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STEERING COMMITTEE MEMBERSThe TA Health Education Foundation and the Wyoming Department of Health, Behavioral Health Division gratefullyacknowledge the contributions of the steering committee.David Birney, Ph.D.David Birney is the Executive Director of the Peak Wellness Center in Cheyenne Wyoming. He is a two-time recipient of the RockyMountain Council of Community Mental Health Centers Distinguished Service Award and a member of the Partnership for theResolution of Mental Health Issues in Wyoming.Art Merrell, M.D.Art Merrell is certified by the American Board of Psychiatry and Neurology, the American Society of Addiction Medicine, the AmericanBoard of Forensic Psychiatry and the American Society of Addiction Medicine. He currently serve as the Medical Director of the PeakWellness Center as well as the Chief Medical Officer of the Wyoming Department of Health, Behavioral Health Division.Shawn Powell, Ph.D., ABPPShawn Powell is a licensed psychologist. He is board certified in school psychology by the American Board of Professional Psychology.Shawn is the President-Elect of the American Academy of School Psychologists. He is a psychology faculty member at Casper Collegeand is an adjunct faculty member of the University of Wyoming and the University of Northern Colorado.Bert Toews. M.D.Bert Toews is a full time addiction physician and founder of the Wyoming Recovery Program and medical director of the WyomingProfessional Assistance Program. Dr. Toews is certified by the American Board of Addiction Medicine and by the American Board ofFamily Medicine. Dr. Toews has taken a leading role in addressing Wyoming’s substance use issues.The Prescription Drug Abuse Stakeholder’s TaskforceAs representatives of the health care community, law enforcement, government, and community members, the Prescription DrugAbuse Stakeholders Taskforce devotes its efforts to eliminating the increasing abuse of prescription medications while ensuring thatthey remain available for patients in need. The Rx Stakeholder’s Taskforce seeks to help doctors, nurses, pharmacists, other healthcareprofessionals, law enforcement, and the general public become more aware of both the use and abuse of prescription medication. Weseek to improve the regulatory framework to ensure that prescription medications are available to the patients who need them whilepreventing these drugs from becoming a source of harm or abuse.

Wyoming is facing a veryserious epidemic ofuncontrolled substanceuse. What may seemlike a practical drugthat can relive painand stress also has a dangerous side that isnot always realized. Patients do not have to beaddicted in order to have their health impactedby a substance. The Center for Disease Controlreported that from 2001 to 2005, alcoholwas involved in thirty four percent of deathsfrom falling in the state of Wyoming. Fromemergency rooms to general practices orobstetric offices, less than addictive substanceuse creates major complications.The Wyoming Department of Health, theBehavioral Health Division and the TA HealthEducation Foundation are determined to givepractitioners tools designed to assist dedicatedhealthcare professionals. All sessions havebeen constructed specifically for Wyominghealthcare providers with guidance from apanel of Wyoming treatment professionals.This training addresses current challengesand developing issues that these expertsbelieve will plague Wyoming in the future. Thevaried sessions are targeted to providers withdifferent roles and responsibilities. Becausethe training is free and live via 2-way broadcastor web broadcast; multiple staff members canattend with minimal interruption to business.Our hope is that this training will provideattendees new and effective ideas in combatingthese problems throughout Wyoming.1

2ABOUT THE TRAININGAttend the sessions that impact you, and interact in real-time with thespeaker, your peers, and other experts. You don’t need to attend everysession; we’ve designed the training so that every mental healthcareconstituent can find specific presentations to help meet Wyoming’smental health and substance abuse needs. This training is free andyou can get one contact hour for each session you attend.LocationThis program will take place February 21 – 22, 2012 live at the TAGuestRanch in Buffalo. It will also be broadcast live, in a 2-wayinteractiveformat via the Wyoming Telehealth Network (see pg.10 for braodcast locations). Participants can join the training atparticipating Hospitals throughout Wyoming, or on their personalcomputer through live web streaming.This conference is specificallydesigned for professionals :• Psychiatrists• Psychologists• Social Workers• General Practitioners• ER Physicians• Pediatricians• Mental Health and Substance AbuseCounselors• Physician’s Assistants• Nurses• Pharmacists• Dentists• Preventionists

