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  • A Brief Introduction to Motivational Interviewing (1.5 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    Earn 1.5 AMA PRA Category 1 Credits while learning the basics of motivational interviewing in clinical practice from this session recording from the ASAM 47th Annual Conference, Innovations and addiction medicine.

    In this 90-minute presentation, William Miller, PhD, the original developer of motivational interviewing, will describe the defining components of this clinical method as contained in the newest (3rd) edition of the textbook and briefly review research on its efficacy. This will be accompanied by a demonstration video interview and an experiential exercise to illustrate the nature of motivational interviewing.

    William Miller, PhD

    Emeritus Distinguished Professor of Psychology and Psychiatry, University of New Mexico

    Dr. William R. Miller is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico where he served as Director of Clinical Training for the doctoral program in clinical psychology and as Co-Director of the Center on Alcoholism, Substance Abuse and Addictions (CASAA). Dr. Miller's publications include over 50 books and 400 articles and chapters including the original 1983 description of the clinical method of motivational interviewing. Fundamentally interested in the psychology of change, he has focused in particular on the development, testing, and dissemination of behavioral treatments for addictions. With more than 40 years of experience in addiction research and treatment, he has served as principal investigator for numerous research grants and contracts, founded a private practice group, directed a large public treatment program, and served as a consultant to many organizations including the United States Senate, the World Health Organization, the National Academy of Sciences, and the National Institutes of Health. In recognition of his research contributions, Dr. Miller is a recipient of the international Jellinek Memorial Award, two career achievement awards from the American Psychological Association, and an Innovators in Combating Substance Abuse award from the Robert Wood Johnson Foundation. He maintains an active interest in the interface of spirituality and psychology. His books have been translated into 26 languages and the Institute for Scientific Information has listed him as one of the world's most cited scientists.

  • Transitional Maintenance of Certification (T-moc) for Addiction Medicine: What it means for the Addiction Medicine Certified Physician (1 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    Presentations will focus on the changes related to maintenance of certification and lifelong learning for the addiction medicine certified physician. Presenters will demonstrate how the T-moc program and lifelong learning serve not only as a tool to assist addiction medicine certified physicians in meeting their requirements, but also as a mechanism that will allow for continuous professional development. In addition, attendees will have an opportunity to discuss the current T-moc Program requirements and lifelong learning program in addiction medicine.

    The landscape of Maintenance of Certification (MOC) is rapidly changing and is a fundamental part of not only addiction medicine, but any specialty of medicine. Initiated by the American Board of Medical Specialties (ABMS) in 2000, MOC programs have quickly become a controversial topic among the 24 member boards of the ABMS. MOC programs are built upon professional standards, based on core competencies and assessed through a four-part framework. In order for addiction medicine certified physicians to stay abreast with the latest evidence based standards of care and medical literature, The Addiction Medicine Foundation has implemented a state-of-the-art program that allows for a more user-friendly, flexible and relevant program. As the addiction medicine specialty evolves, The Addiction Medicine Foundation will be charged with continuing to support a program that is a valuable tool in assessing physician competence, reduces the burden to physicians, and provides assurance of physician competence to the public.

    Lia Bennett

    MPH

    Lia Bennett is an independent consultant serving as the Director of Maintenance of Certification for the American Board of Addiction. She was a quality improvement program coordinator for the American College of Physicians and brings to ABAM, over 10 years of experience developing and managing MOC compliant programs. She has worked in the field of internal medicine conducting continuing medical education research in the areas of adult immunization, cardiovascular risk and diabetes. Ms. Bennett received her Masters of Public Health with a graduate certificate in Integrative Health. She strives to provide superior guidance to ABAM Diplomates.

    Robert Sokol

    MD

    Dr. Robert J. Sokol currently serves as a Distinguished Professor of Obstetrics and Gynecology and Physiology and the John M. Malone, Jr., M.D., Endowed Chair and Director of the C.S. Mott Center for Human Growth and Development at Wayne State University in Detroit, Mich. Dr. Sokol graduated with the highest distinction in philosophy and from medical school with honors from the University of Rochester in New York. After residency training at Washington University/Barnes Hospital in St. Louis, Mo., and after serving as Dr. Willard Allen's last executive Chief Resident, he served in the Air Force as a Major and then completed a fellowship at Maternal-Fetal Medicine, as well as joining the faculty, first at the University of Rochester and then at Metrohealth/Case Western Reserve in Cleveland. He worked his way up to Professor and Director of the Perinatal Clinical Research Center. Recruited as Chair of the Department of Obstetrics and Gynecology at the Wayne State University School of Medicine/Detroit Medical Center in 1983, he served as Dean and Senior Vice President for Medical Affairs from 1988 until 1999. Dr. Sokol is an internationally recognized expert in the area of fetal alcohol spectrum disorders. In 1986, he established and directed the National Institutes of Health-funded WSU Fetal Alcohol Research Center, the only center of its kind in the country at the time. He is currently focused on risk detection and prevention methodology. He is Project Manager II for services in support of the Perinatology Research Branch of the NICHD and was the founding Chair of a University Department of Clinical and Translational Science. He has about 335 referreed papers and about 1500 total publications. He is President Elect of the American Board of Addiction Medicine.

  • Recovery Ready Ecosystems - Integrating Recovery Oriented Practice Methods (1 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    As multiple paradigms shifts have occurred within the treatment of behavioral health concerns (substance use disorders, mental health concerns, and co-occuring disorders), it is paramount that primary care physicians, addiction specialists, therapists, and all practitioners of wellness become well education on integrating long-term sustained recovery practices into each level of care. The following presentation expands upon the transition away from the acute model of behavioral health treatment, exploring the full continuum of care modality.

