SAMHSA announces a working definition of “recovery” from mental disorders and substance use disorders

A new working definition of recovery from mental disorders and substance use disorders is being announced by the United States Substance Abuse and Mental Health Services Administration (SAMHSA). The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative.

The new working definition of Recovery from Mental Disorders and Substance Use Disorders is as follows:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

“Over the years it has become increasingly apparent that a practical, comprehensive working definition of recovery would enable policy makers, providers, and others to better design, deliver, and measure integrated and holistic services to those in need,” said SAMHSA Administrator Pamela S. Hyde. “By working with all elements of the behavioral health community and others to develop this definition, I believe SAMHSA has achieved a significant milestone in promoting greater public awareness and appreciation for the importance of recovery, and widespread support for the services that can make it a reality for millions of Americans.”

A major step in addressing this need occurred in August2010 when SAMHSA convened a meeting of behavioral health leaders, consisting of mental health consumers and individuals in addiction recovery. Together these members of the behavioral health care community developed a draft definition and principles of recovery to reflect common elements of the recovery experience for those with mental disorders and/or substance use disorders.

In the months that have followed, SAMHSA worked with the behavioral health care community and other interested parties in reviewing drafts of the working recovery definition and principles with stakeholders at meetings, conferences and other venues. In August 2011, SAMHSA posted the working definition and principles that resulted from this process on the SAMHSA blog and invited comments from the public via SAMHSA Feedback Forums.  The blog post received 259 comments, and the forums had over 1000 participants, nearly 500 ideas, and over 1,200 comments on the ideas. Many of the comments received have been incorporated into the current working definition and principles.

Through the Recovery Support Strategic Initiative, SAMHSA has also delineated four major dimensions that support a life in recovery:

Health : overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;

Home: a stable and safe place to live;

Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and

Community : relationships and social networks that provide support, friendship, love, and hope.

Guiding Principles of Recovery

Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. 

Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s). 

Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds ? including trauma experiences ? that affect and determine their pathway(s) to recovery. Abstinence is the safest approach for those with substance use disorders.

Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. The array of services and supports available should be integrated and coordinated.

Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery

Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. 

Recovery is culturally-based and influenced : Culture and cultural background in all of its diverse representations ? including values, traditions, and beliefs ? are keys in determining a person’s journey and unique pathway to recovery. 

Recovery is supported by addressing trauma : Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration. 

Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. 

Recovery is based on respect : Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. 

For further detailed information about the new working recovery definition or the guiding principles of recovery please visit:  http://www.samhsa.gov/recovery/


SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.


Wow! – I agree with this but would like to see a greater emphasis on Spirituality.

What do you think?


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Alcohol use disorders represent a substantial public health problem all over the world affecting approximately 2 billion alcohol users worldwide as estimated by the WHO in 2000.

Given the harmful effects of alcohol on the distressed individuals and society as a whole, there is an increasing urge for the development of new, more efficient medications.

Although, investigation of the mechanisms underlying the actions of ethanol in the central nervous system has been ongoing for more than a century, the exact mechanism by which ethanol exerts its effect is still a matter of debate.

In recent years, scientists discovered evidence that alcohol acts on several neurotransmitter systems in the brain to create its alluring effects.

Besides altering the release of neurotransmitters like dopamine, ethanol alters the function of a number of neurotransmitter receptors as well as transporters.

When ethanol is used for longer period of time, changes in these specific neurotransmitter functions occur possibly underlying the development of alcohol dependence.

Therefore, modulators of these targets of ethanol can be useful pharmacotherapeutic agents in the treatment for alcohol dependence.

The aim of this review is to summarize the patent background of these potential candidates clustering them according to their mechanism of effects.

Research; Nagy J. Recent patents on pharmacotherapy for alcoholism. Recent Patents CNS Drug Discov. 2006 Jun;1(2):175-206.

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Psychiatric severity and spirituality, helping, and participation in Alcoholics Anonymous during recovery.

