ON THE ROAD TO
WELLNESS
Dealing with
Addiction Disease
in Dentistry
FINAL REPORT
ON THE ROAD TO
WELLNESS
Dealing with
Addiction Disease
in Dentistry
O C TO B E R 1 2-1 3 , 20 1 2
EXECUTIVE 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. It
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.
2
EXCECUTIVE SUMMARY
ON THE ROAD TO
WELLNESS
What I 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.
In 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.
3
EXCECUTIVE 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
It’s puzzling why some people become addicted and others do not. No single answer has been found.
It 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. It 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.
In 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.
4
EXCECUTIVE SUMMARY
ON THE ROAD TO
WELLNESS
If 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.
In 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. In 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.
5
EXCECUTIVE SUMMARY
ON THE ROAD TO
WELLNESS
If 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.
It 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.
6
EXCECUTIVE SUMMARY
ON THE ROAD TO
WELLNESS
FUTURE DIRECTIONS
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:
EDUCATION & COMMUNICATION
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.
COMPLEXITY
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.
MANAGING OUTCOMES
It is important to take the strength of our existing resources and maximize them. It 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. It is important to capitalize on the current
momentum to move forward together with a sense of urgency.
7
EXCECUTIVE SUMMARY
FOR MORE INFORMATION
Canadian Dental Regulatory Authorities Federation
Irwin Fefergrad
Executive Director
[email protected]
416.710.9571
Canadian Dental Association
Dr. Benoit Soucy
Director of Clinical and Scientific Affairs
[email protected]
613.523.1770
ON THE ROAD TO
WELLNESS
8
EXCECUTIVE SUMMARY
ON THE ROAD TO
WELLNESS
APPENDIX
Tab 1
What is it about dentists? Health & Addiction
Dr. Carolyn Thomson
Tab 2
Anecedotal Perspectives from BC Experience of Member Counselling Support
Dr. John T. Palmer
Tab 3
Addiction in the 21st Century: A Treatable Brain Diseases
Dr. Paul Earley
Tab 4
Addiction in Caregivers
Dr. Graeme Cunningham
Tab 5 CV of Dr. Graeme Cunningham
Tab 6
CV of Dr. Paul Earley
Tab 7
CV of Dr. John Palmer
Tab 8
CV of Dr. Carolyn Thomson
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…
Introvert
Thinker
•
•
•
•
Perceptive
Sensor
compulsive personalities
unrealistic expectations
unnecessarily high standards of performance
require social approval and status
Intuitive
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
Sleep
Snack
Smoking
73%
61%
20%
10%
Alcohol
Average BMI
90%
61%
Myer and Myer 2004
5
6
Musculoskeletal Disorders
•
•
•
•
Other Health Issues
High prevalence 87.2% over 12 months
Low back pain (LBP most common)
Shoulder pain
Wrist pain
7
•
•
•
•
•
Allergic contact dermatitis
Respiratory sensitivity
Eye injuries
Auditory damage
Hepatitis B: vaccine uptake
8
Ten most commonly reported minor ailments
Nitrous Oxide
• Chronic exposure can produce serious risk
• Possible risks to the hematological, reproductive, hematological, hepatic and renal systems
• Increase cancer risk
• Most common: peripheral neuropathy
Usage
• USA and Japan – 50%
• Denmark – 45‐50%
• UK – 30‐40%
9
• 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
–
* Correlates with work stress
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?
12
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%
• Difficulty in sleeping* 48.6%
10
11
• Feeling tired for no apparent reasons* 48.2%
Vulnerability
•
•
•
•
•
•
•
Genetic factors
Dynamics of family of origin
Personal history‐ exposure/response to trauma
Variations in brain chemistry
Personality characteristics
Cultural norms
Religious beliefs
13
Depression
• 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 2005
14
Anxiety
What are the costs?
•
•
•
•
Personal suffering
Impaired relationships
Days lost from work
Impact 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
15
16
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?
• 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
JADA June 2001, Roger Alexander
International Dental Journal, 2012 ‐ Sancho FM
17
18
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
19
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.
20
National Institute on Alcohol Abuse and Alcoholism
Addiction
“A disease process characterized by the continued use of a specific psychoactive substance despite physical, psychological or social harm."
21
• 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
22
Contributing Factors
•
•
•
•
•
High stress
Unrealistic and perfectionistic expectations of oneself
Grandiose feelings of invulnerability
Knowledge about and access to drugs
Other
–
–
–
–
23
stressful environments
long hours
excessive professional demands
demands of patients and staff
The Addicted Dentist
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
24
•
•
•
•
•
•
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
• 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.
Dr. Jerry Gropper
Talbott Marsh Recovery Campus
25
Good News:
• Studies indicate a better than 86% five‐year recovery success rate for the dental profession
26
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. 27
28
Stress
Feelings of low self‐esteem, depression and anxiety and hopelessness.
Younger dentists more prone. Stress
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 2004 29
30
Biggest cause of stress
Running behind schedule and coping with difficult, uncooperative patient. 31
Three Dimensions of Burnout
“Gradual erosion of the person”
• Emotional Exhaustion
• Depersonalization
• Loss of professional satisfaction
32
Prevention
•
•
•
•
Commitment, self‐efficacy, resourcefulness and hope
May have to address at organizational level
Cognitive – behavioural strategies
Exhaustion more easily treated
33
Addressing Burnout: The “3R” Approach
• Recognize
• Reverse • Resilience
34
Key Point
Burnout is easier to prevent than to treat. 35
Stigma
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 •
•
•
•
•
•
36
37
39
Stigma
In 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.
38
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 Intake Survey Fall 2011 Medical and Dental
3
4
How well would you say that you know yourself?
A.
B.
C.
D.
E.
5
Learning about Self
Extremely well
Quite well
Not sure
Not very well
Hardly at all
A.
B.
C.
D.
Self‐reflection
Dialogue with others
Objective feedback
Using stories or fables as a template
E. Comparing myself with others survey responses
6
Test Goals?
The kind of subjects you prefer
When studying for an examination, I usually aimed to get 100%.
A.
B.
C.
D.
E.
I’m drawn toward subjects where the right answer is always clear: where there’s less room for teacher bias to affect my evaluation.
Agree strongly
Agree Uncertain/no opinion
Disagree
Disagree strongly
7
A.
B.
C.
D.
E.
Agree strongly
Agree Uncertain / no opinion
Disagree
Disagree strongly
8
Your Current Theory of Intelligence
Mindset
Indicate 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
• The challenge of learning from failure. • Theory of intelligence (Entity or Incremental) highly correlated with how we deal with failure.
• If you believe intelligence is fixed, you’re at higher risk for having a maladaptive response to failure (e.g using secondary strategies to cope).
11
Research on Coping Styles
• 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)
12
Here's what you said about your personal strengths
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?
13
14
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?
15
16
What you think patients will value in you
We asked what you think patients value
What strength would patients value most in a treating physician or dentist?
17
18
Specific contributors in substance use clients
Strengths that can tumble into liabilities
• Independence (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 self‐
shaming.
• Tendency to hyper‐focus (obsess) and lose the bigger picture.
19
•
•
•
•
High anxiety levels + low trust
Black and white (categorical) thinking
Shame
Tendency to isolate
20
How do we help?
• Respect personhood
• Foster trust
• Minimize shaming
21
23
22
Paul H. Earley, M.D., FASAM
Addiction in the 21st Century:
A Treatable Brain Disease
Presentation Outline
Addiction in the 21st Century:
A Treatable Brain Disease
• Part II: Addiction Characteristics
• Part III: Addiction Neurobiology
Paul H. Earley, M.D., FASAM
Earley Consultancy, LLC
and
Medical Director, Georgia PHP, Inc.
Atlanta, Georgia
USA
www.paulearley.net
• Part I: History of the Addiction Concept
• Part IV: Effective Addiction Treatment
www.earleyconsultancy.com
Historical Perspective
Part I
History of the Addiction Concept
• Late 1800s – Inebriety 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.
• 1954 – AMA declares alcoholism a primary disease.
Paul H. Earley, M.D., FASAM
Earley Consultancy, LLC
Atlanta, Georgia
USA
• 1960s – Alcoholism treatment centers emerge to
treat the illness.
Historical Perspective
Historical Perspective
• 1970s – The addiction movement had to define and
• 2000s – The neurobiology of addiction comes into
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.
Portions of this material are copyrighted.
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.
Page 1
Paul H. Earley, M.D., FASAM
Addiction in the 21st Century:
A Treatable Brain Disease
Symptoms and Drug Use
Prime mover according
to Psychodynamic
Theory
Accepting Addiction as a Disease
• Multigenerational culture bias
• Behaviors of addicts and alcoholics
Symptom
Drug Use
• Failure of early treatment efforts
• Initial marginalization of addiction treatment
Much more critical for
initial abstinence and
recovery
Addiction is an
International Health Problem
Part II
Addiction Characteristics
• 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.
