And for coming to our Presidential Initiative Campaign Summary. I'm excited to introduce our president who, this is the brainchild of our president. And so Dr. Livonis, I'll have you kick us off and then we'll take it from there to summarize our initiative. Thank you so much, Amita. I'm going to say a few words about the Presidential Initiative. But before doing that, we'll have some unfinished business from last night. I don't know how many of you were at the convocation and we had the presidential commendations that were given out last night. Unfortunately, Dr. Sherry couldn't be there last night, but he's here with us today. And I would like to formally give him his commendations. Come up. So, our Presidential Initiative. About one year ago in San Francisco, we came up with the idea of the Presidential Initiative being on addiction. As you probably know, every president of the American Psychiatric Association is given the task and the privilege of some, you know, to focus on one area of particular interest. And so addiction, a major part of psychiatry, had not been addressed ever before as a presidential initiative and we thought that this was a, I thought that this was a great opportunity to bring it to the table. Our task was very straightforward. We wanted to dispel any myths and misconceptions around addiction and shout from the rooftops that addiction treatment exists, is available, is safe, is effective, it works. So these were the two major tasks of the Presidential Initiative. Somewhere around that time, I was looking for who's going to chair the Presidential Initiative group and, of course, right away I thought of Dr. Smita Das. It was by far the first choice and my dream to have her, you know, head this effort. So I called up Smita and said, Smita, would you join me and chair the Presidential Initiative workgroup? Smita said, I'll think about it. And a day or two later, she gives me a call and says, yes, I will do it. And of course, you know, I couldn't be happier that she took on this incredible task. She's going to introduce the other members of the Presidential Initiative task force. Just going to say a few more words about what we wanted to accomplish. We thought that we did not really want to go into the minutiae of addiction psychiatry in the cutting edge of psychedelics and most recent treatments and so on. We wanted to maximize our impact in these 12 months by moving the needle as much as we could between where people were at and where we would like them to be in terms of addiction treatment. What I mean by that, there was a significant gap between the research and the tools that we have for the treatment of opioid use disorder and at the same time, they are not really being implemented in the general community. So that was the task and we decided to do it with four mini campaigns, as you will hear in much more detail, tobacco and vaping, opioids to coincide with September, which is recovery month, the next three months being alcohol to coincide with the holidays, which is a time when people drink a lot, and then the final three months to be on technology and technological addictions and emerging field, of course, of addiction psychiatry. Wonderful choices. I stand by them. I think that we delivered a lot and you're going to be hearing a lot of details about it. There was a downside to it and a very reasonable one, and that was that we left out the stimulants, more specifically crystal methamphetamine. As you know, crystal methamphetamine creates havoc, especially on the West side of the United States, let alone internationally, and it was a tough choice. We really wanted to stick to four campaigns. We couldn't really think of it, maybe our obsessive mind, to go into five, but also in terms of what we know and where we want people to be, it seems that we didn't offer as much of an opportunity as vaping, opioids, alcohol, and technology. So that was an excuse, a reason, the understanding, the rationale behind not going into the stimulants. In retrospect, there's also the fact that over the past 12, 15 months, the combination of crystal methamphetamine with fentanyl has skyrocketed. So this is like a major, of course, concern right now. Perhaps if we were to make this decision now, we would have thought about it maybe a little differently. But anyway, so that's what we decided to do. That's what we set out to do, and again, we're going to hear much more details, many more details about these mini-campaigns. But I couldn't be happier. I couldn't be more pleased with the results. Congratulations to all five of you. Thank you so much. Another component of the presidential initiative was collaborating with other professional organizations. So we convened a panel with the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, pediatrics, OB-GYN, family medicine, internal medicine, osteopathic medicine, and we brought them all to D.C. and we ended up with a consensus that we published and you have copies in front of you with the top ten things that all physicians should know, the top ten things that all people should know. And we translated that in Spanish as well, and it is widely available. We really hope that this convening, this initiative will continue in the future. One of the things that we did was not to invite just the president of these organizations to D.C., but also the staff, the person who is responsible for either advocacy or communications of these organizations so that they are the ones really who can carry the torch and continue the effort into the future. So that's where we're at with the presidential initiative. And now I'm going to turn it over to Smita to introduce our other speakers and take it from there. Thank you. Thank you so much for that introduction and also for your support of this campaign, Dr. Livonis. This is a topic, as was mentioned, that's never been a part of a presidential initiative. It's always been relevant. It's especially timely right now. And we have so much information. We know that there is a gap related to knowledge, treatment, and attitude. So very few people with a substance use disorder get treatment. One out of five people with mental illness has a substance use disorder, so very relevant to the APA. Substance use disorders are a DSM diagnosis. They are core to mental health. And only 2% of psychiatry training is dedicated to learning about substance use disorders. And so the lack of understanding or the appreciation of the extent of the problem and what we can do to improve things in all of the treatments we have available is vast. This is an issue in psychiatry. It expands to the House of Medicine. And so we're really delighted to be able to have this opportunity to create this campaign. So the goal that we came up with around the time of last year's annual meeting was to impact substance use disorder prevalence and treatment rates by increasing reach representation and awareness of substance use disorders in treatment. And our strategy, we created a full strategy document and working very closely with teams at the APA who I will mention. Our four specific campaigns to increase awareness with a coordinated effort with the House of Medicine. The audience were psychiatrists, clinicians, and communities. And we partnered with the APA Department on Communications and the Department on Practice and Policy and started to develop that full-blown strategy and assembled our team. And so with that, I'm excited to reintroduce our campaign leads. And they will each introduce themselves throughout the presentation as they summarize their campaigns and talk more about what they did. I'm going to highlight, I'm going to give the kind of the punchline here, but this really delightful slide that lists a sampling of everything that we created and really more than 80 campaign supporting deliverables to date. I also really appreciate that the comms team was able to create these QR codes which really nicely go directly to this campaign. And we'll flash the QR codes at the end so you can download any of the, most of the deliverables that we have right from a centralized source. So we'll flash the QR codes at the end again as we wrap up our presentation. And with that, I will mention that all the leads, as I said, they'll introduce themselves, they'll go over their main talking points for their campaign, products for their campaign, and the really impressive metrics that are associated for that campaign. And our first speaker will be Dr. Tawhid Zaman. All right, good afternoon, everyone. First of all, I want to thank Drs. Das and Livonis for including me. My name is Tawhid Zaman. My pronouns are he, him. I am an addiction psychiatrist based in San Francisco. In my academic role, I lead the Addiction Psychiatry Fellowship. But in my clinical role, I actually founded and now lead the Addiction Consult Service. And I still remember on my first day on the job, so this is, I think, the day after, or the week after graduation, my chief of our department said, welcome, we're so thrilled to have you here. We have 120 smoking