PETITION FOR THE RECOGNITION OF A
PROFICIENCY IN PROFESSIONAL PSYCHOLOGY
AMERICAN PSYCHOLOGICAL ASSOCIATION
750 First Street, NE
Washington, D.C. 20002-4242
(202) 336-5500
PETITION PACKAGE
Proposed title of new proficiency: Addiction Psychology (RENEWAL Psychological Treatment of
Alcohol and Other Psychoactive Substance Use Disorders)
Definition: A proficiency is a circumscribed activity in the general practice of professional psychology
or one or more of its specialties that is represented by a distinct procedure, technique, or applied skill
set used in psychological assessment, treatment and/or intervention within which one develops
competence.
In order to be responsive to public need, the profession has the responsibility to exercise authority over
the process of proficiency recognition. Organization (s) responsible for the proficiency will define how
the proficiency meets public need and how practitioners acquire the psychological knowledge and
skills that represent the bases for its practice. In addition, organization(s) that are responsible for the
organized development of the proficiency are responsible for collaborating with other organizations to
ensure that appropriate education and training is provided in a sequential and integrated nature. When
education and training in a proficiency can be achieved through interdisciplinary study, organization(s)
responsible for the proficiency will describe how the proficiency meets the criteria within the context
of interdisciplinary education and training.
Petition Form
Page 2
Petition Sponsor
Criterion I. Administrative Organizations. The proposed proficiency is represented by one or
more organizations that provide systems and structures that contribute to the organized
development of the proficiency, in terms of effectiveness, quality improvement, and provider
identification and evaluation.
1.
Please provide the following information for the organization submitting the petition:
Name of organization 1: American Psychological Association, Division 50, Society of
Addiction Psychology, c/o Brandon G. Bergman, Ph.D., Division Secretary
Address: Center for Addiction Medicine, Massachusetts General Hospital, 60 Staniford
Street
City/State/Zip: Boston, MA 02114
Phone: 617.643.7563
Fax: 617.643.7667
E-mail: [email protected]
Website of organization: www.addictionpsychology.org
Name of organization 2: American Psychological Association, Division 28,
Psychopharmacology & Substance Abuse c/o Jane Acri, Ph.D., Division Treasurer
Address: P.O. Box 34085
City/State/Zip: Bethesda, MD 20827
Phone: 301-443-8489
Fax: (301) 443-2599
E-mail: [email protected]
Website of organization: http://www.apadivisions.org/division-28/
2.
Please provide the following information for the President or Chair of the organization:
Division 50
Name: Katie Witkiewitz, PhD
APA membership status: Fellow
Address: Department of Psychology, University of New Mexico, MSC 03-2220
City/State/Zip: Albuquerque, NM 87131
Phone: 505-925-2334
Fax: 505-925-2301
E-mail: [email protected]
Division 28
Name: Stacey Sigmon, Ph.D.
APA membership status: Fellow
Address:
University of Vermont Center on Behavior and Health
1 South Prospect Street, FAHC-UHC, Room 1415
City/State/Zip: Burlington, VT 05401
Phone:
(802) 656-8714
Fax: N/A
E-mail: [email protected]
Petition Form
Page 3
3.
Please provide the following information for the organization submitting the petition:
Year organization founded Division 50: 1993; Division 28: 1966
Organization incorporated Yes_____ No__X___
In what state is the organization incorporated______
Describe the purpose and objectives of the administrative organization.
Division 50
The purposes of the Division include, but are not necessarily limited to, the promotion of human welfare
through encouragement of scientific and professional activities and communication among psychologists and
others working in any capacity in the areas of substance abuse or dependence, and/or other addictive behaviors.
The Division strives to foster excellence in addictions treatment, prevention, research, and professional training
across the broad range of addictive behaviors (e.g., alcohol, tobacco, other drugs, gambling, sex, eating). Special
emphases are promoting professional development of students and early career psychologists, cultural and
lifespan dimensions of addictions, elimination of stigma, and effective technology transfer, such as
dissemination and implementation of evidence-based intervention guidelines. We are strongly committed to
increasing the diversity of our membership and leadership. Interdivisional and inter-professional collaborators
are welcome. The Division seeks to promote and provide the most effective and the highest quality of care to
the general public; demonstrate the necessity of integrating the research and scientific aspects with the actual
practice of this knowledge; illustrate the role that psychologists must have as providers of comprehensive mental
health services and substance use treatment; provide the American Psychological Association with the expertise
and knowledge of both scientist and practitioner so that we, as psychologists, actively participate in the
healthcare reform and managed care movements; work on the credentialing of psychologists who work in the
field of addictive behaviors, including but not limited to education, administration, prevention, treatment, and
research; identify and assist in the development of a continuing education curriculum for psychologists in this
area; and provide leadership in communicating with the professional, government agencies, third party payers,
and the general public. Division 50 will contribute three members to the Addiction Psychology Proficiency
Committee, which is a new collaborative committee comprised of members from Division 28 and 50 and is
charged with the updating and management of this Proficiency. This will include directing the developmental
process, soliciting assistance with needed updates or modifications, and managing the process of maintaining the
Proficiency in good status with the APA.
Division 28
The mission of Division 28 is to encourage the advancement of knowledge on the behavioral effects of
psychotropic drugs and toxicants, which includes not only basic psychopharmacology research but also research
into the determinants and treatment of substance abuse, the pharmacological treatment of mental illness, and
other clinical uses of centrally active drugs. Three primary concerns of the Division are (a) disseminating
research-based information on psychopharmacology and substance abuse within APA, in educational settings,
and to other scientists; (b) encouraging the application of the results of psychopharmacology research to human
affairs; and (c) consideration of education and policy issues pertaining to psychopharmacology, behavioral
toxicology, and substance abuse.
Petition Form
Page 4
Division 28 will contribute three members to the Addiction Psychology Proficiency Committee, which is a new
collaborative committee comprised of members from Division 28 and 50 and is charged with the updating and
management of this Proficiency. This will include directing the developmental process, soliciting assistance
with needed updates or modifications, and managing the process of maintaining the Proficiency in good status
with the APA.
Please append the bylaws for the petitioning organization if bylaws are not provided on the website.
• see http://www.apa.org/divisions/div50/about_bylaws.html for Division 50 by-laws
• see http://www.apadivisions.org/division-28/about/bylaws.aspx for Division 28 by-laws
Please provide the following information for all officials in the organization, including the Executive Officer or
responsible petitioning staff person.
Division 50
A.
Name: Katie Witkiewitz, Ph.D.
Title: President
APA membership status: Fellow (50)
Address: Department of Psychology, University of New Mexico, MSC 03-2220
City/State/Zip: Albuquerque, NM 87131
Phone: 505-925-2334
Fax: 505-925-2301
E-mail: [email protected]
B.
Name: Bruce S. Liese, Ph.D., ABPP
Title: President-Elect
APA membership status: Fellow (29, 50)
Address: University of Kansas Medical Center – Family Medicine, 3901 Rainbow
Blvd., Mailstop 4010
City/State/Zip: Kansas City, KS 66160
Phone: 913-588-1912
Fax: NA
E-mail: [email protected]
C.
Name: Sherry McKee, Ph.D.
Title: Past President
APA membership status: Fellow (50)
Address: Yale University School of Medicine, 2 Church Street South, Suite 109
City/State/Zip: New Haven, CT 06519
Phone: 203.737.3529
Fax: 203.737.4243
E-mail: [email protected]
Division 28
Petition Form
Page 5
A.
Name: Stacey Sigmon, Ph.D.
Title: President
APA membership status: Fellow (28, 50)
Address: University of Vermont Center on Behavior and Health, 1 South Prospect
Street, FAHC-UHC, Room 1415
City/State/Zip: Burlington, VT 05401
Phone: (802) 656-8714
Fax: NA
E-mail: [email protected]
B.
Name: William W. Stoops, Ph.D.
Title: Past President
APA membership status: Fellow (3, 6, 28, 50), Member (25)
Address: 1100 Veterans Drive, Medical Behavioral Science Building Room 140
City/State/Zip: Lexington, KY 40536
Phone: (859) 257-5388
Fax: (859) 257-7684
E-mail: [email protected]
C. Name: Anthony Liguori, Ph.D.
Title: Council Representative for Division 28
APA membership status: Fellow (28), Member (2, 50)
Address: W3803 North Drive, Lakeland College, Division of Social Sciences
City/State/Zip: Plymouth, WI 53082-0359
Phone: (920) 565-1000 X2346
Fax: (920) 565-1206
E-mail: [email protected]
Outline the structure and functions of the administrative organization (frequency of meetings, number of meetings per year,
membership size, functions performed, how decisions are made, types of committees, dues structure, publications, etc.).
Provide samples of newsletters, journals, and other publications, etc.
** See Appendix A for samples of Division newsletters, associated journals, and other relevant
publications
Division 50
Frequency of Meetings. Division Board of Directors meets monthly for conference calls and at the
annual convention; the membership meets once annually.
Number of Meetings/year. 14
Membership Size. 1021
Functions Performed: Promotion of communication and cooperation among addiction psychologists,
as well as facilitation of communication between addiction psychologists and others in service of the
field of psychology as a whole.
How are decisions made? By a vote of the Division Board and/or membership.
Petition Form
Page 6
Types of Committees: Executive Board, Fellows and Awards, Nominations and Elections,
Committee for Professional Practice, Membership, Education and Training, Science Advisory,
Bylaws, Newsletter Staff, Awards, and ad hoc Committees (Convention Program, Evidence Based
Practice in Addiction, Advocacy and Policy, Special Populations, Fostering Careers in Addiction
Psychology).
Dues Structure: $38/yr.
Official Publications: Psychology of Addictive Behaviors (published quarterly as an APA journal) and
The Addictions Newsletter (three issues per year)
Division Website: www.addictionpsychology.org
Links to the Division 50 newsletter, and the Division Journal, Psychology of Addictive Behaviors, are
as follows:
http://www.addictionpsychology.org/publications/newsletters
http://www.apa.org/journals/adb/
Division 28
Frequency of Meetings. The Division Executive Committee meets semi-annually and the
membership meets annually. Also, the Executive Committee supplements this with regular telephone
conference calls.
Number of Meetings/year. 8-10
Membership Size. 450
Functions Performed: Promotion of continuing education for and scientific exchanges among the
APA membership on psychopharmacology and substance abuse through the Division’s programs at
the annual convention. In addition, the Division provides consultation and advice to various
governmental agencies (e.g., NIDA and FDA).
How are decisions made? Decisions are voted on by the Executive Committee and/or the membership
at the Division’s Annual Business Meeting. Bylaw changes require two/thirds of those voting either
while at the annual Division Business meeting or by electronic ballot.
Types of Committees: The Executive Committee consists of the President, President-Elect, Past
President, Council Representative(s), Members-at large, Secretary, Treasurer, Membership Officer,
New Fellows Officer, Awards Chair, and Newsletter Editor. All other committees are ad hoc with a
three-year tenure.
Dues Structure: $20/year
Official Publications: Experimental and Clinical Psychopharmacology (bimonthly),
Psychopharmacology and Substance Abuse News (three issues per year)
Division Website: http://www.apadivisions.org/division-28/
Petition Form
Page 7
Links to the Division 28 newsletter, the Scientist Spotlight, and the Division Journal, Experimental
and Clinical Psychopharmacology, are as follows:
http://www.apadivisions.org/division-28/publications/newsletters/psychopharmacology/index.aspx
http://www.apadivisions.org/division-28/publications/scientist-spotlight/index.aspx
http://www.apa.org/pubs/journals/pha/index.aspx
4.
Present a rationale that describes how your organization provides systems and structures, which make a significant
contribution to the organized development of the proficiency. Describe the role of your organization in
collaborating with other organization/s to ensure the organized development of the proficiency. Describe the role
of your organization in providing oversight to ensure a core of psychological knowledge and training is offered in
a sequential and integrated nature. Describe the role of your organization in providing oversight if the proficiency
is obtained in the context of interdisciplinary education and training.
Divisions 28 and 50 are the organizations most qualified to provide oversight of the Addiction Psychology
Proficiency. These Divisions are comprised of members from across the United States who provide clinical
services, education, supervision, training, and research in a wide range of public and private clinical settings.
Division 28 and 50 members address addictive behaviors involving problems with psychoactive substances, as
well as eating disorders, nicotine, gambling, spending, and sexual behaviors, among others.
Divisions 28 and 50 work closely together to oversee systems and structures necessary for ongoing development
and maintenance of our proficiency. We have formed a joint Addiction Psychology Proficiency Committee
(APPC) consisting of six individuals: three from each Division, including the current President of Division 50
(Katie Witkiewitz), President-elect of Division 50 (Bruce Liese), and Division 50 representative (Mark
Schenker), past President of Division 28 (William Stoops) and Division 28 representatives (Dustin Stairs and
Cecile Marczinski). Each year we will solicit volunteers from each Division, who will then be appointed to the
APPC by the President of each Division. Members of the APPC will serve 2-year terms, which will be staggered
to make sure that the committee is always composed of members with historical knowledge of the committee.
By design, at least two members of this committee – one from each Division – are also members of other
Divisions, in order to expand representation beyond Divisions 28 and 50. For example, one current member of
the APPC is a member of Divisions 50, 2, 12, 29, 42, 43, and 49. Another member of the Proficiency Committee
is a member of Divisions 28, 50, 12, and 5. Again, the purpose of the APPC is to ensure that a core of
psychological knowledge and training is offered in a sequential and integrated manner.
Substantial advances regularly occur in the field of addictions, and the APPC engages in an ongoing review
process to monitor these advances and ensure that Addiction Psychologists stay abreast of current developments
in Addiction Psychology. The APPC meets four times per year to discuss these advances and identify training
necessary for continued growth of the proficiency.
The APPC also works closely with other Division 28 and 50 committees. For example, the APPC meets
regularly with Division 50’s Education and Training Committee (ETC) and together they plan ongoing
sequential and integrated Addiction Psychology education and training opportunities. These two committees
have worked together to develop an Addiction Psychology Webcast Series that will take place at APA
Headquarters in Washington on five consecutive Fridays in February and March 2017. These two committees
(APPC and ETC) also review educational and training activities of the Division 50 annual midyear meeting
(Collaborative Perspectives on Addiction; CPA). This year CPA attendees are given the opportunity to choose
between a research track and a clinical track. More about programs developed and reviewed by the APPC will
be described later in this petition, under Criterion VI (Acquisition of Knowledge and Skills).
The APPC maintains regular ongoing communication with the Executive Committees of both Divisions (28 and
Petition Form
Page 8
50). These Divisions hold regular conference calls where the APPC has opportunities to exchange information
and ideas regarding developments in the Addiction Psychology Proficiency.
The development of proficiency in Addiction Psychology begins in graduate school, where graduate students are
required to take courses in development, psychopathology, personality theory, treatment and assessment skills,
etc. These skills form the foundation of general psychology and Addiction Psychology. Unfortunately, most
graduate psychology programs do not require formal training in Addiction Psychology. Hence, one aim of the
APPC is to monitor Addiction Psychology curricula and encourage graduate programs to provide coursework
and required training in addictive behaviors. For example, many clinical psychology programs offer courses in
Drugs and Behavior and Addiction Treatment Techniques, and many practicum placements involve working
with clients who have addictive disorders. The Clinical Psychology internship also offers opportunities for fulltime clinical practice working with patients with addictive disorders. The APPC maintains a list of internship
sites that focus on the treatment of addictive behaviors and the APPC will update the list annually.
Upon completing graduate school in psychology, Addiction Psychologists depend on continuing education to
develop and maintain proficiency in Addiction Psychology. Hence, the APPC is predominantly focused on
continuing education.
Requirements for this proficiency can be met through work in varied settings. For example, students will be in
programs that would lead to licensure as a psychologist (e.g., through university training in masters and doctoral
work, such as for clinical, counseling, and similar license-eligible psychology training programs). As part of
that kind of training, they would then select specialized course work related to addictions research, assessment,
clinical interventions, etc. In other words, rather than choosing some other types of electives, they will select
electives at their degree granting institution that focused on the type of addiction, alcohol, and drug related
topics that we describe in the content matter related to the proficiency. They also will select specialized
practicum, internship, or postdoctoral placements connected to substance use and addictions assessment,
treatment, and research. These activities will therefore occur at a host degree granting institution, and then
varied placement sites connected to individual institutions, for practica, internship, research experiences, etc.
There is no single program per se where any one student would receive all of the required training. Instead,
there are standard programs of training for students seeking licensure as a psychologist that provide the elements
required for proficiency, as well as associated practica, internship, and postdoctoral training opportunities. This
allows a practical flexibility for those seeking to demonstrate proficiency in this area. This way of doing this is
also quite important as the public health demands in this area are increasing and there are not enough slots in
any single program to accommodate all who would be interested in working in this area. This type of flexible
training model to achieve proficiency benefits psychologists seeking to work in this area and the public by
creating a trained workforce.
The convention programs by Divisions 28 and 50 for the Annual Meeting of the American Psychological
Association provide an important opportunity for interchange among researchers and practitioners who are
experts in the area of substance-related disorders, as well as for those who specialize in other areas of addictive
behavior. Within Division 50, the presence of clinicians, academicians and researchers, and the consistent
expectation of Division leadership that the program address the needs of all the members of the division, has
served to create programs that facilitate the sharing of knowledge and concerns relevant to the area of substancerelated disorders. Division 28, which also includes clinicians and researchers, maintains a major interest in the
etiology, prevalence, prevention, and treatment of substance-related disorders. These two divisions often
collaborate with each other to enhance programmatic offerings at the Annual Convention of APA. During
2012-2014, they collaborated and fiscally supported mutual activities related to the annual mid-year
Collaborative Perspectives on Addiction conference that has also offered clinically oriented continuing
education.
APA has certified Division 28 as a provider of Continuing Education for many years. In this regard, Division 28
has consistently offered state-of-the-art workshops on smoking cessation programs and offered courses on the
Petition Form
Page 9
biological and behavioral bases of addiction at the annual convention. APA certified Division 50 to provide
Continuing Education in the area of addiction in 1999. The division developed and/or otherwise
supported/cosponsored continuing education programming for the 1999 convention and has done so in all
subsequent years since then. For instance, from 2005 through 2010, Division 50 provided continuing education
opportunities at the convention specifically focused on dissemination and implementation of evidence-based
practices in addictions treatment and alcohol-related brief interventions useful to solo practitioners, as well as
practitioners in institutional settings. Subsequent years focused on related topics in special populations of
clients. The Division maintains a strong commitment to providing CE to practitioners.
Moreover, Division 50 launched a journal, Psychology of Addictive Behaviors, which is now a journal of the
American Psychological Association. The journal has a consistently high impact rating and further facilitates
dissemination efforts in this area of proficiency. Division 50 also developed web-based resources focusing on
evidence-based practice for substance-related treatment, designed to provide practitioners with a central point
for accessing current available resources and guidelines. This launched in 2008 and involved collaboration with
Division 56 (Trauma). This was then enhanced by a collaboration with Division 12 (Clinical) to develop similar
resources on specific treatments for substance use disorders to be listed on a website they were maintaining on
treatments for a wide range of disorders. Division 50 also uses its listservs to announce information regarding
evidence-based practices in addictions and related trainings and resources. Through its active Science Advisory
Committee and ad hoc Committee on Evidence-Based Practices in Addiction, it also has participated in a variety
of efforts over the last several years to provide input on guidelines developed by other influential organizations
affecting health care more generally and substance use more specifically. For instance, input was provided to
offer the perspective of psychologists regarding addictions treatment for the National Repository of Evidencebased Programs and Practices by SAMHSA, as well as for National Quality Forum Consensus Standards on
Evidence-Based Practices to Treat Substance Use Conditions.
These and other efforts have been documented in the divisions’ newsletters and developed into other useful
resources for division members and psychologists more generally. Together, through these endeavors, Divisions
28 and 50 strive to provide guidance and opportunities for training and acquiring knowledge of the state-of-theart research and clinical advances to clinicians involved in the treatment of addiction.
5.
List other organizations that are associated with, that promote, or that certify practitioners in this psychological
proficiency. Please provide letters of support from these other organizations supporting your petition.
There are several organizations that are associated with and/or promote efforts to enhance proficiency among
practitioners in this area of work, but we are not aware of any other organization that certifies doctoral
psychologists as practitioners in this proficiency. The Research Society on Alcoholism, The College on
Problems of Drug Dependence, and the Society for Research on Nicotine and Tobacco are organizations that
promote research and information dissemination relevant to the proficiency, but none of those organizations are
involved with certification of practitioners. The Association for Behavioral and Cognitive Therapies has an
Addictive Behaviors Special Interest Group. This group includes researchers and practitioners that are interested
in addiction and its goals reflect the advancement of behavioral treatment and research of addictive behaviors.
The American Academy of Health Care Providers in the Addictive Disorders certifies practitioners, including
psychologists, for the treatment of addictions. However, the certification is not specific to the psychological
treatment of addictions and includes counselors without doctoral degrees within the same rubric as
psychologists. The Association for Addiction Professionals (NAADAC) also offers varied certifications, but
none specifically for doctoral psychologists.
6.
