COURSEDESCRIPTIONSANDSPEAKERBIOGRAPHIES

8:30am–9:30amEmergingIssues(Keynote)AreAlcohol-RelatedProblemsGettingWorse?Numbers,Neuroscience,andNIAAAGeorgeF.Koob,Ph.D.Director,NationalInstituteonAlcoholAbuseandAlcoholism(NIAAA)Dr.Koobwillprovideinformationaboutthescopeandcostofalcohol-relatedproblemsintheU.S.today.Changesintheprevalenceandcharacteristicsofalcohol-relatedproblemsoverthepasttwentyyearswillbediscussed,alongwithreasonsforthechanges,assuggestedbyresearch.Dr.Koobwilldescribethepathologyofaddiction,ingeneral,andasitappliestoalcoholuse.Thethreestagesinthealcoholaddictioncyclewillbepresentedalongwiththebrainregionsandneuralcircuitsassociatedwitheachstage.Dr.Koobwilldiscusstheimpactofthethreestagesontheuser’sbehavioral,emotionalandfunctionaldomains.Hewillexplainhowhavinganeurobiologicaldisorderframeworkforalcohol-relatedproblemsbenefitsdiagnosis,treatment,andrecoveryandwillprovideperspectiveonthequestion“Isalcoholismachoice?”Dr.KoobwillprovideinformationabouttheNIAAAandthegoals/contributionsmadebythatinstitutiontohelpingcliniciansbetterunderstandandtreatalcohol-relatedproblems.HewilldiscusscurrentNIAAAareasofresearch,emergingissueswiththechanginglandscapeofaddictionintheU.S.,theNIAA’sstrategicplan,anddevelopmentofTheTreatmentNavigator.

GeorgeF.Koob,Ph.D.isaninternationally-recognizedexpertonalcoholandstressandtheneurobiologyofalcoholanddrugaddiction.HeistheDirectoroftheNationalInstituteonAlcoholAbuseandAlcoholism(NIAAA)whereheprovidesleadershipinthenationalefforttoreducethepublichealthburdenassociatedwithalcoholmisuse.AsNIAAADirector,Dr.Kooboverseesabroadportfolioofalcoholresearchrangingfrombasicsciencetoepidemiology,diagnostics,prevention,andtreatment.Dr.KoobearnedhisdoctorateinBehavioralPhysiologyfromJohnsHopkinsUniversityin1972.PriortotakingthehelmatNIAAA,heservedasProfessorandChairoftheScrippsCommitteeontheNeurobiologyofAddictiveDisordersandDirectoroftheAlcoholResearchCenterattheScrippsResearchInstitute.Earlyinhiscareer,Dr.Koobconductedresearchinthe

SanDiegoPsychologicalAssociation2018FallConferenceSaturday,October27,2018EncounteringSubstanceUseinClinicalPractice:EmergingIssuesandDivergentPerspectives

DepartmentofNeurophysiologyattheWalterReedArmyInstituteofResearchandintheArthurViningDavisCenterforBehavioralNeurobiologyattheSalkInstituteforBiologicalStudies.Hewasapost-doctoralfellowintheDepartmentofExperimentalPsychologyandtheMRCNeuropharmacologyUnitattheUniversityofCambridge.Dr.Koobbeganhiscareerinvestigatingtheneurobiologyofemotion,particularlyhowthebrainprocessesrewardandstress.Hesubsequentlyappliedbasicresearchonemotions,includingontheanatomicalandneurochemicalunderpinningsofemotionalfunction,toalcoholanddrugaddiction,significantlybroadeningknowledgeoftheadaptationswithinrewardandstressneurocircuitsthatleadtoaddiction.Thisworkhasadvancedourunderstandingofthephysiologicaleffectsofalcoholandothersubstanceuseandwhysomepeopletransitionfromusetomisusetoaddiction,whileothersdonot.Dr.Koobhasauthoredmorethan700peer-reviewedscientificpapersandisaco-authorofTheNeurobiologyofAddiction,acomprehensivetextbookreviewingthemostcriticalneurobiologyofaddictionresearchconductedoverthepast50years.Dr.Koobistherecipientofmanyprestigioushonorsandawardsrecognizinghiscontributionstoresearch,mentorship,andinternationalscientificcollaboration.In2017Dr.KoobwaselectedtotheNationalAcademyofMedicine(NAM).In2016thegovernmentofFranceawardedDr.KoobwiththeinsigniaofChevalierdelaLégiond’honneur(KnightoftheLegionofHonor)fordevelopingscientificcollaborationsbetweenFranceandtheUnitedStates.Inaddition,hehasreceivedtheResearchSocietyonAlcoholism(RSA)SeixasAwardforextraordinaryserviceinadvancingalcoholresearch;theRSAJellineckaward,theRSADistinguishedInvestigatorAward;theRSAMarlattMentorshipAward;theDanielEfronAwardforexcellenceinbasicresearchandtheAxelrodMentorshipAward,bothfromtheAmericanCollegeofNeuropsychopharmacology;theNIAAAMarkKellerAwardforhislifetimecontributionstoourunderstandingoftheneurobiologyofalcoholusedisorder;andaninternationalprizeinthefieldofneuronalplasticityawardedbyLaFondationIpsen.9:30am–10:30amEmergingIssues(Plenary)RedAlert:TheDualCrisesofPainandPrescriptionOpioidsBethD.Darnall,Ph.D.ClinicalProfessor,DepartmentofAnesthesiology,StanfordUniversityMedicalSchool

Dr.Darnallwilldescribetherecentdualcrisesofpainandprescriptionopioidsandwheretheyintersect.Shewilldistinguishaspectsoftheopioidcrisis(addictionvs.misusevs.opioiddependenceintheabsenceofaddictionormisuse)andwillpresenttheroleofmedicalprescribingandtheroleofpsychologyascriticalsolutionstoeffectivelyreducepatientrisksandthepublichealthcrisesathand.Shewilldiscussthebroaderneedsofthealmost18millionAmericansthataretakinglong-termprescriptionopioidsrightnowintheU.S.Dr.Darnallwillpresentthelatestevidenceonopioidreductionstrategiesbeingimplementedinnationallyfundedpragmaticclinicaltrials(thespeakeristhePIforthiswork)thatincludetheintegrationofevidence-basedpsychologicaltreatmentstofacilitatepatient-centeredness.

BethD.Darnall,Ph.D.isClinicalProfessoratStanfordUniversityintheDepartmentofAnesthesiology,PerioperativeandPainMedicine,andbycourtesy,PsychiatryandBehavioralSciences.Sheisprincipalinvestigatorfor$13Mincurrentnationalpainandopioidreductionresearchawards.Sheinvestigatesmechanismsofpsychologicalfactors,targetedpainpsychologytreatmentsanddigitaltreatmentsshehasdevelopedtoreducepost-surgicalpainandopioiduse,andcommunity-basedpatient-centeredopioidtapering.In2018heropioidtaperingresearchwaspublishedinJAMAInternalMedicineandreceivedanationalawardfromtheAmericanAcademyofPainMedicine.Shedeliverspainpsychologyandopioidreductionlecturesandworkshopsnationallyandinternationally.

