ON THE ROAD TO WELLNESS. Dealing with Addiction Disease in Dentistry FINAL REPORT

Transcription

1 ON THE ROAD TO WELLNESS Dealing with Addiction Disease in Dentistry FNAL REPORT

2 ON THE ROAD TO WELLNESS OCTOBER 12-13, 2012 Dealing with Addiction Disease in Dentistry EXECUTVE SUMMARY The disease of addiction plays no favourites. Dentists, like other health care professionals, are susceptible to this disease just like others in the general population. The latest statistics from the United States have at least 15-18% of the dental profession struggling with addiction disease. There is no reason to believe that the problem is any less here in Canada. The stakes are even higher for dentists than for other individuals who are addicted. Because if a dentist s addiction is left untreated, it could not only threaten their own lives and family stability, but place patients and their practices in jeopardy too. For too long, there have been almost insurmountable barriers of shame that prevent dentists from seeking help. Society imposes stigma and its damage on addicts and their families because many of us still believe that addiction is a character flaw or weakness that probably can t be cured. Stigma is the reason there is so much social and legal discrimination against people with addictions. t explains why addicts and their families hide the disease. People who need the help are often afraid to speak up. This stigma is one of the meanest and most difficult aspects of addiction because it makes it harder for individuals and families to deal with their problems and get the help they need.

3 2 EXCECUTVE SUMMARY ON THE ROAD TO WELLNESS What am asking you to focus on is not the shame of the illness which is what you see in your daily regulatory roles but rather remember the dignity of recovery. Dr. Graeme Cunningham Wellness Consultant Royal College of Dental Surgeons of Ontario People who are victims of stigma internalize the hate it carries, transforming it to shame and hiding from its effects. Too often, people with alcohol and drug problems and their families begin to accept the ideas that addiction is their own fault and that maybe they are too weak to do anything about it. n many ways, hiding an addiction problem is the rational thing to do because seeking help can mean losing a job, your social status, the friendship of your colleagues, or even your family. Dentists with substance abuse problems could also lose more because they are usually single practitioners, and if the dentist goes down, so does the practice The profession needs to spread the word that addiction is an illness, not a moral failing, to create a culture within dentistry where no dentist is confronted by a prevailing sense of helplessness in the face of addiction. Dentists don t choose to abuse psychoactive substances or adopt abusive behaviours like gambling, sex, etc. Addiction is not the result of a lack of willpower. Addiction is an illness, not a moral weakness. Yet the stigma against people with addictions is so deeply rooted that it continues even in the face of the scientific evidence that addiction is a treatable disease.

4 3 EXCECUTVE SUMMARY ON THE ROAD TO WELLNESS We have learned more about the neural biology of addiction in the past five years that in the past 500 years. Dr. Paul Earley Medical Director State of Georgia Physicians Health Program t s puzzling why some people become addicted and others do not. No single answer has been found. t seems that people develop addictions through a mixture of factors such as: genes the way a person s brain works difficulties during childhood mental health problems stress cultural influences. While researchers continue to study the mysteries of addiction, some things are clear: nobody chooses to become addicted, and addiction is not simply due to personal weakness or character flaws. The latest scientific evidence is clear: addiction is a brain disease with underlying neurology; it is not simply a behavioural problem. t is a chronic disease. Neuroscience has substantially advanced the understanding that addiction is an organic neurobiological condition that affects perceptual, emotional and motivational processes in the brain. n addition, there are complexities involved because of the psychological, social, and economic determinants involved in the onset of addiction. The societal impact of addiction is staggering. The cost of substance abuse in Canada is estimated at $40 billion per year according the Canadian Centre for Mental Health and Addiction.

5 4 EXCECUTVE SUMMARY ON THE ROAD TO WELLNESS f you remember nothing else, remember two things after your two days here: this is an illness that is chronic and relapsing and recovery is possible with the right treatment. Dr. Graeme Cunningham RCDSO Wellness Consultant The impact of this devastating disease on individual dentist lives, practices and families is enormous. n no way do the statistics capture the human toll of family devastation, broken hearts, broken dreams and financial ruin. There is good news though. With the right support, people with addictions can lead healthy and productive lives. n fact, the current recovery rate for health care professionals is up to 90 % after five years. This incredibly positive outlook for addicted dentists was the culmination of a two-day conference on October 12 and 13 in Toronto entitled, On the Road To Wellness: Dealing with Addiction Disease in Dentistry. The conference was sponsored and organized jointly by the Canadian Dental Regulatory Authorities Federation and the Canadian Dental Association. During the conference, the nearly 80 participants gained a shared knowledge of the science of addiction and a fundamental understanding of its implications for practice and policy. The conference PowerPoint presentations and handouts are in the appendices. There were wide-ranging roundtable discussions on how to best support the well-being of the single most valuable asset in the nation s oral health care system the dentist. Other key themes of the roundtables included the appropriate role of regulators and professional associations in addressing substance abuse and what the barriers are for each group in offering assistance.

6 5 EXCECUTVE SUMMARY ON THE ROAD TO WELLNESS f you get no other take home message, is is coordination that single combination of compassion and control is what makes people shift and get better. Dr. Paul Earley Medical Director State of Georgia Physicians Health Program As the conference closed on late Saturday afternoon, it was clear that both regulators and the provincial dental associations had accepted the challenge to use the insight and knowledge gained to accept the responsibility for change. t was agreed that the right support means a reliance on a non-punitive approach to supporting the addicted health professional. Meeting the incredible challenge of reduction of barriers to dentists seeking and accessing care for addictions must be balanced with an appropriate framework to protect the public from harm. As leaders in the dental community in this country, both the regulators and the provincial professional associations agreed to shoulder the responsibility to be in the vanguard of a much-needed transformation.

7 6 EXCECUTVE SUMMARY ON THE ROAD TO WELLNESS FUTURE DRECTONS This is not a professional issue, nor a regulatory issue, it is a human issue. Dr. Rob Sutherland President, Canadian Dental Association Our ability to respond is only limited by our imagination. Dr. Peter Trainor President, Canadian Dental Regulatory Authorities Federation The two-day event wrapped up with comments from the CDRAF President Dr. Peter Trainor and CDA President Dr. Rob Sutherland as together they synthesized the roundtable discussions on how regulators and the professional associations and looked forward to the future. The key points of their joint presentation were: EDUCATON & COMMUNCATON These are the first critical steps of a successful strategy. Leaders in the dental community and the broader profession need to gain a basic understanding of the nature of the problem and the opportunities for success. COMPLEXTY By pooling and coordinating resources, the probability of success is improved. Addiction disease is a complex problem that will require complex solutions, not a one-off effort. There will need to be recognition of the geographical/language realities of the country so that some provinces are not disadvantaged. MANAGNG OUTCOMES t is important to take the strength of our existing resources and maximize them. t is critical to achieve the best outcomes in the most efficient way possible as effective solutions will be expensive. SYNERGY/TEAMWORK There is need for a synergy of commitment with a collaborative and coordinated response with defined roles for regulators and professional associations. t is important to capitalize on the current momentum to move forward together with a sense of urgency.

8 7 EXCECUTVE SUMMARY ON THE ROAD TO WELLNESS FOR MORE NFORMATON Canadian Dental Regulatory Authorities Federation rwin Fefergrad Executive Director Canadian Dental Association Dr. Benoit Soucy Director of Clinical and Scientific Affairs

9 8 EXCECUTVE SUMMARY ON THE ROAD TO WELLNESS APPENDX Tab 1 Tab 2 Tab 3 Tab 4 Tab 5 Tab 6 Tab 7 Tab 8 What is it about dentists? Health & Addiction Dr. Carolyn Thomson Anecedotal Perspectives from BC Experience of Member Counselling Support Dr. John T. Palmer Addiction in the 21 st Century: A Treatable Brain Diseases Dr. Paul Earley Addiction in Caregivers Dr. Graeme Cunningham CV of Dr. Graeme Cunningham CV of Dr. Paul Earley CV of Dr. John Palmer CV of Dr. Carolyn Thomson

10 What is it about dentists? Health & Addiction Dr. Carolyn Thomson, MD, CCFP, FCFP Co ordinator, Professionals Support Program Doctors Nova Scotia 2 Personalities Dentistry attracts people with Thinker Sensor ntrovert Perceptive ntuitive compulsive personalities unrealistic expectations unnecessarily high standards of performance require social approval and status Judgmental Feeler Extrovert 3 4 General Health Healthy Behaviours Good to excellent health 88% BUT Report poor general health 10% Poor physical state 30% Overweight 27.6% Obese 7.4% Exercise 59% Breakfast 73% Sleep 61% Snack 20% Smoking 10% Alcohol 90% Average BM 61% Myer and Myer

11 Musculoskeletal Disorders Other Health ssues High prevalence 87.2% over 12 months Low back pain (LBP most common) Shoulder pain Wrist pain Allergic contact dermatitis Respiratory sensitivity Eye injuries Auditory damage Hepatitis B: vaccine uptake 7 8 Nitrous Oxide Chronic exposure can produce serious risk Possible risks to the hematological, reproductive, hematological, hepatic and renal systems ncrease cancer risk Most common: peripheral neuropathy Usage USA and Japan 50% Denmark 45 50% UK 30 40% Ten most commonly reported minor ailments Backache or pains in the back 62.3% Nervy, tense or depressed* 60.0% Heartburn, wind or indigestion 59.4% More male Headache* 58.3% More female Difficulty in sleeping* 48.6% * Correlates with work stress Feeling tired for no apparent reasons* 48.2% More female Cough, catarrh or phlegm 38.4% Dry, itchy or tired eyes 34.4% Blocked or runny nose 32.9% Rashes, itches or other skin trouble 28.7% 9 10 Key Point Burnout and poor health are strongly related. To deal preventatively with burnout in dentistry, pay attention to physical health. How could dentists let these things happen to themselves? 11 12

12 Vulnerability Depression Genetic factors Dynamics of family of origin Personal history exposure/response to trauma Variations in brain chemistry Personality characteristics Cultural norms Religious beliefs US Lifetime prevalence 17% One year prevalence 10% Occurs more often in women and lower socio economic status Only female pediatric dentists and periodontists more depressed than male counterparts JADA What are the costs? Anxiety Personal suffering mpaired relationships Days lost from work mpact on quality of care Not the mild, brief anxiety caused by a stressful event Affects 19 million Americans Most common GAD and Panic Disorder Prevalence not increased in dentists Suicide in Dentists Suicide in Dentists Not all those with depression suicidal but most suicides linked to depression Little valid evidence that dentists are more prone to suicide than the general population Some data: female dentists more vulnerable? JADA June 2001, Roger Alexander Suicide rate among dentists higher than those of other occupations New studies required to introduce the demographic variables previous psychiatric morbidity opportunity factor stressors not related to work nternational Dental Journal, 2012 Sancho FM 17 18

13 Top Ten Suicide Rates Key Point 1. Food Batchmakers 2. Physicians and Health Aides 3. Lathe and Turning Machine Operators 4. Biological, Life and Medical Scientists 5. Social Scientists and Urban Planners 6. Dentists 7. Lawyers and Judges 8. Guards/Sales Occupations 9. Tool and Die Makers 10. Police and Public Servants Professional training and licensure do not confer immunity from the realities of our humanity and the potential to experience illness, grief, family problems, stress, trauma or depression Addiction A disease process characterized by the continued use of a specific psychoactive substance despite physical, psychological or social harm." National nstitute on Alcohol Abuse and Alcoholism Lifetime prevalence of alcohol dependence in the general population 13.3 % 12 month prevalence of addiction 4.4 % Rates in healthcare professionals similar to general population Differences related to drugs of choice Reflects familiarity with particular drugs and access Little evidence dentists at greater risk than GPs Contributing Factors The Addicted Dentist High stress Unrealistic and perfectionistic expectations of oneself Grandiose feelings of invulnerability Knowledge about and access to drugs Other stressful environments long hours excessive professional demands demands of patients and staff 80 85% addicted dentists prefer drugs over alcohol Others: tobacco stress reducers upper and downers narcotics including nitrous oxide (hardest to shake) and benzodiazepines Most common: alcohol hydrocodone N2O 23 24

