What Clinicians Need to Know About Trauma - Amelia Roeschlein, DSW, MA, LMFT National Council for Mental Wellbeing June 17, 2021 - Providers ...
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What Clinicians Need to Know
About Trauma
Amelia Roeschlein, DSW, MA, LMFT
National Council for Mental Wellbeing
June 17, 2021
1
Housekeeping
• You will be muted automatically upon entry. Please
keep your phone line muted for the duration of the
webinar.
• Webinar is being recorded and will be archived for
future viewing at www.pcssNOW.org within 2 weeks.
• Submit questions in the Q&A box at the bottom of
your screen.
2
Today's Presenter
Amelia Roeschlein, DSW, MA, LMFT
Consultant
National Council for Mental Wellbeing
3
Disclosures
• Dr. Roeschlein has no disclosures.
4
Target Audience
• The overarching goal of PCSS is to train healthcare
professionals in evidence-based practices for the
prevention and treatment of opioid use disorders,
particularly in prescribing medications, as well for
the prevention and treatment of substance use
disorders.
5
Educational Objectives
• At the conclusion of this activity participants should
be able to:
▪ Describe the impact of trauma
▪ Explain the connection between trauma and
substance use
▪ Provide two trauma-informed strategies of
engagement with clients with substance use
disorders
6
Overview
• Overview of Trauma
▪ Prevalence and impact
▪ Trauma and the human
stress response
▪ Trauma and its
connection to addiction
• Becoming Trauma-Informed
in Your Daily Work
7
Why Address Trauma Now?
8
Trauma and Opioid Use
• Exposure to traumatic events is particularly common among individuals
with opioid use disorders. A national survey in Australia found very high
rates of trauma among individuals with opioid use disorders compared to
individuals without an SUD, 87.8% vs. 56.8% respectively after controlling
for age and sex
https://pubmed.ncbi.nlm.nih.gov/16585440/
• Among a consecutive sample of 113 treatment-seeking opioid-dependent
outpatients seeking buprenorphine treatment, the majority (80.5%)
reported a history of childhood sexual, physical, or emotional abuse,
physical neglect, or violent trauma
https://pubmed.ncbi.nlm.nih.gov/19197597/
9
What is Trauma?
Definition (SAMHSA Experts 2012) includes
three key elements
Individual trauma results from an event , series of events, or
set of circumstances that is experienced by an individual
as overwhelming or life-changing and that has profound effects
on the individual’s psychological development or well-being,
often involving a physiological, social, and/or spiritual impact.
https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
1011
Intergenerational (Historical) Trauma
“Cumulative emotional and psychological wounding,
over the lifespan and across generations, emanating
from massive group trauma experiences.”
Heart, M. Y. (2003). The Historical Trauma Response Among Natives and Its
Relationship with Substance Abuse: A Lakota Illustration. Journal of
Psychoactive Drugs, 35(1), 7-13. doi:10.1080/02791072.2003.10399988 12Intergenerational/ Historical Trauma Events
Genocides Slavery Pandemics Massacres
Prohibition/destruction of Discrimination/Systemic
Forced relocation
cultural practices prejudice
13Intergenerational (Historical)
Trauma Effects
14Historical Trauma Perpetuated Today
Microaggressions are everyday
experiences of discrimination,
racism, and daily hassles that are
targeted at individuals from diverse
cultural groups (Evans-Campbell,
2008).
