A presentation for those working with chronic pain sufferers who use substances to cope with their pain.

1. CHRONIC PAIN AND SUBSTANCE
ABUSE
Kenneth G. Smith, LCSW, LCAS, CCS
Sanford, NC
ksmithlcas@gmail.com
December 2020
www.linkedin.com/in/Kenneth-smith-94554b10

2. INTRODUCTIONS
 Your name (Groups of no more than 8)
 Where your work and what kind of work you do
 How many years in the field?
 What do you most enjoy about being in the
substance/addictions field?
 How much do you know about chronic pain?
 What do you to gain from the workshop today?

3. LEARNING OBJECTIVES
Be able to list at least two pain assessments
that counselors can utilize with SUD clients.
Be able to use formal assessments to diagnose
active substance using chronic pain clients, as
well as learn two MI interventions.
Be able to teach at least three specific coping
skills to their clients in recovery who suffer
from chronic pain.

4. How many people suffer from chronic pain?
More than 100 million Americans (as of 2011)!
At a cost of $600 billion in medical treatments and lost
productivity (Institute of Medicine)
Chronic pain is a stand-alone illness!
“Pain is a more terrible lord of mankind than even
death itself,” Dr. Albert Schweitzer (1931)
National Institute of Health (NIH)
www.painmed.com

5. My story of chronic pain
• Back pain began at age 15
• Ruptured disc at age 26: meds, physical therapy, traction!
• Late 20’s, wore back brace on and off, sciatica pain
• Pain was less in my 30’s
• Worse pain in my mid-40’s: constant pain when standing,
sitting, or sleeping; tried chiropractic, shots, physical
therapy, declined surgery
• Age 55: formally diagnosed with degenerative disc disease,
more pain; treated with chiropractic, physical therapy,
Epidural steroid injections, and meds (NSAID)
• Today: pain varies from slight to bothersome, limited
activities (but do biking, walking, and play golf!); usually
wake up stiff and sore (difficult to bend over)

6. What are the components of chronic pain?
• Aching sensation that persists for more than a few months
• May or may not be associated with trauma or disease, may
persist after the initial injury has healed
• No longer serves survival or any other beneficial purpose
• Lingered past the limits normally associated with tissue
healing
• Sometimes there is no clear cause or cause is hard to find,
objective signs are often absent
• Influenced by ongoing tissue pathology
2015 ICD-9-CM Diagnosis Code 338.2
Mersky and Bogduk (2004) Classification of Chronic Pain (2nd Edition)

7. Persons who suffer from chronic pain may also
suffer from……
• Depression
• Anxiety
• Substance use disorders
• Personality disorders
• Other physical issues or diseases
• Family dysfunction
• PTSD

8. People who suffer from chronic pain have to cope with
it……
• Physically
• Emotionally
• Cognitively
• Spiritually
• Socially
• Daily, moment by moment!

9. Barriers to coping
• Low frustration tolerance
• Low tolerance of uncertainty
• Unresolved trauma/shame
• Addiction
• Perfectionism
• Dependency
• Lack of support
• Poor emotional regulation skills
#May use this slide, but please give credit to the author

10. Assets to coping
• Able to tolerate frustration and uncertainty
• Good emotion regulation skills
• Flexibility/adaptability
• Coping focused/positive thoughts
• Know your body, just the right movement
• Assertive skills
• Healthy boundaries
#May use this slide, but please give credit to the
author

11. Spiritual/life meaning issues
• Spirituality: belief/connection to someone or
something bigger than ourselves; issues of the soul,
transcendent, etc. as opposed to the material or
physical; issues of the ultimate meaning of life
• Often faith is an asset, but can create a spiritual/life
meaning crisis:
• “Why me?” “God (Higher Power)is punishing me.”
“God (Higher Power) doesn’t care about me.”
• Making meaning of one’s life despite the pain is crucial!