14 Personality Profile of Addicted Dentist Key Points Dissatisfied with career choice Fear of causing pain Low professional self esteem Obsessive compulsive & perfectionistic behaviour High need for control (but feeling out of control) Avoidant style in interpersonal relationships Dr. Jerry Gropper Talbott Marsh Recovery Campus The onus is on the dental staff, friends and family to recognize the onset of the individual s personality changes and to encourage the affected individual to seek help. Be aware of your own risk factors. Good News: Studies indicate a better than 86% five year recovery success rate for the dental profession Why should we care? Stress Common cause of early retirement Job dissatisfaction Poor working relationships Stress can be defined as the biological reaction to any adverse internal or external stimulus physical, mental or emotional that tends to disturb the organism's homeostasis. Can be +ve or ve Stress Stress Feelings of low self esteem, depression and anxiety and hopelessness. Younger dentists more prone. Sex differences Parents Work issues Patients often create less stress for dentists than running behind schedule Minor psychiatric symptoms: 32% vs 17.8% in GP Teaching: decreased stress Myers and Myers

15 Biggest cause of stress Three Dimensions of Burnout Running behind schedule and coping with difficult, uncooperative patient. Gradual erosion of the person Emotional Exhaustion Depersonalization Loss of professional satisfaction Prevention Addressing Burnout: The 3R Approach Commitment, self efficacy, resourcefulness and hope May have to address at organizational level Cognitive behavioural strategies Exhaustion more easily treated Recognize Reverse Resilience Key Point Stigma Burnout is easier to prevent than to treat. Associated with experiencing personal difficulties Feelings of shame or guilt can be a self imposed stigma Powerful deterrent People often shun what they don t understand Common view of mental illness Recovery profound feelings of personal frustration and failure Depressed people seek treatment in only 40% of cases 35 36

16 Stigma n Closing High proportion of depressed dentists are not receiving treatment for their illness. We need to understand ourselves better so we can better help our colleagues. Can address their need for help, while allowing them to maintain their professional image and reputation

17 Anecdotal Perspectives from the BC Experience of Member Counselling Support Dr. John T. Palmer Director, Dental Professional Advisory Program British Columbia Dental Association 2 UBC ntake Survey Fall 2011 Medical and Dental 3 4 How well would you say that you know yourself? A. Extremely well B. Quite well C. Not sure D. Not very well E. Hardly at all Learning about Self A. Self reflection B. Dialogue with others C. Objective feedback D. Using stories or fables as a template E. Comparing myself with others survey responses 5 6

18 Test Goals? The kind of subjects you prefer When studying for an examination, usually aimed to get 100%. A. Agree strongly B. Agree C. Uncertain/no opinion D. Disagree E. Disagree strongly m drawn toward subjects where the right answer is always clear: where there s less room for teacher bias to affect my evaluation. A. Agree strongly B. Agree C. Uncertain / no opinion D. Disagree E. Disagree strongly 7 8 Your Current Theory of ntelligence Mindset ndicate your degree of agreement with the following statement: You can learn new things, but you can t really change your basic intelligence. A. Agree strongly B. Agree somewhat C. Disagree somewhat D. Disagree strongly 9 10 Experiencing Failure Research on Coping Styles The challenge of learning from failure. Theory of intelligence (Entity or ncremental) highly correlated with how we deal with failure. f you believe intelligence is fixed, you re at higher risk for having a maladaptive response to failure (e.g using secondary strategies to cope). Primary and secondary responses to coping with failure Both approaches involve attempts to repair impact on self esteem experienced when we fail. Secondary means are ineffective in producing a better outcome going forward. (Dweck) 11 12

19 Personal strengths Here's what you said about your personal strengths What strength word would you choose to best describe what personal quality has brought you to succeed in your application to dental school? When asked about what they would value most in practice What You Value in Colleagues What strength would you value most in a professional colleague? We asked what you think patients value What you think patients will value in you What strength would patients value most in a treating physician or dentist? 17 18

20 Strengths that can tumble into liabilities ndependence (grandiosity) A need to be in control either actively, by competitiveness, aggressive control or passively by opting out. Perfectionism An anxiety driven quest to be perfect in the eyes of others (or ourselves). Can be technically productive but interpersonally damaging. Harsh selfshaming. Tendency to hyper focus (obsess) and lose the bigger picture. Specific contributors in substance use clients High anxiety levels + low trust Black and white (categorical) thinking Shame Tendency to isolate How do we help? Respect personhood Foster trust Minimize shaming

21 Addiction in the 21st Century: A Treatable Brain Disease Paul H. Earley, M.D., FASAM Presentation Outline Addiction in the 21 st Century: A Treatable Brain Disease Paul H. Earley, M.D., FASAM Earley Consultancy, LLC and Medical Director, Georgia PHP, nc. Atlanta, Georgia USA Part : History of the Addiction Concept Part : Addiction Characteristics Part : Addiction Neurobiology Part V: Effective Addiction Treatment Historical Perspective Part History of the Addiction Concept Paul H. Earley, M.D., FASAM Earley Consultancy, LLC Atlanta, Georgia USA Late 1800s nebriety was thought to be a primary medical illness. Various medical & spiritual remedies we tried with marginal success. 1930s With the emergence of psychoanalysis, alcoholism was viewed to be a symptom of other psychiatric diseases AMA declares alcoholism a primary disease. 1960s Alcoholism treatment centers emerge to treat the illness. Historical Perspective Historical Perspective 1970s The addiction movement had to define and differentiate itself in order to promote itself as a primary illness. 1980s The addiction concept was slowly redefined from problematic drinking to a disease caused be certain chemicals and behaviors. Our initial understanding of the brain circuits of addiction evolve. Addiction is differentiated from physical dependence. 2000s The neurobiology of addiction comes into sharp definition. The exact neural circuitry of addiction is demarcated. Additional addictive processes (compulsive sex, gambling and food binging) are discovered to exhibit the same abnormalities with the neural circuitry of chemical addiction. 2010s A few medications appear that help with the primary focus of addiction: craving and relapse prevention. Portions of this material are copyrighted. Page 1

22 Addiction in the 21st Century: A Treatable Brain Disease Paul H. Earley, M.D., FASAM Symptoms and Drug Use Accepting Addiction as a Disease Symptom Drug Use Prime mover according to Psychodynamic Theory Much more critical for initial abstinence and recovery Multigenerational culture bias Behaviors of addicts and alcoholics Failure of early treatment efforts nitial marginalization of addiction treatment Addiction is an nternational Health Problem Part Addiction Characteristics Paul H. Earley, M.D., FASAM Earley Consultancy, LLC Atlanta, Georgia USA Ten percent of all people become addicted throughout their lifetime in western cultures (lifetime prevalence). Addiction-related disease accounts for one-third of all hospital days. Addicts and addiction related crimes are the largest cause of nonviolent crime and incarceration. Addiction Nomenclature Addictionists use the term addiction to refer to alcohol and drug dependence and less technical terms, such as: alcoholism, chemical dependence and drunkenness as well as the behavioral addictions (e.g. gambling and sexual addiction) The term Addict is often used to describe the drug addict or alcoholic. Physiological Dependence versus Addiction Physiological Dependence Occurs in all individuals s a characteristic of certain drugs Craving occurs during drug withdrawal Addiction Occurs in 10% of the population s a characteristic of certain people with certain drugs Craving is tied to many emotional and cognitive triggers, occurring long past the withdrawal time Portions of this material are copyrighted. Page 2

23 Addiction in the 21st Century: A Treatable Brain Disease Paul H. Earley, M.D., FASAM The Etiology of Addiction The Cycle of Addiction Genetic Proclivity Earlier Life Trauma Addiction Acute reinforcing stage (ntoxication) Personality and Psychiatric Disease Environment and Access Preoccupation & Anticipation Withdrawal & Negative Affect Koob & Le Moal (2005) Plasticity of reward neurocircuitry and the 'dark side' of drug addiction. Nature Neuroscience. 8: The Using/Shame Cycle Urge to change strong affect Using Consequences & Guilt Part Addiction Neurobiology Shame Paul H. Earley, M.D., FASAM Earley Consultancy, LLC Atlanta, Georgia USA Addicting Molecules Nicotine Alcohol Heroin Cocaine s there a single pathway to addiction? Drugs of abuse have very different structures and neurotransmitter targets in the brain, but they all exhibit: acute reward chronic reward sensitization negative withdrawal symptoms associative cue learning incentive motivation (relapse) A progression from impulsive to compulsive drug use (which defines the progression from abuse into addiction). Nestler, EJ. Nature Neuroscience 2005; 8(11): Portions of this material are copyrighted. Page 3

24 Addiction in the 21st Century: A Treatable Brain Disease Paul H. Earley, M.D., FASAM Dopamine Reward Circuit Neurochemistry of Wanting Nucleus accumbens Ventral tegmental area (VTA) Nestler, EJ. Nature Neuroscience 2005; 8(11): Neural Adaptation to Drug use Normal Dendrites After extended drug exposure Nestler, E., Malenka, R. The Addicted Brain. Scientific American 290(3): 78 (2004) 22 Cue-induced Craving Amygdala not activated Anterior Amygdala activated Part V Effective Addiction Treatment Posterior Watching a Nature Video Watching a Cocaine Video Paul H. Earley, M.D., FASAM Earley Consultancy, LLC Atlanta, Georgia USA Portions of this material are copyrighted. Page 4

25 Addiction in the 21st Century: A Treatable Brain Disease Paul H. Earley, M.D., FASAM The Addictionectomy Substance Abusing Patient A Desirable Model Continuing Care / Monitoring Early Detection of Relapse Treatment Hospital Detox. Residential Rehab OP Rehab Outpatient Cont Care AA & Tele Monitoring Non-substance Abusing Patient Courtesy of A. Thomas McLellan, Ph.D. Modified from A. Thomas McLellan, Ph.D. Taper (and increase) Treatment as needed ntensity Current treatment Time Best practice treatment Elements of Effective Treatment Viewing addiction though same lens as other chronic diseases. Combination of effective initial intervention and disease management using contingency contracting. ntervene on co-morbid psychiatric and life issues simultaneously. Judicious use of non-addicting medications. Knowing that one size does not fit all. Long term disease management. Education and Consultation Contact Dr. Earley: Web site: by phone: (404) by [email protected] Portions of this material are copyrighted. Page 5

26 References Addiction in the 21 st Century Anton, R; O Malley, S; Ciraulo, D; Cisler, R; Couper, D; Donovan, D; Gastfriend, D; et al Combined Pharmacotherapies and Behavioral nterventions for Alcohol Dependence: The COMBNE Study: A Randomized Controlled Trial JAMA, May 3, 2006; 295: Bechara, A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nature neuroscience. 8 (11), (Nov 2005) Bechara, A; Damasio, H; Damasio, A. Role of the amygdala in decision-making. Annals of the New York Academy of Sciences. 985, (Apr 2003) Berglind, W., et. al. Dopamine D1 or D2 receptor antagonism within the basolateral amygdala differentially alters the acquisition of cocaine-cue associations necessary for cue-induced reinstatement of cocaine-seeking. Neuroscience. 137 (2), (2006). Everitt, B.; Cardinal, R.; Parkinson, J.; and Robbins, T. Appetitive Behavior: mpact of Amygdaladependent Mechanisms of Emotional Learning. Annals of the N/Y/ Academy of Sciences. 985: (2003). Goldstein, R; Volkow, N; Wang, G; Fowler, J; Rajaram, S. Addiction changes orbitofrontal gyrus function: involvement in response inhibition. Cognitive Neuroscience and Neuropsychology 12(11) 8 August Kilts, K, et al. Neural Activity Related to Drug Craving in Cocaine Addiction Arch Gen Psychiatry. 2001;58: Hall, F.S., et al., Molecular mechanisms underlying the rewarding effects of cocaine p Hyman, S. Addiction: a disease of learning and memory. Am J. Psychiatry 162: (2005). Koob, G, Le Moal, M. Plasticity of reward neurocircuitry and the dark side of drug addiction. Nature Neuroscience 8: Nov Nestler, EJ. s there a common molecular pathway for addiction? Nature Neuroscience 2005; 8(11): Schoenbaum, G., M.R. Roesch, and T.A. Stalnaker, Orbitofrontal cortex, decision-making and drug addiction p See, R, et al. Drug addiction, relapse, and the amygdala. Annals of the New York Academy of Sciences. 985, (Apr 2003) Stocker, S. Studies Link Stress and Drug Addiction. NDA Notes. Volume 14, Number 1 (April, 1999) Sugase-Miyamoto, Y; Richmond, BJ. Neuronal signals in the monkey basolateral amygdala during reward schedules. J Neurosci Nov 30;25(48):

