ASAM
News: May-June 1997 ASAM
News: May-June 1997
New
President Says ASAM Has "Talent, Energy, Experience" to Meet Challenges,
G. Douglas Talbott, M.D., FASAM
I assume the Presidency of ASAM with humility, excitement and a sense of exultation.
To follow Dr. David Smith's Presidency is by definition a humbling experience.
It is also humbling to be elected President of ASAM, for this is truly a
great and unique organization.
Nor can I assume the presidency of this organization without exultation.
I have been with ASAM from the birth of the Southeastern addiction movement,
the California movement, and the New York movement. The New York programs
were much older than the California and Georgia programs, but I learned
of the New York program through the work of Drs. Frank Seixas, Sheila Blume,
Stan Gitlow, and through my long-time friend Max Weisman. At the Kroc Ranch
unity meeting, we wrestled with nomenclature-I remember stumbling over the
acronym "AMSAODD." I also remember visiting Manny Steindler at
the American Medical Association and his suggestion that I call a very talented
and professional woman in California, Gail Jara. Gail guided me into meetings
with Jess Bromley, David Smith, Tony Radcliffe, and Max Schneider. Shortly,
the California and Georgia programs joined together to form the American
Academy of Addictionology at the second meeting of the AMA's Physicians
Health Committee. I subsequently approached Drs. Gitlow and Seixas and the
basis of the first Kroc Ranch unity meeting was established.
The Caduceus Foundation once again has agreed to support ASAM in a workshop
exploring pain management. (Some ASAM members may not be aware that it was
the Caduceus Foundation, supported by the Kroc Foundation, that organized
the first Kroc Ranch meeting.) Other Caduceus Foundation meetings have been
staged at the Carter Center in Atlanta, as well as in Chicago and in Washington,
D.C., to study, define and implement the Physicians Health Habit Program.
This program explored and set the standards for zero to minimal blood alcohol
levels for physicians engaged in patient care. Subsequently, the AMA accepted
the standards. As a result, we finally have standards regarding the intake
of alcoholic beverages while physicians care for patients, even over the
telephone.
The Caduceus Foundation also has convened a number of expert meetings on
caffeine, chaired by Dr. Max Schneider. The findings from these sessions
were reported at the 1993 Medical-Scientific Conference in a symposium on
the role of caffeine in addiction treatment.
I exult in the richness of this history, and in the current accomplishments
represented by the ASAM Patient Placement Criteria under the leadership
of Dr. David Mee-Lee and the efforts on tobacco, led by Dr. John Slade.
Goals for the Future
As we look toward the future, I want to dedicate my presidency to the establishment
of residencies in addiction medicine in a number of university medical centers.
With such residencies funded and implemented, specialization with certificates
of added qualifications can be effectively pursued. Under the experienced
and able leadership of Dr. Sidney Schnoll, the academic structure of such
multiuniversity programs are being developed. As a next step, I am taking
responsibility for the CURAM (Consortium of University Residencies in Addiction
Medicine) project. We have completed preliminary discussions with some national
foundations and universities, in which we explored the possibility of creating
a consortium of universities to approach the national foundations for a
three-year grant to fund five residencies in addiction medicine at each
university. We are approaching this carefully, to be certain that all the
pieces are in place before we approach the foundations. A number of ASAM
members are contributing their time and expertise to this effort.
When I helped to organize and chaired the first Kroc Ranch meeting, our
objective was to bring together the disparate organizations that both directly
and indirectly touched on the then-infant field of addiction medicine. I
truly believed then, as I do now, that addiction medicine needs to work
in partnership with psychiatry, each respecting the other's boundaries.
I believed then, as I do now, that we need to be related and to relate to
the disciplines of family practice, internal medicine, preventive medicine,
emergency medicine, and more. Addiction medicine has much to learn from
each of these specialties.
In a second area of effort, we must progress in obtaining independent funding
of all of ASAM's projects. This must be done to avoid the razor-edge budgeting
we now must practice in our central office. A group of ASAM's officers are
being convened to explore these basic problems.
A third major theme I want to pursue in my presidency is suggested by Dr.
David Smith's remark in his farewell address that "there is a light
at the end of the tunnel, but the tunnel seems to be getting longer."
I believe that we can and will make the journey to the end of that tunnel,
but to do so we need to infuse young and energetic new members throughout
the organization. I believe our Board of Directors should make a deliberate
effort to engage young ASAM members in leadership roles wherever possible.
There are daunting problems on the horizon. They include the fight for parity,
discrimination against our recovering brothers and sisters, winning acceptance
for the Patient Placement Criteria, and the creation of addiction medicine
residencies and CAQs. Many of these problems seem to resist solution, but
I believe that we can accomplish our goals. We in ASAM have the talent,
the energy, and the experience to do this. Impossible dreams do come true.
