By becoming a AAAP Member, you will receive substantial savings on your registration rates Name: (Please print) (First) (Last) (Degree)

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1 American Academy of Addiction Psychiatry 27th Annual Meeting and Scientific Symposium December 8-11, 2016 Addiction and Their Treatment December 6-8, 2016 Registration Form By becoming a AAAP Member, you will receive substantial savings on your registration rates Name: (Please print) (First) (Last) (Degree) Title: Organization/Company: Mailing Address: City: State/Province: Country: Zip code: Work Phone: Home Phone: Address: Gender: Male Female Ethnicity: American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander Hispanic or Latino White Other Please check this box if you require special accommodations to participate or if you have special dietary needs. AAAP will contact you for further details before the conference. AAAP will be providing a participant list including contact information to all meeting attendees. Please check this box if you do not want to be included on this list. When preparing name badges, would you like us to use the information you provided us above? If no, please write in the correct name and affiliation: Please indicate your AAAP Membership Status: AAAP Member Non-Member If a AAAP Member, are you interested in joining the AAAP Mentoring Program? Yes No If a Non-Member, would you like to join AAAP and receive a discount on meeting registration? Yes No If Yes, please complete a membership application online or in person. Are you a first time attendee to AAAP Annual Meeting and Scientific Symposium? Yes No How did you hear about the AAAP 27th Annual Meeting and Scientific Symposium? AAAP Newsletter Colleague Social Media AAAP Website AAAP Blast AAAP Mailing AAAP Postcard Advertisement (specify) (Other specify) Hotel and Travel information at the Hyatt Regency Coconut Point Resort & Spa: The hotel conference rate is $219 (plus tax) per night for single/double occupancy rooms. You may reserve a room online or call the Hyatt Regency toll free at (888) Please indicate that you are with AAAP to receive the conference rate. If you need to cancel your reservation, you must do so 72 hours prior to your arrival date. Any cancellation made within 72 hours will be charged 1 night s room and tax. The hotel s check-in time is 4:00 pm and checkout is 11:00 am. The deadline for hotel reservations is on or before November 10, Reservations will be accepted on a space and rate available basis. Reservation requests received after the cut-off date will be based on availability at the hotel s prevailing rates. We suggest flying into Fort Myers (RSW) International Airport. For more information regarding airport transportation, please visit I agree to the hotel room policy noted above: Signature Emergency Contact Information Contact Name: Emergency Contact Phone: Page 1 of 7

2 Registration Fees: (After November 1, 2016, fees go up $50 for each event.) Registration Type will be verified. AAAP Member Rates Annual Meeting and Scientific Symposium Only Non-Member Rates Physician Member: $580 Physician Non-Member: $680 Resident/Fellow/Early Career Member: $310 Resident/Fellow/Early Career Non-Member: $410 Medical Student Member: $75 Medical Student Non-Member: $125 Related Health Professional (RHP) Member: $350 Related Health Professional (RHP)Non-Member: $450 Spouse OF AAAP Member: $310 Spouse of Non-Member: $410 Spouse s Name: Addiction and Their Treatment Course and/or Annual Meeting Spouse s Name: Physician Member Course Only: $750 Physician Non-Member Course Only: $830 attending BOTH events: $1,130 attending BOTH events: $1,285 Related Health Professional (Mem) Course Only: $750 Related Health Professional (Non-Mem) Course Only: $830 attending BOTH events: $1,050 attending BOTH events: $1,230 Early Career Member Course Only: $750 Early Career Non-Member Course Only: $830 attending BOTH events: $1,000 attending BOTH events: $1,180 Fellow/Resident Member Course Only: $450 Fellow/Resident Non-Member Course Only: $550 attending BOTH events: $610 attending BOTH events: $710 Medical Student Member Course Only: $100 Medical Student Non-Member Course Only: $175 attending BOTH events: $175 attending BOTH events: $300 Spouse OF AAAP Member Course Only: $750 Spouse of Non-Member Course Only: $830 attending BOTH events: $1,060 attending BOTH events: $1,240 Spouse s Name: Spouse s Name: Check here if you will be attending the Gala Event and Awards Ceremony on Saturday, December 10, 2016, from 7:00 pm 9:00 pm. Check here if you will be taking a guest. Donation: Would you be willing to contribute $25 to the Sheldon I. Miller Educational Fund to support trainee activities in the field of Addiction Psychiatry? TOTAL (include the total dollar amount for all checked boxes): $ Payment Method: Check made payable to AAAP Visa/MasterCard/American Express Card Number: Exp. Date: Sec. Code Name on card: Authorized Signature: Credit Card Billing Address: City: State/Province: Country: Zip Code Phone: Address: Cancellation Policy: Before November 1, 2016, any written notification of cancellation received by AAAP will receive 50% refund of total registration fee. After November 1, 2016, 12 midnight (ET), no refunds will be allowed. Note: registration will not be processed unless this cancellation policy is signed. I agree to the cancellation policy noted above: Registration can also be completed online at Please mail or fax this form to: American Academy of Addiction Psychiatry 400 Massasoit Avenue, Suite 307, East Providence, RI Phone: (401) ~ Fax: (401) Questions? annualmeeting@aaap.org Page 2 of 7

