Opportunity Annual Meeting Whole Different of a Highlights: Level: New Life Medical Automation Lifetime: Children, Trauma During Simple Marijuana: Quandry: Get Involved & Technology Game Bad Medicine Where to Start Page 3 Page 4 Page 6 Page 11 Page 14

Earn INSIDE:CE Credits! AADAC NAADAC, NThe Association for Addiction Professionals • We help people recovernews their lives. Vol. 21, No. 4, October/November 2011 Is This the Future of Treatment? Pages 8–10 NAADAC BOARD OF DIRECTORS NAADAC OFFICERS SOUTHEAST (updated 10/17/11) Eddie Albright, Alabama President Daniel L. Carzoli, MA, CAP, CMHP, NCAC II, ICADC, Florida Donald P. Osborn, MS, MA, MAC, LMHC E. Wayne Bland, MSW, LCSW, CAC II, Georgia Albert C. Stallworth, Sr., MA, CCAP, ICAADC, Mississippi President-Elect Wrenn Rivenbark, North Carolina Robert C. Richards, MA, NCAC II, CADC III Cathy Jaggars, South Carolina Secretary Toby Abrams, Tennessee Roger A. Curtiss, LAC, NCAC II SOUTHWEST Treasurer James J. Roth, MEd, LPC, LISAC, CADAC, CEAP, Arizona Edward Olsen, LCSW, CASAC, SAP Mita Johnson, Colorado Past President Mark C. Fratzke, MA, MAC, CSAC, CSAPA, Hawaii Patricia M. Greer, BA, LCDC, AAC Della Garlitz, New Mexico Allen Flagg, Jr., Nevada NAADAC-National Certification Commission Chair Allison Weaver, MPH, LADC, Utah James Holder III, MA, MAC, LPC, LPCS ORGANIZATIONAL REPRESENTATIVE Executive Director George Joseph, The Right Step/Spirit Lodge Cynthia Moreno Tuohy, NCAC II, CCDC III, SAP PAST PRESIDENTS REGIONAL VICE PRESIDENTS Robert Dorris (1972–1977) Mid-Atlantic (Represents New Jersey, Delaware, Pennsylvania, Virginia, Col. Mel Schulstad, CCDC, NCAC II (ret’d) (1977–1979) the District of Columbia, Maryland & West Virginia) Jack Hamlin (1979–1981) Thomas Durham, PhD John Brumbaugh, MA, LSW, CADAC IV, NCAC II (1981–1982) Mid-Central (Represents Illinois, Indiana, Kentucky, Michigan, Tom Claunch, CAC (1982–1986) Ohio & Wisconsin) Franklin D. Lisnow, MEd, CAC, MAC (1986–1988) John Lisy, LICDC, OCPS II, LISW-S, LPCC-S Paul Lubben, NCAC II (1988–1990) Mid-South (Represents Arkansas, Louisiana, Oklahoma & Texas) Kay Mattingly-Langlois, MA, NCAC II, MAC (1990–1992) Greg Lovelidge, LCDC, ADC III Larry Osmonson, CAP, CTRT, NCAC II (1992–1994) Cynthia Moreno, NCAC I, CCDC II (1994–1996) North Central (Represents Iowa, Kansas, Minnesota, Missouri, Roxanne Kibben, MA, NCAC II (1996–1998) Editor’s Note Nebraska, North Dakota & South Dakota) T. Mark Gallagher, NCAC II (1998–2000) Diane Sevening, EdD, CDC III Bill B. Burnett, LPC, MAC (2000–2002) Looking Forward Northeast (Represents Connecticut, Maine, Massachusetts, Roger A. Curtiss, LAC, NCAC II (2002–2004) New Hampshire, New York, Rhode Island & Vermont) Mary Ryan Woods, RNC, LADC, MSHS (2004–2006) Every so often, it’s nice to be able to sit Barbara “Bobbi” Fox, LADC, CAC Sharon Morgillo Freeman, PhD, APRN-CS, MAC (2006–2007) Northwest (Represents Alaska, Idaho, Oregon, Montana, Patricia M. Greer, BA, LCDC, AAC (2007–2010) back and reflect on what it is that we do Washington & Wyoming) NAADAC STANDING COMMITTEE CHAIRS Greg Bennett, MA, LAT and how we can stay focused on our goals. Bylaws Committee Chair Southeast (Represents Alabama, Florida, Georgia, Mississippi, Bruce Lorenz, NCAC II, CADC North Carolina, South Carolina & Tennessee) One of those times for me was at the recent Frances Patterson, PhD, MAC Clinical Issues Committee Frances Patterson, PhD, MAC NAADAC conference in San Diego. It was an Southwest (Represents Arizona, California, Colorado, Hawaii, New Mexico, Nevada & Utah) Ethics Committee Chair amazing event, with over 1,000 people at- Jerome L. Synold, CAADAC II, MAC, CPS, CCS Anne Hatcher, EdD, CAC III, NCAC II Finance Committee Chair tending. There is something dynamic about BOARD OF DIRECTORS Edward Olsen, LCSW, CASAC, SAP MID-ATLANTIC Nominations & Elections Chair having so many people together who share Bruce Lorenz, NCAC II, CADC, Delaware Roberta Taggart, MA, CASAC, NCAC II Warren E. Leggett, Jr., CAC III, CCS, District of Columbia a common purpose. You can read the recap Moe Briggs, Maryland Personnel Committee Chair TBD, New Jersey Donald P. Osborn, MS, MA, MAC, LMHC of the conference on page four, and find TBD, Pennsylvania NAADAC Public Policy Committee Chair John Savides, Virginia Gerry Schmidt, MA, LPC, MAC Randy Housh, West Virginia out more about the two professionals and NAADAC AD HOC COMMITTEE CHAIRS MID-CENTRAL one program that were honored this year. Beverly Jackson, Illinois Awards Sub-Committee Chair Ronald A. Chupp, LCSW, LCAC, NCAC II, ICAC II, Indiana Tricia Sapp, BSW, CCJP, CPS, Texas Also in this issue is an interesting article Michael Townsend, MSSW, Kentucky Adolescent Specialty Committee Chair Carrie Reaume, LMSW, CAAC, Michigan Christopher Bowers, MDiv, CSAC, ASE by David Oshman, describing the interna- John Corcoran, Ohio International Committee Chair tional option that has taken him to a treat- Gerry Kaye, Wisconsin Paul Le, BA MID-SOUTH Leadership Retention & Membership Committee Chair TBD, Arkansas Roger A. Curtiss, LAC, NCAC II ment center based in Thailand. He has some TBD, Louisiana TBD, Oklahoma Product Review Committee Chair lessons that could be adopted by other Matthew Feehery, Texas George Joseph treatment centers and his article raises the NORTH CENTRAL Political Action Committee Chair Randy Drake, LMHC, NCC, ACADC, MAC, Iowa Nancy Deming, MSW, LCSW, CCAC-S issue of outsourcing and treatment. Tom Lohff, MSW, NCAC II, Kansas Student Committee Chair J.J. Johnson, Minnesota Diane Sevening, EdD, CCDC II Finally—NAADAC has taken a stand Alice M. Kibby, BA, LISAC, CSAC II, Missouri National Addiction Studies & Standards Collaborative Committee Jack Buehler, LADC, Nebraska Donald P. Osborn, MS, MA, MAC, LMHC (co-chair) against medical marijuana. You can read Christy K. Anderson, North Dakota TBD (co-chair) Jack Stoddard, South Dakota why the association thinks this is bad NORTHEAST NALGAP, The Association of Lesbian, Gay, Bisexual and Charlie MacDonald, Connecticut Transgender Addiction Professionals and Their Allies medicine. Ruth A. Johnson, LADC, SAP, CCS, Maine Joseph M. Amico, MDiv, CAS, LISAC Susan O’Connor, Massachusetts NAADAC–NATIONAL CERTIFICATION COMMISSION I hope you enjoy the issue. Catherine Iacuzzi, New Hampshire Christopher Taylor, New York James A. Holder III, MA, MAC, LPC, LPCS (chair) Donovan Kuehn TBD, Rhode Island Kathryn B. Benson, LADC, NCAC II, SAP William Keithcart, MA, LADC, Vermont Hjalti Bjorensson, NCAC I Editor, NAADAC News Christopher Bowers, MDiv, CSAC, ASE NORTHWEST Cynthia B. Breen, NCAC I Steven Sundby, Alaska Lorraine A. Clyburn, LSW, NCAC I David R. Hadlock, DO, Idaho Susan Coyer, MAC, SAP Julie Messerly, Montana Thadd Labhart, MAC Tanya Pritt, CADC II, Oregon William S. Lundgren, NCAC II Lindsy McGowan-Anderson, MS, CDP, MAC, Washington Rufus Lynch, DSW (public member) TBD, Wyoming Claire Olsen, NCAC II Donald P. Osborn, MS, MA, MAC, LMHC (ex-officio)