Signature of official (s) representing the organization submitting the petition:
name
title
date
Petition Form
Page 10
Katie Witkiewitz, Ph.D. President, Division 50
12/19/2016
Stacey Sigmon, Ph.D.
12/19/2016
President, Division 28
Petition Form
Page 11
Need and Distinctiveness
Criterion II. Documented Need for Proficiency Recognition. A proficiency shall be clearly
responsive to a documented need of the public and the profession.
1.
Describe with relevant references the public needs the proficiency fulfills and how the proficiency meets those
needs.
National surveys of U.S. alcohol and drug use have consistently revealed a large gap between the number of
individuals with addiction-related problems and the subset who receive addiction focused interventions (e.g.,
Cohen, Feinn, Arias, & Kranzler, 2007; Narrow, Regier, Rae, Manderscheid, & Locke, 1993; Substance Abuse
& Mental Health Services Administration [SAMHSA], 2015). Only about 10% of persons with substance use
disorders (SUD), for example, obtain services in specialty care such as traditional addiction treatment programs
(SAMHSA, 2015), and only one in 10 adolescents with an SUD receives treatment of any kind (Clark, Horton,
Dennis, & Babor, 2002; Dennis, Dawud-Noursi, Muck, & McDermiet, 2003). The National Institute on Drug
Abuse (2014) reports that current data from 2012 continue to show very low treatment utilization: of the 23.1
million Americans age 12 and older who needed treatment for problems related to alcohol or other substances,
only about 1% received treatment at a specialty treatment facility. Even among those who received services,
most interventions are not alcohol or substance specific. Also, the minority of substance users who utilize the
healthcare system, use services throughout the medical and mental health sectors (especially expensive inpatient
services) with higher frequency than persons without an addictive disorder, and the cost-offset benefits of
covering addiction treatment in comprehensive medical plans are well documented (e.g., Holder & Blose, 1992).
Of the 3.87 million (13.5%) youth age 12–18 currently enrolled in school with an SUD, only 141,000 (4%) or 1
in 25 received treatment in an addiction or mental health specialty program (Dennis, Clark, & Huang, 2014). In
fact, only 298,800 (8%) or 1 in 12 reported receiving any kind of intervention, including (with overlap)
treatment in an addiction or mental health specialty program (141,000; 4%), a self-help program (99,000; 3%), a
medical office (36,000; 1%), emergency room (34,000; 0.9%), or juvenile detention (27,000; 0.7%). Among
youth with substance use disorder, the rate of unmet need for any intervention (92.3% overall) is similar by
gender but significantly worse for those younger than age 15 years (96.3%) and for African-American youth
(95.0%) and for minority girls versus boys within several minority groups. Thus, there is a great need to increase
access to care and reduce health disparities in access.
These data indicate that the great majority of individuals with addiction-related disorders do not receive formal
or professional treatment that focuses on their addictive behavior problems. This has resulted in an over- or misutilization of other health services by a minority of these clients, and also has shifted some of the burden of care
onto voluntary support networks. Moreover, of addiction-related treatment providers in the U.S., over 80% do
not have doctoral degrees and do not have comprehensive training in the diagnosis and treatment of other
psychological disorders (e.g., anxiety and depressive disorders) that often co-occur with addiction-related
problems. Counselors who do not have doctoral degrees typically offer only a supportive, 12-step intervention,
and lack training to provide the range of evidence-based interventions better matching the heterogeneous nature
of addictive disorders. Doctoral level mental health professionals, such as psychologists and psychiatrists, who
have the expertise to offer a range of evidence-based treatments for addiction and other psychological disorders
contribute only a small percentage (5-10%) of addiction treatment services in the U.S. (NAADAC, 9/23/2014);
licensed psychologists constitute only 5% of this workforce (Rieckmann, Farentinos, Tillostson, Kocarnik, &
McCarty, 2011). This is of particular concern in view of high rates of co-occurrence between addiction-related
and other psychological disorders and the need to provide integrated services to those with co-occurring
addiction and other types of mental disorders (Center for Substance Abuse Treatment [CSAT], 2005; McGovern
et al., 2014). Psychologists are uniquely trained to address such co-morbidity with evidence-based psychosocial
treatment approaches.
Demographic trends also predict a 31% increase in the need for counselors facile in addictions treatment.
Petition Form
Page 12
Because training for this proficiency occurs in multiple venues coordinated by varied universities, practica sites,
and internship and postdoctoral training sites, the training qualifications of faculty are maintained in accord with
general ethical guidelines for practice in terms of the trainers remaining proficient to do their jobs. Regular
reviews of such sites for accreditation insure that individuals are working within their scope of practice and
maintaining adequate knowledge and skills to be trainers. It is expected that supervisors and instructors that
provide supervision and didactic teaching will have adequate experience in the area of addiction and addiction
treatment. Much of the coursework and supervision will be obtained through Ph.D. programs or through APA
approved CE activities that assures adequate experience through the standard review procedures for those
training experiences. Occupations and industries related to healthcare are projected to add the most new jobs
between 2012 and 2022 (Bureau of Labor Statistics, 2014), indicating a corresponding need for psychologists
well prepared in the psychological treatments of addictive disorders to complement the services offered by nondoctoral providers.
In sum: (l) Access to addiction treatment is inadequate to cover the service needs of the U.S. public; (2) the
majority of services that are received by clients with addiction-related problems either are not addiction specific,
or they are delivered by counselors who do not have doctoral degrees and therefore lack (a) comprehensive
mental health training and (b) training in the range of evidence-based interventions for addictive disorders,
which are heterogeneous in nature; and (3) doctoral level psychologists with the necessary comprehensive
training in the clinical management of addiction and other psychological disorders deliver only a very small
portion of the addiction treatment in the U.S.
Psychologists with a proficiency in the psychological treatment of addictive behaviors have specialized
knowledge and skills from training that emphasizes evidence-based assessment and intervention procedures.
Testing to obtain a Certificate in this proficiency requires 12 domains of knowledge (including clinical
pharmacology and epidemiology of addiction, causes of addiction, prevention, screening, diagnosis, treatment,
ethical concerns and issues specific to certain populations) essential for safe and effective treatment of persons
for addiction-related problems. Continued recognition of this proficiency provides a clear path for guiding
continued development of graduate and postdoctoral training in this area and therefore supports the production
of psychologists who can competently provide addiction treatment. This responds to the public need for greater
access to addiction treatment services in general and, specifically, to a greater range of treatments than are
routinely offered by addiction counselors who lack doctoral training. It also provides an avenue for greater
integration of addiction and other mental health services, which is desirable given the substantial rates of comorbid psychological disorders among individuals with addictive disorders.
Note that in 2013, a pause in the process of testing and granting certification in this proficiency occurred when
no new certificates were given due to administrative decisions at APA headquarters, who felt that the lack of
applications for certification warranted a revisiting of the importance of this Proficiency. After deliberation and
discussion, it was determined that there clearly is a need for psychologists who are proficient in this area of
clinical care, and the process of certification was restored in 2015.
** See Appendix B for letters of support from Division 55, the College on Problems of Drug Dependence, the
Association for Behavioral and Cognitive Therapies Addictive Behaviors Special Interest Group, the Research
Society on Alcoholism, and the Society for Research on Nicotine and Tobacco supporting the need for this
proficiency recognition.
References
Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring
disorders. Treatment Improvement Protocol (TIP) Series 42 (DHHS Publication No. SMA 05-3992).
Rockville, MD: Substance Abuse and Mental Health Services Administration.
Clark, H. W., Horton, A. M., Dennis, M., & Babor, T. F. (2002). Moving from research to practice just in time:
The treatment of cannabis use disorders comes of age. Addiction, 97(Suppl. 1), 1-3. doi:10.1046/j.1360-
0443.97.s01.11.x
Petition Form
Page 13
Cohen, E., Feinn, R., Arias, A., & Kranzler, H. R. (2007). Alcohol treatment utilization: Findings from the
National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence,
86(2-3), 214-221. doi:10.1016/j.drugalcdep.2006.06.008
Dennis, M. L., Clark, H. W., & Huang, L. N. (2014). The need and opportunity to expand substance use disorder
treatment in school-based settings. Advances in School Mental Health Promotion, 7(2), 75-87.
doi:10.1080/1754730X.2014.888221
Dennis, M. L., Dawud-Noursi, S., Muck, R. D., & McDermeit, M. (2003). The need for developing and
evaluating adolescent treatment models. In S. J. Stevens & A. R. Morral (Eds.), Adolescent substance
abuse treatment in the United States: Exemplary models from a national evaluation study (pp. 3-34).
New York, NY: Haworth Press.
Holder, H. D., & Blose, J. O. (1992). The reduction of health care costs associated with alcoholism treatment: A
14-year longitudinal study. Journal of Studies on Alcohol and Drugs, 53(4), 293-302.
McGovern, M. P. (2014). Dual diagnosis capability in mental health and addiction treatment services: and
assessment of programs across multiple state systems. Administration and Policy in Mental Health, 41,
205-2014.
Narrow, W. E., Regier, D. A., Rae, D. S., Manderscheid, R. W., & Locke, B. Z. (1993). Use of services by
persons with mental and addictive disorders: Findings from the National Institute of Mental Health
Epidemiologic Catchment Area program. Archives of General Psychiatry, 50(2), 95-107.
doi:10.1001/archpsyc.1993.01820140017002
National Association of Alcoholism and Drug Abuse Counselors (NAADAC). Publications. Retrieved
September 23, 2014, from http://www.naadac.org/publications
National Institute on Drug Abuse. (2014). DrugFacts: Nationwide trends. Retrieved from
http://www.drugabuse.gov/publications/drugfacts/nationwide-trends
Rieckmann, T., Farentinos, C., Tillotson, C. J., Kocarnik, J., & McCarty,
D. (2011). The substance abuse counseling workforce: Education, preparation and certification.
Substance Abuse, 32(4), 180-190. doi:10.1080/08897077.2011.600122
Substance Abuse and Mental Health Services Administration. (2015). Behavioral health trends in the United
States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 154927, NSDUH Series H-50).). Rockville, MD: Substance Abuse and Mental Health Services
Administration.
U.S. Department of Labor, Bureau of Labor Statistics. (2014, January 8). Substance abuse and behavioral
disorder counselors. Occupational Outlook Handbook. Retrieved from
http://www.bls.gov/ooh/community-and-social-service/substance-abuse-and-behavioral-disordercounselors.htm
2.
Describe any regulatory, professional privileging, and/or educational statute or regulation of this
proficiency of which you are aware.
The APA Council currently recognizes this proficiency. The APA College of Professional Psychology has been
offering a credential based on successfully passing the examination for more than 20 years. Beyond that,
Petition Form
Page 14
however, addressing this issue would require a review of the licensing laws governing psychological practice in
all 50 states, because it is the states that license psychologists to practice and who thus would stipulate any
restrictions or regulations governing addiction-related treatment by psychologists.
To our knowledge, most licensing laws affecting doctoral psychologists currently do not have requirements or
restrictions that specifically apply to addiction treatment apart from the general requirement that psychologists
limit their practice to areas in which they are competent to deliver services within their scope of practice.
According to this legal and ethical principle, our presumption is that the great majority of licensed psychologists
do not treat clients exclusively seeking treatment for addiction. Some psychologists may not offer such services
because they lack the necessary specialized knowledge and skills to do so. Others may be well prepared to do so
based on individual training choices they have made. An exception is the State of California, which requires all
candidates for licensure to have completed a graduate level course on alcoholism / chemical dependency
detection and treatment. We believe most states do not explicitly restrict the practice of psychologists with
clients with substance use related problems, apart from requiring them to limit their practice to areas in
which they are competent. However, third party payers in some states (such as Pennsylvania)
make reimbursement for substance-related services contingent upon providers having a credential indicating
they are proficient to deliver such services. Substance use counselors who do not have a doctoral degree
typically possess such a credential. Such arrangements provided part of the initial motivation for the
development of this proficiency, as a comparable credential for psychologists, which was not widely available
prior to the current proficiency. It should be noted that the American Academy of Health Care Providers in the
Addictive Disorders has offered a credential to psychologists for several years. However this credential is not
specific to psychologists but includes many counselors and social workers below the doctoral level. Moreover,
this credential does not require the demonstration of both knowledge and proficiency.
NAADAC (National Association for Alcohol and Drug Abuse Counselors), also known as The Association for
Addiction Professionals, also offers a variety of certificates, but none specifically for psychologists that in any
way restricts their practice beyond the ethical and legal bounds previously noted. Historically in some states
(such as New York), some psychologists who were competent to provide addiction treatment services, but
lacked a credential, had difficulties obtaining reimbursement for addiction treatment services from some third
party payers. This problem is likely to become more widespread as managed care companies increasingly dictate
health and mental health care services and seek to buy the least expensive services for a given disorder (e.g.,
contracting for addiction-related services from counselors without doctoral training, rather than from doctoral
level psychologists). Official recognition of this proficiency certainly has helped alleviate this problem, and its
renewal will continue to do so.
3.
Describe how the recognition of this proficiency will increase the availability and quality of services that
professional psychologists provide without reducing access to needed services.
Substance use disorders, along with anxiety and mood disorders, are the most prevalent psychological disorders
in the general population, yet most psychologists providing care are only minimally versed in the clinical
management of substance use disorders, either alone or in conjunction with comorbid psychological disorders.
Broad knowledge of psychopathology and general clinical management strategies facilitate minimal skills; but
more is needed for thorough treatment. As described under Item #1 in this Criterion, this has contributed to
psychologists being seriously underrepresented among addiction treatment providers and has resulted in the
great majority of services being provided by counselors who do not have doctoral degrees, lack comprehensive
mental health training, and typically work primarily from a single (12-step) approach. This situation is not
optimal for providing public access to the range of evidence-based treatments for addictive disorders that
psychologists have been instrumental in developing (summarized in Bien, Miller, & Tongian;1993; Hester &
Miller, 1989; Bigelow, Stitzer, & Liebson, 1984; Tucker, Vuchinich, & Downey, 1992; Miller, Wilbourne, &
Hettema, 2003 -- see Criterion V.). Although psychologists have been at the forefront of innovations in
addiction treatment for more than three decades, these innovations have not been emphasized in most graduate
training programs, except at a handful of universities with a concentration of faculty experts, nor has there been
an accessible mechanism to gain expertise at the postdoctoral level.
Petition Form
Page 15
A doctoral-level proficiency in the psychological treatment of individuals with addiction-related problems has
promoted the wider dissemination of necessary knowledge and skills among psychologists and will continue to
both improve and provide greater access to effective treatments for individuals with addictive disorders. It is
difficult to envision how continuation of this proficiency would reduce access to addiction-related services,
since psychologists now provide so few of these services in the U.S. In contrast, psychologists having such a
proficiency should facilitate delivery of treatment services by allowing such individuals to supervise those with
lesser training and experience, particularly as related to conditions involving co-morbid addiction and other
mental health conditions. Given that co-occurring disorders are often involved in the treatment of individuals
with addiction, such recognition of the proficiency can only enhance the level of expertise for psychologists,
which is essential in this field of Addiction Psychology.
Historically, there has been an expanded acceptance of this credential in several states, which has enabled
Psychologists in Independent Practice to have less difficulty in receiving reimbursement for caring and treating
individuals with an addiction disorder. It also has enabled psychologists to be included on faculties of medical
schools and other university programs to teach Addiction Psychology. Continuing this proficiency will increase
the presence of psychologists in the addiction treatment delivery system. This will be beneficial to the quality of
services for several reasons. First, psychologists' comprehensive mental health training, when combined with
expertise in addiction treatment, will facilitate integrated care of addiction and mental health disorders, which is
optimal given the substantial rates of comorbidity between addiction and other psychological disorders. Second,
for the same reason, psychologists will be ideal gatekeepers and clinical supervisors in managed care systems
that provide addiction-related and other mental health services. An efficient use of psychologists' comprehensive
training in such systems would entail having them evaluate, treat and refer clients to appropriate care facilities or
other providers in the system and/or providing clinical supervision of substance use counselors who lack
doctoral degrees. Third, there is a great need for more outpatient and early intervention services for the
underserved majority of individuals with addictive disorders who do not require expensive inpatient treatment
(cf. Bien et al., 1993; Miller & Hester, 1986). Many psychological treatments of addiction are well suited for
delivery on an outpatient basis. Fourth, over time, increasing the presence of psychologists who are recognized
with expertise in evidence-based treatments for addiction could facilitate wider adoption of such treatments
within the addiction treatment delivery system at large. The medically-oriented treatment approaches that
dominate the U.S. treatment delivery system have not been as well supported empirically. In addition to being
able to enact different treatment approaches and provide staff training in their use, psychologists with such a
credential also can implement program evaluation mechanisms that will provide feedback on treatment
effectiveness.
References
Bien, T. H., Miller, W. R., & Tonigan, J. S. (1993). Brief interventions for alcohol problems: A review.
Addiction, 88(3), 315-336. doi:10.1111/j.1360-0443.1993.tb00820.x
Bigelow, G. E., Stitzer, M. L., & Liebson, I. A. (1984). The role of behavioral contingency management in drug
abuse treatment. In J. Grabowski, M.L. Stitzer, & J.E. Henningfield (Eds.), Behavioral intervention
techniques in drug abuse treatment (NIDA Research Monograph no. 46, pp. 36-52). Washington, D.C.:
U.S. Government Printing Office.
Hester, R. K., & Miller, W. R. (Eds.). (1989). Handbook of alcoholism treatment approaches: Effective
alternatives. New York, NY: Pergamon Press.
Miller, W. R., & Hester, R. K. (1986). Inpatient alcoholism treatment: Who benefits? American Psychologist,
41(7), 794-805. doi:10.1037/0003-066X.41.7.794
Miller, W. R., Wilbourne, P. L., & Hettema, J. E. (2003). What works? A summary of alcohol treatment
Petition Form
Page 16
outcome research. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment
approaches: Effective alternatives (3rd ed.). Boston, MA: Allyn and Bacon.
Tucker, J. A., Vuchinich, R. E., & Downey, K. R. (1992). Substance abuse. In S. M. Turner, K. S. Calhoun, &
H. E. Adams (Eds.), Handbook of clinical behavior therapy (pp. 203-223). New York, NY: John Wiley
& Sons.
Criterion III. Distinctiveness. A proficiency is represented by a distinct procedure, technique, or
applied skill set used in psychological assessment and/or treatment within which one develops
competence.
1. Provide a brief description of the proficiency by responding to the questions below (limit 400 words). This provides the
foundation for what will appear on the APA website upon recognition of the proficiency and should be understandable to
the general public. Descriptions will be edited for consistency to conform to the CRSPPP website standards.
1.
2.
3.
Provide a brief (2-3 sentences) definition of the proficiency.
What specialized knowledge is key to the proficiency?
What are the essential skills and procedures associated with the proficiency?
This proficiency involves the application of psychological treatment of addiction stemming from the use of
alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions
(e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral,
interpersonal, and other problems arising from the addictive behavior. The treatment of problems associated
with addiction is a proficiency in professional psychology recognized as part of a general practice providing
service to youth, adolescents, adults, and elders, alone, in couples, families, or in groups. To be recognized as
proficient in this area, a psychologist is licensed and has particular knowledge about the factors related to the
origins, course, and treatment of addiction. They also require screening, assessment, and diagnostic skills to
identify these problems in relation to and distinct from other psychological or health behavior disorders. Lastly,
they need training and experience in evidence-based prevention and treatment methods for addictions.
1.
Provide a detailed description of how this proposed proficiency differs from and is similar to existing proficiency
practices. Provide a detailed description of how one develops and is evaluated for competency to practice the
proficiency. The comparison and differentiation must address the distinct procedure, technique or skill set used in
the practice of the proficiency. In addition, the comparison and differentiation must address how a knowledge base
and competency in the proficiency is gained beyond broad and general doctoral training.
This proficiency is distinguished from existing proficiencies primarily with respect to the focus on addictive
behaviors. These problems are recognized as biopsychosocial in nature, reflecting the involvement of biological,
psychological, and social factors, including culture, in the development of problems and the need to address this
range of factors in the amelioration of the problems. On the biological side, this involves a basic understanding
of the pharmacological and psychopharmacological effects and interactions among alcohol, nicotine, and other
substances, as well as an understanding of the development of tolerance and withdrawal. Physical
developmental characteristics related to age are also relevant. Psychological aspects of addictive behaviors
include learning and reinforcement theories, self-efficacy, and outcome expectancies, and coping skills, as well
as other psychological disorders. Social factors of importance in these disorders include cultural beliefs,
practices, and biases, peer influence and norms, and marital/family influence and support.
The populations of importance for this proficiency are defined largely by the presence of addictive behavior
problems. This would include individuals with physical and/or psychological dependence on one or more
psychoactive substances, as well as individuals whose patterns of substance use or addictive behaviors
Petition Form
Page 17
significantly increase the risk for adverse psychological, social, interpersonal, occupational, legal, or health
consequences on its own or by its interactions with other co-morbid conditions.
