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The Official Publication of NAADAC, the Association for Addiction Professionals

Conversations

with NAADAC’s President PAGE 16

Medical and Recreational

Marijuana Healing PAGE 22

the Addicted Brain PAGE 24


NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 75,000 addiction counselors, educators and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support and education in the United States, Canada and abroad.

Why Join NAADAC, the Association for Addiction Professionals

NAADAC Membership Tailored to you:

NAADAC Members Receive Reduced Rates:

• Professional, Associate and Student membership levels available. • Payment plans available to help with your budget. • NAADAC membership dues include membership in NAADAC and your state affiliate.

• Save $100 on national certification and re-certification of the National Certified Addiction Counselor (Levels I and II), Master Addiction Counselor (MAC) and other credentials. • Receive members-only pricing on all NAADACproduced publications, independent study courses and continuing education units (CEUs). • Members save $75 to $100 on NAADACsponsored conferences and public policy events. NAADAC members also save on regional meetings, workshops and conferences. • Malpractice and comprehensive professional liability insurance for individuals and agencies. • 20% discount on all Hazelden resources. • 25% discount off new subscriptions to Substance Abuse Funding News.

Earn Free Online Education and CEs: • Over 85 online continuing education credits (CEs), including four online courses and over 59 webinars available to members for free. • Simply watch the webinar/online course of your choice, complete the online CE quiz, and receive a free CE certificate to use towards your license/credential – all online, at your convenience.

Join NAADAC online at www.naadac.org/join or by calling 1.800.548.0497!

www.naadac.org

Be a part of the NAADAC community! www.facebook.com/Naadac @NAADACorg


Contents DEPARTMENTS

FEATURES

12

NAADAC 2013 Annual Confer-

ence Education You Need; Connections You Can Cultivate; At a Price You Can Afford

5

Advocacy

NAADAC Leader­ship Opposes Recreational Marijuana; Revises Position Statement

7

Certification

The First ACCE Commission Meeting in Jakarta

16

Conversations With NAADAC’s President We are the Few, Advocating for the Many: Robert Richards

18

Smoking Rates High With Men- tal Health Issues The

CDC Cites Tobacco Use in Its New Report

20

Is It Time We Became Recov- ery Profes­sionals?

9

Education

Commentary by William White

NAADAC Launches New Screening Resource: SBIRT

22

Some Straight Truth About Marijuana for Medical Purposes Medical

30

NAADAC

Board of Directors

Marijuana Laws Provide State-sanctioned Use of a Drug by Most Anyone Who Desires It

24

Healing the Addicted Brain

Welcome to the first issue of Advances in Addiction & Recovery! We hope you enjoy it. Donovan Kuehn, Managing Editor

Comments?

Send to Donovan Kuehn at dkuehn@ naadac.org

Countering Brain Injuries From Past Alcohol and Drug Use Can Map the Road to Recovery

28

Help Us Find the Best Pro- fessionals NAADAC Award Nominations Accepted Until April 30

SPRING 2013  Premiere Issue Advances in Addiction and Recovery, the official publication of NAADAC, is focused on providing useful, innovative and timely information on trends and best practices in the profession that are useful and beneficial for practitioners. NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 75,000 addiction coun­ selors, educators and other addiction-focused health care pro­ fessionals in the United States, Canada and abroad. NAADAC’s members are addiction counselors, educators and other ­addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support and education. Mailing Address Telephone Email Fax

1001 N Fairfax Street, Suite 201 Alexandria, VA 22314 1.800.548.0497 naadac@naadac.org 703.741.7698

Managing Editor Donovan Kuehn Graphic Designer Elsie Smith, Design Solutions Plus Editorial Advisory Alan K. Davis, MA, LCDC III Committee Bowling Green State University

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

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

Robert Perkinson, PhD Keystone Treatment Center

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

William L. White, MA Chestnut Health Systems

We are interested in accepting any interesting and topical articles that address issues of interest to addiction-focused professionals. Have a story idea or article that you’d like to submit? Contact Donovan Kuehn at dkuehn@naadac.org and share your story idea. Publication Guidelines ● Articles must be the work of the author(s) and not subject to copyright. ● Articles must not contain information that promotes unethical activities or business practices. ● Submissions can be from 500 to 3,000 words. Longer articles can be submitted in consultation with the editor. ● Submitted works must include citations and a bibliography, or be clearly marked as an opinion piece. ● Authors must submit a biography and photo to be appended to the article. Photos need to be at least 300 KB in size and in JPG or PNG format. NAADAC reserves the right to edit or condense any articles. Advertise With Us NAADAC accepts advertising placements. For more information on advertising, please contact Donovan Keuhn at dkuehn@naadac.org.

Advances in Addiction and Recovery The Official Publication of NAADAC, the Association for Addiction Professionals ISBN: 978-0-9885247-0-5

This publication was prepared by NAADAC, the Association for Addiction Professionals. All material appearing in this publication, except that taken directly from the public domain, is copyrighted and may not be reproduced or copied without permission from NAADAC. For more information on obtaining additional copies of this publication, call 1.800.548.0497 or visit www.naadac.org. Printed March 2013

4  Advances in Addiction & Recovery | SPRING 2013

Cover: steveznuba1 | iStockphoto.com


NAADAC Leadership Opposes Recreational Marijuana Revised Position Statement Speaks out Against Medicinal and Recreational Use B y D onovan K uehn Reacting to the voter initiatives passed in Colorado and Washington allowing recreational use of marijuana, the NAADAC Executive Committee has taken a stand against these laws. NAADAC’s position is unequivocal: “Marijuana should be subject to the same research, consideration and study as any other potential medicine, under the standards of the U.S. Food and Drug Administration (FDA).” NAADAC came to this conclusion because mari­ juana “has a high potential for abuse, has no currently accepted medical use in treatment in the United States and has a lack of accepted safety for use under medi­ cal supervision.”

What About the Voters? In addition to the recreational marijuana initiatives passed in 2012, voters in many states have approved the concept of “medical marijuana” in referenda across the nation. While NAADAC supports the right of citizens to participate in the democratic process, it does not

support legislative or voter ballot initiatives to legalize marijuana for medical and recreational use. The NAADAC position statement states: “Voter and legislative passage of marijuana-legalization laws may actually inhibit good medicine because they shortcut the necessary step of researching the marijuana plant and the chemicals within that may have legitimate med­ ical applications.” “NAADAC recognizes the supremacy of federal regu­ latory standards for drug approval and distribution. NAADAC recognizes that states can enact limitations that are more restrictive but rejects the concept that states could enact more permissive regulatory stan­ dards. NAADAC discourages state interference in the federal medication approval process,” reads the posi­ tion paper. “People who use marijuana are endangering their health,” said Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP, Executive Director of NAADAC. (See position statement on page 6)

MONKEYBUSINESS IMAGES | photospin.com

Advocacy

SPRING 2013  Advances in Addiction & Recovery  5


A pproved

by the

NAADAC E xecutive C ommittee

in

J anuar y 2013.

NAADAC Position Statement on the Medical and Recreational Use of Marijuana Summary NAADAC, the Association for Addiction Professionals does not support the use of marijuana as medicine or for recreational purposes. Marijuana should be subject to the same research, consideration and study as any other poten­tial medicine, under the standards of the U.S. Food and Drug Administration (FDA). NAADAC does not support legislative or voter ballot initiatives to legalize marijuana for medical or recreational use. Further, NAADAC maintains its position that there are significant public health problems and costs related to marijuana legalization.

Background ■ Marijuana is listed in Schedule I of the Controlled Substances Act (CSA), the most restrictive schedule. The

Drug Enforcement Administration (DEA), which administers the CSA, continues to support that placement, and FDA concurred because marijuana met the three criteria for placement in Schedule I under 21 U.S.C. 812(b)(1) (e.g., marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision).1 ■ Marijuana should be subject to the same research, consideration, and study as any other potential medicine. The U.S. Food and Drug Administration (FDA) is the sole Federal agency that approves drug products as safe and effective for intended indications. The Federal Food, Drug, and Cosmetic (FD&C) Act requires that new drugs be shown to be safe and effective for their intended use before being marketed in this country. FDA’s drug ap­proval process requires wellcontrolled clinical trials that provide the necessary scientific data upon which FDA makes its approval and labeling decisions. If a drug product is to be marketed, then disciplined, systematic, scientifi­ cally conducted trials are the best means to obtain data to ensure that drug is safe and effective when used as indicated. Efforts that seek to bypass the FDA drug approval process would not serve the interests of public health because they might expose patients to unsafe and ineffective drug products. FDA has not ­approved smoked marijuana for any condition or disease indication. NAADAC recognizes the supremacy of federal regulatory standards for drug approval and distribution. NAADAC recognizes that states can enact limitations that are more restrictive but rejects the concept that states could enact more permissive regulatory standards. NAADAC discourages state interference in the federal medication approval process. ■ There is currently sound evidence that smoked marijuana is harmful. A past evaluation by several Department of Health and Hu­man Services (HHS) agencies, including the Food and Drug Administration (FDA), Substance Abuse and Men­tal Health Services Administration (SAMHSA) and National Institute for Drug Abuse (NIDA), concluded that no sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use. There are alternative FDA-approved medications (i.e., Oral THC) in existence for treatment of many of the pro­ posed uses of smoked marijuana.2 NAADAC rejects smoking as a means of drug delivery since it is not safe. ■ A growing number of states have passed voter referenda (or legislative actions) making smoked marijuana available for a variety of medical conditions upon a doctor’s recommendation, and for recreational use with­ out a doctor’s recommendation. These measures are inconsistent with efforts to ensure that medications undergo the rigorous scientific scrutiny of the FDA approval process and are proven safe and effective under the standards of the FD&C Act. Further, voter or legislative initiative does not meet the scientific standards for approval of medicine. Voter and legislative passage of marijuana-legalization laws may actually inhibit good medicine because they shortcut the necessary step of researching the marijuana plant and the chemicals within that may have legitimate medical applications. NAADAC does not support legislative, regulatory or voter ballot initiatives to legalize marijuana for medical or recreational use.

No sound scientific studies support medical use of marijuana for treatment and no animal or human data supports the safety or efficacy of marijuana for general medical use.

