Milestone Ahead! Consent... · 2019. 8. 28. · The possibility of a lawsuit hovers over any deal between the state and the Mohegans, who operate the Mohegan Sun, and Mashantucket

Informed Consent

Informed consent is an ongoing process; it is not intended to be a one-time act.

Fall 2019

Q U A R T E R L Y N E W S L E T T E R O F T H E

C O N N E C T I C U T C E R T I F I C A T I O N

B O A R D , I N C .

9 8 S O U T H T U R N P I K E R O A D

W A L L I N G F O R D , C T 0 6 4 9 2

W W W . C T C E R T B O A R D . O R G

Volume 3, Number 3

Protecting the public by enhancing recovery - oriented workforce capacity

Milestone Ahead!

CCB Ready for 40th Anniversary On April 10, 1980, the Connecticut Alcoholism Counselor Certification Board, Inc., then located

in East Hampton, received its Certificate of Incorporation documentation from the Office of Barbara Kennelly, the Secretary of State. During the first year of incorporation, the organization

had receipts totaling $10,650 (the equivalent of about $31,000 in 2019) After a name change, several updates to the mission statement and more support from DMHAS, employers, and the

community, we now have an annual budget of about $325,000.00, certify nearly 1500 professionals with 13 different (and growing) credentials and offer computer-based examinations

in any number of professional disciplines. We are also looked to for expert training on best practices for the treatment of opioid use disorders, ethics and fighting stigma, and rank #15 in

scope of all of the 72 IC&RC-affiliated boards across the country and the world. Finally, the CCB has contributed to the development of the federal standards currently in use for the prescribing of

buprenorphine in SUD treatment, served as a reviewer for the American Society of Addiction Medicine’s most recent standards document and has consulted with both Democratic and Republican legislators in Washington, D.C. on issues related to the opioid overdose crisis. Plans are currently underway to mark the occasion with a one day conference and awards

reception, as well as other activities starting in January 2020. As more information becomes available, it will be published on our social media pages.

Above: The original financial affidavit of the Connecticut Alcoholism Counselor Certification Board supplied to the Secretary of State’s Office in 1981.

Also making their first appearance in

1980… ...Pac Man

...the NHL Whalers in Hartford

In July, the directors of the CCB approved the moving the main office and testing center from the

current Oakdale Office Park in Wallingford to a new location determined by the staff. Effective

December 1, 2019, we will be located at 55 West Main Street in downtown Meriden. The new

space will better suit the needs of the agency, with the added bonus of reducing some of the

associated costs of the current space. The building sits across from the Superior Court, close to

the newly built CT Rail station and newly redeveloped Meriden Green, the Meriden office of the

Department of Children and Families, and the police station . It was important to us to remain in

the center of Connecticut, and is easily accessed in just minutes away from both routes 91 and

691. Minimal on-street parking is available (with a 2 hour limit), and we encourage candidates,

certified professionals and visitors to use one of the downtown public garages or lots as we will be

able to offer 2 hours of free parking (covered or uncovered) with validation.

The move will take place during the month of November with little disruption to our services.

Computer-based testing will be unavailable at our site during the final 2 weeks of November, but

those wishing to test during that time will be able to at one of the other approved test centers. The

BBC testing center will be fully operational at the site on December 1. Please note that all initial

credentialing applications and renewals will be processed as usual.

Numerous other businesses have come and gone (as well as 2 owners!) to and from the property in

the time we have been here. We look forward to the move and a new chapter in the story of the

CCB, with the expectation that it will be a bittersweet process as the current staff have worked for

over 10 years in space at the Oakdale Office Park.

55 west main Street

Meriden, Connecticut 06451

Have a happy and safe fall season!

Connecticut lawmakers strike deal for Bridgeport casino, sports betting and online lottery, ending stalemate over expanded gambling

July 31, 2019 Stephen Singer Legislative leaders announced Wednesday a long-sought deal with Connecticut’s two tribal casinos to

build a third gambling site in Bridgeport, but Gov. Ned Lamont was not involved in drafting the legislation and said it has numerous shortcomings.

In addition to backing a casino resort in Bridgeport, the proposed legislation expands gambling by authorizing the Connecticut Lottery to offer online and app-based lottery ticket sales and to offer iKeno. Tribes also would conduct sports betting at the casinos, via mobile apps and internet gambling. Sports

wagering would be taxed at 8 percent and internet gambling would be taxed at 10 percent. Sen. Cathy Osten, a Sprague Democrat and strong supporter of the Mohegan Sun and Foxwoods Resort casinos, said she has requested a special legislative session for later this year to take up the measure. A

spokesman for the Senate’s majority Democrats said leaders in the House and Senate are considering the request and will consult Lamont before making a decision.

Lamont said he received the draft legislation only last week. “A matter of such significance requires substantial involvement from multiple stakeholders, in particular

the executive branch,” he said. The governor said he is seeking a “global resolution that mitigates the likelihood of years of litigation and positions the state to capitalize on a comprehensive gaming platform.”