cessation consults for you to see. So that raised my eyebrows and we got started. And so that was 10 years ago. You'll be pleased to know we did see those consults. It didn't take us 10 years, but we've certainly continued the work of smoking and vaping cessation. So this is a topic that is close to my heart, and I was able to, I was really pleased to be able to bring that clinical interest to this campaign. Early on in the campaign, we kind of had this sense that there were some major myths regarding vaping that we were going to encounter again and again, and we needed to be prepared to kind of answer to with science. And this was borne out throughout our experience. So here they are. There was a prevalent myth, and there is a prevalent myth that vaping nicotine is not addictive, that it is medically safe, and that vaping is an effective form of quitting nicotine use altogether. And this is something that vaping products are increasingly marketed for, right? So we know that some of these myths have some money and some intention behind them. And as a result of that, we thought we'd develop some key talking points. So we were going to, as a part of this campaign, be talking to various folks. We were going to be writing articles. We were going to be talking to different types of kind of media, and our talking points were as follows, just kind of trying to get ahead of those myths. So we wanted to emphasize that many of the chemicals in vape juice are not approved by the FDA, that the chemicals in the juice can actually harm lungs. And we really identified asthma, bronchitis, emphysema, the kind of respiratory illnesses as being some of the primary kind of harms that we wanted to highlight. Vape products can contain a lot more nicotine than cigarettes, and I think this can be news to a lot of folks. So, you know, a pack of cigarettes may contain 20 milligrams of nicotine, for example, whereas a Juul pot can have 40, a Soren pot can have 90. So these are high amounts of nicotine that we're talking about, and of course, the addictive nature of it goes up with the amount. Also concerning from an addiction standpoint, but developmentally as well, vaping is more common among young people compared to adults 25 and older. Folks who are 18 to 25 have a much higher rate. So in all adults, the rates of vaping and smoking combined are about 4.5. In this group, it's 11. And now there are more and more reports of middle school students vaping. So folks who are vaping earlier, and we worry about the impacts that might have on them just from a brain development perspective. And then the FDA is absolutely just flooded with applications for vaping products. So I think last time we had checked, there were thousands of products that were kind of awaiting review and application, and only 23 at the time that we had put this slide together had been approved. But there are probably more on the way. You all may have heard about the FDA ban on fruit and minty flavors for vaping products. This was really meant to kind of stop marketing towards teens and kids who find fruity flavors perhaps more attractive. However, there is a gigantic loophole when it comes to this ban, which is that it does not apply to reusable products. So this has been exploited tremendously. There are now many, many types of reusable disposable products that are available in this country, made abroad, which are accessible to children. High school students who use cannabis also appear to have gone from smoking it to vaping it. So rather than kind of using vaping as an alternative to smoking, we have seen people go from smoking to vaping and then back to vaping or using both simultaneously. We didn't focus a tremendous amount as a part of this campaign on cannabis specifically, but we certainly know that vaping THC, one of the most kind of psychoactive compounds in cannabis, is not safe from an addiction standpoint and all of the other harms it can have. And the jury really is out on kind of vaping to quit nicotine, but there are currently no such products approved by the FDA. And we wanted people to know that there are effective alternatives, right? So there are FDA-approved alternatives that are available. We don't have to go to vaping necessarily. And finally, because vaping is a relatively new phenomenon, we lack the long-term research to understand all of the harmful effects. So with that, I'm going to go to one of our campaign videos. So this is an explainer video that we developed. It's on YouTube. It's also on our APA nicotine and vaping website. And basically, this was meant to be a very accessible kind of explainer, an overview of what the harms of vaping might be. And so let me go ahead and play that for you all. What is vaping? Why are one in seven teenagers vaping? Vaping is the process of inhaling heated vape juice or e-liquid, a concoction of nicotine flavoring and chemicals through an electronic cigarette or other device, often taking the form of a pen, USB flash drive, or other everyday item. Vaping is not safe. While probably less toxic than cigarettes, vaping aerosol contains heavy metals like nickel, tin, and lead, volatile organic compounds, and cancer-causing agents. All of these can directly harm the development of the teenage brain, including parts that control learning, mood, and impulse control. More than 2 million U.S. middle school and high school students reported using e-cigarettes, with more than 8 in 10 of those youth using flavored e-cigarettes. So why are teens vaping? The most common answer, I am feeling anxious, stressed, or depressed. Vaping as a means to escape stress or anxiety creates a cycle of nicotine dependence. Nicotine addiction can itself be a major source of stress. Don't worry. Resources are available to help you quit vaping, and there are healthy ways to reduce stress. Exercising, using relaxation techniques, spending time with supportive friends, and taking a social media break can help. Contact a mental health professional to help quitting vaping or addressing mental health concerns. For more information, please visit www.psychiatry.org. And so with that short video, you could probably tell that we really were targeting kind of an adolescent population. What is vaping? Why are one in... And I won't make you watch it again. But we were targeting an adolescent population and really trying to highlight those talking points that I mentioned to you earlier and hit upon all of them, as well as dispel those three big myths that we were mentioning. In terms of the numbers of views that this got and people that we reached, I'm going to show you some of the metrics so you can just understand how successful or not these campaigns might be. Oops, I clicked somewhere else. Thank you. In addition to that, we were really lucky to partner with some organizations to have more public-facing events. This was an event that we did with the American Lung Association. And this was a more advanced conversation, I would say, about some of the potential psychiatric and physical harms of vaping over time. We were lucky enough to have Dr. Albert Rizzo, who is the chief medical officer of the American Lung Association, join us, and our facilitator there on the upper left, and of course, I'm at the bottom there. So I'll play a clip for you all so you can get a sense of kind of how this event went. And just overall, one thing we know about all addictions, including to nicotine products, is that treating a mental health issue that someone might have alongside their use can really help people. It can really help people reduce their dependence or their use of any substance, including vaping. So I'm a big proponent of folks kind of talking to their doctors about their vaping, but also all the other mental health issues that might be going on at the same time. Wonderful. Thank you so much for that insight. And I couldn't agree more, and how concerning as well, knowing that this is truly impacting depression symptoms, ADHD symptoms, many of which, you know, users may be utilizing these products as a coping mechanism versus speaking with a clinician and getting a treatment plan in place to really be able to manage and live their best lives, you know. So thank you so much for that. Really appreciate it. Dr. Rizzo, I'd like to toss it over to you. We know, you know, we are inhaling, using these products. It is going into our lungs and we know our lungs really feed our entire body, you know, everywhere the blood flows is affected by what we put into our lungs. Can you tell us a little bit about the lung health impact and just overall, you know, physical impact of vaping on the human body? Sure, sure. Well, as you said, Jennifer, the lungs are so important. Other than the skin, our lungs really are the first exposure to the rest of the world, whether it's wildfire smoke, climate change, effects on particle matter, and really anything we inhale that has potentially irritating substance is going to cause inflammation in the airways. The trouble with e-cigarettes is they've been on the market in an explosive fashion only