Category Archives: International

Building a New Treatment System in South Africa


During a month-long training and consulting project in South Africa, I witnessed first-hand the overwhelming addiction treatment needs of that country. Rampant addiction in South Africa affects many other aspects of its citizens’ lives, including HIV, domestic violence and abuse, with a strong impact on the criminal justice system. South Africa’s current treatment structure is not meeting the vast needs of the population.

Fortunately government officials and treatment professionals are recognizing that fact, and invited Johnson to identify and establish specific areas of reform. As a result, a comprehensive strategic plan was developed to cost-effectively expand or redesign current treatment programs. Some treatment programs are operated illegally, with untrained staff using outdated models and charging exorbitant admission fees. I believe that new strategies are needed, including a more comprehensive, cost-effective approach.

These new strategies include adding trained addiction professionals to other programs and agencies and integrating addiction treatment into primary health care and other agencies such as private physician offices, primary care clinics, public health clinics, schools, hospitals and court service offices. As a result of adding these addiction professionals to non-traditional treatment sites these agencies can share facilities, staff, expenses and resources to expand services for those needing treatment.

In addition to these expanded non-traditional sites for services, I helped train and work with Comprehensive Care Centers that are placed in high-risk areas. These care centers will offer not only addiction treatment but mental health services, medical care for HIV and other physical issues, vocational training and court service staff. These Comprehensive Care Centers will be a one-stop shop for those needing assistance. Since these programs will also share facilities and resources, it can be done in a cost-effective manner and serve more individuals and families.

Treatment programs will also be established in some of the most needed schools, which will assist those children being able to access services. I also provided training for all of those professionals included in the new redesign of services including, doctors, nurses, social workers, court staff and law enforcement.

The training and consultation will be on-going. I will be returning the later part of this year to provide further services and trainings as well as on-going assistance.  I am also assisting in establishing an addiction credentialing board to set international standards for addiction professionals through IC&RC. Trained and credentialed staff will also add to the success and expansion of these new programs.

International, Territorial and Native American Boards

IC&RC is proud of its diverse membership. Our international, territorial, and Native American Member Boards contribute to the vibrant, global nature of our work. We list them here in recognition of their value to our organization.



Native American Regions

ICAA Conference: Cancun, Mexico

By Mary Jo Mather, Executive Director

In early November, I represented IC&RC at the 53rd International Council on Alcohol and Addictions (ICAA) conference in Cancun, Mexico. The theme of this year’s ICAA conference was “New Challenges-New Answers.” Approximately 1,500 addiction professionals were in attendance over the three-day conference. Trainers from around the globe presented plenary sessions including Dr. Andrea Barthwell (US), Dr. Vincenzo Pisani (US), David Templeman (Australia), Dr. Petra Meier (UK), Dr. Victor Manuel Marquez Soto (Mexico), Dr. Jose Armando Salazar Ascencio (Chile), Dr. Thomas Legl (Austria), and Dwight Rodrick (Switzerland). 

Session topics were The Road to Best Practice – Is it Science or is it Marketing?; Marco Political and New Regulatory Approaches to Address Addictions; Family Therapy; Tobacco Dependence; Public Policies; Women and Gender Issues; The Impact of Advertising on Consumption; Alcohol, Drugs and the Global Movement of People; Alcohol and Drug Treatment; Best Practices from Around the World – How To Adopt Them In Different Settings; Alcohol and Drug Prevention; Ethnic Dimensions of Addiction; Alcohol and Drug Problems in Business and Industry; Criminal Justice – Changing Conditions in Prison Treatment; Other Addictions; Therapeutic Communities; Cultural, Social and Economic Differences and Their Impact on Alcohol Consumption and Policy;  Addiction Research and Practice – How Useful is Research; WHO Global Strategy; Redefining Harm Reduction in the Alcohol, Tobacco and Drug Fields; WHO Global Alcohol Strategy; Innovative Prevention Approaches Working in Mexico and Latin America; Stimulants; Marijuana; Universal, Selective and Indicative Prevention Strategies in Latin America; Accessibility of Licit and Illicit Drugs on the Internet and Early Warning Systems; Addiction Care and Media; The Way Forward in Public Health; and Looking Forward – New Directions.

Most of the attendees were treatment and prevention professionals from Mexico.  I had the unique opportunity to speak with many of these individuals and promote certification through IC&RC’s member board in Mexico, the Mexican Certification Board for Professionals on Addiction, Alcoholism and Tobacco.  Many were aware of a credentialing process in Mexico but unsure what was required for certification.  Of great interest was the written examination, along with preparation strategies for taking the exam.