OVERVIEWTuesday, February 21Time Session Credits Offered8:00 – 9:30 am Medication Assisted TherapiesArt Merrell, M.D. and Bert Toews, M.D., FASAM9:45 – 11:45 am Collaborative Practice to Promote Pain Management and Reduce Substance AbuseDavid Brushwood, R.Ph., J.D.1:00 – 2:00 pm Substance Use Sensitive PrescribingBert Toews, M.D., FASAM2:15 – 3:45 pm Less Than Addictive Substance Use: The Case for InterventionLarry Gentilello M.D., F.A.C.S.4:00 – 5:00 pm The Treatment of Mental Health and Substance Abuse: A Cross Disciplinary DiscussionDavid Brushwood, R.Ph, J.D., Dr. Gary Fisher, Ph.D., Larry Gentilello M.D., F.A.C.S.,David R Hadlock, D.O., F.A.C.O.O.G., D.A.B.A.M., C.M.R.O., C.C.H.P., S.A.P., M.A.C., and Bert Toews, M.D., FASAM3Wednesday, February 22Time Session Credits Offered8:00 – 9:00 am Issues in Ethics for Mental Health and Substance Abuse Treatment ProvidersGary Fisher, Ph.D.9:15 am – 12:15 pm Fetal Alcohol Spectrum DisordersDavid R Hadlock, D.O., F.A.C.O.O.G., D.A.B.A.M., C.M.R.O., C.C.H.P., S.A.P., M.A.C.1:45 – 3:15 pm Treating the Unique Needs of Wyoming VeteransMark Mann, M.D.

TUESDAY48:00-9:30Medication Assisted TherapiesArt Merrell, M.D.Bert Toews, M.D., FASAMNumerous studies have demonstrated a significant decline inrecidivism rates when behavioral therapy is accompanied bymedications targeted at substance use. This approach is otherwiseknown as medication assisted therapy. In this presentation, joinDrs. Art Merrell and Berton Toews as they discuss the neurobiologyof addiction, including a discussion of the theory that sluggishdopamine reward systems predispose individuals to addiction.Follow as substance abuse is defined and the differences betweenaddiction and dependence and tolerance are discussed. Theywill explain the neurobiology of detoxification and explore theevidence regarding the efficacy of medications used to assist withthe symptoms of withdrawal. Discover the medication available toassist in treating substance use such as Naltrexone, Buprenorphine,Tegretol, Chantix, Zyban, and more. Examine the evidenceregarding recidivism and the use of these medications. Join thediscussion regarding the role medications play with abstinence orspirituality based recovery programs such as the twelve step model.Art Merrell, M.D.: Dr. Merrell attended the University of ColoradoMedical School, and completed a residency in psychiatry at theUniversity of Colorado Psychiatric Hospital. Dr. Merrell is certifiedby the American Board of Psychiatry and Neurology with addedqualification in addiction psychiatry. He is also certified throughexamination by the American Society of Addiction Medicine, theAmerican Board of Forensic Psychiatry, and the American Boardof Addiction Medicine. Dr. Merrell currently serves as the MedicalDirector of the Peak Wellness Center, the Chief Medical Officer of theWyoming Department of Health, Behavioral Health Division. He alsomaintains a part time private practice in Cheyenne, Wyoming.Berton Toews, M.D., FASAM: Berton Toews was born near Calgary,Alberta, grew up in Bonners Ferry, Idaho, and attended Universityof Idaho and University of Northern Colorado. He received hismedical degree from the University of Cincinnati, and later movedto Casper, Wyoming in 1976. There he became the first graduatefrom the University of Wyoming family practice residency program.He is certified by the American Board of Addiction Medicine andby the American Board of Family Medicine, and is Wyoming’sonly full-time addiction physician. In 1996, Dr. Toews openedWyoming Recovery Program, which is a multi-level addictiontreatment center in Casper that plays a leading role in tacklingthe state’s substance problems. He has also been active in helpinghealth professionals impaired by addictions for more than twentyyears and is medical director of Wyoming Professional AssistanceProgram. He is active on the admitting staff of Wyoming MedicalCenter and as faculty at the University of Wyoming family practiceresidency program. He is also a Senior Aviation Medical Examiner.9:45-11:45Collaborative Practice to Promote PainManagement and Reduce Substance AbuseDavid Brushwood, R.Ph., J.D.Less than two decades ago, emergency rooms saw some 40,000patients in one year who misused prescription pain killers. In 2008,over 300,000 were admitted for this wildly growing problem. Oneexpert reported that about 5.2 of the estimated 7 million Americanswho abuse prescription dugs were improperly using pain relievers.It’s no wonder that prescribers hesitate to write prescriptions forpain medications. Some have resorted to refusing patients painmanagement drugs in fear of promoting or permitting the abuseof these drugs, but does this best serve patients in real pain? JoinDr. David Brushwood as he focuses on reducing substance abusewhile still managing patient’s pain. Dr. Brushwood describes how

