Welcome to the first episode of our Addiction Medicine series!

Today's Guest

Dr. Cara Poland is a recognized expert in addiction medicine. She is a faculty member at Michigan State University. She earned her medical degree from Wayne State University and was trained in internal medicine at St. Joseph Mercy Hospital in Ann Arbor, Michigan and in addiction medicine at Boston Medical Center in Boston, Massachusetts. She received her master’s degree in education from Boston University. She has an interest in educating healthcare providers and providers-in-training to improve care for patients with substance use disorders particularly during pregnancy and early parenting.

Sections from this episode include

• The importance of addiction training
• Addiction medicine becoming a specialty
• Utilizing a systems-based approach to treating addiction

In this episode, Patrick talks with Dr. Corey Waller from the Health Management Associates Institute on Addiction to discuss addiction medicine becoming its own specialty and the importance it plays across all fields and levels of medicine.

Today's Guest

Corey Waller MD, MS, FACEP, DFASAM is a board-certified and actively practicing addiction and emergency medicine specialist with extensive experience working at the local, state, and national levels.

He works with the American Society of Addiction Medicine (ASAM) and related organizations to advance the evidence-based practice of treatment and recovery for individuals affected by substance use disorder (SUD). A nationally recognized expert in SUD, he is the editor-in-chief of The ASAM Criteria. As a principal with the Health Management Associates (HMA) Institute on Addiction, he is directly responsible for consultation regarding addiction treatment system development for hospitals, primary care practices, justice-involved populations, and addiction treatment providers. He oversees the HMAedu.com learning management system and continues to develop educational resources covering addiction, pain management, behavioral health, and administrative support for these systems.

Sections from this episode include

• How the medical perspective of addiction has changed over time
• Understanding and emphasizing with patients
• The ethics of addiction medicine

In this episode, Amy meets with Dr. Jaime Alan from Michigan State University to discuss the neurobiology of addiction.

Today's Guest

Jamie K. Alan, RPh, PharmD, PhD, is an Assistant Professor of Pharmacology & Toxicology in the College of Human Medicine. Dr. Alan received her PharmD from Ohio Northern University in 2005, where she graduated with high distinction. She has been a licensed and practicing pharmacist for 8 years and has experience in retail, hospital, clinical and compounding pharmacy along with experience in conducting and designing clinical trials.

Sections from this episode include

• Misuse not abuse
• Addiction is not a choice
• The struggle of quitting
• The long term neurological effects of addiction

In this episode, Amy meets with Dr. Jaime Alan from Michigan State University to discuss the toxicology and pharmacology involved in addiction.

Today's Guest

Jamie K. Alan, RPh, PharmD, PhD, is an Assistant Professor of Pharmacology & Toxicology in the College of Human Medicine. Dr. Alan received her PharmD from Ohio Northern University in 2005, where she graduated with high distinction. She has been a licensed and practicing pharmacist for 8 years and has experience in retail, hospital, clinical and compounding pharmacy along with experience in conducting and designing clinical trials.

Sections from this episode include

• Methods used to treat addiction
• Side effects of various drugs and effects on the body
• Treating addiction in and outside of the hospital

In this episode our hosts Dr. Stewart Bryant and Mariah Siddiqui discuss the chemical composition of opioids and how they affect the body and the medications used to treat opioid addiction. They also breakdown several USMLE-style questions to help you understand how opioids may be presented on the boards and how to best treat patients with Opioid use disorder both short term and long term.

Sections from this episode include

• How opioids impact the body and affect the body's pain response
• The history of opioids in the US and their alternatives
• Medications used to treat opioid addiction

Today Mariah breaks down alcohol use and withdrawal with Dr. Tahir from Elmhurst Hospital in Queens, New York.

Sections from this episode include

• Medications to treat alcohol intoxication and withdrawal
• Which medications may be contraindicated due to liver damage and the alternatives to use instead
• The four stages of alcohol addiction as well as the timeline and symptoms of withdrawal
• Review of diagnostic tools such as CIWA and the CAGED questions

Today's Guest

Dr. Allek Scheele is a pediatric hospitalist fellow at the Helen Devos Children's Hospital in Grand Rapids, Michigan. She completed undergrad and medical school at the University of Missouri. Following that she completed her pediatric residency at the University of Kansas. Her research now focuses on pediatric and adolescent substance use and exposure.