3 AAAP s 27 Annual Meeting and Scientific Symposium Additional Registration Questions (Required) APA Integrative Care Training Registration Question Background In September 2015, the Centers for Medicare & Medicaid Services (CMS) launched the Transforming Clinical Practice Initiative (TCPI) to provide technical assistance for clinicians as they prepare to practice in a valuebased world. The American Psychiatric Association (APA) was awarded with $2.9 million to support this initiative by training 3,500 psychiatrists in integrated care through Training curriculum includes both didactic content and interactive group exercises on population health management, use of registries and real-time clinical outcomes data, telephonic consultation methods, coordinating with a primary care team, and use of evidence-based methods for managing patients with common mental disorders in primary care. Once psychiatrists are trained in core integrated care principles, they will have the option to participate in online learning collaboratives. Learning collaboratives will provide advanced training, troubleshooting support, and peer-to-peer support. As a stakeholder in this initiative, American Academy of Addiction Psychiatry is pleased to offer the APA integrated care training during its Annual Meeting and Scientific Symposium on Thursday, December 8, 2016 from 8am-12pm. The training course is titled, Applying the Integrated Care Approach: Practical Skills for the Consulting Psychiatrist. Admittance for the session is FREE but we are requesting preregistration. Please check one of the following: Yes, I will attend this APA training No, I will not attend this APA training Fun Activities Registration Questions Select the fun sessions you plan to attend: Yoga (Thursday, December 8th from 7:15pm-8:15pm) Yoga (Friday, December 9th from 6:00pm-7:00pm) Yoga (Saturday, December 10th from 6:30am-7:30am) Fun Run/Walk (Friday, December 9th from 6:30am-7:30am) If checked off, please answer the following question below. I do not plan to attend any of these fun sessions. If you plan to attend the Fun Run/ Walk, then we want to make sure you get the right T-shirt size when you attend the Fun Run. What size T-shirt are you? Small Medium Large X-Large I do not want a T-shirt. Page 3 of 7

4 Workshops Registration Questions Please answer the 4 questions below if you are planning on registering for our Annual Meeting. We are offering 5 workshops on Thursday, December, 8th from 4:00 pm - 5:30 pm. A-1: Buprenorphine Treatment of Opioid-Dependent Physicians: Pros and Cons - Presented by John Fromson, MD and Kirk Brower, MD 1. Describe the evidence for formulating guidelines and what additional studies are required. 2. Examine one's views and alternative ones given the evidence and its limitations. 3. Apply the pros & cons of BUP-MT to formulate policy & tailor interventions for individual physicians. A2: Best Practices in Addiction Psychiatry Education - Presented by Scott Oakman, MD 1. Describe successful educational efforts to enhance addiction training in medical education. 2. Demonstrate effective teaching methods for application of knowledge to patient care. 3. Discuss educational needs for training the next generation of addiction providers. A-3: Acceptance and Commitment Therapy for Substance Use Disorders: Treatment Principles and Empirical Findings - Presented by Igor Weinberg, PhD 1. Review treatment principles of ACT for substance use disorders. 2. Review empirical findings regarding effectiveness of ACT for substance use disorders. 3. State our preliminary data of feasibility trial of ACT for substance use disorders. 4. Cite clinical examples of ACT for substance use disorders. A4: Working with parents and families to improve outcomes for adolescents with substance use disorders: Incorporating family-centered care into your practice - Presented by Christopher J. Hammond, MD 1. Describe the role of the family system in SUDs and how targeting family systems improves outcomes. 2. Demonstrate how to talk to and work with parents and families of youth with substance-related disorders. 3. Use a basic family-focused approach to treating youth substance-related disorder. A-5: New CDC Guidelines for Opioid Prescribing, How Is An Addiction Psychiatrist to Respond? - Presented by Brian Johnson, MD 1. State current CDC guidelines for chronic pain treatment. 2. Describe potential treatments with advantages and disadvantages of each. 3. Discuss the difference between opioids used for peripheral pain, central pain, addiction. Question 1: Please select ONE workshop you plan on attending on Thurs, Dec. 8th, 4:00 pm - 5:30 pm: Workshop A1: Buprenorphine Treatment of Opioid-Dependent Physicians: Pros and Cons Workshop A2: Best Practices in Addiction Psychiatry Education Workshop A3: Acceptance and Commitment Therapy for Substance Use Disorders: Treatment Principles and Empirical Findings Workshop A4: Working with parents and families to improve outcomes for adolescents with substance use disorders: Incorporating family-centered care into your practice Workshop A5: New CDC Guidelines for Opioid Prescribing, How Is An Addiction Psychiatrist to Respond? Page 4 of 7

