I am appreciative of the opportunity to lead and serve SoAP during this coming year. My year as President- Elect and the first months of my term have already produced numerous rewarding experiences, the best of which has been getting to know a new group of colleagues and students through Division 50 activities. As some of you know, this is my second tour of duty as an APA Division president; I served Division 28 back in 2006. That now seems so long ago, which I feel must be true given that I agreed to run for President of Division 50—we all know painful memories fade over time (just kidding, sort of). I find that contributing to our clinical science and profession through these types of leadership activities brings renewed energy towards what we signed up for when we embarked upon our training to become psychologists. That is, how can we best help those in need, whether through scientific investigation, clinical development and application, teaching, or policy development and implementation?
Such rekindling through involvement with SoAP, along with our ongoing work on the most pressing task of the Division Executive Board, i.e., developing a renewal application for the certificate of proficiency in Psychological Treatment of Alcohol and Other Psychoactive Substance Use Disorders, has prompted some curious reflections. What have we learned about addiction over the past 10 years that substantially advances our knowledge base from 10 years ago? And, what comprises a realistic set of expectations for the progress and impact that can occur in a decade?
As we contemplate how to modify the content of the proficiencies for our field, we are challenged to identify what basic or clinical science advances truly hold promise for improving our ability to help those with problems related to addiction or to prevent such problems from occurring. Are there newly developed interventions or modifications to existing treatments that substantially increase our effectiveness as change agents? Even though NIH funding levels have not been ideal, NIAAA, NIDA, SAMHSA, and multiple foundations have funded a plethora of projects designed to deliver products (knowledge and treatment innovations) that should hopefully result in an affirmative response to this question.
At first thought, my inclination was to conclude that there was not much to update since our last proficiency renewal, and this seemed rather sad and somewhat demoralizing. In some regards we seem to be struggling with the same old problems and issues; for example: a) how do we better motivate those who are ambivalent about their problems to engage in treatment or change behavior, b) how do we improve the positive response rate to our outpatient interventions (typically less than half of participants show clinically significant improvement in clinical trials, c) how do we better maintain abstinence or reductions in substance use and prevent relapse, d) how do we reduce the divisiveness that arises from harm reduction vs. abstinence approaches, e) how do we best measure outcomes in our clinical trials, f) how do we increase the dissemination of our most efficacious interventions, g) how do we address health disparities related to SES and ethnicity, h) how do we make our interventions affordable or get payers to increase funds to cover the costs of effective services, and i) how do we reduce the stigma associated with substance use problems?
Upon further reflection and after taking off my cynical, pessimistic glasses that remind me of my aging status, I realized that many exciting signs of progress have emerged in the past 10 years. For example, a) a new version of the DSM produced modified criteria for substance use disorders (not that the changes are perfect, but they do move in a positive direction), b) incentive-based interventions (contingency management) that enhance treatment response continue to be refined, with some signs of interest in wider dissemination, c) technology-based interventions have emerged and show much promise as alternatives or adjuncts to treatment that can increase access to effective treatments and perhaps enhance outcomes, d) health care reform may lead to provider systems that have more incentive to adopt evidence-based interventions, e) pharmacotherapy development, particularly for opioid and tobacco use disorders continues to expand its alternatives and increase positive outcomes, f) a number of state regulatory bodies have increased standards and requirements for obtaining licensure or credentialing in an attempt to ensure higher quality care, and g) NIAAA and NIDA did not merge, but the Collaborative Research on Addiction (CRAN) program has produced multiple inter-agency FOA’s that encourage focus on poly-substance use and comorbidity. And I’m certain you all could list many more exciting signs of progress!
Oops, I forgot one. We seem to have discovered that marijuana is good for everything that ails you—NOT! But perhaps the silver lining is that the legalization and medicalization movements appear to have stimulated interesting science and thoughtful discourse related to marijuana and drug policy in general. Maybe our Groundhog Day, merry-go-round ordeal with marijuana is finally coming to an end—maybe, but somehow I doubt it!
My optimistic and emotionally detached take on all this is that change takes time, and the progress in our field is impressive and commensurate with what is generally observed across fields of science and implementation. My impulsive, impatient, and less mature side wants to just shake my head in amazement at our failure to advance much more quickly.
I encourage you all to take a moment in similar contemplation; maybe list what you feel are the 5 most important issues facing our field and the top 5 advances we’ve made over the past decade. And please, if you don’t mind, send them my way. Perhaps these will shape my focus during the coming year in my role as President of Division 50. Your thoughts might also provide some interesting data to include in my next column for TAN!
Before I finish, I wanted to mention a few important housekeeping issues:
1) Please consider submitting a poster or symposium idea for the Collaborative Perspectives on Addiction (CPA) conference to be held in Baltimore in March, and the APA annual convention in Toronto in August. Due dates for CPA are as follows: October 20 for workshops; November 20 for symposia; and January 20 for posters! Also keep an eye out for STUDENT TRAVEL AWARDS, we plan to offer 4 or 5! This will be my first time at CPA so I hope we have a great turnout! Info: http://research.alcoholstudies.rutgers.edu/cpa
For APA, due dates are: Collaborative Programs: October 15; CE Workshops: November 10; Division Submissions: December 1, 2014. Info: https://www.apa.org/convention/index.aspx
2) Clinical psychologists, please consider applying for the Certificate of Proficiency in the Psychological Treatment of Alcohol and Substance Use Disorders. John Kelly, Nancy Piotrowski, Ray Hanbury and many others worked very hard to get this Certificate reinstated, but if only a few Psychologists apply for the Certificate, it will likely go away again. More importantly, as we try to make progress in advancing Psychologists as experts in Addiction and purveyors of the most effective interventions, this certification will provide a means for State Associations to recognize this expertise and more effectively utilize our knowledge base and talent. Info on this process and how to apply will be sent out via our listserv as soon as the most recent application is posted by the APA.
3) Remember to vote in the APA Presidential election!!! (if it isn’t too late by time this comes to press,closes October 29). Your vote counts and the person in charge does make a difference.
4) Remember to send me your top 5 issues and advances, along with any other thoughts relative to Division 50’s mission! Email: email@example.com
Thanks again for the opportunity to become an integral part of the Society of Addiction Psychology! Have a great Fall!