the Prescription Drug Abuse Prevention Plan in 2011. Implementation of those plans supported and expanded community-based efforts to prevent drug use reduce deaths, and help people receive treatment. In addition, under the Af­ ford­able Care Act, 17 million people have health­care who could not previously afford it, health care costs have been reduced, and more insurance plans have to cover substance use disorders.

The budget President Obama has sent to Congress includes $133 million dollars for enhanced treatment and prevention programs to invest in state overdose prevention programs, prepare more first responders to save more lives, and expand the number of medication-assisted treatment centers. Rather than spending billions of taxpayer dollars on long-term prison sentences for non-violent drug offenders, President Obama pointed out that we could reduce costs and increase outcomes by getting treatment to those that need it. Those savings could then be used to ensure law enforcement has the resources to go after individuals who are bringing hard drugs into our country.

At the forum, President Obama announced that on that day he had issued a Memorandum to Federal Departments and Agencies directing two important steps to combat prescription drug abuse and heroin epidemic: • Prescriber Training: Requiring Federal Departments and Agencies to provide training in opioid prescribing to Federal health professionals who prescribe opioids to establish the Federal Government as a model for other health care professionals; and • Improving Access to Treatment: Requiring Federal Departments and Agencies to “directly provide, contract to provide, reimburse for, or otherwise facilitate access to health benefits, to conduct a review to identify barriers to medication-assisted treatment for opioid use disorders, and develop action plans to address these barriers.”2

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President Obama stressed that evidence shows that medication-assisted treatment, if done properly in combination with behavioral therapy and other support/counseling/12-step programs, can work and be an effective strategy to support recovery. He continued that this approach cannot be just replacing one drug with another; it has to be a part of a total package, with plans to explore any existing barriers to medication-assisted treatment that are preventing the creation of more of these treatment facilities.

President Obama also announced an increase of private sector involvement, with commitments from over 40 provider groups, including the American Medical Association, American Nurses Association, and the American Dental Association, to concrete actions over the next two years, such as expanding prescriber training, increasing the use of naloxone, certifying more physicians to provide medication-assisted treatment for opioid use disorder, increasing the number of health care providers registered with their State Prescription Drug Monitoring Pro­grams, and reaching more than 4 million health care providers with awareness messaging on opioid abuse, appropriate prescribing practices, and other important provider actions. In addition, major broadcasters, companies, and national sports associations will donate more than 20 million dollars of airtime and advertising space for public service announcements about the risks of prescription drug misuse.

To further expound on these efforts, President Obama turned the forum over to the esteemed panel on stage, asking the panelists to share what their agencies or groups are doing to help solve the prescription drug and heroin problem at the Federal, State, and local level: • Secretary Burwell stated that the U.S. De­partment of Health and Human Services is focused on evidence-based strategies, changing prescribing practices, working on medication-assisted treatment, and expanding naloxone usage and accessibility. Among other actions, HHS recently launched HHS.gov/opioids as a one-stop federal resource with tools and information for families, health care providers, law enforcement, and others on prescription drug abuse and heroin use prevention, treatment, and response.

• Dr. Brumage, Executive Director of the Kanawha Charleston Health Department, stated that West Virginia has the highest rate of Hepatitis B and 2nd highest rate of Hepatitis C in the nation, largely due to needle sharing amongst addicts. He reported that Charleston, WV has begun to move towards a harm reduction program with a syringe exchange, testing for Hepatitis B and C, and HIV, and offering contraceptives to and treating people who walk through their clinic doors with dignity and respect. He stated that West Vir­ginia University researchers are ex­ploring mindfulnessbased relapse prevention with people in recovery from opioid use disorders, based on pioneering work done at the University of Wash­ing­ton. He also reported that West Virginia Delegate Dr. Chris Stansbury from Kana­wha County has plans on sponsoring legislation to make naloxone an over-the-counter medication.

• Chief Webster of the City of Charleston Police Department stated that the De­partment was implementing a number of strategies, including training all officers on the use of naloxone, and working with the U.S. Attorney’s Office and Project LEAD, the Law Enforcement Assisted Diversion Program. He stated that since

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2014, of the 39 people considered low-level users who were arrested and offered the option of treatment instead of jail, only one person has been re-arrested. Chief Webster also discussed the success of the “Handle With Care” pilot program in Charleston, WV set up for children who have had a parent arrested, etc., in which the day after the arrest, the arresting officer contacts the children’s school principal or school counselor to ask that the children be “handled with care” that day (perhaps get an extra day for assignments, etc.).

Finally, the Charleston Gazette had a community member share the story of his daughter’s overdose and ask President Obama about solutions to the issue of access to treatment, especially in places of great need like West Virginia where there are not enough treatment providers or facilities.

The President addressed these concerns by first mentioning his favorite quote on children: “Having children is like having your heart walking outside of your body. All you care about is making sure they are okay.”

He acknowledged that the opioid epidemic and the pain it is causing families and great parents who love their kids is happening across the country — that is an American problem. He stated that we need to build, fund, and support more treatment centers locally, as having insurance coverage isn’t enough if there isn’t a treatment center to send your family member to when they need one. He also stated that consumer groups, medical asso­ciations, and others need to voice to insurance companies that coverage for treatment is vital as everyone’s children are at risk.