Dr.Darnallisauthorofthreebooks:TheOpioid-FreePainReliefKit(2016);LessPain,FewerPills:Avoidthedangersofprescriptionopioidsandgaincontroloverchronicpain(2014);andPsychologicalTreatmentforPatientswithChronicPain(2018).Shespokeatthe2018WorldEconomicForum(Davos,Switzerland)onthepsychologyofpainrelief,andhasbeenfeaturedinmajormediaoutlets,includingOMagazine,Forbes,ScientificAmerican,TheWashingtonPost,BBCRadio,NatureandTIMEMagazine.10:50am–11:50amEmergingIssues(Plenary)TheDemiseofDreamland:SocioculturalRootsoftheU.S.OpiateCrisisSamQuinones,InvestigativeJournalistAwardWinningAuthorDreamland:TheTrueTaleofAmerica’sOpiateEpidemicSamQuinones,anotedhealthjournalistwithextensiveexperiencecoveringthenarcotictradewillpresenttheinvestigativejournalismworkunderlyinghis2015awardwinningbookDreamland:TheTrueTaleofAmerica’sOpiateEpidemic.ThisbookisanaccountoftherecentspreadofopiateaddictiontohundredsofsmallruraltownsandsuburbsacrossAmericawithdevastatingimpactonthosecommunities.Thespeaker’sjournalisticeffortdescribesthreemainsocioculturaldevelopmentsthatservedastherootsforthecurrentopiateepidemic.First,Mr.Quinonesdiscussestheevolutioninmedicalpolicyoverthepastthirtyyearsregardinguseofopiatesforpainreliefandwhetheropiatesareaddictive.Hediscusseskeyeventsandinfluencesdeterminingsignificantchangesinmedicalpolicyandpracticeandvariousfactorsunderlyingthisevolution.Second,Mr.Quinonescharacterizestheattitudesandbehaviorofpharmaceuticalindustriesduringthisperiodofdevelopingandmassmarketingopiatemedicationswithgreaterpotencyandaddictivepotential,reachingnewareasofthecountry.Third,Mr.QuinonesrecountsthemassiveinfluxofblacktarheroinfromoneregioninMexicowhichassaultedsmalltownandmid-sizedcitiesacrossthecountry,includingruralareaspreviouslyprotectedbyvirtueoftheirremotenessandisolation.Thisstreetheroininfluxcameontheheelsofthecoincidentexplosionofincreasedmarketinganduseofprescriptionopiates.Whenopiateprescriptionsranoutorbecameunaffordableforusersovertime,thereadysupplyofrelativelyinexpensivestreetheroinwasathandtofillthevoid.Manyusers,bynowdependentontheirregularuseofopiates,switchedtothecontrabandsupplywithitsmanyinherentrisks.Finally,tosummarize,analyze,andconclude,Mr.Quinonesexploresthedeeper,more“existential”rootofopiateoverusebyintegratingallofthesesocialandeconomicpressures,alongwiththeexplosionoftechnology,intoanunderlyinglossofcommunityformanypeopleintheU.S.Theresultingalienation,lossofimportantrelationshipnetworks,andsocioeconomicdeprivationformedariskprofilethatmadeithardtoresisteasypainrelieffromsubstances.ThespeakerwillendbypresentingpossiblesocioculturalsolutionstothiscorrosivethreatthatAmericacontinuestoface,withtheaimofmitigatingthepredisposing,precipitatingandperpetuatingfactorsfuelingindividualaddictionsandthus,ournation’sdevastatingopiatecrisis.Note:Becauseofthevolumeofinformationtobecovered,thiscoursewillbeconductedinaninterviewformatwithDr.MaryMulvihill,ConferenceCo-Chair,whowillpromptthedifferentdomains,andstructurethepresentationtobesurethatallareasarecoveredinthetimeallotted.

SamQuinones,aveteraninvestigativeandphotojournalist,isoneofthenation’stopexpertsregardingimmigration,narcoticstrafficking,andsocioculturalissuesinMexico,specializingthroughouthisdistinguishedjournalismcareerintheseareas.AftertheU.S.opiatecrisisburgeoned,hecameoutofretirementtodelveintoexplainingthisunprecedentedphenomenon.Theresultsofhisinvestigationwerecompiledintoanaward-winningtomewhichexplainstheevolutionofavarietyofunrelatedactorswhichcametogetherina“perfectstorm”tocreatethepresentopiateepidemicintheU.S.Hehaslecturedatmorethan50universitiesacrosstheUnitedStatesandheistheauthorof4booksonsocioculturalissuesinMexico.Sam’sthirdbook,Dreamland:TheTrueTaleofAmerica’sOpiateEpidemicwonthe2015NationalBookCriticsCircleAwardforGeneralNon-Fiction.12:55pm–1:55pmDivergentPerspectives–ConceptualizingTheProblem(BreakoutSession)MarijuanaPost-Legalization:NewLandscape,NewLandminesSusanD.Writer,Ph.D.,ClinicalEducationandPublicAffairsOfficer,AuroraBehavioralHealthCare

Dr.Writerwillexplorethelogistic,legal,evaluative,andclinicalimplicationsofthelegalizationofcannabisinCalifornia.Logistically,wewilldiscussthepotencyoftoday’scannabis,thedifferentmodesofingestionofcannabisproducts,theramificationsofcannabisnotbeingregulatedbytheFDA,andthedifferentialeffectsonthebody,brain,andoverallfunctioning.Dr.Writerwilladdressthediscrepancybetweenfederalandstatelaws,legalissuesaroundimpaireddriving,work-placedrugpolicies,andtherestrictionsaroundthepurchaseanduseofcannabis.Shewillexaminehowcannabisusemaybefactoredintotheevaluationprocessandpotentiallyinformrecommendationsaboutfitness,competency,capacity,disability,orothercriteriaforwhichtheevaluationisbeingmade.Dr.Writerwillidentifypossiblecannabis-druginteractions,cannabis-inducedsymptoms,andexaminehowcannabisinteractswithpsychological,interpersonal,andoverallfunctioningofindividualsandfamilies.

SusanD.Writer,Ph.D.hasherdoctorateinclinicalpsychologyfromAlliantInternationalUniversityandisaRegisteredPsychologicalAssistant.SheistheClinicalEducationandPublicAffairsOfficerforAuroraBehavioralHealthCare(ABHC),anacutein-patientpsychiatrichospitalinSanDiegothattreatschildren,adolescents,adults,andseniorsstrugglingwithmentalillnessandsubstanceabuse.Inaddition,sheseessubstanceuseandmentalillnessclientsinprivatepractice.Dr.Writerisexperiencedinworkingwithfamiliestohelpthemnavigatecomplexmentalhealthtreatmentsystemsandtodevelopresourcesinthecommunitytomanagesubstanceuseandmajormentalhealthconditionsrecovery.Inadditiontomajormentalillness(depression,bipolardisorder,anxietydisorders)Dr.WriterhasaspecialtyfocusinSubstanceUse,particularlycannabisuse,inteensandadults.InherroleasacommunityoutreachspecialistatABHC,Dr.Writerspeakswidelyonthetopicofcannabisuseanditsmanyeffectstoprofessionalgroups,ofteninconjunctionwithSanDiegoSuperiorCourtJudgesfrom“DrugCourt”.Shehasgivenanumberofwellreceivedcommunitytalks,includingGoingGreen:ImplicationsofMarijuanaLegalizationinMediation,presentationatDivorceMediationGroupMonthlyMeeting,andatWesternStatesMarijuanaSummit2017;GoingGreen:CannabisUseinVeterans,presentationatSanDiegoVeteransAssociationAnnualSocialWorkRetreat;TeenDrugUse&TrendsinSanDiego,full-daytrainingatBehavioralHealthEducation&TrainingAcademy,YouthandFamilyServicesContract;TheEffectsofMentalIllnessorSubstanceUseonCustodyRecommendations,presentedattheSanDiegoFamilyLawBar–SanDiegoCAMFTLuncheon;Co-OccurringIllness:WhateveryfamilymemberneedstoknowaboutlovedoneswhohavementalhealthANDsubstanceuseissues,presentationtoNationalAllianceforMentalIllnessNorthCoastalChapterand2016CommunityAlliancefor

