April 25, 2015

Thank You to Corporate Round Table Members

Thank you to ASAM's 2015 Corporate Round Table Members

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Media Award Winner Focuses on Prescription Drug Addiction

The Hungry Heart follows the story of Fred Holmes, MD, (right) seen with patient Dustin Machia.

The Hungry Heart follows the story of Fred Holmes, MD, (right) seen with patient Dustin Machia.

The Hungry Heart, a movie about patients struggling with prescription drug addiction seen from the perspective of a Vermont pediatrician, will receive ASAM’s 2015 Media Award at the ASAM Annual Awards Luncheon. The movie, with a discussion following, screens Saturday during ASAM Movie Night, at 8 pm in Governor’s Ballroom E, Fourth Floor.

Made by Vermont filmmaker Bess O’Brien and Kingdom County Productions, the film follows Fred Holmes, MD, who collected the stories of his patients with the assistance of one of those patients, Katie Tanner.

“They wanted to do a project highlighting the stories of these folks. They wanted to humanize them and break the stereotype of who these kids were,” said O’Brien, who directed the film. People who go through recovery and hit bottom, who go through the eye of the needle and come out the other end, are truly wise and amazing folks. It’s been an honor to be part of their lives and tell their stories.”

The movie, released in late 2013, had such an impact in his state that Vermont Governor Peter Shumlin focused his entire State of the State Address in January 2014 on prescription drug addiction, and he referenced the film several times in the address.

Bess O'Brien

Bess O’Brien

“It was amazing. It was a big deal because no governor had ever focused his State of the State on one issue, or on prescription drugs and opiate addiction,” O’Brien said. “The next day, The New York Times, The Boston Globe, CBS, NBC, Al Jazeera, etc. were focused on Vermont. The idea that the governor in the beautiful state of Vermont was talking about us having a problem was a shock to the system. He pushed the issue nationally.”

Since then, The Hungry Heart has moved from being a regional film to a national statement playing from Alaska to Arkansas to New York. A related educational package has been distributed around the world, she said.

“It is a wonderful way of putting a human face on this issue. The film continues to be booked all over the place, from small towns to cities,” O’Brien said, adding that those wanting to show the movie or have her speak at a showing can visit the Hungry Heart website.

O’Brien has a background in theater and is married to a filmmaker, so she fell into filmmaking more than 20 years ago. She has produced a variety of topical films in Vermont, where she lives, covering subjects such as misuse of opiates, domestic violence, and teenagers. Her next film will be about body image and eating disorders.

“This film came to me through Fred,” she said. “This is just one of many films. I don’t have any direct connection in my family to addiction in that way. I like revealing human stories around particular issues that are a hot topic and sometimes seen only through the eyes of sensationalism or public safety. The Hungry Heart is an intimate look at people struggling with addiction on a daily basis in their lives.

“I am interested in human stories and people’s vulnerability and going straight to the source. I like to hear from the people who are in the trenches. It fascinates me.”

ASAM’s Media Award is presented annually for excellence in print or electronic journalism. This Award is bestowed for a newspaper, magazine, television, radio or website story, column, or program that improves the public’s understanding of addiction, addiction treatment, recovery, or the profession of addiction medicine. A full listing of past award winners is available on ASAM’s website.

Claim CME Credits Using the New e-Learning Center

114x76 bannerAn important part of attending ASAM Annual Conference education sessions is earning continuing medical education (CME) credits, so remember to claim your CME hours using a new process.

ASAM recently launched its new e-Learning Center, which replaced the e-Live Learning Center. Everyone who registered for the Annual Conference or the Pain & Addiction Course automatically has a preloaded account on the e-Learning Center site.

How to Access the e-Learning Center, View Slides and Claim CME:

Go directly to the e-Learning Center, or go the ASAM home page and click on the e-Learning Center button.

Full Registrants-Annual Conference and Pain and Addiction

  1. Select Dashboard from the left menu
  2. Select the conference registered for-Check out slides
  3. Select the sessions attended-For CME
  4. Enter verification code when prompted-For CME:
  • For ASAM Annual Conference: ANNUAL2015
  • For Pain and Addiction: Common Threads XVI: PAIN2015

The CME process has changed from previous years because the new e-Learning Center is a learning management system, an upgrade from the e-Live content capture system. The new system is designed to allow more options for online learning in addition to housing conference education sessions. At the end of the Annual Conference, it will have more than 340 hours of content, and more content will be added in the near future.

You can track your CME credits or print a certificate showing the credits in the Transcript area of the site. All CME credits are archived in the Transcript area so you can go back to print a certificate at any time. You also can save the certificate as a PDF on your computer so you can print it at any time.

