1. health and fitness
2. disorders

AGENDA-AT-A-GLANCE
SATURDAY, MAY 16, 2015
9:00 a.m. - 12:00 p.m.
Symposium
Advances in Medications Development to Treat Alcohol Use Disorder and
Co-Occurring Psychiatric Disorders
Chair: Raye Litten, Ph.D., NIAAA
ROOM 701 B • SOUTH, LEVEL 700
2:00 p.m. - 5:00 p.m.
Alcohol Use Disorder and PTSD: New Findings, New Challenges
Symposium
Chair: Anita Bechtholt, Ph.D., NIAAA
ROOM 701 B • SOUTH, LEVEL 700
3:30 p.m. - 5:00 p.m.
Innovative Pharmacological Strategies to Treat Alcohol Use Disorder
Lecture
Barbara Mason, Ph.D., Scripps Research Institute
EXHIBIT HALL A • NORTH, LEVEL 300
3:30 p.m. - 5:00 p.m.
Youth Alcohol and Marijuana Use and Substance Use Policy
Forum
Sharon Levy. M.D., M.P.H. and Susan Tapert, Ph.D., Children’s Hospital Boston
ROOM 206 C-D • NORTH, LEVEL 200
SUNDAY, MAY 17, 2015
8:00 a.m. - 11:00 a.m.
Symposium
Healing the Broken Bough: Update on the Diagnosis, Prevention and Treatment
of Fetal Alcohol Spectrum Disorders
Chair: Kenneth Warren, Ph.D., NIAAA
Discussant: Edward Riley, Ph.D., San Diego State University
ROOM 701 B • SOUTH, LEVEL 700
12:30 p.m. - 2:30 p.m.
Screening and Discussion of the Film "Anonymous People"
Forum
George Koob, Ph.D., NIAAA and Nora Volkow, M.D., NIDA
EXHIBIT HALL G • SOUTH, LEVEL 800
2:30 p.m. - 4:00 p.m.
Helping Patients Who Drink Too Much: Using the NIAAA’s Clinician’s Guide
Workshop
Mike Fleming, M.D., M.P.H., Northwestern University
ROOM 802 A/B • SOUTH, LEVEL 800
MONDAY, MAY 18, 2015
9:00 a.m. - 10:30 a.m.
Workshop
Medications for the Treatment of Alcohol Use Disorder and Related
Comorbidities: A Brief Guide
Domenic Ciraulo, M.D., Boston University
ROOM 104 B • NORTH, LEVEL 100
2:00 p.m. - 5:00 p.m.
Youth Interrupted: Alcohol Use Disorder and Adolescents
Symposium
Chair: Robert Huebner, Ph.D., NIAAA.
Discussant: Aaron White, Ph.D., NIAAA
ROOM 701 B • SOUTH, LEVEL 700
TUESDAY, MAY 19, 2015
1:30 p.m. - 3:00 p.m.
Lecture
How Science can Inform the Diagnosis, Prevention, and Treatment of Alcohol
Use Disorder
George Koob, Ph.D., NIAAA
EXHIBIT HALL A • NORTH, LEVEL 300
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
WELCOME LETTER
May 2015
Dear Colleague:
On behalf of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the
American Psychiatric Association (APA), it is our privilege to welcome you to a special
research-based track, Advances in the Treatment of Alcohol and Co-Occurring Psychiatric
Disorders Across Patient Populations and Settings during the 168th Annual Meeting of the
American Psychiatric Association in Toronto, Canada.
The NIAAA-supported sessions featured in this research track include lectures, symposia,
workshops, and forums by some of the world’s leading scientists that will address the
aforementioned and other topics of importance to all psychiatrists.
Example presentations include:
• How Science can Inform the Diagnosis, Prevention, and Treatment of Alcohol Use Disorders
• Innovative Pharmacological Strategies to Treat Alcohol Use Disorder (AUD)
• Helping Patients Who Drink Too Much: Using the NIAAA’s Clinician’s Guide
• Healing the Broken Bough: Update on the Diagnosis, Prevention and Treatment of Fetal
Alcohol Spectrum Disorders
In addition to providing updates on new research, a number of sessions will focus on the
development of clinical knowledge and skills.
We look forward to sharing the NIAAA research series with you, and hope you find it both
educational and inspirational.
Sincerely,
Paul Summergrad, M.D.
President
American Psychiatric
Association
Saul Levin, M.D., M.P.A.
CEO and Medical Director
American Psychiatric
Association
George Koob, Ph.D.