27 Addiction in Caregivers Graeme M. Cunningham, MD, FRCPC RCDSO Wellness Consultant 2 Caregiver mpairment Prevalence One who is unable to practice giving care with reasonable skill and safety to patients because of physical or mental illness, including deterioration through the aging process, characterologic or psychiatric difficulties, excessive use of alcohol or other drugs and sero positivity for HV and Hep C. 10% were daily drinkers 9.3% had 5 drinks a day at least once in past year 17.6% had self prescribed benzodiazephines in past year 17.6% had self prescribed opiates in past year 8% reported dependency in their lifetimes Hughes PH, Brandenburg N., Prevalence of Substance Use Among US Physicians. JAMA 1992;267: Prevalence in Dentists Psychological Characteristics of Caregivers Alcohol 12 19% Opiates hydrocodone and oxycodone 37% Nitrous Oxide almost exclusively in dentists 5% Nicotine Street drugs cocaine 10% Dedication/Focus Delayed Gratification Workaholics Guilt Prone Exaggerated Responsibility Limited Emotional Expressiveness Regularly Suppress Anger 5 6

28 Psychological Characteristics of Caregivers Female MDs/Dentists Obsessive/Compulsive Traits Perfectionist Demanding mpatient Hyperconscientious Difficulty with Fun (it s OK if we make work of it!) am my Work Just as compulsive, but value relationships more than male MDs/Dentists 75 80% do own housework Frequently feel guilty Try to be Superwoman 7 8 Risk factors for Caregivers ssues Specific to Professionals Genetic tendency solation Specialty Childhood tapes Enablers Smoking Pedestal profession Terminal uniqueness Difficulty in patient role Tendency to intellectualize Severe guilt and shame Entrenched denial Tendency to self medicate Threatened loss of licence Return to work issues 9 10 Homewood Experience Work related ssues Drugs used in order of frequency: Nicotine Alcohol Opioids codeine, morphine, dilaudid, percocets, oxycontin Benzodiazepines Cocaine Antihistamines ncorrect narcotic counts Alteration of narcotic vials Patient complaints of ineffective pain relief Large volumes of wastes Discrepancies in orders,progress notes and mars Many corrections on narcotic records 11 12

29 Suggestive Signs Clues to Recognition Crippling anxiety Frequent bathroom relief Desire to work alone Deteriorating appearance Always wearing long sleeves Appearing when off duty Marked mood swings Change of personality Loss of efficiency and reliability ncreased sick days Complaints from patients, particularly about a changed attitude Development of indecision Professional and social isolation Physical changes Heavy wastage of drugs MD giving analgesics Unpredictable work habits More Clues to Recognition mpaired Health Professionals Programs Mood swings, suicidal ideation Memory loss, blackouts after parties nappropriate prescribing large doses long term narcotics Offering to waste patient s supply Changes in routine Sloppy charts and writing (worse than usual) Desire to work alone Long sleeves in hot weather Frequent bathroom breaks n when should be off duty Assessment Recovery Program Peer Group Therapy Mirror mage Therapy 12 Step Mutual Help Family Treatment Process Addictions Relapse Prevention Special ssues Assessment Value of Peer Group Therapy Multidisciplinary History Usual Medical Hx Alcohol/Drugs Emotional Spiritual Family Collateral Drug Screening Psychological Assessment Psychiatry Group/Peer Exposure 12 Step Exposure This group scares me. Confront denial/support recovery Chemical free coping skills ssues of trust and friendship Confront terminal uniqueness Deal with GOD issues Dump secrets Transition to 12 step process Communication/listening skills 17 18

30 Group Work Health Professionals ssues Process Addictions God, now they want me to talk in front of 50 people! Are they or aren t they? Access/safe environment Licensing/disciplinary issues Returning to work Recovery checklist Advocacy contract Clinical histories Gambling Sexual Excitement Food Return to Work : Practical ssues Typical Contract Full restoration of work capacity may require 4 6 months even though symptom remission begins in 4 6 weeks ssues of disability insurance and finances Challenges in gradual return to work: practical arrangements and monitoring Attitudes of others in the workplace Agreement on diagnosis Attendance at AA, Caduceus, Addiction Doctor, after care group Attendance at family doctor Random urine monitoring expectations Advocacy role of treating doctor Clear consequences of breach of contract Third party reporting where necessary Typical Work ssues Re Entry to Practice Location of continuing employment Need for buddy system Narcotic issues Home nursing Need for external reports Properly treated physicians in recovery are no more, and probably less of, a risk to patients than the general physician population Pelton C, Lang DA, Nye GS et al. Physician Diversion Program: Experience with Successful Graduates. J Psychoactive Drugs 1993;25(2):

31 Re Entry to Practice The Homewood Experience ssues that arise for colleagues thought d be good to myself and take three days off before go back. Average return to work is three months Emergency, night, and weekend work avoided wherever possible for the first six months Phase in with part time Clean office no mood altering drugs Avoid drug reps Tell those who need to know Anger and resentment Fear Uncertainty Over protectedness Minimizing the professional s needs Family of origin stuff Summary n Closing Health professionals are different. They require and deserve specific treatment paths. These paths offer a 73% 90% recovery rate at five years. We need to understand ourselves better so we can better help our colleagues. Can address their need for help, while allowing them to maintain their professional image and reputation

32 C U R R C U L U M V T A E (Revised March 2010) NAME: Graeme MacCallum Cunningham HOME ADDRESS: 24 Latenda Place Guelph ON N1G 3B8 (519) OTHER PERSONAL DATA: D.O.B. 04/07/43 Married, 5 children EDUCATONAL BACKGROUND: 1967 M.B., Ch.B. University of Glasgow, Scotland 1970 M.R.C.P. (U.K.) 1971 L.M.C.C F.R.C.P. (C) 1983 F.R.C.P. (GLASG) 1988 Certificant, American Society of Addiction Medicine 1997 Fellow, American Society of Addiction Medicine 2001 Certificant, Canadian Society of Addiction Medicine 2009 Certificant, American Board of Addiction Medicine CURRENT STATUS AT McMASTER: Assistant Clinical Professor, Department of Medicine, McMaster University Associate Clinical Professor, Department of Psychiatry, McMaster University 2009 Clinical Professor, Department of Psychiatry, McMaster University REV. March

33 PROFESSONAL ORGANZATONS: Ontario Medical Association Past Chairperson District 9 Past Chairperson Section of nternal Medicine Past Chairperson Section of Addiction Medicine Canadian Medical Association American Board of Addiction Medicine Canadian Society of Addiction Medicine Past Board member for Ontario College of Physicians & Surgeons of Ontario President, HONOURS: 2000 Courage to Come Back Award presented by the Centre for Addiction & Mental Health, Toronto, Ontario. Honorary Life Membership Award, Canadian Society of Addiction Medicine The award is inscribed: Canadian Society of Addiction Medicine HONOURARY LFE MEMBERSHP AWARD presented to Dr. Graeme Cunningham on the occasion of the 16 th Anniversary of our Society, in recognition of his dedicated service and visionary leadership provided to the field of Addiction Medicine REV. March

34 EMPLOYMENT HSTORY: House Physician to Professor E.M. McGirr August 1967 January 1968 University Department of Medicine, Glasgow Royal nfirmary. House Surgeon to Professor W.A. MacKay February 1968 August 1968 University Department of Surgery, Glasgow Royal nfirmary Faulds Research Fellow August 1968 August 1969 University Department of Medicine, Glasgow Royal nfirmary Senior House Office in Medicine Registrar in General Medicine Family Physician August 1969 April 1970 April 1970 October 1970 October 1970 December 1973 Glasgow Royal nfirmary Glasgow Royal nfirmary Parry Sound, Ontario Senior Resident, nternal Medicine University of Toronto Chief Resident, nternal Medicine St. Michael's Hospital, University of Toronto Teaching Fellow University of Toronto Consultant nternist Timmins, Ontario Senior Resident, University of Toronto, Medicine of Addictions Addiction Research Foundation, Toronto Director, Homewood Addiction Division Homewood Health Centre REV. March Guelph, ON 3

35 SCHOLARLY AND PROFESSONAL ACTVTES: Chairman, Section of nternal Medicine Member, Committee on Hospitals Ontario Medical Association Ontario Medical Association Chairman, District Nine Ontario Medical Association Member of Board of Directors Timmins Chamber of Commerce Past Chief of Staff General Hospital, Parry Sound, ON Past Chief of Medicine St. Mary's General Hospital, Timmins, ON Past Director, ntensive Care Unit St. Mary's General Hospital, Timmins, ON Consultant Ontario Heart Foundation nspector, Medical Review Ministry of Health Committee Board Member Canadian Society of Addiction Medicine Chair, Advisory Committee Physician Health Program Ontario Medical Association Member of Council College of Physicians & Surgeons of Ontario Chair, Methadone Governance Committee Province of Ontario Member, Executive Committee College of Physicians & Surgeons of Ontario Vice-President College of Physicians & Surgeons of Ontario President College of Physicians & Surgeons of Ontario Past-President College of Physicians & Surgeons of Ontario AREAS OF NTEREST: Teaching of Addiction Medicine, Assessment and Treatment of Addicted Physicians. REV. March

36 COURSES TAUGHT: () Undergraduate - Electives in Addiction Medicine for all undergraduate units. act as preceptor/supervisor. A teaching handbook in Addiction Medicine has been developed. The electives are of varying lengths of 1 day to 3 weeks. Project CREATE is a joint effort of the five Ontario Medical schools to develop teaching modules in Addiction Medicine for all clinical services. have assisted in the development of the module for E.R. physicians and for the recognition of stress and substance misuse in medical students. (ii) Postgraduate. A Fellowship position in Addiction Medicine has been developed in the Homewood Addiction Division. Goals, objectives and an evaluation tool for this Fellowship have also been developed. am the supervisor of the Fellow-in-training and it is a yearlong position. n 1993 & 1994, helped organize and chair two international symposia in Addiction Medicine at the University of Guelph. n 1995, assisted the University of Ottawa in curriculum development and teaching in Addiction Medicine. n 1996, organized and chaired the 7th Annual Scientific meeting of the Canadian Society of Addiction Medicine. Since January 2000, am responsible for all Addiction Medicine Teaching in the Department of Psychiatry at McMaster University. This involves 24 hours of workshops/academic year. LFETME PUBLCATONS: Peer Reviewed: "The Effect of Oral Anticoagulant Drugs on Platelet Aggregation in the Chandler's Tube", (1965) - Cunningham GM, McNichol GP, Douglas AS. Lancet l, 279. "The Effect of Glyvenol (CBA) on Pain and Capillary Fragility in Rheumatoid Arthritis", (1969) - Dick WC, Cunningham GM, Nuki GK, Whaley KW. Annals of Rheumatic Diseases, 28, 187. "The Effect of Oxygen on the Fibrinolytic Enzyme System in Vivo:, (1971) - Cunningham GM, Boyd GD, McNichol GP. Journal of Clinical Pathology, 8, 705. "Drug-nduced nternuclear Opthalmoplegia", (1983) - Cunningham GM. Canadian Medical Association Journal, Vol. 128, 892. "Recovery from Chemical Dependency - The Process and Role of the Physician" Medicine North America , "Developing an Office Management Plan for the Alcoholic Patient" - Canadian Journal of Diagnosis , REV. March 2010

