Co-Occurring Inter-relational Domestic Violence and Substance Use Disorders - Terry Gray, M.S - Naadac

Co-Occurring Inter-relational Domestic
           Violence and
     Substance Use Disorders
                Presented by
            Terry Gray, M.S.

               August 23, 2017

Thomas Durham, PhD

Director of Training
NAADAC, the Association for Addiction Professionals
www.naadac.org
tdurham@naadac.org

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Using GoToWebinar – (Live Participants Only)

   Control Panel

   Asking Questions

   Audio (phone preferred)

   Polling Questions

Webinar Presenter

       Terry Gray, M.S.
     Licensed Substance
       Abuse Counselor

 NOPAL Counseling, LLC
Your Tucson, Arizona
  tdgray4cg@hotmail.com

Terry Gray, M.S.
Licensed Substance Abuse Counselor
 Terry has been providing counseling services for
substance abusers, couples, and DV offenders/victims
   for over 40 years. He is the Founder of Cactus
Counseling Associates, a private Outpatient Treatment
  facility in Tucson, Arizona and is now the founder,
 CEO, and Chief Counselor and NOPAL Counseling,
LLC in Tucson, Arizona. He can be reached by e-mail
               at tdgray4cg@Hotmail.com

Webinar Learning Objectives

         1                  2               3

Identify dynamics of       Identify   Develop effective
the interrelationship   appropriate    interventions
of the two disorders     treatment
    and risk level       strategies

Treating Domestic Violence and Substance
 Use Disorders: Co-occurring Disorders?

          Evaluating Treatment Needs
          Applying Workable Strategies

Polling Question #1
In your work as a therapist, have you treated
any domestic violence offenders who also
have been diagnosed with a substance use
disorder?

Yes
No

How to address Domestic Violence

    The proper design of public policies
 requires a clear and sober understanding
 of the nature of man and, in particular, of
   the extent to which that nature can be
              changed by plan.

                         -

J.Q. Wilson, Thinking About Crime (1983)

Interactive, NOT DIRECTLY co-occurring

  85% of domestic violence incidents involve the use/abuse of
   some chemical substance by at least one party present
  The dynamics of DV and SUD are remarkably similar and are
   typically re-inforcements for each condition
  Substance Use Disorder and Domestic Violence are NOT
   “cause and effect”
  The current evolution of understanding DV and developing
   treatment approaches closely mirrors the history of SUD
  As with SUD, DV is a FAMILY problem

PREVALENCE
 1 in 4 women will experience domestic violence in her lifetime
 1.3 million women are victims of physical assault annually—mostly by
  someone they know
 Females 20-24 are at the greatest risk of non-fatal DV
 835,000 men are victims of physical assault annually—the number from
  intimate partners is unknown
 Most domestic violence incidents are never reported
 On average, the first report to the police occurs after the 9th actual physical
  incident—frequency of non-physical incidents are unknown
 11% of Lesbian women report physical abuse, while 15% of gay men report
  physical abuse
 1-2 million elderly persons are estimated to be abused annually; only 1 of
  every 14 is reported

PREVALENCE (cont.)
 More than 3 women and 1 man are killed by intimate partners every day
 In 70% of intimate partner homicides, no matter which partner was killed, the
  woman was physically abused before the murder
 If a firearm is present in the residence, the likelihood of murder by weapon
  increases five times
 Between 3.3 and 10 million children witness domestic violence at some point each
  year
 Witnessing violence as children is a primary risk factor in transmitting violence to
  the next generation
 30-60% of perpetrators of intimate partner violence also abuse the children
 About one-half of “Orders of Protection” are violated, as are two-thirds of
  “Restraining Orders”

AWARENESS
 Emergency Room personnel still do not routinely receive training in
  recognition of DV or Child abuse symptoms
 Many major USA metropolitan police departments now receive some
  level of specialized training in recognizing and managing domestic
  disputes—generally these involve interrogation and arrest procedures
  directed toward the male
 Most smaller police departments continue to operate with no
  specialized training
 Women’s shelters remain a well-kept secret in many metro referral
  systems (including “911”)
 Men’s shelters are virtually non-existent
 Shelters for abused children are rare and typically involve child
  welfare/CPS/foster care

Domestic Violence and the World

 To date, only five countries have any official recognition of
  Domestic Violence as an issue
 Only four of those five countries address DV as a legal issue
 Only three of those five countries address DV as treatable
 Remember—only 36 US states recognize Domestic Violence
  as a specific legal or treatment issue.

