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The Journey through Grief and Loss Presented by Lisa Connors, LCPC, NCC, MAC, CT, ABD February 28, 2018

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Page 1: The Journey through Grief and Loss › assets › 2416 › journey_through_grief...Complicated grief is like being in an ongoing, heightened state of mourning that keeps a client from

The Journey through Grief and Loss

Presented by

Lisa Connors, LCPC, NCC, MAC, CT, ABD

February 28, 2018

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Thomas Durham, PhD

Director of Training

NAADAC, the Association for Addiction Professionals

www.naadac.org

[email protected]

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Produced By

NAADAC, the Association for Addiction Professionalswww.naadac.org/webinars

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www.naadac.org/webinars

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www.naadac.org/journey-grief-and-loss-webinar

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Cost to Watch:

Free

CE Hours

Available:

1.5 CEs

CE Certificate for

NAADAC

Members:

Free

CE Certificate for

Non-members:

$20

To obtain a CE Certificate for the time you spent watching this

webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at

www.naadac.org/journey-grief-and-loss-webinar

3. If applicable, submit payment for CE certificate or join

NAADAC.

4. A CE certificate will be emailed to you within 21 days of

submitting the quiz.

CE Certificate

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Using GoToWebinar – (Live Participants Only)

Control Panel

Asking Questions

Audio (phone preferred)

Polling Questions

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Lisa Connors, LCPC, NCC, MAC, CT, ABD

Contact: 410.777.7382

E-mail: [email protected]

Webinar Presenter

Your

Anne Arundel Community College

School of Health Sciences

Human Services Program

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Webinar Learning Objectives

Understand the

components of grief &

loss, dispel myth and

misconceptions about

grief and loss, and

explore how grief affects

individuals from a

physical,

emotional/psychological,

behavioral, and spiritual

perspective.

Define complicated grief,

identify when grief is

complicated, and explore

ways to help individuals

address complicated grief.

Identify warning signs

associated with grief and loss,

and how to support individuals

who are experiencing intense

emotions.

1 32

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Let grief find the freedom to be expressed. Let

grief find the right to be understood.

~Kei Gilbert

Inspirational Reading

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Polling Question #1

Experiencing grief and seeking help for it may

be seen as a personal weakness.

Yes or No

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Anger is not a normal response to loss.

A grieving person should minimize feelings.

It takes 2 weeks to 3 months to get over grief.

All losses are the same.

Everyone grieves differently.

Grief and loss is only attributable to death.

Clearing the Air: Some myths and misconceptions about grief and loss

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Grief is…

“deep or intense sorrow or distress, especially at

the death of someone. It is something that causes

keen distress or suffering as a response to a loss.”

Grief…what is it?

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Grief is a continuing process with many changes.

Grief is a natural reaction.

Grief is a reaction to the experience of many kinds

of losses, not just death alone.

Grief: A Reaction to Loss

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the absence of a possession or future possession;

absence of a relationship.

Loss is…

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What are some losses we

experience?

Brainstorm Activity

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Loss of a spouse through death or divorce

Loss of a parent or child through death or divorce

Loss of a family member or friend

Miscarriage or Abortion

Loss of a beloved pet

Loss of a relationship

Various Losses

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Loss of functioning through disability

Loss of sense of identity

Loss of sense of security

Loss of childhood through abuse or neglect

Loss of a job or financial stability

Loss of health

Various Losses, continued

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Polling Question #2

As clinicians and practitioners, we should

consider our clients’ cultural and spiritual

values when addressing grief and loss with

them.

Yes or No

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Grief is different for everyone.

Support systems will vary.

Resources are not always known or available.

Everyone has different coping styles.

There are gender differences related to grief.

Grief reflects cultural and religious differences.

Grief depends on what else is going on in a

person’s life.

The Nature of Grief

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Anticipatory – experienced before the loss;

associated with diagnosis, acute, chronic &

terminal illnesses

Uncomplicated – often called “normal”; may

include physical, emotional, cognitive, and

behavioral responses to loss

Types of Grief

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Disenfranchised - is a loss that cannot be openly acknowledged, socially

validated, or publicly mourned. DG often include grief that is encountered when

a loss is experienced, but can not be openly acknowledged or publicly shared

(i.e. HIV clients, family of HIV patients and clients, mistresses/lovers, ex-

spouses or partners, death from substance use/overdose, suicide, abortion,

miscarriages, stillbirth, loss of a pet, chronic illness or disease, etc.).

