AAAP 2006 Annual Meeting Highlights
The American Academy of Addiction Psychiatry (AAAP), an organization founded in 1985 to promote research, education, and improved clinical practice in addiction psychiatry, convened its 17th Annual Meeting in St. Petersburg, Florida, on December 7-10, 2006. Among a number of topics of interest to addiction professionals was the issue of optimizing pharmacotherapy for alcohol dependence, which was explored in several presentations.

On Friday, December 8, Mark Willenbring, MD, of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, Maryland, presented a draft of a self-audit instrument developed by the AAAP Evidence-based Practice Committee that is designed to help members assess their own medical practices. The first audit tool to be developed by the Committee, this instrument was designed to monitor performance in providing pharmacotherapy for alcohol dependence, as such treatment was considered to be a core area of addiction psychiatry supported by a substantial evidence base for the use of US Food and Drug Administration-approved medications. As yet unnamed, the instrument is expected to take approximately 10 minutes to use, and is recommended for a sample of 10-20 charts per physician per year. It will be available both in paper form and on the AAAP Web site, as will a site for each physician to input his or her own anonymous results for the formation of a database providing normative data from all physicians who use the audit. Though initially planned for AAAP members, the audit instrument may be made available to the American Society for Addiction Medicine and the APA Council on Addiction Psychiatry in the future.

Initial experiences with the self-audit instrument in both the academic medical center and private practice settings were presented. Daniel Hall-Flavin, MD, of the Mayo Clinic Department of Psychiatry, Rochester, Minnesota, discussed the results of a retrospective chart review of acamprosate treatment using the instrument in both residential and intensive outpatient programs. A surprising initial finding of this review was the low rate of prescribing of the medication (15%), even among patients considered appropriate candidates. Over the 18-month course of developing the database using the audit instrument, however, Dr. Hall-Flavin noted that the rate of prescribing more than doubled, to 37%. This experience was echoed by Syed Pirzada Sattar, MD, who reported the results of his application of the audit instrument to monitor his private practice. With increased practice in using the instrument, he found that the time to complete the audit fell to approximately 4 minutes per chart, and that documentation of treatment rationale and potential risks and side effects improved considerably. Perhaps of greatest importance, the rate of certain medication prescriptions for alcohol dependence increased.

According to the panel discussants, pharmacotherapy for alcohol dependence continues to be grossly underutilized for a variety of reasons, including therapeutic nihilism, patient resistance, or lack of access to physicians experienced in providing the treatment. As described by Drs. Hall-Flavin and Sattar, however, even addiction psychiatrists may underuse these treatments or use them inconsistently. Interventions that improve a clinician's awareness of his or her own prescription patterns thus have the potential to enhance patient care significantly. The self-audit instrument developed by the AAAP Evidence-based Practice Committee appears to be feasible in diverse settings and is likely to optimize pharmacotherapy for alcoholism, both in terms of standardization of treatments and improved prescription rates. According to Dr. Willenbring, the Evidence-based Practice Committee plans to identify additional areas for performance monitoring annually.