    As multiple paradigms shifts have occurred within the treatment of behavioral health concerns (substance use disorders, mental health concerns, and co-occurring disorders), it is paramount that primary care physicians, addiction specialists, therapists, and all practitioners of wellness become well educated on integrating long-term sustained recovery practices into each level of care. The following presentation expands upon the transition away from the acute model of behavioral health treatment, exploring the full continuum of care modality. The presenters will identify innovative practice methods, such as the My Recovery is E.P.I.C. program, that have integrated into treatment facilities to expand recovery oriented systems into residential and out patient services. The presenters will go further into exploring primary and tertiary intervention methods that include primary care, recovery oriented practices, and follow-up community aftercare resources. A third exploration will include an overview of the "recovery ready ecosystems" framework that incorporates integration of primary care, behavioral health care, and aftercare with a continuum of recovery practices. Practitioners at all levels have been well educated up to this point on the disease model, successful intervention, and remission practices - but a distinct lack of recovery education has been found at most levels of practice. The presenters, as subject matter experts, hope to increase awareness of innovative programs and practices, recovery to practice initiatives, and solicit critical thinking around next stage concepts for private and public practice.

    Therese McHale

    Project Coordinator

    Therese McHale is a Project Coordinator for Young People in Recovery.

    Damien C. Warsavage

    YE-CRS, CRS

    A Japanese/Korean vocal musician by trade, Damien Christopher Warsavage, YE-CRS, CRS earned his Recovery Specialist credentials from The Council Of Southeast Pennsylvania & the Pennsylvania Certification Board in 2015 & was hired by Young People In Recovery as a Site Leader for its "My Recovery Is E.P.I.C." program in the Greater Philadelphia area as of September 2015. Supporting causes greater than his own self-interests, Mr. Warsavage is also a community leader in Upper Darby, Pennsylvania, where he has met with local leaders & elected officials regarding equitable public school funding, LGBT+ youth rights advocacy, & increased access to recovery supports for the Upper Darby School District. While he isn't providing recovery services to clients in need, Mr. Warsavage volunteers his time to PRO-ACT (an arm of The Council Of Southeast Pennsylvania) & the Philadelphia chapter of YPR, taking part in lectures, training sessions, & group/individual facilitations whenever possible.

    Damien Warsavage's passion for recovery community advocacy was born from the sudden losses of his brother, Allen Christopher, & father, John Christopher, both of whom passed away from drug-related circumstances, within a week of each other, in April 2014. It is Mr. Warsavage's greatest hope that his family's life story will empower others to turn their grief into positive change by any (productive) means necessary.

  • Women, Girls and Alcohol: Current Research on Screening and Brief Intervention (1.5 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    Drinking too much alcohol can seriously affect the health of women and girls. Excessive alcohol use increases the risk of certain types of cancers, heart disease, sexually transmitted diseases, unintended pregnancy, and many other health problems. Drinking during pregnancy can also lead to sudden infant death syndrome and fetal alcohol spectrum disorders. Screening and brief intervention is an effective strategy that can be used with women to help reduce their alcohol use and prevent alcohol-exposed pregnancies and other negative health outcomes. Targeted research projects can help us better understand the role gender may play in discussing alcohol use with women and girls and in providing appropriate prevention services. This symposium will highlight current research on screening and brief intervention in a variety of settings serving women and girls.

    Drinking too much alcohol can seriously affect the health of women and girls. Excessive alcohol use increases the risk of certain types of cancers, heart disease, sexually transmitted diseases, unintended pregnancy, and many other health problems. Drinking during pregnancy can also lead to sudden infant death syndrome and fetal alcohol spectrum disorders. Screening and brief intervention is an effective strategy that can be used with women to help reduce their alcohol use and prevent alcohol-exposed pregnancies and other negative health outcomes. Targeted research projects can help us better understand the role gender may play in discussing alcohol use with women and girls and in providing appropriate prevention services. This symposium will highlight current research on screening and brief intervention in a variety of settings serving women and girls.

    Constance Weisner

    DrPH, MSW

    Dr. Constance Weisner, DrPH, LCSW, is the Chief of Behavioral Health, Aging, and Infectious Diseases at the Division of Research, Kaiser Permanente and a Professor at the Department of Psychiatry, University of California, San Francisco. She has a doctorate in Public Health from the University of California, Berkeley and a Masters in Social Work from the University of Minnesota. She directs a research program addressing access, outcome, and cost effectiveness of substance use and mental health treatment. She is a member of the International Expert Advisory Group on Alcohol and Drug Dependence of the World Health Organization. She has also been a member of the National Advisory Council of the National Institute on Drug Abuse and of the National Advisory Council for the Center for Substance Abuse Treatment. She has participated on several Institute of Medicine committees, including Improving the Quality of Health Care for Mental and Substance-Use Conditions, and Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces. She has received Merit Awards from NIDA and NIAAA. Her on-going work focuses on integrating alcohol, drug, and mental health services with health care.

    Grace Chang

    MD, MPH

    Dr. Grace Chang is professor of psychiatry at Harvard Medical School and is currently the Director of Addiction Psychiatry for Mental Health and the Chief of Consultation Liaison Psychiatry at VA Boston. She has dedicated her clinical research career to the identification and treatment of the substance use disorders among women.

    Barbara L. Bonner

    PhD

    Barbara L. Bonner, PhD, a Clinical Child Psychologist, is a Professor and the CMRI/Jean Gumerson Endowed Chair, Director of the Center on Child Abuse and Neglect (CCAN), and Associate Director of the Child Study Center (CSC) in the Department of Pediatrics at the University of Oklahoma Health Sciences Center. Her clinical and research interests include the assessment and treatment of abused children, treatment outcome and program effectiveness, prevention of child fatalities, and treatment of children and adolescents with inappropriate or illegal sexual behavior. Dr. Bonner is Past-President of the Board of Councilors of the International Society for Prevention of Child Abuse and Past President of the American Professional Society on the Abuse of Children (APSAC). She has presented her research throughout the US and internationally.