Director
National Institute on Alcohol
Abuse and Alcoholism
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
TABLE OF CONTENTS
5
Organizing Committee
6
Conference Information
7
Agenda
19
Notes
4
Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
ORGANIZING COMMITTEE
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
NIAAA STAFF - DIVISION OF TREATMENT
AND RECOVERY RESEARCH (DTRR)
Robert B. Huebner, Ph.D.
Acting Director
Raye Z. Litten, Ph.D.
Associate Director
Anita Bechtholt, Ph.D.
Health Science Administrator
AMERICAN PSYCHIATRIC ASSOCIATION (APA)
Paul Summergrad, M.D.
President
Saul Levin, M.D., M.P.A.
CEO and Medical Director
Philip R. Muskin, M.D.
Chair, Scientific Program Committee
Joanne Fertig, Ph.D.
Health Science Administrator
Beatrice A. Eld
Director, Addiction Psychiatry
Division of Education
Daniel E. Falk, Ph.D.
Health Science Administrator
Frances R. Levin, M.D.
Chair, Council on Addiction Psychiatry
Deidra Roach, M.D.
Medical Project Officer
Megan Ryan
Clinical Project Manager
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
HIGHLIGHTS AND CONFERENCE INFORMATION
This program book provides information
about lectures, forums, symposia, and
workshops organized and supported by the
National Institute on Alcohol Abuse and
Alcoholism (NIAAA).
Featured Sessions
APA FRONTIERS OF SCIENCE LECTURE:
Barbara Mason, Ph.D., Scripps Research
Institute
Innovative Pharmacological Strategies to Treat
Alcohol Use Disorder
Saturday, May 16, 2015
3:30 p.m. - 5:00 p.m.
Exhibit Hall A North, Level 300, Metro
Toronto Convention Centre
Continuing Medical
Education (CME)
The NIAAA Research Track is part of the
American Psychiatric Association Annual
Meeting Scientific Program.
The American Psychiatric Association (APA)
is accredited by the Accreditation Council
for Continuing Medical Education to provide
continuing medical education for physicians.
The APA designates this live activity (the
APA Annual Meeting) for a maximum of 50
AMA PRA Category 1 Credit(s)TM. Physicians
should only claim credit commensurate
with the extent of their participation in the
activity.
MEDIA WORKSHOP/FORUM: Shuttle Bus Information
George Koob, Ph.D., NIAAA and Nora
Volkow, M.D., National Institute on Drug Abuse
Screening and Discussion of the Film
“Anonymous People”
Sunday, May 17, 2015
12:30 p.m. - 2:30 p.m.
Exhibit Hall G South, Level 800, Metro
Toronto Convention Centre
The Toronto Convention Centre will serve
as the hub for all shuttle bus routes. See the
APA Conference Program for daily shuttle
bus routes.
APA FRONTIERS OF SCIENCE LECTURE:
Monday, May 18, 2015 • 7:00 a.m. – 7:30 p.m.
How Science can Inform the Diagnosis,
Prevention, and Treatment of Alcohol Use
Disorders
George Koob, Ph.D., NIAAA
Tuesday, May 19, 2015
1:30 p.m. - 3:00 p.m.
Exhibit Hall A North, Level 300, Metro
Toronto Convention Centre
Tuesday, May 19, 2015 • 7:00 a.m. – 5:30 p.m.
HOURS OF OPERATION:
Saturday, May 16, 2015 • 7:00 a.m. – 5:30 p.m.
Sunday, May 17, 2015 • 7:00 a.m. – 7:30 p.m.
Wednesday, May 20, 2015 • 7:00 a.m. – 5:30 p.m.
Website
Information about NIAAA research,
programs, and publications is available on
the NIAAA website: www.niaaa.nih.gov/.
Download the Free Toronto App
Get the inside scoop on all the exciting things to see and do during your stay in Toronto.
Visit www.seetorontonow.com/mobile-app/
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
DETAILED AGENDA
PRESENTED BY: THE NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
SATURDAY, MAY 16, 2015
9:00 A.M. - 12:00 P.M.
