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IN THE CIRCUIT COURT FOR SULLIVAN COUNTY

AT KINGSPORT, TENNESSEE

BARRY STAUBUS, in his official capacity as the District )


Attorney General for the Second Judicial District and on behalf )
of all political subdivisions therein, including SULLIVAN )
COUNTY, CITY OF BLUFF, CITY OF BRISTOL, CITY OF ) JURY DEMAND
KINGSPORT; ) Case No. C-41916
STATE OF TENNESSEE ex rel. BARRY STAUBUS;
TONY CLARK, in his official capacity as the District Attorney
) Division C
General for the First Judicial District and on behalf of all political )
subdivisions therein, including CARTER COUNTY, CITY OF )
ELIZABETHTON, CITY OF WATAUGA, JOHNSON )
COUNTY, CITY OF MOUNTAIN CITY, UNICOI COUNTY, )
TOWN OF UNICOI, TOWN OF ERWIN, WASHINGTON )
COUNTY, CITY OF JOHNSON CITY, TOWN OF )
JONESBOROUGH; )
STATE OF TENNESSEE ex rel. TONY CLARK; )
DAN ARMSTRONG, in his official capacity as the District )
Attorney General for the Third Judicial District and on behalf of
)
all politic al subdivisions therein, including GREENE COUNTY,
CITY OF TUSCULUM, TOWN OF BAILEYTON, TOWN OF
)
GREENVILLE, TOWN OF MOSHEIM, HAMBLEN COUNTY, )
CITY OF MORRISTOWN, HANCOCK COUNTY, TOWN OF )
SNEEDVILLE; HAWKINS COUNTY; CITY OF CHURCH )
HILL; TOWN OF BULLS GAP; TOWN OF MOUNT )
CARMEL, TOWN OF ROGERSVILLE, TOWN OF )
SURGOINSVILLE; )
STATE OF TENNESSEE ex rel. DAN ARMSTRONG; )
and BABY DOE, by and through his Guardian Ad Litem, )
)
Plaintiffs,
)
v.
)
)
PURDUE PHARMA, L.P.; PURDUE PHARMA, INC.; THE )
PURDUE FREDERICK COMPANY; MALLINCKRODT LLC; )
ENDO HEALTH SOLUTIONS, INC; ENDO )
PHARMACEUTICALS, INC; ELIZABETH ANN BOWERS )
CAMPBELL; PAMELA MOORE; and ABDELRAHMAN )
HASSABU MOHAMED, )
)
Defendants.
I. Assignment......................................................................................................................... 1
II. Qualifications..................................................................................................................... 1
III. Summary of opinions ........................................................................................................ 2
IV. The opioid crisis in the United States is a widespread epidemic that
constitutes a critical public health problem.................................................................... 3
V. The impact of this crisis has been particularly severe in Tennessee and, in
particular, the counties at issue in Northeast Tennessee ............................................. 10
VI. Addressing the opioid crisis requires a comprehensive and continuous
remediation program ...................................................................................................... 12
A. Primary prevention ............................................................................................................. 13
B. Secondary prevention: Screening for OUD........................................................................ 13
C. Treatment that is continuous and comprehensive .............................................................. 15
D. Social supports ................................................................................................................... 19
E. Data collection for continuous program assessment and quality improvement ................. 20
VII. Special populations will require additional programs and resources ........................ 21
A. People with HIV/AIDS or hepatitis C ................................................................................ 21
1. Opioid use disorder, HIV, and hepatitis C.................................................................... 21
2. Appalachia and Tennessee are particularly vulnerable to HIV and HCV
infection ........................................................................................................................ 23
3. Additional treatment and programs required to remediate the opioid crisis in
these populations .......................................................................................................... 26
4. Expected scope of the program in treating people with HIV and HCV ....................... 31
B. People in the criminal justice system ................................................................................. 31
1. The opioid epidemic and the criminal justice system ................................................... 31
2. Additional treatment and programs required to remediate the opioid crisis in
this population .............................................................................................................. 36
3. Examples of effective programs ................................................................................... 42
4. Expected scope of program in county jails ................................................................... 43
5. A comprehensive program should include drug courts, a proven effective way
of addressing criminal justice problems related to the opioid crisis ............................. 43
C. People who are homeless ................................................................................................... 51
1. Homelessness and the opioid epidemic ........................................................................ 51
2. Additional treatment and programs required to remediate the opioid crisis in
the homeless population ............................................................................................... 51
D. Children and families ......................................................................................................... 56

i
1. Impact of the opioid epidemic on children and families .............................................. 56
2. Addressing the impact of the opioid crisis on children and families ............................ 61
E. Babies with NAS and pregnant women ............................................................................. 68
1. The opioid epidemic and NAS ..................................................................................... 68
2. Additional treatment and programs required to remediate the opioid crisis in
this population .............................................................................................................. 70
3. Expected scope of the program .................................................................................... 74

ii
1. I have been engaged by counsel for the Plaintiffs in this case. I have been asked to

provide my opinion regarding the opioid crisis and approaches that local officials in the affected

region of Northeast Tennessee1 can use to address certain health and mental health problems

caused by that crisis. Specifically, I was asked to address methods for remediating the effects of

the crisis in five special populations of people with : (1) people with

HIV or hepatitis C, (2) people in the criminal justice system, (3) homeless people, (4) children

and families, and (5) babies with Neonatal Abstinence Syndrome (NAS) and pregnant women.

2. I am a psychiatrist and a public health doctor. After 30+ years of direct patient

care and increasingly responsible clinical administrative positions, I shifted my focus and began

my public health work, almost 20 years ago. My Curriculum Vitae details my qualifications and

is attached as Exhibit A.

3. From 2000-2002, I was Director of Clinical Services at The American Psychiatric

Association in Washington, DC, where my work especially focused on 1) developing treatment

guidelines and quality measures for the field of psychiatry and 2) developing a model for

prospective payment for inpatient psychiatric services paid by Medicare (and later adopted by

Medicaid).

1
The nine counties at issue in Northeast Tennessee are: Carter, Johnson, Unicoi, Washington, Sullivan, Greene,
Hamblen, Hancock, and Hawkins.

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4. In 2002, I was recruited by the new Mayor of New York City, Michael

Bloomberg, to serve as Commissioner for Mental Hygiene (encompassing mental health,

addictions, and developmental disorders).

5. In 2007, I was recruited to be the Chief Medical Officer for the NYS Office of

Mental Health, the largest state mental health agency in the country, serving approximately

750,000 people annually through non-profit and state mental health services. In April of 2019, I

stepped down from this role but was asked to remain on as Distinguished Psychiatrist Advisor

for the agency. I accepted that position and continue in that role.

6. I have reached the following opinions regarding this case to a reasonable degree

of certainty based on my education, training and experience as a physician and public health

doctor and administer and my review and analysis of relevant materials in this matter:

a. The opioid crisis in the United States is a widespread epidemic that constitutes

a critical public health problem.

b. The impact of this crisis has been particularly severe in Tennessee and, in

particular, the counties at issue in Northeast Tennessee.

c. Addressing the opioid crisis requires a comprehensive remediation program. I

have identified nine components of a comprehensive remediation program.

d. Special populations will require additional programs and resources. This

report describes a comprehensive approach to five special populations:

(1) people with HIV or hepatitis C, (2) people in the criminal justice system,

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HIGHLY CONFIDENTIAL PAGE 2
(3) homeless people, (4) children and families, and (5) babies with Neonatal

Abstinence Syndrome (NAS) and pregnant women.2

7. To reach these conclusions, I have reviewed documents produced in this case,

publications in the fields of medicine and public health, government reports, and publicly

available datasets reflecting the prevalence and epidemiology of physical diseases, substance use

disorders and mental illnesses. I have also relied on my own extensive experience as both a

psychiatrist with decades of experience caring for patients and also as a public health doctor who

has designed and administered large-scale programs to address health, mental health and

substance use conditions. A list of the documents I have reviewed and relied upon in writing this

report is attached as Exhibit B.

8. For my work on this case, I am being compensated at a rate of $750 per hour. My

compensation is not contingent upon my opinions, my conclusions, or the outcome of this

matter. I reserve the right to modify my opinions based on new information or the opinions

offered by other experts in this case.

9. The opioid epidemic seizing this country is indeed an epidemic and has been

declared so by the Centers for Medicare and Medicaid Services (CMS).3 The opioid epidemic

has taken more lives per year than the HIV/AIDS epidemic at its apogee, and its annual death toll

2
All of these opinions are to a reasonable degree of medical certainty and reflect observations that are more likely
than not accurate.
3
Centers for Medicare and Medicaid Services (CMS), https://www.cms.gov/about-
cms/story-page/reducing-opioid-misuse.html.

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exceeds the entirety of U.S. military losses in the Vietnam War.4 Its impact extends to children,

adolescents, adults, and those not yet born prenatal children who are developing in an opioid-

saturated uterine environment, which results in Neonatal Abstinence Syndrome (NAS) and

ongoing developmental and behavioral disturbances throughout their early years, perhaps longer.

Data on the epidemic illustrates its severity:

10. Sales of opioids. Sales of opioids have grown dramatically since the early 1990s.

Wholesale sales of prescription opioid analgesics to the retail channel in the United States were

five times as high in 2010 as they were in 1992 in terms of morphine milligram equivalents

(MMEs),5 as shown in Figure 1 below, reprinted from an FDA report.6

Figure 1

4
National Academies of Sciences, Engineering, and Medicine, Pain Management and the Opioid Epidemic:
Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, National Academies Press, 2017,
p. 187, https://www.ncbi.nln.nih.gov/pubmed/29023083.
5
A morphine milligram equivalent (MME) is a standard value that enables the comparison of quantities of different
opioids. For each opioid, an MME is the quantity that has the same potency as a milligram of morphine.
6
FDA analysis of long-term trends in prescription opioid analgesic
products: Quantity, sales, and price trends, March 1, 2018, p. 3, Figure
aggregate opioid analgesic market

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11. Wholesale dollar sales of prescription opioid analgesics to the retail channel in the

United States were ten times as high in 2014 as they were in 1992, as shown in Figure 2 below,

also from the FDA report.7

Figure 2

12. Prescriptions. In 2012 alone, 255 million opioid prescriptions were filled a

supply that could medicate all the adults in the United States.8

13. Opioid misuse, abuse, and addiction. The flood of opioids has taken a huge toll

on human health. The rate of emergency department visits associated with prescription opioid

misuse or abuse increased 153% between 2004 and 2011.9 The rate of costly hospital admissions

7
Ibid
8
IQVIA, Nat
https://www.census.gov/quickfacts/fact/table/US/PST045218. Total population on July 1, 2018, was 327,167,434,
and the adult percentage was 77.6%.
9
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics
and Quality, Highlights of the 2011 Drug Abuse Warning Network (DAWN): Findings on drug-related emergency
department visits, The DAWN Report, February 22, 2013, Table 2.

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HIGHLY CONFIDENTIAL PAGE 5
to treat substance use disorder in 2009 was six times what it was in 1999.10 In 2016, 11.8 million

people in the United States misused opioids, which is 4.4 percent of the population of people

over the age of 12. In the great majority of cases, these people were misusing prescription

opioids.11

14. Mortality. Concomitant with the rise of opioid addiction and abuse, there has

been an alarming increase in the number of opioid overdose deaths, which went from 8,050 in

1999 to 42,249 in 2016, a five-fold increase (see Figure 3).

10
Centers for Disease Control and Prevention (CDC), Vital signs: Overdoses of prescription opioid pain relievers
United States, 1999-2008 Morbidity and Mortality Weekly Report, 60(43), 2011, pp. 1487 1492.
11
SAMHSA Shares Latest Behavioral Health Data, SAMHSA News,
October 12, 2017, https://www.myhealthycitizen.com/samhsa-shares-latest-behavioral-health-data-including-opioid-
misuse/.

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Figure 312

15. The upward trend in opioid overdose deaths has been remarkably persistent. In

to deter abuse, but the data indicate that this effort has not reversed the trend. In fact, the release

of an abuse-deterrent version of OxyContin in 2010 was followed by a sharp increase in the

number of deaths from overdoses of heroin and the synthetic opioid, fentanyl, as represented in

the graph above.13 Heroin use is closely associated with prescription opioid use: approximately

12
CDC, National Drug overdose deaths in the United States, 1999 NCHS Data
Brief No. 294, December 2017; see data tables, https://www.cdc.gov/nchs/data/databriefs/ db294_table.pdf#1.
13
A. Alpert, D. Powell Supply-side drug policy in the presence of substitutes: Evidence from the
introduction of abuse- NBER Working Paper Series, Working Paper 23031, January 2017.

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75-80% of heroin users in recent years report that their initial opioid use was prescription

drugs.14

16. Neonatal abstinence syndrome (NAS). NAS is a condition suffered by

newborns whose mothers were using opioids at the time of the birth of the infant. Since the start

of the opioid epidemic, rates of NAS have increased alongside rates of maternal OUD, and they

were over 5 times greater in 2014 than they were in 2004, as illustrated in Figure 4.15

14
CDC, -
Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012, Morbidity and Mortality Weekly Report, 64(17),
2015, pp. 453-458, citing J.C. Maxwell The prescription drug epidemic in the United States: A perfect storm
Drug and Alcohol Review, 30, 2011, pp. 264 70.
15
National Institute on Drug Abuse (NIDA), Dramatic increases in maternal opioid use disorder and neonatal
abstinence syndrome, 2019, https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-
increases-in-maternal-opioid-use-neonatal-abstinence-syndrome. See also, M. Honein, , C. Boyle, and R. Redfield,
Public health surveillance of prenatal opioid exposure in mothers and infants Pediatrics, 143(3), 2019, pp. 1-3; T.
Winkelman, et al., Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004-
2014 Pediatrics, 141(4), 2018, pp. 1-8; and CDC, Opioid use disorder documented at delivery hospitalization
United States, 1999 2014 Morbidity and Mortality Weekly Report, 67(31), 2018, pp. 845-849.

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Figure 4

In 2014, 32,000 newborns were diagnosed with NAS in the United States at a total estimated cost

of $563 million.16

17. Deaths from opioids have now exceeded those from motor vehicle accidents and

gunshot wounds.17 The Council of Economic Advisors estimated the annual cost of the opioid

crisis in the United States at $504 billion in 2015.18 To put these numbers in perspective, this is

nearly as much as the 2015 Federal Budget for Medicare ($539 billion) or Defense ($582 billion)

16
Honein, et al., op. cit.
17
National Safety Council, Injury Facts, Odds of dying, 2017, https://injuryfacts.nsc.org/all-injuries/preventable-
death-overview/odds-of-dying/.
18
The underestimated cost of the opioid crisis

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and much greater than the budget for Medicaid ($350 billion).19

a tsunami.

18. Certain states and counties in the U.S. have been hit harder than others: they are

what are called epicenters of the epidemic. The State of Tennessee and the nine counties at issue

have suffered greatly from the consequences of an epidemic. These counties are seeking to

mitigate the epidemic affecting its citizens, including children, families, babies with neonatal

abstinence syndrome, pregnant women dependent on opioids, and other special populations

19. Tennessee has extraordinarily high rates of opioid use disorder (OUD), as shown

by claims analyses conducted by Tennessee insurers. According to Blue Cross, Blue Shield,

-Cities area, which encompasses Johnson City,

Bristol, and Kingsport, has the 6th highest opioid use disorder rate in the country.20 An internal

analysis conducted by TennCare shows an even higher rate of 19.7 per 1,000 people in 2015.21

20. Tennessee also has high rates of death from opioid overdose. According to data

from the CDC, Tennessee consistently has had one of the 15 highest overdose mortality rates in

the country since at least as far back as 2005.22 Despite statewide attention, policy changes, and

19
Congres repared by Maureen Costantino and Leigh Angres
(January 2016), https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/graphic/51110-
budget1overall.pdf.
20
Blue Cross, Blue Shield, The opioid epidemic in America: An update, Local Data, Appendix B: Opioid Use by
MSA [metropolitan statistical area], July 12, 2018.
21
B. Heavrin, Rural Health Association of Tennessee, 24th Annual Conference,
November 15, 2018.
22
-adjusted death rates for 1999, 2005, 2014, 2015, 2016, and 2017,
https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm; CDC, Drug and
opioid-involved overdose deaths United States, 2013 2017, Morbidity and Mortality Weekly Report, 67(51 and
52), January 4, 2019, pp. 1419 1427, https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm.

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some limited progress, the opioid epidemic in Tennessee has malignantly evolved and persisted.

As opioid prescription rates have decreased, usage of heroin and fentanyl has increased, resulting

in increasing rates of morbidity and mortality (illness, disability, and death), including increases

in opioid-related inpatient stays, opioid-related emergency department visits, rates of neonatal

abstinence syndrome, and overdose deaths.23 Deaths from prescription opioid overdose have

declined since 2016; however, this decline is more than offset by an increase in overdose deaths

from heroin and fentanyl, and, as a result, overall deaths from opioid overdose have continued to

rise.24

21. Another indicator of the epidemic in Tennessee is the increase in admissions for

opioid use treatment. The Tennessee Department of Mental Health and Substance Abuse

use treatment for limited numbers of

adults with incomes below 133% of the poverty level and without insurance coverage.25 Between

2014 and 2018, the number served in opioid abuse treatment increased by 44%.26 In 2018, 65.8%

of individuals receiving TDMHSAS-funded substance use treatment in Johnson County were

abusing opioids; in Carter County, 61.1% were abusing opioids; in Unicoi County, 79.5%; in

23
National Institute on Drug Abuse (NIDA), Tennessee Opioid Summary, (2019),
https://www.drugabuse.gov/node/pdf/21986/tennessee-opioid-summary; The Sycamore Institute, The opioid
epidemic in Tennessee: 2018 update on indicators of progress, Written by Mandy Pellegrin and Courtnee Melton,
August 9, 2018, https://www.sycamoreinstitutetn.org/opioid-epidemic-tn-indicators/.
24
CDC, Provisional drug overdose death counts, Data from April 2014 through February 2019,
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. CDC tracks overdose mortality for four categories of
opioids: heroin (T40.1); natural opioid analgesics, including morphine and codeine, and semisynthetic opioids,
including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone (this category includes almost
all prescription opioids) (T40.2); methadone, a synthetic opioid (T40.3); synthetic opioid analgesics other than
methadone, including drugs such as fentanyl and tramadol (this category is made up mostly of fentanyl overdoses)
(T40.4).
25
Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), Fast Facts Dashboard,
https://www.tn.gov/behavioral-health/research/tdmhsas-fast-facts-test-3/fast-facts-tdmhsas-opioid-treatment.html.
26
Ibid.

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Washington County, 56.9%; in Sullivan County, 54.8%; in Greene County, 64%; in Hawkins

County, 68.7%; and in Hamblen County, 61.1%.27

22. Public health approaches have a long history of beating back epidemics: think of

polio, smallpox, tuberculosis, car accident deaths, and the morbidity and mortality associated

with cigarette smoking. What is needed now, across the U.S. and in Tennessee, is a

comprehensive, adequately resourced and ably and continuously executed public health approach

to the opioid epidemic nothing less will succeed.

23. Public health is a discipline dedicated to developing evidence-based solutions to

complex, stubborn problems affecting identified populations of persons. A public health

approach to the opioid epidemic would have a number of essential elements. First, there would

be a focus on primary prevention, which means preventing people from developing opioid use

disorder in the first place. Second, there would be secondary prevention, which means early

detection (and treatment) before the disease or health problem becomes more advanced and thus

more challenging to remedy. Third, there would be early intervention, providing solutions at the

early stages of the identified problem, which for any condition is likely to be more effective and

can prevent its worsening. Fourth, there would be comprehensive, continuous treatment. Fifth,

there would be the provision of social supports to people suffering from opioid use disorder.

Fifth, the program must have, from its outset, processes for real-time, quantifiable performance

measures to drive continuous quality evaluation and improvement and to assure accountability.

Because so many lives are at stake, there must be specific and public assignment of

27
Ibid.

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responsibility for each element of the program to collect data, determine what is working and

what is not, and for which patients and populations. Specific measures enable the assessment of

program effectiveness and prompt course corrections.

24. The aim of primary prevention is to reduce the risk of developing OUD. It could

include public service announcements and programs, in schools, faith-based organizations, and

community centers, that build skills in children and families. One example is that of programs

that train youth to cognitively process the offer for drugs (from other youth or dealers or both),

and thereby build the capacity to recognize the value to them of foregoing drugs. Primary

prevention also would address the upstream causes of OUD: the social and economic factors that

fuel this epidemic. It would also dam the flood of opioids into communities: it would shut down

pill mills, curtail diversion of prescription opioids, and assist physicians in understanding and

delivering alternatives to opioids for managing pain and in the proper prescribing and use of

opioids.

25. With any condition, physical or mental, the sooner its problems are detected the

more likely the person can benefit from care. Unfortunately, in the case of OUD, there have been

many barriers to its early detection. Stigma, shame, and fear of some form of social or vocational

reprisal have resulted in many people at risk for an OUD, or in early stages of the disorder, not

asking for or seeking help.28 In addition, a culture prevails in some primary care medical

practices (including family and general medicine, obstetrics and gynecology, emergency rooms,

28
For example, see T. Monroe and H. Kenaga, Substance abuse and addiction among nurses,
Journal of Clinical Nursing 20(3-4), 2011, 504-509.

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and mental health clinics as well) that can be described as clinicians

and abuse .29

26. These barriers can be counteracted by a county-based, broadly and effectively

delivered screening program. Screening for risk and presence of an OUD can be conducted in

primary care, mental health, and emergency room settings; it also can be conducted in schools,

HIV clinics, jails, homeless shelters, and other locations where people with substance use

problems can be found.

27. To be effective, screening must become a standard part of medical practices, no

different from taking a pulse or a blood pressure or doing a mental status exam in a mental health

setting. Unless it becomes standard practice, the rule not the exception, the provision and

adherence to delivering screening will be very limited and thus not accomplish the essential

goal of detecting opioid use, misuse and dependence. One proven way to improve adherence to

screening in a variety of settings is to build and deploy a cadre of peer recovery coaches. These

are people who typically have suffered with addiction but are in advanced and stable states of

recovery. They have been trained in screening for substance use disorders, early detection, and

patient engagement, support and retention in care. Evidence from a substantial body of research

indicates that peer-recovery coaching is effective, providing increased treatment retention,

improved access to and use of social supports, decreased involvement with the criminal justice

system, reduced relapse rates, reduced rates of re-hospitalization, reductions in the use of

substances and in the prevalence of substance use disorders, and in greater housing stability.30

29
Personal communication with former NYS Mental Health Commissioner, Dr. Michael Hogan, my boss for the
first six years I was at my current position, until he retired.
30
This body of research is summarized in the following document: SAMHSA, Peers supporting recovery from
substance use disorders, 2017, https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/peers-
supporting-recovery-substance-use-disorders-2017.pdf.

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28. There are various available screening tools that are scientifically tested and

effective and that impose a low burden on clinicians. These include the CAGE-AID screening

questionnaire, the DAST-10 (Drug Abuse Screen Test), and the NIDA (National Institute on

Drug Abuse) Drug Use Screening Tool. A more developed form of screening and intervention is

termed SBIRT (Screening, Brief Intervention, and Referral for Treatment). These specific tools

are illustrative of the wide variety of means of screening and early detection described in the

extensive literature on this topic.31

29. Continuous treatment. It is critical to understand that OUD is a chronic,

relapsing condition. What this means is that those affected remain at risk for relapse, sometimes

for the remainder of their lives. Successful

treatment for addiction typically requires continual evaluation and modification as appropriate,
32
similar to the approach taken for other chronic diseases. The percentage of patients who

relapse after treatment for drug addiction is between 40% and 60%, which is comparable to the

relapse rates for other chronic diseases: type 1 diabetes (30 50%), hypertension (50 70%), and

asthma (50 70%).33 Recovery is not achieved in an instant, but over time. Treatment,

rehabilitation, and support, therefore, must be sustained for 10, 20, or more years in order to

effectively serve those who suffer from any chronic illness, including OUD.

31
M. Young, et al. Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to
Treatment (SBI
Systematic Reviews, 3(1), 2014, p. 2
Pain Medicine, 6(6), pp. 432-443; and R. Saitz,
-based practice, Substance Abuse,
28(3), pp. 7-31; SAMHSA-HRSA Center for Integrated Health Solutions, Screening tools,
https://www.integration.samhsa.gov/clinical-practice/screening-tools.
32
Principles of drug addiction treatment: A research-based guide (Third Edition
33
NIDA Guide, p. 15.

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30. Comprehensive treatment. The effective treatment of OUD requires attending to

the biological, psychological, and social dimensions of the disorder. That is what is meant by a

comprehensive treatment. This standard exists for all chronic diseases, and it is no less warranted

for a substance use disorder.

31. The primary biological intervention for OUD is medication-assisted treatment

(MAT). Once an OUD has set in, it is characterized by cravings and dependence, both
34
physiological states

These states of craving, of a person experiencing a singular, dominant preoccupation with

obtaining and using a drug (in this case an opioid), can be substantially mitigated by MAT,

the use of medications in combination with counseling and behavioral therapies for
35
the treatment of substance use disorders Evidence supports the conclusion that MAT is an

effective method for treating substance use disorders, for preventing overdose deaths, and that it

can help some people maintain their recovery.36

32. The FDA approved MAT medications in use today are buprenorphine (Suboxone

and others), methadone, and naltrexone (Vivitrol), each of which can be beneficial for certain

patients, and thereby assist individuals, families, communities and government stakeholders. 37

33. Buprenorphine is a lifesaving intervention for OUD. Those people with OUD

who are maintained on appropriate buprenorphine show a marked reduction in overdoses and

34
Personal communication, Nora Volkow, MD, director of the federal agency, NIDA.
35
SAMHSA-
https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview.
36
Ibid.
37
National Academies of Sciences, Engineering, and Medicine, Pain Management and the Opioid Epidemic:
Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, National Academies Press, 2017,
, https://www.ncbi.nln.nih.gov/pubmed/29023083.;
Medication-assisted treatment (MAT) for opiate dependence
to drug addict https://www.nursingworld.org/~4af5f1/globalassets/practiceandpolicy/work-environment/health--
safety/ana-paw_medication-assisted-therapy.pdf.

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deaths.38 A once-monthly injection of buprenorphine has recently been approved by the FDA.

This may be favored for use in jails because it is administered by a medical professional and

cannot be diverted as contraband.39

34. Methadone remains an effective means of controlling cravings and forestalling

withdrawal from opioids, but it has some shortcomings. With the exception of its use in short-

term pain control, detoxification from opioids, and treating symptoms of NAS, methadone must

be administered daily and under direct observation at a specifically licensed program. Because of

these significant requirements (as experienced by those with an OUD) and reported

side-effects (e.g., sedation and reduced cognitive functioning), methadone use by and in the

OUD population has been limited. Yet, it should be provided for those who require its potency

and structured provision of care.40

35. Naltrexone (Vivitrol) acts by fully blocking the mu (opioid) receptor in the brain,

which means that a person taking it will not experience the high, the neurochemical reward

from using an opioid. Because of these features, especially its lack of delivering a igh

because it is not an opioid, it has greater acceptability among some of the stakeholders involved

in the opioid epidemic. Another advantage of long-acting naltrexone (Vivitrol) is that it is

administered only once a month, though it must be administered intra-muscularly

office or medical, substance use, or mental health clinic.41

38
Julie Dupouy, Aurore Palmaro,
Mélina Fatséas, Marc Auriacombe, Joëlle Micallef, Stéphane Oustric, and Maryse Lapeyre-Mestre, Mortality
associated with time in and out of buprenorphine treatment in French office-based general practice: A 7-year cohort
study, Annals of Family Medicine 15, 2017, 355-358.
39
Christopher Moraff, Pennsylvania DOC to Pilot Injectable Buprenorphine for Detoxing Prisoners, Filter,
October 12, 2018; 37. Terry Demio, Jail using medicine to help inmates addicted to drugs, AP News, Jun. 29,
2019, https://www.apnews.com/c173956e8e3448a0a49071d8f0157106.
40
National Academies of Sciences, Engineering, and Medicine, op. cit.
41
Ibid.

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36. A variety of other important biological interventions assist in recovery from an

OUD. These include proper nutrition, exercise, restorative sleep, the intrinsically invaluable

bi -

(such as meditation, mindfulness, yogic breathing and yoga). These forms of self-care can be

very helpful to a person managing OUD, as they are with many other chronic medical

conditions.42

37. Psychological treatment interventions. Patients can benefit from a diverse set of

ot every shoe fits every foot,

intervention over another is a strong predictor of whether they will adhere to it. I often see that

patients are more likely to do what they want, not what the doctor or nurse says they should do.

Therefore, it is helpful to think of a clinical setting offering a menu of psychological

interventions. These might include: Motivational Interviewing; Cognitive Behavioral Therapy

(CBT); Family Behavior Therapy; Assertive Continuing Care, including outreach services; 12-

Step Recovery Groups (on site when possible, or nearby when not); and Contingency

Management.43 - because a large percentage of

those people with OUD (or at risk for the disorder) have had Adverse Childhood Experiences

(ACEs).44 Even if a new program cannot offer this full menu from the very start, it is a mistake

42
J. Weinstock, H. Wadeson, and J. Vanheest, Exercise as an adjunct treatment for opiate agonist treatment:
Review of the current research and implementation strategie Substance Abuse, 33(4), 2012, pp. 350 360; L.P.
Grant, B. Haughton, and D.S. Sachan
Journal of the Academy of Nutrition and Dietetics, 104(4), 2004, pp. 604-610; E.L. Garland
-based treatment of addiction: current state of the field and envisioning the next
Addiction Science and Clinical Practice, 13(14), 2018, pp. 1-14.
43
NIDA Guide, pp. 49 66.
44
M. Stein, et al e, and overdose
among persons with opioid use disorder, Drug and Alcohol Dependence, 179, 2017, pp. 325-329. For these
-
address them. For example, some people who have experienced trauma (especially trauma that is persistent and
severe) are hyper-reactive to perceived emotional and physical harm. Alternatively, others may seem under-reactive
to their environment; this generally is the result of their using dissociation to distance and protect themselves from
further harm. In addition, traumatized youth may have little grounds for trusting other people. As a result, clinicians

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to rely on only one method. A fuller menu may be achieved over time by training existing staff

and recruiting new, trained staff.

