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

St. Louis Cathedral, New Orleans, Lousiana

I love to visit churches. I once loved to visit castles but today churches appeal to me. I wonder at the inspiration that has given rise to such extraordinary architecture. I love the church art too. Mostly I love to sit and pray where thousands sometimes millions have come through the centuries to meditate and find communion with God alone or together.
St. Louis Cathedral has seen so much.  It’s the oldest Catholic Church in the USA.  The original place of worship was 1718 with the permanent St. Louis church at the present site since 1727.  Destroyed by fire in 1788, the Spanish church was completed in 1794 then the present church was built over the Spanish foundations and completed in 1851.  I loved the Fleur de Lis.
When I arrived for mass a wedding was taking place. I felt badly as an intruder but sat quietly until I could escape and return. But it was a blessing to see the handsome groom and beautiful bride joined in the sacrament of marriage by the priest, their whole community of friends and family so well dressed and gathered for just this occasion.  Later I came back and I gathered mass was cancelled but I was able to take photographs and light some votive candles as well.
The gift store was open and I purchased yet another rosary.  I also bought a stature of St. Joan d’Arc. Her statue was in the church and the lovely woman in the shop told me of the great statue of St. Joan d’Arc gifted to the town by France.  “St. Joan D’Arc is a special saint of New Orleans,” she told me.
General Jackson, greatly outnumbered by a British force of 10,000 won the battle of 1815 , though the war of 1812 was over by that time. Later he went to the Ursuline Convent Chapel to thank the  the nuns who had prayed all night on behalf of New Orleans.
I received a prayer from the lovely lady there which reads as thus:
“O Jesus, eternal God, I thank you for your countless graces and blessings. Let every beat of my heart be a new hymn of thanksgiving to you, O God. Let every blood circulate for you Lord. My soul is one hymn in adoration of your mercy. I love you, God, for yourself alone. Amen.