37 "Prescription Drug Abuse - dentifying the Prescription Drug Addict" - Canadian Journal of Diagnosis , "Paying Attention To Substance Abuse n Physicians" - Canadian Journal of Diagnosis , "A Program to Treat mpaired Physicians - Graeme M. Cunningham, Annals of Royal College of Physicians and Surgeons of Canada , 27, Physicians as Patients D. Whitney, G. Cunningham, S. Abdool 2001, Psychiatry Rounds 5:7. Book Chapters: 1996 The Substance-Abusing Physician - dentification and Management. The CMA Guide to Medical Administration in Canadian Hospitals. D. Gellman, Editor The mpaired Physician - Management of Alcohol, Tobacco and other Drug Problems. Bruna Brands, Editor. Letter to the Editor - Alcohol Misuse Among Doctors (1997) Cunningham, G.M., British Medical Journal 314, Unpublished Documents: (a) Naltrexone in the Treatment of Alcohol Dependence - A Canadian Trial (1997) Authors: M.K. Romach, E.M. Sellers, G. Somer, M. Landry, G. Cunningham, R. Jovey, C. McKay, J. Boislard, C. Mercier, J. Pepin, J. Perrault, E. Lemire, F. Bastien, R. Baker, W. Campbell, D. Ryan. (b) The Outcome of Treatment of 100 Alcohol Dependent Adults using the Addiction Severity ndex - A study undertaken jointly with the University of Pennsylvania. REV. March

38 PRESENTATONS AT MEETNGS: (nvited = ) (Contributed = C) Date Location Topic /C March 1, 1991 Seminar - Owen Sound, Addictions and the Community March 26, 1991 St. Joseph's Hospital Quarterly Medical Staff Meeting Hamilton, Ontario April 23, 1991 Toronto and District Correctional Services Annual Meeting April 29-30, Concerns Canada - Seminar on 1991 Prescription Drug Abuse June 14, 1991 The Ontario Chapter of the College of Family Practice Annual Spring Meeting, Minaki Lodge, Ontario. Annual Meeting of the Ontario Parole Board Clinical Perspectives of Alcoholics Anonymous. mpaired Physicians - Risks and Treatment. Discussion of Detoxification Techniques Keynote Speaker and Workshop leader in Prescription Drug Abuse ssues. Seminar on Recovery Sept. 5, 1991 Treatment of Substance Abuse in Prisoners Oct. 23, 1991 Telemedicine Canada - Toronto Office Management of Alcoholism. Oct. 24, 1991 Ontario Alternate Housing Committee Workshop on Dual Disorders Annual Conference Oct. 25, 1991 Canadian Medical Society on Workshop leader on Prescription C Alcoholism and Other Drugs Annual Meeting Drug Abuse. Nov.18, 1991 Concerns Canada Drug Awareness Week Keynote speaker. The Disease of Seminar London, Ontario. Addiction. Nov. 20, 1991 Lecturer at Queen's University Kingston The mpaired Physician. General Hospital Nov. 21, 1991 Dual Disorders Workshop Queen Street Annual Dual Disorder Meeting C Mental Health Centre Dec. 3, 1991 Telemedicine Canada Journal Club in Medicine. March 4, 1992 Half day at the University of Guelph. Seminar on Drug Addiction C April 7, 1992 University of Toronto - Mental Health Physician mpairment half day for residents and interns April 11, 1992 College of Family Physicians - Manitoba The Office Management of Chapter, Winnipeg Manitoba Substance Abuse April 15, 1992 Ontario Hospital Association Chief of Physician mpairment Staff Seminar April 23, 1992 Concerns Canada Prescription Drug Abuse April 26, 1992 Sept. 25, 1992 REV. March 2010 Canadian Association of Medical Directors of Teaching Hospitals Canadian Anaesthesia Society Annual Meeting 7 Physician mpairment Substance Abuse in Anaesthetists

39 Nov. 7, 1992 Ontario Association of Physicians in the Ambulatory Detoxification Correctional Services. Techniques. Nov. 11, 1992 Grand Rounds, St. Michael's Hospital, Physician mpairment. Toronto April 23, 1992 Concerns Canada Prescription Drug Abuse. April 26, 1992 Canadian Association of Medical Physician mpairment Directors of Teaching Hospitals Sept. 25, 1992 Canadian Anaesthesia Society Annual Substance Abuse in Anaesthetists Meeting Nov. 7, 1992 Ontario Association of Physicians in the Ambulatory Detoxification Correctional Services Techniques Nov. 11, 1992 Grand Rounds, St. Michael's Hospital, Physician mpairment Toronto Nov. 13, 1992 Ontario Chapter, Canadian College of Detoxification Techniques Family Practice Annual Meeting Nov. 22, 1992 Canadian Medical Society on Recovery from Addiction! The Role C Alcoholism and Drugs Annual Meeting, Vancouver British Columbia. of the Physician Feb. 10, 1993 Multidisciplinary Half-Day, McMaster Physician mpairment University Feb. 11, 1993 Grand Rounds, Kitchener-Waterloo Physician mpairment Hospital March 11-13, 14th Annual Winter Symposium "Grand Rounds in Medicine" 1993 McMaster University - Dalhousie University, Deerfield Beach, Florida April 19, 1993 Basic Seminar for Physician Managers, Physician mpairment Ontario Hospital Association May 29, 1993 Ontario Medical Association Annual Physician Support Programs Meeting June 11, 1993 Addictions '93 - University of Guelph Detoxification Techniques C Oct. 22, 1993 Jan. 21, 1994 Annual Meeting - Physicians Support Program, British Columbia Medical Association City-Wide OB-GYN Rounds, Mount Sinai Hospital, Toronto Ontario Medical Students Weekend, McMaster University, Hamilton Recovery from Addiction; Programme Components Physician mpairment Feb. 5, 1994 Physician Stress and Substance Abuse March 23, 1994 Telemedicine Conference Practical Management of the Alcoholic in the Office March 29, 1994 College of Physician and Surgeons of Addiction in Anaesthetists Ontario, Leaders in Anaesthesia Day April 24, 1994 Operating Room Nurses Annual Substance Abuse in the Operating Meeting, Ottawa Room REV. March

40 May 10, 1994 Norfolk General Hospital, Medical Medical Detox Techniques Grand Rounds May 13, 1994 Ontario Association of Medical mpairment in Health Professionals Radiation Technologists Hamilton, ON June 10, 1994 Addictions '94 - University of Guelph Methadone Maintenance in.v. Drug C Users June 10, 1994 Addictions '94 - University of Guelph The Health Professional Marriage C July 19, 1994 McMaster University nstitute in The Homewood Treatment Program Addiction Studies Sept. 17, 1994 Canadian Medical Society on Drug Testing in the Workplace C Alcoholism Ottawa, Ontario Sept 19, 1994 nternational Conference on Physician Treatment of mpaired Physicians C Health Plenary Session, Ottawa Ontario October 6, 1994 Basic Medical Officers Course Armed Relapse Prevention Forces Base, Barrie Oct. 14,1994 Address to Law Enforcement Officers Physician Prescribing ssues College of Physicians & Surgeons of Ontario Oct. 22, th Annual Renascent Centre Addiction and Relapse Symposium Plenary Presentation Jan. 30, 1995 Ontario Psychiatric Association Annual Group Therapy for Addicted Doctors C Meeting March 29, 1995 Address to the Council, College of ncapacity in Nurses Due to Nurses of Ontario Substance Abuse April 8, 1995 Canadian Association of Chief Residents Resident Stress & Substance Abuse in Medicine Annual Meeting, Vancouver, British Columbia April 12, 1995 Basic Program for Physician Managers mpaired Physicians - The Role of Ontario Hospital Association, Toronto the Chief of Staff April 18, 1995 Federation of Health Care Colleges Fitness to Practice ssues Working Group Annual Meeting Mitchener nstitute, Toronto April 28, 1995 Workshop American Society of Addiction Group Therapy for Addicted Doctors C Medicine Annual Meeting, Chicago, llinois May 18, 1995 Addictions Teaching Session University of Physician mpairment and Ottawa ntercollegial Responsibility May 24, 1995 Telemedicine Canada Substance Abuse in Nurses, ts dentification and Treatment July 17, th Annual nstitute on Addiction Studies Workshop on Dual Disorders Sept. 29, 1995 Basic Medical Officers Course Substance Abuse in Physicians Oct. 16, 1995 Canadian Medical Society of Alcohol & Other Drugs. Annual Meeting, Banff, Alberta Prescription Drug Abuse in Women and Physician Prescribing Practices C REV. March

41 Nov. 1, 1995 British Medical Association Annual The Politics of a Physician Support C Meeting. York, England Programme Feb. 8, 1996 nternational Conference on Physician The Role of Spirituality in the C Health Chandler, Arizona Recovery from Addiction April 20, 1996 Workshop for Family Doctors, Toronto Alcoholism in Office Practice April 22, 1996 Annual Meeting, Dupont Pharmaceuticals Plenary Session - The Varied Victoria, B.C Presentations of Addiction April 26, 1996 Ontario Bar Assistance Programme Addiction in the Legal Profession April 26, 1996 Keynote Speaker Annual Meeting of the Addiction ntervention Association Sept. 19, 1996 Workshop for Medical Society of Prince Office Management of Alcoholism Edward sland October 1996 Chairperson, Organizing Committee, Annual Meeting Canadian Society of Toronto, ON Addiction Medicine January 1997 Women s Health Conference Toronto, ssues of Addiction in Women, Their Ontario Recognition and Treatment February 1997 Annual Meeting, College of Family Practice, Alberta Chapter Plenary Session June 1997 Monthly Medical Rounds Henderson General Hospital, Hamilton July 1997 nstitute for Addiction Studies, McMaster University Plenary Presentation August 1997 Annual Meeting of the Canadian Bar Association, Ottawa Plenary Session September 1997 Medical Grand Rounds. Kings Health Centre, Toronto September 1997 Basic Medical Officer Course, Base Borden, Barrie, Ontario Plenary Session October 1997 Twenty-First Annual Meeting, British Doctors and Dentists in Recovery Group. Brighton, England Plenary Session November 1997 nput 97. A conference for Employee Assistance Program Providers. Ottawa, Ontario Plenary Session Jan. 17, 1998 Canadian Association of nsurance Underwriters Annual Meeting, Toronto. Plenary Session Feb. 4, 1998 Basic Medical Officers Course, Base March 4, 1998 Borden, Barrie College of Physicians & Surgeons of Manitoba Workshop presentation. The Office Management of Alcoholism mpairment in Health Professionals The Pharmacotherapy of Drug Addiction mpairment in the Legal Profession Recognition of Alcoholism in Office Practice Physician mpairment Physician mpairment, Recognition and Management What s New in Alcoholism? Alcoholism - Morbidity and Morality Addicted Health Professionals Sexual Addiction C C REV. March