Sections from this episode include

• In adolescents who use marijuana chronically, their prefrontal cortex will not develop as well, their long-term decision making is going to be decreased and their long-term ability to concentrate is going to be impaired
• The younger someone starts using marijuana chronically the more at risk they are for developing schizophrenia or schizophrenia-like symptoms which are permanent once they set in.
• 3 in 4 adolescents who smoke regularly will go on to smoke into adulthood and adolescents who vape are more likely to use combustible tobacco in their 20's
• The number of adolescents who are vaping specifically because they feel like they are hooked and they 'have to' has tripled in the last year

Today's Guest

Patrick reviews Ambosss questions related to ethics and addiction

Today Patrick is joined again by Dr. Cara Poland to discuss the affects and complications of addiction during pregnancy.

Today's Guest

Dr. Cara Poland is a recognized expert in addiction medicine. She is a faculty member at Michigan State University. She earned her medical degree from Wayne State University and was trained in internal medicine at St. Joseph Mercy Hospital in Ann Arbor, Michigan and in addiction medicine at Boston Medical Center in Boston, Massachusetts. She received her master’s degree in education from Boston University. She has an interest in educating healthcare providers and providers-in-training to improve care for patients with substance use disorders particularly during pregnancy and early parenting.

Sections from this episode include

• How substance use affects pregnancy and the different effects of various substances
• How infants can be impacted by a mothers substance use
• Medications and treatments used in pregnancy

Today ITB's own Patrick and Nick discuss the mental health aspect of addiction as well as common psychiatric comorbidities and potential causes and treatments available.

Today's Guest

Dr. Nissen is a Harvard Medical School Clinical Fellow and Resident Physician in the HMS Department of Psychiatry. He is Co-Founder and Chief Operations Officer of InsideTheBoards. He is interested in addiction medicine and medical education and spends his free time experimenting on new dinner dishes with his wife.

Sections from this episode include

• How someone becomes addicted and what keeps them addicted are not usually the same things
• Keep in mind the ‘self-medication theory’ and ask “what are they treating with their substance use?”
• It's important for diagnostic and treatment reasons to understand if the substance use or mental disorder occurred first because likely one causes the other and this may impact the treatment

Today Patrick talks about the importance that language has when speaking with patients.

Today's Guest

Dr. Alëna A. Balasanova is an assistant professor in the Department of Psychiatry at the University of Nebraska Medical Center (UNMC). She is dually board certified in psychiatry and addiction medicine with specialized expertise in integrated treatment for substance use disorders co-occurring with other psychiatric conditions. After obtaining her undergraduate degree from The Johns Hopkins University, Dr. Balasanova went on to earn her MD at Harvard Medical School and completed residency training at Boston University Medical Center before joining UNMC/Nebraska Medicine in Fall 2016. As the Director of Addiction Psychiatry Education, Dr. Balasanova has developed novel educational programs for medical students, residents, fellows, and allied health professionals. She is the founder and director of the Longitudinal Integrated Mental health/Substance use Outpatient Clinic (LIMSOC), an internationally recognized clinical experience for Creighton University Psychiatry Residents. Dr. Balasanova also founded and directs Nebraska Medicine’s Outpatient Addiction Psychiatry Clinic and also developed and now co-directs the inpatient Addiction Psychiatry Consultation Liaison Service at the Nebraska Medical Center. She is on Twitter at @DrPsychMD.

Sections from this episode include

• The important role language plays in our interactions
  "The way that we talk about patients is the way that we treat them"
• The importance of word choice
  “remove the word ‘abuse’ from your vernacular”
• Common terms used in the addiction space and alternative words/phrases to replace them
  "Substance abuse should be replaced with either 'substance use' or 'substance misuse'

Today Patrick is joined by Dr. Christopher Blazes to discuss how various drugs affect different parts of the brian and what makes some substances more addictive than others as well as individuals vunerability to addicition.