Although helping others is a critical part of Alcoholics Anonymous (AA) and many treatment programs, measures for assessing helping and describing its relationship with sobriety are lacking.

A sample of 200 subjects completed a Helper Therapy Scale including three subscales: Recovery Helping (alpha = 0.78), Life Helping (alpha = 0.62), and Community Helping (alpha = 0.60).

A previous analysis using structural equation modeling found that length of sobriety predicted measures of spirituality, helping, and AA participation.

The analysis reported here examined whether psychiatric severity was associated with these variables.

Results indicated significant relationships between psychiatric severity and measures of spirituality (Self Transcendence, Forgiveness, Positive Coping, and Negative Coping) and AA Achievement (defined as completing the 12 steps and serving as a sponsor).

However, no relationships were found between psychiatric severity and length of sobriety, the three Helper Therapy subscales, or AA involvement.

The findings suggest that individuals with higher psychiatric severity may need assistance from their peers or professional service providers to develop a spiritual life, serve as a sponsor for others, or complete the steps of AA.

Polcin DL, Zemore S. Psychiatric severity and spirituality, helping, and participation in alcoholics anonymous during recovery. Am J Drug Alcohol Abuse. 2004 Aug;30(3):577-92.

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          Alcoholics Anonymous As a Mutual-Help Movement: A Study in Eight Societies
by Ilkka Arminen, Kim Bloomfield, Irmgard Eisenbach-Stangl, Karin Helmersson Bergmark, Noriko Kurube, Nicoletta Mariolini, Hildigunnur Olafsdottir, John H. Peterson, Mary Phillips, Jurgen Rehm, Robin Room, Pia Rosenqvist

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Study says alcohol addiction responds to the Alcoholics Anonymous 12-step program

The Alcoholics Anonymous (AA) program for beating alcohol addiction has a long history and has helped millions of people around the world back to health.

It works as a 12-step program – the Steps being the program of the system which guide the user away from their dysfunctional relationship with drink. The 12-steps involve belief in and surrender to a ‘higher’ power which the AA people always stress need not be a formal ‘God’. So does the 12-step approach work for those who are not religious?

Those enrolled in a 12-step program like Alcoholics Anonymous did better than those who did not.

Researchers at the Massachusetts General Hospital/Harvard Addiction Program studied a group of 227 alcoholics. Those enrolled in a 12-step program like Alcoholics Anonymous did better than those who did not. It is the camaraderie and support you get in the 12-step program that likely provides the benefit, the researchers say.

Source; Alcoholism: Clinical and Experimental Research August 2006

Brief-TSF will assist in referring to AA.

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Spiritual assessment

By  | Filed in Assessment, Spirituality

Spiritual assessment in biomedicine

The recent surge of interest in links between spirituality and health has generated many assessment approaches that seek to identify spiritual need and suggest strategic responses for health care practitioners.

The interpretations of spirituality made within health frameworks do not do justice to the way spirituality is understood in society in general.

Spiritual assessment should not impose a view or definition of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life.

Spiritual assessment tools should not be used without adequate exploration of the assumptions made. Assessment processes need to be adequately conceptualised and practically relevant.

In agencies organised according to biomedical priorities, spirituality is a personal coping mechanism that need not be incorporated into the health treatment plan.

Integration is the patient’s issue – patients must work out how to incorporate their experience of the biomedical system into the rest of their lives.

Social perspectives that regard spirituality as a means of social support view spiritual care as the responsibility of the cultural and religious communities supporting the patient.

Practitioners operating within a social model may be more intentional about involving these communities in care, but they still leave the decision to participate to the patient and family.

In both these approaches, it is for patients to decide whether they will seek spiritual care alongside the health care being provided.

However, spiritual care may be seen differently within a biopsychosocial framework. Here spirituality is related to quality of life and is thus one of the individual characteristics that shape health beliefs and motivations. It affects compliance and outcomes, and is thus legitimately an area of interest for clinicians.