• Using endearments
• Same behavior, different
description
• Benevolent Sexism
• Underestimating
• Attribution Bias
Evans-Campbell T. Historical trauma in American Indian/Native Alaska
communities: a multilevel framework for exploring impacts on
individuals, families, and communities. J Interpers Violence. 2008 15
Mar;23(3):316-38. doi: 10.1177/0886260507312290. PMID: 18245571.A Client’s Journey
16Current Landscape
According to the National Institute of Mental Health, “members of racial
and ethnic minority groups in the U.S. are less likely to have access to
mental health services, less likely to use community mental health
services, more likely to use inpatient hospitalization and emergency
rooms, and more likely to receive lower quality care.”1
• Within psychiatry, it has been shown that racial minorities are less
likely to achieve symptom remission and are more likely to be
chronically impaired given a mental health diagnosis.2
• Bias and racism have been identified as key factors contributing to
these inequities. The legacy of slavery and racism, as well as the
current realities of racial oppression and violence, has uniquely
impacted the mental health of African Americans.3
1https://www.ncsl.org/Portals/1/HTML_LargeReports/DisparitiesBehHealth_Final.htm#:~:text=According%20to%20t
he%20National%20Institute,and%20more%20likely%20to%20receive
2https://academic.oup.com/swr/article-abstract/36/1/41/1646733?redirectedFrom=fulltext
3https://www.mededportal.org/doi/pdf/10.15766/mep_2374-8265.10618
17Current Landscape(2)
• Additionally, African Americans have higher rates of
severe depression, yet lower rates of treatment
compared to white populations. 1
• African Americans are less likely to receive office-
based counseling for psychological stressors and
are more likely to be seen in emergency rooms.2
• The disproportionate diagnosis of schizophrenia
among African Americans persists today, and they
are more likely to be treated with antipsychotic
medications that can have lasting, negative side
effects.3
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1199525/
2https://archive.ahrq.gov/research/findings/nhqrdr/nhdr10/nhdr10.pdf
3https://www.ncsl.org/Portals/1/HTML_LargeReports/DisparitiesBehHealth_Final.htm#:~:text
=According%20to%20the%20National%20Institute,and%20more%20likely%20to%20receive
18Trauma Shapes Our Beliefs
➢Worldview
➢Spirituality
➢Identity
19https://www.echotraining.org/we-love-science/ Hedges, F. (2012). Fight or Flight. Retrieved from 20 https://www.acesconnection.com/blog/fight-or-flight-infographic.
Impact of Trauma on Behavior
Triggers
External reminders Internal reminders
of traumatic event of traumatic event
• Smell
• Sound • Emotions
• Sight • Thoughts
• Touch
• Taste
21Loneliness Ali, S. (2018, July 12). What You Need to Know About the Loneliness Epidemic. Retrieved from https://www.psychologytoday.com/us/blog/modern- 22 mentality/201807/what-you-need-know-about-the-loneliness-epidemic
The Elephant in the Room
Disrupted Mood
Regressive behavior
Perfectionism
Anger Fear Difficult concentrating
Defiance
Aggression
Difficulty forming relationships
Low self-esteem
Physical Illness
Avoidant behavior
Guilt
Sleep problems Dissociation
Persistent irritability Sensory sensitivity
Hyper arousal Trauma re-enactment
Inattention
Depression
Mistrust
Need to control
Shame Traumatic grief
23Trauma and the Human Stress
Response
24Survival Mode Response
Trauma Theory. (2011, November 12). Retrieved June 10, 2020, from
http://kate-thegirlwholived.blogspot.com/2011/11/trauma-theory.html
25Impact of Trauma on Brain
Development
Developmental Trauma
Typical Development
Cognition
Cognition
Social/ Emotional
Social/ Emotional
Regulation
Regulation
Survival
Survival
Perry, Bruce D., Szalavitz, Maia (2006). The boy who was raised as a dog: 26
And other stories from a child psychiatrist's notebook. Basic Books.Survival Mode Response
Inability to
• Respond
• Learn
• Process
27How Childhood Trauma Can Make You
a Sick Adult
Davis, B. (Director). (2015). How Childhood Trauma Can Make You A Sick
Adult [Video file]. Retrieved from http://mentalhealthchannel.tv/episode/how-
childhood-trauma-can-make-you-a-sick-adult 28The Adverse Childhood Experience Study:
Behavioral Heath at the Foundation of all Health
• Over 17,000 adults studied from
1995-1997
• Almost 2/3 of participants reported
at least one ACE
• Over 1/5 reported three or more
ACEs, including abuse, neglect,
and other types of childhood trauma
• Major links identified between early
childhood trauma and long term
health outcomes,
• including increased risk of many chronic
illnesses and early death
Adverse Childhood Experiences (ACE) and adolescent health.