Paul H. Earley, M.D., FASAM
Earley Consultancy, LLC
Atlanta, Georgia
USA
• Addicts and addiction related crimes are the
largest cause of nonviolent crime and
incarceration.
Addiction Nomenclature
Physiological Dependence versus
Addiction
• Addictionists use the term addiction to
• Physiological
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.
Portions of this material are copyrighted.
Dependence
– Occurs in all
individuals
– Is a characteristic of
certain drugs
– Craving occurs during
drug withdrawal
• Addiction
– Occurs in 10% of the
population
– Is a characteristic of
certain people with
certain drugs
– Craving is tied to many
emotional and cognitive
triggers, occurring long
past the withdrawal time
Page 2
Paul H. Earley, M.D., FASAM
Addiction in the 21st Century:
A Treatable Brain Disease
The Etiology of Addiction
Genetic
Proclivity
The Cycle of Addiction
Acute reinforcing
stage
(Intoxication)
Earlier Life
Trauma
Addiction
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. 8:1442-4
The Using/Shame Cycle
Part III
Addiction Neurobiology
Using
Urge to change
strong affect
Consequences
& Guilt
Paul H. Earley, M.D., FASAM
Shame
Addicting Molecules
Nicotine
Earley Consultancy, LLC
Atlanta, Georgia
USA
Is there a single pathway to addiction?
Alcohol
• Drugs of abuse have very different structures and
neurotransmitter targets in the brain, but they all exhibit:
Heroin
Cocaine
–
–
–
–
–
–
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):1445-49
Portions of this material are copyrighted.
Page 3
Paul H. Earley, M.D., FASAM
Addiction in the 21st Century:
A Treatable Brain Disease
Neurochemistry of Wanting
Dopamine Reward Circuit
Nucleus
accumbens
Ventral tegmental area
(VTA)
20
Nestler, EJ. Nature Neuroscience 2005; 8(11):1445-49
Neural Adaptation to Drug use
After extended
drug exposure
Normal Dendrites
Nestler, E., Malenka, R. The Addicted Brain. Scientific American 290(3): 78 (2004)
22
Cue-induced Craving
Amygdala
not activated
Amygdala
activated
Anterior
Part IV
Effective Addiction Treatment
Posterior
Watching a
Nature Video
Portions of this material are copyrighted.
Watching a
Cocaine Video
Paul H. Earley, M.D., FASAM
Earley Consultancy, LLC
Atlanta, Georgia
USA
Page 4
Paul H. Earley, M.D., FASAM
Addiction in the 21st Century:
A Treatable Brain Disease
The Addictionectomy
Substance Abusing Patient
Treatment
A Desirable Model
Continuing Care / Monitoring
Early Detection of Relapse
Hospital
Detox.
Residential
Rehab
IOP
Rehab
Outpatient
Cont Care
AA & Tele
Monitoring
Non-substance Abusing Patient
Modified from A. Thomas McLellan, Ph.D.
Courtesy of A. Thomas McLellan, Ph.D.
Taper (and increase)
Treatment as needed
Elements of Effective Treatment
• Viewing addiction though same lens as other chronic
diseases.
Intensity
Current treatment
• Combination of effective initial intervention and
disease management using contingency contracting.
• Intervene on co-morbid psychiatric and life issues
Best practice treatment
Time
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: www.paulearley.net
– by phone: (404) 492-7669
– by E-mail: [email protected]
Portions of this material are copyrighted.
Page 5
References – Addiction in the 21st Century
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Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: The COMBINE Study: A
Randomized Controlled Trial
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Bechara , A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive
perspective. Nature neuroscience. 8 (11), 1458-63 (Nov 2005)
Bechara, A; Damasio, H; Damasio, A. Role of the amygdala in decision-making. Annals of the New
York Academy of Sciences. 985, 356-69 (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), 699-706 (2006).
Everitt, B.; Cardinal, R.; Parkinson, J.; and Robbins, T. Appetitive Behavior: Impact of Amygdaladependent Mechanisms of Emotional Learning. Annals of the N/Y/ Academy of Sciences. 985:233250. (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
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Kilts, K, et al. Neural Activity Related to Drug Craving in Cocaine Addiction Arch Gen
Psychiatry. 2001;58:334-341.
Hall, F.S., et al., Molecular mechanisms underlying the rewarding effects of cocaine. 2004. p. 47-56.
Hyman, S. Addiction: a disease of learning and memory. Am J. Psychiatry 162:114-23 (2005).
Koob, G, Le Moal, M. Plasticity of reward neurocircuitry and
the ‘dark side’ of drug addiction. Nature Neuroscience 8:11 1442- 1444. Nov 2005.
Nestler, EJ. Is there a common molecular pathway for addiction?
Nature Neuroscience 2005; 8(11):1445-49
Schoenbaum, G., M.R. Roesch, and T.A. Stalnaker, Orbitofrontal cortex, decision-making and drug
addiction. 2006. p. 116-24.
See , R, et al. Drug addiction, relapse, and the amygdala. Annals of the New York Academy of
Sciences. 985, 294-307 (Apr 2003)
Stocker, S. Studies Link Stress and Drug Addiction. NIDA Notes. Volume 14, Number 1 (April, 1999)
Sugase-Miyamoto, Y; Richmond, BJ. Neuronal signals in the monkey basolateral amygdala during
reward schedules. J Neurosci. 2005 Nov 30;25(48):11071-83.
Addiction in Caregivers
Graeme M. Cunningham, MD, FRCPC
RCDSO Wellness Consultant
2
Caregiver Impairment
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 HIV 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;267:2333‐8
3
4
Prevalence in Dentists
•
•
•
•
•
5
Psychological Characteristics of Caregivers
Alcohol 12‐19%
Opiates‐hydrocodone and oxycodone 37%
Nitrous Oxide‐almost exclusively in dentists 5%
Nicotine
Street drugs – cocaine 10%
•
•
•
•
•
•
•
6
Dedication/Focus
Delayed Gratification
Workaholics
Guilt Prone
Exaggerated Responsibility
Limited Emotional Expressiveness
Regularly Suppress Anger
Psychological Characteristics of Caregivers
Female MDs/Dentists
• Obsessive/Compulsive Traits
–
–
–
–
• Just as compulsive, but value relationships more than male MDs/Dentists
• 75 ‐ 80% do own housework
• Frequently feel guilty
• Try to be ‘Superwoman’
Perfectionist
Demanding
Impatient
Hyperconscientious
• Difficulty with Fun
– (it’s OK if we make work of it!)
• I am my Work
7
8
Risk factors for Caregivers
•
•
•
•
•
•
•
Genetic tendency
Isolation
Specialty
Childhood “tapes”
Enablers
Smoking
Pedestal profession
9
Issues Specific to Professionals
•
•
•
•
•
•
•
•
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
10
Homewood Experience
Drugs used in order of frequency:
– Nicotine
– Alcohol
– Opioids
• codeine, morphine, dilaudid, percocets, oxycontin
– Benzodiazepines
– Cocaine
– Antihistamines
11
Work‐related Issues
•
•
•
•
•
•
12
Incorrect 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
Suggestive Signs
•
•
•
•
•
•
•
Crippling anxiety
Frequent bathroom relief
Desire to work alone
Deteriorating appearance
Always wearing long sleeves
Appearing when off duty
Marked mood swings
13
Clues to Recognition
• Change of personality
• Loss of efficiency and reliability
• Increased sick days
• Complaints from patients, particularly about a changed attitude
• Development of indecision
14
More Clues to Recognition
• Mood swings, suicidal ideation
• Memory loss, blackouts after parties
• Inappropriate 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
• In when should be off duty
15
Impaired Health Professionals Programs
•
•
•
•
•
•
•
•
•
Assessment
Recovery Program
Peer Group Therapy
Mirror Image Therapy
12‐Step Mutual Help
Family Treatment
Process Addictions
Relapse Prevention
Special Issues
16
Value of Peer Group Therapy
Assessment
• Multidisciplinary
• History
•
•
•
•
•
•
17
• Professional and social isolation
• Physical changes
• Heavy “wastage” of drugs
• MD giving analgesics
• Unpredictable work habits
Usual Medical Hx
Alcohol/Drugs
Emotional
Spiritual
Family
Collateral
• Drug Screening
• Psychological Assessment
• Psychiatry
• Group/Peer Exposure
• 12‐Step Exposure
“This group scares me.”