38. Treatment of co-occurring conditions. Active, co-occurring biological and

psychological conditions can interfere with OUD treatment. Depression and other mental

conditions are risk factors for OUD and can thwart successful treatment.45 Biological illnesses,

like diabetes and cardiovascular diseases, can also pose a barrier to treatment of substance use

disorders by increasing their cost and producing a variety of medical complications.46 Therefore,

treatment of any co-occurring mental or physical condition, to the extent possible, is an

important element of OUD treatment.47

39. Social supports are essential to successful recovery from OUD. These include

providing safe and affordable housing, where appropriate. 48 They also include family education

about OUD, training in how to help the affected family member and how family members

themselves can cope with this chronic illness. Families and loved ones are the most important

resource a person with a chronic disease may have, and they need to be supported and coached. 49

and caregivers have to work to build trust and recognize how precarious that trust can be (Jack P. Shonkoff and
Andrew S. Garner, Pediatrics 129, 2012, e232-
e246).
45
Depression effects on long-term prescription op Clinical Journal
of Pain, 34(9), 2018, pp. 878 884, at 879 880; A. Grattan, et al., Depression and prescription opioid misuse among
chronic opioid therapy recipients with no history of substance abuse Annals of Family Medicine, 10(4), 2012, pp.
304 311; D. Feingold, et al. The association between severity of depression and prescription opioid misuse among
chronic pain patients with and without anxiety: A cross-sectional study Journal of Affective Disorders, 235, 2018,
pp. 293-302; D. Hasin, et al., Effects of major depression on remission and relapse of substance dependence,
Archives of General Psychiatry, 59, pp. 375 380 at p. 378; and K. Domino, et al., Risk factors for relapse in health
care professionals with substance use disorders, JAMA, 293, 2005, pp. 1453-1460, at pp. 1456 and 1457.
46
American Society of Addiction Medicine, The ASAM Criteria: Treatment Criteria for Addictive, Substance-
Related, and Co-Occurring Conditions, 2013, Chapter 7,
47
NIDA Guide, pp. 26 27.
48
U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, and Office of
Disability, Aging and Long-
i
49
NIDA Guide, p. 18.

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Social supports also include employment counseling and job retraining.50 Unemployment is a

major risk factor for substance use and disorder, and is a barrier to successful treatment.51 More

to address what existing social factors may hinder the effectiveness of any OUD treatment

provided.

40. Finally, a public health program to address the opioid epidemic would have

processes for collecting data, monitoring program performance, and continuous quality

improvement. These critical processes, along with clear assignment of and public accountability

of responsibilities, enable the county, payer and program administrators to learn from successes

and mistakes and cont

41. In addition to the approach I have outlined above, a complete remediation of the

opioid crisis would include initiatives to address social ills stemming from the opioid crisis.

These would include the problems of: (1) the growth in non-violent and violent crimes, which

add to the burden of law enforcement and drive up court, incarceration and probation costs;

(2)

lost producti

adequately) short and long-term disability, and premature mortality; and (3) the erosion of

families and social support networks.52 However, the provision of programs such as these is

beyond the scope of my report.

50
NIDA Guide, pp. 31 and 33.
51
- Current Drug Abuse
Reviews, 4(1), 2011, pp. 4 27 at p. 17.
52
C. S. Florence, et al.
Medical Care, 54(10), 2016, pp. 901 906.

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42. Certain populations of people will require additional programs and resources to

effectively treat their OUD and remediate the effects of the opioid epidemic. I identify five of

these special populations and describe evidence-based programs for addressing the impact of the

opioid epidemic on them. They are (1) people with HIV/AIDS or hepatitis C, (2) people in the

criminal justice system, (3) homeless people, (4) children and families, and (5) babies born with

NAS and pregnant women.

43. Infectious diseases have long been the mainstay of the field of public health.

Historically, they have been the principal disease causes of morbidity and mortality worldwide.

But in recent years, the consequences of infectious diseases have been eclipsed by non-

communicable diseases such as hypertension, diabetes, cancer, heart disease, and depression

and now the opioid epidemic. One terrible irony is that the opioid epidemic has ushered back in a

host of infectious diseases, principally HIV/AIDS and hepatitis C.

44. Prescription opioid misuse and abuse has shifted in recent years from oral forms

to injectables, and injection drug use increases the transmission of HIV and hepatitis C.

-abusing individuals, including

injecting and non-injecting drug users, are at increased risk of human immunodeficiency virus

(HIV), hepatitis C virus (HCV), and other infectious diseases. These diseases are transmitted by

sharing contaminated drug injection equipment and by engaging in risky sexual behavior
53
Because of these behaviors, the opioid epidemic has led

53
NIDA Guide, p. 29.

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to increases in HIV and hepatitis C transmission. For example, the well-documented HIV

outbreak in Scott County, Indiana, between 2014 and 2015 was ultimately demonstrated to have

been caused by shared needles and injection paraphernalia associated with injection of

oxymorphone.54 A CDC report states: The opioid epidemic has also increased the number of

PWID [people who inject drugs] in the United States and thereby substantially increased the risk

of transmission of blood-borne viruses, including human immunodeficiency virus (HIV),

hepatitis C virus (HCV) and hepatitis B virus (HBV) through use of shared equipment. Unsafe

injection of drugs, such as by sharing injection equipment (e.g., syringes, cookers, water, and

cotton) to inject or split drugs, contributed to an increase in new HCV infections from 1,232 to
55
2,436 from 2011 through 2015

45. For these reasons, OUD treatment also is an effective form of HIV/HCV

prevention.56 Moreover, OUD treatment among people already carriers of HIV and HCV can

reduce the spread of these infections. It can also improve the success of HIV and HCV treatment

for multiple reasons. First, effective OUD treatment reduces activities that can spread the viruses,

such as needle sharing, unprotected sexual activity, and having multiple sexual partners.57 OUD

treatment programs often include counseling that targets and helps to reduce behaviors that

increase the risk of transmitting HIV and HCV.58 Furthermore, successful OUD treatment can

54
P.J. Peters, et al. use of oxymorphone in Indiana, 2014- New England
Journal of Medicine, 375(3), 2016, pp. 229 239.
55
Managing HIV and hepatitis C outbreaks among people who inject drugs A guide for state and local
health departments https://www.cdc.gov/hiv/pdf/programresources/guidance/cluster-
outbreak/cdchiv-hcv-pwid-guide.pdf.
56
NIDA Guide, p. 29.
57
NIDA Guide, p. 8; and A.J. Schranz, et al
Current HIV/AIDS Reports, 15(3), 2018 pp. 245-254.
58
NIDA Guide, p. 29.

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other medical treatments, such as HIV or HCV therapies. 59 In summary, OUD treatments

these infectious diseases.

46. Indeed, a body of research illustrates that, for injection drug users, treatment of

substance use disorder reduces rates of HIV and HCV infection. One article found that, among

injection drug users, medication-assisted treatment reduced HIV acquisition by 54%;60 another

found that it also significantly reduced HCV acquisition.61 According to another study,

to six times more likely to become


62

47. Injection drug use, a major risk factor for both HIV and HCV, is highly prevalent

in Appalachia. According to a study of a rural county in Appalachia, 63 there were 1,857 PWID in

the county they surveyed (Cabell County, WV) out of an estimated 76,062 residents over 18

years old.64 months were heroin (82.0%),


65
In other words, approximately 2.4% of

adults in this rural Appalachian county were active PWID, with over 80% of these using heroin,

and over 50% using fentanyl.

48. Injection drug use in Northeast Tennessee also is well-documented. Despite

measures to combat the illegal drug market like closing pill mills and establishing a

59
NIDA Guide, p. 8.
60
G.J. MacArthur, et al
Systematic review and meta- British Medical Journal, 345, 2012, pp. 1-16.
61
Schranz, et al., op. cit.
62
NIDA Guide, p. 30.
63
S. Allen, et al., American
Journal of Public Health, 109(3), 2019, pp. 445 450.
64
Ibid., pp. 446 447.
65
Ibid., p. 447.

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HIGHLY CONFIDENTIAL PAGE 23
prescription drug monitoring program, the rate of injection drug has continued to climb.

Tennessee injection drug use nearly doubled from 2011 to 2016.66

49. Research on Tennessee, Kentucky, Virginia, and West Virginia found high and

increasing rates of HCV infection due to injection opioid use. Between 2006 and 2012, there was

an estimated 364 percent increase in HCV infection among people under age 30 in these states,

for a total of 1,377 reported cases.67 Among the 265 cases for which risk information was

available, 73 percent of infected persons reported injection drug use. The authors of this study

note that during the same period, there was a surge in the number of young people in these states

admitted for treatment for OUD related to use of prescription opioids and heroin, suggesting that

the increase in acute HCV infections in central Appalachia is highly correlated with the region s

epidemic of prescription opioid abuse and facilitated by an upsurge in the number of persons
68
who inject drugs in these four states An analysis of national surveillance data showed similar

trends throughout the U.S., with the author available information indicates that

early prescription opioid abuse and addiction, followed by initiation to IDU [injection drug use],
69
is fueling increases in HCV infection among young persons

50. A 2017 CDC county-level vulnerability assessment identified the 220 counties in

the U.S. most vulnerable to outbreaks of HIV and/or HCV as a result of the opioid epidemic.70

66
TDMHSAS, Emerging drug abuse trends May 2017 presentation,
https://www.tn.gov/content/dam/tn/mentalhealth/documents/Emerging_Drug_Abuse_Trends_TN.pdf.
67
Increases in hepatitis C virus infection related to injection
Kentucky, Tennessee, Virginia, and West Virginia, 2006 2012 Morbidity and Mortality Weekly Report, 64(17),
2015, pp. 453 458 at p. 455.
68
Ibid., p. 457.
69
National Academies of Science, Engineering, and Medicine, op. cit.
citing A.G. Suryaprasad, et al., Emerging epidemic of hepatitis C virus infections among young
nonurban persons who inject drugs in the United States, 2006-2012 Clinical Infectious Diseases, 59(10), 2014, pp.
1411 1419 at p. 1417.
70
M. Van Handel, et al., County-level vulnerability assessment for rapid dissemination of HIV or HCV infections
among persons who inject drugs, United States Journal of Acquired Immune Deficiency Syndrome, 73(3), 2016,
pp. 323 331, Supplemental Digital Content.

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Of the nations 220 most at-risk counties, which represent only five percent of all counties, 41

were in Tennessee. Thus, a state representing two percent of the U.S. population accounted for

eighteen percent of its most at-risk counties. Eight counties in Northeast Tennessee were

included on the list.71 An in-state vulnerability assessment found that [t]he distribution of

vulnerability reinforces earlier research indicating that eastern Tennessee is at particularly high
72
risk, but also demonstrates that the entire state has high vulnerability.

51. In 2015, the Tennessee Department of Health issued a Public Health Advisory

regarding Hepatitis C, indicating that the rate of acute Hepatitis C cases in Tennessee has more

than tripled in the last seven years, and the steadily increasing number of cases may only
73
represent the tip of the iceberg of the state s Hepatitis C epidemic. The Hepatitis C epidemic

continues unabated.74

52. Tennessee currently has an estimated 69,800 people living with Hepatitis C, a rate

of 1,380 cases per 100,000 people.75 According to 2018 CDC National Surveillance Data,

Tennessee was fourth among states for acute Hepatitis C case rates, about 63% higher than the

71
Ibid.
72
M. Rickles, Tennessee s in-state vulnerability assessment for a rapid dissemination of human immunodeficiency
virus or hepatitis C virus infection event utilizing data about the opioid epidemic Clinical Infectious Diseases, 66,
2018, pp. 1722-1732.
73
Cleveland Daily News, July 28, 2015.
74
See, for ex Hep Magazine, July 2, 2015;
Hep Magazine
hard by hepatitis C mostly because of opioid ep Chattanooga Times-Free Press,

News Channel 11
The Tennessean, June 4, 2019.
75
HepVu database, , https://hepvu.org/state/tennessee/.

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HIGHLY CONFIDENTIAL PAGE 25
national rate.76 Tennessee also has high levels of HIV, with an estimated 16,425 people living

with HIV, a rate of 297 cases per 100,000 people.77

53. To adequately treat patients with OUD and co-occurring HIV or HCV infection, a

program should adhere to a public health approach by providing comprehensive, integrated care

that not only treats these co-occurring infectious diseases but also prevents their transmission.

Such a program would provide OUD treatment, HIV/HCV treatment, and mental health services;

it would integrate these three forms of care in the same location or in the same clinical service

delivery system.

54. The components of such a program would include (1) onsite screening of patients

with co-occurring OUD and HIV or HCV, (2) OUD treatment, including MAT where

appropriate, (3) HIV or HCV treatment, and (4) mental health services.

55. Onsite screening. Screening for HIV and HCV would be conducted onsite at
78
is recommended by the

National Institute of Drug Abuse in preference

Treatment Clinical Trials Network showed that providing rapid onsite HIV testing in substance

abuse treatment facilities incre


79
A second approach to screening is to test for substance use disorders at HIV/AIDS

76
Acute Hepatitis C cases reflect only a portion of the true burden of incident infections. The majority of persons
with Hepatitis C (75%) establish chronic infection (Rickles, et al., op. cit. -
phase hepatitis C virus infection: Implications for research Clinical Infectious Diseases,
40, 2005, pp. 959-61).
77
AIDSVU database, https://aidsvu.org/local-data/united-states/south/tennessee/.
78
NIDA Guide, p. 8.
79
NIDA Guide, p. 30.

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clinics. This is an effective way to identify those people with co-occurring OUD and HIV (and

Hep C) who do not voluntarily seek or enter treatment for a substance use disorder. 80

56. OUD treatment. OUD treatment should be offered to patients according to the

approach described above in section VI. Where appropriate, it would include MAT, which has

been proven effective in patients with HIV.81

57. HIV or HCV treatment. For patients in OUD treatment facilities who test

positive for HIV or HCV, they should be informed about the appropriate treatments for those

troviral therapy (HAART) has proven effective in


82
combating HIV, including among drug- For HCV, there now are highly

effective oral treatments -acting antiviral (DAA) agents

have few adverse effects and enable treatment completion in as little as 8 12 weeks, with success
83
These treatments can be provided in-house, in the substance use

-stop shopping, , full care at one site.

Alternatively, the patient may be referred to a primary care physician or medical clinic. If the

patient is referred, concerted efforts should be made to link them to a treatment provider and help

them remain in care.84

58. Psychological services. An effective treatment program also would include

psychological services. These would include risk-

focused on reducing infectious disease risk can help patients further reduce or avoid substance-

related and other high-risk behaviors. Counseling can also help those who are already infected to

80
P.T. Korthuis, et al., Primary care based models for the treatment of opioid use disorder: A scoping review,
Annals of Internal Medicine, 166, 2017, pp. 268-278, at pp. 269-272.
81
Ibid., pp. 269-271.
82
NIDA Guide, p. 8.
83
S. Martin, et al and treatment of chronic hepatitis C in addiction
Addiction Science & Clinical Practice, 13(10), 2018, pp. 1-4.
84
NIDA Guide, p. 8.

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85
There are some patients who would require more extensive

psychological services as part of their OUD treatment, as described above in section VI.

59. I present two specific models of OUD treatment for HIV-infected populations:

BHIVES (Buprenorphine HIV Evaluation and Support) Collaborative Model and the One-Stop

Shop Model. I offer them as illustrations; the actual programs developed by the Plaintiff

counties need not match them exactly. Both models provide integrated care for treatment of an

OUD and primary medical care, including HIV (and Hep C) treatment. Both the programs noted

above offered MAT as a component of their OUD treatment. And both offered onsite mental

health services. The One-Stop Shop Model provides more comprehensive psychological services

based in a mental health clinic rather than an HIV clinic.86

60. The BHIVES (Buprenorphine HIV Evaluation and Support) Collaborative Model

is based in HIV clinics. It is a model for integrating OUD treatment, including MAT with

buprenorphine, into existing HIV clinics. This is a well-tested and effective model, and it is

recommended as the standard of care for engaging HIV-infected patients with OUD in
87
treatment In this model, the primary care doctors in an HIV clinic administer buprenorphine

to HIV-positive patients. The primary care physicians are assisted by a nonphysician coordinator

of the OUD program. The program also offers on-site psychosocial services. The model has been

receiving buprenorphine showed 49% treatment retention at 12 months, and opioid use in the
88
previous 30 days decreased from 84% at baseline to 42% at 12 months One advantage of the

85
NIDA Guide, p. 8.
86
Korthuis, et al., op. cit., pp. 269-272.
87
Ibid., pp. 269-271.
88
Ibid., pp.270-271.

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BHIVES model is that it provides integrated care
89

61. The second model is the One-


90
an outbreak of This is

different from BHIVES in that it is based in a mental health clinic rather than a HIV clinic, but

l provides integrated

care for HIV and hepatitis C virus infection, MAT, mental health, primary care, and syringe

exchange. A primary care provider embedded in the mental health clinic prescribes extended-
91
release naltrexone as well as antiretroviral therap This approach was successful where it was

used in Indiana, but, unlike BHIVES, its effectiveness and outcomes in a greater variety of

settings have not been assessed in randomized, controlled trials.92

62. A similar model of integrated care is recommended for hepatitis C, as described in

93
addiction care. The model is based in OUD treatment facilities, which are logical locations for

HCV screening (and treatment) because of the high risk of HCV among injection drug users. 94

Both the screening and the treatment are conducted in-house at the OUD treatment facility. This

was

strongly supported by the American Society of Addiction Medicine, which stated that

are has been successful

89
Ibid., p. 271.
90
Ibid., pp. 270-272.
91
Ibid., p. 272.
92
Ibid., p. 272.
93
Martin, et al., op. cit.
94
Ibid., p. 2.

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in Australia, Switzerland, and Italy. Recently this success was repeated in Connecticut where
95
The pilot

program tested in this article was highly successful in treating OUD patients with HCV.96 A

similar integrated approach could be used by the Plaintiff counties in Tennessee.

63. A specific example of an effective screening and treatment program for hepatitis

C can be found in New York. New York State has the largest state government-operated public

mental health (MH) system in the country: the New York State Office of Mental Health (OMH).

It has a budget of over $3.6 billion/year, complemented annually by Medicaid payments that

approximately double those dollars.97 OMH operates and runs 3,300 inpatient beds and scores of

adult, outpatient mental health clinics; the remainder of public mental health service in NYS are

delivered by ~2,500 not-for-profit community-based agencies, all of which are licensed and

surveyed by OMH.98

64. The 22 OMH operated hospitals (called State Psychiatric Centers) have a daily

census of ~3,300 patients. Adults over 18 are served in civil and forensic hospitals and represent

about 90% of the OMH inpatient population. Youth under 18 are served in Children s

Psychiatric Centers (or units in OMH civil hospitals). Since 2018, the OMH Office of the Chief

Medical Officer has worked to detect inpatient adults with hepatitis C and offer them a full

course of treatment (usually 8-12 weeks).

95
Ibid, p. 2 (citations omitted).
96
Ibid.
97
2017 interim report to the statewide comprehensive plan
https://www.omh.ny.gov/omhweb/planning/docs/2017-interim-report-web.pdf.
98
2017 interim report to the statewide comprehensive plan -2017
https://www.omh.ny.gov/omhweb/transformation/docs/2016-report.pdf
https://www.omh.ny.gov/omhweb/transformation/docs/omh-monthly-report-april-2018.pdf.

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65. The affected governments in Northeast Tennessee should similarly screen the

population for those with hepatitis and HIV and then provide standard-of-care treatment for

those diseases.

66. If a comprehensive and effective program is launched in the Plaintiffs; counties, it

is reasonable to expect that, within a year, 50% of the people with OUD who are diagnosed with

HIV and 43% of people with OUD who are also diagnosed with HCV would be receiving

treatment for their HIV or HCV. The 50% number used for HIV is based on models of the cost-

effectiveness of screening strategies for HIV. 99 The 43% number used for HCV is based on a

study of injection drug users who were screened for HCV. Of all of the patients screened for

HCV, 22.5% tested positive, and all of these were offered DAA treatment, either in the OUD

treatment clinic or outside the clinic. After approximately a year, 43% had entered DAA

treatment for HCV.100

67. The opioid crisis has imposed a heavy burden on the criminal justice system, and

a comprehensive opioid crisis remediation program must specifically address this problem. It

must effectively treat people with OUD who are within the criminal justice system, including

those who are incarcerated, recently released from jail, on parole, or facing charges in court; and

it must attend to their different and particular needs. It must work to prevent and minimize the

99
An estimate of 50% is used in the model presented by the following article: L.E. Cipriano, et al ost

PLoS One, 7(9), 2012. This article takes the 50% estimate from another article, which identifies the number as
Juusola, et al., The cost-effectiveness of symptom-based testing and routine screening for acute
HIV infection in men who have sex with men in the United States, AIDS, 25(14), 2011, pp. 1779-1787).
100
Martin, et al., op. cit.

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larger societal problems stemming from the impact of the opioid crisis, including those affecting

the criminal justice system.

68. Opioid misuse and addiction lead to crime, including robbery, theft, prostitution,

violence and abuse, and driving under the influence (DUI). To obtain drugs, it is common for

people with addiction to perpetrate fraud or steal property and money to stave off withdrawal

symptoms. Many will also become drug dealers to support their habit. A survey of state prisoners

and jail inmates found that 15% of those convicted of violent crimes and 40% of those convicted

of property crimes reported that they committed their offense to support a drug addiction.101

Opioid use also greatly increases the probability of arrest and incarceration. Indeed, a large-scale

study of 78,976 U.S. adults found that the probability of involvement in the criminal justice

system increased as the intensity of opioid use increased: With no opioid use (the baseline), the

probability was 16%; with prescription opioid use, it was 22%; with prescription opioid misuse,

it was 33%; with prescription opioid use disorder, it was 52%; and with heroin use, it was

77%.102

69. Opioid addiction and misuse among people in the criminal justice system is now a

significant problem. A DOJ Special Report (2017) found More than half (58%) of state

prisoners and two-thirds (63%) of sentenced jail inmates met the criteria for drug dependence or

abuse more than ten times the rate in the general population.103 In addition, they found that,

among inmates in local jails, 19% reported regular use of opiates.104 The rates of opioid use

101
Use of medication-assisted treatment for opioid use disorder in criminal justice settings
Publication No. PEP19-MATUSECJS, 2019, at p. 3, https://store.samhsa.gov/system/files/guide_4-0712_final_-
_section_508_compliant.pdf.
102
T.N.A. Winkelman, V.W. Chang, a
JAMA Network Open, 1(3), 2018, e180558.
103
soners and jail inmates,
2007- 2017, at p. 1, https://www.bjs.gov/content/pub/pdf/dudaspji0709.pdf.
104
Ibid., p. 5.

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disorder are particularly high in Appalachia, where the opioid epidemic has been severe. 105 Of

those receiving substance use disorder treatment in Kentucky correctional facilities, 55.2% were

abusing opioids prior to incarceration and 28.8% were using heroin. 106 In Tennessee,

approximately 55-60% of men entering prison and 70% of women entering prison self-identified

as having a substance use disorder.107 Opioid addiction and misuse also affect other branches of

the criminal justice system. For example, about half of drug courts serve a population where
108
Moreover, parental incarceration in general

has been shown to be significantly associated with the development of psychiatric and functional

impairments in their children, often by young adulthood.109

70. These trends in opioid use and crime have greatly impacted the local law

enforcement and county jails in Northeast Tennessee. In Tennessee, from 2009 to 2016, the

number of opioid-related arrests increased by 28%, and the number of heroin-related arrests

increased by a stunning 797%.110 Opioid-related arrest rates were highest in East Tennessee and

in small towns and rural areas.111 In addition to obvious opioid-related arrests like possession,

trafficking, or DUI, opioid use disorder drives other types of criminal activity as well.

71. The criminal justice system typically does not adequately address opioid misuse

and addiction. -

105
S. Allen, et al., American
Journal of Public Health, 109(3), 2019, pp. 445 450.
106
Criminal justice Kentucky treatment outcome study
8.
107
Tennessee State Government, Criminal Justice Investment Task Force, Mental Health and Substance Abuse
Subcommittee, Presentation 2019, p. 5
108
-
PEP19-MATBRIEFCJS, 2019, citing B. Nordstrom and D. Marlowe, Medication-assisted treatment for opioid use
disorders in drug courts NDCI Drug Court Practitioner Fact Sheets, 11(2).
109
E.J. Gifford, et al., Association of parental incarceration with psychiatric and functional outcomes of young
adults JAMA, 2(8), 2019.
110

https://www.tn.gov/content/dam/tn/mentalhealth/documents/Heroin_Indicators_3.15.2017.pdf.
111
Ibid.

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health conditions, addiction, and homelessness are not properly managed by services specific to

those populations. The police often have - what have become

unattended and neglected social and behavioral problems.

72. Treatment of OUD in prisons and jails is needed. Most inmates with opioid use

disorder do not receive any treatment for their disorder while incarcerated. Thus, they reenter

their communities with a dangerously reduced tolerance from not having had access to opioids

when incarcerated. Between 2007 and 2009, only 22% of jail inmates who met the criteria for

drug dependence or abuse participated in any drug treatment program since their admission.112

Reintegration into society itself can be chaotic and highly stressful, 113 as individuals struggle to

re-engage with their families and to secure work, health care, a safe place to live, and other

elements of needed social and economic support. These stressors can evoke powerful cravings,

leading to individuals resorting to self-medication, otherwise known as relapse to opioid use and

abuse. The combination of the intense need to use coupled with a lowered tolerance to opioid

blood levels upon release from incarceration is associated with a dramatic increase in death from

opioid overdose.114 A 2007 study showed that former inmates have a risk of death 3.5 times

irst 2 weeks of

release is more than 12 times that of other individuals, with the leading cause of death being a

fatal overdose.115

112
U.S. Department of Justice, op. cit. p. 1.
113
I.A. Binswanger, et al. and other causes of death, risk factors,
Annals of Internal Medicine, 159(9). 2013, pp. 592 600. See also S.I.
Ranapurwala, et al American
Journal of Public Health, 108(9), 2018, pp. 1207-1213.
114
Ibid.
115
I.A. Binswanger, et al., New England Journal of
Medicine, 356(2), 2007, pp. 157-165. See also Ranapurwala, et al., op. cit..

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73. There are various explanations for these low levels of treatment. In some cases,

jails or prisons do not have the capacity to offer substance use disorder treatment; often because

they do not have trained medical personnel or the cost burden of treatment on already financially

challenged institutions.116

74. Treatment programs in Northeast Tennessee jails need to be funded. Seven of

nine Northeast Tennessee counties have jails with a census above capacity.117

75. Tennessee officials have recognized the link between the opioid crisis and crime,

and they have noted that one of the most effective interventions against crime would be to better

treat substance use disorders. The Commission on the Future of the Tennessee Judicial System, a

commission created by the Tennessee Supreme Court to examine the future of the judicial

what great good might come of advances in treatment for substance

use, a change that would have more effect on crime than almost anything the judicial system
118
The front line of this fight against substance use disorder has become the jails and

prisons themselves. There is a consensus that incarceration will not, cannot, adequately address

the illegal opioid crisis.119 Numerous Tennessee officials agree that Tennessee cannot arrest and

116
Use of medication-assisted treatment for opioid use disorder in criminal justice settings op. cit., p.
10.
117
Bristol Herald Courier, April 2, 2019,
https://www.heraldcourier.com/news/sullivan-county-grand-jury-jail-overcrowding-needs-
attention/article_cd6e58fc-e2dc-5001-96fb-4df938e663b1.html; Tennessee Department of Correction, Tennessee
Jail Summary Report, July 2019, https://www.tn.gov/content/dam/tn/correction/documents/JailJuly2019.pdf
118
nnessee
Julie A. Warren, Defining the opioid crisis and the limited role of the criminal
justice system resolving it, The University of Memphis Law Review 48, 2018, 1205-1298, at p. 1243.
119
Binswanger, et al. (2013), op. cit.; Ranapurwala, et al., op. cit.

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incarcerate its way out of the opioid epidemic.120 Comprehensive and continuous remediation

drug treatment programs are needed to reverse the opioid epidemic.

76. Research over the last three decades has consistently reported the benefits of

treating substance use disorder in criminal justice settings. Incarceration provides an opportunity

to provide evidence-based treatment in a controlled setting that removes typical addiction

with opioid use disorder need to begin meaningful change. Many people with addiction come

face-to-face with the criminal justice system for the first time in county jails, long before they

commit crimes that warrant a prison sentence. Providing screening and treatment, and then

helping inmates transition to community-based treatment resources upon release, is critical to

addressing the harms caused by the illegal opioid market in Northeast Tennessee.

77. Jail-based opioid use treatment programs should, to the extent practicable, provide

the following: (1) comprehensive screening and assessment to develop an individualized

treatment plan; (2) medication-assisted treatment, if indicated, and other biological interventions

for co-occurring mental and physical disorders; (3) psychological treatments (noted earlier); (4) a

therapeutic residential community in a designated area of the jail; and (6) a re-entry program that

begins before release and ensures continuity of care by connecting the individual to community-

120
Bristol Herald Courier,
September 22, 2017, https://www.heraldcourier.com/news/beth-harwell-talks-finances-education-and-opioid-
epidemic-at-bristol/article_1d1e3e21-d299-5df5-b682-
Johnson City Press, August 1, 2016,
https://www.johnsoncitypress.com/Local/2016/08/01/Law-enforcement-efforts-to-battle-impact-of-opioids-on-
community.html?ci=stream&lp=6&p=1.

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based resources upon release. This is consistent with the joint recommendations of the American

Correctional Association (ACA) and the American Society of Addiction Medicine (ASAM).121

78. For each new entrant to the criminal justice system, the program should conduct a

comprehensive screening for opioid misuse and opioid use disorder, and on the basis of what is

discovered, offer an assessment that leads to the provision of an individualized treatment plan.

All incoming detainees at jails and prisons should be screened, and all of those with active

substance use disorders should be provided detoxification.122 Because the length of stay for many

inmates in county jails is brief, such screening should be provided promptly upon admission.

79. Medication-assisted treatment (MAT) has been proven effective for OUD and

should be offered and then provided to all individuals with OUD in the criminal justice system,

when indicated. 123 There have been numerous studies specifically on the use of MAT for people

in the criminal justice system, and they support its use in that population.124

80. Studies show that MAT reduces deaths and improves outcomes after release from

incarceration. hile release from jail and prison is associated

with a dramatic increase in death from opioid overdose among those with untreated opioid use

disorder (OUD), there are considerable data to show that treatment with opioid agonists and
125
partial agonists reduces deaths and improves outcomes for those with opioid use disorders

121

https://www.asam.org/docs/default-source/public-policy-statements/2018-joint-public-
correctional-policy-on-the-treatment-of-opioid-use-disorders-for-justice-involved-
individuals.pdf?sfvrsn=26de41c2_2
122
ACA/ASAM.
123
ACA/ASAM.
124
Use of medication-assisted treatment for opioid use disorder in
criminal justice settings op. cit., p. 5.
125
ACA/ASAM.