The possibility of a lawsuit hovers over any deal between the state and the Mohegans, who operate the Mohegan Sun, and Mashantucket Pequots, who run Foxwoods. MGM Resorts, which operates casinos in Springfield and Yonkers, N.Y., has considered Bridgeport as a site for a casino. A spokesman said MGM

would not comment. Rodney Butler, chairman of the Mashantucket Pequot Tribal Nation, and James Gessner, interim chairman of the Mohegan Tribe, said they are “extremely grateful for the bipartisan support.” “We’ve long believed

that the best way forward for the state is to protect and preserve the historic partnership with our two tribes, one that’s generated more than $8 billion in revenue for Connecticut,” they said.

Compacts with Connecticut give the tribes exclusive rights for slot machines in return for paying the state 25 percent of the proceeds. In the state budget year that ended June 30, that amounted to nearly $253

million. Lamont said the measure also falls short of what he wants for Bridgeport: “A bill that only authorizes vs. requires a meaningful project in Bridgeport is not good enough.” “The administration looks forward to its

participation in ongoing negations with the tribes," the governor said. The legislation calls for the tribes to spend a minimum of $100 million on the Bridgeport site that would be an anchor for private development around the casino facility that would bring the total project development

to $300 million. Construction and surrounding development will create at least 1,000 construction jobs and lead to 500 permanent jobs at the development, lawmakers said. The facility is expected to generate $15 million

annually for the state. The deal ends a stalemate among lawmakers divided along party lines and geography. Several Republicans were uneasy with expanded gambling in Connecticut and rural legislators who represent the tribal casinos

in Uncasville and Mashantucket and urban lawmakers in Bridgeport failed to find common ground. “The proposal being presented today takes action and doesn’t pit Connecticut communities against each

other," said Rep. Christopher Davis, R-Ellington. Osten said the legislation will “deepen our partnership with two of our biggest employers and our large

single taxpayers.” “With slot revenues showing a steady and gradual decline because of increased competition, we can’t afford to kick the can down the road,” she said.

In the fiscal year that ended June 30, Mohegan Sun and Foxwoods posted revenue of about $1 billion, down nearly 7 percent from the previous year. In comparison, the two casinos posted $1.7 billion in

revenue in the fiscal year that ended June 30, 2007. Connecticut’s casinos face growing competition. Encore Boston Harbor, a $2.6 billion gambling, hotel and entertainment complex owned by Wynn Resorts opened June 23 in Everett, Mass., 10 months after MGM

Springfield launched.

See Hartford Courant, next page

Hartford Courant, Continued Asked about a possible lawsuit by MGM to block the deal, Osten said, “MGM is a litigious company. They

have sued many people. That’s what they’ve done in the state of Connecticut, to stymie growth in business.”

The legislation places all of the financial risk on the tribes. If a court overturns any part of the law, the bill is rescinded. Osten said lawmakers from delegations representing Bridgeport, southeast Connecticut and East Windsor, where the two tribes are planning a casino to stem traffic to the MGM Springfield casino,

were key players in drafting the legislation. “I believe the problem was we were not cohesive in our messaging,” she said. “Now we have the combined effort of three delegations.”

The legislation also calls for a 10 percent contribution from a casino in Bridgeport to the state’s tourism marketing fund. It’s built on a standard set in the legislature’s authorization of the Tribal Winds Casino, a gambling facility planned by the Mohegans and Mashantuckets in East Windsor to divert traffic headed to

Springfield MGM. Under the proposal, additional “mitigation dollars” will go to Fairfield, Hartford, New Haven, Norwalk,

Stratford, Trumbull and Waterbury. https://www.courant.com/business/hc-biz-bridgeport-casino-sports-betting-20190731-

ozvneqbbhbhdbc5k4rnqgun3zy-story.html

Connecticut becomes

16th state to adopt

Tobacco21 Legislation

From the Executive Director As we go through a period of change, with new board members, new specialty endorsements for the CPRS credential and even new office space in a new city, one thing remains the same

for all of us here, the mission of the organization. Our focus solely is to “protect the public by enhancing recovery-oriented workforce capacity.” We do this through standards based

credentialing that verifies one’s competence through a combination of education, practical training/supervision, work experience and a standardized examination process. Our standards meet, and often exceed, the international standards set by the IC&RC. Often, when standards

are adjusted or increased based upon data or development of new best practices, we hear concerns of inconvenience or hardship on the applicant. Although that is taken into

consideration during decision-making, the role that plays is minimal. We simply seek what is best for the person served, the public and the field as a whole.