    Andrea Kline-Simon

    MS

    Andrea Kline-Simon, MS, has worked as an Analyst and Data Consultant with the Drug and Alcohol Research Team (DART) at the Kaiser Permanente Northern California Division of Research for 8 years, on a variety of health, alcohol and drug treatment and mental health services studies, as well as epidemiological studies of vulnerable populations, including women, adolescents and patients with co-occurring disorders. She has collaborated with a number of researchers, individual clinicians, program directors and policy-makers on studies utilizing the Kaiser health system's diagnostic, utilization and cost data, as well as multi-level and longitudinal survey data. She led the analysis of an NIAAA trial examining different modalities of screening, brief intervention and referral to treatment (SBIRT) for adolescents during primary care well-visits, and is continuing to lead analyses on models of adolescent SBIRT, in a study funded by the Conrad N. Hilton Foundation. She has examined the prevalence of behavioral health conditions and co-occurring medical conditions among both adults and adolescents in Kaiser, using its electronic health record. Using longitudinal cohorts of individuals who entered treatment for alcohol use disorders, she has also led time survival analyses (DTSA) examining relapse rates between alcohol patients who were abstinent 1 year post treatment versus those who became non-problem uses, and have further examined this population by comparing differences in costs and utilization between the drinker status groups over a 5 year period.

    Heidi Hutton

    PhD

    Heidi E. Hutton, PhD is a clinical psychologist and associate professor in Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine. Her interest and expertise is in the development and implementation of person- and computer-delivered interventions to reduce alcohol and drug use among HIV infected and HIV at risk individuals. Her work includes the development of an avatar delivered, computer based intervention for substance use and testing the efficacy of text messages and interactive voice response technology for reduction of alcohol misuse among women. Her research focuses primarily on interventions for inner city women that increase safer sexual behaviors and increase HIV testing, treatment enrollment and adherence. More recently, she is has expanded her work to include two international projects, adapting evidence based interventions for HIV infected patients in Uganda and Vietnam. A key interest is the implementation of substance abuse interventions that are effective and sustainable in real world settings. As a clinician, she has provided treatment for over 20 years to HIV-infected patients with extensive histories of psychiatric disorders, trauma, and substance abuse at the Johns Hopkins HIV clinic.

    Deidra Y. Roach

    MD

    Dr. Roach has more than 30 years of experience in the field of addiction treatment. She currently serves as a Program Director for the National Institute on Alcohol Abuse and Alcoholism where, among other responsibilities, she manages research portfolios addressing the treatment of co-occurring mental health and alcohol use disorders and alcohol-related HIV/AIDS among women. She also serves on the Interagency Coordinating Committee on Fetal Alcohol Spectrum Disorders (ICCFASD) and the NIH Coordinating Committee for Research on Women’s Health. Dr. Roach chairs the Women Drinking, and Pregnancy Work Group of the ICCFASD.

  • A New Paradigm for Old Epidemics: Updates in Hepatitis C and HIV (1 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    Earn 1.0 APA PRA Category 1™ credits while learning about the latest updates in treating patients with Hepatitis C and HIV, from this conference recording at the ASAM 47th Annual Conference. Acute hepatitis C virus (HCV) infections have increased 150% from 2010 to 2013 as reported by the Centers for Disease Control. A recent CDC health advisory noted that acute HCV infection is increasing especially among young nonurban persons who inject drugs. Regional HIV outbreaks have also been documented in this same population. In the midst of the current opioid epidemic, addiction treatment providers are uniquely positioned to fight the resurgence of HCV and HIV. Recently a new paradigm for the treatment of HCV has emerged, with higher virologic response rates, shorter treatment times, and improved safety profiles compared to older interferon-based drug regimens. The psychiatric side effects, intramuscular injection, and long treatment course so strongly associated with HCV treatment will likely become obsolete concerns. The HCV/HIV care continuum is concurrently being rapidly expanded to treat at-risk populations pre- and post-infection as well. This session will also update addiction treatment providers on the new Hepatitis C and HIV medications recently approved by the FDA.

    Overview

    Acute hepatitis C virus (HCV) infections have increased 150% from 2010 to 2013 as reported by the Centers for Disease Control. A recent CDC health advisory noted that acute HCV infection is increasing especially among young nonurban persons who inject drugs. Regional HIV outbreaks have also been documented in this same population. In the midst of the current opioid epidemic, addiction treatment providers are uniquely positioned to fight the resurgence of HCV and HIV. Recently a new paradigm for the treatment of HCV has emerged, with higher virologic response rates, shorter treatment times, and improved safety profiles compared to older interferon-based drug regimens. 

    The psychiatric side effects, intramuscular injection, and long treatment course so strongly associated with HCV treatment are becoming obsolete concerns. The HCV/HIV care continuum is concurrently being rapidly expanded to treat at-risk populations pre- and post-infection as well. This session will also update addiction treatment providers on the new Hepatitis C and HIV medications recently approved by the FDA.

    Learning Objectives

    At the end of the session participants will be able to: 

    1. Identify at-risk populations in need of evaluation and/or treatment for Hepatitis C and HIV. 
    2. Describe new pharmaceutical options for treating Hepatitis C and HIV to high risk patients. 
    3. Utilize new treatment algorithms in special populations that match treatment based on severity and type of illness. 

    Soraya Asadi

    MD, DABAM

    Soraya Asadi, MD, DABAM currently serves as Medical Director of the Opioid Treatment Program and as Medical Review Officer at Hines Veterans Administration Hospital in the near western suburbs of Chicago, IL. She completed her psychiatry residency at Washington University School of Medicine in St. Louis, MO and her addiction psychiatry fellowship at the University of Illinois at Chicago. She is an assistant professor of psychiatry and program director of the addiction medicine fellowship at Loyola University Stritch School of Medicine in Maywood, IL. Dr. Asadi is board certified by the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. She is a fellow of the American Psychiatric Association, a member of ASAM Women's Action Group, and an inaugural ambassador for Shatterproof, an organization dedicated to the prevention of addiction in adolescents and young adults. Her academic interests include theories of chronic pain, Spanish for medical professionals, and the integration of medicine and psychiatry.

    Oluwaseun Falade-Nwulia

    MBBS, MPH

    Oluwaseun Falade-Nwulia, MBBS, MPH, is an Assistant Professor in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine.She focuses her clinical pursuits on care of HIV and HCV infected patients and educating clinicians and public health practitioners about STDs, HIV, and hepatitis. Her research focuses on understanding the distribution and impact of highly active antiretroviral therapy on hepatitis B and C outcomes, and on improving HIV and hepatitis C (HCV) testing and access to care in medically underserved communities.

