We both haven't changed enough to just forget The windows we built with another, the secrets we spoke I'm sorry, I'm sorry if it doesn't mean too much right now I know that you've probably forgotten, but these things don't weigh me down I missed the way my mom knew what to do She said to do her by her name and I'll do her by you When we get older we can forget the truth But if you do her by your name, I'll do her by you I'm sorry, I'm sorry if it doesn't mean too much right now I know that you've probably forgotten, but these things don't weigh me down I missed the way my mom knew what to do She said to do her by her name and I'll do her by you When we get older we can forget the truth But if you do her by your name, I'll do her by you Time flies by when the night is young Daylight shines on an undisclosed location Location Bloodshot eyes looking for the sun Paradise delivered and we call it a vacation Vacation You painted me a dream that I wouldn't belong in Wouldn't belong in Over the hills and far away A million miles from LA Just anywhere away with you I know we've got to get away Some place where no one knows our name We'll find a start with something new Just take me anywhere Take me anywhere Anywhere away with you Just take me anywhere Take me anywhere Anywhere away with you Nonetheless Nonetheless Truth comes out when we're blacked out Looking for connection in a crowd of empty faces Empty faces Your secrets are the only thing I'm craving now The good and the bad let me in Cause I can take it I can take it You painted me a dream that I wouldn't belong in Wouldn't belong in Over the hills and far away A million miles from LA Just anywhere away with you I know we've got to get away Some place where no one knows our name We'll find a start with something new Just take me anywhere Take me anywhere Anywhere away with you Nonetheless Oh, anywhere Anywhere away with you Take me anywhere Over the hills and far away A million miles from LA Just anywhere away with you I know we've got to get away Some place where no one knows our name We'll find a start with something new Just take me anywhere Take me anywhere Anywhere away with you Anywhere, anywhere, anywhere Oh my, my, my, I die every night with you Oh my, my, my, living for your every move Spark up, buzz cut, I got my time between your teeth Go slow, go fast, feel like you're just as much as me Oh my, my, my, let's start running from love, running from love Let's start my thing, my thing Let's start running from us, running from us Let's start my thing Oh my, my, my, I die every night with you Oh my, my, my, living for your every move Oh my, my, my, I die every night with you Oh my, my, my, living for your every move Every move All right. Good morning, everyone. It's good to see you all again. I hope everyone had a good night and you were able to get some rest. I'm excited to start the second day of our conference. Today's the first day of the networking bingo. So remember to get your cards, remember to fill them, and then the first five people to get their cards completed will get a prize that you can claim from the information desk. Now, a reminder of the housekeeping rules. Keep your phones off. The information desk is your best friend. The reception tomorrow is disco themed, so if you don't have any disco clothing, you can get a tie-dye shirt. Well, you're not going to get a tie-dye shirt. You can tie-dye a shirt that will be provided from the information desk. I heard that no one is taking us up on this offer, so it's a lot of fun. Please do it. And if you have any questions, there are two microphones in the aisles. You can ask them at the end of the symposia. And that's it for the housekeeping remarks. So the first event for today is I'm very excited to kick the day off with the first keynote session honoring the recipient of the Outstanding Achievement and Service Award, Dr. Esmini Petrakis. So please give Dr. Petrakis a round of applause. Dr. Mariani will be interviewing her. Okay, good morning. John Mariani here. Very excited to introduce Dr. Esmini Petrakis today. Dr. Petrakis is a professor of psychiatry at Yale University and has served as chief of psychiatry and mental health services at the VA of Connecticut for over a decade. She earned her undergraduate degree from Northwestern University and her medical degree from the University of Pittsburgh, completing her residency in addiction psychiatry fellowship at Yale. With over 25 years of experience, she focuses on clinical treatment and research in addictive disorders, receiving funding from various sources, including NIH and the VA. So Dr. Petrakis, if you would please join me on stage to accept our Outstanding Achievement and Service Award for recognition of your exceptional contributions to the field of psychiatry, your dedication to advancing the treatment of addictive disorders, and your commitment to education and mentorship in mental health. Your impactful research and service have greatly enhanced the lives of many individuals struggling with addiction and co-occurring disorders. Wow, thank you so much. Can you hear me okay? I'm so honored and touched by this award, especially knowing who came before me. I just feel like I'm in an amazing group, and I really thank you all for this. So I'm just going to say a few words, hopefully, if I can get the slides to... They are not moving, I don't think. Is it me, or... Wow. Okay, thank you. All right, you already heard this briefly. I went to medical school at the University of Pittsburgh. I came to Yale to do my residency. I stayed to do an NIH T32 fellowship, which also served as my addiction psychiatry fellowship. And then I joined the faculty, and I've been there ever since. So I just want to say a few words. How did I get interested in addiction psychiatry? Well, I did have this sort of vague interest in addiction when I was in medical school. It wasn't particularly well-formed, and at the time, you only saw patients with addiction in other settings, you know, medical settings. But I was kind of interested in sort of it from a cultural aspect almost. Like I didn't understand sort of the life that they led, and that was my first just little bit of interest. So when I was a resident, we were given an opportunity to do research. Dennis Charney, who was the associate chair at the time, asked us as residents if we might be interested in connecting with a mentor to do research. And when I said I was interested maybe in addiction, I met Tom Koston. And so this was my first foray into addiction work and research. And it whet my appetite, and so I agreed to do a T32 training grant after my residency that was run by Richard Schottenfeld. That's