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For example, a JAMA research report on the Rhode Island Department of Corrections (a unified

jail and prison) indicated that the implementation of a robust MAT program was associated with

a 60.5% reduction in mortality compared to those who did not receive MAT.126 The message is

clear: one way to keep people with opioid addiction alive after they leave a correctional setting is

to prescribe them MAT while incarcerated. Because of this, ACA and ASAM recommend that

reatment induction for the individuals who choose treatment for opioid use disorder (MAT)
127
should begin 30 days or more prior to release

81. Use of MAT in criminal justice settings is becoming increasingly common and is

supported by numerous entities, including not only ACA and ASAM128 but also the 2017
129
the Opioid Crisis

Despite this, only three jails in Tennessee currently offer medication-assisted treatment:

Cheatham County Jail, Clay County Jail, and Knox County Jail.130 These jails offer Vivitrol

(long-acting naltrexone) injections and varied psychosocial treatments. Though new, these

programs already have proven effective.131 Any MAT program in Northeast Tennessee would

126
T. Green, et al., Postincarceration fatal overdoses after implementing medications for addiction Treatment in a
statewide correctional system, JAMA Psychiatry, 75(4), 2018.
127
ACA/ASAM.
128
ACA/ASAM.
129
Commission on Combating Drug Addiction and the Opioid Crisis, Interim Report,
https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf.
130

The Tennessean, March 19, 2019,


https://www.tennessean.com/story/news/local/cheatham/2019/03/19/pilot-program-bring-vivitrol-cheatham-county-
jail-expected-combat-
gates:

https://www.wbir.com/article/news/local/10investigates-knox-county-jail-vivitrol-program/51-5db1b9cc-15ea-4237-
947c-def422986190.
131
Ibid
10News, January 15, 2018, https://www.wbir.com/article/news/local/od-epidemic/former-inmate-overcomes-opioid-
addiction-through-jail-treatment-program/51-508235637.

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HIGHLY CONFIDENTIAL PAGE 38
necessarily be administered by local law enforcement authorities, who would determine the

scope, operations and continually monitor and improve the effectiveness of the program.

82. A jail-based program should offer a variety of other important biological

interventions, which can assist in recovery from OUD. These include proper nutrition,

therapeutic exercise, restorative sleep, the intrinsically invaluable biological effects of

supportive, fostering relationships outside a drug-using community -

interventions such as meditation, mindfulness, yogic (slow) breathing and yoga.132 Effective

implementation of these interventions that are complementary to MAT require that they be

taught, supported, and monitored in jail settings as would any other intervention in the care of a

chronic disorder.

83. All new inmates should be screened for co-occurring OUD and mental disorders,

especially trauma-related disorders. OUD treatment for all inmates should include behavioral

health treatment and support services, where appropriate.133

84. To the extent practical, a jail-based program should include a therapeutic

community, a separate section where people in recovery can learn from and support one another.

Incarceration-based therapeutic communities are separated residential drug programs that focus

(the support of others

recovering from addiction) as key instruments for change. Strict community rules and norms,

reinforced with set rewards or loss of privileges, are implemented to foster self-control, the

132
Weinstock, et al., op. cit.; Grant, et al., op. cit.; Garland and Howard, op. cit.
133
ASAM and ACA.

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restoration of personal responsibility, structured daily routines, and the teaching of goal planning

and its achievement. Residents participate in assigned chores and jobs for maintaining the

community and its daily operations. Community activities include community meetings (large

groups of all in the residential setting), daily tasks, individual and group counseling, and role

playing to better understand and master problems. Community responsibilities include chores

and jobs for maintaining the community and its daily operations. Aside from

individual counseling, psychotherapeutic and recovery services occur in group format. Residents

typically participate in a minimum of 4 to 5 hours of treatment a week.134Therapeutic community

and counseling approaches were, respectively, 1.4 and 1.5 times more likely to reduce

reoffending, according to a review of 66 incarceration-based treatment evaluations.135

Therapeutic community-style treatment has proven successful in the Kenton County Detention

Center in northern Kentucky.136 Local law enforcement authorities would administer any jail-

based, therapeutic community program in light of their existing policies and community

priorities.

85. Experts agree that, when inmates are released from incarceration, there is a need

for formalized continuity of care from incarceration to community-based services.137 Returning

134
National Institute of Justice, Incarceration-based therapeutic communities for adults,
https://www.crimesolutions.gov/PracticeDetails.aspx?ID=52.
135
R K. Chandler, B.W. Fletcher, and N.D. Volkow, Treating drug abuse and addiction in the criminal justice
system: Improving public health and safety, JAMA, 301(2), 2009, pp. 183 190.
136
See, e.g CBS News,
October 19, 2016, https://www.cbsnews.com/news/kentucky-jail-pioneering-treatment-for-inmates-addicted-to-
The New York Times, June 16, 2017,
https://www.nytimes.com/2017/06/16/opinion/sunday/opioid-epidemic-kentucky-

https://www.wbir.com/article/news/local/ky-jail-wants-to-share-with-tn-successful-addiction-treatment-
program/303115321.
137
The Sequential Intercept Model and criminal justice: Promoting community alternatives for individuals with
serious mental illness, P. Griffin, K. Heilbrun, E. Mulvey, D. DeMatteo, C. Schubert, eds., New York: Oxford
University Press, 2015.

EXPERT REPORT OF LLOYD I. SEDERER: OPIOIDS


HIGHLY CONFIDENTIAL PAGE 40
to neighborhoods associated with past drug use places individuals with opioid use disorder in an

environment rich in drug cues, which serve as powerful triggers to use.138 Re-entry planning and

warm handoffs -to-face contact between jail-based and community-based

clinicians) can reduce failures to engage in treatment as well as prevent disruptions of care,

important factors in reducing rates of relapse and improving clinical and social outcomes.

86. Former inmates are at extremely high risk of overdose and death in the period

an estimated 77 percent of formerly incarcerated

individuals with an OUD relapse to opioid use within three months of release even after
139
participating in a counseling program while incarcerated According to a study by

Binswanger et al. (2007)

inmates was that among other state residents, with a markedly elevated relative risk
140
of death from drug The authors

conclude that treatment interventions are necessary to reduce this risk. 141

87. The high rate of relapse after release from incarceration leads to high rates of

criminal recidivism. Among substance-involved inmates, those who have committed a crime to

get money to buy drugs have the highest average number of past arrests (6.6).142 Relapse must be

prevented in order to stop the cycle of release, criminal activity, and re-arrest.

88. For all these reasons, all released inmates with OUD should, to the extent possible

in light of the priorities of local law enforcement officials, receive (1) MAT prior to release, if

138
Chandler, et al., op. cit.
139
-
2019, PEP19-MATBRIEFCJS, citing T.W. Kinlock, et al., A Study of methadone maintenance for male prisoners:
3-month postrelease outcomes Criminal Justice and Behavior, 35(1), 2008, pp. 34 47.
140
Binswanger, et al. (2007), op. cit., pp. 157 and 160.
141
Binswanger, et al. (2007), op. cit., p. 157.
142
Behind bars II: Substance
https://www.centeronaddiction.org/addiction-
research/reports/behind-bars-ii-substance-abuse-and- -prison-population.

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HIGHLY CONFIDENTIAL PAGE 41
appropriate (this needs to be coordinated by local law officials in light of local circumstances),

(2) education on opioid overdose and death and strategies for preventing these potentially lethal

events, (3) opioid antagonist (naloxone) kits or prescriptions, and (4) a firm attachment to

services in a community-based clinic in order to sustain life-saving OUD treatment. Furthermore,

it is important to foster and maintain collaboration between OUD treatment clinics and the
143
former inmat

89. To implement the program described above, it will be necessary to provide

training and education on OUD and its treatment for all personnel in the criminal justice system.

This would include not only physicians and psychologists, but also counselors, correctional and

parole officers, and others.144

90. In addition, there is a critical need for a well-funded and continuous effort to

engage and maintain an adequate supply of primary care and other physicians and nurses to work

in jail settings, where they would prescribe MAT to a caseload of patients with OUD. This can

be achieved by providing financial and professional incentives to healthcare professionals, as

well as embedding recovery coaches in their practices to assist them.

91. Northeast Tennessee should look to Kentucky as a model. Twenty-four Kentucky

jails currently provide medication-assisted treatment. Inmates receive a Vivitrol injection five

weeks prior to release and a second Vivitrol injection one week prior to release. Inmates

participate in education classes and discussion groups on chemical dependency

dependence and disorder), cognitive behavioral therapy, and a twelve-step recovery program.

143
ACA/ASAM.
144
ACA/ASAM.

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Some offer residential treatment in a zero tolerance, drug- and alcohol-free environment.145 The

Kentucky Department of Corrections has determined that for every dollar spent on corrections-

based substance use disorder treatment, there was an estimated $4.46 offset due to a recidivism

rate of only 28.5% among a high-risk population that typically has a much higher recidivism rate

than the non-substance-involved prison population.146

92. As of May 2019, there were 2,797 inmates in county custody in Northeast

Tennessee.147 If sufficient resources were employed, if all inmates in the county jails were

screened for OUD, nearly all of these inmates would, subject to the determination of local law

enforcement officials, be candidates for and receive MAT if indicated, as well as other indicated

treatments and services.

93. As explained above, the criminal justice system often fails to adequately address

the problems of the person, their family, and their community in cases of opioid use disorder. An

extremely high percentage of jail inmates meet the criteria for drug dependence or abuse, over

ten times the rate in the general population as a general rule.148 Most of these inmates with drug

dependence or abuse receive no treatment while in jail.149 And the rates of relapse after release

145
Kentucky Department of Corrections Substance abuse program ,
https://www.yumpu.com/en/document/read/38861473/138-substance-abuse-program-kentucky-department-of-
corrections; N. Beckman, H. Bliska, and E.J. Schaeffer, Medication assisted treatment programs in Vermont state
correctional facilities, Evaluating H.468 through a State by State Comparison, Presented to the Vermont House
Committee on Corrections and Institutions, PRS Policy Brief 1718-03, February 22, 2018.
146
Beckman et al., op. cit.
147
Tennessee Department of Correction, Tennessee jail summary report May 2018,
https://www.tn.gov/content/dam/tn/correction/documents/JailMay2018.pdf.
148
USDOJ, op. cit., p. 1.
149
USDOJ, op. cit.

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from jail are very high.150 A proven, innovative way to address this problem is to institute drug

courts.

94. Drug courts (also known as recovery courts) are a means whereby individuals

charged with a crime are screened for and thus identified as in need of substance-use treatment.

The presiding court judge may give an identified individual a choice between incarceration or

being diverted to a substance-use treatment program, in lieu of traditional criminal justice system

case processing, where appropriate.151 Through the court-ordered diversion, people with OUD

receive intensive treatment and other social services that help them stay off substances, in this

case opioids, enter a state of recovery, and begin to rebuild their lives. These individuals, now

patients in treatment, are held accountable by the drug court judge for meeting their obligations

to the court, society, themselves, and their families. They are regularly and randomly tested for

drug use, and they are required to appear in court at a frequency determined by the judge to

review their participation in treatment and what progress they are making. If a person with OUD

diverted in this manner progresses in treatment, they are supported by the judge for doing well.

If, however, they fail to meet their treatment obligations, they are subject to sanctions including

being remanded into jail custody.152

95. Because drug courts combine the administration of justice with social services,

substance use treatment, including psychological therapies and MAT, employment counseling,

and other needed services, they require the hiring of additional court and social service

150
-
2019, PEP19-MATBRIEFCJS, citing T. Kinlock, et al -
Criminal Justice and Behavior 35(1), 2008, pp.34 47.
151
Chandler, et al., op. cit., p. 183.
152
TDMHSAS, 2013 Adult recovery court survey analysis, January 8, 2014,
(https://www.tn.gov/content/dam/tn/mentalhealth/documents/2013_Adult_Recovery_Court_Survey_Presentation_1-
8-2014.pdf; The National Association of Drug Court Professionals and the Bureau of Justice Assistance, Drug Court
Standards Committee, Defining drug courts: The key components, January 1997, reprinted October 2004.)

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personnel, and often further training of existing personnel. Team members in drug courts can

include: the drug court judge, a drug court coordinator, a defense and a prosecuting attorney,

treatment providers, a probation officer, law enforcement, case managers, a court clerk, a jail

liaison, and community partners.153

96. Program evaluations show that drug courts work. 75% of those who complete an

adult court program are never arrested again.154 The re-


155

97. Although drug courts have been implemented in Tennessee with positive results,

there is a need for significant additional courts and related resources (noted above). A March 9,

2016, report by the Tennessee Department of Mental Health and Substance Abuse Services

depicts the positive improvements demonstrated by completion of those people diverted to drug

courts: 59% percent of people diverted to drug courts complete the program, compared to 49% in

the past. The data indicate that the principal age group served has been between the ages of 25-

39, and men exceeded women as court attendees. A high-school education was a predictor of

success, implying that greater work needs be done in reaching and engaging those without that

level of education.156

98. Innovation in drug courts is not only underway in Tennessee but is being led by a

nationally recognized figure, Fourth Tennessee Judicial District Circuit Court Judge Duane

Slone. Judge Slone has received the National Center for State Courts Distinguished Service

Award for his leadership in responding to the opioid epidemic in Eastern Tennessee. He

153
Ibid; G. Lerner-Wren and R. Eckland, A court of refuge: Stories from the bench of America's first mental health
court , Beacon Press, 2018.
154
National Association of Drug Court Professionals, Treatment courts in the U.S. cutting crime, saving money,
2018, https://www.nadcp.org/wp-content/uploads/2018/03/US-Drug-Court-Fact-Sheet.pdf.
155
Chandler, et al., op. cit.
156
Tennessee Department of Mental He -
March 9, 2016.

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fashioned the Jefferson County TN ROCS docket, which has made drug courts available to those

previously not considered at great enough risk to qualify for this more therapeutic approach to

addiction. erves the gap population of people who need substance abuse treatment
157
but don't meet the criteria for a Recovery Court program It has made drug courts available to

non-violent, repeat drug offending women, many with children whom they would otherwise be

likely to lose to foster care. The Judge has been candid in his personal commitment to court

innovation. He and his wife adopted a young boy who was born with Neonatal Abstinence

Syndrome (NAS) and has experienced persistent behavioral sequelae. Understanding the power

of addiction is essential to comprehending how a mother can continue to use opioids when

pregnant, and is fundamental to taking a non-punitive, non-correctional response to addiction.

Currently, there are 5 TN-ROCS programs serving 230 people in 10 Tennessee counties

(Rutherford, Warren, Van Buren, McMinn, Monroe, Sevier, Cocke, Jefferson, Grainger, and

Sullivan).158 These numbers should be substantially increased.

99. Increased funding would enable the counties in Northeastern Tennessee to found

additional drug courts, which are greatly needed. Drug courts are present in Eastern Tennessee

and in Northeast Tennessee, there are six:

First Judicial District Recovery Court, serving Carter, Johnson, Unicoi, and Washington
Counties;
Washington County Recovery Court;
Sullivan County Felony Recovery Court;
Greene County Recovery Court;
Hamblen County Recovery Court;

157
Tennessee State Government, Criminal Justice Investment Task Force, Mental Health and Substance Abuse
Subcommittee, Presentation 2019, p. 28.
158
Tennessee Department of Mental Health & Substance Abuse, Summit for Opioid Addiction and Response
(SOAR), August 1, 2019, http://tennessee.edu/wp-content/uploads/2019/08/State-Response-Panel-1.pdf

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Hawkins County Recovery Court.159

However, only one area has a robust concentration of drug courts, so there is an opportunity to

increase geographic access. Northeast Tennessee should receive funding to create and maintain

additional drug courts as well as a TN ROCS program in each county.

100. There is a clear unmet need for additional drug courts in Northeastern Tennessee:

there are ample substance-dependent candidates for such programs. As of June 30, 2018, there

were 2,381 inmates from Northeast Tennessee in Tennessee Department of Correction Custody

and 5,228 individuals on community supervision in District 10, which is comprised of all

Northeast Tennessee counties except Hancock.160 As of May 2019, there were 2,797 inmates in

county custody in Northeast Tennessee.161 Seven of the nine Northeast Tennessee counties have

jails above capacity.162 In spite of this, in FY 2016, there were 1,682 new admissions to drug

courts in all of Tennessee (the program lasts 18 months), but of those, only 60 were in Region 1,

which comprises 8 of the 9 Plaintiff Counties (all but Hamblen).163 Region 1 has the lowest

number of new admissions to recovery courts per 100,000 population: 11.8, which is only 46%

of the statewide rate for Tennessee, which is 25.5, and only 30% of the rate in Region 4, which is

39.0.164

159
Tennessee Department of Mental Health and Substance Abuse Services, Fast facts: Certified recovery court
locations https://www.tn.gov/behavioral-health/research/tdmhsas-fast-facts-test-3/fast-facts--recovery-court-
locations.html.
160
Tennessee Department of Correction, Annual statistical report 2018,
https://www.tn.gov/content/dam/tn/correction/documents/StatisticalAbstract2018.pdf.
161
Tennessee Department of Correction, Tennessee jail summary report May 2019,
https://www.tn.gov/content/dam/tn/correction/documents/JailFemaleMay2019.pdf.
162
Ibid.
163
Tennessee Department of Mental Health and Substance Abuse Services, 2017 behavioral health county and
region services data book September 2017, pp. 3 and 53,
https://www.tn.gov/content/dam/tn/mentalhealth/documents/DPRF_BH_county_region_service_data_book_9-
2017_FINAL.pdf.
164
Ibid.

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101. Increased funding would also enable drug courts to increase their numbers and

capacities, allowing better access for those in need and thereby improve the provision of

recovery support services, and better achieve the positive outcomes they provide. Funding is

needed for the following programs and staff, identified as important elements of drug courts in

Tennessee.165

a. Coordinators: Drug court coordinators handle all administrative and budgeting

tasks, with oversight from the drug court judge; oversee subcontractors

delivering clinical and social services to participants; and assist the judge with

docket management.

b. Treatment providers: At present, most Northeast Tennessee Recovery Courts

do not employ court-based clinical treatment providers. Allowing Recovery

Courts to hire their own treatment staff, including licensed clinicians and

recovery coaches, would increase the provision and range of medical and

psychotherapeutic treatments, as well as wrap-around social services.

c. MAT: Increased funding would also permit Recovery Courts to provide better

access to medication-assisted treatment, by court hired physicians and

prescribing nurses as well as those added to existing community-based

programs.

d. Housing: Northeast Tennessee does not have a residential substance disorder

program, and lack of more general supportive housing (affordable housing

165
Tennessee Department of Mental Health & Substance Abuse Services (TDMHSAS) Office of Research, 2013
adult recovery court survey analysis, January 8, 2014,
https://www.tn.gov/content/dam/tn/mentalhealth/documents/2013_Adult_Recovery_Court_Survey_Presentation_1-
8-2014.pdf; The National Association of Drug Court Professionals and the Bureau of Justice Assistance, Drug Court
Standards Committee, Defining drug courts: The key components, January 1997, reprinted October 2004.

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HIGHLY CONFIDENTIAL PAGE 48
with psychosocial services) is a problem for counties.166 Northeast Tennessee

should have its own Recovery Court residential programs to service the First,

Second, and Third Judicial Districts.

e. Specialized treatment: Increased funding also would enable Recovery Courts

to refer more participants to more specialized, and necessary, treatments for

co-occurring mental disorders or to more intensive and longer duration of care

facilities for those with severe opioid use disorder not responding to briefer,

more conventional (even if comprehensive) substance use disorder programs.

f. Transportation: Additional funding would enable the provision of greater

transportation services, for patients, clinicians, and family members (when

indicated).

g. Long-term follow-up: Recovery Court is currently an intensive, strict 18-

month program that provides a high level of supervision for participants.

Graduations from the program are much celebrated achievements for patients,

their families, and clinicians. Recovery Court outcomes analyses show that

participants are more likely to be employed and have stable housing at that

time. Nonetheless, former participants s

after graduation, going from frequent court supervision to sometimes none

at all. Some report they feel as though they need some level of continued

166
J. Bobo,
Kingsport Times News. May 8, 2017, https://www.timesnews.net/Law-Enforcement/2017/05/08/We-re-up-against-a-
lot-of-obstacles-Hawkins-County-s-drug-court-needs-housing-transportation.html?ci=content&lp=6&p=1; J. Bobo,
Hawkins judge building fund he hopes will someday pay for halfway house, Kingsport Times News, May 15,
2019, https://www.timesnews.net/Law-Enforcement/2019/05/15/Hawkins-judge-building-fund-he-hopes-will-
someday-pay-for-halfway-house.html?ci=content&lp=4&p=1; J. Bobo, Cost of GPS, drug patch program may end
hopes for Hawkins halfway house Kingsport Times News, August. 4, 2019, https://www.timesnews.net/Law-
Enforcement/2019/08/04/Cost-of-Hawkins-GPS-drug-patch-program-may-end-hopes-for-halfway-
house.html?ci=content&lp=1&p=1.

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HIGHLY CONFIDENTIAL PAGE 49
contact from the Recovery Court program (which is true to the nature of

addiction, a chronic, relapsing disease). Funding should be provided to permit

staffing increases such that longer contact, even if less frequent, is provided.

h. Other assistance: Additional funding would also allow Recovery Court

personnel to supply participants with other types of assistance, like health

care, childcare, dental care, parenting classes, GED support, job services, and

contingency management (i.e., benefits from staying in recovery, or loss of

privileges when they do not). These services are currently available to some

but far from all Recovery Court participants and are opportunities for well-

spent funding.

102. If an aggressive, comprehensive program is launched in the Plaintiff counties, it

is reasonable to expect that within 18-24 months the drug courts in Northeast Tennessee would

be operating with complete staffing and access to community-based substance use (and mental

health) programs. A reasonable benchmark for a fuller-capacity drug court system is T

Region 7 (Davidson County), whose drug court system has the highest rate of new admissions

per 100,000 in the state: 39.0, which is 3.3 times the rate in Northeast Tennessee (Region 1).167

Increasing the capacity of the drug courts in the Plaintiff Counties to that level would entail

-court expenditures by an estimated 3.3 times.

167
health county and
region services data book, ,
https://www.tn.gov/content/dam/tn/mentalhealth/documents/DPRF_BH_county_region_service_data_book_9-
2017_FINAL.pdf.

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103. Drug addiction leads to homelessness, and a substantial percentage of homeless

people have OUD, other substance addictions, as well as mental and physical disorders. A study

of OUD and other co-occurring conditions among veterans served by the VA Administration in

2012 indicated that approximately 18% had a diagnosis of OUD, and among those with OUD

approximately 35% were homeless.168

homelessness.169 The Veterans Administration study also found that the co-morbidity of OUD

and homelessness results in greater service use and higher costs.

104. For these reasons, it is important to provide comprehensive OUD treatment to

homeless people in Northeast Tennessee. In 2018, Tennessee had an estimated 7,883 homeless

people on any given day.170 In the Appalachian Region of Tennessee, where the Plaintiff

Counties are located, there were 360 homeless people.171 Out of these 360 people, 85 (24%) were

identified as having a chronic substance use disorder.

105. Detailed roadmaps have been drawn up for providing OUD to homeless people.172

The general components of care for homeless people are essentially the same as those described

in Section VI above; however, there are two aspects of treatment that demand special attention

168
r and homelessness in the Veterans Health
Journal of Opioid Management, 14(3), 2018, pp. 171 182.
169
Ibid.
170
United States Interagency Council on Homelessness, 2018, https://www.usich.gov/homelessness-statistics/tn/.
171
HUD 2018 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations,
January 23, 2018.
172
D. Meges., et al. Adapting your practice: Recommendations for the care of homeless patients with opioid use
disorders Nashville, TN: National Health Care for the Homeless Council, Inc., 2014.

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HIGHLY CONFIDENTIAL PAGE 51
and additional resources: the prevalence of co-occurring mental and physical diseases and lack of

stable housing.173

106. First, it is extremely important to recognize the high prevalence of serious mental

illness (SMI) among those who are chronically homeless.174 This co-occurrence of SMI is

particularly common in those with addictions to opioids, as well as other drugs. Mental illness

has been shown to interfere with OUD treatment in homeless peopl

homeless populations including psychiatric illness, HIV infection, hepatitis C, and chronic

substance use disorders correlate with unsuccessful treatment of severe opioid use disorder/
175
Mental illness can also contribute to cognitive impairments (limited capacities to

recognize their illness(es) and to plan and pursue essential housing, nutrition, and medical care),

which are common barriers

control, and low intellectual functioning may interfere with treatment adherence. As many as

80% of homeless persons receiving neuropsychological testing have marked deficits in cognitive

functioning. Cognitive impairments seen in homeless patients are often associated with traumatic

brain injury (TBI), mental illness, chronic substance abuse, infection, strokes, tumors, poisoning,
176
These mental conditions must be treated concurrently with the

OUD. Studies have irrefutably established that unless detection and treatment of both the mental

and substance disorders is achieved the person will not recover from either one.

173

stable housing. Nevertheless, primary care providers who routinely serve homeless individuals recognize
an increased need to take living situations and co-occurring disorders into consideration to develop a
Ibid., p. 7).
174
ould be cognizant of the high rates of addiction, mental illness, and
Ibid., p. 51).
175
Ibid.
176
Ibid., p. 54.

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HIGHLY CONFIDENTIAL PAGE 52
107. Second, when treating OUD in homeless people, it is important to provide

housing during treatment and to help them obtain safe, reliable and affordable housing after

risk for relapse). Homelessness itself is a barrier to OUD treatment and to maintaining

f safe and affordable housing, instability, and social isolation complicate


177 178
Therefore, directly

addressing homelessness, as early as possible and for adequate duration, is, to the extent

practicable, important to the successful OUD treatment in the homeless population. For example,

the article by Meges et al


179
And during follow-up, it

180
This approach is

supported by research:

ployment assistance - supported employment,


particularly in combination with permanent supportive housing has been
demonstrated to be an effective model for individuals with a primary substance
abuse diagnosis who experience homelessness. Employment as a treatment
outcome assists in social reintegration, helps prevent relapse, and promotes
181

housed. Housing should be a component of any treatment strategy to manage


opioid use disorder. Provide or refer to medical respite care facilities where
homeless patients can convalesce when ill, recuperate following hospitalization,
and receive harm reduction informed addiction treatment. Facilitate entry into
affordable permanent housing with supportive services in the community and/or
available on site an integrated package of care management with coordinated

177
Ibid., p. 5.
178
Ibid., p. 56.
179
Ibid., p. 2.
180
Ibid., p. 2.
181
Ibid., p. 50.

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HIGHLY CONFIDENTIAL PAGE 53
primary and behavioral health care to reduce problems and complications
182
associated with treatment. [citati

108. Homelessness typically increases the required level of care and, thus, the

persons ending up in residential treatment facilities or with more intensive monitoring than is
183

109. Finally, when the OUD treatment program facilitates entry into stable housing,

the housing should be safe and adequate . Shelters are not the solution.

But

homeless people have consistently avoided them, often for good reasons: they are prone to

victimization in shelters; there are rodents and bedbugs and lice; and because, in effect a shelter
184
is not housing, they have no home In addition, people living in shelters do not learn to live

autonomously and have no rights, thereby putting them at risk on a daily basis to being on the

street once again.

110. What homeless people need, to the extent available, is safe, reliable housing, in

which they are tenants. This is called First Step Housing, and has been proven to be effective,

182
Ibid., p. 57.
183
Ibid., p. 28.
184

https://www.omh.ny.gov/omhweb/statistics/clinical_care_assessment/
Journal of
Psychiatric Services, 60, 2009, pp. 528-
Enabling Recovery: The Principles and Practice of Rehabilitation Psychiatry, Holloway,
F, Kalidini, S, Killaspy, H, Roberst, G, eds., RCPsych Publications, 2015, 409-424;
The Wall Street Journal, Op-Ed, January 12, 2013, p. A13,
https://www.wsj.com/articles/SB10001424127887324081704578234002322233718
New York Times, March 10, 2018, https://goo.gl/zxZp3P
www.huffingtonpost.com/lloyd-i-sederer-md/real-progress-on-
homeless_b_178217.html
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-homeless----how-to-pr_b_529364.html.

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HIGHLY CONFIDENTIAL PAGE 54
even for those who refuse taking medications for a mental disorder and who continue using a

substance they are dependent upon, like heroin.185

111. Which brings us to Supported Housing. This means a simple, modest and clean

apartment with a kitchen, bathroom, living area and a bed. Supported housing combines tenancy

with medical, mental, and substance use disorder services, as well as social welfare assistance

(e.g., to obtain or renew Medicaid). Annual costs for a supported housing apartment are under

$20,000.186

112. Supported housing also provides a person with a case worker, someone who visits

them regularly (at their apartment) sometimes several times a week, develops a supportive

relationship with the now formerly homeless person, and helps them, step by step, to reduce or

end their use of substances, and obtain needed medical and mental health care. The costs of case

management and clinical services are customarily paid by Medicaid or by county or state

funds.

113. To summarize, an adequate OUD treatment program for homeless people would

provide the same integrated services as the standard OUD treatment program described in

Section VI, but with additional resources for comprehensive, accessible, affordable mental health

and medical care, stable housing during treatment, and assistance finding adequate housing after

the completion of intensive treatment.

185
S.Tsember
Psychiatric Services, 51(4), April 2000, pp. 487-493; S. Tsemberis, L. Gulcur, and

American Journal of Public Health, 94(4), April 2004, pp. 651-


HuffPost, March 23, 2009.
186
D.

Foundation, 13(1), 2002, pp. 107-163). See Ibid. for examples of supportive housing.

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114. The opioid epidemic is a multigenerational crisis that has lasting negative impacts

on child development and family stability. Children and adolescents are particularly vulnerable

to the health and mental health consequences of parental substance misuse and dependence.

Intervention is needed to break the cycle that use, abuse and addiction produces on children and

their progeny.

115. An estimated 12.3% of children aged 17 or younger reside in households with at

least one parent with a substance use disorder.187 Children exposed to parental substance use are

at increased risk for emotional and behavioral problems, conduct disorder, poor developmental

outcomes and risky substance use and addiction by the time they enter adolescence and on into

adulthood.188 With almost half of opioid overdoses in Tennessee taking the lives of people

between the ages of 25 and 44, children bear a huge burden. 189 That is because those fatalities are

often their parents, their uncles and aunts, their guardians, teachers, coaches, mentors, and

neighbors.

116. An analysis conducted by the Nashville Tennessean found that the number of

parents permanently losing their rights to a child has grown significantly. 190 Between 2010 and

2014, the most recent year data is available, there was a 51 percent increase in the number of

parents who have had their parental rights terminated.191 During the same time period, there was

187
R. Lipari and S. Van Horn., Children living with parents who have a substance use disorder The CBHSQ
Report, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, Rockville, MD, August 24, 2017.
188
Ibid.
189
Tennessee Department of Health, Drug overdose dashboard, TN data by age distribution,
https://www.tn.gov/health/health-program-areas/pdo/pdo/data-dashboard.html.
190
A. Wadhwani, Tennessee parents lose kids as opioid crisis rages on , Tennessean, November 16, 2016,
https://www.tennessean.com/story/news/investigations/2016/11/26/nas-loss-parental-rights/94231538/.
191
Ibid.