CONTENTS NAADAC NEWS is published by NAADAC, the Asso­ci­ation for Addic­tion vary by state. Call 800.548.0497 or visit www.naadac.org for more informa- Pro­fes­sionals. tion. NAADAC News’ readership exceeds 12,000. CE Quiz Editor: Donovan Kuehn Editorial Policy: Letters, comments and articles are welcome. Send Page 13 Layout: Design Solutions Plus/Elsie Smith sub­missions to the Editor, NAADAC News. The publisher reserves the right Contributors to this issue: Kevin Large, Yvonne Riege, David Oshman, to refuse publication and/or edit submissions. Paul Le, Maxim Furek and Donovan Kuehn. Advertising: Media kit requests and advertising questions should be made Heroin Chic Photos: Images utilized through flickr.com creative commons attribution to Donovan Kuehn, 1001 N. Fairfax St., Ste. 201, Alex­andria, VA 22314; Page 17 license from Sarah Ackerman, Michelle Tribe, Luis de Bethencourt, Jenny phone 800.548.0497; fax 800.377.1136 or email [email protected]. Downing, Samantha Marz, R. Alton, Art Comments and Poppy Dyer; and © 2011 NAADAC, the Association for Addiction Professionals Donovan Kuehn. Upcoming Events October/November 2011, Volume 21, Number 4 Materials in this newsletter may be reprinted, provided the source Page 20 ­(“Re­printed from NAADAC News October/November 2011”) is provided. Change of Address: Notify NAADAC three weeks in advance of any For non-NAADAC material, obtain permission from the copyright ­owner. ­address change. Change of addresses may take up to six weeks, so please For further information about NAADAC member­ship, publications, cata­log notify us as soon as ­possible. and services, write: NAADAC, 1001 N. Fairfax St., Ste. 201, Alexandria, VA Send your old and new addresses to NAADAC, 1001 N. Fairfax St., Ste. 22314; phone 800.548.0497; fax 800.377.1136 or visit www.naadac.org. 201, Alexandria, VA 22314; phone 800.548.0497; fax 800.377.1136 or Subscription Information: The annual subscription rate is $30. Indi- send an email to [email protected]. vidual ­copies are $6, free to NAADAC members. NAADAC membership costs NEWS FOR PROFESSIONALS

The Opportunity of a Lifetime! Getting Involved in the Profession of Addiction Counseling Kevin M. Large, MA

“We’ve all heard that we have to learn from our mistakes, but I • Contribute to the NAADAC Political think it’s more important to learn from successes. If you learn Action Committee (PAC). For more information, only from your mistakes, you are inclined to learn only errors.” go to www.naadac.org and click on the tab for Advocacy – Norman Vincent Peale and then PAC. Your contribution to the NAADAC PAC helps to support legislation favorable to the cause of the Who We Are treatment of alcoholism and drug addiction at the na­ The people who compose the addictions treatment profession tional level. are a diverse group. We have come from varied life experiences, which have often been our greatest teacher. We have come from • Write to your congressperson and various academic backgrounds, ranging from little or no college senator, urging them to support legislation favorable through doctoral level training. We have worked in a variety of to addictions treatment. For more information, go to www. treatment settings. No matter what the degree is behind our naadac.org and click on the tab for Advocacy, and you will name, no matter what the professional title or license/certifica­ find a wealth of information, links, and resources. tion that we may hold, we have something in common! • Volunteer in your community. For example, What we have in common is specialty knowledge, training participate in a community-wide panel on substance abuse and experience in the addiction treatment profession. It is this prevention and/or treatment. specialty background that both brings us together and makes us valuable. It is our diversity that is inherently reflective of our • Volunteer your time as a mentor for a new varied backgrounds that makes us such an interesting group! professional who is just starting his or her career. Your advice could help new professionals avoid some of the Why We Become Involved pitfalls many people face in their career. There are many individuals who have become addictions counselors as a result of their own personal journey to recovery. Where Do We Go From Here? Many people who choose a career of counseling individuals and We will always be specializing in one area of treatment or families that are dealing with alcoholism and drug addiction another. We will always be searching for different ways of en­ have themselves come from a family with a history of alcoholism gaging our difficult clients. We will always be searching for some and/or drug addiction. And there are many professionals who new tools for our counselor’s “tool box” and seek out some have come to be interested and involved in the treatment of rest and relaxation for ourselves along the way. alcoholism and addiction based upon the needs of the clients So, let us not forget who we are and what we are here for! they work with on a daily basis. We are dedicated professionals, committed to caring for others whose lives have been strangled by the throes of addiction, and Ways of Getting Involved in Support of the Profession seeking to warn those that would suffer the same fate and at­ The greatest thing we do is providing care and counseling tempt to help them steer their lives on a different course. to our clients, their families and the community. In addition, I To paraphrase a couple of familiar quotations: would suggest some other ways to get involved: “Ask not what your organization can do for you, but • Write an article—or even develop and write a what can you do for your organization.” “Now is the time column—for a local newspaper. for all great addictions counselors to come to the aid of their profession!” • Write an article for publication in a professional magazine or for an association newsletter. I thank each and every one of you for what you do for both our clients and our profession. It is through our long days and • on a committee or in a leader­ Volunteer to serve many years that we have helped those that have been able to ship position with a membership association at the local, pull their lives back together and hopefully enjoy a more stable state or national level. and meaningful existence. • Develop a lecture presentation on a topic related to alco­holism and/or drug addiction, and work in Kevin Large works as a clinician in south­ ­conjunction with a teacher or professor that could utilize western Michigan. your experience and knowledge in making a presentation to a class. • Teach a course on alcoholism and drug addiction counseling at a local school, college or university. www.naadac.org NAADAC News 3 NEWS FOR PROFESSIONALS

Children, Trauma and Technology Highlight Annual Meeting San Diego Conference Attended by Over 1,000 Participants Donovan Kuehn, NAADAC News Editor

an Diego was at the center of While pointing out that health infor­ Integrated Recovery Initiative mation technology is “supporting behav­ some of the most interesting Several leading organizations in mental S ioral health aspects of the EHRs based on health and addiction treatment an­ discussions on addictions in Sep­ standards in the system,” he added that nounced that they have joined forces to data collection, privacy and confidential­ tember. Host of the NAADAC advance a model of integrated treatment. ity will also be a key components of the The effort, which began on September national conference, some of the new process. 14th, was rolled out at the conference in “These are all issues concerning infor­ San Diego. best minds focused on addiction preven­ mation practices. But these issues are not Focus on Integrated Recovery, a col­ tion, intervention and treatment gathered peculiar to behavioral health; they are not laboration between Hazelden, Dart­ with over 1,000 participants to address specific to substance abuse,” Clark said. mouth Psychiatric Research Center, the issues of the day. “They are general. And all of us will have NAADAC, the Association for Addiction Here are some of the highlights of the to deal with these issues.” Professionals, the National Association proceedings. of Addiction Treatment Providers President Obama (NAATAP), the National Council for Jerry Moe The President sent a message to partici­ Community Behavioral Healthcare and The National Director of the Betty pants that was read out at the conference. Westbridge Community Services, has set Ford Center Children’s Programs, ad­ “Substance abuse and addiction affect out to address the 5.6 million clients dressed the issue of parental recovery and millions of Americans and their families, who have co-occurring addiction and its impact on children. straining relationships, communities, our mental health disorders. Moe asked the profession to be pro­ economy and our health care system. As The group has taken action to define active: “I want to see a study on recovery a Nation, we must do more to address the model for integrated treatment and how it affects families, not more on these challenges. Though long-term re­ ­delivery and provide information and how kids are affected by addiction.” covery is a reality for everyone struggling resources for its successful implementa­ Moe, pulling from his sometimes heart- with addiction, with the help of dedi­ tion across treatment organizations. breaking experiences at the Betty Ford cated professionals, we can aid recovering Cynthia Moreno Tuohy, Executive Center, had a simple point for clinicians. addicts in breaking the cycle of abuse and Director of NAADAC, the Association “Kids don’t care about how much you rebuilding their lives.” for Addiction Professionals said, “It is know until they know about how much vital in this new era of integrated services you care,” he said. Dr. Stephanie Covington with addiction and mental health that In her Sept. 20 plenary session, our professionals are educated and in­ Dr. H. Westley Clark ­women’s treatment expert Stephanie S. formed of the technologies related to During his presentation, titled Does Covington, PhD, noted how the ­approach co-occurring disorders. This partnership Health Information Technology Have a to the issues of violence and sexual abuse in integrated treatment brings the best of Place in Addiction Treatment?, H. West­ with patients has evolved. educational technologies, resources, and ley Clark, MD, JD, MPH, CAS, FASAM, Twenty-five years ago, “[Clinicians] outreach to addiction and other helping Director of SAMHSA’s Center for Sub­ were saying their clients were not ready. professionals.” stance Abuse Treatment, asked the What they were really saying was they Educational information, events and pointed question: “How many of you are were not ready [to address these issues],” resources are available at the website, using electronic health records?” said Covington, co-director of the Insti­ www.integratedrecoverynow.org. The response was underwhelming. tute for Relational Development and the In addition to the plenary sessions and Dr. Clark said too many treatment Center for Gender and Justice. over 70 workshops, NAADAC presented providers still haven’t implemented elec­ Dr. Covington spoke about how its awards on September 20 — Addiction tronic health records (EHRs) despite the changes have created a more supportive Professionals Day. “need to have the ability to document environment for addressing all of the is­ The award winners and highlights of what they do.” sues clients need to resolve, and the need their accomplishments are laid at right. “People want to know what they are to create a safe and approachable space. As the number of colleges that offer getting,” said Dr. Clark. “Stories are not She asked the participants to consider true recovery support services and hous­ enough; we need data, a sense of quality. their treatment centers. “When someone ing grow, Rutgers stands out as a pioneer. Otherwise, how are we supposed to learn comes for help, does it feel like a safe Watch out for information on the 2012 that people are getting better?” place?” she asked. conference at www.naadac.org.