when I met Bruce Rounseville, and I did most of my clinical training. And I served as both an addiction research and a clinical training in the methadone clinic at the Abt Foundation. So while I was finishing my first year, a position opened up at the West Haven VA. It was a clinical position that was also a faculty position, and I really was not, didn't know much about the VA, wasn't particularly interested in the VA or veterans or veterans' health, but I thought, okay, this is a faculty position. Maybe I'll use this position to leverage a different position at Yale, so I took the job. And then when I got there, there was a newly funded VA Yale Alcohol Research Center that John Crystal was the PI, and so I became an alcohol researcher. So I've had sort of three areas in my career, a research, an education, and a clinical administrative, and I thought I'd just touch very briefly on all of them. And I'm going to start about research. So my research interest has mostly been in sort of two buckets. One is in understanding the neurobiology underlying alcohol use disorder and doing laboratory studies. I've continued to do them over my career, and now laboratory studies have been a good place to test potential new medications that might be useful for alcohol use disorder. I was also interested in the development of treatments for alcohol, mostly alcohol use disorder, and more recently sort of come back around to opiate use disorder, particularly as they co-occur with psychiatric disorders. So the laboratory studies have been fun. I mean, I got interested because there were the resources at the West Haven VA. The mentors were doing this kind of work, and so I learned how to do administration of medications like ketamine, alcohol administration, both oral and IV. And the reason I included this picture is for the young people out there, there was a time where journals were all paper. There were no online journals, and if your manuscript was featured in an issue, they asked you if you wanted to suggest artwork for the cover, and so this was a nod to my Greek roots. This is Dionysus, the god of wine. It was kind of a fun sort of side product of my study. So after I was at the VA, Tom Costin came to the VA, and he recruited Bruce Roundsville, and Bruce Roundsville, if you know his work, was one of the first people interested in comorbidity, and under their tutelage, I became interested in looking at treatments for comorbid disorders. One of the things I didn't like about my new job at the VA was that it was so isolated. I was in an addiction setting, and the research in addiction did not include people who had comorbid conditions, and people who had psychiatric disorders with comorbid substance abuse were often excluded from research, and so we started doing a series of studies that looked at treatments, but in individuals who also had other disorders, and being at the VA, I became more and more interested in PTSD. More recently, this is one of my favorite studies. I have a recently, well, not that recently, but we're in the middle of a study, a comparative effectiveness trial that's funded by the VA. It's a multi-site trial. I feel like I've come sort of full circle back to opiate use disorder. This is comparing two formulations of buprenorphine, sublingual and injectable, and this is a comparative effectiveness trial. It's going to be messy. It has a lot of people with comorbid conditions, but it's really fun to do, and actually several of the local site investigators are here at this meeting, as well as individuals who serve on our board, the DSMB and the executive committee, so it's been a really fun experience for me. Okay, so there are times in your career where you sort of have to make choices, and I'm particularly bad at that, so what I find that I do sometimes is just add things to my plate rather than choose one thing over another, and that has its both advantages and disadvantages, so I'm going to switch a little and talk about education. So most of you know that addiction psychiatry was recognized in 1993 as a specialty, and our program was one of the first. Dr. Richard Schottenfeld was the inaugural program director, and he was also the program director for me when I was a trainee, and then soon after it was recognized, the VA had an RFP to fund specific stipends for addiction psychiatry training, and these were going to be used. The way the VA works, they come from Washington, and you can only use it for education. You can't use the money for something else, which is nice because it gets in a bucket that can't be touched, so there was this RFP, and I talked to Richard Schottenfeld. At the time, the VA was not a part of the addiction psychiatry training at all. It was not a site, and I said, what about expanding to the VA and we could get these dedicated stipends? He agreed, we applied, I got the stipends, and we added the VA as a training site, and I became the VA site training director. Now, I can't remember exactly what year, but Dr. Schottenfeld got an interesting opportunity. He moved to the undergraduate campus. He became what was called master, now called head of a college, so he moved to the undergraduate campus. He gave up a lot of his psychiatric work, and he literally called me one day and said, how would you like to be the director of the addiction psychiatry program? And I thought, okay, who, me? And then I thought, sure, I'll do that, and it was one of the best decisions I made. So our fellowship is great. I know I'm tooting our own horn here, but we've been accredited since 1996. Originally, it was run as part of the T32, and then we got these extra stipends, as I mentioned, and at the time, the ACGME was not quite as strict about requirements, so we could sort of co-run it with the T32, but that ended, and so the VA stipends came in very handy. When I was my first year as program director, though, there were only two trainees in the program, and it expanded, even though we had six accredited positions. It's expanded over the years for a number of different reasons, and we're now the largest fellowship in the country. So one thing I'm really good at is recognizing great talent, so I have two associate program directors who are wonderful, Ellen Edens and Srinivas Muvvala, who are both graduates of the program, and I couldn't do it without them. So this is just some pictures. I just did this for fun. This is the last few years of our trainees. You can notice the one on the upper left. That was COVID year. We actually had to get together outside, and we took an appropriate socially distancing photograph. And then one of the things, one of my goals with the fellowship has been