In the first part of this column, I pointed out some unsettling research implications for our field. Sooner or later, these implications will have a direct impact on your everyday work.

In a nutshell, the past research methods have not been up to the task of answering our ever complex treatment questions. The traditional technology model of psychotherapy research doesn’t seem able to give us clear answers as to what parts of various addiction therapies work as they are supposed to work. For example, why does Cognitive Behavior Therapy (CBT) work with one client and not another? The same can be said for Motivational Interviewing (MI), Behavior Couples and 12-Step oriented treatments. You now need to recall mediators and moderators, those pesky co-variants that screw-up everything.

The current research methods  seemingly cannot do the job. Yet, we shouldn’t  abandon the old ways; rather, we need new methods to peer deeper into addiction treatment. Specifically, the technology model of psychotherapy is limited by what is called its linear, dose-response assumptions. Basically, the research model assumes you give a quantity of treatment in a straight, uniform manner. However, that cannot account for all client and counselor variables which not only confuse the technology model, but also yield confusing results.  

We need something new—something that better explains the interactions that take place, such as rapport, bond, relationship (non-specific effects); and specific effects (change talk, refusal skills, belief in spirituality, etc.), as well as the back and forth mix between them.
Morganstern and McKay (2007) discuss three such approaches. The first two—critical sessions and patient-focused research—focus on new research strategies to model client response to various effects. They are still in development, and what they presently offer is limited. The third approach—generic model of psychotherapy—studies the interaction between non-specific and specific factors.

Have you ever noticed how one client session can produce sudden—and sometimes noticeably more significant —changes in a client? Further­more, these changes don’t die out in a week, but seem to continue. Some data indicates that just prior to these sudden changes, certain clients began to process what is going on in therapy better. Often, good adherence to treatment goals and good alliance in early sessions set the stage for these sudden breakthroughs. In addition, key mediators, such as increase in self-efficacy (e.g., thinking “I can do this”), or the ability to better handle a craving, may lay the ground work for a sudden gain. Basically, critical session models point toward finding subgroups of clients who respond well to specific treatments. Instead of applying one treatment, such as CBT, to all your clients, you may want to apply parts of the treatment to selected clients. The idea is to find who responds to what and use more of the application on this subgroup. For instance, research indicates that MI seems to get better results from clients who have high levels of anger. However, that does not mean you should use MI with all your angry substance abuse clients. It does mean you may have to become more sophisticated in your application of treatments to clients, and not just apply one treatment across-the-board. This approach requires more thought, more assessment and more work, but the end product would be potentially higher levels of recovery.

While interesting and promising, not much is available from this perspective at this time which remains in development.
This approach, which is also known as treatment algorithms, claims that there is sizeable variability in the way clients respond to treatment. Thus, it is very difficult to predict how clients will respond to any one intervention. Therefore, you have to collect data after each and every session (not just progress notes). Based on that data, you can make modifications to your treatment direction. In terms of addiction, this research model is still very much in development. We do know from all that data collected from treatment sessions may emerge decision rules (algorithms) which can guide or modify your treatment. Some of the data collected could include: daily or weekly substance use levels; 12-step group attendance (daily/weekly); and changes in a client’s level of self-efficacy. As stated, how all this comes together is still in the development process, but if created, such protocols

The genetic model of psychotherapy views therapy as dynamic, evolving and ordered (Orlinsky, Rønnestad and Willutzki, 2004), and focuses on the interaction between non-specific and specific factors. From this perspective, you are to pay attention to critical components of treatment that include what’s inside a session and what happens across many sessions. There are five components:
• The therapeutic contract, or roles played by client and counselor, whether treatment is conducted individually or in a group, as well
as treatment model and session schedule, among others.
• Therapeutic operations, which include how the client presents his complaints and problems; how he thinks; how the counselor under­stands the client (e.g., diagnosis, case formulation); the strategy used (e.g., 12-step model); and how the client responds or cooperates with the interventions.
• Therapeutic bond, or the quality of involvement and rapport between client and counselor
• In-session impacts, or therapeutic realizations, such as insights vs. confusion, relief vs. distress, as
well as the counselor impact,
such as frustration vs. feeling
good about a session.
• Temporal patterns, or distinctive moments of facilitation as well as total number of sessions.