  • Disruptive Technology in Addiction Education: Integrating Multimedia Modules into Traditional Didactic Curricula (1 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 credits while reviewing this workshop, which is primarily focused on the use of technology in medical education to assist educators to engage residents and other trainees who may at times prefer to use multimedia learning modules outside the classroom or have these integrated into their education to a greater extent. There seems to be a gap at present in the use of such innovative teaching methods in medical education and narrowing this gap may help us employ more principles of adult learning theory in our teaching.

    Disruptive technology is reshaping both traditional industry as well as education (as evidenced by the rapid success of companies like Uber, AirBNB and Khan Academy), while traditional institutions can lag behind or even oppose such technology if they are unable to integrate it. One such technology gaining popularity in the education community are multimedia-based learning modules, utilizing video content with or without interactive features. In this workshop, participants will learn how to develop their own multimedia modules, as well as ways to integrate existing multimedia into traditional teaching settings. 

    After a brief review of adult learning theory, we will discuss ways educators can integrate “off-the-shelf" video resources (pre-made video content) into their didactics using the example of motivational interviewing. Next, we will briefly review options for software that educators can use to develop multimedia content (including non-proprietary software). Participants will then view a 2-minute multimedia module that we created using Powerpoint Mix to educate trainees on buprenorphine/naloxone induction, followed by an interactive demonstration of how this priming activity (similar to “pre-reading") can be used to make greater use of adult learning theory in classroom didactics. Finally, learners will be asked to brainstorm in small groups how they might integrate such technology into a didactic session they are planning at their home institutions.

    David Marcovitz

    MD

    David Marcovitz, M.D. is a PGY4 resident in psychiatry at Massachusetts General Hospital and McLean Hospital and a clinical fellow at Harvard Medical School. He will be staying at Partners Healthcare for his addiction psychiatry fellowship. He attended the Vanderbilt School of Medicine for medical school and Princeton University for his B.A.

    John Teal

    MD

    John Teal, MD, is an Instructor at McLean Hospital/Harvard Medical School.

    Michael Bierer

    MD, MPH

    Michael F. Bierer MD MPH has been at Massachusetts General Hospital (MGH) for 30+ years. He holds the ranks of Physician there and Assistant Professor of Medicine at Harvard Medical School. He completed his MD at Albert Einstein College of Medicine in Bronx NY in 1985 and his MPH at Harvard School of Public Health in Boston MA in 1989. He completed his Internal Medicine Residency at MGH in 1988 and participated in the Addiction Medicine Fellowship in the Department of Psychiatry at Boston University Medical Center in 2001. He ran the component of Boston Health Care for the Homeless Program based at MGH from 1989-2001, has been providing integrated care for addictions in a hospital-based primary care practice since 2002, and has been a leader in the education of medical housestaff at MGH about drug and alcohol problems. He is part of the new Substance Use Disorders Iinitiative at the hospital. He is former Secretary of MASAM and serves currently as President. He is one of the podcast voices for the New England Journal of Medicine.

  • Buprenorphine Dose and Treatment Outcomes: is 16 mg/day Enough? (1 CME)

    Contains 3 Component(s), Medical Credits Offered

    Despite over 10 years of office-based treatment for opioid dependence, the optimal dose for buprenorphine therapy is still not known. In this focus session we will review existing evidence from the literature about the relationship between buprenorphine dose and treatment outcomes. We will then share results from our recent study that specifically addressed this question. We will then conclude with a discussion about optimal buprenorphine dosing for outpatient practice and methods for studying it.

    Focus Session Proposal:

    Office-based treatment for opioid dependence with buprenorphine has expanded access to treatment for individuals with opioid use disorders and has proven to be effective in a variety of settings. However, despite over 10 years of experience, there are still questions about the optimal dose for buprenorphine treatment. In this focus session, we will review existing evidence from the literature about the relationship between buprenorphine dose and physiologic measures and patient outcomes. Early studies suggested that doses of 8 to 16 mg per day of the the sublingual formulation should be sufficient and some insurers have limited access to doses higher that 16 mg/day as a result. Some guidelines have discouraged use of doses higher than 16 mg/day. However, there is growing clinical data that suggests that higher doses may lead to improved treatment retention and outcomes. This includes a recent study that we have conducted that specifically addressed this question. ¨The focus session with then conclude with an opportunity for discussion about optimal buprenorphine dosing for outpatient practice and methods for studying it. In this discussion, the relative risks and benefits of dose limits will be considered. Tension may exist between the goal of increasing treatment retention and the goal of minimizing drug diversion and cost, and these factors will be considered.

    Anthony J. Accurso, MD

    Assistant Professor of Medicine

    Anthony Accurso, MD, grew up in New York City and attended Hunter College High School. He received his B.A. with honors in Biology from Dartmouth College in 1999. He taught high school science for six years before enrolling in medical school. He completed medical school at SUNY Downstate, in Brooklyn NY in 2010. He completed his residency in Internal Medicine at Johns Hopkins Bayview in 2013, and then joined the faculty there. He is currently an Assistant Professor of Medicine in the Division of Chemical Dependence. He is an ASAM member and passed the Addiction Medicine board exam in October 2015. He is also the faculty director of Providers for Responsible Ordering, a group that promotes high-value care.

    Darius Rastegar, MD, FASAM

    Associate Professor

    Dr. Rastegar provides treatment for substance use disorders in an outpatient primary care setting and an inpatient unit. He is an Associate Professor of Medicine at Johns Hopkins University School of Medicine and is the medical director for the Chemical Dependence Unit at Johns Hopkins Bayview Medical Center. He is the co-author of The ASAM Handbook of Addiction Medicine.