12. • Chronic pain and suffering:
A) The chronic pain person’s conscious and
unconscious view of suffering is crucial to the
outcome of how they will cope with the pain.
Compare these beliefs:
1. “Suffering is terrible. I must avoid it or get immediate
relief from it at all costs.”
2. “I don’t deserve to suffer. If I do, I must blame it on
something or someone.”
3.”I deserve to suffer because I am an unworthy person. I
must have done something wrong.”
4. “I don’t like to suffer, but I can figure out how to deal with
it. I can even make meaning from it. I can accept it.”
What is the result of the above beliefs?
#May use this slide, but must give credit to the author

13. ASSESSING PAIN FORMALLY
Brief Pain Inventory (BPI) Short Form Cleeland (1991)
www.npcrc.org (download form)
McGill Pain Questionnaire Melzack, R. (1987)
(Public download available)
Numeric Pain Rating Scale AHCPR (1992)
www.PainEDU.org
American Chronic Pain Association (Quality of life Scale, Daily Activity
Checklist, Ability Chart)
www.theacpa.org/Communication-Tools
Collateral Information: Family, other clinicians, med records
To Assess Coping: Chronic Pain Acceptance Questionnaire (McCracken,
Vowles, & Eccleston, 2006) CPAQ-R

14.  ADDITIONAL PAIN ASSESSMENT SKILLS
A) Subjective experience
B) Location
C) Severity
D) Type
E) Duration
F) Effect on daily life
G) Nociceptor pain-Injury to the tissue (sharp, dull,
throbbing aching)
H) Neuropathic pain-injury to the nerve (burning,
shooting, numb)

15. Chronic pain and DSM-V Disorders
Major Depressive Disorder (MDD)
Requires meeting 5 of 9 criteria
Depressed mood most of the day, nearly every day
Loss of interest or pleasure
Significant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy nearly every day
Feelings of worthlessness
Concentration and focus problems
Vulnerable to thought of death or suicide

16. Persistent depressive disorder
Major depression symptoms have existed for two years
Does not include manic or hypomanic episodes
High risk for anxiety and substance abuse disorders!
Chronic pain and depression:
Increases feelings of worthlessness (“Because of my pain, I have
nothing to offer anyone.”)
Increases feelings of hopelessness (“I might as well give up.”)
Increases insomnia or hypersomnia (“It hurts when I sleep” or
“The only time I don’t feel pain is when I sleep.”)
Increases loss of energy (“My pain saps me.”)
Increases loss of pleasure (“I just hurt too much to do
anything.”)
#May use this slide, but must give credit to the author

17. ANXIETY DISORDERS
Generalized Anxiety Disorder(GAD): Excessive, worry
and tension; restlessness of being on edge; irritability;
body tension (headaches, sweating, upset stomach);
difficulty focusing; sleep problems; worrisome thoughts
out of proportion to the situation
Social Anxiety Disorder: fear of situations that require
social interaction; fear of performance in front of
others; blushing, rapid heartbeat, dry throat to the
point of affecting functioning
Panic Disorder: palpitations, pounding heart, trembling,
sweating, feelings of choking, other discomfort, believe
going to “lose it” or even die; fears detached from
reality
Phobias
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder

18. Chronic pain and Anxiety
Disorders
Increase worrisome thoughts (“What if my pain never
goes away?”)
Increases irritability (“I just can’t stand this pain
anymore!)
Increases social anxiety (“I can’t go anywhere, I hurt
too much.”)
Increases sleep difficulty (“I just can’t go to sleep when
I hurt.”)
Increases sense of doom (I’ll never get any better!”)
Increase physical symptoms due to lack of body
movement, fear of exercise, mind/body connection,
etc.
Can possibly be a trigger for unresolved trauma
Can lead to panic when person get overhyped
#May use this slide, but must give credit to the author

19.  Chronic Pain and Personality
Disorders
Narcissistic Personality Disorder: Grandiose sense of
self-importance; entitlement; need for admiration;
superiority complex covering an inferiority complex
Chronic pain and narcissism becomes demanding;
disowns fears; blames others for not fixing the problem;
lack of empathy toward others
Dependent Personality Disorder: excessive passivity and
under responsibility; subordinates owns needs; excessive
need to be taken care of
Chronic pain and dependency withdraws; doesn’t speak
up for self; seeks to be rescued; hidden anger
#May use this slide, but mut give credit to the author

20. MORE PERSONALITY DISORDERS
Borderline Personality Disorder: switches between help
seeking and help rejecting; unstable relationships; impulsivity
Chronic pain and borderline personality: Creates drama
around pain; feels abandoned by others, including
professionals; unregulated emotions about pain
Chronic pain exacerbates the “general” criteria for personality
disorders:
Cognition (self-talk, interpretation of situations)
Affectivity (range and intensity of emotions)
Interpersonal functioning (how relate to
family/friends/professionals
Impulse control (reactive behaviors around pain)
#May use this slide, but must give credit to the author