Credentialing Around the World

By David Powell, PhD, International Center for Health Concerns, Inc.  

Addiction treatment is growing worldwide, particularly in Asia, from Beijing to Istanbul. Addiction professionals are being trained, as institutes and other educational opportunities are developing. As individuals are trained, they are asking vital questions:  What is the “end-product” of the training? Is there any credential available for trained addiction professionals? Also, they want to know where they can apply their knowledge and education in treatment centers.

The answer to the last question is more complex than the first two. As treatment centers are developed, there are many political, regulatory and systemic issues that arise. In some countries, such as China, the medical and psychiatric community sees itself as the main site for treatment. Physicians remain the primary, if not sole, provider of services. Establishing free-standing, non-hospital affiliated treatment programs in such environments will be difficult.

Considering the Questions

The first two questions, about credentialing, though is long overdue. Although several certification organizations (NAADAC, IC&RC, NBCC, etc.) have established footholds internationally, credentialing remains a patchwork quilt that will only grow more complex and confusing as time goes on.

From my perspective, here is what countries seek:

  • An internationally-recognized “good housekeeping seal of approval” for trained addiction professionals;
  • A country-specific process that addresses their unique legal, ethical, and cultural issues; and,
  • A certification process that is affordable, in their language, and fits into their health care credentialing process.

The United States has led the way in credentialing of addiction professionals. There is reluctance, though, on the part of many countries to accept in total what is seen as an “Americanized” process. Whether because of politics or geocentrism, other countries want to gain from the American experience in credentialing but want it to be “their” process as well. As Thomas Freidman in The New York Times reminds us, the world may look more like America, but globalization will mean an international slant to all that’s done. We shouldn’t be fooled by the Starbucks in the new Beijing airport. They are modernizing, not necessarily westernizing.

I want to focus on three countries as examples of what is happening throughout Asia.

Lessons from the Road

First, Turkey. A 120-bed, adolescent, substance abuse treatment center began three years ago in Gaziantep, in southern Turkey, on the Syrian/Iraq border. At the time, there were no addiction counselors providing treatment in the country. Services were offered primarily by psychiatrists and psychologists, in traditional mental institutes. The Gaziantep center trained all 50 staff members over a two-year period. Most staff would now qualify for certification by most international standards. However, there is no credentialing available, approved by the government, in Turkey. As we shall see below in other countries, what is needed now is an internationally-recognized process, approved by the Turkish government, available in Turkish, with an examination that addresses the unique issues of Turkey. Also, the process needs to be affordable for the average addiction counselor who may earn the equivalent of $10,000 USD/year.

Vietnam is a similar example. The U.S. government has invested significantly in the development of addiction treatment programs, specifically methadone maintenance and addiction counseling. Over the past five years, hundreds of counselors have been trained in the Matrix Model, family counseling, and clinical supervision, and many would qualify for certification at this time. Although the Vietnamese government is prepared to offer a credential through their Ministry of Health, there is no certification process available to them. The cost per person for this process would have to be significantly reduced to make certification affordable to these counselors. Further, as a nominally Communist country, the examination would need to reflect many country-specific issues. Duty-to-warn questions take on a totally new meaning in such an environment.

China is the awakening giant in Asia in health care. Although addiction remains a “back-burner” issue for the government, trailing far behind issues of economic growth, it is slowly taking root. China, if the current trajectory remains, will have the highest per capita rate of alcohol consumption in the world in the next twenty years. A small but growing number of individuals have been trained in addiction counseling over the past ten years through the International Center for Health Concerns, Inc. Jobs for these trained professionals will not become available until there is a viable credentialing organization in China. Although several organizations have tried to make headway into China, to date, no certification process is in place. Frustration is growing among the trained professionals, asking, appropriately, “So what is the pay off for all that training I have received?”

It is imperative at this point that the credentialing organizations in the addiction field be unified in their efforts so as to not foster a patchwork quilt of certification on the world.  This means, we need to offer countries the option to develop their own policies and procedures, as well as examination questions that reflect their country-specific issues, and we need to do so in a way that is affordable for developing countries. This may mean regional certification bodies are established, such as an Asia-Pacific Certification Organization, a European organization, and a Latin American organization.

The timing is right now for the U.S. to work with other nations in offering this growing body of addiction professionals the credentials they urgently need.