  • Implementing CONTINUUM: The ASAM Criteria Decision Engine(TM) in Your Practice and System (1 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    ASAM began addressing the adversarial prior authorization process with managed care with the 1991 ASAM Criteria. After 20 years of research, ASAM has released CONTINUUM – The ASAM Criteria Decision Engine™ nationwide. This workshop will provide the practical exposure to help active clinicians and program administrators understand how to organize, introduce and use this new clinical standard for success. The workshop will review counselor and patient evaluations from the alpha, beta and national demonstration projects. Attendees will review evaluation findings, the Harvard Business School study, the national survey of state requirements, and undergo a tour of the tool. The workshop will explain how to use CONTINUUM to address the federal Parity Act and the summer 2015 federal Medicaid specifications for external third party review of all substance use disorder placements. Attendees will assess the software’s ease of use, learning curve, impact on clinical assessment and potential for managed care reform. The discussion will examine the practical issues of HIPAA and 42cfr data privacy and how these support the national patient data registry.

    Addiction assessment is in a sorry state of affairs – there's literally no standard model. Counselors use an approach that might charitably be called “intuitive". As a result, managed care utilization review nurses keep demanding more data from treatment providers – and let the telephone tag begin. Then, there is the problem of proprietary medical necessity criteria, which gives managed care companies rampant control of access to care on the basis of cost, not quality. METHOD: ASAM began addressing this with the publication of its Patient Placement Criteria, beginning in 1991. After 20 years of research, over $8 million of research and validation, and support from SAMHSA, ASAM is releasing CONTINUUM – The ASAM Criteria Decision Engine™ to the entire US treatment field. This workshop will provide the practical explanation, background, and interview experience to help active clinicians and program administrators understand how to organize, introduce and use this new clinical standard for success. The workshop will review counselor and patient evaluations from the alpha, beta and national demonstration projects. RESULTS: Attendees will review recent findings that CONTINUUM's decision engine can effectively revolutionize or even eliminate telephone prior authorizations and utilization review, as predicted by a Harvard Business School study and as currently being considered by states and county Medicaid systems across the U.S. The Workshop will review findings from a national survey of state requirements of the ASAM Criteria (more than 30 require or endorse it) and which states, counties, managed care companies and healthcare systems have shown interest in or have already begun adopting CONTINUUM™. A tour of the tool will demonstrate the counselor-ready structured interview, the intricate branched-chain algebraic decision tree that implements every adult admission criteria decision rule in the current 2013 ASAM textbook, and how CONTINUUM finally standardizes medical necessity admissions criteria. The Workshop will explain how to use CONTINUUM to meet the new requirements of the federal Parity Act for publicly available medical necessity criteria and to meet the summer 2015 federal Medicaid specifications for state Medicaid 1115 Waivers, requiring independent, external third party review of all substance use disorder placements. DISCUSSION: Through the Workshop, attendees will gain their own perception of the software's ease of use, learning curve, impact on the clinical assessment process and impact on managed care reimbursement – with both public and commercial payers. Attendees will learn how treatment systems were able to implement CONTINUUM across all adult levels of care, even achieving mandated use across all clinicians. The discussion will examine the practical issues of HIPAA and 42cfr data privacy. Finally, attendees will assess the software's potential for nationwide adoption for addiction treatment evaluation, placement and periodic re-evaluation. This includes consideration of its potential for: reforming or eliminating telephonic prior authorization and utilization review, integrating with electronic health records, and establishing a national addiction patient clinical registry.

    David Gastfriend

    MD, DFASAM

    David R. Gastfriend, MD, served on the faculty of Harvard Medical School for 25 years, most recently as Director of the Addiction Research Program at Massachusetts General Hospital (MGH). His studies of the Patient Placement Criteria published by the American Society of Addiction Medicine (ASAM) have been supported by the NIH's National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the U.S. Centers for Disease Control, U.S. state governments, managed care corporations, including Aetna Behavioral Healthcare, and foreign governments, including Belgium, Finland, Iceland, Israel, Norway, Switzerland, and the World Health Organization. The author of over 125 scientific publications, he has served on the Boards and Editorial Boards of a number of societies and journals, including ASAM and the International Society of Addiction Medicine (ISAM). He is co-editor of the leading book on treatment matching in the field, The ASAM Patient Placement Criteria for Substance-Related Disorders and editor of Addiction Treatment Matching. In addition to his role at RecoverySearch, Dr. Gastfriend is also Vice President for Scientific Communications at Alkermes, Inc. (NASDAQ: ALKS) where he is involved in research, education and scientific publication on extended-release naltrexone (VIVITROL®) and the company's efforts in the field of addiction treatment.

    Paul Earley

    MD, FASAM

    Dr. Earley has been an Addiction Medicine Physician for 30 years. He treats all types of addictive disorders and specializes in the assessment and treatment of health care professionals. As a therapist, he works with patients already in recovery, providing long term therapy for those who suffer from this disease. His professional expertise extends to advocacy for professionals before agencies and licensing boards.

    Dr. Earley is a dynamic speaker and educator; he speaks and trains on topics of addiction, its treatment and addiction among health care professionals. In addition, he trains therapists about the neurobiological basis of addiction and psychotherapy. In his travels, he has provided training in the United States, Canada, the United Kingdom, Italy and Switzerland.

    He is the author numerous books and articles on addiction and its treatment, including The Cocaine Recovery Book. He has contributed to the American Society of Addiction Medicine (ASAM) Textbook: Principles of Addiction Medicine, as author of the chapter: Physician Health Programs and Addiction among Physicians. He is also a minor author to the ASAM Criteria.

    His work was featured in the documentary series on addiction entitled Close to Home by Bill Moyers. Dr. Earley is a Fellow of ASAM and has been on the board of ASAM for over 14 years in several capacities and is currently a director-at-large. He has been the Medical Director of two nationally acclaimed addiction programs specializing in the care of addicted health care professionals. Currently, he is the Medical Director of the Georgia Professionals Health Program, Inc. and a principal with Earley Consultancy, LLC, a training and consulting firm.

    David Mee-Lee

    MD, FASAM

    David Mee-Lee, M.D. is a board-certified psychiatrist, and is certified by the American Board of Addiction Medicine (ABAM). Based in Davis, California, he trains and consults both nationally and internationally.  Dr. Mee-Lee is Chief Editor of the American Society of Addiction Medicine's (ASAM) Criteria for the Treatment of Addictive, Substance-Related, and Co-Occurring Conditions and is President of DML Training and Consulting. He is co-founder of the Institute for Wellness Education. Dr. Mee-Lee has forty years of experience in person centered treatment and program development for people with co-occurring mental health and substance use conditions.