Today's Guest

Dr. Blazes is triple board-certified in psychiatry, addiction psychiatry, and emergency medicine and is the director of the OHSU addiction psychiatry Fellowship. He is a clinician educator whose practice is based out of the Portland VA Medical Center. He lectures widely and publishes on such topics as benzodiazepines, synthetic fentanyl analogues, buprenorphine, and the neurobiology of addiction and recovery. Watch Dr. Blazes lecture on benzodiazepines on YouTube

Sections from this episode include

• The different parts of the brain that various drugs affect
• Why some drugs are more likely to cause addiction than others
• The vulnerability to addiction
• The relation of addiction and incentive salience

Today Patrick is joined by Dr. Nora Volkow, the Director of the National Institute on Drug Abuse (NIDA) to discuss the importance of addiction treatment within the broader scope of healthcare and changing the public perception of substance use disorder.

Today's Guest

Nora D. Volkow, M.D., is Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. NIDA is the world’s largest funder of research on the health aspects of drug use and addiction.

Dr. Volkow’s work has been instrumental in demonstrating that drug addiction is a disease of the human brain. As a research psychiatrist and scientist, Dr. Volkow pioneered the use of brain imaging to investigate the toxic and addictive properties of abusable drugs. Her studies have documented changes in the dopamine system affecting, among others, the functions of frontal brain regions involved with motivation and self-regulation in addiction. She has also made important contributions to the neurobiology of obesity, ADHD, and aging and to the imaging field.

Dr. Volkow has published more than 780 peer-reviewed articles, written more than 100 book chapters and non-peer-reviewed manuscripts, and co-edited the Neuroscience for the 21th Century Encyclopedia and edited four books on neuroimaging for mental and addictive disorders.

Sections from this episode include

• Encourage your patients to be open and honest about addiction
• How to ask about addiction without judgement and how to intervene
• "By not intervening, we're condoning"
• Addiction is a disease of free will and treating addiction is not replacing one drug with another

Today Patrick is joined by Dr. Gabor Mate to discuss his career in addiction medicine, the impact students can have going forward, and also Dr. Mate's book In the Realm of Hungry Ghosts.

Today's Guest

After 20 years of family practice and palliative care experience, Dr. Maté worked for over a decade in Vancouver’s Downtown East Side with patients challenged by drug addiction and mental illness. The bestselling author of four books published in over twenty-five languages, Gabor is an internationally renowned speaker highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. His book on addiction received the Hubert Evans Prize for literary non-fiction. For his groundbreaking medical work and writing he has been awarded the Order of Canada, his country’s highest civilian distinction, and the Civic Merit Award from his hometown, Vancouver.

Sections from this episode include

• Why the term "hungry ghost"?
• How did you get interested in addiction medicine?
• How stress impacts students' empathy levels
• Is treating addiction replacing one substance with another?

Today Mariah talks with Dr. Alan about benzos and what students can do to help treat the addiction epidemic.

Today's Guest

Jamie K. Alan, RPh, PharmD, PhD, is an Assistant Professor of Pharmacology & Toxicology in the College of Human Medicine. Dr. Alan received her PharmD from Ohio Northern University in 2005, where she graduated with high distinction. She has been a licensed and practicing pharmacist for 8 years and has experience in retail, hospital, clinical and compounding pharmacy along with experience in conducting and designing clinical trials.

Sections from this episode include

• Use cases of benzodiazepines and short term vs long term use
• Signs/symptoms of an overdose and how to treat it
• What are withdrawal symptoms and treatment options

Today Patrick is joined again by Dr. Corey Waller to breakdown USMLE-style questions about alcohol, opioids, and cannabis.

Today's Guest

Corey Waller MD, MS, FACEP, DFASAM is a board-certified and actively practicing addiction and emergency medicine specialist with extensive experience working at the local, state, and national levels.

He works with the American Society of Addiction Medicine (ASAM) and related organizations to advance the evidence-based practice of treatment and recovery for individuals affected by substance use disorder (SUD). A nationally recognized expert in SUD, he is the editor-in-chief of The ASAM Criteria. As a principal with the Health Management Associates (HMA) Institute on Addiction, he is directly responsible for consultation regarding addiction treatment system development for hospitals, primary care practices, justice-involved populations, and addiction treatment providers. He oversees the HMAedu.com learning management system and continues to develop educational resources covering addiction, pain management, behavioral health, and administrative support for these systems.