42 April 30, 1998 nternational Conference on Physician Health. Paper - The Politics of a Physician Health Program C May 11, 1998 Canadian Society of Medical Underwriters Plenary Session Alcoholism Morbidity & Morality May 20, 1998 August 1, 1998 August 21-22, 1998 Annual Day at Newport Plenary Session Annual Meeting, American Bar Association Addictive ssues into the 21st Century, Vancouver B.C. Addicted Doctors mpairment in Lawyers 1.Sexual Addiction (workshop) 2.Physician mpairment (workshop) 3.Spirituality & Addiction (workshop) Recovery & Spirituality Sept. 10, 1998 Annual Meeting Wayside House of Hamilton Oct.17-19, British Doctors & Dentists Annual Physician mpairment 1998 Meeting, Manchester, England Nov. 2, 1998 Annual Meeting, Ontario Medical Addiction & Mental Health in the Association General Hospital Nov. 6, 1998 Pragma Council, University of Waterloo Addiction and the Search for Normalcy Nov. 19, th Annual Seminar on Substance Abuse Substance Abuse in the Workplace in the Workplace November 25 - Community Addiction Agencies Annual dentification & Management of 26, 1998 Meeting, Saskatchewan Alcoholism (workshop) Dec. 2, 1998 Multidisciplinary Academic Day, Physician mpairment McMaster University Jan. 18, 1999 Canadian nsurance Underwriters Evaluating Drug Dependency Seminar, Ottawa ON Jan. 27, 1999 Ontario Methadone Prescribing Host - Review of Methadone Policies C.P.S.O., Toronto ON April 13, 1999 Addictions, P.E. Substance Abuse in Nurses April 14, 1999 Grand Rounds, Department of Psychiatry, McMaster University April 29, 1999 Ruth Fox Course for Physicians, New York, NY Aug.12-14,1999 Foundation for Medical Excellence, Vancouver B.C. Sept. 17, 1999 Annual Meeting, Canadian Psychiatric Association, Toronto Oct. 16, 1999 British Doctors & Dentists Annual Meeting, Cambridge, England Nov. 22, 1999 OMA, Physician Health Program Annual Meeting, Toronto Addiction in Physicians Spirituality in Addiction Medicine Spirituality in Addiction Sexual Addiction - Workshop mpaired Physicians The Psychology of the 12-steps The Politics of a Physician Health Program REV. March

43 Feb.13-14, 2000 Substance Abuse Symposium for Medical Professionals, Montgomery, AL Feb. 17, 2000 Physicians at Risk, McMaster University, Hamilton February 27 - ALU Seminar, San Diego, California 29, 2000 March nternational Conference on April 2, 2000 Physician Health April 28 - April Washington Physicians Health Program 30, 2000 October 5-7, Addiction Update, Foundation for 2000 Medical Excellence, Vancouver, B.C. October 18-21, British Doctors, Dentists Group 25 th 2000 Annual Conference, Cheltenham, England. February 2-4, Addiction Update Conference, 2001 March 1, 2001 June 4, 2001 June 13, 2001 June 20 22, 2001 August 16 18, 2001 Montgomery, Alabama, USA Southwest Addiction Conference, Windsor District Health Council, Windsor, Ontario Addiction ntervention Association, Annual Conference, Toronto, Ontario nsurance Underwriters of Southern Ontario Federation of Medical Licensing Assoc. Canada, Annual Meeting, St. Johns, NFL Addictive ssue Update, Foundation for Medical Excellence, Vancouver, B.C. Spirituality and Addiction Medicine Chiefs of Staff Recognizing Alcoholism and Treating Alcoholism Sexual Addiction, the Secret of the 90's Sexual Addiction, the Secret of the 90's Prescription Drug Abuse Workshop Sexual Addiction - Plenary Spirituality in Addiction Medicine Spirituality in Addiction Medicine Recognition & Treatment of Alcoholism Substance Abuse in the Workplace Substance Abuse in the Workplace The Disruptive Doctor Prescription Drug ssues Workshop Sexual Addiction Plenary Spirituality & Addiction Plenary Recovery & the Family Doctor Oct. 4 6, th Annual Addiction Conference, Harrogate, England Nov , Update Annual Canadian EAP Substance Abuse in the Workplace 2001 Conference, Ottawa, Ontario Nov. 22, th Annual Scientific Assembly, Ontario Recovery & the Family Doctor College of Family Physicians Toronto, ON Feb. 8, 2002 Addiction ssues in PTSD, Guelph, ON April 12, 2002 June 12, 2002 June 27, 2002 August 17, 2002 Toronto MEDCO-LEGAL Society Annual Meeting Annual Presidents & Chiefs of Staff Day, College of Physicians & Surgeons of Ontario, Toronto Annual Retreat, Talbott Recovery Campus, Atlanta, Georgia Addiction Conference, Aberdeen University, Scotland Addiction in Lawyers Physician mpairment 3 PLENARY Presentations 2 PLENARY Presentations REV. March

44 Sept. 23, 2002 World Drug Forum, Montreal, Quebec Medicine & the 12 Steps Oct. 27, 2002 Spirituality and Health University of Toronto Nov. 2, 2002 Mental Health and Addiction C Annual Meeting Canadian Psychiatric Association, Banff, Alberta Nov. 7, 2002 Dinner Meeting, Medical Staff, Chronic Pain and Opioids Windsor, Ontario Nov. 21, 2002 Annual Meeting, College of Addiction in Health Professionals Veterinarians of Ontario June 7, 2003 Annual Meeting, Federation of Licensing The Disruptive Physician Medical Authorities, Quebec City Oct. 1, 2003 Annual Meeting, College of Physicians Addiction and the C.P.S.O. & Surgeons of Prince Edward sland Oct. 8, 2003 Grand Rounds, McMaster University A Pot-Pouri of College ssues Nov.20, 2003 Annual Scientific Assembly, Ontario Physician Heal Thyself College of Family Practice Keynote Presentation Jan.16, 2004 Physician Heal Thyself Annual Dinner St. Joseph s Hospital, Hamilton Medical Staff Jan.21, 2004 Substance Abuse in the Workplace Guelph Chamber of Commerce Annual Meeting Feb. 4, 2004 Hospital Rounds Homewood Health Centre Nov , Treatment of mpaired Physicians (2) Annual Meeting B.C. Physicians 2004 The Psychology of the 12 Steps Health Programme, Vancouver, British Columbia Feb 28 Nov Addiction Treatment: Costs and American Life Underwriters 2005 March 9 10, 2005 Benefits Addiction Treatment Association, New Orleans, U.S Annual Meeting of Regina Regional Health Authority, Regina, Saskatchewan. April 12, 2005 Grand Rounds, Medicine Hamilton General Hospital April 27, 2005 Grand Rounds Henderson Hospital, Hamilton, Ontario April 28, 2005 Disruptive Physicians Annual Meeting of Canadian Association of Rural Physicians, Montreal, Quebec April 29, 2004 Chronic Pain of Addiction Annual Meeting, O.M.A. Section of Chronic Pain. June 2004 Six presentations, contracted by College March 2005 of Family Practice, to OCFP Regional Meetings covering the Province of Oct. 13, 2004 REV. March 2010 Ontario. Disruptive Physicians, the Ontario Experience 13 Joint AMA CMA nternational Meeting of Physician Health in Chicago

45 Nov. 12, 2004 Treatment of Addiction, the Canadian Experience Annual Meeting of the New England Professional Group, Maine April 30 May 2, 2005 Keynote Speaker Annual Meeting of British Columbia Physician Health Programme, Vancouver, British Columbia May 5, 2005 Grand Rounds, Medicine Southlake Regional Hospital, Newmarket, Ontario June 10, 2005 Grand Rounds Queen s University, Dept. of Psychiatry, Kingston, Ontario June 17, 2005 Grand Rounds Ottawa University, Dept. Of Psychiatry, Ottawa, Ontario Nov. 2, 2005 High Risk Chronic Pain Patients Presentation to Family Physicians in North Toronto Nov.17, 2005 Keynote Presentation Western Canadian Conference in Addiction & Mental Health, Vancouver, British Columbia Dec. 7, 2005 ssues of Physician Health Post Graduate N.A.D. Day, McMaster University Feb. 1, 2006 Keynote Presentation Regional Conference on Methamphetamines, Prince George, British Columbia March 22, 2006 ssues of Physician Health Family Medicine Residency Core Day, University of Toronto April 24, 2006 Managing Employees with Substance Richmond, British Columbia Abuse Conference June 22, 2006 Workplace Substance Abuse ssues Union Standards Association, Keynote Presentation Oct. 16, 2006 Managing Addictions in the Ontario Hospital Association Workplace Toronto, Ontario Oct. 18, 2006 Keynote Presentation The College of Family Physicians of Canada Annual Meeting, University of Newfoundland & Labrador Oct. 27, 2006 ssues of Substance Abuse in the Legal Profession The American Bar Association National Conference, San Francisco, California Nov.12, 2006 ssues of Physician Health 56 th Annual Conference of the Canadian Psychiatric Association, Presentation Nov. 18, 2006 Myths and Misconceptions of Addiction Western Canadian Conference on Addictions and Mental Health Jan.26-27, 2007 Keynote Presentation 7th Annual Conference Principles of Treatment of Addiction and Substance Abuse Lexington, Kentucky C REV. March

46 March 15, 2007 March 30, 2007 Keynote Presentation on Methamphetamine Dependency Addiction Medicine for Family Physicians Big Land Health Conference, Goose Bay, Labrador Vancouver sland Health Authority, Victoria, British Columbia April 28, 2007 The Physician Health Program of British Whistler, British Columbia Columbia Annual Education Conference May 14, 2007 St. John s Rehabilitation Hospital Grand Toronto, ON Rounds May 17, 2007 Networking Breakfast at Guelph Guelph, ON Chamber Conference May 20, 2007 Addiction Conference Kitimat, British Columbia June 15, 2007 Annual Education Day Department of Psychiatry, Goderich, Ontario Oct. 21, 2007 Association of Home Office Toronto, Ontario Underwriters of America Annual Conference Nov. 3, 2007 Presentation of Treatment of British Columbia Psychiatric Addictions Association Annual Meeting Nov. 10, 2007 Department of Anesthesia & Critical Southlake Regional Hospital Care Clinical Day Nov. 26, 2007 ssues of Substance Canadian Centre of Substance Abuse National Conference, Edmonton, Alberta Nov. 29, 2007 The Evolving Role of Pharmacotherapy Toronto, Ontario in Alcoholism Jan. 21, 2008 The Evolving Role of Pharmacotherapy Homewood Health Centre, Guelph in Alcohol Addiction Management, Grand Rounds Feb.11, 2008 The Management of Alcohol Bellwood Addiction Treatment Dependence Centre, Toronto, Ontario Mar. 27, 2008 Management of Chronic Pain and Regional Rehabilitation Program, Addiction University of Western Ontario, April 4-5, Presentation is the 12 Steps, their clinical relevance 2. Withdrawal Management 3. Myths and Misconceptions in Addiction London, Ontario Annual Meeting New Brunswick College of Family Practice April 10, 2008 Spirituality and Recovery Ruth Fox Course Ruth Fox Course is part of the American Society of Addiction Medicine Annual Meeting April 24, 2008 The Evolving Role of Pharmacotherapy in Alcohol Addiction Management May 12, 2008 Pain and Addiction Clinical Opponents or Siblings 15 REV. March 2010 Monthly Meeting of Medical Staff, Windsor, Ontario Grand Rounds Department of Medicine, University of Western C

47 July 25, 2008 Presentation on Addiction in the Legal Profession Ontario Annual Meeting of the Ontario Lawyer s Assistance Program Sept. 4, 2008 Sept. 26, 2008 Alcoholics Anonymous What Does the Science Tell Us Treatment of Alcohol Addiction in the Elderly Annual Meeting of the Canadian Psychiatric Association, Vancouver, B.C. 54th Annual Scientific Assembly, College of Family Practice, Saskatchewan, Saskatoon Neuroscience Update, University of Western Ontario, London, Ontario Oct.17, 2008 Pain and Addiction Opponents on Siblings Nov.5, 2008 Presentation, Addiction and Pain McMaster University Academic Pain Day Nov. 6, 2008 Addiction in Nurses Ontario Nurses Association Union Annual Meeting, Toronto, Ontario Nov. 13, 2008 Keynote Presentation Addiction Canadian Conference in Addiction Medicine Overview and Update 5 th Annual Meeting Workshop Treating the Substance Dependent Nov. 17, 2008 Dr. Saul Cohen Memorial Lecture Credit Valley Hospital, Mississauga, Ontario Nov. 20, ) Substance Abuse in the Workplace 2) The Management of Addiction in the Community and in Residential Treatment Nov. 26, 2008 Dec. 3, 2008 Jan. 16, 2009 Mar. 6, 2009 April 23, 2009 May 29, 2009 Chronic Pain in Addiction: ssues, Management and the Perspective of the College of Physicians and Surgeons of Ontario Mental Health ssues in Today s Workforce Management of the Difficult Adolescent. Drug & Alcohol ssues. Physician Health, Spirituality and Recovery Keynote Presentation: Alcoholic Anonymous, a Design for Living that Really Works ntervening and Managing Addictions in the Workplace Oct. 1, 2009 Chronic & Addiction. Problems and Solutions Oct. 27, 2009 Keynote Presentation: Managing Addictions in the Workplace. 16 REV. March 2010 Substance Abuse Seminar to the Substance Abuse Representatives of the major Automotive Unions nterdisciplinary Pain Rounds, University of Western Ontario Homewood Employee Health Annual Conference Walter School District, Delta, B.C. Ultimate Education Annual Meeting Alberta Medical Association Annual Spring Meeting, Edmonton, Alberta Embrace the Future of Addiction, Salvation Army Harbor Light Addictions Conference,Toronto,ON Workplace Mental Health Toronto Board of Trade First Canadian Trade, Toronto, Ontario Canadian Healthcare Anti-Fraud Association, Toronto, ON Drug and Alcohol Council for Safe Alberta Workplaces, Edmonton, C