Complicated – often include chronic (grief that will not subside and continues

over time), delayed (grief that are suppressed or postponed—avoiding the pain

of the loss), exaggerated (grief that resorts to self-destructive behaviors), and

masked grief (grief in which the individual is not aware that behaviors are

interfering with normal functioning).

Types of Grief, continued

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Polling Question #3

Is there a time-limit on grieving?

Yes or No

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Complicated grief is like being in an ongoing, heightened state of mourning that keeps a client from healing. In

complicated grief, feelings of loss are debilitating and don't improve even after time passes. It is sometimes called

persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that

someone may have trouble recovering from the loss and resuming their life (Mayo Clinic, 2017). Signs and symptoms

of complicated grief may include:

Intense sorrow, pain and rumination over the loss of your loved one

Focus on little else but your loved one's death

Extreme focus on reminders of the loved one or excessive avoidance of reminders

Intense and persistent longing or pining for the deceased

Problems accepting the death Numbness or detachment

Bitterness about your loss Feeling that life holds no meaning or purpose

Lack of trust in others

Inability to enjoy life or think back on positive experiences with your loved one

Complicated Grief

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Other signs and symptoms of complicated grief may include:

Recurrent troubling thoughts about the death (e.g.: thinking over and

over that someone could have done something different that would have

prevented this death)

Behaviors to try to block out the painful reality (leaving a room or

possessions untouched, spending a lot of time day dreaming about being

with the deceased person, protecting oneself from being reminded of

them, trying to avoid people places or things that they used to do with

the deceased person)

Feelings like guilt or anger that are difficult to control

Complicated grief, continued

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Has trouble carrying out normal routines

Isolates from others and withdraws from social activities

Is stuck

Has health issues/health is jeopardized

Experiences depression, deep sadness, guilt, or self-blame

Believes they did something wrong or could have prevented the death

Feels life isn't worth living without their loved one

Wishes they had died along with their loved one

Complicated grief continues when someone….

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Complicated grief occurs more often in females and with older age. Factors that may

increase the risk of developing complicated grief include:

Losing a loved one in a sudden or violent way/An unexpected or violent death, such as

death from a car accident, or the murder or suicide of a loved one

Death of a child

Close or dependent relationship to the deceased person

Social isolation or loss of a support system or friendships

Individuals vulnerable to mood or anxiety disorder/Past history of depression, separation

anxiety or post-traumatic stress disorder (PTSD) or other mental health disorders

Traumatic childhood experiences, such as abuse or neglect

Other major life stressors, such as major financial hardships, difficult relationships with

parents growing up

Risk Factors of Complicated Grief

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1. Be present and available. Understand that the bereaved may feel abandoned and

recognize that you could inadvertently contribute to these feelings.

2. Take initiative in making contact. Don’t expect reciprocity during acute grief. Try to

understand that the bereaved person might not be able to meet expectations and demands

during this time.

3. Listen closely. Share knowledge and advice sensitively and honestly, if requested. Be

willing to sit in silence, squeeze their hand or give them a hug.

4. Encourage honest disclosure from the bereaved. Let the person know it’s okay to cry

and to feel scared or angry. Make it known that you won’t judge them. Understand that a

grieving person may feel the need to put up a front because they are worried that others

can’t deal with their emotions. Encourage the bereaved not to do this with you.

Providing Support for Complicated Grief

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5. Provide help with problem solving in a spirit of partnership and not as an authority. Be

honest when you are uncertain about what will be helpful; share this with the bereaved

person in a respectful way.

6. Let the bereaved person lean on you, especially in ways that are not so obvious.

7. Be respectful of the mourning process and patient with its progress. Have faith in the

bereaved person.

8. Remember the deceased and talk about this person.

9. Look for ways to promote positive feelings in the present and hope for the future.

Don’t feel discouraged by the natural sadness that infuses these feelings.