Criteria for appropriate spiritual assessment

Spiritual assessment should thus not impose a view, let alone a definition, of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life. This implies taking seriously the idea that spirituality preserves identity and sense of self, particularly in professionalised environments, and ensuring that professional practice assessments are made within a framework that matters to the patient.

This means identifying spiritual needs and resources in ways that

  • Respect patients’ perspectives and do not infringe privacy;
  • Involve all members of the interdisciplinary team to the extent that they are able and willing to contribute;
  • Permit clear documentation of needs, strategic responses to these needs, resources required, and outcomes;
  • Integrate strategies into an overall care plan in ways that are readily understood by all members of the interdisciplinary team;
  • Provide a shared framework for continuity of care between community agencies and inpatient services; and
  • Provide a place for religious care but do not conflate spiritual issues with religious practice. While spiritual care in general may be provided by a team, specific religious care is best provided by a person from the same faith community, preferably one willing to participate in the team.

Appropriate process for spiritual assessment

Spiritual assessment must be a process, not merely an event, as it needs to take account of emergent insights and accommodate the patient’s exploration of particular issues if he or she so chooses.

The discussion here applies to health care contexts in which process is possible (such as general medical practice, community health or residential care), rather than the brief encounters of day surgery or the emergency room.

The process should begin with a form of screening, preferably one that maps significant relationships within the domain of spirituality. This screening can be carried out descriptively, noting connections as they emerge in taking patient histories and in general clinical and informal encounters by all members of the team.

For more information see; Bruce D Rumbold. A review of spiritual assessment in health care practice. Medical Journal of Australia 2007; 186 (10): S60-S62


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Teenaged girl in record store uid 1181048 Alcoholics Anonymous and Narcotics Anonymous Benefit Adolescents Who Attend

While Alcoholics Anonymous (AA) has existed for more than 70 years, and is the most commonly sought source of help for alcohol-related problems, there is little “hard scientific evidence” showing that AA and Narcotics Anonymous (NA) can improve substance-use outcomes.  This study examined how helpful AA and NA may be for adolescents, finding long-term benefits even though many youth discontinue attendance after time.

“It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA ‘intervention,’ being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way,” explained John F. Kelly, associate director of the MGH-Harvard Center for Addiction Medicine at Massachusetts.

Yet their popularity and cost-effectiveness cannot be denied, added Kelly, also the study’s corresponding author.

“AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed ‘on demand’ – particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire,” he said.

However, he added, despite growing evidence that adults benefit from AA and NA, little is known about how these abstinence-focused organizations help youth, and what is known lacks scientific rigor.  

“This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers,” said Kelly.  “Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs.  ‘Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?’”  These are the questions Kelly and his colleagues wanted to address.

The researchers recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centers in California having a focus on abstinence and based on a 12-step model.  The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.

“We found that most of the youth attended at least some AA/NA meetings post-treatment,” said Kelly.  “Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most.  The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support.”

Even though many of the youth discontinued AA/NA after time, they nonetheless appeared to benefit from attendance. 

“We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever – it weakened over time,” said Kelly.  “The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome.”

A little can go a long way, he added.  “During the first six months post-treatment,” said Kelly, “even small amounts of AA/NA participation – such as once per week – was associated with improved outcome, and three meetings per week was associated with complete abstinence.  This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes.”

Kelly believes that part of the reason for the success of AA/NA among adolescents who attend meetings is related to their developmental needs.

“Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behavior of young people,” he noted.  “When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery.  In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone.  So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities.”

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

Sandra A. Brown, Mark Myers, Ana Abrantes, Christopher W. Kahler.  (August 2008).  Social recovery model: an 8-year investigation of adolescent 12-step group involvement following inpatient treatment.  Alcoholism: Clinical & Experimental Research (ACER).  31(8).