Symposium
Advances in Medications Development to Treat
Alcohol Use Disorder and Co-Occurring Psychiatric
Disorders
LOCATION: Metro Toronto Convention Centre • Room 701 B •
South, Level 700
SAT URD AY, MAY 16, 2015
Advances in the Treatment of Alcohol and
Co-Occurring Psychiatric Disorders Across
Patient Populations and Settings
CHAIR: Raye Litten, Ph.D., NIAAA
Medications Development for Alcohol Use Disorder: Why
Human Laboratory Models Are a Good Idea
PRESENTER(S):
Daniel Falk, Ph.D., National Institutes of Health
A Double-Blind, Placebo-Controlled Trial Assessing the Efficacy and Safety of Varenicline
Tartrate for Alcohol Dependence
Ihsan Salloum, M.D., M.P.H., Miller School of Medicine at University of Miami Treatment of Alcohol Use Disorder With Co-Occurring Bipolar Disorder: Efficacy and
Prediction of Treatment Response
Alan Green, M.D., Geisel School of Medicine at Dartmouth
Alcohol Use Disorder and Schizophrenia: Approaches to Pharmacologic Interventions
OBJECTIVES:
• Identify promising medications to treat alcohol use disorder and co-occurring psychiatric
disorders
• Understand how effective screening models can be developed and implemented to
advance the development of new medications
• Specify high-priority research questions that will better inform clinical practice
ABSTRACT:
Alcohol use disorder (AUD) is among the most prevalent mental health disorders found
in the world today. More than 76 million worldwide are estimated to have a diagnosable
AUD. Moreover, AUD frequently co-occurs with other psychiatric disorders, resulting in
an increased risk for suicide, relapse to drinking, violence, and overall poor response to
treatment. Unfortunately, there is little evidence-based research to guide clinical care for
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
SATURD AY, MAY 16, 2015
DETAILED AGENDA
this population. In this symposium, presentations will be delivered on a variety of topics
detailing the advancements made in medications development. The first presentation will
focus on strategies in streamlining the drug development process for more efficiency and
increasing the predictability through utilization of human laboratory paradigms as screening
models for candidate compounds. The second presentation will feature results of the
NIAAA Clinical Investigations Group (NCIG) multi-site clinical trial assessing varenicline
for alcohol dependence. The third presentation will focus on the most recent advances in
pharmacotherapies and psychosocial interventions specifically designed to address AUD
and bipolar comorbidity, including recent results of a clinical trial using a combination
of valproate and naltrexone. Finally, new advances in medications development will be
presented in treating patients with schizophrenia and comorbid AUD. Specifically, new
strategies for drug development will be presented, exploring a combination of targets across
translational studies. During the discussion session, high-priority research questions will
be identified and addressed. Although significant progress has been made in medications
development to treat AUD and psychiatric comorbidity, more work remains if we are to
provide more effective guidelines for the treatment community.
2:00 P.M. - 5:00 P.M.
Symposium
Alcohol Use Disorder and PTSD: New Findings, New
Challenges
LOCATION: Metro Toronto Convention Centre • Room 701 B •
South, Level 700
CHAIR: Anita Bechtholt, Ph.D., NIAAA
PRESENTER(S):
Kathleen Brady, M.D., Ph.D., Medical University of South Carolina
New Developments in the Treatment of Co-occurring PTSD and Alcohol Use Disorders
Murray Raskind, M.D., VA Puget Sound Health Care System
The Alpha-1 Adrenoreceptor Antagonist Prazosin for Alcohol Use Disorder in Combat
Veterans (and Civilians) With PTSD
Kerry Ressler, M.D., Ph.D., Emory University / HHMI
Update on Translational Research: Neurobiology of Appetitive and Aversive Behaviors in
Mice and Alcohol Use Disorders and PTSD in Humans
Lisa Najavits, Ph.D., Boston University School of Medicine
An Update on the Seeking Safety Model: Empirical and Clinical Developments 8
OBJECTIVES:
• Know the nature and course of PTSD symptoms and their co-occurrence with alcohol use
disorders
• Understand the major behavior and pharmacological interventions for co-occurring PTSD
and alcohol use disorder
• Know the neurological and genetic underpinnings of PTSD and alcohol use disorders
Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
DETAILED AGENDA
Dr. Kathleen Brady will focus on the link between early childhood trauma and the
development of alcohol dependence and recent research on pharmacological and behavioral
treatment s tailored to victims of childhood trauma. Then, Dr. Murray Raskind will address
the treatment of PTSD and alcohol use disorders among combat veterans. The potential for
using a generically available CNS-active alpha-1 adrenoreceptor antagonist (prazosin) will be
discussed and recent results from a pilot study and placebo controlled trail will be presented.
Dr. Kerry Ressler will address co-morbid PTSD and alcohol use disorders from a translational
research perspective. He will synthesize findings from Finding from a series of both animal
and human studies focused on the intersection of fear / stress and appetitive / addictive
disorders, along with the shared risk factors of childhood trauma, emotion dysregulation,
prefrontal-amygdala dyscontrol, and genetic mechanisms. The relative contribution of
each of these factors in dysregulated stress responses characteristics of PTSD and alcohol
use disorders will be discussed. Finally, Dr. Lisa Najavits will present an update on a wellestablished, multimodal behavioral intervention for PTSD-Seeking Safety. Seeking Safety
focuses on helping patients learn coping skills to attain greater safety in their lives. Data
will be presented on combining Seeking Safety with pharmacotherapy and the use of mobile
phone applications as adjuncts to the core behavioral intervention.
