10th Annual Meeting 

December 2-5, 1999

Nassau Marriott

Nassau, Bahamas

PROGRAM CONTENTS

Conference Sessions

Many crimes are committed under the influence of drugs or may be motivated by a need to obtain money for drugs. While national crime rates in general continue to decline, drug-law violations are at an all-time high. Several issues arise concerning punishment for drug use. These individuals could be punished for using drugs, for committing a nonviolent but drug-related crime or for committing a crime while under the influence of drugs. Many persons in correctional institutions or on probation or parole have addiction problems. Primary treatments used in jails and prisons are therapeutic communities, which are very intensive treatments in which the criminal behavior and the criminal’s value systems are addressed as well as the addiction. However, treatment modalities for people on parole or probation vary widely and give the criminal justice system and the treatment providers the latitude in determining the best modality for the criminal’s substance abuse problem. This workshop will discuss the high prevalence of drug use correlated with criminal behavior and the treatments being used in the criminal justice system. Dr. James Cornich and other experts will participate.

Dr. Steven Mirin is Medical Director of the American Psychiatric Association (APA) in Washington, DC. The APA is the nation’s oldest medical specialty organization, with approximately 40,000 physician members in 77 district branches nationwide.

Dr. Mirin’s research activities have focused on the biological and psychosocial aspects of substance use disorder and on the outcomes of treatment for psychiatric patients. In 1991, he received the Presidential Award for Research from the National Association of Psychiatric Health Systems and is an elected member of the Alpha Omega Alpha Honor Society. He is the author of approximately 130 professional papers and the author or editor of seven books. He has served as a reviewer and editorial board member for a number of psychiatric journals. Dr. Mirin is also a member of the American Academy of Addiction Psychiatry.

Sports participation and observation are mainstays of American culture. Concomitant with other societal problems, a portion of collegiate and professional athletes may be vulnerable to problems with substance abuse over and above that of the general population. There have been many different responses by organized sports to deal with identification, treatment and disposition of substance problems. Dr. Pichot will present an overview of the NCAA program for substance abuse testing. Dr. Millman will describe his experiences in consulting to professional baseball and tennis. Finally, from the unique perspective of a Medical Director, Dr. Spatafora will present his experience with the NFL/NFL Player’s Association Policy and Program for Substances of Abuse, which is probably the pre-eminent program of its type in professional sports.

Workshop: Adding Treatment of Nicotine Dependence to Your Practice or Program

Addiction psychiatrists can play several roles in the treatment of smoking. First, most states are allocating significant settlement monies to the treatment of smoking. Addiction psychiatrists can assist in setting up treatment programs and infrastructure as well as supervise non-degreed tobacco dependence counselors. Second, over 50% of smokers have failed first line treatments (patch and gum) and many of these have psychiatric comorbidities including alcohol/drug problems. Addiction psychiatrists are well trained to assess and treat such treatment resistant smokers and payers are beginning to reimburse for such care. Third, increasing evidence indicates smoking-related illnesses cause a major portion of morbidity and mortality among alcohol and illicit drug abusers; many alcohol/drug abusers want to stop smoking during or soon after treatment and, for most, stopping smoking does not threaten sobriety. Thus, addiction psychiatrists need to learn to integrate offers to treat smoking into their existing practice or program.

Little research has been done regarding prevalence, diagnosis and treatment of substance abuse and use in racial and ethnic minorities. Differences in prevalences of substance abuse while present are not as great as previously thought, but substantial differences may exist for certain drugs, access to treatment and outcome.

Accreditation is an important vehicle to review and monitor organizations that deliver health care. The fluidity and dramatic changes in the nature of the health care delivery system that have occurred over the past several years have resulted in commensurate changes in the accreditation process. Many states require accreditation to become licensed or certified in that state. JCAHO accredits hospitals, psychiatric facilities, substance abuse programs, community mental health programs, ambulatory care facilities and HMOs.

This workshop will educate participants on various aspects of physician health programs, update participants on recent developments and promote the exchange of information and ideas. The history, functional aspects, legal issues, operational aspects, illnesses, treatment of physician’s substance use disorders, psychiatric leadership and research or research needs for physician health programs will be discussed.

Based on a pilot curriculum for training primary care practitioners, this workshop will allow participants to be exposed to and practice the skills needed to provide office-based treatment to stabilized opioid dependent patients. This symposium is in collaboration with the Center for Substance Abuse Treatment.

