My name is Dr. John Mariani. I'm the president of the American Academy of Addiction Psychiatry, and I welcome you to the 35th AAAP Annual Meeting and Scientific Symposium in Naples, Florida. We have over 500 attendees here in person, and we're thrilled to see so many familiar faces and new ones. I'm honored to be with you here today and welcome you. This is the coming to the end of the first year of my term as the two-year term as president. This is the halfway point, and I just wanted to spend a few minutes reflecting on what AAAP is working on and what to expect in the future. I first want to start out just acknowledging the AAAP staff. Our CEO, Catherine Cates-Wessel, and our associate director, Michelle Durst, are providing outstanding leadership, and the entire staff works really hard throughout the whole year, but especially hard to put on our signature event, which is this meeting. So let's just start off with a round of applause for them. And when you're out and about in the reception area and at the registration desk, feel free to thank them and shower them with praise. Just a few personal remarks and just starting this. I've been coming to this meeting since 2002, and I really find AAAP has always been my professional home, so I'm really happy to be here. And the meeting itself, I found, really is what attracted me to the organization. I felt that the scale of it was manageable, and I met a lot of people here that have gone on to become mentors, friends, colleagues, and I look forward every year to coming here. So I'm really happy to be here, and the time that I've spent in various aspects of working in the organization have been really rewarding to me professionally, and I encourage everyone to try to get involved. There's really a lot of opportunities within the AAAP for professional activity that's not clinical care or administrative, where we have opportunities in policy and other education, other aspects of keeping the field going. I'll talk more about that in a minute or two. So things I've been focusing on, for people who read the newsletter, I wrote a column at the beginning of the year talking about my own personal concern that the fellowships, ultimately, the addiction psychiatry fellowship training are ultimately one of the foundations of our specialty. And we're doing OK. We filled about half the positions this year, and we have about the same number of programs open and programs closed. We have about the same number of programs, recruiting is in the low 50s, which is what it's been for a long time. But I think there's clearly a very large gap between the workplace need for addiction psychiatrists and how many people we're producing. And I'm certainly interested in trying to understand the current state of encouraging young people to come into the field and what the AAAP as an organization can do to facilitate it. My general suspicion is that recruiting, getting more general psychiatry residents interested earlier is probably part of the answer. But I'm spending some time, both at this meeting and outside the meeting, I plan to try to talk to as many program directors that will meet with me to gather information. And then next year, I'll come back with some recommendations on how we can potentially be addressing this together. Other things that are happening potentially with the fellowship training is ABPN, American Board of Psychiatry and Neurology, is considering moving towards fast tracking, which would be to let general psychiatry residents enter the fellowships in their fourth year. That's something they're thinking about and considering. It's not a done deal yet. The feedback I've gotten from program directors so far is that that potentially would help with recruitment since the top consideration that residents give for not wanting to pursue fellowship training is just concerns over debt and another year of reduced income. So we'll have more about that for me in the coming months. Probably write another column about it. Another important thing that's happening this year is that the American Journal on Addictions, which is the journal that the AAAP owns, that it's our journal, our editorial leadership team is going to be leaving. And we're going to be recruiting new leadership. The editor Tom Costin and the deputy editor Kareem Domingo will be stepping down. They've been of service for many years. And the journal is a great resource for the field, for the scientific community. And we really appreciate their hard work. Tom's here somewhere, but we'll give Tom a hand. He's really participated in founding the journal and has really worked hard for a long time on it. And we're going to have trouble replacing him. We're working at it, but we're going to miss his leadership there. Another area of organizational change that we've made in the academy, the last couple of years we've met for strategic planning, and we've reorganized our committee and special interest group structure. And the way that we structure committees and special interest groups now is that the committees are expected to be meeting outside of the annual meeting, in addition to having meetings here, and should be working on elements of the strategic plan driving these goals forward. And so the committees really are an opportunity. And we have over 10, maybe 12, 13 committees. And