Addressing the vul­nerability of children, President Obama pointed out that research shows that kids are a sponge for knowledge, even under three years old, and that we need to invest more in early childhood education, prenatal education for parents, home visitations with at-risk moms - initiatives that need to be focused on at the state and local level.

President Obama closed his inspiring and engaging discussion by stating: “We need to remember ‘there, but for the grace of God, go I,’ and when we do, we have the chance to do something.”

It was an honor and privilege to represent WVAADC, the West Virginia affiliate of NAADAC at such a compelling and history-making event — sitting second row, center — in front of our 44th President, Barrack Obama, listening to his compelling and thoughtful perspectives. I even got to shake his hand and get a hug from our Commander in Chief! What an incredible experience!

Patrice M. Pooler, MA, ADC, is President of the West Virginia State Association of Addiction Professionals. With an addictions career spanning over 20 years, she has worked in residential substance abuse programs, outpatient treatment centers and community mental health. Pooler is the Executive Director of Mid-Ohio Valley Fellowship Home, Inc., (www.movfh.org) a residential recovery program. She works with a great team and helps rebuild lives. Pooler is wife to her best friend, Matt. She is mom to three awesome young adults and her 7-year old black Lab. REFERENCES 1 Trust for America’s Health (2013). Prescription Drug Abuse: Strategies to Stop the Epidemic.

Available at https://healthyamericans.org/reports/drugabuse2013/ 2 White House Office of the Press Secretary (2015). FACT SHEET: Obama Administration Announces Public and Private Sector Efforts to Address Prescription Drug Abuse and Heroin Use. (October 21, 2015). Available at https://www.whitehouse.gov/the-press-office/2015/ 10/21/fact-sheet-obama-administration-announces-public-and-private-sector

The Counselor and Social Media Technologies

By Pamela J. Van Cott, CPCU, Assistant Vice President, American Professional Agency, Inc.

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ever before have communication technologies exploded as rapidly as they have with the advent of Social Media.

Certainly, as far as counseling is concerned, these changes have prompted countless guidelines, rules and laws in order to control the use of evolving technologies and to protect the public.

“Social Media” — did this phrase even exist in 2005? Can it really be less than 10 years ago that we were trying to wrap our heads around this new method of communication? Considered then to be a novelty for young people, a flash in the pan, not many could envision how social media and other internet based communication technologies would change our world. For instance, 10 years ago could I imagine merely speaking my questions into my cellphone and receiving feedback in less than two minutes? Here is what my cellphone came up with today: • In February 2005 Facebook, originally developed for the exclusive use of college students, had 9% of young adults enrolled as users. By August 2006, that number grew to 49%.

• In September 2006, Facebook offered enrollment to the general population.

• By December 2006, the number of people using Facebook was 12 million.

• In October 2015, the number of people using Facebook was 1.49 billion.

• By December 2015, the expected number of people using all types of social media will be a shade under 2 billion. This would have represented the entire world population in 1927.

There are now hundreds of social media sites worldwide with professional people currently using tools like Facebook, Twitter, LinkedIn, Instagram, Pinterest, WhatsApp, Snapchat and Skype to get their message across to others.

So what does this explosion in the use of social media mean to Substance Use Counselors?

Consider these BENEFITS: • Counselors can join a community of online therapists to exchange ideas and network with each other.

• They can pursue continuing education and get professional information from blogs, webinars and online journals.

• Through sites such as LinkedIn, a counselor can set up a personal pro­file to attract and maintain a network of like-minded pro­fessionals.

• Sites like Facebook can be used to share timely articles, inspirational stories and links to other resources.

• Sites providing the ability to video chat give counselors the oppor­ tunity to provide services to clientele who find it difficult to travel to an office for tra­ditional face-to-face counseling.

• Bursts of inspirational pictures and quotes can be found on Pinterest or through Tweets.

But it is the use of social media when communicating with clients that has been a cause for concern for counselors, insurance companies and consumers of mental health/addiction services. A counselor will not find much concrete information when looking for legal guidelines related to the use of social media with clients.

So what does a counselor do when faced with: • receiving a “friend request” from a client on Facebook?

• the temptation to search for information regarding a client on the Internet?

• the desire to use email/texting as a convenient way to correspond with clients in a professional manner?

• contemplating the delivery of counseling services via videoconferencing or teleconferencing sites?

• an employee’s use of Social Media when it concerns clients?

The lack of legal guidelines for the proper use of social media should not be construed as a green light for professionals to use social media without careful consideration. Rights to privacy and boundary issues don’t stop at the edge of a keyboard. Privacy laws such as HIPAA 1996 and various state laws must be considered every time you use current technologies to spread your message and communicate with clients. You should present your online services with the same professionalism and concerns as you would in face-to-face sessions with clients. My perspective comes from a liability standpoint as a provider of malpractice insurance to counselors for over 20 years. So here are my thoughts on what to consider in order to avoid the time, expense and anguish incurred if sued due to the incautious use of social media and other technologies.

Develop Technical Skills (or Get It From a Professional) Some counselors may feel that they will only avoid exposure to risk if they avoid any and all use of social media, emailing or texting with clients.