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HIGHLY CONFIDENTIAL PAGE 56
a 56% increase in the number of Tennessee children waiting to be adopted.192 The National

Center on Addiction and Substance Abuse at Columbia University (CASA) estimates that

substance abuse is a causal or contributing factor in at least 70 percent of all reported cases of

child maltreatment.193 Moreover, [c]hildren whose parents abuse drugs and alcohol are almost

three times (2.7) as likely to be abused and more than four times (4.2) as likely to be neglected
194
than children of parents who are not substance abusers.

117. Similarly, reports from multiple agencies and organizations throughout the state

have reported that children in Tennessee are entering the child welfare system at accelerated

rates, largely due to the opioid epidemic.195 In Tennessee, child welfare is state-administered and

directed by the Department of Children s Services ( DCS ). According to the current director,

DCS is currently overburdened due to the opioid epidemic in the state and struggling to handle

increased numbers of children in foster care, those with parental substance abuse or incarcerated,

and increasing rates of neonatal abstinence syndrome.196 In January 2019, DCS requested an

additional $78.2 million for the agency s 2019-2020 budget, noting that there has been a 10.3%

increase in the number of children in foster care since 2016. 197 Additionally, recent calculations

192
Ibid.
193
National Center on Addiction and Substance Abuse at Columbia University (CASA), No safe haven: Children
of substance abusing parents 13 (1999), https://ncsacw.samhsa.gov/files/508/NoSafeHaven.htm. CASA s national
survey of child welfare professionals found that most reported that substance abuse causes or contributes to at least
half of all cases of child maltreatment; nearly 40% of respondents cited it as a factor in over 75% of cases.
194
Ibid.
195
See e.g. Opioid crisis has an impact on foster care Johnson City Press, January 5, 2018,
https://www.johnsoncitypress.com/Editorial/2018/01/05/Opiod-crisis-leaves-its-mark-on-foster-care; S. Martinez-
Beltran, Opioid crisis strains DCS budget with more foster kids Nashville Public Radio, January 28, 2019,
https://www.nashvillepublicradio.org/post/opioid-crisis-strains-dcs-budget-more-foster-kids#stream/0; Opioid
crisis sparks urgent need for foster families in Tennessee The Rogersville Review, May 3, 2019,
http://www.therogersvillereview.com/rogersville/article_0cff492c-3b2a-5b23-9315-cf122c5a4878.html;
forcing more Tennessee children into foster care, WVLT-8, May 22, 2019,
https://www.wvlt.tv/content/news/Opioids-forcing-more-Tennessee-children-into-foster-care-510288641.html.
196
A. Wadhwani, Driven by opioid crisis, more children in Tennessee living in foster care; DCS seeks additional
funding, The Tennessean, January 28, 2019, https://www.tennessean.com/story/news/2019/01/28/tennessee-opioid-
crisis-kids-custody-foster-care/2701274002/.
197
Ibid.

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using the federal Adoption and Foster Care Analysis and Reporting System (AFCARS) and data

from the U.S. Census Bureau show a 12 percent increase in the number of children entering

foster care in Tennessee due to parental drug use from FY 2016 to 2017.198 Further, research

shows that counties with high overdose rates and drug-related hospitalizations tend to have

higher foster caseloads. Child placements primarily due to indicators of substance use often are

the more complex of child welfare cases.199

118. According to the latest five-year estimates from the U.S. Census Bureau s

American Community Survey, there are over 75,000 grandparents in Tennessee raising their

grandchildren, one of the highest rates in the country. 200 In the nine counties in the Northeast

Tennessee region, there are at least 7,715 grandparents living with grandchildren that the

grandparent is responsible for raising.201 A Knox County juvenile court judge said that cases

involving grandparent caretakers are very common, and he sees them in his courtroom two to

three times per week.202 He attributed the issue to the opioid epidemic.203

119. This emerging social issue in Appalachia has been described as a childcare
204
generation gap, and it can significantly burden and destabilize households, especially since

198
K. Sepulveda, One in three children entered foster care in 2017 because of parental drug abuse, Child Trends,
February 26, 2019, https://www.childtrends.org/one-in-three-children-entered-foster-care-in-fy-2017-because-of-
parental-drug-abuse.
199
L. Radel, et al., Substance use, the opioid epidemic, and the child welfare system: Key findings from a mixed
methods study ASPE Research Brief, March 2018,
https://aspe.hhs.gov/system/files/pdf/258836/SubstanceUseChildWelfareOverview.pdf.
200
AARP, Tennessee Grand Parents Fact Sheet, https://www.aarp.org/content/dam/aarp/relationships/friends-
family/grandfacts/grandfacts-tennessee.pdf.
201
U.S. Census Bureau, American Community Survey, Why we ask questions about grandparents as caregivers
https://www.census.gov/acs/www/about/why-we-ask-each-question/grandparents/ (Website contains data by
county).
202
B. Bates, Opioid epidemic forcing grandparents to raise children when their parents turn to drugs, News 10
WBIR, April 29, 2019, https://www.wbir.com/article/news/opioid-epidemic-forcing-grandparents-to-raise-children-
when-their-parents-turn-to-drugs/51-609e3fa8-2fcd-4617-8395-c646a3502800.
203
Ibid.
204
J. Moore, Grandparents raising children: Caregivers behind the opioid crisis, News Channel 11 WJHI, July
16, 2018, https://www.wjhl.com/news/local/grandparents-raising-children-caregivers-behind-the-opioid-crisis/.

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21.9% are living in poverty.205 Grandparents often have physical custody of their grandchild but

not legal custody, which creates significant difficulties when trying to enroll these children in

school, secure their medical care, or obtain essential child support and benefits. Northeast

Tennessee now has a Relative Caregiver Program, in which over 100 families have enrolled.

Sara Grindstaff, a Family Advocate in the program, said, Over half of our clients have custody

of the children due to drug abuse by t


206
us what type of drug use and a majority is due to opioid use. The Relative Caregiver Program

provides one-time financial aid, enrichment activities, relationship building, and home visits.207

120. Appropriate intervention is critical for the care of a child impacted by parental

substance use. The goal of intervention is, first, to provide immediate safety while also treating

the trauma of the separation from the parent, as well as the social emotional and behavioral

problems the child frequently has developed. These treatments and interventions often can make

the difference for a child between achieving a positive developmental trajectory and fulfilling his

or her potential, or, alternatively, repeating disordered familial patterns and becoming a costly

burden to society.

121. Toxic stress, or early environmental trauma, has been proven to disrupt normal

brain development and trigger genetically predisposed diseases. The tragic results include

impairments in the ability to regulate emotions and learn, to adapt socially with others and

produce, in adolescence and adulthood, lifelong physical and mental disorders, including heart

205
AARP, Tennessee grandparents fact sheet https://www.aarp.org/content/dam/aarp/relationships/friends-
family/grandfacts/grandfacts-tennessee.pdf.
206
Moore, op. cit.
207
Ibid.

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disease, asthma, arthritis, obesity, diabetes, cancer, depression, substance abuse and PTSD.

Trouble staying and succeeding in school are also common, as are brushes with the law.208

122. Adverse Childhood Events, or ACEs, were initially studied by Kaiser Health of

Southern California and then by the World Health Organization (WHO) World Mental Health

Survey Initiative. ACEs include:

Direct psychological abuse


Direct sexual abuse
Direct physical abuse
Substance abuse in household
Mental illness in household
Mother treated violently
Criminal behavior in household.209

The greater the number of ACEs, the greater the risk of developing a chronic medical, mental or

substance use disease, or multiple chronic diseases. From post-traumatic disorder research, we

know the greater the severity and frequency of the trauma the greater the likelihood that it will

burn itself into the brain s neural circuitry.210

123. The mechanisms by which early childhood adversity lays its toxic roots are

numerous and complex. Its manifestations are as specific as youth engaging in impulsive and

dangerous behaviors (well beyond normal adolescent risk-taking), including reckless (and drunk)

driving and unprotected sexual behaviors, the latter of which can result in sexually transmitted

diseases and teenage pregnancies. The mechanisms for the development of trauma-induced

208
Vincent J. Felitti, Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards,
Mary P. Koss, and James S. Marks, Relationship of childhood abuse and household dysfunction to many of the
leading causes of death in adults: The adverse childhood experiences (ACE) study, American Journal of Preventive
Medicine 14(4), 1998, 245-258.
209
CDC-
https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html.
210
Ibid.

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disorders include: (1) the unregulated and ongoing release of stress hormones, including cortisol

and adrenaline, which weaken body defenses (compromising the immune system s ability to

protect from infection and cancer) or, conversely, turn our own immune systems against us in the

form of autoimmune diseases); (2) sustained increases in blood pressure; (3) the promotion of

plaque formation in arteries, putting a person at greater risk for heart attack and stroke: (4)

damaging the beta cells in the pancreas, which produce insulin, the consequence of which is

earlier onset Type 2 diabetes; and (5) brain (neurological) propensities to develop depressive and

post-traumatic stress illnesses, even schizophrenia.211

124. There is, therefore, an urgent need to identify those children experiencing ACEs

and to meet their needs and, in addition, to identify the problems in their families inducing this

myriad of problems in order to prevent and remediate the longer-term developmental, medical,

and mental health consequences of parental opioid misuse and dependence.

125. Opioid use disorder treatment for parents is necessary but not sufficient to address

this crisis: the needs of families affected by opioid use disorder are complex and often are

intertwined with a host of other problems. These include poverty, co-occurring mental health

conditions, use of other substances, domestic violence, incarceration, teenage pregnancies, and

homelessness. Cross-systems collaboration is essential to ensure comprehensive, collaborative

care for these parents and their children, as are evidence-based, skill building parenting

programs, family-oriented treatment, and the proper care of co-existing mental health and

substance use disorders.

211
Jack P. Shonkoff and Andrew S. Garner, lifelong effects of early childhood adversity and
toxic stress Pediatrics 129, 2012, e232-e246; Felitti et al., op. cit.

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126. Trauma-informed schools. Recently, multiple Northeast Tennessee schools

received a grant to receive trauma-informed training.212 Local officials have embraced the idea of

addressing child trauma. Schools systems receiving this grant are Johnson City, Kingsport City,

Hawkins County, Greeneville City Schools, Greeneville Middle School, Unicoi County, and

Unicoi Elementary.213 All schools in Northeast Tennessee should develop and sustain a culture

of trauma-informed education and behavioral interventions. They will need to be fully staffed to

screen and provide on-site mental health and cognitive enhancement services, as needed.

127. School counselors and wraparound services in schools. School counselors

should be qualified and trained to address opioid use-related trauma and adolescent opioid use,

abuse and dependence. Mental health clinicians should be present in schools and able to provide

on-site services for students, as needed. The National Association for College Admission

Counseling and the American School Counselor Association recommend a ratio of 250 students

per every school counselor, and a ratio of 50 to 1 is recommended if the students have more

intensive needs. The ratio in Tennessee is 336 to 1. I estimate that a minimum of 5% of students

will have more intensive and longer-term needs due to the opioid epidemic, who will require a

significant number of additional counselors to meet their needs.214

128. In addition to addressing students opioid-related adverse experiences and trauma,

school counselors also must be used to identify and assist adolescent students with an opioid use

212
News 10 WBIR, October 18, 2018,
https://www.wbir.com/article/news/local/east-tennessee-schools-chosen-for-trauma-response-training/51-
605444361.
213
Ibid.
214
American School Counselor A -to-school-counselor ratio 2015-
https://www.schoolcounselor.org/asca/media/asca/home/Ratios15-16.pdf. The following numbers were taken from
ASCA:

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disorder in entering and remaining in treatment. School counselors could be used to scale up

Northeast Tennessee s SBIRT (Screening, Brief Intervention, and Referral to Treatment) efforts.

An early intervention to identify youths and adults with problem substance use (drugs and

alcohol), SBIRT has already been embraced and implemented in Northeast Tennessee, though on

a very small scale.215 Youth interventions will vary by age (9 11, 11 14, and 14 18). SBIRT can

be provided in universal settings, including schools, family and pediatric medicine practices, and

in faith-based organizations. Teenagers at risk or displaying evidence of a likely consequence of

substance use, such as accidents, school problems, risky behaviors, and trouble with the law, are

asked as few as two questions.216

129. Due to the neglect that results from parental opioid use and dependence, children

fail to learn necessary life skills, which can result in a greater risk of their using and abusing

substances as they enter adolescence and into young adulthood. Various evidence-based

programs have been proven to address these addiction-related problems. On a universal level, a

demonstrably effective example is LifeSkills Training (LST). LST curricula are available for

elementary schools (grades three to six); middle or junior high schools (grades six to eight or

seven to nine); and high schools (grades nine or ten). For example, LST can be delivered for

three years in middle schools. Students are taught essential, usually previously underdeveloped

skills, such as problem solving and decision making, which help these youth resist peers and

media encouraging drug use, which are also termed drug-resistance skills. Programs such as LST

can improve the coping methods that youth employ to manage stress and anxiety, rather than

215
Opportunities for Implementation
216
National Institute on Alcohol Abuse and Alcoholism, Alcohol screening and brief intervention for youth, 2011,
https://www.niaaa.nih.gov/sites/default/files/publications/YouthGuide.pdf.

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resorting to the use of substances or risky behaviors. Self-esteem and self-control also typically

improve.217

130. Due to the severity of the opioid epidemic in Northeast Tennessee and the

multigenerational cycle of opioid use and addiction currently experienced by families, the region

must be able to provide wraparound mental health services and comprehensive community

psychological services. These would address the common and multiple service needs of parents

and children, including those related to parenting skills, identifying and treating mental health

and health conditions, interventions for domestic violence, stable housing, employment support

or re-training, income support for those living in poverty, the education of children and youth (as

well as adult education), and child care. Examples of evidence-based programs for family-

oriented care include the following:

131. In-home, intensive family services for high-risk families. The Therapeutic

Intervention, Education, and Skills (TIES) program has served parts of Middle Tennessee as part

of a 5-year grant (2012-2017).218 The program blended in-home intensive preservation services

(IFPS) with Seeking Safety to address the complex needs of families with children at risk of out-

of-home placement due to parental substance use.219 The program was in high-demand, and it

exceeded its initial enrollment target of 300 families.220 On average, families spent 5.7 weeks in

the program, completing 19 two-hour sessions.221 Families spent about 80% of this time in

217

://www.hhs.gov/ash/oah/sites/default/files/tag-in-action-lifeskills.pdf.
218
Tennessee Department of Mental Health and Substance Abuse Services, Therapeutic intervention, education &
skills: Findings from an intensive family preservation program , TIES Final Report 2012 2017,
https://www.tn.gov/content/dam/tn/mentalhealth/documents/TIES%20Final%20Report%20Submission.pdf.
219
Ibid.
220
Ibid.
221
Ibid.

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intensive family preservation services and 20% in Seeking Safety. 222 The program served 305

families (516 adults and 627 children) during the grant.223 Because of the high demand for this

program in Middle Tennessee, I conclude that, if funded, the program in Northeast Tennessee

would operate at the same scale as the program in parts of Middle Tennessee: at least 300

families will be in need of these services in Northeast Tennessee every five years for the next 15-

20 years as a result of the opioid epidemic, and this service should be funded to meet those needs

for that duration.

132. Strengthening Families Program for moderate-risk families. Another

universal approach is exemplified by the family-based Strengthening Families Program for

parents and youth ages 6 17. This program notably has been provided in rural areas. It helps

parents build the skills needed to manage a family, communicate with their children and each

other in positive (non-critical, non-judgmental) ways, improve relationships with their children,

and helps them learn to support academic and extracurricular activities. There is considerable

flexibility in where and when services are delivered, and babysitting, transportation, and meals

help with engagement and ongoing family participation. The Strengthening Families Program is

available in Tennessee224 and is recommended by the TN Together initiative to combat the

opioid epidemic.225 The program has not been implemented in Northeast Tennessee. 226 I estimate

that 50 75% of parents misusing or dependent on opioids could benefit from this intervention or

a similar one.

222
Ibid.
223
Ibid.
224
https://www.kidcentraltn.com/program/strengthening-
families-program.html.
225
https://www.tntogether.com/activities/get-
involved-strengthening-families-program.
226
KidsCentral TN, op. cit.

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133. Relative Caregiver Program. It is vital that kinship caregivers have access to

services and resources while taking care of children so that their households are not significantly

burdened and destabilized. The Northeast Tennessee Relative Caregiver Program discussed

above should be funded to help meet the needs of the relatives caring for grandchildren (and

other family relatives of affected youth) as a result of the opioid epidemic. At a minimum, the

program should provide assistance for those living in poverty. Based on statements from officials

and reporters in Northeast Tennessee,227 I estimate that 50 percent of families requiring care are

opioid-related.

134. The Positive Parenting (Triple P) Program is an intervention that provides

parents with tools to raise healthier children who are better able to deal with stressors. Triple P

was demonstrated in an experimental trial to reduce the rates of child maltreatment in the

counties in which it was implemented relative to control counties by over 20%. It also decreased

out-of-home placements and childhood injuries.228

135. Community Reinforcement and Family Training (CRAFT) is a valuable

resource for families, developed by Dr. Robert Meyers. His work begins with recognizing the

value of most families (and friends) in enabling a person with a substance use disorder to begin

the work of recovery. CRAFT has been described by the American Psychological Association as

a tool for families with a member who misuses or has become dependent on alcohol or other

drugs. The CRAFT approach has been effective with different types of substance users, as well

as across family relationship types (e.g., parent-child, sibling, etc.).229

227
A judge in Knox county attributes the increase in grandparents caring for their grandchildren to the opioid
epidemic (Bates, op. cit Local leaders place most of the blame on the opioid epidemic
[emphasis added].
228
R. Prinz, et al
Prevention Science, 10, 2009, pp.1-12.
229

https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/community-reinforcement;

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136. This approach benefits the person with an addiction. It has been shown to help the

person with a substance dependence to engage in treatment even after family members have

had as few as five sessions of CRAFT. The families themselves receiving CRAFT reported

feeling less depressed and less angry. The families also experienced reduced conflict and greater

cohesion even if the affected family member had yet to enter treatment. This approach

appreciates that, while most families may mean well, they often lack the tools to do well.

Families are urged to understand their emotional states, motivation to help their

loved one, their optimism or pessimism, and their level of self-care, since they need to take care

of themselves if they are to effectively care for a loved one. Family members are encouraged to

develop clear goals for self-care for instance, getting adequate sleep, proper nutrition, and time

with other loved ones and to practice responding clearly and consistently to reinforce healthy

behaviors in a loved one with an addiction. Doing so helps ensure the adoption of beneficial

practices both early on and in the ongoing work of sustaining recovery. 230

137. The CRAFT approach stresses collaboration, not conflict; it stresses kindness, not

confrontation. It enlists a person s motivation to change by seeking to understand how the

addictive behavior is rewarding to the user, how the drug use serves a purpose even if it is not

doing so effectively. From that foundation, non-judgmental in nature, the CRAFT method helps

all family members build alterative, more adaptive activities and strategies that generate similar,

but healthier, rewards than from using a substance.231

Center for Motivation and Change, What is craft https://motivationandchange.com/outpatient-treatment/for-


families/craft-overview/, (last visited Sep. 19, 2019).
230
Ibid.
231
Ibid.

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138. In 2016, an estimated 61% of Tennessee s need for behavioral health providers

was not met, and in 2018, the ratio of mental health providers to population was 1:700.232 The

ratio varies greatly across the state and by county in Northeast Tennessee. According to the

Robert Wood Johnson Foundation County Health Rankings, Hawkins County had a ratio of

1:6,270; Hamblen County, 1:660; Greene County, 1:1,150; Washington County, 1:330; Sullivan

County, 1:850; Johnson County, 1:1,180; Carter County, 1:3,530; and Johnson County,

1:5,290.233 Each of the nine counties has been designated a Federal Health Professional Shortage

Area for Mental Health.234 Based on my experience and the nature and severity of the opioid

epidemic in Northeast Tennessee, there is a need for additional mental health providers to serve

the region.

139. Neonatal Abstinence Syndrome (NAS) is the term used to describe the almost

immediate onset of symptoms, within hours after birth in some cases, as opioid levels in a new-

umbilical cord.

140. either prescription

analgesics like OxyContin, Percodan, or Vicodin, or illegal opioids like heroin or the illegal,

non-prescription use of fentanyl.235 Newborns experiencing NAS can show a range of symptoms.

232
The Sycamore Institute, The opioid epidemic in TN (3 of 3): The environment for prevention and treatment
August 23, 2017, https://www.sycamoreinstitutetn.org/opioid-addiction-treatment-prevention/.
233
Robert Wood Johnson Foundation, County health rankings and roadmaps Mental Health Providers in
Tennessee, https://www.countyhealthrankings.org/app/tennessee/2019/overview.
234
T Federal shortage areas https://www.tn.gov/health/health-program-
areas/rural-health/federal-shortage-areas.html.
235
One study reported that 82.6% of people using heroin began with misuse of prescription opioids (C. Jones,
eroin use and heroin use risk behaviors among nonmedical users of prescription opioid
pain relievers: United States, 2002-2004 and 2008- Drug Alcohol Depend, 132(1 2), 2013, 95 100).

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They may be irritable, tremulous, and spike a fever. They may sweat, and their heart rate and

respirations may elevate. Some of these children experience seizures. They can have troubles

feeding, may regurgitate their food, have projectile vomiting or diarrhea, and have difficulty

maintaining their weight. Their sleep often is disrupted. They may cry out with high pitched

agonal expressions. Efforts to comfort these infants often are ineffective. Indeed, the child may

be inconsolable evoking palpable distress in nurses, doctors and other caregivers when they

try.236

141. In the period just after birth, NAS is an awful, potentially dangerous state for the

infant that requires the provision of acute, short-term, intensive and comprehensive care. But the

consequences of NAS do not stop there. NAS has been linked to longer-term problems with

motor skills, vision, hearing, behavior, and cognitive abilities. The children born with NAS may

suffer from these kinds of problems for several years or longer. 237

142. NAS was first described almost fifty years ago, 238 but since that date it has

become far more prevalent. Rates of NAS have increased greatly since the start of the opioid

epidemic, and they were 5 times greater in 2014 than they were in 2004. 239 In 2012 in the United

States, there were an estimated 21,732 newborns diagnosed with NAS out of a total 3,716,916

236
D. Maguire, et al. -term outcomes of infants with neonatal Neonatal Network
35(5), 2016, pp. 277 286, at 277 278; S. Patrick, et al., Increasing incidence and geographic distribution of
neonatal abstinence syndrome: United States 2009-2012, Journal of Perinatology 35(8), 2015, pp. 650 655.
237
Maguire, op. cit.
238
L. Finnegan, et al Neonatal abstinence syndrome: Assessment and management Addict Dis 2, 1975, pp.141
58.
239
National Institute on Drug Abuse, Dramatic increases in maternal opioid use disorder and neonatal abstinence
syndrome, 2019, https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-
maternal-opioid-use-neonatal-abstinence-syndrome. See also, M. Honein,, et al., Public health surveillance of
prenatal opioid exposure in mothers and infants Pediatrics, 143 (3), 2019; T.Winkelman, et al., Incidence and
costs of neonatal abstinence syndrome among infants with Medicaid: 2004 2014 Pediatrics, 141 (4), 2018; S.
Haight, et al., Opioid use disorder documented at delivery hospitalization United States, 1999 2014 Morbidity
and Mortality Weekly Report, 67 (31), 2018, p. 845; J.R. Pryor, et al.
Archives of Disease in Childhood, Fetal and Neonatal
Edition, 102, 2017, pp. F183-187.

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births a rate of 5.8 cases per 1000 births. In Tennessee, the rate of NAS is much higher: the

East South Central census division (including Tennessee, Kentucky, Mississippi, and Alabama)

had a rate of 16.2 cases per 1000 births, 2.8 times the national average.240

143. A program for remediating the effect of the opioid crisis on pregnant mothers and

NAS children would include prevention, non-pharmacologic treatment, opioid replacement and

psychological therapies, recovery peers (coaches), and long-term follow-up.

144. Prevention. Prevention of NAS would focus on pregnant women. Pregnant

women should be screened for opioid use and addiction using the methods described in section

VI above. If a pregnant woman has OUD, then she urgently needs treatment, for herself, the

fetus, and other children in the home. The recommended evidence-based treatment for pregnant

women with OUD is MAT, using either buprenorphine or methadone; both drugs have been

found to be safe and effective treatments for OUD during pregnancy. 241 These treatments do not

necessarily eliminate NAS in the babies of mothers who receive them; however, they

significantly reduce the severity of NAS.242 In addition, MAT has been shown to be more

effective for pregnant women than trying to reduce (wean) the dose of opioids ingested or

reducing medication dose to prevent NAS, as it may lead to increased illicit drug use, resulting in
243
greate Methadone and buprenorphine treatment is also recommended by

240
S. Patrick, et al., Increasing incidence and geographic distribution of neonatal abstinence syndrome: United
States 2009-2012, Journal of Perinatology, 35(8), 2015, pp.650 655.
241

https://www.drugabuse.gov/publications/treating-opioid-use-disorder-during-pregnancy/treating-opioid-use-
disorder-during-pregnancy.
242
Ibid.
243
Ibid.

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American Society of Addiction Medicine support methadone and buprenorphine treatment as
244
There is no consensus, as yet, on

whether methadone or buprenorphine is preferable. Methadone has been associated with higher

245

145. Acute non-pharmacological care. Newborns with NAS need extensive and

ongoing supportive care. This includes creating a low stimulation milieu (limiting lighting and

noise), regularly holding and swaddling the newborn, but allowing the baby to rest when it can.

The newborn needs to be given opportunities to suck, and not only when being nourished. When

possible, the mother-infant dyad should be maintained to promote critical bonding and

attachment from birth on. Studies show that outcomes improve if the mother rooms with the

infant and breast-feeds, when possible and appropriate.246 The creation of quiet, dimly lit spaces

and hospital rooms where the mother and baby can stay together requires additional resources.

146. Opioid replacement treatment. For some newborns with NAS, non-

pharmaceutical treatments are sufficient, but between 55% and 94% of infants born to opioid-

dependent mothers have NAS symptoms severe enough to require opioid replacement therapy.

The use of this class of medication (and its effective doses and duration) is meant to prevent and

control serious problems like fever, seizures, dehydration and weight loss and to mitigate the

visible distress these infants demonstrate. Reviews of the medical literature and statements by the

244
Ibid.
245
Ibid.
246
E. Wachman, D. Schiff, and M. Silverstein, Neonatal abstinence syndrome: Advances in diagnosis and
treatment, JAMA, 319(13), 2018, pp.1362-1374.

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American Academy of Pediatrics support the use of opioid replacement treatment for NAS. 247

There is not yet a universal standard regarding which replacement opioid should be used.248 Oral

morphine is commonly administered, as is oral methadone. Sublingual buprenorphine also now

is used and has been associated with briefer duration of treatment and time in the hospital (23

compared to 38 days and 32 compared to 42 days, respectively).249 Some infants will show

severe and protracted withdrawal requiring the use of other pharmacological agents, like

phenobarbital.250

147. Long-term follow-up. The potential long-term effects of NAS are serious

impediments to normal maturation and the acquisition of essential cognitive, social and

emotional skills. Hence, the presence of impairments in development must be detected in these

children (from as early as one to several months old). Children with NAS, their families, and

other caregivers (foster-


251
With EI services, licensed clinicians provide weekly, or more frequent, services, usually

in the home. A team of therapists is selected, determined by the findings of an extensive

evaluation, and they work with the child and with all available caregivers (in order to amplify the

and language therapists, child psychologists with expertise in promoting social-emotional

development and managing behavioral disorders, child occupational therapists to improve motor

and coordination skills, and social workers to help train caregivers to optimize their contribution

247
W. Kraft, et al., Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid
abstinence syndrome Addiction, 106, 2011, pp. 574 80.
248
J. Davis, et al., Comparison of safety and efficacy of methadone vs morphine for treatment of neonatal
abstinence syndrome: A randomized clinical trial, JAMA Pediatrics, August 2018, 172(8), pp. 741 748.
249
Kraft, op. cit.
250
Ibid.
251
D. Maguire, et al - Neonatal Network,
35(5), 2016, 277 286, pp. 282 283.

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to the chil

148. Evidence-based home-visit programs, where a trained home visitor provides

services to pregnant women and families with young children, have proven effective at reducing

child abuse, neglect, and domestic violence and improving health outcomes for children and

parents. One such program is the Nurse Family Partnership (NFP), which has been shown in

experimental trials to reduce state verified rates of abuse and neglect by 48%,252 reduce

emergency room visits by 56%,253 and produce a 79% reduction in the number of days that

children were hospitalized with injuries and toxic ingestions during the first two years of life.254

A number of other long term benefits are linked to the NFP program, including improved

maternal life course and infant school readiness.255 Similar programs could be used for children

born with NAS.

149. Management of lifelong effects. The longer-term consequences of NAS are not

well understood because longitudinal, multi-year, prolonged studies of these children and their

families has yet to occur. Common sense, however, tells us that those infants who experienced

NAS and then went on to show developmental and behavioral problems in their early years are at

greater risk for more of the same as they enter latency and adolescence. Perhaps persistent

problems in these children as they grow older may be mitigated by comprehensive and longer-

252
https://www.nursefamilypartnership.org/wp-
content/uploads/2017/07/NFP_Overview.pdf.
253
Ibid.
254
Nurse-Family Partnership is often cited as THE intervention for preventing child
abuse and neglect https://www.nursefamilypartnership.org/about/proven-results/prevent-child-abuse-neglect,
citing H. Kitzman, et al Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes,
childhood injuries, and repeated childbearing: a randomized controlled trial JAMA, 278(8), 1997, pp.644-652.
255
https://www.nursefamilypartnership.org/about/proven-
results/improve-school-readiness/
https://www.nursefamilypartnership.org/about/proven-results/changes-mothers-life-course/.

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HIGHLY CONFIDENTIAL PAGE 73
term Early Intervention services. That remains to be seen, and longitudinal studies have yet to be

conducted. And, of course, it calls for ongoing monitoring and service provision as these youth

age.

150. To adequately address the NAS crisis, the Counties could implement the

following programs:

a. Hospitals in the region could create a wing or separate unit dedicated to NAS

babies. The NAS program would provide a dimly lit, quiet environment; it

would provide rooms for mothers and their babies to stay together, when

possible and appropriate; and it could offer the care that NAS babies require,

kind that could be used as a model.256

b. In addition, hospitals could institute programs to provide mothers of NAS

babies with education and resources to help them manage the critical

transition home from the hospital. It could include classes in breast feeding

(when the mother is substance free) and childcare; substance use disorder

counseling and peer (recovery) coaches; identification and treatment of highly

prevalent co-occurring mental disorders; and ongoing case management to

ensure sustaining their connections to whatever services and resources are

needed. Niswon

the Families Thrive program, which could be used as a model. 257

256
Bristol Herald Courier, 2017.
257
Ballad Health, Monday, July 23, 2018,
https://www.balladhealth.org/news/niswonger-childrens-hospital-launches-families-thrive.

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c. After the transition home, the counties could support a home visit program

such as the Nurse Family Partnership, described above.

d. Finally, the counties should implement an extended monitoring and treatment

program for children born with NAS. Evidence suggests that these children

will be at higher risk for learning difficulties and developmental problems.