not just to train people, but I remember thinking, I'm going to populate the Department of Psychiatry at Yale with graduates of our program, and we have been remarkably successful. So this is a picture from our faculty retreat last year. These are the faculty that train the current fellows, and except for three psychologists and I think there are two people who are not, all these people are graduates of the program, and many of them you will notice. One of the things I'm particularly proud of, though, is that they aren't just working at the VA, where I get to have an influence on who's hired. They're working at the Connecticut Mental Health Center at Yale New Haven Hospital, including in settings that are not just dedicated for addiction, and I think that's really important for our settings and for our field, and it's something that I'm particularly proud of. Okay, why stop at Yale? Our graduates have infiltrated the entire country, and they have faculty positions across the country and internationally, particularly in Canada. Many have national leadership positions. You know a lot of them. They're also in community settings. They have directorship positions, private practice, medical directors, organizational leaders. It's been a really great group, and it's been really heartening to see their successes. I'm just going to skip this one. Okay, so last I'm just going to say a few words about clinical administrative. It's not exactly what I planned, but when I look back, all my jobs at the VA have had a clinical administrative component. I started out as the director of a rehab unit with an inpatient unit. After a year, the unit chief left, and I became the unit chief of the detox and rehab unit. That has since closed. Over the years, I became the associate program director of the substance abuse program and the program director, and more recently, the chief of psychiatry at VA Connecticut. Yeah. And you can do academic work with anything. You can do scholarly work with administration, with education, and that's been another thing that I think has been very gratifying. All right, so mentorship is very important, has been very important in my career. These are the main mentors that I've worked with over the years. The late Bruce Roundsville, who came to the VA. I'd worked with him as a fellow and then at the VA. John Crystal, who I worked with from day one when I walked into the VA and has continued to be a mentor and a friend and a colleague. And, of course, the ever-present Tom Koston, who left Yale a few years ago but has continued to be influential in my career as a colleague, even from the faraway land of Texas. These aren't... they aren't the only mentors. These are other people who have influenced me. Bob Rosenheck, who just retired, is brilliant, even if he is a little irreverent, and he knows more about the VA than I think anybody. The late Steve Southwick, who taught me a lot. His work on PTSD and resilience taught me a lot about PTSD and working with veterans. Richard Schottenfeld, I already mentioned, stays in touch, serves as an advisor to our T32 and has sent us fellows from Howard. The late Kathy Carroll, who's a brilliant methodologist and grant writer. And Stephanie O'Malley, who's a leader in the field in alcohol use disorder. And then one of the things that's been important to me also is AAAP membership. I've been a member since 2011. I come every year, except for the COVID years, scientific content, but also learning about things that are best practices, clinically relevant information. But that's not really why I come. Really, it's the networking. It's a great place to recruit for the fellowship. It's a great reunion of our fellows. And we always have lots of fun. This is from last year. This is our Yale annual dinner. And then, I may not be the poster child of this, but of course, work-life balance is very important. It's important to have support from family and friends and colleagues. So, the reason I called myself an accidental academic is my career has had several twists, not just one of things that I didn't predict that I tried on and ended up being very impactful. My research contribution, I think, has mostly been in the comorbidity focus, but I still enjoy doing laboratory studies and hope to continue to do those. I think some of the biggest things that are gratifying is to see the expanding interest in addiction that's happened nationally, not just at Yale, but nationally, and having the fellowship and training people who keep you on your toes and young. It's been important to have mentors, the support of others, and I hope to inspire people. So, my take-home message, take advantage of opportunities. You never know when an opportunity presents itself. You never know sometimes how it will fit until you try it on. It's hard to predict what's most impactful. I would never have predicted this looking back forward, you know, now that I look back. There are lots of opportunities for scholarly work for those of you who have academic careers, not just traditional research. Mentorship is really important, but it doesn't have to be perfect, that you can have a variety of mentors who may contribute differently. There's always going to be obstacles, and it's important to have support. So that's it. OK, thanks, Dr. Petrakis. I think your presentation illustrates why you were selected for the award, because you do have a history of outstanding achievement and service. So I want this to be conversational. And my main topic I want to talk about is just the generativity in producing trainees and networks of individuals who got into the field. And I think that the picture is actually, we're really good at representing that. It's like a family tree. And we were meeting last night with the travel award recipients, and the people on the board were just trying to get them excited about getting in contact with the AAAP. And I think that meeting people, connections, mentorship, training opportunities are, I think in your talk, you really showed how people gave you opportunities, and then you've been giving other people opportunities. And I think that that's how it works the best. In terms of training people, what do you find rewarding about it? What's challenging about it? So it's really great to meet young people who are enthusiastic about the field and bring ideas. I mean, it really keeps you fresh, I think. If you don't do it, I think it's harder to stay current with literature and to get great new ideas. So I think that's been a big part of it. It's really gratifying to see people go on and do great things in their career. I feel like, ooh, I was maybe a part of that journey. So that's very