•
•
•
•
•
•
•
•
18
Confront denial/support recovery Chemical‐free coping skills
Issues of trust and friendship
Confront terminal uniqueness
Deal with “GOD” issues
Dump secrets
Transition to 12‐step process
Communication/listening skills
Group Work – Health Professionals Issues
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
19
•
•
•
•
20
Return to Work : Practical Issues
• Full restoration of work capacity may require 4‐6 months even though symptom‐remission begins in 4‐6 weeks
• Issues of disability insurance and finances
• Challenges in gradual return to work: practical arrangements and monitoring
• Attitudes of others in the workplace
21
Typical Contract
• 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
22
Typical Work Issues
•
•
•
•
•
23
Gambling
Sexual
Excitement
Food
Location of continuing employment
Need for “buddy” system
Narcotic issues
Home nursing
Need for external reports
Re‐Entry to Practice
• 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):159‐6
24
Re‐Entry to Practice
Issues that arise for colleagues
The Homewood Experience
“I thought I’d be good to myself and take three days off before I 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’
25
•
•
•
•
•
•
26
Summary
• Health professionals are different.
• They require and deserve specific treatment paths.
• These paths offer a 73% ‐ 90% recovery rate at five years.
27
Anger and resentment
Fear
Uncertainty
Over‐protectedness
Minimizing the professional’s needs
Family of origin stuff
In Closing
• 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.
28
CURRICULUM VITAE
(Revised March 2010)
NAME:
Graeme MacCallum Cunningham
HOME ADDRESS:
24 Latenda Place
Guelph ON N1G 3B8
(519) 823-2323
OTHER PERSONAL DATA:
D.O.B. 04/07/43
Married, 5 children
EDUCATIONAL BACKGROUND:
1967
1970
1971
1975
1983
1988
1997
2001
2009
M.B., Ch.B. University of Glasgow, Scotland
M.R.C.P. (U.K.)
L.M.C.C.
F.R.C.P. (C)
F.R.C.P. (GLASG)
Certificant, American Society of Addiction Medicine
Fellow, American Society of Addiction Medicine
Certificant, Canadian Society of Addiction Medicine
Certificant, American Board of Addiction Medicine
CURRENT STATUS AT McMASTER:
1991 - 1998
Assistant Clinical Professor, Department of Medicine, McMaster University
1998 - 2008 Associate Clinical Professor, Department of Psychiatry, McMaster University
2009
Clinical Professor, Department of Psychiatry, McMaster University
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PROFESSIONAL ORGANIZATIONS:
Ontario Medical Association
Past Chairperson District 9
Past Chairperson Section of Internal 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, 2002 - 2003
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.
2004
The award is inscribed:
“Canadian Society of Addiction Medicine
HONOURARY LIFE MEMBERSHIP AWARD
presented to
Dr. Graeme Cunningham
on the occasion of the 16th Anniversary of our Society, in recognition of his
dedicated service and visionary leadership provided to the field of
Addiction Medicine
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EMPLOYMENT HISTORY:
House Physician to Professor E.M.
McGirr
August 1967
January 1968
University Department of Medicine,
Glasgow Royal Infirmary.
House Surgeon to Professor W.A.
MacKay
February 1968
August 1968
University Department of Surgery,
Glasgow Royal Infirmary
Faulds Research Fellow
August 1968
August 1969
University Department of Medicine,
Glasgow Royal Infirmary
Senior House Office in Medicine
August 1969
April 1970
Glasgow Royal Infirmary
Registrar in General Medicine
April 1970
October 1970
Glasgow Royal Infirmary
Family Physician
October 1970
December 1973
Parry Sound, Ontario
Senior Resident, Internal Medicine
1974 - 1975
University of Toronto
Chief Resident, Internal Medicine
1975 - 1976
St. Michael's Hospital, University
of Toronto
Teaching Fellow
1976 - 1977
University of Toronto
Consultant Internist
1977 - 1988
Timmins, Ontario
Senior Resident, University of Toronto,
Medicine of Addictions
1988 - 1989
Addiction Research Foundation,
Toronto
Director, Homewood Addiction Division
Homewood Health Centre
1990 - 2010
Guelph, ON
3
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SCHOLARLY AND PROFESSIONAL ACTIVITIES:
Chairman, Section of Internal
Medicine
Ontario Medical Association
1982 - 1986
Member, Committee on
Hospitals
Ontario Medical Association
1984 - 1987
Chairman, District Nine
Ontario Medical Association
1985 - 1987
Member of Board of Directors
Timmins Chamber of Commerce
1984 - 1985
Past Chief of Staff
General Hospital, Parry Sound, ON
1980 - 1982
Past Chief of Medicine
St. Mary's General Hospital, Timmins, ON
1982 - 1986
Past Director, Intensive Care
Unit
St. Mary's General Hospital, Timmins, ON
1982 - 1985
Consultant
Ontario Heart Foundation
1981 - 1989
Inspector, Medical Review
Committee
Board Member
Ministry of Health
1985 - 2000
Canadian Society of Addiction Medicine
1992 - 1996
Chair, Advisory Committee
Physician Health Program
Ontario Medical Association
1995 - 2000
Member of Council
College of Physicians & Surgeons of Ontario
1999 - 2004
Chair, Methadone Governance
Committee
Province of Ontario
1999 – 2004
Member, Executive Committee
College of Physicians & Surgeons of Ontario
2000 – 2004
Vice-President
College of Physicians & Surgeons of Ontario
2001 – 2002
President
College of Physicians & Surgeons of Ontario
2002 - 2003
Past-President
College of Physicians & Surgeons of Ontario
2003-2004
AREAS OF INTEREST:
Teaching of Addiction Medicine, Assessment and Treatment of Addicted Physicians.
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COURSES TAUGHT:
(I) Undergraduate - Electives in Addiction Medicine for all undergraduate units. I 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. I 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. I am the supervisor of the Fellow-in-training and it is a yearlong position.
In 1993 & 1994, I helped organize and chair two international symposia in Addiction Medicine at
the University of Guelph.
In 1995, I assisted the University of Ottawa in curriculum development and teaching in Addiction
Medicine. In 1996, I organized and chaired the 7th Annual Scientific meeting of the Canadian
Society of Addiction Medicine.
Since January 2000, I am responsible for all Addiction Medicine Teaching in the Department of
Psychiatry at McMaster University. This involves 24 hours of workshops/academic year.
LIFETIME PUBLICATIONS:
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 (CIBA) 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-Induced Internuclear 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 - 1991, 1946-1951
"Developing an Office Management Plan for the Alcoholic Patient" - Canadian Journal of Diagnosis
- 1992, 77-89
5
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"Prescription Drug Abuse - Identifying the Prescription Drug Addict" - Canadian Journal of
Diagnosis - 1992, 63-81
"Paying Attention To Substance Abuse In Physicians" - Canadian Journal of Diagnosis - 1993, 7688
"A Program to Treat Impaired Physicians - Graeme M. Cunningham, Annals of Royal College of
Physicians and Surgeons of Canada - 1994, 27, 219-221
“Physicians as Patients” – D. Whitney, G. Cunningham, S. Abdool – 2001, Psychiatry Rounds 5:7.
Book Chapters:
1996 The Substance-Abusing Physician - Identification and Management. The CMA Guide to
Medical Administration in Canadian Hospitals. D. Gellman, Editor.
2000 The Impaired 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, 1833 - 1834.
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 Index
- A study undertaken jointly with the University of Pennsylvania.
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PRESENTATIONS AT MEETINGS:
Date
March 1, 1991
March 26, 1991
April 23, 1991
April 29-30,
1991
June 14, 1991
Sept. 5, 1991
Oct. 23, 1991
Oct. 24, 1991
Oct. 25, 1991
Nov.18, 1991
Nov. 20, 1991
Nov. 21, 1991
Dec. 3, 1991
March 4, 1992
April 7, 1992
April 11, 1992
April 15, 1992
April 23, 1992
April 26, 1992
(Invited = I) (Contributed = C)
Location
Seminar - Owen Sound, Addictions and
the Community
St. Joseph's Hospital Quarterly Medical
Staff Meeting Hamilton, Ontario
Toronto and District Correctional Services
Annual Meeting
Concerns Canada - Seminar on
Prescription Drug Abuse
Topic
Clinical Perspectives of Alcoholics
Anonymous.
Impaired Physicians - Risks and
Treatment.
Discussion of Detoxification
Techniques
Keynote Speaker and Workshop
leader in Prescription Drug Abuse
Issues.
Seminar on Recovery
The Ontario Chapter of the College of
Family Practice Annual Spring Meeting,
Minaki Lodge, Ontario.
Annual Meeting of the Ontario Parole Treatment of Substance Abuse in
Board
Prisoners
Telemedicine Canada - Toronto
Office Management of Alcoholism.