Another important task that relates to meeting our mission is a standardized, nonpartisan ethics investigation process. We take all complaints seriously and without prejudice, relying on the

facts and evidence of the case to render decisions. We also, when appropriate, will offer training that may be applied to one’s initial credentialing

application or renewal, however, we do not offer a complete training program to meet all of one’s needs. Part of one’s competency is the ability to research, determine and follow their

own path to certification. We will provide feedback and limited guidance, but the onus of the process falls upon the shoulders of those seeking certification. In short, despite the cries of a few, our role is not to “get people certified.” Certification of qualified professionals is simply one of the vehicles we use to provide public and service recipient protection. As an officer of another certification body jokingly tells clinicians what the role of his board is: “Our job is to protect your clients from you.” A better way to express that comes from Dr. Arjun Venkatesh

of Yale University: “We have to start expecting of ourselves what we demand of others.” We look forward to continuing our efforts with one of the best-trained and competent

workforces among all of the IC&RC member boards.

Young people learn how to help their peers stay drug free BRISTOL - For a group of Bristol young people who attended the Youth to Youth

Conference [in July], it was an experience in building their confidence to be positive role models for their peers.

Seven local young people from B.E.S.T.-4-Bristol, joined up with groups from Southington and Naugatuck for the bus trip to the four-day retreat at Bryant

University in Rhode Island, where they met with hundreds of their peers from around the country.

B.E.S.T.-4-Bristol, which stands for Bristol Eliminating Substance Use Together, works to reduce youth substance use in the city, with grant funding through the

federal Drug Free Communities program. The members who attended the conference were: Angel Jiminez, a rising sophomore at Bristol Central High School; Kaidyn Sigmund, a rising freshman at BCHS; Koda Rodriguez, a rising senior at Bristol

Eastern High School; Molly McGivney, a rising freshman at BEHS; Gabriel Wolf, a rising sophomore at BCHS; and Kasey Beck and Star Maher, both recent BCHS graduates who are heading to their first year at

Tunxis Community College. They have been meeting weekly, working with prevention coordinator Christina Sanchez and outreach

support worker Stephen Bynum, from Bristol Youth & Community Services, who accompanied them on the trip.

The goal of the conference was to give young people confidence in their ability to positively influence others in their drug-free beliefs and other healthy behaviors. Workshops and activities from 6 a.m. to 11

p.m. each day focused on leadership training, substance abuse prevention, mental health promotion, violence and bullying prevention, etc.

“I found a lot of new skills in myself,” said Angel. “I found a support group I can always fall back on. You can get really motivated by the stories you hear from other people.”

“As I head into the new school year it gives me the confidence to be able to expand my activities to things outside of school,” he said. “I’m a Bristol Blues Explorer, a vice president of the Outdoors Club that’s

newly started at my school. I really found the confidence to know no matter what my plan is I can act on it. Here at B.E.S.T.-4-Bristol we’re going to start planning events to show the community how to have drug-

free fun.” Gabriel said one of his school counselors got him interested in joining the group, because he was already concerned about substance abuse he saw going on in his family and with his friends, behaviors including

vaping and underage drinking. “I figured the more I learned about it, it would help me be able to change that,” he said. “It kind of bothers

me that vaping is becoming such a big thing in our school.” Sanchez noted that vaping is so new there hasn’t been a lot of research on its potentially harmful effects, but elsewhere in the country there have been news stories about teenagers ending up in the emergency

room for severe lung disease from vaping. Molly said their group came away from the conference with some ideas for projects, like creating YouTube videos. “We would talk about normal everyday things young people are interested in and maybe put in an

anti-drug message, so people wouldn’t be like - ‘all they ever talk about is don’t do drugs!’” she said. She also wants to bring some of the conference’s motivational speakers to Bristol’s high schools, such as comedian Kevin Wanzer, and Jesse LeBeau, who spoke about overcoming his short stature to become a

successful college basketball player. Koda said she really connected with the speakers, because it helps to hear from adults who had experience

with the same stressors that young people have, like ADHD “People have to turn to something when they’re stressed,” she said. “For me, I have mild ADHD and I play football and I used to play softball for 10 years. A lot of kids also have anger issues and they need things to

let it all out.” Molly said they would like to bring a program called Hidden in Plain Sight back to town.

It’s geared for parents, to walk them through a mock bedroom with contraband hidden in it, to give them an idea of what to watch out for, Sanchez explained. “We are bringing it to three of our schools this year,

Chippens Hill Middle School and the two high schools. We did it last year and had great success with it.” Kaidyn likes the idea of Fifth Quarter, a program to provide teenagers with a place to hang out to dance,

play basketball, eat pizza, and have fun after Friday night football games, as an alternative to drinking and partying.

“We’re happy to provide this experience to our youth, and put Bristol on the map that we’re taking a stance against youth substance abuse and there are other outlets and ways to have fun,” Sanchez said.

She said the conference participants also liked seeing a college campus, staying in the dorms, and eating in the dining halls. “So they come away saying ‘hey, maybe I could see myself at college.’”