Retrieved from https://www.cdc.gov/violenceprevention/acestudy/ 29Epigenetics https://www.sciencemag.org/news/2019/07/parents-emotional-trauma-may-change- their-children-s-biology-studies-mice-show-how 30
Dose-Response Relationship:
More ACEs = More Disease
Severe obesity 1.6 x
Diabetes 1.6 x
Cigarette Smokers 2.0 x
Response gets bigger
Fair/poor health 2.2 x
Hepatitis/jaundice 2.4 x
Had an STD 2.5 x
50+ intercourse partners 3.2 x
COPD 3.9 x
Depressed 2 weeks 4.6 x
Illegal drug use 4.7 x
Alcoholic 7.4 x
Injected drugs
10.3 x
Suicide attempt 12.2 x Dose gets bigger
National Center for Injury Prevention and Control, Division of Violence
Prevention. (n.d.). Adverse Childhood Experiences (ACEs). Retrieved from
https://www.cdc.gov/violenceprevention/acestudy/
31Life-Long Physical, Mental & Behavioral Health
Outcomes Linked to ACEs
• Alcohol, tobacco & other drug addiction • Intimate partner violence—perpetration
• Auto-immune disease & victimization
• Chronic obstructive pulmonary disease & • Liver disease
ischemic heart disease • Lung cancer
• Depression, anxiety & other mental • Obesity
illness • Self-regulation & anger management
• Diabetes problems
• Multiple divorces • Skeletal fractures
• Fetal death • Suicide attempts
• High risk sexual activity, STDs & • Work problems—including absenteeism,
unintended pregnancy productivity & on-the-job injury
Mate, G. (2003). When the Body Says No: The Cost of Hidden Stress
32Trauma is a risk factor for Substance Abuse
Substance Abuse is a risk factor for Trauma
33PTSD and Opioid Use
Disorder
• “Prescription opioid use problems are a risk factor for co-occurring PTSD symptom
severity. Being female or younger increase the likelihood of this co-morbidity. Further
research is needed to confirm these finding, particularly using more rigorous diagnostic
procedures. These data suggest that patients with prescription opioid use problems should
be carefully evaluated for PTSD symptoms.
• “The odds of having severe PTSD symptoms was 3.81 times higher for patients with a
prescription opioid and sedative use problem (CI: 1.47–9.88, p < 0.01). The odds of having
PTSD for those with prescription opioid and cocaine use problems were 2.24 times higher
(CI: 1.40–3.57, p ≤ 0.001)." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883674/ 34Addiction and the Brain
As Gabor Mate notes in his book, In the Realm of Hungry Ghosts, those with
substance use disorder
“self-medicate to sooth their emotional pain – but more than
that, their brain development was sabotaged by their
traumatic experiences.”
Mate, Gabor, MD. (2010). In the Realm of the Hungry Ghosts. Berkeley, CA:
North Atlantic Books. Print. page 203.
35Why do People Use Alcohol and
Drugs?
To feel better
To feel good
To lessen:
To have
Anxiety
novel:
Worries
Feelings
Fears
Sensations
Depression
Experiences
Hopelessness
AND
Withdrawal
to share them
Slide credit: Thomas E. Freese, Ph.D., Co-Director of the UCLA Integrated Substance
Abuse Programs, Director of the Pacific Southwest ATTC 36Shame is the intensely painful feeling or experience of believing
that we are flawed and therefore unworthy of love and
belonging – something we’ve experienced, done, or failed to do
makes us unworthy of connection. Brene Brown
Brene’ Brown, (2012). Daring Greatly: How the Courage to be Vulnerable 37
Transforms the Way We Live, Love, Parent, and Lead.Adverse Childhood Experiences
The #1 Chronic Health Epidemic
in the United States
“The impact of ACEs can now only be ignored as a
matter of conscious choice. With this information
comes the responsibility to use it.”
-Anda and Brown, CDC
• ACE Study DVD from Academy on Violence and Abuse
38ACEs are not Destiny – So What Can We Do?
39Trauma-Informed Resilience-Focused
REALIZES the widespread impact of IDENTIFIES programs and best
trauma and understands potential paths practices proven to build resiliency
for recovery at both individual and systemic levels
RECOGNIZES the signs and symptoms INOCULATES the system culture from
of trauma in individual and systemic the effects of stress and trauma
levels proactively rather than reactively by
having a strategic plan
RESPONDS by fully integrating INSTILLS a shared vocabulary and
knowledge about trauma into policies, skills for resiliency into every aspect of
procedures and practices the life of the system
RESISTS re-traumatization IMPROVES the health of the entire
system by promoting restoration, health
and growth in ongoing ways
Substance Abuse and Mental Health Services Administration. Trauma-Informed Care
in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS
Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health
Services Administration, 2014.