personally gratifying. But there are always challenges. I mean, some of the challenges are administrative for running a fellowship, like funding. So the VA turned out to be a great investment, because it was one of the places where we couldn't have stipends for the trainees. But sometimes things can still be siloed. I think addiction medicine is a great addition to the field, but it can be a competition to our field. So those are some of the challenges I think I find. And I know recently we've had a drop off, maybe, in the number of applicants nationally. And I think there are other competing opportunities. Addiction still, you don't have to have an addiction psychiatry training to get some jobs in addiction, which has its pros and cons. And what advice would you give to trainees or junior career people about finding mentors and how best to use mentor relationships? Yeah, finding mentors is a really interesting and sometimes difficult thing. I think you look around and see locally who are mentors. I think one of the things you have to keep in mind, though, is mentors don't have to be perfect. Their interests don't have to align 100% with what you are interested in. Sometimes you may not even be sure you know what you're interested in. And I found, for me, having more than one mentor was really helpful, because you could get different perspectives. And that way, you could grow in different ways. I think it's important to ask and make sure you're meeting with, if you have a mentor that you've identified, that they know that you're their mentor. And you meet with them regularly and talk to them about not just what's the next project, maybe, but even career advice. You can always ask people questions. And you don't have to necessarily do exactly what they tell you. But you can filter in from what sounds right and works for you. And what about, as a mentor, about what mentees can do for you? Because I do think there's obviously a power differential. And more is flowing down from the mentor to the mentee. But sometimes mentors need something from the mentees. And my own opinion is I think it works better when mentees are more prepared to give back, too. I don't know if you want to say a little bit about that. Well, of course. Yeah, it's nice to have mentees who are enthusiastic. And sometimes they might write a grant that you're part of. You don't have to write every grant to expand your research, just to use research as an example. Or you can encourage them to write papers that you then get to put your name on if you help mentor them. So it definitely is a two-way street, I think. And then they bring ideas that maybe you didn't think of or a perspective that you haven't necessarily. It's different from yours. And I think that's very important for everybody. So my own bias about career progression is that when you ask people about their careers, they describe it in a linear way, because that's how it unfolded. But there's all of these various decision points that could have gone very differently, which I think your talk illustrated. And there were two things that stood out to me. One was calling yourself an accidental academic, which I think is probably more common than, I don't know if it's more common than not, but it's common. And the idea about pursuing alcohol research, because the opportunity arose, rather than some preformed idea about what kind of researcher you were going to be. I don't know if you could talk about that. Yeah, absolutely. I really enjoyed working in the methadone clinic. And working with the opiate use disorder population, and doing research in that space. And I assumed I would just continue to do that. But then this opportunity to do alcohol research presented itself, and to do laboratory studies. I hadn't even considered that. And it turned out that I really enjoyed those, and it was a good thing that I did that. So if you have an opportunity, there are times where you might try something and it doesn't fit, and you decide you don't really want to do that. And that's fine, too. But being open to maybe trying different things, and also taking advantage of strength where you are. So we have some resources that I know don't exist everywhere. So we have a bio-studies unit where we can do these laboratory studies. If that doesn't exist, that may be hard to do. There may be people who have more interest in health services research, for example, or other aspects. And if you can have opportunities to take advantage of that, I think that's really important, and can be, surprisingly, can be a good fit, even if you weren't expecting it. Can you give any examples of roads you went down and then decided it was the wrong way? Well, yes. So there was a point where our chief of staff left, and they were doing a search for a new chief of staff. And they look at the service chiefs, and does anybody want to do this? And they asked me if I wanted to apply for a chief of staff, and I thought, not really. There was an opening, but while they were doing the search, and they asked me to step in for a few months. So I thought, OK, I'll try this out. So I tried it out. Really glad I did it, and I'm really glad I didn't do it. It was too much outside of psychiatry. I had to worry about things that were the OR temperature, and it was not for me. But I'm really glad I tried it. I got to learn something about the hospital, the way it ran. But it was clearly a bridge too far. So learning what you don't like is just as important in some ways, and helps influence the direction you're going to go. I like the way you had the research, the Venn diagram of the different domains of the career. And I think not everybody's going to have that same configuration. I mean, that's a very typical academic configuration, and not everybody's going to have that. But I think maybe it would be helpful if it just talks about your particular pros and cons of each. What do you like about doing research, and what do you not like about doing research? Yeah, I mean, I just want to say overall that it's not for everyone, and people should. I have sort of, I think I have a short attention span, so it's nice for me to have different things. But there are downsides to having too many things on your plate, and that is that you can't focus as deeply on one as you might want. So that's, I know that's not exactly your question, but so that is something that people should consider. If somebody really wants to do research all the time, they really can't have an administrative and an educational role. For me, I like doing, having my hands in it, but there are downsides to it. I'm sorry, say again what you were going to say. Well, let's just