about 5, 10 years now. And in the short run, we know that they do cause inflammation, bronchitis, wheezing, cough. We don't have long-term studies showing what is that going to mean with regard to developing chronic conditions, COPD, and potentially even lung cancer. We know that the e-juice that you mentioned contains chemicals and carcinogens very similar to what's in tobacco smoke, maybe not at the same degree, but they are there. And we know that the long-term exposure to those kind of chemicals can do permanent damage in the lungs. So that's the concern we have for the fact that we don't know a lot about the long-term effects of e-cigarette inhalation. So I think this video kind of gives you a flavor for the conversation and kind of our realization early on that there are other organizations out there who are doing parallel work and reaching kind of a broad audience of their own, depending on their kind of area of expertise. So it was really important, I think, to partner with these organizations to get this message out. And this is kind of one of those examples. So how successful were we? And this is overall one thing we know about all addictions. So these are kind of some of our metrics that I wanted to kind of share with you. So in terms of kind of APA member outreach, we had a psychiatric news special report that went out last August. My gratitude to Dr. Das for authoring that in my absence. We had a Looking Beyond series webinar. This was in September, and we talked about the intersection of race, ethnicity, and sexual orientation status on the prevalence of vaping among minoritized youth, which was a really excellent conversation. And then we had these public outreach kind of efforts. So the animated explainer video that we started with at the time that we had put this slide set together had 81,027 views. There was also a Spanish version that we put up, and that had 11,121 views. On social media, there were 62 posts total. It reached, in terms of users, 64,230. And in terms of media impressions, there were 175,265 individual media impressions. The Facebook Live event that I showed you a clip from with the American Lung Association had 11,650 views. In retrospect, if I'd known how many people were going to be watching these, I might have been more nervous. So I'm glad to have these numbers after the fact. In terms of our webpage content, we did update our webpage at psychiatry.org and had a couple of blog posts there and at lasaludmental.org. That had 9,957 views. Earned media, an op-ed that we had go out to Insight Sources. That's a syndication to 300-plus other outlets, so that reached 25 million readers. Key media placements, ABC News, we reached 27.5 million visits. Health Day, 200,000. Conversations on healthcare, 4,000 listeners. And so the total impact to date for the vaping campaign specifically, which was the quarter I was involved with, was 53 million plus. So that has been our impact so far. So this has been a tremendous learning experience, a tremendous opportunity to get outside the clinic and talk to the public and to our patients directly about a really important issue. So with that, I'm going to thank you all for listening. And turn it over to Dr. Leif for his section on opioids. Thank you. Hey, folks. My name's Leif, Leif Fenno. I'm in Austin, where I work at UT Health, Dell Medical School, and then also our local safety net provider, Integral Care, at Runner-Bupe Clinic. And I'm also the incoming chair of the Council for Addiction Psychiatry with the APA, where I'll continue working with the rest of these folks. So the backdrop for opiates is that things are kind of wild, right? So if we look at total overdose deaths, opioid overdose deaths, these are actually dated numbers. You can see this exponential increase, and it's continued to go up. And maybe provisional numbers suggest that it might have stabilized over the last year to around about 100,000 overdoses per year. So we have an incredible need for interventions. And at the same time, we have fantastic interventions for managing opioid dependence. And there's been a lot of fluidity on the legal side as well, and a lot of confusion around what is the law surrounding the management using FDA-approved medications for opioid dependence. And so some of the legal regulations, like the X waiver, some of the NTP, OTP, like methadone rules, loosened up during COVID. They were extended temporarily multiple times. And then final rules were finally put through by SAMHSA in conjunction with the DEA federally recently. But there's a lot of confusion around that. And so our goals in this campaign on opioids were to try to address some of those, to encourage providers and providers widely defined. So that's everybody in this room, everybody at this conference, but then as you'll see in a moment, all of our allied providers in the community to actually treat opioid dependence, opioid addiction, and then also to provide information to the community about what the treatment options are. Specifically, we had four main aims. So one of them is that naloxone is fantastic. Naloxone saves lives. It's over the counter now. It's available without a prescription, and everybody should carry it. The second one is that buprenorphine, which is the active component of suboxone, is now able to be prescribed by anyone with, essentially anyone with a DEA registration. So there's no more X-Waiver. The X-Waiver's gone. Anyone in this room has a DEA registration, you too can prescribe suboxone. The third is that opioid use disorder, opioid addiction, can be effectively managed using FDA-approved medications, and that's because it is a medical condition. And then last, the fourth point, is that some ways of using opioids are less harmful than others. And so emphasizing some of the harm reduction approaches that from a public health level can actually reduce the mortality rates I mentioned a moment ago. And we did this with a whole bunch of different deliverables, in some ways overlapping with the vaping campaign and the other campaigns. Some of them, which I'll highlight in a moment, were unique to this one. One of them that I'm sure all of you read multiple times was a special report in Psychiatric News, but is actually a nice reference for some of the legal changes that happened over the last few years. And then highlighted here on the bottom are updates to the APA website, there are a bunch of blog posts, an explainer video, which I'll play for you in a moment, and my personal favorite is Naloxone Nation docuseries. So this is a small docuseries, currently just a few episodes, but highlighting again allied providers who are critical in the continuum of care for patients with opioid use disorder. And so in this case, for example, highlighting an EMT program, which I'll play that five-minute video for you on the next slide, second talking about a nurse practitioner working in one of our clinics, and we have potentially more episodes planned. So let me show you one of these deliverables here. ♪♪♪ Good afternoon, everybody. My name is Leif Benno. I'm a psychiatrist and neuroscientist. I treat opioid use disorder, opioid addiction. Welcome to a docuseries sponsored by the American Psychiatric Association, where our mantra is treatment everywhere by providers anywhere. And today we're working with Mike Sasser, a paramedic with Travis County. So Mike, tell us a bit about your treatment program here in Travis County. The way our program kind of starts is like every time somebody experiences some kind of overdose that interacts with the 911 system, that name generates on a report that I see daily, and then we evaluate that report and find out if that somebody who looks like they're struggling with substance use or actually has a problem, and that's why the Narcan was used, that's when we send somebody out to follow up with them. And we always start with the conversation with, hey, are you okay? Because that's really what it matters for us, is like just checking in with somebody to figure out, is there anything that we can do? And sometimes, and lately is when we follow up with people, that overdose and that conversation kind of brings us back to the conversation around fentanyl. And we take the opportunity to have a conversation about harm reduction, provide Narcan, provide training, provide advice about not using alone, testing your drugs, and then we evaluate whether or not somebody actually has a problem in a medical situation. I always address that by asking, use every day, and do you get sick when you stop? And the answer to that is yes, I know what the life looks like, I know that it's just this constant rollercoaster of pain and trauma. We offer connection to programs or inpatient programs or whatever it is that people think that they're going to need to get sober and get their life back together and get everything under control. And so what we do is we offer buprenorphine treatment. We'll start somebody when they're ready, provide medication, we'll do an induction at home or wherever we may need to be when we do that, and