HealthyMindsConference;PreventionandEarlyIntervention:WhatCollegeCampusProvidersNeedtoKnowAboutMarijuana.Dr.Writerhasexperienceintrainingmedicalandmentalhealthprofessionals,lawenforcementandfamilylawprofessionals,howtoevaluatewhenmarijuanausebecomesproblematic(inanydomain),andhowtofactorinmarijuanauseinmentalhealthevaluations,especiallytriageforacuteandresidentialcare.Inadditiontohercommunityeducationrole,Dr.WriterchairstheABHCClinicalCESeriesformentalhealthprofessionalsandnurses.ShealsocurrentlyisaninstructorandconsultantfortheNavyDrugandAlcoholCounselorsSchoolinPointLoma,SanDiegoStateUniversitySchoolofSocialWork,BehavioralHealthEducation&TrainingAcademy(BHETA),AcademyforProfessionalExcellence&CulturalCompetencyAcademy,CaliforniaStateUniversitySanMarcosSchoolofNursing,andArgosyUniversity.Dr.WriterisactiveinthecommunitywithlocalprofessionalgroupsrelatedtoSubstanceUse.SheservedasPresidentoftheNationalCouncilforAlcoholandDrugDependence,SanDiegoChapter(NCADD)from2009-2010.ShebeenontheBoardofDirectorsoftheSocietyforAddictionProfessionals(SOAP),SanDiegochapterandisalsoanactivememberofSmartApproachestoMarijuana(SAM),theSanDiegoCountyMethStrikeForce,theNorthCityCommunityCoalition,DrugFreeCommunityCoalitionforSanDiegoCity,theSanDieguitoAlliance,DrugFreeCommunityCoalitionforDelMar,Encinitas,Carlsbad,Oceanside,andRanchoSantaFe,andtheSafetyWellnessAdvocacyCommunityCoalition(SWACC),DrugFreeCommunityCoalitionforPoway,RanchoBernardo,andRanchoPenasquitos.Dr.Writeroftenisinvitedandservesoncommunityboardsorcoalitionswhereexpertiseinmentalhealthandsubstanceuseisneededbyvariousorganizationsorhealthcarefacilities,assheisanexperiencedspeakerandadvocateonthesetopics.12:55pm–1:55pmDivergentPerspectives–ConceptualizingTheProblem(BreakoutSession)TheInsidiousEpidemic:HowBenzodiazepinesStealLivesKristaRoybal,M.D.,AddictionMedicine/Psychiatry,Founder/Director,TrueLifeCenter,LaJollaWhileincreasedpublicawareness,legalrestrictions,andamultitudeofinterventionshaveledtoadramaticdropinthenumberofprescriptionsforopiatepainkillers;benzodiazepineprescriptionscontinuetoriseatstartlingrates.Highlyphysicallyandpsychologicallyaddictive,butoftenprescribedwithlittlewarningorconsideration,benzodiazepinesarethesecondleadingcauseofoverdosedeathsintheUnitedStates.Thiscoursewilladdresstheproblemofbenzodiazepineaddiction:apublichealthcrisisthat,despiteitsprevalenceanddanger,remainsintheshadowsoftheopiatecrisis.Duringthiscourse,participantswillexaminethemakingofanepidemicthroughexplorationofsocietaltrends–includingourcollectiveinabilityto“sitwithpain”–thathavepavedthewayforanationalpredilectionforimmediaterelieffromsuffering,atanycost.Thiscourseshinesalightonthehistoryofbenzodiazepines:fromLeoSternbach’sserendipitousdiscovery,totheingeniousbutinsidiousmarketingofbenzodiazepinesas“Mother’sLittleHelper”,totheearlyrecognitionanddenialofthedrugs’addictiveproperties.Thecoursealsodemonstratestheurgencyandgravityofthebenzodiazepineepidemicthroughthereportingofdramaticstatisticsregardingtheupwardtrendsinthenumberofbenzodiazepineprescriptionswritten,quantityfilled,overdosefatalities,andcomplicationsofco-morbidity.Courseparticipantswillgainknowledgeofbenzodiazepines’mechanismsofactionandtheirvarioustherapeuticactions.Participantswillalsohavetheopportunitytocontrastappropriateclinicalindicationsagainstcommonprescribingpractices.Thebenefitsofbenzodiazepines,incomparisontotheirmanyadverseeffects,willbedescribedanddiscussed.Newresearchshowingpreviouslyunappreciatedassociationsofbenzodiazepineusewithdementiadevelopmentandearlymortalitywillbereviewed.Dr.Roybalwillalsouseclinicalexperienceandmultimediatopowerfullyillustratethefacesofbenzodiazepineaddictionandwithdrawal.Forthoseproviderswithexperienceintreatingsubstanceusedisorder,thiswillbeahelpfulreminderthatbenzodiazepinepatientsdonotfitthestereotypical‘addictprofile’andmaynotpresentasonewouldexpect.Thefinalportionofthecoursewillofferpractitionerswithapplicablepracticesandskillstobetterservethispopulationofpatients.Dr.Roybalwillpresentpractitionerswithalistofquestionstoaskthemselvesbeforeprescribingabenzodiazepine,givetipstoidentifypatientswithabenzodiazepineproblem,andsharehersecretsforslow,successfultapers.Practitionerswillleavewithanunderstandingofbestprescribingpractices,patient/familyeducationtechniques,andalternativesolutionsforsleepmanagementandaffectregulation.Dr.Roybalwillalsoproposeamulti-disciplinarytreatmentmodelthataddressesthemulti-facetednatureofthischallengingissue.Finally,shewillproposesolutionsforpatientempowermentandcommunitysupport,andencourage

societalinterventionsincludingincreasedresearchandreassessmentoftheroleoftheprimarycaredoctor.Havingoverseenthousandsofsuccessfulbenzodiazepinetapersoverthecourseofherdiversecareer,andwithpassionandexperienceineducatingpractitionersaboutthedangersofbenzodiazepines,Dr.Roybalwillbringnecessaryawarenesstothiscriticalpublichealthtopic.

KristaRoybal,M.D.isarecognizedaddictionmedicinepsychiatristwhouseshercompassionate,strength-basedapproachtotreatcomplexpresentationsofanxiety,depression,trauma,addictionandbipolardisorder.Dr.Roybalisanexpertinbenzodiazepinetapersandmedicaldetox,psychopharmacologicevaluationsandmedicationmanagement.AfterattendingmedicalschoolatNewYorkMedicalCollegeandaninitialtrainingatUCSanFranciscoinFamilyandCommunityMedicine,Dr.RoybalwentontospecializeinpsychiatryattheUniversityofNewMexico,whereshetrainedundersomeofthenation’stopaddictionpsychiatrists.WhileworkinginprivatepracticeandattophospitalsincludingScrippsLaJolla–wheresheservedasCo-MedicalDirectoroftheScrippsDrugandAlcoholTreatmentProgramformanyyears–Dr.Roybalbecamepassionateaboutcreatingamoreinnovativeapproachtotreatment.In2014,sheopenedTrueLifeCenter,anationalleaderinmultidisciplinarytreatmentthatutilizesthemind-bodyconnectiontoprovidecomprehensivehealing.AsMedicalDirectorofTrueLifeCenter,Dr.Royballeadsateamof20+integrativepractitionersindeliveringexceptionaloutpatientcaretothosestrugglingwithmentalhealthandco-occurringdisorders.12:55pm–1:55pmDivergentPerspectives–ConceptualizingTheProblem(BreakoutSession)Uppers,Downers,DogsandDopamine:ANeurosciencePerspectiveonAddictionandPersonalityKaiMacDonald,M.D.AddictionMedicine/Psychiatry,AssistantClinicalProfessorofPsychiatryandFamilyMedicineUCSD

Dr.MacDonaldwillexploreaspectsofthebraindiseasemodelofaddiction(BDMA),includingthepositivesandnegativesofthismodel.Theconceptofan“addictivepersonality”willbediscussed,andDr.MacDonaldwillreviewpersonalitytraitsandcharacteristicsthatincreasetheriskofaddiction(assupportedbyempiricalresearch).Ultimately,thesepersonalitytraitswillbelinkedbacktobrainsystemsthatcanbemodifiedbytherapy,medication,andexperience,sothatthewholebraindiseasemodelofaddiction,includingrisk,treatment,andrecovery,isgroundedinneuroscience.