they're meeting throughout the annual meeting. But those committees, if you go to one of these committee meetings and sign up, you can also participate during the year. And there's lots of opportunity for various professional activities that I think we're really doing some interesting stuff. Special interest groups meet at the annual meeting. They can meet outside the annual meeting. And special interest groups, if they put in work outside the annual meeting and start developing a work product, could be promoted to committees. So that's something that's changed in the last few years. And I think the organization's more effective as a result of that. Another area of change that we've had, we've had a number of paid courses that the AAAP, CME paid courses that the AAAP offers. The addictions and their treatment courses we've had for a very long time, for decades. And that has traditionally been seen as a board review course primarily, especially since the board, the recertification process is changing. And there's probably less demand for studying for recertification tests. Their orientation is changing a bit. And they're going to be offering two different curricula where one year is more focused towards the year that the board exam is offered. They'll be offering a curriculum geared towards that test. And then the other year, the alternating year will be a different set of topics, but focused more on basic addiction psychiatry. The advanced addiction psychopharmacology course, which I'm one of the course directors for, along with Kevin Severino and Christina Breesing, we are doing the same thing. We just finished the second of the two year alternating curriculum. So the first year is focused primarily on pharmacotherapy of substance use disorders themselves. And the 2024 course was focused more on pharmacotherapy of co-occurring conditions and other special situations. So now with those two courses each having two components to it where we have potentially a suite of four courses, we're looking to develop a paid CME psychotherapy course. And then the general plan is we'll have a suite of five courses and then offer an exam. And I think that this will be a nice opportunity, particularly for general psychiatrists who've not done fellowship training, although others I think would benefit also, other physicians, nurse practitioners, to get a pretty comprehensive amount of didactic material all in one spot. And these courses are also offered as enduring products. They're video on demand. So we're very excited about that. The full fruition of it's going to take a few more years, but we've been working hard on that. So as we move on to our program, I'd like to offer a friendly reminder to please turn off or silence your cell phones during the presentations. We do hope, however, you'll share your favorite moments of the conference on social media using the hashtag triple AP24. To start, I want to recognize the hard work of our scientific program committee chaired by Dr. Aoun. Without his great leadership and the hard work of this committee, none of this would have been possible. I always say that being the scientific program committee chair is the hardest job in the organization. It's really a lot of work to put this conference on, and we really appreciate them. Under his leadership, the SPC has put together a fantastic program. Dr. Aoun is an assistant professor of clinical psychiatry at Columbia University, division of law, medicine, and psychiatry, and the chief of psychiatry for the New York State Sex Offender Treatment Program. Would the scientific program committee members in attendance please stand up to be recognized? OK. OK. I'm now going to hand it over to Dr. Aoun to get us started, and thank you all for being here. All right. Thank you, John, for this great introduction. Are both microphones on? All right. So welcome, everyone. I'm very, very excited to welcome you all to this 35th annual meeting for the American Academy of Addiction Psychiatry. We have an incredible program, and I'm not just tooting the SPC's horn, but we really do have a wonderful program that we have for you. Like we always do, we had a lot of submissions, and we were lucky to select a lot of wonderful talks for everyone to attend. It's great to see you in person. I know that we missed each other in person for a couple of years, but things are back in person. I really wanted to thank the AAAP staff, who've done an incredible job. Catherine, Michelle, Kamala, Jamie, Beth, Nicholas, Seth, everyone, thank you. We take all the credit, but you guys are doing all the work, so thank you. Now, Gabel, the meeting is in order. The first thing I'm going to ask you is, please download the AAAP app. You can go on your app store. It's called AAAP Conference. Apple, Samsung, any phone you have, you can find it there. The other reminder is we have a great exhibitor hall that's open till 5 PM today, till 4 PM tomorrow, till noon on Saturday. So stop by and visit them. And what else do I want to talk about? This is going to be a family-friendly meeting. I know that a lot of us have brought family members with us. There's going to be a family event, family social gatherings at 10 AM at the pool, at the mangrove pool. The other reminder is a reminder about the scavenger hunt. All the trainees should have gotten an