then we will provide daily dosing until they can connect to another program. Mike, when you meet people in the field and they've just had an opioid overdose, how do you describe Narcan and buprenorphine to them? So when I talk about Narcan, I always describe it kind of as the fire extinguisher for people who are playing with fire. Like if we're involved in the situation, then it's probably a situation where somebody was messing with something, put them in a dangerous place. And when you, when you think about it from a public safety perspective, we say that fire department has fire prevention and everybody understands the concept of fire prevention. The difference between us and them is we do that for humans. So that's kind of how we evaluate how Narcan works is we talk about people like this is prevention. This is going to keep you alive. This is going to save you when something terrible happens. And then as far as the buprenorphine goes, we're trying to turn ourselves in back into that medical mindset and it needs to be managed like a chronic disease. And the best way that I've found to make people understand what buprenorphine is and what, how it works, manage your opioid use disorder the way that people learn to manage diabetes. And I draw comparisons between how diabetes is managed and how methadone works and how buprenorphine works and how glipizide works and how insulin works. And so we, we talk to people about that kind of thing. So we use that opportunity to, to explain the medical side of it. So you're a paramedic, but you're managing Suboxone, buprenorphine. How did that come about? I wanted to give people Narcan and save somebody's life. Once I started giving out Narcan, it took about a week and then we started trying to figure out more than that. And every overdose follow-up that we would go on, we'd have a conversation with people saying, Hey, what do you need to get sober? Like that conversation always leads you back to meds, right? Especially when it comes to opioid use disorder, because without, without medication, opioid use disorder, the relapse rate is over 80%. Because the relapse rate is so high, we were trying to get people into programs. Well, it takes about a week to get most people into a program. Like the clinics are great and they work really, really hard to try and squeeze people in and fit the schedule, but there's, there's limited space in your clinic. So we were like, well, why can't I just give that medication? I'm a paramedic. So you start patients on buprenorphine, you give them Narcan. And then what happens between that point when you first meet them and when they get into a clinic? Currently, our average is about four days to get somebody into a program. First day I'm with somebody, I'm going to do an induction and we're going to spend an hour and a half to two hours with them, making sure that we establish the correct dose for them. And then the next day is follow-up. And then we come back on the second day and we do the follow-up. We're like, okay, let's see how the medication made you feel. How did you do last night? How did it go? Do we need to take your dose up? Do we need to take your dose down? It seems like it's filling a big gap in the treatment continuum. I feel like it is because before we had the option to be able to treat people, there were so many times that we were frustrated because we were trying to get somebody in and we had multiple people who literally died waiting to get into treatment. We also had people who were just give up, right? If you had to tell somebody who's in a bad place, who's having to use every single day just to stay well, then you tell them like, okay, we'll get you in next Thursday. And they're like, okay, well, I guess that's not going to work out. And so they give up. When I go follow up with people on the overdose side, the conversation is, if you're not ready in this moment to start right now, you call me whenever you are and I will come meet you whenever you are, whenever you're ready. Because we have 24-hour coverage now. So I have somebody I can send 24 hours a day to respond when somebody calls 911 for opioid control. Mike, as a paramedic who's prescribing buprenorphine, I'm curious what you would say to other medical providers who might be nervous about using this medication. When it comes to like managing this medication, if you pay attention to what you're doing and respect the story and where people are coming from and stop and listen to your patients and understand what they're at, where they've been and be honest with them and let them know like where this could go. And as long as we've been very conservative in our dosing. What would you say to patients who are nervous about starting this medication? At that point, I'm like, why are you nervous? Like, what is it you're concerned about? Like, is it a matter of you're afraid you're going to make yourself sick because you had a bad experience? And let's explain why you had that bad experience, that it is a competitive agonist. But we, of course, explain it in terms that patients can understand a little bit better. And to explain it that way, if it's a matter of I don't want to get addicted to something else, then that's a whole different level of conversation where we start talking about opioid use disorder as a medical condition and what it actually means and what's going on within their brain chemistry. But again, finding ways to make it work. Well, Mike, thanks for coming out today. If people wanted to get in touch with you or with your program to learn more, what would be a good way for them to do that? Look up Austin-Travis County EMS online. We also have a duty officer phone number. Just call 911 in town. Well, thank you very much. Thank you for coming today. We're here with Mike Sasser, paramedic, who really embodies the idea of treatment anywhere, my providers everywhere. Thank you. That's an example with Mike Sasser, who is awesome. Travis County EMT. If you want to start a program like this in your community, get in touch with this guy. He's amazing. He drove the entire program development, and now his ambulance responds, or his team responds to every opioid overdose in Travis County. And they daily dose people to bridge them to clinic treatment. So they'll start them in the community and bridge them. Last, I wanted to share with you the opioid use disorder explainer video. And this will be the last piece of media that I share from my campaign. And this is, again, in English and Spanish. What are opioids? Opioids are chemicals that interact with opioid receptors in the body and brain and are intended to reduce the perception of pain. Doctors may prescribe opioids for short periods of time to treat pain. Opioids are powerful pain relievers, but can also be very dangerous when not taken as prescribed. Opioid use disorder, or opioid addiction, is a treatable medical condition that can lead to serious consequences. Some of the signs of opioid use disorder include continuing to take opioids even though you want to stop. Needing to take more and more opioids to feel the same effect. Finding that taking opioids is causing problems with work, family, and friends. Feeling sick when you don't take opioids. Opioid use disorder is especially dangerous because the brain adapts to opioid use quickly, and this can rapidly lead to physical dependence. This dependence leads to a person experiencing severe withdrawal symptoms if they stop using opioids and creates a strong motivation to continue using. Unfortunately, over 2.7 million Americans have experienced opioid use disorder. Opioid overdose has become a leading cause of death for Americans aged 18 to 45. For every fatal overdose, there are about 10 non-fatal overdoses and 20 opioid-related hospitalizations. Some opioids, such as fentanyl, are especially dangerous. Fentanyl is 50 times more potent than heroin, 100 times more potent than morphine. If you have a friend or family member struggling with opioid use disorder, help is available and recovery is possible. Treatment can include medication and therapy. Buprenorphine, methadone, and naltrexone are three effective FDA-approved medications for the treatment of opioid use disorder. You can help people with opioid use disorder by learning about and carrying naloxone, which is an over-the-counter medication that keeps someone who is experiencing opioid overdose alive until an ambulance arrives. For more information, please visit www.psychiatry.org. in great detail here, except this last one. So approximating the vaping campaign, we had over 50 million impressions. And those were distributed across all of the different deliverables. These continue to rack up hits online right now, all day. I'm sure you guys are all looking at this right now on your phones. And then we'll, as mentioned, ideally continue into the future as well. And with that, I will turn it over to my colleague, Dr. Kidd, who will take us into 2024 with the alcohol campaign. Thank you. Thanks, Slave. Good afternoon, everybody. Before I begin, I also want to echo