IC&RC to Work with South Africa on Credentialing

 by Donna Johnson JD, CAS, ICADC, ICCJP, ICCDP, LADC

When you travel across South Africa you can’t help but be in awe of the vastness of the land, and the complexities and beauty of this country.  From the city of Johannesburg with its big city feel and technology that competes with anywhere in the world, to the coastal area of Cape Town filled with a breathtaking view of the city from Table Mountain, and the magnificence of nature that surrounds it.  South Africa is indeed a country that displays a knowledge and understanding of its past, that brings with it a strength and passion for its bright future.

During the past several years, I have had the honor of working in South Africa to provide training, consulting, and education on addiction. I am amazed not only by the beautiful people of South Africa and their resilience, but by the determination and dedication of a group of professionals and individuals who understand the impact addiction has, not only on those affected, but on the families and communities who also suffer.

With all of its beauty and offerings, South Africa like most other countries has not been able to escape the devastation of addiction. Substance use in South Africa, as in the rest of the world reaches across racial, social, cultural and religious barriers and places an immense health burden on South African society. South Africa represents a wide variety of cultures. With over 11 languages spoken, addiction impacts all of those cultures.  Substance use in South Africa has increased in recent years.  Alcohol is still the most widely used substance with methamphetamine (tik), cannabis (dagga), and mandrax (Quaaludes) smoked with cannabis, and cocaine and heroin following closely behind.

Recognizing that substance use is taking a toll on the citizens of South Africa and the communities that encompass this beautiful country, agencies, government and professionals have joined together to develop a comprehensive plan and policy to address addiction in South Africa.  This plan emphasizes special needs populations, such as those infected with HIV/AIDS, those involved in the criminal justice system, homeless, youth and women.

Just recently in the city of Cape Town, a comprehensive treatment program was developed to treat those most vulnerable to addiction.  With the Office of the Premier of the Western Cape, the City of Cape Town, agencies, professionals, and Substance Misuse, Advocacy, Research and Training (SMART) joining forces to develop a strategic plan for Western Cape province, programs have been implemented to address the impact of addiction on Cape Town.  Sarah Fisher, Executive Director of SMART, has been a critical figure in bringing evidence-based programs and treatment to the Cape Town area. 

Last month the Community Awareness Rehabilitation and Education Services (CARES) Center was opened. This program is a one-stop, drop-in center to provide evidence-based treatment and to reduce crime and economic issues caused by substance use disorders. This program will target those most vulnerable, such as those citizens with HIV/AIDS.  The CARES program provides an intensive array of services, such as substance abuse treatment, case management, education, access to primary health care, job development, parenting skills and aftercare programs – to name a few.

During the past several years, Cape Town has developed a model of care that incorporates Matrix-Model, evidence-based addiction treatment into four primary health centres/clinics . This type of comprehensive program will utilize not only evidence-based treatment models, such as motivational interviewing and Matrix Model, but will also seek to utilize staff that is competent and credentialed in the treatment of addiction. With no current credentialing process in place in South Africa, it is recognized that development of such a process is vital to the future of appropriate treatment.

Sarah Fisher with SMART has not only been instrumental in bringing training to South Africa for evidence-based models, she has also been a key figure in adding IC&RC credentialing into the provincial strategy for the Western Cape.  Government offices such as the Office of the Premiere, Office of the Mayor, SMART and other agencies recognize that appropriate treatment need to employ a diverse group of individuals who have demonstrated education, skills, and experience in working with addictions.  This past year IC&RC was added to the provincial policy/laws and strategy to bring about standards for addiction credentialing processes in South Africa.  IC&RC very much looks forward to working with South Africa as they formalize their board and certification process.

Regional Board Formed in Nordic/Baltic

By Stefán Jóhannsson, MA, ICADC, ICPS, ICCS

On September 30, the Nordic/Baltic Regional Certification Board (NBRCB) held its first annual meeting at Drejervej 15, in Copenhagen, Denmark. The following countries were approved and confirmed as affiliates of the NBRCB: Denmark, Iceland, Norway, Finland, Sweden, Estonia, Latvia and Lithuania.

At the meeting, the group approved a constitution for NBCRB:

“The Nordic/Baltic Regional Certification Board is a non-governmental and non-profit organization. Membership is open to all people of all ages regardless of gender, color, nationality, creed, social position or political persuasion living in the Nordic and Baltic states.”