In today’s world, it is very hard to take a rigid stance against using these technologies because there are so many positive interactions made possible by their existence. At the simplest level, this is an efficient way to schedule appointments, send reminders and announcements to your clients, and in fact this has now become standard practice. But, if you are a novice in the use of social media, emailing and/or texting, and you do not have a thorough knowledge of how to use privacy filters, encryption methods or other techniques to maintain privacy, then do not communicate with clients in these ways until you become more proficient.

• We have been told repeatedly that anything you post online has the potential of being out there permanently. So if you have a doubt about whether you’re posting or sending of information may cause a privacy breach, reconsider sending this.

• Consider what the use of emails or texts could do if a counselor is not aware of technical methods to insure privacy. For instance, an addiction counselor simply wants a quick and easy way to notify her clients of her new office location. So she sends a group email to her clients...without using the BCC (blind copy) option, thus W I N T E R 2 015 | 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 3

inadvertently announcing to all the recipients the identities of her other substance use clients. Group emails are a form of social media and you should avoid using this communication method with clients if you are not confident on how to maintain privacy. Encryption software should be installed on both your side and the recipient side.

• If forwarding anyone’s email to other parties, always read the entire e-mail trail to delete material that could be construed as a private.

This practice of quickly forwarding emails can cause embarrassment at the very least, or a breach of confidentiality at worst.

• Consult with a professional to give you the technical knowledge you need to maintain privacy.

Unfortunately, no matter how good your technical skills are and even when you do your best to maintain privacy, hackers will have a better skill set than you. Use of informed consent wordage can lessen your exposure should a client’s personal information get into the wrong hands.

Develop a Social Media Policy for Both Clients and Employees Clients: If you want to use a site like Facebook to reach out to professionals or clients, it is just common sense to create and maintain a separate online page for your professional life. Clients should not be privy to what you did during your last vacation. Clients may not want you to be checking their sites to see what they have been up to either. Develop written guidelines for clients that clearly state what the boundaries are for both you and your client. These guidelines should include “friending” practices. Be aware that if you “friend” a client, or a client “likes” a statement you post, that client may now have access to the names of everyone else that “friends” you or “likes” what you post. Guidelines should also cover the use of “messaging” through social media. For some excellent examples of guidelines and informed consent statements, just do an Internet search for “Guidelines for counselors and social media” and you will find plenty of helpful information and examples that will fit in with your counseling style.

Employees: It must be assumed that most of your employees use social media sites while away from the office. It is tempting for employees to want to gripe about a difficult client when they get home or to share amus­ing anecdotes about clients to their social media friends. They may even feel they have the right to do this because of their “freedom of speech” as long as the client is not identified. If unique enough, sometimes an amusing or difficult situation can identify a client without using names.

The fact is you can be held legally responsible for privacy breaches by em­ ployees even though you were not aware of their actions. Strongly urge your employees to use the strongest privacy settings available on sites like Facebook so that their content is not available to the general public. When Facebook does an update, remind employees to recheck their settings to make sure they did not default to a public setting.

It is essential that you have clear employee guidelines that stress that client privacy is a top priority of the organization. Clearly spell out what is not allowed and state what the consequences will be of deliberate breaches of the rules. Go over the guidelines with each employee and have them sign a statement that they understand the rules. Having rules in place makes your position clear and paves the way for enforcing consequences if the need arises.

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E-Counseling or Online Counseling Using teleconferencing sites to provide services could expose you to liability that may not be covered by professional liability insurance, especially if a client is not located in a state in which you are licensed. Most pro­fessional liability policies for counselors have exclusions if services are provided in a state in which the insured is not properly licensed or certified.

States differs in their laws concerning this practice but in many states a coun­selor must be licensed in the state in which your client receives your services. Be sure to check with the licensing board of the states in which your clients reside to see if you must obtain a license to practice in that state. Written guidelines for you and your clients and informed consent should be in place before you provide services. The use of passwords just makes sense to make sure you are communicating with your client and not another party who has use of your client’s computer.

Not all teleconferencing sites are HIPAA compliant, therefore, make sure you check on a site’s HIPAA compliance status before you use it.

Skype is not HIPAA compliant though they began working with a strategic partner this year to work toward that goal. A HIPAA compliant site will offer a Business Associate Agreement as required by HIPAA regulations.

Consult with “telemental health” organizations such as Telemental Health Institute (www.telehealth.org.) This organization keeps updated lists of sites that are HIPAA compliant as well as provide educational articles, webinars and other training options.

If a Breach of Privacy Does Occur Most professional liability insurance policies state that it is the duty of the insured to inform the insurance company as soon as possible if an incident occurs that could give rise to a claim. Delaying reporting the incident could jeopardize insurance coverage. But there is another reason to report incidents to your insurance company or representative in a timely manner. The insurance company claim or risk management department may be able to minimize the damage before the incident cascades out of control.

Whether meeting clients face to face or using social media sites and other technologies to communicate with clients, a counselors most important responsibilities are to maintain a professional presence, to do your utmost to safeguard your clients privacy and to respect boundaries, all while providing the standard of care expected of counselors. Written guidelines, informed consent and keeping up to date when using the latest technologies help counselors achieve those goals. Some professional counseling organizations have already revised their Ethics Codes to address the use of Social Media with clients. You can also reach out to your state licensing board to see if they have guidelines for your professional profiles on social media sites.