1001 N. Fairfax Street, Suite 201 Alexandria, VA 22314 www.naadac.org/advocacy naadac2@naadac.org phone 703.741-7686 or 800.548.0497 fax 703.741.7698 or 800.377.1136

Further, NAADAC opposes proposals to legalize marijuana anywhere in the United States. Note: This position statement incorporates and expands upon the Position Statement on Medical Marijuana, ­approved by the NAADAC Executive Committee in January 2011. Sources: 1 The DEA Position on Marijuana, http://www.justice.gov/dea/docs/marijuana_position_2011.pdf 2 ASAM White Paper on State-Level Proposals to Legalize Marijuana, http://www.asam.org/docs/publicy-policy-statements/state-levelproposals-to-legalize-marijuana-final2773DD668C2D.pdf?sfvrsn=2


The First ACCE Commission Meeting Jakarta, Indonesia, June 4–6, 2012 B y Tay B ian H ow

PHOTO: ACCE Team, 2012

selfit | photospin.com

Certification

The Colombo Plan Asian Commission for Certification and Education (ACCE) aims to professionalize the addic­ tion treatment providers of the Asia–Pacific region through training, examination and credentialing and thereby address the growing concerns of substance use and high relapse rate which is largely due to lack of trained staff and dearth of evidence based practices in the region. In order to ensure the high quality and standard of this ini­ tiative, it was imperative that the ACCE established a policy making body. The ACCE Commission was thus established on June 4, 2012, through a meeting held in Jakarta, Indonesia. The Commission is composed of ten members representing nine member countries of the Colombo Plan. H.E. Mr. Ahwil Lutan of Indonesia is elected as the Chair, Dr. Shanti Ranganathan of India as the Secretary and Mr. Edgar Galvante of the Philippines as the Treasurer of the ACCE Commission for a term of two years. The other Commission members are Mr. Khandker Mohammad Ali (Bangladesh), Dr. Benny Ardjil (Indonesia), Dr. Rushidi Ramly (Malaysia), Hon. Minister Uza Lubna Mohamed Zahir Hussain (Maldives), Mr. Edgar Galvante (Philippines), Ms. Bhadradevi Leisha Chandrasena De Silva (Sri Lanka), Mr. Anggoon Patarakorn (Thailand), and Dr. Mohammad Raza Stanikzai (Afghanistan). Following the establishment of the ACCE Commission, the First ACCE Commission meeting was held June 4–6, 2012, in Jakarta in collaboration with the National Narcotics Board (BNN), Indonesia. The meeting was attended by all ten Commissioners. Ms. Shirley Beckett Mikell, Director of Certification, NAADAC, Dr. Sallyan Henry, President of Professional Testing Corporation, New York, Mr. Tay Bian How and five ACCE staff were also present in the meeting. In the course of the meeting three Sub-Committees were set up: training, ethics, and examina­ tion and certification. Each sub-committee is represented by three ACCE com­ missioners and the Chairman H.E Ahwil Lutan is the ex-officio member of all three sub-committees. The newly elected Commission reviewed, finalized and adopted the ACCE Commission policies and procedures, the Code of Ethics for the Com­mis­ sioners and the Code of Ethics for the treatment professionals who would be credentialed through ACCE. The eligibility criteria for the three levels of ACCE Credentials were also finalized. The Commission members signed the “Code of Ethics for the ACCE Commissioners” and took an oath to abide by the eth­ ical guidelines. Subsequent to the meeting, the ACCE Commissioners electronically ap­ proved the names of the ACCE Examination and Credentials. The Credentials have been titled “International Certified Addictions Counsellor” with the acro­ nym ICAC. It was decided that the Basic Level Examination would be known as ACCE I and the credentials as ICAC I. The Clinical Level Examination would be known as ACCE II and the credentials as ICAC II. The Advanced Level Examination would be known as ACCE III and the credentials as ICAC III. For more information on the Asian Centre for Certification and Education of Addiction Professionals, please visit www.colombo-plan.org/acce/?page_id=19 or contact Tel. +94 11 2684188 (Hotline) or info@ colomboplan.com. (L to R) Sitting: Mr. Tay Bian How, Dr. Sallyan Henry (Resource Person, USA), Dr. Shanti Ranganathan (India), H.E. Mr. Ahwil Lutan (Indonesia), Mr. Edgar Galvante (Philippines), Hon. Minister Uza Lubna Mohamed Zahir Hussain (Maldives), Ms. Shirley Backett Mikell (Resource Person, USA). Standing: Mr. Anggoon Patarakorn (Thailand), Mr. Khandker Mohammad Ali (Bangladesh), Dr. Benny Ardjil (Indonesia), Dr. Mohammad Raza Stanikzai (Afghanistan), Dr. Rushidi Ramly (Malaysia), Ms. Bhadradevi Leisha Chandrasena De Silva (Sri Lanka). SPRING 2013  Advances in Addiction & Recovery  7


Why Join NAADAC, the Association for Addiction Professionals Gain Free Access To: • The NAADAC online Find a Professional listing, a comprehensive list of NAADAC members and certification holders searchable by zip code. • Advances in Addiction and Recovery, the journal of NAADAC. AAR is focused on providing useful, innovative and timely information on trends and best practices in the profession that are useful and beneficial for practitioners in the field. • The NAADAC Calendar of Events to view events throughout the US and online.

• Notifications about hot topics, events, opportunities, and important announcements about the addiction profession through mail, email and/or social media. • The NAADAC Career Center, where you can look through NAADAC's national and international job listings and post openings with your organization. • The electronic Legislative Alert Network (e-LAN), which provides up-to-date information on policy developments in Washington, D.C.

Support Your Profession: • NAADAC members are eligible to apply to become distinguished members of NAADAC's Speakers Bureau. • NAADAC members contribute to maintain a professional identity and association that helps preserve and honor the unique talents of addiction professionals.

Join NAADAC online at www.naadac.org/join or by calling 1.800.548.0497!

www.naadac.org

• NAADAC is an influential and effective voice for addiction professionals before Congress and the federal administration, the key governmental bodies that determine how addiction treatment is funded and administered in America. • NAADAC members are bound by a nationally recognized Code of Ethics to promote professional ethics.

Be a part of the NAADAC community! www.facebook.com/Naadac @NAADACorg


NAADAC Launches New Screening Resource Communication is Key When Screening for Alcohol Use

Education

The Addiction Professional’s Guide to Screening, Brief Intervention and Referral to Treatment (SBIRT) is a 175-page skill-based training manual on SBIRT de­ signed specifically for addiction-focused professionals. This guide brings together the tools that addiction pro­ fessionals need to screen clients for unhealthy drink­ ing, deliver effective brief counseling, refer to other specialists and provide successful case management and follow-up. This guide also provides numerous appendices, ­resources, worksheets and specialty topics on the ­following: ■ Understanding the dynamics of the alcoholic family in order to support both the family members, as well as the client, with alcohol-related issues; ■ Assessing and treating older adults whose use of alcohol or prescription pain medications may create additional complications; ■ Assessing and treating young adult and adolescents whose drinking patterns are unhealthy; and ■ Connecting clients to mutual support groups.

Want to learn more? Check out the archived SBIRT webinar featuring Carlo DiClemente, PhD and Tracy McPherson, PhD. Full details can be found at www.naadac.org/education/webinars.

Addiction Professionals and SBIRT The therapeutic setting is a great place to establish education, prevention and brief intervention programs to impact one of the top three avoidable killers of Americans today — unhealthy and dependent alcohol use. Screening, Brief In­terven­tion and Referral to Treat­ment (SBIRT) is the leading evidence-based protocol to iden­ tify clients who drink in ways that ­increase their risk of physical and emotional health problems, dis­ ease, injury, work, family and so­ cial problems and help them re­ duce its impact. SBIRT is widely used in outpa­ tient medical clinics, hospital emergency depar tments and trauma centers, communit y health centers and the Veterans Ad­min­is­tra­tion, and it is taking hold in the addiction profession. Increasingly, addiction treat­ ment and prevention settings are building SBIRT into practice

routines and expecting that all clinicians be skilled in SBIRT. Luckily, since many addiction professionals ­already incorporate screening for alcohol use into their practice, as well as Motivational Interviewing (MI) ­techniques and referral to other professionals, utilizing the SBIRT protocol does not require much change in workflow. SBIRT can be an effective and efficient method with­ in the total delivery system of addiction prevention and treatment. Granted, often times in an addiction treat­ ment setting, the individual coming in for services has already self-identified his or her “drug of choice” and associated treatment needs. However, there may be other entry points within the system of care for addic­ tion professionals to use the SBIRT protocol, such as private practice sessions, community mental health center settings, hospitals, primary care clinics, com­ munity support center settings, emergency depart­ ments or homeless shelters. Some of the components of the system of care, such as hospitals, primary care clinics, community mental health and other community support centers, may not find it efficient to provide SBIRT services them­ selves, and therefore, look to addiction professionals to contract them externally. Addiction professionals can create additional revenue streams by providing these services (screening, brief intervention, referral to treatment and follow-up) through contract work, as well as by partnering with another component of the system of care in the community to receive referrals for those individuals identified as needing specific addiction counseling and/or treatment.

Overview from “35,000 Feet” There are three core components of SBIRT: 1) Screening – the process of assessing risk Asking three simple questions about the quan­ tity and frequency of alcohol use (the three question AUDIT-C1) takes 30 seconds to one minute. This is followed by the seven remaining questions of the AUDIT if responses to the first three questions sug­ gest higher addiction than average unhealthy use. Other good, brief screening instruments exist, but the AUDIT is the benchmark questionnaire that we recommend. If you do not ask, clients will not tell you about un­ healthy drinking. 2) Brief Intervention – a behavior change strategy focused on helping your client reduce or stop unhealthy drinking. If screening indicates unhealthy alcohol use, you may choose to provide immediate feedback on how her drinking compares to others her age and gender, SPRING 2013  Advances in Addiction & Recovery  9


Education The U.S. Preventive Services Task Force reviewed the research­ literature on screening for unhealthy alcohol use and brief counseling and recommended that it be routinely provided to adolescents and adults. For some addiction professionals, the Addiction Professional’s Guide to Screening, Brief Intervention and Referral to Treatment (SBIRT) training program will be a refresher — reminding and reinforc­ ing skills that you already know and use. Perhaps it will increase the use of skills already well-honed and encourage professionals to use them more often. For others, the training program will fill a gap, pro­ vide new information and teach new skills. Regardless of your experi­ ence with the skills, the important first step is the same — you have to ask. Everything else flows from simply asking in a sensitive manner about your clients’ alcohol use. This is an excerpt from the Addiction Professional’s Guide to Screening, Brief Intervention and Referral to Treatment (SBIRT). For more information, visit NAADAC’s online bookstore at www.naadac. org/component/oscommerce/index.

AA

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SBIRT is simple, brief and effective. An analysis of more than 360 controlled clinical trials of treatments for alcohol use disorders found that screening and brief intervention was the most effective treatment method of more than 40 methods studied.

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offer simple advice, explore the pros and cons of her drinking and ask if she is willing to change. Brief intervention can take as little as 30 seconds (when providing normative behavior information or brief advice) or can extend to 3–5 minutes or longer, and may take place in one or several sessions. Alcohol may be your client’s pri­ mary problem and may become the focus of your interaction, or unhealthy alcohol use may be a factor that complicates the prob­ lems that your client came to resolve. Brief intervention can help many, but certainly not all, clients to make changes. Some will not be ready to change or may need specialized addiction treatment. 3) Referral to Treatment and Follow-up – linking your client to specialized addiction treatment and staying with the client to support sustained success. When alcohol problems are more serious or complicated, more intensive and specialized addiction-focused treatment may be a good option. “Referral to treatment” means connecting your client to a physician for medical treatment or a specialty addiction treat­ ment program. “Follow-up” means care management according to your organization’s protocols, as well as supporting your client dur­ ing treatment and post-treatment follow-up contacts. Follow-up in the form of brief contact is appropriate for all clients.

DAC Webin a

Want to learn more? Check out the archived SBIRT webinar featuring Carlo DiClemente, PhD and Tracy McPherson, PhD. Full details can be found at www.naadac.org/education/webinars.

7, 2013! 1 & 6 1 IL R P A – S E T A SAVE THE D Help shape the national agenda on addiction and health care policy at the

www.naadac.org  •  www.saasnet.org www.treatmentcommunitiesofamerica.org EVENT CO-HOSTS

Holiday Inn & Suites Alexandria–Historic District 625 First Street, Alexandria, VA 22314 • toll-free 877-504-0047 www.hioldtownalexandriahotel.com (use code C5A when registering) 10  Advances in Addiction & Recovery | SPRING 2013

The Advocacy Leadership Summit will provide up-to-date information on current national issues that impact how you do business and provide services. This includes the Affordable Care Act, Parity implementation and other policies affecting the field of addiction. The agenda is ­designed to prepare you for face-to-face meetings with your members of Congress to help ­re-shape how they view addiction. Platinum Sponsor

Supporters


ARCHIVED

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Early Bird Rate ends August 12, 2013

The NAADAC Annual Conference

October 11–14, 2013    Atlanta, Georgia Intercontinental Buckhead Atlanta

Education You Need

Educational Tracks

• Connections You

Clinical Techniques

Can Cultivate • At a

Cultural Competence / Special Populations

Price You Can Afford

Ethics

Clinical Supervision

Co-occurring Disorders / Dual Diagnosis

Educational and Professional Development

Prevention Trauma and Addiction

Earn Up to 25 Continuing Education Credits The NAADAC annual conference will include keynote speakers, daily plenary sessions and breakout workshops. October 11 will feature several all-day, pre-conference seminars. The conference will also feature an Awards Lunch which will honor outstanding addiction-focused professionals from around the nation and an evening event for the NAADAC Political Action Committee (admission by donation). Also included will be optional evening events, to allow you to earn more education credits or to enjoy your time in Atlanta.