pause on that for a second. So I think that's good. I mean, I think it's nice to have varied stuff, but there's still a fixed amount of time available to you, and everything you did talk about kind of like tending to accumulate things. I think that is, there is a point, earlier in your career, I think it's good to say yes to a lot of stuff, but then mid-career, you have to learn what to say no to in some ways also. So in terms of just the- Can I say something about that actually? So there are also times in the career where things wouldn't have been right for me. So like being the chief of psychiatry at the VA, I really wouldn't have wanted to do that when my kids were younger, or when my research career was still getting started. It would have been taken away, and I probably would never have been able to do some of the things. So it did happen a little bit later in my career, and I had an established research team that could help me, and it was just different. So I think that there are sometimes it's not just what you want, but it's timing can make a difference. Anyway, I didn't mean to interrupt. No, I think that's valuable advice. In terms of research, so what do you like about doing research, and what do you not like about doing research? So I really love doing those comparative effectiveness trials. That sounds kind of crazy, because they can be very difficult, especially with comorbidity. It's hard to recruit. But I feel like it's a population that really is understudied, so that is gratifying to try to recruit them, and try to figure out what kinds of treatments make sense in that space. It's fun to do research to recruit subjects, to make decisions about, I don't know, how you're going to design the study, working with colleagues. It can be very gratifying. I don't know if that's too vague. So I've enjoyed contributing to the literature, writing manuscripts. I mean, you enjoy it up to a point, but you relatively enjoy it. And being able to influence things, I think that's been important. And what are the parts about it that you don't like as much? Well, I mean, writing another grant sort of makes my blood pressure go up. And so it's a lot of work. And it's a lot of work, like writing a grant, for example, can be a lot of work on top of an already busy schedule. It's not like people say, oh, go take three weeks off and write your grant. So that is difficult. It can just be overwhelming at times. And in terms of your education activities, what do you find rewarding about that? Oh, I really love interacting with our fellows and having them, again, they bring new ideas. They want to learn. They ask really good questions. Sometimes I have to go look things up after meeting with them to doing supervision just to see, well, am I right about that? And that just is fun and rewarding. Any parts about it that are downsides? Well, sometimes it's a little frustrating, some of the administrative headaches. I mean, the VA is a great training site, but it only doesn't pay malpractice. You sometimes see something that could be so obviously good, but there's no way to fund it. It can be very frustrating. So in terms of being an accidental academic, one thing I always try to communicate with trainees is that if you want to do research, you have to be at a place in a system that has the capability to do it, because you can't really, as a junior person, create those opportunities yourself. So your path was accidental, but you were embedded in a place that had that possibility for you. I don't know if you want to say something about that. Yeah, I think sometimes that's a little bit, it's true, and it's too bad, because sometimes places that have a lot of research just keep generating it, and it's hard for other places. I think you're completely right, and I could never have done the things that I talk about without the infrastructure, support, mentorship that occurred at Yale. And so it is much easier to do research when you have that infrastructure. First of all, resources. I mean, say you want to do, if you want to do something like clinical trials, you can't just do that on your own. You need staff. You need money. And to get started, you need pilot data. And how do you get pilot data except for working with somebody else? Even health services research, where you're using big data, it's important to have someone who knows statistics if you don't know it, or to have access to it to know how to get the information. It's not easy to do in settings that don't have a big academic center. In part of your talk, you showed in some ways your family tree of career development. And it's interesting, because I'm at Columbia, and it's almost like having heard relatives. Like Bruce Roundsville, I'd never met, but Herb Cleaver used to work with him, and Herb ran the division when I first got there. You could draw a family tree. Addiction psychiatry is not that. There's only a few progenitors. There's the Penn, the Columbia, the Yale family tree. But I think when you come to a meeting like this, you do see people at all different stages. You have Tom sitting right here, who's brought you along, and then you have trainees. And I want to talk about what that experience is like a little bit. I mean, I think it's great. And Yale, I was lucky, because Yale has a long tradition of being supporting addiction. I mean, there have been, like you said, Herb Cleaver and Bruce, there were times where addiction wasn't recognized in a lot of places. And Yale did have a place for that. So if you were interested in it, you could learn about it. You could do research in it. But then it's fun to see that growing. So that's not the case anymore, that there are only a few centers that do addiction. And it's required that everybody learn about addiction, and I think that's spread out. And part of the fun thing is that some of the people that we've trained have gone out and done some of the work that we're talking about to disseminate addiction training and research and educate those kinds of things out in the field. I neglected to mention the Mark Gallander NYU branch of the tree, which they had their dinner last night. There's several streams of trainees developing into faculty. So I mean, I've known you through the AAAP for a long time, and you've been kind of plugging away, doing various things for the AAAP in the time I've known you. Maybe talk about your experience with the AAAP specifically, how it's impacted your career. Well, it's been actually the most fun meeting of the meetings I go to. It's the one that I go to the most regularly. The second one would be RSA, maybe after that, the alcohol meeting, but it's really the most fun