4 October/November 2011 www.naadac.org NEWS FOR PROFESSIONALS

Mel Schulstad Professional of the Year clinical staff and intern students since 1980 in both Massachu­ The Mel Schulstad Professional of the Year award was created in setts and Southern Vermont. He has published multiple profes­ November 1979 and is named after the first President of sional articles, and has been involved with a number of the U.S. NAADAC. The award recognizes an individual who has made Department of Health and Human Services, SAMSHSA Treat­ outstanding and sustained contributions to the advancement of ment Improvement Protocol (TIP) publications. His selection the addiction counseling profession. as Counselor of the Year was endorsed by many professionals, including David Mee-Lee, MD, Chief Editor of the ASAM Rocio Del Milagro Patient Placement Criteria and Senior Vice President for the Woody, MSW, is the Change Companies, stated that the longer clinicians work in 2011 Mel Schulstad Pro­ the profession the more they can succumb to a been there, done fessional of the Year. The that perspective. Peltz stands out because he has avoided this primary area of interest for pitfall and has always demonstrated a professional humility and Ms. Woody in the clinical admirable thirst for improving knowledge and skills in counsel­ field is the impact of lin­ ing. These qualities help explain the clinical excellence he strives guistically appro­priate and for and delivers to the people he serves. culturally sensitive health care in the treatment NAADAC Organizational Achievement Award needs of children, adoles­ Presented to organizations that have demonstrated a strong com­ cent and adult patients mitment to the addiction profession and particularly strong sup­ suffering of psychiatric disorders. In 1995, she founded the port for the individual addiction professional. Road to Recovery, Inc., the first fully multilingual and multi­ cultural professional counseling clinical practice for behavioral The Rutgers University health and substance abuse services and is the only private, Alcohol & Other Drug minority owned clinical practice to have been awarded local, Assistance Program state and federal contracts to provide DUI, drug court behav­ (ADAP) in New Jersey, is ioral health services and psychological counseling for minors. the winner of the 2011 Woody serves in the Drug Court Advisory Committee of the NAADAC Organizational Georgia Supreme Court, is a member of the Board of Visitors Achievement Award. The of Grady Health Systems and is on the Advisory Board of the program, one of the first Southeast Addiction Technology Transfer Center at Morehouse in the nation, focuses on School of Medicine. She also serves in the community as a building ties with the Founder of the International Family Center, a non-profit organi­ community and support zation dedicated to the prevention of domestic abuse in the students in the university Latino community is a former Council Member of the Gen­ c o m m u n i t y. A D A P eral Consulate of Peru in Miami, Florida and is the immediate strengthens these ties by training psychiatrists, psychologists, past President of the League of Women Voters of DeKalb social workers, interns and graduate students both inside and County, Georgia. Woody is originally from Lima, Peru. She outside of the Rutgers system. In 2011, over 300 individuals proudly became a citizen of the United States of America on were trained. ADAP has helped support recovery housing, with November 13, 1987. 28 students in New Brunswick and three more in Newark. Students in recovery housing maintain a higher Grade Point Lora Roe Memorial Alcoholism and Drug Abuse Average than the average Rutgers student. Counselor of the Year With the support of ADAP, students in the program speak This award is presented to a counselor who has made an outstand­ at hospitals, detox centers, rehabs, correction facilities, other ing contribution to the profession of addiction counseling. universities and high schools. This is done for free, and not part of any other 12-step work that they do. ADAP also offers free Thomas A. Peltz, CAS, training and advice to other university campuses, either in per­ LADC I, has worked in the son, via email or on the phone. mental health field as both Accepting the award on behalf of Rutgers was Frank L. a counselor and an admin­ Greenagel, LCSW, LCADC, ACSW. istrator since 1973. In his private practice in Beverly Farms, he works with adults, Know a person or program that and offers individual, cou­ ples and family treatment. deserves recognition? Check out the NAADAC awards online at Peltz leads group sessions www.naadac.org/about/recognition-and-awards. and lectures in the commu­ nity and has supervised www.naadac.org NAADAC News 5 NEWS FOR PROFESSIONALS

A Whole Different Level Tedious Topics can Spring New Life During a Simple Game Yvonne R. Riege “ hat is this?” my disturbed that they’ve never played this game sober. When this is brought up, we client questioned. “I W discuss it: How does it feel to partici­ hate board games!” another pate in something that formerly was only enjoyed drunk? Are you experi­ grumped. We were playing encing cravings? How can you deal Blokus. Clients were obviously with these cravings? Other group members often have excellent ideas, so frustrated. I don’t hesitate to stop the game and I smiled as I placed one of allow everyone to share. In fact, I often interject more questions as we go. my plastic shapes on the board. Jenga provides an opportunity to “Let’s just keep working our discuss how use and abuse have ­affected various spheres of individuals’ way toward the middle. And lives. After the game is set by stacking start thinking about the parallels the blocks as indicated in the game directions, I’ll begin play by sug- to life.” gesting something like loss of a job “The WHAT?” Miss Disturbed promotion or stress with spouse as a exclaimed. way to get group members thinking. “Think of the ways that this game This is a particularly apt way to imitates our daily lives,” I explained. ­emphasize ­topics such as stress related Someone moaned. to use/abuse or family issues related I’d moved these Intensive Outpa­ to dependency. tient (IOP)/Moderate Outpatient Often in the first hour of IOP I’ll (MOP) participants into a game. And cover these topics in a more tradi­ I always know that they’ll be a bit tional fashion and then move into a ­resistant to my atypical style of teach­ game for emphasis during the second ing—at first. After all, most all of us hour. Each person in the group is ex­ don’t like to step out of our comfort pected to share something when they zones. pull a block and set it on top. What’s Though I use the Courage to interesting to me is observing how Change curriculum, I like to change it many persons will share at a much up. I encourage what is best described deeper level while playing a game. It’s by the much-abused term, “out-of- as though they processed the topic at the-box” thinking. Though my topic hand intellectually during the earlier of the day was “recognizing your lecture or worksheet time, but are able warning signs,” the group had tired of to personalize and share from the heart discussing their interactive journaling as they interact with one another dur­ answers. ing the game. Several years ago, I began introduc­ Recognizing that sometimes there ing games like Blokus, Quirkle and are individuals that experience shaking Jenga to emphasize the day’s topic. hands for a variety of reasons, I stress At first clients are resistant. I’ve come that if the tower falls we will simply say to expect that. Many are used to “ooops” and rebuild it. When this ­glazing through lectures offering happens, I often offer the group mem­ minimal input. bers the option of playing the second I have found that games provide a round or watching—however they are venue for exploring topics in greater not exempt from sharing something depth. Jenga is a game many are famil­ when it is “their turn.” They must iar with; some clients will comment remain involved by interacting ­verbally

6 October/November 2011 www.naadac.org NEWS FOR PROFESSIONALS

“Gosh, I didn’t see that!” she smiles. “What’s the parallel to life?” I encourage. “I get lonely. I have a pity party. I drink.” Miss Disturbed squirms. I nod. “So if you can identify your negative self-talk, what might happen?” “I could stop it before I go out, right? I could walk on my treadmill or do something else.” “You got it! There’s a new path in watching your warn­ ing signs,” I reply… Later Mr. ‘I-Hate-Board-Games’ interjects, “I like THIS game. I learned something!” Tedious topics can spring new life during a simple game. And best of all, clients are not even aware that they are processing what’s new—on a whole different level.