© 2013, kevin c. rose | atlantaphotos.com

The NAADAC annual conference will provide a well-balanced educational experience focusing on the needs of addiction-focused professionals. Innovative sessions and cutting edge presenters will provide education you need to get ahead in your job and provide the hours you need for your certification or license. You can pick a track or attend the sessions that are the best fit for you.

12  Advances in Addiction & Recovery | SPRING 2013

© 2013, kevin c. rose | atlantaphotos.com

Education You Need

A T L NAADAC 2013 N T A

Above: Participants in the 2012 Rally for Recovery on the steps of the Indiana Legislature. Photo by Donovan Kuehn. Left: Beautiful Antebellum, Buckhead area home.


Explore Atlanta!

© 2013, kevin c. rose | atlantaphotos.com

Atlanta is a world-class, modern city with a rich, passionate history. It is one of only two cities in the world to lay claim to two Nobel Peace Prize winners — Martin Luther King, Jr. and former President Jimmy Carter. The Centennial Olympic Park, the Martin Luther King Jr. National Historic Site and the exciting arts and entertainment spots are just a few of the attractions to take advantage of while in Atlanta to earn your education credits from the profession’s thought leaders. With October average temperatures in the range of 53 to 74 degrees, Atlanta’s summer heat is gone and a lovely fall should be in swing. Collage of assorted buildings and attractions in Atlanta, including the Fox Theater, Turner Field, CNN Center, The Georgia Aquarium, King Center and the Georgia Dome.

The nearest airport is Hartsfield-Jackson Atlanta International Airport – ATL Airport Phone: 404.530.6600 Airport website: www.atlanta-airport.com Distance to hotel: 19 miles Nearly 80 percent of the country is within a twohour flight of the Hartsfield-Jackson Atlanta In­t er­ national Airport, which has nonstop service to 151 U.S. destinations. Airlines that serve the airport include AirTran Airways, Air Canada, American Airlines, Alaska Air­ lines, Delta Air Lines, Frontier Air Lines, GeorgiaSkies, Southwest Airlines, Spirit Airlines, United Airlines and US Airways.

Airfare Discounts To help reduce costs, NAADAC has negotiated discounts with two national airlines. Flying on American Airlines NAADAC has partnered with American Airlines to provide our attendees with a 5 percent discount off ANY published airfare on www.aa.com for the conference in Atlanta. The valid travel dates for this discount are October 7 to 17, 2013. Apply this discount by going

to www.aa.com to book your f light. Place the code 695H3BI in the promotion code box and your discount will be calculated automatically. This special discount is valid off any applicable published fares listed for American Airlines, American Eagle and American Connection. Flying on United Airlines Earn a 2–10 percent discount (depending on the type of ticket) when coming to the NAADAC conference in Atlanta on United Airlines between October 8 and 17, 2013. Book online at www.united.com and enter ZNF5582220 in the Offer Code box when searching for your flights.

© 2013, kevin c. rose | atlantaphotos.com

Getting to Atlanta

Renting a Car? Save With Your Avis Conference Discount If you’re thinking of renting a car during your stay in Atlanta, use this Avis Worldwide Discount (AWD) Number: D016314 when calling Avis directly at 1.800.331.1600. Or if you plan to book online, visit www. naadac.org/conferences for more information.

Hartsfield-Jackson International Airport bears the proud distinction of being the “world’s busiest passenger airport.” Long known as a major connecting hub serving numerous destinations around the globe, its vitality of growth is also a product of an increasing number of air travelers who start or finish their journeys in the Southeast region.

SPRING 2013  Advances in Addiction & Recovery  13


NAADAC Board of Directors Meeting

© 2013, kevin c. rose | atlantaphotos.com

Scheduled for October 14, 2013, the NAADAC Board of Directors is the leadership body of the association that helps set the ­direction and priorities for the organization on behalf of its members. This session is open to all NAADAC members. The agenda will include an Approval of minutes, reports from the Association’s President, Executive Direc­ tor, Treasurer, a financial review and goal setting for the Association.

Atlanta Skyline 150th Celebration in downtown Atlanta at the Centennial Olympic Park.

Ready to be Seen? The NAADAC annual conference is the perfect place to highlight your business. To download the conference prospectus, please visit www.naadac.org/conferences. To exhibit and participate in other marketing pro­g rams please cont act Leslie R inge, Account Executive for the NAADAC Annual Conference Marketing Program. Phone 215.343.7363 Fax 215.249.4741 or send an email to leringe@verizon.net.

Scholarships

Intercontinental Buckhead Atlanta 3315 Peachtree Road, NE Atlanta, GA, 30326 Toll free: 1.888.424.6835 If people back at the office need you, the hotel includes a full service business center and free Internet is included with your room reservation. Rooms are $149 per night plus applicable taxes for rooms booked by September 16, 2013. You can register online by visiting www.naadac.org/conferences or contact the Reservations Department at 404.946.9191 or 1.877.422.8254 toll free and let them know you are with the NAADAC meeting in order to receive your special group rate.

Participants in the 2012 Hill Day breakfast at the NAADAC conference in Washington, D.C.

© 2013, katie snyder | atlantaphotos.com

© 2013, james duckworth | atlantaphotos.com

Scholarships are available. All scholarship applications must be received 60 days before the first day of the conference (August 12, 2013). Download a scholarship form by visiting www.naadac.org/education.

Where you’ll be Staying

“BIG A” collage.

14  Advances in Addiction & Recovery | SPRING 2013

The patio in the rear of the Atlanta History Center in Buckhead.


NAADAC 2013 ANNUAL CONFERENCE Registration Form Attendee Information

Conference Registration Fees

(please print clearly)

EARLY BIRD: REGISTER BY AUGUST 12, 2013 AND SAVE!

❑ This is my first NAADAC Training/Conference

Full Conference Only October 11–14, 2013

NAADAC/GACA, INCASE or NALGAP Member #_________________________________

Early Bird

Regular

(register by August 12)

(register after August 12)

Member

❑ $375

❑ $425

❑ $150

❑ $150

Non-Member

❑ $500

❑ $550

❑ $200

❑ $175

N/A

❑ $250

❑ $150

❑ $150

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Email:_______________________________________________ ❑ YES, I want to join NAADAC now and SAVE UP TO $125 on the conference! Please consult www.naadac.org for membership fees or call 800.548.0497 to enroll. ❑ Please send me additional information about membership. Total Amount Enclosed_ ______________________________

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Please return check (made payable to NAADAC) or money order by mail to: NAADAC 1001 N Fairfax Street, Suite 201, Alexandria, VA 22314 Or pay by credit card: ❑ Visa  ❑ Mastercard  ❑ American Express  ❑ Discover Fax to: 800.377.1136 Name as appears on card_ ____________________________ (please print clearly) Original crypt of Martin Luther King Jr., (pre 2007), viewed through the arcade at The King Center.

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Conference refund policy: A partial refund of 75% of registration cost is refundable 30 days before the conference. Thereafter, 50% of conference fees are refundable.

Questions? Downtown Atlanta Skyline at Centennial Olympic Park with World of Coca-Cola in fhe foreground during Christmas time.

Visit www.naadac.org/conferences or call 1.800.548.0497. SPRING 2013  Advances in Addiction & Recovery  15


“We are the few, advocating for the many.” A Q&A With NAADAC’s President B y D onovan K uehn Rober t C . R icha rd s, M A , NCAC II, CADC III, assumed the presidency of NA ADAC at the end of the Annual Conference in Indianapolis last summer. Since then, he has been working at a ­feverish pitch, with monthly Executive Committee meetings, presentations at regional conferences and outreach to the President and Congress over the tragic mass-shooting at Sandy Hook Elementary in Newtown, Conn. The Managing Editor of Advances in Addiction and Recovery was able to catch up with Richards to learn about his thoughts and plans for NAADAC.

Q

Donovan Kuehn: You have the opportunity to travel and speak with many addiction profes­sionals and NAADAC members. What are the issues you’re hearing about?

Robert C. R ichards : (1) Will older existing members who don’t have higher education degrees be forced out of the profession as credentialing changes? (2) Treatment operating costs continue to increase while reimbursement rates and funding continue to decline. How will the Patient Protection and Affordable Care Act (PPACA) be “affordable” to providers? (3) With mental health services, addiction treatment services and medical services being pulled together, many are concerned that addiction services will be “swallowed up” by the others.

Q

Kuehn: Do you believe that this is a good time for addiction professionals?

R ichards : I believe that it is both a good time and a difficult time for addiction professionals. There are still so many unanswered questions (re: concerns listed above) which generate a lot of fear for many addiction professionals. In addition, with the “graying” of our work force there is a big gap between qualified “veteran” addiction professionals and those who are new to the profession. This could be a “bonanza” for younger professionals. In a very short time, as older professionals retire, younger professionals will have the opportunity to be on “the fast track” for advancement. Unfortunately, many addiction professionals are simply leaving the profession due to all of the changes.

Q

Kuehn: How about for NAADAC?

R ichards : I am a “glass half full” type of person. My experience is that NAADAC has met and will continue to meet

16  Advances in Addiction & Recovery | SPRING 2013

all of the challenges head on and focus on turning them into opportunities. As we move forward, advancing the professionalism of our work force, our professionals and their credentials will gain more credibility. NAADAC has always been the leader in our profession and I believe that we will become even more so as we continue to advocate, develop new and innovative trainings and products. Our role at the “decision-making table” can only grow stronger.

Q

Kuehn: What are the top challenges that the association faces this year?

R ichards : Making our voice louder by increasing our membership and making our presence known at the national, state and local levels. We have had great success in national issues and that will continue as the PPACA continues to develop.

Q

Kuehn: Personally, what do you think will be your challenges as President?

R ichards : I am incredibly fortunate to be following in the footsteps of three outstanding NAADAC past presidents. Mary Woods, Pat Greer and Don Osborn have not only been wonderful friends and colleagues, but have also provided a great deal of quality mentoring to all of us on the NAADAC Executive Committee. All three have been so effective as President that my term has been made much easier. Because we are primarily a membership organization, membership must be my primary challenge. Numbers have dropped dramatically, primarily due to the economy. We must not only regain, but also increase our numbers. The larger our membership, the louder our voice as we advocate for our profession. In turn, we will be mentoring our future leaders.

Q

Kuehn: Why did you decide to pursue a role in NAADAC’s leadership?

R ichards : Simply because I believed in the organization and that belief grew into a passion. When elected president of AADACO, (the Oregon affiliate) I discovered that, as Oregon’s delegate, I had also become a NAADAC board member. I found myself welcomed by some of the most friendly, intelligent and dedicated individuals I had ever met and they wasted no time in “grooming” me for future roles (whether I liked it or not). Four years later, past NAADAC President Roger Curtis persuaded me to run for Northwest Regional Vice-president. (He didn’t tell me that I would be running


unopposed.) I don’t think I really grasped just how much we could influence the profession until I had completed my first, then second term. By the time I was asked to run for treasurer, and eventually President-Elect, I was already hooked. I love this organization from our newest member to our most senior veteran.

Q

Kuehn: With so much going on in your life, how do you find time for NAADAC?