In addition to general clinical knowledge and techniques, this proficiency includes a number of procedures
developed specifically for use with addiction. With respect to screening, assessment, and diagnosis, these
include specialized measures of problem identification, addiction or dependence severity, problems associated
with and likely resulting from substance use and misuse, and behavioral patterns of addiction. More
psychologically-oriented assessments may include measures characterizing history of use, reasons for use, issues
of motivation and beliefs around use, treatment history, and other facets of attitudes towards treatment and helpseeking. Other assessments relate to the biopsychosocial nature of the disorder and may include assessments for
differential diagnosis, and of peer use, spousal, and family substance use and other addictive behavior.
Collecting information, with a client’s informed consent, from key individuals in the social network, or
collaterals, is also a common procedure. There also are a number of specific treatment/prevention techniques
including methods to address motivation for treatment, to identify and reduce the risks (e.g., relapse) to
successful treatment, and to mobilize social resources to enhance therapeutic effects.
Training for this proficiency builds upon what standard doctoral level clinical training provides. Typical training
involves formal instruction and supervised clinical exposure to varied client populations for screening,
assessment, diagnosis, and treatment procedures. Similarly, training to achieve this proficiency uses the same
types of methods but broadens exposure to populations exclusively affected by addiction with or without other
mental health problems. Additionally, the complex nature of the cases often involves exposure to individuals
diagnosed with related physical conditions that interact with addictions and other psychological disorders. As
such, the proficiency demands greater attention to a knowledge base and training experiences focused on
differential diagnosis, treatment approaches with more integrated goal management, and more adaptive
continuing care.
Criterion IV. Diversity. The organization(s) responsible for the proficiency demonstrate the
recognition of cultural and individual differences and diversity in the development, modification
or evaluation of the proficiency.
1.
Describe how education and training of cultural and individual differences and diversity are integrated into the
curriculum. Include information on coursework and training experiences.
Addiction Psychology is rooted in clinical psychology, which has a significant history in the assessment of
individual and cultural differences (Comas-Diaz, 2012; Zane et al., 2016). A clinical psychology curriculum
generally begins training of doctoral students with attention to individual and cultural differences in courses
related to basic theories of psychopathology, assessment, and approaches to providing treatment (Diller, 2015;
Falender & Shafranske, 2016; Falender et al., 2014). Most clinical psychology graduate students also take
specific courses focused on multicultural issues and working with clients of varied backgrounds.
Addiction Psychology training at the Ph.D. level takes multicultural education further with focused seminar-type
coursework going into more depth on theories related to the nature and impact of addictive behavior, ranging
from in-depth focus on epidemiology, broad public health approaches to intervention, specific theories of
disorders related to different classes of substances, or comorbidity of specific addictive disorders combined with
varied mental health conditions. In some cases there may be even more specific multicultural issues and
addictions courses, as well as the general integration of these issues into other courses. Individual and cultural
difference issues are incorporated into most specialized courses pertaining to addiction because it is well
recognized that addictive behavior problems may affect individuals of any background (Gordon, 2004;
Straussner, 2001). Addictions coursework tends to emphasize recognition of meaning and belief differences tied
to ethnicity, religion, nationality, profession, political ideology, as well as differences related to gender, race,
social class, minority status, and disability status. Theoretical course matter specifically addresses how these
individual and cultural differences may relate to expansion or adaptation to theory, as well as to practice.
Psychopharmacology coursework also sensitizes trainees to important individual and cultural differences related
Petition Form
Page 18
to ethno-pharmacology, both in terms of substances of abuse, but also in terms of prescription medications.
Coursework emphasizes recognized areas of limitation within the field (e.g., a lack of clinical trials on women
and minorities, relative to White males), as well as key considerations and cautions (e.g., telescoping of
problems, sensitivity to substances of abuse, need for dose adjustments on medications to avoid severe side
effects).
Coursework in this area also extends to use of addiction-specific screening, assessment, diagnosis, and treatment
assessments and clinical procedures. Similarly, training to achieve proficiency in addiction-specific assessments
and procedures takes place through both coursework and supervision in clinical settings. Clientele range from
individuals who may have no to mild problems, where only screening and brief interventions are needed, to
individuals with more moderate to severe problems, where extensive assessment and intensive manualized
interventions may be utilized. Individual and cultural differences may translate into different substance use
patterns, risk factors, course, concomitant psychological and social functioning, access barriers, and treatments
designed specifically to address special needs. Screening, assessment, and diagnostic instruments are sometimes
available in different languages; or they may be tailored to different settings, such as prisons, emergency or
inpatient medical facilities, or private practice. Treatment-related assessments and clinical procedures are also
often tailored to specific approaches and populations, where students may be given some flexibility to read in
different areas. For instance, there are Treatment Improvement Protocols focused on addictions assessment and
treatment available through SAMHSA that apply specifically to pregnant women, elders, sexual minorities (e.g.,
LBGTQ), Native Americans, individuals with HIV/AIDS, or individuals with comorbid mental health
conditions, among others.
Coursework in this area emphasizes evidence-based practice approaches. In general, practice foundations for
evidence-based practice generally assert that in the absence of data to the contrary, practitioners are best advised
to use an evidence-based practice in working with individuals from diverse backgrounds. This is preferred to
making adjustments that are not supported by empirical data and may in fact deprive such individuals of the best
possible treatments available (Hays, 2008). As such, training experiences related to diversity should be
integrated into regular training procedures. This allows underscoring of this point, as well as opportunities to
present any important data to inform any necessary adjustments to successfully address diversity and individual
differences.
Supervised clinical practice opportunities foster curiosity and respect for individual and cultural differences,
openness to culture-specific adaptations, and related transformations of theory to practice where needed.
Supervision of such training experiences generally involves discussion of individual and cultural differences in
case formulation, triage, and management of clinical cases. It is well-recognized that emerging knowledge
related to individual and cultural differences is important to addictions training. There are also important
individual differences related to gender, race, social class, and minority status that raise social justice issues in
treatment. This means that in supervised clinical practice experiences, trainees generally are sensitized to
fostering empowerment in their clients, while maintaining awareness of issues related to choice, barriers to
treatment, stigma, and local values that can affect treatment engagement and sustained progress. Competencybased supervision models involving systems approaches that are multidimensional and ecological in nature are
commonly used (Falender & Shafranske, 2016; Holloway, 2016).
Examples of coursework/training materials are provided via syllabi in Appendix C. These show requirements
for either broad inclusion across the class, or specific units within a class addressing individual and cultural
differences.
2.
Describe how knowledge of cultural and individual differences and diversity are applied in practice.
Practitioners proficient in this area of practice apply knowledge of cultural and individual differences and
diversity very much in the same way they are applied in general clinical practice. They must look to individual
and family experiences, rather than making assumptions about any individual or family (Pedersen, 2004). They
Petition Form
Page 19
must communicate effectively with clients from diverse backgrounds and continually seek accurate
understanding of how the therapeutic relationship is working given any cultural or individual differences that
may affect it. This understanding includes but is not limited to: proper knowledge of barriers to treatment and
how to overcome them; therapist behaviors that facilitate or hinder client engagement and retention in treatment
(e.g., empathic style, telephone follow-up; and any special needs that may arise in treatment). They also must
keep abreast of developments in the field informing any screening, assessment, diagnostic, or treatment processes
that could be affected, in terms of validity, reliability, or utility, for work with specific populations. For example,
maintaining knowledge of different approaches for client-treatment matching as affected by client or family
preference and cultural competence. And they must be knowledgeable about subtle differences or special needs
or problems related to the application of evidence-based practices to specific groups, so as to be able to tailor
practice as needed For example, knowledge of ethno-pharmacology issues may be important when discussing
drug effects with clients from special populations that may react to drugs with greater or lesser sensitivity than
others (Myers, 2013). Sexual minority groups also may need specialized additional assessment or intervention
considerations related to different risk profiles for complicating conditions such as HIV or hepatitis. Women may
have special needs related to presenting for treatment with perinatal substance use, and elders may present with
more specific treatment needs due to changing drug sensitivities, increased psychosocial needs, or different
patterns of risk or treatment response.
Finally, practitioners work in diverse settings, which in and of themselves may interact with individual and
cultural differences (Room, 2004). As such Addiction Psychology trainees and practitioners must be sensitive to
adaptations necessary for working in varied settings, such as hospitals, prisons, community clinics, and within
multidisciplinary teams. This is fostered through encouragement of experiences throughout training in different
settings. Further, clinical supervisors apply attention to individual and cultural differences in their work not only
with clients, but with trainees in Addiction Psychology to insure high quality clinical service in the form of
accurate assessments and effective treatment for diverse clientele, and high quality training experiences for
supervisees.
3.
Describe the opportunities for continuing professional development and education related to cultural and
individual differences in diversity.
Since 2008, Division 50 has had an ad hoc Committee on Population and Diversity Issues in Addiction. This
committee has a mission of helping to develop continuing educational activities for practitioners working in this
area at any conference and convention meetings the Division sponsors or cosponsors. This has resulted in several
symposia, discussion panels, and round table sessions to facilitate continued professional development and
education on cultural and individual issues in diversity. Additionally the Division disseminates information on
such opportunities on its listserv, in its newsletter, and through its journal. Listserv postings also include
dissemination of meetings offered by other groups, such as varied state psychological association annual
conventions, the Multicultural Summit offered by other APA divisions, trainings offered by other professional
associations (e.g., Association for Behavioral and Cognitive Therapies Addictive Behavior Special Interest
Group, the College on Problems of Drug Dependence, the Research Society on Alcoholism, the Society for
Research on Nicotine and Tobacco). At the present time, the Division is in fact working on expanded
programming in this area through efforts to secure grant funding, demonstrating high commitment to this area of
activity.
In addition to these Division-initiated activities, there are numerous webinars, DVD, and live trainings available
through APA at the annual convention. Division 50 also now sponsors an annual meeting called Collaborate
Perspectives on Addiction (CPA) that offers a clinical training track that includes program components with
objectives addressing varied individual and cultural differences. All levels of trainees are encouraged to attend
these events, with some sessions more tailored to more or less experienced individuals. And finally, there is
increasing availability of APA-approved CE opportunities through print matter in journals affiliated with the
professional associations noted above, as well as through state psychological associations.
4.
Petition Form
Page 20
Describe how students are evaluated. How is competency measured? Please include samples of evaluation tools
related to an understanding of cultural and individual differences and diversity.
Addiction Psychology students typically are evaluated in both their course work and supervised clinical training
experiences for individual and cultural differences competencies through quizzes and tests; peer evaluations;
self-evaluations; assignments such as handling example cases; oral case presentations; use of
simulations/automated standard patient; observation of skills by a supervisor or teacher; client ratings from
clinical practice in settings where satisfaction measures are used; standardized tests (EPPP for general
competence; proficiency exam). Initial and ongoing competency typically is evaluated at the exam level first,
and then via supervised experiences with a supervisor who is knowledgeable in this area of work.
Again, these are the standard evaluation procedures for any clinical program. With this effort, the difference
would be the focus of the content evaluated and the special supervisor experience with addiction clients needing
specialized practice approaches based on their individual differences or diversity status. It is also important to
note that work in this area must encompass the student/trainee evaluating their own individual differences and
cultural fit with the methods chosen. Ideally it would be desirable for any trainee to perform any task needed,
this is not always possible. And so to the extent necessary, trainees are also encouraged to recognize their own
individual differences, limitations, and preferences as these may also affect their scope of practice and are
relevant to this section of questions.
In terms of practical measurement of competency, professors and clinical supervisors generally complete and
provide written qualitative feedback on cases, feedback on rubric forms, or clinical evaluation forms used by
clinical doctoral programs to collect information about the performance of students on practicum assignments
and internship placements. For any of these, in courses where objectives include attention to individual and
cultural differences, the comments and/or grading forms will include comments or a section related to individual
and cultural difference awareness, sensitivity, or applications skills as shown by trainees in their work.
Appendix D provides an example of a rubric used on a self-awareness paper.
References
Comas-Diaz, L. (2012). Multicultural care: A Clinician’s guide to cultural competence. Washington, DC:
American Psychological Association.
Diller, J.V. (2015). Cultural diversity: A primer for the human services. Stamford, CT: Cengage Learning.
Falender, C.A., & Shafranske, E.P. (2016). Competency-based supervision. Washington, DC: American
Psychological Association. DVD
Falender, C.A., Shafranske, E.P., & Falicov, C.J. (Eds.) (2014). Multiculturalism and diversity in clinical
supervision: A competency-based approach. Washington, DC: American Psychological Association.
Gordon, J. U. (1994). Managing multiculturalism in substance abuse services. Thousand Oaks, CA: SAGE
Publications.
Hays, P.A. (2008). Addressing cultural complexities in practice, Third Edition. Washington, DC: American
Psychological Association.
Holloway, E.L. (2016). Supervision essentials for a systems approach to supervision. Washington, DC:
American Psychological Association.
Myers, P. L. (2013). 21st century research on drugs and ethnicity. New York, NY: Haworth Press.
Petition Form
Page 21
Pedersen, P.B. (2004). 110 Experiences for multicultural learning. Washington, DC: American Psychological
Association.
Room, R. (2014). Cultural aspects and responses to addiction. In: el-Guebaly, N., Carra, G., & Galanter, M.
(Eds.), Textbook of addiction treatment: International perspectives. (pp. 107–114). New York, NY:
Springer.
Straussner, S. L. A. (2001). Ethnocultural factors in substance abuse treatment. New York, NY: Guilford Press.
Zane, N., Bernal, G., & Leong, F.T.L. (Eds). (2016). Evidence-based psychological
practice with ethnic
minorities: Culturally informed research and clinical strategies. Washington, DC: American
Psychological Association.
Criterion V. Parameters of Practice. A proficiency is represented by a distinct procedure,
technique, or applied skill set that may be applied broadly or to specific populations, settings,
and or biopsychosocial problems.
1.
Provide a description of the procedures and techniques utilized in the practice of the proficiency. The narrative
should include a description of the assessment techniques, intervention strategies, consultative methods, diagnostic
procedures and ecological strategies used in the practice of the proficiency. In addition, the description should
describe the settings in which the techniques and strategies are applied, the specific populations served by those
practicing in the proficiency, and the biopsychosocial problems the proficiency addresses.
Assessment techniques: A number of assessment instruments have been developed to assess the presence of a
substance use disorder, and various parameters associated with it. Assessment has evolved from attempts to
identify underlying personality variables (e.g., MacAndrews, 1965), to evaluation of specific behaviors defining
the problem. Currently used interventions include the Alcohol Use Disorders Identification Test (AUDIT;
Saunders, Aasland, Babor, De La Fuente, & Grant, 1993), the Michigan Alcohol Screening Test (MAST; Selzer,
1971). The development of the Addiction Severity Index (ASI; McLellan, Luborsky, Woody, & O’Brien, 1980)
was a significant advance in that it not only assessed the presence of an addictive disorder, but included
subscales useful in assessment and treatment planning; the ASI has been updated, and is now also available in a
briefer form and in a computerized self-administered form.
Intervention strategies: A large array of evidence-based interventions based on established psychological
principles is available for the clinician. Individual psychologists utilize the method which best suits the client
and circumstances. Prominent interventions include:
 Relapse Prevention (Marlatt & Donovan, 2007), based on principles of cognitive-behavioral
therapy, identifying high-risk situations and development of appropriate coping strategies.
 Motivational Interviewing (Miller & Rollnick, 2002), a client-based intervention, which solicits the
patient’s internal motivation for change and builds on it.
 The Transtheoretical Approach (Prochaska, DiClemente & Norcross, 1992), which assesses the
process of change and has identified specific strategies for intervention at each stage.
 Twelve-Step Facilitation (Nowinski & Baker, 1992) works with patients to engage in the TwelveStep program of recovery.
 Community Reinforcement Approach (Smith, Meyers, & Milford, 2003). This approach utilizes the
naturally reinforcing elements in the life of the patient to effect change. This has also been adapted
into a family based intervention to assist the family to engage an unmotivated family member to
engage in treatment.
 Contingency Management (Higgins & Silverman, 1999), an approach based on principles and
procedures developed in the field of Behavior Analysis, that specifies clinical targets (e.g., drug
abstinence) that are objectively measured and systematically reinforced. Multiple demonstrations of
Petition Form
Page 22


the efficacy of this approach have been published across substance use disorders and clinical
populations.
Harm Reduction (Marlatt, Larimer & Witkiewitz, 2012) is based on the premise that it is as
important to minimize the harm of SUDs as to eradicate it. Such programs as needle-exchange,
opiate replacement medications and condom distribution have been demonstrated to decrease some
of the negative consequences of addiction.
Moderation Management (Rotgers, Kern & Hoeltzel, 2002). While most addiction treatment
programs in the United States stress an abstinence-based model, a subset of patients are able to
resolve their problems through learning skills to moderate their use, particularly of alcohol.
It is of note that all of these interventions have been developed by psychologists using established scientific
principles, and all have been empirically supported in rigorous randomized clinical trials.
Consultative methods: Psychologists cooperate with other professionals in assessing and addressing addiction.
In residential settings, for example, the evaluation of the psychologist can dovetail with the medical information
provided by the physician and with the psychosocial data collected by the addiction counselor. These elements
are typically combined within an “Integrative Assessment” which leads to an appropriate Treatment Plan for the
patient.
Diagnostic procedures: In addition to the instruments mentioned above, a reliance on structured interviews is
common. The criteria of DSM-5 can often be identified through an in-depth clinical interview. The integration
of collateral information (spouse, medical records, legal records) is extremely useful in developing an effective
treatment plan for each patient. While there are structured formats for gathering such information, clinicians
may also rely on their own strategies to assess individual patients and solicit the information needed to make an
accurate diagnosis.
Ecological strategies: As addiction treatment has evolved, it has included a recognition of the social and
cultural parameters of this syndrome and interventions to treat it. This includes interventions based on family
dynamics, community resources and public policy interventions. Family dynamics have been recognized as
critical components of interventions for adolescents (Waldron & Turner, 2008, Winters, 1998) and adults
(O’Farrell & Fals-Stewart, 2003). Prevention programs (Kumpfer, 2002) engage families and communities
around interventions to address substance use and behaviors which are related to it. Several successful programs
have integrated skill-based training with community interventions. Public policy interventions have also shown
an effect on the rate of substance use consumption; examples include raising the drinking age, training
bartenders, and raising taxes. Specific interventions for special populations (e.g., racial and cultural minorities,
adolescents and the elderly) are also the subject of intervention and ongoing exploration.
Settings in which techniques and strategies are applied: The interventions identified previously are delivered
across a range of settings (Schenker, in press). The intensity of service intervention may differ based on level of
care and specific patient needs. Addiction treatment in the United States is provided along a continuum of levels
of care. A system for defining levels of care and assessing appropriate client placement have been developed
(Mee-Lee, Shulman, Fishman, Gastfriend, & Miller, 2013) and has been widely adopted. These settings range
from more restrictive inpatient and medical settings to brief intervention techniques. Patients often travel
through this system as need for level of care changes. Patients may begin with a stay in a medical detoxification
facility, to address the concerns of a patient in dangerous withdrawal from certain drugs that demonstrate
physical dependence. The next less restrictive level of care includes several variations of residential treatment,
including Therapeutic Communities (De Leon, 2000) or a “traditional” 28-day Minnesota Model program
(Anderson, 1981) in which the principles of AA are stressed. Within a Minnesota Model program, various
models of interventions (12-Step Facilitation, Motivational Enhancement, Cognitive-Behavioral Therapy) may
be utilized. One step down from these 24-hour residential programs are Partial Hospital Programs (PHPs) and
Intensive Outpatient Programs (IOPs). PHPs blend the content of the residential program with the social
supports of a home environment. IOPs provide a less intensive treatment experience, typically several hours a
day on several days a week, which allow the patient to continue to build on his/her “recovery capital” (Kelly &
Petition Form
Page 23
White, 2011) of the home environment. The majority of patients in the treatment system (estimated at 80%) are
treated in outpatient programs, which range from individual and family treatment to group therapy, but provide
less intensity than a PHP or IOP. A wide variety of interventions that parallel those described above for
outpatient setting may be employed across settings. At each of these levels, collaboration between psychologist
and patient results in better outcomes.
Specific Populations served: The population relevant to this proficiency includes those with a wide range of
addictive behavior problems associated with substance-related disorders (as defined diagnostically in the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, [DSM-5]; American Psychiatric
Association, 2013). Substance-related problems are not confined to any single, specific population, and may
affect any individual at any point in the lifespan. However, certain groups of individuals are at particularly high
risk for these problems. Prevalence and characteristics of these problems varies by demographic variables
including age, gender, ethnicity, marital status, and socioeconomic status. Moreover, there are differences from
one population to another with respect to specific nature and development of substance-related disorders.
Assessment and intervention must be tailored for specific populations.
Normative developmental processes and transitions characteristic of adolescence, for instance, affect the
topography of alcohol and other substance use involvement, the prevalence of various problems arising from
use, and the means by which teenagers make and maintain behavioral changes as well. Thus, adolescence
carries additional risks to develop substance-related problems and has unique aspects to it, relative to adult risks
(Brown, 2004; Chassin et al., 2004; D’Amico et al., 2005; Deas, Riggs, Langenbucher, Goldman, & Brown,
2000; White, 2014; Winters, 1998; Ramo, Anderson, Tate, & Brown, 2005). The effects of cannabis, for
example, have more significant consequences for adolescents than for adults (Meier, et. al., 2012).