Ontario Alternate Housing Committee
Annual Conference
Canadian Medical Society on
Alcoholism and Other Drugs Annual
Meeting
Concerns Canada Drug Awareness Week
Seminar London, Ontario.
Lecturer at Queen's University Kingston
General Hospital
Dual Disorders Workshop Queen Street
Mental Health Centre
Telemedicine Canada Journal Club in
Medicine.
Half day at the University of Guelph.
University of Toronto - Mental Health
half day for residents and interns
College of Family Physicians - Manitoba
Chapter, Winnipeg Manitoba
Ontario Hospital Association Chief of
Staff Seminar
Concerns Canada
Canadian Association of Medical
Directors of Teaching Hospitals
Sept. 25, 1992
Canadian Anaesthesia Society Annual
Meeting
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I/C
I
I
I
I
I
I
I
Workshop on Dual Disorders
I
Workshop leader on Prescription
Drug Abuse.
C
Keynote speaker. The Disease of
Addiction.
The Impaired Physician.
I
Annual Dual Disorder Meeting
C
I
I
Seminar on Drug Addiction
C
Physician Impairment
I
The Office Management of
Substance Abuse
Physician Impairment
I
Prescription Drug Abuse
I
Physician Impairment
I
Substance Abuse in Anaesthetists
I
I
Nov. 7, 1992
Nov. 11, 1992
April 23, 1992
April 26, 1992
Sept. 25, 1992
Nov. 7, 1992
Nov. 11, 1992
Nov. 13, 1992
Nov. 22, 1992
Feb. 10, 1993
Feb. 11, 1993
March 11-13,
1993
April 19, 1993
May 29, 1993
June 11, 1993
Oct. 22, 1993
Jan. 21, 1994
Feb. 5, 1994
March 23, 1994
March 29, 1994
April 24, 1994
Ontario Association of Physicians in the
Correctional Services.
Grand Rounds, St. Michael's Hospital,
Toronto
Concerns Canada
Ambulatory Detoxification
Techniques.
Physician Impairment.
I
Prescription Drug Abuse.
I
Canadian Association of Medical
Directors of Teaching Hospitals
Canadian Anaesthesia Society Annual
Meeting
Ontario Association of Physicians in the
Correctional Services
Grand Rounds, St. Michael's Hospital,
Toronto
Ontario Chapter, Canadian College of
Family Practice Annual Meeting
Canadian Medical Society on
Alcoholism and Drugs Annual Meeting,
Vancouver British Columbia.
Multidisciplinary Half-Day, McMaster
University
Grand Rounds, Kitchener-Waterloo
Hospital
14th Annual Winter Symposium
McMaster University - Dalhousie
University, Deerfield Beach, Florida
Basic Seminar for Physician Managers,
Ontario Hospital Association
Ontario Medical Association Annual
Meeting
Addictions '93 - University of Guelph
Physician Impairment
I
Substance Abuse in Anaesthetists
I
Ambulatory Detoxification
Techniques
Physician Impairment
I
Detoxification Techniques
I
Recovery from Addiction! The Role
of the Physician
C
Physician Impairment
I
Physician Impairment
I
"Grand Rounds in Medicine"
I
Physician Impairment
I
Physician Support Programs
I
Detoxification Techniques
C
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
Telemedicine Conference
Recovery from Addiction;
Programme Components
I
Physician Impairment
I
Physician Stress and Substance
Abuse
Practical Management of the
Alcoholic in the Office
Addiction in Anaesthetists
I
Substance Abuse in the Operating
Room
I
College of Physician and Surgeons of
Ontario, Leaders in Anaesthesia Day
Operating Room Nurses Annual
Meeting, Ottawa
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I
I
I
I
May 10, 1994
June 10, 1994
Norfolk General Hospital, Medical
Grand Rounds
Ontario Association of Medical
Radiation Technologists Hamilton, ON
Addictions '94 - University of Guelph
June 10, 1994
Addictions '94 - University of Guelph
May 13, 1994
July 19, 1994
McMaster University Institute in
Addiction Studies
Sept. 17, 1994
Canadian Medical Society on
Alcoholism Ottawa, Ontario
Sept 19, 1994
International Conference on Physician
Health Plenary Session, Ottawa Ontario
October 6, 1994 Basic Medical Officers Course Armed
Forces Base, Barrie
Oct. 14,1994
Address to Law Enforcement Officers
College of Physicians & Surgeons of
Ontario
Oct. 22, 1994
12th Annual Renascent Centre
Symposium Plenary Presentation
Jan. 30, 1995
Ontario Psychiatric Association Annual
Meeting
March 29, 1995 Address to the Council, College of
Nurses of Ontario
April 8, 1995
Canadian Association of Chief Residents
in Medicine Annual Meeting,
Vancouver, British Columbia
April 12, 1995
Basic Program for Physician Managers
Ontario Hospital Association, Toronto
April 18, 1995
Federation of Health Care Colleges
Working Group Annual Meeting
Mitchener Institute, Toronto
April 28, 1995
Workshop American Society of Addiction
Medicine Annual Meeting, Chicago,
Illinois
May 18, 1995
Addictions Teaching Session University of
Ottawa
May 24, 1995
Telemedicine Canada
Medical Detox Techniques
I
Impairment in Health Professionals
I
Methadone Maintenance in I.V. Drug C
Users
The Health Professional Marriage
C
The Homewood Treatment Program
I
Drug Testing in the Workplace
C
Treatment of Impaired Physicians
C
Relapse Prevention
I
Physician Prescribing Issues
I
Addiction and Relapse
I
Group Therapy for Addicted Doctors
C
Incapacity in Nurses Due to
Substance Abuse
Resident Stress & Substance Abuse
I
Impaired Physicians - The Role of
the Chief of Staff
Fitness to Practice Issues
I
Group Therapy for Addicted Doctors
C
I
I
I
July 17, 1995
Physician Impairment and
Intercollegial Responsibility
Substance Abuse in Nurses, Its
Identification and Treatment
36th Annual Institute on Addiction Studies Workshop on Dual Disorders
Sept. 29, 1995
Basic Medical Officers Course
Substance Abuse in Physicians
I
Oct. 16, 1995
Canadian Medical Society of Alcohol &
Other Drugs. Annual Meeting, Banff,
Alberta
Prescription Drug Abuse in Women
and Physician Prescribing Practices
C
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I
I
Nov. 1, 1995
Feb. 8, 1996
April 20, 1996
April 22, 1996
British Medical Association Annual
Meeting. York, England
International Conference on Physician
Health Chandler, Arizona
Workshop for Family Doctors, Toronto
The Politics of a Physician Support
Programme
The Role of Spirituality in the
Recovery from Addiction
Alcoholism in Office Practice
C
C
I
I
April 26, 1996
Annual Meeting, Dupont Pharmaceuticals Plenary Session - The Varied
Victoria, B.C
Presentations of Addiction
Ontario Bar Assistance Programme
Addiction in the Legal Profession
April 26, 1996
Keynote Speaker
I
Annual Meeting of the Addiction
Intervention Association
Sept. 19, 1996
Workshop for Medical Society of Prince Office Management of Alcoholism
Edward Island
October 1996
Chairperson, Organizing Committee,
Annual Meeting Canadian Society of
Toronto, ON
Addiction Medicine
January 1997
Women’s Health Conference Toronto,
Issues of Addiction in Women, Their
Ontario
Recognition and Treatment
Workshop presentation.
February 1997
Annual Meeting, College of Family
The Office Management of
Practice, Alberta Chapter Plenary
Alcoholism
Session
June 1997
Monthly Medical Rounds Henderson
Impairment in Health Professionals
General Hospital, Hamilton
July 1997
Institute for Addiction Studies,
The Pharmacotherapy of Drug
McMaster University Plenary
Addiction
Presentation
August 1997
Annual Meeting of the Canadian Bar
Impairment in the Legal Profession
Association, Ottawa Plenary Session
September 1997 Medical Grand Rounds. Kings Health
Recognition of Alcoholism in Office
Centre, Toronto
Practice
September 1997 Basic Medical Officer Course, Base
Physician Impairment
Borden, Barrie, Ontario Plenary Session
October 1997
Twenty-First Annual Meeting, British
Physician Impairment, Recognition
Doctors and Dentists in Recovery Group. and Management
Brighton, England Plenary Session
November 1997 Input 97. A conference for Employee
What’s New in Alcoholism?
Assistance Program Providers.
Ottawa, Ontario Plenary Session
Jan. 17, 1998
Canadian Association of Insurance Alcoholism - Morbidity and Morality
Underwriters Annual Meeting, Toronto.
Plenary Session
Feb. 4, 1998
Basic Medical Officers Course, Base Addicted Health Professionals
Borden, Barrie
March 4, 1998
College of Physicians & Surgeons of Sexual Addiction
Manitoba
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I
I
C
I
I
I
I
I
I
I
C
I
I
I
I
April 30, 1998
International Conference on Physician Paper - The Politics of a Physician
Health.