R ichards : It is a challenge, and my term as President promises to be even more challenging. I am also Executive Director of a very large treatment agency and do have a great deal of responsibility there. Luckily, my agency Board of Directors supports my role with NAADAC. I am also dedicated to a Native American Spiritual family where I have additional responsibilities. They too strongly support my involvement with NAADAC, so much so that our drum circle attended last year’s national conference, drumming for the opening ceremony and other events. I am also extremely fortunate to have an incredibly supportive wife and family. They are already accustomed to having to schedule family events and vacations around NAADAC activities. As for “spare time,” what exactly is that anyway?

Q

Kuehn: How would you describe your leadership style?

Q

Kuehn: If you could point out one thing that could turn a non-member into a member, what would it be?

R ichards : Motivation. We must motivate our work force to the need for their membership, as well as the advantages. Mem­ber­ ship benefits are wonderful and we need to continue adding to them. However, we are in an economic and political climate where we need all addiction professionals advocating for our profession (and the clientele we serve). It is indeed one of our core principals. Unfortunately, it is estimated that only between five and 10 percent of eligible addiction professionals across the country are NAADAC members. We are the few, advocating for the many. We simply must get the message across just how important every member’s voice is and how much difference each of them can make. The larger our membership, the louder our voice and the more “clout” we will have at the table. We have to do a better job of carrying the message to our colleagues across the country about just how important it is for them to join our voice. I don’t mean by using fear tactics, which seems to be so much a part of politics today, but by “cheer leading” and motivating others to join us. My experience is that when individuals learn just how important their voice is, they want to hear more about it. Just think about what would happen if every NAADAC member convinced just one addiction professional to join NAADAC each year. Each year our numbers would double. In just four years we could have over 130,000 members. Now that is one incredibly loud voice.

Robert C. Richards has been a NAADAC board member for the past 12 years and is Executive Director of Willamette Family Inc. which operates eight facilities in Eugene, Springfield and Cottage Grove, Ore. During his 27+ years as an addiction professional he has worked as a counselor, clinical supervisor, administrator and educator. Richards has served as President of AADACO, the Oregon NAADAC affiliate, NAADAC Northwest Regional Vice President for two terms, treasurer, President-Elect and has been involved in numerous committees which include: finance, personnel, tobacco awareness, membership, capital campaign and development, bylaws, veterans and the NCC/ NAADAC ad hoc committee. He can be reached at robrich88@yahoo.com.

ivelin radkova | photospin.com

R ichards : I am a total “team work” person. I have been taught the team approach to leadership by several of the best. I embrace that approach for one simple reason, that being, it works. I have learned that authority based, autocratic leadership seldom works and usually results in micro managing, low morale and low productivity. Team work, however, empowers everyone in the organization, utilizes the best of their talents and results in far higher levels of morale and dedication. It is my personal belief that the newest, lowest ranking member of the team is equally as important as the most senior leaders. No one gets the job done unless everyone gets it done. Only by working together as a team can NAADAC move forward as the “Champion” of the challenges ahead of us. Everyone must know and do their job. The board’s responsibilities are actually very simple. They are responsible for oversight of the CEO, fiscal stewardship and advocacy. Everything else is the responsibility

of the CEO and her/his staff. If we all work together in our common interest we can’t help but succeed.

SPRING 2013  Advances in Addiction & Recovery  17


Smoking Rates High for People With Mental Health Issues The CDC Cites Tobacco Use in Its New Report B y D onovan K uehn “Got a light?” Americans suffering from mental illnesses are far more likely to ask this question, and the health implications are staggering. According to a report released by the Centers for Disease Control and Prevention in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), smoking among U.S. adults with mental illness is 70 percent higher than for adults with no mental illness. The research shows that 36 percent of adults with a mental illness are cigarette smokers versus 21 percent of adults who do not have a mental illness. Combined data from SAMHSA’s 2009– 2011 National Sur vey on Drug Use and Health (NSDUH) were used to calculate national and state estimates of cigarette smoking among adults aged 18 years and older who reported having any mental illness. Mental illness was defined as having a diagnosable mental, behavioral, or emotional disorder, excluding developmental and substance use disorders, in the past 12 months. Future research will analyze the smoking rates among people with substance use disorders. “Smoking harms nearly every organ of the body, causing many diseases and affecting the health of smokers in general,” said Cynthia

Moreno Tuohy, NCAC II, CCDC III, SAP, Executive Director of NAADAC, the Asso­cia­ tion for Addiction Professionals. “With careful monitoring, quitting smoking does not interfere with treatments and can be effectively incorporated as a part of treat­ment,” added Moreno Tuohy. Almost one in five adults in the United States — about 45.7 million Americans— have some type of mental illness, noted the report.1 Younger adults, American Indians and Alaska Natives, those living below the poverty line and those with lower levels of ­e ducation displayed the highest rates of smoking. 2 Where you live can also have an ­impact as smoking rates differ from state to state. Rates ranged from an estimated low of 18.2 percent in Utah to a high of 48.7 percent in West Virginia.3

18  Advances in Addiction & Recovery | SPRING 2013

Developing an Action Plan “Smokers with mental illness, like other smokers, want to quit and can quit,” said Tom Frieden, MD, MPH, who serves as the Direc­ tor of the Centers for Disease Control and Prevention. “Stop-smoking treatments work — and it’s important to make them more available to all people who want to quit.”

■ Nicotine has mood-altering

evgeniya uvarova & nrey | photospin.com

■ Risk for a heart attack drops

Source: CDC Vital Signs, February 2013, page 2, www.cdc.gov/vitalsigns

The report confirms that on average adult smokers with mental illness smoke more cigarettes per month than those without mental illness (331 vs. 310 cigarettes).4 Adult smokers with mental illness are also less likely to quit smoking cigarettes than adult smokers without mental illness.5 “Special efforts are needed to raise awareness about the burden of smoking among people with mental illness and to monitor progress in addressing this disparity,” said Pamela S. Hyde, JD, Administrator of the Substance Abuse and Mental Health Services Administration.

Smoking and mental illness

Smokers who quit have immediate health benefits. sharply just one year after quitting. ■ After 2 to 5 years, the chance of stroke can fall to about the same as a nonsmoker’s. ■ Within 5 years of quitting, the chance of cancer of the mouth, throat, esophagus, and bladder is cut in half. ■ Ten years after quitting smok­ ing, the risk for dying from lung cancer drops by half.

Smoking More

effects that put people with mental illness at higher risk for cigarette use and nicotine addiction. ■ People with mental illness are more likely to have stressful living conditions, be low in­ come, and lack access to health insurance, health care, and help quitting. All of these factors make it more challeng­ ing to quit. ■ Evidence shows that there has been direct tobacco marketing to people with mental illness and other vulnerable groups of people. Source: CDC Vital Signs, February 2013, page 2, www.cdc.gov/vitalsigns


more common ntal illness ts.

For quitting assistance, call 1-800 -QUIT-NOW (1-800-784-8669) or visit www.smokefree.gov. Or visit www.BeTobaccoFree.gov for information on quitting and preventing children from using tobacco.

Source: National Survey on Drug Use and Health, 2009–2011, Adults ages 25 or older. 4 Source: National Survey on Drug Use and Health, 2009–2011, Adults ages 25 or older, www.cdc.gov/mmwr/preview/mmwrhtml/ mm62e0205a1.htm?s_cid=mm62e0205a1_w#tab3 5 Source: National Survey on Drug Use and Health, 2009–2011, Adults ages 25 or older, www.cdc.gov/mmwr/preview/mmwrhtml/ mm62e0205a1.htm?s_cid=mm62e0205a1_w#tab3 6 The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, U.S. Department of Health and Human Services, page 598, www.surgeongeneral.gov/ library/reports/secondhandsmoke/chapter10.pdf 7 Centers for Disease Control and Prevention, 2013, www.cdc.gov/ vitalsigns/SmokingAndMentalIllness/index.html 3

ENDNOTES 1 Percentage of adults with any mental illness, by sex and selected characteristics — National Survey on Drug Use and Health, United States, 2009–2011, www.cdc.gov/mmwr/preview/mmwrhtml/ mm62e0205a1.htm?s_cid=mm62e0205a1_w 2 Source: National Survey on Drug Use and Health, 2009–2011, Adults ages 18 or older, www.cdc.gov/mmwr/preview/mmwrhtml/ mm62e0205a1.htm?s_cid=mm62e0205a1_w#tab2

Smoking Statistics for US Adults with Mental Illness By Age 50

42%

By Education**

40

34%

40%

38%

40

30

30

20

13%

10

0

0 Ages 18-24

Ages 25-44

Ages 45-64

Less than high school

Ages 65+

By Racial/Ethnic Groups 50

55% 40%

30

39%

40

38%

Some college

High school graduate

College graduate

By Region

50 40

19%

20

10

60

47%

50

41%

34%

35%

32%

30

32%

20

21%

20

38%

10

10 0

0 American Indian/ Other White Black Alaska Native (Non-Hispanic) (Non-Hispanic) (Non-Hispanic) (Non-Hispanic)

Hispanic

Asian (Non-Hispanic)

AK

WA

Midwest

MT

OR

Cigarette Use among Adults with Any Mental Illness

South

MN

SD

WI

WY NV CA

AZ

IL CO

NM

KS OK

OH

IN

PA WV

MO

KY

ME

AL

VA

NH MA RI CT NJ DE MD

NC

TN

AR MS

TX

NY

MI

IA

NE UT

West

VT

ND

ID

HI

Northeast

GA

SC

LA FL

<30%

30-34%

35-39%

40-44%

45%+

Source: National Survey on Drug Use and Health, 2009-2011, Adults ages 18 or older **Source: National Survey on Drug Use and Health, 2009-2011, Adults ages 25 or older

3

SPRING 2013  Advances in Addiction & Recovery  19

http://www.cdc.gov/vitalsigns/SmokingAndMentalIllness/infographic.html

T he 2 0 0 6 Su r geon General’s Report found that smoke-free policies reduce exposure to secondhand smoke and help smokers quit.6 To address the high rates of tobacco use among people with mental illness, SAMHSA, in partnership with the Smoking Cessation Lead­ er­ship Center (SCLC), is working to promote tobacco cessation efforts in behavioral health care. SAMHSA and the SCLC developed a nd imple mented the 100 Pioneers for Smoking Cessation Campaign, which provide support for mental health facilities and organizations to undertake tobacco cessation efforts. SA MHSA and t he SCLC expanded the Pio­ neers Campaign by working with states through Leadership Academies for Wellness and Smoking Cessation, whose goal is to reduce tobacco use among those with behavioral health needs and staff. Participating states bring together policymakers and stakeholders (including leaders in tobacco control, mental health, substance abuse, public health and consumers) to develop a collaborative action plan. C ig a ret t e smok i ng continues to be the leading cause of preventable death and disease in the United St ates a nd through­o ut the world. Cigarette smoking is responsible for an estimated 4 43,0 0 0 deat hs in t he United States each year.7


C O M M E N TA R Y

Is It Time We Became Recovery Professionals?