Yvonne Riege currently works as a even though they are not pulling out and replacing blocks. counselor for Addictions Recovery in Games provide a means for the involvement of everyone. Northern Indiana. She emphasizes in And if I can reposition person’s thinking by this totally behavioral and cognitive methods in­ different learning framework, I’ve succeeded. What I’ve cluding modeling, shaping and re­ found most intriguing is how much clients learn and re­ shaping thoughts and changing risky tain—even though it certainly wasn’t their personal self-talk to positive self-talk. Spiritual agenda. elements are also included based on her former experience of “This is ridiculous! It’s pointless!” Miss Disturbed serving several local congregations as pastor. Riege has keen grouched. “I don’t know what this has to do with any­ interest in utilizing Howard Gardner’s Multiple Intelli­ thing!” gences and the Enneagram in group work. Again I smiled, encouraging clients to keep playing. Blokus is one of those games that seem pointless at first. Individuals place their “Tetris-like” colored pieces on a plastic grid and are encouraged to move toward the middle of the board from their corners. For several rounds nothing seems to happen. Furrowed brows are common; many sit and stare. Some get agitated. However, it wasn’t more than a minute or two later that both of these frustrated individuals changed their tune. Once clients reach a point in the game where it’s no longer easy to place their pieces on the board, they are stuck. They immediately see pieces they’ve laid that they regret putting in specific spots. “I’m seeing a parallel here; I see some regret,” I com­ ment. “Yeah, like I never expected to get arrested for a DUI!” Mr. ‘I-Hate-Board-Games’ interjects. “Or paying for all these fines and classes!” someone added. Others look closely at the remaining pieces in their trays. Some realize there were better choices. Another adds, “Next round I’d know more!” I comment on life’s parallels (especially relating to gain­ ing insight in group) as they continue. “I can’t play anywhere!” Miss Disturbed moans. “What about this?” I suggest. Since she’s sitting to my right, I point out her single yellow square. I place it so that she has a whole new region of the board into which to venture. www.naadac.org NAADAC News 7 FEATURE ARTICLE

Enhanced Recovery Universal Lessons From a Unique Overseas Program David Oshman, CADAC

The additional problem is cost. I dependency issues. But, interestingly, remember when the typical (forgive some do not. We have found that the that word!) 28-day treatment program recovery process, and the need for in­ set the suffering alcoholic or addict ner peace and balance, is universal and back possibly $4,000. Nowadays, the not something unique to alcoholics sticker price for a primary stay in a and drug addicts. So we view the treatment program (imagining that 28 events that led up to our clients “sur­ days might be just the right amount of render” or need for help as precipi­ time) is easily exceeding $30,000. tants, not the main problem. In response to this, there are what There is certainly a “Buddhist fla­ are best described as “alternative treat­ vor” in our team’s treatment approach. ment programs” popping up all over The objective, always, is to eliminate the world. I’m privileged to work with internal conflict, and thus internal suf­ one in Koh Samui, Thailand! fering. This aligns completely with A.A. principles, especially the spiritual Infinite Horizons axiom from the Big Book “any time One such program that is worth we are disturbed, there is something noting, and has been developing a wrong with us.” The acknowledge­ quite novel, and apparently effective ment and application of this truth, approach, is Infinite Horizons in Koh throughout treatment, empowers our Samui. clients to find the inner peace and ac­ You might say “Koh Samui? Is this ceptance that was attempted by their a resort disguised as a treatment cen­ prior often self-destructive choices and ter?” No, it is actually a treatment behaviors. center disguised as a resort! Long-term sobriety, and recovery, The first question is why would depends on a person’s ability to remain someone travel such a long distance to undisturbed. Focusing on this elimi­ s a practicing drug and alco- receive treatment for a disease that can nates the “dry drunk syndrome,” and be treated close to their home? allows our clients to actually feel the Ahol counselor for over 25 Frankly, it comes down to costs. benefits of recovery, not just the loss years, I’ve seen and experienced Support staff and even clinical staff, are of chemical and behavioral distraction available at a more reasonable cost. and relief. This approach often lessens many changes in treatment since And other elements such as food and the occurrence of relapse. I began. materials are much cheaper in Thai­ land. At the Helm I remember with great fondness the Then there is the therapeutic value As Program Director, I was chosen famous “Minnesota Model,” and how of moving the alcoholic or addict out from a number of candidates because that became the standard for many of his home environment. Well, how of my background. Besides my years treatment programs. Based on the more removed can you get than mov­ of experience, I have been recovering philosophy and experience of tradi­ ing the client overseas? from very severe drug addiction and tional behavioral modification treat­ Finally, and probably most impor­ alcoholism for over 27 years. This ment, along with valid Alcoholics tant, there is the progressive and cre­ means two things: I have remained Anonymous (A.A.) principles and ative approach to therapy and recovery abstinent from all mood-altering appli­cation, how could it miss? Unfor­ that can be implemented in a center chemicals (a very important, and often tunately, it can, and did. such as Infinite Horizons. overlooked, component of successful This does not make this treatment recovery), and I have lived life with approach obsolete, in any way. Many A Modern Treatment possibilities and passion that I was people truly benefit and blossom in Philosophy and Approach never able to experience before. As such a treatment modality. But what Infinite Horizons views its program Program Director, I am leading a about the people who don’t? Where as an enhanced recovery program. dedicated group of professionals who can they go? Many of our clients have chemical want to offer this gift to our clients.

8 October/November 2011 www.naadac.org FEATURE ARTICLE

I lead a diverse and professional group. Imagine a treatment team consisting of a classic psychotherapist, a well-trained drug and alcohol coun­ selor, a nutritionist, a yoga instructor, a full-time certified nurse, a physical trainer, a spa and massage expert, a reiki master (reiki is a Japanese tech­ nique for stress reduction and relax­ ation that also promotes healing), a homeopathic physician, a medical doc­ tor and a dog named “Black.” Diverse? Yes? Unique? Possibly. Effective? It certainly has been. The holistic approach mandates that I allow the professionals to just do their jobs. This eliminates the need to micro­manage them, and frees me up to spend more time with clients, and less time with the staff. And since our maximum population is seven patients at any particular time (yes, seven), I in empowering people to regain con­ the problem, we feel that our clinic is get to know and offer guidance and trol of their lives. We offer classic the answer! therapy to them. And, for me, that’s psychotherapy, spiritually centered the greatest joy of being a psycho­ (not religious) counseling and educa­ Co-Occurring/Dual Diagnosis therapist and counselor. tion, medical assessment and support. It is difficult for clinicians to accu­ While all of this intensive healing is rately assess when patients presenting A Different Approach taking place, we offer a concurrent for drug addiction or alcohol addiciton Quite often, rehabs and treatment program of healing for the body, treatment are actually also experienc­ centers throughout the world, well- spirit and soul with yoga meditation, ing dual diagnosis, also known as co- meaning as they are, merely offer an personalized physical training, reiki occurring disorders. Clients with co- overwhelming series of meetings and healing, hydro and aroma therapies, occurring disorders are defined as 12-step based lectures. This can be naturopathic consultations and more. ­individuals experiencing both an productive, but quite often fails to Every person is complex, and unique ­addiction and a mental health condi­ adequately acknowledge, address and in their own way. So the standard tion, such as mood or anxiety disor­ effectively resolve internal and external “cookie cutter” approach to treatment ders. Often, they are failed by the issues that have a severe impact on the is dismally ineffective. We treat our current system. Accurate evaluations ability to maintain a successful and clients as individuals and devise and and assessments are often not utilized, comfortable sobriety. implement a treatment plan that is and the patient becomes categorized In our program, we take a very dif­ specifically designed to support growth as either suffering primarily from a ferent approach. Instead of repeating and richness of life. And, using a mental health condition or an addic­ the same information over and over ­concept that is unheard of in most tion as opposed to a co-occurring again, we feel it is much more effective treatment programs, we empower our dis­order. This dramatically impacts the to assist our clients in regaining long- clients by inviting and encouraging patient’s subsequent quality of care term health and balance of body, mind them to take an active role in formulat­ and course of treatment. To ensure the and spirit. This approach is ­completely ing and implementing that plan. They client receives appropriate care, we supported by the 12 steps of A.A. and truly become an active part of the have implemented an intensive intake other self-help groups. The difference solution. process that helps to accurately iden­ is that our clients experience a tremen­ All of our clinicians agree that absti­ tify clients with co-occurring disorders dous amount of growth and change nence and sobriety is inadequate if not and aggressively treat individuals who within treatment, and are much more combined with happiness, content­ are deemed as having dual diagnosis prepared to succeed and live a full and ment, a richness of life, and an ability or co-occurring disorders. meaningful life when they complete to function and improve the quality of Statistically, substance abuse and treatment. their lives at all levels. If anhedonia (the mental health conditions are intrinsi­ We merge many different proven inability to experience pleasure from cally linked. Frequently substance techniques in a manner that is effective activities usually found enjoyable) is Enhanced, cont. on page 10 www.naadac.org NAADAC News 9 FEATURE ARTICLE