Interactions between variables, such as race and age also must be considered. Young African-American adults
are at substantially lower risk for alcohol use disorders than are other ethnic groups at this age. However, among
older cohorts, these differences disappear. Similarly, substance-related disorders are less common among the
elderly, but these rates are expected to double between 2006 and 2020 (Han, Gfroerer, Colliver & Penne, 2009).
However, medical problems and medications that are more common in this population can interact with alcohol
and other substances to create potential health risks in the absence of a diagnosable disorder. Other populations
known to be at a higher risk for substance-related disorders are the offspring of parents with substance-related
disorders, individuals from multi-problem families, and individuals with mental health disorders. Individuals
involved in the criminal justice system also have a high prevalence of problematic substance use. Knowledge
concerning the nature and development of substance-related problems across the lifespan and within populations
at high risk is particularly critical to the assessment and treatment of these populations. Psychologists with such
knowledge are in a unique position to offer both assessment and treatment matching to diverse special
populations at differential risk (e.g., elders, youth, women, ethnic minorities).
Problems addressed: The most definitive parameter of practice relevant to this proficiency is the specific
problem of interest: substance-related problems. In 2015, according to the National Surveys of Drug Use and
Health (NSDUH), 21.5 million American adults had some degree of substance use disorder (Substance Abuse
and Mental Health Services Administration, [SAMHSA] 2015). The National Institute of Alcohol Abuse and
Alcoholism (NIAAA) estimates that over 100,000 deaths a year are related to alcohol abuse alone; substance
abuse costs our nation over $400 billion a year (CASA, 2012).
In the present context, we must note the prevalence of addiction in clinical practice. In 2012, the rate of any
substance use among patients with any reported mental illness was double the rate in the general population
(26.7% vs. 13.2%) and there was a similar pattern for those with diagnosable substance abuse disorders (19.2%
vs. 6.4%) (SAMHSA, 2013). Conversely, there is a higher proportion of mental illness among individuals with
substance use disorders (40.7%) than among those with no substance use disorder (16.5%). The percentage of
persons with substance use disorder increases with the severity of mental illness. Unfortunately only about 10%
of those with substance use disorder receive any treatment for these problems (CASA, 2012; SAMHSA, 2015).
Petition Form
Page 24
These disorders, like other addictive behaviors, are best conceptualized as biopsychosocial problems. At the
biological level, these disorders are marked by the ingestion of a substance or repeated engagement in a
behavior that has specific pharmacological and psychopharmacological effects. The nature of these effects may
differ according to the specific substance or behavior and the physical/psychological state of the individual.
Moreover, these effects may change within a single ingestion (e.g. biphasic effects of alcohol, behavioral
tolerance). With frequent repeated administration, tolerance may develop in which the same dose of a substance
or a behavior has a reduced impact or in which a higher dose or more repetitions of the behavior is required to
achieve the same impact. With the development of physical dependence, aversive physiological reactions or
withdrawal symptoms can develop, ranging from mildly unpleasant feelings of anxiety or nausea to convulsions
and the risk of death. The nature of these biological effects varies from substance to substance, but the use of
one substance can alter the biological system in such a way as to influence the biological impact of another
substance, when both substances are in the system (i.e. drug interactions), as well as when the first substance is
no longer present (e.g. cross-tolerance). These effects may also interact with idiosyncratic neural issues such as
impulsivity, impaired behavioral control, and frontal cortex problems. In addition, the various substances can
cause or facilitate the development of a variety of medical problems, and these are substance specific. For
example, chronic heavy alcohol use is a cause of liver disease (fatty liver disease, cirrhosis), and clearly
contributes to the development of hypertension and cancers of the upper digestive tract. Tobacco use is a cause
of lung cancer, chronic bronchitis and emphysema, and has also been associated with cancers of the upper and
lower digestive tract (e.g. mouth, pharynx, larynx, esophagus, stomach). Other substance use has been linked to
HIV-AIDS, hepatitis (through intravenous drug administration), cardiovascular problems (methamphetamine,
cocaine), neurological impairment, and a host of more specific health problems.
Addictive behaviors are often influenced, in part, by a number of different psychological factors. With substance
use disorder, for example, there is substantial evidence that the administration of alcohol and other substances
can serve as unconditioned stimuli within a classical conditioning framework. As a consequence of this
conditioning, drug cues may come to elicit drug-similar effects, as well as drug-opposite effects, with the
possibility that these cues may activate withdrawal reactions and drug craving. There is also considerable
evidence that alcohol and other substances serve as reinforcers - both positive (e.g., euphoric feelings) and
negative (e.g., relief from withdrawal and other negative affective states) - within an instrumental conditioning
framework. Behavioral choice and behavioral economics approaches to substance use have demonstrated that
access to the particular substance and the availability of alternative reinforcers influence substance use. Social
learning theory has provided the most comprehensive psychological perspective on the development and
maintenance of substance use, and the recovery from substance-related disorders. This perspective highlights
psychological processes such as observational learning, substance-related outcome expectancies, self-efficacy
and coping skills. Recently, theoretical extensions of social learning theory have expanded on certain cognitive
processes to explain key characteristics of substance-related problems.
The presence of other psychological factors associated with an individual’s addictive behavior also can modify
the course and nature of the addiction-related problems. In particular, depressive disorders, anxiety disorders,
conduct disorder, and antisocial personality are among the most important of the various disorders that may cooccur with addiction. A recent household survey found that among adults in the United States who are
dependent on alcohol, tobacco, or other illicit substances, approximately 20-25% have co-morbid depression or
anxiety, and these individuals are two to four times more likely to have these disorders than those not dependent
on substances (Kandel, Huang, & Davies, 2001). Other surveys have reported much higher rates of comorbidity
for specific combinations of substance and mental disorders (e.g., illicit drug dependence and personality
disorders; nicotine dependence and schizophrenia) (for a comprehensive review, see Jane-Llopis & Matytsina,
2006). It is also quite common for an individual with one substance use disorder (e.g., alcohol dependence) to
have another substance use disorder (e.g., tobacco dependence). With training in the treatment of both mental
health and addiction, as well as awareness of the health complications co-morbid conditions may pose,
psychologists are in a unique position to provide both therapeutic and prevention services, as well as to
contribute research on these problems and their amelioration (Piotrowski, 2007).
Petition Form
Page 25
Social factors are also key influences on addiction-related problems. Among adolescents, peer norms and peer
influence are important contributors to the onset of substance use. There is also evidence that peers may have
some influence among young adults. Drinking in one's immediate family and in one's social network appears to
influence adult patterns of drinking, and to influence recovery. It is also the case that substance-related problems
can have a deleterious impact on the individual's social functioning, by disrupting marital and parental
processes, impairing role functioning, and creating, both directly and indirectly; a variety of adverse and
stressful challenges to the individual and his or her family. Furthermore, through behaviors related to their
substance use or attempts to abstain, clients may communicate interpersonal messages about how they see
themselves and expect to be treated in interpersonal transactions. Therapeutic efforts from an interpersonal
perspective to understand the meaning the client attributes to his or her own substance use help tailor
appropriate interventions to reduce related interpersonal problems. Attempts to repair the social disruptions
created by substance-related problems have been shown to facilitate recovery from the disorder (e.g., peer
influence and norms, cultural beliefs and biases, etc.; Glidden-Tracey, 2005).
This base of knowledge is of critical importance in the assessment, treatment; and management of the client with
substance-related problems. The proficient practitioner must master this information to effectively intervene
with and motivate these clients, and to be able to ensure that the client's psychological, social, and medical needs
are effectively addressed.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
Anderson, D. (1981). Perspectives on treatment: The Minnesota experience. Center City, MN: Hazelden.
Brown, S. A. (2004). Measuring youth outcomes from alcohol and drug treatment [Review on conceptual,
design and measurement issues critical in optimizing the study of treatment outcomes for alcohol and
drug abusing youths]. Addiction, 99(Suppl. 2), 38-46. doi:10.1111/j.1360-0443.2004.00853.x
Chassin, L., Hussong, A., Barrera, M., Jr., Molina, B. S. G., Trim, R., & Ritter, J. (2004). Adolescent substance
use. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology (2nd ed., pp.665696). Hoboken, NJ: John Wiley & Sons.
D'Amico, E. J., Ellickson, P. L., Wagner, E. F., Turrisi, R., Fromme, K., Ghosh-Dastidar, B., ... Wright, D.
(2005). Developmental Considerations for Substance Use Interventions from Middle School Through
College. Alcoholism: Clinical and Experimental Research, 29(3), 474-483.
doi:10.1097/01.ALC.0000156081.04560.78
Deas, D., Riggs, P., Langenbucher, J., Goldman, M., & Brown, S. (2000). Adolescents are not adults:
Developmental considerations in alcohol users. Alcoholism: Clinical and Experimental Research, 24(2),
232-237. doi:10.1111/j.1530-0277.2000.tb04596.x
De Leon, G. (2000). The therapeutic community: Theory, model, and method. New York, NY: Springer
Publishing Company.
Glidden-Tracey, C. E. (2005). Counseling and therapy with clients who abuse alcohol or other drugs: An
integrative approach. Mahwah, NJ: Lawrence Erlbaum Associates.
Han, B., Gfroerer, J. C., Colliver, J. D., & Penne, M. A. (2009). Substance use disorder among older adults in
the United States in 2020. Addiction, 104(1), 88-96. doi:10.1111/j.1360-0443.2008.02411.x
Petition Form
Page 26
Jane-Llopis, E., & Matytsina, I. (2006). Mental health and alcohol, drugs and tobacco: A review of the
comorbidity between mental disorders and the use of alcohol, tobacco, and illicit drugs. Drug and
Alcohol Review, 25(6), 515-536. doi:10.1080/09595230600944461
Kandel, D. B., Huang, F-Y., & Davies, M. (2001). Comorbidity between patterns of substance use dependence
and psychiatric syndromes. Drug and Alcohol Dependence, 64(2), 233-241. doi:10.1016/S03768716(01)00126-0
Kelly, J. F., & White, W. L. (Eds.). (2011). Addiction recovery management: Theory, research and practice.
New York, NY: Humana Press.
Kumpfer, K. L. (2002). Prevention of alcohol and drug abuse: What works? In M. R. Haack & H. Adger (Eds.),
Strategic plan for interdisciplinary faculty development: Arming the nation’s health professional
workforce for a new approach to substance use disorders (pp.25-46). Providence, RI: Association for
Medical Education and Research in Substance Abuse.
MacAndrews, C. (1965). The differentiation of male alcoholic outpatients from nonalcoholic psychiatric
outpatients by means of the MMPI. Quarterly Journal of Studies on Alcohol, 26(2), 238-246.
Marlatt, G. A., & Donovan, D. M. (Eds.). (2007). Relapse prevention (2nd ed.). New York, NY: Guilford Press.
Marlatt, G. A., Larimer, M. E., & Witkiewitz, K. (Eds.). (2012). Harm reduction, second edition: Pragmatic
strategies for managing high-risk behaviors (2nd ed.). New York, NY: Guilford.
McLellan, T. A., Luborsky, L., Woody, G. E., & O’Brien, C. (1980). An improved diagnostic evaluation
instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental
Disease, 168(1), 26-33.
Mee-Lee, D., Shulman, G. D., Fishman J.J., Gastfriend, D. R., & Miller, M. M. (Eds.). (2013). The ASAM
criteria: Treatment criteria for addictive, substance-related and co-occurring conditions (3rd ed.).
Carson City, NV: The Change Companies.
Meier, M. H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R. S. E., ... Moffitt, T. E. (2012).
Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the
National Academy of Science, 109(40), E2657-E2664. doi:10.1073/pnas.1206820109
Miller, W. R., & Rollnick, S. (Eds.). (2002). Motivational interviewing (2nd ed.). New York, NY: Guilford.
National Center on Addiction and Substance Abuse (CASA). (2012). Addiction medicine: Closing the gap
between science and practice. New York, NY: Columbia University, CASA.
Nowinski, J., & Baker, S. (1992). The 12-step facilitation handbook. New York, NY: Lexington Books.
O’Farrell, T. J., & Fals-Stewart, W. (2003). Marital and family therapy. In R. K. Hester & W. R. Miller (Eds.),
Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed., pp. 188-212). Boston,
MA: Allyn and Bacon.
Piotrowski, N. A. (2007). Comorbidity and psychological science: Does one size fit all? Clinical Psychology:
Science & Practice, 14(1), 6-19. doi:10.1111/j.1468-2850.2007.00057.x
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to
addictive behaviors. American Psychologist, 47(9), 1102-1114. doi:10.1037/0003-066X.47.9.1102
Petition Form
Page 27
Ramo, D. E., Anderson, K. G., Tate, S. R., & Brown, S. A. (2005). Characteristics of relapse to substance use in
comorbid adolescents. Addictive Behaviors, 30(9), 1811-1823. doi:10.1016/j.addbeh.2005.07.021
Rotgers, F., Kern, M. F., Hoeltzel, R. (2002). Responsible drinking: A moderation management approach for
problem drinkers. Oakland, CA: New
Harbinger.
Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the
Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of
Persons with Harmful Alcohol Consumption-II. Addiction, 88(6), 791-804. doi:10.1111/j.13600443.1993.tb02093.x
Schenker, M. (In Press) Addiction Treatment Settings. In: Norcross, J.C., VandenBos, G.R., & Freedheim, D.K.
The APA Handbook of Clinical Psychology Washington, D.C. American Psychological Association.
Selzer, M. L. (1971). The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument.
American Journal of Psychiatry, 127(12), 1653-1658.
Smith, J. E., Meyers, R., J., & Milford, J. L. (2003) Community reinforcement approach and community
reinforcement and Family Training. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism
treatment approaches: Effective alternatives (3rd ed.). Boston, MA: Allyn and Bacon.
Stitzer, M., & Petry, N. (2006). Contingency management for treatment of substance abuse. Annual Review of
Clinical Psychology, 2, 411-434. doi:10.1146/annurev.clinpsy.2.022305.095219
Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Results from the 2012
National Survey on Drug Use and Health: Mental Health Findings (NSDUH Series H-47, DHHS
Publication No. SMA 13-4805). Rockville, MD: Substance Abuse and Mental Health Services
Administration.
Substance Abuse and Mental Health Services Administration. (2015). Behavioral health trends in the United
States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 154927, NSDUH Series H-50).). Rockville, MD: Substance Abuse and Mental Health Services
Administration.
Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance
abuse. Journal of Clinical Child and Adolescent Psychology, 37(1), 238–261.
doi:10.1080/15374410701820133
White, W. L. (2014). Slaying the Dragon: The history of addiction treatment and recovery in America (2nd ed.).
Bloomington, IL: Chestnut Health Systems.
Winters, K.C. (1998). Treatment of adolescents with substance use disorders. Treatment Improvement Protocol
(TIP) Series 32 (DHHS Publication No. SMA 99-3283). Rockville, MD: Substance Abuse Mental Health
Service Administration.
Education and Training
Criterion VI. Acquisition of Knowledge and Skills. A proficiency is acquired through a defined
program of study and training that enables psychologists to develop the necessary competence to
use this proficiency. Education and training in a proficiency may occur at the doctoral or
Petition Form
Page 28
postdoctoral level or through an organized continuing education program. Irrespective of when
it is offered, education and training in a proficiency is of a sequential, integrated nature with
organized oversight of didactic and appropriate supervised experience related to the knowledge
base and skill sets distinctive to the proficiency. In addition, there are organizational
mechanisms in place that provide oversight and coordination of the education and training in the
proficiency. When education and training in a proficiency is achieved through interdisciplinary
study, organization/s responsible for the proficiency will describe how the proficiency meets the
criteria within the context of interdisciplinary education and training.
1.
Identify the type of organization or consortium of organizations that provide oversight of education and training
programs in the proficiency.
As mentioned under Criterion I, Divisions 28 and 50 have formed a committee that provides oversight of
education and training in the Proficiency of Addiction Psychology. This Addiction Psychology Proficiency
Committee (APPC) consists of six individuals who meet at least four times per year to formally review the
Proficiency. The APPC works closely with the Education and Training Committees of Divisions 28 and 50, who
are both APA-approved Continuing Education Sponsors.
Training in Addiction Psychology begins in psychology doctoral programs, with formal didactic courses and
supervised practicum experiences, and then continues with more specialized training in clinical internships and
post-doctoral research and clinical experiences. Clinically-oriented psychology doctoral programs typically
include the following coursework:









History and Systems of Psychology
Biological Bases of Behavior
Social Bases of Behavior
Cognitive/Affective Bases of Behavior
Ethics
Assessment
Psychopathology
Research Design and Statistics
Psychotherapy Theories and Methods
In addition to this coursework, doctoral programs require supervised clinical practicum experiences and an
internship prior to graduation. These didactic and clinical experiences (overseen by doctoral training programs
and internship sites) provide some of the basic foundation necessary for acquiring proficiency in Addiction
Psychology. However, graduate psychology programs vary in the degree to which they provide formal education
and supervision in addictions treatment, with few providing adequate training for the achievement of proficiency
in Addiction Psychology. As a result, most of the knowledge and skills necessary for proficiency in Addiction
Psychology is acquired through continuing education programs following graduation from doctoral programs.
APPC is therefore mostly concerned with oversight of continuing education programs in Addiction Psychology.
2.
Describe how the oversight organization/s:
 Defines the learning objectives in terms of competencies within the proficiency, and ensures that these learning
objectives are assessed as program outcomes;
The Addiction Psychology Proficiency Committee (APPC; described under Criterion I above) provides
oversight regarding the competencies, learning objectives, and requirements for obtaining the Addiction
Psychology proficiency. The following is a list of 12 competency areas, which map onto 12 domains of
knowledge, followed by specific learning objectives for each area:
Petition Form
Page 29
Competency area #1: Clinical Pharmacology and Epidemiology of Substance Use Disorders and
Addictive Behavior
Addiction Psychologists:
A. Possess knowledge of incidence and prevalence rates for various addictions and substance use
disorders.
B. Are familiar with how socio-demographic characteristics relate to likelihood of having an addiction
or substance use disorder.
C. Can describe the pharmacological underpinnings of substance use disorders and addictive behaviors
D. Are able to list specific drugs and the classes they belong to, including:
1. Alcohol
2. Opioids
3. Cannabis and derivatives
4. Stimulants, including cocaine and methamphetamine
5. Anxiolytics and barbiturates
6. Hallucinogens
7. Inhalants
8. Caffeine
9. Nicotine
E. Understand the impact of routes of administration, interactions with other drugs, behavioral
manifestations, and physical signs of use
F. Are able to describe the acute and chronic effects of the drugs listed above, for example:
1. Dependence and withdrawal
2. Effects on specific physical organ systems (e.g., cardiovascular, CNS, etc.)
3. Relationships to physical illness (e.g., cancer, heart disease)
G. Understand negative effects of acute and prolonged use of the above substances on psychological,
physiological, and social functioning
Competency area #2: Etiology of Substance Use Disorders and Addictive Behavior
Addiction Psychologists:
A. Understand physiological, psychological and social risk and protective factors in the etiology of
addictions and substance use disorders
B. Possess knowledge of key factors in the etiology of addictions and substance use disorders,
including:
1. Genetic factors
2. Psychological factors
3. Family factors
4. Social factors
5. Cultural factors
Petition Form
Page 30
Competency area #3: Initiation, Progression, and Maintenance of Substance Use Disorders and Addictive
Behavior
Addiction Psychologists:
A. Are able to describe the biological, psychological, and social factors that contribute to the initiation
of addiction and substance use disorders.
B. Have knowledge of the psychological factors that facilitate the progression and maintenance of
addictive behaviors and SUDs.
C. Have knowledge of the biological factors associated with the progression and maintenance of
addictive behaviors and SUDs.
D. Are able to describe the social factors, societal attitudes, and expectations that are associated with
the progression and maintenance of addictive behaviors and SUDs.
Competency area #4: Course and Natural History of Substance Use Disorders and Addictive Behavior
Addiction Psychologists:
A. Are able to describe the long term course and natural history of addictions and substance use
disorders
B. Are aware of the various trajectories involved in the progression of addictions and substance use
disorders, with attention paid to stages of addiction and change, natural recovery, and the influence of
other variables.
C. Demonstrate awareness of factors involved in help-seeking behavior.
D. Are able to describe the alternatives to formal treatment that can help promote behavior change.
Competency area #5: Early Intervention, Prevention, and Harm Reduction
Addiction Psychologists:
A. Understand the importance of early intervention and prevention efforts to minimize the impact and
course of addictions and substance use disorders.
B. Possess knowledge regarding various types of prevention programs currently in use, and the
theoretical underpinnings of each.
C. Recognize signs and symptoms that indicate the need for early intervention.
D. Are skillful at Screening, Brief Intervention, and Referral for Treatment (SBIRT).
E. Are familiar with harm reduction and public health strategies, including:
1. Needle exchange programs
2. Condom distribution programs
3. The role of social policy in reducing substance use
4. Screening for communicable diseases
5. Agonist replacement therapies
Petition Form
Page 31
Competency area #6: Screening and Assessment of Addictions, Psychoactive Substance Use, and
comorbid conditions
Addiction Psychologists:
A. Possess working knowledge of structured instruments to assess addictions and substance use
disorders.