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The Aging Alcoholic

By Lakeside | Filed in Alcohol, Alcoholism, Assessment, Demographics

The patient who abuses alcohol often is in denial about his addiction and frequently becomes unruly and obstinate as necessary detox measures and treatments are carried out. When the patient is elderly, additional issues can come into play, such as dementia and a poorly functioning immune system caused by years of drinking.

Increasing Numbers

Unfortunately, caring for elderly alcoholics is not an uncommon challenge. Studies find an increasing prevalence of alcoholism among older adults in health care settings. In fact, surveys show 6% to 11% percent of elderly people admitted to hospitals have symptoms of alcoholism, as do 20% in psychiatric wards and 14% in emergency departments.

Alcohol-related admission rates to acute care hospitals also have been found to be similar to those for myocardial infarction, and evidence shows the prevalence of problem drinking in nursing homes is as high as 49%.

Alcoholism itself can be a major concern, but when combined with medical problems associated with aging, care and treatment issues often are compounded. For instance, alcohol consumption causes more falls involving hip fractures in the elderly than would otherwise occur, due to their decreased bone density compared to elderly nonalcoholics.

Elderly drivers who have consumed alcohol are at greater risk for accidents; with age it takes less alcohol to interfere with coordination, judgment and medications.

Increased medication use and age-related liver degeneration means that older adults’ bodies cannot break down the drugs and eliminate them as quickly; this puts them at more risk to suffer adverse reactions. The heart, gastrointestinal tract, immune system and cognitive and motor functions of the brain also are negatively affected by alcohol consumption, and it has been found to increase the risk for some cancers.

Subtle Symptoms

Regardless of age, caring for a patient with alcoholism is a challenge. Unless someone reports the ED patient is an alcoholic, staff often have to look for subtle symptoms, according to Catherine Wilson, RN, a psychiatric nurse clinician at Virginia Commonwealth University Hospital, Richmond. “Most patients are not going to come to you and say they drink every day,” she said.

When a patient shows up in the ED with a fractured hip, sky-high blood alcohol level and is taking out his hostilities on caregivers, the important thing is to keep him from going into withdrawal, Wilson said. Symptoms of this can be a rising temperature, tremors, nausea and vomiting.

With the elderly, these syptoms can mean the patient may be deteriorating rapidly. He can go into delirium tremens, including hallucinations, as well as develop other symptoms—seizures, coma and even death. “People do die from alcohol withdrawal,” Wilson emphasized.

Decision Time

In the ED, many elderly alcoholic patients require surgery after a fall. The attending physician must decide what should come first, the surgery or detoxification. The anesthesiologist, in fact, may make the call to detox first, based on lab results showing magnesium deficiency and/or other abnormal values.

“Obviously, the risks of postponing any surgical intervention must be weighed against the risks of undergoing surgery,” said William J. Lorman, PhD, MSN, PsyNP, chief clinical officer at Livengrin Foundation in Bensalem, Pa., a facility caring for those requiring intervention due to alcohol or drug abuse.

Detox Measures

Wilson stressed, “There is a very fine balance with the elderly, because they tend to react to benzodiazepines [e.g., lorazepam, a commonly used detox drug], more than younger adults. Sometimes phenobarbitol is used instead.”

ED staff also must look for comorbidities such as high blood pressure and other sequelae that tend to accompany prolonged alcohol use.

“If surgery is urgent, the use of benzodiazepines will prevent withdrawal for up to 14 days,” Lorman said.

“Interestingly,” he noted, “the complications reported postoperatively are not secondary to alcohol withdrawal itself, but instead are related to infection, bleeding and delayed wound healing as a result of chronic alcohol misuse.”