For more information about B.E.S.T.-4-Bristol, visit www.best4bristol.com or @best4bristol. http://www.bristolpress.com/BP-Bristol+News/355545/young-people-learn-how-to-help-their-peers-stay-drug-free

Changes for IC&RC This past summer has been one of significant change for the International Certification & Reciprocity

Consortium, of which the CCB is a member board. The IC&RC, through the use of subject matter experts and professional psychometricians, creates the credentialing products and examinations used all over the world with many being written into state-wide statutes (including the examination used for the LADC in Connecticut). The products created by the IC&RC are unrivalled, with over 50,000 professionals holding

reciprocal IC&RC credentials in addiction counseling (including master’s level), clinical supervision, prevention, criminal justice and peer supports.

For the past 13 years, the IC&RC has operated with a management contract with the Pennsylvania Certification Board in Harrisburg, led by Mary Jo Mather. During this time the organization has grown,

with an expansion of products a strengthening of the financial stability necessary to fund the product development. Beginning on September 1, the PCB has opted not to renew the management contract and the IC&RC elected leadership has been actively developing a transition plan, of which the CCB has been

actively assisting. In addition, David Turpin, in the middle of his second term as President of the IC&RC, opted to step down

from his post due to health issues he is experiencing. I had the opportunity to serve on the IC&RC Executive Committee in David’s administration for two years and work alongside him on many projects.

He will be missed. Per the bylaws of the organization, the Vice President, Crystal Smalldon, will complete the final year of David’s term as acting President. I am proud that the CCB has been selected to be a part of the small transition team, as it speaks to the knowledge, skills and ability of our board among the 72 total

members. This behind-the-scenes transition will create no disruption of credentialing or the testing process, so it will be business as usual for all of us. I wish to thank the Pennsylvania Certification Board for their efforts in

the improvement of the organization, and it was a joy to work alongside the staff dedicated to the IC&RC’s success: Mary Jo Mather, Rachel Witmer, Terri Wray, Kristen Pamula and Cristi Arbuckle. Thank you,

ladies! - JQ

www.internationalcredentialing.org

Former NBA All-Star, Olympic

Gold Medalist, and current

Milwaukee Bucks coach Vin

Baker has graciously given the

CCB a limited number of

hand-autographed copies of his

book, God and Starbucks.

These books are available for

purchase for $25 (plus $7.35

priority shipping) at

https://www.ctcertboard.org/vin

-baker-book

(or you can pick one up at the CCB office to

save shipping costs)

Please consider joining the CWC for one or more of these Fall 2019

trainings. All courses are CCB approved for initial certification and renewal.

• Opioids: Whole Person Approaches to Treatment & Recovery | 9/6

• Developing Person-Centered Recovery Plans | 9/11

• Where There’s Life, There’s Hope: Diminishing Risk in the Midst

of the Opioid Epidemic Conference | 9/12

• Challenges to Recovery: Concurring Developmental Disorders |

10/15

• Substance Use Disorder Counseling: Strategies for Relapse

Prevention | 10/23

• Recovery 101 | 11/6

• Across Women's Lifespans: Trauma & Gambling | 11/7

• Holistic Healing through Integrative Medicine Conference (for

Staff & Clients) | 12/6

For more information: https://www.womensconsortium.org/training

The Connecticut Women’s Consortium 2321 Whitney Avenue, Suite 401, Hamden, CT 06518

(203) 909-6888 | Fax: (203) 909 – 6894

Website • Catalog • LinkedIn • Facebook • Twitter • Instagram • Mailing List

Need hours for initial certification or renewal? Check out our CCB Approved Training Providers page on the CCB website:

https://www.ctcertboard.org/approved-training-providers

im·por·tant (imˈpôrtnt/)

adjective: of great significance or value; likely to have a profound effect on success, survival, or

well-being.

Credential Renewal Reminders Are Sent Via Email 90 Days Before The

Due Date As A Courtesy.

Please Make Sure That We Have Your Updated Email Address So That The

Information Reaches You.

It Is Important To Note That Each Certified Professional Is Responsible To Ensure That Their Materials Are Submitted To The CCB In A Timely

Fashion. You Can Verify Your Renewal Date By Checking Our

Website At https://www.ctcertboard.org/verify-

credentials

If you think you can do it, that’s confidence; If you do it, that’s

competence -Unknown

Remember, you represent not only yourself, but your

colleagues, your agency, our Connecticut system of

care and the profession as a whole.

Professionalism Matters

August 31, 2019 was Mary Jo Mather’s final day as the Executive Director at the IC&RC. For 13 years, she provided steady, professional leadership based upon integrity and honesty, while

also maintaining her position as the leader of the Pennsylvania Certification Board. She leaves with the IC&RC in the best fiscal position it has ever been in and with a process of credential development that guarantees that IC&RC products are unrivaled. The CCB will miss working

alongside her.