Executive Vice President's Report:
Reviewing ASAM'sGoals and Accomplishments: Dr. James F. Callahan
Few individuals in medicine have had the opportunity to influence the development of the profession, to actually define how medicine is practiced. Each ASAM member has precisely that opportunity through your pursuit of ASAM's mission, which is unique in the history of medicine. That mission is:
o To establish the prevention and treatment of addictive disorders as a
basic health
benefit (parity), and
o To establish the specialty of addiction medicine.
While ASAM's mission is historic, we are in a period in the history of medicine
in which treatment for all illnesses, including addictive disorders, is
being rationed. We also are in a period in which specialty training is being
de-emphasized, and training of generalists is being given greater emphasis.
All of this is being done with almost total disregard for the consequences
of these changes for patient care and the medical profession.
We live in harsh and brutal times, times that challenge the truth and validity
of our mission and of our resolve to pursue our mission. And so it is appropriate
for us to ask: Is ASAM's mission true? Is its attainment feasible in bad
times such as the present, as well as in the good? Is our resolve to pursue
our mission firm? The answer to all these questions is "Yes."
The evidence shows that our accomplishments and our ability to envision
goals for advancing even further toward attainment of our mission.
Accomplishments
Let us review our accomplishments in several areas: first, achievements
in the science of addiction medicine; second, achievements in defining what
it means to practice addiction medicine; third, achievements in the integration
of that basic and clinical science into medical education and into the health
care system.
o Developments in the Science: In recent years, we have demonstrated and
described what characterizes addiction, through both animal and human studies,
as Dr. Ting-Kai Li so clearly described in his lecture on animal models
and alcoholism, and as Dr. Enoch Gordis and his colleagues presented in
their symposium on the Genetics of Alcoholism during the ASAM Medical-Scientific
Conference. In recent years, we have shown how addictive substances act
on the reward center of the brain, the nucleus accumbens. We have learned
that continued assault of the brain with addictive drugs alters brain circuitry
and triggers a craving for more drugs. In short, we have shown that it is
this biologically driven compulsiveness to repeatedly consume the drug,
despite physical or other consequences, that characterizes addictive disorders.
One of ASAM's proudest 1996 achievements in linking the science and practice
of addiction medicine was its State-of-the-Art Course in Addiction Medicine,
chaired by Drs. Allan Graham and Terry Schultz.
o Advances in Defining the Practice: The practice of addiction medicine
has been a reality since physicians first recognized intoxication and its
consequences and tried to intervene and treat. But it is only in the past
few years that we have formally codified what constitutes the body of clinical
knowledge that we call addiction medicine. The most complete description
of the science and practice of addiction medicine is presented in Principles
of Addiction Medicine, edited by Drs. Norman Miller and Martin Doot.
Further definition of the practice of addiction medicine is contained in
the ASAM Practice Guidelines. Drs. Kasser Chris Kasser, Michael Mayo-Smith,
and the members of the Practice Guidelines Committee recently were informed
that ASAM's practice guideline on Pharmacologic Management of Alcohol Withdrawal
has been accepted for publication in the Journal of the American Medical
Association.
o Integration of Science and Practice into the Health Care System: It is
one thing to have demonstrated the scientific basis of a disorder and define
how that disorder may be identified and treated. It is still another thing
to integrate teaching about that disorder into the medical education system,
and treatment of the disorder into the health care system. Over the past
five years, ASAM has made significant strides in each of the following areas.
In education and training, ASAM has published its Guidelines for Fellowship
Training Programs in Addiction Medicine, and has established AMA policies
calling for increased training in addiction medicine in each of the primary
care residencies. Several ASAM members have been key actors in the ASAM-supported
establishment of the subspecialty of addiction psychiatry by the ABPN, and
in the formation of the subspecialty of addiction medicine by the American
Osteopathic Academy of Addiction Medicine.
To date, ASAM has certified 2,939 physicians. Every ASAM-certified physician
will be pleased to know that the National Committee for Quality Assurance
(NCQA) revised its accreditation standards in 1997 to stipulate that managed
care organizations must hire psychiatrists and/or physicians who are certified
in addiction medicine to treat the addicted patient.
o Integration of Addiction Medicine Treatment into the Health Care System:
The ultimate basis for assuring the practice and, therefore, the education,
training and specialty of addiction medicine is assuring that prevention
and treatment of addictive disorders are a basic health benefit. We have
accomplished the following in this regard.
Several states have told ASAM that they will use the ASAM Patient Placement
Criteria, including Connecticut, Florida, Hawaii, Illinois, Iowa, Virginia,
Washington and Tennessee. All organizations doing business in these states,
including all managed care companies, will be required to use the ASAM Criteria.