KaiMacDonald,M.D.isboard-certifiedinAddictionMedicine.ThoughhehasfocusedhisprofessionalpracticeinPsychiatry,heisalsotrainedinFamilyMedicine.Dr.MacDonaldhasparticularclinicalexperienceinAddictionMedicine,servingasMedicalDirectorofLastingRecoveryOutpatientTreatmentCenterforover10years.Dr.MacDonaldalsohasexpertiseinmooddisorders,anxietydisorders,andADD/ADHD.Hehasconsiderabletraininginbrain-basedmedicationtreatment(psychopharmacology),generalmedicalissues,andpsychotherapy.Hehasextensive

traininginshort-termdynamictherapy.HeisanexperiencedQME(qualifiedmedicalexaminer)forfitnessfordutyexaminations,andhasservedasanexpertwitnessinforensicpsychiatrymanytimes.AttheUniversityofCalifornia,SanDiego,Dr.MacDonaldhasparticipatedasaninvestigatorindozensofclinicalresearchtrialsinadultADHD,bipolardisorder,schizophrenia,majordepressivedisorder,andanxiety.Hehaspublishedextensivelyintheneurosciencefield.HewasaPrincipalInvestigatorintheUCSDOxytocinClinicalResearchProgram.Hehasauthoredorco-authoredpeer-reviewedarticlesonADHD,bipolardisorder,trauma,andanxiety.Dr.MacDonaldisactivelyinvolvedinteachingphysiciansintrainingandothercommunityprofessionalsonthesesubjects.Withtwoothercolleagues,hedesignedandservesasafacultymemberinanationallyrecognizedprogramthatteachesphysiciansinpracticeabouthealthyrelationshipsinhealthcare.Dr.MacDonaldservedastheAssistantDirectoroftheConsult-LiaisonPsychiatryServiceatUCSDMedicalCenter.12:55pm–1:55pmDivergentPerspectives–ConceptualizingTheProblem(BreakoutSession)LostinTranslation?EstablishingaTherapeuticRelationshipwithPeopleofColorMonicaD.Hinton,Ph.D.,BehavioralHealthTherapist,SharpMcDonaldCenter Thegoalofthiscourseistoeducatementalhealthcliniciansattheintroductorylevelhowtocreateandmaintainatherapeuticalliancewithpeopleofcolorseekingchemicaldependencytreatment.Thecoursewillutilizerelevanthistoricalfactsabouthealthcare,evidence-basedresearch,availablegovernmentstudiesanddata,andtheinstructor’sexperienceofover20yearsworkinginmentalhealthandchemicaldependencytreatmentwithpeopleofcolor.ThefirstrecordedpsychiatricdiagnosisofanAfricanslavewasDrapetomania.Themainsymptomofthisdisorderwasthatslavetriedtofleefromcaptivity.Thetreatmentforthisdisorderincludedwhippingtheurgetofleeoutoftheslave.Historically,peopleofcolorhavebeenmisdiagnosedand/orreceivedpoortreatmentinthehealthandmentalhealthsystems.TherehavebeenrecordedhistoricalincidencesofmedicalprofessionalsusingAfricanAmericanbodiesforresearchandwithouttheirconsent.AfricanAmericanshavebeenexposedtodiseasesandotherillnessesforthesakeofscience.Whenitcomestomentalhealththehistoryisnodifferent.Othergroupsofcolor,suchasNativeAmericanshavehadsimilarexperienceswithinthehealthandmentalhealthsystemsintheUnitedStates.Giventhesenegativeexperiences,itisunderstandablethatpeopleofcolorhavedifficultytrustinghealthcaresystems.Becauseofthesehistoricalfactors,peopleofcolorareburdenedwithrealandperceivedracialbiaseswhenseekingbehaviorhealthtreatment.Atthesametime,providerstoooftenwillbelieveandacceptthestereotypesandmisinformationaboutgroupsofcolorresultinginpoortreatmentand/ormisdiagnosis.Highratesoftraumafromraciallybiasedincidents/interactionsandunappreciatedinstitutionalracism,aswellastheintergenerationaltraumaresultingfromthedisplacement,abuseandenslavementoftheirancestorsconstituteanextralayerofissuestowhichthetherapistmustbeawareof,sensitiveto,andskillfulindealingwiththerapeutically. Theoverallhealthcaredisparitiesfordiversepopulationsinriskforsubstanceuse,challengesinaccesstosubstanceusetreatment,highdropoutratesfortreatment,andtreatmentoutcomeandrecidivismfindingswillbediscussedinthispresentation.Secondly,theenhancedstigmarelatedtoracialandculturalissues,aswellastosubstanceuse,andhowthoseinteractwitheachotherandwithtreatment,willbedescribed.Theinstructorwillexplainhowbothdisparitiesandstigmaaffectclientsofcolorseekingsubstanceuserecovery,andtheimpacttheyhaveonsubstanceusetreatmentandpotentially,treatmentretentionandoutcome.Intreatingpeopleofcolor,itisimportanttobeawareofthedataregardingthetreatmentcontextforpeopleofcolorandtobecomeculturallycompetentinaddressingtheneedsofclientsofcolor.AccordingtoSAMSHA,theaveragetreatmentproviderinsubstanceuseprogramsisamiddle-agedCaucasianfemale,whiletheprototypeclientofthepopulationmostinneedofsubstanceusetreatmentisayoungBlackmale.Thisgapisthoughttoaccountinpartforthelowerrateofclientsofcolorseekingtreatment,thehigherdropoutratesfromtreatment,andpoorertreatmentoutcomes.Fewcliniciansreceivetraininginculturalcompetency,howtotalkaboutrace,ethnicityorstigmaintherapy,andevenfeweraretaughtspecificskillswithwhichtoengageclientsofcolorintreatment.Thiscoursewillofferabriefexperientialtrainingexercisetointroduceculturallyspecificengagementskillsandgiveattendeesanopportunitytopracticethemwitheachotherinasmallgroupsettingwithpeerfeedback.Thiswillbefollowedbyadebriefwiththeentiregroup.The

instructorwillelicitquestions,pointsofclarificationasneeded,andpersonalreactionsduringthepost-discussion.Finally,theoveralllessonswillbesummarized,withconcludingcommentsandrecommendationsforfurthertraininginthisarea.

MonicaHinton,Ph.D.hasworkedinMentalHealthandSubstanceAbuseforover20years.SheisaBehavioralHealthTherapistatSHARPMcDonaldCenter,whichisamedicallysupervisedsubstanceabuserecoveryprograminSanDiegoCounty.Dr.HintonhasbeentheProgramDirectorofAlpineSpecialTreatment,Inc.,thatisa24-hoursecuredsettingthatofferssupportive,rehabilitativeservicesforpeoplesufferingfrompsychiatricandsubstanceabusedisorders.Dr.HintonhasbeentheChairpersonoftheTrainingandImplementationCommitteeforChangeAgentsDevelopingRecoveryExcellence(CADRE)usingtheComprehensive,Continuous,andIntegratedSystemofCare(CCISC)modelforSanDiegoCounty.CADREiscomprisedofcountystaffandproviderswhoarecommittedtotheCCISCmodelofservicedelivery.ThiscommitteedecidesuponthetrainingtopicsandthedeliveryofthattrainingforcliniciansworkinginbehaviorhealthprogramsthroughouttheSanDiegoCounty.Dr.HintonisthePresidentofTheAssociationofBlackPsychologists(ABPsi),SanDiegoChapter,aninternationalorganizationthatactivelyaddressesthebehavioralhealthchallengesoftheAfrican/Blackdiaspora.Dr.Hintonutilizesthisplatformtoteachandadvocateformoreculturallyappropriatetreatmentforpeopleofcolor,especiallyAfrican-AmericansinSanDiegoCounty.12:55pm–1:55pmDivergentPerspectives–ConceptualizingTheProblem(BreakoutSession)UnderstandingSubstanceUseRelapse:TheDevilisintheDetailsArthurJ.Farkas,Ph.D.,SAP,ClinicalDirector/Co-Founder,LastingRecoveryOutpatientTreatmentRelapseisacommonandvexingproblemforclientsstrugglingwithsubstanceabuse.Thoughcommonlyknown,evenacceptedtothepointofstigmatizationfortherecoveringindividual,whatarethefactsaboutrelapse?Itisaparticularriskinoutpatienttherapyafterintensivesubstanceabusetreatment.Buthowdoessubstanceuserelapsecomparetorelapseinothercommonmedicalconditions?Theresultsmaysurpriseyou!Whatpredictsrelapseinsubstanceusetreatment?Arethereprotectivefactorsthathavebeendeterminedbyresearch?Whatarethemainriskfactorsthatmaypredisposesomeoneinoutpatienttherapyforrecoverytoexperiencearelapse?Thiscoursewillhavethreeparts.First,adiscussionofthechallengeofavoidingrelapseinoutpatienttherapy–howcommonisit?Whatarethemainpredictors?Whatabouttheprotectivefactors,especiallythoserelatedtoclientselfhelp?Ausefulassessmenttool,theAWARESurveywillbepresentedasavalidatedinstrumenttopredictrelapseinthefollowing60days,usefulinoutpatienttreatment.Factorsrelatedtoclientself-help,thathavebeenidentifiedaspredictingagoodoutcomeinaddictionresearch,willalsobediscussed.Ofinterest,theepidemiologyofrelapseinsubstanceabusetreatmentwillbepresented.Theseresearchfindingswillbecomparedtorelapseratesforcommonmedicalconditionsinordertoputtherelapseissueintoperspective.Thisisimportantsinceclients,therapistsandfamilymembersmaygetdiscouragedorgiveupontreatment,whenactuallyrelapseispredictable,andmayidentifyimportanttriggersorskilldeficitswhichneedtobeaddressforlongtermsuccess.Second,theimportantroleoftherecoveringclient’sfriend,familyandsocialrelationshipswillbediscussed.Whatcomprisesan“enabling”relationship-thatis,onewhichinadvertentlypromotesareturntosubstanceuse?Howdoesthisstigmatizeapartner?Howdoesthisaffectriskforrelapse?Theconceptofco-dependency,inpartners,itsoriginanditsrelationshiptorelapseriskwillbeexplained.Howtotalktoclientsaboutthevalueofmorein-depthexplorationoftheirfamilyoforigin’sdysfunctionanditsrelationtotheirrelapseriskandtosuccessfulrecoverywillbeexplained.