21. Chronic Pain and Substance Abuse
“Chronic pain is not harmless; it has physiological, social, and psychological
dimensions that can seriously harm health, functioning, and well-being. As
a multidimensional condition with both objective and subjective aspects,
chronic pain is difficult to assess and treat. Although it can be managed, it
usually cannot be completely eliminated. When patients with chronic pain
have comorbid substance use disorders or are recovering from SUD, a
complex condition becomes even more difficult to manage.”
Up to 32% of people who suffer from chronic pain may have a
substance use disorder
TIP 54, “Managing Chronic Pain In Adults With or In Recovery From Substance Use
Disorders.” SAMHSA

22. DSM-5 CRITRERIA FOR SUBSTANCE USE DISORDERS
1. Substance is taken in larger amounts or over a longer period of time than was intended
2. A persistent desire or unsuccessful efforts to cut down or control
3. A great deal of time is spent in activities needed to obtain, use, and recover from the effects
of the substance.
4. Craving or a strong desire/urge to use
5. A failure to fulfill life obligations due to use
6. Continued use despite the persistent/recurrent social or interpersonal problems
7. Important social, occupational, or recreational activities are given up.
8. Use in high risk or hazardous situations
9. Continued use despite knowledge of problems likely to have been caused by use
10. Tolerance-need for more to achieve the desired effect or markedly diminished effect with
continued use of the same amount of the substance
11. Withdrawal-Withdrawal symptoms when remove the substance or substance taken to
relieve or avoid withdrawal symptoms
Chronic pain and substance use disorders: relying on substances to
cope; often actually makes the pain worse; keeps person from using
“healthier’ coping skills; vicious cycle

23. THE ADDICTION CYCLE

24. Formal SA Assessments:
Alcohol: AUDIT, MAST
Drugs: DAST, CAGE
Addiction Severity Index
SUBSTANCE ABUSE ASSESSMENTS
INFORMAL:
Do you use alcohol and/or drugs?
What do you use? How often?
In the past week/three months, how often ………
How do you decide to drink/uses drugs? What happens when
you drink/use drugs?
Addiction cycle: Pre-occupation, rituals, use, letdown

25. After assessment, then what?
• What does the patient want (Motivational interviewing
techniques)?
• Are they more motivated to change their pain coping or
change their substance use?
• Do they see a connection between the two? If so, what is
it?
• What is the impact of other DSM V diagnosis on their
pain and substance abuse?
• What are the barriers that the patient may have to
overcome?
• Give patient specific feedback regarding assessment
findings, then ask, “So what do you think?”

26. Tobacco and chronic pain
A) Smokers make up a disproportionate amount of pain patients
B) Tobacco restricts delivery of blood and other nutrients to the bones
and tissues; thus causing degeneration in the disc and spine
C) Tobacco is linked to more fatigue and slower healing of pain
D) Tobacco impairs the immune system
E) Tobacco can cause pain to linger longer
F) Tobacco-and the dozens of chemicals found in tobacco products-
inevitably affect most very system of the body
www.clevelandclinic.org December 2014
www.painscience.com June 2015

27. IMPACT OF ALCOHOL ON CHRONIC PAIN
A. Reasons CP clients tell me they drink: “relieve pain,” “forget
the pain,” “go to sleep,” “pleasurable feelings.”
B. Alcohol can have an analgesic effect (limbic system).
C. Some studies have shown that low to moderate drinking is
associated with less overall pain. 1
D. Too much alcohol consumption can exacerbate pain, alcohol
withdrawals can increase pain sensitivity. 2
1 www.painnewsnetwork.com 7-23-15
2 www.webmd.com 7-30-15

28. CANNABIS AND CHRONIC PAIN
“Cannabinoid receptors are present in the nervous
system and they interact with systems relevant to pain
perception………it shows promise for treating pain”
TIP 54 SAMHSA
My experience: Cannabis used as a “one stop
shop,”, that is a tendency to “idolize” it and see it
as the answer to pain and to dealing with stress.
WHAT IS YOUR EXPERIENCE?