B. Possess the ability to conduct a clinical interview to assess the presence of addictions and substance
use disorders.
C Maintain awareness of and ability to utilize key screening instruments for addictions and substance
use disorders.
D. Are able to engage clients when an addiction or substance use disorder is detected or suspected.
Competency area #7: Diagnosis and comorbid conditions
Addiction Psychologists:
A. Are able to make a differential diagnosis between addictions and other psychiatric disorders.
B. Are knowledgeable about DSM-5 constructs related to addictive disorders.
C. Have a working familiarity with DSM-5 criteria for diagnosing addictions and substance use
disorders.
D. Have a working familiarity with DSM-5 categories and criteria for diagnosing other psychiatric
disorders that may co-exist with addictions and substance use disorders.
E. Possess the ability to make a differential diagnosis between symptoms of addictions and other
disorders.
F. Understand the interactions between addictions and other mental disorders.
Competency area #8: Treatment Models and Approaches
Addiction Psychologists:
A. Are knowledgeable about effective principles for practice and evidence-based interventions.
B. Are familiar with major models of psychological treatment for addictions and substance use
disorders:
1. Cognitive Behavioral Approaches
2. Relapse Prevention
3. 12-Step Facilitation
4. Motivational Enhancement and Motivational Interviewing
5. Community Reinforcement
6. Contingency Management
7. Family and Couples approaches
8. Moderation Management
9. Mindfulness Approaches
10. Harm Reduction
Petition Form
Page 32
C. Possess skills necessary for applying these models to individuals in treatment.
D. Possess knowledge and skills related to discussing medications that are used to treat addictive
behavior problems.
Competency area #9: Treatment Planning, Management, Implementation, and Course of Recovery
Addiction Psychologists:
A. Are able to plan treatment and prioritize areas of importance to the client.
B. Possess skills necessary for engaging the client in developing a treatment plan.
C. Engage in ongoing reassessment of the treatment plan, and revision of the treatment plan as clinically
indicated.
D. Facilitate involvement of other professionals as needed.
E. Are able to provide appropriate treatment for independent mental health disorders as well as
addictions, or to be able to triage, make specialty referrals, and facilitate psychiatric consultation.
F. When treatment is provided for comorbid addictions and mental health problems, it is provided in an
integrated manner.
Competency area #10: Issues in Specific Populations
Addiction Psychologists:
A. Understand that treatment may need to be modified based on social and cultural differences.
B. Maintain awareness of cultural and social factors relevant to the etiology, progression, and treatment
of specific populations.
C. Understand the dynamics and trends in the presentation and treatment of specific cultural and
demographic groups.
D. Possess the ability to incorporate cultural norms into the process of treatment planning and treatment
itself.
E. Possess the ability to manage their relationships with clients of differing cultural traditions.
Competency area #11: Research Knowledge
Addiction Psychologists:
A. Maintain up-to-date knowledge of current research pertaining to the treatment of addictions and
substance use disorders.
B. Demonstrate knowledge of current research in the assessment and treatment of addictions and
substance use disorders.
Petition Form
Page 33
C. Possess the ability to translate research findings into clinical practice.
D. Understand the mechanisms of change associated with each clinical intervention.
Competency area #12: Legal and Ethical Issues
Addiction Psychologists:
A. Understand Ethical Standards of Psychologists as they relate to people with addictions and substance
use disorders.
B. Possess knowledge of local and federal laws pertaining to substance use.
C. Are familiar with Federal Regulations regarding confidentiality of records of SUD clients. (e.g., CFR
42).
D. Are familiar with state and/or other local regulations on confidentiality of records of individuals with
addictions and substance use disorders.
E. Possess knowledge of ethical concerns specific to this population.
F. Are aware of the importance of collaboration with other professionals involved in the treatment of the
client and ability to facilitate such collaboration.
G. Are knowledgeable about the professional limits of scope of practice with licensure as a
psychologist.
Members of the APPC closely follow developments in the field of addictions in order to evaluate curriculum
guidelines, training, and supervision necessary to acquire and maintain proficiency in Addiction Psychology. As
knowledge develops and changes, competencies and corresponding objectives are reviewed and revised.
There are dozens of scientific journals in the field of addictions. These journals provide current research
necessary for staying abreast of developments in Addiction Psychology. Members of Divisions 50 and 28 are
active as Editors, Associate Editors, Consulting Editors, and Reviewers for all of the addiction journals. The
following is a list of the top 20 publications, according to Google Scholar:














Psychology of Addictive Behaviors (APA publication)
Experimental and Clinical Psychopharmacology (APA publication)
Addiction
Drug and Alcohol Dependence
Alcoholism – Clinical and Experimental Research
Addictive Behaviors
Nicotine and Tobacco Research
Addiction Biology
Alcohol and Alcoholism
Journal of Studies on Alcohol and Drugs
Drug and Alcohol Review
International Journal of Drug Policy
Alcohol Research: Current Reviews
Journal of Substance Abuse Treatment






Substance Use and Misuse
Alcohol
Journal of Psychoactive Drugs
The American Journal on Addictions
European Addiction Research
International Journal of Mental Health and Addiction
Petition Form
Page 34
Members of Divisions 28 and 50 are regular consumers and contributors to these journals. The APPC regularly
draws upon the knowledge of Division members to stay current with the addictions literature.
 Develops curriculum guidelines regarding the didactic and supervised practice experiences required to acquire
competence in the proficiency. These shall include the content areas to be addressed, the populations worked
with, and the procedures undertaken
APPC has developed curriculum guidelines regarding the didactic and practice experiences required for
competence in Addiction Psychology. These guidelines include didactic courses necessary to meet the above
mentioned competencies which are commonly required for Clinical Psychology graduate programs, including
Evidence-Based Treatment, Psychopathology, Biological Bases of Behavior, Social Bases of Behavior,
Cognitive/Affective Bases of Behavior, Ethics, Clinical Psychopharmacology (i.e., Drugs and Behavior),
Psychological Assessment, Cultural Competency and Diversity, and Research Methods. All proficiency
candidates should have supervised experience working with clients with addictive disorders. Supervised
experiences working with addiction will often occur during graduate training practicum placements or through
the clinical psychology internship.
Updates to the knowledge base and practice developments are provided at least once every 7-10 years, or as
needed, through the Renewal of the Proficiency application process.
Populations. Because addictive disorders are among the most prevalent clinical conditions, they affect
virtually every population. Practice considerations must be sensitive to variability across specific populations,
there is a core knowledge base in this proficiency that generalizes across specific populations. In the ideal
integrated and sequential training sequence, considerations related to specific populations should be learned
after having mastered the core knowledge base. For instance, additional attention to life span, developmental,
and cultural issues would be beneficial via either didactic courses or through continuing education.
Content: Psychological, biological, or social problems. Clients receiving treatment for addiction
manifest a range of problems in each of these categories. Many areas of psychology's scientific substrate provide
foundations for this knowledge, including behavior neurosciences, behavioral pharmacology, cognitive, social,
personality, experimental analysis of behavior, quantitative methods and statistics, qualitative methods,
developmental and interpersonal psychologies. Addictive behavior problems are associated with numerous
short-term and chronic physical health conditions, and so training should include some basic pharmacology,
behavioral pharmacology, and the immediate and long-term effects of psychoactive substances on organ
systems. This is essential because treating the psychological aspects of addiction often requires first addressing
significant medical conditions, and clinicians must be attuned to identifying and properly referring individuals
for needed medical care. Significant psychological and social problems also are associated with addiction,
including but not limited to cognitive, educational, vocational, and relationship functioning (e.g., familial,
interpersonal). Course work should cover relevant research areas that have identified and measured how these
problems manifest in clinical and non-clinical populations of individuals with addictive disorders. Course work
also should cover the prevalence and incidence of addiction, addiction-related disorders, risk factors, natural
history, and theory and evidence regarding etiology.
Procedure and techniques. Developing clinical assessment and treatment procedures specific to
addictive behavior problems has been one of the more active research areas in psychology over the past four
decades, and covering this large amount of material in didactic formats is essential for core training. Clinical
assessment procedures have included a variety of diagnostic schemes as well as questionnaire, interview, self-
Petition Form
Page 35
monitoring, and behavioral observation measurement procedures. An extremely wide range of treatment
procedures for addiction have been developed and studied. From a broad theoretical perspective, cognitivebehavioral- and/or behavioral-based methods have shown to be efficacious, while motivational and interpersonal
therapies also show promise. To date, some of the most efficacious specific interventions for substance use
disorders are brief interventions, the Community Reinforcement Approach (CRA), and addiction medications
(Institute of Medicine, 1998, 2006; Miller et al., 2003; Miller & Wilbourne, 2002). Adaptive continuing care
methods further enhance such approaches to treatment (McKay, 2009). The efficacy of any one approach,
however, may vary depending on the specific substance-related disorder being treated, the treatment outcome
desired, and the background of the client receiving treatment, among other factors. It is important that clients
also be made aware that addictions medications also may provide useful avenues of treatment, particularly for
opioids. As such, psychologists working in this area of proficiency should remain aware of the various
addiction medications available and understand when and how these medications may combine with
psychosocial interventions. It is also imperative to note that even though clients may have been in treatment
numerous times, no one may have informed them about available addictions medications. Use of addiction
medication in conjunction with psychosocial therapy consistently ranks among the most effective substancerelated interventions (Amass et al., 2004; Miller & Wilbourne, 2002; National Consensus Development Panel on
Effective Treatment of Opiate Addiction, 1998; Power, Nishimi, & Kizer, 2005), yet remains underutilized in
clinical practice (Institute of Medicine, 1998, 2006). Course work in these areas should provide the necessary
foundation for the initial clinical experiences. Thus, trainees should be able to identify and assess the various
substance use patterns and disorders, and be aware of treatment alternatives, especially those that are evidencebased. They should also have a background in understanding treatment outcome evaluation methodology and
interpreting treatment outcome evaluation findings. They should be sensitive to the possibility of comorbidity
and be able to perform differential diagnoses.
The sheer amount of scientific and clinical material in this area precludes complete coverage in any particular
training setting. Thus, instructors and supervisors must necessarily be selective in the material they cover, which
will result in some variability in courses across settings. We have included examples of curricula Appendix C to
show the breadth of material typically covered in didactic format.

Provides to CRSPPP, the Board of Educational Affairs, and APA members on a regular, periodic basis an update
of the knowledge base, documentation of evidenced-based practice developments, and education and training
program outcomes in the proficiency.
The APPC will provide a summary of the knowledge base, documentation of evidence-based practice
developments, and education and training program outcomes in the proficiency on the Division 50 Website
(section: Education and Training). Specifically, we will keep an updated list of all ongoing and future continuing
education activities approved by the Education and Training Committees of Divisions 28 and 50. We will also
provide an annual report of continuing education activities and continuing education program evaluations that
will be submitted to CRSPPP, the APA Board of Education Affairs, and posted on the Division 50 website.
3.
Provide examples of the kinds of settings where education and training for the proficiency is acquired (e.g.,
residency, postdoctoral training experience, continuing education, didactic and experiential sequence in a doctoral
program).
As described above, proficiency in Addiction Psychology begins in graduate training with general knowledge
and skills acquired in the areas of assessment, treatment, research, psychopathology, biological bases of
behavior, research methods and statistics, etc. Some competency may be acquired during practicum experiences
and internship, however there is no standardized requirement for curricula in Addiction Psychology in graduate
training. Similarly, pre-doctoral internships vary in the amount of training and supervision they provide. It is
therefore assumed that most of the education and training for the proficiency will be through continuing
education and professional experience.
Petition Form
Page 36
Division 28 and 50 have designed sequential and integrated training programs specifically to meet the needs of
psychologists who wish to become proficient in Addiction Psychology. The following are just a few examples
of these training programs:




Annual 2-day Continuing Education Program in Addiction Psychology held in conjunction with the
Division 50 mid-year meeting (known as the “Collaborative Perspectives on Addiction” meeting).
Monthly Addiction Psychology Live CE Podcasts
A 10-hour Addiction Psychology Webinar, sponsored by APA, NIDA, and NIAAA.
One-day (7-hour) Workshops on Addiction Psychology sponsored by Division 50, offered in
conjunction with various conferences (e.g., APA, CPA, Research Society on Marijuana)
All of these programs are integrated and sequential in nature. They all contain content reflecting the competency
areas listed above, and all aim to achieve the objectives listed for each competency area.
4.
Describe the types of mechanisms that programs offering education and training in the proficiency use to ensure
oversight and coordination of a program of study in the proficiency.
All education and training programs leading to proficiency in Addiction Psychology must be provided by APA
CE sponsors. Hence, APA CE sponsors provide program oversight, while coordination of the program and
process (i.e., competency areas, objectives, etc.) is overseen by the APPC.
5.
Describe how the program sponsor ensures that psychology trainees enrolled in the program have completed, or
are in the process of completing their education and training in the scientific and applied professional foundations
of the profession.
As part of the proficiency application process, psychology trainees who wish to become proficient in Addiction
Psychology provide evidence of licensure in their state, as well as letters of recommendation from two
references who know the trainee.
6.
Describe the qualifications necessary for faculty who teach in these programs.
Qualifications necessary for faculty include demonstrated expertise in their field of study. At a minimum,
evidence of expertise includes scholarly work and practice in faculty’s field of study
7.
Describe how the program sponsor ensures that all promotional materials have accurate and complete information,
including how potential participants can obtain detailed information about program requirements, goals,
objectives, etc.
As APA CE sponsors, Divisions 28 and 50 are required to review promotional materials to ensure that they are
accurate and complete. These materials must include detailed information about program requirements, goals,
objectives, qualifications of the presenter, etc.
8.
What qualifications are sought for student admission?
In order to qualify for proficiency in Addiction Psychology, applicants must complete an internship in clinical
psychology, possess a doctoral degree, and be licensed in the state where they intend to practice.
9.
Describe how program sponsors provide data on attainment of competence in the proficiency program by
participants as defined by standards set by those responsible for program oversight of the proficiency. This will
include both short and long-term data on program outcomes.
APPC will maintain records on continuing education offerings, including program evaluations, and will also
conduct an annual survey of Division 28 and 50 members who are currently working in practice settings. The
annual survey will include questions regarding competency in the 12 areas described in Section VI.
Petition Form
Page 37
The integrated and sequential training required to become proficient in Addiction Psychology has several
standards, which are monitored by various parties across the process of obtaining proficiency. Methods for how
competencies are measured are noted below in terms of the area and the types of competencies we look for,
followed by varied evaluation strategies.
Assessment technique competencies: Appropriate selection, application and interpretation of evidence-based
assessments. Evaluation: Typically through course assignments such as example cases; oral case
presentations; in some settings use of simulations/automated standard patient; observation by supervisor or
teacher of an administration.
Intervention strategy competencies: Appropriate selection, application and adaptation of evidence based
treatments for addiction. Evaluation: Written course tests of knowledge, or assignments as with cases
examples; observed role play by a teacher; in some settings use of simulations/automated standard patient;
observation by supervisor of tapes of therapeutic work, or direction observation of a live case.
Consultative method competencies: Recognition of different stakeholders, recognition of potential for varied
ethical and legal obligations among stakeholders, and maintained adherence to ethical guidelines and working
within scope of practice. Evaluation: Written course quizzes and tests for ethics knowledge or methods
knowledge; course assignments as with cases examples; observed role play by a teacher; direction observation
of a live consultation.
Diagnostic procedures competencies: Appropriate selection, administration, differential diagnosis,
interpretation, and presentation of instruments and their data; knowledge of diagnostic systems and their
evolution and how such change may evidence in an individual client chart or record. Evaluation: Written
course quizzes, tests; course assignments as with cases examples; observed role play by a teacher; direction
observation of a live consultation.
Overall competency: Achievement of a state license as a psychologist is required for initial consideration of
competence. Similarly, ongoing maintenance of state licensure as a psychologist and then continuing education
as related to the state license serve to demonstrate maintenance once established. Finally, the exam to establish
the proficiency is a final screen of practitioner competency in Addiction Psychology. The expert-developed
exam is grounded in sound principles of practice and review of all relevant Addiction Psychology literature.
Completion of ongoing continuing education offerings in Addiction Psychology are required to maintain the
proficiency.
10. Describe how program sponsors ensure that the curriculum addresses: (a) ethical decision making and practice, (b)
issues of cultural and individual diversity, and (c) the most current information on evidence-based practice as that
construct is defined by APA policy.
First, applicants must be licensed as psychologists and in good standing. These requirements ensure that those
who apply for the certificate have had adequate and ongoing training and experience in ethical decision-making
and practice related to general clinical practice. Many states now require annual ethics training as part of the
ongoing re-licensure as a psychologist, further insuring ongoing training in this area. Because training for this
proficiency occurs in multiple venues coordinated by varied universities, practica sites, and internship and
postdoctoral training sites, training curricula on diversity and evidence-based practices are maintained in accord
with general ethical guidelines for practice in terms of the trainers remaining proficient to do their jobs. Regular
review of such sites for accreditation insure that individuals are working within their scope of practice and
maintaining adequate knowledge and skills to be trainers. The Guidelines and Application for individuals
seeking the proficiency also indicate the importance or competence in these areas and the examination tests to
ensure competence is achieved. Finally, as mentioned previously, Division 50 and its members regularly
Petition Form
Page 38
disseminate information on the most up to date evidence-based practice and training approaches via its
newsletter, website, annual conference, and scholarly journals. Division 28 uses a similar approach, especially
through publications in Experimental and Clinical Psychopharmacology and presentations at the annual
convention.
References
Amass, L., Ling, W., Freese, T. E., Reiber, C., Annon, J. J., Cohen, A. J., ... Horton, T. (2004). Bringing
buprenorphine-naloxone detoxification to community treatment programs: The NIDA Clinical Trials
Network field experience. The American Journal of Addictions, 13(Suppl. 1), S42-S66.
doi:10.1080/10550490490440807
Institute of Medicine. (1998). Bridging the gap between practice and research: Forging partnerships with
community-based drug and alcohol treatment. S. Lamb, M. R. Greenlick, and D. McCarty (Eds.).
Washington, DC: National Academies Press.
Institute of Medicine. (2006). Improving the quality of health care for mental and substance-use conditions:
Quality of chasm series. Washington, DC: National Academies Press.
McKay, J. R. (2009). Treating substance use disorders with adaptive continuing care. Washington, DC:
American Psychological Association.
Miller, W. R., Wilbourne, P. L., & Hettema, J. E. (2003). What works? A summary of alcohol treatment
outcome research. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment
approaches: Effective alternatives (3rd ed.). Boston, MA: Allyn and Bacon.
Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of
treatments for alcohol use disorders. Addiction, 97(3), 265-277. doi:10.1046/j.1360-0443.2002.00019.x
National Consensus Development Panel on Effective Treatment of Opiate Addiction. (1998). Effective medical
treatment of opiate addiction. Journal of the American Medical Association, 280(22), 1936-1943.
doi:10.1001/jama.280.22.1936
Power, E. J., Nishimi, R. Y., & Kizer, K. W. (Eds.). (2005). Evidence-based treatment practices for substance
use disorders - workshop proceedings. Washington, DC: National Quality Forum.
Criterion VII. Professional Development and Continuing Education. The organization (s)
seeking recognition for the proficiency is responsible for identifying or providing its practitioners
with a broad range of regularly offered opportunities for continuing professional development in
the proficiency practice and mechanisms to assess the acquisition of knowledge and skills.
1.
Describe the opportunities for additional continuing professional development and continuing education in the
proficiency practice. Provide detailed examples.
There are numerous opportunities for continuing professional development in Addiction Psychology. Both
Division 28 and 50 are approved APA sponsors of Continuing Education, and we have developed programs that
provide integrated and sequential continued professional education and training. Some of these programs were
listed in Criterion IV, above, including: Annual Workshops, Live Webcasts, Live Webinars, and CE programs at
APA and other conferences.
2.
Petition Form
Page 39
Describe the formal requirements for additional continuing professional development and continuing education in
the proficiency and recognition of practitioners. What credits are required?
Within each 3-year certification cycle, 18 hours of CE in the content area directly related to the Psychological
Treatment of Addiction are required. This Continuing Education must fall within the knowledge domain tested
(issues directly related to the treatment of addiction) and be provided by an APA-approved sponsor, a state
psychological association, the American Society of Addiction Medicine (ASAM) or approved by its state
licensing board. As noted previously, Divisions 28 and 50 are certified by APA to provide Continuing
Education, and Continuing Education programs developed by the division for Annual Meeting of APA and the
Collaborative Perspectives on Addiction (CPA) annual meeting can be used to satisfy this requirement.
Currently there are 14 approved courses on the APA Continuing Education website focused on addiction, all of
which satisfy the requirements for additional continuing professional development and continuing education in
the proficiency. The APA annual meeting provides multiple CE training opportunities in Addiction including
Continuing Education workshops and symposium sessions. The CPA annual meeting sponsors at least 12 hours
of continuing education in the form of clinical Continuing Education workshops, keynote presentations, and
symposium sessions.