Efforts are being made to figure out how to code these components for a session, so that counselors can assess actual progress with clients, rather than relying on hunches. After several of these coding sessions you are able to effectively correlate what contributed to a client’s positive or negative outcome. Such specific information could hold more weight as to why clients don’t change, versus blatantly faulting denial or client laziness.

The bottom line to these new research approaches is that they tell us treatment is more complex then simply applying a treatment model to a client. Truth be told, addiction treatment always was complex. It was never about simply apply treatment “X” and get “Y” results.
Since the newer research models need more time to evolve, only the briefest application ideas are outlined here. In terms of critical sessions,  you can  be observant of what seems to precede critical sessions, be it the application of a certain therapy with a certain type of client; an increase of trust in the client-counselor relationship; a flash of client confidence; or whatever. The point is to really pay attention to what preceded a sudden breakthrough.

The practical application of the patient-focused model is a little tricky. The main idea is to collect data (e.g., days of sobriety, session attendance, a client’s self-proclaimed level of motivation) not just write the run-of-the-mill progress notes. The patient-focused approach requires a bit more work, but, in turn, will give you more information to work with. For example, once you have collected a month’s worth of data, you might be able to establish “a decision rule” to a client. A very primitive example might be, “When you attend your scheduled sessions on time, and you and I trust one another, you do not drink at all or as much. So, a decision for you to use might be to keep all your scheduled sessions, and work on keeping our trust strong.”

In terms of the generic model, one useful idea is just to code two of the five items listed above, such as therapeutic bond and in-session impacts. This code will be subjective, and can be as simple as a three point scale—high, nominal, none. Following each session, ask the client to select (high, nominal, none) for how he rates the therapeutic bond between you, and if the session made an impact on his treatment goals. After a few of these ratings, you should get an idea if your counseling is making a difference in the recovery process. If the ratings are high, you may be on the right track. If the ratings are low, that might signal that you need to improve your professional relationship. In addition, if the ratings are low you would need to adjust.

Keep in mind that past research methods are showing their limitations as we get deeper into the 21st century. These promising new research methods may well have the potential to reveal new and meaningful ideas for addiction treatment strategies.  

Mike Taleff has written numerous articles, several books, teaches at the college level, and conducts trainings and workshops (e.g., the latest treatment practices, Critical Thinking and Advanced Ethics). He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


References
Baron, R.M. & Kenny, D.A. (1986). The moderator-mediator variable distinction in social psycholoical research: Conceptual, strategic, and statistical considersations. Journal of Personality and Social Psychology, 51, 6, 1173–1182.
Morgenstern, J. & McKay, J.R. (2007). Rethinking the paradigms that inform behavioral treatment research for substance use disorders. Addiction, 102, 1377–1389.
Orlinsky, D.E., Rønnestad, M.H. & Willutzti, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. Lambert (Ed.). Handbook of psychotherapy and behavior change. (5th ed., pp: 307-389). New York: John Wiley & Sons.
Wigner, D.E., & Solberg, K.B. (2001). Tracking mental health outcomes: A therapist’s guide to measuring client progress, analyzing data, and improving your practice. New York: John Wiley & Sons

This article is published in Counselor, The Magazine for Addiction Professionals, February 2010, v.11, n.1, pp.16-17. 

Methamphetamine use is widely recognized as a problem that has ravaged many parts of the country, with rural areas being particularly hard hit (California Department of Alcohol and Drug Programs, 2007). The drug carries detrimental consequences not only for the users, but also for the communities in which these users reside.

Many communities have seen problems ranging from increased violence and crime, family deterioration and environmental contamination, to strains on child welfare  agencies that are having to place children displaced in law enforcement raids on residences where methamphetamine is manufactured or used.

Recovery management is an emerging approach geared toward treating addiction, similar to how other chronic and progressive illnesses, such as cancer and diabetes, are treated (W. White, E. Kurtz, & M. Sanders, 2006). This treatment is usually longer term and often is anchored in the client’s natural environment. There are three phases of recovery management, which make it an ideal approach with methamphetamine users—pre-treatment recovery support, in-treatment recovery support and post primary treatment recovery support.