    Desiree Crevecoeur-MacPhail

    PhD

    Desirée A. Crèvecoeur-MacPhail, Ph.D. received her doctorate from Claremont Graduate University in social psychology and master's degree in clinical psychology from Pepperdine University. She has worked in program evaluation for almost 20 years with various institutions examining areas as diverse as substance use disorder treatment, “housing first” programs, anti-hate violence/anti-discrimination educational interventions in high schools and student satisfaction with graduate school. She has worked at the University of California Los Angeles (UCLA) Integrated Substance Abuse Programs (ISAP) as a project director and research psychologist for over 15 years and is currently the Principal Investigator of the Los Angeles County Evaluation System: An Outcomes Reporting Program examining treatment engagement, retention and performance management. Dr. Crèvecoeur-MacPhail has worked with OPCC (formerly Ocean Park Community Center) as an external evaluator for several years. She is the author of over 24 papers and book chapters on topics including the treatment system in Los Angeles County, the impact of substance withdrawal on the body, how addiction affects the brain, addiction medications, the increase in use of methamphetamine for American Indians and Latinos, substance use disorder treatment effectiveness, health disparities, and program evaluation. She works with federally qualified health centers (FQHCs) to assess and improve treatment integration. She has extensive experience in health research, including quantitative and qualitative methods and outcomes measurement. In addition to her research, Dr. Crèvecoeur-MacPhail has taught at a number of colleges and universities including UCLA, California State University Dominguez Hills, Chapman University and Claremont Graduate University.

  • Population Health: The Promise, Perils, and Pitfalls of the Electronic Health Record (1 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    The mandate to adopt electronic health records (EHR) has created great promise and opportunity throughout medicine. The promise has been in efforts to meaningfully use the information contained in the EHR to improve patient safety and outcome. With this opportunity comes challenge. In this focus session, three principal investigators from the NIDA Clinical Trials Network will share their work covering the promise, perils, and pitfalls of the electronic health record as related to the identification, treatment, and privacy of patients who use alcohol, tobacco, and other drugs. Dr. Li-Tzy Wu will show a population health initiative that identifies comorbid mental health and substance use diagnoses in Type 2 diabetics. Dr. Katharine Bradley will address systems quality improvement through EHR initiatives on marijuana and alcohol screening in primary care settings. Dr. Gavin Bart will address the complexities of privacy protections in the era of the EHR and solicit audience feedback on how privacy protections are implemented within their EHR.

    The mandate to adopt electronic health records (EHR) has created great promise and challenge throughout medicine. The promise has been in efforts to meaningfully use the information contained in the EHR to improve patient safety and outcome. With this opportunity comes challenge. In this focus session, three principal investigators from the NIDA Clinical Trials Network will share their work covering the promise, perils, and pitfalls of the EHR as related to the identification, treatment, and privacy of patients who use alcohol, tobacco, and other drugs. Dr. Li-Tzy Wu will share her experience in utilizing a large EHR data warehouse with data from more than 170,000 adults to identify comorbid substance use and mental health diagnoses in patients with type 2 diabetes mellitus (T2DM). Prevalent diagnoses among adults with T2DM were mood (21.22%), SUD (17.02%: tobacco 13.25%, alcohol 4.00%, drugs 4.22%), and anxiety diagnoses (13.98%). The data sets allow for identification of risk groups in general medical settings that can be used to inform the need and structure of collaborative care models and to identify utilization patterns. Dr. Katharine Bradley will describe collaboration with health system clinical and IT leaders to integrate marijuana and drug screening into the EHR. Working in a learning healthcare environment, these partnerships have allowed over 12,000 patients to be screened in the first 6-months. She will present rates of drug and marijuana screening, rates of standardized substance use disorders assessment for high risk patients, and rates of marijuana- and drug- related discussions documented in primary care progress notes. How this process allows for greater monitoring of practice performance and impact on HEDIS measures for initiation and engagement of patients with drug use disorders in care at the level of health system, practice, and practitioner will be discussed. Dr. Bradley will also discuss the challenges of obtaining meaningful data from the EHR progress note through automated natural language processing. Given the high prevalence of marijuana use and the focus of health plans nationwide on HEDIS measures, she will facilitate an audience discussion of perceptions of primary care “best practices" for addressing marijuana use and for improving HEDIS measures. Dr. Gavin Bart will address the complexities of patient privacy protections as specified in 42 CFR Part 2 in the age of the EHR. These protections enacted more than 40 years ago could not have predicted the adoption of the EHR and the integration of addiction and general medical care. Whether 42 CFR Part 2 hampers patient safety through the segregation of medical information in EHRs or threatens the ability to improve population health through the analysis of data in EHR and claims/utilization databases will be discussed. Because there is little understanding of the variability in how the rule is interpreted by health systems, the audience will be encouraged to share their experiences in how the rule has influenced their EHR roll out and ability to track patience centered outcomes and utilization.

    Gavin Bart

    MD, PhD, FACP, DFASAM

    Dr. Gavin Bart is Director of the Division of Addiction Medicine at Hennepin County Medical Center and Associate Professor of Medicine at the University of Minnesota. He received his MD from the University of Minnesota and trained in internal medicine at the Hennepin County Medical Center. His PhD is in experimental and clinical pharmacology, also from the University of Minnesota. He trained in addiction medicine at The Rockefeller University where he continued as Director of Clinical Research until moving to Minnesota where is is co-PI of the NorthStar Node of the NIDA Clinical Trials Network. His areas of expertise include clinical pharmacology and the pharmacological management of opioid dependence. 

    His current research areas include the population pharmacokinetics of methadone, genetic influences of methadone pharmacology and treatment outcome, electronic health record privacy provisions of 42 CFR Part 2, and clinical decision support tool development for SUD. 