Health Program
C
May 11, 1998
Canadian Society of Medical Underwriters Alcoholism Morbidity & Morality
Plenary Session
I
May 20, 1998
Annual Day at Newport
Plenary Session
Annual Meeting, American Bar
Association
Addictive Issues into the 21st Century,
Vancouver B.C.
Addicted Doctors
I
Impairment in Lawyers
I
1.Sexual Addiction (workshop)
2.Physician Impairment (workshop)
3.Spirituality & Addiction
(workshop)
Recovery & Spirituality
I
Physician Impairment
I
Addiction & Mental Health in the
General Hospital
Addiction and the Search for
Normalcy
Substance Abuse in the Workplace
I
Identification & Management of
Alcoholism (workshop)
Physician Impairment
I
Evaluating Drug Dependency
I
Review of Methadone Policies
I
Substance Abuse in Nurses
I
Addiction in Physicians
I
Spirituality in Addiction Medicine
I
Spirituality in Addiction
Sexual Addiction - Workshop
Impaired Physicians
I
The Psychology of the 12-steps
I
August 1, 1998
August 21-22,
1998
Sept. 10, 1998
Oct.17 - 19,
1998
Nov. 2, 1998
Nov. 6, 1998
Nov. 19, 1998
November 25 26, 1998
Dec. 2, 1998
Jan. 18, 1999
Jan. 27, 1999
April 13, 1999
Annual Meeting Wayside House of
Hamilton
British Doctors & Dentists Annual
Meeting, Manchester, England
Annual Meeting, Ontario Medical
Association
Pragma Council, University of Waterloo
9th Annual Seminar on Substance Abuse
in the Workplace
Community Addiction Agencies Annual
Meeting, Saskatchewan
Multidisciplinary Academic Day,
McMaster University
Canadian Insurance Underwriters
Seminar, Ottawa ON
Ontario Methadone Prescribing Host C.P.S.O., Toronto ON
Addictions, P.E.I
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
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I
I
I
I
I
The Politics of a Physician Health I
Program
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 29 2000 International 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 25th
2000
Annual Conference, Cheltenham,
England.
February 2 - 4,
Addiction Update Conference,
2001
Montgomery, Alabama, USA
March 1, 2001
Southwest Addiction Conference,
Windsor District Health Council,
Windsor, Ontario
June 4, 2001
Addiction Intervention Association,
Annual Conference, Toronto, Ontario
June 13, 2001
Insurance Underwriters of Southern
Ontario
June 20 – 22,
Federation of Medical Licensing Assoc.
2001
Canada, Annual Meeting, St. Johns, NFL
August 16 – 18, Addictive Issue Update, Foundation for
2001
Medical Excellence, Vancouver, B.C.
Oct. 4–6, 2001
Nov. 19-21,
2001
Nov. 22, 2001
Feb. 8, 2002
April 12, 2002
June 12, 2002
June 27, 2002
August 17,
2002
Spirituality and Addiction Medicine
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Chiefs of Staff
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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
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Spirituality in Addiction Medicine
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Recognition & Treatment of
Alcoholism
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Substance Abuse in the Workplace
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Substance Abuse in the Workplace
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The Disruptive Doctor
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Prescription Drug Issues Workshop
Sexual Addiction – Plenary
Spirituality & Addiction – Plenary
Recovery & the Family Doctor
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26th Annual Addiction Conference,
Harrogate, England
“Update” Annual Canadian EAP
Substance Abuse in the Workplace
Conference, Ottawa, Ontario
39th Annual Scientific Assembly, Ontario Recovery & the Family Doctor
College of Family Physicians
Toronto, ON
Addiction Issues in PTSD, Guelph, ON
Toronto MEDICO-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
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Addiction in Lawyers
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Physician Impairment
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3 PLENARY Presentations
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2 PLENARY Presentations
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Sept. 23, 2002
World Drug Forum, Montreal, Quebec
Oct. 27, 2002
“Spirituality and Health”
University of Toronto
Mental Health and Addiction
Annual Meeting – Canadian Psychiatric
Association, Banff, Alberta
Dinner Meeting, Medical Staff,
Windsor, Ontario
Annual Meeting, College of
Veterinarians of Ontario
Annual Meeting, Federation of Licensing
Medical Authorities, Quebec City
Annual Meeting, College of Physicians
& Surgeons of Prince Edward Island
Grand Rounds, McMaster University
Nov. 2, 2002
Nov. 7, 2002
Nov. 21, 2002
June 7, 2003
Oct. 1, 2003
Oct. 8, 2003
Nov.20, 2003
Jan.16, 2004
Annual Scientific Assembly, Ontario
College of Family Practice
“Physician Heal Thyself”
Jan.21, 2004
“Substance Abuse in the Workplace”
Feb. 4, 2004
Nov. 17-18,
2004
“Hospital Rounds”
“Treatment of Impaired Physicians” (2)
“The Psychology of the 12 Steps”
Feb 28 – Nov
2005
March 9 – 10,
2005
“Addiction Treatment: Costs and
Benefits”
“Addiction Treatment”
April 12, 2005
Grand Rounds, Medicine
April 27, 2005
Grand Rounds
April 28, 2005
“Disruptive Physicians”
April 29, 2004
“Chronic Pain of Addiction”
June 2004 –
March 2005
Six presentations, contracted by College
of Family Practice, to OCFP Regional
Meetings covering the Province of
Ontario.
“Disruptive Physicians, the Ontario
Experience”
Oct. 13, 2004
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Medicine & the 12 Steps
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“Chronic Pain and Opioids”
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“Addiction in Health Professionals”
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“The Disruptive Physician”
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“Addiction and the C.P.S.O.”
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“A Pot-Pouri of College Issues”
I
“Physician Heal Thyself” –
Keynote Presentation
Annual Dinner – St. Joseph’s
Hospital, Hamilton – Medical Staff
Guelph Chamber of Commerce
Annual Meeting
Homewood Health Centre
Annual Meeting B.C. Physicians
Health Programme, Vancouver,
British Columbia
American Life Underwriters
Association, New Orleans, U.S
Annual Meeting of Regina Regional
Health Authority, Regina,
Saskatchewan.
Hamilton General Hospital
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Henderson Hospital, Hamilton,
Ontario
Annual Meeting of Canadian
Association of Rural Physicians,
Montreal, Quebec
Annual Meeting, O.M.A. Section of
Chronic Pain.