ASAM Annual Awards Luncheon

Several people will be recognized during the ASAM Annual Awards Luncheon, from 12:30 to 2:30 pm Saturday in Governor’s Ballroom A-C, Fourth Floor. This is a ticketed event, and tickets can be purchased at Registration.

“We use the Awards Luncheon to take an opportunity to thank our committee chairs and officers who have committed time and effort to ASAM’s mission,” said ASAM Past President Louis E. Baxter Sr., MD, FASAM. “It is an opportunity to recognize people in government who have championed our cause and who have made contributions to the advancement of addiction and addiction treatment.

“We also give young investigators awards to encourage them to become interested in addiction medicine and recognize people in the media who have produced books, movies, and documentaries that add to our visibility and the understanding of the addiction to the general public.

Awards that will be presented are:

  • Presidential Award, Alexis Geier-Horan, MPP
  • Public Policy Award, Michael P. Botticelli
  • Annual Award, Paul H. Earley, MD, FASAM
  • Annual Award, H. Westley Clark, MD, JD, MPH, CAS, FASAM
  • Annual Award, Richard K. Ries, MD, FAPA, FASAM
  • John P. McGovern Award, Mark S. Gold, MD, FASAM
  • Media Award, Bess O’Brien
  • Young Investigator Award, Crispa J. Aechbach Jachmann, MD
  • ASAM Annual Conference Program Planning Committee Award, Terry Horton, MD
  • ASAM/Millennium Research Institute Annual Conference Program Committee Award, Ashwin A. Patkar, MD, MRCPsych
  • Brinkley Smithers Distinguished Scientist Award, George F. Koob, PhD

Managing Patients with Addiction, HIV, HCV a Complex Challenge

Almost 90 percent of patients with HIV also have a hepatitis C infection (HCV), and many of these patients need to be treated for addiction, too. FDA approval of two new drugs, though, has increased the options for the complex management of these patients.

The treatment of these patients is a multidisciplinary challenge that will be explored Saturday in “Clinical Management of Substance Abusers with Co-occurring HIV and HCV Infections.” The session will be presented from 11 am to 12:30 pm in Governor’s Ballroom D, Fourth Floor.

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Jag H. Khalsa, MS, PhD

“These two new drugs are highly effective in treating hepatitis C infection to such an extent that within 12 weeks of therapy the patient is completely cleared of the virus,” said Jag H. Khalsa, MS, PhD, session organizer. “For physicians, the problem becomes ‘What should I treat first?’ Shall I treat a patient with HIV medications first, or treat the patient with HCV medications first?

“Then, should we treat these drug-abusing patients for drug dependence because they are really not very compliant with treatment protocols? So, the clinical management of this situation of drug abuse, HIV infection, and hepatitis C infection is a very complex and difficult task.”

The new drugs used to treat patients with HCV are directly acting antivirals (DAAs), sofosbuvir and ledipasvir, which can be used separately or in combination. Several other DAAs are in development but have not been approved by the Food and Drug Administration. Previously, patients with HCV were usually treated with ribavirin or gamma interferon, also called pegylated interferon.

Patients with HIV are treated using highly active antiretroviral therapy (HAART), which uses any of the 27 antiretroviral medications or combinations of two or more drugs. Patients with addiction generally are treated with methadone or buprenorphine for addiction involving opiates, and naltrexone for alcohol addiction, said Dr. Khalsa, Chief of the Medical Consequences Branch with the Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health.

Joining Dr. Khalsa to sort through these many options will be two infectious disease experts. Jeffrey H. Samet, MD, MA, MPH, Chief and Professor of Medicine, Boston University School of Medicine, will discuss pain assessment in patients with HCV. David L. Thomas, MD, MPH, Professor and Chief of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, an expert in HCV and HIV, will discuss DAA therapy.

“For the person who comes to you for addiction-related infections, this session will show what you should be aware of and how you should refer this patient for further care to an infectious disease doctor or a hepatologist or a gastroenterologist,” Dr. Khalsa said. “Both the addiction expert and the infectious disease docs need to work together on this issue of treating a complex, multidisciplinary medical problem.”

New World of Medicine Focuses on Integrating all Health Care

The evolving universe of health care is quickly moving toward more team-based treatment of patients, which will be explored for the management of addiction in “Advancing the Integration of SUD Services and Health Care.”

“This is where medicine is going—to integration of behavioral services into mainstream medicine, and vice versa,” said R. Corey Waller, MD, MS, FACEP, DABAM, the course organizer. “This course will talk about some of the practical aspects of how to do that.