Pre-treatment recovery support
This phase often involves the use of recovery coaches (individuals in recovery) who engage clients in their natural environments prior to treatment, with the goal of motivating them to seek help for their addiction. In spite of the fact that methamphetamine use is a continuous crisis in rural America, methamphetamine users constitute only eight percent of all U.S. treatment admissions (SAMHSA E-Network, 2009). Their symptoms (i.e., apathy, feelings of depression, isolation, involvement with destructive peer groups and physical deterioration) make it difficult for methamphetamine addicts to reach out for help (California Department of Alcohol and Drug Programs, 2007). I recently heard a CSAT administrator state, “If they’re not coming in, we’ll have to go out and get them.”

In-treatment recovery support
Approximately 50 percent of chemically dependent clients leave treatment prematurely (White, 2005). Methamphetamine addicts have biopsychosocial challenges (California Department of Alcohol and Drug Programs, 2007) that make completing primary treatment even more difficult, including: memory deficit , which makes it difficult to grasp materials presented in treatment; intense cravings that send them rushing out the door, against medical advice, to purchase methamphetamines; depression, resulting in a lack of energy to participate in treatment; and heightened emotionality and anger, which can lead to outbursts and a tendency to leave treatment early or be administratively discharged.
One study indicated that 50 percent of methamphetamine addicts drop out of inpatient treatment prematurely, and 70 percent drop out of outpatient treatment (California Department of Alcohol and Drug Programs, 2007).

A promising approach is the use of recovery coaches to engage clients during their initial treatment, in order to encourage and motivate them to complete primary treatment. These recovery coaches also can serve as a link to the outside world, as 80 percent of clients who relapse do so within 90 days of completing treatment (White, 2005). The State of Connecticut uses volunteer recovery coaches to meet with clients while they are in primary residential treatment. While they are inpatients, the recovery coaches provide recovery support and then follow up with weekly phone calls for 12 weeks following discharge. Research reveals that 80 percent of these clients are still sober at the 90-day period (White, 2008).

Post-primary treatment recovery support
Methamphetamine addicts face many difficulties upon discharge that make staying sober a challenge (Ojbert J.L., 2000), including:
• Criminal record—Methamphetamine users are more likely to be under criminal justice supervision than other clients, making it difficult to secure employment.
• Intense cravings—This often lures meth users back to active addiction.
• Depression and anhedonia—For approximately one-and-a-half months following discontinuing use, meth addicts often feel depression and have difficulty achieving pleasure from anything other than drug use. This increases the chance of relapse.
• Difficulty with memory and cognitive impairment

Clients requiring the greatest recovery support include those with the highest problem severity and lowest recovery capital (i.e., internal and external assets that aid in recovery efforts) (White, W. & Cloud,W., 2008). According to Brecht (2005) these include clients who: live in rural communities where there are often fewer resources and for which they have to travel long distances to access; have less education than a high-school diploma; suffer with co-occurring disorders; with histories of sexual trauma; started using methamphetamines at an early age; have greater severity of meth use; and inject methamphetamines.

Recovery coaches can arrange for a range of services to these clients in early recovery, including: social recovery support; assistance in arranging travel to and from treatment resources; vocational and occupational recovery support; symptom management support; help with problem solving and decision making; help with disengagement from drug cultures; help with linkages into communities of recovery; and support around family reintegration.

Rarely, in modern history has a drug developed such a stronghold over rural America in such a short period of time. Recovery management offers clients, families and communities a great deal of recovery support before, during and after primary treatment.

Mark Sanders, LCSW, CADC, is on the faculty of the addictions studies program at Governors State University. He is a consultant for Great Lakes ATTC and CEO of On The Mark Consulting, an international training and consulting organization.