Pamela J. Van Cott, CPCU, is Assistant Vice President with the American Pro­ fes­sional Agency, Inc. (APA, Inc.) and has 25 years of experience insuring professional liability, with a concentration in the addiction field. APA, Inc. has been a leading writer of professional liability for mental health and other pro­fessionals for 40 years. With over 100,000 insureds, APA, Inc. has been en­dorsed or sponsored by many national and regional mental health asso­ ci­ations, including NAADAC. In addition, APA, Inc. has experienced staff to provide risk management consultation services for policyholders.

The Field That Was Ashamed (and Proud) of Itself

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xploring the sociological concepts of “courtesy stigma” and “dirty work” affords important insights into how the addiction-related social stigma gets acted out within and between individuals and organizations within the addiction treatment and recovery support arenas. This essay explores how socially-induced shame serves as a catalyst for a number of destructive dynamics within the field while simultaneously spawning strong organizational cultures that assert pride in the work of this specialized profession.

Stigma, as revealed in the classic work of sociologist Irving Goffman (Stigma, 1963), refers to a socially discredited status that affects how the discreditors and discredited see themselves and relate to each other. Courtesy stigma is the diminished status shared by individuals and organizations closely associated with stigmatized people and issues.

Internalized stigma is the propensity of those who have experienced social and courtesy stigma to self-incorporate devaluing judgments from the dominant culture into their own view of self.

Such processes wound self-esteem, lower selfexpectations, and, in the extreme, stir acts of self-destruction and aggression against one’s own kind.

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By William L. White, MA Dirty work, as outlined by Everett Hughes (Men and their Work, 1951), refers to tasks or occupations that, due to their physical, emotional, social, or moral taint, are culturally perceived as repugnant or degrading, even when deemed of value to society. “Dirtiness” is a social construct: it is not inherent in the work itself or the workers, but is instead imputed socially based on subjective and evolving standards of cleanliness and purity (Ashforth & Kreiner, 1999).

Persons experiencing courtesy stigma due to their involvement with dirty work elicit disparagement, discomfort, and avoidance responses from the general citizenry. As a result, they often isolate themselves professionally and socially to avoid “civilians’” misunderstanding, distaste, or unsolicited and often ill-timed requests for discrete advice. Such discomfort is buffered by the creation of closed (“us versus them”) organizational cultures within stigmatized fields.

Closed cultures help workers manage the ambivalence toward their chosen work by countering experiences of demoralization with shared expressions of value and pride in the work being done.

Courtesy Stigma & Dirty Work in Addiction Treatment The field of addiction treatment illustrates the complex dynamics flowing from addiction-related stigma and its accompanying courtesy stigma and dirty work designations. Examples of such dynamics include: • Inadequate social resourcing of socially designated dirty organizations and dirty workers on grounds that the dirty people served do not morally qualify for greater resource allocation.

• Organizational instability resulting from ineffectual boards, insulated leaders, and oft-changing organizational structures and ownership.

• Inter-organizational competition resulting in exaggerated claims of effectiveness (“Our way is THE way”) as a means of status assertion.

• Organizational isolation, inter- and intra-organizational conflict, and isolation from larger professional and social arenas as strategies of taint management (e.g., treatment and mutual aid organizations as “closed incestuous systems” [White, 1997]).

• Organizational/workforce hypersensitivity to 1) external attacks on the field, 2) addictionrelated casualties of treated patients, and 3) successful recoveries whose sources appear unrelated to professional treatment.

• Workforce instability (problems of recruitment and retention) influenced by social perception of addiction treatment as “dirty work.”

• Alternating media portrayals of the addiction treatment workforce as rescuing angels one day and a mix of hustlers, con artists, wanna-be-messiahs, and incompetent or impaired castoffs from other professions on the next day.

• Alternating episodes of recruiting and purging persons with recovery experience as workers within the addiction treatment field.

• Professional taint management strategies that include defensive exaggerations of the value of recovery status as a sole professional credential, professional “passing” (accumulating educational credentials while hiding one’s recovery status), or professional distancing (reactive assurances in new social/professional interactions that one’s work in the addiction field is not motivated by any past addiction problem).

• Extrusion of impaired counselors as morally unworthy of future work in the addiction treatment field while promoting medical interventions and continued support, rehabilitation, and retention of impaired workers to employers outside the field.

• Continued co-existence of moral (emphasis on personal culpability) and medical models (emphasis on biopsychosocial vulnerability) within treatment and recovery support milieus.

• Incorporation of stigma- and moral-laden language into professional and lay lexicon (e.g., abuse/abuser, clean/dirty, lapse/relapse), deperson­al­i­zation via focus on diagnostic labels, and acts of contempt toward those being served (e.g., sick humor — laughing at versus laughing with).

• Internalizing societal pessimism about recovery and acting out societal stigma via our own anger, frustration, lowered expectations, and apathy, or through frenzied efforts to rescue and save.

• Pejorative labeling of those served who have the most severe, chronic, and complex problems, (e.g., “retreads,” “frequent flyers”).