“We will talk about the legislative and regulatory barriers, and, more importantly, some of the emotional barriers when trying to approach a patient with a disease that not everybody understands.”

The course will be presented from 11 am to 12:30 pm Saturday in Room 412, Fourth Floor. It will feature three other speakers discussing integrated medicine in general and specifics about how their practices use integrated approaches.

“The approach we use for integrated team-based care is also a move away from this thought of one doctor, one patient, and it is more one patient, one team,” said Dr. Waller, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan. “That team includes therapists, a physician, a medical assistant, and community health workers, and either you integrate those people into the current pathway of treatment, or you change the pathway of treatment so they can be integrated.”

Dr. Waller will discuss his clinic, which is fully integrated with behavioral health and mainstream medical treatments. The Spectrum Health Center for Integrative Medicine is not an addiction clinic, but 85 percent of its patients have a substance use disorder.

“We also treat their medical issues, their psychological issues, and their social issues, and we have been able to fully integrate that into a single platform,” Dr. Waller said. “Attendees will be able to see what it takes to integrate as far as the cost, the structure, the administrative aspects, the barriers, and lessons learned so they don’t have to re-invent the wheel in trying to do this.”

Becky D. Vaughn, MSEd, Vice President of Addictions for the National Council for Behavioral Health, Washington, DC, will discuss her group, which is a society of members who operate behavioral health programs that focus on integration.

“She will bring this national perspective to the table about what is happening in many places around the country and what are some of the barriers they have found,” Dr. Waller said.

Les Sperling, BA, LAC, is Chief Executive Officer of the Central Kansas Foundation, Salina. “He has worked with primary care practices to integrate the aspects of addiction treatment within a primary care setting,” Dr. Waller said.

Ned J. Presnall, LCSW, is Executive Director of Clayton Behavioral, Saint Louis, Missouri, which offers a variety of mental health clinical services. It uses the strategies of cognitive behavioral therapy to help clients understand the sources of their emotional distress and unwanted patterns of behavior.

“The hope is that people walk away knowing this is possible—and inevitable,” Dr. Waller said of integration. “We treat one patient, and to think we can’t do that in one system doesn’t make any sense.”

Workshop Offers Guidance on Helping Change through Motivational Interviewing

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Peter Selby, MBBS, FCFP, DABAM

Working with patients to help them decide what they want to do to solve a problem related to a chronic illness or a behavior change could be a challenge for addiction medicine specialists.

“In medicine, we are trained to fix things and tell people what to do. We’re always looking for what’s wrong with someone so we then can provide a solution,” said Peter Selby, MBBS, FCFP, DABAM, Professor of Family and Community Medicine and Psychiatry, Center for Addiction and Mental Health (CAMH) at the University of Toronto, Ontario.

Dr. Selby will present “Motivational Interviewing: Evoking Change Humanely” with Ramm Hering, MD, CCFP, MSc, Dip PH, who recently completed a fellowship at CAMH. The session will be presented from 11 am to 12:30 pm Saturday in Governors Ballroom E, Fourth Floor.

“Unfortunately, a communication style of trying to fix someone doesn’t work when you’re trying to motivate and inspire someone to address an addiction or change a behavior,” Dr. Selby said.

Motivational interviewing is a compassionate and open way of communicating to help individuals start to make changes they would not have made had they been confronted to make such changes.

A range of learners can participate—whether they are beginners or more advanced counselors. In this interactive workshop, presenters will engage learners with the spirit (compassion, acceptance, partnership, and evocation) and processes (engaging, focusing, evoking and planning) of motivational interviewing.

“They will learn by doing as opposed to learning by listening, making for a dynamic program,” Dr. Selby said. “Motivational interviewing is a trainable skill. It transforms your practice so you can inspire people rather than fight with people to change. Participants will come away with a better way to set boundaries, have compassion for their patients who aren’t able to change, and help those who are ready to overcome their ambivalence to change.”

Intimate Partner Violence Workshop Provides Tools for Intervention

In the United States, nearly one in four women report experiencing violence by a current or a former spouse or boyfriend at some point in their lives. Substance use plays a facilitative role in intimate partner violence (IPV) by precipitating or exacerbating violence.

During a 2:30 to 3:30 pm Saturday workshop in Room 410, speakers will share advances in the basic understanding of how to treat both victims and perpetrators with addiction.