Finally,itisoftenobservedthatmanyclientsengaginginsubstanceabusehaveco-occurringmentalhealthdisorders.Theseincludemooddisorders,anxietydisorders,trauma,andpersonalitydisorders.Howandwhentoassessclientsforthesecommonconditions,whichmightpredisposeorprecipitatearelapsebacktosubstanceabusewillbeexplained.Anexampleofanevidence-basedtreatmentforeachofthesecommondisorderswillbeprovided.Overall,thekeytounderstandingasubstanceabuserecoveryclient’sriskforrelapseentailscarefulattention,observation,andassessmentbythetherapist,sothatthesepredisposingfactorscanbeidentifiedandaddressedeffectivelywiththeappropriatetreatment.Helpfulself-helpbehaviorscanalsobeencouraged.Withacomprehensiveunderstandingofrelapsefacts,andaplanforwhatriskfactorstolookforandhowthesefactorstriggerareturntosubstanceabuse,thetherapistcanintervenetoguideaclientinrecoverythroughtheshoalsoftheirparticularrelapseriskprofiletoattainlongtermsobriety.

ArthurFarkas,Ph.D.SAPisalicensedclinicalpsychologistandsubstanceabuseprofessional.HeservedonthefacultyofUniversityofCaliforniaSanDiegoMedicalSchoolandhasauthored/co-authoredover40publicationsonaddictioninpeer-reviewedjournals.Dr.FarkasisCo-FounderandClinicalDirectorofLastingRecoveryOutpatientSubstanceUseTreatmentCenter.Hisrolethereistofacilitatepsychologicaltestingforallclients,guidethedevelopmentofLastingRecovery’sprogramcurriculum,andtooverseecontinuousqualityimprovementefforts.Aftermorethan30yearsofworkinthesubstanceuserecoveryfield,Dr.Farkas,isarespectedleader,andmentor.HeisafoundingmemberoftheSDPAAddictiveDisordersCommittee,newthisyear.12:55pm–1:55pmDivergentPerspectives–ConceptualizingTheProblem(BreakoutSession)SpecialWorkshop(Galleria–NoAudiotape)RocktoRecovery:UsingMusicwithNon-MusicianstoImproveMentalHealthandRecoveryOutcomesConstanceScharff,Ph.D.,ChrisFeldman,SonnyMayo,RocktoRecovery,LagunaBeachClientsinrecoveryfromsubstanceusedisorderoftenstruggletofindthewordstoarticulatetheirfeelingsandmanagetheminaconstructivewaywhendeprivedofsubstancesasacopingmodality.Music,theuniversallanguage,canbeabridgetoassistclientsduringthisvulnerabletimebyofferinganexpressiveoutlet,andexpressivemusicisaskillwhichtheycanlearnforself-expressionandpersonalgrowthduringtheirtreatmentandbeyond.RocktoRecoveryisanorganizationbasedinLagunaBeach,foundedbyWesGeer,founderandguitaristforHedPE,whichhassoldmorethanamillionalbumsandformerleadguitaristforthenumetalbandKorn.Whenheretiredasatouringmusician,Weslookedtoseehowhecouldgivebacktoothersinrecovery.HerememberedhistimeinrehabwheretherewasnomusicandfoundedRocktoRecovery.Hecreatedaprogramwithprotocolsforguidingnon-musiciansinacuteandearlysubstanceusetreatmenthowtousemusic,particularlyexpressivesongwriting,toaidtheirrecovery.Besidestheexternalizationofdifficultemotionsandtraumaticnarratives,theprocessofcreatingapersonalizedsonginagroupcontext,whichisanauthenticexpressioncanbeempowering,validatingandcreateanewavenueforattainingself-esteem.Theexperienceofcollaborativerelationshipsformedinthe“band”istherapeutic.Findingpositivemeaningthroughcreativeartistrycanencouragethehardworkofrecoveryandforgeanew,morewholesomepath.Thiscoursewillintroduceparticipantstohowmusiccanbeused,asanexampleofanexpressiveartstherapyapproach,inrecoveryfromsubstanceuse.RocktoRecoveryoperatestheirprograminover100residentialandoutpatientrecoveryprogramsinCalifornia.TheyhaverecentlyexpandedtoNashville,TennesseeandhaveacontractwiththeDepartmentofDefensetoprovideservicestoveteransnationallythroughtheAirForceWoundedWarriorsprogram.Theywilldiscusstheirexperienceworkinginrecoveryprogramsaspartoftheclinicalteam,includingspecificguidelinesandprotocolstheyhavedevelopedoverthepast6years.ThiscoursewillbeleadbyConstanceScharff,Ph.D.,aRocktoRecoveryBoard

memberandanaddictionadvocatewhospecializesintheapplicationofcomplementarypracticesandinnovativepsychotherapeuticinterventionstoaddictiontreatment.Shewillbesupportedbyfounder,WesGeerandtwootherRocktoRecoveryprogramstaffmembers,whowillprovidethemusicalsupport.Thecoursewillbeginwiththetheoreticalbackground(expressiveartstherapy),andresearchfindings.Forexample,facedwithepidemicratesofyouthsubstanceuse,Icelandhasevaluatedtheeffectsofimplementingacountrywideprogramofthearts,includingmusicandsongwriting.Byinvolvingfamiliesandprovidingfacilitiesformusic,artandsports,ineveryvillage,ratesofyouthsubstanceusehaveplummeted.Followingtheintroduction,therewillbeanexperientialcomponent,wherenon-musicianparticipantswillbeguidedinthecompositionofasongusingRocktoRecovery’sprotocolsasafeasibilitydemonstration,followedbyadebriefingwithDr.Scharffandthemusicians.Whathappenedintheexercisewillbelinkedbacktotheintroductorytheories,andparticipantsmayengageinQ&Awiththeinstructors.Aspartoftheconcludingdiscussion,participantswillbeadvisedoncommonchallengesinimplementingRocktoRecoverytypeprograms,whichclientsmightbenefit,andwhichmightbecontra-indicatedforparticipation.Finally,localresourcesavailableandwhattolookforwhenaddingthisadjunctivetherapytorecoveryprogramsorpsychotherapywillbediscussed.