email about that, and you can find the information for the scavenger hunt in the app. That way, you can get to meet others, socialize with others. And then the winners of the scavenger hunt are going to get a prize. And once you win, please bring your scavenger and heart to the information desk, and you can get your prize. We always have a reception, a fun reception, with a nice dinner and some alcohol. So that's on Saturday, and we moved it a little bit earlier so that you can go out afterwards and explore Florida. The theme this year is disco, so we have a tie-dye station. If you didn't bring any disco clothing with you, there's the tie-dye station where you can tie your best shirt. Well, you're not going to have to tie your own shirts, but the AAAP staff have brought shirts that can be tie-dyed. It's stopped by the information desk, and you can get more information on that. The other exciting thing that we have this year is the film and media workshop. This year, Dr. Schroeder will be presenting a film called Sip and On Scissor, Hip Hop Culture, Lean, and Media Presentation of Opioid Use Among Minoritized Populations in the South. And he's going to be joined by a medical student, Adit Ram, and then Dr. Michelle Durham from Boston University. Now, before we begin, I'm going to give you a couple of housekeeping items. The information desk is where you can have all of your questions answered. It's right outside the store. Very friendly staff. And then on your badges, you're going to see in the back of your badges two different colors of tickets. The red ones get you drinks in tonight and Saturday's reception, and then the blue ones are for the lunches, for the box meals today and tomorrow. In order to get the CME credits, you have to complete the evaluations that you're going to be getting every day, at the end of every day. If you would like to go and explore Florida, all of the sessions are going to be recorded, so you can watch them at your leisure after the meeting and still get the credits for them. We're probably not going to get the recordings until after the holidays, so of course when the recordings are available you're going to get a reminder by email and you can access all the recordings that way. We're going to have a lot of symposia and workshops at the end of every session. There's going to be a Q&A. If you'd like to ask questions, you can come to the middle of the aisle, there's going to be a microphone and you can ask. There's a microphone on this side and a microphone on the other side. That's it for the housekeeping announcement. Now I'm happy to welcome Dr. Mariani back to start the first session. Thank you. Okay. Alright, hello everyone. I'm very excited to introduce Dr. Petros Lavounas to you all today. He's going to give a brief speech about confronting prevention to recovery, followed by an interview with Dr. Aung. Before I read Dr. Lavounas' bio, I just want to share, I've known Petros for a long time. We were just reminiscing. I first met him when I was still a resident. He was a faculty member at the Addiction Institute in New York and a co-resident of mine knew him. I was going to meet with him to just get some career advice about pursuing fellowships and a career in addiction psychiatry. I think that's just an important reflection because I think Petros is somebody who's really always been committed to the field and available to trainees and junior people in the field as a source of guidance and assistance. He really has an optimistic, positive disposition and I think promotes and makes the field seem attractive and fun. I'm really glad that he's here today. Dr. Lavounas serves as a professor and chair of the Department of Psychiatry and is the associate dean at Rutgers New Jersey Medical School. He's the immediate past president of the American Psychiatric Association. Dr. Lavounas came to Rutgers from Columbia University where he served as the director of the Addiction Institute of New York from 2002 to 2013. This morning he will be speaking about Confronting Addiction from Prevention to Recovery. Dr. Lavounas, please join us on stage. Thank you. Thank you so much, John. I'm absolutely delighted to be here and giving this keynote address. I'm honored more than anything else being among my peers and so many of my mentors here. I'm not going to name anyone because there are just so many people who have contributed to my professional and personal development over the past years. So I was asked to talk today about our work at the American Psychiatric Association over the past year, specifically as it pertains to addiction psychiatry. Every president of the APA has a theme, a theme they choose a theme to focus on during the presidency. My two major academic interests have been addiction psychiatry and LGBTQ mental health. It was kind of a difficult decision to choose one over the other. Somebody suggested to combine the two. Terrible idea. Absolutely terrible idea. Totally feeds into that stereotype that all there is to it. Anyway, I chose addiction psychiatry for many reasons and I'm very glad that I did. Our efforts in promoting addiction psychiatry, getting the message out, had two major arms. One of them was the mini-campaigns. We decided to do four campaigns, one each for three months each. The first one was on tobacco and vaping, the