New research suggests MDMA could be used to treat alcoholism Derek Beres, BigThink.com, August 20, 2019

When John Hopkins professor Roland Griffiths and NYU professor Stephen Ross brought a unique study on psilocybin's efficacy in treating cancer patients' existential distress to the FDA, they were surprised

when the government agency asked them to expand their focus and ambition. Recognizing that SSRIs are not working in treating mental health disorders, the FDA was willing to explore other avenues - even a

Schedule 1 drug like "magic mushrooms." When Michael Pollan contacted the FDA while reporting for his book on psychedelics, How to Change Your Mind, the agency refused to confirm or deny this account due to its longstanding practice of not

discussing substances under regulatory review. Still, this marks an important advancement in our broader understanding of the potential benefits of psychedelics.

Let's face it: until the twentieth century, these substances, predominantly used in ritual for all of recorded history (and likely longer), were generally not viewed as dangerous. In fact, it has been long been argued

that they're necessary for personal and societal therapy. Even more modern incarnations, such as LSD and MDMA, affect the same (or similar) serotonin circuits as psilocybin and DMT. Sanctioned drugs, such as alcohol, cigarettes, and sugar, have proven far more

damaging to our health than the class of substances known as psychedelics. MDMA is not always broadly considered a psychedelic, given that it does not provoke the same

hallucinations or altered consciousness as other "trips." Yet MDMA binds to the same serotonin-2a receptor (the "mystical experience" receptor) as LSD and psilocybin, as well as dopamine receptors,

accounting for the intense euphoria. All of these substances have been used recently in addiction treatment. As Pollan notes, MDMA

specifically was being used to treat alcoholism back in the fifties and sixties, before sanctioned studies were commissioned. It was only due to Nixon's racist profiling that these class of drugs were deemed

Schedule 1. Now that the first study on MDMA's role in treating alcoholism is complete, it turns out that the

longstanding anecdotal evidence might bear fruit. Led by Ben Sessa, a senior research fellow at Imperial College London, the team studied seven volunteers during an eight-week MDMA-assisted psychotherapy

course to see if it would help curb their alcoholism. This preliminary paper focuses on four volunteers who have completed the course.

While this is an extremely small sample size, it does open the door for further studies, which is the general aim of such research. Given the tenuous nature of psychedelic research due to the drugs' illegality,

governments (and the public) have to be brought in slowly, even as advocates can vouch for their value. Simply put, we need better interventions. As the team notes, 6 percent of men and 2 percent of women in England are alcohol-dependent; a quarter of the population has an abusive relationship to alcohol. As a depressant, alcohol also heavily influences mental and emotional health. It is often a chicken-and-egg

scenario in regards to mental health and alcoholism, but one thing is certain: drinking doesn't help. The total cost of alcohol-related problems in England, ranging from health disorders and domestic

problems to crime and accidents, is £20 billion. Current treatment methods are insubstantial. Relapse rates there are 60 percent after one year, jumping to 80 percent after three years.

For this study, the patients received ten therapeutic sessions. Eight were non-drug psychotherapy sessions. The other two, administered during weeks three and six, included 125 mg doses of MDMA (with an

optional 62.5 mg "booster" dose after two hours). None of the volunteers experienced adverse effects during or after the course, nor did they return to

drinking. Importantly, none felt any craving for MDMA after the study's conclusion. As one participant commented, the drug itself was more a mediator than anything:

It's not about the drinking, the MDMA healed me inside and the drinking looks after itself … I'm seeing things anew, nature for the first time … I'm in control of my decisions, I've got control back … Life is just

good! Comments from other participants include the feeling of a "weight being lifted off my shoulders" and

"being under MDMA was beautiful. It showed me the real me; the me without alcohol." Now the team is calling for twenty volunteers with alcohol dependency in order to conduct another study. Separating the actual efficacy of psychedelics and its sordid legal status and past fear-mongering will take time, but hopefully not too much. Earlier this year, ketamine became the first FDA-approved psychedelic

to be legally prescribed. The Multidisciplinary Association for Psychedelic Studies (MAPS) has trained its sights on legal MDMA

by 2021. Given the emerging science on the topic, such a goal is within reach. That's good news for addicts that feel their time is running out.

https://bigthink.com/surprising-science/mdma-alcoholism?rebelltitem=3#rebelltitem3

Shows the public and employers that you have met high international standards for education,

training, and experience that are transferable to other states, regions and countries.

Enhances your professional reputation and credibility.

Offers both you and your clients the protection of an enforceable, legally defensible Code of

Ethical Conduct.

Demonstrates your commitment to continued professional development and skills expansion.

Increases your opportunities for career advancement.

Provides opportunities for you to contribute to advocacy efforts for the profession.

Makes you part of a 50,000+ network of professionals certified by the IC&RC, the largest and

most financially sound organization for substance use and co-occurring disorders prevention,

treatment and recovery professionals in the world.

Affords you an opportunity to be selected as a subject matter expert and/or item writer for cre-

dential and examination updates that impact the profession internationally.

Hold a credential that maintains a focus on public protection and the needs of those served,

and is not subject to change based upon the whims of the state legislature or groups whose

advocacy puts the needs of clients behind the desires of counselors or agencies.