The Board of NBCRB is composed of one representative from each country, elected for two year terms. The newly elected board of directors for the period of 2010 – 2012 is:

Árni Einarsson (Iceland)

Aurelijus Veryga (Lithuania)

Hasse Schneiderman (Denmark)

Janis Caunitis (Latvia)

Joonas Turtonen (Finland)

Kjetil Vesteras (Norway)

Lauri Beekmann (Estonia)

Mats Gunnarsson (Sweden)

A three-member executive committee was elected and will provide daily management to the organization. The first executive committee for 2010-2012 will be comprised of:

Chairman: Stefán Jóhannsson MA, ICADC, ICPS, ICCS

Treasurer: Árni Einarsson, MA, ICPS

Secretary: Sigurlína Davíðsdóttir, PhD, ICADC, ICPS, ICCS

This development is the result of a great deal of work over the past three years. In October 2007, at the NordAN conference, the situation in the Nordic and Baltic countries was discussed as a part of a special seminar entitled, “Qualifying the Workforce in Alcohol and Drug Prevention and Rehabilitation.”

During the session, Stefán Jóhannsson, head of the the Icelandic School of Addictions Studies, Hasse Schneidermann, secretary general of NordAN, Sigurlína Davíðsdóttir, professor at the University of Iceland, and Jeff Wilbee, then-president of IC&RC, gave presentations on the benefits of more educated staff in the field  and the need to enhance workforce professionalization through education and measuring of skills, knowledge, and competencies of prevention specialists and alcohol and drug addiction counselors.

Focus on: International and Cultural Affairs

Jeff Wilbee

Dear Friends,

There is an old adage in the 12 Step movement – that you have to give it away to keep it. That, to me, means being open to sharing the knowledge and wisdom that I have received. Very few would argue that addictions are not a serious problem, not just here in North America, but across the world. There is not a society, culture or religion that is not affected in some way. Our whole world is poorer because of this affliction and those who suffer from it. So, what is our responsibility, our role in alleviating some of this burden? Perhaps, in this week of America’s Thanksgiving holiday, we need to follow President Bill Clinton’s words when he said, “America needs to be known not by its example of power, but by its power of example.”

There were visionary people, going onto thirty years ago now, who saw that a good part of the solution was having competent professionals in prevention and treatment and came together to develop the National Certification and Reciprocity Consortium. When Canada joined this American group, it became IC&RC, and we have grown exponentially since then. We are operating in all areas of the United States and, at this point, in fifteen other countries with a whole certification product line. A number of other countries have approached IC&RC interested in becoming part of our family of boards.

We are once again at an exciting point in our history and one that, to my way of thinking, calls us to the responsibility to share what we know and assist our fellow travellers in meeting their challenges. In one sense, we human beings are the same no matter what our language or culture. And, of course, in other ways we are quite different.

We need to honour both our similarities and our diversity. That is why it was gratifying to have a motion passed at the last IC&RC meeting for a pilot project to test out an option where a country, region or jurisdiction could choose to become an Associate Certification Board (ACB). This will allow boards to develop one-third of the examination questions to reflect the reality and standards of care in the area being represented. The ACB will not have full voting privileges but have the opportunity to enter all discussions. This member classification is meant as a stepping stone to eventual full membership and reciprocity of their certifications.

In talking about expanding across the world with all the complexities that presents, the question is can IC&RC’s present governance and operations structure meet those complexities. The answer is no. We must make some fundamental changes. IC&RC’s International and Cultural Affairs Committee has developed a concept paper on setting up a regional structure that would align with the United Nations regions. The Executive Committee of IC&RC has reviewed and approved the general idea, and the plan has been shared with delegates at the Fall 2010 meeting. The Committee, along with our staff, will gain expert advice and propose a structure at the Spring 2011 meeting.  

The United States of America has been the world economic, political and military leader for many decades, and we expect that it shall continue to be so. The western world has been the champion for human rights and assisting many nations in enhancing the quality of life for their people. Together, through IC&RC, we can make a significant difference through addiction workforce development and certification. That also means that we will call all who join us into accountability, to pay their way and to observe the high-quality standards as laid down by the people who came before us over these thirty years. We invite you all to join us in this exciting initiative if only supporting the idea of IC & RC really strengthening the “I.”

No one can watch the evening newscast without concluding that the world is on the brink of great change in all aspects of our existence. I am reminded of the words of the great American author, scientist, and theologian William Pollard: “Without change there is no innovation, creativity or incentive for improvement. Those who initiate change will have a better opportunity to manage change that is inevitable.”  Let us get on the move with  innovation and creativity and positively impact millions of people’s lives wherever they may be walking their journey.


Jeff Wilbee

Chair, International and Cultural Affairs Committee