SAT URD AY, MAY 16, 2015
ABSTRACT:
There is little doubt that alcohol use disorder (AUD) and Posttraumatic Stress Disorder (PTSD)
co-occur across a variety of patient populations. Epidemiological studies show that between
25-40 percent of those seeking treatment of for alcohol use disorder (AUD) meet criteria for
current PTSD. Researchers and clinicians have highlighted the potentially cyclical nature of
this co-morbidity: persons with PTSD may use alcohol to self-medicate or manage their PTSD
symptoms. This reduction in PTSD symptoms may, in turn, serves to reinforce inappropriate
alcohol consumption, which then may lead to alcohol problems and the maintenance of
PTSD symptomatology. The purpose of this symposium is to highlight recent NIAAA-funded
research on understanding the neurological and behavioral underpinnings of PTSD and
breaking the cycle of PTSD and alcohol use disorder (AUD).
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
SATURD AY, MAY 16, 2015
DETAILED AGENDA
3:30 P.M. - 5:00 P.M.
Lecture
Innovative Pharmacological Strategies to Treat
Alcohol Use Disorder
LOCATION: Metro Toronto Convention Centre • Exhibit Hall A •
North, Level 300
PRESENTER:
Barbara Mason, Ph.D., Scripps Research Institute
OBJECTIVES:
• Identify symptoms of protracted alcohol withdrawal that may be associated with
heightened relapse risk.
• Understand appropriate human laboratory models to screen medications for therapeutic
potential in alcohol use disorder.
• Evaluate the research data assessing the safety and efficacy of gabapentin (Neurontin),
pregabalin (Lyrica) and duloxetine (Cymbalta) as treatments for alcohol use disorder.
ABSTRACT:
Fewer than 5% of the 17 million Americans currently afflicted with alcohol use disorder
(AUD) are treated with approved medications for AUD, and development of more effective
medications to treat AUD is a large, unmet medical need. We have applied three strategies
for drug development for AUD: 1.) Address a novel therapeutic target in the addiction
cycle: the brain stress systems; 2.) Screen drug candidates in pre-clinical and human lab
models to assess therapeutic potential for AUD; and 3.) Evaluate selected drug candidates in
randomized controlled trials to assess safety and efficacy in outpatients with AUD.
The transition from alcohol use to dependence involves powerful neuro-adaptations in the
extended amygdala which manifest clinically as persisting disturbances in sleep, mood and
alcohol craving. Gabapentin (Neurontin), a generic calcium channel/GABA-modulating
medication, was shown pre-clinically to restore homeostasis in GABA-CRF interactions in
the extended amygdala in dependent rats, and to significantly reduce craving and sleep
disturbance relative to placebo in dependent participants in a human lab study of alcohol
cue reactivity. Subsequently, a 3-arm, double blind, randomized, dose-ranging clinical trial
of 0, 900, and 1800 mg/d gabapentin in 150 outpatients with AUD ≥ moderate severity found
significant linear dose effects in the rates of complete abstinence and no heavy drinking and
in sleep, mood and craving over the 12-week study; the rate of complete abstinence was 4x
greater in the 1800mg group relative to placebo (p=0.04, nnt=8) and the rate of no heavy
drinking twice that of placebo (p=0.02, nnt=5). A 3-arm (n=150) double-blind placebocontrolled trial was conducted with Pregabalin (Lyrica), 300-600mg/d, to validate and extend
gabapentin results, vs. The serotonin/norepinephrine reuptake inhibitor (SNRI) duloxetine
(Cymbalta), 40-60mg/d, which suppressed binge drinking in rats. Outpatients treated with
Pregabalin had significantly lower levels of craving in response to alcohol cues, and higher
rates of abstinence and no heavy drinking over the 12-week treatment study, relative to
placebo. Conversely, outpatients treated with duloxetine had higher levels of craving in
10
Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
DETAILED AGENDA
Positive effects of gabapentin and Pregabalin on drinking outcomes provide clinical
validation of central stress systems as pharmacological targets for the treatment of AUD.
Results of cue reactivity testing were congruent with clinical trial outcomes for all 3 drugs
studied, and support the predictive validity and reliability of this method for screening
medications for therapeutic potential in AUD.
3:30 P.M. - 5:00 P.M.