to seven days. The length of Phases 2 through 4 depends Enhanced, from page 9 entirely on the needs of the client. Phase 5 runs three days. abuse arises as a symptom of underlying psychiatric diag­ Therapeutic decisions regarding the phase movement is noses and most individuals seeking assistance are in fact never punitive. It is always with a complete sensitivity to dual diagnosis patients. Compelling peer reviewed research, the needs of each client and a willingness to address those recently published in the Journal of Psychiatric Services, needs in an effective and loving manner, that these decisions states that the overwhelming majority of patients are, in are made. fact, experiencing co-occurring disorders. This population This is one of many approaches that has made our pro­ is also growing at an alarming rate, and they are often mis- gram so effective. categorized due to an ongoing lack of proper diagnostic Length of treatment ranges from 35 to over 90 days, techniques. Epidemiological data suggests a co-occurring and this is reassessed by clinical staff on a continual basis. disorders rate of 79 percent in patients initially presenting We are not insurance driven, but rather rely on self payment for substance abuse treatment. Unfortunately, only 8 per­ and a hefty grant fund. cent of these individuals receive the necessary simultaneous treatment for both their addiction and co-morbid psychi­ Family Program atric conditions (Kessler et al.,1996). This demonstrates a Substance abuse and co-occurring disorders affect not shocking gap in health care delivery systems for dual diag­ only individuals, but their families as well. To deal with this nosis patients who are suffering from their co-occurring reality, Infinite Horizons has developed a fully comprehen­ disorders worldwide. sive program to address the unique difficulties faced by families and loved ones in the aftermath of addiction. Treatment Centers and Co-occurring Disorders We incorporate a family therapy program into each Treatment centers are actively addressing this gap for ­client’s treatment. Family therapy provides a greater level clients with co-occurring disorders through a comprehen­ of understanding between client and family, repairs relation­ sive evaluation processes, including highly extensive psychi­ ships and creates a positive support system to help promote atric and psychosocial assessments, that accurately diagnose ongoing sobriety and stability. patients who have co-occurring disorders and then create Relationships can be destroyed by the power of addiction an appropriate treatment program to meet their unique and related behaviors. Our goal is to educate families about needs. The initial assessments conducted by the clinical their loved one’s addiction, re-introduce and reunite loved team at Infinite Horizons take into account the possibility ones who have been alienated by negative behaviors and of dual diagnosis or underlying psychiatric conditions, and fully incorporate supportive family members into the re­ are vital for the formulation of a comprehensive and ap­ covery process. Families and relationships are composed of propriate plan to simultaneously treat these conditions with individuals, but interact and behave as systems. maximum clinical value. Research shows that an individual’s chances at ­succeeding Instead of having our clients thrown into sessions that are linked to family interventions and the quality of support are not appropriate to their treatment progress, we have systems. This serves to ease the transition from treatment developed a five phase system to insure that all elements to home environment and foster the emotional bonds are effective and properly timed. necessary for continued healing and recovery. Infinite Horizons includes in it program this very special Family Phase 1: Balancing and Regeneration Therapy program hosted on the client’s last three days of treatment. Phase 2: Introspection We are truly passionate about recovery. Our programs Phase 3: Processing and Resolution focused on individualized care, unique locale and inte­ Phase 4: Internalization and Integration grated treatment team increase our ability to help our clients Phase 5: Real Life Re-Entry in finding their own path of joy and fulfillment.

David Oshman, CADAC, is the Pro­ During Phases 1 through 3, all activities and elements gram Director for Infinite Horizons. He are considered an integral and vital part of the program and can be reached at +66 813618448. so are not optional. However, Phase 4 and 5 allows the client to make responsible decisions about the activities and Resources elements that are most productive for them. This supports Alcoholics Anonymous Big Book Fourth Edition empowerment and reinforces the message that ultimately http://www.aa.org/bigbookonline Co-occurring Disorders: Substance Abuse & Mental each person needs to take responsibility for their recovery Health Services Administration, www.samhsa.gov/co-occurring/default.aspx and their life. Minnesota Model: Description of Counseling Approach: National Institute It is important to note that these phases are not pre- on Drug Abuse - Approaches to Drug Abuse Counseling http://archives.drugabuse.gov/adac/ADAC11.html determined and are adjusted according to the needs of Thailand: Background: U.S. Department of State every client individually. Generally, Phase 1 runs from three www.state.gov/r/pa/ei/bgn/2814.htm

10 October/November 2011 www.naadac.org NEWS FOR PROFESSIONALS

Medical Marijuana is a Bad Prescription NAADAC Speaks Out Against Legalized Pot Donovan Kuehn, NAADAC News Editor

he organization that speaks out for 75,000 supports the right of citizens to participate in the democratic process, it does not support legislative or voter ballot initiatives addiction-focused professionals has made it T to legalize marijuana for medical use. clear: marijuana is not medicine. “NAADAC recognizes the supremacy of federal regulatory Issuing a position statement on the issue, NAADAC, the standards for drug approval and distribution. NAADAC recog­ Association for Addiction Professionals states, “Marijuana nizes that states can enact limitations that are more restrictive should be subject to the same research, consideration and study but rejects the concept that states could enact more permissive as any other potential medicine, under the standards of the U.S. regulatory standards. NAADAC discourages state interference Food and Drug Administration (FDA).” in the federal medication approval process,” reads the position NAADAC came to this conclusion because marijuana “has paper. a high potential for abuse, has no currently accepted medical “The name ‘medical marijuana’ is false. Marijuana is mari­ use in treatment in the United States and has a lack of ­accepted juana, with a negative impact on the health of the user, the safety for use under medical supervision.” community that needs to police the use and sale of the drug NAADAC represents the professional interests of addiction and the negative impact that comes from the manufacture and counselors, educators and other addiction-focused health care sale of this illegal product,” said Cynthia Moreno Tuohy, NCAC professionals in the United States, Canada and abroad. II, CCDC III, SAP, Executive Director of NAADAC. Voters in many states have approved the concept of “medical “People who use marijuana are endangering their health,” marijuana” in referenda across the nation. While NAADAC she added.

NAADAC Position Statement on Medical Marijuana Summary indication. NAADAC recognizes the supremacy of federal regulatory NAADAC, the Association for Addiction Professional does not support standards for drug approval and distribution. NAADAC recognizes that the use of marijuana as medicine. Marijuana should be subject to the states can enact limitations that are more restrictive but rejects the same research, consideration and study as any other potential medicine, concept that states could enact more permissive regulatory standards. under the standards of the U.S. Food and Drug Administration (FDA). NAADAC discourages state interference in the federal medication ­approval Further, NAADAC does not support legislative or voter ballot initiatives to process. legalize marijuana for medical use. • There is currently sound evidence that smoked marijuana is harmful. Background A past evaluation by several Department of Health and Hu­man ­Services • Marijuana is listed in Schedule I of the Controlled Substances Act (HHS) agencies, including the Food and Drug Administration (FDA), (CSA), the most restrictive schedule. The Drug Enforcement Adminis- Sub­stance Abuse and Men­tal Health Services Administration (SAMHSA) tration (DEA), which administers the CSA, continues to support that and National Institute for Drug Abuse (NIDA), concluded that no sound placement, and FDA concurred because marijuana met the three ­criteria scientific studies supported medical use of marijuana for treatment in for placement in Schedule I under 21 U.S.C. 812(b)(1) (e.g., mari- the United States, and no animal or human data supported the juana has a high potential for abuse, has no currently accepted safety or efficacy of marijuana for general medical use. There are al­ medical use in treatment in the United States, and has a lack of ac- ter­native FDA-approved medications (i.e., Oral THC) in existence for cepted safety for use under medical supervision). treat­ment of many of the proposed uses of smoked marijuana. NAADAC rejects smoking as a means of drug delivery since it is not safe. • Marijuana should be subject to the same research, consideration, and study as any other potential medicine. The U.S. Food and Drug Admin­ • A growing number of states have passed voter referenda (or legislative is­tration (FDA) is the sole Federal agency that approves drug products actions) making smoked marijuana available for a variety of medical as safe and effective for intended indications. The Federal Food, Drug, conditions upon a doctor’s recommendation. These measures are in- and Cosmetic (FD&C) Act requires that new drugs be shown to be safe consistent with efforts to ensure that medications undergo the rigor- and effective for their intended use before being marketed in this ous scientific scrutiny of the FDA approval process and are proven safe country. FDA’s drug ap­proval process requires well-controlled clinical and effective under the standards of the FD&C Act. Further, voter or trials that provide the necessary scientific data upon which FDA makes legislative initiative does not meet the scientific standards for appro­ its approval and labeling decisions. If a drug product is to be ­marketed, val of medicine. Voter and legislative passage of marijuana-as-medicine then disciplined, systematic, scientifically conducted trials are the laws may actually inhibit good medicine because they shortcut the best means to obtain data to ensure that drug is safe and effective necessary step of researching the marijuana plant and the chemicals when used as indicated. Efforts that seek to bypass the FDA drug within that may have legitimate medical applications. NAADAC does approval process would not serve the interests of public health because not support legislative or voter ballot initiatives to legalize marijuana they might expose patients to unsafe and ineffective drug products. for medical use. FDA has not approved smoked marijuana for any condition or disease Approved by the NAADAC Executive Committee: January 2011.

www.naadac.org NAADAC News 11

CONTINUING EDUCATION QUIZ

CE Quiz

Earn continuing education credits by taking this quiz on the articles from pages 8 to 10 of this issue. A grade of 70% or above will earn you a Certificate of Completion for three nationally certified continuing education hours. This is an open-book quiz. After reading the article, complete the quiz by circling one of the answers for each question. Please give only one response per question. Incomplete or multiple answers will be marked as incorrect. The quiz is worth three continuing education (CE) credits. Send a photocopy of this page along with your payment of $35 for three CEs (NAADAC members) or $50 for three CEs (non-menbers). Please complete the information sections below and print clearly.

1. Which of the following statements about the Minnesota Model 4. What is the best way to address the unique needs of each indi- of treat are true? vidual in treatment? a. The treatment mode is obsolete. a. Adopt a ”cookie cutter” approach that applies to all patients. b. It can only be used with patients from the Mid-West of the b. Reduce the input of patients. ­United States. c. Devise and implement a treatment plan in consultation with the c. It lacks cohesive principles and application. patient. d. It is an appropriate treatment model for some, but not all d. Only accept compliant patients into treatment programs. ­patients. 5. Epidemiological data suggests a co-occurring disorders rate of 2. Why would a client choose to get treatment overseas? 79 percent in patients initially presenting for substance abuse a. Treatment is more affordable. treatment. What percentage of these patients receive appropri- b. There is a therapeutic value to treating clients in away from his ate treatment? or her home environment. a. 1% c. 35% c. There are innovative treatment approaches that can be imple- b. 8% d. 79% mented in overseas clinics. 6. Which of the following is NOT a benefit of incorporating fami- d. All of the above. lies into treatment modalities? 3. Diverse treatment teams are referred to as: a. Repairing family relationships. a. Cognitive dissonance. b. Creating a a greater level of understanding between client and b. Integrated treatment. family. c. Dual diagnosis. c. Friends and family discounts. d. Long overdue. d. Creating a positive support system to help promote ongoing sobriety and stability.