Definitions
 Domestic Violence is an act of abuse/violence
  committed by one or more persons to one or
  more persons within an identified family unit.
 It is not necessarily an act of physical contact.
 Not all domestic disputes are major or have
  the potential to become more severe over
  time.
 While Domestic Abuse/Violence often occurs
  in a recognizable continuum, it is not a
  condition that necessarily worsens with time

Common Characteristics
 The common stereotype of male to female DV is not as common as is often
  believed and is not typically an issue of men hating or depersonalizing all
  women.
 Much Domestic Violence committed by men is about men having issues with
  being male.
 Much Domestic Violence committed by women is about women having issues
  with being female.
 It may be a safe assumption that most Domestic Violence/abuse is a person
  having issues with themselves.

Styles of Domestic Violence
Different Shades
   Adult versions:
  Male to Female
  Female to Male
  Female to Child
  Male to Child
  Parents to Child
  Child to Older Parent
  Male to Male (Gay & Straight)
  Female to Female (Lesbian and Straight)

Styles of Domestic Violence (cont.)
 More Shades
     Child/Youth versions:
    Male to Female (relationship)
    Female to Male (relationship)
    Female to Child (sibling, babysitters, etc.)
    Male to Child (sibling, babysitters, etc.)
    Child to Child (siblings, bullying, etc.)
    Child to Parent
    Male to Male Bullying (Gay & Straight)
    Female to Female Bullying(Lesbian and Straight)

Adult Male-perpetrated Domestic Violence
 Approximately 15% of Male offenders are
  acting from rage – poor anger skills
 Approximately 5% of male offenders fit the
  extremes of Anti-Social Personality Disorder –
  Psychopathic PD
 The majority of male offenders are much less
  readily categorized
 Approximately 85% of male-perpetrated
  violence is concurrent with being under the
  influence of a psychoactive chemical
 Comparatively, we know little, statistically, of
  female-perpetrated abuse and virtually nothing
  of bullying or child abuse.

Classification
Forms of domestic violence typically have a primary purpose—
              to exert, gain, and maintain control over another person

Michael P. Johnson identifies four major types of intimate partner violence:

    Common Couple Violence -                  not connected to general control behavior, but arises from a single
    argument in which one or both partners physically “lash out” at the other

    Intimate Terrorism -             more common, more likely to escalate over time, more likely to involve injury, less
    likely to be mutual.

    Violent Resistance - known more as “self-defense”;               violence perpetrated by victims against their abusive
    partner

    Situational Couple Violence - not control-based, but arises out of conflicts that escalate from
    arguments. Less frequent than other types in established relationships, can increase in frequency and become serious
    or life-threatening

Types of Abuse

Emotional/Verbal
Financial
Sexual
Isolation/Information
Threats and Intimidation
Indirect – pets, children, parents, objects
Physical

Polling Question #2
Have any of your clients exhibited one or
more of these types of abuse co-occurring
with a substance use disorder?
Yes
No

Treating Domestic Conflict
Persons who are involved in domestic conflicts can learn to identify the
consequences and the specific nature of their actions. Intervention strategies
must promote a change in both attitude and behavior. Change includes:
      Improved awareness of the dynamics involved
      Better understanding of situations in which conflict occurs
      Implementation of alternative beliefs and actions
     These areas can be integrated components of any program
The effects of family conflict on children cannot be overstated, nor can the
frequent correlation between family conflict and substance use disorder.