5 We are offering 5 workshops on Friday, December, 9th from 10:45 am - 12:15 pm. B-1: Acceptance, Mindfulness, and Values in Chronic Pain: An Introduction and Skills Building Workshop - Presented by Kevin Vowles, PhD 1. Describe the ACT model with regard its relevance & utility in human behavior change. 2. Practice exercises to augment acceptance, mindfulness, and aid in values clarification. 3. Review training and reference materials that can be used in clinical practice. B2: How to Apply Alcoholics Anonymous in Different Clinical Settings - Presented by Marc Galanter, MD 1. Evaluate clinical situations regarding how to employ TSPs in those respective settings. 2. Apply techniques from the workshop to specific patients, for optimal use of TSPs. 3. Apply the techniques described in institutional settings where they work. B-3: Addictions Treatment in Medically Complex Patients: Liver, Kidney, and Heart Failure - Presented by Caridad Ponce-Martinez, MD 1. Recognize the importance of the role of an addiction psychiatrist in the treatment of addictions. 2. Identify when a medically complex patient should be referred for transplant evaluation. 3. Describe pharmacological treatment of addictions in the medically complex patient. B4: Science and the Sobering Truth: The Relationship between ADHD and Substance Use Disorders - Presented by David Atkinson, MD 1. Identify the limitations of psychological testing as a diagnostic tool in ADHD adults. 2. Recognize common problems ADHD individuals encounter when using substances. 3. Examine the risk of diversion of stimulants, and the possibility of harm to the substance user. 4. Describe potential clinical benefits of stimulant use to ADHD individuals in SUD treatment. B-5: Benzodiazepines for Patients with other Substance Use Disorders: When (if ever) to use them and how to discontinue them- Presented by Olivera Bogunovic, MD 1. Identify the role of benzodiazepines in the treatment of patients with substance use disorders. 2. Describe other pharmacological approaches to the treatment of insomnia and anxiety. 3. Describe behavioral approaches to the treatment of insomnia and anxiety in patients with SUD. 4. Describe how to identify behavioral therapists and leverage technology as an adjunctive treatment. Question 2: Please select ONE workshop you plan on attending on Fri, Dec. 9th 10:45 am - 12:15 pm: Workshop B1: Acceptance, Mindfulness, and Values in Chronic Pain: An Introduction and Skills Building Workshop Workshop B2: How to Apply Alcoholics Anonymous in Different Clinical Settings Workshop B3: Addictions Treatment in Medically Complex Patients: Liver, Kidney, and Heart Failure Workshop B4: Science and the Sobering Truth: The Relationship between ADHD and Substance Use Disorders Workshop B5: Benzodiazepines for Patients with other Substance Use Disorders: When (if ever) to use them and how to discontinue them Page 5 of 7