References
Brecht, M.L., Greenwell, L. & Anglin, M.D. (2005). Methamphetamine Treatment: Trends and Predictors of Retention and Completion in a Large State Treatment System (1992—2002). Journal of Substance Abuse Treatment, 29(4), pp. 295–306.
California Department of Alcohol and Drug Programs (2007), Methamphetamine Treatment: A Practitioner’s Reference (2007) Sacramento, CA .
Gonzales, R., Marinelli-Casey, P., Shoptaw, S., Ang, A.& Rawson, R.A. (2006). Hepatitis C Virus Among Methamphetamine-dependent Individuals in Outpatient Treatment. Journal of Substance Abuse Treatment, Vol. 31, pp. 195–202.
Hoffman, D.B. & Lefkowitz, R.J. (1993). Catecholamines and Sympathomimetic Drugs. Pharmacological Basis of Therapeutics 8th Edition, New York: McGraw-Hill, pp. 187–220.
Holton, W.C. (2001). Unlawful Lab Leftovers. Environmental Health Perspectives, 109(12) A576.
Olbert, J.L., McCann, M.J., Marinelli-Casey, P. et al (2000). The Matrix Model of Outpatient Stimulant Abuse Treatment: History and Description Journal of Pschoactive Drugs, 32(2), pp. 157–164.
Cognitive Deficits among Methamphetamine Users with Attention Deficit Hyperactivity Symptomatology, Journal of Addiction Disorders, Vol. 21, pp. 75–89.
SAMHSA (2009) TEDS 2007 Highlights Report http://
oas.samhsa.gov/TEDS2k7highlights/TOC.cfm
White, W., (2008) Perspectives on Systems Transformations. Chicago, IL: Great Lakes ATTC.
White, W., Kurtz, E., Sanders. M. (2006) Recovery Management. Chicago, IL: Great Lakes ATTC.
White, W. (2005) Recovery Management: What if We Really Believed that Addiction Was a Chronic Disorder? Chicago, IL: GLATTC Bulletin.

“Knowing your own darkness is the best method for dealing with the darknesses of other people.”
—Carl Jung

As we usher in the New Year, it seems prudent to reflect on the symbols of dark and light. After all, winter is an invitation to the hibernation and renewal of one’s soul. Such introspection can lead to enlightenment and, as Jung asserts, the ability to counsel others with greater compassion and discernment (Jung, 1973).

Such a moment of clarity can be illustrated by two experiences of a dear friend who confronted some fears and woke up bathed in the warming sunlight of growth. The first reflection involves facing a deep-seeded literal fear of the dark, with subsequent freedom to walk in the light:
I used to be afraid of the dark, and felt my older brothers made me so. I’m still afraid of the dark, but when need be, I call out for help and on I go. To deal with my fear of the dark I used to only walk when it was light so I wouldn’t feel the fear. I’m still afraid of the dark, walk in it anyway and am able to find my way home. That’s because I never walk alone.

Many of us in the helping professions have taken a courageous and long walk through the darkness of our depths. For me the reward has been a resilience that propelled me beyond the pain to recognition of my truth, which has allowed for an ongoing healing process. It’s difficult to encourage others to walk when we can’t help them see and understand the path that lies ahead.

A journey and a peace not planned
The same gentle man who faced his fear of the dark also went on an unplanned “flight” to forgiveness and renewal. He had planned his first past life regression session with a sensitive practitioner in his home state of Rhode Island. To his surprise and delight, the session took a turn when the woman suggested he begin by first seeing himself flying over the New England shore.

He saw himself with arms outstretched, wind in his face with a bird’s eye view of woodlands below and the ocean bay ahead. He recounted, with eyes closed, the next portion of his journey. “I plunged head long into the water like an Olympic diver. The water was warming and crystal clear. When I broke the water’s surface my breath was exhilarating, not desperate,” he recalled.

Even more vivid was his detailing of coming out of the water and walking onto the wrap- around, wooden deck of a beach house and taking a seat on a wooden chair facing the ocean: “My feet were resting on the wood railing and I was wearing a black cowboy hat pulled down over my nose. I felt the warmth of the sun mingling with perspiration and salty ocean droplets.”

At this point he was moved to stand up. “As I did, I flung the black hat Frisbee style, away from the water and three-quarters of the way around the right side of the house. It landed in the middle of a huge pricker bush with red berries, like the one beneath the big Japanese Magnolia in the front yard of my childhood home.” He explained that the hat represented the responsibility he had taken for being sexually abused as a pre-teen and the pall it cast on his life, loves and acceptance of self. “I will never pick up that hat again!” What courage and insight I was blessed to witness. This man now looks forward with hope and not back in dread.

Anticipation and hope
Anticipation of what the New Year will hold for each of us is a gift and a freeing invitation to begin anew. I’m a collector of old postcards and antique booklets of prose. On the Threshold of the Year speaks of this theme of renewal and hope (Downey, 1900):

On the threshold of the year, ere the snow wreaths disappear, half in hope and half in fear, waits the heart…On the threshold of the year see, the Lord is standing near, and the heart forgets its fear in His smile. Trembling soul, He speaks to thee, “I Myself, thy guide will be—All the way is known to me, mile by mile. On the threshold of the year, if the path looks dim and drear, then my love shall make it clear to thine eyes; Only trust thy change-less Friend, if thou wilt on Me depend, what awaits thee at the end? Paradise!