• Aggression towards those served, e.g., acts of emotional, sexual, or financial exploitation; invasive therapies; profane confrontations; ridicule and humiliation; clinical abandonment (i.e., physical/emotional distancing, throwing clients out of treatment for confirming their diagnosis via AOD use); and blaming poor treatment outcome on the service recipient’s lack of motivation rather than on flawed design or execution of treatment protocols.

• Expiating problems of collective self-esteem via scapegoating of organizational leaders or persons within the field who challenge prevailing ideologies.

It is my contention as a historian of addiction treatment that the above conditions are influenced by courtesy stigma and the social definition of addiction treatment as emotionally dirty work. They differ in prevalence and intensity across geographical, cultural, and organizational settings, and across individual workers. They also ebb and flow over time in response to changes in social attitudes toward addiction, addiction treatment, and addiction recovery, and to changes in the quality of care within the addiction treatment and mutual aid arenas.

Stigma also feeds periodic public and professional attacks on our organizations and our workers, with such attacks serving the role of status enforcement — reminding the field and those it serves of their place in the social order. This is not to say that some of the criticisms of the field during such backlash periods lack factual merit. It does, however, raise questions about such criticisms related to their timing (Why now?), intent (Is the purpose of criticism reform or restraint?), and intensity (Why is part of the field so adamantly portrayed as the whole?).

Effective Taint Management The suggestion that the history of addiction treatment has been profoundly influenced by the collective wounds inflicted by courtesy stigma and the dirty work designation may on the surface seem ridiculous to those, like the author, who so value this field and worked so long to elevate its status. But that is precisely the conclusion that I have drawn from my studies of this history. Addiction treatment and addiction counselors stand with many similarly affected fields and roles. From the hospice nurse to the police officer, from the AIDS outreach worker to the child protection worker, from the psychiatrist to the prison guard, from the nursing home attendant to the grief counselor, and on and on, people are confronted with the question/comment: “How do you handle it? It must take a SPECIAL person to do that kind of work. I don’t think I could do it.”

In making this suggestion, it is equally important to acknowledge the strides made to date in altering these dynamics. The resistance and resilience of the addiction treatment field in the face of such marginalization is itself an important story.

Addressing occupational stigma has required three overlapping strategies. The first has been to build a strong infrastructure upon which the field’s continued maturation can be based. That has come in the form of numerous professional associations. I anticipate a period of consolidation of these organizations that will allow the field to speak with one voice on issues of emerging consensus. The professional development of the field, including the growth in science-based treatments, improved professional training, refined credentialing/licensing mechanisms, and improved models of clinical supervision — have all been critical to elevating the quality and perception of addiction treatment. These developments have provided a backdrop for the emergence of ennobling ideologies that extol

the legitimacy, meaningfulness, and importance of work within the field.

A second taint management strategy has been to move out of professional isolation and enter into collaboration with professionals from allied fields. These collaborations have increased our own sense of professionalism and have afforded important learning opportunities that have affected how we see ourselves and are seen by other health and human service disciplines and the larger culture.

A third, and recently emerging, taint management strategy involves not just improved methods of personally and organizationally managing the social taint, but actually working to change the taint at broad social levels. We must protest, educate, advocate, legislate, and create forums that bring the public into contact with addiction professionals and individuals and families in long-term recovery. We must, through our own stories of lives transformed, become part of the living proof that recovery is a reality, is achieved through diverse pathways, and flourishes in supportive communities.

It is this strategy that I think has the most long-term potential. It involves solidifying those working in the field as an advocacy force not just to advocate for their own personal and institutional interests, but to work actively to change the public understanding of addiction, addiction recovery, and the value of specialized treatment in enhancing long-term recovery outcomes. There is a new recovery advocacy movement closely aligned with those goals, and it is time addiction professionals entered into full partnership with that movement. If we are ever to expect people in recovery and their families to publicly tell their stories, we must pave the way by telling the stories of the meaning and value we have found in this unique service ministry. We must share with the civilian world what we have learned about addiction, its treatment, and the fruits long-term recovery extends to individuals, families, and communities.

We need public stories, not of addiction, but of healing, recovery, and recovery giving back what addiction has taken from individuals, families, and communities. We will know that stigma is a thing of the past when the concepts of courtesy stigma and dirty work applied to addiction treatment and recovery lie deep within the dustbin of our professional history.

William L. White, MA, is a Senior Research Consultant at Chestnut Health Systems/Lighthouse Institute and past-chair of the board of Recovery Com­ mu­nities United. White has a Master’s Degree in Addiction Studies and has worked full-time in the addictions field since 1969 as a street-worker, counselor, clinical director, researcher and well-traveled trainer and consultant.

He has authored or co-authored more than 400 articles, monographs, research reports and book chapters and 16 books. His book, Slaying the Dragon – The History of Addiction Treatment and Recovery in America, received the McGovern Family Foundation Award for the best book on addiction recovery.

His collected papers are posted at www.williamwhitepapers.com.

REFERENCES Ashforth, B. E., & Kreiner, G. E. (1999). “How can you do it?”: Dirty work and the challenge of constructing a positive identity. Academy Of Management Review, 24(3), 413–434.