While licensure through the Department of Public Health provides your permission to practice,

certification verifies that you are competent to practice. Having BOTH is the gold standard.

Certification by the Connecticut Certification Board and IC&RC...

Reporting Unethical Behavior of Certified Professionals As certified professionals, we hold the responsibility for many things, with the two most

important being the protection of the clients we serve and the public, followed by protection of the field of SUD prevention, counseling and recovery. This responsibility is not simply aspirational, being something that we aim for, but we also must take an active role. We cannot be satisfied by simply managing our own behavior, we must also be aware of the behavior of others, and when

they behave in an unethical fashion, make a formal report to the CCB Ethics Committee. It is your duty, and you agreed to do such when you agreed to abide by the CCB Code of Ethical Conduct

with your credential. Not reporting unethical behavior makes you complicit in the potential violation and makes you

subject to sanctions, up to and including permanent revocation of all credentials. This is not stated in a threatening manner, simply to underscore the importance of our ethical responsibilities. Often times clients will not report things out of fear of retribution, and we can (and must) be their voice. A copy of the CCB Code of Ethical Conduct, Ethics Complaint form and Disciplinary Procedures

are available on the CCB website at https://www.ctcertboard.org/ethics.

The Research Says (and it isn’t pretty)...

A 2016 study published in the peer-reviewed journal Substance Abuse, in a special section dedicated to the Opioid Misuse Epidemic, entitled “Counselor training and attitudes

toward pharmacotherapies for opioid use disorder” measured acceptance of the use of buprenorphine and methadone among 725 counselors from across the country. The results,

although not surprising, are certainly interesting:

• Diffusion of information about the medications is not adequate, and the training that is provided on either medication is not extensive enough.

• Counselors reported more training on, and more acceptability of, buprenorphine than methadone.

• Clinical use of methadone was rated the LEAST acceptable of ALL treatment approaches to OUDs.

Additional results showed that certain geographic areas (most notably those that are

considered “blue” states) and those individuals with higher educational attainment and more training on the medications for OUDs were more accepting of pharmacotherapy.

In short, the better informed counselors ad a greater acceptance of these evidence-based interventions. Finally, the study also showed, that among the 725 respondents,

adherence to a 12-step orientation was negatively associated with acceptability of the clinical use of medications to treat OUDs.

This research was funded by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and the

National Institutes of Health in Bethesda, MD.

Thoughts? Comments?

[email protected]

Lydia Aletraris, Mary Bond Edmond, Maria Paino, Dail Fields & Paul M. Roman (2016). Counselor training and attitudes toward pharmacotherapies for opioid use disorder, Substance Abuse, 37:1, 47-53,

DOI: 10.1080/08897077.2015.1062457

Our Position on the Matter

The use of medication for treatment of opioid use disorders is an effective and evidence based practice with nearly 70 years of supporting research. Although individual

professionals may have their own opinions on it, the choice to use medications or not should be between their patient and the physician, with reliance on the ethical principle

of client autonomy. Personal opinion should have no place in determining another’s route to recovery, and this countertransference is damaging to the therapeutic

relationship and should be addressed in clinical supervision. Presenting a client with misleading information to sway their decision towards “our” preference is a violation of

the CCB Code of Ethical Practice.

A Former Opioid Addict at Harvard Says We’re Getting Addiction Wrong Kathy Jean Schultz, Daily Beast, November 27, 2018

We’re in the midst of an opioid epidemic. In the U.S., deaths spiked from 10,000 in 2002 to more than 49,000 in 2017. Canada’s steady uptick in opioid-linked deaths is highest for ages 30-39. Treatments vary,

and most of them use faith-based initiatives to attempt to stem addiction in the bud, and rely on an absti-nence-only method.

The problem, say a growing number of scientists, is that these faith-based options don’t work—especially given new knowledge about how addiction affects our bodies through our brains.

The movement to redefine and understand opioid use disorder, or OUD, is welcomed by Peter Grinspoon.

A little more than a decade ago, Grinspoon had the veneer of success. He had a medical degree, a family, and was doing well in his practice. But, as he chronicled in his 2016 memoir, Free Refills: A Doctor Con-

fronts His Addiction, he was hiding a secret: he was addicted to opioids.

Now Grinspoon, who is 11 years sober, is advocating for medication-assisted treatment, called MAT, which combines behavioral therapy with FDA-approved medications to help stem addiction. Last month, Grinspoon published a post on Harvard Health Blog that questioned the very medical basis of addiction.

Titled “Does Addiction Last a Lifetime?,” the post questions what mental health professionals understand about an “addictive personality,” a concept that he argues saddles people with lifelong vulnerability to

relapse, or to re-addiction to new substances.

Grinspoon sees no scientific evidence that being diagnosed with addictive personality is effective in treatment.