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Joint AMA – CMA International
Meeting of Physician Health in
Chicago
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Nov. 12, 2004
“Treatment of Addiction, the Canadian
Experience”
Annual Meeting of the New
England Professional Group, Maine
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April 30 – May
2, 2005
Keynote Speaker
I
May 5, 2005
Grand Rounds, Medicine
June 10, 2005
Grand Rounds
June 17, 2005
Grand Rounds
Nov. 2, 2005
“High Risk Chronic Pain Patients”
Nov.17, 2005
Keynote Presentation
Dec. 7, 2005
“Issues of Physician Health”
Feb. 1, 2006
Keynote Presentation
March 22, 2006
“Issues of Physician Health”
April 24, 2006
Managing Employees with Substance
Abuse Conference
“Workplace Substance Abuse Issues”
Annual Meeting of British
Columbia Physician Health
Programme, Vancouver, British
Columbia
Southlake Regional Hospital,
Newmarket, Ontario
Queen’s University, Dept. of
Psychiatry, Kingston, Ontario
Ottawa University, Dept. Of
Psychiatry, Ottawa, Ontario
Presentation to Family Physicians in
North Toronto
Western Canadian Conference in
Addiction & Mental Health,
Vancouver, British Columbia
Post Graduate N.A.D. Day,
McMaster University
Regional Conference on
Methamphetamines, Prince George,
British Columbia
Family Medicine Residency Core
Day, University of Toronto
Richmond, British Columbia
Union Standards Association,
Keynote Presentation
Ontario Hospital Association
Toronto, Ontario
The College of Family Physicians of
Canada Annual Meeting, University
of Newfoundland & Labrador
The American Bar Association
National Conference, San Francisco,
California
56th Annual Conference of the
Canadian Psychiatric Association,
Presentation
Western Canadian Conference on
Addictions and Mental Health
7th Annual Conference Principles
of Treatment of Addiction and
Substance Abuse Lexington,
Kentucky
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June 22, 2006
Oct. 16, 2006
Oct. 18, 2006
“Managing Addictions in the
Workplace”
Keynote Presentation
Oct. 27, 2006
“Issues of Substance Abuse in the Legal
Profession”
Nov.12, 2006
“Issues of Physician Health”
Nov. 18, 2006
“Myths and Misconceptions of
Addiction”
Keynote Presentation
Jan.26-27, 2007
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March 15, 2007
Keynote Presentation on
“Methamphetamine Dependency”
Addiction Medicine for Family
Physicians
Big Land Health Conference, Goose
Bay, Labrador
Vancouver Island Health Authority,
Victoria, British Columbia
Whistler, British Columbia
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Toronto, ON
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Guelph, ON
I
May 20, 2007
The Physician Health Program of British
Columbia Annual Education Conference
St. John’s Rehabilitation Hospital Grand
Rounds
Networking Breakfast at Guelph
Chamber Conference
Addiction Conference
Kitimat, British Columbia
I
June 15, 2007
Annual Education Day
I
Oct. 21, 2007
Association of Home Office
Underwriters of America Annual
Conference
Presentation of “Treatment of
Addictions”
Department of Anesthesia & Critical
Care Clinical Day
Issues of Substance
Department of Psychiatry,
Goderich, Ontario
Toronto, Ontario
British Columbia Psychiatric
Association Annual Meeting
Southlake Regional Hospital
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2007 - Canadian Centre of
Substance Abuse National
Conference, Edmonton, Alberta
Toronto, Ontario
C
Homewood Health Centre, Guelph
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Bellwood Addiction Treatment
Centre, Toronto, Ontario
Regional Rehabilitation Program,
University of Western Ontario,
London, Ontario
Annual Meeting New Brunswick
College of Family Practice
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Ruth Fox Course – Ruth Fox
Course is part of the American
Society of Addiction Medicine
Annual Meeting
Monthly Meeting of Medical Staff,
Windsor, Ontario
Grand Rounds Department of
Medicine, University of Western
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March 30, 2007
April 28, 2007
May 14, 2007
May 17, 2007
Nov. 3, 2007
Nov. 10, 2007
Nov. 26, 2007
Nov. 29, 2007
Jan. 21, 2008
Feb.11, 2008
Mar. 27, 2008
April 4-5, 2008
April 10, 2008
April 24, 2008
The Evolving Role of Pharmacotherapy
in Alcoholism
The Evolving Role of Pharmacotherapy
in Alcohol Addiction Management,
Grand Rounds
The Management of Alcohol
Dependence
Management of Chronic Pain and
Addiction
1. Presentation is the 12 Steps, their
clinical relevance
2. Withdrawal Management
3. Myths and Misconceptions in
Addiction
Spirituality and Recovery
The Evolving Role of Pharmacotherapy
in Alcohol Addiction Management
May 12, 2008
Pain and Addiction Clinical Opponents
or Siblings
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July 25, 2008
Presentation on Addiction in the Legal
Profession
Sept. 4, 2008
Alcoholics Anonymous – “What Does
the Science Tell Us”
Sept. 26, 2008
Treatment of Alcohol Addiction in the
Elderly
Oct.17, 2008
Nov.5, 2008
Pain and Addiction – Opponents on
Siblings
Presentation, Addiction and Pain
Nov. 6, 2008
Addiction in Nurses
Nov. 13, 2008
Keynote Presentation – Addiction
Medicine Overview and Update –
Workshop – Treating the Substance
Dependent
Dr. Saul Cohen Memorial Lecture
Nov. 17, 2008
Nov. 20, 2008
Nov. 26, 2008
Dec. 3, 2008
Jan. 16, 2009
Mar. 6, 2009
April 23, 2009
May 29, 2009
Oct. 1, 2009
1) Substance Abuse in the Workplace
2) The Management of Addiction in the
Community and in Residential
Treatment
Chronic Pain in Addiction: Issues,
Management and the Perspective of the
College of Physicians and Surgeons of
Ontario
Mental Health Issues in Today’s
Workforce
“Management of the Difficult
Adolescent. Drug & Alcohol Issues.”
Physician Health, Spirituality and
Recovery
Keynote Presentation: Alcoholic
Anonymous, a Design for Living that
Really Works
Intervening and Managing Addictions in
the Workplace
Chronic & Addiction. Problems and
Solutions
Oct. 27, 2009
Keynote Presentation: Managing
Addictions in the Workplace.
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Ontario
Annual Meeting of the Ontario
Lawyer’s Assistance Program
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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
McMaster University – Academic
Pain Day
Ontario Nurses Association Union
Annual Meeting, Toronto, Ontario
Canadian Conference in Addiction
5th Annual Meeting
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Credit Valley Hospital,
Mississauga, Ontario
Substance Abuse Seminar to the
Substance Abuse Representatives of
the major Automotive Unions
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Interdisciplinary Pain Rounds,
University of Western Ontario
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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,
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Nov. 6, 2009
Nov. 19, 2009
Jan. 13, 2010
Feb. 24, 2010
Feb. 26, 2010
Concurrent Workshop: Are Addictions a
Symptom of an Underlying Root Cause
“There is a Solution”
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
Alberta
Winnipeg, MB
Opening Speaker at the conference
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Critical Incident 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 55th Annual Scientific
Assembly, Alberta College of Family
Physicians
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ADMINISTRATIVE RESPONSIBILITIES:
As Director of the Addiction Division at the Homewood Health Centre, I 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. I head the Management Team and I 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, I 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.
I 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.
I 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, I led the development of the Physician Health
Programme of the Ontario Medical Association in 1995.
As chair of the Standards Committee of the Canadian Society of Addiction Medicine, I led in the
development of national standards to allow for assessment and examination of physicians
knowledgeable and practicing in the field of Addiction Medicine.
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OTHER RESPONSIBILITIES:
President, Timmins & District Shriners Club, (1984).
Member, Granite Masonic Lodge, #356, Parry Sound, Ontario (1978-current)
Board Member, Wellington & Dufferin District Health Council (1996 - 1999)
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PAUL H. EARLEY, M.D., F.A.S.A.M.
Talbott Recovery Campus
5448 Yorktowne Drive
Atlanta, Georgia 30349
USA
[email protected]
www.talbottcampus.com
www.paulearley.net
Office Voice: 678.251.3188
Office Facsimile: 770.991.4909
PERSONAL INFORMATION
Date of Birth
Place of Birth
March 29, 1954
Cincinnati, Ohio
EDUCATION
1971 to 1975
1976 to 1980
1980 to 1981
1981 to 1984
1992 to 1995
B.A. in Biology, Reed College, Portland, Oregon
M.D., University of Cincinnati College of Medicine, Cincinnati,
Ohio
Internship in Internal Medicine, Good Samaritan Hospital and
Medical Center, Portland, Oregon
Residency in Neurology, University of Oregon Health Sciences
Center, Portland, Oregon
Three year training for certification in PBSP Psychomotor Therapy
PROFESSIONAL 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, 1981.
 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. 000029). Recertified, December, 1996
 ASAM Certified Medical Review Officer, 1996
WORK HISTORY
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Paul H. Earley, M.D.
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2007 to Present
Medical Director, Director Healthcare Professionals Program,
Talbott Recovery Campus, Atlanta, Georgia USA
1991 to 2006
Program Director of Adult Addiction Medicine, Ridgeview
Institute, Smyrna, Georgia.
1991 to 2006
Medical Director of the Ridgeview Impaired Professional’s
Program, Ridgeview Institute, Smyrna, Georgia.
1991 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 Impaired Professionals, and Professional
Wellness.
2002 to 2005
Chief Science Officer, CMHC Systems, Inc. CMHC Systems is the
leading provider of clinical and financial software solutions to the
behavioral healthcare industry (see Computers in Medicine
heading below).
1994 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.
1984 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.
1977 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
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PUBLICATIONS
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, 2009.
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, 2004.
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, 2003.
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. Insight Magazine, 18(2), Fall, 1997.
Earley, Paul H., Fishman, Michael L. The M-Deity Syndrome: Help for the Impaired
Health Professional. Insight Magazine, 16(2), Fall, 1995.
Harris, Steve, Earley, Paul H. The Icarus Phenomenon: Power Dilemmas on the Road to
Manhood. Insight Magazine, 14(1):6-9, 1993.
Fishman, Michael L., Earley, Paul H. Nicotine Dependence in Treatment Centers: The
Next Challenge. Journal of Substance Abuse Treatment, 1993.
Earley, Paul H. The Changing Face of Addiction: Is Everything I do an Addiction?
Insight Magazine, 12(3):2-7, 1992.
Earley, Paul H. The Cocaine Recovery Book, Newbury Park, California: Sage
Publications, 1991.
Earley, Paul H. The Cocaine Recovery Workbook, Newbury Park, California: Sage
Publications, 1991.
Earley, Paul H., Dickey, C. The Cocaine Addict, Principles of Identification and
Treatment. Mental Health Notes of the Georgia Division of NMHA, 40:5-7 (1986).