48 Concurrent Workshop: Are Addictions a Alberta Symptom of an Underlying Root Cause Nov. 6, 2009 There is a Solution Winnipeg, MB Opening Speaker at the conference Nov. 19, 2009 Jan. 13, 2010 Feb. 24, 2010 Feb. 26, 2010 Chronic Pain Stress in Addictions: Problems & Solutions Addiction Medicine Perspectives: Addiction & Disability Alcoholics Anonymous: What does the science tell us? Keynote Presentation: Physician Heal Thyself: A Doctor s Story Workshop Presentation: Alcoholics Anonymous: What does the Science Tell Us Critical ncident Reenactment Conference, Hamilton Place Medical Legal Conference Canada Pension Plan Disability, Ottawa, ON Psychiatry and Behavioral Neurosciences Grand Rounds, McMaster University, Department of Psychiatry Banff Alberta 55 th Annual Scientific Assembly, Alberta College of Family Physicians ADMNSTRATVE RESPONSBLTES: As Director of the Addiction Division at the Homewood Health Centre, am responsible for a budget using a program management model of $7.5 million dollars annually as well as 100 full-time multi-disciplinary staff members. head the Management Team and am ultimately responsible to the Executive of the Homewood Health Centre for revenue generation and academic marketing. As a member of Council of the College of Physicians & Surgeons, and President of the College for 2003, have had extensive administrative experience both of self-regulation of the medical profession as well as in the development of a governance model for the Province s self-regulatory body. also chaired a working group that developed the first clinical guidelines in the use of Methadone in chronic non-cancer pain.these are the first such guidelines in North America. chaired the Search Committee for the appointment of the new Registrar of the College of Physicians & Surgeons. As part of my intense interest in physician health, led the development of the Physician Health Programme of the Ontario Medical Association in As chair of the Standards Committee of the Canadian Society of Addiction Medicine, led in the development of national standards to allow for assessment and examination of physicians knowledgeable and practicing in the field of Addiction Medicine. REV. March

49 OTHER RESPONSBLTES: President, Timmins & District Shriners Club, (1984). Member, Granite Masonic Lodge, #356, Parry Sound, Ontario (1978-current) Board Member, Wellington & Dufferin District Health Council ( ) REV. March

50 PAUL H. EARLEY, M.D., F.A.S.A.M. Talbott Recovery Campus 5448 Yorktowne Drive Atlanta, Georgia USA Office Voice: Office Facsimile: PERSONAL NFORMATON Date of Birth March 29, 1954 Place of Birth Cincinnati, Ohio EDUCATON 1971 to 1975 B.A. in Biology, Reed College, Portland, Oregon 1976 to 1980 M.D., University of Cincinnati College of Medicine, Cincinnati, Ohio 1980 to 1981 nternship in nternal Medicine, Good Samaritan Hospital and Medical Center, Portland, Oregon 1981 to 1984 Residency in Neurology, University of Oregon Health Sciences Center, Portland, Oregon 1992 to 1995 Three year training for certification in PBSP Psychomotor Therapy PROFESSONAL STATUS Board Certified in Addiction Medicine by the American Board of Addiction Medicine, 2009 Fellow of the American Society of Addiction Medicine, December, 1996 Diplomate of the National Board of Medical Examiners, July 1, Licensed to practice medicine in Georgia (license #30454). Licensed to practice medicine in Oregon (license #12784). Certified through examination by the American Society of Addiction Medicine (ASAM), 1986 (cert ). Recertified, December, 1996 ASAM Certified Medical Review Officer, 1996 WORK HSTORY Version 3.1, Feb 2011

51 Paul H. Earley, M.D. Page to Present Medical Director, Director Healthcare Professionals Program, Talbott Recovery Campus, Atlanta, Georgia USA 1991 to 2006 Program Director of Adult Addiction Medicine, Ridgeview nstitute, Smyrna, Georgia to 2006 Medical Director of the Ridgeview mpaired Professional s Program, Ridgeview nstitute, Smyrna, Georgia to 2006 President and Senior Partner at Earley Associates, a 4 member group practice in founded in 1986 with offices in Smyrna and Alpharetta Georgia. The practice specialized in Addiction Medicine, the care of mpaired Professionals, and Professional Wellness to 2005 Chief Science Officer, CMHC Systems, nc. CMHC Systems is the leading provider of clinical and financial software solutions to the behavioral healthcare industry (see Computers in Medicine heading below) to 2002 Founder and Chief Science Officer, Earley Corporation. Earley Corporation developed clinical management software for the behavioral healthcare industry. (See Computer Software heading below) 1986 to 1991 Program Director, Counterpoint Center (Adult Addiction Medicine Program) at CPC Parkwood Hospital, Atlanta, Georgia to 1991 Physician, Private Practice, Specializing in Addiction Medicine and Eating Disorders, Atlanta and Decatur, Georgia 1984 to 1985 Associate Medical Director, Eating Disorders Program and Substance Abuse Treatment Unit, Decatur Hospital, Decatur, Georgia to 1980 Research Associate in Neurology and Electrodiagnostics. University of Cincinnati College of Medicine, Cincinnati, Ohio 1975 to 1976 Research Associate in Neuroendocrinology. Reed College, Portland, Oregon Version 3.1, Feb 2011

52 Paul H. Earley, M.D. Page PUBLCATONS Earley, P. Physicians Health Programs and Addiction among Physicians in the American Society of Addiction Medicine s Principles of Addiction Medicine, Fourth Edition (eds Ries, Miller, Fiellin, Salitz) Lippincott, Williams and Wilkins, Regger, J., Ansseau, M., Gustin, F., Pirard, S., Van Deun, P., Seghers, A., Earley, P. Besson, J. and Gastfriend, D. Adaptation and validation of the ASAM PPC-2R criteria in French and Dutch speaking Belgian drug-addicts. Paper at CPDD Conference, Talbott, G.D., Earley, P. Addiction in the Health Professional Section 9, Chapter 5 in the American Society of Addiction Medicine s Principles of Addiction Medicine, Third Edition. (eds Graham, Schultz, Mayo-Smith, Ries, and Wilford) ASAM Press, Substance Abuse Related Disorders a chapter in the monograph Problem Physicians, a National Perspective a monograph published by the problem physician workgroup and subsequently endorsed by physician health programs across the United States (First Edition 1995, second edition 1998). Earley, Paul H., Fishman, Michael L. The Road to Recovery: Chemical Dependence and Treatment Today. nsight Magazine, 18(2), Fall, Earley, Paul H., Fishman, Michael L. The M-Deity Syndrome: Help for the mpaired Health Professional. nsight Magazine, 16(2), Fall, Harris, Steve, Earley, Paul H. The carus Phenomenon: Power Dilemmas on the Road to Manhood. nsight Magazine, 14(1):6-9, Fishman, Michael L., Earley, Paul H. Nicotine Dependence in Treatment Centers: The Next Challenge. Journal of Substance Abuse Treatment, Earley, Paul H. The Changing Face of Addiction: s Everything do an Addiction? nsight Magazine, 12(3):2-7, Earley, Paul H. The Cocaine Recovery Book, Newbury Park, California: Sage Publications, Earley, Paul H. The Cocaine Recovery Workbook, Newbury Park, California: Sage Publications, Earley, Paul H., Dickey, C. The Cocaine Addict, Principles of dentification and Treatment. Mental Health Notes of the Georgia Division of NMHA, 40:5-7 (1986). Earley, Paul H. mplementation of the Morrow M26 Hard Disk System in the S100 Environment. Microsystems 3:26 (1981). Arch, S., Earley, P. and Smock, T. Biochemical solation and Physiological dentification Version 3.1, Feb 2011

53 Paul H. Earley, M.D. Page of the Egg-Laying Hormone in Aplysia californica. Journal of Gen. Physiol. 68: (1976). Arch, S., Smock, T. and Earley, P. Precursor and Product Processing in the Bag Cells of Aplysia californica. Journal of Gen. Physiol.68: (1976). Earley, Paul H. solation and Characterization of Hormonal Proteins Synthesized in the Bag Cells of Aplysia californica B.A. Thesis, Reed College, Portland, Oregon (1975). MEDA APPEARANCES Close to Home a five part series produced for public television by the award winning documentary filmmaker Bill Moyers featured Paul Earley and his work at Ridgeview nstitute in Part 3 Changing Lives. Premiered nationally on the Public Broadcasting System on March 29, Oprah Winfrey Show. nvited as expert and appeared on an Oprah Winfrey Show to discuss the Bill Moyer s documentary: Close to Home, Chicago, llinois, August, 1998 Turning Point: from Hollywood to Main Street Appeared in this ABC News hour long prime time special as an expert on heroin addiction. May, Oprah Winfrey Show. nvited as expert and appeared on an Oprah Winfrey Show focused on heroin addiction, Chicago, llinois, October, PRESENTATONS Ten Emotionally Unintelligent Things that Health Care Providers Do. One hour plenary presentation at the Health Care Consortium of Georgia s Annual Meeting. March An ntroduction to RecoveryMind Training. One hour presentation at the Arizona Chapter of the American Society of Addiction Medicine s Annual Meeting. February, Brain Models and Psychotherapy. Three hour training before the mago Training Faculty at Annual mago nternational Conference, November, What really happens in Addiction Treatment? One hour presentation at the Louisiana Psychiatric Association fall conference. November, Relationships and Recovery. Three hour Workshop presenting with Wanda Faurie, Ph.D. at the North Carolina Physicians Health Program Biennial Retreat, October Version 3.1, Feb 2011

54 Paul H. Earley, M.D. Page Assessing Readiness to Return to Work: the MPAR Project, One hour Presentation at the AMA/CMA nternational Conference on Physician Health, Chicago, llinois, October Clinical Presentation: njectable Naltrexone in the Treatment of Opioid Dependence before the FDA Advisory Board considering expanding the indication of Vivitrol for the treatment of Opioid Dependence, September The Assessment and Treatment of Alcohol Problems in Commercial Pilots One hour presentation at the annual HMS Conference in Denver Colorado, September Controversies and Lessons Learned From The Treatment of Addiction in Physicians New Advances in Addiction Medicine Conference in Phoenix, AZ, March, Addiction in the Workplace: mproving Patient Outcomes. Second Annual Mississippi Addiction Conference in Jackson, MS, January Hour Assessment for Pharmacy Professionals. Southwestern Pharmacists Recovery Network Conference in Sedona, AZ, September Recognizing and Diagnosing Alcoholic Physician and Treating the Addicted Physician: The Talbott Model. Keynote address and presentation at Ardere, Non Bruciarsi, the talian Conference on Physician Health sponsored by the Centro di Formazione Albert Schweitzer. Turin, taly, September Addiction Memory and Craving: Clearing a Path to Recovery. American Dental Association Conference in Chicago, L, September Teetering on the Brink of Collapse: Treating the Addicted Physician. Georgia Psychiatric Physicians Association Conference in Amelia sland, FL, August Conducted Two-Day Workshop for the Addiction and Recovery Ministry Conference in Langley, British Columbia, June Neurochemistry and Medications in Addiction Treatment. Royal College of Dental Surgeons of Ontario Council Meeting in Toronto, Ontario, May 2009 Pearls in Assessing the mpaired Dentist. Royal College of Dental Surgeons of Ontario Council Meeting in Toronto, Ontario, May Addiction in the Operating Room. Wake Forest University in Winston Salem, North Carolina, May 2009 Current Controversies in the Treatment of Physician mpairment Federation State Physician Health Programs Annual Meeting and Conference in New Orleans, Louisiana, April Version 3.1, Feb 2011