Many a clinician’s journey has been successfully transitioning from a human doing to a human being, enlightened by willingness to walk in the dark to seek the light. Jung helps put a bow on the gift of the year ahead. “As far as we can discern, the sole purpose of human existence is to kindle a light of meaning in the darkness of mere being” (Jung, 1961).

Thomas M. Greaney, MEd, LADC, CCDP, provides his private practice clients in CT and RI with creative ways to view and overcome addiction. He facilitates groups for 18-24-year-olds at an agency in southern CT. Tom presents seminars on creative approaches to group therapy. Contact him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 860-912-2944.

References
Downey, S. (1900). On the Threshold of the Year. Marcus Ward & Co. Limited, London.
Jung, C.G. (1973). Letters, volume 1: 1906–1950. Princeton University Press, Princeton, New Jersey.
Jung, C.G. (1961). Memories, dreams and reflections. Random House/Pantheon Books, New York.

We have spent a good deal of time in this column over the years addressing issues of smoked marijuana. The American Medical Association’s (AMA) Council on Science and Public Health has spent just over a year working on a revision to its original report covering the potential medical uses of marijuana. The new report, released in November 2009, updates previous reports of 1997 and 2001, and essentially reviews the scientific literature released since the most recent report.

The report, titled Use of Cannabis for Medicinal Purposes, reveals that 13 (now 14, and quickly growing) states have enacted laws to in some way permit qualifying patients to use marijuana without legal repercussions. It notes that the federal government has refused to recognize any accepted medical benefit, however. So who is right; the state legislatures or the federal ­government?

The literature reveals that fewer than 20 randomized trials, involving a total of approximately 300 subjects studied for relatively short durations, have been conducted over the past 35 years. These trials indicate that smoked marijuana reduces neuropathic pain; improves appetite and caloric intake in patients with reduced muscle mass; and may relieve spasticity and pain in patients with multiple sclerosis. The studies do not demonstrate:  that the benefits outweigh the risks for long term use; that results with marijuana improve upon results possible with safer drugs; which ingredient within smoked marijuana is ­pharma-cologically responsible for accomplishing the achieved outcomes; and that marijuana has any medical value compared with traditional measures of prescription drug products.

Let’s look for a moment at an analogy. Imagine that I have a goal of improving the discomfort of a chronic cough in a patient with tuberculosis (TB). I conduct a short-term study that reveals that methadone nearly eliminates the cough, resulting in a marked improvement in patient comfort. That does not mean that methadone should be used as a medication for cough in TB, however. It simply demonstrates a relationship between use of methadone and cough suppression. Many other factors must be considered before applying this knowledge within a medical context. Might suppression of the cough worsen the underlying condition? Might methadone have side effects or direct effects that are far more hazardous than the cough? Might there be a result of long-term use of methadone to be considered? Could there be alternative cough suppressants that lead to a better resolution of the condition? Is it possible that other drugs would more readily treat the TB leading to resolution of the cough, and that use of methadone would delay the application of what would ultimately be a better treatment?

Given that a few short-term trials demonstrating a relationship between marijuana use and improvements in specific symptoms have been published, and given the enormous ­literature detailing the negative consequences of smoking marijuana, the AMA could not reasonably conclude that marijuana has any medical value. What it did, however, based on the small positive evidence and the increasing legislation flying in the face of existing evidence, was to call for adequate and well-controlled studies of marijuana in patients who have serious conditions for which anecdotal evidence suggests possible value. A way to ease the path to legitimate clinical research would be to remove marijuana  from Schedule I. Since there is no current alternative DEA Schedule into which marijuana would readily fit, the AMA asked that the Schedule status be reviewed with the goal of facilitating appropriate clinical research. The AMA specifically stated that this is not an endorsement of medical cannabis, legalization, or that existing scientific evidence meets current standards for a prescription drug.