    He is Chair of the Life-Long Learning and Self-Assessment committee for the American Board of Addiction Medicine and is ASAM Region VI (IA, IL, IN, MI, MN, WI) director. Internationally, he is co-director of the SAMHSA-funded Vietnam HIV and Addiction Technology Transfer Center and provides ongoing technical assistance for the Substance Abuse and Mental Health Administration in South East and Central Asia.

    Ryan Caldeiro

    MD

    Ryan Caldeiro obtained his medical degree from Case Western Reserve University School of Medicine in Cleveland, OH. He then completed residency training in Psychiatry and Addiction Psychiatry from the University of Washington in Seattle. During his education and training, he participated in research studies exploring pharmacotherapies for addictive disorders and treatment outcomes for patients with co-occurring chronic pain. Upon completing training, he joined Group Health Cooperative of Washington, where he serves as the Chief of Chemical Dependency Services and Consultative Psychiatry. Group Health is both the largest medical group in Washington State, providing integrated multispecialty care, as well as the largest HMO in Washington State. In his position, he oversees clinical delivery of services for substance use disorder care within the physical healthcare delivery system and provides medical leadership in directing health plan operations as it administers chemical dependency benefits for its members within a contracted network of providers. He also oversees consultative psychiatry services. Within the medical group, he works closely with Primary Care leadership and primary care providers in evaluating and managing patients with substance use disorders and developing capacity and support for delivery of office based buprenorphine in primary care settings developing integrated behavioral health services which includes screening, assessment and population management for patients with depression and substance use disorders. He continues with research activities through the Group Health Research Institute with investigations in collaborative care models for patients with substance use disorders.

    Li-Tzy Wu

    ScD, RN, MA

    Dr. Wu is a Professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, Durham, North Carolina, USA. She received pre-doctoral and post-doctoral training in psychiatric and drug addiction epidemiology from the School of Public Health at the Johns Hopkins University, Baltimore, Maryland. She is one of the node Principal Investigators of the National Drug Abuse Treatment Clinical Trials Network.

    Katharine A.Bradley

    MD, MPH

    Katharine Bradley, MD, MPH is a general internist and health services researcher who, for the past 25 years, has conducted research on how alcohol-related care can be practically integrated into medical settings. She is Senior Investigator at Group Health Research Institute, Affiliate Professor of Medicine and Health Services at University of Washington, and Associate Investigator at Veterans Affairs (VA) Puget Sound Health Care System in the U.S. Her research has included validation of the 3-item AUDIT-C and collaboration with VA clinical and quality leaders to implement alcohol screening and brief alcohol interventions in over 900 VA sites nationwide. Ongoing research includes the NIAAA-funded CHOICE trial of nurse-delivered collaborative care for alcohol use disorders (AUDs); an NIAAA-funded study developing a patient decision aid for AUDs; and a pragmatic trial of implementation of alcohol screening, brief alcohol interventions, and shared decision making for AUDs across 25 primary care clinics in a regional integrated health delivery system in the U.S. Dr. Bradley is currently supported by an NIAAA Mid-career Mentoring Award and is a multiple PI, along with Drs. Weisner and Campbell, on the new Health Systems Node of the NIDA Clinical Trials Network. Finally, NIDA CTN has funded pilot research on marijuana and drug screening in 3 primary care clinics which Dr. Bradley will be presenting at ASAM.

  • CNS Pharmacogenetics Determine Pain Perception, Opioid Risk, Addiction Treatment and Non-Opioid Alternatives (1 CME)

    Product not yet rated Contains 3 Component(s), Medical Credits Offered

    Earn 1 AMA PRA Category 1 credits while learning about CNS Pharmacogenetics (PGx) studies of pain, addiction risk and treatment. Our goal is determining which variants (single nucleotide polymorphisms: SNPs) affect patient's pain perception, require higher analgesic doses, increase opioid risk, and affect treatment outcome. While various SNPs predict pain sensitivity and opioid risk; their value is during the acute injury before chronic pain and opioid use. The discovery of COMT SNPs grouped into low, average and high pain sensitivity haplotypes has been reproduced in clinical studies showing prolonged morbidity in high pain sensitive patients with TMJ disorders, motor vehicle accidents and postherniotomy pain. Additional SNPs include voltage-gated sodium and calcium channel variants with new non-opioid treatment. Melanocortin-1, associated with red hair, and new research correlates eye color with pain tolerance. SNPs associated with addiction include Dopamine: DRD2, ANKK1, DRD4, DBH and DAT1. GABA α 2 correlates with adult addiction, yet in adolescents, rule-breaking behaviors. Additional SNPs with opioid risk include serotonin transporter 5HTTLPR and STin2, COMT and BDNF vs. the protective effects of Vasopressin/Oxytocin system. Finally the δ and κ opioid receptors are reviewed.