29. Brief History of Pain and Addiction in America
(Past hundred years)
• Narcotic Farm-Lexington, KY: Experiments on prisoners.
• Methadone introduced: 1948; clinics proliferate in the 1970’s
• Time released morphine pill developed around 1972
• World Health Organization (WHO) declares “war” on pain; WHO Ladder “freedom from
pain a universal right” around 1980
• Sloan Kettering expanded use of opiates for chronic pain/MS Contin released, around
1984
• Article in medical journal Pain claims “opiates not inherently addictive”
• PAIN made the “Fifth Vital Sign” around 1988 (should not have physical pain)
• Drug companies push to “destigmatize” opiates and use them for chronic pain (1990’s);
OxyContin gains a foothold
• “Foundations” and web site funded by Purdue (drug company)
• By the 2000’s “The American pain revolution was complete”
• Result: More and more people using prescription pain reliever non-medically;
exponential increase in abuse and overdoes deaths
• SOURCE: Dreamland: the True Tale of America’s Opiate Epidemic” by Sam Quinones.
Bloomsbury Press, 2015.

30. WHAT IS THE STORY OF YOUR TYPICAL
CHRONIC PAIN/SUBSTANCE ABUSING
CLIENT?
PERSON DEVELOPS CHRONIC PAIN (FROM PHYSICAL LABOR, MILITARY SERVICE,
ACCIDENT, ETC.)
BEGIN TAKING PRESCRIBED OPIATES AND/OR OTHER SUBSTANCES
BECOMES DEPENDENT, USES THEM NON-MEDICALLY (EXPERIENCE PAIN RELIEF
AND ENERGY/EUPHORIA, SEEK MORE AND MORE TO MAINTAIN FEELING)
MAY SWITCH TO HEROIN OR SNORTING/INJECTING OTHER OPIATES
HITS BOTTOM/SEEKS HELP/ENDS UP IN MAT
THESE FOLKS NEED PSYCHO-SOCIAL REHAB, COPING SKILLS, AND CHRONIC PAIN
MANAGEMENT SKILLS
THIS IS WHERE CLINICAL ADDICTIONS SPECIALISTS ARE CRUCIAL!
Let’s hear from you!

31. TREATING CHRONIC PAIN WHEN THE
PERSON IS ACTIVELY USING:
 Presence of active addiction makes successful treatment of chronic pain
improbable. This person should be referred to formal addiction treatment.
 If the person refuses treatment, then use MI.
 If patient remains pre-contemplative, should not be prescribed scheduled
medications, except for acute pain or detoxification.
TIP 54 SAMHSA

32. Definition of MI
• “Client-centered, directive method for enhancing
intrinsic motivation to change by exploring and
resolving ambivalence” (Miller and Rollnick)
• Newly evolving definition: “a collaborative, goal-
oriented method of communication with
particular attention to the language of change. It
is intended to strengthen the person’s motivation
for and commitment to a target behavior change
by eliciting and exploring a person’s own
arguments for change.”

33. Ambivalence
• “I want to change, but don’t want to.”
• Ambivalence is normal!! (Feel two ways about
something)
• Examples: changing jobs, eating junk food,
security screening at airports, being at this
workshop, etc.
• Ambivalence can be resolved by working with
intrinsic motivation and values. Will ambivalence
(getting off the fence) be resolved by pressure or
persuasion, or by the client making the argument
for change?

34. Spirit of Motivational Interviewing
• Collaboration – a cooperate partnership that
honors the client’s perspective, conducive
atmosphere, “meeting of aspirations.”
• Evocation – drawing out client’s concerns,
wishes, hopes, goals, etc. With the idea that
motivation and resources for change reside
within the client.
• Autonomy – affirms client’s right and capacity for
self-direction, client is tasked with the job of
arguing for and implementing change.

35. Opposite polarity of MI
• Confrontation – imposing reality on the client
that the client can not see or will admit;
persuasion, argumentive stance.
• Education – counselor is the “expert” and
must fill in the gaps of client knowledge; direct
advice/prescribing solutions.
• Authority – counselor tells the client what he
or she must do; client is seen as a passive and
obedient recipient; can be coercive.

36. Principles of Motivational Interviewing
• Express Empathy
• Develop Discrepancy
• Support Self-Efficacy
• Roll With Resistance
• GOAL: Elicit change talk and commitment

37. What Makes for Change?
• Willing: problem recognition, discrepancy,
expectations.
• Able: confidence, hope.
• Ready: intention, let’s do it!
• Go to WAR on your problems!