thanking Dr. Livonis and Dr. Doss for the invitation and the opportunity to be part of this, and also to thank the APA staff and the APA comms team who had a huge, a tremendous hand in putting together all of the deliverables that we're showing you today. So the alcohol campaign, we situated this around the holidays and then dipping over into dry January, which for those of you aren't familiar is sort of a, I want to say a social media phenomenon, but I think it's bigger than social media, but this idea of after maybe the excesses of the holidays, taking an opportunity in the sort of spirit of New Year's resolutions to try to not drink for the month of January, to sort of see what that's like. Some people have coined the term damp January to take a more moderation approach to try to drink less, and we really wanted to capitalize on this and take a more prevention and harm reduction approach. I think that this really exemplifies why I love talking to people about alcohol, because it's widely available. Even people who don't drink likely know someone who does. If you approach it the right way, it's really straightforward to have a conversation with somebody about their drinking, because you can come at it from a non-stigmatizing point of view. Dry January doesn't take a moralistic approach to drinking, and we can include ourselves in the conversation, too. I mean, as somebody who drinks alcohol, it's good for me to reexamine my relationship with alcohol, too, and really kind of normalize that message. So we tried to provide a few different talking points in our messages around dry January. So we wanted to increase awareness of the role of alcohol in people's lives and relationships by kind of taking this break, that people could notice the positive aspects of not drinking. They understand how drinking might be used sort of unknowingly as a coping mechanism for mental health struggles or to cope with stress. They could use this to set goals for the rest of the year to have a more intentional relationship with alcohol. They might not stop drinking entirely, but they might make changes to help them mitigate some of the negative things that they had noticed during that month. And if it is hard to control, if it's something they thought was going to be really easy and it's actually really hard, that might be a reason to reach out to their primary care doctor or a mental health professional to seek help and to have a healthier relationship with alcohol in the future. We also wanted everyone to know that treatment is available. And this is not just patients, but we wanted clinicians to know that treatment is available, too. We know that only about 10% of individuals with an alcohol use disorder receive an evidence-based treatment and a fraction of those individuals receive medication treatments for alcohol use disorder. And so we wanted to get the word out there to clinicians that this is an option for them as well. And I include this sort of a little bit difficult to read, but screenshot from a piece that we did with the Denver Post where they interviewed us about this initiative and about a survey that the APA had done about drinking consumption in the holidays and sort of goals for dry January. And this reporter put together the interview into what I thought was a really nice sort of top 10 list of some of these, and I'll just sort of highlight a couple of them for you. You know, number three, if you notice that alcohol is primarily affecting your life, maybe dry January feels like too big of a hurdle for you, but maybe you can try to change your drinking around that. So if you notice that you're getting into more fights with your partner, maybe you can try to take some breaks from drinking when you spend time with them or have a conversation with them about what they notice in terms of how alcohol is affecting your relationship, or it's an opportunity to support friends who might be in recovery who are sometimes alone in being the one to not drink. And so now you can be an ally for that person and really thinking of this as an empowering thing and strengthening your relationships as well. So with that, I'm going to start off by showing you the alcohol explainer video that we put together. Many people drink alcohol occasionally, but has drinking ever seemed difficult to control? Has frequent or heavy drinking led to problems with family, friends, or work? These could be signs of alcohol use disorder, a very common illness affecting one in 10 Americans every year, including one in six individuals aged 18 to 29. Alcohol use disorder is a pattern of drinking that leads to significant distress and prevents someone from functioning normally. Some of the symptoms include trying unsuccessfully to cut down or control alcohol use, wanting to drink so much it's difficult to think of anything else, continuing to drink despite it causing problems at work, at school, or at home. People who drink alcohol heavily and regularly are at risk for developing withdrawal symptoms when they stop or reduce use. Having two or more of these symptoms in the last year could signal an alcohol use disorder. Alcohol use disorder is the third leading preventable cause of death and can lead to serious consequences for your mind and body, affecting your digestive, cardiovascular, and nervous systems, to name a few. It can also contribute to increased risk of accidents and violence. There is hope and recovery is possible. You can seek treatment and make changes at any point during your life's journey. The goal can be to stop drinking altogether or to cut back on drinking. Once the problem is recognized and acknowledged, the road to recovery from alcohol use disorder can begin. Treatment for alcohol use disorder can include therapy, medication such as naltrexone, and community-based peer support such as a 12-step program. Recovery is possible with both a treatment plan with your doctor and loving support from friends or family. For more information, please visit www.psychiatry.org. As you can see with all these, we really tried to take a positive approach to say that treatments available, this isn't this sort of very like dark and scary topic, that this is something that people can recognize in themselves and get help. I realized that I didn't introduce myself actually, but this next piece gives me a chance to do that. I am based here in New York City. I'm on faculty at Columbia University and do research and work in a public mental health clinic. This is a piece that we did with CBS, but it's kind of a funny story because a reporter showed up at my office. In New York City, we have very tiny offices. They're like, we can't possibly do this interview in your office. We had to go around the building. I met the podiatrist that worked next door in a suite. We had to commandeer their waiting room to do this interview. We were approached by CBS about doing a piece for Dry January and really helping people to think through how they might optimize this sort of trendy thing that might be part of their social circles to really lead healthier lives the rest of the year. Many people try to cut back on their alcohol consumption after the holidays, but Dry January, as it's known, isn't always that easy. Michael George has some tips on how to succeed and potentially improve your health. New Yorker Jalal Talib gave up alcohol for a month and noticed some big improvements. Sleep has gotten much deeper and better. I feel stronger physically and mentally. After the excesses of the holidays, many Americans consider going cold turkey for the entire month of January, but it can be daunting. I feel like I sleep a lot better when I don't drink, so I'm interested in trying. Alcohol use and abuse rose sharply during the pandemic, but a survey from the American Psychiatric Association found about a third of Americans say they're drinking less over the last three years. I think one of the biggest benefits of Dry January is it gives all of us a chance to reexamine our relationship with alcohol. Cutting back can be good for everything from heart health, blood pressure and liver function to improved sleep, mental clarity and mood. Dr. Jeremy Kidd says many find it tough to go the whole month without drinking, but there are some things you can do to succeed. Setting short-term, achievable goals, so sometimes taking that week by week rather than an entire month. He also suggests using the buddy system and talking to a therapist if you need extra support. Talib says after finding he could part with alcohol temporarily, he decided to give it up for good. Everything is great in moderation, but with alcohol in specific, if you stop it for a little, it'll make a big difference in your life. A small step that could lead to some big life changes. What do you want a little help cutting back? The National Institute on Alcohol Abuse and Alcoholism has a website called Rethinking Drinking. They've got some helpful resources. You can see that again, we took this very prevention-based approach that we don't have to wait until people showing up in our