For one thing, he supports the use of buprenorphine. Drugs like buprenorphine lessen withdrawal symptoms and the cravings that lead to relapse and overdose. While in rehab, Grinspoon was told, ‘A drug is a drug is a drug.’ “This mentality does not allow for a difference between the powerful opiate fentanyl, which kills thousands of people every year, and buprenorphine, which is a widely-accepted treatment for

OUD,” he posted.

Grinspoon also sees a problem with the abstinence-only approach many rehabilitation centers have adopt-ed.

“I have come to believe that an uncompromising ‘abstinence-only’ model is a holdover from the very beginnings of the recovery movement, almost 100 years ago, and our understanding has greatly evolved

since then,” Grinspoon said. “The concepts of addiction and recovery that made sense in 1935, when Alcoholics Anonymous was founded, and which have been carried on by tradition, might not still hold true

in the modern age of neurochemistry and functional MRIs.” Given the opioid-overdose death rate, “uncompromising” is the key word.

“It seems as if it’s just what we’ve been doing since 1935 because there was nothing else,” he told the Daily Beast. “Now we have multi-faceted approaches to treatment, including the use of drugs like

buprenorphine, which fuels OUD recovery."

The problem, according to Grinspoon, is the very basis by which we think about and treat opioid addiction. “You treat opiate withdrawal differently than you treat alcohol withdrawal,” he said. “Yet the rehabs tend

to treat every addiction the same. Most rehab centers are not using cutting-edge science.” MAT could change that. It includes not only buprenorphine for opioid addiction, but also acamprosate for alcoholism, and naltrexone for opiates and/or alcohol. None of these drug treatments were discovered until recently,

and definitely weren’t known in 1935.

But implementing change here is difficult, thanks to court-mandated NA and AA meeting attendance. Courts and probation officers, as well as police, prosecutors and local, state and federal agencies, often

order OUD-related offenders to attend abstinence-only, faith-based NA or AA meetings, and have done so for decades. Yet people within the U.S. criminal justice system experience high rates of OUD and

overdose, according to a recent Johns Hopkins University study. That study, published last December in the journal Health Affairs, looked at 72,000 adults in an OUD treatment program, including 17,000 referred by criminal justice agencies. The researchers found that less than 5 percent of OUD-related offenders ordered

into treatment received MAT. In contrast, 40 percent of people referred by employers or healthcare providers received MAT. That potentially set them up for failure. The study authors found that MAT’s behavioral therapy-fueled approach could decrease overdose risk within the court-ordered population,

many of whom lack homes, jobs, medical care or other factors that contribute to OUD upon release from jail. Despite its promise, researchers found that courts were unlikely to refer misusers to MAT.

That doesn’t surprise Grinspoon. “Judges are vastly under-educated about modern addiction, both the disease and the treatment,” Grinspoon said. “I was forced, by my professional medical society, into a pretty

religious 12-step rehab program for 90 days and, as an atheist, I found it counterproductive at best.

See Daily Beast on next page

Daily Beast, continued

Judges need to enable people to access modern treatments, not the old-fashioned, non-evidence-based mush that is called ‘treatment’ at many rehab centers.”

Nora Volkow, the Director of the U.S. National Institute on Drug Abuse, agrees. “In general, studies show abstinence-only programs do not work with opioids,” Volkow told the Daily Beast. “There may be some

misusers for whom it does work, but in the majority of cases it does not. People with OUD have a very high rate of relapse in abstinence-only programs, and the death rate during relapse can be as high as 90

percent.”

Volkow said that many treatment options don’t take into account the fact that OUD acts differently from that of other disorders from common addictive substances. “What opioids do is to kidnap the system that

drives our motivation for survival,” she explained. “For example, if you have not eaten for days your brain will make getting food a priority, for survival. But when you are opioid-addicted your brain is not able to

do any of the things we normally do to survive.”

Laura Schmidt is a University of California San Francisco School of Medicine professor who recently wrote a paper published in Drug and Alcohol Review on alternative methods of opioid addiction treatment.

She says addiction remains surprisingly misunderstood. “The addictive-personality concept has pretty much been debunked by research,” Schmidt told The Daily Beast. “The biggest problem now is capacity.

We simply don’t have enough treatment slots for everyone who needs them.” Analyses have shown OUDs far exceed treatment need: in 2017, more than 450,000 people with OUD were unable to access treatment.

Schmidt, like Grinspoon, points out that addiction has been freighted by history, ever since the 19th century temperance movement that saw alcohol consumption as abhorrent. “With that framework in place, treatment providers strategically deploy what’s called a moral/medical model, depending upon the patient,” Schmidt explained. “When providers decide patients need to be held morally accountable, they get patients

to stay sober by shaming them.

“In the very process of doing that, they continue to promulgate the idea that addiction is the addicts’ fault,” Schmidt added. “Providers think by shaming patients they can get them clean.”

That approach is problematic, and leads to a vicious circle of further stigmatization, which Schmidt said could also lead to the significant barrier to funding treatment patients face in dealing with insurance

companies.