38. Change Talk
DARN CAT
• Desire (I want to) Commitment
• Ability (I can) Activation
• Reasons (I should because) Taking Steps
• Need (I must because)

39. Stages of Change
(Prochaska/DiClemente)
• Precontemplation: not yet considering change or
unwilling/unable to change; reluctant, rebellious,
rationalizing, resigned (4 R’s)
• Contemplation: acknowledges concerns, but
ambivalent and uncertain
• Preparation: committed to and planning to make
a change
• Action: operationalizing and modifying plans
• Maintenance: sustaining changes, consolidating
gains
Stages are fluid, can go backwards or forwards!

40. Precontemplative
Contemplation
Preparation
Action
Maintenance

41. Avoiding MI Traps
A. Question-Answer Trap: using to many closed
questions
B. Taking Sides Trap: telling client’s what’s wrong,
what must do
C. Expert Trap: giving all the answers, power
differential
D. Labeling Trap: labeling or forcing diagnosis,
stigmatizing
E. Premature Focus Trap: trying to hard to hone in
one the problem
Avoid “being right” at the expense of the therapy relationship

42. Recognizing Resistance
Resistance is a sign that the client has a different view that you!
• Arguing: (challenging, discounting, hostility)
• Interrupting: (talking over, cutting off)
• Negating: (blame, excuse, minimize, deny)
• Ignoring: (inattention, non-response, side-tracking)
• Behaviors: (not following through, missing sessions)

43. Responding to Resistance
• Simple Reflection – mirroring back client statements
• Amplified Reflection – exaggerated reflection
• Double-sided Reflection – reflecting both ways of
thinking/feeling
• Shifting Focus – shift attention to common ground
• Reframing – invites a new perspective
• Agree with a Twist – offer initial agreement with change
or direction
• Emphasize Choice – remind client that only he can
change
Resistance is an opportunity!
Respond to resistance with non-resistance!

44. Core MI Skills (OARS)
• Open-ended questions
• Affirmation
• Reflective listening
• Summarizing

45. Change Talk (EARS)
Listen, respond, reinforce
• Elaborating
• Affirming
• Reflecting
• Summarizing
Recognize readiness to change!

46. Other Important Strategies
• Decisional Balance
• Developing Discrepancy
• Importance/confidence Rulers
• Values Card Sort
• Use Extremes
• Looking Back and Forth
Continue to support client’s choice to change!

47. Recognize Readiness For Action
• Decreased resistance
• Fewer statements about problem, more about
change
• Self-motivational statements
• Envisioning and/or experimenting with change
• Spontaneous change talk

48. Negotiating A Change Plan
• Goals: (changes I want to make)
• Reasons: (most important reasons)
• Steps/Strategies: (specific who, what, when,
where, how)
• Obstacles: (what could interfere, how I will
handle)
• Signs of Progress: (how will know plan is
working)
• Support: (people that can encourage/help me)

49. Maintenance of Changes
• Continue to support resolve and self-efficacy
• Maintain supportive interaction
• Assist the client to practice new skill/plan;
review status
• Know the first sign or regression, have plan in
place
• ALWAYS keep collaborative stance!

50. Overall MI Goals
• Decrease resistance, increase change talk
• Talk less than your client does
• Ask mostly open-ended questions
• Don’t ask three questions in a row
• Use complex reflections (paraphrase and
summarize)

51. Sources
1. Miller, W.R. and Rollnick. “Motivational
Interviewing” Preparing People For Change.
Guilford Press, 2013.
2. Zuckoff, A. “Motivating the Reluctant Client.”
Family Networker Symposium, 2008.
3. www.motivationalinterviewing.org
For slides 32-50

52. Telling your story
 Briefly describe your chronic pain
 When did it first begin? How?
 What is your understanding of your medical diagnosis?
 What seems to increase your pain? Decrease it?
 What do you tell yourself about your CP?
 How do you believe your CP has affected your life?
 What do you most want others to understand about your CP?
 What does your best coping with CP look like?
 What is your biggest challenge/struggle regarding your CP?
 What life experiences can you draw upon from the past that can help you
deal with your CP?
 Who are you besides someone with CP? What life roles do you participate
in? Which roles do you enjoy the most?
 What are the most helpful things others say and do? The least helpful?
#May use this slide, but must give credit to the author

53.  Chronic Pain Anonymous
www.chronicpainanonymous.org
“For those who seek to recover from the emotional and
spiritual debilitating effects of chronic pain and illness.”
“Goal is to live our lives to the fullest by minimizing the
debilitating effects of chronic pain and illness.”
12-steps are same as AA:
“powerless over our chronic pain and illness”
Step 1
“we carry the message to others with chronic pain
and illness”
Step 12

54. Practical Skills for Managing Pain
• Stretching/Exercise (obtain MD approval)
• Yoga/tai chi
• Prayer/meditation/guided imagery
• Biofeedback
• Hypnotherapy
• Sleep hygiene
• Nutrition/homeopathic
• Body posture/mechanics
• 10 steps from American Chronic Pain
Association(www.acpa.org)
• Treatments: Acupuncture, massage, physical therapy, heat
or cold packs; Pain Clinic (meds, shots, etc.)