office meeting criteria for an alcohol use disorder that there are things that we can do to take small steps in our own lives to have a healthier relationship with alcohol. Also repeat that website, Rethinking Drinking, that's a great website made by the National Institute on Alcohol Abuse and Alcoholism. It's a great resource for you, but it's also a great resource for patients. It's really user-friendly. Here are some other deliverables. A special report in Psychiatric News in February that was co-written with Dr. Sean Lynch, who's a APA Foundation fellow and a local resident here in New York City who did a great job working on that piece. The Looking Beyond series that was a webinar focused on addressing alcohol and substance misuse in the Hispanic and Latinx community. The animation explainer video that you saw that was available in English and Spanish, and a variety of social media posts, in fact, almost 70 social media posts. Here you can see some of the numbers in terms of views in the tens of thousands and impressions on social media, almost 200,000. We also created a number of pieces for the APA website that these are enduring products that we'll live on. Similar to the vaping campaign and op-ed that was around setting SMART goals for dry January to set goals that are measurable and achievable and specific that was picked up by Insight Sources, a syndication of over 300 outlets. The piece on CBS, also an interview on Sirius XM Doctor Radio, and a piece in Psychology Today, and in total, 135 million total impact. A really wide reach, and it was a real privilege to be able to be part of this to, again, speak directly to our patients, and to deliver a different kind of message that I'm often delivering in my clinic, working with folks who are coming in for treatment, but really trying to prevent this disorder in the first place. With that, I will hand it off to Dr. Scheer to tell us about technology. Hello, everybody. Thank you so much for sticking with us until the end. I'm James Scherer. I am delighted to be here. Thank you so much to Petrus and Smita for involving me. Thank you so much to the APA team for everything you did, producing a lot of this material. I want to shout out, in particular, Bob Ensinger, as well as James Cardy, who produced a lot of the materials we put out, and they were excellent, yes. I am an addiction psychiatrist. I'm the medical director of addiction psychiatry at a hospital in Summit, New Jersey, called Overlook Medical Center. I run a co-occurring disorder intensive outpatient program. I run a medication-assisted therapy clinic, and I also run an addiction consult service, and I'm in private practice as well. I want to tell a little story that I think and hope will kind of convey about how far we've come on the technological addiction since I started talking about this as a resident. The first poster, the first thing I ever did with regards to internet gaming disorder in particular, I put a poster together, a literature review about the evidence at the time showing which medications could be effective for internet gaming disorder. This was back in 2017. I was a resident. I presented the poster at the annual meeting of the American Academy of Addiction Psychiatry. I was very proud. I was so happy to be there talking about this subject, which was near and dear to my heart. So I'm standing there in front of my poster, you know, as we do as trainees. Not a whole lot of people are coming by. I'm just waiting for someone to come by and ask me about the literature review. Finally someone comes by, an older distinguished psychiatrist, and he's looking at the poster pretty critically. You know, he's doing a little bit of this. He's stroking his chin, and the first words out of his mouth are, I don't believe this. And I said, oh, well, you know, it is preliminary evidence, but you know, there actually is pretty good evidence that, you know, methylphenidate and bupropion can be pretty effective for reducing the symptoms of internet gaming disorder. And in a very polite way, he goes, no, no, no, no, no. I don't believe that this exists. I don't think that internet gaming disorder exists. I don't think that you can be addicted to video games any more than an alcoholic can be addicted to the bottle. And I was just so kind of taken aback by that, but I rolled with it, and fast forward to 2023, the Surgeon General of the United States of America puts out a bulletin, you know, extolling all of the issues with social media and its addictiveness, and now I have parents knocking down our door at Overlook Medical Center saying, my son is addicted to Fortnite. Please help. My son is addicted. My daughter is addicted to TikTok. Please help. How far we've come in such a short time. So another great thing that I had the pleasure of doing is I co-edited and co-authored a textbook with Petros called The Technological Addictions, which was the first textbook to kind of comprehensively cover a lot of these technological addictions, social media, cybersex and online porn, video games. And I think from there, there has been a lot of interest and there's been a lot of, you know, fervor, a lot of desire for a deeper understanding of what exactly is going on here, what can we as psychiatrists do, and should we be doing anything? I think the answer to that is yes. And one of the, you know, simplest statistics that we share that I try to tell people so I can kind of get engagement into this is that even by a very strict defining of what social media is, the prevalence worldwide is probably somewhere in the range of 5 to 8%, maybe in the United States as high as 14 or 15%. So that is among the most prevalent things that we treat. And if you're sitting there and you're wondering, well, if it's so prevalent, why haven't I seen it? The answer to that question is usually because you haven't learned how to ask yet. And so a lot of what we did during this campaign was to try to put information out there, not only for the public but for you all, to teach you how can I start having this conversation with my patients? Which scales do I use? What does the Bergen social media addiction scale actually look like? So a lot of the things that we'll talk about got into that to a certain extent. As I said, a lot of stakeholders are sounding the alarm, the Surgeon General of the United States among them, but also parents, schools, law enforcement. I work very closely with a local school right near our hospital that really sees this social media addiction as kind of public enemy number one. And you know, because our patients are asking, we should be ready to identify and treat this when it's appropriate to do so. And of course, there's a growing body of evidence showing that there are really effective talk therapies for this. And there may even be, when it comes to social media addiction, but certainly for internet gaming disorder, medications that can really make the difference in terms of, you know, getting someone away from perhaps a dependence and to healthy engagement with the technology. So one of the first and most important things that we did was we put out a special report, is social media misuse a bad habit or harmful addiction? I hope that many of you saw this in this special report. We go through the Bergen Social Media Addiction Scale, which is probably the easiest and most powerful tool at our disposal to identify this issue in our patients. If you haven't, please take a look. We also put out a little explainer video that I'm going to play in a second that I'm really proud of. It got 48,000 views in four weeks, and it's climbing, climbing, climbing. Eventually, it's going to take down some of these other. I'm coming for you. And this one is really appropriate for families, patients, providers, anyone. I have shown this to providers at my hospital who want to know where do I even start in terms of my conceptualization of this issue, and I've showed this to parents and I've showed it to patients as well. So let me give you guys a little preview here. Technology is an integral part of most of our daily routines, helping us to learn, socialize and be entertained. But has your online use ever felt like just too much, even out of control? Despite technology's benefits, compulsive technology use has the potential to be problematic in various addictive forms, including social media and general internet addiction, through an obsessive need to check and update social media platforms and overall excessive use of the internet, internet gaming addiction through compulsively playing video games and making in-app purchases, shopping and auction addiction through frequent impulsive online purchases and online pornography addiction involving the need to view explicit content. All of these addictive forms share an inability to control technology use that can lead to missing out on life's responsibilities, be harmful to mental health and adversely impact personal relationships. In some cases, physical symptoms like eye strain, headaches and sleep disruption can appear. A variety of factors