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1 ACCBO 2054 N Vancouver Ave, Portland OR 97227-1917 (503)231-8164 E-Mail: APPLICATION FOR CADC RECERTIFICATION Name Date Address I have changed addresses in the last 2 years Personal Email Please include me on the ACCBO Email List City Business email Please include me on the ACCBO Email List State Home Phone Zip Work Phone Highest level of degree received? Current Employer (primary) I have not misused alcohol or other drugs at any time during the two years immediately preceding this application. I will abide by all current ACCBO Ethical Codes. Applicant Signature Date To the best of my knowledge the above statement is true. Clinical or Administrative Supervisor Date RECERTIFICATION APPLICATION CHECK LIST (be sure to complete all of the following): Application Page (demographic data , include official documentation of any name changes) Education Log - You must attach photocopies of certificates and/or transcripts to verify all education $175 Recertif ication Fee - Do not mail payment separately.

2 Payment must accompany this application. Extension request and any applicable fees if filing after the expiration of your certification. Check if you are paying online by To pay online, please visit (you do NOT need a PayPal account) Course / Training / Workshop / College Course Date: month/ year Provider Sponsor Instructor Category I or II? Clock Hours Ethics Training (minimum 6 hours) - List Here Tobacco Training (minimum 2 hours) - List Here This page MUST be completed Please do NOT write "see attached" Name Date Certification Expiration Date * Required *Required Tobacco Dependence Competency Resources Tobacco Cessation and Education Online Courses: Daystar Education Tobacco Cessation - 2 CEUs - $17 This course on Tobacco Cessation can be taken at any time, on demand, and is free to participate in. However, upon passing the course, you will have the option to pay $17 to gain 2 CEUs.

3 Tobacco Use and Dependence: An Updated Review of Treatments The University of Wisconsin has just launched a free tobacco dependence treatment course (with CMEs) that includes substance abuse counselors, social workers, and psychologist. More support for certification requirements. For more information visit: #desc\ Clinician-assisted tobacco cessation Rxforchange- University of California, San Francisco. More information available at: New York State Tobacco Free Provider Training and Resources- Shortly after this regulation was implemented, NY realized they also had to put in place a requirement for counselors to have a minimum of 4 hours of training related to tobacco use and nicotine dependence. Here are some links to NY State training. These are free and available on-line: Freedom From Tobacco - Counselor Video- New York State This is a 20-minute training video for substance abuse counselors.

4 It sets up the rationale for having counselors learn to address tobacco with their clients and addresses very clearly the strong association of nicotine addictions with alcohol and/or substance abuse: FREE OASAS Addiction Medicine Educational Series Each course offers CASAC and/or CPP/CPS credits. Smokeless Does Not Mean Harmless The history of smokeless tobacco and an overview of the detrimental effects of its use. (2 hours - CASAC, CPP, CPS Section I) After reading PDF, create an account or log into your existing account to take a test. Tobacco - Chemical Dependence Connection In-depth explanation of the impact of tobacco on chemical addiction, recovery and health (1 hour - CASAC, CPP, CPS Section I) After reading PDF, create an account or log into your existing account to take a test. Training Resources for Counselors: SAMSHA KAP Helping Smokers Quit Mayo Clinic Tobacco Treatment Specialist Certification NAADAC Tobacco Addiction Specialist Credentialing Program view=article&id=250&Itemid=77 Northeast Addiction Technology Transfer Center Smoking Cessation Treatment at Substance Abuse Rehabilitation Programs (2006) (enter smoking in the search box) State University of New York, University of Albany, Rockefeller College, Professional Development Program, Tobacco Recovery Resource Exchange University of Massachusetts Medical School, Center for Tobacco Treatment Research & Training University of Medicine and Dentistry of New Jersey Tobacco Dependence Program, Professional Education Programs Tobacco Cessation Consumer-Run Resources: Choices - Consumer driven program for smokers with mental illness.

5 Peer to Peer -- A Tobacco Cessation Curriculum: Peers are a powerful motivator! This curriculum offers step by step instructions for consumers to help their peers quit tobacco. Available for download at Free Resource Guides and Toolkits: Bringing Everyone Along Resource Guide and Summary Developed by the Tobacco Cessation Leadership Network, this guide and summary assists an array of health professionals to adapt tobacco cessation services to the unique needs of tobacco users with mental illness and/or substance use disorders. Smoking Cessation for Persons with Mental Illness: A Toolkit for Mental Health Providers Tobacco Free Living in Psychiatric Settings National Association of State Mental Health Program Directors Tobacco Cessation Web Resources: The Quit Smoking Community - Leave The Pack Behind - BeTobaccoFree - CDC Smoking & Tobacco Use - Smokefree - Smokefree Teen - Certification is granted for a two year period.

6 It may be renewed by recertification, a process designed to assist the CADC in maintaining and expanding competence. If your certification has lapsed, you must file for an extension (see Extension Policy below), otherwise your certification will expire. After the 120 day maximum extension period available, but before one year after your certificate has expired, you may reactivate your certification by submitting a completed recertification application and a $50 reinstatement fee in addition to the $175 recertification fee. All CADC s must complete 6 hours of Ethics and 2 hours of Tobacco dependence/prevention continuing education as a part of their 40 hours of continuing education, in order to renew their certification. ACCBO will accept virtually all counseling related Ethics courses. 1. The recertification applicant must demonstrate 40 clock hours of continuing education. This can be a college course work, workshops, in-services, trainings, or classes.

7 2. The recertification applicant must complete the Record of Training Education and attach all certificates or transcripts. Only training hours recorded on the log form accompanied by a certificate will be accepted. Program schedules, syllabuses, flyers will not be accepted. 3. Hours are broken down into two categories: Category I: Alcohol & Drug Counseling Education - minimum 20 hours- A&D Tx, Tx Planning, Dual Diagnosis, Special Populations in A&D Tx, Counseling methodologies focusing on substance abuse, Relapse Prevention, ASAM, methadone, ATOD Prevention, alcohol and drug specific behavioral health software training, ethics Category II: Counseling Education - maximum of 20 hours: Managed Care, Counseling Survivors of Trauma, Psychiatric Disorders, general college psychology coursework, social work coursework, general behavioral health software training, ethics etc. All 40 hours can be alcohol and drug specific training.

8 Continuing Education hours do not necessarily have to be ACCBO approved. 4. You must submit the Application page, Training Record, attach copies of all certificates, and recertification fee to ACCBO by the expiration date of the certificate. 5. Once your recertification has been approved, you may view the online registry at to check the status of your certification EXTENSION POLICY Any CADC (CADC I, CADC II, CADC III) wishing to acquire an extension on expiring certification, must present a request for extension to the Board in writing to our office, or submit a request via the online submission form on our website. A no charge 30 day extension will be granted upon request. An additional 90 days (for a total of 120 days of extension from expiration of the certificate), may be granted at a cost of $50.