Earley, Paul H. Implementation of the Morrow M26 Hard Disk System in the S100
Environment. Microsystems 3:26 (1981).
Arch, S., Earley, P. and Smock, T. Biochemical Isolation and Physiological Identification
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of the Egg-Laying Hormone in Aplysia californica. Journal of Gen. Physiol. 68:197-210
(1976).
Arch, S., Smock, T. and Earley, P. Precursor and Product Processing in the Bag Cells of
Aplysia californica. Journal of Gen. Physiol.68:211-225 (1976).
Earley, Paul H. Isolation and Characterization of Hormonal Proteins Synthesized in the
Bag Cells of Aplysia californica B.A. Thesis, Reed College, Portland, Oregon (1975).
MEDIA 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
Institute in Part 3 – Changing Lives. Premiered nationally on the Public Broadcasting
System on March 29, 1998.
Oprah Winfrey Show. Invited as expert and appeared on an Oprah Winfrey Show to
discuss the Bill Moyer’s documentary: Close to Home, Chicago, Illinois, 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, 1995.
Oprah Winfrey Show. Invited as expert and appeared on an Oprah Winfrey Show
focused on heroin addiction, Chicago, Illinois, October, 1994.
PRESENTATIONS
Ten Emotionally Unintelligent Things that Health Care Providers Do. One hour plenary
presentation at the Health Care Consortium of Georgia’s Annual Meeting. March 2011.
An Introduction to RecoveryMind Training. One hour presentation at the Arizona
Chapter of the American Society of Addiction Medicine’s Annual Meeting. February,
2011.
Brain Models and Psychotherapy. Three hour training before the Imago Training Faculty
at Annual Imago International Conference, November, 2010.
What really happens in Addiction Treatment? One hour presentation at the Louisiana
Psychiatric Association fall conference. November, 2010.
Relationships and Recovery. Three hour Workshop presenting with Wanda Faurie, Ph.D.
at the North Carolina Physicians Health Program Biennial Retreat, October 2010.
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Assessing Readiness to Return to Work: the MPARI Project, One hour Presentation at the
AMA/CMA International Conference on Physician Health, Chicago, Illinois, October
2010.
Clinical Presentation: Injectable 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 2010.
The Assessment and Treatment of Alcohol Problems in Commercial Pilots One hour
presentation at the annual HIMS Conference in Denver Colorado, September 2010.
Controversies and Lessons Learned From The Treatment of Addiction in Physicians.
2010 New Advances in Addiction Medicine Conference in Phoenix, AZ, March, 2010.
Addiction in the Workplace: Improving Patient Outcomes. Second Annual Mississippi
Addiction Conference in Jackson, MS, January 2010.
96-Hour Assessment for Pharmacy Professionals. Southwestern Pharmacists Recovery
Network Conference in Sedona, AZ, September 2009.
Recognizing and Diagnosing Alcoholic Physician and Treating the Addicted Physician:
The Talbott Model. Keynote address and presentation at Ardere, Non Bruciarsi, the
Italian Conference on Physician Health sponsored by the Centro di Formazione Albert
Schweitzer. Turin, Italy, September 2009.
Addiction Memory and Craving: Clearing a Path to Recovery. American Dental
Association Conference in Chicago, IL, September 2009.
Teetering on the Brink of Collapse: Treating the Addicted Physician. Georgia Psychiatric
Physicians Association Conference in Amelia Island, FL, August 2009.
Conducted Two-Day Workshop for the Addiction and Recovery Ministry Conference in
Langley, British Columbia, June 2009.
Neurochemistry and Medications in Addiction Treatment. Royal College of Dental
Surgeons of Ontario Council Meeting in Toronto, Ontario, May 2009
Pearls in Assessing the Impaired Dentist. Royal College of Dental Surgeons of Ontario
Council Meeting in Toronto, Ontario, May 2009.
Addiction in the Operating Room. Wake Forest University in Winston Salem, North
Carolina, May 2009
Current Controversies in the Treatment of Physician Impairment. 2009 Federation State
Physician Health Programs Annual Meeting and Conference in New Orleans, Louisiana,
April 2009.
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Current Dilemmas in the Treatment of the Impaired Professional. AP Webinar - Vendom
Group in Atlanta, Georgia, April 2009.
All Day Training Program. 2009 SCSCSW Conference in Charleston, South Carolina,
February 2009.
Addiction as a Chronic Disease: The Challenge of Best Practice and the Best Care
Environments. 2009 SECAD Conference in Atlanta, Georgia, February 2009.
Current Dilemmas in the Treatment of Impaired Professionals. 2009 SECAD Conference
in Atlanta, Georgia, February 2009.
Changes in Addiction Treatment – The Good, Bad and the Indifferent. 2009 CAPTASA
Conference in Lexington, Kentucky, January 2009.
A literature review of addiction in physicians. 2008 International Conference on Doctors
Health in London, England, United Kingdom, November 2008.
Course Director. ASAM Review Course in Addiction Medicine in Chicago, Illinois,
October 2008.
Addiction Craving and Addiction Memory: Clearing a Path to Recovery. EAPA’s 2008
Annual World EAP Conference in Atlanta, Georgia, October 2008.
Assessment and Triage of the Opioid Addict. 2008 Florida Academy of Family
Physicians Summer Break Away Conference in Naples, Florida, June 2008.
What Makes a Case Difficult? Learning From Our Experience. 2008 Federation of State
Physician Health Programs in San Antonio, Texas, April 2008.
How to Recognize and Intervene Effectively on the Spectrum of Addictive Disorders.
15th Annual A&D Conference in Columbia, South Carolina, January 2008.
Is Buprenorphine Maintenance Recovery? Presentation at SECAD 2007 in Atlanta,
Georgia. November 2007.
Trauma and Memory. 2007 Carolinas Conference on Addiction and Recovery in Chapel
Hill, North Carolina. November 2007.
The Neurochemistry of Addiction and the Hope of New Medications. EAPA meeting in
San Diego, California. October 2007.
The Neurochemistry of Addiction and the Hope of New Medications. Presentation at
Cape Cod Symposium on Addictive Disorders. September 2007.
Deception in the Evaluation of the Professional Patient. Southeastern Regional
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Conference of the Federation State Physician Health Programs, Virginia Beach, Virginia.
September 2007.
The Impaired 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 2007.
Addiction Memory in Addiction Recovery. Three hour workshop at the Southeastern
Conference on Addiction (SECAD) December 2006.
Medications and Brain Neurochemistry: New Hope in the Treatment of Addiction. Two
hour presentation at the National Employee Assistance Professionals Association,
September 2006.
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, 2005.
ASAM PPC-2R Assessment Software Research: Evidence for a New International
Standard. Symposium at the American Society of Addiction Medicine’s 36th Annual
Medical Scientific Conference April 16th, 2005
Evaluating Impairment in Psychologists, Lecture at the 2004 Association of State and
Provincial Psychology Boards. October 22, 2004.
ASAM: Patient Placement Criteria Presentation at the 2004 NAADAC Annual
Conference, October 7, 2004.
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 Institute, Sept 12, 2004.
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, 2003.
Evidence-based Medicine and Behavioral Health - Talk at the CMHC user Group
meeting in Columbus Ohio, May 3, 2003. Similar talk presented May 15, 2004.
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
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The Therapeutic Community: Its Power and Purpose in the Treatment of Disease. Three
hour workshop presented with Branko Radulovacki, M.D., 11 October 2002 at
Ridgeview Institute, 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, 2002.
Attorneys and Diseases of Self-Care. Presentation to the NOSSCAR Conference, June,
2002.
Interacting with the Addicted Patient - Tricks of the Trade. Three hour experiential
workshop for 80 participants, presented June, 2001, Ridgeview Institute, 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 Institute to physicians,
psychologists and masters level therapists for training in Addiction Medicine.
Computers and Internet Addiction. Presentation to the Southeastern Conference of the
National EAP Professionals, September 2000.
Outpatient Detoxification - Ambulatory Detoxification in an Outpatient Setting.
One Hour Presentation at Ridgeview Institute, Smyrna, Georgia, January 8, 1997.
Clinical Technologies - Design Issues in Measuring Outcomes with Various Treatment
Populations. Two Hour Presentation at Clinical Technologies Conference, Phoenix,
Arizona, November 11 - 14, 1996.
Appropriate Prescribing of Controlled Substances. Two Hour Presentation at Mercer
University School of Pharmacy, Atlanta, Georgia, October 8, 1996.
New Paradigms in the Treatment of Addiction. Two Hour Presentation at Ridgeview
Institute’s Clinical Series for Professionals, August 23, 1996.