TUESDAYcollaboration between prescribers, patients and pharmacists canmeet the needs of chronic pain patients without “knowingly” fillinginappropriate prescriptions by following VIGIL (Verification,Identification, Generalization, Interpretation and Legalization).This presentation will clarify the challenging problem ofdistinguishing pain behaviors from suspect behaviors as well asclearly identifying addiction with the FSMB regulatory approach.Dr. Brushwood will demonstrate how to avoid prescription fraudwith the help of information from the DEA Pharmacist Manual.A knowledgeable and trusted expert in the crucial education ofpharmacist professional responsibility and pain management policy,Dr. David B. Brushwood, R.Ph., J.D. will be sure to deliver essentialeducation on these increasingly important issues.David B. Brushwood, R.Ph., J.D.:David Brushwood is Professorof Pharmaceutical Outcomes and Policy at the University ofFlorida College of Pharmacy in Gainesville. His primary teachingresponsibilities are in the areas of pharmacist professionalresponsibility and pain management policy. Professor Brushwoodhas received grant funding from agencies such as the CommunityPharmacy Foundation, the Robert Wood Johnson Foundation, andthe National Institutes of Health. He currently directs an onlineMaster of Science in Pharmacy program that he founded in 2006.The program has over 200 students actively pursuing graduatestudies. Professor Brushwood is a frequent contributor to pharmacyjournals and to law journals.1:00–2:00Substance Use Sensitive PrescribingBert Toews, M.D., FASAMIf a patient broke his leg in a car accident caused by substance use,should this information change how the prescriber treats the painof the broken leg? Americans are showing a decreasing tolerancefor pain. In fact, prescriptions for pain relievers in 2003 were anastounding 16 times higher than in 1994. Unfortunately, thesepowerful tools for relieving pain carry the perilous potential ofaddiction. According to NIDA, a many as 7% of patients prescribednarcotic or opioids analgesics will become addicted. Furthermore,the Drug Enforcement Agency’s Office of Diversion and Controlreports that 74% of American abusing prescription drugs areabusing pain relievers. Americans are abusing prescription drugsmore than cocaine, hallucinogens, inhalants and heroin combined,but shockingly, 40 percent of physicians do not know their patient’ssubstance use background when prescribing these potentiallyaddictive substances. In this session, addiction specialist BertToews will outline crucial steps prescribers can take to treat theirpatients while being sensitive to potential addiction. Dr. Toews willexplain the vital importance of knowing a patient’s substance usehistory before prescribing. Drawing on his extensive experience intreating addiction, Dr. Toews will explain the use and effectivenessof pain contracts. Inspired by real life clinical situations, thissession promises to deliver practical solutions for prescribers inevery day practice.Berton Toews, M.D., FASAM: Berton Toews was born near Calgary,Alberta, grew up in Bonners Ferry, Idaho, and attended Universityof Idaho and University of Northern Colorado. He received hismedical degree from University of Cincinnati, and moved to Casper,Wyoming in 1976. There he became the first graduate from theUniversity of Wyoming family practice residency program. Heis certified by the American Board of Addiction Medicine and bythe American Board of Family Medicine, and is Wyoming’s onlyfull-time addiction physician. In 1996, Dr. Toews opened WyomingRecovery Program, a multi-level addiction treatment center inCasper that plays a leading role in tackling the state’s substanceproblems. HE has also been active in helping health professions5