second one on alcohol, the third one on opioids, and the fourth one was on technology. And the idea behind those mini-campaigns was to really focus on the things that we are absolutely sure about, the things that are not controversial, the things that are not cutting edge, but the things that have not been implemented to the general public. And I'm glad we did that. I would say that this part of the presidential theme was particularly successful, headed by none other than Smita Das. I'm not sure if Smita is here today. Smita, are you here? I don't see her, but she did an amazing job spearheading the four campaigns and getting the message out. We're talking about hundreds of thousands of ticks or appreciations on the internet. I'm not quite sure how they measure these things, but we did op-eds, we were on CNN, we were on other TV programs. And for each one of those four topics, I think that we did move the needle significantly. The second part of the presidential theme was not quite as successful, and that was to bring together different like-minded people and organizations, including, of course, AAAP and ASAM and other professional organizations like pediatrics, osteopathic medicine, family medicine, internal medicine, OB-GYN, pediatrics, people who work with us in all kinds of other ways during the APA. We convened a group, and we exchanged ideas. We produced two documents, which I'm proud of, the 10 things that every physician should know, and the 10 things that every person should know about addiction. They were very well thought out, and they look good, and I'm glad we did that. But the group was not sustained. I think it was sustainable, but it did not sustain. So, yes, we did move the needle, but we failed in keeping the needle moving. So when I think back about that, how come that group did not really gel and move forward, I think that we missed the mark as to whom we invited to that group. Not so much the professional organizations, but much more who represented those organizations. We focused on the president, the president-elect, and maybe the executive director of the organization, but in retrospect, I think it's the communications people. If we're ever going to do that again, either from AAAP or from APA, we do need to bring together whoever is responsible for communications in each one of these organizations and have them hopefully come together and help us promote whatever message we want to propagate. So that was pretty much my presidential year at the APA. It was a lot of work, obviously, but lots and lots of fun. Had wonderful people join our effort, and I'm really proud of what we accomplished in 12 months. Thank you, Petrus. Talking of pride, I take a lot of pride that one of our own, an addiction psychiatrist, was the president of the APA, the biggest psychiatric organization. So thank you for representing our field so well, Petrus. You talked a little bit about the road bumps that you encountered, but can you tell us a little bit more about how you see the work that you did with the APA during your presidency? How is that going to inform the practice of addiction psychiatry and addiction medicine down the line? Our main focus was a little bit beyond the addiction psychiatrist. We know the stuff. We come to these meetings. We get the best of the best to give us this symposia and workshops. We're more concerned about the primary care physician, perhaps the general psychiatrist, and things that they may not even know. There are people out there who've never heard of buprenorphine, and they are full physicians being certified by their own board. So as basic as that, something as fundamental as that in our work is missing out there. Even when people know about the science and know about the safe and effective treatments that we have for addiction, very often they say, that's too hard. That's too much. I cannot go there. It's not really my responsibility because it's just too complex. One of the leaders in addiction medicine wrote a book and started the textbook with the first line being, addiction is the most complex illness of mankind. Wow. Addiction is the most complex illness of all mankind. You don't attract people to treat addiction that way. You scare people away. It's like too much. Our effort was to simplify, simplify, simplify things at the cost sometimes of some sophistication. For example, there was a major discussion in our group about vaping. On one hand, we wanted to make sure that vaping does not really afflict young people. On the other, of course, as you know, there are data to support the idea that somebody who is like 40 years old and has been smoking two packs a day all their lives and they do not want to go to FDA approved medications, there may be very well a place for vaping for them. So do you just cut some of the sophistication out in order to give a message that's clean and very clear and perhaps more effective? These were kind of interesting discussions that we had in our group. But once again, the main focus was simple, simple, simple. Let's boil down what people are missing here so that we can move the needle forward. We have 600 people roughly registered to this meeting coming from all over the country, from all over the world. We have people from Brazil to Saudi Arabia. These are all people who are addiction psychiatrists. What's