PLEASE PRINT CLEARLY AND MAIL WITH PAYMENT TO:

NAADAC, The Association for Addiction Professionals, CE Quiz, 1001 N. Fairfax Street, I certify that I have completed this quiz with- Suite 201, Alexandria, VA 22314 out receiving any help in choosing the answers.

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Address Method of Payment: City State Zip ❏ Check ❏ VISA ❏ MasterCard

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Type of License/Certification Credit Card Number Exp. Date

Name (as it appears on card) Make checks payable to NAADAC, The Association for Addiction Professionals. Please allow three to six weeks for notification of your results and your Certificate of Completion. You may want to keep a copy of this quiz as a record for your licensing board. NAADAC, The Association Authorized Signature for Addiction Professionals is an approved provider for continuing education home study (Provider #189). NAADAC maintains responsibility for the program.

www.naadac.org NAADAC News 13 NEWS FOR PROFESSIONALS

The Automation Quandary Understanding Where to Start With Clinical Technology Paul H. Le

othing is wrong with paper and pencil. There, I • “I already have a solution/system in place, but it doesn’t seem to do what I want.” said it, after more than 10 years of helping addic­ N Does the solution really fall short, or do you not under­ tion and mental health professionals assess technology stand its capabilities? And is what you want, really what you need? Be honest before upgrading or swapping. needs and feasibility. I admit that paper and pencil may • “I’m fine with using paper/pencil to work with clients. I’m tip the scales on technology for cost. Arguments can be sure software would help, but I doubt I can afford it.” made on both sides for convenience, transportability and Embrace the golden rule: if it ain’t broke, don’t think you have to fix it. However, if you think “software” equals practicality. But when it comes to efficiency, technology “better services for my clients” then it may be worth look­ is hard to top. ing into. Especially if it can be more cost-effective. There are numerous programs out there (web-based specifically) Efficiency is critical in most clinical settings—for good that only cost a small monthly fee. Think of it this way: If or bad. Ensuring everyone’s on the same page regarding you assess only one client a month, that cost alone could client treatment plans, schedules, etc., is important. It ranks easily pay the monthly fee and more. And yes, quality sys­ right up there with making sure the coffee station is stocked. tems at that cost do exist. Clicking a button and having instant access to a client’s treatment plan—to know progress or anything else, any­ • “We’re forced to use a system for state/federal/contract time—has value. Technology enables clinical staff to per­ funding which is critical, but it lacks clinical relevance. So form certain tasks with more efficiency. It doesn’t guaran­ we use another system to handle our case ­management.” tee success, of course, but the right “solution” used the Another all-too-common, legitimate complaint among right way leads to good things. addictions professionals. Work with the software vendor So the question really isn’t whether technology can be and the state on interoperability solutions. Most state/ helpful. More often, I find people asking what technology federal systems have the capability to work with third- would work best for them. Whether for a counselor assess­ party vendor software systems, which may allow you to ing clients from a small office in an outdoor strip mall, or reduce a lot of duplicate data entry. And remember, tech­ for an entire county of treatment providers, there is some­ nology people love to solve problems, innately. thing out there that can work. But to make matters frustrat­ • “My facility doesn’t use any software system at all, how can ing, today there are about as many technology options as I expect to purchase and implement a full Electronic Health there are choices in the salad dressing aisle. Record (EHR)?” Help is here. I’m not selling a be-all, end-all method for Not everyone needs to implement an EHR, at least not selecting the right technology, but I am willing to share right away. Legislation still will go through modifications what has helped me and many others: keep…it…simple. and regulations will change. However, it’s only natural that In order to figure out what technology suits you or your other payors will start requiring some form of technology organization’s needs: be used in the years to come. But for now, even if you can 1. Write it out—what you have, want and need. start with a small system that fits your needs now, it can get you prepared for the future. 2. Understand the options—what’s out there and how do I know its right for me? • “The only way I’ll purchase a system is if it’s a CCHIT- certified EHR system.” Write it Out Keep in mind, the core of CCHIT requirement is based Write out what you already have, what you want and on Medicaid/Medicare billing. If you don’t bill for these what you need—for documentation, tracking, planning, clients, it may not affect you, at least for now. You may be scheduling, reporting and so on. You may already have a a counselor that contracts with the court house to conduct Clinical Management System, use MS Word, or paper and assessments and refer. However, there is a chance that in­ pencil. surance companies and other third-party payors will follow Again, keep it simple. Are you dissatisfied? Write out the federal guidelines. It is estimated that by 2014, Medicaid/ reasons and then push yourself to answer—honestly—if Medicare will no longer pay providers for services if they they justify change. Most likely, some will and some will are not using a certified system. So, unless you plan on not. The following are just some examples. operating solely on serving self-pay clients, you may want

14 October/November 2011 www.naadac.org NEWS FOR PROFESSIONALS

to consider looking for systems that are modular, fully or Understand the Options in development to meet CCHIT certifications. If you are After coming up with your list of haves, wants and needs, not billing for Medicaid/Medicare, just keep a close eye proceed to discovering the best method for improving out for changes that continue to take place in healthcare things. Start researching your options, and where you fit that will impact how you bill for services. Even though in. Talk to professional peers, other organizations, consul­ CCHIT certification was originally intended for medical tants. Surf the ’net, get quotes, talk to vendors about dif­ based practice, there are now specific requirements for ferent solutions. Keep in mind that your prioritized needs behavioral health EHRs. are the litmus test by which every “solution” must pass. Wants are “nice-to-haves.” And while they aren’t neces­ Just beware of software that’s decked out with features sities, they are important. “Wants” (like needs) should be that make it really “cool.” Cool may mean more expensive, prioritized. Make them known, up front, because you will harder to support, and less likely to use. I always go back be frustrated if—after a long and costly implementation— to, “What do you need?” you’re disappointed to realize you’ve gotten what you Regardless of your clinical needs, however, the one thing need…but not what you want. Put them out there, but be I find everyone needs in a technology solution is simplic­ clear and honest with yourself: “These are wants…not ity or usability. Simple software gets used. needs.” A few other factors to consider outside of simplicity of Many times I have been approached by providers with use are scalability (Will it grow with me or my organiza­ the same technology quandary. “Paul, I saw 10 different tion?), cost efficiency (Does the cost outweigh the benefit? vendors (at a conference) selling (automation) systems from Is it worth paying more for wants vs. needs?) and flexibil­ $500 to $500K, but I don’t know what’s right. I’m in ity (Can it adapt to work with and support our clinical private practice with a few other clinicians and we know we workflow?). can improve workflow and documentation, but I’m not sure which system fits us best.” I encouraged her to write Usability ➧ Adopt ➧ Benefit out her goals, follow the steps already outlined in this ar­ ticle, and then helped her prioritize what they need. In my 12-plus years of consulting on technology imple­ Confusion is natural when what we know to be our needs mentation, the biggest “X” factor (which I refer to as an doesn’t match what others say our needs must be. This “S” factor) in my mind when it comes to looking for a could be consultants, trainers, regulatory entities, parent technology solution is service. No matter how easy to use companies, peer organizations, friends, family, and yes, even the software is, no matter how “cool” the technology ap­ software vendors. “No one knows my needs better than pears, and no matter how cheap or expensive the solution me.” Pile on more confusion if technology experts are is, a huge factor resulting in the end user’s overall satisfac­ com­bining “need” talk with technology mumbo jumbo. tion is the level of service it receives with the technology. Tech­nology is meant to provide benefit, not headache. When searching or evaluating a software solution (or one So let’s get back to basics. Ask yourself: what areas about you currently use), ask yourself: Does the vendor provide your practice can/should improve—administration, billing, you with the proper training, consultation and personal tracking, treatment efficacy, staff efficiency, etc.? Then, attention you need? Is it aware of health reform and how prioritize, to know whether or not each of those areas-of- it affects the addiction field? Can I trust it to have my improvement is a “need” or a “want.” You don’t have to organ­ization’s best interest at heart? have formal statements. It’s more important to be honest Of course I understand that need is different for every­ and realistic. one. For some, a 20-minute orientation on the software Examples of some needs statements are: will have them off and running and they will never need • “I need a system that I can just log in to, and find a help again unless they forget the password. But maybe you client’s treatment plan quickly, so I don’t have make need a full program evaluation with custom development, a visit to that dreaded file cabinet.” on-site training and follow-up consulting, plus project • “I need to know how many clients admitted in the last management throughout implementation. Regardless of six months have thought about or attempted suicide.” what support you need, it is important that you know that • “I need to reduce the time it takes my staff to docu­ your technology vendor understands what you need and is ment their work because it is decreasing their produc­ responsive when needed. tivity and even morale.” I’ve seen many technology vendors enter the behavioral • “I need to know if our cultural treatment model is health market, offer “cool” technology, and then fail after really helping improve the lives of the kids we see and a two-year stint because they couldn’t provide adequate how it impacts the community.” support. That doesn’t breed trust. • “I need to start billing for Medicaid, but I’m not sure Automation, cont. on page 16 where to get started, much less what software I need.” www.naadac.org NAADAC News 15 NEWS FOR PROFESSIONALS