55 Paul H. Earley, M.D. Page Current Dilemmas in the Treatment of the mpaired Professional. AP Webinar - Vendom Group in Atlanta, Georgia, April All Day Training Program SCSCSW Conference in Charleston, South Carolina, February Addiction as a Chronic Disease: The Challenge of Best Practice and the Best Care Environments SECAD Conference in Atlanta, Georgia, February Current Dilemmas in the Treatment of mpaired Professionals SECAD Conference in Atlanta, Georgia, February Changes in Addiction Treatment The Good, Bad and the ndifferent CAPTASA Conference in Lexington, Kentucky, January A literature review of addiction in physicians nternational Conference on Doctors Health in London, England, United Kingdom, November Course Director. ASAM Review Course in Addiction Medicine in Chicago, llinois, October Addiction Craving and Addiction Memory: Clearing a Path to Recovery. EAPA s 2008 Annual World EAP Conference in Atlanta, Georgia, October Assessment and Triage of the Opioid Addict Florida Academy of Family Physicians Summer Break Away Conference in Naples, Florida, June What Makes a Case Difficult? Learning From Our Experience Federation of State Physician Health Programs in San Antonio, Texas, April How to Recognize and ntervene Effectively on the Spectrum of Addictive Disorders. 15 th Annual A&D Conference in Columbia, South Carolina, January s Buprenorphine Maintenance Recovery? Presentation at SECAD 2007 in Atlanta, Georgia. November Trauma and Memory Carolinas Conference on Addiction and Recovery in Chapel Hill, North Carolina. November The Neurochemistry of Addiction and the Hope of New Medications. EAPA meeting in San Diego, California. October The Neurochemistry of Addiction and the Hope of New Medications. Presentation at Cape Cod Symposium on Addictive Disorders. September Deception in the Evaluation of the Professional Patient. Southeastern Regional Version 3.1, Feb 2011

56 Paul H. Earley, M.D. Page Conference of the Federation State Physician Health Programs, Virginia Beach, Virginia. September The mpaired Physician. Presentation at Orange County Medical Society in Orlando, Florida. September 2007 Addiction Memory in Addiction Recovery and Medications and Brain Neurochemistry Two presentations at the Neuroscience Meets Recovery annual conference in Las Vegas, Nevada. March Addiction Memory in Addiction Recovery. Three hour workshop at the Southeastern Conference on Addiction (SECAD) December Medications and Brain Neurochemistry: New Hope in the Treatment of Addiction. Two hour presentation at the National Employee Assistance Professionals Association, September PPC-2R Where has it come and where are we going? Presentation at the National Association of Addiction Treatment Providers National Conference Phoenix Arizona May 22, ASAM PPC-2R Assessment Software Research: Evidence for a New nternational Standard. Symposium at the American Society of Addiction Medicine s 36 th Annual Medical Scientific Conference April 16 th, 2005 Evaluating mpairment in Psychologists, Lecture at the 2004 Association of State and Provincial Psychology Boards. October 22, ASAM: Patient Placement Criteria Presentation at the 2004 NAADAC Annual Conference, October 7, The Crucible of Addiction Treatment Where the Twelve Steps, Psychotherapy and Pharmacotherapy Collide - Workshop at the National Association of Addiction Treatment Providers (NAATP) Conference, May 18, 2004 Same conference in a three hour workshop to 100 participants at Ridgeview nstitute, Sept 12, Not in the Service of Your Disease: The Life Work of Thomas Butcher, Ph.D. Presented at the Southeastern Conference on Alcohol and Drugs (SECAD), December 3, Evidence-based Medicine and Behavioral Health - Talk at the CMHC user Group meeting in Columbus Ohio, May 3, Similar talk presented May 15, What s New in Addiction Medicine: Recent Developments in Medications and Addiction Assessment, 2003 Presented at the Southeastern Conference on Alcohol and Drugs (SECAD), December 4, 2002 Version 3.1, Feb 2011

57 Paul H. Earley, M.D. Page The Therapeutic Community: ts Power and Purpose in the Treatment of Disease. Three hour workshop presented with Branko Radulovacki, M.D., 11 October 2002 at Ridgeview nstitute, Atlanta, Georgia. Addiction and the Health Professional. Grand Rounds presentation to North Georgia Medical Center July, 2002, Gainesville, Georgia. The ASAM PPC-2R Algorithm Software. Workshop at the American Society of Addiction Medicine (ASAM) annual Medical-Scientific Conference, April, Attorneys and Diseases of Self-Care. Presentation to the NOSSCAR Conference, June, nteracting with the Addicted Patient - Tricks of the Trade. Three hour experiential workshop for 80 participants, presented June, 2001, Ridgeview nstitute, Atlanta, Georgia. The Drug Menagerie. A three part series of talks, totaling over 10 hours of training presented in April, August and October, 2000 at Ridgeview nstitute to physicians, psychologists and masters level therapists for training in Addiction Medicine. Computers and nternet Addiction. Presentation to the Southeastern Conference of the National EAP Professionals, September Outpatient Detoxification - Ambulatory Detoxification in an Outpatient Setting. One Hour Presentation at Ridgeview nstitute, Smyrna, Georgia, January 8, Clinical Technologies - Design ssues in Measuring Outcomes with Various Treatment Populations. Two Hour Presentation at Clinical Technologies Conference, Phoenix, Arizona, November 11-14, Appropriate Prescribing of Controlled Substances. Two Hour Presentation at Mercer University School of Pharmacy, Atlanta, Georgia, October 8, New Paradigms in the Treatment of Addiction. Two Hour Presentation at Ridgeview nstitute s Clinical Series for Professionals, August 23, Managing Medications in Physician Patients. Two Hour presentation at 1996 nternational Conference on Physician Health Sponsored by AMA, February 7-10, 1996, Chandler, Arizona. Georgia Licensing Board, Medical Society, and Treatment Centers Working Together with Problem Physicians: A Cooperative Paradigm. Two Hour presentation at the 1996 nternational Conference on Physician Health Sponsored by AMA, February 7-10, 1996, Chandler, Arizona. Version 3.1, Feb 2011

58 Paul H. Earley, M.D. Page Appropriate Prescribing of Controlled Substances - Mechanisms for Proper Practice within the System. 4.5 Hour Training and Lecture for Center for Substance Abuse Education, Mercer University, Atlanta, Georgia. The ASAM PPC-2: Criteria for Diagnosis and Treatment. One Hour Presentation to Mississippi Association of Recovering Pharmacists for Addiction: Your Personal & Professional Responsibility, Conference, Jackson, Mississippi, October 15, dentification, Treatment and Ethical Dilemmas in the Care of mpaired Professionals. Two Hour Workshop presented to the Alabama Psychological Association Annual Meeting, Gulf Shores, Alabama, May, New Paradigms for the Care of Addicted Physician Assistants. Two Hour Workshop at the 1995 nternational Conference of Physician Assistants, Las Vegas, Nevada, May, Addiction Training of House Staff - Medical Center of Central Georgia, Macon, Georgia, August, Facets of Substance Abuse - Theories and Research/Application and Treatment Facets of Substance Abuse - Clinical Pharmacology and Assessment/Continuum of Care and Outcome Research. Three day Workshop Preserving and Expanding our Profession, The American Psychological Association, New Orleans, Louisiana, March, dentification of Addictive Disease in the Primary Care Setting. n-house staff training at The Medical Center of Central Georgia, September, Creating a Smoke-free Environment and Counseling Techniques for Creating Change in Staff and Patients. Four hours of presentation at The 2nd Annual Southwest Conference on Nicotine Dependence, June 5, 1993, Houston, Texas. The mpaired Physician. One hour presentation at: Saving our own - The mpaired Healthcare Professional, May 14, 1993, Atlanta, Georgia. Nicotine Dependence: Making Your Facility Smoke Free. Three hour conference at The 24th Annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM), May 1, 1993, Los Angeles, California. Understanding Addictions: Assessment and Therapy. Six hour workshop at the Annual Meeting of the Georgia Psychological Association, April 14, 1993, Atlanta, Georgia. Addiction and Medication Management - The Dual Diagnosis Dilemma. One hour presentation at the medical staff meeting of Ridgeview nstitute, April 7, 1993, Smyrna, Georgia. Version 3.1, Feb 2011

59 Paul H. Earley, M.D. Page New Hope for Treatment Failures: Rethinking Addiction Treatment. One hour presentation on the dual diagnosis, childhood trauma, and the use of experiential treatment for addicted populations. A Ridgeview Education Series Lecture. January 29, 1993, Smyrna, Georgia. Documentation in the 90's: Patient Records Workshop. All day workshop concerning improving the quality of the medical record in medical treatment. September 28, 1992, Detroit, Michigan; September 30, 1992, Kansas City, Missouri; October 2, 1992, Atlanta, Georgia. Addressing Nicotine in Chemical Dependency Programs and Nicotine Dependence Treatment in Addicted Patients. Two 1 hour presentations at the Fifth National Conference of Nicotine Dependence, American Society of Addiction Medicine (ASAM). The Goals and Directions of the American Society of Addiction Medicine (ASAM). Presentation at the First Annual Georgia ASAM and Georgia aapaa Joint Scientific Conference, October 4, 1991, St. Simons, Georgia. Cocaine Addiction: Treatment Strategies for the 1990's. Presentation at the Northeastern Conference on Addictions (NECAD), May 21, 1991, Newport, Rhode sland. s Nicotine Dependence Like Other Addictions? Presentation at the First Annual Southeastern Conference on Nicotine Dependence. March 22, 1991, Atlanta, Georgia. A Neurobiological and Behavioral Approach to the Treatment of Cocaine Addiction. Three hour conference at The 21 st Annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM), April 23, 1990, Phoenix, Arizona. Cocaine: The Addiction of the 1980's and Current concept in cocainism. Two seminars to the Professional Development Series, August 17, 1989, New Orleans, Louisiana. The Therapy of Cocainism, An ntegrated Approach. Three hour workshop at The 20 th Annual Medical-Scientific Conference of the American Medical Society on Alcoholism and Other Drug Dependencies (AMSAODD, now ASAM), April 30, 1989, Atlanta, Georgia. The Neurophysiology of Addiction and Denial. Presentation at the nternational PRDE Conference, April 11, 1989, Atlanta, Georgia. Drug Specific Relapse Prevention. Lecture at The Seventh National mpaired Nurse Symposium, March 12, 1989, Atlanta, Georgia. Cocainism: Using the Scientific Literature to Redefine Treatment. Three hour workshop at The 19 th Annual Medical-Scientific Conference of the American Medical Society on Alcoholism and Other Drug Dependencies (AMSAODD, now ASAM), April 22, 1988, Version 3.1, Feb 2011