Violence and Substance Use

Substance use disorder is not a cause of violent
 behavior

Problematic substance use enables and allows violence

Violence is a common correlate of Substance use
 disorders

Substance use disorders and Violence are interrelated

Treating Substance Use Disorders

Persons who are involved in substance use disorders can learn to identify the
consequences and the specific nature of their actions. Intervention strategies
must promote a change in both attitude and behavior. Change includes:
      improved awareness of the dynamics involved
      better understanding of situations in which drinking/using occurs
      implementation of alternative beliefs and actions
     These areas can be integrated components of any program

The effects of substance use disorders on children cannot be overstated, nor can
the frequent correlation between family conflict and substance abuse.

Necessities for Treatment
   Accurate Evaluation/Assessment
   Non-Judgmental
   Stigma Management
   Symptom Management
   Personal Awareness
   Accepting Responsibility
   Support, Support, Support
   Unique (non-mainstream) services

Recipe for Violence
   Impaired judgment + lowered inhibitions + poor
decision-making + lack of impulse control + adrenaline
                 + proper stimuli =

                  VIOLENCE

Types of Violence
 Violence to self
             suicide
             self-mutilation
 Violence to Others
             “stranger” violence
             “acquaintance” violence
 Violence to Family (domestic violence)
             spousal abuse
             child abuse

Denial and Violence
 Violence is typically related to:
               blaming others
               lack of emotional control (highs and lows)
 Domestic Violence is typified after the act by:
               minimizing
               intellectualizing
               rationalizing
               excuse-making
               distracting
               altering “history”

Role of Denial

 Dynamics of denial are similar with both violent
  behavior and substance use disorders
 Allows individuals to explain behavior without
  accepting responsibility

DENIAL
 Types of cognitive denial
    Excuses
    Blaming
    Intellectualizing
    Labeling
    Minimizing
    Deflecting
    Justifying
 Shame
 Stigma
 Cognitive Impairment
 Traumatic memory and survival

SUBSTANCE USE DISORDER

 Trauma relief
 Stress relief
 Emotional “deadening”
 Social Equalizer
 Impact on Decision-Making and judgment
 Effects on Children/family

Psychoactive Chemistry

 Drug effects are primarily in the brain
 Impact is on these major areas:
       Cognition/Comprehension
       Judgment
       Perception
       Emotional experience
       Behavior
       Memory
       Assessment/future planning

Terry’s Law
YOU CANNOT BE HIGH AND STRAIGHT SIMULTANEOUSLY

   “Under the Influence” means just that
   Count the number of brains you have
   Place your brain in the blender and turn to “whip”
   Operate normally
   It cannot be done
   Implications
   Domestic Violence and substance abuse are not a cause
   and effect relationship

Altered/Distorted Realities

With each experience of being “high” reality becomes increasingly
altered by the drug or drugs being used

     Alcohol—lowered inhibitions, impact on frontal lobe, memory,
      perception
     Marijuana—impaired perceptions, memory (short and long term),
      emotions
     Meth—impaired judgment, sleep deprivation, impaired perception,
      paranoia, feeling of invincibility
     Opiates—impaired judgment, emotional deadening
     Sedative/Hypnotics—lowered inhibitions, impact on frontal lobe,
      memory, perception, emotional deadening
     Cocaine—impaired judgment, paranoia, sense of superiority, sleep
      problems

Drug Effects/Trauma Response

 What happens when the frontal lobe is not engaged?
 Differences between motives for choice of drugs
 Examples:
    Lack of sense of personal power perhaps could lead to use of
     meth or cocaine
    Feeling overwhelmed by emotional needs could result in use of
     alcohol/opiates/tranquilizers
    While the choice of drug does not always correlate to
     attachment/BPD/abuse background, the likelihood is always
     important to assess

What do we want to know?