Roger Weiss, MD; Edward Nunes, MD; Jack Blaine, MD The purpose of this workshop is to help addiction psychiatrists with the development of their research ideas. Individuals who are considering a research career, or those who are in the early stages of a research career, are particularly welcome. This workshop would be appropriate for those individuals interested in developing a research project; those who have done a small amount of research but don’t know how to proceed with the development of a research career; or individuals who are confronting a clinical problem that they have thought about studying, but don’t know how to frame it as a research project. The panelists will draw on their experience in writing and reviewing grants to discuss characteristics of successful and unsuccessful proposals.

Substance use disorders in the elderly population has become an area of increasing concern over the past several years. It is unclear whether the problem is actually growing in magnitude, detection of substance use disorders in general is improving or the aging of the baby-boomers accounts for this increased attention. In any case, aging is accompanied by a unique set of stressors including retirement, health problems and higher rates of the loss of loved ones which may well contribute to the late development of substance use disorders. This symposium will provide an overview of the area of substance use disorders in the geriatric population. The prevalence estimates and clinical presentation of substance use disorders in this population will be given. Special etiologic considerations and treatment needs in the geriatric population will be reviewed. Finally, specialized treatments including considerations for both pharmacotherapeutic and psychotherapeutic options will be discussed.

This symposium will consist of a case presentation followed by brief comments by two addiction psychiatrists who are well-respected clinicians. After this, there will be a discussion period in which audience participation will be encouraged. It is hoped that reactions, concerns and treatment approaches related to the case will be shared.

Studies show that a high prevalence of HIV, Hepatitis B and C are found in Injection Drug Users (IDUs). IDUs represent a major public-health challenge. Multiple health, mental health and complex social issues must be overcome in addicted IDUs in order to treat addiction and disease transmission problems. The importance of a good knowledge base on drug abuse and its relationship to other diseases will be discussed. This symposium is in collaboration with the Center for Substance Abuse Treatment.

As an introduction, Dr. Rosenthal will briefly present some conceptual issues related to creating a structured process for determining site and intensity of care for dually diagnosed patients. Dr. Gastfriend will present data from the ASAM Criteria Validity Study, including data that suggest that patients mismatched to lower intensity services have more frequent admissions and higher resource utilization. Dr. Sowers will present his experience with the creation and implementation of LOCUS, a patient placement instrument developed with the public sector patient in mind. He will also present preliminary data from a study of the use of LOCUS. Finally, Dr. Wohlreich will illuminate covert principles underlying the decision making process in typical practitioner-driven settings, and offer explanations as to why the current base of knowledge, which would apparently serve to further clinical and administrative efficacy, does not translate into decision-making behavior.

Comparisons between inpatient and outpatient detoxification treatments, new roles of inpatient and outpatient treatment and guidelines on how to do outpatient detoxification will be discussed.

Conference Schedule

2-7 pm Registration

4:30-5:30 pm New Member Orientation

5:30-7:30 pm Special Workshop: The Criminal Justice System and Substance Abuse

7:30-9:30 pm President’s Welcome Reception

7 am-5:30 pm Registration

7 am Exhibit Hall Opens

7-8 am Continental Breakfast

8-9 am Opening Session: Steven M. Mirin, MD, Medical Director, APA

9-9:30 am Break

9:30-11:30 am Symposium I: American Sports and Substance Abuse: Identification and Treatment

11:30 am-12:30 pm Area Meetings

12:30-2 pm Share the Vision Luncheon

2-3:30 pm Concurrent Workshops and Case Consultation Sessions

3:30-4 pm Break

4-5:30 pm Concurrent Workshops and Case Consultation Sessions

5:30-7:30 pm Poster/Exhibit Reception

7:30-8:30 pm Recovery Meeting

7 am-2:30 pm Registration

7 am Exhibit Hall Opens

7-8 am Breakfast for Trainees

7-8 am Continental Breakfast

8-10 am Symposium II: Substance Use Disorders in the Elderly: Prevalence, Special Considerations and Treatment

10-10:30 am Break

10:30 am-Noon Symposium III: Case Conference: Master Clinicians

Noon-1:30 pm Lunch with the Experts

1:30-2:30 pm Symposium IV: Medical Update

This symposium is in collaboration with the Center for Substance Abuse Treatment.

2:30-3:30 pm Committee Meetings

3:30 pm Free Afternoon

7:30-8:30 pm Recovery Meeting

7 am-12:30 pm Registration

7-8 am Continental Breakfast

8-10 am Symposium V: Who Gets Treated Where: Establishing Procedures for Levels of Care

10-10:30 am Break & Check-out of Hotel

10:30 am-12:30 pm Symposium VI: Inpatient VS Outpatient Detoxification Treatments

12:30 pm Adjourn

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