40Safety and Respect: Creating a Safe and
Secure Environment for EVERYBODY
We need to create a mutually respectful
interpersonal climate that fosters safety, trust,
choice, collaboration, and empowerment
“Mistakes made here often.”
41Cultural Humility https://thelinkbetweenworlds.com/tag/cultural-humility/ 42
We need to have…
43Health Care Toolbox. (n.d.). Healthcare Toolbox Home Page. Retrieved June 18, 2020, from https://www.healthcaretoolbox.org/ 44
Build Relationships
Honor voice and choice
Partner with people
Request feedback
Ensure comfort
“Keep the Human in Human Services”
-Dr. Pat Deegan
Masten, A. (2001). Ordinary Magic: Resilience Processes in Development. American
Psychologist 56, 227-238.
Beardslee et al. (2010). Building Resilience: The Power to Cope with Adversity. Zero to
Three. 45The RSA. (2013, December 10). Brené Brown on Empathy [Video file]. Retrieved from
https://www.youtube.com/watch?v=1Evwgu369Jw
46Organizational Strategies for combatting
bias/stigma in patient-provider relationships
Simplify and translate client-facing forms and documentation
Adopt community-defined , promising practices
Hire providers that represent the local community
Client engagement- provide language support and build mental health
literacy
Develop a plan for addressing engagement during the current pandemic,
and beyond
Develop an organizational approach to case management
Checks for patient understanding of treatment decisions and next steps
47Be Attentive to All Language
“Non-compliant”
“Manipulative”
“Naughty”
“Lazy”
48Why It Matters How We Conceptualize It, What
We Call It, People with It
49Studies have shown that…
• Compared to other psychiatric symptoms, Substance Use
is more stigmatized, tend to view those using substances
as more to blame for their use and consequences of use
• Describing Substance Use as Treatable Helps
• Individuals shown to hold stigmatizing biases against those
using substances; view them as unmotivated,
manipulative, dishonest
• Survivors who hold more stigmatizing beliefs about
Substance Use are less likely to seek treatment;
discontinue sooner
50
https://www.shatterproof.org/about-addiction/stigma/stigma-reducing-language51
Impact the Lower Brain
Interventions that impact the lower brain when someone is
in a dysregulated state focus on the 6 Rs:
Rhythmic Repetitive
Respectful Relational
Rewarding Relevant
Brous, K. (2014, April 11). Perry: Rhythm Regulates the Brain. Retrieved from
https://attachmentdisorderhealing.com/developmental-trauma-3/ 52Implications for Practice
53Screen for Trauma
1. Unhealthy substance use is common.
2. Relying on personal impressions is unreliable and may
underestimate prevalence.
3. Opens up a dialogue about other impacts on a person’s
life.
4. Early interventions can prevent development of more
severe substance use disorders.
5. SBIRT has a role in fighting the opioid epidemic
alongside MAT, naloxone and safe prescribing
54SBIRT is a comprehensive,
integrated public health model
Screening to quickly identify the severity of substance use
and appropriate level of treatment.
Brief Intervention to raise awareness of risks and
consequences, internal motivation for change, and help set
healthy lifestyles goals.
Referral to Treatment to facilitate access to specialized
services and coordinate care for patients with higher risk.
55Evidence-Based Screening Tools
• AUDIT
• DAST
• ASSIST
• CRAFFT (adolescents)
• S2BI (adolescents)
• PHQ-9 (depression)
• GAD-7 (anxiety)
• ACES
56Educate about Trauma
57Taking Care of Ourselves
58Understand Daily Translation of
TIROC Principles
Principles of trauma-informed, recovery-oriented care (TIROC):
• Be patient and persistent
• Convey respect
• Be validating and affirming
• Read clients’ needs and respond accurately
• Set realistic expectations and goals
• Provide ongoing choices and supports
• Know your role
• Follow through with what you say you will do
• Provide consistency; minimize surprises
59Recognize our Humanity
We’re all just trying to survive
We frequently observe misplaced Coping Strategies
We are all part of the problem therefore we can all be part of the Solution
60References
• Mills, K. L., Teesson, M., Ross, J., & Peters, L. (2006). Trauma, PTSD, and substance use disorders: findings from the Australian National Survey of Mental Health and Well-Being. American Journal of
Psychiatry, 163(4), 652-658.