3.
Describe how the assessment of an individual's professional development and continuing education as it relates to
initial competency or the maintenance of competency is accomplished in the proficiency.
The APPC continuously works with the Education and Training Committees of Divisions 28 and 50 to assess
the continuing education offerings by both Divisions and assess results of the Annual Division 28/50 Survey of
Practitioners. Initial competency in the Proficiency is established via appropriate graduate education, practicum
experience working with clients with addictive disorders, and through the clinical psychology internship and
supervised post-doctoral clinical experiences. Obtaining state licensure and passing the Certification exam
provide further evidence of initial competency. Maintenance of competency is accomplished via continuing
education.
Evaluation and Assessment
Criterion VIII. Effectiveness. A proficiency is characterized by a body of evidence that
demonstrates the effectiveness of the distinct procedure(s), technique(s), or applied skill set(s)
that comprise the proficiency.
1.
Summarize evidence of the effectiveness of the proficiency, utilizing the published literature, manuscripts
published in refereed journals (or equivalent), outcome studies, practice guidelines, consumer satisfaction surveys,
etc., that demonstrate the efficacy of the proficiency. The manuscripts cited should be relevant to the proficiency,
drawn from a variety of sources and inform the practice of the proficiency.
Numerous evaluation studies have been conducted that demonstrate the effectiveness of both acute and longterm treatments for addiction. Evidence indicates that treatment for these conditions is as effective as treatment
for other chronic health conditions such as diabetes, hypertension, and asthma (Leshner, 1999; McLellan et al.,
2000). Clinical outcomes for addiction are enhanced also by effectively addressing co-existing problems (e.g.,
medical, psychological, social, vocational, and legal problems) in addition to the addiction-related problems
(McLellan et al., 1997; Mertens, Lu, Parthasarathy, Moore, & Weisner, 2003; Milby et al., 2003). The treatment
outcome literature has been summarized in systematic reviews and meta-analyses comparing effectiveness
across treatment modalities. In part because of funding mechanisms, research tends to be conducted and
summarized separately for three broad areas that fall within this proficiency: 1) treatment of alcohol-related
problems 2) treatment of other substance problems (heroin, cocaine, etc.), and 3) treatment of tobacco
dependence and treatments for adolescents. Here, we present an abbreviated overview of the treatment
effectiveness literature in these areas.
Petition Form
Page 40
Treatment of Alcohol Use Disorders
There is a large empirical literature on outcome effectiveness of psychosocial (Benishek et al., 2014; Blodgett,
Maisel, et al., 2014; Godley, Godley, Dennis, Funk, & Passetti, 2007; Jonas et al., 2012; Moyer, Finney,
Swearingen, & Vergun, 2002; Prendergast, Podus, Finney, Greenwell, & Roll, 2006; Finney & Moos, 1998;
McKay, Van Horn et al., 2010; Scott & Dennis, 2009) and pharmacological interventions (Blodgett, Del Re, et
al., 2014; Maisel, Blodgett, Wilbourne, Humphreys, & Finney, 2013; Skinner, Lahmek, Pham, & Aubin, 2014)
for alcohol use disorder. Due to the heterogeneity in symptom and use patterns and clinical presentation and
course of AUD, no one approach produces uniformly superior results establishing it as the treatment of choice.
Treatment response/non-response should be continually assessed and monitored and different types and levels of
interventions tried to maximize therapeutic gains from treatment (McLellan et al., 2005; McKay, 2010). Among
the many psychological interventions investigated, several meet criteria as sufficiently evidence-based (e.g.,
brief interventions, behavioral couples therapy, community reinforcement approach, cognitive-behavioral
relapse prevention, motivational interviewing/enhancement therapy, Twelve-step Facilitation; see McCrady &
Epstein, 2013). Since most of these studies have been funded by the National Institutes of Health (NIH), the
majority of these interventions are widely available in published treatment manuals.
Pharmacotherapies have been identified as clinically useful components in the treatment of AUD with the
evidence of effectiveness for naltrexone, acamprosate, disulfiram, and topiramate (Blodgett, Del Re, et al., 2014;
Jonas et al., 2014; Maisel et al., 2013). In 2006, the FDA approved a depot formulation of naltrexone to treat
moderate-severe alcohol use disorder. This once per month injectable formulation enhances patient compliance
with the medication and has shown to be effective (Garbutt et al., 2005; Lobmaier Kunøe, Gossop, & Waal,
2011). While there are a growing number of empirically supported treatments reported in the efficacy literature,
sufficient effectiveness studies evaluating treatments in community settings are still lacking.
Alcohol and other drug use disorders confer a prodigious clinical and public health burden in the US and around
the world. Alcohol, for example, is the leading cause of disability-adjusted life years lost among males 15-24
years old worldwide (WHO, 2013). Yet, alcohol and other drug use disorders are preventable conditions. Given
this, screening and brief interventions to detect alcohol and drug use problems earlier are being required
increasingly across US health care systems. Systematic reviews of the literature (Angus, Latimer, Preston, Li, &
Purshouse, 2014; Solberg, Maciosek, & Edwards, 2008) show that alcohol screening and brief counseling to be
highly beneficial in terms of reducing economic costs to healthcare systems and broader society. Solberg et al.
(2008) conclude that their results make alcohol screening and counseling one of the highest-ranking preventive
services among the 25 effective services evaluated using standardized methods.
References
Angus, C., Latimer, N., Preston, L., Li, J., & Purshouse, R. (2014). What are the implications for policy makers?
A systematic review of the cost-effectiveness of screening and brief interventions for alcohol misuse in
primary care. Frontiers in Psychiatry, 5(114). doi:10.3389/fpsyt.2014.00114
Benishek, L. A., Dugosh, K. L., Kirby, K. C., Matejkowski, J., Clements, N. T., Seymour, B. L., & Festinger, D.
S. (2014). Prize-based contingency management for the treatment of substance abusers: A meta-analysis.
Addiction, 109, 1426–1436. doi:10.1111/add.12589
Blodgett, J. C., Del Re, A. C., Maisel, N. C., & Finney, J. W. (2014). A meta-analysis of topiramate's effects for
individuals with alcohol use disorders. Alcoholism: Clinical and Experimental Research, 38: 1481–1488.
doi:10.1111/acer.12411
Blodgett, J. C., Maisel, N. C., Fuh, I. L., Wilbourne, P. L., & Finney, J. W. (2014). How effective is continuing
care for substance use disorders? A meta-analytic review. Journal of Substance Abuse Treatment, 46(2),
87-97. doi:10.1016/j.jsat.2013.08.022.
Petition Form
Page 41
Finney, J. W., & Moos, R. H. (1998). Psychosocial treatments for alcohol use disorders. In P. E. Nathan, J. M.
Gorman (Eds.), A guide to treatments that work (pp. 156-166). New York, NY, US: Oxford University
Press.
Garbutt, J. C., Kranzler, H. R., O’Malley, S. S., Gastfriend, D. R., Pettinati, H. M., Silverman, B. L., ... Ehrich,
E. W. (2005). Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: A
randomized controlled trial. Journal of the American Medical Association, 293(13), 1617-1625.
doi:10.1001/jama.293.13.1617.
Jonas, D. E., Amick, H. R., Feltner, C., Bobashev, G., Thomas, K., Wines, R., ... Garbutt, J. C. (2014).
Pharmacotherapy for adults with alcohol use disorders in outpatient settings: A systematic review and
meta-analysis. Journal of the American Medical Association, 311(18), 1889-1900.
doi:10.1001/jama.2014.3628
Jonas, D. E., Garbutt, J. C., Amick, H. R., Brown, J. M., Brownley, K. A., Council, C. L., ... Harris, R. P.
(2012). Behavioral counseling after screening for alcohol misuse in primary care: A systematic review
and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 157(9), 645654. doi:10.7326/0003-4819-157-9-201211060-00544
Leshner, A. I. (1999). Science is revolutionizing our view of addiction—and what to do about it. American
Journal of Psychiatry, 156, 1–3. doi:10.1001/jama.282.14.1314
Lobmaier, P. P., Kunøe, N., Gossop, M., & Waal, H. (2011). Naltrexone depot formulations for opioid and
alcohol dependence: A systematic review. CNS Neuroscience & Therapeutics, 17, 629–636.
doi:10.1111/j.1755-5949.2010.00194.x
Maisel, N. C., Blodgett, J. C., Wilbourne, P. W., Humphreys, K., & Finney, J. W. (2013). Meta-analysis of
naltrexone and acamprosate for alcohol dependence: When are these medications most helpful?
Addiction, 108, 275–293.
McCrady, B., & Epstein, E. (2013). Addictions: A comprehensive guidebook (2nd ed.). Oxford University Press.
McKay, J. R. (2010). Treating substance use disorders with adaptive continuing care. Washington, DC:
American Psychological Association.
McKay, J. R., Van Horn, D., Oslin, D., Lynch, K. G., Ivey, M., Ward, K., ... Coviello, D.M. (2010). A
randomized trial of extended telephone-based continuing care for alcohol dependence: Within treatment
substance use outcomes. Journal of Consulting and Clinical Psychology, 78(6), 912–923.
doi:10.1037/a0020700
McLellan, A. T., McKay, J. R., Forman, R., Cacciola, J., & Kemp, J. (2005). Reconsidering the evaluation of
addiction treatment: From retrospective follow-up to concurrent recovery monitoring. Addiction,
100, 447–458. doi:10.1111/j.1360-0443.2005.01012.x
McLellan, A. T., Woody, G. E., Metzger, D., McKay, J., Durell, J., Alterman, A. I., & O'Brien, C. P. (1997)
Evaluating the effectiveness of addiction treatments: Reasonable expectations, appropriate comparisons.
In J. A. Egertson, D. M. Fox, & A. I. Leshner (Eds.), Treating drug abusers effectively (pp. 7-40).
Cambridge, MA: Blackwell.
Mertens, J. R., Lu, Y. W., Parthasarathy, S., Moore, C., & Weisner, C. M. (2003). Medical and psychiatric
conditions of alcohol and drug treatment patients in an HMO: Comparison with matched
controls. Archives of Internal Medicine, 163(20), 2511–2517. doi:10.1001/archinte.163.20.2511
Petition Form
Page 42
Milby, J. B., Schumacher, J. E., Wallace, D., Frison, S., McNamara, C., Usdan, S., & Day, M. (2003). Day
treatment with contingency management for cocaine abuse in homeless persons: 12-month followup. Journal of Consulting and Clinical Psychology, 71(3), 619–621. doi:10.1037/0022-006X.71.3.619
Moyer A, Finney J. W, Swearingen C. E., & Vergun P. (2002). Brief interventions for alcohol problems: A
meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking
populations. Addiction, 97, 279–292. doi:10.1046/j.1360-0443.2002.00018.x
Prendergast, M., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Contingency management for treatment
of substance use disorders: A meta-analysis. Addiction, 101(11), 1546–1560. doi:10.1111/j.13600443.2006.01581.x.
Scott, C. K. & Dennis, M. L. (2009). Results from two randomized clinical trials evaluating the impact of
quarterly recovery management checkups with adult chronic substance users. Addiction, 104, 959–971.
doi:10.1111/j.1360-0443.2009.02525.x
Solberg, L. I., Maciosek, M. V., & Edwards, N. M. (2008). Primary care intervention to reduce alcohol misuse:
Ranking its health impact and cost effectiveness. American Journal of Preventive Medicine, 34(2), 143152. doi:10.1016/j.amepre.2007.09.035
Skinner M. D., Lahmek P., Pham H., & Aubin H. J. (2014). Disulfiram efficacy in the treatment of alcohol
dependence: A meta-analysis. PLoS ONE, 9(2): e87366. DOI: 10.1371/journal.pone.0087366
World Health Organization. (2007). Status report on alcohol and health in 35 European countries 2013.
Copenhagen, Denmark: WHO Regional Office for Europe.
Treatment of Nicotine Dependence
Given that most smokers visit a primary care physician every year, guidelines for smoking cessation treatment
emphasize the importance of the value of offering pharmacotherapy and concomitant behavioral therapy to
every person who smokes (Fiore et al., 2008), as well as specific types of assessment in primary care settings.
Recommended assessment is summarized as the 5 A’s: ask about smoking status, advise all smokers to quit,
assess willingness to quit, assist those willing to make a quit attempt, and arrange for follow-up to prevent
relapse. Motivational enhancement centered around 5 R’s should be provided to those unwilling to make a quit
attempt. These smokers should be asked to indicate why quitting is relevant and to identify risks of smoking,
potential rewards of cessation, and roadblocks (barriers) to quitting. This process should be repeated at each
visit (Fiore et al., 2008). When tobacco users attempt to quit smoking on their own without the use of
psychosocial or pharmacological treatments, overall quit rates are very low, with only about 3-5% succeeding at
maintaining long-term abstinence (Hughes, Stead, Hartmann-Boyce, Cahill, & Lancaster 2004). Combining
behavioral and pharmacotherapies produces the highest long-term quit rates (Fiore et al., 2008; Stead &
Lancaster, 2012a, 2012b).
However, while no specific form of behavioral intervention is routinely superior, both individual and group
counseling greatly improve the chances of quitting beyond brief advice, usual care or self-help materials. When
no psychosocial treatment is provided, overall quit rates are low (Hughes et al., 2004). All forms of nicotine
replacement therapy (NRT), use of single form or combination NRT, have demonstrated effectiveness, including
transdermal patch, gum, lozenge, nasal spray, and inhaler, and improved quit rates by 50-70% over those
obtained with psychosocial treatment alone (Carpenter et al., 2013; Fiore et al., 2008; Stead et al., 2012).
Bupropion is an atypical antidepressant that has doubled the odds of quitting when used with or without nicotine
replacement (Hughes et al., 2014). Varenicline (Chantix), the smoking cessation medication approved by the
FDA in 2006, is an alpha4beta2 nicotinic acetylcholine receptor partial agonist that has shown a two to threefold increase in quitting when compared to placebo (Cahill, Stevens, Pereera, & Lancaster, 2013). Increasing
evidence suggests that varenicline reduces cravings, nicotine withdrawal, and smoking satisfaction, and that it
Petition Form
Page 43
yields a slightly superior smoking cessation outcome when directly compared to bupropion and when indirectly
compared to NRT (Cahill et al., 2013; Gonzales et al., 2006; Hartwell et al., 2013; Jorenby et al., 2006; Wu,
Wilson, Dimoulas & Mills, 2006). Clinicians should be aware of the FDA warnings associated with both
bupropion and varenicline regarding possible neuropsychiatric events, including depression and suicidal
ideation, and weigh these risks against the substantial benefits associated with quitting smoking.
A recent phenomenon warranting attention is the emergence of Electronic Nicotine Delivery Systems (ENDS),
more commonly known as e-cigarettes. Although these may resemble cigarettes in external appearance, rather
than burning tobacco, the user inhales a nicotine aerosol created by heating a liquid solution. Use of e-cigarettes
has been increasing exponentially and the technology has been rapidly advancing, with public health research
lagging behind. Although the majority of e-cigarette users report initiating use to quit or cut down on smoking
(Etter & Bullen, 2011), e-cigarettes are not approved for therapeutic use, and the limited data are inconclusive
regarding their efficacy (Bullen et al., 2013). Nevertheless, in all likelihood, e-cigarettes are considerably less
harmful than conventional cigarettes (Wagener et al., 2012), and e-cigarette users appear to view these products
as superior to approved nicotine replacement therapies (Harrell et al., 2014).
As the prevalence of smoking has declined, smoking today is concentrated among those with lower income, less
education, and other psychiatric and substance abuse conditions (Grant, Desai, & Potenza, 2004; Lasser et al.,
2000; Smith, Mazure & McKee, 2014). Consequently, cessation interventions may require greater efforts to
reach the current population of smokers and more integrative approaches to cessation treatment and relapse
prevention (Aubin, Rollema, Svensson, & Winterer, 2012).
Although significant gains have been made in the general public, the rates of smoking among individuals with
substance-related disorders in addition to tobacco dependence have not declined (Schroeder & Morris, 2010;
CDC 2013). National clinical guidelines for treating tobacco dependence emphasize the importance of
addressing smoking during substance-related treatment (Fiore et al., 2008). Meta-analyses of clinical trials in
this area, however, indicates that improved treatments are needed (Prochaska, Delucchi, & Hall, 2004; Okoli et
al., 2010). With the growing emphasis to address smoking during substance use treatment knowledge of the
current empirical literature in this area is needed to guide public and agencies policies (Miller-Thomas,
Leoutsakos, Terplan, Brigham & Chisolm, 2014; Ziedonis, Guydish, Williams, Steinberg, & Foulds, 2006).
References
Aubin, H. J., Rollema, H., Svensson, T. H., & Winterer, G. (2012). Smoking, quitting, and psychiatric disease:
A review. Neuroscience & Biobehavioral Reviews, 36(1), 271-284. doi:10.1016/j.neubiorev.2011.06.007
Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V., Williman, J., & Walker, N. (2013). Electronic
cigarettes for smoking cessation: A randomized controlled trial. Lancet, 382(9905), 1629-1637.
doi:10.1016/ S0140-6736(13)61842-5
Cahill, K., Stevens, S., Perera, R., & Lancaster, T. (2013). Pharmacological interventions for smoking cessation:
An overview and network meta-analysis. Cochrane Database System Reviews, 5, CD009329.
doi:10.1002/14651858.CD009329.pub2
Carpenter, M. J., Jardin, B. F., Burris, J. L., Mathew, A. R., Schnoll, R. A., Rigotti, N. A., & Cummings, K. M.
(2013). Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation:
A review of the literature. Drugs, 73(5), 407-426. doi:10.1007/s40265-013-0038-y
Centers for Disease, Control, & Prevention. (2013). Vital signs: Current cigarette smoking among adults aged
>/=18 years with mental illness - United States, 2009-2011. MMWR Morbidity and Mortality Weekly
Report, 62(5), 81-87.
Etter, J. F., & Bullen, C. (2011). Electronic cigarette: Users profile, utilization, satisfaction and perceived
efficacy. Addiction, 106, 2017-2028. doi:10.1111/j.1360-0443.2011.03505.x
Petition Form
Page 44
Fiore, M. C., Jaen, C.R., Baker, TB, Bailey, W.C., Benowitz, N. L., Curry, Susan J., ... Wewers, M. E. (2008).
Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Retrieved from
http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
Gonzales, D., Rennard, S. I., Nides, M., Oncken, C., Azoulay, S., Billing, C. B., ... Reeves, K. R. (2006).
Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs sustained-release Bupropion and
placebo for smoking cessation: A Randomized controlled trial. Journal of The American Medical
Association, 296(1), 47-55. doi:10.1001/jama.296.1.47
Grant, J. E., Desai, R. A., & Potenza, M. N. (2009). Relationship of nicotine dependence, subsyndromal and
pathological gambling, and other psychiatric disorders: Data from the National Epidemiologic Survey on
Alcohol and Related Conditions. Journal of Clinical Psychiatry, 70(3), 334-343.
doi:10.4088/JCP.08m04211
Harrell P. T., Marquinez N. S., Correa J. B., Meltzer L. R., Unrod M., Sutton S. K., ... Brandon T. H. (2014).
Expectancies for cigarettes, e-cigarettes, and nicotine replacement therapies among e-cigarette users
("Vapers"). Nicotine & Tobacco Research, Aug 28. pii: ntu149. [Epub ahead of print]. doi:
10.1093/ntr/ntu149
Hartwell, K. J., Lematty, T., McRae-Clark, A. L., Gray, K. M., George, M. S., & Brady, K. T. (2013). Resisting
the urge to smoke and craving during a smoking quit attempt on varenicline: Results from a pilot fMRI
study. American Journal of Drug Alcohol Abuse, 39(2), 92-98. doi:10.3109/00952990.2012.750665
Hughes, J. R., Stead, L. F., Hartmann-Boyce, J., Cahill, K., & Lancaster, T. (2014). Antidepressants for smoking
cessation. The Cochrane Database of Systematic Reviews, 1CD000031.
doi:10.1002/14651858.CD000031.pub4
Jorenby, D. E., Hays, J. T., Rigotti, N. A., Azoulay, S., Watsky, E. J., Williams, K. E., ... Reeves, K. R. (2006).