ConstanceScharff,Ph.D.isaninternationallyrecognizedspeakerandauthoronthetopicsofaddictionrecoveryandmentalhealth.ShecurrentlyservesRocktoRecovery,amusictherapybasedaddictionandtraumatreatmentgroup,ontheirBoardofDirectorsandiswritingabookonthepowerofmusictherapywiththeirfounder,WesleyGeer.Previously,shewastheSeniorAddictionResearchFellowandDirectorofAddictionResearchforCliffsideMalibu,anaddictiontreatmentcenterbasedinMalibu,California.Heraddictiontreatmentandresearchinterestscenteraroundusingcomplementaryhealthandcontemplativepracticestoimprovetreatmentoutcomesamongaddictsandthementallyill.Dr.Scharffisco-authoroftheAmazon.combest-sellingbookEndingAddictionforGoodandtheaward-winningpoetrybookMeetingGodatMidnight.Sheregularlytravelstheworldspeaking,teachingandadvocatingforcompassionatehealthpracticesthatde-stigmatizementalhealthproblems.ShehasworkedwithsuchgroupsasUNESCO,theWorldFederationforMentalHealth,GlobalAddiction,theAmericanLegion,VeteransofForeignWars(VFW),InteramericanSocietyofPsychology,theWorldCongressonPsychotherapy,andmanyothers.

ChristianHeldmanhasbeenasinger-songwriterforover25years.Asaboyhewasinfluencedbyhisfather,JerryHeldman,aworld-classjazzbassistandoftengottositinwithartistssuchasLarryCoryell,McCoyTynerandDavidFriesen.ASeattlenative,Christianwasentrenchedinthegrungesceneofthe90’s,performingregularlywithmembersofAliceinChains,PearlJam,Soundgarden,andtheScreamingTrees.Heisamulti-instrumentalistandcurrentlyplaysinahostofSanDiegobands.Christian’ssubstanceabusestartedatayoungageandwasasmuchapartofhislifeashismusiccareer,“IalwaysthoughtthedrugsandalcoholweremysolutionuntilIdiscoveredtheywerejustholdingmebackfromaccessingmyartisticnature.”Christiannowfindsgreatpurposeandenjoymentinhelpingotherstorecoverandheseesmusicasoneofthegreatestvehiclesforthatadventure.

SonnyMayoisontheboardofdirectorsandaprogramadministratorforRocktoRecovery,a501(c)3organizationthatbringsmusictopeopleinvariousstagesofrecoveryfromdrug/alcoholdependence,PTSD,mentalhealthissues,andmore.SonnyisaprofessionalmusicianwhobeganplayinginathrashmetalbandcalledSilenceinthelate1980s.In1995,MayomovedtoSantaBarbara,CAtojointhebandSnot.Hehasplayedandtouredwithmanybandssincethen,includingUglyKidJoeandSevendust.InJune2014,SonnyjoinedWesGeerinthenonprofitorganization,RockToRecovery,(www.rocktorecovey.org),whichharnessesthehealingpowerofmusicbybringingmusicalinstrumentsandequipmentintotreatmentfacilitiestowriteandrecordoriginalsongswithpeoplerecoveringfromdrug/alcoholaddiction,PTSD,eatingdisorders,andothermentalillnesses.2:10pm–3:10pmDivergentPerspectives–InterventionStrategies(BreakoutSession)TreatingDiverseAddictionswithCognitive-BehavioralTherapy:LessonsLearnedOver25YearsBruceS.Liese,Ph.D.,ABPP,ProfessorofFamilyMedicineandPsychiatry,UniversityofKansasClinicalDirector,Cofrin-LoganCenterforAddictionResearch&Treatment,UniversityofKansasParticipantswilllearnabouttheinitiation,development,andmaintenanceofsubstanceusedisorders(SUDs)andaddictionsfromacognitive-behavioraltherapy(CBT)perspective.TheywillbepresentedwithcommonmisconceptionsofCBT,alongwithmoreaccurateandcurrentapproachestoCBTforSUDsandaddictions.GraphicconceptualmodelsofSUDSandaddictionswillbeprovided,andcomponentsofCBTwillbedescribedandexplainedindetail.

BruceS.Liese,Ph.D.,ABPPisProfessorofFamilyMedicineandPsychiatryattheUniversityofKansasMedicalCenter,CourtesyProfessorofPsychology,andDirectorofClinicalServicesattheCofrin-LoganCenterforAddictionResearch&TreatmentattheUniversityofKansas.Hecompletedpost-doctoraltrainingattheCenterforCognitiveTherapyunderthesupervisionofDr.AaronT.Beckandhasco-authoredtwotextsonaddictionswithDr.Beck.HeisPast-PresidentofAPADivision50(SocietyofAddictionPsychology;SoAP).Dr.Lieseisaresearcher,teacher,clinicalsupervisor,andclinician.Hisworkfocusesprimarilyonthediagnosisandtreatmentofaddictivebehaviorsand,overtime,hehassupervisedhundredsofcognitive-behavioraltherapistsandpublishedmorethan50articlesandchapters.2:10pm–3:10pmDivergentPerspectives–InterventionStrategies(BreakoutSession)AlternativeNoMore!Evidence-BasedPsychologicalTreatmentsforPainBethD.Darnall,Ph.D.ClinicalProfessor,DepartmentofAnesthesiology,StanfordUniversityMedicalSchoolNational needs assessments reveal that the overwhelming majority of psychologists and mental health professionalsreport a training and skills gap to treat clients with chronic pain. These data reveal a critical gap in competency andcomforttoaddresspaininthetherapeuticcontext,despitethefactthat1/3oftheU.S.populationislivingwithongoingpain. This session equips learners with a fundamental understanding of the role of psychology in the experience and

treatmentofpain.Thissessionprovidesanoverviewofthepsychologicalscienceofpainandpainrelief,andprovidesabasicreviewofevidence-basedtreatmentsforpain.Clinicianandpatientresourcesincluded!SeeBethD.Darnall,Ph.D.biographicalinformationabove.2:10pm–3:10pmDivergentPerspectives–InterventionStrategies(BreakoutSession)RefugeRecovery:AMindfulness-BasedApproachtoSubstanceUseandTraumaDanielDoyle,LMFT,ClinicalDirector,RefugeRecoveryTreatmentCenters,LosAngelesThiscoursewillintroduceaninnovativenewapproachtosubstanceusetreatment,RefugeRecovery,developedinthelastfewyears.BasedonclassicalprinciplesofBuddhistpsychology,includingtheFourNobleTruthsandtheEightfoldPath,asspecificallyappliedtosubstanceuse,thisapproachprovidesapsycho-spiritualframeworkforrecovery.Thisapproachisalsobasedupontheevidencebaseassemblednowdemonstratingthecognitiveandaffectivebenefitsofvariousmindfulness-basedapproachesonattentionalcontrol,interoceptiveawareness,behavioralrestraint,negativethoughtsuppression,affectiveregulation–allparametersrelevanttosubstanceuserecovery.TheRefugeRecoveryApproachprovidesnotjustanewmodel,butanumberofpracticalcomponentswhichmayfacilitaterecoverythroughchangingsubstancemisusebehaviors,promotingalternativecopingbehaviors,decreasingvulnerabilitytotriggeringthoughtsandemotionalstates.Acriticalpartoftheapproachistheregularpracticeofmindfulness-basedmeditation,oftenaspartofagroupor“sangha”.Throughthemeditativepractice,skillsofdirectingattentionawayfromsubstancesandtowardmorewholesomefocicanbedeveloped.Theadoptionofacompassionate,“witness”stanceofmindfulobservationofwhatisreallyhappening,inboththeinterior(affective,cognitiveandphysiological)andtheexterior(behavioral&social/relationalcontext)aspectsofthesubstanceuser,provideusefulinformationabouttriggersandconsequencesofsubstanceuse.Mindfulness-basedprinciplesarealsoappliedbeyondformalmeditationpracticetostressfulsituationsindailylife.Thereisspecificapplicationofmindfulnesstorelapseprevention,acriticalissueinmaintainingsobrietyinsubstanceuserecovery.Manysubstanceusersstrugglewithlowself-esteem,shame,regretsoverpastactions,andethicallapses,somindfulness-basedcompassionpractice(inmeditationanddailylife)canbehelpfulindevelopingmoreself-acceptance&self-understanding.Adoptionofastanceofkindnesstowardoneselfcanleaddirectlytoreducingbehaviorharmfultooneselforothers.Thisstancecanbecultivatedovertimewithpractice(formalandinformal),withtheaimofbecominghabitual.Theabilitytobettermanagetroublesomeemotionalstatesandreducestress-relatedupregulationofthenervoussystem,asfacilitatedbythesemindfulness-basedtreatmentcomponents,mayleadtosignificantharmreductiontothesubstanceuserinrecoveryandtoothersintheirsocialcircle.Addictionsstealtheuser’sattention.Thesystematicattentionaltrainingofmindfulness,whichhasbeenshowntofacilitatecognitiveandaffectivefocus,andimprovedirectedattentionovertime,mayplayakeyroleinhelpingasubstanceuserretraintheirreactionstostimuliandhabitual,maladaptivethoughtpatterns.AnimportantaspectofthisRefugeRecoveryapproach,istheuseofsangha,oracommunityoffellowmindfulnesspractitioners,includingthoseinrecoveryfromsubstanceuse,asakeycomponentofsocial,psychologicalandbehavioralrecovery.Thetraditional“ThreeRefuges”:dharma(truth),Buddha(Buddhistphilosophy&mindfulnessprinciples)andsangha(fellowshipgroups),areintegraltotherecoveryapproach.Thesehelpfacilitateemotionalsafetyandthus,sobriety.Whenclientssettleintoclearobservationandquietreflection,manyclientsconnectwithunderlying,unprocessedtrauma,includingattachmentdisruption.TheRefugeRecoveryprogramemploystheEMDRtreatmenttemplatetoassistclientsintraumaprocessing.Mindfulnesstraining,inturn,assistswiththisprocessing,bringingcalm,acceptance,andself-compassiontotheprocess.Othertrauma-focusedorattachment-basedinterventionscanalsobeengagedin,asneeded.Thistrauma-informedsubstanceusetreatmentfitswithinaBuddhistframeworkofseekinginsightandwisdominone’sactions,andapplyingcompassiontoeverything.ThisaspectoftheRefugeRecoverymodel,isknownastheMindfulness&EMDRTreatmentTemplateforAddictions,theMET(T)AProtocol.(MettaisaSanskritworddenoting“friendlinessoftheheart”)