your advice to expand the mission of your APA presidency? How can they support their colleagues? What can people do at an individual level? I think that we need to move somewhat our responsibility from treating patients, which of course is a major responsibility that we have, a major privilege that we have, to see ourselves as teachers. When I get a third year medical student or resident who says I'm thinking about addiction psychiatry as a career, one of the first things that I ask them is, how do you feel about teaching? Because if you're allergic to teaching, then this is not going to be good for you. There are so few of us around that we have to see ourselves as educators, as the ones who are going to train the trainer model, to move our expertise out there. Then hopefully there are competent people, primary care clinicians, who can take that and put it a step further. For people who are curious, can you tell us something that you learned about working as the APA president that most people wouldn't know about the inner workings? Why is it so complex to get things done? Behind the curtain idea. I knew there would be tough questions here. Okay. Well, I was delighted to find out the level of support that I got at the APA, but also the level of oversight. I couldn't really say anything. Before somebody would ask me a question, I would just blab out an answer. Not so fast at the APA. Things need to be checked out. I remember giving an interview when I was still president elect for some television station. I said, blah, blah, blah, blah, blah. Addiction is such a blah, blah, blah. It's a call to arms. The APA went behind us like, whoa. Don't say call to arms. The gun control people just behind you ready to talk here. It's a call to action. Okay. All right. Roll back. It's a call to action. Just a small example. Everything had to be vetted. I'm glad because there were Scientology people who approached me to sign this and sign that. As you know, people are very shrewd and clever. They have ways of masking. The word Scientology never showed up, but they have other proxy organizations that sound very, very legitimate. If I didn't have that kind of backing and that kind of very thorough vetting that I got from the APA, I might have been falling for them. Petrus, when I became an addiction psychiatrist, when you became an addiction psychiatrist, addictions was not a sexy field. Over the past 10 years, that has changed. There's a lot of interest from everyone in the community, from medical students. People are interested in addictions. I think there's an opportunity to capitalize on. With that in mind, that comes with a lot of good opportunities, but also a lot of risk. You see a lot of non-evidence-based treatments that are out there. A lot of people who say, well, treatment is this. Everyone is trying to define what treatment and addictions is. What needs to happen in terms of spreading the message on what evidence-based addiction treatment is and what the role of the addiction psychiatrist as the leader of a lot of these teams is? That's an excellent point here. We talked a lot about technological addictions. One of the first things that we would say is if we're talking about social media addiction, we're talking about people who meet some criteria and maybe 2% or 3% of the population. We're not talking about the vast majority of people who are engaged with social media and will be just fine with it. Well, not so fast. I think that people are now asking us not just simply talk and say something intelligent about people with a DSM-5 TR or something that can be diagnosable as a DSM-5 TR illness. They also want some advice and they want some direction and they want to talk about problematic use of not only alcohol but this and that and just expand our expertise beyond the very kind of narrow medical diagnosis. And we are ambivalent about that because it's a little bit outside our area of expertise but that's the ask. That's the what society is really demanding from us. And let me just say something that maybe doesn't sit very well with people but psychologists have done that quite successfully. You go to psychology today on the internet and you find pretty well evidence-based things, a lot of times written by psychiatrists by the way, Mark Gold being one of them, but that you know go beyond just illnesses as to kind of social problems. V codes if you like from the DSM, you know, marital discord, all kinds of things that can come up in people's lives, acculturation, retirement. And we're not comfortable as psychiatrists talking about these matters but the ask is there and going back to your question, if we have any chance of helping people not give in to crooks who promise them, you know, X, Y, and Z, then we have to take on this task. Thank you. So when you started our conversation today you talked about the relevance of addictions to the LGBTQ community and I'd love to hear your thoughts on what needs to happen in terms of promoting treatment and supporting the LGBT community address addiction related issues and what can allies to the LGBTQ community do to help? Yeah, when I think about that I think about context, context, context. There was a study about LGBTQ mental health in in New York and I was in charge of the addiction part of that survey and the results of the