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

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

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

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

5. 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

7. Continuum of Care

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

10. 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)

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

12. 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?

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

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

15. Substance Use Disorders Kratam Diphenhydramine DXM Etizolam Dark Web

16. Disclosure/Bias Primarily Abstinence Based Rarely ORT Rarely Stimulants

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

18. Abstinence Based Naltrexone (ReVia) Vivitrol Alcohol and Opioid Approval

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

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

21. ADHD Non FDA Approval Prozac Wellbutrin Effexor

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

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

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

25. 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

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

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

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

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

30. Treatment at TRC

31. Michael Fishman, MD Director of Young Adult Program (678) 251-3184 (800) 445-4232

32. FURTHER INFORMATION To contact one of TRC’s Intake specialists Please call: 800-445-4232 OR Visit our website at: talbottcampus.com