Risk Indicators
      Prior incidents
      Arrests/convictions
      Substance Use Disorder
      Witness or victim of abuse as a child
      Trauma history
      PTSD symptoms
      Mental Illness
      Attachment/Abandonment issues
      Strict or dogmatic upbringing
      “Cluster B” symptomology (personality disorders)

Implications For Treatment

   Stigma
   Denial
   Stressors
   Trauma History
   Family abuse history
   Parental Attachment

Treatment Issues
Does being judgmental help?
                   batterer
                   offender
                   perpetrator
                   wife beater
                   combatant
On the contrary:
                   victim
                   survivor
                   co-combatant

Evaluation/Assessment
Should Include:
    A recognized DV Assessment instrument
    A detailed Psycho-Social questionnaire
    Specific Domestic Violence addendum
    Lethality assessment
    Substance Use Assessment instrument
    Mental Health assessment (if indicated)
    Duty to Warn
    Victim ID

Polling Question #3
In your opinion, would the use of a domestic
violence assessment tool be effective in
gathering accurate information from a client
diagnosed with a substance use disorder?
Yes
No

ATTACHMENT

Types of attachment
    Secure
        Quality “equal” communication
    Insecure
        Inconsistent communication
            Avoidant
            Ambivalent
            Disorganized
            Declarative/Interrogative
    Involves the integration of brain function

ATTACHMENT ISSUES IN TREATMENT

 Therapeutic relationship
    A secure attachment that enhances and promotes the
     growth of trust between client and counselor
    A consistent environment that promotes trust between peers
     and enhances feedback
 Reliable and consistent messages
 Non-judgmental
 Repetitive
 Emotionally supportive

Acknowledgement

Forming Personal Identity
Male Dominant Cultures
Forming Bonds
Gender Identity
Role Identity
Approval

Dependency

Self-Esteem Issues
Role Identity damaged
Emotional immaturity
Outside vs. Inside measures of value
Living in a continual state of tension

Cycle                                    VICTIM'S RESPONSE: Protects self any way possible.
of Violence                                                    Police called by friend, children,
                                                               neighbor. Tries to calm partner.
                                                               Leaves. Practices self-defense.

                                             2. BATTERING
                                                BATTERER:
                                             Pushing, shoving, hitting, punching,
                                             choking, humiliation ,imprisonment,
              1. TENSION BUILDING             rape, use of weapons, beatings.
                BATTERER:
          Moody, nitpicking. Isolates                                         3. CALM STAGE
          victim. Withdraws affection.       POWER & CONTROL                     BATTERER:
          Name-calling. Put-downs.               DENIAL
          Verbally abusive, yelling. Uses                                   Says sorry. Begs
           drugs or alcohol. Threatens.                                 forgiveness. Promises to
               Destroys property.             get counseling. Promises to go to church.
                  Criticizes. Sullen.         Promises to go to AA/be sober. Sends flowers,
                     Crazy-making.            brings gifts.
VICTIM'S                                       "I'll never do it again." Wants to make
                                                love. Declares love, devotion. Enlists
RESPONSE:
                                               family support. Cries.
Attempts to calm partner.                                                     VICTIM'S RESPONSE:
Nurturing. Silent/talkative. Stays away from family,           Agrees to stay or return. Takes partner
friends, support system. Keeps children quiet.                 back. Attempts to stop legal proceedings.
Agreeable, passive. Withdraws. Tries to reason.                Sets up counseling appointment
Cooks favorite dinner. Feels as if walking on                  for partner. Feels happy, hopeful.
eggshells.

The Cycle of Violence revisited

 Is it really a cycle?
 Build-up/tension – explosion – remorse – honeymoon
 Most relationships change and emerge into differentiated
  patterns over time
 Cycle or evolving/evolved pattern?

Poor Empowerment/Self-Esteem
State of being in constant conflict
    No trust in self, role, ability
    Seek stability via emotional contact
    Relationships are fleeting, untrustworthy
    Overly dependent on partners, yet resent
    Attempts to control environment and emotional content
    Use drugs to cope, control, compensate
    Drug use alleviates, then compounds emotional state
    Kick into primitive brain function
    Leads to greater efforts to control, cope, compensate
    Tightened downward spiral as stress increases

Complications/Coping Strategies

  Social presence/amiability
  Appears fair, but can feel overwhelming
  Plentiful social contacts, few real friends
  Typically ready to “party”
  Chronic over or under achiever
  Easily becomes defensive—”hurt feelings”