survey made the front page of the New York Times, it was very well received and my question, my section was not addressed at all. The people who were in charge of the of the project decided not to go there, they just put the addiction aside. That was some years ago but the things have not changed that much and it had to do with the cultural context of New York that at least at the time was not particularly ready to make that connection. Cut to San Francisco where San Francisco is a very different kind of situation where LGBTQ issues are very mainstream and so you can have huge advertisements alerting the gay community to the risks of chem sex, of using chemicals while having sex and the like. So it is quite geographical in a sense, does the community and as we're entering a new administration now in the next four years things may become a little different in terms of what its culture accepts or how they interpret whatever messages we may want to be delivering. So I'm saying all that to caution people to when you, when anybody starts a campaign on LGBTQ issues, take a moment to think about who the audience is and how they are going to be interpreting your messages. So that would be my thought there. In terms of LGBTQ mental health and specifically about addiction, yes there are some unique things. For example, crystal methamphetamine use among gay men, it is somewhat of a unique phenomenon. It does need some special attention and there are treatments that are more, you know, tailored to this population. But in general, I don't know, opioid addiction is opioid addiction and alcoholism is alcoholism and tobacco use disorder is tobacco use disorder and it applies. I'm much more impressed by how similar gays and straights are in mental health and and in addiction issues rather than how different we may be. One thing I always remember from a presentation I attended that you gave is a slide that says in big font, why it's not okay to not know about Grindr anymore, which kind of brings me back to the issue of what, how allies can participate in this and I think you mentioned some campaigns, but is there anything else that you... Yeah, well back when I trained, it was totally the responsibility of the patient to teach us about their own subculture. So, you know, we would be just fine to be there and be non-judgmental perhaps, but it was just the responsibility of the patient. In 2024, things have changed, thankfully, and it's a joint effort and so the patient has some responsibility to teach us about the specifics of their world and we have some responsibility to learn about these worlds. You can, very easy, you just go to Wikipedia, you go on the internet, you find about a particular kind of subculture that our patient may be living in, you learn about the new substances that are out there. So, yes, I had a patient who was very much in the kink world. I didn't know much about it, I didn't know anything about the kink world and there are specific things there that, how they train the police officers when they are called into a particular venue, not to be able to discriminate between a crime and a non-crime, all kinds of things that I didn't know about, but I learned some from my patient and some I had to do my own research so that I can treat my patient better. So, yeah, that's, what was the question again? It was about the role of allies. Okay, some of our trainees, whether they're fellows, residents, or medical students, get paralyzed because they think they're gonna make a mistake in front of an LGBTQ patient. God forbid I use the wrong pronoun and I offend somebody, so their go-to is to shut up, not to ask any questions and actually isolate themselves or isolate the patient from the medical team. So, my advice there is, in the moment, just go there, ask the question, whatever may be, and if you make a mistake, so what, you, oops, and you know, you apologize and you move on. At the same time, you educate yourself the best you can about the particular culture or subculture that your patient lives in. And I do have a personal example here, since this is a fireside chat here. True story, my husband goes to the doctor at the place where I work and, you know, during their initial conversation, my husband tells the doctor, says, you know, Petros Levounis, you know, he's chair of psychiatry here, you know, he's my husband. And the doctor goes, oh yeah, of course, I know him, yeah, great, great, great. And then she pauses and goes, ah, so you're gay. Yeah, of course, I'm gay. Ah, okay, who's the man, who's the woman? Like, it's such a kind of outdated, you know, wrong, all the things you can think about. And yet, she was coming from a point of view of curiosity and warmth and wanting to find out more about us. So, you know, so what did she use, like a whole construct that is just really neither here nor there. She was really interested in us and I think that's so far more valuable than using the correct pronoun or saying the exactly correct thing to us. Or not saying anything. Absolutely, that's probably the worst. You were talking a minute ago about fellows and residents and I know both you and I are very passionate about education, training, and working with more junior people. What, I'm gonna ask you an annoying question, can you give us five pieces of advice for, three pieces of