meeting. I've learned a lot from here. I think it's changed over the years. It was, I think, a little smaller and maybe more insular, if I can say that, originally. And then it's just grown, and we have a bunch of trainees come, faculty, all people from the community, academic centers, and I've learned a lot. I'm more clinically relevant than some of the other meetings, which are much more heavily research-focused. And also, it's really a great place to network, not just for the fun of it, but really to meet potential fellows, or to see fellows and see what they're doing, and also talk to colleagues. How do you handle whatever is happening in addiction psychiatry? How are you handling your relationship with addiction medicine? There's so many things that we can talk about as a group that it's very nice to come every year and do that. Just to speak about opportunities for trainees, I think that this is a great place for both training program directors to find potential trainees, and also for potential trainees to, we're actually having an event tonight for that. And I can say that's how I got connected to Frances Levin. I don't know if she's here or not, but my first meeting, I came to in 2022 and presented a poster and met her, and I've been coming since. And I think that this organization and this meeting specifically, I think, is really very helpful for just moving all of that along. Because it's still a small specialty, and there are lots of trainees that are at institutions that don't have addiction psychiatrists or ways to know about it. What about your own, you put a lot of time and effort into AAAP. What do you get out of that, not just the meeting, but participating in the organization? I mean, I think the organization is important for a sense of identity for addiction psychiatrists, not just as addiction professionals, but addiction psychiatrists, which I strongly believe is very important since there's so much comorbidity that occurs with addiction. So I think important, the psychiatric perspective or lens is particularly important. And having that identity and having that advocacy, I think, is really critical. And so I think it's an important society for our field and, honestly, for the medical field in general, not to be too dramatic about it. But I think it's really important. So it's an honor to be part of it and to contribute to it. Where do you see the field, as someone who's been a thought leader and training a lot of people and doing research and active in the VA, where do you see the field going? Well, let me start with the good news, which is I think there's such a difference in the way addiction is looked at now than it was when I was in residency. But even early faculty years, where people thought addiction was nothing to be taken seriously or something that should be done over there, it really was so siloed. I don't know if people who hadn't lived through that didn't really know what that was like. So it's been really nice to see it grow into something that's more respected and more part of the mainstream, that residents who come in, medical students and residents who are training now are interested in addiction in a way that they weren't how many years ago. So I think that that's important. I think that it needs to continue to grow. I think one of the things that I think is a downside is the fact that psychiatry seems to continue as a field to have an ambivalent relationship in some ways to addiction. Even though we were first here as addiction psychiatry, it seems like primary care and medicine is getting the message that it's important to treat addiction everywhere. And in psychiatry, I think there's still that's not the case. I encourage you all to come to Sri's talk this afternoon, where he looked at psychiatric hospitals and whether or not they provide care for addictive patients. And it's appalling, if I may say that. So I think that that's important for us to continue to work on treating addiction, but also making it more mainstream and having our colleagues in psychiatry accept it, treat it, and have it be part of whatever everybody does, even if they don't have the specialty to do the more complicated cases. How much clinical work do you do now? Most of my work is clinical administrative. I don't do very much clinical work anymore. I supervise trainees, but most of my work that's clinical is really in that administrative sphere. Want to say anything about the joys or suffering of administrative work? Yeah, sure. So I probably have a higher tolerance for bureaucracy than most people. Having been at the VA, although I will tell you something funny, we're dealing with some bureaucracy with the Greek government. And boy, they give the VA a run for their money. They're much worse than the VA. Makes the VA seem tame. So it's not for everybody. It's not for the faint at heart. But I do enjoy problem solving, looking at a big service, trying to recruit people is one of my favorite things, recruiting faculty members who also do clinical work, organizing new programs or having people, giving them permission or encouraging them to do new programs. I find that all very fun and exciting. Right, you can't have the type of career that you've had and have the structure around you without engaging in the administrative operation. And I think in these systems, addiction psychiatrists have a unique perspective to offer. And I think addiction psychiatrists are often acting as advocates for their patients, maybe in ways that other specialties don't need to. How do you see it going forward? Yeah, that's the million dollar question. I'm not 100% sure. I know that I enjoy mentoring people, and so I'm hoping going forward, I can help other people write grants rather than write too many to myself. I hope to inspire people to become leaders and mentors and educators as well, and give them, advise or coach them on how to deal with certain things that come up. I mean, I really enjoy that, especially for their academic career, but for other things as well, administrative difficulties and grant opportunities. I really do enjoy that. So I imagine that it will be more of that. You're the specific service position you've had with the AAAP for a while, has been chair of the Area Directors Committee. I wanted to say a little bit about how the areas operate and what the mission is. Well, the areas, you know, it's interesting because part of it was the purpose, my understanding, because that was before my time when they made the Area Directors, was a way to encourage, you know, to encourage AAAP to bring it to the attention of people in different areas and maybe have some identity of things that may occur, not