Within 24 hours of the AMA’s release
of the new report, the National Organization for the Reform of Marijuana Laws (NORML) released a press release titled, “AMA Calls for Ending the ‘Schedule I Lie.’” The release states that the AMA “demolished long-held pot prohibitionist claim . . . that ‘no sound scientific studies have supported medical use of smoked marijuana.” NORML supported this contention by quoting the AMA’s report where it presents the results of short-term controlled trials that I described above. In fact, the AMA’s report did not demolish the claim that no sound scientific studies have supported medical use of smoked marijuana; rather, the report shows quite directly that no sound scientific studies have supported such use. The spin, however, takes advantage of the hoped-for failure by the general public and state legislatures in recognizing the difference between studies that support use and studies that demonstrate a relationship.

Even the National Center on Addiction and Substance Abuse at Columbia University missed the boat initially, releasing a story that ran with the headline, “AMA Says Marijuana has Medical Uses, Calls for More Research,” and a lead that read, “Marijuana has been shown through limited research to have proven medical uses, the AMA said in a new policy statement . . .” The news feature, published as part of the Join Together website, was quickly amended to more accurately reflect the actual content of the AMA report, but this proved a demonstration of just how easily this material can be misinterpreted.

The Los Angeles Times, in its Nov. 21 editorial, titled “The AMA’s reversal on marijuana,” asked readers to “hold the brownies” and to note that “ideally, major healthcare policy shouldn’t be enacted by popular opinion. In that light, the AMA’s recommendation is all the more powerful for its restraint.” The Times has been, in the past, supportive of the California Compassionate Use Act, noting now that legalization for medical purposes has been based upon “a small body of research.” They agreed ultimately that more facts are needed.

And that is, at this point, the proper choice—a component of marijuana may indeed have medical value. We need further study to determine whether there is value, and what component is valuable, so as to avoid having far more widespread use of a known addictive agent than we already have.

Stuart Gitlow MD MPH MBA is a member of the American Medical Association’s Council on Science & Public Health, and an officer of the American Society of Addiction Medicine. This column represents his personal opinion and does not imply any position or policy taken by either the AMA or ASAM.

The days of treating alcohol and drug abuse and dependency issues from a punitive or criminal justice approach have proven to be ineffective and counterproductive. President Obama’s administration has encouraged Congress to recognize that health care reform focus on wellness and prevention. For the past 20 plus years, The California Association of Alcoholism and Drug Abuse Counselors  (CAADAC) has attempted to obtain parity via licensure by political lobbying and support. Perhaps educating policy makers about the impact alcoholism and drug dependency has on public health and safety would cause acceptance of meeting our industry’s financial needs. Though many policymakers are becoming aware of the benefits of treatment, many still view addiction as a moral issue. CAADAC has been very fortunate in recent years to have champions like Congresswoman Mary Bono-Mack, Senator Mark DeSaulnier, Assemblyman Jim Beall Jr. and Assembly­man Charles Calderon in promoting awareness and support for treatment and maintaining funding.

Mental illness and substance use disorders cost society heavily. The National Mental Health Association estimates that mental illness costs society $205 billion a year (51 percent due to loss of productivity; 45 percent due to treatment costs; and 4 percent due to crime and welfare). The Office of National Drug Policy estimated that substance abuse costs in 2000 were $161 billion (69 percent to productivity loss; 22 percent to crime, drug control and welfare; and 9 percent to treatment) (DiNitto, 2005).

It seems that the basic solution for decreasing socioeconomic differences in healthcare is to minimize the inequalities in society that perpetuate poor health among the disadvantaged. Many fail to recognize that quality and quantity is poor among those who cannot afford healthcare services. The social stigma about addiction and mental illness continues to be the blame for low public usage of such social services. With the federal government promoting outcome measures and evidence-based campaigns in recent years, the entry level counselor or line-counselor is burdened with minimal resources and exhausting caseloads. This may, at times, impact retention of clients/patients as well as counselors. In addition, there may be a risk of providing poor quality of care due to counselor burn out.

Many substance abuse professionals are being forced to take furloughs, decreases in pay with increased responsibilities, and even face termination due to budgetary constraints.   If funding cuts continue at the current rate for mental health and substance abuse treatment, we may impact the workforce in such a catastrophic manner that it takes many years to rebound. I believe one of the main reasons that President Obama is so passionate about a national health program is that it would bring all U.S. residents up to a minimum acceptable standard and eliminate the worst of poverty which contributes to ill health.  The form of a progressive health care system has already been adopted in Maine, Vermont and Massachusetts. Other states, such as California, Illinois, Missouri and Louisiana have considered such an expansion in 2007 (Eitzen, Zinn, & Smith, 2009).