Entangled Issues
 Cognitive denial from DV
 Distorted thinking/denial from SUD
 Denial looks like denial and works the same way
 Which is worse?
       Alcoholic
       Drug addict
       Wife beater
       Child abuser
       Worthless
       Bad mother
       Poor provider

Three Phases of Treatment
Phase One—Cognitive Re-Structuring
   Education
          Types of Abuse
          Personalizing the Victim(s)
          Power and Control
          Substance Use
          Stages of Change
          Denial
          Distorted Thinking
          Accepting Responsibility
          Detailing Personal Behavior (DV incidents)

Three Phases of Treatment (cont.)
 Phase Two—Self-Awareness
    Therapy
          Bonding and Attachment
          Button, Button, Who’s got the button?
          Emotional Development
          Communication
          Fear and Anger
          Core Beliefs
          Personal “Canyon”
          Shame and Blame
          Setting Goals
          Identity

Three Phases of Treatment (cont.)
   Phase Three—Skills
      Application
             Intellect over Emotion
             Establishing Trust
             Boundaries
             Negotiation
             “Walking a Mile in Your shoes”
             Silencing Expectations
             Re-Framing (new positive associations)
             Substance Use Disorder Treatment/Recovery
             Self-Inventory
             Impulse Regulation

CONCLUSIONS
 Domestic Violence involves everyone
 No single definition/description fits all cases
 No single treatment approach can be effective in every
  situation
 Domestic Violence and Substance Use Disorders are a
  serious and often deadly combination
 Intervention strategies must be designed to meet individual
  personality profiles as much as feasible
 Treatment works

References
•   Arntz, A. (1994).Treatment of borderline personality disorder: A challenge for cognitive-behavioral
    therapy. Behavioral Research and Therapy, 32(4), 419-430.
•   Babcock et al. Does batterers treatment work? A meta- analytic review of domestic violence
    treatment Clinical Psychology Review, 2003, xxx-xxx.
•   Bandura, A. (1979). The social learning perspective: Mechanisms of aggression. In H. Toch (Ed.).
    Psychology of crime and criminal justice. New York: Holt, Rinehart, & Winston.
•   Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and
    Personal Relationships, 7, 147-178.
•   Bodnarchuk, M., Kropp, P.R., Ogloff, J.R., Hart, S.D., & Dutton, D.G. (1995). Predicting cessation of
    intimate assaultiveness after group treatment. Family Violence Prevention Division, Health Canada.
•   Bowlby, J. (1969). Attachment and loss. Vol. 1, Attachment. New York: Basic.
•   Bowlby, J. (1973). Attachment and loss. Vol. 2, Separation. New York: Basic.
•   Brown, JAC (2004) hame and Domestic Violence: treatment perspectives from self psychology and
    affect theory. Sexual and Relationship Therapy. 19(1). 39-56.
•   Carmen, E.H., Rieker, P.P., & Mills, I.E. (1984). Victims of violence and psychiatric illness. American
    Journal of Psychiatry, 141, 378-379.
•   Celani, D. (1994). The illusion of love. New York: Columbia University Press.
•   Coleman, Valerie E. (2005) Treating the Lesbian Batterer. Journal of Aggression. 7(1-2), 159-205.
•   Dowd, Lynn (2001). Female Perpetrators of Partner Aggression. Journal of Aggression. 5(2) 73-104.
•   Duke, Alysondra & Davidson, Meghan. (2009) Same Sex Intimate partner Violence. Journal of
    Aggression. 18, 795-816.
•   Dutton, D.G. (1995). The domestic assault of women: Psychological and criminal justice
    perspectives, 2nd ed. Vancouver, BC: UBC Press.
•   Dutton, D.G. (1996). Antecedents of the abusive personality. Journal of Family Violence, 11(2), 113-
    132.
•   Dutton, D.G., & Holtzworth-Munroe, A. (1997). The role of early trauma in males who assault their
    wives. In D. Ciccetti & S.L.Toth (eds.), Rochester Symposium on Developmental Psychopathology #4.
    University of Rochester Press.