Automation, from page 15

To be fair, sometimes the end users Large or small, there can always be vider of technology solutions will don’t always convey their “needs” and barriers that impede our progression pay off in the end-even if it means “wants” clearly. Or they are not always to automation. Here are some com­ that the extra “bells and whistles” sure of what they want or need. And mon issues that stop professionals/ don’t make the next software up­ there’s always the possibility of the end facilities from using software: date. user changing its mind, during or after • Affordability. EHRs and technol­ Some software programs are com­ implementation. Otherwise known as ogy have tons of buzz these days, plete systems that can help you with “feature creep,” this type of behavior often creating the misperception many areas of the clinical process. But can pose a major hurdle during imple­ that it’s too expensive. Like any­ it can be a major task to automate mentation, possibly causing unneces­ thing else, there are functional and everything you do. What I recommend sary delays and costs. This goes back cost options-small, medium and to many providers, big or small, is to to the earlier message of knowing what large. Many smaller systems, which separate implementation into phases. you need and want, then keeping it offer true solutions, are now being Maybe just start doing intake/assess­ simple. offered at a daily cost less than that ments and progress notes for the first of a run to the coffee shop. three months, and then introduce treatment plans and follow-ups over • Technology aversion. There are the next three months, etc. people who don’t like technology Once you’ve selected a vendor for and might even say it doesn’t belong technology solutions, work with it to in practice. This doesn’t apply only come up with an implementation plan. to the older generation. I’ve seen a It doesn’t need to be long, just useful. lack of knowledge on computers The key is that you know what to ex­ result in fear and, well, aversion. pect during implementation. That • Resistance to change. A lot of could be as simple as your signing off

brux | iStockphoto.com people don’t like change in general. on the purchase of the software license, Clinicians know this all too well. your installing or getting set up with When faced with changing from the software, then starting to use the paper to point-and-click, people software after a quick initial orienta­ often show major resistance. tion. Or it could mean a full five months of developing specs, custom­ • Resources. This could be an indi­ Upcoming NAADAC izing the system, training of staff, etc. vidual counselor trying to see Webinars Finally, after you have written out enough clients to make ends meet, your needs and priorities, selected a Earn continuing education credits and or a facility not even having its own system, and started using it for, say, stay current on the trends in the profession. company e-mail, much less high- three months, did you achieve what You can also access archived webinars and speed Internet. you wanted? Have you reached your see what you missed. • Leadership. Owner adoption is a goals? And if not, what are you and Full registration details at www.naadac. major factor. How many times have your software partner going to do to org/education. you been positively motivated or make it better? negatively influenced by your super­ NOVEMBER 17: Change is Coming: New visor’s actions? Many times I’ve seen Paul H. Le is Vice Regulations in 2012 for Diagnosis Codes the attitude of, “If they aren’t P r e s i d e n t o f and Claim Submission bought into using this system, why ­Omaha, Neb.- featuring Paul Le, NAADAC International should I?” b a s e d O r i o n Committee Chair and Vice President at Healthcare Tech­ Orion Healthcare Technology • Realistic goals. Be realistic with n o l o g y , I n c . , goals and expectations. Yes, technol­ ­de­veloper of soft­ DECEMBER 15: Clinical Supervision: ogy can do just about anything. But ware solutions for addiction and mental Keys to Success that doesn’t equate to, “It should health organizations and a preferred featuring Thomas Durham, PhD, from be easy for you to add these 20 ques­ vendor of NAADAC. He is a clinical ABT Associates tions to the software.” Some things software expert and frequent conference take time, and having realistic goals presenter. His e-mail address is ple@ with open and honest communica­ orionhealthcare.com. tion between you and your pro­

16 October/November 2011 www.naadac.org NEWS FOR PROFESSIONALS

Heroin Chic From Back Alleys to the Fashion Runway Maxim W. Furek, MA, CADC, ICADC

eroin chic was a perverse and twisted fashion trend that resulted in the ex­ Hploitation of vulnerable young minds. The look, promoting emaciated features and androgyny, was a marketing strategy to seduce young women ever closer to the flame. Called the “dead look,” the “waif look,” and later “junkie chic,” the trend became properly known as the more-sophisticated “heroin chic.” It was a fashion statement, a bizarre alternative in direct contra­ diction to the healthy, vibrant look of models such as Christy Brinkley, Cindy Crawford, Claudia Schiffer and Heidi Klum. dubious standard that continues to this day. Twiggy altered Thin, white-skinned models, lips painted in black or pale the ideal of beauty and created an irrational image that hues, stared vacantly into nothingness. Their exaggerated bordered on near-starvation. A 1967 article in Newsweek red eyes were fixed—highlighted with green and hyper blue noted: “Whatever her ultimate influence on fashion, shadows to emphasize the blank, hollow stare of the Twiggy is a radical departure from the past.” junkie. Associated with the look of lifeless and empty drug Still, there were voices of protest against the unrealistic addicts, heroin chic was an American cultural anomaly that expectations being imposed on young women, voices such lasted roughly six years. It was intended to be the next new as Gillian Bobkoff, a British model in the ’60s, decrying thing, the hot “in look,” but, in the end, it was only a the movement: “It was dreadful. [Twiggy] started a trend, ghoulish fad. and you had to be just the same. I had my hair cut and Synonymous with the decadence of the 1990s, heroin started killing myself, taking a million slimming pills. I had chic’s roots sprang from two unique decades of exciting bulimia. It was a nightmare, trying to keep up.” Anna Greer, British culture. The first was the London fashion scene of editor of the feminist Wo! Magazine, charged that “Eating the 1960s. London was the birthplace of numerous artistic disorders are a huge problem for especially teenage girls, trends that reflected the incredible energies of Beatlemania, and I think the impossible body ideals imposed on them the English Invasion, the James Bond craze and Carnaby by the fashion industry and media and pop culture is obvi­ Street fashion. London-based designers, artists and models ously a huge contributor to this.” created trends, such as Dr. Martens and Mary Quant de­ It is difficult to comprehend anorexia as a fashion signs, that resonated around the globe. Heroin chic also ­concept, yet the macabre trend endured. Twiggy, first in mimicked punk fashion, developed in the waning days of a parade of emaciated models, promoted the extreme look the late 1970s. It echoed the hard street culture of the in the 1960s and, three decades later, Kate Moss, the drugged-out London underground, individuals who “Twiggy of the ’90s,” was recruited to promote heroin sported colored, spiked hair, leather jackets and safety-pin- chic. pierced ears. Heroin chic was the basis of a 1993 Calvin Klein adver­ A unique aspect of feminine beauty also emerged during tising campaign that featured Kate Moss and actor-film this period. Lesley Hornsby, aka Twiggy, was a salon sham­ director Vincent Gallo. Later, in 1997, Klein released a poo girl who rapidly became a global celebrity after her notorious set of print ads that again used junkie-like ­models, photo was featured in a Daily News article titled “This is this time to promote his new perfume cKbe. Some of the the face of 1966.” Standing at 5'6½" with a 91-pound sickly models appeared to be in the throes of withdrawal. pubescent figure, Twiggy was acknowledged as the world’s All were young, drastically underweight, and conveyed that first supermodel. The 17-year-old Twiggy exemplified the lost, spaced-out look. mod look—androgynous, anorexic and hip—that set the Chic, cont. on page 18 www.naadac.org NAADAC News 17 NEWS FOR PROFESSIONALS