Efficacy of Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustainedrelease Bupropion for smoking cessation: A randomized controlled trial. Journal of the American
Medical Association, 296(1), 56-63. doi:10.1001/jama.296.1.56
Kotz, D., Brown, J., & West, R. (2014). Prospective cohort study of the effectiveness of smoking cessation
treatments used in the "real world". Mayo Clinic Proceedings, 89(10), 1360-1367.
doi:10.1016/j.mayocp.2014.07.004
Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000). Smoking
and mental illness: A population-based prevalence study. Journal of the American Medical Association,
284(20), 2606-2610. doi:10.1001/jama.284.20.2606
Miller-Thomas, T., Leoutsakos, J. M., Terplan, M., Brigham, E. P., & Chisolm, M. S. (2014). Comparison of
cigarette smoking knowledge, attitudes, and practices among staff in perinatal and other substance abuse
treatment settings. Journal of Addiction Medicine, 8(5), 377-383. doi:10.1097/ADM.0000000000000068
Okoli, C. T., Khara, M., Procyshyn, R. M., Johnson, J. L., Barr, A. M., & Greaves, L. (2010). Smoking
cessation interventions among individuals in methadone maintenance: A brief review. Journal of
Substance Abuse Treatment, 38(2), 191-199. doi:10.1016/j.jsat.2009.10.001
Prochaska, J. J., Delucchi, K., & Hall, S. M. (2004). A meta-analysis of smoking cessation interventions with
individuals in substance abuse treatment or recovery. Journal of Consulting and Clinical Psychology, 72,
1144-1156. doi:10.1037/0022-006X.72.6.1144
Petition Form
Page 45
Schroeder, S. A., & Morris, C. D. (2010). Confronting a neglected epidemic: Tobacco cessation for persons with
mental illnesses and substance abuse problems. Annual Review of Public Health, 31, 297-314
doi:10.1146/annurev.publhealth.012809.103701
Smith, P. H., Mazure, C. M., & McKee, S. A. (2014). Smoking and mental illness in the US population.
Tobacco Control. doi:10.1136/tobaccocontrol-2013-051466
Stead, L. F., & Lancaster, T. (2012a). Behavioural interventions as adjuncts to pharmacotherapy for smoking
cessation. The Cochrane Database of Systematic Reviews, 12CD009670.
doi:10.1002/14651858.CD009670.pub2
Stead, L. F., & Lancaster, T. (2012b). Combined pharmacotherapy and behavioural interventions for smoking
cessation. The Cochrane Database of Systematic Reviews, 10CD008286.
doi:10.1002/14651858.CD008286.pub2
Stead, L. F., Perera, R., Bullen, C., Mant, D., Hartmann-Boyce, J., Cahill, K., & Lancaster, T. (2012). Nicotine
replacement therapy for smoking cessation. The Cochrane Database of Systematic Reviews,
11CD000146. doi:10.1002/14651858.CD000146.pub4
Wagener, T. L., Siegel, M., & Borrelli, B. (2012). Electronic cigarettes: Achieving a balanced perspective.
Addiction, 107(9), 1545-1548. doi:10.1111/j.1360-0443.2012.03826.x
Wu, P., Wilson, K., Dimoulas, P., & Mills, E. J. (2006). Effectiveness of smoking cessation therapies: A
systematic review and meta-analysis. BMC Public Health, 6300-16. doi:10.1186/1471-2458-6-300
Ziedonis, D.M., Guydish, J., Williams, J., Steinberg, M. & Foulds, J. (2006). Barriers and solutions to
addressing tobacco dependence in addiction treatment programs. Alcohol Research & Health, 29(3), 228235.
Treatment of Other Substance Use Disorders
As with Alcohol Use Disorder, both psychological and pharmacological interventions and their combination
have demonstrated efficacy for other types of substance use disorders. Across most types of SUDs, evidence has
emerged for cognitive behavioral approaches, motivational enhancement therapies, the community
reinforcement approach, contingency management interventions, and structured family therapy, and their
combinations (Carroll & Onken, 2005). These interventions and the accompanying evidence of their efficacy
appear in multiple textbooks, professional organization practice guidelines, and published review articles (e.g.,
Dutra et al., 2008; McCrady & Epstein, 2013; Glasner-Edwards & Rawson, 2010; National Quality Forum
2007; Prendergast, Podus, Finney, Greenwell, & Roll, 2006). Many of these behavioral therapies can be used
across a range of SUDS with fairly little adaptation. Pharmacological interventions are generally SUD specific,
and FDA approved medications are available only for opioid and tobacco use disorders. Below are brief
summaries of the interventions for various types of SUDs that have accumulated evidence for their efficacy.
Opioid Use Disorders. The outcome literature documents the effectiveness of pharmacological and
behavioral for opioid dependence (Fudala & Woody, 2002) in reducing illicit opioid use, HIV risk behavior, and
drug-related criminal behavior. While no specific form of psychosocial intervention has consistently been shown
to be more or less efficacious, programs with standard, required counseling have been shown to be generally
more effective than agonist substitution medications alone (McLellan et al., 1993). A number of studies have
also demonstrated that using abstinence-based contingency management can enhance abstinence outcomes, for
illicit opioid and other drug use, among those enrolled in treatment for an opioid use disorder (e.g., Silverman,
Robles, Mudric, Bigelow, & Stitzer, 2004).
Petition Form
Page 46
Psychologists also must be acutely aware that opioid agonist maintenance under appropriate medical
supervision integrated with concurrent addiction-focused psychosocial treatment is considered a first-line
treatment for opioid dependence (National Consensus Development Panel, 1998; Fudala & Woody, 2002). The
most commonly used agonists with documented efficacy are methadone and buprenorphine. Maintenance
treatment with methadone or buprenorphine is appropriate for patients with a prolonged history (>1 year) of
opioid dependence, with the goals of the medication treatment being to achieve a stable maintenance dose of
opioid agonist and facilitate engagement in a comprehensive program of rehabilitation. Maintenance treatment
with naltrexone, an opiate antagonist is an alternative medication strategy, although the utility of this strategy is
often limited by lack of patient adherence and low treatment retention. New formulations of medications
continue to emerge for opioid dependence. A combination of buprenorphine and naloxone, Suboxone, combines
agonist and antagonist effects, and thus is viewed as an option with less potential for misuse and diversion, and
more effective for preventing relapse. Addiction psychologists should be aware of these effective medications
and consider how to best combine psychological and pharmacological treatments for opioid dependence.
Cocaine/Stimulant Use Disorders. Cocaine Use and other Stimulant Use Disorders are treated primarily
with psychosocial treatments, as no effective medications have yet to be approved for this indication. The
preponderance of evidence indicates that cognitive behavioral approaches, community reinforcement approach,
contingency management and their combinations are first-line treatments of choice (Vocci & Montoya, 2009;
Shoptaw et al., 2005; Dutra et al., 2008; Magill & Ray 2009). Evidence-based therapy manuals for community
reinforcement approaches and contingency management (Budney & Higgins, 1998), cognitive-behavioral
relapse prevention (Carroll, 1998), and individual drug counseling (Mercer & Woody, 1998) have been
developed for treating cocaine addiction and are distributed by the National Institute on Drug Addiction.
Cannabis Use Disorders. Similar to Cocaine Use Disorder, Cannabis Use Disorder is treated primarily
with behavioral treatments. Although much research has been performed testing potential medications, none
have yet been found to be efficacious. Motivational enhancement therapy, cognitive behavioral therapy,
contingency management, and their combination have demonstrated efficacy in multiple clinical trials and
should be considered treatments of choice (Budney, Roffman, Stephens, & Walker, 2007; Davis et al., 2014;
MTP Research Group, 2004; Litt, Kadden, & Petry 2013).
Technology-assisted interventions. Most recently, multiple studies have provided evidence that various
forms of computer and web-assisted therapies can be valuable tools for increasing access and efficacy of
psychological interventions across multiple SUDs (Kiluk et al., 2011; Marsch, Carroll, & Kiluk, 2014). These
innovations to practice may increase overall effectiveness and cost-effectiveness in treating SUDs in the next
decade.
Continuing Care. Strategic applications of continuing care following a course of psychological
interventions can be effective for SUDs (Lash et al., 2013; McCollister et al., 2013; McKay et al., 2014). These
interventions can both extend positive treatment responses as well increase treatment re-entry upon relapse.
References
Budney, A. J., & Higgins, S. T. (1998). National Institute on Drug Abuse therapy manuals for drug addiction:
Manual 2. A Community Reinforcement Approach: Treating Cocaine Addiction (NIH Publication No. 984309). Rockville, MD: US Department of Health and Human Services.
Budney, A. J., Roffman, R., Stephens, R. S., & Walker, D. (2007). Marijuana dependence and its treatment.
Addiction science & clinical practice, 4(1), 4. doi:10.1151/ASCP07414
Carroll, K. M. (1998). A cognitive behavioral approach: treating cocaine addiction. Rockville, MD: National
Institute on Drug Abuse.
Carroll, K. M. & Onken, L. S. (2005). Behavioral therapies for drug abuse. American Journal of Psychiatry,
162, 1452-1460. doi:10.1176/appi.ajp.162.8.1452
Petition Form
Page 47
Davis, M. L., Powers, M. B., Handelsman, P., Medina, J. L., Zvolensky, M., & Smits, J. A. (2014). Behavioral
therapies for treatment-seeking cannabis users: A meta-analysis of randomized controlled trials.
Evaluation and the Health Professions. doi:10.1177/0163278714529970
Dutra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., & Otto, M. W. (2008). A meta-analytic
review of psychosocial interventions for substance use disorders. American Journal of Psychiatry,
165(2), 179-187. doi:10.1176/appi.ajp.2007.06111851
Fudala, P. J., Woody, G. E. (2002). Current And Experimental Therapeutics for the Treatment Of Opioid
Addiction. In Davis, K.L., Charney,D, Coyle,J.T. and Nemeroff, C. (Eds.). Neuropsychopharmacology:
The Fifth Generation of Progress. Lippincott, Williams, & Wilkins, Philadelphia, Pennsylvania.
Glasner-Edwards, S., & Rawson, R. (2010). Evidence-based practices in addiction treatment: Review and
recommendations for public policy. Health Policy, 97(2-3), 93-104. doi:10.1016/j.healthpol.2010.05.013
Kiluk, B. D., Sugarman, D. E., Nich, C., Gibbons, C. J., Martino, S., Rounsaville, B. J., & Carroll, K. M. (2011).
A methodological analysis of randomized clinical trials of computer-assisted therapies for psychiatric
disorders: Toward improved standards for an emerging field. American Journal of Psychiatry, 168(8),
790-799. doi:10.1176/appi.ajp.2011.10101443
Lash, S. J., Burden, J. L., Parker, J. D., Stephens, R. S., Budney, A. J., Horner, R. D., ... Grambow, S. C. (2013).
Contracting, prompting and reinforcing substance use disorder continuing care. Journal of Substance
Abuse Treatment, 44(4), 449-456. doi:10.1016/j.jsat.2012.09.008
Litt, M. D., Kadden, R. M., & Petry, N. M. (2013). Behavioral treatment for marijuana dependence:
Randomized trial of contingency management and self-efficacy enhancement. Addictive Behaviors,
38(3), 1764-1775. doi: 10.1016/j.addbeh.2012.08.011
Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: A
meta-analysis of randomized controlled trial. Journal of Studies on Alcohol & Drugs, 70(4), 516-527.
Marsch, L. A., Carroll, K. M., & Kiluk, B. D. (2014). Technology-based interventions for the treatment and
recovery management of substance use disorders: A JSAT special issue. Journal of Substance Abuse
Treatment, 46(1), 1-4. doi:10.1016/j.jsat.2013.08.010
McCollister, K. E., French, M. T., Freitas, D. M., Dennis, M. L., Scott, C. K., & Funk, R. R. (2013). Costeffectiveness analysis of Recovery Management Checkups (RMC) for adults with chronic substance use
disorders: Evidence from a 4-year randomized trial. Addiction, 108(12), 2166-2174.
doi:10.1111/add.12335
McCrady, B. S., & Epstein, E. E. (Eds.). (2013). Addictions: A comprehensive guidebook (2nd ed.). New York,
NY: Oxford University Press.
McKay, J. R., Van Horn, D. H., Lynch, K. G., Ivey, M., Cary, M. S., Drapkin, M., & Coviello, D. (2014). Who
benefits from extended continuing care for cocaine dependence? Addictive Behaviors, 39(3), 660-668.
doi:10.1016/j.addbeh.2013.11.019
McKay, J. R. (2010). Treating substance use disorders with adaptive continuing care. Washington, DC:
American Psychological Association.
McLellan, A. T., Arndt, I. 0., Metzger, D. S., Woody, G. E., & O'Brien, C.P. (1993). The effects of psychosocial
Petition Form
Page 48
services in substance abuse treatment. Journal of the American Medical Association, 69, 1953-1959.
doi:10.1001/jama.1993.03500150065028
Mercer, D., & Woody, G. (1998). Therapy manuals for drug abuse. An Individual Drug Counselling Approach
to treat Cocaine Addiction. The Collaborative Cocaine Treatment Study, National Institute on Drug
Abuse, EE. UU.
The Marijuana Treatment Project Research Group. (2004). Brief treatments for cannabis dependence: Findings
from a randomized multisite trial. Journal of Consulting and Clinical Psychology, 72(3), 455466. doi:10.1037/0022-006X.72.3.455
National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. (1998). Effective
medical treatment of opiate addiction. Journal of the American Medical Association, 280(22), 19361943. doi:10.1001/jama.280.22.1936
National Quality Forum. (2007). National Voluntary Consensus Standards on Evidence-Based Practices to Treat
Substance Use Conditions. Retrieved from http://www.qualityforum.org/projects/ongoing/sud.asp
Prendergast, M., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Contingency management for treatment
of substance use disorders: A meta-analysis. Addiction, 101(11), 1546-1560. doi:10.1111/j.13600443.2006.01581.x
Shoptaw, S., Reback, C. J., Peck, J. A., Yang, X., Rotheram-Fuller, E., Larkins, S., ... Hucks-Ortiz, C. (2005).
Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk
behaviors among urban gay and bisexual men. Drug and Alcohol Dependence, 78(2), 125-134.
doi:10.1016/j.drugalcdep.2004.10.004
Silverman, K., Robles, E., Mudric, T., Bigelow, G. E., & Stitzer, M. L. (2004). A randomized trial of long-term
reinforcement of cocaine abstinence in methadone-maintained patients who inject drugs. Journal of
Consulting and Clinical Psychology, 72(5), 839-854. doi:10.1037/0022-006X.72.5.839 .
Vocci, F. J., & Montoya, I. D. (2009). Psychological treatments for stimulant misuse, comparing and contrasting
those for amphetamine dependence and those for cocaine dependence. Current Opinion in Psychiatry,
22(3), 263–268. doi:10.1097/YCO.0b013e32832a3b44
Adolescent Substance Use Disorders
There is evidence of efficacious approaches in the adolescent alcohol treatment literature (Bekman, Wilkins, &
Brown, 2013; Brown, Anderson, Ramo, & Tomlinson, 2005). Although nearly all teenagers entering SUD
treatment are using alcohol, marijuana is typically their primary substance on treatment entry (Greene & Kelly,
2014). Because alcohol and other drug use disorders typically onset during adolescence and young adulthood, a
number of treatments have been developed and tested to address an array of substance-related problems
including alcohol and cannabis (Dennis, Godley, Diamond, et al, 2004) and these have demonstrated efficacy
and effectiveness (Carney & Myers, 2012; Tanner-Smith, Wilson, & Lipsey, 2013; Waldron & Turner, 2008).
Findings suggest treatments for youth produce outcomes comparable in magnitude to those found among adults
with alcohol use problems, yield varied improvement across areas such as school performance, emotional
distress, family relations, and with the possible exception of outpatient family therapy, and do not differ
substantially from one another in their likelihood of success (Tanner-Smith, Wilson, Lipsey, 2013). This is
confirmed in meta-analyses by Waldron and Turner (2008) and Tanner-Smith et al., (2013) which found
treatment approaches (e.g., Multidimensional Family Therapy, Functional Family Therapy, and Group
Cognitive-Behavioral Therapy) producing similar benefits. Adolescents with greater alcohol and other drug use
problem severity at intake are just as likely to reap short-term benefit from treatment as youths with lesser
Petition Form
Page 49
problem severity (Latimer, Newcomb, Winters, & Stinchfield, 2000; Wagner, Dinklage, Cudworth, & Vyse,
1999; Winters, Stinchfield, Opland, Weller, & Latimer, 2000; Tanner-Smith et al., 2013). As with adults treated
for SUD, it is important to note that for one of every two teenagers treated there will be a relapse within three
months of completing treatment, with two thirds relapsing within six months of completion (Brown, Mott, &
Myers, 1990; Brown, Vik, & Creamer, 1989; Latimer et al., 2000; Tanner-Smith et al., 2013). Despite this
similarity to other chronic diseases and health problems, the earlier that treatment is initiated the shorter the time
to remission and the lower the negative impact on adolescent lives (Carney & Myers, 2012; Dennis, Scott, Funk,
& Foss, 2005). Historically, through to the 1980s, adolescents received treatment for alcohol problems in
programs designed for adults and, in some cases, even in the same actual program as adults (White, 2014). This
is no longer the case. Adolescents are now seen as distinctly different from adults in terms of their treatment
needs and programs utilize treatments devised specifically for young people (Bekman, Wilkins, & Brown,
2013).
Bekman, N. M., Wilkins, K.C., & Brown, S.A. (2013). Treatment for adolescent alcohol and drug problems. In
B. S. McCrady & E. E. Epstein (2nd Ed.), Addictions: A comprehensive guidebook (pp. 708-741). New
York, NY: Oxford University Press.
Brown S. A., Anderson, K. G., Ramo, D. E., & Tomlinson, K. L. (2005). Treatment of adolescent alcoholrelated problems. A translational perspective. Recent Developments in Alcoholism, 17, 327–348.
Brown, S. A., Mott, M. A., & Myers, M. G. (1990). Adolescent alcohol and drug treatment outcome. In Drug
and alcohol abuse prevention (pp. 373-403). Humana Press.
Brown, S. A., Vik, P. W., & Creamer, V. A. (1989). Characteristics of relapse following adolescent substance
abuse treatment. Addictive Behaviors, 14(3), 291-300.
Carney, T., & Myers, B. (2012). Effectiveness of early interventions for substance-using adolescents: Findings
from a systematic review and meta-analysis. Substance Abuse Treatment, Prevention, & Policy,
7(25). doi:10.1186/1747-597X-7-25
Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., ... Funk, R.R. (2004). The
Cannabis Youth Treatment (CYT) study: Main findings from two randomized trials. Journal of
Substance Abuse Treatment, 27(3), 197–213. doi:10.1016/j.jsat.2003.09.005
Dennis, M. L., Scott, C. K., Funk, R., & Foss, M. A. (2005). The duration and correlates of addiction and
treatment careers. Journal of Substance Abuse Treatment, 28, S51–S62. doi:10.1016/j.jsat.2004.10.013
Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R. R., & Passetti, L. L. (2007). The effect of assertive
continuing care on continuing care linkage, adherence and abstinence following residential treatment for
adolescents with substance use disorders. Addiction, 102: 81–93. doi:10.1111/j.1360-0443.2006.01648.x
Greene, M. C., & Kelly, J. F. (2014). The prevalence of cannabis withdrawal and its influence on adolescents'
treatment response and outcomes: A 12-month prospective investigation. Journal of Addiction Medicine.
8 (5), 359-367. doi:10.1097/ADM.0000000000000064.
Latimer, W. W., Newcomb, M., Winters, K. C., & Stinchfield, R. D. (2000). Adolescent substance abuse
treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors.
Journal of Consulting and Clinical Psychology, 68(4), 684. doi:10.1037//0022-006X.68.4.684
Tanner-Smith, E. E., Wilson, S. J., & Lipsey, M. W. (2013). The comparative effectiveness of outpatient
treatment for adolescent substance abuse: A meta-analysis. Journal of Substance Abuse Treatment, 44:
145–158. doi:10.1016/j.jsat.2012.05.006.
Petition Form
Page 50
Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance
abuse. Journal of Clinical Child and Adolescent Psychology, 37:238–
261.doi:10.1080/15374410701820133
Wagner, E. F., Dinklage, S. C., Cudworth, C., & Vyse, J. (1999). Pilot project: A preliminary evaluation of the
effectiveness of a standardized student assistance program. Substance Use & Misuse, 34(11), 1571-1584.
doi:10.3109/10826089909039415
White, W. L. (2014). Slaying the Dragon: The history of addiction treatment and recovery in America (2nd ed.).
Bloomington, IL: Chestnut Health Systems.
Winters, K. C., Stinchfield, R. D., Opland, E., Weller, C., & Latimer, W. W. (2000). The effectiveness of the
Minnesota Model approach in the treatment of adolescent drug abusers. Addiction, 95(4), 601-612.
doi:10.1046/j.1360-0443.2000.95460111.x
Criterion IX. Quality Improvement. A proficiency promotes ongoing investigations and
procedures to develop further the quality and utility of its applications.
1.
Provide a description of the types of investigations that are designed to evaluate and increase the usefulness of the
applications used in the practice of the proficiency. Estimate the number of researchers conducting these types of
studies, the scope of their efforts, and how your organization and/or other organizations associated with the
proficiency will act to foster these developments. It also is appropriate to provide evidence of current efforts in
these areas.
The general area of studies related to alcohol, nicotine, and other substance use is one of the most active
research areas in clinical psychology (Gifford & Humphreys, 2007). Although it is difficult to estimate the
number of researchers in this area, the current membership of the Research Society on Alcoholism (RSA) is
over 1600 drawn from countries all over the world, with the majority from the United States. Membership in
the College on Problems of Drug Dependence (CPDD) exceeds 1000, and membership in the Society for
Research on Nicotine and Tobacco (SRNT) exceeds 900. Consequently, numerous studies across the spectrum
of scientific methods and models have been and will continue to be brought to bear of the effectiveness of the
proficiency (Tucker & Roth, 2006). The types of studies mentioned here represent only a small sample of this
large body of work. First, there are basic science (both pre-clinical and clinical) investigations of the
psychological effects of psychoactive substances and of the determinants of psychoactive substance
consumption. These studies provide critical information on the mechanisms of action of these substances and on
the conditions that can produce problematic consumption, both of which are critical for the development of
rational clinical assessment and treatment procedures. Second, there are epidemiological studies of the general
population and individuals with clinically significant psychoactive substance problems that are aimed at
describing consumption patterns, other characteristics that may be related to consumption patterns, and
psychological and environmental variables that may be related to changes in consumption patterns over time.