Because the long-term effects of fetal opioid exposure are not well known,

this program should be provided to all children exposed to opioids in utero,

even if they did not meet the diagnostic criteria for NAS. It would not only

provide early detection and care for children who develop symptoms related

to opioid exposure, but it also would offer a means for doctors and

government agencies to collect information and better understand the long-

term effects of prenatal opioid exposure and the effectiveness of various

interventions.

151. Closing Remarks: It has been a privilege to develop this plan on behalf of those

people with OUD, their families, and the county governments seeking to remediate the effects of

the opioid epidemic. As a public health doctor, I have seen how comprehensive and ongoing

programs shaped by principles of public health can be of enormous benefit to the health and

welfare of individuals and communities. Those same benefits can be achieved by the counties of

Northeast Tennessee. That is what this report aims to convey.

EXPERT REPORT OF LLOYD I. SEDERER: OPIOIDS


HIGHLY CONFIDENTIAL PAGE 75
Lloyd Sederer, M.D.

September 20, 2019

Expert Report OF Lloyd I. Sederer: Opioids


H i g h l y C o n fi d e n t i a l Page76
Attachment A
CURRICULUM VITAE

August 30, 2019

Lloyd I. Sederer, MD
Residence: New York City
US Citizen

Table of Contents

Background pages 01 - 04
Professional Publications pages 04 - 11
Books pages 11 - 12
Chapters pages 12 – 15
Monographs and Web Essays pages 15 – 17
NYS Interagency Publications pages 17 – 17
Book Reviews pages 17 – 24
Movies, TV & Theatre pages 24 – 31
Editorials, Letters, and Commentary pages 31 – 34
Additional HuffPosts pages 34 – 46
Psychology Today Blogs pages 46 – 50
US News & World Report pages 50 – 53
Non-fiction Essays pages 54 – 55
Video Commentaries, Podcasts, Webcasts pages 55 – 58

……………………

Background

Academic Training:
1962 Bronx High School of Science
1966 B.S. City College of New York
1970 M.D. State University of New York, Upstate Medical Center

Traineeship:
1970-1972 Intern and Resident in Psychiatry, SUNY, Upstate Medical Center,
Syracuse, New York
1974-1975

Board Qualification:
1976-2005 Massachusetts Medical License
1977 American Board of Psychiatry and Neurology Certification
2002- New York State Medical License

Professional Organizations and Societies:

1
American Psychiatric Association
American Association of Community Psychiatrists
American College of Psychiatrists
American Medical Association
American Association of Social Psychiatry
Phi Beta Kappa
Alpha Omega Alpha

Academic Appointments:
1975-1976 Instructor in Psychiatry, Physicians and Surgeons
Medical School, Columbia University, New York
1976-1985 Instructor in Psychiatry, Harvard Medical School,
Boston, Massachusetts
1985-1995 Assistant Professor of Psychiatry, Harvard Medical School,
Boston, Massachusetts
1995-2000 Associate Professor of Clinical Psychiatry, Harvard Medical
School, Boston, Massachusetts
2000-2003 Associate Clinical Professor of Psychiatry, Harvard Medical
School, Boston, Massachusetts
2008-2009 Senior Lecturer, Columbia/Mailman School of Public Health
2009- Adjunct Professor, Columbia/Mailman School of Public Health

Hospital Appointments:
1975 Attending Psychiatrist, Mary Imogene Bassett Hospital
1976-1977 Assistant Director, Inpatient Psychiatric Service, Massachusetts General
Hospital
1977-1982 Director, Inpatient Psychiatric Service, Massachusetts General Hospital
1982-1989 Director, Outpatient and Emergency Psychiatric Services, Mount Auburn
Hospital
1983-1989 Associate Chair, Department of Psychiatry, Mount Auburn Hospital
1989-1990 Assistant General Director, McLean Hospital
1990-1994 Associate General Director, McLean Hospital
1994-1997 Member, Board of Directors, National Association of Psychiatric Health
Systems
1994-1997 Senior Vice President for Clinical Services, McLean Hospital
1996-2000 Medical Director, McLean Hospital
1997-2000 Executive Vice President, McLean Hospital

Honors:
1964 Phi Beta Kappa
1966 Magna Cum Laude
1968 Alpha Omega Alpha
1987 Fellow, American Psychiatric Association
1992 American College of Physician Executives, Innovation in Improving
Health Care Cost Management
1993 American College of Psychiatrists

2
1997 National Alliance for the Mentally Ill, Exemplary Psychiatrist Award
1990- Named lecturer at numerous conferences and events
2003 Fellow, New York Academy of Medicine
2003 Distinguished Fellow, American Psychiatric Association
2004 Distinguished Psychiatric Administrator Award, Am. Assn. Psychiatric
Administrators (Regional - New York)
2005 Courage to Change Award, NYS Assn Psychiatric Rehabilitation Services
2005 National Advisory Committee, Health Policy Institute, National Center for
Political and Economic Studies, Washington, DC
2006 Distinguished Life Fellow, American Psychiatric Association
2006 Institute for Community Living Quality Care Award
2006 Public Servant Exemplar Award, National Committee for Furtherance of
Jewish Education
2006 Community Partnership Award, United Way of New York City
2009 Psychiatric Administrator of the Year, American Psychiatric Association-
American Association of Psychiatric Administrators
2009 Rockefeller Scholar in Residence
2010 Harry Stack Sullivan Award, Sheppard Pratt Health System
2011 Dutch Psychiatric Association, Certificate of Honor, 25th Anniversary:
Dutch Society of Administrative Psychiatry
2011 United Jewish Appeal - Federation of New York, Mental Health Annual
Award
2011 Keynote Speaker, New York University School of Medicine, Graduation
of Residents and Fellows in Psychiatry
2013 APA Irma Bland Award for Excellence in Teaching Residents
2019 National Council for Behavioral Health - Doctor of the Year Award of
Excellence

Fellowship and Grant Support:


Co-investigator on numerous federal and foundation grants –
including Project Liberty and Project Hope (FEMA Disaster Mental Health)

Teaching Experience and Responsibilities:


Thirty years of local, national and international teaching and lecturing.

Co-Leader, Columbia Department of Psychiatry, Workshop on Medical Writing for the General
Public, 2011- present

Major Administrative Responsibilities (selected since 2002):


2003-2007 Member, Board of Directors, Fund for Public Health for New York City
2002-2007 Member, Board of Directors, NYC Health and Hospitals Corporation
2002-2007 New York City Director of Community Services
2002-2007 Executive Deputy Commissioner for Mental Hygiene Services,
New York City Department of Health and Mental Hygiene
2007-2019 Chief Medical Officer, NYS Office of Mental Health
2011-2012 Acting Director, Nathan Kline Institute for Psychiatric Research
2019- Distinguished Psychiatrist Advisor, NYS Office of Mental Health

3
Editorial Boards:
1981- Reviewer, American Journal of Psychiatry
1983-2002 Reviewer, General Hospital Psychiatry
1983-2000 Editorial Advisor, Williams and Wilkins Publishers
1985- Reviewer, Hospital and Community Psychiatry/Psychiatric Services
1986-1991 Book Review Editor, General Hospital Psychiatry
1988- Reviewer, The Journal of Clinical Psychiatry
1991- Reviewer, American Psychiatric Press
1992-1993 Member, Editorial Board, The Psychiatric Hospital
1993-2003 Reviewer, Harvard Review of Psychiatry
1994-2000 Affiliate Editor, Revista de Siquiatria (Puerto Rico)
1995-2000 Editorial Advisory Board, Forum/Resource, Harvard Risk Management
1996-1999 American College of Psychiatrists, Psychiatry Update Editorial Board
2001- Reviewer, Journal of Psychiatric Practice
2001- Reviewer, Journal of Social Psychiatry and Psychiatric Epidemiology
2001-2002 Editor (and principal author), Patient and Family Page, Psychiatric
Services
2007- Editorial Board, Psychiatric Quarterly
2008- Member, Board of Directors, Research Foundation for Mental Hygiene
2008 - Reviewer, Social Psychiatry and Psychiatric Epidemiology
2010 Reviewer, Journal of Adolescent Health
2011 Medical Editor, Mental Health, The Huffington Post
2011 - Reviewer, British Journal of Psychiatry
2011 - Reviewer, American Journal of Public Health
2012 - Reviewer, Archives of General Psychiatry

……………..

Professional Publications:

1. Sederer LI. Psychotherapy patient transfer: second hand rose. Am J Psych. 1975;
132:1057-1061.

2. Sederer LI, Seidenberg R. Heiress to an empty throne: ego-ideal problems of


contemporary women. Contemporary Psychoanalysis. 1976; 12:240-251.

3. Sederer LI. Moral therapy and the problem of morale. Am J Psych. 1977;
DOI: 10.1176/ajp.134.3.267

4. Sederer LI, Sederer N. A family myth: sex therapy gone awry. Family Process. 1979;
18:315-321.

5. Leeman CP, Sederer LI, Rogoff J, Berger HS, Merrifield J. Should general hospitals
accept involuntary psychiatric patients? Gen Hosp Psych. 1981; 3:245-253.

4
6. Sederer LI, Katz B, Manschreck T. Inpatient psychiatry: perspectives from the general,
private and state hospital. Gen Hosp Psych. 1984; 6:180-190.

7. Drake RE, Sederer LI. The adverse effects of intensive treatment of chronic
schizophrenia. Comp Psych. 1986; 27:313-326.

8. Sederer LI, Thorbeck J. Short-term inpatient psychotherapy of the borderline patient:


First do no harm. Hosp Comm Psych. 1986; 37:692-697.

9. Drake RE, Sederer LI. Inpatient psychotherapy of chronic schizophrenia: avoiding


regression. Hosp Comm Psych. 1986; 37:897-901.

10. Sederer LI. Utilization review and quality assurance: staying in the black and working
with the blues. Gen Hosp Psych. 1987; 9:210-219.

11. Towery OB, Sederer LI. Psychiatric expertise in clinical decision making for psychiatric
inpatients. Hosp Comm Psych. 1987; 38:758-763.

12. Mitchell JB, Dickey B, Liptzin B, Sederer LI. Bringing psychiatric patients into the
Medicare prospective payment system: alternatives to DRG's. Am J Psych. 1987;
144:610-615.

13. Sederer LI. An organizing model for those entering the field of psychiatry. J Psych
Educ. 1988; 12:71-81.

14. Sederer LI, St. Clair RL. Managed health care and the Massachusetts Experience. Am J
Psych. 1989; 146:1142-1148.

15. Freiman MP, Sederer LI. Transfers of hospitalized psychiatric patients under Medicare's
prospective payment system. Am J Psych. 1990; 147: 100-105.

16. Sederer LI, St. Clair RL. Quality assurance and managed care. Psych Clin N Amer.
1990; 13:89-97.

17. Sederer LI. Judicial and legislative responses to cost containment. Am J Psych. 1992;
149:1157-1161.

18. Sederer LI, Eisen SV, Dill D, Grob MC, Gougeon ML, Mirin SM. Case-based
reimbursement of psychiatric hospital care. Hosp Comm Psych. 1992; 43:1120-1126.

19. Sederer LI, Summergrad PS. Criteria for hospital admission. Hosp Comm Psych. 1993;
44:116-118.

20. Sederer LI, Mirin SM. The impact of managed care on clinical practice. Psychiatr Q
1994; 65(3):177-188.

5
21. Mirin SM, Sederer LI. Mental health care: current realities, future directions. Psychiatr
Q. 1994; 65(3):161-175.

22. Sederer LI. Managing suicidal inpatients. Death Studies. 1994; 18:471-482.

23. Sederer LI. Managed mental health care and professional compensation. Behavioral
Sciences and the Law, 1994; 12(4):367-378.

24. Sederer LI, Libby M. False allegations of sexual misconduct: clinical and institutional
considerations. Psychiatric Services. 1995; 46(2):160-163.

25. Sederer LI, Dickey B. Acute and chronic psychiatric care: establishing boundaries.
Psychiatry Q. 1995; 66(3):263-274.

26. Sederer LI, Dickey B, Hermann, R. The Imperative of outcomes assessment in


psychiatry. Am J Med Qual. 1995; 10(3):127-132.

27. Eisen S, Griffin M, Sederer LI, Dickey B, Mirin SM. The impact of preadmission
approval and continued stay review on hospital stay and outcome among children and
adolescents. Journal of Mental Health Administration. 1995; 22(3):270-277.

28. Sederer LI, Bennett MJ. Managed mental health care in the United States: a status report.
Administration and Policy in Mental Health. 1996; 23(4):289-306.

29. Sederer LI, Dickey B, Eisen SV. Assessing outcomes in clinical practice. Psychiatry
Q. 1997; 68(4):311-325.

30. Sederer LI, Ellison J, Keyes C. Guidelines for prescribing psychiatrists in consultative,
collaborative and supervisory relationships. Psychiatric Services. 1998; 49(9):1197-
1202.

31. Ito H, Sederer LI. Mental health services reform in Japan. Harvard Review of
Psychiatry. 1999; 7:208-215.

32. Eisen S, Dickey B, Sederer LI. A Self-Report Symptom and Problem Rating Scale to
Increase Inpatients’ Involvement in Treatment. Psychiatric Services. 2000; 51(3):349-
353.

33. Huxley NA, Rendall M, Sederer LI. Psychosocial treatments in schizophrenia: a review
of the past twenty years. J. Nervous and Mental Disease. 2000; 188:187-201.

34. Ito H, Eisen SV, Sederer LI, Tachimori H. Involuntary Admission in Japanese
Psychiatric Hospitals. International Medical Journal. 2000;7:109-112.

35. Ito H, Eisen SV, Sederer LI. Acute Care Psychiatry at McLean Hospital, International
Medical Journal. 2001;8:91-96.

6
36. Dickey B, Azeni H, Weiss RW, Sederer LI. Schizophrenia, substance use disorders and
medical co-morbidity. J. Mental Health Policy and Economics, 2000; 27-33.

37. Busch, AB, Sederer, LI. Assessing Outcomes in Psychiatric Practice: Guidelines,
Challenges, and Solutions. Harvard Review of Psychiatry, 2000;8:323-327.

38. Ito H, Sederer LI. Are Publicly-Insured Psychiatric Outpatients in Japan Satisfied?
Health Policy; 56: 205-213.

39. Ito H, Eisen, SV, Sederer, LI, Yamada O, Tachimori, H. Factors Affecting Psychiatric
Nurses’Intention to Leave Their Current Job. Psychiatric Services, 52:232-234, 2001.

40. Sederer LI. Inpatient and Partial Hospital Care Under Medicare. Psychiatric Services,
52:1023-1025, 2001.

41. Sederer LI, Clemens, N. The Business Case for Quality Mental Health Care. Psychiatric
Services, February, 2002.

42. Goetzel RZ, Ozminkowski RJ, Sederer LI, Mark TL. The business for quality mental
health services: why employers should care about the mental health and well-being of
their employees. J Occup Environ Med. 2002;44:320-330.

43. Sederer LI, Ryan, KL, Rubin, JF: The Psychological Impact of Terrorism: Policy
Implications. International Journal of Mental Health, Vol. 32, No. 1, Spring 2003: 7-19

44. Sederer LI, Kolodny AJ. The Medical and Mental Health Needs of New Yorkers.
International Journal of Mental Health, 2007

45. McVeigh, KH, Galea, S, Thorpe, LE, Maulsby, C, Henning, K, Sederer, LI: The
Epidemiology of Nonspecific Psychological Distress in NYC, 2002 and 2003, J. Urban
Health 2006;83:394-405

46. Sederer, LI, Silver, L, McVeigh, KH, Levy, J: Integrating Care for Medical and Mental
Illnesses: Prevention and Chronic Disease (Serial Online), 2006, April,
http://www.cdc.gov/pcd/issues/2006/apr/05_0214.htm

47. Sederer, LI, Petit, JR, Ephross, P: New York City’s Buprenorphine program, J. Urban
Health, In Press. (as of 6/13/2013)

48. Sederer, LI, Petit, JR, Paone, D, Ramos, S, Rubin, J, Christman, M: Changing the
Landscape: Depression Screening and Management in Primary Care, Joint Center for
Political and Economic Studies, Health Policy Institute, Washington, DC, 2007.

49. Lieberman, JA, Drake, RE, Sederer, LI, Belger, A, Keefe, R, Perkins, D, Stroup, S:
Science and Recovery in Schizophrenia, Psychiatric Services 2008; 59:487-496.

7
50. Sederer, LI: Mental Health Policy and Services Five Years after the President’s
Commission Report: An Interview with Michael F. Hogan, Psychiatric Services 2008;
59:1242-1244.

51. Smith, T, Sederer, LI: A New Kind of “Homelessness” for People with Serious Mental
Illnesses? The Need for a “Mental Health Home.” Journal of Psychiatric Services. 2009;
60:528-533

52. Essock, S, Sederer, LI: Understanding and Measuring Recovery, Schizophrenia Bulletin,
2009, 35:279-281.

53. Hogan, MF, Sederer, LI. Mental Health Crises and Public Policy: Opportunities for
Change? Health Affairs. 2009; 28:805-808

54. Chemtob, CM, Nomura, Y, Josephson, L, Adams, RE, Sederer, LI. Substance use and
functional impairment among adolescents directly exposed to the 2001 World Trade
Center attacks. Disasters. 2009; 33:337-352

55. Essock, S, Covell, N, Leckman-Westin, E, Lieberman, JA, Sederer, LI, Kealey, E,


Finnerty, M, and Members of the Scientific Advisory Committee: Identifying Clinically
Questionable Psychotropic Prescribing Practices and their Prevalence among Medicaid
Recipients in New York State, Psychiatric Services. 2009; 60(12): 1595-1602.

56. Smith,TE, Sederer,LI. Changing the Landscape of an Urban Public Mental Health
System: The 2008 New York State/New York City Mental Health-Criminal Justice
Review Panel. Journal of Urban Health, Bulletin of the NY Academy of Medicine. No.
87, Vol. 1, January 2010, pp 129-135
http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s11524-009-9407-y

57. Mangurian, C, Miller, GA, Jackson, CT, Li, H, Essock, SM, Sederer, LI. Physical Health
Screening in State Mental Health Clinics: The New York Health Indicators Initiative.
Psychiatric Services. 2010; 61(4): 346-348

58. Smith TE, Appel A, Donahue SA, Essock SM, Jackson CT, Karpati A, Marsik T, Myers
RW, Tom L, Sederer LI: Using Medicaid claims data to identify service gaps for high-
need clients: The NYC Mental Health Care Monitoring Initiative. Psychiatric Services.
Vol. 62, No. 1, January 2011; pp 9-11

59. Hogan MF, Sederer LI, Smith TE, Nossel IR. Making room for mental health in the
medical home. Prev Chronic Dis 2010;7(6).
http://www.cdc.gov/pcd/issues/2010/nov/09_0198.htm.

60. Sederer, LI. Inpatient psychiatry: why do we need it? Epidemiologica e Psichiatria
Sociale, 19, 4, 2010: 291-295

8
61. Sederer, LI, Lanzara, CB, Essock, SM, Donahue, SA, Stone, JL, Galea, S. Lessons
learned from the New York State mental health response to the September 11, 2001
terrorist attacks. Psychiatric Services 62:1085-1089, 2011

62. Gabel, S, Madigan, M, Wang, R, Sederer, LI. Health Promotion in Youth with
Psychiatric Disorders: Program Development and Initial Findings. Psychiatric Services
2011; 62 (11): 1331-1337

63. Cerimele, JM, Katon, WJ, Sharma, V, Sederer, LI. Delivering Psychiatric Services in a
Primary-Care Setting Mount Sinai Journal of Medicine July 2012; Vol.79, No. 4, pgs
481-489; DOI: 10.1002/msj.21324

64. Wisdom JP, Knapik S, Holley M, Van Bramer J, Sederer L, Essock S. New
York State outpatient mental health clinic licensing reform: Incorporating tracer
methodology to improve service quality. Psychiatric Services. 2012; 63(5): 418-420

65. Arbuckle MR, Weinberg M, Cabaniss D, Kistler S, Isaacs A, Sederer, LI, Essock S.
Training Psychiatry Residents in Quality Improvement: An Integrated Year-long
Curriculum. Academic Psychiatry, 37:1, January-February 2013
http://ap.psychiatryonline.org/data/Journals/AP/926207/42.pdf

66. Rodriguez CI, Arbuckle MR, Simpson HB, Herman DB, Stroup S, Skrobola MA, Sederer
LI, Appel, A, Essock, SM. A Rapid Small Grant Program for Policy-Relevant Research:
Providing Incentives for Public-Academic Partnerships. Psychiatric Services. 2013 Feb;
64 (2) 106-108. PMID:23370621.

67. Arbuckle MR, Weinberg M, Kistler S, Cabaniss D, Isaacs A, Sederer LI, Essock SM.
Screening and Monitoring of Depression in a Psychiatric Resident Clinic: A Curriculum
in Measurement Based Care. Academic Psychiatry. In press. (as of 6/13/2013)

68. Smith, TE, Erlich, MD, Sederer, LI. Integrated Physical and Behavioral Healthcare: the
New York State Perspective, Psychiatric Services. 2013; 64 (9):828-831

69. Sederer, LI: Opening Closed Doors: Helping Families Help Their Loved
Ones With A Mental Illness, Journal of Infant, Child, and Adolescent Psychotherapy,
13:4, 335-341, DOI: 10.1080/15289168.2014.951272
http://dx.doi.org/10.1080/15289168.2014.951272

70. Sederer, LI, Derman, M, Carruthers, JW, Wall, M. The New York State Collaborative
Care Initiative: 2012-2014. Psychiatric Quarterly 87(1), 1-23 February 5, 2016, online at
http://link.springer.com/article/10.1007/s11126-015-9375-1

71. Wisdom, JP, Wenger, D, Robertson, D, Van Bramer, J, Sederer, LI. The New York State
Office of Mental Health Positive Alternatives to Restraint and Seclusion (PARS) Project
January 5, 2015. Psychiatric Services 2015; 66(8):851-856
http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201400279

9
72. Radigan, M, Hailing, L, Miller, GA, Smalling, M, Barth Lanzarra, C, Dixon, LB,
Sederer, LI. Sustaining Screening of Key Health Risk Factors in New York State Mental
Health Clinics After Implementation of the Health Indicator Initiative Published online:
December 1, 2015
DOI: http://dx.doi.org/10.1176/appi.ps.201500081
http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201500081

73. Covell, NH, Margolies, PJ, Myers, RW, Sederer, LI, Ruderman, D, Van Bramer, J, Fazio,
ML,McNabb, LM, Thorning, H, Watkins, L, Hinds, M, Dixon, LB. Using Incentives for
Training Participation. Psychiatric Rehabilitation Journal, 2016, Vol. 39, No. 1, 81–83
http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/prj0000165

74. Carruthers, J, Radigan, M, Erlich, MD, Gu, Wang, R, Frimpong, EY, Essock, SM,
Olfson, M, Castillo, EG, Miller, GA, Sederer, LI, Stroup, TS. An Initiative to Improve
Clozapine Prescribing in New York State Jan 2016
http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201500493

75. Amado, I, Sederer, LI. Implementing Cognitive Remediation Programs in France: The
“Secret Sauce” March 17, 2016
http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201600033

76. Smith, T, Myers, R, Sederer, LI, Berezin, J. How Value-Based Payment Arrangements
Should Measure Behavioral Health November 29, 2016
http://healthaffairs.org/blog/2016/11/29/how-value-based-payment-arrangements-should-
measure-behavioral-health/

77. Radigan, M, Wang, R, Calderwood, C, Perkins, MB, Lanzara,C, Sederer, LI. Achieving
Wellness: Monitoring the Success and Challenges of the Youth Health Indicator Program
for Youth Treated in Outpatient Psychiatric Settings. Psychiatric Quarterly September 6,
2016 DOI: 10.1007/s11126-016-9464-9
http://link.springer.com/article/10.1007%2Fs11126-016-9464-9

78. Bello, I, Lee, R, Malinovsky, I, Watkins, L, Nossel, I, Smith, T, Ngo, H, Birnbaum, M,


Marino, L, Sederer, LI, Radigan, M, Gu, G, Essock, S, Dixon, L OnTrackNY: The
Development of a Coordinated Specialty Care Program for Individuals Experiencing
Early Psychosis December 15, 2016
http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201600512

79. Nossel I, Wall MM, Scodes J, Marino L, Zilkha S, Bello I, Malinovsky I, Lee R, Radigan
M, Smith TE, Sederer L, Gu G, Dixon L Results of a Coordinated Specialty Care
Program for Early Psychosis and Predictors of Outcomes Psychiatric Services, May 15,
2018
https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201700436
https://doi.org/10.1176/appi.ps.201700436

80. Medalia, A, Saperstein, AM, Erlich, MD, Sederer, LI Cognitive Remediation in Large
Systems of Psychiatric Care Cambridge University Press May 2, 2018

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http://dx.doi.org/10.1017/S1092852918000822

81. Sederer L, Marino L. Ending the Opioid Epidemic by Changing the Culture
Psychiatric Quarterly July 1, 2018
https://link.springer.com/article/10.1007/s11126-018-9589-
0?wt_mc=Internal.Event.1.SEM.ArticleAuthorOnlineFirst

82. Moise N, Shah RN, Essock S, Jones A, Carruthers J, Handley MA, Peccoralo L, Sederer
L. Sustainability of collaborative care management for depression in primary care
settings with academic affiliations across New York State BMC/Implementation Science
October 12, 2018
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-018-0818-6
https://doi.org/10.1186/s13012-018-0818-6

Books:

83. Sederer LI, ed. Inpatient psychiatry: diagnosis and treatment. Baltimore: Williams and
Wilkins, 1983.

84. Sederer LI, ed. Inpatient psychiatry: diagnosis and treatment. 2nd Edition. Baltimore:
Williams and Wilkins, 1986.

85. Milkman HB, Sederer LI, eds. Treatment choices for alcoholism and substance abuse.
Lexington: Lexington Press, 1990.

86. Sederer LI, ed. Inpatient psychiatry: diagnosis and treatment. 3rd Edition. Baltimore:
Williams and Wilkins, 1991.

87. Sederer LI, Dickey B, eds. Outcome assessment in clinical practice. Baltimore:
Williams and Wilkins, 1996.

88. Sederer LI, Rothschild AJ, eds. Acute care psychiatry: diagnosis and treatment.
Baltimore: Williams and Wilkins, 1997.

89. Murphy M, Cowan R, Sederer LI. Medical student guide to the boards in psychiatry.
Cambridge: Blackwell Science, Inc., 1997.

90. Murphy M, Cowan R, Sederer LI, Medical student guide to the boards in psychiatry, 2nd
Edition, Blackwell Science, Inc, 2001.

91. Dickey B, Sederer LI. Commitment to quality: improving mental health care.
Washington, DC: APPI, 2001.

92. Burt T, IsHak W, Sederer LI, Outcome measurement in psychiatry: a critical review.
Washington, DC: APPI, 2002.

11
93. Murphy M, Cowan R, Sederer LI, Medical student guide to the boards in psychiatry, 3rd
Edition, Blackwell Science, Inc, 2003

94. Murphy M, Cowan R, Sederer LI, Medical student guide to the boards in psychiatry, 4th
Edition, Blackwell Science, 2006.

95. Murphy, M. Cowan, R, Sederer, LI, Medical student guide to the boards in psychiatry, 5th
Edition, Blackwell Science, 2009.

96. Sederer, LI: The Family Guide to Mental Health Care, WW Norton, 2013.

97. Neugeboren, J, Friedman, MB, Sederer, LI: The Diagnostic Manual of Mishegas
(DMOM), May, 2013.

98. Sederer, LI: Improving Mental Health: Four Secrets in Plain Sight, November 1, 2016,
American Psychiatric Press.

99. Sederer, LI: Controversies in Mental Health and the Addictions: An Expert’s Anthology,
Cognella Press, 2017.

100. Sederer, LI: The Addiction Solution: Treating Our Dependence on Opioids and Other
Drugs, Scribner, 2018.

Chapters:

101. Sederer LI. Depression. In: Sederer LI, ed. Inpatient psychiatry: diagnosis and treatment.
Baltimore: Williams and Wilkins, 1983:1-27.

102. Sederer LI. Mania. In: Sederer LI, ed. Inpatient psychiatry: diagnosis and treatment.
Baltimore: Williams and Wilkins, 1983:28-41.

103. Sederer LI. Schizophrenic disorders. In: Sederer LI, ed. Inpatient psychiatry: diagnosis
and treatment. Baltimore: Williams and Wilkins, 1983:42-63.

104. Sederer L, Thorbeck J. Borderline character disorder. In: Sederer LI, ed. Inpatient
psychiatry: diagnosis and treatment. Baltimore: Williams and Wilkins, 1983:64-82.

105. Sederer LI. Diagnosis, conceptual models, and the nature of this volume. In: Milkman H,
Shaffer H, eds. The addictions: an interdisciplinary synthesis of concepts and treatments.
Lexington Books, D.C. Heath, Lexington, MA, 1985:185-195.

106. Sederer LI. Depression. In: Sederer LI, ed. Inpatient psychiatry: diagnosis and treatment.
Baltimore: Williams and Wilkins, 1986:3-35.

107. Sederer LI. Mania. In: Sederer LI, ed. Inpatient psychiatry: diagnosis and treatment.
Baltimore: Williams and Wilkins, 1986:36-52.

12
108. Sederer LI. Schizophrenia disorders. In: Sederer LI, ed. Inpatient psychiatry: diagnosis and
treatment. Baltimore: Williams and Wilkins, 1986:53-80.

109. Sederer LI, Thorbeck J. Borderline character disorder. In: Sederer LI, ed. Inpatient
psychiatry: diagnosis and treatment. Baltimore: Williams and Wilkins, 1986:81-106.

110. Sederer LI. Multiproblem patients: mental disorders and substance abuse. In: Milkman HB,
Sederer LI, eds. Treatment choices for alcoholism and substance abuse. Lexington:
Lexington Press, 1990:163-181.

111. Grady T, Sederer LI. Depression. In: Sederer LI, ed. Inpatient psychiatry: diagnosis and
treatment. Third Edition, Baltimore: Williams and Wilkins, 1991:3-45.

112. Aranow R, Sederer LI. Depression. In: Sederer LI, ed. Inpatient psychiatry: diagnosis and
treatment. Third Edition, Baltimore: Williams and Wilkins, 1991:46-69.

113. Sederer LI. Schizophrenia. In: Sederer LI, ed. Inpatient psychiatry:
diagnosis and treatment. Third Edition, Baltimore: Williams and Wilkins, 1991:70-107.

114. Sederer LI, Thorbeck, J. Borderline character disorder. In: Sederer, LI ed. Inpatient
psychiatry: diagnosis and treatment. Third Edition, Baltimore: Williams and Wilkins,
1991:108-140.