kbuntu | photospin.com

B y W illiam L. W hite , MA

More than four decades ago, I decided to spend my life helping people recover from alcohol and other drug (AOD) addictions. The subsequent years working in this unusual avocation have been filled with blessings beyond what I could have imagined as a young man. Yet in reflecting on my years in addiction counseling and the broader arena of addiction treatment and research, there seems to have been something missing within the organizing center of our field. This missed dimension is evident in both how addiction counselors (and other specialized addiction-related professionals) are trained and how we have defined ourselves. Put simply, our growing knowledge and expertise in the intricacies of AOD problems and the nuances of ever-briefer interventions into those problems has left little room for developing knowledge and expertise in the long-term solutions we seek. Most of us are thrown so rapidly into the daily demands of working in addiction treatment that we quickly lose our capacity to see — really see — the profession’s central focus or changes in that focus over time. In this short essay, I ask that you step back from such demands and look afresh at the field, not through the lens of addic­ tion or the lens of addiction counseling/ treatment but through the lens of longterm addiction recovery. As part of our training, we are taught the pharmacology of alcohol and other psychoactive drugs, including the acute and chronic effects of excessive use. We are not taught which of these effects remit with sustained abstinence, when such remission of effects ­normally occurs, which effects may constitute a burden carried for years into the recovery process, and how such longer-term or permanent impairments and risks can be managed within the recovery process. We are regularly provided detailed statistical tables of the latest drug use prevalence trends with recent changes in these patterns meticulously plotted against decades of past surveys. What we are not taught is the prevalence of long-term recovery in the United States and how this has changed over time, nor are we privy to the evolution of annual rates of recovery initiation. Are there more people in recovery in the U.S. and in your state today than a year ago? Did more people enter recovery this year than last year? We 20  Advances in Addiction & Recovery | SPRING 2013

simply don’t know. Detailed profiles of those with alcohol and ­other drug problems are pervasive, but glaring by their omission are the demographic and health profiles of individuals and families in addiction recovery. We are taught how to define addiction, the inclusion and exclusion criteria for a whole menu of substance use dis­orders as well as nuanced understandings of varying patterns of problem severity, complexity and chronicity. We are not taught a similarly uniform definition of recovery nor are we pro­v ided in-depth training on the multiple pathways and styles of long-term addiction ­recovery. We are taught what science and clinical practice reveal about problem progression and the late stages of addiction, but we are not taught the course and stages of long-term per­sonal and family recovery. We are taught the genetics and neurobiology of addiction as a brain disease with unending slides of drug-hijacked brains and promises that promotion of the brain disease model will reduce stigma, but we are not told how this very model could inadvertently increase stigma and discrimination. We are not taught the neurobiology of recovery (the likelihood of such recovery, the mechanisms of such recovery and when such recovery can be expected to occur). Nor are we taught how to answer a client’s most basic questions about the personal implications of addiction-related ­genetic research: 1.  Are all of my children higher risk for addiction because of my personal and family history? 2. Will my recovery status or failure to recovery affect my children’s vulnerability or their chances of recovery if they should experience addiction? 3. Is there anything I can do as a parent to reduce these elevated risks for my children? We know a great deal about how to facilitate acute bio-psychosocial stabilization for people seeking addiction treatment, but we know very little about the transition to recovery maintenance and the stages of recovery that follow. We know a lot about the effects of addiction on the family and its members, but little about how to build the support scaffolding that can prepare the family for what Dr. Stephanie Brown has christened the “trauma of recovery” — a


trauma whose greatest effects are seen after treatment professionals have terminated their brief service relationships. We are trained in the basic treatment modalities of addiction treatment and a wide spectrum of counseling techniques, but we learn little about the role of community in recovery, the role indigenous helpers can play in recovery initiation and maintenance and how we can best collaborate with these recovery support resources. We know a great deal about how to counsel individuals in the earliest days of recovery but very little about how to counsel individuals and families with years or decades of recovery. In recent years we have access to a robust body of information on AOD problems among historically disempowered populations such as women, youth, ethnic and sexual minorities and persons with cooccurring (and often equally stigmatized) conditions, but we are far less likely to learn about how such populations have resisted and recovered from these problems. For example, AOD problems in Native American and African American communities are visibly portrayed in the public and professional media, but the high rates of recovery and the recovery stories from these communities are missing from public reports and from the training of addiction counselors. We are taught the laws, regulations, ethics and etiquette governing our profession while neglecting the very thing for which all of these exist. Without connection to long-term recovery as a measurable outcome, what value are any of these professional trappings? We are taught to look to the “addiction studies” programs; “addiction medicine” specialists; national offices, institutes and centers on “Drug Control Policy,” “Alcohol Abuse and Alcoholism,” “Drug Abuse” and “Substance Abuse Treatment”; and regional “Addiction Technology Transfer Centers,” but there are no “recovery studies” programs, no “recovery medicine specialists,” no offices, institutes or cen-

ters on “recovery” and no “recovery technology transfer centers.” We have journals of alcohol and drug studies, psychoactive drugs, substance misuse, addiction, addictive behavior, addiction research and theory, alcohol and drug dependence, alcoholism treatment and substance abuse treatment, to name a few, but only one (Journal of Groups in Addiction and Recovery) that even suggests by its title an interest in the scientific study of recovery. Experts and resources abound on alcohol and other drug problems and their acute treatment. Where are the professional experts and professional resources on the long-term solutions to these problems? If we examined the curricula of addiction studies programs in the United States, the content of certification and licensing exams required to work in addiction counseling and the topical content of continuing education programs for addiction counselors, what percentage of that content would we find focused the subject of recovery? We escaped the brand of “paraprofessional.” We evolved from seeing ourselves as addiction professionals to seeing ourselves as treatment professionals. Perhaps it is time we become recovery professionals. William L. White is a Senior Research Consultant at Chestnut Health Systems/Lighthouse Institute and past-chair of the board of Recovery Communities United. Bill 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

Interested in earning continuing education credits for reading this article? Think about these questions while reading and then take the continuing education quiz.

? ? ? ? ? ?

According to the author, what is the addiction profession lacking? How does the author asks professionals to look at the addiction profession?

According to the author, what is it that addiction-focused professionals tend not to focus on? According to the author, what issue important to patients is being neglected?

According to the author, the critical issue of professional education on the neurobiology of recovery is being ad­ dressed by the profession. According to the author, what specific issue(s) do the addiction-focused profession need to understand? According to the author, what areas need to be strength­ ened for addiction-focused professionals? What subjects do the mainstream media tend to focus on when discussing addiction and Native American and African American communities?

? ?

?

According to the author, what new field of studies needs to grow? Earn TWO continuing education credits for reading this article. To learn more, visit www.naadac.org/ education/magazineces.

SPRING 2013  Advances in Addiction & Recovery  21


SPECIAL FOR NA ADAC

Some Straight Truth About Medical Marijuana Laws Provide State-sanctioned Use of a Drug by Most Anyone Who Desires it B y K evin S abet , P h D Is marijuana medicine? The answer is yes, no, and maybe. Modern science has synthesized the marijuana plant’s primary psychoactive ingredient — THC — into a pill form. This pill, dronabinol (or Marinol®, its trade name) is sometimes prescribed for nausea and appetite stimulation. Another drug, Cesamet, mimics chemical structures as that naturally occur in the plant. But when most people think of medical marijuana these days, they don’t think of a pill with an isolated component of marijuana, but rather the entire smoked, vaporized, or edible version of the whole marijuana plant. Rather than isolate active ingredients in the plant — like we do with the opium plant when we create morphine, for example — many legalization proponents advocate vehemently for smoked marijuana to be used as a medicine. But the science on smoking any drug is clear: smoking especially highly-potent whole marijuana, is not a proper delivery method, nor do other delivery methods ensure a reliable dose. And while parts of the marijuana plant have medical value, the Institute of Medicine said in its landmark 1999 report: Scientific data indicate the potential therapeutic value of cannabinoid drugs… smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances…and should not be generally recommended…”1 It is not so unimaginable to think about other marijuana-based medications that might come to market very soon. Sativex®, an oral mouth spray developed from a blend of two marijuana extracts (one strain is high in THC and the other in CBD, which counteracts THC’s psychoactive effect), has already been approved in 10 countries and is in late stages of ap­ proval in the U.S. It is clear to anyone following this story that it is possible to develop marijuana-based medications in accordance with modern scientific standards, and many more such legitimate medications are just around the corner. Recently, the federal government has expanded its enforcement actions against commercialized “medical mari­-

Want to learn more on the impact of marijuana? Check out the archived webinars at www.naadac.org/education/webinars. luis carlos jimenez | photospin.com

22  Advances in Addiction & Recovery | SPRING 2013

juana” operations. They have closed down dispensaries in states like California (including the “Harvard” of medical marijuana ­learning — the now-defunct “Oaksterdam University”), Colorado, and Oregon. Here is some straight truth about marijuana for “medical” purposes.”

HOW does medical marijuana currently work in the various states?

At present in California, and in several other states, it is widely recognized that the reality of the “medical use” of marijuana is highly questionable. For payment of a small cash sum, almost anyone can obtain a physician’s “recommendation” to purchase, possess, and use marijuana for alleged medical purposes. Indeed, numerous studies have shown that the most customers of these dispensaries do not ­suffer from chronic, debilitating conditions such as HIV/AIDS or cancer.2, 3 Both sides of the argument agree that this system has essentially legalized marijuana for recreational use, at least amongst those individuals able and willing to buy a recommendation.4 To date many pot dispensaries are mom and pop operations, though some act as multimillion dollar, professional companies. A recent documentary on the Discovery Channel, which examined the practices of Harborside Health Center in Oakland, California — by its own admission, the largest marijuana dispensary “on the planet,” the buds (which are distributed directly to member-patients) are merely examined visually and with a microscope. The buds are also handled by employees who do not use gloves or face masks. Steve DeAngelo, Harborside’s cofounder, states that they must “take it as it comes.” The documentary noted that some plant material is tested by Steep Hill Laboratory, but there was no evidence that Steep Hill’s instrumentation and techniques are “validated,” that its operators are properly trained and edu­ cated, that its reference standards are accurate, and that its results are replicable by other laboratories.

WHAT if we rescheduled marijuana? In the wake of recent enforcement efforts by the Obama Administration, the governors of Washington, Rhode Island, and Colorado have filed a petition with the Drug Enforcement Administration (DEA) to reschedule marijuana. 5 Specifically, the petition asks the DEA to reclassify marijuana from Schedule I to Schedule II of the federal Controlled Sub­ stances Act (CSA). The governors contend that such rescheduling will eliminate the conflict between state and federal law and enable states to establish a “regu­ lated and safe system to supply legitimate patients who may need medical cannabis.” The current petition takes a unique approach. It seeks to move marijuana to Schedule II “for medicinal purposes only.” Marijuana advocacy organizations, such as the Marijuana Policy Project (MPP)


Marijuana for Medical Purposes and Americans for Safe Access (ASA) are urging other governors around the country to join onto the petition. The petition has garnered considerable publicity, but, as MPP acknowledges, “[r]escheduling is not a cure-all.”6 This is an understatement. Indeed, it is not even a significant step in the direction that the governors, MPP, and ASA hope to move. Part of the confusion over the actual significance of Schedule II status stems from a misunderstanding of the interrelated, but distinct, functions of the CSA and the Food, Drug, and Cosmetic Act (FDCA). Under the FDCA, the FDA approves specific medical products produced by particular “innovator” (for branded products) or generic manufacturers. For example, oxycodone, an opioid, is in Schedule II. Specific products, such as OxyContin® (an extended release form), are also in Schedule II. Physicians prescribe a specific branded or generic product, in a particular dose and dosage form. So until the FDA approves a smoked marijuana product, it cannot be prescribed or sold in “dispensaries” for medical use. And the FDA has been clear that smoked marijuana does not pass its rigorous approval standards. Imagine for a moment that the “medical marijuana” advocates were instead “medical opium” advocates and that various states passed laws decriminalizing (or affirmatively authorizing and regulating) the cultivation and distribution of opium plant material, i.e., opium latex or poppy straw. Even though opium latex and poppy straw are each in Schedule II, there would still be a conflict between such state laws and both the CSA and the FDCA. As a well-known drug reform advocacy website states: “If poppies are gown as sources for opiates, there is no question that it violates the CSA.”7 Furthermore, physicians would not be authorized to prescribe, nor pharmacists to dispense, dried opium latex or poppy straw.8 In order to be prescribed, a spe­cific product containing opiates would have to pass muster in the FDA ­approval process. Therefore, the mere act of placing herbal marijuana in Schedule II would not make it available to patients nor address the conflict between state and federal law.