Birenbaum. A. (1970). On managing a courtesy stigma. Journal of Health and Social Behavior, 11(3), 196–206. Goffman, I. (1963). Stigma: Notes on the management of a spoiled identity. Englewood Cliffs, NJ: Prentice-Hall. Hughes, E.C. (1958). Men and their work.

Glencoe, IL: Free Press.

McMurray, R. (2014). ‘Why would you want to do that?’: Defining emotional dirty work.

Human Relations, 67(9), 1123. Strong, P.M. (1980). Doctors and dirty work – the case of alcoholism. Sociology of Health and Illness, 2(1), 24–47.

Thomas, S. P. (2014). Emotional dirty work: a concept relevant to psychiatric-mental health nursing?. Issues In Mental Health Nursing, 35(12), 905.

White, W. (1997). The incestuous workplace: Stress and distress in the organizational family. Center City, MN: Hazelden.

Originally published on September 19, 2015 at www.williamwhitepapers.com (http://www.williamwhitepapers.com/blog/2015/09/the-field-that-was-ashamed-andproud-of-itself.html)

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Addressing the Future of Addiction Studies in Higher Education

By Peter L. Myers, PhD

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he Community Colleges movement of the 1960’s created educational programs for the “new profession als” of alcoholism counselors to treat persons affected by this disease. This movement created a level of para professionals specific to alcoholism and drug addiction and was modeled after “Teacher Aides,” “Human Service Workers,” and the “Mental Health Tech” paraprofessional movement. That paraprofessionals movement has developed a more advanced curriculum to match the career ladder that now ranges from a technician/ paraprofessional to a Master’s Degreed professional. Dr. Ed Reading chronicled the rise of addictions curricula in college and university settings in the Fall issue of Advances in Addiction & Recovery. The scope of ­practice and the addiction specific education to match those scopes have been identified and are being used by the International Coalition for Addiction Studies Education (INCASE), National Addiction Studies Accreditation Commission (NASAC), and NAADAC. A profession is not identified as a profession until the education is specific to that discipline and accredited as such. Today, there are many colleges and universities that have upgraded their curricula to these models but much more needs to be accomplished.

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The creation of “Recovery Support Specialists” or “Recovery Coaches” to serve in the recovery mentor role in the Recovery Oriented System of Care (ROSC) model opens the door to confusion. In some states and locations, these roles mean something different with a variety of scopes of practice. Recovery Support Specialists or Recovery Coaches and Mentors perform many of the same functions as addictions counselors have in the past: community navigation; support and coping skills enhancement; long term support for emotional, behavioral, and cognitive stability; and referral to treatment when relapse prevention or other counseling supports are needed. Curricula for recovery mentors needs to be developed and upgraded to include specific knowledge, skills, and competencies that reflect the scope of practice. Confusion between the role of the “sponsor” and the role of the “Addiction Counselor” verses the role of the Recovery Support Specialists or Recovery Coaches. (White 2006) Other components and standards of the ROSC model such as for sober living facilities will also need to be added to the curricula. Very few colleges and universities have courses on long-term recovery support and textbooks that train specifically to this new practice need writing as upgrading as the ROSC model replaces the old acute care model (SAMHSA 2010).

The future of addiction studies need to include critical thinking about addictions and counseling (ethics, treatment, and support modalities), the pros/cons and limitations of the SBIRT models along with the various uses of SBIRT models, and the proliferation of non-12 step mutual support groups to curricula. The era of dogmatism in addictions treatment is eroding.

Whereas years ago it was once actually forbidden to offer an in-service workshop of SMART Recovery, students and counselors are now inquisitive about the menu of options in the road to recovery, including SMART, Charlotte Kasl’s 16 step “spirituality lite” model, and LifeRing Secular Recovery, as well as others (White 2005).

Additionally, the “third wave” of cognitivebehavioral therapies (Forman et al. 2007, Hayes et al. 2004), mindfulness (Hoffman et al. 2007, Williams and Kraft 2012), coping skills, and the integration of addictions counseling into primary health care are innovations that also need to be added to the addiction studies curricula.

In working with families who have a member with a substance use disorder, too often educators and texts repeat non-evidence-based formats on typologies of children of alcoholics that are decades old, and copied from classic family systems research on families in general. These too need to be upgraded (Corcoran 2003).

The future possess several threats. One threat is that many professors who teach or supervise addictions courses identify as a social worker, counseling psychologist, or even a health educator, and not primarily as an addiction specialist. Their education and loyalty lies to organizations in those disciplines, and they gravitate towards accreditation by the bodies formed by these disciplines. The dispersal of substance use disorder studies among many college/university departments can make it difficult to even identify SUD specific curricula.

Another threat, which is endemic to higher education as a whole, is the “adjunctification” of instruction. This writer, as well as many other faculty that have been trained in SUD studies, retired from full-time faculty status and have been replaced by an assortment of adjunct faculty who are loosely supervised and not necessarily well-educated and trained in SUD-specific studies. This problem is compounded when we view the rise of private online curricula in which the supervisor of the adjunct instructors is often not in a helping professions, but instead is a technocrat who may not care whether the course

has been updated to reflect the latest developments and practices. There is often no oversight by qualified professionals in the structuring of the curriculum and no assurance that the ­c urriculum is aligned to national or state standards.

