Plenary Focuses on Recovery, Education

(From left) H. Westley Clark, Penny S. Mills, R. Gil Kerlikowske, Louis E. Baxter, Sr., Pamela S. Hyde, Howard Moss, Nora D. Volkow, and Donald J. Kurth.

(From left) H. Westley Clark, Penny S. Mills, R. Gil Kerlikowske, Louis E. Baxter, Sr., Pamela S. Hyde, Howard Moss, Nora D. Volkow, and Donald J. Kurth.

A group of addiction medicine leaders emphasized recovery, workforce development, and education in lectures Friday at the Opening Scientific Plenary and Distinguished Scientist Lecture.

Renowned researcher George E. Vaillant, M.D., received the R. Brinkley Smithers Distinguished Scientist Award and closed the session with his presentation “Using Occam’s Razor on Dual Diagnosis.”

The session began, though, with remarks by outgoing President Louis E. Baxter, Sr., M.D., FASAM, followed by a series of short addresses from R. Gil Kerlikowske, M.A., Director of the Office of National Drug Control Policy; Pamela S. Hyde, J.D., Administrator of the Substance Abuse and Mental Health Service Administration; Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse; Howard Moss, M.D., Associate Director for Clinical and Translational Research, National Institute on Alcohol Abuse and Alcoholism; and H. Westley Clark, M.D., J.D., M.P.H., FASAM, Director of the Center for Substance Abuse Treatment.

Kerlikowske, who became Drug Czar in 2009, said, “One area I’m particularly proud of was to open up an Office of Recovery, to have people think about recovery. So we’re not just about addiction and (drug control).” He noted the new version of the federal Drug Control Program comes out next month. “It has your voice in it. It’s an excellent document,” he said. “It will include issues dear to your heart, such as (treatment of) college students and military (personnel).”

Addressing substance abuse means confronting many tough realities, said Hyde, including rising prescription drug use in all populations; disproportionate numbers of uninsured among people with mental or substance abuse disorders; and a $2.2 billion drop in mental health funding by the states.

However, she remains confident. “We can treat it and people do recover,” Hyde said.

Noting that “we have a much more challenging disease on our hands than other fields,” Dr. Volkow said this is “a period of extraordinary opportunity and responsibility for all of us. We need to build the blocks to treat substance abuse; we need education in medical schools and specialties.”

Dr. Clark told the audience, “You can function as a linchpin” for mainstreaming addiction medicine. “It’s about making the health care field aware of addiction. Health care reform cannot progress … without addressing substance abuse disorders.

“I applaud ASAM for providing physician education,” he said. “I always like to point out that when funds were being made available for the Recovery Act, behavioral health didn’t get any money. We are the orphans of the system, but we will prevail with your help and that of organizations like ASAM.”

Dr. Vaillant’s lecture focused on whether alcoholism is the cart or the horse for depression. “Occam’s razor is a fancy way to say the bumper sticker, ‘Keep It Simple,'” he said, admitting it was impertinent for him to recommend simplifying such a complex condition. “It’s a very tough disease and I’m going to try to make it simple, which you can do from a lecture podium, but is extremely hard to do in real life.”

The simplest dual diagnosis is depression and alcoholism. “Alcoholics who go to AA and recover tend not to be depressed,” Dr. Vaillant said. “Careful work … has shown that alcohol and depression certainly are genetic illnesses, but don’t overlap.”

He presented results from his 60-year Harvard study, showing AA meeting attendance correlates with abstinence. Subjects who achieved abstinence from alcohol had attended more than 100 — in some cases 140 — AA meetings. The study also showed a 20-year period before people became abstinent.

“You don’t tell someone to stop drinking on a dime,” Dr. Vaillant said. “To stop an addiction you’ve got to have a competing behavior. You’ve got to have some way to boost a person’s hope and self-esteem. You’ve got to have some kind of supervision, because alligators don’t come when they’re called. And you’ve got to have a new source of love. You need a new trusting employer or a new person to love you, who doesn’t remember what a jerk you were — and AA is a source.”