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Richard G. Soper, MD, JD, MS, FASAM, DABAM

Richard G. Soper, MD, JD, MS, FASAM, DABAM, Chief of Addiction Medicine and Chair of the Board of Directors for the Center for Behavior Wellness in Nashville, Tennessee, and Hendree Jones, PhD, Executive Director of the Horizons Program and Professor of Obstetrics and Gynecology at the University of North Carolina, Chapel Hill, are the presenters.

“Most victims have a huge sense of personal shame, embarrassment, and fear. Almost all suffer from post-traumatic stress disorder and depression. A lot use substances to self-medicate,” Dr. Soper said. “There is no way we’ll ever turn some of this around if we are not willing to intervene. We need to help break the chain so the next generation realizes the behavior they have witnessed in their homes between adult companions is not acceptable.”

The workshop will provide clinicians with specialized and practical tools to competently identify past and current IPVs, make brief office interventions to assist IPV victims, and offer strategies to refer victims for subspecialty and community-based evaluation, treatment, and advocacy.

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Hendree Jones, PhD

Health care professionals need to recognize that experiences in infancy and early childhood, including trauma, provide an organizing framework for a child’s intelligence, emotions, and personality. Dr. Jones noted that the midbrains and forebrains of children who grow up in violent and abusive living situations are affected more than their cortexes.

“They enter every interaction as one that may threaten their survival,” she said. “We need to help providers recognize that abuse often starts in childhood and may be experienced in adulthood, unless we can help recognize, address and prevent the abuse.”

“We at least need to raise the level of conversation by approaching victims in a nonjudgmental way. We can use a particular vocabulary and a survey method to screen patients so we then can provide patients with tools and other options,” Dr. Soper said. “There certainly are some boundaries. A lot of situations can be volatile and even fatal, so we need to intervene and move the victim and children to a safe house immediately.”

Intimate partner violence has no discrimination, affecting heterosexuals, lesbians, gays, bisexuals, and transgender individuals equally.

“I don’t know anyone in health care who can say none of their patients have this problem,” Dr. Soper said. “We are not here to judge our patients. We’re here to help them. If my patients can be honest with me, trust me, and talk to me, then I can try to go over our options so they don’t have to be concerned financially or about their safety,” said Dr. Soper, pointing to his center’s own 12-step program that meets weekly, community health centers where they can receive care, Junior League anger management classes, and 24-hour hotlines to get immediate transportation and housing, for example.

Attendees will leave the workshop with a view of childhood trauma that can help guide assessment and intervention with IPV victims.

“We hope to educate and raise awareness so that those who participate leave knowing they can at least have an informal dialogue about how to address intimate partner violence,” Dr. Soper said.

Ruth Fox Scholars Track Growth From Attending Conference

Last year, 11 residents and medical students chosen as Ruth Fox Scholars were able to attend the ASAM conference through funding from the Ruth Fox Memorial Endowment Fund. But that scholarship can do more than punch a ticket to a meeting; it can open doors in a career.

“I think the Ruth Fox scholarship solidifies an interest many people have in working with addictive disorders,” said Brian Hurley, MD, MBA, a Ruth Fox Scholar. “It formalizes that interest within the context of addiction medicine. It goes from being an area of need you think about but don’t know how to address, to a field of medical practice with a body of knowledge and its own set of skills.”

Since being chosen as a Ruth Fox Scholar in 2004, Dr. Hurley has held numerous positions in ASAM and will be the Treasurer in 2015-17. He is a Veterans Affairs National Quality Scholar affiliated with the University of California, Los Angeles at the VA Greater Los Angeles Healthcare System.

Catherine Friedman, MD

Catherine Friedman, MD

Catherine Friedman, MD, was a Ruth Fox Scholar in 2007. Although she has attended every ASAM Annual Conference since, she still carries fond memories of that first meeting.

“Many medical societies have programs like this to bring trainees to their annual meetings. Ruth Fox could be an example to all such programs of how to do these in a way that engages the participants and pulls them into both the specialty area and the society,” said Dr. Friedman, an Assistant Professor (Clinical) at the Department of Psychiatry and Human Behavior at Alpert Medical School of Brown University.

“My involvement in ASAM has made me much more aware of general addiction issues,” she said. “I have specialized in perinatal and adolescent addictions, but being involved with ASAM has increased my awareness of the general field of addiction medicine and how issues in these subpopulations relate to addiction medicine as a whole.”

Dr. Friedman recalls being directed around the meeting by the late Max Schneider, MD, a former ASAM President and Chair of the Ruth Fox Memorial Endowment Fund.

“He was an amazing person. He said we were going to go to every single function that had to do with ASAM because ASAM brought us there,” Dr. Friedman said. “We had to get up and introduce ourselves many times, and the ASAM members were incredibly welcoming every single time. Every evening the scholars got together with Max, and he had us share what we learned during the day and what we enjoyed most about the day. It helped us get to know each other as a group and to create a community among the scholars.

