Thursday, August 11, 2016

Continuing Medical Education, IDAA 2016, New Orleans, Louisiana

I love the annual IDAA conference. It was here that I met some Addiction Medicine specialists and chose to do gain my certification in ASAM, then subsequently in CSAM And ISAM. Now each year I am fortunate enough to some of my favourite academics given the most learned presentations on cutting edge topics in the field of addiction and alcoholism.
I loved hearing Dr. Penny Ziegler again. She presented last year on addiction in the LGBTQ community and this year again presented on ‘issues of shame’ and ‘acceptance’.
Dr. Mel Pohl is truly one of the greats in addiction medicine and one of my all time favourite presenters. He did a superb workshop on “mindfulness meditation” coupled with a ‘guided meditation’ for the whole group. The question and answer period with excellent and though I’m a long term meditator I was glad to be able to clarify a technical issue. Later Mel presented on “controversies in addiction medicine’ and was very comforting. Often as a clinician I feel alone in my work in the office and it’s extremely reassuring to learn that what appears a local conflict is indeed part of a greater whole.
I always love to hear Dr. David Smith, truly a great in the field of recovery. This year he spoke on confronting barriers to 12 step programs working with adolescents. He showed how the ‘language’ of the teens today actually was in line with that of the 1930’s when AA began but they use ‘different words’. Spirituality remains very important. His examples on engaging youth were delightful. But what was even more of an eye opener was the ubiquity of drug availability for youth in the Marin County middle class communities with the parents rarely aware.
Dr. Paul Early, another favourite, presented on the ASAM Criteria for treatment of the Safety Sensitive Worker. This was so timely for my own work and addressed the local concerns I was facing especially with the increasing use of marijuana in the community.
There were others. I ‘ve ordered the tapes for the ones I missed, I really had wanted to hear Dr. Barton on Implants, but I’ll hear them while driving along in my truck this winter Each year I’ve brought back CME disks and enjoyed reviewing them, making better use of traffic jams than giving in to ‘road rage’.
These are some of the bits and pieces of notes I took, more of collage for my own memory than anything relevant to others I’d believe. Still I like to blog these bits and pieces because I can’t say how many times I’ve been able to use the search engine on the blog to find the meeting notes.In them I’ll find the bit I recorded for ‘future’ reference. The blog has this search function that my previous attempts at keeping records of cme didn’t have. Thanks to the blog I can search for Dr. Earley and see what he’s lectured on in the past and appreciate all over again how much I’ve enjoyed learning from him and others.

ASAM Paul Earley
ASAM PPC -placement criteria
-followed Cleveland Criteria
- levels of care, not duration
- research evaluates outcome when matching criteria
ASAM Continuum software
ASAM Criteria new book
- safety sensitive criteria
Safety Sensitive
- power companies
- defence contracts
- public servants in police and fire
- airline pilots
- at tourneys and judges
- healthcare workers
- employees of pharmaceutical companies
Safety sensitive
- responsibility to public
- need to balance individuals rights to privacy /with public safety
- healthcare workers have potential to divert a usable substances
- safety sensitive workers who are placed in roles of authority
Motivational Model
- prochaska and diclemente model
-motivational model has 'fail first' paradigm
These premises do not apply to SSW's
- failed treatment decreases perception of safety
Treatment Setting
-safety sensitive workers
- setting should provide protection from media and section of society to whom you are responsible
-peers - help reduce shame
--- collegial support
---model of how a pilot, physician etc should comport themselves in recovery
Staff need to understand the work trauma associated with the work
- political context of the group
- monitoring and licensing agencies
Neurocognitive testing should occur
Physicians exhibit obsessive compulsive features normal for their group
- should include "collateral data collections"
Chronic management is structured as "contract"
Now called an "agreement"
Screening - urine, blood, hair, and nail
- polygraph
- group support sessions
(Cadeuceus - what it is to be a physician in recovery)
Managing Public Opinion

Overcoming Barriers to 12 step recovery in adolecent
David smith
Genetic predisposition abnormal reward system D1 & D2
Addiction is a pediatric disease. Tim Cermak MD
Barriers to youth 12 step
- parents attitude to "those" people in recovery groups; don't understand or like the steps; want cure rather than chronic disease model
- school attitudes - we don't have problem - only bad kids go to 12 steps
- bottom not a good paradigm for adolescents
YPAW groups - fun in recovery
Spirituality versus religion
12 step - help others - new identity

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