• Sansone, R. A., Whitecar, P., & Wiederman, M. W. (2009). The prevalence of childhood trauma among those seeking buprenorphine treatment. Journal of Addiction & Addictive Disorders, 28(1), 64-67.
• https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
• Heart, M. Y. (2003). The Historical Trauma Response Among Natives and Its Relationship with Substance Abuse: A Lakota Illustration. Journal of Psychoactive Drugs, 35(1), 7-13.
doi:10.1080/02791072.2003.10399988
• Evans-Campbell T. Historical trauma in American Indian/Native Alaska communities: a multilevel framework for exploring impacts on individuals, families, and communities. J Interpers Violence. 2008
Mar;23(3):316-38. doi: 10.1177/0886260507312290. PMID: 18245571.
• National Conference of State Legislatures. (2018, Feb). The Costs and Consequences of Disparities in Behavioral Health
Care. https://www.ncsl.org/Portals/1/HTML_LargeReports/DisparitiesBehHealth_Final.htm#:~:text=According%20to%20the%20National%20Institute,and%20more%20likely%20to%20receive
• Eack, S. M. & Newhill, C. E. (2012). Racial Disparities in Mental Health Outcomes after Psychiatric Hospital Discharge among Individuals with Severe Mental Illness. Social Work Research, 36(1), 41-52.
• Medlock, M., Weissman, A., Wong, S. S., Carlo, A., Zeng, M., Borba, C., Curry, M., & Shtasel, D. (2017). Racism as a Unique Social Determinant of Mental Health: Development of a Didactic Curriculum for
Psychiatry Residents. MedEdPORTAL, 13, 10618.
• Dunlop, D. D., Song, J., Lyons, J. S., Manheim, L. M., & Chang, R. W. (2003). Racial/Ethnic Differences in Rates of Depression Among Preretirement Adults. American Journal of Public Health, 93(11), 1945-
1952.
• Agency for Healthcare Research and Quality. (2011, Mar). 2010 National Healthcare Disparities Report. AHRQ Publication No. 11-0005. https://archive.ahrq.gov/research/findings/nhqrdr/nhdr10/nhdr10.pdf
• Echo. (2019). Physical Impact of Trauma. https://www.echotraining.org/we-love-science/
• Hedges, F. (2012). Fight or Flight. Retrieved from https://www.acesconnection.com/blog/fight-or-flight-infographic.
• Ali, S. (2018, July 12). What You Need to Know About the Loneliness Epidemic. Retrieved from https://www.psychologytoday.com/us/blog/modern-mentality/201807/what-you-need-know-about-the-loneliness-
epidemic
• Trauma Theory. (2011, November 12). Retrieved June 10, 2020, from http://kate-thegirlwholived.blogspot.com/2011/11/trauma-theory.html
• Perry, Bruce D., Szalavitz, Maia (2006). The boy who was raised as a dog: And other stories from a child psychiatrist's notebook. Basic Books.
• Davis, B. (Director). (2015). How Childhood Trauma Can Make You A Sick Adult [Video file]. Retrieved from http://mentalhealthchannel.tv/episode/how-childhood-trauma-can-make-you-a-sick-adult
• Adverse Childhood Experiences (ACE) and adolescent health. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/
• Curry, A. (2019, July 18). Parents' emotional trauma may change their children's biology. Studies in mice show how. Science. https://www.sciencemag.org/news/2019/07/parents-emotional-trauma-may-
change-their-children-s-biology-studies-mice-show-how
• National Center for Injury Prevention and Control, Division of Violence Prevention. (n.d.). Adverse Childhood Experiences (ACEs). Retrieved from https://www.cdc.gov/violenceprevention/acestudy/
• Mate, G. (2003). When the Body Says No: The Cost of Hidden Stress.