just at the annual meeting, but also between. And that's been a little bit of a challenge. There are some areas that are geographically more condensed and they have an easier time and then some that are more widespread. And so it's hard to figure out exactly how to do that. We had our meeting yesterday to talk about how we might continue to encourage identification in your area, not just at AAAP. We also have done the awardees. Now we have AAAP Area Awardees as a way to continue to foster some sense of being part of an area. But I think we're still working on that. Well, you know, you said something earlier about your involvement with the AAAP helping your professional identity. And, you know, I do think that that's an important concept to have because this is really one of the few places that we really talk about that as a, you know, lots of other settings were in collaboration with other professionals, with other training, other background. The focus of this organization, not exclusively, but primarily is the idea of people who have psychiatric training and additional specialty training, you know, in addictions. And I think that that is a idea to have of oneself, which it sounds like you've internalized and operated in and spread. And do you think it would have been different with a different, you know, maybe you can't, if that's a counterfactual, like if you had gone in a different direction, but was there something about addiction psychiatry for you that it was a particularly good fit in terms of a professional identity? Definitely, even though sometimes it's hard to know why. So my, as I mentioned, when I look back, I don't think when I was there looking forward, I thought about when I look back, I think I was interested in addiction way back when. And so it's been a true interest throughout my medical and residency training. So I think the identity as an addiction psychiatrist is really part of my professional identity. I mean, everything is, I mean, I guess being chief of psychiatry, you don't have to be an addiction psychiatrist, but having the addiction background, I think is a plus, of course I'm biased. But my education and my research is all in the addiction psychiatry sphere. So it is definitely part of my identity. And I hope that people, it's not just me. I mean, that is something that I do think that it's important that we do, where people feel like that it is an identity and an important part of the, so if you think about the whole medical field, it's an important part of it, that people need to have that expertise in order to do something impactful for patients. So I think this was a nice conversation about your professional trajectory and just the ways that you've given to the field and the people you've helped along. I'm wondering if there are any questions from the audience about, yes, Dr. Nunez. Oh, hey. You wanna go to the microphone? Yeah. All right, speak louder then. I can hear you, I just can't see you. Speak louder. Yeah. Right. Yeah, so we're both lucky and, I mean, it's a mixed bag. So it's been, clearly there are not enough addiction professionals if we just, to take care of all the addiction. So I think it's a really important step and it is good to train as many people as possible. We are lucky in that we mostly, and I say mostly, have a good relationship with our addiction medicine colleagues. We do a lot of co-training with them, mostly the education curriculum. And that's Ellen's, thanks to Ellen Edens for that, really. We do less clinical work with them. But, you know, there's some competition there as well. It's not all roses, I would like to say. So we have to sort of figure out who owns what and who gets, yeah, it's complicated. Does that answer your question, kind of? No. Dr. Kostin. Like Ned, I feel like I have a big mouth. I'll take a microphone anyway. As you think about this, recruiting psychiatrists into clinical academic positions has become a bit challenging. And it's not confined to addictions, but is, in fact, cutting across the board. And I think you're right that the academic settings that integrate research, clinical care, and essentially education are the ones that can probably do that best. But a real challenge that we found in Houston has been, oh, sorry, I'm Tom Kostin. The challenge has been that people come with such debt for medical schools that they can't afford an academic career. I mean, at least that's what they say. And even if they come for a couple of years, say, to the VA, they see that as a launching pad for picking up patients and getting to know the people in private practice. And I think I've seen that increasingly in the membership of AAAP, that we've become a continuing education enterprise for people who I think otherwise might get a certain amount of isolation from their practices that really focus on how many RVUs can you produce in the day. Do you want to comment on that? Because you're in a setting in which you probably do have, first, the largest number of fellows, but also your productivity of putting people out into the world for academic positions is quite extraordinary. Yeah, so a couple of thoughts. First of all, I think that there is some movement. Even the VA salaries have gone up in order to retain people. So that's been one thing. The other thing I realized is most of my talk was so academically focused. And the fellows we train are not all interested in academics, and certainly we have many who have gone to academic settings across the country and have leadership positions, but we also have individuals who are leaders in clinical sort of domain. And our goal for our fellowship is to train not just academicians, but also clinicians. I think that's really important. But yeah, I do know, I think one of the hardest things, sometimes it's hard to get people to do a fellowship because they don't want to do yet another year with a low salary when they can go out, make more money, and work in addiction settings because nobody requires that you have an addiction psychiatry background. But I do think training people to do both is important to do academic and to do clinical work because we need, as clinicians out there, to be seeing a lot of the patients. I know that's not exactly what you asked, but those are just my thoughts. So exactly when the answer is, you wonder if it's in the question. All right. There is the NIH loan repayment program is available for people who choose research careers. I mean, it's more competitive now than it used to be, but I actually got a fair amount of my loans paid back through that. Are there other questions for Dr. Petrakis? I've got one hiding over here. Thank you so