60 Paul H. Earley, M.D. Page Arlington, Virginia. The Disease of Addiction. Presentation at the nternational PRDE Conference, April 14, 1988, Atlanta, Georgia. The History and Physiology of Cocaine; the Central Nervous System Effects of Cocaine; and the npatient Treatment of Cocaine Dependence. Three lectures at Cocaine: A Seminar for Professionals The University of Alabama Conference Series, June 4, 1987, Birmingham, Alabama. Cocaine, the Addiction of the 1980s. Feature speech at the Southeastern Regional conference of ALMACA (Association of Labor/Management Administrators and Consultants on Alcoholism), February 23, 1987, New Orleans, Louisiana. Dealing with Addiction in Your Practice: the Nuts and Bolts. Forum Presentation with Judith Knight Earley, Ph.D. at the Georgia Psychological Association Mid-Winter Conference, February 6, 1987, St. Simons, Georgia. The Diagnosis and Treatment of Eating Disorders Fall Workshop Series, National Association of Social Workers. Eight hour seminar with Judith Knight Earley, Ph.D., September 19, 1986, Atlanta, Georgia. The Neuropsychology of Starvation and the Treatment of Eating Disorders. Four hour seminar at the Division E Conference of the Georgia Psychological Association, 1986, Atlanta, Georgia. The Treatment of Addictions in the Ethnic Community. Lecture at the yearly conference on Mental Health in the Ethnic Community, Mental Health Association of Metropolitan Atlanta, Sociocultural aspects of a New Disease Epidemic. Lecture to the Emory University Freshman Class concerning eating disorders, academic years. The Assessment and Treatment of Eating Disorders in the npatient Milieu. Lecture at the University of Georgia, June 3, 1985, Athens, Georgia. Computerization of the Neuroscientific Laboratory. Lecture and Seminar at the 23rd Annual Academy of Neurology Meetings, 1983, San Diego, California. PROFESSONAL ORGANZATONS Medical Association of Georgia. American Medical Association. Version 3.1, Feb 2011

61 Paul H. Earley, M.D. Page American Society of Addiction Medicine (ASAM): Board of Directors, Director at Large, 2011 to Present Director, ASAM Board Certification Review Course, 2010 to Present Chair, Physicians Health Committee, 2009 to Present Board of Directors, ex-officio 1995 to 1997, Regional Director, 1997 to 2005 Certification Examination Test Development Committee, 1989 to State Chapters Committee, Chairman, 1990 to 2001 Georgia Chapter of the American Society of Addiction Medicine (Georgia ASAM) President of the Georgia Chapter of ASAM, 1989 to 1996 National Psychiatric Alliance, Outcomes Research Project, 1993 to Phi Beta Kappa Scholastic Fraternity. CAREER SPECALZATON Addiction Medicine Physician Health Long-term therapy of Addiction Recovery Computers in Medical Care, computers as tools for change in behavioral medicine. COMPUTERS N MEDCNE 1989 Developed TxPlan Clinical Management Software the first comprehensive software designed to use the treatment plan to guide daily treatment by a multidisciplinary treatment team in inpatient and outpatient behavioral healthcare settings Founded Earley Corporation to continue developing TxPlan and market the product to the behavioral healthcare industry TxPlan installed in over 200 organizations throughout the United States TxPlan developed for the Windows environment and Microsoft SQL Server. Development partially funded by SBR Grant #R44- AA11235 from the National nstitute on Alcohol Abuse and Alcoholism (NAAA). Dr. Earley was the principle investigator in this grant. Version 3.1, Feb 2011

62 Paul H. Earley, M.D. Page Lead developer on the computerized version of the American Society of Addiction Medicine s Patient Placement Criteria for the treatment of Psychoactive Substance Disorders, Version 2, Revised (ASAM PPC-2R). Development funded in part by SBR Grant #R44-AA12004 from NAAA. Dr. Earley was the principle investigator in this grant Earley Corporation merged with CMHC Systems, nc. Dr. Earley becomes Chief Science Officer of CMHC Systems, nc. His work at CMHC Systems continues to focus on the computerization of the ASAM PPC-2R Participated in the French and German-speaking European conference on Addiction. Presented research findings on the PPC- 2R in conjunction with the University of Liege, Belgium to Present Research coordinator in the joint United States / Norwegian research team on the applicability of the ASAM PPC-2R Computer Software for the Trondheim District, Norway. Version 3.1, Feb 2011

63 Curriculum Vitae (Short Version) John T. Palmer, Phone (Home): , Verdon Way, (Work): Abbotsford, British Columbia, (Fax) : Canada, V2T7Y3 [email protected] EDUCATON Master s Degree in Counselling (Trinity Western University) June focus on Marriage & Family and Addiction counselling. Continuing Clinical Counselling Education Seminars and Workshops to maintain active registration as a Clinical Counsellor with the British Columbia Association of Clinical Counsellors ( ). This includes: Western Canadian Conference on Addictions and Mental Health ( ) Biennial National nstitute on Dentist Well-Being- American Dental Association ( ) Gottman Method Couples Therapy (Levels &2) Emotionally Focused Therapies for ndividuals and Couples (Externships completed) Motivational nterviewing for Addictions Cognitive Therapies for Addictions, Depression and Anxiety Disorders. Batchelor of Dental Surgery (University of Dundee, Scotland) 1973 (with merit in Dental Jurisprudence) Current Position Director: Dental Profession Advisory Program (DPAP Counselling) BC Dental Association (2001 present) Adjunct Faculty Member, Dean s Office, UBC Faculty of Dentistry (appointed 2011)

64 John T. Palmer Curriculum Vitae (March 2012) Relevant Work Experience General dental practice ( ) Manchester, England ( ) St, John s, Newfoundland Providing individual counselling and proactive mental health educational seminars, and workshops to members of the BC Dental Association and BC Certified Dental Assistants Association (2001 present). Advocating for Registrants of the BC College of Dental Surgeons who are under sanction by the College and undergoing treatment for impairment as a result of physical illness, mental illness or substance use/ dependency. (2001 present). Seminar Co-presenter: UBC Faculty of Dentistry Orientation Week Taking Care of Yourself in Dental School (2001 Present) Presentation of workshops on Motivational nterviewing, American Dental Association Biennial National nstitute on Dentist Well-Being (2005, 2007). nvited Closing Speaker, 2007.

65 CAROLYN THOMSON, MD, CCFP, FCFP 23 Caitland Court, Halifax, NS B3N 3K1 Cell: (902) ٠ PROFLE Passionate about physician health as reflected in continuing medical education and advocacy within the medical community. Recognize and support the unique wellness needs of physicians and their families. Balancing roles as a family physician, faculty member and educator at Dalhousie Family Medicine and coordinator of the Professionals Support Program at Doctors Nova Scotia As former hospital department head, have developed exceptional organizational, planning, and administrative skills while continuing to provide a high standard of patient care Experienced physician with demonstrated expertise in program development as a CME consultant as a champion for the Primary Maternity Care Program at the WK Health Centre.. EDUCATON RESDENCY N FAMLY MEDCNE Dalhousie University Medical School, Halifax, NS Chief Resident NTERNSHP N FAMLY MEDCNE Dalhousie University Medical School, Halifax, NS MEDCAL DOCTOR DEGREE Dalhousie University Medical School, Halifax, NS Lawrence Max Green Memorial Award in Obstetrics BACHELOR OF SCENCE N BOLOGY Cum Laude Dalhousie University, Halifax, NS RELEVANT CONTNUNG MEDCAL EDUCATON National and nternational Conferences on Physician Health, (2004, 2008, 2009, 2010, 2011) Leadership and Physician Health Workshop, Dr. Mamta Gautam, Halifax, NS (2003) Physician Health for Physician Leaders, Canadian Medical Association (2004) ntensive Coach Training Program, College of Executive Coaching, Phoenix, Arizona (2007) Physician Coaching Advanced Training Program, Physician Coaching nstitute, Seattle, Washington, (2007) Annual Forum on Primary Health Care, Toronto, ON (2006) Physician Manager nstitute Levels and (2006, Levels and V (Sept. 2007), Canadian Medical Association AGM Canadian Society of Physician Executives, Ottawa, ON (2007 & 2010)

66 CAROLYN THOMSON, MD, CCFP, FCFP Page 2 Problem Based Small Group Learning, The Foundation for Medical Practice Education, Hamilton, ON ( ) Psychotherapy & Counseling for Family Physicians, University of Toronto, ( ) WORK EXPERENCE COORDNATOR, PROFESSONALS SUPPORT PROGRAM Doctors Nova Scotia December Present The PSP program provides confidential support and resources for physicians, dentists, veterinarians and their families that are struggling with substance abuse, mental illness, burnout, stress and family issues. t also provides education around health and wellness topics and advocacy for those facing regulatory and legal issues. CHEF, FAMLY MEDCNE May 2006 December 2011 WK Health Centre, Halifax, NS Department of Family Medicine consists of 100+ community-based and academic family physicians that provide maternity, newborn, and pediatric emergency care at the WK Health Centre. The department is affiliated with Dalhousie University Department of Family Medicine. Reporting directly Executive Leadership Team, provide leadership and strategic direction to department members, and oversee the administration and functioning of the department which includes Antenatal Clinics, Newborn Care Service, and Primary Maternity Care Program. Conceptualized and developed an innovative pilot Primary Maternity Care Program a collaborative care model aimed at decreasing workload and burnout of all family doctors in the community while providing a high standard of maternity/neonatal care in the hospital. Act as an advocate for family doctors to ensure their interests are represented within the hospital and in the community through committee participation and relationship development with stakeholders, other departments, nursing staff, executive leadership team, Doctors Nova Scotia, etc. Actively participate in the strategic planning and resource allocation and utilization for the WK Health Centre, with a dual role as Chief of Family Medicine and as a practicing family physician. Lead the development of the department s mission, objectives, strategic plans and operating budget Annually review the professional conduct, competence, performance, and qualifications of departmental members for purpose of making recommendations for reappointments, change of privileges, and possible disciplinary actions Facilitate and support teaching, continuing education, and research within the department Hold and chair regular executive and departmental meetings FACULTY/ DALHOUSE FAMLY MEDCNE Halifax, NS Clinical practice, teaching and obstetrics 2009-Present FAMLY MEDCNE/OBSTETRCS Sunnyside Family Practice, Bedford, NS A group practice of six family physicians serving a diverse practice population from newborns to geriatrics, with an individual caseload of up to 3,000 patients

67 CAROLYN THOMSON, MD, CCFP, FCFP Page 3 Provide leadership to colleagues and staff on partnership practices, locum coverage, human resources, and patient satisfaction PARTNER, FAMLY MEDCNE/EMERGENCY/OBSTETRCS R.B. White Clinic, Penticton, BC A group practice of 25 partners and associates who provide both inpatient and outpatient care in a small community SHP PHYSCAN EMERGENCY/PRMARY CARE Holland America Line, Seattle Washington, DC EMERGENCY ROOM PHYSCAN 1993 Saint John Regional Hospital & St. Joseph s Hospital, Saint John, NB FAMLY MEDCNE/EMERGENCY/OBSTETRCS (LOCUMS) Hokianga Health Service, Northland, New Zealand Dr. Russell Meads, Ohope, New Zealand Fourth Avenue Family Practice, Tauranga, New Zealand FAMLY PRACTCE/OBSTETRCS (LOCUM) Dalhousie University, Halifax, NS EMERGENCY ROOM PHYSCAN Department of Emergency, Victoria General Hospital, Halifax, NS CURRENT MEMBERSHPS Certificant, Canadian College of Family Physicians Fellow, Canadian College of Family Physicians N.S. College of Family Physicians College of Physicians and Surgeons of Nova Scotia Department of Family Medicine, Dalhousie Family Medicine Canadian Medical Association Doctors Nova Scotia Canadian Physician Health Network COMMTTEES: Steering Committee, Capital Health District Department of Family Practice ( ) Educational Consultant (development and facilitation of programs), Continuing Medical Education for Family Physicians ( ) National Committee on CME, Canadian College of Family Physicians ( ) CME Representative and Accreditor, N.S College of Family Physicians ( ) Doctors Nova Scotia Negotiation Steering Committee (2001) nterdisciplinary Working Group on Legislation of Midwifery in Nova Scotia ( ) Council Member, Capital Health District Department of Family Medicine ( ) District Department of Family Medicine Executive ( )

68 CAROLYN THOMSON, MD, CCFP, FCFP Page 4 WK Committees: Chair, Executive Committee Department of Family Medicine Medical Advisory Committee Women's and Newborn Health Program Operations Committee Family and Newborn Health Committee Neonatal Care Committee Models of Care Committee Nova Scotia Reproductive Care Program Peer Review Midwifery Committee