• Meier, A., Lambert-Harris, C., McGovern, M. P., Xie, H., An, M., & McLeman, B. (2014). Co-occurring prescription opioid use problems and posttraumatic stress disorder symptom severity. American Journal of
Drug and Alcohol Abuse, 40(4), 304-311.
• Mate, Gabor, MD. (2010). In the Realm of the Hungry Ghosts. Berkley, CA: North Atlantic Books. Print. page 203.
• Brene’ Brown, (2012). Daring Greatly: How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent, and Lead.
• Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801.
Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
• https://thelinkbetweenworlds.com/tag/cultural-humility/
• Health Care Toolbox. (n.d.). Healthcare Toolbox Home Page. Retrieved June 18, 2020, from https://www.healthcaretoolbox.org/
• Masten, A. (2001). Ordinary Magic: Resilience Processes in Development. American Psychologist 56, 227-238.
• Beardslee et al. (2010). Building Resilience: The Power to Cope with Adversity. Zero to Three.
• Shatterproof. (2021). Stigma-reducing language. https://www.shatterproof.org/about-addiction/stigma/stigma-reducing-language
• The RSA. (2013, December 10). Brené Brown on Empathy [Video file]. Retrieved from https://www.youtube.com/watch?v=1Evwgu369Jw
• Brous, K. (2014, April 11). Perry: Rhythm Regulates the Brain. Retrieved from https://attachmentdisorderhealing.com/developmental-trauma-3/
61Resources
• Robert Wood Johnson Foundation (2013) Health Policy Brief: Patient Engagement.
People actively involved in their health and health care tend to have better
outcomes—and, some evidence suggests, lower costs.
https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf404446
• Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness Matters: A Theoretical and
Empirical Review of Consequences and Mechanisms. Annals of Behavioral
Medicine : A Publication of the Society of Behavioral Medicine, 40(2),
10.1007/s12160–010–9210–8. http://doi.org/10.1007/s12160-010-9210-8
• Trauma 101- https://youtu.be/1pNwHMjPrxY
• Trauma-informed Care Guiding Principles-
https://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_2/trauma_tip/gui
ding_principles.html
• Trauma-informed Care in BH Services-
https://store.samhsa.gov/shin/content/SMA14-4816/SMA14-4816.pdf
62SAMHSA TIC TIP
TIP 57: Trauma-Informed Care in Behavioral Health Services
Assists behavioral health professionals in understanding the
impact and consequences for those who experience trauma.
Discusses patient assessment, treatment planning strategies that
support recovery, and building a trauma-informed care workforce.
Inventory#: SMA14-4816
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63Thank You!
Amelia Roeschlein, DSW, MA, LMFT
Consultant
National Council for Mental Wellbeing
AmiR@thenationalcouncil.org
64PCSS Mentoring Program
▪ PCSS Mentor Program is designed to offer general information to
clinicians about evidence-based clinical practices in prescribing
medications for opioid use disorder.
▪ PCSS Mentors are a national network of providers with expertise in
addictions, pain, evidence-based treatment including medications for
addiction treatment.
• 3-tiered approach allows every mentor/mentee relationship to be unique
and catered to the specific needs of the mentee.
• No cost.
For more information visit:
https://pcssNOW.org/mentoring/
65PCSS Discussion Forum
Have a clinical question?
http://pcss.invisionzone.com/register
66PCSS is a collaborative effort led by the American Academy of Addiction
Psychiatry (AAAP) in partnership with:
Addiction Technology Transfer Center American Society of Addiction Medicine
American Academy of Family Physicians American Society for Pain Management Nursing
Association for Multidisciplinary Education and
American Academy of Pain Medicine
Research in Substance use and Addiction
American Academy of Pediatrics Council on Social Work Education
American Pharmacists Association International Nurses Society on Addictions
American College of Emergency Physicians National Association for Community Health Centers
American Dental Association National Association of Social Workers
American Medical Association National Council for Behavioral Health
American Osteopathic Academy of Addiction
The National Judicial College
Medicine
American Psychiatric Association Physician Assistant Education Association
American Psychiatric Nurses Association Society for Academic Emergency Medicine
67Educate. Train. Mentor
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Funding for this initiative was made possible (in part) by grant no. 1H79TI081968 from SAMHSA. The views expressed in written conference materials or
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