advice for a medical student who's interested in pursuing a career in addiction psychiatry? Oh, wow. We're talking about medical students? Oh, start with medical students and then move to residents and fellows. Okay, well one of them I have already kind of delivered, so one down, four to go. Certainly an interest in teaching will be a major part to that because we're going to be called to be consultants and teachers and educators and all that more and more so in the next years. I think there's little doubt about that. The second one is a matter of affect, like there are patients who use substances who have a substance use disorder somewhat different affectively than let's say other psychiatric patients and so you need to be comfortable with that and you need to like that. And if you happen not to like that, then that's a deal-breaker. You know, you're not going to teach yourself how to like it. I would say the third thing is that it's an incredibly rewarding specialty in that when the patient does well, the patient does extremely well. I vow not to mention any of my mentors here but I cannot help myself. I learned that from Mark Gallanter sitting right here in the front row, my first mentor in addiction psychiatry. Thank you so much Mark. And I find that to be so true 30 years later that when the patient does well, the patient does extremely well and they're so grateful and so happy to see you even though they may be not using anymore and still being under your care. How am I doing? Three? You're good. I'm good? At the beginning I said I want to make sure that people get to participate and ask questions. So we still have some time. I would love to get some questions from the audience that that way you can all give me a break. I see some usual suspects going today. Yes, there you go. Thank you so much Petros. Carol Weiss here. Yes, you are a mentor and a hero to me. Thank you so much for all the wise things that you said. I was interested in the concept of simplify, simplify, simplify, which is a very smart approach. How do you balance that with the nuanced perspective of there are certain things that the primary care psychiatrist and primary care physician can't handle? How do you teach when to refer? How do you teach when to refer? I do use analogies. I do use analogies with diabetes quite often. I say that any primary care provider should know how to treat diabetes, but if you have a brittle diabetic with DKA's going in and out of the hospital, you need to call in the endocrinologist to offer some extra expert advice. Similarly for us, if you have somebody who's on buprenorphine and need to be in the hospital going through surgery and need the full opioid, you know, analgesia and becomes a little complicated, then you may very well need to call an addiction specialist, an addiction psychiatrist to offer some opinion there. So that's how I use it. Yeah. Thank you. Thank you. Do you have a question? Well, thank you very much, Petros. Wilson Compton from the National Institute on Drug Abuse. And your leadership of APA has been just such an important milestone for our field, one that our institute has been pushing for in terms of the integration of addiction into general psychiatry now for quite a while, at least throughout Dr. Volkow's tenure at NIDA, which is 21 years and counting so far. My question for you is, how do we build on the momentum of a temporary presidency at APA? How can AAAP help with that? And how can your allies in the federal government, such as NIDA and NIAAA and others, help with this effort? And I will just add one pet peeve of mine is people often talk about addictions and mental illness as if they were separate conditions when we are part of psychiatry. Addictions are just one other disorder within the psychiatric nomenclature, for example. I'll just make a comment about the last one. The way that I use it is addiction and other psychiatric disorders. That's my kind of way to formulate that. Or substance use and other psychiatric disorders. In terms of how we make sustainable change, the answer is pretty straightforward to me. Forget about presidents. Presidents come and go in all these organizations. Turn to the permanent staff. The people who are there year in and year out and do the work. There's such a thing as called the group of six, which is psychiatry, pediatrics, OBGYN, family medicine, internal medicine, and osteopathic medicine. And we come together and we go to Capitol Hill and we advocate for all kinds of things that have to do with primary care. And we're extremely powerful. We represent 300,000 physicians. But this organization, the group of six, has been so successful because it just has the presidents as figureheads. It's all run by the permanent staff. And I think that that's something that we may want to take at heart. I'll keep them in my Rolodex in a prominent place. Thank you. Thank you. Unfortunately, I think we're running out of time. You want to take one more? You're the boss here. I'll get in trouble. Dr. Livounis is going to be here for the conference. Please see him outside. Thank you so much for this conversation. Thank you so much. All right. Thank you. Thank you.

Addiction Psychiatry

AAAP Annual Meeting

Fellowship Positions

Leadership Transition

CME Courses

Addiction Education

LGBTQ Support

Cultural Contexts