BUT won’t rescheduling allow for research to be done? No. Rescheduling is not necessary to make marijuana products available for research. A committee of the California Medical Association recently called for the rescheduling of marijuana “so it can be tested and regulated.” However, it is not necessary for mari­ juana to be rescheduled in order for legitimate research to proceed. Schedule I status does not prevent a product from being tested and researched for potential medical use. Schedule I research certainly does go forward. In a recent pharmaceutical company-sponsored ­human clinical study investigating a product derived from marijuana extracts, the DEA registered approximately 30 research sites in the U.S. and also registered an importer to bring the product into the U.S. from the U.K., where it was manufactured.9 And a quick search of NIH-reporter reveals more than $14 million of current research going forward on marijuana and medicine. Research is happening.

WHAT about obtaining marijuana for research? Researchers wishing to conduct studies with herbal/whole plant marijuana may obtain it from the National Institutes of Health (or import formulated extracts). Researchers who obtain grant funding from an institute of the National Institutes of Health (NIH), such as NIDA, can obtain marijuana for their study; researchers who are externally funded must undergo the equivalent of a grant review process (review of their study design by an expert committee of the Public Health Service) in order to obtain such marijuana at cost from NIDA. NIH (via the University of Mississippi’s National Center for Natural Products Research) has the ability to produce standardized marijuana of varying THC potencies. Its cultivation area of five acres has been adequate to supply all marijuana-related studies to date.10 In theory, NCNPR could also produce marijuana extracts, or such products could be imported from outside the US for research, as is currently the case with Sativex.

WHAT has been the result of medical marijuana in various states on drug use rates? An in-depth examination of medical marijuana and its relationship to the explosion in use and users came in 2012 from five epidemi­ o­logical researchers at Columbia University. Using results from ­several large national surveys, they concluded that: “residents of states with medical marijuana laws had higher odds or marijuana use and marijuana abuse/dependence than residents of states without such laws.”11 States with medical marijuana laws also show much higher average marijuana use by adolescents, and lower perceptions of risk from use, than non-medical pot states.11 This would seem to indicate that ­relaxed community norms about drug use contribute greatly to an ­increased prevalence of use and users, a situation resulting from the spread of an attitude that “if pot is medicine and is sanctioned by the state, then it must be safe to use by anyone.” Medical marijuana should really only be about bringing relief to the sick and dying, and it should be done in a responsible manner that formulates the active components of the drug in a non-smoked form that delivers a defined dose. However, in most states with medical mari­juana laws, it has primarily become a license for the statesanctioned use of a drug by most anyone who desires it. Developing marijuana-based medications through the FDA process is more likely to ensure that seriously ill patients, who are being supervised by their actual treating physicians, have access to safe and reliable products. Kevin Sabet, PhD, has worked on drug policy issues for more than eighteen years and is an internationally-acclaimed expert on substance abuse. From 2009-2011, he served in the Obama Administration as the Senior Advisor to Director Kerlikowske at the White House Office of National Drug Control Policy (ONDCP). He is the co-founder, with Patrick J. Kennedy, of Project SAM: Smart Approaches to Marijuana. Through www.kevinsabet.com, Dr. Sabet is currently is a consultant to numerous domestic and international organizations. See references on page 27 ☛

For more on Medical Marijuana, check out the upcoming webinar on marijuana: September 10, 2013 @ 3-4pm EST with Allan Barger. Details at www.naadac.org/education SPRING 2013  Advances in Addiction & Recovery  23


Healing

the Addicted Brain B y H arold C. U rschel III, MD, MMA

This is Part One of a two-part series.

Introduction Each year, medical problems caused by addiction, along with lost earnings, accidents and crime, cost Americans more than $500 ­billion. State and federal governments spend more than $15 billion per year, and insurers another $5 billion more annually, on substance abuse treatment services for about four million people. Researchers estimate that some 20 million Americans who could ­b enefit from treatment are not getting it. Additionally, for those ­patients who are receiving treatment, the majority of our industry still treats alcohol and drug addiction with only behavioral and psycho­social approaches. While traditional, 12-step based programs have certainly helped countless people achieve sobriety, the long term sobriety failure rate is estimated at 70 percent, a figure most would consider unacceptable, as alcoholism is the third leading cause of death in the United States. Also, the majority of patients do not have the funds or the time to commit to residential treatment or intensive outpatient counseling. The bottom line is that until we stop treating alcohol and drug addiction insufficiently in the U.S., we will cont i nue to see countless people die unnecessar­ i l y, a s m a n y o f them will give up hope if they can’t get well. Fortunately, we now have scientific evidence that concludes addiction is a chronic, progressive disease of the brain with many similarities to other chronic medical diseases such as diabetes, hypertension and asthma and needs to be treated with a combination of behavioral therapy and a medical approach. The American Medical Association (AMA), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), World Health Organization (WHO), American Psychiatric Association (APA), as well as many other organizations in the scientific and medical fields, now

recognize alcohol/drug addiction as a chronic and progressive physical disease that attacks the brain, damaging key parts of the limbic system and cerebral cortex causing lasting changes in the brain. These changes don’t go away, sometimes for months or years, even after recovering patients stop using. Although an individual’s initial choice to drink alcohol or use another substance is a voluntary one, over time the substance physically changes the brain to where the individual truly cannot stop his or her addictive behavior, even though the desire to do so might be high. In chronic, multi-factorial conditions such as cardiovascular ­disease, the standard of care involves front-line physiological inter­ ventions through surgery or medication, followed by environmental and behavioral modifications. ­Hy­per­tension and high cholesterol are often controlled by medication, but modifying dietary habits and exercise are necessary steps as well. Addiction treatment is no different, and with the proper treat­ment it too can be managed and more importantly, give addicts realistic hope that they can be healed and live a clean or sober life. In f igure 1, you can clearly see the m a rke d over a l l ­decreased activity in the brain of a 38-year-old ma le w it h 17 years of heavy weekend alcoho l u s e w hen

marila pekna | photospin.com

Countering Brain Injuries From Past Alcohol and Drug Use Can Map the Road to Recovery

24  Advances in Addiction & Recovery | SPRING 2013


Figure 1: Profound Changes in Brain Metabolism

Normal brain

Underside surface of an affected brain

compared to a normal brain. (SPECT images courtesy of D.G. Amen, MD) These scans clearly demonstrate that alcohol severely injures the brain. Scientists believe that it is this damage that causes the brain disease of alcoholism. As a result, millions of dollars have been spent on basic science and clinical research studies on alcohol/drug addiction treatment each year by the NIH, so, we now have an increasing understanding of the neurobiological mechanisms of the brain that maintain substance dependence. This has led us to be smarter about how to treat addiction, and in recent years has resulted in the development of several FDA-approved, anti-addiction medications that when combined with the appropriate behavioral approaches can dramatically improve the treatment outcomes of substance-dependent patients. New anti-addiction pharmacological treatments can be used to counter the brain injury from past alcohol/drug use, to relieve withdrawal symptoms, or to help overcome alcohol/drug cravings. These science-based, anti-addiction medications circumvent the neurological pathways in the brain that cause the cravings and/or the euphoric “high” an addict experiences. Once this circumvention is interrupted, and the substances are removed from the body, the brain can effectively start to “rewire” those harmful pathways (i.e. heal itself). Addi­ tionally, there are other medications that can help to accelerate the brain’s healing, returning the damaged portions to up to 90 percent of their pre-addictive state. These anti-addiction medications allow the brain to cool down to a more “normal” state, so it can begin to “reboot” and start the healing process. These medications are a remarkable tool in treating addiction, but they are not a magic bullet. You still have to combine the medication with various evidence-based therapies to get the full benefits and significant healing you will need for life-long sobriety.

Treatments for Alcohol Dependence: A Variety of Effective Treatment Options In spite of the long-standing national focus on drug addiction, it is important to remember that alcoholism is still the most serious substance abuse problem in the U.S. According to the latest statistics,­ alcoholism is the nation’s third leading cause of death behind cancer and heart disease, with approximately 100,000 deaths each year attributed to excessive alcohol use. Several medications are currently being used in alcohol rehabilitation including Vivitrol™, Campral®, the Prometa™ Treatment Program and Antabuse®. Vivitrol is an intramuscular medication for the treatment of alcohol dependence. A once-monthly extended-release, injected version of naltrexone, which was approved by the FDA in mid-2006, has sig-

Front on surface of an affected brain

Right side surface of an affected brain

nificantly revolutionized the recovery from alcoholism by removing the need for daily decision-making about compliance, thereby drastically reducing or completely stopping alcohol use for alcoholics receiving the medication and attending active treatment programs. Vivitrol reduces the reward (or “high”, the ability to get drunk) from alcohol ingestion, significantly reducing cravings for alcohol and decreasing the “priming effect” of the first drink for a relapse or slip. Campral (acamprosate) was approved in the U.S. by the FDA in 2004. Although the precise mechanism of action or “cellular target” of Campral is unknown, it appears to decrease cravings for alcohol primarily by restoring the balance in certain neurotransmitter pathways (most likely GABA) that have become altered by chronic alcohol consumption. In some instances, Campral has appeared to enhance the ability to accelerate the brain’s healing back towards its pre-addictive state. In actual practice, I have found it helpful to prescribe both Campral and Vivitrol simultaneously to most alcoholics. As both medications have different mechanisms of action, they are rather syner­ gistic in their impact on this devastating chronic medical illness. Vivitrol begins working effectively by the third day after it is injected, and primarily focuses on keeping the alcohol out of the brain (decreasing cravings and blocking the ability to get drunk), so that the brain can begin to heal on its own but it does not heal the brain at all. (Brain healing usually takes four to 12 months of complete sobriety from alcohol/drug use.) Campral, on the other hand, can actually help to accelerate brain healing, which can occur over eight to 12 weeks, but does nothing to keep alcohol out of the brain for the first four to eight weeks that one are taking it. Many patients ask for what length of time will they need to take Vivitrol/Campral? The answer is it depends on each person’s specific life circumstances. In general, however, they should be on them for a minimum of 18 months. Yet another potentially exciting treatment option which has been recently introduced for the treatment of alcoholism is the Prometa™ Treatment Protocol, which is a combination of medications, nutri­ tional education and psychosocial therapy. From a pharmacological standpoint, the Prometa protocols consist of a combination of FDAapproved medications administered orally and intravenously, over a 30-day time period. Finally, Antabuse (disulfiram), the oldest approved medication for alcoholism, is probably the least used today. It has been used as an aid in managing chronic alcoholic patients who want to remain in a state of ­enforced sobriety, so that they can pursue supportive and psychoSPRING 2013  Advances in Addiction & Recovery  25


therapeutic treatment to their best advantage. Although, disulfiram does have a valid place as an integral part of certain alcoholic recovery programs, in my opinion, it is obviously more effective when its compliance can be verified, most frequently via direct daily observation of ingestion. During chronic abuse of alcohol and drugs, an imbalance between the inhibitory and excitatory activity in the brain occurs, triggering undesirable symptoms and behaviors leading to relapse. An analogy would be that with both alcohol and stimulant addiction, the circuit breakers within the brain have flipped off, and consequently the brain’s normal functioning is significantly impaired. One hypothesis is that restoring the brain’s neurotransmitter balance — analogous to “resetting the circuit breakers” — could help a patient who is in recovery to stay sober more easily. Campral and the Prometa Treatment Protocol constitute a new class of treatment taking this approach. They target changes in brain chemistry (most probably in the GABA neurotransmitter systems) and function, which play an important role in the physical and behavioral symptoms of substance dependence, including tolerance, withdrawal symptoms, craving and relapse.