In closing, this article suggests the importance of upgrading the education and texts specific to SUD by educators that are well trained and supervised in the new methodologies and practices that have been and will become part of the foundation of addiction practice.

Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 762–799.

Peter L. Myers, PhD, is a Past President of INCASE, an emeritus member of NASAC, and emeritus Editor-in-Chief of the Journal of Ethnicity in Substance Abuse. He is coauthor of Becoming an Addictions Coun­ selor: A Comprehensive Text, and coauthor or editor of five other books in the SUD field.

He works for the publishing conglomerate ABC-CLIO as Series Editor of volumes concerning substance use disorders.

White, W. (2005). Styles of Secular Recovery. Available at http://www.williamwhitepapers.com/pr/ 2005Stylesofsecularrecovery.pdf.

REFERENCES Corcoran, J. (2003). Clinical Applications of Evidence-Based Family Interventions. New York: Oxford University Press.

Hayes S. C., Masuda, A., Bissett, R., Luoma, J., & Gueffero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 33–54.

Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: New wave or old hat?

Clinical Psychology Review, 28(1), 2–16.

Substance Abuse and Mental Health Services Adminis­ tration. (2010). ROSC Resource Guide Book. Available at http://www.samhsa.gov/sites/default/files/rosc_ resource_guide_book.pdf.

White, W. (2006). Sponsor, Recovery Coach, Addiction Counselor: The Importance of Role Clarity and Role Integrity. Philadelphia, PA: Philadelphia Department of Behavioral Health and Mental Retardation Services.

Available at https://www.oasas.ny.gov/recovery/ documents/WhiteSponsorEssay06.pdf.

Williams, R and Kraft J. (2012) The Mindfulness Workbook for Addiction. Oakland, CA. New Harbinger Publications, Inc.

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■ NA ADAC LE ADERSHIP NAADAC OFFICERS

NAADAC BOARD OF DIRECTORS

Updated 9/9/15

President Kirk Bowden, PhD, MAC, LISAC, NCC, LPC President Elect Gerry Schmidt, MA, LPC, MAC

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

Susan Coyer, MAC

Secretary Thurston S. Smith, CCS, NCAC I, ICADC

Mid-Central (Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)

Treasurer John Lisy, LICDC, OCPS II, LISW-S, LPCC-S Immediate Past President Robert C. Richards, MA, NCAC II, CADC III National Certification Commission for Addiction Professionals (NCC AP) Chair Kathryn B. Benson, LADC, NCAC II, QSAP, QSC

Kevin Large, MA, LCSW, MAC Mid-South

(Represents Arkansas, Louisiana, Oklahoma and Texas)

Sherri Layton, MBA, LCDC, CCS North Central

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

Executive Director Cynthia Moreno Tuohy, NCAC II, CDC III, SAP

Diane Sevening, EdD, LAC Northeast

(Represents Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont)

Catherine Iacuzzi, PsyD, MLADC, LCS Northwest (Represents Alaska, Idaho, Montana, Oregon, Washington and Wyoming)

Greg Bennett, MA, LAT Southeast

(Represents Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee)

Angela Maxwell, MS, CSAPC Southwest

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

Organizational Member Delegate Matt Feehery, MBA, LCDC, IAADC

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

PAST PRESIDENTS

Finance & Audit Committee Chair John Lisy, LICDC, OCPS II, LISW-S, LPCC-S

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

NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS (NCC AP) Kathryn B. Benson, NCAC II, LADC, QSAP, QSC NCC AP Chair Tennessee

NERF Committee Chair Nancy Deming, MSW, LCSW, CCAC-S Nominations and Elections Chair Robert C. Richards, MA, NCAC II, CADC III

James “Kansas” Cafferty, NCAAC California

Personnel Committee Chair Kirk Bowden, PhD, MAC, LISAC, NCC, LPC

Steven Durkee, NCAAC Secretary Kentucky

Public Policy Committee Chair Michael Kemp, ICS, CSAC, CSW

Tay Bian How, NCAC II Sri Lanka

AD HOC COMMITTEE CHAIRS

Thaddeus Labhart, MAC, LPC Treasurer Oregon

Awards Committee Chair Jamie Durham Adolescent Specialty Committee Chair Christopher Bowers, MDiv, CSAC, ASE

Rose Maire, MAC, LCADC, CCS New Jersey Sandra Street, MAC, SAP West Virginia

International Committee Chair Paul Le, BA

Loretta Tillery, MPA, CPM Public Member Maryland

Leadership Committee Chair Robert C. Richards, MA, NCAC II, CADC III Membership Committee Co-Chairs Diane Sevening, EdD, LAC Margaret Smith, EdD, LADC