Providing Support for Complicated Grief

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10. Show respect for the person’s need for independence and solitude while making clear

your strong commitment to being available and responsive.

11. Let the bereaved know that you want to stay in touch for the long haul. Make it clear

that you understand that there are days of the year that are especially difficult and that you

want to help with those times.

12. Be aware of your own feelings about what you want from the bereaved person that

they can’t give to you right now. Don’t try to push these feelings away. Do try to find

other ways to have your own needs met.

13. Encourage the bereaved person to ask for help. Ask them what you can do and if they

don’t know, make suggestions. You might be able to help with errands, accompany them

on a walk or drive them somewhere. You might just spend quiet time with the person.

Providing Support for Complicated Grief

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Tightness in throat or heaviness in the chest

Empty feeling in the stomach; hollowness

Loss of appetite/appetite change

Difficulty sleeping/sleep disturbances

Crying at unexpected times

Change in mood (depression)

Shortness of breath

Lack of energy

Physical Responses to Grief

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Anger

Afraid

Anxious

Ashamed

Bitter

Confused

Depressed

Despair

Detached

Emptiness Fear

Guilty Helpless Hopeless Jealously

Emotional Responses to Grief

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Guilty Helpless

Lonely Lost

Numbness

Overwhelmed

Preoccupied

Relief

Resentment

Sadness

Shocked

Vulnerable

Yearning

Emotional Responses to Grief

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Confusion

Inability to concentrate

Preoccupation with thoughts and images of the

deceased

Dreams of the deceased

Disbelief

Search for meaning in life and death

Cognitive Responses to Grief

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Impaired work or school performance

Crying

Withdrawal

Avoiding reminders of the deceased

Seeking or carrying reminders of the deceased

Over-reactivity

Changed relationships

Self-destructive behaviors (i.e. alcoholism, drug use, etc.)

Behavioral Responses to Grief

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Loss of faith in God

Confusion about God

Questioning God about the

death/not understanding “why”

Angry with God about the death

Abandoning religious practices

Not attending worship services

Spiritual Responses to Grief

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Denial

Anger

Bargaining

Depression

Acceptance

What is Normal Grieving: The 5 Stages of Grief

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Shock/Denial

Facing Emotions

Depression

Physical Symptoms

Panic

Guilt

Hostility

Drifting

Hope

The Grief Cycle

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Polling Question #4

People should not grieve over those who

have died from drug overdoses.

Yes or No

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To accept the reality of the loss

To work through & experience the pain of grief

To adjust to an environment in which the deceased

is missing

To emotionally relocate the deceased and move on

with life.

Four Tasks of Mourning

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What are some common

responses or comments people

make when someone is

grieving?

Brainstorm Activity

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“He was sick---you knew he was going to die”

“It was God’s will”

“They’re better off now”

“At least they’re not in anymore pain”

“There must be a reason”

“You will be ok”

“The Lord giveth & the Lord taketh”

“They are resting in heaven”

“I understand/I know how you feel”

“This is what happens when you live that type of lifestyle”

Some common responses & comments…

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“You will get over it in time”

“Weeping may endure for a night, but joy comes in the morning”

“It will be alright---you will get through it”

“What happened---was she sick?”

“Snap out of it”

“You got to be strong/Be strong for your family”

“He/she lived a good life”

“You must or should move on”

“You have gotten through other things, you can get through this”

“You are the strong one”

Some common responses & comments…

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“God will never give you more than you can handle”

“Be thankful you have other children”

“Get a hold of yourself/Pull yourself together”

“You can always have other children”

“You’re young”

“Others have it worse than you”

“At least he/she is not suffering”

“They are in a better place”

“Earth has no sorrow that HEAVEN cannot heal”

“He did it to himself”/”She did it to herself”

Some common responses & comments…

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“I am sorry for your loss”

“I can’t imagine what you are going through”

“I care”

“I don’t know why”

“I don’t know what to say, but I’ll be glad to listen”

“What can I do to help?”

OR

Give a hug or kiss Hold the person’s hand

Be silent Listen

What can you say or do?

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How many feelings can you name?

