Sunday, August 2, 2009

2009 IDAA - Continuing Medical Education

The CME this year was superb. Dr. Robert Jiminez opened with a discussion of the amazing integretation of services for the mentally ill and addicted patients in the San Antonnio area. He discussed the integration of the rehabilitation programs with the criminal justice system, the shelters for the homeless and the Mayor's Office, Mental Health and Addiction Services, and Community agencies coming together to share resources. They even have a court room set up in the rehab centre so that alcoholics and addicts who have committed offences can be dealt with more expeditiously. Amazingly the cost saving to the legal system has been in the millions by freeing up overextended resources. At lunch in the Hyatt I just happened to talk to the attractive woman beside me as we waited for the chef to stir fry our meals. She turned out to be a lawyer in the District Attorney's office and when I told her about our course expressed really positive sentiments about the improvements that all were finding came from working together. Stephen Jurd, MD from Australia had presented the experience of the Australian community with the 'addicted physician." He described the difficulties they'd had initially with a behaviouralist psychologist fond of spinning drunks to make them puke. He said "if puking was a sufficient aversive deterrent to drinking, there would be no drunks." However this had delayed the integration of addictions and alcohol treatment services initially. Further a couple of front page cases of a "butcher" doctor who'd killed several patients caught the media attention and negatively affected all physicians with difficulties. "He wasn't even an addict or mentally ill. Just a psychopathic sort and yet his story in the media made everyone fearful of any doctor who might have problems." Despite these set backs the Australians now had an excellent rehab and monitoring program . Dr. Michael Kaufman from the Ontario Physicians program had come down to help set up a model physician rehab presently operating in Victoria. They all incorporated AA but in addition had the latest in urine drug screening as well as blood monitoring.

Randle Adair, MD presented on Anorexia/Bulemia showing that the brain imaging results for Anorexia clearly showed impairment in body perception similiar to what is seen in stroke patients who disown parts of their body. Obesity however was principally an addiction which responded to the same approaches that worked so well for alcoholism. It was a superb presentation with pathos and humor and many people sharing that it really spoke to their own issues or those of their patients. The key was that Body Mass Index really did directly correlate with longevity, quality of life. So many medical and surgical illnesses and costs derived directly from over eating and eating as a substitute for love and a way to address anger and anxiety.

Dr. Gordon King gave the most in depth discussion of the Neurobiology of Addiction. With slides of rat brains from experiments, pictures of the neuropathways of reinforcement, the different drugs and how they affect Dopamine, the Amygdall and Nucleus Accumbens role in addiction, he said it all. My brain was literally reeling with the massive down load of information that he shared over a couple of days of presententation. An excellent speaker and he did his best to make the cutting edges advances in the understand clear for most of us struggling with the very ideas of down and up regulation in addition to competing neurotransmitters and membrame and intracellular sites of actions. The knowledge of this brain disease has expanded exponentially.

Dr. Author Merrell gave a clinically relevant and very helpful presentation on the Pharmacotherapy of Addictive Disorders. He began by showing how much money and effort is spent on treating diabetes and heart disease and expressed his heart felt opinion that we need to put the same effort into what is essentially a lethal and too often terminal illness. To this end he pointed to the various medications which have helped recovery. He made a strong point that these medications needed to be used as part of an overall treatment program. Just as exercise is coupled with medication in the heart programs he expressed the need to couple AA programs with medications. He discussed the proven benefits of naltrexone, topamax, buproprion, as well as looking at the future medications that are beginning to show promise. In addition he discussed sympton management of those people who despite havinga very good recovery program may need medications that themselves are potentially dangerous. In this regard he asked the audience how many judiciously used medications such as ritalin for adult ADHD, or sleep medications or even pain medications and the vast majority put up their hands. With that he talked about the pros and cons of medical intervention but overall made the strong point that in face of what is lethal a doctor needs to consider any option that shows promise when all the traditional treatments aren't working. It was an excellent thought provoking and clinically useful presentation.

Vern Williams MD discussed the difficult subject of Detox from Opiates and Benzodiazepines. The Michael Jackson story was often a topic and the fact that prescription drug abuse was so prevalent was often a topic of the meeting.

The IDAA website at has much of the material which was presented and I was glad to be able to get speaker cd's to share with colleagues who do similiar work to mine and will appreciate the update. The CME alone was worth the trip, though I think having the Alamo across the street, the River Walk of fine restaurants and great shops, seeing old friends and sharing a year of catch up as well as historical trips of Missions and riding a 2009 Harley Davidson in Texas made the learning a tad 'less dry'. In AA we distinguish just not drinking as 'dry' because the same restlessness, irritability , and discontent (RID's) remains. Sober in contrast is what comes with recovery and refers to being 'joyous, happy and free' with "life on life's terms'. The CME was exciting and enjoyable and provoked much inter meeting discussion. I'm looking forward to reading the handouts and looking up the references given.

Next year, Aug 4 - 8, 2010 this conference is in Buffalo.

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