    Pharmacogenetics (PGx) studies the treatment of pain management [1] addiction risk [2] and medication-assisted treatment [3]. Precision medicine focuses on single nucleotide polymorphisms (SNPs) in the DNA that encode for receptors, transporters and other CNS enzyme variants. Our goal is determining which SNPs affect patient's exaggerated pain perception [4] require higher doses of analgesics [1] and be at increased risk of opioid or other addiction [2] along with response/treatment outcome[3]. Despite isolating various SNPs, the end result depends upon multiple feedback pathways to up- or down-regulate the mRNA and production of proteins (GABA, glutamate, serotonin & dopamine receptors, transporters, etc.) within the mesocorticolimbic pathway stimulating the Ventral Tegmental Region [VTA] to Nucleus Accumbens [NAc] dopamine release, among other pathways [5]. Similarly, the feedback loop of the Raphe Nucleus on afferent nociceptive pain fibers and the Locus Coeruleus on afferent neuropathic pain fibers are integral to new discoveries of non-opioid pain treatments [6]. While various SNPs help predict pain sensitivity and risk of substance abuse; these analyses need to be done early during the acute phase of injury, or pain process. The longer a patient is on opioids stimulating NAc dopamine release, regulation feedback on RNA affects protein/receptor density. An early pain study found Catechol-o-methyltransferase (COMT) Val158Met variant having reduced activity and subsequent increased OPRM1 receptor density due to continuous dopamine bombardment down-regulating natural endorphin production [7]. The original discovery of 4 COMT SNPs grouped into three haplotypes, low, average and high pain sensitivity [4] has continued to be reproduced from the bench to the bedside in clinical studies showing exaggerated and prolonged pain in high pain sensitive patients in TMJ disorders, minor motor vehicle accidents [8] and postherniotomy pain [9] adding GTP cyclohydrolase (GCH1) to the COMT. Additional SNPs include the calcium channel complex subunit CACNA2D2, which increased sensitivity to opioid treatment [10], and the importance of voltage-gated sodium channel variants in new non-opioid pain treatments [11]. Several of these SNPs also have significant affects based upon gender [12]. Melanocortin-1, closely associated with red hair color has some equivocal findings with pain sensitivity, and new research correlates eye color with pain tolerance. Several key SNPs associated with opioid abuse and addiction includes Dopamine: DRD2, ANKK1, DRD4, DBH and DAT1 [13] but varies by the allele in regards to addiction risk vs. another allele in poor responders to buprenorphine [14] Other SNPs correlating with addiction include GABA α 2 (GABRA2) in adults, but race specific as some variants were addiction protective in African Americans [15]. In adolescents it was associated with rule-breaking behaviors that may lead to addiction vulnerability [16]. Additional SNPs with opioid risk include serotonin transporter, SLC6A4, specifically 5HTTLPR and STin2, COMT, BDNF [17] including stress-related reward affects on DA release in the NAc and protective effects of Vasopressin/Oxytocin system in reducing addiction and relapse [18]. Finally the importance of the δ and κ opioid receptors will be reviewed.

    Daniel A. Schwarz

    MD, CMRO, FASAM

    Dr. Schwarz obtained his M.D. from the University of Illinois at Chicago, and then completed his Surgery Residency at the University of Toledo, becoming Board Certified in 1994. He combined productive surgical research at the University of Michigan, while an active Level-1 Trauma Surgeon/Clinical Instructor of Surgery at the University of Toledo. After a business sabbatical, he returned to the University of Michigan where he expanded the Craniofacial Research Lab, was awarded several grants, research awards and co-authored an NIH RO1 funded grant, with Steven Buchman, MD. He mentored a dozen students, fellows and some residents.

    Recognizing increased opioid abuse in surgical and pain management patients, he pursued a formal Addiction Medicine fellowship at St. John's Brighton Hospital under John Hopper, MD, becoming Board Certified in 2010. He initiated the first prospective study correlating addiction after gastric bypass, published 2010. He became MRO certified, is CLIA high-complexity certified in toxicology, and laboratory director for office EIA and reference LC-MS/MS laboratories. He practices pain management and addiction medicine, specializing in co-occurring disorders, primarily ADHD. He was Medical Director for Summit Diagnostics, LLC, overseeing both toxicology and Pharmacogenetics (PGx), and then became Chief Medical Advisor for Iverson Genetics, educating physicians before joining Proove Biosciences as Executive Director R&D;Medical Director Pain and Addiction. He authored and was P.I. for two large IRB approved, multi-center longitudinal studies on pain and PGx, and commercialized a reproducible pain perception PGx test, originally published in 2004. He went on to develop his own PGx algorithms in pain and addiction, as Principal of JAS Consulting, LLC, and interprets genetic tests for physicians, while speaking, educating, and consulting. He is currently authoring three manuscripts: Pain Management, Addiction Medicine and PGx in Toxicology for Elsevier's Clinics in Laboratory Medicine series.

    Mark K. Greenwald

    PhD

    Mark Greenwald, Ph.D. (tenured Professor) is the Associate Chair for Research, and directs the Substance Abuse Research Division, its Human Pharmacology Laboratory and outpatient opioid treatment clinic in the Dept. of Psychiatry and Behavioral Neurosciences at Wayne State University (WSU) School of Medicine in Detroit, Michigan. He is jointly appointed in the WSU Dept. of Pharmacy Practice. Dr. Greenwald has published about 90 research papers and book chapters, and over 165 research abstracts. His research program focuses on (1) pharmacological, environmental and individual difference – including genetic – determinants of drug seeking/use as they relate to progression, persistence and relapse problems; (2) using brain-imaging techniques (e.g. PET to measure mu-opioid receptors, MRS to measure glutamate), pharmacokinetics, and behavioral phenotyping (laboratory models of drug motivation) to advance the clinical neurobiology of substance use disorders; and (3) developing novel medication and behavioral treatments for substance use disorders (e.g. opioid, cocaine and cannabis). The National Institutes on Health (NIH) has continuously funded his research since 1996. He has been principal investigator and co-investigator on many federally funded grants (especially related to opioids and buprenorphine treatment), has consulted for pharmaceutical companies related to emerging addiction medicine products, regularly reviews grant applications and has peer-reviewed manuscripts for more than 30 substance abuse and psychiatric journals. He is a past President of Division 28 (Psychopharmacology and Substance Abuse) of the American Psychological Association. Dr. Greenwald proudly mentors tenure-track junior faculty members, medical residents, postdoctoral fellows, graduate students, postbaccaulaureate, and undergraduate honors students.

    Inna Belfer

    MD, PhD

    Inna Belfer, MD PhD is a human geneticist with a primary interest in the relationship between genes and complex traits such as human pain, psychiatric diseases, and addictions. Her research focuses on identifying genetic and pharmacogenomic signatures predicting acute and chronic pain and analgesic response. Dr. Belfer is a nationally and internationally recognized expert in human pain phenotyping and genotyping as well as in modifiers of genetic effects on pain, analgesia and opioid addiction. Currently Dr. Belfer is a Clinical Analyst at the Division of Analgesic, Anesthetic and Addiction Products at the Food and Drug Administration. In addition she is an Adjunct Professor of Medicine and Human Genetics at the University of Pittsburgh, Pittsburgh, Pennsylvania and an Adjunct Professor of Neuroscience at McGill University, Montreal, Canada.