Noonetreatmentapproachisappropriateforallsubstanceuseclients,sincetheyvaryinlearninghistory,degreeofaddiction,natureofsubstance,functionofsubstance,genetics,&personality.ThecoursewillconcludewithadiscussionofwhichsubstanceuseclientsmaybethebestmatchfortheRefugeRecoveryapproach,howtheapproachishelpfulforthem,versuswhichclientsmightbebetterservedbymoretraditionalrecoverymodels.

DanielDoyle, LMFT is the ClinicalDirector of theRefugeRecoveryOutpatient Treatment Program.Daniel is a licensedMarriage&FamilyTherapist,certifiedinEMDR.DanielhasaprivatepracticeinSouthPasadena,CAandhasspecializedinsubstance abuse for 15 years. He also treats clients through Headstrong, an organization that provides no costpsychotherapytoPost9-11veterans.DanielintegrateshisloveoftheatreasapracticingDramaTherapist.Hehaspresentedonhiswork,integratingDramaTherapyandEMDRattheExpressiveTherapySummitinNewYorkandLosAngeles,attheNationalConferenceoftheNorthAmericanDramaTherapyAssociation(NADTA),andattheAppliedImprovisationNetworkWorldConference.DanielisaBoardMemberoftheSouthernCaliforniaChapteroftheNADTA.HeisonthefacultyoftheSoCalDramaTherapyCenter,whereheteachesacourseontrauma-informedintervention.DanielworkscloselywithRefugeRecovery’sfounder,NoahLevine,anotedBuddhistteacher,andauthorofthebooksRefugeRecovery,DharmaPunx,AgainsttheStream,andHeartoftheRevolution,ontheongoingdevelopmentoftheinnovativenewprogramatRefugeRecoveryTreatmentCenters,basedinVenice,CA.2:10pm–3:10pmDivergentPerspectives–InterventionStrategies(BreakoutSession)LoveisaSkill:UsingtheCRAFTModelwithSignificantOthersofSubstanceUsersJuliaRosengren,Psy.D.,AddictionSpecialist,CRAFTProvider,SanDiegoSubstancemisuseinafamilymemberorlovedoneisemotionallypainfulforeveryonewhocaresaboutthatsubstanceuser.Substancemisusetreatmentoftenleavesoutanintegralpartoftheproblem’sdynamic,namelythesubstanceusersconcernedsignificantothers(CSO’s).Inmany30-dayrehabfacilities,onlyoneweekendisdevotedtofamilyintervention.TellingCSOsthattheyjusthaveto“lettheirlovedonehitrockbottom”isoftennotveryhelpfulforthemnortheirlovedonesufferingfromsubstancemisuse.CommunityReinforcementandFamilyTraining,or“CRAFT”treatmentisanempiricallysupportedapproachthatteachesfriendsandfamilybehavioralstrategiestoincreasethelikelihoodofpositivechangefortheirstrugglinglovedones.Clientsarecoachedtogainnewskillstorespondtotheirfamilymemberwiththeaimofreducingsubstancemisuseandaccessingtreatment.Regardlessoftheoutcome,theconcernedsignificantothers(CSOs)areabletohaveimprovedqualityoflifebylearninghowtocreatehealthyboundariesandpracticeself-care.TheskillsprovidedtofamilymembersbylearningCRAFTbehavioralstrategiesgivesthempowerofinfluenceinsteadofleavingthemfeelinghelpless,withoutknowingwhattodotosupporttheirfamilymember.CRAFTisgroundedinMotivationalInterviewing,behaviorism,andharm-reductiontechniques.Duringthiscourse,mentalhealthprofessionalswilllearnthebasicsofCRAFTtreatmentandthebehavioralandcommunicationtechniquesusedintheCRAFTapproach.Dr.RosengrenwilldiscusswhatkindofclientorpopulationsareagoodmatchforCRAFTtreatment,howtoassessclientstodeterminethismatch.Shewilldescribehowtoeffectivelycommunicatetoincreasemotivationforchangewithboththeconcernedsignificantothersandtheirlovedoneswhoareresistanttotreatmentforsubstancemisuse.