much, Dr. Petrakis, for being my mentor right now. So I come from AMSA and I own nothing. I'll just throw out a new paradigm. You say, who owns what? You know, ASAM or AAAP. And I would suggest none of us. I'll just throw out a new paradigm. You know, disease and its infancy. And maybe we should learn from our patients. I've had the gift of, you know, one patient saying, who better to learn from, from our patients? So, and I appreciate the opportunity of meeting one gentleman earlier. He said, you know, just sit and listen to our patients. And I just, where I'm at is I think that's the whole key. Thank you. Yeah, it was more of a comment than a question, so we'll take it. Yeah. Yeah, thank you. Yeah, I, do you want to say anything else about? No, no, you can say, yeah. Yeah, what I always say is there's no AAAP meeting that's not complete unless we talk about the tension between addiction medicine and addiction psychiatry. So, you know, we collaborate as an organization. We collaborate deeply with ASAM on lots of initiatives, particularly at the federal level. And we lobby the federal government in collaboration with them. So, you know, we're, areas that we, our interests overlap, we're very happy to, and many people in this room are members of both organizations. And, but I think that there is, you know, the reality is, is that the energy that's gone into the development of the addiction medicine programs, I think to some degree was subtracted from our efforts because some of the people doing it are addiction psychiatrists. But it's not wrong. We need more people trained, whatever their discipline, but it still is a reality, I think, for us. Our growth, I think, has in some ways been hindered by that. But that's a challenge for us to solve. It's not their problem. Right. Another question up there. Yes, Dave Cundiff from Milwaukee, Washington. I think that there's a distinction to be made between addiction specialists who do not have psychiatric skills or collaborate closely with psychiatrists and addiction physicians who do. And one of the things we love in our treatment center is getting prescreens from people who have relapsed over and over again from other good programs because those are the people whose psychiatric comorbidities have not been previously addressed. And our psychiatric partner and we can do a really good job and often get out of the cycle of relapse people who could not get out of it on their own without the psychiatric care. So there is enormous value in my outside but yet a member opinion. There's enormous value to the unique roles that psychiatric professionals bring into the addiction medicine field. We could not do as good a job without that field, without that special preparation in psychiatry. Thank you. I couldn't agree more. Yes, Carla. Since the comments are okay, I have a comment. And I was just reflecting on the fact that this is a service award in our field and I think the discussion of our field is really important but I wanna bring it back to the service that you have provided to our field and the reason why we are honoring you. And I hope it's okay that I speak for many, many, many, many people in this room to just highlight how effective you are. And I think you sitting up on the stage embody this sort of understated powerful effectiveness that you have in the field and in helping people come into their own identity as addiction psychiatrists, find the perfect fit, whether it's clinical, academic, whatever, and always really helping people be that through your role modeling of that very powerful understated effectiveness as a mentor and a supporter and a champion. And I think there are so many here who are incredibly grateful for that and so just wanted to say thank you and honor you in your work. And that's just why I love education. Thank you, Carla, thank you, Carla, yeah. Mike Dawes, VA Boston and Boston Medical Center, Boston University. I also wanna say thank you for just all you've done for especially program directors looking at how you do what you do. But the question that I think is wrestling with a lot of the program directors and the education folks that are here is how to integrate competency-based education across psychiatry and our specialty as well as far as the fellowships. And I'd just be interested actually in both you and John's thoughts in terms of where the future is in terms of training and your thoughts of what essential skills and knowledge we should impart moving forward, particularly in terms of training our fellows to take leadership positions, what your thoughts are on that. Do you want me to talk first? Yeah. Yeah, just off the top. Well, I mean, a couple thoughts. I think that it's important for general psychiatrists to feel somewhat comfortable with basic addiction principles. I think that's what you're getting at, right? So right now it's one month, it's not probably enough. And I think having more addiction training within psychiatric residency is important. And then I think that there is a role for subspecialists who have a particular expertise in that to take care of more difficult patients who have addictive disorders, especially with comorbidities. I think that's really important. I think our field is, one of the questions is, would we get more people with this specialty if they moved, I think this is what you're getting at, moved fellowship to the one through four, the fourth year of residency. And that may be something that would be effective in getting more interest or more people with this expertise. I think in terms of leadership positions, I mean, what we tell people is try it out, go to a meeting, join a committee, continue to go to the committee, pretty soon you're gonna be a leader of that committee. And your leadership opportunities present themselves and you have to take them and advocate for addiction. Is that kind of what your question? I don't know if you wanna. Thank you. If there are no other questions, I wanna really thank Dr. Petrakis for all she's done for the field and the organization. She's quite deserving of this award. Thank you all for your attention. Yeah, thank you. Really, thank you. I really appreciate it. Put that on your desk at home. Yes, yes. Thank you so much. ♪ Just a little baby girl is in need ♪ ♪ Them all coming out of left field ♪ ♪ Ooh, I'm a rebel just for kicks now ♪ ♪ I've been feeling it since 1966 now ♪ ♪ Might be over now, but I feel it now ♪

Dr. Esmini Petrakis

psychiatry

addiction disorders

Yale University

Outstanding Achievement and Service Award

mentorship

addiction psychiatry education

American Academy of Addiction Psychiatry

addiction medicine

psychiatric residency programs