Kirk Bowden, PhD, MAC, LISAC, NCC, LPC (ex-officio) Arizona

STANDING COMMITTEE CHAIRS

Product Review Committee Chair Matt Feehery, MBA, LCDC, IAADC

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

Professional Practices and Standards Committee Chair Donald P. Osborn, PhD, LCAC

Clinical Issues Committee Chair Frances Patterson, PhD, MAC

Tobacco Committee Chair Diane Sevening, EdD, LAC

Mita Johnson, EdD, LPC, LAC, MAC, SAP

NAADAC REGIONAL BOARD REPRESENTATIVES

NORTHEAST AK

NORTH CENTRAL

MID-CENTRAL

Gloria Nepote, LAC, NCAC II, CCDP, BRI II, Kansas-Missouri Ted Tessier, MA, LAMFT, LADC, Minnesota Tiffany Gormley, Nebraska John Wieglenda, LAC, North Dakota Linda Pratt, LAC, South Dakota

Mark Sanders, LCSW, CADC, Illinois Angela Hayes, MS, LMHC, LCAC, Indiana Michael Townsend, MSSW, Kentucky Terrance Lee Newton, BAS, CADC, Michigan Jim Joyner, LICDCCS, ICCS, Ohio Gisela Berger, PhD, Wisconsin

Susan Campion, LADC, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Gary Blanchard, MA, LADC, Massachusetts Lori Ford-Magoon, MLADC, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, DOT SAP, New York William Keithcart, MA, LADC, Vermont

WA MT

Northwest

OR

VT

MN

NORTHWEST

SD

ID

Diane C. Ogilvie, MAEd, Alaska Malcolm Horn, LCSW, MAC, SAP, NCIP, Montana Arturo Zamudio, Oregon Greg Bauer, CDP, NCAC I, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming

ME

ND

North Central

WY

IL

CO

Southwest

KS

CT

PA

UT CA

NY

MI

IA

NE

NV

North-NH east MARI

WI

Mid-Central OH IN

MO

KY

NJ MD

MidAtlantic

DE

WV

VA NC

TN

SOUTHWEST

HI

AZ

OK

NM

Carolyn Nessinger, MS, NCC, BHT, Arizona Thomas Gorham, MA, CADC II, California Thea Wessel, LPC, LAC, MAC, Colorado Kimberly Landero, MA, Nevada J.J. Azua, LADAC, CPSW, New Mexico Michael Odom, LSAC, Utah

Mid-South TX

AR

AL LA

SC

Southeast

MID-ATLANTIC Jevon Hicks Sr., BS, ICADC, Delaware Johnny Allem, MA, District of Columbia Ron Pritchard, CSAC, CAS, Virginia Patrice Pooler, MA, ADC, West Virginia

GA

MS

FL

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

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A d va n c e s i n A d d i c t i o n & R e c o v e r y | W I N T E R 2 015

Eddie Albright, MS, Alabama Bobbie Hayes, LMHC, CAP, Florida David A. Burris, CAC II, NCAC II, CCS, Georgia Angela Maxwell, MS, CSAPC, North Carolina Charles Stinson, MS, South Carolina Lori McCarter, LADAC, QCS, Tennessee

2016 Call for Presentations We cordially invite you to submit a proposal to present at NAADAC’s 2016 Annual Conference: Embracing Today, Empowering Tomorrow, being held in Minneapolis, MN at the Hyatt Regency Minneapolis from October 7–11, 2016.

NAADAC members and nonmembers are invited to submit presentation proposals for pre-conference and post-conference full-day training sessions, breakout sessions, and plenary sessions. NAADAC encourages young investigators, researchers, and addiction and co-occurring professionals from diverse organizations and fields to submit.

Submission Deadline: January 19, 2016.

We are seeking current and relevant information within these eight topics: ■ Business of Addiction Practice: Health Information Technology (HIT), Electronic Health Records (EHR), Certification/Licensure, Patient Retention, Billing/ Insurance, Social Media, Teletherapy, and Ethical, Legal, and Liability Issues, Policy/Regulatory Issues, Affordable Care Act (ACA).

■ Co-Occurring Disorders: Integrated Treatment, Changes from DSM-IV to DSM-5, Mental Health Disorders, Trauma, and ICD 10.

■ Psychopharmacology: Neurobiology of Addiction, Pharmacotherapy/Medication-Assisted Treatment, Opioids, Alcohol, Marijuana, Sedatives, Stimulants, Synthetic Drugs, Tobacco/Nicotine, and Designer Drugs.

■ Clinical Skills: Evidence-based Practices, Case Studies, Relapse Prevention/Recovery Support, Treatment Planning, Screening & Assessment, Counseling Theories, The ASAM Criteria, and Promising Practices.

■ Cultural Humility: Introduction to Cultural Humility, Addiction-Specific Issues Involving LGBTQ, Racial/Ethnic Groups, Gender, Spirituality, Low-Income/Homeless, and Veterans/Military.

■ Process Addictions: Gambling Addiction, Sexual Addiction, Internet Addiction, and Eating Disorders.

■ Recovery Support: Community Navigation, Individual & Community Capital, Family Support, and Treatment Coordination.

■ Education/INCASE: Presentations with a postsecondary educational focus, designed for an audience of college level faculty who are seeking to enhance the quality of training and education in addiction studies, to disseminate professional knowledge and share ideas regarding addiction studies, students and scholarship in the field of addiction studies with a creative evidence-based focus.

To apply and for more information on the submission and selection processes, conference information, timelines, and presenter resources, please visit www.naadac.org/2016-Call-for-Presentations.

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