JuliaRosengren,Psy.D.hasaDoctoraldegreeinClinicalPsychology.Forthepast12years,Dr.Rosengrenhasspecializedinaddiction,depression,anxiety,andrelationshipdifficulties,applyingapsychodynamicandhumanisticlens.Foraddiction-relatedtreatment,Dr.Rosengrenusesanalternativetothe12-stepmodelthatinvolvesCognitiveBehavioralTherapy,MotivationalInterviewing,andharm-reductiontechniques.Forthepastfiveyears,Dr.RosengrenhasbeenaSMARTRecoveryfacilitator,workingwithindividualsstrugglingwithaddictionofallkindsandtheirconcernedsignificantotherswithaCBT/harm-reductionapproach.TheweeklySMARTRecoverymeetingsherunsisforFamilyandFriendsinSanDiegoandisbasedonCommunityReinforcementandFamilyTraining(CRAFT)principles.SheisoneofthefewtherapistsinCaliforniathatistrainedCRAFT,whichisanempiricallysupportedindividualtreatmentforthelovedonesofpeoplestrugglingwithaddiction.Forthepast8years,inadditiontoherprivatepractice,Dr.RosengrenhasalsoworkedatNewVistasCrisisCenterinSanDiego.Thecrisiscenterisa24-hourfacilitythatisa“stepdown”fromahospital.Herexperienceinacutecrisismanagementforsubstancemisuseandserious,chronicmentalhealthissuesalsoinformsherapproachworkingwithclients,includingfamilymembersofthosestrugglingwithaddiction.2:10pm–3:10pmDivergentPerspectives–InterventionStrategies(BreakoutSession)RethinkingRisk/Benefit:UseofMedicallyAssistedTherapy(MAT)withPsychodynamicMarkersKristyLamb,M.D.,ChrisSmall,M.D.,AddictionMedicine/Psychiatry,Co-Founders,BOLDHealth,Inc.WithrapidlyrisingopioidaddictionratesintheU.S.,providingeffectivetreatmenthasbecomeapublichealthpriority.Lastyear,72,000deathsduetosubstanceuseoccurred,theworstyearever.Yetsubstanceusetreatmentischallenging,fraughtwithdifficulty,andrelapseisfrustratinglycommon.Increasingly,thereisanappreciationthatgeneticdifferencesinneurobiologicalresponsetosubstancesmaydetermineinparthowdifficultwithdrawalandmaintenanceareforaparticularclient.Forsomeindividuals,multipletreatmentattemptsmaybenecessaryforavarietyofreasons,includingneurobiologicalchangesrenderedbysubstances.Thismakesaddictionrecoverymatchtoa“chronicillness”model:wheremanagementandharmreductionarethegoal.Clientscanalsovaryinpsychologicalvulnerability,basedontemperament,developmentalhistory/trauma,personalitydisorders,co-morbidmentalhealthdiagnoses,andotherfactors.Medication-assistedtherapyistheadjunctiveuseofanopiateblockeroralongactingopioid,whichprovidesrelieffromdrugwithdrawalsymptomswhileavoidingthe“high”ofusing.Forsomeindividualsinrecoverywhostruggletostayclean,MATmaybeanoptiontohelpthemstabilizemedicallywithroutine,controlledopioidadministration,whiletheybuildnewskills,relationshipsandundergoreparativepsychotherapy.MATmaypreventrelapsingbackintouncontrolledsubstanceuse,byprovidingthiscontrolledadministrationroutinely,whichpreventsdrugseekingbehaviorduringrehabilitation.Alimitationofthistherapy,whichisnew,andasyetnotcompletelytested,isthatsomeclientscanstillabuse(orsell)thisdrugandithasitsownrisks.Additionalcertificationisrequiredforpsycho-pharmacologiststosafeguardadministrationofMAT.HowdoestheaddictionpractitionerknowwhichsubstanceuserecoveryclientwillbeagoodcandidateforusingMAT?Agoodstartingpointisacompletepsycho-diagnosticevaluation,wherepsychodynamicmarkerssuchasaffectidentification/tolerance,self-esteem,self-careandrelationshipquality,indicatethepsychicvulnerabilityof acliententeringsubstanceusetreatment.OnceaclienthasenrolledinMAT,it’simportanttoappreciatethatMATisnotacompletetreatment,butacomponentvaluabletosomeclients.MATshouldbeintegratedintoapsycho-dynamically-informedtreatmentprogramforsubstanceabuse,whereaclient’sneedforcomfort,safety,andcontrol,aswellastheirdegreeofdissociation,helplessness,self-organizationandomnipotencecanbeascertainedandworkedwiththerapeutically.

ThecoursewillendwithadiscussionwiththeattendeesabouthowusingMATinthetreatmentofaddictionaffectstherecoveryclientandthetherapistrelationshipsinpsychotherapy,aswellastheoverallrecoverytreatmentcontext.Theintegrationofthisstateoftheartpharmacologywithapsycho-dynamicallyinformedevaluationandtreatmentprogram,includingpsychotherapy,createsapowerfulcombinationthatmayenableclientsattemptingtoachievesubstanceuserecoverytosucceedinmaintainingsobriety.

KristyLamb,M.D.andChrisSmall,M.D.aretheCo-FoundersofaninnovativeclinicinEncinitas-BoldHealthOutpatientClinic.Thisindependentpracticeoffersavarietyofprogramsfocusingonwellnessandmentalhealth,includingauniqueoutpatientmentalhealthandaddictionprogramthatspecializesinthetreatmentofsubstanceusedisordersanddualdiagnosisclients.Additionally,BOLDoffersa10-weekprogramforthetreatmentofanxietydisorders,andaprivate/individualpsychiatrictreatmentclinic.Dr.Smallisuniquelyqualifiedtotreatbothmedicalandmentalhealthconditions.HecompletedhismedicalandpsychiatrictrainingatUCSD,wherehecurrentlyholdsthetitleofHealthSciencesAssistantClinicalProfessor.HeholdsBoardCertificationbytheAmericanBoardsofPsychiatryandFamilyMedicine.Dr.LambisBoardcertifiedinbothFamilyMedicineandPsychiatryfromUCSanDiego.Dr.Lambiswellversedinthemostcutting-edge,evidencebased,psychopharmacology,butasimportantly,shepursuedfurthertraininginpsychodynamicpsychotherapywithabeliefthatformany,psychotherapyisanintegralpartofpersonaltransformationandhealing.Dr.LambstartedhertrainingasanundergraduateatVanderbiltUniversity,obtainingabachelor’sdegreeinNeuroscience.Shewentontoobtainamaster’sdegreeinhumanitieswithafocusonphilosophyandsocialtheoryfromtheUniversityofColorado.ShesubsequentlycompletedafellowshipincommunityandpublicpsychiatryatUCSanDiegoaswellasthefellowshipinpsychodynamicpsychotherapyattheSanDiegoPsychoanalyticSocietyandInstitute.Dr.LambisanAssociateClinicalProfessoratUCSanDiegoandspecializesinprovidingcarefromanintegrativeperspective.Shespecializesinpsychopharmacology,intensiveshort-termdynamicpsychotherapy,addictionmedicine,preventivehealthcare,women’shealth,maternalmentalhealth,aswellasprimarycareandmentalhealthintegration. 3:45pm–4:30pmClosingPanel:IntegratingtheDivergentPerspectives,OneClientataTimeModerator–RichardLevak,Ph.D.,HostofMindMatters–Fox5MorningNewsPanelists–BruceS.Liese,Ph.D.,ABPP,KaiMacDonald,M.D.,ArthurJ.Farkas,Ph.D.,SAPMostcliniciansareawarenowoftheepidemicofsubstanceuseoccurringintheU.S.Inresponse,amyriadoftreatmentapproachesandprogramshaveproliferatedinrecentyears.Ifyouarenotanaddictionspecialist,howdoyouknowwhatthebestpracticesforsubstanceusedisordertreatmentareforaparticularclient?Thispanelwillfeatureamoderateddiscussionbetweenseveralexpertaddictionspecialistswhocanhelpilluminatehowtheirparticulartreatmentapproachesaffecttheconceptualizationofaclient’ssubstanceuseproblemandhowtheconductoftreatmentproceedsfromtheirperspectives,orwhichreferralforspecializedservicesisrecommendedbasedontheirmodel.RepresentingtheCBTperspectiveandaharmreductionapproachwillbeDr.BruceLiese.RepresentingtheAbstinence-Based,includingAAapproachwillbeDr.ArthurFarkas.Dr.KaiMacDonaldrepresentstheneurobiological/relationalmodelthatconsidersattachmentinjury/disruptionanditsneurobiologicalsequelae(attemptstoself-regulatewithsubstances).Allofthesepresentershavemanyyearsofexperienceintheaddictiontreatmentfield,sotheirconversationsaboutmakingcomplexclinicaldecisionsandclarificationsofsimilaritiesanddifferencesinsubstanceusetreatmentapproachesshouldbeilluminating.

RichardLevak,Ph.D.,ClinicalPsychologist,HostofMindMatters–Fox5MorningNewswillusehismoderator’sskilltohelpintegratethepro’sandcon’softhedifferenttreatmentapproaches,willhelpthepanelspeakersexplainanddiscusshowtheirsubstanceusemodelstranslateintodifferentassessmentandtreatmentapproaches,andapplytoaparticularclientseekingsubstanceuserecovery.Theaimofthisdiscussionwiththethreespeakersandthen,theQ&Awiththeaudiencewillbetodiscussthecontroversiesandambiguitiesinthesubstanceusefield,integratethedifferenttheoreticalperspectivesandhelpaudiencemembersrefinetheirthinkingabouthowtoapproachindividualsubstanceuseclient’swithdifferentriskprofilesandneeds.