Clinton used the opportunity to attack The body mass index is a measure­ the destructive heroin chic. He stated, ment of body fat that doctors typi­ “In the press in recent days, we’ve seen cally apply to study obesity. It is based reports that many of our fashion lead­ on height and weight and calculated ers are now admitting—and I honor for both adult men and women. Any them for doing this—they’re admitting reading under 18.5 is considered to be flat-out that images projected in fash­ underweight, and a reading under 15 ion photos in the last few years have is considered “grossly underweight.” made heroin addiction seem glamor­ United Nations health experts have ous and sexy and cool. And as some of recommended a BMI of between 18.5 those people in those images start to and about 25 for healthy individuals. die now, it has become obvious that On a sad, related note, Luisel’s this is not true. You do not need to 18-year-old sister Eliana Ramos, also glamorize addiction to sell clothes.” a model, died at her grandparents’ “American fashion has been an home in Montevideo of an apparent enormous source of creativity and heart attack. Her death, on February beauty and art, and frankly, economic 13, 2007, was believed to have been prosperity for the United States, and caused by malnutrition. we should respect that. But the glori­ The 21-year-old Brazilian model fication of heroin is not creative, it’s Ana Carolina Reston, who worked for destructive. It’s not beautiful, it is ugly. Giorgio Armani, had been in the busi­ And this is not about art; it’s about life ness since the age of 13. Reston was and death. And glorifying death is not hospitalized on October 25, 2006, for Automation, from page 17 good for any society. Society can’t take kidney malfunction due to anorexia a tough attitude toward illegal drugs and bulimia nervosa. Her condition Heroin, a morphine derivative, was and on the other hand send a very became more serious and deteriorated a likely choice for those working in the dif­ferent message every time there into generalized infection that led to fashion industry. As a drug that sup­ might be a little money to be made out her death. At the end of her life, in pressed the appetite, heroin allowed of it.” order to maintain a lowered body models enough euphoria and energy Even the comments from a standing weight, she ate only tomatoes and to work long, strenuous hours under American President held little sway as apples. Reston died on November 14, the lights and in front of the cameras. the emphasis on the waif look trans­ 2006, in a San Paulo hospital. At the But it was also dangerous and raised lated into more photo shoots and fi­ time of her passing Reston weighed scattered voices of concern. In 1996 nancial gain. Perhaps the tipping point only 88 pounds and stood 5'8". Her the Los Angeles Times argued that the occurred after the terrible 2006 deaths BMI was a shocking 13.4. fashion industry had “a nihilistic vision of two Latin American models who One immediate consequence of of beauty” reflective of drug addiction. starved themselves to death. Reston’s death emanated from the U.S. News and World Report called the On August 2, 2006, Luisel Ramos Spanish Association of Fashion De­ heroin chic movement a “cynical died soon after stepping off the Mon­ signers, who banned underweight trend.” tevideo, Uruguay, Fashion Week run­ models on the basis of their BMI. As After a revealing New York Times way. Ramos, a 22-year-old Uruguayan of September 18, 2006, rail-thin mod­ article on photographer Davide Sor­ model, fainted on the way to her dress­ els with a BMI below 18 were rejected renti’s fatal heroin overdose, President ing room and suffered “heart failure from the Madrid catwalks and offered Bill Clinton accused the fashion indus­ caused by anorexia nervosa.” Medical medical treatment for their anorexia. try of portraying heroin use as a glam­ personnel were unable to revive her. The Madrid group explained that it orous, fashionable drug and an at­ According to her father, the model had wanted to promote a more positive tempt at promoting clothing lines. On gone “several days” without eating and healthy aesthetic of feminine May 21, 1997, in an address organized and, for a three-month-period, had beauty for teenagers to follow. That by the United States Conference of existed on a starvation diet of salads, mindset was not lost on Spain’s Asso­ Mayors, Clinton addressed a group of greens and Diet Coke. At the time of ciation in Defense of Attention for 35 mayors. The White House meeting her death she stood 5'9" and weighed Anorexia and Bulimia, which threat­ was intended to discuss issues of drug 98 pounds. Her body mass index ened to have the government legislate control in major American cities, but (BMI) was only 14.5. to ban stick-thin models if designers

18 October/November 2011 www.naadac.org NEWS FOR PROFESSIONALS

beauty? Starvation, as explained by the provide our youth with appropriate Food and Agricultural Organization role models who project positive values of the United Nations, is a “severe and body images. The physical de­ reduction in vitamin, nutrient and struction and celebration of addiction, energy intake,” and is the most ex­ as reflected in heroin chic, has endured treme form of malnutrition. In hu­ long enough, both on and off the mans, prolonged starvation (in excess catwalk. of one to two months) causes perma­ nent organ damage and will eventu­ Maxim W. Furek, MA, CADC, ally result in death. ICADC, is Director of Garden Walk What began with “the Twiggy look” Recovery, an organization promoting was generally ignored for the next wellness through drug prevention and three decades, but then, that deliberate education. His book The Death Proc­ look of death found a new home in the lamation of Generation X: A Self 1990s. Heroin chic became an exam­ Fulfilling Prophesy of Goth, Grunge ple of a purposeful and deliberate act and Heroin is currently being utilized of self-destruction, on the part of at Penn State University as “recom­ fashion designers, that exploited a mended reading” for “Introduction to vulnerable group of individuals. Young Abnormal Psychology” and “Health women need a dramatic alternative, a Psychology.” He is a member of paradigm shift, away from the images NAADAC and can be reached at www. that are being bombarded at them. As maximfurek.com. a caring and protective society we must refused to cooperate with the volun­ tary restrictions. Italy’s fashion industry followed in December 2006, as it, too, imple­ mented a code of conduct to battle anorexia. The self-regulatory code was intended to ban models younger than Need Continuing 16 and called for fashion collections to add larger sizes. The code, drawn up in cooperation with the Italian govern­ Education Credits? ment, also required models to provide medical proof that they did not suffer from eating disorders. It has been es­ timated that about three million indi­ viduals suffer from eating disorders in Italy. The Italian fashion code aimed Earn 22 CE to redefine feminine beauty and to s on promote “a healthy, sunny, generous NAADAC’s we Mediterranean model of beauty.” bsite Yet despite the controversy, the . outrage and the deaths, there were some in the industry who definitely were not convinced. In their 2006 U.S. Autumn collections the Banana Republic and Nicole Miller group in­ For more details, visit troduced, for the first time, “sub-zero” sized fashions for American women. Why have we allowed individuals www.naadac.org/education like Twiggy—with a skeletal BMI of

14.7—to redefine our standard of | iStockphoto.com Bishop Keith www.naadac.org NAADAC News 19 NAADAC News NON-PROFIT NAADAC Education and Research Foundation ORG. 1001 N. Fairfax Street, Suite 201 US POSTAGE Alexandria, VA 22314 PAID PERMIT #2896 MERRIFIELD, VA

UPCOMING EVENTS

November 4, 2011 November 15, 2011 November 18 – 19, 2011 December 4 through December 11, 2011 Sign the Petition Supporting Drug Promoting Awareness of Motivational Free Workshop: Treatment of TB, STDs, Exam Dates for the Winter NCAC I, NCAC II, Prevention Incentives (PAMI) HIV, Hepatitis C and Substance Abuse on MAC, ASE, Nicotine Depen dence Specialist Tell the White House that prevention needs Salem, OR the Border and Basic Exams more support. 4-hour Workshop (4 CE Hours) Bisbee, AZ For credential descriptions, please visit More details at http://wh.gov/2Yh. Principles, history, research and suggestions Continuing education hours through NAADAC www.naadac.org. for overcoming implementation barriers of and NASW will be awarded. The Professional Testing Company adminis- November 12 –18, 2011 Motivational Incentives will be discussed. More details at http://cabhp.asu.edu/files/ ters testing for the NAADAC National Certifi- NAADAC Professional Exchange Details at www.attcnetwork.org/regcenters/ blasts/treatment-of-tb-stds-hiv-hepatitis-c- cation Commission. For more information on Havana, Cuba trainingevents.asp?rcid=10&ViewType=1. and-substance-abuse-on-the-border. the exam, visit www.ptcny.com/clients/NCC. For more details contact Cynthia Moreno Tuohy at [email protected]. Wednesday, November 16, 2011 November 28 – December 6, 2011 December 15, 2011 HIV, Meth and Engagement in Care: Train-the-Trainers in the Foundations of Webinar – Clinical Supervision: Keys to Monday, November 14, 2011 What Clinicians Need to Know Addiction Practice, Conflict Resolution and Success HIV, Meth and Engagement in Care: Yuma, AZ SBIRT Time: Noon–2pm EST (includes live Q&A at What Clinicians Need to Know This free continuing education workshop is Majuro, Republic of Marshall Islands the end of the presentation) Yuma, AZ available to physicians, physician assistants, For more details contact Cynthia Moreno Full details at www.naadac.org/education. This free continuing education workshop is nurse practitioners, nurses and other Tuohy at [email protected]. available to physicians, physician assistants, providers serving the impacted patient MARK YOUR CALENDAR FOR 2012 EVENTS! nurse practitioners, nurses and other populations. November 29 – December 1, 2011 March 12–14, 2012 providers serving the impacted patient More details at http://cabhp.asu.edu/events. Group Counseling and Facilitation Skills Advocacy in Action Conference populations. Honolulu, HI Washington, D.C. More details at http://cabhp.asu.edu/events. November 17, 2011 3-day Course (18 CE Hours) Meet with lawmakers and learn about trends Webinar – Change is Coming: New If you would like to register for a workshop impacting on the workforce. Regulations in 2012 for Diagnosis Codes please go to NFATTC’s Training & Events For more information, visit www.naadac.org/ and Claim Submission calendar at www.attcnetwork.org/regcenters/ advocacy. Earn 2 continuing education credits trainingevents.asp?rcid=10&ViewType=1 Noon EST NAADAC Workforce Development Summit More details at www.naadac.org/education. November 30, 2011 Creating, Sustaining and Retaining the Hawai’i Association of Addiction and Drug Addiction-Focused Workforce Abuse Counselors Monthly Meeting Washington, D.C. More details at www.cchono.com/~fratzke. For more information, visit www.naadac.org. Kaiser Sosa | iStockphoto.com Kaiser For a complete interactive calendar, visit www.naadac.org/education > Calendar of Events Have an event we should know about? Contact 800.548.0497, ext. 125 or email [email protected].