It’s something Schmidt has, in fact, seen in her own work. “I worked on a study of a healthcare organization offering OUD treatment to their members,” Schmidt said. “There was a waiting list, and while

people were waiting to enroll in our study, a few were able to receive MAT. They told others on the waiting list that MAT had helped them stay off opioids, and eventually through word-of-mouth, OUD

misusers began asking us if they could get into MAT. So the word spread that it helped to quell craving and withdrawal sickness. “This was really notable to me,” Schmidt continued. “The misusers themselves were

more open-minded about treatment alternatives than NA suggestions. They wanted what works.”

Advances in MAT grew out of investigation into the science of brain imaging. Scientists were able to see inside the brain of an addicted person and pinpoint parts affected by drug abuse. The discovery of brain

circuits underlying addiction has resulted in development of effective medications - including buprenorphine, naloxone, and acamprosate. One study actually mapped out what appear to be relapse

pathways in the brains of opiate-dependent users.

New research has shown how those neural circuits are detectable via functional magnetic resonance imaging, or fMRI. fMRI can show whether oxygen levels and electricity flows inside a misuser’s brain are normal or abnormal. fMRIs have shown how craving contributes to cocaine relapse, for example. Cocaine users’ own feelings of craving matched their fMRI images, which showed activity in the craving area of

their brains. It’s a critical discovery in the science of addiction, one that Schmidt said was “hard to deny.”

Multi-pronged approaches that combine fMRI, recovery program meetings and MAT, along with other new techniques, are beginning to gain acceptance. They’re already in place in states from Washington to

Vermont.

But will that actually stem the deaths resulting from the opioid crisis? “There is a pervasive bias in the rehab network against this kind of medicine-assisted treatment,” Grinspoon said - but he's optimistic that MAT and other medically based treatments might help reverse the upward spike of opioid deaths every

year.

Peter Grinspoon, M.D. is the author of the memoir Free Refills: A Doctor Confronts His Addiction. He currently practices as a primary care physician at an inner-city clinic in Boston and is on staff at Massa-

chusetts General Hospital. He teaches medicine at Harvard Medical School. He spent two years as an Associate Director for the Physician Health Service, part of the Massachusetts Medical Society, working

with physicians who suffer from substance use disorders.

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Gambling Everywhere - And On Credit - Could Be Coming to Connecticut

https://www.wtnh.com/news/politics/gambling-everywhere-and-on-credit-could-be-coming-to-

connecticut/1843245003

How do you feel about gambling everywhere in Connecticut? How about being able to do it with a credit

or debit card account on your smartphone? That's part of the latest gambling expansion proposals before

state lawmakers. The Chairman of the legislative committee that must approve any expansion of gambling

told News 8 he'll call for a vote next week.

The head of the lottery told lawmakers on Tuesday that in order to continue to provide the state with a

constant flow of revenue, the lottery must switch from an all cash business at local retailers to credit and

debit card purchases and allow all the games to be purchased online on mobile devices as well as being

able to place bets on sporting events the same way. "If sports betting is not convenient to people, meaning

geographically throughout the state, and online and in mobile, betters will continue with their local bookies

or their current illegal off-shore websites that they currently use," Connecticut Lottery President Greg

Smith told lawmakers on the Public Safety & Security Committee.

If Governor Lamont can come to an agreement with the Native American casino operators, the bill

currently before the committee would also license them for sports betting as well as the 16 Off Track

Betting facilities around the state. In other words, gambling everywhere in the state and on credit.

To prove you are 21, you would be required to open an account in person the first time you placed a bet.

The proposed tax on bets would be 10 percent subject to negotiation. You could bet on professional and

intercollegiate sports. Pro sports teams would get a small cut of the wagers.

Diana Goode of the Connecticut Council on Problem Gambling said, "What they're proposing now is; you

can be on your couch, in your pajamas and betting online, so that's definitely an issue."

There seems to be no question that this massive expansion of gambling would increase the number of

problem gamblers in the state, currently estimated at 35,000.

Also currently, less than one percent of gambling revenue goes to gambling addiction prevention and

treatment. Those organizations currently get less than one percent of gambling revenue to help those with

addiction. They're hoping to increase that amount to as high as three percent.

Attention All Certified Peer

Recovery Specialists:

Specialist in Family Recovery endorsement,

a valuable and voluntary addition to your

CPRS credential. Requirements:

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C C B L e a d e r s h i p B o a r d o f D i r e c t o r s

E x e c u t i v e C o m m i t t e e David Borzellino, Farrell Treatment Center, New Britain, President

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Joanna Crowell, Middlesex Health, Middletown Fred Fetta, DMHAS Problem Gambling Services, Middletown

John Hamilton, Liberation Programs, Norwalk Denise Keane, Veteran’s Administration, Willimantic

Jennifer Kolakowski, Recovery Network of Programs, Shelton/Bridgeport Arthur Mongillo, Connecticut Council on Problem Gambling, Wethersfield

Steven Randazzo, Aware Recovery Care, North Haven

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