By Bette Mooney who is a freelance writer and retired editor at ADVANCE.
    Handbook of Alcoholism Treatment Approaches (3rd Edition)
by Reid K. Hester, William R. Miller, Hester, Miller

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Review of the book ’Alcoholics Anonymous’

From; The NEW ENGLAND JOURNAL OF MEDICINE, Vol. 221(15), October 12, 1939

ALCOHOLICS ANONYMOUS: The story of how more than one hundred men have recovered from alcoholism. 400 pp. New York Works Publishing Co., 1939, $3.50.

The psychological aspect of alcoholism taxes the entire skill and intuition of the therapist, and the authors of this book claim that in the long run the ex-alcoholic patient who is properly trained in psychological method is an extremely effective person to bring about the cure of the neurotic alcoholic individual.

The first part of the book discusses methods, with particular stress on twelve steps in the recovery program. This program includes the general principles of psychotherapy found in such books as those by Durfee and Peabody. There is, however, an essentially new note, namely, that the alcoholic individual should be helped to admit to God, to himself and to another human being (preferably an ex-alcoholic patient) the exact nature of his personality deficit Some will perhaps shy from the emphasis on God and religion until it is realized that the alcoholic patient is asked in this relation to believe sincerely in a power greater than himself. He then sees that his life is really unmanageable without this power.

The second part contains the stories of twenty-nine individuals who were cured by the method of working out their character problems in relation to God, themselves and another human being. All these individuals were "convinced by an ex-alcoholic therapist" Those who at some time must deal with the problem of alcoholism are urged to read this stimulating account

The authors have presented their case well, in fact, in such good style that it may be of considerable influence when read by alcoholic patients.

Bloggers note; Its now sold over 25 million copies and has helped over 100 million people recover from alcoholism and about 500 other maladies – not just alcoholism.

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism

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Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals,

Abstract

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse.

The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule.

The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies.

They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Research; Cheryl Slaughter Smith. Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals, Journal of Addictions Nursing, Volume 18, Issue 2 April 2007 , pages 75 – 80


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Mutual-aid support groups play a vital role in substance abuse treatment.

In 2005, a national survey of participants in mutual-aid support groups for addiction was conducted to identify key differences between participants in various recovery groups. Extensive data was collected from survey respondents on many aspects of recovery.

In their recently published article, researchers focus on the impact of survey respondents’ level of spirituality on their recovery and their participation in mutual-aid support groups.

Key findings include:

  • Active involvement in groups significantly improves the chances of remaining clean and sober, regardless of the group (Save Our Souls, SMART, Women For Sobriety, and 12-step such as Alcoholics Anonymous) in which one participates.
  • Respondents whose individual beliefs better matched those of their primary support groups showed greater levels of group participation, resulting in better outcomes as measured by increased number of days clean and sober.
  • Spiritual respondents were more likely to actively participate in 12-Step groups and WFS, both of which have spiritual components in their programs.
  • Non-religious respondents were significantly less likely to participate in 12-Step groups.
  • Respondents with low levels of spirituality were more likely to actively participate in groups with secular programs, such as SOS and SMART Recovery.

This study provides more evidence that in recovery “one size does not fit all.” These results have important implications for treatment planning and implementation, indicating that matching clients to appropriate support groups according to their individual beliefs can have a positive impact on their program involvement and, ultimately, on their treatment outcomes.

When participants in recovery groups feel more comfortable with the philosophies of the groups they attend, they are more likely to become actively involved in these groups, which often results in longer periods of remaining abstinent from the use of alcohol and other drugs.

This research was funded by a grant from the National Institute on Drug Abuse. The survey was conducted with the assistance of The Center for Survey Research at the University of Virginia, Secular Organizations for Sobriety (SOS), SMART Recovery, and Women for Sobriety (WFS).

Reference: Atkins, R.G., Hawdon, J.E. (2007) Religiosity and participation in mutual-aid support groups for addiction. Journal of Substance Abuse Treatment, 33(3): 321-331.
      The Spirituality of Imperfection: Storytelling and the Search for Meaning
by Ernest Kurtz, Katherine Ketcham

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