Brainstorm Activity

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No interest in regular activities

Loss of capacity to love

Physical distress

Preoccupation with the image of the person

Guilt

Hostile reactions/Angry

Withdrawal

Hopelessness/Helplessness

No will to live

Warning signs that someone needs HELP!

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Know when to use active listening (communicating empathy)

Feeling comfortable with active listening comes with practice

Don’t give up too quickly

Accept that active listening will feel artificial at first

Try using other listening skills (i. e. door openers, no feedback)

Avoid pushing or imposing active listening on others

Don’t expect people to accept your solution

Listen to what is not being said

If you are providing grief services, please consider these guidelines…

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Grief Coaching is helping clients transition, adjust, and plan their changed life in ways

meaningful for them (Hitchens, 2017). Grief Coaching supports, encourages, and helps

clients discover the meaning of life after the death of a loved one. Grief Coaching also

helps clients identify life going forward, visualizing the future without their loved one,

discovering challenges associated with their grief, moving past those challenges, and

helping clients refocus on life’s goals and possibilities.

Grief Counseling involves helping clients facilitate uncomplicated or “normal” grief to a

healthy adaptation to the tasks of mourning within a reasonable time frame. Grief

counseling is usually offered as a service under the auspice of hospice organizations. It is

done by licensed clinician, and is usually short-term. Clients seeking grief counseling

usually have more supports and resources in place.

Grief Coaching, Grief Counseling, or Grief Therapy

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Grief Therapy involves helping clients better adapt to the loss or death. It is helping

clients resolve conflicts of separating that precludes them from accomplishing the tasks of

mourning. The grief is usually chronic, delayed, excessive, or masked. Grief Therapy

helps clients with abnormal or complicated grief reactions by helping them experience

thoughts and feelings that may have been avoided. It requires more “deeper” work with

clients. Some procedures of grief therapy is to:

Rule out physical disease

Set up a contract and establish an alliance

Revive memories of the deceased

Assess which of the four mourning tasks the client is struggling with

Deal with affect or lack of affect stimulated by memories

Help clients acknowledge the finality of the loss

Assess and help clients improve social relationships

Grief Coaching, Grief Counseling, or Grief Therapy, continued

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Assure the person that their feelings and emotions are normal

Allow person to cry

Be there: your presence

Initiate something to do (dinner, pick the person up, help with

arrangements)

Listen attentively (esp. non-judgmentally)

Avoid clichés or quick answers

Be silent

Encourage people to express their feelings

Helping others through grief

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Anger may be a part of the grief

Do not ask questions about how the death happened

Offer opportunities for them to talk & remember

Allow people to grieve as long as needed/at their own pace

Help them find support, connect them to a grief counselor

Post-death syndrome (be aware of suicidal ideations,

homicide, etc.)

Helping others through grief

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Gestalt Technique/Empty Chair

Journaling

Writing letters to the deceased/Goodbye letters

Homework Assignments

Role Playing

Bibliotherapy

Rituals/Customs

Some Techniques to Use With Clients…

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“We can not give what we do not have. Self-care is

the foundation for caring about others.”

Judith A. Graham

Parting Words for the Clinician

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Consider how you replenish your mind, body, heart, and spirit (How do you fill

your emotional cup)?

Access and nurture support (What are your sources of meaningful support)?

Stay connected to meaning (What brings you joy as a helper)?

Engage in reflective practice (How do you increase your self-awareness)?

Be kind to yourself (In what ways are you kind and compassionate to yourself)?

When working with individuals who are grieving, consider this:

Pathways to Self-Care

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Accept your own grief

Accept your feelings

Learn about grief

Find an outlet for your feelings/Express your grief through talking,

journaling, etc.

Focus on the grief and then pull back

Find an outlet for your feelings

Care for your whole being---body, soul, and spirit

Draw on your resources (creativity, spirituality)

Helping yourself through grief

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Provide gentle self-care when grief is fresh

Seek ongoing support

Seek and accept ongoing support from others

Manage the stress of change/adjust to those changes

Embrace the memories

Search for meaning

Have fun and relax!

Have HOPE

Helping yourself through grief

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“Grief is a normal and necessary process that is

fundamentally a journey of the heart and soul.”

