Michael Fishman, MD Director of Young Adult Program Talbott Recovery Challenges Facing CRC’s and Young Adults in Recovery

Collegiate Recovery Communities (CRC) Bridging Transition Levels of Care Co-occurring Disorders Medically Assisted Therapy Medications for Cravings Cross Addiction

ASAM Dimensions of Multidimensional Assessment Dimension 1 – Acute Intoxification/Withdrawal Dimension 2 – Medical Conditions/Complications Dimension 3 – Emotional, Behavioral, Cognitive and Complications

ASAM Dimensions of Multidimensional Assessment Dimension 4 – Readiness to Change Dimension 5 – Relapse or Continual Problem Potential Dimension 6 – Recovery/Living Environment

ASAM Dimensions of Multidimensional Assessment 6 Dimensions Creates a Holistic, Biopsychosocial Assessment Used for Service Planning Across All Services Used for Service Planning Across All Levels of Care

Continuum of Care

CRC’s/CRP’s Challenges Students with Different Levels of… Motivation Prior Treatment Experience(s) Co-occurring Disorders Education

CRC’s/CRP’s Challenges Cross Addiction Medications for Cravings Medication for Mood or Thought Disorders, ADHD, etc. “Philosophies” of Recovery Insisting on Using Alcohol and/or Marijuana (MJ)

CRC’s/CRP’s Challenges Trends in Addiction Medicine Potential Complications ED Basic Principles and Medications –Even if not prescribing them Process Addictions

CRC’s/CRP’s Challenges Physicians and Therapists Have Different Philosophies Not All Students Believe in 12-Step Recovery MJ Maintenance Program ORT’s Are All Medications a Crutch?

Substance Use Disorders DSM5 vs. DSM4 Primarily Opioids Alcohol/Benzodiazepine Cocaine/Other Stimulants Hallucinogens/Inhalants

Substance Use Disorders Cannabinoids – A Constant Wax Dabs Edibles Combinations – Roxi’s and Bars

Substance Use Disorders Kratam Diphenhydramine DXM Etizolam Dark Web

Disclosure/Bias Primarily Abstinence Based Rarely ORT Rarely Stimulants

ORT (OST or OMT) Methadone – Federal License vs. Pain Subutex/Suboxone/Zubsolv –Maintenance vs. Detox

Abstinence Based Naltrexone (ReVia) Vivitrol Alcohol and Opioid Approval

Other FDA Approved Medications Antabuse (Disulfiram) Campral (Acamprosate) NRT Zyban, Wellbutrin (Byproprion) Pamelor (Nortriptyline) Catapres (Clonidine) Varenicline (Chantix)

ADHD Intuniv (Guanfacine) Straterra (Antomoxetine) Schedule II and IV Stimulants

ADHD Non FDA Approval Prozac Wellbutrin Effexor

ADHD Risk vs. Benefits ↑ Drugs of Abuse ↑ Alcohol Cross Addiction

Other MMT Depression – SSRI’s, SNRI’s, Other Anxiety Bipolar Psychosis

Other MMT/Impact on Mood Impact of Drugs/Alcohol Personality Traits Post Acute Withdrawal Overt and Covert Cravings

MMT Connection with Student Health Rotate Physician in Seminar List of Referral Sources Monthly or Bimonthly Physician Appointments ROI – Controversial Clinical Liaison in CRC Random UDS - Controversial

Abstinence Based Programs Naltrexone/Vivitrol – Considered Abstinent Suboxone/Subutex – More Controversial –May be Appropriate Stimulants – More Controversial –May be Appropriate

Naloxone (Narcan, Evzio) Critical in All CRC’s/CPC’s Easily Administered Injection Insufflations Available Training – All Staff and Students

Considerations Is ORT “Recovery”? How to Monitor “Abstinence”? Require Outside Aftercare and Monitoring? Require Quarterly Letters from Monitor?

Considerations Are UDS, Monitors, Letters Outside the Scope of a Community?

Treatment at TRC

Michael Fishman, MD Director of Young Adult Program (678) (800)

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