55. Cognitive therapy
(Kenneth Smith version)
Hindering thoughts:
Demanding: “I have to fix this pain now”
“I can’t live unless I’m pain free”
“Why isn’t the doctor doing anything?
“This treatment is not working!”
RESULTS: Angry, bitter, blaming
Despair: “I might as well give up”
“I just can’t live like this.”
“I can’t do anything anymore”
RESULTS: Lose hope, withdraw, negative focus
Denial: “This isn’t happening to me”
“Maybe the next shot will fix everything”
RESULTS: Desire to escape, avoid responsibility
Drained: “I am my pain”
“I can’t try any harder”
RESULTS: Depression, over focused energy
This fear based thinking and negative interpretations may actually increase pain!
#May use this slide, but must give credit to the author

56. Cognitive therapy continued
Helping thoughts:
Living: “I choose to accept this”
“I’ll do the best I can just for today”
“I am okay with limits”
Loving: “I choose to care for myself”
“I can give and receive in healthy ways”
Learning: “I have options”
“I can learn new ways to mange my pain”
Laughing: “I am more than my pain’
“I can engage in purposeful joy and laughter.”
Other: “I don’t like the pain, but I can make meaning from it”
“My life still has much purpose”
Refocus on positive self and stop letting pain define them.
#May use this slide, but must give credit to the author

57. DOING GRIEF WORK WITH CP
SUFFERERS
A LOSS occurs when someone or something significant to us has been
removed entirely from us or has been removed to the degree that
getting it back in the same form is highly unlikely.
INTANGIBLE LOSSES: (can’t measure) loss of status, identity, etc.
TANGIBLE LOSSES: (measurable/concrete) job/career, money, etc.
PERSONAL LOSSES: people, youth, physical, mental
EXISTENTIAL LOSSES: life meaning, purpose
Questions:
How did/does CP contribute to this loss? How has it impacted me
physically, emotionally, spiritually? Have I accepted this loss? What
feelings do I have about these losses and how have I coped with these
feelings? What do I need now about these losses?
#May use this slide, but must give credit to the author

58. Dialetical Behavioral Therapy for CP sufferers (DBT):
(Marsha Linehan)
Radical acceptance: All the way, complete, and total
acceptance in mind, heart, and body.
Accepting reality as it is (in this case, chronic pain),
everything has a cause, but life can worth living even
with the chronic pain.
Rejecting reality leads to more suffering and keeps
the person stuck in bitterness, anger, and
unhappiness.
Radical acceptance is NOT approval, passivity, or
being against change.

61. RELAPSE PREVENTION
 Pain in itself is a relapse trigger!
 Watch out for return to dysfunctional thinking
 Notice any changes in self care (reduction or stop using non-
medical coping skills, not taking prescribed meds, etc.)
 Immediately deal with new stressful events or a return of an
old stressor
 Have person keep a specific list of their triggers, check
frequently
 Maintain change plan and continue to work toward goals

62. CONCLUSION
Remember, persons who suffer from chronic
pain are SUFFERING! In all likelihood, their pain
will always be with them.
Addiction professionals and other helpers can
assist these brave individuals to not only cope
with their pain, but thrive, and, as result, live a
high quality of life.
THANK YOU FOR COMING!
Kenneth Smith (chronic pain sufferer)

63. For more information, contact:
Kenneth Smith, MSW, LCSW, LCAS, CCS
ksmithlcas@gmail.com
Kenneth G. Smith is a North Carolina licensed clinical social worker, clinical
addictions specialist, and certified clinical supervisor with over 35 years clinical
experience. He is a chronic pain sufferer who finds purpose and meaning in
helping fellow chronic pain sufferers live a more effective life. Kenneth lives in
central North Carolina where he currently serves as clinical director of a non-
profit agency. He also supervises practitioners seeking to obtain clinical social
work, addictions specialist, and certified clinical supervisor credentials.