115. Sederer LI. Quality, costs and contracts. In: Sederer LI, ed. Inpatient psychiatry: diagnosis
and treatment. Third Edition, Baltimore: Williams and Wilkins, 1991:419-431.

116. Sederer LI. Brief hospitalization. In: American psychiatric press review of psychiatry, Vol
11,1992:518-534.

117. Sederer LI, Dickey B, Hermann R. Imperative of outcomes assessment in psychiatry. In:
Seder LI, Dickey B, eds. Outcomes assessment in clinical practice. Baltimore: Williams and
Wilkins, 1996:1-7

118. Sederer LI. The four questions. In: Sederer LI, Rothschild AJ, eds. Acute care psychiatry:
diagnosis and treatment. Baltimore: Williams & Wilkins, 1997:3-14.

119. Grady T, Sederer LI, Rothschild AJ, Depression In: Sederer LI, Rothschild AJ, eds. Acute
care psychiatry: diagnosis and treatment. Baltimore: Willams & Wilkins, 1997:83-121.

120. Sederer LI, Centorrino F. Schizophrenia. In: Sederer LI, Rothschild AJ, eds. Acute care
psychiatry: diagnosis and treatment. Baltimore: Williams & Wilkins, 1997:161-193.

121. Treibwasser J, Sederer LI. Borderline and antisocial personality disorders. In: Sederer LI,
Rothschild AJ, eds. Acute care psychiatry: diagnosis and treatment. Baltimore: Williams &
Wilkins, 1997:293-322.

13
122. Dickey B, Sederer LI. Assessing quality of care in clinical practice. In: Sederer LI,
Rothschild AJ, eds. Acute care psychiatry: diagnosis and treatment. Baltimore: Williams &
Wilkins, 1997:503-515.

123. Sederer LI, Lee M. Professional satisfaction and compensation. In: Sederer LI, Rothschild
A, eds. Acute care psychiatry: diagnosis and treatment. Baltimore: Williams & Wilkins,
1997:543-551.
124. Sederer LI. Psychiatrists and the new managed systems of care: roles and responsibilities.
In: Lazarus J, Sharfstein SS, eds. The role of psychiatrists in new managed systems of care.
Washington, D.C.: American Psychiatric Press, 1998:41-56.

125. Sederer LI. Quality of care in an era of Wall Street medicine. In: Dickey B, Sederer LI, eds.
Commitment to Quality: Improving Mental Health Care. Washington, D.C.: American
Psychiatric Press, 2001: 37-48.

126. Lorenz S, Sederer LI. Risk adjustment. In: Dickey B, Sederer LI, eds. Commitment to
Quality: Improving Mental Health Care. Washington, D.C.: American Psychiatric Press,
2001:89-100.

127. Eisen S, Dickey B, Sederer LI. Increasing consumer involvement in treatment. In: Dickey
B,Sederer LI, eds. Commitment to Quality: Improving Mental Health Care. Washington,
D.C.: American Psychiatric Press, 2001: 275-284.

128. Zarate C, Seigel A, Sederer LI. Adverse drug reactions. In: Dickey B, Sederer LI, eds.
Commitment to Quality: Improving Mental Health Care. Washington, D.C.: American
Psychiatric Press, 2001: 251-264

129. Dickey B, Sederer LI. Afterword: What is ahead in clinical measurement and quality
improvement? In: Dickey B, Sederer LI, eds. Commitment to Quality: Improving Mental
Health Care. Washington, DC: American Psychiatric Press, 2001: 325-326.

130. Perlis RH, Davidoff D, Falk W, Round D, Verma S, Sederer LI. Outcome Measurement in
the Geriatric Psychiatry. In: IsHak WW, Burt T, Sederer LI, eds. Outcome Measurement in
Psychiatry: A Critical Review. Washington, DC.: American Psychiatric Press, 2002: 77-
96.

131. Baker H, Sederer LI. Outcome Measurement in Sleep Disorders. In: IsHak WW, Burt T,
Sederer LI, eds. Outcome Measurement in Psychiatry: A Critical Review. Washington, DC:
American Psychiatric Press, 2002: 259-271.

132. Oldham J, Sederer LI. Resistance to the Implementation of Outcome Measures. In: IsHak
WW, Burt T, Sederer LI, eds. Outcome Measurement in Psychiatry: A Critical Review.
Washington, DC: American Psychiatric Press, 2002: 347-353.

133. Sederer LI, Ryan KL, Rubin JF: The Psychological Impact of Terrorism: Policy
Implications International Journal of Mental Health, Vol. 32, No. 1, Spring 2003, pp.

14
134. Sederer LI, Ryan KL, Rubin JF: Challenges of Urban Mental Health Disaster Planning:
Geffner, Robert, ed. Journal of Aggression, Maltreatment, & Trauma. San Diego, CA: The
Hawthorne Maltreatment and Trauma Press, 2005: 695-706.

135. Hepburn B, Sederer LI. The State Hospital, in Textbook of Hospital Psychiatry,
Sharfstein, SS, Dickerson, FP, Oldham, JM, APPI, Washington DC, 2009: 207-222.

136. Holloway F, Sederer LI. Inpatient Treatment. In: Thorncroft G, Szmukler G, Mueser K,
Drake R, eds. Textbook of Community Mental Health. Oxford, UK: Oxford University
Press, 2011:167-177.

137. Holloway, M, Erlich, M, Sederer LI. Rehabilitation: An International Perspective, In:


Enabling Recovery: The Principles and Practice of Rehabilitation Psychiatry, Holloway, F,
Kalidini, S, Killaspy, H, Roberst, G, eds. RCPsych Publications, 2015: 409-424

Monographs and Web Essays:

Sederer LI. The importance of seeing psychiatry as more than a science. Psychiatric
Opinion. 1977; 14: No. 4.

Sederer LI. A young psychiatrist reaffirms his profession. Psychiatric Opinion.


1978; 15: No. 5.

Sederer LI. Psychiatry letter: the inpatient treatment of the borderline patient 1987: 5(3).

Sederer LI. Hospital treatment of the severe borderline patient. Psychiatric Times.
August, 1989:5(8).

Sederer LI. Problems and opportunities in managed health care. Psychiatric Times,1989;
43-44.

Sederer LI. Legal status, patient safety, and hospital passes and privileges. Forum: Harvard
Risk Management Foundation. December, 1993;14:10.

Sederer, LI. Suicide Risk Advisory Committee of the Harvard Risk Management
Foundation. Guideline for the identification and assessment of suicidality. Forum: Harvard
Risk Management Foundation. December, 1993;14:14-19.

Sederer LI. Whose business is health care in America? Boston Business


Journal 1995;15(22):17.

Ellison J, Sederer LI. Single patient, multiple providers: risk management implications for
mental health treatment. Forum: Harvard Risk Management Foundation. October,
1996; 10-12.

Lorenz S, Sederer LI. Assessing the outcome of treatment. Directions in Psychiatry,Spring,

15
1998:18:129-148.

Ito, H, Sederer, LI. Psychiatric services at McLean Hospital. Abstract. Japan Association
of Neuropsychiatry Annual Meeting. Tokyo, 1999.

Perez E, Sederer LI. The leadership role of psychiatrists. Canadian Bulletin of Psychiatry.
August, 1999: 110-111.

Sederer LI, Gottlieb G. Insurance practices feed stigma of mental illness. Boston Business
Journal, January 21, 2000; p.63

Sederer LI, Petit, JR, Paone, D, Ramos, S, Rubin, J, Christman, M. Changing the
Landscape: Depression Screening and Management in Primary Care, Health Policy
Institute, Washington DC, 2007

Sederer LI, Kealey, E, Runnels, P. Assessment of Clinical Care, and Local Government
Opportunities NYS Office of Mental Health website October 2007
https://www.omh.ny.gov/omhweb/statistics/clinical_care_assessment/

Friedman, MB, Sederer LI, Furst, L, Williams, KA. Are You Missing the Person in the
Patient you are Treating? Aging Well, Fall 2011; Vol. 4, No. 4, pg 18
http://www.agingwellmag.com/archive/fall2011_p18.shtml

Sederer LI. Depression and Primary Care. Mental Health News. Spring 2012; Vol. 14, No. 2, pgs
13 and 36

Sederer LI. The Enemy Is Apathy. Posted in Psychiatric Times on July 26, 2012
http://www.psychiatrictimes.com/display/article/10168/2092557

Friedman, MB, Sederer, LI, Williams, KA. Health Care Reform Benefits Americans with
Behavioral Conditions. Med Monthly November 2012
http://issuu.com/medmedia9/docs/mm_nov_2012/45

Sederer LI. Mental Health and Hurricane Sandy: What can we expect, what can we do?
Published by the Columbia University Mailman School of Public Health. November 5, 2012
http://the2x2project.org/mental-health-and-hurricane-sandy/
Reprinted in the Huffington Post on November 7, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/hurricane-sandy-mental-
health_b_2089645.html

Katz, C, Sederer, LI. Psychological First Aid - Mental Health Care After Sandy
Published in the 2x2 Project by the Columbia/Mailman School of Public Health on
December 3, 2012
http://the2x2project.org/grassroots-mental-health-care/
Reprinted in the Huffington Post on November 5, 2012
http://www.huffingtonpost.com/craig-l-katz-md/sandy-mental-health_b_2240907.html

16
Sederer, LI. Improving Public Mental Health: Four Secrets in Plain Sight, Psychiatric News,
December 16, 2016
http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.12b2

Lieberman, JA, Goldman, ML, Olfson, M, Pincus, HA, Sederer, LI. Improving Mental Health
Care in America: An Opportunity for Comprehensive Reform, Psychiatric Times, April 2017:
34(4); Cover -1, 6-7

Sederer, LI. Public Health Principles Apply To Solving Opioid Epidemic Vol 22 (2) Paradigm
2018 http://addictionrecov.org/paradigm/excerpts/Sederer_Paradigm_V22.pdf

Sederer, LI. Harm Reduction & The Opioid Epidemic Behavioral Health News Vol 5 No. 4
Spring 2018 http://www.mhnews.org/back_issues/BHN-Spring2018.pdf

Sederer, LI. The Medical Irony of the Deadly Opioid Epidemic Psychiatric Times May 15 2019
https://www.psychiatrictimes.com/substance-use-disorder/medical-irony-deadly-opioid-epidemic

Sederer, LI. Spirituality in the Psychiatric Office Interview of Paul Summergrad, MD Psychiatric
Times May 20, 2019
https://www.psychiatrictimes.com/apa/spirituality-psychiatric-office

Sederer, LI. What Does “Rat Park” Teach Us About Addiction? June 10, 2019
https://www.psychiatrictimes.com/substance-use-disorder/what-does-rat-park-teach-us-about-
addiction

…………..

NYS Interagency Publications:

Report of the OMH/OASAS Task Force on Co-Occurring Disorders, September 2007.

New York State/New York City Mental Health-Criminal Justice Panel report and
Recommendations, June 2008.
………….

Book Reviews:

Sederer LI. The addictive behaviors. Shaffer H. J Psychoactive Drugs. 1984; 16(4):373.

Sederer LI. How you can help. Korpell HS. Gen Hosp Psych. 1985:7(2):183.

Sederer LI. General hospital psychiatry. Taylor MA, Sierles FS, Abrams R. Gen Hosp
Psych. 1987; 9:231.

17
Sederer LI. Medical care, medical costs. Fein R. Gen Hosp Psych. l987; 9:387-388.

Sederer LI. Dynamic therapy in brief hospitalization. Oldham J, Russakoff L. Am J


Psych. 1988;11:1472-73.

Sederer LI. Catalogue of psychiatric procedures. Rafferty, FT. Gen Hosp Psych.
1989;11:68-69.

Sederer LI. The treatment of alcoholism. Nace, EP. Gen Hosp Psych. 1989;11:145-146.

Sederer LI. Guide to quality assurance, joint commission on accreditation of healthcare


organizations. Am J Psych. 1989;146:930.

Sederer LI. The new medical marketplace, Stoline A & Weiner JP. Gen Hosp Psych.
1989; 11: 377-378.

Sederer LI. Concise guides to psychiatry series (clinical psychiatry; consultation


psychiatry, somatic therapies in psychiatry). Am J Psych. 1990; 147:516.

Sederer LI. Treatment of patients in the borderline spectrum, Meissner WW. Gen Hosp
Psych. 1990; 12:130-131.

Sederer LI. The fate of borderline patients, Stone MH. Gen Hosp Psych. 1991;
13:214-215.

Sederer LI. Stigma and mental illness, Fink PJ, Tasman A. Am J Psych. 1994;151:447-
448.

Sederer LI. Psychiatry and general practice today. Pullen I, Wilkinson G, Wright A, Gray
DP, eds. Am J Psych. 1995;152:1092-1093.

Sederer LI. Controversies in managed mental health care. Lazarus A, ed. Am J Psych.
1997;154(1):125-126.

Sederer LI. A way of looking at things. Erikson E. Am J Psychiatry. 1998;155(1): 147-


148.

Sederer LI. Evaluating treatment environments, 2nd ed., Moos. R. J Nerv Ment Dis.
1998;186(11):733-734.

Sederer LI. Between mind, brain and managed care. Meyer R, McLaughlin CJ, eds. Am J
Psychiatry. 2000; 157(3):477-478.

Sederer LI. Improving Health in the Community: A Role for Performance Monitoring,
Durch JS, Baily LA, Stoto MA, eds. Am J Psychiatry. 2001; 158: 830.

Sederer LI. The Evidence-Based Practice: Methods, Models, and Tools for Mental Health

18
Professionals, Stout, CD, Hayes, RA, eds, Psychiatric Services, 2006; 57:1219-1220.

Sederer LI. Improving Mental Healthcare, Hermann, RC, Psychiatric Services, 2006.

Sederer, LI. The Garden of Last Days, Dubus, A, Psychiatric Services; 59:1479, 2008.

Sederer LI. The Unit. Holmquist N. Psychiatric Services 60:1692-1693, 2009.

Sederer, LI. Untreatable: Healing in the Realms of Madness, Steinman, I., Am J


Psychiatry. 2010; 167: 356-357

Sederer, LI. Healing the Broken Mind: Transforming America’s Failed Mental Health
System, Kelly, TA. Am J Psychiatry, 167:6 June 2010, p. 724

Sederer, LI. Everything Ravaged, Everything Burned, Tower, Wells. Psychiatric Services,
December 2010; 61:1266

Sederer, LI. The Naked Lady Who Stood On Her Head: A Psychiatrist's Stories Of His
Most Bizarre Cases, Small, Gary, Vorgan, Gigi. Huffington Post November 23, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-naked-lady-who-stood-_b_786553.html

Sederer, LI. Outcome Measurement in Mental Health: Theory and Practice, Trauer, T.
Psychiatric Services, November 2011; 62:1399-1399

Sederer, LI. It's Not the Illness That Stands to Destroy You
Huffington Post January 18, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/its-not-the-illness-that-_b_809729.html

Sederer, LI. From Mission to Movement: 'KaBOOM!' and the Renaissance of Play in
America Huffington Post May 12, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/kaboom-playgrounds_b_858958.html

Sederer, LI. A Trip to Heaven and Back Huffington Post July 11, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/heaven-is-for-real_b_894937.html

Sederer, LI. Henry’s Demons: Living with Schizophrenia, a father and son’s story,
Cockburn, Patrick, Cockburn, Henry. Am J Psychiatry, January 2012; 169:101-101
(doi:10.1176/appi.ajp.2011.11081175)

Sederer, LI. The Bone Thief, Jefferson, Jon, Bass, Bill. Psychiatric Services, December
2011; 62:1519-1520
http://ps.psychiatryonline.org/article.aspx?articleid=180940

Sederer, LI. 'The Alzheimer's Prevention Program': Huffington Post January 10, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-d/alzheimers_b_1182345.html

Sederer, LI. Monday Mornings Huffington Post April 16, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/monday-mornings_b_1424827.html
19
Sederer, LI. The Guardians -- An Elegy Huffington Post May 16, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-guardians-elegy_b_1516600.html

Sederer, LI. Twelve Patients: Life and Death at Bellevue Hospital


Huffington Post July 11, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/twelve-patients_b_1666270.html

Sederer, LI. Brain-Based Parenting: The Neuroscience of Caregiving for Healthy


Attachment Huffington Post August 9, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/parenting-book_b_1760026.html

Sederer, LI. Waiting for Sunrise, Boyd, William. Psychiatric Services, December 1
2012; doi: 10.1093/app.ps.631211
http://ps.psychiatryonline.org/article.aspx?articleID=1392923&utm_source=Silverchair%20Infor
mation%20Systems&utm_medium=email&utm_campaign=PsychiatricServicesnowavailableonP
sychiatryOnline12/04/2012

Sederer, LI. You Need Help! Huffington Post September 20, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/you-need-help_b_1901640.html

Sederer, LI. The Godfather’s Daughter Huffington Post November 28, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/godfathers-daughter-book-
review_b_2206564.html

Sederer,LI. God's Hotel Huffington Post July 22, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/book-review_b_3624307.html

Sederer, LI. The Gift of Adversity Huffington Post August 26, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/book-review_b_3773370.html

Sederer, LI. Man ALIVE! Huffington Post September 4, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/book-review_b_3838595.html

Sederer, LI. Tinderbox Huffington Post September 10, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/book-review_b_3876036.html

Sederer, LI. Bond, James Bond: A Book Review of SOLO, by William Boyd -- in the Ian
Fleming Tradition Huffington Post December 4, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/solo-james-bond_b_4374261.html

Sederer, LI. 'Quiet Dell' by Jayne Anne Phillips Huffington Post December 19, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/book-review_b_4465357.html

Sederer, LI. One Day I Will Write About this Place. Psychiatric Services January 1, 2014
Psychiatric Services 2014; doi: 10.1176/appi.ps.650111
http://ps.psychiatryonline.org/article.aspx?articleid=1792206

20
Sederer, LI. The American Health Care Paradox Huffington Post January 29, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/health-care_b_4682507.html
Also published online at Columbia/Mailman 2 X 2 Project Newsletter February 10, 2014
http://the2x2project.org/healthcare-paradox/
Also published online at Psychology Today February 13, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201402/the-american-health-
care-paradox-book-review

Sederer, LI. 'Back From the Brink' by Graeme Cowan Huffington Post March 10, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-book-review_b_4915386.html
Also published online at Psychology Today March 15, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201403/back-the-brink

Sederer, LI. Four Funerals and a Wedding by Jill Smolowe June 2, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/book-review_b_5433616.html
Also published online at Psychology Today June 7, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201406/four-funerals-and-
wedding

Sederer, LI, Remnants of a Life on Paper: A Mother and Daughter’s Struggle with Borderline
Personality Disorder by Bea Tusiani, Pamela Ann Tusiani & Paula Tusiani-Eng July 14, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/book-review_b_5579991.html

Sederer, LI. The Examined Life: How We Lose and Find Ourselves by Stephen Grosz
Book Review July 21, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201407/the-examined-life-
how-we-lose-and-find-ourselves

Sederer, LI. Sea of Hooks by Lindsay Hill Psychiatric Services December 2014; 65(12):e12

Sederer, LI. The Field Guide to Lucid Dreaming by Dylan Tuccillo, Jared Zeizel and Thomas
Peisel September 21, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201409/the-field-guide-lucid-
dreaming

Sederer, LI. Putting Education to Work: How Cristo Rey High Schools Are Transforming Urban
Education October 8, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/putting-education-to-work_b_5946974.html

Sederer, LI. Suspicious Minds, By Joel Gold and Ian Gold January 6, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/suspicious-minds-by-joel-_b_6413014.html

Sederer, LI. Hope: Entertainer of the Century by Richard Zoglin January 26, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/hope-entertainer-of-the-
c_b_6542096.htmlSederer, LI. Just Mercy by Bryan Stevenson July 27, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/just-mercy-book-review_b_7859828.html

21
Sederer, LI. On The Move by Oliver Sacks August 19, 2015 The Lancet Psychiatry
doi:10.1016/S2215-0366(15)00375-2
http://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(15)00375-2.pdf

Sederer, LI. The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and
Behavior after Brain Injury New York Journal of Books October 10, 2015
http://www.nyjournalofbooks.com/book-review/traumatized-brain

Sederer, LI. A Common Struggle November 26, 2015


DOI: http://dx.doi.org/10.1016/S2215-0366(15)00538-6
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00538-6/fulltext

Sederer, LI. Inside the O’Briens December 1, 2015


DOI: http://dx.doi.org/10.1176/appi.ps.661204
http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.661204

Sederer, LI. Reporting Always – Writings from The New Yorker By Lillian Ross December 4,
2015 New York Journal of Books
http://www.nyjournalofbooks.com/book-review/reporting-always

Sederer, LI. Little Victories: Perfect Rules for Imperfect Living January 10, 2016 New York
Journal of Books
http://www.nyjournalofbooks.com/book-review/little-victories

Sederer, LI. Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine


March 9, 2016
http://www.nyjournalofbooks.com/book-review/snowball-blizzard

Sederer, LI. Narco-Nomics: How to Run A Drug Cartel April 4, 2016


http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2816%2930027-X/fulltext

Sederer, LI. The Gene: An Intimate History August 25, 2016


DOI: http://dx.doi.org/10.1016/S2215-0366(16)30269-3
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30269-3/fulltext

Sederer, LI. Changing to Thrive: Using the Stages of Change to Overcome the Top Threats to
Your Health and Happiness November 3, 2016
http://www.nyjournalofbooks.com/book-review/changing

Sederer, LI. Born to Run November 24, 2016


http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30398-4/fulltext

Sederer, LI. A Really Good Day January 15,


2017https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201701/the-lysergic-
acid-solution-depression

22
Sederer, LI. The Telomere Effect January 22, 2017
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201701/the-telomere-effect

Sederer, LI. Attending: Medicine, Mindfulness, and Humanity February 6, 2017


http://www.nyjournalofbooks.com/book-review/attending-medicine-mindfulness

Sederer, LI. This Close to Happy, by Daphne Merkin February 26, 2017
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201702/close-happy-daphne-
merkin

Sederer, LI. Sometimes Amazing Things Happen, by Elizabeth Ford June 3, 2017
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201706/sometimes-amazing-
things-happen

Sederer, LI. The Mind of God, by Jay Lombard June 10, 2017
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201706/the-mind-god

Sederer, LI You Belong To Me June 20, 2017


http://www.huffingtonpost.com/entry/5948f613e4b0f7875b83e5aa

Sederer, LI Committed: The Battle Over Involuntary Psychiatric Care July 8, 2017
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201707/committed-the-
battle-over-involuntary-psychiatric-care

Sederer, LI. ‘You Are Not The Brightest Of My Four Sons’... And Other Depressing Things That
Have Been Said To Me July 24, 2017
http://www.huffingtonpost.com/entry/5975ed3be4b06b511b02c4ca

Sederer, LI. Born To Be Wild: Why Teens Take Risks, and How We Can Help October 1, 2017
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201710/born-be-wild-why-
teens-take-risks-and-how-we-can-help

Sederer, LI. Slow Medicine: The Way to Healing October 20, 2017
http://www.nyjournalofbooks.com/book-review/medicine

Sederer, LI. Lee Child’s Jack Reacher Books: A Confession And Holiday Reading list
December 8, 2017
https://www.huffingtonpost.com/entry/lee-childs-jack-reacher-books-a-confession-and-
holiday_us_5a2afe3ae4b022ec613b8225

Sederer, LI. Two Girls Down by Louisa Luna January 7, 2018


https://www.huffingtonpost.com/entry/two-girls-down-by-louisa-luna-a-book-review-by-
dr_us_5a523a4ce4b0cd114bdb344c

Sederer, LI. Fulfilled: How the Science of Spirituality Can Help You Live January 13, 2018
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201801/fulfilled-how-the-
science-spirituality-can-help-you-live

23
Sederer, LI. Starting with Goodbye: A Daughter's Memoir of Love after Loss May 1, 2018
https://www.nyjournalofbooks.com/book-review/starting-goodbye-daughters

Sederer, LI. Healthier: Fifty Thoughts on the Foundations of Population Health June 1, 2018
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18020177

Sederer, LI. The Mars Room: A Novel by Rachel Kushner June 16, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201806/the-mars-room-
novel-rachel-kushner

Sederer, LI. Also Human: The Inner Lives of Doctors June 28, 2018
https://www.nyjournalofbooks.com/book-review/also-human

Sederer, LI. Book review of How to Change Your Mind by Michael Pollan July 3 2018
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30232-3/fulltext
https://doi.org/10.1016/S2215-0366(18)30232-3

Sederer, LI. Book review of Because I Come from a Crazy Family: The Making of a Psychiatrist
August 1, 2018
http://www.washingtonindependentreviewofbooks.com/bookreview/because-i-come-from-a-
crazy-family-the-making-of-a-psychiatrist

Sederer, LI. Book review of Rush: Revolution, Madness, and the Visionary Doctor who Became
a Founding Father The Lancet October 31, 2018
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2818%2930430-9/fulltext

Sederer, LI. Book Review of Past Tense: A Jack Reacher Novel New York Journal of Books
November 5, 2018
https://www.nyjournalofbooks.com/book-review/past-tense

Sederer, LI. Book Review Love is Blind Washington Independent Review of Books November
7, 2018
http://www.washingtonindependentreviewofbooks.com/bookreview/love-is-blind-a-novel

Sederer, LI. Book Review The Peacock Feast: A Novel New York Journal of Books February 6,
2019
https://www.nyjournalofbooks.com/book-review/peacock-feast-novel

Sederer, LI. Book Review Thomas Szasz: An Appraisal of His Legacy Psychiatric Times April
24 2019
https://www.psychiatrictimes.com/film-and-book-reviews/thomas-szasz-appraisal-his-legacy

Sederer, LI. Book Review Well The Lancet May 1, 2019


https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30141-
5/fulltext?dgcid=raven_jbs_etoc_email

24
Sederer, LI. Book Review The Rabbit Effect: Live Longer, Happier, and Healthier with the
Groundbreaking Science of Kindness New York Journal of Books August 27, 2019
https://www.nyjournalofbooks.com/book-review/rabbit-effect

…………

Movies, TV & Theatre:

All So Human: Where the Wild Things Are. October 20, 2009
http://www.huffingtonpost.com/lloyd-i-sederer-md/all-so-human-where-the-wi_b_325364.html

A Lesson in Leadership. December 29, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/a-lesson-in-leadership_b_405507.html

Resilience and Responsibility. January 7, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/resilience-and-responsibi_b_415001.html

Asperger’s Syndrome: Film Shows Life With Asperger’s May 24, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/aspergers-syndrome-film-s_b_584018.html

A Hero’s Journey: Winter’s Bone July 9, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/a-heros-journey-emwinters_b_638824.html

The King's Speech: What The Film Teaches Us About Life With A Disability
December 14, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-kings-speech-making-a_b_795618.html

All in the Family: What 'The Fighter' Reveals About the Power of Blood Ties
December 28, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/all-in-the-family-the-fig_b_801719.html

“Limitless': Would the FDA Approve? April 7, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/limitless-movie-would-the-
fda_b_845428.html

The Dark World of Depression: 'The Beaver' (Movie Review April 27, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-dark-world-of-depress_b_854587.html

Buck: No Horsing Around July 21, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/buck-no-horsing-around_b_901536.html

Contagion: Scary Movie September 9, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/contagion-scary-movie_b_954071.html

25
“Unguarded:' The High Life of Chris Herren October 31, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/chris-herren-addiction_b_1063575.html

“A Dangerous Method”: Notes on a Film About Freud and Jung December 2, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/a-dangerous-method-freud-
jung_b_1119401.html ; reprinted, with revisions, in The American Psychoanalyst, Vol 46, No. 4,
Fall/Winter 2012, p.11.

The Best Exotic Marigold Hotel -- For the Elderly and Beautiful May 3, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/best-exotic-marigold-hotel_b_1389987.html

OC 87: The Obsessive Compulsive, Major Depression, Bipolar, Asperger's


Movie June 4, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_1566318.html

'Moonrise Kingdom': A Tale About Purity June 18, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/moonrise-kingdom-wes-
anderson_b_1604509.html

'Take This Waltz' (or Let It Pass?) July 2, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/take-this-waltz-or-let-it_b_1641106.html

The Master September 24, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/the-master-movie-review_b_1907800.html

Middle of Nowhere October 12, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/middle-of-nowhere-movie_b_1954327.html

Lincoln - A timeless tale of fighting inequity November 9, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/lincoln-movie-review_b_2102594.html

Promised Land December 31, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/promised-land-review_b_2371956.html

Documentary Movie Review: A Place at the Table February 28, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/a-place-at-the-table-review_b_2753434.html

Man of Steel: Superman Past and Present June 17, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/man-of-steel-review_b_3450230.html

Documentary Movie Review: Teach: A Participant Media Production October 9, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/teach-documentary_b_4067576.html

Everyone Lies: The Fifth Estate October 17, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/fifth-estate-review_b_4025751.html

How Do Actors Act? February 3, 2014

26
http://www.huffingtonpost.com/lloyd-i-sederer-md/film-review_b_4713022.html

TV Series Review: House of Cards February 14, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/house-of-cards-review_b_4791134.html

Evil -- Marvelously Portrayed -- Why Do You Watch 'House of Cards'? March 4, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/house-of-cards-review_b_4893491.html

How to Start a Movement: A Movie Review of 'Chavez' March 31, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/chavez-movie-review_b_5060789.html

'Locke' June 9, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/film-review_b_5472789.html

‘Ida’ June 16, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/film-review_b_5497794.html

Gahan Wilson: Born Dead, Still Weird July 18, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/gahan-wilson-born-dead-st_b_5623616.html

The Hundred-Foot Journey August 8, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/the-hundredfoot-journey_b_5655480.html

Here One Day: A Documentary Film Review September 22, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/here-one-day-a-documentar_b_5864284.html

How to Get Someone to Change His Mind: A Film Review of Diplomacy November 3, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/how-to-get-someone-to-cha_b_6089954.html

A Most Violent Year December 31, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/a-most-violent-year_b_6322684.html

The Second Best Exotic Marigold Hotel March 6, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/the-second-best-exotic-marigold-hotel-a-
movie-review_b_6802542.html?utm_hp_ref=tw

The Public Health Message of House of Cards, Season 3: A Series Review March 10, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-public-health-message-of-house-of-
cards-season-3-a-series-review_b_6833622.html?utm_hp_ref=healthy-living

'Ex Machina': A Film Review April 20, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/ex-machina-a-film-review_b_7102738.html

"So You're Going Crazy" Psychology Today June 20, 2015


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201506/so-youre-going-
crazy-hilary-dean

27
Amy: A Film Review August 11, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/amy-a-film-review-by-lloyd-i-sederer-
md_b_7967682.html

Not So Good Vibrations: 'Love and Mercy' - The Brian Wilson/Beach Boy Movie
August 24, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/not-so-good-vibrations-lo_b_8028804.html

The Business of Recovery: A Documentary Film August 31, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/the-business-of-recovery-_b_8048170.html

'Limitless' -- The TV Show September 23, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/limitless-the-tv-show_b_8180770.html

Please Like Me: A TV Series Review October 13, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/please-like-me-a-tv-serie_b_8281062.html

Bridge of Spies: Film Review October 16, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/bridge-of-spies-reviewed-_b_8294556.html

Steve Jobs: A Film Review November 9, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/steve-jobs-a-film-review-by-dr-lloyd-
sederer_b_8499510.html

The Moral Entropy of Institutions A Film Review of Spotlight January 18, 2016
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-moral-entropy-of-
institutions_b_9003462.html

The Young Men and the Sea -- The Finest Hours January 28, 2016
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-young-men-and-the-sea----the-finest-
hours_b_9090634.html

Not Just a Movie About China: Mountains May Depart February 16, 2016
http://www.huffingtonpost.com/lloyd-i-sederer-md/not-just-a-movie-about-china-mountains-
may-depart_b_9242578.html

House of Cards, Season 4: Everyone Lies March 9, 2016


http://www.huffingtonpost.com/lloyd-i-sederer-md/house-of-cards-season-4-everyone-
lies_b_9413316.html

‘No Letting Go’ March 21, 2016


http://www.huffingtonpost.com/lloyd-i-sederer-md/no-letting-go-a-film-review_b_9508070.html

“Girl On The Edge” April 14, 2016


http://www.huffingtonpost.com/lloyd-i-sederer-md/girl-on-the-edge-a-film-
review_b_9684160.html

28
PBS Series Offers Hope for People With Mental Illness April 26, 2016
http://www.huffingtonpost.com/lloyd-i-sederer-md/pbs-series-offers-hope-for-people-with-
mental-illness_b_9731828.html

The Music of Strangers: A film review by Dr. Lloyd Sederer June 19, 2016
http://www.huffingtonpost.com/entry/the-music-of-strangers-a-film-review-by-dr-
lloyd_us_5766d293e4b0092652d7a275

The Innocents – A Film Review August 21, 2016


http://www.huffingtonpost.com/entry/the-innocents-a-film-
review_us_57ba0fdfe4b07d22cc38a434

The Light Between Oceans – A Film Review by Dr. Lloyd Sederer September 3, 2016
http://www.huffingtonpost.com/entry/the-light-between-oceans-a-film-review-by-dr-
lloyd_us_57cb1c2fe4b0b9c5b738d17c

Deepwater Horizon: A Film Review October 1, 2016


http://www.huffingtonpost.com/entry/57f05856e4b07f20daa10c90?timestamp=1475369317193

Sederer, LI. Love, Love, Love: A fine play about some very unlikeable people - a theatre review
October 20, 2016
http://www.huffingtonpost.com/entry/love-love-love-a-fine-play-about-some-very-
unlikeable_us_5808c579e4b00483d3b5d08b?