contribute to the development of technology addiction, including social isolation and a lack of in-person connections, easy access to technology and its intentional design to keep you engaged and coming back and ongoing mental health issues like depression and anxiety. Children and teens may be particularly vulnerable because their brains are still developing. Online interactions play a significant role in experiences that impact growth, development and mental health. Technology addiction can be treated by addressing underlying psychological factors as well as through establishing boundaries that promote its healthy use. Unplugging from technology and reducing compulsive behaviors can be achieved by increased awareness of potential risks, establishing time limits and increasing in-person interactions. Talk therapy and even medications can help if cutting back on technology becomes challenging. Further, healthy social media use can be experienced by avoiding toxic social interactions that harm one's positivity and doom scrolling or continuing to scroll through bad news despite its negative effect on mood. Technology provides enormous benefits but staying mindful of how we use and how it's affecting us can help prevent or address problems. For more information please visit www.psychiatry.org. Oh I could have shown you the bigger screen version on the next slide, I'm sorry. All right so let's talk about what we what we did. In terms of social media, we had a collective footprint of about 1.5 million impressions, we had 37 posts, we reached about 28,000 users and about 83,000 impressions and again this is early days for this campaign, it was the last one in the year and it's still very much ongoing. I participated in an APA webinar on gambling and online gambling. I think this is again a growing you know point of concern for many of us psychiatrists. The ease with which our patients can gamble away an insane amount of money with the tap of a finger is is alarming to me and I think it really behooves us to ask our patients which apps are you using, you know how are you funding those apps, what was your biggest gain and what's your biggest loss and how much how much are you down right now, do you find that you're chasing your losses, so on and so forth. There was also a webinar that we did on social media and youth along with our child psychiatry colleagues which was really well received. I appeared on the psychiatry show on Doximity, on Sirius XM, the doctor's show which fulfilled a lifelong dream of mine to pretend to be Frasier Crane and take radio calls from people calling and asking young people, old people, am I addicted to social media and me saying some form of I don't know. Here are the questions you should ask yourself. Again we put a psychiatric news special report in April, the Looking Beyond series webinar also in April, a webinar on gambling and online gambling and then we also have a textbook coming up, a full textbook, 13 chapters published by the APA, about 50% done at this point just on internet gaming disorder. We're really seeking to be like the definitive source on this and so I'm really excited to see when that comes out, hopefully not too long from now. Again our animated explainer videos and our social media posts a really big output there. This is I think just rehashing but I think the total impact to date is about 53 million impressions which is really something else. Again it's all down to the team that we had and I'm just thrilled that I could be a part of it and I'll hand it over to Smita. Great, so I'll close us out here. As Dr. Lovonis mentioned, we wanted to involve the House of Medicine and so we had a delightful convening meeting in July where we invited and worked with all of these organizations that are listed here and we created a collaborative action plan and part of that is what resulted in the top ten things every physician should know about addiction and everyone should know about addiction and this has been a widely successful campaign. Everything from trying to distill the the most relatable language to have it at a good reading level to really come to what is going to be most relevant for these groups and getting a lot of feedback from a lot of groups including for example the Addiction Council. So from the House of Medicine we have a lot of outreach as well especially through these top ten things. We've also had some social media posts for example these highlights on some of the specific top ten and with that we have had 3.6 billion impressions from that campaign. As mentioned we've had 50 to 100 million impressions from our other various campaigns and that resulted in 3.9 billion audience impressions from our presidential campaign and so for that I want to be super thankful of our campaign leads but I also want to mention some learnings and one of the first learnings is are the people that I need to and I'm delighted to mention at the APA that I had the privilege of working with. You want to work with the experts. We're psychiatrists. I'm not involved in media or show business. I don't know. Leif may have a future in media with his Naloxone Nation docuseries but you know we all are doing our own thing. James is writing a book on the side here so we're not the experts when it comes to communication and you know psychiatrists we probably should be very good at communication and so we rely on our experts and so I wanted to say that I really truly appreciate the time, the effort, the motivation, and the energy and the constant reminding us we need to get things done from the folks at the APA and we have two of our leaders here. We have Bob Eggensinger, Chief Communications Officer, and in his team Deb Cohen, James Cardy, Cheyenne Brown, Jenny Titterton, and then Kristen Kroger who is Chief of Policy Programs and Partnerships and Brooke Trainam from her team as well and so really without their expertise and them working behind the scenes to make us look good none of this would have been possible and so that's one of the learnings. Other learnings are don't try to do it all. We kept the scope narrow. It was hard to just do the four campaigns. Invite as many collaborators as possible so we didn't do all of the deliverables. We had members from the Council on Addictions as well as partners come to us and work on blogs and other deliverables and it was really you know there's just not enough people that can help us with this effort and so we want all hands on deck and I think that's the spirit of the APA ever since I've been involved in in parts of the APA that we've just I've been so happy to see how inclusive folks are and how much they want to invite participation. That's how so many of us with Petra's motivation and leadership and mentorship ended up getting involved in in what we do today. Language and detail matter. There were nuances that you noticed probably about harm reduction, having a more open conversation. It's different from as Jeremy said different from the conversations that he may be having in clinic. These are things that we wanted to have so that the the conversation was more inclusive. Those videos there's a lot of work that goes into figuring out what's the right set of words so that we are reaching the largest audience possible. And I'll say we're not finished. There is an excellent campaign from the APA Foundation. I will play this video. I never considered myself to be a heavy drinker. At first I only drank with friends then to get through the day. I hit rock bottom when I realized I was choosing alcohol over my family. That's when I made the call. With my doctor's help I was diagnosed with alcohol use disorder. Now I'm getting to the root of my addiction and finding better ways to cope. Mental health care works when you make the call. That's a beautiful example of how our work will continue to live on in addition to all of these deliverables that we have here on this slide. And so with that again I'm just so thrilled with how this campaign turned out and I will highlight our QR code which will take you to all of the deliverables in one place that the comms team nicely put together for us. Thank you. If there's any questions or comments we're happy to take them now. Thank you so much for this wonderful presentation. Just as a being a child psychiatrist along with the drug addiction but the internet gaming addiction it's it's really high. It's very concerning so I'm really glad the APA is you know taking an initiative because the parents, teachers, everyone is struggling. So I'm really grateful for that resource. Thank you. Thank you. And we're glad that we have child psychiatrists like you Dr. Zeeshan who are willing to tackle it head-on. I mean I think this year's work has been tremendous and the impact will be tremendous. Oh hi I'm Gabrielle Shapiro. I'm a child and adolescent psychiatrist here in New York and professor at Mount Sinai and secretary of the APA right now. Used to be child council chair. And so I just wanted to say we might want to also look at the addiction to self diagnosis that's going on