6 We are offering 5 workshops on Saturday, December, 10th from 10:15 am - 11:45 am. C-1: The Intersection of Addiction Psychiatry and Emergency Psychiatry: Clinical Case Presentations - Presented by Brian Fuehrlein, MD 1. Describe common causes of psychiatric emergencies in a substance abusing population. 2. Recognize the often deadly nature of substance abuse, particularly in the ER population. 3. Identify and apply clinical interventions aimed at substance abuse treatment. C-2: Opioid Alternatives: A Menu of Options for Pain - Presented by Ken Martz, PhD 1. List at least 10 non-opioid interventions for pain. 2. Identify interventions for comprehensive biopsychosocial treatment plan. 3. Apply skill development in case presentation. C-3: Evidence-Based Approach to Treating Pregnant Women with Opiate Use Disorder - Presented by Kathryn Myer, MD 1. Describe current clinical management of pregnant women diagnosed with OUD. 2. Identify the pros and cons of the current treatment options for OUD in this patient population. 3. Practice providing psychoeducation for mothers presenting with OUD seeking treatment. C4: Acceptance and Commitment Therapy for Addictions - Presented by John Matthews, MD 1. Describe the differences in treatment approaches between CBT and ACT. 2. Cite and apply the six ACT processes for psychological flexibility. 3. Cite the common principles of ACT and AA. C-5: Cannabis Abuse and Psychosis: Why it is equally important to address both conditions and what treatment recommendations and resources are available to providers - Presented by Nadia Tayeb, MD 1. Identify differences between cannabis-induced psychosis and a primary psychotic disorder. 2. Describe treatment resources and recommendations for patients with schizophrenia and cannabis use. 3. Recognize the significance of addressing ongoing cannabis use in this patient population. 4. Describe commonalities between substance use disorders and mental illness. Question 3: Please select ONE workshop you plan on attending on Sat, Dec. 10th 10:15 am - 11:45 am: Workshop C1: The Intersection of Addiction Psychiatry and Emergency Psychiatry: Clinical Case Presentations Workshop C2: Opioid Alternatives: A Menu of Options for Pain Workshop C3: Evidence-Based Approach to Treating Pregnant Women with Opiate Use Disorder Workshop C4: Acceptance and Commitment Therapy for Addictions Workshop C5: Cannabis Abuse and Psychosis: Why it is equally important to address both conditions and what treatment recommendations and resources are available to providers Page 6 of 7

7 We are offering 5 workshops on Sunday, December, 11th from 9:30 am - 11:00 am. D-1: Chronic Opioid Therapy and Multimodal Chronic Pain Management: An Evidence-Based/Case-Based Approach - Presented by Charles Argoff, MD 1. Discuss the use of opioid analgesics for chronic pain. 2. Apply such knowledge to successful use of opioids for multimodal pain care. 3. State the long term analgesic benefits of opioids. 4. Recognize how to modify opioid therapy to enhance benefit and minimize harm. D-2: Change the Things We Can: Train Every Future Physician in Addiction Medicine - Presented by Jenifer Van Deusen, MD 1. Tell why all physicians must know the biomedical and behavioral constructs of addiction. 2. Describe competencies that may guide development of med school curriculum, instruction & assessment. 3. Construct sample Entrustable Professional Activities for Entering Residency in addiction medicine. D-3: Working with Emotions: The Core of Motivational Interviewing, Harm Reduction, and Transformational Opportunities - Presented by Mark Green, MD 1. Describe the role of emotion in addiction acquisition, maintenance and treatment. 2. Apply mindfulness techniques to tolerate and identify emotions. 3. Apply techniques to deepen emotional experiencing. 4. Recognize maladaptive defenses and turn patients against them. D4: The Role of Addiction Psychiatrists in Integrating Substance Use Disorder Treatment into Primary Care - Presented by Dong Chan Park, MD 1. Describe current evidences for integrating SUD treatment into primary care. 2. Identify common real-world barriers and facilitators. 3. Recognize key opportunities for the integration of SUD treatment into primary care. D-5: Addiction, Suicide and Military Culture - Presented by John Rodolico, MD 1. Recognize four major differences between the Post 9/11 veterans and other veteran populations. 2. Summarize military cultural influences on clinical interventions. 3. Describe the Army s Comprehensive Soldier Fitness Program and how it applies to soldier reintegration. Question 4: Please select ONE workshop you plan on attending on Sun, Dec. 11th 9:30 am - 11:00 am: Workshop D1: Chronic Opioid Therapy and Multimodal Chronic Pain Management: An Evidence- Based/Case-Based Approach Workshop D2: Change the Things We Can: Train Every Future Physician in Addiction Medicine Workshop D3: Working with Emotions: The Core of Motivational Interviewing, Harm Reduction, and Transformational Opportunities Workshop D4: The Role of Addiction Psychiatrists in Integrating Substance Use Disorder Treatment into Primary Care Workshop D5: Addiction, Suicide and Military Culture Page 7 of 7