~Dr. Alan D. Wolfelt

Remember…

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Hitchens, J. (2017). Navigasting grief: A coach for grief. Retrieved from http://www.navigatinggrief.com/about-coaching/.

Mayo Clinic (2017). Complicated grief. Retrieved from https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-

causes/syc-20360374

McMahon, R. & Persson, K. L. (2008). Good Mourning: A resource for healing. Fall Church, VA: Capital Caring.

Modern loss (2017). Complicated grief: How it’s different. Retrieved from http://modernloss.com/complicated-grief-different/

Mortell, S. (2015). Assisting clients with disenfranchised grief: The role of a mental health nurse. Journal of Psychosocial Nursing and Mental

Health Services, 53(4), 52-57.

Pillai-Friedman, S., & Ashline, J. L. (2014). Women, breast cancer survivorship, sexual losses, and disenfranchised grief – a treatment model

for clinicians. Sexual and Relationship Therapy, 29(4), 436-453.

Spidell, S., Wallace, A., Carmack, C., Nogueras-Gonzalez, G.M., Parker, C., & Cantor, S. B. (2011). Grief in healthcare Chaplains: An

investigation of the presence of disenfranchised grief. Journal of Health Care Chaplaincy, 17, 75-86.

St. Clair, J. S. (2013). The witnessing of disenfranchised grief: Reliability and validity. Journal of Nursing Measurement, 21(3), 401-414. doi:

10.1891/1061-3749.21.3.401

The Center for Complicated Grief (2017). Providing Good Support. Retrieved from https://complicatedgrief.columbia.edu/resources/resources-

public/providing-good-support/

WebMD (2017). What is normal grieving, and what are the stages of grief? Retrieved from https://www.webmd.com/balance/normal-grieving-

and-stages-of-grief#1.

Wolfelt, A. D. (2006). Companioning the bereaved: A soulful guide for caregivers. Fort Collins, CO: Companion Press.

Worden, W. (2009). Grief counseling and grief therapy (4th ed.). New York, NY: Springer Publishing Company.

References

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Lisa Connors, LCPC, NCC, MAC, CT, ABD

Contact: 410.777.7382

E-mail: [email protected]

Thank You!

Your

Anne Arundel Community College

School of Health Sciences

Human Services Program

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www.naadac.org/journey-grief-and-loss-webinar

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Cost to Watch:

Free

CE Hours

Available:

1.5 CEs

CE Certificate for

NAADAC

Members:

Free

CE Certificate for

Non-members:

$20

To obtain a CE Certificate for the time you spent watching this

webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at

www.naadac.org/journey-grief-and-loss-webinar

3. If applicable, submit payment for CE certificate or join

NAADAC.

4. A CE certificate will be emailed to you within 21 days of

submitting the quiz.

CE Certificate

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March 14, 2018 April11, ,2018

March 28, 2018 April 25, 2018

Upcoming Webinars

www.naadac.org/webinars

Treating the Relapse Process Using Mindfulness

By Christopher Shea, MA, CRAT, CAC-AD, LCC

Cultural Aspect of Trauma and

Substance Use Disorders

By Gladys Smith, PsyD, LPC, MAC, CCMHC, RYT

Neuroscience of Addiction

By Daniel Hochman, MD

Comprehensive Treatment for Medication

Assisted Treatment

By Michael Weaver, MD, FASAM, DABAM and

Don Hall, LCDC

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www.naadac.org/webinars

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Over 145 CEs of free educational

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credits are FREE for NAADAC

members.

WEBINAR SERIES

In each issue of Advances in

Addiction & Recovery, NAADAC's

magazine, one article is eligible for

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MAGAZINE ARTICLES

NAADAC offers face-to-face

seminars of varying lengths in the

U.S. and abroad.

FACE-TO-FACE SEMINARS

Earn CEs at home and at your own

pace (includes study guide and

online examination).

INDEPENDENT STUDY COURSES

NAADAC Annual Conference, October 6-8

2018, Houston, TX

www.naadac.org/2018annualconference

CONFERENCES

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Thank you for joining!

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phone: 703.741.7686 / 800.548.0497

fax: 703.741.7698 / 800.377.1136

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