Forum
Youth Alcohol and Marijuana Use and Substance Use
Policy
LOCATION: Metro Toronto Convention Centre • Room 206 C-D •
North, Level 200
SAT URD AY, MAY 16, 2015
response to alcohol cues in the lab, and showed no advantage in drinking outcomes relative
to placebo.
PRESENTER(S):
Sharon Levy, M.D., M.P.H., Children’s Hospital Boston
Susan Tapert, Ph.D., Children’s Hospital Boston
OBJECTIVES:
• Describe the neurologic basis of the vulnerability to substance use related harms that
occurs during adolescence
• Identify associations between college alcohol policies and student drinking
• Identify associations between medical marijuana policies and adolescent marijuana use
• Describe the impact of industrialization on product evolution, including changes to
marijuana that have occurred in conjunction with policy changes.
ABSTRACT:
For adolescents and young adults, use of alcohol, marijuana and other substances use
is associated with greater morbidity and mortality than use by adults. The neurobiology
underlying the developmental vulnerability is currently being elucidated, though the risk
has long been appreciated. Federal law has long restricted sales and marketing of tobacco
products to anyone under age 18 and the legal “drinking age” has been set at 21 for more than
a generation. New laws that allow recreational use of marijuana prohibit use by youth under
age 21, and even laws that allow access to marijuana as a medication are more restrictive for
youth. Despite these prohibitions, rates of substance use peak during adolescence and young
adulthood, and patterns of consumption and attendant harms are distinct. The impact of
specific policies designed to limit youth access, youth use rates and harms remain a perennial
topic of debate. Policy approaches to reducing college student binge drinking vary widely from interventions at the individual level to stricter environmental controls to reducing the
legal drinking age to 18. Debates over marijuana policy frequently center on the concern that
legalization in any form (i.e. for medical or recreational purposes) will increase youth access
by reducing perceived harm, increasing supply or access and “marketing” of marijuana,
which could affect adolescent behavior even if campaigns are targeted at adults. Legalization
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
S UN D AY, MAY 17, 2015
DETAILED AGENDA
proponents counter that despite a wealth of data; to date there is no convincing evidence
of increased youth marijuana use rates in states that have legalized “medical marijuana”.
Marijuana legalization for recreational purposes in Colorado and Washington are still to recent
for definitive conclusions regarding impact. This presentation will begin with a brief overview
of how brain development impacts behavior related to alcohol and marijuana use leading
to unique patterns of use in youth. The forum will also include a review of college alcohol
policies and their impact on campus drinking, medical marijuana laws and their impact
on adolescent marijuana use and then discuss the potential impacts of full legalization of
marijuana, using the tobacco industry as an historical analogy.
SUNDAY, MAY 17, 2015
8:00 A.M. - 11:00 A.M.
Symposium
Healing the Broken Bough: Update on the Diagnosis,
Prevention and Treatment of Fetal Alcohol Spectrum
Disorders
LOCATION: Metro Toronto Convention Centre • Room 701 B •
South, Level 700
CHAIR: Kenneth Warren, Ph.D., NIAAA
DISCUSSANT: Edward Riley, Ph.D., San Diego State University
PRESENTER(S): Kenneth Warren, Ph.D., NIAAA
Overview of Fetal Alcohol Spectrum Disorders Elizabeth Sowell, Ph.D., USC, Children’s Hospital LA
Brain Development In Children and Adolescents With Prenatal Alcohol Exposure Peter Hammond, Ph.D., Institute of Child Health, London
Facial Clues to the Effects of Prenatal Alcohol Exposure on Brain and Behavior Sarah Mattson, Ph.D., Emory University
Developing a Neurobehavioral Profile of FASD Julie Kable, Ph.D., Emory University
Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure: Reliability and
Validity of Diagnostic Criteria and Interventions for FASD OBJECTIVES:
• Identify common characteristics of individuals with a history of prenatal alcohol
exposure, including how these characteristics differ from key features of other
neurodevelopmental disorders.
• Demonstrate knowledge of latest developments in the screening and diagnosis of fetal
alcohol spectrum disorders.