Sederer, LI. Career Suicide: A one man, one act comedic journey into despair October 29, 2016
http://www.huffingtonpost.com/entry/career-suicide-a-one-man-one-act-comedic-
journey_us_5815209ce4b09b190529c5b8

Silence: A Film Review January 16, 2017


http://www.huffingtonpost.com/entry/587cddf7e4b094e1aa9dc80f?timestamp=1484578903073

‘Sneaky Pete’: An Amazon Studios TV Series Review February 6, 2017


http://www.huffingtonpost.com/entry/sneaky-pete-an-amazon-studios-tv-series-
review_us_58988b97e4b061551b3e00eb

Sederer, LI. The One With Friends - A TV Show Within a Play February 14, 2016
http://www.askdrlloyd.com/so/cLfEgqX9?cid=98f3c8bb-355e-4b04-a12f-d7306f8e5e3c#/main

Come From Away: A Broadway Theatre Review By Dr. Lloyd Sederer March 25, 2017
http://www.huffingtonpost.com/entry/58d6d78ee4b0f633072b3846

Warning: This Drug May Kill You April 23, 2017, A review of an HBO documentary
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201704/warning-drug-may-
kill-you

‘The Last Shaman’: A Documentary by Raz Deegan May 8, 2017


http://www.huffingtonpost.com/entry/59108eaee4b046ea176aed7d

29
Sederer, LI. Far From The Tree: A Documentary Review November 8, 2017
https://www.huffingtonpost.com/entry/5a032dcce4b0230facb841c1

‘Three Billboards Outside Of Ebbing, Missouri’ — A Film Review November 26, 2017
https://www.huffingtonpost.com/entry/three-billboards-outside-of-ebbing-missouri-a-
film_us_5a1ad81fe4b0250a107c002f

‘The Marvelous Mrs. Maisel’ — An Amazon TV Series Review December 28, 2017
https://www.huffingtonpost.com/entry/the-marvelous-mrs-maisel-an-amazon-tv-series-
review_us_5a450e26e4b06cd2bd03de65

The Young Karl Marx February 22, 2018


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201802/the-young-karl-marx

Little League: A Play by Jack Spagnola March 1, 2018


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201803/little-league-play-
jack-spagnola

Sederer, LI. Abductions: Two Film Reviews March 25, 2018


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201803/abductions-two-
film-reviews

Sederer, LI. Sometimes Decency and Grit Win April 17, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201804/sometimes-
decency-and-grit-win

Sederer, LI. A Review of Films at a Festival by the Host (Me) April 26, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201804/review-films-
festival-the-host-me

Sederer, LI. Rock Rubber 45s June 26, 2018


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201806/rock-rubber-45s

Sederer, LI. The Wife, a Film Review September 3, 2018


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201809/the-wife-film-
review

Sederer, LI. Only the best will do: Patrick Melrose on page and screen September 6, 2018
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30344-4/fulltext

Sederer, LI. Pure Heart, Big Voice - A review of Won't You Be My Neighbor? October 1, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201810/pure-heart-big-
voice

A Star Is Born, a Film Review October 8, 2018


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201810/star-is-born

30
The Power of a Cult - A review of Netflix’s Wild, Wild Country October 14, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201810/the-power-cult

Menace to Society A review of 22 July: When the Unimaginable Happened in Norway October
20, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201810/menace-society

House of Cards: Season 6 A series review by Dr. Lloyd Sederer November 11, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201811/house-cards-
season-6

Homecoming (not): Season 1 A review of the Amazon Series by Dr. Lloyd Sederer December 3,
2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201812/homecoming-not-
season-1

The Marvelous Mrs. Maisel: A Review December 13, 2018


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201812/the-marvelous-
mrs-maisel-review

How I Felt When I Saw That Girl February 10, 2019


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201902/how-i-felt-when-
i-saw-girl
Men Growing Old February 16, 2019
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201902/men-growing-old

They Shoot Horses, But Not People April 7, 2019


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201904/they-shoot-
horses-not-people

"The Mule": A Film Review April 17, 2019


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201904/the-mule-film-
review

Never Look Away, May 12, 2019


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201905/never-look-away-
1

The Lavender Scare June 8, 2019


https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201906/the-lavender-
scare

Alternate Endings: Six New Ways to Die in America August 12, 2019
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201908/alternate-endings-
six-new-ways-die-in-america

31
…………

Editorials, Letters, and Commentary:

Sederer LI. Inpatient psychiatry: what place the milieu? Editorial. Am J Psychiatry.
1984; 141:673-74.

Sederer, LI. Limit Kids’ TV Watching April 12, 2004


http://www.nytimes.com/2004/04/12/opinion/l-limit-kids-tv-watching-175358.html

Sederer LI. What does the President’s Commission on Mental Health have to do with
NYC? Mental Health News, Winter 2004 issue.

Sederer LI, Kolodny AJ. Taking Issue: Office based buprenorphine offers a second
Chance, Psychiatric Services, 55:743, July 2004

Friedman, MB, Sederer, LI, Runnels, P: What the Presidential Candidates Should Say
About Mental Health, The Journal News (Westchester, NY), 2 May, 2008.

Sederer, LI: Changing the Oil While Driving the Car: Implementing Evidence-Base
Treatments, Psychiatric Services. 2009; 60:575

Sederer, LI: Science to Practice: Making what we know what we do, Schizophrenia
Bulletin. 2009; 35:714-718

Sederer, LI: Are Human Made Disasters Different? Journal of Epidemiology and
Psychiatric Sciences. October 2011 http://journals.cambridge.org/repo_A84HEPPg

Sederer, LI: Leadership, Psychiatric Services. February 2, 2012


doi: 10.1176/appi.ps.20110 p103.
http://ps.psychiatryonline.org/article.aspx?articleid=432919

Sederer, LI - Physician Leadership: The Top 10 List. American College of Physician


Executives, Newsletter, January 10, 2012
http://net.acpe.org/services/2012/Update/01-05/update.htm

Sederer, LI: Goplerud, E: - Pay for Health Reform with an Alcohol Tax. September 28,
2009, Washington Post.com
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/28/AR2009092802796.html

Sederer, LI. FEMA Approves $8.2 Million for Post-Sandy Mental Health Outreach
TheAtlantic.com, November 19, 2012 in
http://www.theatlantic.com/health/archive/2012/11/fema-approves-82-million-for-post-sandy-
mental-health-outreach/265236/

32
Sederer. LI. In Psychiatric Illness, Families Must Be Our First Responders
No mental health system will ever be able to identify serious behavioral problems as early
as family. TheAtlantic.com, December 26, 2012
http://www.theatlantic.com/health/archive/2012/12/in-psychiatric-illness-families-must-be-our-
first-responders/266628/

Sederer, LI. The Tragedy of Mental Health Law, The Wall Street Journal, Op-Ed, January
12, 2013, p. A13; also at the WSJ.com
Also published online at Psychology Today September 23, 2013
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201309/the-tragedy-mental-
health-law-0

NYT Letter To the Editor, 2.5.2013


http://www.nytimes.com/2013/02/05/opinion/a-tale-of-adderall-abuse-and-suicide.html?_r=1&

Sederer, LI. What Does It Take for Primary Care Practices to Truly Deliver Behavioral
Health Care? JAMA Psychiatry. Published online March 5, 2014.
doi:10.1001/jamapsychiatry.2014.26
http://clicks.emailcampaigns.net/trkr/?c=13562&g=293511&p=2b1e015c8602e1c34d5b05b8162
8f499&u=35944879641099f65c59d7267c38ab0e&q=&t=1

Sederer, LI, Sharfstein, SS: Fixing the Troubled Mental Health System. JAMA Viewpoint,
JAMA. September 24, 2014; Volume 312, Number 12
JAMA. Published online August 14, 2014. doi:10.1001/jama.2014.10369
http://jama.jamanetwork.com/article.aspx?articleID=1897537&utm_source=Silverchair%20Infor
mation%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst08%2F14%2
F2014

Sederer, LI. Changing the Landscape of Mental Health Disaster Response Published in the 2x2
Project by the Columbia/Mailman School of Public Health on August 15, 2014
http://the2x2project.org/mhdisasterresponse/

Sederer, LI, Summergrad, P: The Mental Health Mission of Rep. Tim Murphy. Psychiatric News
http://dx.doi.org/10.1176/appi.pn.2015.3a27, February 26, 2015
http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2015.3a27

Sederer, LI. The Social Determinants of Mental Health, Psychiatric Services,


Psychiatric Services 67:234-235 February 2016, online at
http://ps.psychiatryonline.org/doi/10.1176/appi.ps.201500232

Sederer, LI. Strategies of Living Well: Four Secrets in Plain Sight January 4, 2017
http://www.nami.org/Blogs/NAMI-Blog/January-2017/Strategies-of-Living-Well-Four Secrets-
in-Plain-S

Carruthers, JC, Sederer, LI. New York State’s Path to Behavioral Health Integration June 15,
2017
http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2017.6a16

33
Sederer, LI. Five Question Fridays With Dr. Lloyd Sederer August 4, 2017
http://blog.datis.com/2017/08/04/five-question-fridays-with-dr-lloyd-sederer/

Sederer, LI. America’s Opioid Epidemic October 20, 2017


https://www.scattergoodfoundation.org/publication/americas-opioid-epidemic/?previous=7

Sederer, LI. Trying to Help a Homeless Woman March 10, 2018


https://goo.gl/zxZp3P

Sederer, LI. We can't punish our way out of the opioid crisis, Mr. President March 21, 2018
http://www.nydailynews.com/opinion/punish-opioid-crisis-article-1.3887700

Sederer, LI. Opioids and Substance Abuse: What Can We Do? June 25, 2018
https://www.nami.org/Blogs/NAMI-Blog/June-2018/Opioids-and-Substance-Abuse-What-Can-
We-Do

Sederer, LI. Questions and Answers for Clinicians Facing the Opioid Epidemic September 2018
http://www.psychiatrictimes.com/psychopharmacology/questions-and-answers-clinicians-facing-
opioid-epidemic

The Opioid Epidemic: How Can We Save the Most Lives? A National Association of Counties
Article by Dr. Lloyd Sederer February 18, 2019
https://drive.google.com/file/d/1EVijEpOQ3gsiuyqlbugxvbC_wDT7rjA6/view

………..

Additional HuffPosts by LI Sederer:

Real Progress on Homelessness. March 23, 2009


www.huffingtonpost.com/lloyd-i-sederer-md/real-progress-on-homeless_b_178217.html

Neuroenhancers: Paying the Piper. June 1, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/paying-the-piper-brain-ne_b_209702.html

Adolescent Depression: Do we have the will to make a difference? June 9, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/adolescent-depression-do_b_212866.html

The FDA and Recommendations for Antipsychotic Medications in Children. June 18, 2009
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-fda-and recommendatio_b_216253.html

Can You Trust Your Psychiatrist? June 30, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/can-you-trust-your-psychi_b_222761.html

Late Bloomers? July 14, 2009

34
http://www.huffingtonpost.com/lloyd-i-sederer-md/late-bloomers_b_230838.html

What are the Wounds of War? July 28, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/what-are-the-wounds-of-wa_b_245846.html

Reaching for the Prescription Pad. August 5, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/reaching-for-the-prescrip_b_252272.html

So, Your Child Is Going Off to College... Drinking, Drugs, Depression and Dealing with
Colleges and Universities. August 13, 2009
http://www.huffingtonpost.com/lloyd-i-sederer-md/so-your-child-is-going-of_b_258998.html

Narcissists. September 8, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/narcissists_b_278844.html

Where is Mental Health in Health Care Reform? September 24, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/where-is-mental-health-in_b_295776.html

Problem Drinking. October 9, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/problem-drinking_b_315922.html

Is There a Relationship Between Mental Illness and Violence? October 29, 2009
http://www.huffingtonpost.com/lloyd-i-sederer-md/is-there-a-relationship-b_b_339174.html

What in the world is a social entrepreneur? November 14, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/what-in-the-world-is-a-so_b_355173.html

Antipsychotic Medication Use In Children And Adolescents: What's A Parent To Do?


December 4, 2009
http://www.huffingtonpost.com/lloyd-i-sederer-md/antipsychotic-medication_b_372872.html

R U OK? December 14, 2009


http://www.huffingtonpost.com/lloyd-i-sederer-md/suicide-prevention-r-u-ok_b_389924.html

War Veterans, PTSD and The Media. January 18, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/war-veterans-ptsd-and the_b_426659.html

Can Electrically Stimulating The Brain Improve Mental Health? February 1, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/can-electrically-stimulat_b_443517.html

Let’s Not Get Too Depressed About Depression. February 8, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/lets-not-get-too-depresse_b_452599.html

The Good News About the 'Bad' News About Antidepressants. February 12, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-good-news-about-the-b_b_457464.html

Is Your Doctor Using A Checklist? February 23, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/is-your-doctor-using-a-ch_b_473068.html
35
The Path to Mental Health Insurance Parity. March 8, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-path-to-mental-health_b_488693.html

How to Quit Smoking for Good. March 29, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/quitting-smoking-how-to-s_b_507177.html

What Does it Take to Get Something Done? April 8, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/the-homeless----how-to-pr_b_529364.html

Community and Faith: Rebuilding Brownsville, Brooklyn April 27, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/community-and-faith-rebui_b_548699.html

Deadly Consequences: Why We Need to Integrate Health and Mental Health May 11, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-deadly-cons_b_566630.html

A New Treatment for Narcotic Addiction June 7, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/addiction-recovery-a-new_b_595448.html

What’s Your Attitude Towards Mental Illness? June 21, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/whats-your-attitude-towar_b_615691.html

Recovery From Serious Mental Illness: Sometimes It Takes 'The Village' July 2, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/recovery-from-serious-men_b_632930.html

Obesity Linked to Poor School Performance July 27, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/obesity-linked-to-poor-sc_b_646747.html

The Psychology of Resilience September 23, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/resilience_b_732450.html

The Anatomy Lab: What's Wrong With Medical Education Today? October 5, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-anatomy-lab_b_748695.html

Children as Caregivers: Saving the Saviors October 21, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/children-as-caregivers-sa_b_768916.html

Medication for Alcoholism: Alternatives to Abstinence October 25, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/abstinence-may-not-be-
eno_1_b_759904.html

Finding the Right Psychiatrist November 1, 2010


http://www.huffingtonpost.com/lloyd-i-sederer-md/finding-a-psychiatrist_b_776727.html

How the Stress of Combat Affects Family and Work at Home November 11, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/military-service-and-beyo_b_781874.html

36
Seasonal Affective Disorder: How to Beat 'Winter Depression' November 23, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-seasons-and-your-mood_b_786752.html

Alcohol Energy Drinks: There's More You Should Know December 6, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/alcohol-energy-drinks-the_b_791804.html

How to Break Free From Your Unhealthy Habits January 1, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/addiction-help-want-to-quit-
smoking_b_802828.html

Henry, CL, Sederer, LI,: Haiti: Trauma and Resilience a Year After the Earthquake January
12, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/haiti-earthquake-trauma-
resilience_b_808054.html

Sederer, LI, Smith, TE: Patient Care: Managing High Need, High Cost Medical Patients
January 26, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/patient-care-managing-high-
need_b_813469.html

Depression Treatment: Treating Depression the Old-Fashioned Way February 8, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/depression-treatment-_b_819798.html

Suicide Prevention: We Can Do Better February 16, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/suicide-prevention-_b_823414.html

Ink-Stained for Life: What Makes for a Great Teacher February 26, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/inkstained-for-life-great-
teacher_b_828031.html

When to Consider Acupressure: An M.D.'s Prescription March 10, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/what-is-acupressure_b_829432.html

Advice For Those With a Loved One With Mental Illness March 14, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-illness-relationship_b_835100.html

The Body Project: School Program Measures Obesity Right Along With Grades April 4,
2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/child-obesity-education-_b_842782.html

Music, Madness and Medicine: A Visit with Richard Kogan, M.D. April 27, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/music-madness-and-medicin_b_852867.html

Company with a Conscience: Participant Media's Social Action Campaign and 'The Beaver'
May 6, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/company-with-a-conscience_b_854598.html

37
MindUP: How Goldie Hawn Is Out to Change the Landscape of Childhood Learning
May 10, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/better-learning-mindfulness_b_859113.html

The Good News and the Bad News About Mental Health Care in America May 16, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_862051.html

'Bath Salts' Aren't What They Used To Be May 26, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/bath-salts-banned-arent-what-
the_b_867002.html

Dying with Your Rights On: Mental Illness, Civil Rights and Saving Lives June 7, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_871274.html
Reprinted in the WSJ.com: http://onespot.wsj.com/politics/2011/06/07/cc843/lloyd-i-sederer-md-
dying-with-your-right

The Future of Psychiatry June 20, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/the-future-of-psychiatry-_b_880137.html

What Does Suicide Prevention Have to Do with Health Care? July 18, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/eradicate-suicide_b_901219.html

The American Psychiatric Association's New Bible Part 1 of 2 July 26, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-american-psychiatric-_b_906333.html

Brownies Your Mother Never Made: FDA Issues Warning August 5, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/brownies-lazy-cakes-
melatonin_b_919015.html

Raising the Hope Ceiling August 9, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/raising-the-hope-ceiling_b_922343.html
Reprinted in the WSJ.com:http://onespot.wsj.com/politics/2011/08/09/63b94/lloyd-i-sederer-
md-raising-the-hope

Rapid Cycling Bipolar Disorder: In the Office and on 'The Street' August 26, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/rapid-cycling-bipolar-dis_b_936998.html
Reprinted in the WSJ.com: http://onespot.wsj.com/politics/2011/08/26/23473/lloyd-i-sederer-md-
rapid-cycling-bipolar

Ehrlich, MD, Sederer, LI: With Mental Health Drugs, Greater Risk Means More Marketing
September 6, 2011
http://www.huffingtonpost.com/matthew-d-erlich-md/the-snakeoil-paradox-with_b_947220.html

Lessons from New York City's 9/11 Mental Health Response September 8, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/911-mental-health-response_b_949390.html

38
The DSM-5: The Changes Ahead (Part 2) September 19, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/dsm-5_b_961966.html

Who Is The Most Dominant Player In Professional Sports Today? October 3, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/esther-vergeer_b_988567.html

Ehrlich, MD, Sederer, LI: When Can Making Medical Decisions Be Hazardous to Your Health?
October 12, 2011
http://www.huffingtonpost.com/matthew-d-erlich-md/decision-making-fatigue_b_1004918.html

Prescription Drug Abuse: The New Killer on the Block November 8, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/prescription-drug-abuse_b_1076166.html

Screening Our Youth for What Ails Them November 15, 2011
http://www.huffingtonpost.com/lloyd-i-sederer-md/screening-kids-for-
depression_b_1091156.html

Erlich, MD, Sederer, LI: Should Health Care Providers Be Afraid of the 'Nocebo' Effect?
November 29, 2011
http://www.huffingtonpost.com/matthew-d-erlich-md/health-care-noceboeffect_b_1113131.html

Sleepwalking Is For Real December 15, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/sleepwalking_b_1145958.html

Erlich, MD, Sederer, LI: Mastering the Anniversary Reaction: Putting Memory to Rest
December 25, 2011
http://www.huffingtonpost.com/matthew-d-erlich-md/grief_b_1164254.html

I Hear You: Responding to Cries for Emotional Help January 18, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/sinead-oconnor-suicide
twitter_b_1207374.html

Casinos for Kids January 24, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/kids-gambling_b_1223812.html

Mysterious Illness at Le Roy School: Understanding Conversion Disorders


February 3, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/le-roy-illness_b_1251202.html

The DSM-5: Will it Work in Clinical Practice? February 6, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/dsm-5_b_1256123.html

Trauma and Adversity in Childhood: History Need Not Be Destiny February 27, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/childhood-trauma_b_1291387.html

Les Grands Hamsters d'Alsace March 9, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/france-wild-hamsters_b_1332142.html

39
Erlich, MD, Sederer, LI: Neurotechnology: Science Fiction or Applied Science?
March 21, 2012
http://www.huffingtonpost.com/matthew-d-erlich-md/neurotechnology-science-
f_b_1346386.html

Comparing Psychiatric and General Medical Medications: What Does the Evidence Say?
March 28, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/medication_b_1383598.html

Erlich, MD, Sederer, LI: Neuroethics: Whose Mind Is It Anyway? April 23, 2012
http://www.huffingtonpost.com/matthew-d-erlich-md/neuroethics-whose-mind-
is_b_1444014.html

Disruptive Doctors: Changing Psychiatric Practices (in Japan and elsewhere)


June 13, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/japan-health-care_b_1590644.html

Addiction: America's Most Neglected Disease June 26, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/casa-addiction-report_b_1622978.html

Addiction: Help You Can Get Beyond 12-Step and Conventional Western Medications
July 16, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/addiction-treatment-_b_1665302.html

'Random' Acts of Violence Are Not So Random July 22, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_1693714.html

The 'War' on Drugs August 27, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/drug-war_b_1833357.html

Doctors Make Mistakes: A Commentary on Medical Errors November 2, 2012


http://www.huffingtonpost.com/lloyd-i-sederer-md/medical-errors_b_2050397.html

Mental Health and Hurricane Sandy: What Can We Expect, What Can We Do?
November 7, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/hurricane-sandy-mental-
health_b_2089645.html
Also published online by the Columbia University Mailman School of Public Health.
November 5, 2012
http://the2x2project.org/mental-health-and-hurricane-sandy/

Mental Health and Hurricane Sandy: What Can We Expect, What Can We Do?
November 7, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/hurricane-sandy-mental-
health_b_2089645.html
Also published online by the Columbia University Mailman School of Public Health.

40
November 5, 2012
http://the2x2project.org/mental-health-and-hurricane-sandy/

Alisic, EA, Sederer, LI Children's Mental Health After the Shooting in Newtown
December 16, 2012
http://www.huffingtonpost.com/eva-alisic-phd/children-mental-health-ewtown_b_2311875.html

‘Where Have All the Flowers Gone?’: Thoughts After the Newtown Massacre
December 17, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_2315550.html

A Stroke of Insight: A TED Talk Commentary


Published in the Huffington Post/AOL on January 4, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/neuroscience-ted-talks_b_2405283.html

Biomarkers for Depression: Promise or Prime Time? February 21, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/depression-biomarkers_b_2720412.html

The Painted Bird: Stigma and Mental Illness March 19, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-illness-stigma_b_2891227.html

Who Can You Trust? Commentary on a TED Talk on Psychopaths April 2, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/who-can-you-trust_b_2979792.html

Things You Want to Know About Psychiatric Medications But Didn't Know Who (or How)
to Ask April 18, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/psychiatric-medications_b_3064821.html

Bipolar Disorder: What a Family (Or Friend) Might See and What a Family Can Do May 2,
2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/catherine-zeta-jonesbipolar_b_3195539.html

Huffington Post Stress Less 14 Day Series: LI Sederer, moderator, April 2013
http://www.huffingtonpost.com/2013/04/12/huffpost-stress-less-
challenge_n_3072250.html#slide=more286211

Readying for a Radiological Disaster? Preparing for Dirty Bombs, Nuclear Disaster and
Other Radiological Emergencies May 7, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/disaster-preparation_b_3215586.html
Also published in The Columbia 2x2 Project May 8, 2013
http://the2x2project.org/radiological-disaster/

Traumatic Stress Disorder May 8, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/traumatic-stress-disorder_b_3233038.html

41
Everything You Always Wanted to Know About The Diagnostic Manual of Mishegas
(DMOM): An Interview With the Authors May 13, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/diagnostic-manual-of-
mishegas_b_3247269.html
Also published in The Columbia 2x2 Project May 15, 2013
http://the2x2project.org/dmom/

The Trauma That Will Succeed the Tornadoes May 28, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/natural-disasters-trauma_b_3336701.html

Galea, S, Sederer, LI: Wartime PTSD: What Works and How to Care for a Loved One
June 11, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/veterans-ptsd_b_3408128.html

Sederer, LI, Chung, H: The Cost of Not Caring for People With Serious Mental Illness
July, 16, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_3605777.html

Addiction: The Equal Opportunity Threat to Life August 9, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/christina-huffington-
addiction_b_3732420.html

Amado, I, Sederer, LI: What Is Cognitive Remediation in Psychiatric Practice and Why Do
We Need It? August 13, 2013
Published in the Huffington Post/AOL on 13 August 2013
http://www.huffingtonpost.com/isabelle-amado-md-phd/cognitive-remediation_b_3728023.html
Also in the Paris Edition of the Huffington Post on 15 August 2013 at:
http://www.huffingtonpost.fr/isabelle-amado-md-phd/quest-ce-que-la-remediation-
cognitive_b_3728095.html

Eleanor Longden's TEDTalk: "The Voices In My Head" August 26, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/eleanor-longdens-tedtalk_b_3792232.html

The Best News for Baby Boomers in a Long Time September 16, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/baby-boomers-health_b_3931370.html

Rosenberg, L. Sederer, LI: When Mental Illness Hits Home - Mental Health First Aid
October 21, 2013
http://www.huffingtonpost.com/linda-rosenberg/mental-illness_b_4101189.html

A Third Strike Against Big Pharma November 5, 2013


http://www.huffingtonpost.com/lloyd-i-sederer-md/patient-centered-care_b_4219963.html

ACEs: Adverse Childhood Experiences -- and Problems for a Lifetime November 13, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/adverse-childhood-
experiences_b_4256732.html

42
Why? How Great Leaders Inspire Action December 6, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/simon-sinek-ted-talk_b_4394925.html

Population Health: Transforming Health Care to Improve Our Health December 16, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/health-care_b_4455582.html
Also published in the 2 X 2 Project Newsletter December 17, 2013
http://the2x2project.org/transforming-care-improving-health/

Influencing Children, the Icelandic Way January 6, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/iceland-culture-and-myths_b_4545001.html
Also published online at Psychology Today February 2, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201402/influencing-children-
the-icelandic-way

A Fowl Fable January 14, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/a-fowl-fable_b_4591771.html

Pope Francis and People with Mental Disorders January 23, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-
news_b_4645023.html?utm_hp_ref=healthy-living

Philip Seymour Hoffman and America’s Most Neglected Disease February 4, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/addiction-and-recovery_b_4719822.html

Pope Francis and the Paradox of Faith February 21, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/pope-francis_b_4823924.html

Community Policing and Child Development: Averting Traumatic Disorders March 25, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-news_b_5017346.html
Also published online in the 2 X 2 Project Newsletter March 26, 2014
http://the2x2project.org/child-trauma/

Violence and Serious Mental Disorders: Do Something, Don't Just Wait for a Diagnosis
March 3, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/violence-mental-disorders_b_5085206.html

The Future of Mental Health Care April 21, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_5182772.html

Thrive: Finding the Recipe for a Good Life April 26, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/thrive-conference_b_5215773.html

A Defining Moment for Mental Health in America May 6, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-news_b_5272950.html
Also published online in the 2 X 2 Project Newsletter May 13, 2014
http://the2x2project.org/mindfulact/

43
Rosenberg, L, Sederer, LI: Mental Health First Aid for Veterans May 20, 2014
http://www.huffingtonpost.com/linda-rosenberg/mental-health-
veterans_b_5354168.html?1400601553

Privacy, Liberty and Another Mass Murder May 27, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-news_b_5390604.html

Depression: The Everywhere and Everyone Illness August 18, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/stronger-together_b_5682989.html

Human Masks and Mental Illness August 25, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-awareness_b_5708487.html

Thomas Szasz, M.D.: Radical and Transformative Psychiatrist September 2, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/thomas-szasz-md-radical-a_b_5744244.html

Do Not Go Gentle Into That Good Night September 10, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/world-suicide-prevention_b_5783596.html

Sederer, LI, Sharfstein, SS: Fixing the Broken Mental Health System October 13, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/fixing-the-broken-mental-_b_5973106.html
Also published online in the 2 X 2 Project Newsletter October 14, 2014
http://the2x2project.org/brokenmhsystem/

Listening to Your Marshmallow October 23, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/listening-to-your-marshma_b_6038278.html

The Impact of Hurricane Sandy on Mental Health: What More We Could Have Done
October 29, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-impact-of-hurricane-s_b_6056618.html

Depression: It's Not Just in Your Head; It's Also in Your Genes November 28, 2014
http://www.huffingtonpost.com/lloyd-i-sederer-md/depression-its-not-just-i_b_6229394.html