TUESDAY1:45-3:15Treating the Unique Needs of Wyoming VeteransMark Mann, M.D.As our veterans return home, they need our help now more thanever according to many recent studies. A Rand Corporation reportin 2009 found that as many as 20 percent of Iraq and Afghanistanveterans exhibited symptoms of Post Traumatic Stress Disorder(PTSD) or depression. The VA estimates that in 2005, the suiciderate per 100,000 veterans among men ages 18-29 was 44.99 butjumped to an astonishing 56.77 in just two years. Furthermore,while prescription drug abuse doubled among U.S. militarypersonnel from 2002-2005 it almost tripled during 2005-2008.In consistent defense against these devastating problems is theVeterans Administration. In this increasingly relevant session,join the impressively qualified Dr. Mark Mann as he highlights theunique mental health and substance abuse challenges that faceour returning veterans today. He will explain the leading role takenby the Veterans Administration in identifying and treating thisheroic population. Dr. Mann will discuss approaches utilized by theVeterans Administration like Acceptance Commitment Therapy(ACT) and Cognitive Behavioral Therapy (CBT) in the treatmentof mood disorders as well as additional evidence based therapiessuch as Cognitive Processing Therapy (CPT) and ProlongedExposure Therapy (PE) in the treatment of PTSD. The SeekingSafety approach to treating comorbid substance abuse and PTSDwill be reviewed as well as the use of safety contracts in treatingsuicide in the veteran population. Dr. Mann will demonstrate howevery treatment professional can take advantage of these lifesavingservices for the veterans they serve by accessing VA servicesthrough the VA’s extensive telehealth network. This session is vitalto providing up-to-date and life changing and saving information tohelp all treatment professionals care for those who have valiantlyserved our country.Mark Mann, M.D.: Dr. Mark Mann is currently the Associate Chiefof Staff for Mental Health at the Sheridan VA Medical Center. TheSheridan VAMC Mental Health Department is responsible for 135inpatient beds that range from a locked Acute Psychiatric Unit toResidential Substance Dependence and Post-Traumatic StressDisorder Treatment. He obtained his Ph.D. in Clinical CommunityPsychology from the University of Maryland. He has over 10 yearsexperience teaching psychology at the University level and haspublished multiple peer review journals articles and book chapters.He completed five years of neuropsychological assessment at theNational Institute of Health and has worked on research projectswith the National Institute of Justice, the Maryland Department ofCorrections, the University of Maryland, and the Baltimore VAMC.He was a consultant for the Clinical Trials Unit of the NationalInstitute of Drug Abuse and the University of Maryland CollegePark. Dr. Mann is considered an expert in the study and treatmentof both Substance Abuse Disorders and Post-Traumatic StressDisorder.9

BROADCAST LOCATIONSAftonStar Valley Medical CenterEvanstonWyoming State HospitalSheridanSheridan Memorial Hospital10BuffaloJohnson County HealthcareCenterCasperWyoming Medical CenterBehavioral Health ServicesCheyenneCheyenne Regional MedicalCenterCheyenne VeteransAdministrationCodyCody LibraryDouglasMemorial Hospital of ConverseCountyGilletteCampbell County MemorialHospitalJacksonSt. John’s Medical CenterLanderLander Regional HospitalLaramieIvinson Memorial HospitalLovellNorth Big Horn HospitalRawlinsMemorial Hospital of CarbonCountyRock SpringsSouthwest Counseling CenterSheridan VeteransAdministrationNorthern Wyoming MentalHealth CenterSundanceCrook County Medical ServicesDistrictThermopolisHot Springs County MemorialHospitalWheatlandPlatte County Memorial HospitalCan’t make it to a broadcastlocation? Log-on from yourdesktop computer!

REGISTRATION FORMTo register for the Mental Health and Substance Abuse Training, visit www.tahealth.org, mail this form to the TA Health EducationFoundation, 28623 Old Hwy 87, Buffalo, WY 82834, or fax it to 307.684.8779. For information, call 307.684.5833. Please note: the trainingand CME, CEU, and POST credits are free.Name of AttendeeAffiliation/Organization11Mailing AddressPhoneEmail (note: it is our policy not to sell our email list)Facility where you will be attending the training (list of videoconferencing locations below)Number of continuing education credits you will apply for

TA HealthEducationFoundation28623 Old Hwy 87Buffalo, WY 82834www.tahealth.org