References
•   Dutton, D.G., & Starzomski, A. (1993). Perpetrator characteristics associated with women’s reports
    of psychological and physical abuse. Violence & Victims, 8(4), 326-335.
•   Dutton, D.G., Starzomski, A., Saunders, K., & Bartholomew, K. (1995). Intimacy-anger and insecure
    attachment as precursors of abuse in intimate relationships. Journal of Applied Social Psychology,
    24(15), 1367-1386.
•   Dutton, D. G., Bodnarchuk, M., Kropp, R., Hart, S., & Ogloff, J. (1997). Wife assault treatment and
    criminal recidivism: An eleven year follow-up. International Journal of Offender Therapy and
    Comparative Criminology, 41(1), 9 – 23.
•   Dutton, D.G., Bodnarchuk, M., Kropp, R., Hart,S. & Ogloff, J. (1997) Client personality disorders
    affecting wife assault post treatment recidivism. Violence & Victims, 12(1), 37–50.
•   Freud, A. (1942). The ego and the mechanisms of defense. New York: International Universities
    Press.
•   Goldenson, Julie; Geffner, Robert; Foster, Sharon L.; Clipson, Clark R. (2007) Female Domestic
    Violence Offenders: Their Attachment Security, Trauma Symptoms, and Personality Organization.
    Violence and Victims. 22(5). 532-545.
•   Gunderson, J.G. (1984). Borderline personality disorder. Washington, DC: American Psychiatric
    Press.
•   Hamberger, K.L., & Hastings, J.E. (1986). Characteristics of male spouse abusers: Is pychopathy
    part of the picture? Paper presented at the American Society of Criminology, Atlanta, GA.
•   Holtzworth-Munroe, A., & Stuart, G.L. (1994). Typologies of male batterers: Three subtypes and
    the differences among them. Psychological Bulletin, 116, 476-497.
•   Karen, R. (1994). Becoming attached. New York: Warner Books.
•   Kelly, Joan B. & Johnson, Michael P. (2008). Differentiation Among Types of Intimate Partner
    Violence: Research Update and Implications for Interventions. Family Court Review. 46(3) 476-
    99.
•   Kropp, P.R., Hart, S.D., Webster, C.D., & Eaves, D. (1995). Manual for the Spousal Assault Risk
    Assessment Guide (2nd ed.). The British Columbia Institute on Family Violence - Multi-Health
    Systems.

References
•   Lewis, H.B. (1971). Shame and Guilt in Neurosis. New York: International Universities Press.
•   Prochaska, J.O., DiClementi, C.C., & Norcross, C.C. (1992). In search of how people change:
    Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.
•   Roberts, Ph.D, Albert (1998). Battered Women and Their Families, 2nd Ed. Springer Publishing
•   Rosenfeld, B.D. (1992). Court-ordered treatment of spouse abuse. Clinical Psychology Review, 12,
•   Saunders, D.G. (1992). A typology of men who batter: Three types derived from cluster analysis.
    American Journal of Orthopsychiatry, 62, 264-275.
•   Schore, A. (1994). Affect regulation and the origin of the self: The neurobiology of emotional
    development. Hillsdale, NJ: Lawrence Erlbaum Assoc.
•   Shengold, L. (1989). Soul murder: The effects of childhood abuse and deprivation. Fawcett: New
    York.
•   Sherman, L.W., & Berk, R.A. (1984). The specific deterrent effects of arrest for domestic assault.
    American Sociological Review, 49, 261-272.
•   Starzomski, A., & Dutton, D.G. (1994). Attachment style, anger, and attribution in the intimate
    context. Masters’ Thesis. Unpublished manuscript. University of British Columbia.
•   Tweed, R., & Dutton, D.G. (1998). A comparison of impulsive and instrumental subgroups of
    batterers. Violence and Victims, 13(3), 1-14.
•   Westen, D., & Shedler, J. (1999). Revising and Assessing Axis II. American Journal of Psychiatry,
    156(2), 258-285.
•   van der Kolk, B. (1987). Psychological Trauma. Washington, DC: American Psychiatric Press.