In conclusion, it is time that we pay special attention to the funding of programs, such as substance abuse treatment, and recognize addiction as a primary, chronic and PREVENTABLE disease. It has already been proven that incarceration and the punitive approach for non-violent drug offenses is ineffective. Prop 36 proved saved money and reduced the rate of recidivism. Let’s establish parity and funnel monies towards those heroes who are in the trenches saving lives as change agents on a daily basis. Contact your local legislative representatives and express your concerns about poor funding for substance abuse treatment.

Jose D. Aragon, CADCII, ICADC, SAP is the President of CAADAC.

References
DiNitto, D. (2005). Social Welfare: Politics and Public Policy (6th Ed.) Pearson Education, Inc.: Boston
Eitzen, D. Stanley, Zinn, Maxine Baca, & Kelly Eitzen Smith (2009). Social Problems (11th Ed.). Pearson Education, Inc.: Boston

In October, IC&RC member boards gathered to set the organization’s direction for the coming year and elected Rhonda Messamore, Executive Director of California Association of Alcoholism and Drug Abuse Counselors (CAADAC), President, and Scott Breedlove, Administrator for the Missouri Substance Abuse Professional Credentialing Board (MSAPCB), as Treasurer. Both offices hold two-year terms.

In her nominating speech, Messamore remarked, “I must pay tribute to our most humble, hard-working board members, staff, executive committee and our fearless leader for their tireless efforts and ongoing commitment, which has led IC&RC to be the most prominent organization for addiction and prevention certification in the world. As your President, I shall work diligently with every facet of IC&RC and all other national, international and local organizations. I am grateful to be surrounded by the many accomplished and notably experienced professionals that make IC&RC the premiere certification organization in the world.”

Messamore, who holds a CADC II and ICADC, oversees the California membership board, certification board and education foundation. She started her tenure with IC&RC in 2006, and since then has sat on multiple standing committees and advisory task forces, including Business Plan, Standards, Marketing and AODA.

In her home state, she serves on the several committees for the California Department of Alcohol and Drug Program Administration—Continuum of Services Redesign (including workforce development), Ethics Subcommittee and Certification Advisory Board.  

Messamore has worked as an addiction treatment provider for inpatient, outpatient, residential, therapeutic communities and women/children. She also is also a volunteer youth advocate with her church.

After the election, Messamore reiterated her “passion for consumer protection and maintaining the highest standards of competence.” She also described her determination: “It is with a grateful heart that I recognize Jeff Wilbee and his efforts to take IC&RC to the highest level. I am determined to continue his work, though his shoes are very hard to fill.”

Breedlove has been involved with the IC&RC since October 2006. During that time, he has served as the Distance Learning Taskforce Chair, Mentoring Taskforce Chair, Membership Services Co-Chair and Finance Committee Chair. He has a bachelor’s degree in Accounting and over 10 years of work experience in various Accounting work settings.

In his acceptance speech, Breedlove said, “As the MSAPCB Administrator, I have a good understanding of the needs facing member boards and as a member of the IC&RC Executive Committee, I have gained knowledge about how our organization operates and the needs and challenges we face to continue to move our organization forward. It would be my honor to serve the IC&RC as Treasurer for the next two years.”
Hope Taft, former First Lady of Ohio who  has been a vital advocate for the substance abuse prevention and treatment community gave the keynote address. She joins other governors’ spouses and co-chairs the Leadership to Keep Children Alcohol Free, an initiative dedicated to keeping children aged nine to 15 alcohol-free. Taft has been an active participant with the Substance Abuse and Mental Health Services Administration’s Too Smart to Start and Underage Drinking Programs, and has served on several committees.

“I was very happy when I was made a certified prevention specialist, which qualifies me for IC&RC’s CPS credential,” explained Taft. “I’m concerned now, because funding for universal prevention efforts is decreasing at a time when it should be increasing. I do work in Washington, and this year the national funding was zeroed out. I was told that all the letters to Congress were important, but they all came from professionals who had jobs to preserve. Where were letters from parents, business­people, the community?”