nearly any other medical treatment or human service program. However, methadone maintenance treatment has remained a controversial issue among addiction treatment providers, public officials, policy makers, the public at large and the medical profession itself. Consequently, the opiate addiction treatment field is predominantly turning to the use of buprenorphine. The Drug Addiction Treatment Act in 2000, granted physicians the right to use approved opioids (buprenorphine) to treat opioid dependence in their offices. Initially developed to treat pain, buprenorphine was approved by the FDA for this purpose in October 2002. Buprenorphine is a partial opioid agonist, meaning its opioid effects partially mimic those produced by full opioid agonists such as hydrocodone or heroin and partially mimic those produced by opioid antagonists such as naltrexone. The primary formulation, Suboxone®, contains buprenorphine and naloxone, an opioid antagonist to discourage people from dissolving the tablet and injecting it. Consequently, most practitioners only prescribe Suboxone to their narcotic addicts, as it has less potential for diversion or misuse. Suboxone is an amazing and life-saving medication which is used to reduce illicit opioid use and help patients stay in treatment by blocking the effects of opioids, decreasing cravings and suppressing symptoms of withdrawal. Most narcotics addicts seem to benefit from Suboxone, regardless of their histories of opiate addiction. Suboxone is very safe and effective and is a revolutionary step in the treatment of narcotic addiction. It can be easily used in both the detoxification and maintenance phases of opiate treatment. Also, because of its ease of use and excellent safety profile, its adoption by the growing number of primary care physicians who are screening for and recognizing narcotic addiction in their patient populations and then referring them to appropriate psychosocial treatment programs, should make a very positive impact in the treatment success for narcotic addicts. Finally, oral naltrexone also has been successfully used to treat narcotic addiction. Once-daily ingestion of a 50 mg tablet will almost completely block the effects of any narcotic that an addict will attempt to use. Consequently, naltrexone prevents any euphoria or other benefit which an addict may hope to achieve through an opiate relapse. Because daily administration is required, it is best to have an addict take oral naltrexone under direct observation to enhance his/her compliance (for this reason Vivitrol {see above} is an even more effective treatment option for this population). Naltrexone treatment is not successful in all narcotic addicts, yet there is strong data that it significantly enhances a sobriety program especially when used with impaired professionals who are highly motivated to stay sober (i.e. physicians). The FDA approved the use of Vivitrol for the treatment of opiate addiction in October of 2010.

This has led us to be smarter about how to treat addiction and resulted in the development of anti-addiction medications that, when combined with the appropriate behavioral approaches, can dramatically improve the treatment outcomes of substance-dependent patients.

Progress in New Treatments for Opiates Over the past decade, the use of opioids, including prescription painkillers and heroin, has grown significantly. According to the 2009 National Sur vey on Drug Use and Health, nearly two million Americans were dependent on or abusing prescription pain relievers — nearly twice as great as the number of people addicted to cocaine, and 2007 statistics compiled by the Centers for Disease Control and Prevention indicate painkillers killed twice as many people as cocaine and five times as many as heroin. Unfortunately, only a fraction of these patients (maybe 25 percent at most) was currently receiving treatment for their chronic medical illness of narcotic addiction. Opiates have been used for pleasure and for treating pain for thousands of years, but abuse again became prevalent during the second half of the 19th century after the invention of the hypodermic syringe. By the early 1960s, the medical profession concluded that no known treatment could cure more than a small fraction of long-term opiate addicts, 70 to 90 percent of whom would relapse within a short time. As part of research to determine if addicts could be maintained on stable doses of pharmaceutical opiates, a synthetic narcotic called metha­done was found to be effective in stabilizing opioid addicts, without the euphoria or other negative effects of opiates. It also had the advantage of being cheap, significantly orally active and longacting. Methadone maintenance treatment then moved into the mainstream, allowing addicts to be restored to productive lives, reestablish relationships with families and improve their physical and mental health. It has received more scientific scrutiny and evaluation than 26  Advances in Addiction & Recovery | SPRING 2013


Progress in New Treatments for Stimulants The stimulant class of substances (i.e.. methamphetamine and cocaine) has proved to be one of the most difficult dependencies to treat, methamphetamine addiction in particular. To date, there are no medications in widespread use for the treatment of stimulant addiction. A number of medications commonly used for other indications are under examination or in use to various degrees in the attempt to treat cocaine and methamphetamine addiction, including disulfiram, ­gabapentin, baclofen, Provigil, Seroquel and ondansetron to name a few. Additionally, double-blind, placebo controlled trials evaluating the Prometa Protocol for Stimulant Dependence have been published and have added more rigorous data into this important treatment’s relevance for this difficult to treat population. In my opinion, it is the first line pharmacological treatment component for treating ­stimulant addiction. Part Two will continue in the next issue. Harold C. Urschel III, MD, MMA, a board-certified addiction psychiatrist, is chief medical strategist of Enterhealth, LLC, an addiction disease management company based in Dallas, and author of the New York Times best seller, Healing the Addicted Brain. Dr. Urschel is responsible for overseeing and implementing all addiction psychiatric treatments delivered through traditional clinical outlets, telemedicine support and online coaching services for Enterhealth. For more information on Dr. Urschel and Enterhealth, please visit www.enterhealth.com.

Want to learn more from Dr. Urschel on healing the addicted brain? Check out the archived webinar the Addicted Brain: Cutting Edge Science and Brain Neurochemistry at www.naadac.org/education/webinars.

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Straight Truth About Marijuana, continued from page 23 REFERENCES 1 Marijuana and Medicine: Assessing the Science Base, Institute of Medicine 1999. http://books.nap.edu/catalog.php?record_id=6376 2 O’Connell, T and Bou-Matar , C.B. (2007). Long term marijuana users seeking medical cannabis in California (2001–2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduction Journal, http://www.harmreductionjournal.com/content/4/1/1 3 Nunberg, Helen; Kilmer, Beau; Pacula, Rosalie Liccardo; and Burgdorf, James R. (2011) “An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California,” Journal of Drug Policy Analysis: Vol. 4: Iss. 1, Article 1. Available at: http://www.bepress.com/jdpa/vol4/iss1/art1 4 According to Allen St. Pierre of NORML, “in California, marijuana has also been de facto legalized under the guise of medical marijuana.” See Transcript of Don Lemon CNN Television Show with Kevin Sabet and Allen St. Pierre: http://transcripts.cnn.com/TRANSCRIPTS/0905/09/cnr.04.html. Accessed January 22, 2012 5 Ingold, J. (Dec. 29, 2011) “Colorado Asks DEA To Reschedule Marijuana.” Denver Post Accessed on January 20, 2012 at http://www.denverpost.com/news/ marijuana/ci_19636149 6 Marijuana Policy Project, Message to Governors, Letter. (2011). Accessed on Jan. 12, 2012: https://secure2.convio.net/mpp/site/Advocacy?cmd=display&page= UserAction&id=1079 7 http://www.erowid.org/plants/poppy/poppy_law.shtml 8 Both Laudanum and Paregoric (tinctures of opium) pre-existed the original Food and Drugs Act of 1906. Recently, the FDA has taken enforcement action against these products as “unapproved drugs” that have not undergone FDA trials to prove safety and efficacy, as well as for violations of Good Manufacturing Practices. See, e.g., FDA, Warning Letter, Hi-Tech Pharmacal Co., Inc (June 28, 2010), http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ ucm219984.htm (Paregoric). See also, FDA, Guidance for FDA Staff and Industry,

“Marketed Unapproved Drugs—Compliance Policy Guide,” http://www.fda.gov/ downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ ucm070290.pdf. 9 GW Pharmaceuticals, “Sativex Commences US Phase II/III Clinical Trial in Cancer Pain,” http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatory Information/Guidances/ucm070573.pdf (press release); DOJ, DEA, “Importer of Controlled Substances; Notice of Registration,” 71 Fed. Reg. 64298 (Nov. 1, 2006). 10 See DOJ, DEA, “Lyle E. Craker; Denial of Application,” 74 Fed. Reg. 2101, 2104 (Jan. 14, 2009). 11 Cerda, M. et al. (2011). Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol Dependence. Found at http://www.columbia.edu/~dsh2/pdf/MedicalMarijuana.pdf ; Wall, M. et al (2011). Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear, Annals of epidemiology, Vol 21 issue 9 Pages 714–716.

SPRING 2013  Advances in Addiction & Recovery  27


Help Us Find the BEST Professionals B y D onovan K uehn , M anaging E ditor

“If you wish to succeed in life, make perseverance your bosom friend, ­experience your wise counselor, caution your elder brother and hope your guardian genius.” Joseph Addison (1672–1719), British writer and politician

Do you know someone who deserves accolades for his or her effort, professionalism and devotion to the profession? Perhaps there is an “unsung hero” whose fine example and work should be nationally recognized. Wherever you are, you can submit that person for consideration for a NAADAC national award.

The Program NAADAC established its awards program to identify and honor the outstanding work of addiction professionals and organizations that treat addiction. NAADAC’s program provides a unique opportunity to let others know about the professionalism and expertise exhibited by addiction professionals throughout the U.S. and the rest of the world. Over 80 groups, individuals and organizations have received recognition from NAADAC in the 30 years since it began its awards program. Very select company considering that NAADAC has 8,000 members and the addiction profession encompasses over 76,000 clinicians. NAADAC has recognized the best practices of addiction professionals since 1979, when it established the Alcoholism and Drug Abuse Counselor of the Year Award (since re-named the Lora Roe Memorial Alcoholism and Drug Abuse Counselor of the Year Award). The first winners, the Counselors of the U.S. Navy alcoholism and drug abuse program, came to prominence after the U.S. Department of Defense revised its policies to encourage voluntary identification and enrollment of those with addictions in treatment programs. The Navy’s program was the first non-punitive military rehabilitation programs developed with a focus on treatment. The program treated addiction as a disease and ensured that those who volunteered for treatment could not be discharged under other than honorable conditions. In a profession where interventions can have life or death consequences, choosing outstanding addiction professionals can be a difficult job. NAADAC, the Association for Addiction Professionals, recognizes the work of addiction professionals, organizations and public figures who work above and beyond to make a difference. NAADAC honored three professionals and one program in 2012.

Mel Schulstad Professional of the Year This award recognizes an individual who has made outstanding and sustained contributions to the advancement of the addiction counseling profession. William J. Cosgriff, PhD, spent most of his professional career working for the Springfield Public Schools as a teacher, counselor/social worker, psychologist and administrator. He initiated the first Student Assistance Program in Massachusetts in 1980 and later was the driving force behind the establishment of the Springfield Recovery High School and served as its first Director. For the past 25 years, Dr. Cosgriff has been an adjunct faculty member at several colleges in the greater Springfield area, teaching classes in educational and adolescent psychology, as well as substance abuse prevention, intervention and treatment. Dr. Cosgriff is also a person in long-term recovery from substance abuse, having been clean and sober since 1975.