Again, information from such studies is critical for the development of rational clinical assessment and
treatment procedures. Third, there are studies of the reliability, validity, and clinical utility of a wide variety of
clinical screening and assessment procedures. Fourth, there are randomized clinical trials that compare the
efficacy of different clinical treatment procedures. These last two types of studies obviously have direct and
immediate relevance to increasing the effectiveness and usefulness of practitioners in the proficiency. Fifth,
there are studies of treatment effectiveness and treatment utilization that evaluate whether efficacious treatments
are also effective in real-world clinical settings as well as provide information on how to increase the utilization
of clinical services for substance-related problems. Sixth, there are implementation studies examining the best
ways to integrate evidence-based practices into different settings (Carroll & Rounsaville, 2007).
The sponsoring Divisions foster these efforts in several ways. Many Division 28 and 50 members are
Petition Form
Page 51
themselves active scientists in the alcohol and drug fields and serve on NIH agency Study Sections and
Councils. The Divisions offer annual student, early career psychologist, and investigator research awards.
Division 50 regularly offers continuing education programs on the latest clinical procedures at the APA
convention and the Division 50 mid-year meeting, Collaborative Perspectives on Addiction (CPA). Divisions 28
and 50 publish APA journals (Experimental and Clinical Psychopharmacology; Psychology of Addictive
Behaviors, respectively), for original investigations and review articles. Numerous Division members serve on
the editorial boards of these and other journals in the fields of substance-related problems and general clinical
psychology. Additionally, Divisions 28 and 50 regularly collaborate to support activities related to research in
this area by working with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National
Institute on Drug Abuse (NIDA) at the annual convention. A poster session devoted to these activities takes
place annually, featuring presentations by promising new researchers. Recently members of the Division 50
leadership were funded through an R13 mechanism for three consecutive three-year support periods (e.g., 9
years) to bolster such efforts. A fourth renewal is awaiting a funding decision. These funds have and will allow
additional awards to investigators for travel to the convention, invited addresses by prominent senior scientists,
increased interaction and networking among the junior and senior researchers, and expanded audiences of
potential participants and attendees at division convention sessions. In addition, Division 50 has committed to
developing a Committee on Special Populations to also foster growth related to treatment for addictive
behaviors in diverse populations. In conjunction with this, Division 50 has also developed Special Travel
Awards to support student attendance at special APA or divisional summits and the Division 50 CPA annual
meeting. One example was planned student attendance, coordinated with members who are presenting, at the
meeting Culturally Informed Evidence Based Practices: Translating Research and Policy for the Real World.
Another was planned student attendance, coordinated with members who are presenting, at the APA Summit on
Violence and Abuse in Relationships: Forging New Directions. Similarly, Division 28 established a new
Undergraduate Scholarship to support the attendance and participation of undergraduate students involved in
psychopharmacology research at the annual APA convention. Such efforts reflect the desire of our Divisions to
facilitate addiction student researchers opportunities to network in the broader community of psychologists in
such areas and to bring back reports of their experiences to the membership.
In sum, psychology has a unique ability to integrate basic experimental and applied clinical science and to apply
the knowledge gained from multiple levels of analysis to the pragmatic goal of reducing the prevalence of
addiction. Divisions 28 and 50 are demonstrated and committed contributors to such efforts.
2.
Describe how the proficiency seeks ways to improve the quality and usefulness of its practitioners' services
beyond its original determinations of effectiveness.
The sponsoring Divisions, and other APA Divisions and organizations, seek to improve the quality and
usefulness of practitioners' services in the treatment of addiction through application of principles from
implementation science (Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004) including education and
various other ways of facilitating adoption of new findings and techniques (Miller, Sorensen, Selzer, &
Brigham, 2006). These organizations present workshops regularly at the annual APA convention. They also
maintain e-mail listservs for exchange of ideas regarding clinical cases as well as general issues in the field.
Members of the sponsoring Divisions serve as committee members in the development of treatment guidelines
and standards of evidence-based practice (National Quality Forum, 2006). Members of the Divisions serve on
the Study Sections and Councils of federal agencies that determine the priorities and funding of research
activities. Information about these activities is conveyed to practitioners through the newsletters and other
regular communications. Members of Division 28 and 50 serve in leadership capacities for other national and
international organizations concerned with substance-related problems (e.g., RSA, CPDD, SRNT, among
others). Formal liaisons are maintained between many of these organizations, assuring direct and speedy
communication between them and to their members.
3.
Describe how the research and practice literature are regularly reviewed for developments, which are relevant to
the proficiency's skills and services, and how this information is publicly disseminated.
Petition Form
Page 52
As noted above, basic and applied research on the psychological and other effects of psychoactive substances,
the determinants of maladaptive consumption, and improvements in clinical procedures are extensive scientific
efforts that are dominated by Addiction Psychologists. Literature reviews are a normal and frequent part of the
activities of such a scientific community. Some of this work is routinely published in high quality, mainstream
psychological journals, such as Journal of Consulting and Clinical Psychology, Journal of Abnormal
Psychology, and Psychological Bulletin. This large amount of scientific activity also has generated numerous
specialized, peer-reviewed journals as outlets for the research. Among the better of the specialized journals are
Psychology of Addictive Behaviors, Experimental and Clinical Psychopharmacology, Addictive Behaviors,
Journal of Studies on Alcohol and Drugs, Psychopharmacology, Drug and Alcohol Dependence, Addiction, and
Alcoholism: Clinical and Experimental Research. Moreover, scientific and clinical topics on addiction-related
disorders are routine program items at national and international psychological conventions, such as the annual
meetings of the American Psychological Association, the Association for Behavioral and Cognitive Therapy,
and the Association for Behavioral Analysis. Specialized conferences, such as the annual meetings of the RSA,
CPDD, and SRNT also provide valuable information regarding substance-related problems. Finally, both the
National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse routinely publish
and disseminate monographs and brochures on research and practice developments in the area of substancerelated problems.
All educational opportunities that individuals seeking to obtain or maintain for the proficiency must meet APA
standards, or the relevant standards for internships (APPIC). With clinical training, for example, as in
postdoctoral or internship opportunities, individuals are supervised by licensed professionals and then tested for
proficiency to become a licensed psychologist. This sets the base for work related to this proficiency. They then
must take a test to show knowledge in the area of this proficiency. In terms of continuing education, courses
that are recognized must be reviewed in accord with APA continuing education rules. This means they are
reviewed by qualified licensed psychologists for meeting the appropriate standards for the course matter. We
expect colleagues working in such roles to limit their participation to their areas of expertise as is standard.
Participants must sign in and out of sessions, participate as required, and take an evaluation. CE providers must
document these items to grant CE. Occasionally CE opportunities are run in workshop formats and have many
practical opportunities and so peer to peer feedback is offered from the presenter and other participants. If these
continuing educational opportunities result in some additional “certification ” for a technique (for instance,
Motivational Interviewing), they usually have a practical test. But if they are more knowledge based, they do
not. Such evaluations are also reviewed as part of the overall approval of the CE offering for recognition, as all
providers have to say how they provide an evaluation. Ultimately the actual proficiency is assessed by the
individual passing the test associated with the certificate of proficiency.
References
Carroll, K. M., & Rounsaville, B. J. (2007). A vision of the next generation of behavioral therapies research in
addiction. Addiction, 102, 850-862. doi:10.1111/j.1360-0443.2007.01798.x
Gifford, E., & Humphreys, K. (2007). The psychological science of addiction. Addiction, 102, 352-361.
doi:10.1111/j.1360-0443.2006.01706.x
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in
service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581-629.
doi:10.1111/j.0887-378X.2004.00325.x
Miller, W. R., Sorensen, J. L., Selzer, J. A., & Brigham, G. S. (2006). Disseminating evidence-based practices in
substance abuse treatment: A review with suggestions. Journal of Substance Abuse Treatment, 31, 25-39.
doi:10.1016/j.jsat.2006.03.005
National Quality Forum. (2007). National Voluntary Consensus Standards on Evidence-Based Practices to Treat
Petition Form
Page 53
Substance Use Conditions. Retrieved from http://www.qualityforum.org/projects/ongoing/sud.asp
Tucker J., & Roth D. (2006). Extending the evidence hierarchy to enhance evidence-based practice for
substance use disorders. Addiction, 101, 918–32. 10.1111/j.1360-0443.2006.01396.x
Criterion X. Guidelines for Proficiency Service Delivery. Proficiency practitioners conform
their professional activities, not only to the profession's general practice guidelines and ethical
principles but also to any relevant proficiency guidelines.
1.
Describe how the proficiency's practitioners assume effective and ongoing communication to members of the
discipline and the public as to the proficiency's practices, practice enhancements, and/or new applications.
Communication with members of the discipline regarding the practice, practice enhancements, and new
applications occurs through a variety of publications and venues. These include division journals, newsletters,
websites on evidence based practice information, convention programming and trainings, official APA
administrative functions from the practice directorate and CPP related to examinations, renewals, and the like.
The divisions also are networked with other professional associations and government agencies that are
stakeholders in addictions treatment, research, and training, and committed to disseminating up to date
information relevant to practice.
One of the primary publications in this regard is the quarterly APA journal Psychology of Addictive Behaviors,
the journal of Division 50. Other journals of the American Psychological Association often address major issues
relevant to the practitioners of the proficiency. In particular, the APA journal Experimental and Clinical
Psychopharmacology, the journal of Division 28, publishes many articles that are of importance to the
proficiency. Moreover, the Journal of Consulting and Clinical Psychology and the Journal of Abnormal
Psychology usually devote several articles per issue to manuscripts of immediate interest to practitioners of the
proficiency. In addition to these formal publications, both Division 28 and Division 50 publish divisional
newsletters. Psychopharmacology and Substance Abuse Newsletter, the newsletter of Division 28, is published
three times a year and provides members with updates on divisional activities, including information regarding
the division's APA convention program. The Addiction Newsletter, which is published by Division 50, provides
similar services to its members. The Addiction Newsletter has also played a key role in informing psychologists
about the existing Proficiency of Psychological Treatment of Alcohol and Psychoactive Substance Use
Disorders and about The College of Professional Psychology. Division 28s and 50 also have active websites
which receive regular updates on information regarding research and practice.
Both Division 28 and Division 50 are active participants in the annual APA convention, with considerable
collaboration between the two divisions in the presentation of programs of importance to the proficiency. In
addition, as addressed elsewhere, Division 50 is now able to sponsor continuing professional education and is
working to provide easy access to these activities for practitioners of this proficiency. Both Division 28 and
Division 50 maintain active and vigorous listservs that enable communication among members regarding
ongoing research, treatment, prevention, and public policy issues.
In addition to these APA Division structures that are directly related to supporting the establishment and
promotion of the proficiency, there are additional APA offices that interface with practitioners, the public, and
policy makers around substance-related issues. The Practice Directorate, in partnership with the Center for
Substance Abuse Treatment and with assistance from Division 50 members, developed a mechanism for
assessing more precisely, the nature of clinical practice, with the initial aim of specifying the extent of
substance-related issues in clinical practice. The CPP also maintains information on the APA website on the
proficiency for general information.
There are also interdisciplinary specialty professional societies devoted to pre-clinical and clinical research on
Petition Form
Page 54
substance-related disorders, including societies such as the RSA, CPDD, SRNT. All three societies publish
scientific journals (Alcoholism: Clinical and Experimental Research and Drug and Alcohol Dependence, and
Nicotine and Tobacco Research; respectively) and hold annual conventions.
Proficiency practitioners serve as investigators and content experts for the National Institutes of Health
(especially the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and
the National Cancer Institute). The National Institute on Drug Abuse Clinical Trials Network has 16 research
center nodes and affiliated community treatment programs across the country. This extensive infrastructure
provides an unprecedented opportunity to conduct effectiveness studies, disseminate and implement evidencebased practice and promote research relevant to interests of clinical providers. Conversely, information derived
from these resources is then echoed back through the communications resources previously described at the
division level.
2.
How does your proficiency encourage the development of guidelines of practice?
The proficiency helps to keep the standard of practice high, setting a floor for what is expected to do work in
this area. The proficiency is a public way for psychologists working in addictions to ensure a standard of
practice and regularly revisit the standard for updating and continued improvement.
This is in line with Division 50 functioning as a key stakeholder in the treatment of addiction problems. The
division regularly disseminates information to inform practice guidelines through its listserv, website portal on
evidence based practices in addiction, newsletter, and affiliated journal. The proficiency further supports
practice guidelines in this area by being a public way for Addiction Psychologists to assert our standards as a
stakeholder in broader conversations about standards of practice.
For example, in 2007, the development of practice standards was greatly advanced when the National Quality
Forum (NQF) announced endorsement of the National Voluntary Consensus Standards on Evidence-Based
Practices to Treat Substance Use Conditions (National Quality Forum, 2007). The NQF is a federally chartered,
private, not-for-profit membership organization created to develop and implement a national strategy for
healthcare quality measurement and reporting through voluntary consensus standards of care involving over 350
healthcare provider organizations, consumer groups, professional associations, purchasers, federal agencies and
research and quality improvement organizations (http://www.qualityforum.org/). Members of the sponsoring
divisions of this proficiency participated in an extended consensus development process as one of over two
dozen stakeholder groups to provide comments on the draft Consensus Standards.
Moreover, the Substance Abuse and Mental Health Services Administration (SAMHSA), which includes the
Center for Substance Abuse Treatment (CSAT) and the Center for Substance Abuse Prevention (CSAP), also
plays an important role in the translation of research to standards of practice. CSAT has involved investigators,
clinical providers, and program administrators on Consensus Panels to produce over four dozen Treatment
Improvement Protocols (TIPs; available online at their website). These TIPs are widely disseminated as best
practice guidelines supported by existing research when available. Members of the sponsoring divisions have
been influential in the selection of topic areas and the development and field review of the TIPs. SAMHSA also
supports a national network of Addiction Technology Transfer Centers with training resources for professionals
and the general public.
The curriculum of training and general practice guidelines outlined in the Addiction Psychology Proficiency
renewal application are consistent with the standards of practice developed by other organizations, including the
American Society of Addiction Medicine (ASAM) course in addiction medicine, the Substance Abuse and
Mental Health Services Administration (SAMHSA) standards of practice, and numerous state-level
requirements for certified addiction treatment providers. Specifically these organizations make
recommendations for formal coursework in evidence-based assessment and treatment approaches, continuing
education to learn new empirically supported treatments and assessment tools, and both initial and ongoing
training in treatment approaches for special populations, including adolescents, pregnant women, individuals
with co-occurring psychiatric and medical disorders, and individuals in the criminal justice system.
Petition Form
Page 55
References
National Quality Forum. (2007). National Voluntary Consensus Standards on Evidence-Based Practices to Treat
Substance Use Conditions. Retrieved from
http://www.apa.org/divisions/div50/doc/Executive_Summary_for_Substance_Use_Report.pdf
Criterion XI. Provider Identification and Evaluation. The administrative organization(s)
responsible for the proficiency has sound methods for evaluating competence in the proficiency
and recognizing practitioners who have achieved competency.
1.
Describe how and by whom the proficiency identifies those who are qualified to practice in the proficiency.
Individuals who are qualified to practice this proficiency are identified by the College of Professional
Psychology (CPP) of APA with a physical certificate awarded directly to them. The active status of the
certificate may be verified with the CPP, as they maintain a list of all individuals with the certificate. CPP
provides individuals with a certificate on the basis of meeting the following criteria:
(1) possession of a current state or provincial license in good standing to engage in the independent practice
of psychology;
(2) provide treatment of addiction as a licensed psychologist for at least one year during the preceding three
years;
(3) provide health services in psychology;
(4) successfully pass an examination in the treatment of addiction.
Additionally, Division 50 is redeveloping our website and we plan to list all psychologists holding proficiencies
on our new website, with the understanding that they must regularly renew their proficiency to remain on our
list of providers.
2.
Describe how and by whom the proficiency assesses the competencies of individuals who wish to be identified as
practitioners in this proficiency.
The APA College of Professional Psychology administers an examination that assesses the knowledge and skills
of those applying for the Certificate of Proficiency. The examination consists of 150 multiple choice items
covering 12 domains of knowledge (including clinical pharmacology and epidemiology of psychoactive
substances, causes of substance-related disorders, prevention, screening, diagnosis, treatment, ethical concerns
and issues specific to certain populations) essential for safe and effective treatment of persons for substancerelated problems. These items are reviewed with respect to their performance by a testing firm on an ongoing
basis. Historically, an expert panel of approximately 30 members, which includes members of Divisions 28 and
50, has met yearly to write items and develop new forms of the exam to reflect recent knowledge and research
results. As mentioned above, a pause in this process occurred when no new certificates were given due to
administrative decisions at APA headquarters, this process is being reinitiated to go forward. Two new test
forms were developed in 1999, updating the original two forms that were developed in 1996. The last set of
updates was completed prior to 2010. New updates will be forthcoming post-proficiency renewal.
In addition to the proficiency examination, in Spring 2016 we started implementing an annual survey of
Division 50 members and we plan to begin an annual survey of Division 28 and 50 members in 2017 who are
engaged in clinical practice. The survey will inquire about use of evidence-based practices, ongoing training in
evidence-based treatments, and other clinical practice topics relevant to the competency in the proficiency (e.g.,
conducting professional trainings, providing supervision in evidence-based practices). We will also collect data
Petition Form
Page 56
annually on the continuing education offerings provided by Division 50 through the Collaborative Perspectives
on Addiction meeting, the American Psychological Association annual meeting, and our other continuing
education programs (e.g., monthly conference calls). Data to be collected will inquire about the continuing
education programs and the applicability of the continuing education programs to ongoing clinical practice.
3.
Describe how and by whom the proficiency educates the public and the profession concerning those who are
identified as practitioners of this proficiency. How does the public identify practitioners of the proficiency?
Currently, education of the public with respect to the proficiency has been conducted with Single Source Payer
agencies of various states and with major managed care medical plans. The APA College of Professional
Psychology (CPP) conducts this activity. Practitioners who hold the Certificate of Proficiency are encouraged to
feature this certification when they advertise themselves to the public. Division 50 is also in the process of
developing a list of Certified clinicians which is to be featured as a link on our website. This will allow the
public to find local credentialed psychologists. We have also been making efforts to reach out to the local
certification boards which certify addictions counselors in each state (e.g., for a Certified Alcohol and Drug
Counselor credential) and nationally, in order to advocate for the recognition of this credential as the equivalent
of the CADC for purposes of billing and offering services. As this effort progresses, the Certificate of
Proficiency will become better known and recognized. Education related to Addiction Psychology has been
undertaken jointly by Division 50 and by CPP. Several articles have been published in the Division 50
newsletter with respect to the certificate of the proficiency, and several Presidents of Division 50 have sent a
personal letter during their terms in office to Division 50 members updating them on the potential value of the
certificate and the proficiency, and urging them to explore the value themselves. New applications for the
Certificate were suspended in 2011 by CPP putatively because low interest from Psychologists. Division 50
successfully petitioned to have the Certificate application process reinstituted, and CPP is now accepting new
applications for the Certificate. Division 50 leadership has developed an active plan to enhance awareness and
interest in the Certificate among the APA membership. The Division 50 Education and Training Committee has
also recently begun plans to promote the proficiency more regularly among division members. Brochures
describing the certificate and proficiency were published by CPP and have been distributed to psychologists
attending symposia and plenary talks of Division 50 at the Annual Meeting of APA. We currently have a roster
of over 400 psychologists and psychologist trainees who have expressed a strong interest in obtaining the
Certificate of Proficiency.
4.
Estimate how many practitioners are qualified to practice in this proficiency (e.g., spend 25% or more of their time
in services characteristic of this proficiency). Provide whatever demographic information is available.
Currently, there are approximately 900 psychologists who hold the certificate of proficiency in the
Psychological Treatment of Alcohol and Psychoactive Substance Use Disorders. There are also psychologists in
a variety of locations that would probably be eligible to be certified for this proficiency but have not had reason
to do so as of this time. For example, there are many psychologists who treat clients with substance-related
problems in Veteran's Hospitals or in public treatment centers, but who have not yet applied for the proficiency.
5.
Estimate how many practitioners are qualified to practice in this proficiency (e.g., spend 25% or more of their time
in services characteristic of this proficiency), and whose primary practice is not within the discipline of
psychology (i.e. Pharmacists). Provide whatever demographic information is available.
This proficiency is exclusively for Psychologists who already have a license as a Psychologist in their state and
meet the other noted requirements. Therefore, there are no practitioners qualified to practice in this proficiency
who are not in the discipline. This is not a proficiency that would be offered to anyone outside the discipline.
END OF PETITION FORM