Violence as a Public Health Problem: A Most Violent Year December 9, 2014


http://www.huffingtonpost.com/lloyd-i-sederer-md/violence-as-a-public-
heal_b_6288740.html?utm_hp_ref=healthy-living
Amado, I, Sederer, LI. Je Suis Charlie: A First-Person Account From the Paris Rally
January 12, 2015
http://www.huffingtonpost.com/isabelle-amado-md-phd/je-suis-charlie-a-first-
p_b_6455280.html

Glasofer, DR, Sederer LI. 3 Little Words: How Apology Can Enhance Romance -- A Valentine's
Day Series, Part 1 February 9, 2015
http://www.huffingtonpost.com/deborah-r-glasofer-phd-/science-of-sorry_b_6613780.html

44
Sederer LI. That Which I Love Destroys Me: 'Veterans Fought for Our Freedom. Now It's Our
Turn to Fight for Theirs' February 11, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/that-which-i-love-destroy_b_6648660.html
Also published online in the 2 X 2 Project Newsletter February 17, 2015
http://the2x2project.org/ptsd-doc/

Suicide, Violence and Mental Illness March 30, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/germanwings-mental-llness_b_6964190.html

Safety and Professional Standards 'From the Inside Out' -- A Not So Modest Proposal
April 7, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/safety-and-professional-standards-from-the-
inside-out-a-not-so-modest-proposal_b_7012272.html

A Prescription for Mental Health in America May 13, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/a-prescription-for-mental-health-in-
america_b_7156966.html

7 Things to Know About Mental Health After a Disaster June 9, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/7-things-to-know-about-mental-health-after-
disaster_b_7547224.html

Refusing to Accept the Way Things Are: Making a Difference With Schizophrenia
June 22, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/refusing-to-accept-the-wa_b_7636324.html

How Doctors Think: Addiction, Neuroscience and Your Treatment Plan June 29, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/how-doctors-think-addicti_b_7687986.html

Sederer, LI, Carruthers, JW. How Doctors Think: Suicide Prevention August 4, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/how-doctors-think-suicide-
prevention_b_7917772.html

Men Are Different September 10, 2015


http://www.huffingtonpost.com/lloyd-i-sederer-md/men-are-different_b_8112632.html

The Five Signs, FLOTUS, POTUS, Rock & Roll and Brian Wilson October 5, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-five-signs-flotus-potus-rock--roll-and-
brian-wilson_b_8233286.html

Sederer, LI. Reporting Always – Writings from The New Yorker By Lillian Ross
January 5, 2016
http://www.huffingtonpost.com/lloyd-i-sederer-md/reporting-always-writings_b_8918488.html

Sederer, LI. Better Living Through Psychedelic Chemistry? LSD, Psilocybin and Ketamine in
the Headlines February 10, 2016

45
http://www.huffingtonpost.com/lloyd-i-sederer-md/-lsd-psilocybin-and-ketamine-in-the-
headlines_b_9202074.html

Sederer, LI. Mental Health and Civil Rights: The Kennedy Legacy February 24, 2016
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-and-civil-rights-the-kennedy-
legacy_b_9302968.html

Sederer, LI. Helping Young People Succeed February 25, 2016


http://www.huffingtonpost.co.uk/lloyd-i-sederer-md/helping-young-people-
succeed_b_9311124.html?1456428308

Sederer, LI. “Not for Human Consumption” - Synthetic Psychoactive Drugs April 6, 2016
http://www.huffingtonpost.com/lloyd-i-sederer-md/not-for-human-
consumption_b_9619658.html

Sederer, LI. Caring for the Patient May 31, 2016


http://www.huffingtonpost.com/lloyd-i-sederer-md/caring-for-the-patient_b_10206814.html

Sederer, LI. Why Are Psychoactive Drugs So Popular? June 8, 2016


http://www.huffingtonpost.com/lloyd-i-sederer-md/why-are-psychoactive-
drug_b_10335368.html

Sederer, LI. Violence: What We Know And What We Need To Know June 16, 2016
http://www.huffingtonpost.com/entry/violence-what-we-know-and-what-we-need-to-
know_us_5762b069e4b07d4d0a41c551?jgizl4ettd3d6lxr

Sederer, LI. Murder Amidst Celebration: Nice, France July 15, 2016
http://www.huffingtonpost.com/entry/murder-amidst-celebration-nice-france-by-
lloyd_us_5788aa45e4b0cbf01e9f822d

Sederer, LI. A War With No Name July 27, 2016


http://www.huffingtonpost.com/entry/a-war-with-no-name-dr-lloyd-sederer-writing-
from_us_5798b67ae4b0e002a3146e4d

Sederer, LI. The Opioid Addiction Epidemic and the US Surgeon General
http://www.huffingtonpost.com/entry/the-opioid-addiction-epidemic-and-the-us-surgeon-
general_us_57c9afd8e4b06c750dd9c525

Sederer, LI. When Celebrities Die By Suicide That Makes News September 15, 2016
http://www.huffingtonpost.com/entry/57daa752e4b0d5920b5b25ce?timestamp=1473956479061

Sederer, LI. Genes, Chance And Destiny: Siddhartha Mukherjee Chronicles The Human
Genome’s Turbulent Future September 28, 2016
http://www.huffingtonpost.com/entry/57ebb303e4b0972364dea808?timestamp=1475065281488

Sederer, LI. Improving Mental Health: 4 Secrets in Plain Sight – Excerpt December 5, 2016
http://www.huffingtonpost.com/entry/5841f398e4b04587de5de9d7?timestamp=1480717532183

46
Sederer, LI. Francis Greenburger, A Man On Many A Mission: A Profile February 20, 2017
http://www.huffingtonpost.com/entry/58ab7b05e4b0417c4066c1e1

Sederer, LI. The Deadly War On Drugs, Waged By Your Local SWAT Team March 19, 2017
http://www.huffingtonpost.com/entry/58ce980de4b0e0d348b34497

Sederer, LI What The Washington Post Gets Wrong About Opioids August 4, 2017
http://www.huffingtonpost.com/entry/5984d86ae4b0f2c7d93f55a6

Sederer, LI. Cannabis Is No Ordinary Commodity September 5, 2017


http://www.huffingtonpost.com/entry/59aea0e5e4b0bef3378cdb29

Sederer, LI Psychiatric Diagnosis Gone Astray September 28, 2017


http://www.huffingtonpost.com/entry/59cd5e0ae4b0f58902e5caa5

Psychology Today Blogs by LI Sederer:

What Makes Therapy Therapeutic Psychology Today May 10, 2013


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201305/what-makes-therapy-
therapeutic

What Happens to People After a Traumatic Event? Psychology Today


June 10, 2013
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201306/what-happens-people-
after-traumatic-event

Gornish Helfin: Nothing Will Help Psychology Today June 20, 2013
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201306/gornish-helfin-
nothing-will-help

Therapy is a Team Sport Psychology Today July 28, 2013


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201307/therapy-is-team-sport

Addiction: The Equal Opportunity Threat to Life September 2, 2013


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201309/addiction-the-equal-
opportunity-threat-life

The Tragedy of Mental Health Law: How privacy and liberty laws may be
closing doors to families who can help. Psychology Today - September 23, 2013
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201309/the-tragedy-mental-
health-law-0
Originally published in The Wall Street Journal, Op-Ed, January
12, 2013, p. A13; also at the WSJ.com

Involuntary Psychiatric Hospitalization: A life saving yet often aversive


Intervention Psychology Today October 8, 2013

47
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201310/involuntary-
psychiatric-hospitalization
Republished in the 2x2 Project on October 16, 2013
http://the2x2project.org/involuntary-psychiatric-commitment/

Rosenberg, L. Sederer, LI. When Mental Illness Hits November 8, 2013


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201311/when-mental-illness-
hits-home-0

ACEs: Adverse Childhood Experiences November 30, 3013


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201311/adverse-childhood-
experiences-aces
Also published online at Huffington Post November 13, 2013
http://www.huffingtonpost.com/lloyd-i-sederer-md/adverse-childhood-
experiences_b_4256732.html

A Third Pharma Settlement Psychology Today December 11, 2013


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201312/third-pharma-
settlement

Population Health: Transforming Health Care to Improve Our Health


Psychology Today December 19 2013
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201312/population-health-0

A Fowl Fable, January 10, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201401/fowl-fable

Pope Francis and People with Mental Disorders January 25, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201401/pope-francis-and-
people-mental-disorders

Philip Seymour Hoffman and America’s Most Neglected Disease


February 3, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201402/philip-seymour-
hoffman-and-america-s-most-neglected-disease

The American Health Care Paradox February 13, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201402/the-american-health-
care-paradox-book-review

Influencing Children, the Icelandic Way February 2, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201402/influencing-children-
the-icelandic-way

House of Cards: A Series Review February 16, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201402/house-cards-series-
review

48
Pope Francis and the Paradox of Faith February 24, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201402/pope-francis-and-the-
paradox-faith

How Do Actors Act March 1, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201403/how-do-actors-act

More Than A Touch of Evil March 11, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201403/more-touch-evil

Back From The Brink March 15, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201403/back-the-brink

Community Policing and Child Development: Averting Traumatic Disorders April 1, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201403/community-policing-
and-child-development

How to Start a Movement: A Movie Review of 'Chavez' April 1, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201404/how-start-movement-
movie-review-chavez

IDA: A Film Review Psychology Today June 20, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201406/ida-film-review

The Hundred-Foot Journey: A movie review. August 9, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201408/the-hundred-foot-
journey

Thomas Szasz, M.D.: A Profile by Dr. Lloyd Sederer August 11, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201408/thomas-szasz-md-
profile-dr-lloyd-sederer

The Field Guide to Lucid Dreaming by Dylan Tuccillo, Jared Zeizel and Thomas Peisel
September 21, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201409/the-field-guide-lucid-
dreaming

Here One Day: A movie review. September 27, 2014


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201409/here-one-day

Sederer, LI, Sharfstein, SS: Fixing the Broken Mental Health System October 19, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201410/fixing-the-broken-
mental-health-system

How to Get Someone to Change His Mind: A Film Review of Diplomacy November 8, 2014

49
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201411/how-get-someone-
change-their-mind

Depression: It's Not Just in Your Head; It's Also in Your Genes December 1, 2014
http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201412/depression-not-just-
in-your-head-it-s-also-in-your-genes

A Most Violent Year: A movie review January 1, 2015


http://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201501/most-violent-year

The 'Other' Marshmallow Test March 13, 2015


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201503/the-other-
marshmallow-test

My Sunday Morning With Mental Health Advocates April 26, 2015


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201504/my-sunday-morning-
mental-health-advocates

Voices - A documentary by Hiroshi Hara and Gary Tsai (2015) May 3, 2015
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201505/voices

Glasofer, DR. Sederer, LI. Build a Better Apology June 9, 2015


https://www.psychologytoday.com/blog/managing-your-mindset/201506/build-better-apology

Glasofer, DR. Sederer, LI. The Better Way to Say 'I'm Sorry' June 12, 2015
https://www.psychologytoday.com/blog/managing-your-mindset/201505/the-better-way-say-im-
sorry

Middle America and the Opioid Addiction Epidemic October 10, 2016
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201610/middle-america-and-
the-opioid-addiction-epidemic

Crossing the Political Chasm: A Psychiatrist’s Perspective December 19, 2016


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201612/crossing-the-
political-chasm

Three Steps Towards a New Year, Not Just Another Resolution January 8, 2017
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201701/three-steps-towards-
new-year-not-just-another-resolution

God Knows Where I Am March 29, 2017


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201703/god-knows-where-i-
am

4 Secrets to Improving our Health and Mental Health April 4, 2017


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201704/4-secrets-improving-
our-health-and-mental-health

50
4 Strategies for Families Facing Addiction February 4, 2018
https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201802/4-strategies-families-
facing-addiction

The Deadly Flow of Opioids February 13, 2018


https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201802/the-deadly-flow-
opioids

………..

US News & World Report:

Sederer, LI. Tinkering Can't Fix the Mental Health Care System March 20, 2015
http://www.usnews.com/opinion/blogs/opinion-blog/2015/03/20/fixing-the-mental-health-
system-requires-disruptive-innovation

The Right Takeaway From the Germanwings Crash April 1, 2015


http://www.usnews.com/opinion/blogs/opinion-blog/2015/04/01/germanwings-flight-tragedy-
shows-need-for-better-mental-health-monitoring

A Secret Worth Sharing May 12, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/05/12/how-early-intervention-
programs-stop-mental-illness-before-it-is-disabling

No Asylum for Asylums May 20, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/05/20/bringing-back-asylums-will-not-
help-mentally-ill-people

A Blind Eye to Addiction June 1, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/06/01/america-is-neglecting-its-
addiction-problem

Overprescribing and Underperforming July 2, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/07/02/the-us-is-overprescribing-
antipsychotic-medications-to-youth

Another Side of Gun Violence: Suicide July 28, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/07/28/suicide-is-the-other-side-of-
americas-gun-problem

The Not-So-Nice Spice August 5, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/08/05/synthetic-marijuana-is-much-
worse-than-weed-and-its-a-public-health-threat

America Wakes Up to Mental Health August 11, 2015

51
http://www.usnews.com/opinion/blogs/policy-dose/2015/08/11/house-and-senate-mental-health-
bills-show-americas-progress

Prove It September 1, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/09/01/the-problem-and-the-promise-of-
replicating-science-results

Where Have All the Psychiatrists Gone? September 15, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/09/15/the-us-needs-more-psychiatrists-
to-meet-mental-health-demands

Shoring Up Psychiatry's Supply September 22, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/09/22/how-to-confront-psychiatrys-
supply-problem

Shrink Demand on Psychiatrists September 28, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/09/28/how-to-reduce-us-mental-health-
demands-on-psychiatrists

Dying Preventable Deaths November 4, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/11/04/white-americans-are-dying-
because-we-ignore-mental-health\

America's Deadly Gun Disease December 7, 2015


http://www.usnews.com/opinion/blogs/policy-dose/2015/12/07/eradicate-americas-gun-disease

The Political Promise of a Drug Epidemic January 19, 2016


http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-01-19/obama-is-right-fighting-
drug-addiction-is-a-bipartisan-issue

Take Action Against Addiction February 1, 2016


http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-02-01/10-ways-to-combat-
americas-drug-abuse-problem

Take Care of Caregivers March 1, 2016


http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-03-01/mental-health-
caregivers-are-essential-and-endangered

Better Than a War on Drugs March 21, 2016


http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-03-21/cdc-opioid-guidelines-
are-a-step-forward-to-end-painkiller-abuse

Amplify Obama's Drug Abuse Actions March 30, 2016


http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-03-30/obamas-plan-to-curb-
drug-abuse-is-only-the-beginning

The Folly of Supply-Side Drug Intervention April 19, 2016

52
http://www.usnews.com/opinion/blogs/policy-dose/articles/2016-04-19/substance-use-treatment-
works-better-than-any-war-on-drugs

Painful Shadow of Prince's Death May 10, 2016


http://www.usnews.com/opinion/articles/2016-05-10/what-were-overlooking-about-opioids-
pills-and-princes-death

Force Changes In Mental Health Care May 19, 2016


http://www.usnews.com/opinion/articles/2016-05-19/obamas-mental-health-task-force-can-stop-
insurer-discrimination

Bridges to Care, Not Incarceration August 31, 2016


http://www.usnews.com/opinion/articles/2016-08-31/how-police-in-massachusetts-can-arrest-
the-drug-epidemic

Keep Moving on Opioid Abuse Efforts September 22, 2016


http://www.usnews.com/opinion/articles/2016-09-22/sustain-president-obamas-progress-on-
combating-opioid-abuse

Answer the Call to Tackle Addiction November 21, 2016


http://www.usnews.com/opinion/policy-dose/articles/2016-11-21/surgeon-general-is-right-to-
target-the-public-health-crisis-of-addiction

The Case Against 'Trumpcare' February 2, 2017


http://www.usnews.com/opinion/policy-dose/articles/2017-02-02/resist-donald-trump-and-the-
republicans-obamacare-rollback

Trump's Recipe for More Addiction February 14, 2017


http://www.usnews.com/opinion/policy-dose/articles/2017-02-14/the-opioid-epidemic-could-
worsen-under-donald-trump

Beware the Trumpcare Con March 3, 2017


https://www.usnews.com/opinion/policy-dose/articles/2017-03-03/donald-trump-and-
republicans-are-trying-to-con-you-on-obamacare-repeal

Where Is Trump on the Opioid Epidemic? May 3, 2017


https://www.usnews.com/opinion/policy-dose/articles/2017-05-03/what-happened-to-the-opioid-
epidemic-president-donald-trump

The Claws are Out on Health Care June 26, 2017


https://www.usnews.com/opinion/policy-dose/articles/2017-06-26/beyond-the-senate-bill-3-
ways-the-gop-is-derailing-the-opioid-fight

What Canada Gets About Pot July 13, 2017


https://www.usnews.com/opinion/policy-dose/articles/2017-07-13/6-takeaways-for-us-pot-
policy-from-canadas-marijuana-guidelines

53
Contradict, Blame and Renege That's The Trump Way August 16, 2017
https://www.usnews.com/opinion/policy-dose/articles/2017-08-16/donald-trumps-opioid-flip-
flop-was-inevitable

No Urgency in Trump's Emergency October 26, 2017


https://www.usnews.com/opinion/policy-dose/articles/2017-10-26/trumps-opioid-health-
emergency-is-a-weak-response-to-a-serious-problem

AG Sessions’ woeful approach to “the worst drug crisis” November 30, 2017
https://www.usnews.com/opinion/civil-wars/articles/2017-11-30/jeff-sessions-new-war-on-
drugs-is-the-wrong-way-to-fix-the-opioid-crisis

Enabling a Dysfunctional President December 15, 2017


https://www.usnews.com/opinion/policy-dose/articles/2017-12-15/the-enabling-of-president-
donald-trump-is-putting-american-lives-at-risk

Inside Trump's Brain January 17, 2018


https://www.usnews.com/opinion/policy-dose/articles/2018-01-17/donald-trumps-mental-state-
raises-concerns-about-fitness-for-presidency

The Blind Giants of the Opioid Crisis March 5, 2018


https://www.usnews.com/opinion/policy-dose/articles/2018-03-05/opioid-crisis-is-struggle-
between-david-and-goliath-of-trumps-white-house
………..

Non-fiction essays by LI Sederer:

Journey for Body and Soul: The St. Jacques de Compostelle Pilgrimage Trail
August 2, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/journey-for-body-and-soul_b_666756.html

The End of My Mother's Life: There Must Be a Better Way September 7, 2010
http://www.huffingtonpost.com/lloyd-i-sederer-md/the-end-of-my-mothers-lif_b_704327.html

Ink-Stained For Life, International Herald Tribune/Global Edition of the


New York Times, December 24, 2010, p7
http://www.nytimes.com/2010/12/24/opinion/24iht-edsederer24.html?_r=2&ref=global

Psychoanalysis: Journeying Into Therapy March 28, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/psychoanalysis-treatment-_b_840033.html

The Movie Dinner August 3, 2011


http://www.huffingtonpost.com/lloyd-i-sederer-md/the-movie-dinner_b_917661.html

Crime in the military: madness, badness, and survival. Psychiatric Times,


October 2011;28(10):14-16,54

54
The Unveiling, Commonweal Magazine May 4, 2012, p. 38.

Invitations to Write, Psychiatric Times, May 18, 2012,


http://www.psychiatrictimes.com/display/article/10168/2073565

Sederer, LI, Erlich, MD – How Thoughts Become A Diagnosis (Diagnosis in Psychiatry),


The Atlantic.com, July 18, 2012
http://www.theatlantic.com/health/archive/2012/07/how-thoughts-become-a-psychiatric-
diagnosis/260012/

Null and Void? Commonweal Magazine, February 22, 2013, p. 31

An Arthritis Treatment Worthy of the Pope and Kobe


TheAtlantic.com October 15, 2012
http://www.theatlantic.com/health/archive/2012/10/an-arthritis-treatment-worthy-of-the-pope-
and-kobe/261606/

A Safe Place to Be Smart: The Bronx High School of Science October 22, 2012
http://www.huffingtonpost.com/lloyd-i-sederer-md/bronx-high-school-science_b_1983682.html

Erlich, MD, Sederer, LI. Minding Our Zeros and Ones: Are Psychiatrists Ready For
Neurotechnology? Psychiatric Times, November 2012, p.1, 3
www.psychiatrictimes.com/display-old/article/10168/2112069

Sederer, LI. Vets Who Commit Crimes: Madness or Badness? February 20, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/eddie-routh-trial-madness-or-
badness_b_6716520.html

Sederer, LI. A Writer's Writer and Teacher Is Gone -My tribute to Bill Zinsser May 15, 2015
http://www.huffingtonpost.com/lloyd-i-sederer-md/a-writers-writer-and-teacher-is-
gone_b_7292580.html

Sederer, LI. Changing the World, One Word at a Time, Psychiatric Times July 29, 2015
http://www.psychiatrictimes.com/blogs/couch-crisis/changing-world-one-word-time

Sederer, LI. Last Word: Mission Accomplished, Commonweal December 16, 2015
https://www.commonwealmagazine.org/last-word-mission-accomplished

Sederer, LI. Fogo Island August 1, 2017


http://www.huffingtonpost.com/entry/5980cc28e4b02be325be01b5

Sederer, LI. The Pilgrim And The Patient: The Santiago De Compostela Trail October 23. 2017
https://www.huffingtonpost.com/entry/59ee0980e4b092f9f24193ec

Living, Dying and the Moral of Phillip Roth’s Life August 13, 2018
https://www.psychologytoday.com/us/blog/therapy-it-s-more-just-talk/201808/living-dying-and-
the-moral-phillip-roth-s-life

55
Opioids: From Being a Doctor to Being a Patient September 6, 2018
https://ps.psychiatryonline.org/doi/10.1176/appi.ps.691002

..…….

Video Commentaries, Podcasts and Webcasts

George Stephanolopos interviewed by Dr. Lloyd Sederer American Psychiatric Association,


Conversation, June 2004
http://psychnews.psychiatryonline.org/doi/full/10.1176/pn.39.11.0390013a

What Do I Say? “Are you OK?’ July 19, 2011


http://www.huffingtonpost.com/2011/07/19/friend-depression_n_902260.html?1311076129

What Do I Say? Depression August 24, 2011


http://www.huffingtonpost.com/2011/08/24/friend-depression_n_935043.html

Integrating Health and Mental Health: Government Can Help Solve This Problem May 2011
http://uwaims.org/integrationroadmap/summit_video_clips.html

Integrating Health and Mental Health: Integrating Care for SMI Is the Next Frontier May 2011
http://uwaims.org/integrationroadmap/summit_video_clips.html

ADVICE for families with a member with a mental illness October 2011
http://youtu.be/CyMgCds06pM
http://www.youtube.com/watch?v=CyMgCds06pM

Medicate My Addiction - HuffPost Live, October 18, 2012


http://live.huffingtonpost.com/r/segment/506f033578c90a78eb000049

The Tavis Smiley Show - PBS.org, June 3, 2013


http://www.pbs.org/wnet/tavissmiley/interviews/dr-lloyd-sederer/

When Mental Illness Enters the Family, TEDx Albany January 6, 2015
https://www.youtube.com/watch?v=NRO0-JXuFMY

The Family Guide to Mental Health, "Your Family's Health", WHCP-Radio, Nassau Community
College January 7, 2015
http://ruby.streamguys.com:5420/whpc.m3u
• On computer - http://ncc.edu/whpc
• On Smartphone - http://tunein.com
• As a Podcast - download at iTunes.ncc.edu

Bring Back Asylums Debate - Ezekiel Emanuel v. Lloyd Sederer April 22, 2015
https://www.youtube.com/watch?v=_efFSi1jfcI

56
Collaborative Care: Integrating Mental Health into Primary Medical Care – Lloyd I. Sederer,
MD: developed by the Center for Practice Innovations at Columbia Psychiatry, NYS Psychiatric
Institute, MOC, Modules 2, (http://vimeopro.com/firedancer/cpi-moc-modules-round-
2#/video/130366177, Password LisaPaulNancy (11 minutes), July 2015

Men’s Mental Health: HuffPost Live TV, September 10, 2015


http://huff.lv/1PQncJ9

How To Stop The Mentally Ill From Becoming Violent – Mental Health Channel TV
March 7, 2016
http://www.mentalhealthchannel.tv/episode/how-to-stop-the-mentally-ill-from-becoming-violent

Podcast – Audio Only – Psychiatry and Cinema, Lancet Psychiatry May 24, 2016
(Cinema section begins at the 42 minute 39 second mark; 4 minutes total)
http://www.thelancet.com/pb/assets/raw/Lancet/stories/audio/lanpsy/2016/24may.mp3

CBS TV Interview on Four Secrets Hiding in Plain Sight November 19, 2016
http://newyork.cbslocal.com/video/3580663-improving-mental-health/

Read Learn Live Podcast - Improving Mental Health – Ep 10 with Dr. Lloyd Sederer
March 6, 2017
http://www.readlearnlivepodcast.com/improving-mental-health-ep-10-with-dr-lloyd-sederer/

Improving Mental Health: Four Secrets in Plain Sight, NatCon 17, March 2017
https://www.youtube.com/watch?v=WQmikAjRDd8

Sederer, LI: Improving Mental Health: Four Secrets in Plain Sight


https://vimeo.com/316636397/c8f5e61054 one continuous play
http://www.fictionless.com/series/#/dr-lloyd/
Behavior Serves A Purpose: https://vimeo.com/275750673
As A Rule, Less Is More: https://vimeo.com/275750731
Chronic Stress Is The Enemy: https://vimeo.com/275750794
The Power of Attachment: https://vimeo.com/275751044

Fox5 News, Morning Show with Rosanna Scotto, 12.2016, 4 Secrets to Improving Mental
Health
http://ep-
fox.s3.amazonaws.com/captures/0F0/C13/0F0C13FE7FC9403A8AC20F5F7A2829C4.mp4

Sederer, LI. Psychiatric Services From Pages to Practice - Psychiatric Workforce Issues,
Depression Awareness in Schools, and Implicit Bias March 15, 2018
https://ps.psychiatryonline.org/podcast

Sederer, LI. 9 Things That Matter about Psychoactive Drugs May 8, 2018
https://blogs.scientificamerican.com/observations/9-things-that-matter-about-psychoactive-
drugs/

57
Sederer, LI. The Addiction Solution Gaithersburg Book Festival C-SPAN May 19, 2018
https://www.c-span.org/video/?445042-13/the-addiction-solution

Sederer, LI. The Addiction Solution US News Interview May 11, 2018
https://www.usnews.com/news/the-report/articles/2018-05-11/dr-lloyd-sederer-on-treating-and-
preventing-addiction

Sederer, LI. Ignite Session at NatCon18 April 24, 2018


https://www.youtube.com/watch?v=wy5Zkm2pm-o

CBS Television on-line. Are We Growing Numb To The Opioid Epidemic? May 22, 2018
http://newyork.cbslocal.com/2018/05/22/lloyd-sederer-growing-numb-opioid-epidemic/

Brian Lehrer, WNYC Public Radio. 7.19.2018, Lloyd Sederer, MD/The Addiction Solution
(Scribner 2018)
http://www.wnyc.org/story/treating-addiction-stigma/

Sederer, LI. A Public Health Approach to Substance Abuse & Mental Health, Business of
Healthcare Series August 13, 2018
http://www.bohseries.com/episodes/38/a-public-health-approach-to-substance-abuse-mental-
health

Sederer, LI. The Opioid Crisis With Dr. Lloyd Sederer November 20, 2018
https://soundcloud.com/thehealthhub/the-opioid-crisis-with-dr-lloyd-sederer

Sederer, LI. The Fulfilled Series - Teaser, with Dr. Anna Yusim - Dr. Lloyd Sederer September
7, 2018
https://www.youtube.com/watch?v=OKHmqymI9jg&feature=youtu.be

Sederer, LI, Lieberman, JA. Drs. Jeffrey Lieberman and Lloyd Sederer discuss the devastating
consequences of mass violence on the physiology and biology of survivors. Medscape July 31,
2019
https://www.medscape.com/viewarticle/915939

Caplan, AL, Klitzman, RL, Sederer, LI How Long Should Physicians' Past Deeds Be Held
Against Them? Medscape July 9, 2019 (with transcript)
https://www.medscape.com/viewarticle/914893?src=WNL_bom_190714_MSCPEDIT&uac=22
0207BG&impID=2026156&faf=1

……….

Frequent Speaker at Professional and Public Events, nationally and internationally

Letters/Commentary/Radio/TV:
• Numerous letters and columns

58
• Frequent Radio and TV appearances; regular on SiriusXM Radio, Tell Me
Everything, hosted by John Fugelsang
• Website: www.askdrlloyd.com
Twitter @askdrloyd

59
Lloyd Sederer, M.D.
Court Testimony Over the Last Four Years

Hedgewood Home for Adults against Howard Zucker, M.D., in his official capacity as
Commissioner of Health of the State of New York; and Anne Marie T. Sullivan, M.D., in her
official capacity as Commissioner of Mental Health for the State of New York, Supreme Court
of the State of New York, County of Dutchess

• Affidavit, January 17, 2017


• Trial Testimony, August 7, 2019
Attachment B: Materials Relied Upon

EXPERT REPORT OF LLOYD I. SEDERER: OPIOIDS


HIGHLY CONFIDENTIAL ATTACHMENT B
Attachment B: Materials Relied Upon

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Appalachia,” American Journal of Public Health, 109(3), 2019, pp. 445–450.

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HIGHLY CONFIDENTIAL ATTACHMENT B: PAGE 2
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b682-848853fb9ce7.html.

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HIGHLY CONFIDENTIAL ATTACHMENT B: PAGE 3
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guide (Third Edition),” January 2018.

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HIGHLY CONFIDENTIAL ATTACHMENT B: PAGE 8
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pregnancy/treating-opioid-use-disorder-during-pregnancy.

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injuries/preventable-death-overview/odds-of-dying.

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2018, https://www.balladhealth.org/news/niswonger-childrens-hospital-launches-
families-thrive.

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course/.

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preventing child abuse and neglect,”
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neglect.

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“Opioid crisis has an impact on foster care,” Johnson City Press, January 5, 2018,
https://www.johnsoncitypress.com/Editorial/2018/01/05/Opiod-crisis-leaves-its-mark-on-
foster-care.

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HIGHLY CONFIDENTIAL ATTACHMENT B: PAGE 9
“Opioid crisis sparks urgent need for foster families in Tennessee,” The Rogersville Review, May
3, 2019, http://www.therogersvillereview.com/rogersville/article_0cff492c-3b2a-5b23-
9315-cf122c5a4878.html.

“Opioids forcing more Tennessee children into foster care,” WVLT-8, May 22, 2019,
https://www.wvlt.tv/content/news/Opioids-forcing-more-Tennessee-children-into-foster-
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