• Be familiar with current research on promising interventions for individuals with FASD
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
DETAILED AGENDA
SUN D AY, MAY 17, 2015
ABSTRACT:
Kenneth Warren, Deputy Director of NIAAA, will provide an introduction to describe fetal
alcohol syndrome (FAS) and the broader spectrum that has been referred to as fetal alcohol
spectrum disorders (FASD), as well as the new APA DSM 5 category of neurobehavioral
disorder: prenatal alcohol exposed (ND-PAE). The history of this neurobehavioral disorder
will be discussed, including the reasons underlying the delay in its identification until the
last quarter of the 20th century. Also to be addressed are the research and clinical challenges
that remain. Dr. Elizabeth Sowell will discuss results from longitudinal brain imaging studies
demonstrating that brain structure and function are different in children and youth prenatally
exposed to alcohol compared to unexposed children and youth, and that the effects of
prenatal alcohol exposure persist into adolescence. Understanding how brain maturation
evolves in children and youth with PAE is important to understand both the long-term
impact of drinking during pregnancy and to evaluate possible interventions and treatments
to determine which are most effective. Findings from brain imaging studies to date suggest
that early identification and treatment of children with prenatal alcohol exposure may
make the biggest difference, and may improve the outcomes for these children and their
families. Dr. Peter Hammond will discuss links between prenatal alcohol exposure, facial
dysmorphism, and cognitive impairment in FASD using novel morphometric analysis of 3d
facial photos and MRI images of the brain. The face and brain develop in close harmony
and so facial form often heralds atypical development associated with genetic anomaly
and teratogenic exposure. Dr. Sarah Mattson will discuss the development and use of a
neurobehavioral profile(s) of FASD in the diagnosis of alcohol-affected children. Data from a
multi-site collaborative study on FASD (Collaborative Initiative on FASD) will be described,
further characterizing the broad array of neurobehavioral deficits that may be associated with
heavy prenatal alcohol exposure. Dr. Julie Kable will provide a critical review of progress
towards validating the proposed diagnostic criteria for neurobehavioral disorder associated
with prenatal alcohol exposure (ND-PAE), including establishing reliability in making the
diagnosis and validating the relative contribution of each of the proposed symptoms in
identifying the severity of ND-PAE. Her presentation will also address recent improvements in
access to mental health care and services and specific treatment strategies found to facilitate
adaptation and adjustment.
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
S UN D AY, MAY 17, 2015
DETAILED AGENDA
12:30 P.M. - 2:30 P.M.
Forum
Screening and Discussion of the Film “Anonymous
People”
LOCATION: Metro Toronto Convention Centre • Exhibit Hall G •
South, Level 800
CHAIR: George Koob, Ph.D., NIAAA CO-CHAIR: Nora Volkow, M.D., National Institute on Drug Abuse
OBJECTIVES:
• Know the perspective of people in long term recovery from alcohol and other drug abuse,
especially relating to social stigma
• Understand the history of recovery advocacy in the United States
• Describe the impact of public policy on the recovery movement
ABSTRACT:
The anonymous people is a documentary film about the 23.5 million Americans living in
long-term recovery from addiction to alcohol and other drugs. The story is told through
the faces and voices of the leaders, volunteers, corporate executives, and celebrities who
are telling their stories to save the lives of others just like them. This new public recovery
movement is fueling a changing conversation that aims to transform public opinion. Dr.
George Koob, the Director of the National Institute on Alcohol Abuse and Alcoholism, and
Dr. Nora Volkow, Director of the National Institute on Drug Abuse, will lead a discussion on
the film.
2:30 P.M. - 4:00 P.M.
Workshop
Helping Patients Who Drink Too Much: Using the
NIAAA Clinician’s Guide
LOCATION: Metro Toronto Convention Centre • Room 802 A/B •
South, Level 800
CHAIR: Mike Fleming, M.D., M.P.H., Northwestern University OBJECTIVES:
• Understand the use of the NIAAA Clinician’s Guide and the specific relationship between
alcohol consumption and the risk of alcohol-related problems
• Obtain increased knowledge and research supported guidance for screening, intervention,
and treatment of alcohol related problems
• Discuss the NIAAA Clinician’s Guide and how it can be implemented into a variety of
different service settings
14
ABSTRACT:
This workshop will examine the research-based NIAAA Clinician’s Guide and its application
in a variety of treatment settings. The presentation will address the use of the guide, including
screening and interventions, medication management support, alcohol counseling resources, and
patient education. Implementation of the guide in different service settings will also be addressed.
Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
DETAILED AGENDA
9:00 A.M. - 10:30 A.M.