the youth and adults. I did a talk that Bob helped me do in Miami for you Miami and it we talked about the internet induced psychiatric disorders and there were over four billion hits for things like OCD you know Tourette's and you know we've seen manifested in different clinical cases you know sort of contagion episodic hundred Tourette's at different hospitals across the country in the ER. So really interesting another sort of addiction to internet and social media. Thank you. Just a quick comment about that. We had a whole talk yesterday about imposter syndrome as a process addiction in medical students and residents and trainees and I was just thinking about that when when you were saying that. But yeah I agree if I had a dollar for every time a patient came into our IOP and said I have autism and I found out on tick-tock I mean I wouldn't be here I think I would be in a Caribbean island somewhere so it's a big issue. Hey I'm Tara Kerner I'm an adult psychiatrist in Connecticut and one thing that I got from this talk today which thank you was how to talk to sort of clients patients lay people about addiction. I recently got some funding in Connecticut to talk with doctors though about prescribing and so I'm about to start that initiative where literally I'm going out and speaking with pain management dot pain management primary care doctors about opiate addiction and prescribing of suboxone. How any suggestions on how to adapt the language for prescribers and sort of teaching them about this grant is focused on opiate addictions and so you know prescribing of suboxone how simple it is how easy it is how simple Narcan is and sometimes I feel like I also need to modify the way I speak to the medical professionals as well and sometimes I get too technical and I think I need to like bring it down a little bit for them as well so I don't know that makes sense. Sure I mean that's that's awesome wait so you have some money to do this in Connecticut? Hey good for you. You know I think when I talked to other providers so we do this at UT like I met with a number of other docs who want to start prescribing buprenorphine and we actually talked about this a bit yesterday our council meeting is it's usually just like the first time like there there's a study came out recently showing that the number of buprenorphine prescriptions hasn't really increased since the X waiver went away although the interest is there and so anything that can reduce that anxiety I think is is the key or it has been in my experience so you know if if you're helping somebody prescribe for the first time making yourself available like you know walking through what the contingencies are going to be if things go off the rails you know what does that look like what do you do about it and you know the great news is that there's a limited set of things that can really go wrong and so you know walking through those with whoever's kind of holding their hand has been successful in in my experience. I might add on one thing I completely agree I think so I spend a half a day a week in primary care as well kind of talking about these issues case selection really matters but I think particularly in primary care where there may not be as much kind of robust behavioral treatment or support so whenever someone's doing their first buprenorphine induction or really any kind of medication for a substance use disorder I really help them think about how to kind of stack the odds in their favor for the first few cases by choosing appropriate cases and not ones that are so severe that kind of it'll be tough to kind of manage in that setting and the second is I think that primary care providers have a very little bit of time to address a lot of comorbidities and so often I will focus just as a part of my kind of education or motivational interviewing whatever we want to call it on the medical issues impacted by the substance use that is kind of top of mind so if you are worried about this person's risk of having you know another stroke let's talk about their stimulant use disorder you know so I think making it very pertinent to what they're trying to focus on in their limited time is really helpful one other hint that comes to mind as well as sometimes I'll invite other providers just come join me in clinic and kind of see what it looks like directly if I may add first first time I forgot to introduce myself and Petros will say you didn't introduce so I'm a musician I'm a faculty at Rutgers I think two comments about the you know the tick-tock and the diagnosis on social media so one thing I am teaching in my patient population you know whenever you type depression type depression recovery because whatever the word you type tick-tock same kind of videos come so many time when children teenagers when they type they are trying to get some help the moment they put depression suicide all the people who are talking about depression suicide that comes so one talking point that I'm sharing with them is depression recovery depression treatment the second thing which is very frustrating for many parents they say okay no we know our child is addicted what to do we took away the screen who took away all those things we call crisis multiple time and that's where I share you know this strategy I said you know there are five S's that make every child to be addicted to anything so every child want to feel seen want to feel safe want to feel soothe want to feel significant and want to feel successful and I encourage parents I said that's so every child want to feel seen safe soothe successful and significant and I told them you know the the screens are not toxic itself they become toxic when our child children are getting all those five S's only from the screen and and I encourage them you know that if you want to help your child with the screens don't take away the screens bring offline activities where they can be feel seen safe soothing activity thank you great point I mean all of that and I hadn't heard the S's thing before but I am gonna write that down I'm gonna text you later so you can remind me but I we know building off of what you said I also wanted to say and this is germane to a lot of our a lot of our initiatives and to a lot of what we do is you know you should be you should be asking your patients where are you getting this information and you should be asking them to share that information with you you know if if someone is using kratom and they're learning about the perceived benefits of it via reddit I asked them can you show me the post the reddit post where you where you you know learned that kratom has no downsides and is great for you know recovery after the gym so on and so forth and if you actually take a minute to look at that then you can you know identify with the patient there okay well this is actually true but did you know you know actually this point is a little bit off and actually it's a stimulant at low doses but it's full opioid agonist at high doses and I find that that type of intervention can be very very effective did the paramedic have prescription prescribing privileges did he say he could prescribe yeah great question so no so he's not a prescriber so there's an MD that supervises that program and then actually the prescriptions filled and then kept in a lockbox in the ambulance and so the EMT actually does give the doses to patients so they will go meet them anywhere in the community and he said in the woods under a bridge at their home wherever but it's supervised by the medical director for the EMT program and that's for the Narcan of the beep that's for buprenorphine yeah just another comment on that we just got a grant for a mobile crisis team and we do have a nurse practitioner who goes and gives the medication on site but we also have a peace officer as part of the team not in uniform and uniformed but we do that for the safety of everyone because we we operate in a highly you know high-risk area of the country but also has the benefit that it brought us much closer to police brought us much closer to peace officers so that they can do this kind of work so that program is I'm particularly proud of wonderful well I'd like to thank you all for attending I just think one more comment before we close a huge thank you again to the staff to Bob and to Kristen thank you so so so much I mean incredible work there are things that I would never have considered at all I don't know if you noticed that in the last video there was a plug there for telepsychiatry where the person is seeing his doctor not you know in person but through like a video just these things that are not part of our kind of way of advocacy and going out there but of course they can be brought up by the experts as you said the experts in the field so huge thanks to the two of you and your staff for these campaigns. Thank you. We'll close with that. Thank you.

American Psychiatric Association

addiction

Presidential Initiative

vaping

opioids

alcohol

technology addiction

Dr. Livonis

Dr. Smita Das

naloxone

treatment advocacy