Managing Medications in Physician Patients. Two Hour presentation at 1996
International 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
International Conference on Physician Health Sponsored by AMA, February 7 - 10,
1996, Chandler, Arizona.
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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, 1995.
Identification, Treatment and Ethical Dilemmas in the Care of Impaired Professionals.
Two Hour Workshop presented to the Alabama Psychological Association Annual
Meeting, Gulf Shores, Alabama, May, 1995.
New Paradigms for the Care of Addicted Physician Assistants. Two Hour Workshop at
the 1995 International Conference of Physician Assistants, Las Vegas, Nevada, May,
1995.
Addiction Training of House Staff - Medical Center of Central Georgia, Macon, Georgia,
August, 1995.
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, 1995.
Identification of Addictive Disease in the Primary Care Setting. In-house staff training at
The Medical Center of Central Georgia, September, 1994.
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 Impaired Physician. One hour presentation at: Saving our own - The Impaired
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 Institute, April 7, 1993, Smyrna,
Georgia.
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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 Island.
Is 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 21st 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 Integrated Approach. Three hour workshop at The 20th
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 International PRIDE
Conference, April 11, 1989, Atlanta, Georgia.
Drug Specific Relapse Prevention. Lecture at The Seventh National Impaired Nurse
Symposium, March 12, 1989, Atlanta, Georgia.
Cocainism: Using the Scientific Literature to Redefine Treatment. Three hour workshop
at The 19th Annual Medical-Scientific Conference of the American Medical Society on
Alcoholism and Other Drug Dependencies (AMSAODD, now ASAM), April 22, 1988,
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Arlington, Virginia.
The Disease of Addiction. Presentation at the International PRIDE Conference, April 14,
1988, Atlanta, Georgia.
The History and Physiology of Cocaine; the Central Nervous System Effects of Cocaine;
and the Inpatient 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, 1985.
Sociocultural aspects of a New Disease Epidemic. Lecture to the Emory University
Freshman Class concerning eating disorders, 1985-88 academic years.
The Assessment and Treatment of Eating Disorders in the Inpatient 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.
PROFESSIONAL ORGANIZATIONS
Medical Association of Georgia.
American Medical Association.
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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 1993.
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 1997.
Phi Beta Kappa Scholastic Fraternity.
CAREER SPECIALIZATION
Addiction Medicine
Physician Health
Long-term therapy of Addiction Recovery
Computers in Medical Care, computers as tools for change in behavioral medicine.
COMPUTERS IN MEDICINE
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.
1990
Founded Earley Corporation to continue developing TxPlan and
market the product to the behavioral healthcare industry.
1995
TxPlan installed in over 200 organizations throughout the United
States.
1997 - 1999
TxPlan II developed for the Windows environment and Microsoft
SQL Server. Development partially funded by SBIR Grant #R44AA11235 from the National Institute on Alcohol Abuse and
Alcoholism (NIAAA). Dr. Earley was the principle investigator in
this grant.
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2000
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 SBIR Grant
#R44-AA12004 from NIAAA. Dr. Earley was the principle
investigator in this grant.
2002
Earley Corporation merged with CMHC Systems, Inc. Dr. Earley
becomes Chief Science Officer of CMHC Systems, Inc. His work
at CMHC Systems continues to focus on the computerization of
the ASAM PPC-2R.
2003
Participated in the French and German-speaking European
conference on Addiction. Presented research findings on the PPC2R in conjunction with the University of Liege, Belgium.
2009 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.
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Curriculum Vitae (Short Version)
John T. Palmer,
32597, Verdon Way,
Abbotsford, British Columbia,
Canada, V2T7Y3
Phone (Home): 604 853 4370
(Work): 604 853 0089
(Fax) : 604 853 0992
Email: [email protected]
EDUCATION
Master’s Degree in Counselling (Trinity Western University) – June 2001
- 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 (2001 – 2012).
This includes:
 Western Canadian Conference on Addictions and
Mental Health (2003 – 2010)
 Biennial National Institute on Dentist Well-BeingAmerican Dental Association (2001- 2009)
 Gottman Method Couples’ Therapy (Levels I&2)
 Emotionally Focused Therapies for Individuals
and Couples (Externships completed)
 Motivational Interviewing 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)
John T. Palmer
Curriculum Vitae
(March 2012)
Relevant Work Experience
General dental practice (1973 – 1976) Manchester, England
(1976 – 1996) 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 Interviewing, American Dental
Association Biennial National Institute on Dentist Well-Being (2005, 2007). Invited
Closing Speaker, 2007.
CAROLYN THOMSON, MD, CCFP, FCFP
23 Caitland Court, Halifax, NS B3N 3K1
Cell: (902) 483-1380 ٠ [email protected]
PROFILE
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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 IWK Health Centre.
.
EDUCATION
RESIDENCY IN FAMILY MEDICINE
Dalhousie University Medical School, Halifax, NS
 Chief Resident
1990 – 1991
INTERNSHIP IN FAMILY MEDICINE
Dalhousie University Medical School, Halifax, NS
1989 – 1990
MEDICAL DOCTOR DEGREE
Dalhousie University Medical School, Halifax, NS
 Lawrence Max Green Memorial Award in Obstetrics
1985 – 1989
BACHELOR OF SCIENCE IN BIOLOGY – Cum Laude
Dalhousie University, Halifax, NS
1982 – 1985
RELEVANT CONTINUING MEDICAL EDUCATION
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National and International 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)
Intensive Coach Training Program, College of Executive Coaching, Phoenix, Arizona
(2007)
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Physician Coaching Advanced Training Program, Physician Coaching Institute, Seattle,
Washington, (2007)
Annual Forum on Primary Health Care, Toronto, ON (2006)
Physician Manager Institute – Levels I and II (2006, Levels III and IV (Sept. 2007),
Canadian Medical Association
AGM Canadian Society of Physician Executives, Ottawa, ON (2007 & 2010)
CAROLYN THOMSON, MD, CCFP, FCFP
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Problem Based Small Group Learning, The Foundation for Medical Practice Education,
Hamilton, ON (2000 – 2007)
Psychotherapy & Counseling for Family Physicians, University of Toronto, (2011-2012)
WORK EXPERIENCE
COORDINATOR, PROFESSIONALS’ SUPPORT PROGRAM
Doctors Nova Scotia
December 2009- 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. It also provides
education around health and wellness topics and advocacy for those facing regulatory and legal issues.
CHIEF, FAMILY MEDICINE
IWK Health Centre, Halifax, NS
May 2006 – December 2011
Department of Family Medicine consists of 100+ community-based and academic family physicians that provide
maternity, newborn, and pediatric emergency care at the IWK Health Centre. The department is affiliated with
Dalhousie University Department of Family Medicine.
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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 IWK 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/ DALHOUSIE FAMILY MEDICINE
Halifax, NS
Clinical practice, teaching and obstetrics
2009-Present
FAMILY MEDICINE/OBSTETRICS
1997 – 2009
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
CAROLYN THOMSON, MD, CCFP, FCFP
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Provide leadership to colleagues and staff on partnership practices, locum coverage, human
resources, and patient satisfaction
1994 – 1997
PARTNER, FAMILY MEDICINE/EMERGENCY/OBSTETRICS
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
SHIP PHYSICIAN – EMERGENCY/PRIMARY CARE
Holland America Line, Seattle Washington, DC
1993 – 1994
1993
EMERGENCY ROOM PHYSICIAN
Saint John Regional Hospital & St. Joseph’s Hospital, Saint John, NB
FAMILY MEDICINE/EMERGENCY/OBSTETRICS (LOCUMS)
 Hokianga Health Service, Northland, New Zealand
 Dr. Russell Meads, Ohope, New Zealand
 Fourth Avenue Family Practice, Tauranga, New Zealand
1992 – 1993
FAMILY PRACTICE/OBSTETRICS (LOCUM)
Dalhousie University, Halifax, NS
1991 – 1992
EMERGENCY ROOM PHYSICIAN
Department of Emergency, Victoria General Hospital, Halifax, NS
1991 – 1992
CURRENT MEMBERSHIPS
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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
COMMITTEES:
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Steering Committee, Capital Health District Department of Family Practice (2006-07)
Educational Consultant (development and facilitation of programs), Continuing Medical
Education for Family Physicians (1999-2009)
National Committee on CME, Canadian College of Family Physicians (1998-03)
CME Representative and Accreditor, N.S College of Family Physicians (1998-03)
Doctors Nova Scotia Negotiation Steering Committee (2001)
Interdisciplinary Working Group on Legislation of Midwifery in Nova Scotia (1997-98)
Council Member, Capital Health District Department of Family Medicine (2008- 2011)
District Department of Family Medicine Executive (2008-2011)
CAROLYN THOMSON, MD, CCFP, FCFP
IWK 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
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