Workshop
Medications for the Treatment of Alcohol Use
Disorder and Related Comorbidities: A Brief Guide
LOCATION: Metro Toronto Convention Centre • Room 104 B •
North, Level 100
CHAIR: Domenic Ciraulo, M.D., Boston University School of
Medicine
OBJECTIVES:
• Demonstrate knowledge of the efficacy, and safety of the FDA approved medications for
the treatment of alcohol use disorder (AUD)
• Identify the steps involved in screening for AUD and developing a medications-assisted
treatment plan
• Identify the special considerations in treating AUD patients with psychiatric comorbidities
MO N D AY, MAY 18, 2015
MONDAY, MAY 18, 2015
ABSTRACT:
Three oral medications (disulfiram, acamprosate, and naltrexone) and one injectable
medication (extended-release injectable naltrexone) have been approved by the U.S. Food
and Drug Administration (FDA) for the treatment of alcohol use disorder (AUD). This
workshop will review the rationale for selecting each medication including the mechanism
of action, dosing, efficacy and safety of each medication for the treatment of alcohol use
disorders and related comorbidities. Steps in assessing the patient for risky alcohol use,
as well as developing and implementing a medication assisted treatment plan will be
discussed. Topics will include steps involved in screening the patient for medication use;
taking a relevant patient history; conducting a physical exam with a focus on evaluating
neurocognitive function, sequelae of alcohol use, and looking for evidence of hepatic
dysfunction. In addition to standard laboratory testing such as CBC, vitamin deficiencies,
hepatic and renal testing, the use of newer biomarkers such as Carbohydrate-deficient
transferrin (CDT), gamma-glutamyl transpeptidase (GGT) and aminotransferase (AST) will
be discussed. The role of recently developed, highly sensitive alcohol metabolites such as
ethyl glucuronide (EtG) and phosphatidylethanol (PEth) will be also be reviewed. When
a patient’s initial assessment supports a diagnosis of AUD developing a comprehensive
treatment plan becomes critical. Stages in this process involve setting goals with the patient
for medication assisted treatment, establishing expectations by educating the patient as
to how the medication works and what to expect from treatment will be discussed. A full
disclosure about the medication and the reasons it was selected, including discussion of
potential risks and benefits and the time to full effect should be included. The strategy of
integrating pharmacologic and non-pharmacologic therapies and their relative merits will be
discussed as well as the importance of maintaining close coordination between medication
management and other aspects of addiction treatment when providers are separate.
Factors affecting the physician’s choice of medication will be considered. In addition to
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
M O N D AY, MAY 18, 2015
DETAILED AGENDA
factors specific to each medication, the clinician should consider the patient’s (a) past
experience with addiction medication; (b) beliefs and opinions as to which medications may
be most helpful; (c) level of patient’s motivation; (d) medical status and contraindications for
each medications; and (e) history of medications adherence. The final topic to be discussed
will be medication assisted treatment of patients with co-occurring psychiatric disorder.
2:00 P.M. - 5:00 P.M.
Symposium
Youth Interrupted: Alcohol Use Disorder and
Adolescents
LOCATION: Metro Toronto Convention Centre • Room 701 B •
South, Level 700 CHAIR: Robert Huebner, Ph.D., NIAAA
DISCUSSANT: Aaron White, Ph.D., NIAAA PRESENTER(S): Andrey Ryabinin, Ph.D., Oregon Health Sciences University Modeling Effects of Social Isolation on Alcohol Drinking in Adolescent Mice
Marisa Silveri, Ph.D., McLean Hospital Adolescence and Emerging Adulthood: Development, GABA & Alcohol Use
Sharon Levy, M.P.H., Ph.D., Boston Children’s Hospital
Alcohol Screening and Brief Intervention: Using the NIAAA Youth Alcohol Screening
Guide in Outpatient Psychiatry
Sandra Brown, Ph.D., University of California Using Development to Inform Adolescent Alcohol Intervention
Antonia Abbey, Ph.D., Wayne State University Alcohol’s Role in Sexual Assault on College Campuses: What is the Evidence and What
Research is Still Needed?