Taft went on to add, “Every child is at risk for early drug use. We need to think about how we can reenergize the broader public to make prevention a public issue.”

Kay Glass is the Marketing Director for the International Certification and Reciprocity Consortium (IC&RC).

Please join the National Association for Children of Alcoholics (NACoA) and the many others serving children and families, including NACoA’s affiliate organizations, as we celebrate Children of Alcoholics (COA) Week, February 14–20, 2010.  COA Week offers us a vehicle to do what is actually needed all year long—to help shatter the silence that is imposed upon children living in a home where there is parental addiction. Much can be done to spread the word that children living with addiction in the family need the support of caring adults. During COA Week we can join our voices to spread the word that children of alcoholics can be encouraged and supported to seek out help, and that they can and should have access to caring adults who are able to provide that help.

During COA Week we are all invited and urged to be a part of this critical public health campaign. Why?  Because we have the power to impact the lives of still-suffering and silent COAs . . . and so we should.      

Counselors can:
• Use the week to address the needs of clients’ children where addiction is or has been in the family by asking whether the child is receiving education and support through a structured group program and recommending local resources or school programs.
• Display the COA Week poster on a stand at the reception desk and leave the It’s Not Your Fault pamphlets and Al-Anon and Alateen information on the waiting room table or in the handout racks.
• Offer an educational program for school personnel—perhaps an in-service presentation—using the compelling DVD “Lost Childhood:  Growing Up in an Alcoholic Family” or the training DVD from SAMHSA’s free Children’s Program Kit.
Teachers can:
• Initiate activities—for example, poetry writing for middle and high school students or poster contests for elementary students—with a theme of helping students who live with parental addiction to understand that asking for help is important and that there are safe adults to whom they can turn.
• Ensure that drug education includes the perspective that the people hurt most by alcohol and drugs are the ones who don’t use at all—they are the one in four children who are living in a ­family with a parent who drinks too much or uses drugs.
• Leave fact sheets in the faculty lunch room on the impact of parental addiction on child development, including information on fetal alcohol spectrum disorder (FASD) and its often hidden cognitive impairment.
Child and Family Advocates can:
• Work with their local council on alcoholism and drug dependence or community anti-drug coalition to engage local media to focus on the “COAs in our midst who need our support” using public service announcements, radio and TV interviews and feature stories in neighborhood newspapers.
• Encourage adoption of whole family recovery support programs as part
of recovery planning for addicted ­persons.

NACoA welcomes the insights of Counselor readers about their COA Week activities. Resources mentioned above can be obtained through NACoA: This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 1-888-554-2627

In Pleasure Unwoven, Dr. Kevin McCauley addresses a question that has been a subject of debate for many years: “Is addiction really a disease?”
With Utah’s State and National Parks as the backdrop, Dr. McCauley educates viewers on the disease model of addiction by explaining complex neuroscientific concepts in an easy-to-understand documentary.

The DVD, which is available through the Institute for Addiction Study, is designed to help addicts and their families understand the disease that has hijacked their lives, and that recovery is possible. As such, it would be an ideal tool for clinicians and treatment providers to share with clients, to help them gain a better understanding of the biology of addiction, and to prepare them for treatment and recovery.

McCauley points out in the film that addiction is indeed a disease, not a moral failing or a personality failure, which he says are symptoms of the disease. According to McCauley, addiction occurs when something goes wrong in the frontal cortex, which is our social, emotional, moral and spiritual center. In a normal functioning brain, the frontal cortex exerts a top-down control over the unconscious survival impulses of the mid-brain, which tells us when to eat, defend ourselves and procreate. Although the mid-brain is essentially what keeps a person alive, it is not where thinking or choice occurs, McCauley said.

However, in addiction, the frontal cortex is short-circuited and the mid brain becomes more powerful at guiding behavior than the frontal cortex. McCauley cites experiments that have confirmed his theory that “addiction is pleasure unwoven.” Basically, addiction is a defect in the pleasure sense, affecting the brain’s ability to percieve, process and act upon pleasurable experiences, McCauley said.

It is for this reason, McCauley notes, that addicts are often seen in moral terms because their particular defect has to do with pleasure. McCauley further states the importance of coming up with a definition of addiction that everyone can agree on. If doctors had made the decision to call addiction a disease, then addicts would be going to treatment rather than being sent to prison, McCauley adds.