ADDITIONAL REFERENCES

Cohen, Steve. (2004) Children and Domestic Violence. Presentation. National Clearinghouse on Child
Abuse and Neglect Information
Carter, Jay. (2003). Nasty People, Revised Edition. McGraw-Hill Publishing: New York.
Hare, Robert D., Ph.D. (1999) Without Conscience: The Disturbing World of the Psychopaths Among Us.
Guilford Press: New York.
Magid, Dr. Ken & McKelvey, Carolyn A. (1988) High Risk: Children Without A Conscience. New York:
Bantam Books.

Thank You!

       Terry Gray, M.S.
     Licensed Substance
       Abuse Counselor

 NOPAL Counseling, LLC
Your Tucson, Arizona
  tdgray4cg@hotmail.com

www.naadac.org/co-occurring-domestic-violence-
               SUDs-webinar

Cost to Watch:             CE Certificate
Free

CE Hours             To obtain a CE Certificate for the time you spent watching this webinar:
Available:
2 CEs                1.   Watch and listen to this entire webinar.

                     2.   Pass the online CE quiz, which is posted at
CE Certificate for
NAADAC                www.naadac.org/co-occurring-domestic-violence-SUDs-webinar
Members:
Free                 3.   If applicable, submit payment for CE certificate or join NAADAC.

CE Certificate for   4.   A CE certificate will be emailed to you within 21 days of submitting
Non-members:              the quiz.
$25

Upcoming Webinars

September 13 2017                                October 11, 2017

Electronic Screen Addiction:                    Influences on Addiction and Mental Health
Don’t Take My Ice Cream                         in the LGBT Population
by Christina Migliara, LMFT, MAC, CAP, CASAC    By Mary Sue Green, PhD. LMFT
and Beth Donnellan, MEd, ABD, FT

September 27, 2017                               October 24, 2017

Addiction as a Relational Disorder:             Applying Emotional Intelligence to
A Neuro-Informed Treatment Perspective          Recovery
by Chad Luke, PhD, LPC/MHSP, NCC, ACS, MAC      By Brenda Grieg, MBA, MA, LADC

                           www.naadac.org/webinars

www.naadac.org/webinars

                          Free CEs for
                          Members

                          Levels:
                          Professional
                          Associate
                          Student

                          www.naadac.org/
                          join

INDEPENDENT STUDY
                                        COURSES
              WEBINAR SERIES
                                        Earn CEs at home and at your own
 Over 75 CEs of free educational
                                        pace (includes study guide and
webinars are available. Education
                                        online examination).
  credits are FREE for NAADAC
                        members.
                                        CONFERENCES
          MAGAZINE ARTICLES
                                        NAADAC Annual Conference,
    In each issue of Advances in        September 22-26, 2017, Denver, CO
Addiction & Recovery, NAADAC's
magazine, one article is eligible for
                               CEs.
                                        CERTIFICATE PROGRAMS
     FACE-TO-FACE SEMINARS
      NAADAC offers face-to-face        Demonstrate advanced education
 seminars of varying lengths in the     in diverse topics with the NAADAC
                 U.S. and abroad.       Certificate Programs.

Cost to Watch:            CE Certificate
Free

CE Hours             To obtain a CE Certificate for the time you spent watching this
Available:           webinar:
1.5 CEs
                     1.   Watch and listen to this entire webinar.
CE Certificate for
                     2.   Pass the online CE quiz, which is posted at
NAADAC
Members:              www.naadac.org/value-based-reimbursements-webinar
Free
                     3.   If applicable, submit payment for CE certificate or join
CE Certificate for        NAADAC.
Non-members:
$20                  4.   A CE certificate will be emailed to you within 21 days of
                          submitting the quiz.

Contact Us!
                                     NAADACorg
NAADAC
44 Canal Center Plaza, Suite 301
Alexandria, VA 22314                 Naadac
phone: 703.741.7686 / 800.548.0497
fax: 703.741.7698 / 800.377.1136     NAADAC
naadac@naadac.org
www.naadac.org

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