OBJECTIVES:
• Identify the unique vulnerabilities of adolescents to the short- and long-term effects of alcohol
• Recognize the signs of alcohol use disorder in adolescents and how to screen for such
disorders
• Identify the roles that alcohol plays in sexual assaults involving adolescents
ABSTRACT:
Adolescence is a time of increased risk-taking combined with immature decision-making and
poor self-control, leading to high rates of morbidity and mortality. Alcohol and other drug use
commonly begins during adolescence at a time when the frontal lobes, charged with decision
making and impulse control, are still developing. Excessive drinking during the teen years
can lead to both short- and long-term consequences. Acute consumption contributes to sexual
assaults, overdoses, injuries and death. The earlier one starts drinking the greater the odds of
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
DETAILED AGENDA
T UE SD AY, MAY 19, 2015
developing and alcohol use disorder down the road. The heightened vulnerability of adolescents
to the deleterious effects of alcohol pose difficult challenges for those in the treatment and
prevention fields. Much remains unknown regarding the reasons for the increased susceptibility
of adolescents to alcohol-related harms, how to detect alcohol problems in this age group and
what to do about it. This symposium will cover a spectrum of issues relevant to adolescent
alcohol use. Dr. Andrey Ryabinin will discuss translational findings on the effects of social
isolation on alcohol consumption in mice with an eye toward helping attendees understand the
contributions of socialization to alcohol consumption in adolescent animals. Dr. Marisa Silveri
will present data on the neurochemistry involved in the developmental effects of binge alcohol
consumption during adolescence. Dr. Sharon Levy will discuss brief interventions in adolescents
and demonstrate the use of the NIAAA Youth Alcohol Screening Tool that can be incorporated
into outpatient psychiatry care. Dr. Sandra Brown will discuss ways in which insights from
adolescent neurocognitive and social development can inform effective interventions for
dissuading or reducing alcohol use among youth. Finally, Dr. Antonia Abbey will explore
the roles that alcohol plays in sexual assaults involving college students. Collectively, these
presentations will help attendees understand the state of the knowledge regarding the impact of
alcohol, both short- and long-term, on adolescents and their brains.
TUESDAY, MAY 19, 2015
1:30 P.M. - 3:00 P.M.
Lecture
How Science can Inform the Diagnosis, Prevention,
and Treatment of Alcohol Use Disorder
LOCATION: Metro Toronto Convention Centre • Exhibit Hall A •
North, Level 300
PRESENTER:
George Koob, Ph.D., NIAAA
OBJECTIVES:
• Understand the cycle of addiction and the neurobiological circuits involved in each stage
• Understand the role of the rewards system, the stress system, and executive function in
the neuropathological progression of the addiction cycle.
• Identify research areas of high priority at NIAAA that derive from this scientific
framework
ABSTRACT:
Alcohol use disorder (AUD) causes an enormous amount of human suffering, loss of
productivity and cost to our medical care system. The aim is to show advances in the
neuroscience of AUD can lead the way to better diagnosis, treatment and prevention of
this health problem. Conceptualizing alcoholism as a three-component cycle composed
of a binge/intoxication stage, a withdrawal/negative affect stage, and a pre-occupation/
anticipation (craving) stage has allowed identification of key neurocircuits underlie addiction
to alcohol and many other drugs. Each stage of the addiction cycle is hypothesized to
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
TUESD AY, MAY 19, 2015
DETAILED AGENDA
be mediated by a different circuit: the binge-intoxication stage involves recruitment of
reward neurotransmission in the basal ganglia; the withdrawal-negative affect stage
involves loss of reward neurotransmission and gain of stress in the extended amygdala;
and the preoccupation-anticipation stage involves loss of prefrontal cortical function. Key
neuropathological elements are hypothesized to parallel the stages of the addiction cycle
providing a powerful impetus for the drug-seeking behavior associated with AUD: increases
in incentive salience in the binge-intoxication stage, decreases in reward function and
sensitization of brain stress systems in the withdrawal negative affect stage and disruption
of prefrontal executive function, in the preoccupation-anticipation stage. Understanding
multiple stages and presentations of AUD can inform clinical practice by identifying
clinically relevant endophenotypes for neurobiological mechanisms ultimately may lead
to better diagnosis and biomarkers of vulnerability. Understanding the combination of
dysregulated incentive salience-reward function, sensitized stress systems and disrupted
orbitofrontal/prefrontal executive function may lead to the development of novel treatments
for AUD particularly in the domain of stress and negative affect regulation. A priority for
the scientific agenda at NIAAA will be the identification of common elements in negative
affect systems relative to co-occurring psychiatric disorders such as post-traumatic stress
disorder. Strengthening knowledge about the neuroscience of AUD can also inform a second
NIAAA priority: underage drinking. The frontal cortex does not fully develop until age
25, understanding the neurocircuitry neuroadaptations in executive function systems will
provide new insights into identifying vulnerability to addiction in adolescents. Understanding
of the pathological trajectory of adolescent alcohol use can inform the development of
novel, science-based approaches to prevention and treatment of AUD. Recent advances in
behavioral approaches to the treatment of AUD and NIAAA’s work on understanding barriers
to the implementation evidence-based practice in primary care, mental health, and other
health care settings will be discussed.
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
NOTES
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
NOTES
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
NOTES
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM
Metro Toronto Convention Centre | Overview
FLOORPLAN
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Advances in the Treatment of Alcohol and Co-Occurring Psychiatric Disorders Across Patient Populations and Settings
PRESENTED BY: THE NATIONAL INSTITIUTE ON ALCOHOL ABUSE AND ALCOHOLISM