NAADACAward Nominations Accepted Until April 30

B olstad

28  Advances in Addiction & Recovery | SPRING 2013

C osgriff

Lora Roe Memorial Alcoholism and Drug Abuse Counselor of the Year This award is presented to a counselor who has made an outstanding contribution to the profession of addiction counseling. The Rev. Carol Bolstad, MATS, LADC I, the 2012 recipient of the Lora Roe Counselor of the Year Award, has been in the social ­service sector since 1998 when she began working with incarcerated men and women who were HIV positive. She has a deep commitment to working with those who are striving towards recovery, working with the street homeless, the mentally ill and, prior to her social ­service experience, she worked with college students in residential life who were just beginning to show signs of substance use disorders. Throughout all of this experience the majority of the indi­ viduals she has worked with have been living with substance use ­disorders. Rev. Bolstad was ordained as a priest in the independent catholic movement and the International Council of Community Churches in 2009. Since that time she founded Southeastern Open Door Mission, Inc. She does street and recovery ministry, continuing her commitment to working with the disenfranchised and ­dually diagnosed. C ross


The NAADAC President presents this award to an individual, institution or corporation in recognition of a long and continued commitment to the Association and in appreciation for support of the addiction profession. Helene Cross, MS, has ser ved as the President and CEO of Fairbanks for 11 years and has provided leadership for capital improvement and building projects exceeding $12 million — all funded by grants and donations. Under her leadership, program revenue has tripled and all debt was eliminated. Cross has selflessly given of her time and talent to make hope and recovery a reality for thousands of individuals and families. Today, Fairbanks is a nationally recognized addiction treatment and recovery center. She is a mem­ber of the Greater Indianapolis Progress Com­mittee and received the Annual Achieve­ ment Award from the American College of Ad­dic­tion Treatment Administrators in 2012. Joshua Holt “Josh” Hamilton has played in Major League Baseball since 2007 and is a member of the Texas Rangers (2008 – present). He is a five-time All-Star and won the American League Most Valuable Player in 2010. Hamilton’s struggles with drugs and alcohol are well documented. He was spurred into recovery after being confronted by his grandmother, Mary Holt. Hamilton’s teammates — mindful of his past struggles — have chosen to celebrate major events with ginger ale instead of champagne. John McAndrew is a singer/songwriter and piano player from St. Paul, Minn., who currently lives in Nashville, Tenn. His music has been heard around the world. Recent appearances include numerous NAADAC conferences, the 50th Anniversary of NATO at the Vice President’s Residence in Wash­ing­

H amilton

ton, D.C., the Betty Ford 25th Anniversary Alumni Banquet and the National Town Hall Meeting with Colin Powell. McAndrew performed his composition, Like We Were Made of Gold at the closing ceremonies of the 2000 International AA Convention. While touring, he speaks and performs for recovery audi­ ences across the country, working regularly with Cumberland Heights in Nashville, the Betty Ford Center in California, Hazelden in Center City, Minnesota and Cirque Lodge in Sundance, Utah.

NAADAC has six awards to recognize excellence in the addiction profession. They include:

“Our professionals help save lives every day. The recipients of these awards exemplify the qualities held in highest regard by the ­addiction profession and the community,” said NAADAC Executive Director, Cynthia Moreno Tuohy. Who will be the new professionals recognized for their excellent work? You may have a hand in telling that story. Nominations for the 2013 awards must be received by the NAADAC Awards Committee no later than April 30, 2013. For full descriptions of NAADAC’s awards, please visit www. naadac.org/about/recognition-and-awards. To make a submission, or for additional information, please contact Donovan Kuehn, NAADAC Director of Operations and Out­ reach, at 800.548.0497, ext. 125, or by e-mail at dkuehn@naadac.org.

Lora Roe Memorial Alcoholism and Drug Abuse Counselor of the Year

Donovan Kuehn serves as the Director of Operations and Outreach for NAADAC, the Association for Addiction Pro­fessionals. While serving as Editor of the NAADAC News, the publication won an Apex Award for Communi­ cation Excellence in 2008. In 2010, Kuehn won a Rising Star Scholarship from the Angerosa Research Foun­ dation, a nonprofit organization established in 2003 to conduct industry research to benefit the association publishing and marketing professions.

Mel Schulstad Professional of the Year Presented for outstanding and sustained contributions to the advancement of the addiction profession.

William F. “Bill” Callahan Award Presented for sustained and meritorious service at the national level to the profession of addiction counseling.

Presented to a counselor who has made an outstanding contribution to the profession of addiction counseling.

NAADAC Organizational Achievement Award Presented to organizations that have demon­ strated a strong commitment to the addiction profession and particularly strong support for the individual addiction professional.

Medical Professional of the Year Presented to a medical professional who has made an outstanding contribution to the addiction profession.

Lifetime Honorary Membership Award This award recognizes an individual or entity who has established outstanding service through a lifetime of consistent contributions to the advancement of NAADAC, the addiction profession and its professionals. Full awards criteria available atwww.naadac.org/ about/recognition-and-awards.

M c A ndrew

konstantin kirillov | photospin.com

NAADAC President’s Awards

SPRING 2013  Advances in Addiction & Recovery  29


NAADAC BOARD OF DIRECTORS REGIONAL VICE PRESIDENTS

PAST PRESIDENTS

Mid-Atlantic

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

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

Ron Pritchard, CSAC, CAS Mid-Central (Represents Kentucky, Illinois, Indiana, Michigan, Ohio and Wisconsin)

Stewart Turner-Ball, LMFT, LCSW, LCAC, MAC

NAADAC

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

NAADAC OFFICERS

Sherri Layton, MBA, LCDC, CCS

Updated 1/15/13

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

President Robert C. Richards, MA, NCAC II, CADC III

Diane Sevening, EdD, CDC III

President Elect Kirk Bowden, PhD

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

Secretary Thurston S. Smith, CCS, NCACI, ICADC Treasurer John Lisy, LICDC, OCPS II, LISW-S, LPCC-S

Barbara “Bobbi” Fox, LADC, CAC Northwest

Past President Donald P. Osborn, PhD (c), LCAC

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

Southeast

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

Frances Patterson, PhD, MAC

Gloria Boberg, LSAC, CAC

National Addiction Studies and Standards Collaborative Committee Co-Chairs Donald P. Osborn, PhD (c), LCAC TBD (co-chair)

NAADAC AD HOC COMMITTEE CHAIRS Awards Sub-Committee Chair Tricia Sapp, BSW, CCJP, CPS

NALGAP, The Association of Lesbian, Gay, Bisexual and Transgender Addiction Professionals and Their Allies Joseph M. Amico, MDiv, CAS, LISAC

Adolescent Specialty Committee Chair Christopher Bowers, MDiv, CSAC, ASE International Committee Co-Chairs Paul Le, BA

NAADAC-NATIONAL CERTIFICATION COMMISSION OF ADDICTION PROFESSIONALS

Ethics Committee Chair Anne Hatcher, EdD, CAC III, NCAC II

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

Student Committee Chair Diane Sevening, EdD, CDC III

NAADAC Public Policy Committee Chair Gerry Schmidt, MA, LPC, MAC

Clinical Issues Committee Frances Patterson, PhD, MAC

Southwest

Organizational Representative Philip L. Herschman, PhD

Political Action Committee Chair Nancy Deming, MSW, LCSW, CCAC-S

Personnel Committee Chair Robert C. Richards, MA, NCAC II, CADC III

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

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

Product Review Committee Chair Philip L. Herschman, PhD

Nominations and Elections Co-Chairs Roberta Taggart, MA, CASAC, NCAC II

NAADAC STANDING COMMITTEE CHAIRS

Greg Bennett, MA, LAT

NAADAC-National Certification Commission Chair James Holder III, MA, MAC, LPC, LPCS

Leadership Retention & Membership Committee Chair Roger A. Curtiss, LAC, NCAC II

NAADAC-National Certification Commission of Addiction Professionals Full details below

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

Kathryn B. Benson, NCC, AP Chair Nashville, Tenn. lightbeing@aol.com

Rose M. Maire Glen Rock, NJ rmmaire@aol.com

Christopher C. Bowers Powhatan, VA chriscbowers@comcast.net

Claire L. Olsen Lake Grove, NY claire48@msn.com

Susan L. Coyer Huntington, WV susah.coyer@prestera.org

Ricki Townsend Fair Oaks, CA ccrtowns@aol.com

Thaddeus S. Labhart John Day, OR tlabhart@hotmail.com

James Holder Past Chair Effingham, SC james.holder10@yahoo.com

William S. Lundgren Denver, CO lund1365@msn.com

NAADAC REGIONAL BOARD REPRESENTATIVES

AK

NORTHEAST

MID-CENTRAL

NORTH CENTRAL

Susan Campion, LMFT, Connecticut Ruth A. Johnson, LADC, SAP, CCS, Maine Susan O’Connor, Massachusetts Peter DalPra, LADC, New Hampshire Christopher Taylor, CASAC, LMHC, MAC, DOT SAP, New York William Keithcart, MA, LADC, Vermont

Beverly Jackson, Illinois C. Albert Alvarez, LMHC, Indiana Michael Townsend, MSSW, Kentucky Shannon Rozell, MPA, Michigan Leon Collins, LICDC, ICADC, ICCS, Ohio Gisela Berger, PhD, Wisconsin

James P. Johnson, BS, LADC, ICS, Minnesota Alice M. Kibby, BA, LISAC, CSAC II, Missouri Jack Buehler, LADC, Nebraska Kurt Snyder, MMGT, LSW, LAC, North Dakota Jack Stoddard, MA, CCDC III, South Dakota WA

NORTHWEST MT

Steven Sundby, PhD, Alaska David R. Hadlock, DO, FACOOG, CMRO, CCHP, SAP, MAC, Idaho Julie Messerly, LAC, Montana Christine Stole, Oregon Greg Bauer, CDP, NCAC I, Washington SueAnne Tavener, MS, LPC, LAT, Wyoming

OR

ME

ND VT

MN

Northwest

SD

ID

North Central

WY

NJ

Mid-Central IL

CO

Southwest

KS

CT

NH MA RI

PA

UT CA

NY

MI IA

NE

NV

Northeast

WI

IN

MO

MD

OH

Mid- Atlantic

DE

WV

KY

VA NC

TN

SOUTHWEST

HI

AZ

OK

NM

Del Worley, MC, LPC, LISAC, Arizona Thomas Gorham, MA, CADC II, California Mita Johnson, LPC, LMFT, LAC, MAC, ACS, Colorado Mark C. Fratzke, MA, MAC, CSAC, CSAPA, Hawaii Kimberly Landero, MA, Nevada Michael Odom, LSAC, Utah

Mid-South TX

AR

AL LA

Matthew Feehery, MBA, LCDC, Texas

30  Advances in Addiction & Recovery | SPRING 2013

GA

MS

SOUTHEAST MID-SOUTH

SC

Southeast

FL

MID-ATLANTIC Jevon Hicks Sr., Delaware Johnny Allem, MA, District of Columbia Moe Briggs, NCC, LCPC, MAC, SAP, Maryland Patrice Porter, LPC, Virginia Susie Mullens, MS, LPC, ALPS, AADC-S, West Virginia

Eddie Albright, MS, Alabama Bobbie Hayes, LMHC, CAP, Florida Diane Sherman, PhD, NCAC II, Georgia Martha Wittig, PhD, CAADC, CCS, Mississippi Angela Maxwell, MS, CSAPC, North Carolina Ernie Kirkland, South Carolina Toby Abrams, LADAC, Tennessee


SPRING 2013  Advances in Addiction & Recovery  31


NCC AP Announces New Credentials/Endorsements The NCC AP’s newest credentials and endorsements provide national recognition of a professional’s current knowledge and competence. We encourage you to continue to learn for the sake of your clients which provides assistance to employers, health care providers, educators, government entities, labor unions, other practi  tioners, and the public in the identi   fication of quality counselors who       have met the national       competency standards.

Nationally Certified Adolescent Addiction Counselor A nationally recognized standard of competencies and effective clinical practice utilized in treating adolescent Substance Use Disorders (SUDs). Nicotine Dependence Specialist Credential (NDS) A nationally recognized standard of competencies that demonstrates foundational knowledge of nicotine dependence, develops skills and strategies for tobacco addiction counseling and examines related recovery and wellness issues.

Nationally Endorsed Student Assistance Professional A nationally recognized endorsement developed to address the need for professional competencies for practitioners treating adolescent Substance Use Disorders (SUDs). Over the past ten years there has been an emerging necessity to distinguish a unique set of skills for this practice when addressing adolescent issues in a school setting; identify an adequate awareness of adolescent development and differentiate issues related to co-occurring disorders that practitioners need to understand when working with adolescents.

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

www.naadac.org/certification


Advances in Addiction & Recovery (Spring 2013)