“That led me into ASAM. I got involved with founding and then leading the Women in Substance Use Disorders Action Group. I also started to do presentations.”

© alexandermorozov.com

Brian Hurley, MD, MBA

Dr. Hurley agreed about the impact of the meeting on his career.

“This program gives you exposure so you learn how addiction medicine is practiced in a variety of contexts,” he said. “You see the breadth of addiction medical practice. I walked away with a lot of new ideas about how to practice addiction medicine. I learned there are all kinds of ways I could address the needs of patients with substance abuse that I hadn’t even previously considered. The only place you get that is the ASAM conference.”

More information about the scholarship program is available on ASAM’s website. This year, 10 Ruth Fox Scholars from around the nation will be attending the ASAM conference. Help continue to support this important foundational program, and help ASAM to carry forward activities aimed at improving the quality of addiction care with a generous donation to the Ruth Fox Memorial Endowment Fund.

A Promise to Keep: Ruth Fox Endowment Renews Commitment to Goal

The Ruth Fox Memorial Endowment Fund, established to secure the future of ASAM, is marking its 25th anniversary with a re-energized campaign drive—A Promise to Keep—and a reception to honor its first chair, the late Max Schneider, MD, FASAM, Saturday night.

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Andrea Barthwell, MD, FASAM, DABAM

“There is a double meaning to ‘A Promise to Keep,’ a promise to medicine that we will always be here to make sure physicians are capable and qualified to help people who suffer from this disorder and to keep our original promise to generate $10 million in the reserve fund to make sure ASAM has a sustained future to grow and expand,” said Andrea Barthwell, MD, FASAM, DABAM, Chair of the Ruth Fox Memorial Endowment Fund Committee.

When it was established, the Ruth Fox Memorial Endowment Fund’s goal was to ensure that ASAM always had adequate funding to better serve addiction medicine professionals, but the fundraising effort has plateaued about halfway to the goal. A Promise to Keep is refocusing the fundraising campaign. The endowment earnings are used to help medical students and residents attend the ASAM Annual Conference and to support other organizational priorities.

“A Promise to Keep is recognizing that we have done something, but we have not done enough,” Dr. Barthwell said. “It is recognizing that as a Society we are aging, and there are a lot of opportunities for us who have grown up in this Society to look back at our professional lives and make sure we are doing what we need to do as we wind down our careers—meaning those in my generation are making sure to take care of the Society that took care of us.”

The campaign establishes new tiers for donors, who will now be recognized as their donations grow and move to higher tiers to encourage continued giving by members. In addition, members of ASAM leadership are being asked to make financial commitments to demonstrate their support as they work with outside donors, she said.

Details of the campaign will be shared at the annual ASAM Donors/Ruth Fox Reception Saturday night (invitation-only event), when Dr. Schneider, who died last fall, will be honored. He was a Past President of ASAM and Chair of the Endowment for 22 years.

“Max was a leader in the field. He was very welcoming to all,” said Dr. Barthwell, a Past President of ASAM. “He was known for his tremendous sense of humor and his ability to be very graceful in asking for more money. He was very involved until the end of his life, and his passing was very sad.

“Max recruited me to take over, and it was quite an honor to have him ask and for the Board to appoint me to this position. I hope I can do a fraction of what he did. It is with that in mind that we have attacked with new vigor our activities to make sure our promise is kept. We have a lot of people who are trying to help us achieve our goals in carrying on the work that Max set in motion.”

Interest from the fund also is used to attract young physicians to the specialty through the Ruth Fox Scholars program, which offers scholarships to applicants to increase their opportunities to learn about the diagnosis and treatment of substance use disorders. See a related story about how being a Ruth Fox Scholar helped the careers of two ASAM members.

“Last year we doubled the number we were able to invite, and we want to continue to promote that because it is important for the growth and vitality of our Society that we attract young people to the meeting,” Dr. Barthwell said.

This year, 10 Ruth Fox Scholars are attending the Annual Conference and will be recognized during the Saturday night reception. The scholarship winners are:

  • Sarah Bur, MD
  • Jenna Butner, MD
  • Smita Das, MD, PhD, MPH
  • David Dayan-Rosenman, MD
  • Gibson George, MD
  • Aaron Greenblatt, MD
  • Michael Mirbaba, MD, PhD
  • Enrique Oviedo, MD
  • Wesley Ryan, MD
  • Zoe Weinstein, MD