In a major breakthrough, the Department of Defense recently issued its new
policy on substance abuse treatment, which will establish a continuum of
care "compatible with the Patient Placement Criteria of the American
Society of Addiction Medicine." This treatment policy will apply to
all servicemen and women and their dependents in all regions of the United
States, Europe and the Pacific.
In an equally significant breakthrough, the Department of Veterans Affairs
recently announced its decision to incorporate the ASAM Patient Placement
Criteria into its addiction treatment guidelines for use in the VA's 171
facilities treating over 150,000 patients worldwide. The ASAM PPC-2 are
available both in hard copy and in software, thanks to the work of Dr. David
Mee-Lee and the ASAM Software Task Force, chaired by Dr. Ken Hirsch.
Another significant advance in integrating addiction treatment into health
care has been the establishment of a joint ASAM-AMBHA workgroup. AMBHA,
the American Managed Behavioral Healthcare Association, represents 19 major
behavioral healthcare organizations that collectively cover 120 million
lives. AMBHA has agreed to issue four papers with ASAM on: (1) Parity in
Benefit Design, (2) Treatment Protocols, (3) Treatment Outcome Measures,
and (4) Credentialing of Providers of Addiction Services. If successful,
the dialogue between ASAM and AMBHA can open doors that have long been closed
to our patients and our members, so that our patients will receive appropriate
treatment, and our members will be given credentials to provide treatment.
ASAM members who are working with AMBHA are Drs. Christine Kasser, David
Mee-Lee, Michael Miller, and Tony Radcliffe.
Another significant advance in assuring addiction treatment is the dialogue
that Drs. David Smith and Doug Talbott have undertaken with the White House.
Dr. David Smith and I had the pleasure of an extended meeting with General
Barry McCaffrey, where we briefed him on ASAM's work, including the development
of our state chapters. In addition, Dr. Talbott and I have had an opportunity
to meet President Clinton and give him greetings from ASAM.
Goals: 1997 - 2002
I have spoken of our mission and our accomplishments in pursuit of our mission.
I presented our accomplishments as evidence that our mission is true and
realizable, even in the painful times iny which we now live. Before closing,
I want to say a word about our goals, which I present to you both as further
evidence that our mission is attainable, and as evidence of our continued
resolve to achieve our mission. We have much work to do.
o State Chapter - National ASAM Partnership: The next five years will be
characterized by a partnership between state chapters and the national ASAM
organization. To strengthen our chapters, Dr. Earley and the State Chapters
presidents will continue their excellent work in increasing state and national
membership. Last year, 90 percent of our members renewed their membership,
and the number of new members increased by 50 percent. At the national level,
ASAM will form a close working relationship with the National Association
of State Alcohol and Drug Abuse Directors (NASADAD) and continue its collaboration
with NCQA, AMBHA and other national associations. We will work closely with
the White House, the Institutes and CSAT, and with Congress to the extent
that our charter allows. We also will seek monies to fund the Parity Advisory
Board, to be chaired by Senator George McGovern.
o Parity: Our goal is to establish the ASAM Patient Placement Criteria as
the national guideline governing decisions on need for treatment and level
of treatment. We have begun work on a third edition which will include guidelines
for dual diagnosis and an update of the adolescent guidelines. We also will
produce an algorithm software version. Our goal is to have each state chapter
work with the governor's office or the director of the state agency responsible
for addiction treatment to assure the use of the ASAM PPC-2. We will encourage
our chapters to work with their state medical societies and state legislatures
to pass laws mandating parity for addiction treatment.
o Specialty: To promote recognition of the specialty of addiction medicine,
we will work with each specialty to increase the teaching of addiction medicine
in residencies and establish accredited residencies in addiction medicine.
Dr. Talbott has committed himself to raising the monies necessary to establish
training. Dr. Sid Schnoll has agreed to chair the ASAM workgroup on accredited
training.
We will publish a second edition of Principles of Addiction Medicine, with
Drs. Allan Graham and Terry Schultz as Co-Editors, and Dr. Chris Kasser's
committee will continue to publish practice guidelines.
o Prevention of Tobacco Use: I would be remiss if I failed to mention a
special achievement and an ongoing goal to which ASAM, in the persons of
Dr. John Slade and the members of the Nicotine Dependence Committee, has
made a significant contribution. I am speaking, of course, of the recent
advances in the prevention of tobacco use, especially among young people.
ASAM's members include many who are giants in the field of addiction medicine
prevention, research, treatment, education, training and public policy.
Scarcely a week goes by when I do not receive a call or letter from John
suggesting that he take action in ASAM's name to prevent or reduce the use
of tobacco or to increasingly eliminate its harmful contents. Dr. Slade
played a major role in the disclosure of tobacco industry documents and
in helping to formulate the FDA regulations on advertising and marketing.
Conclusion ASAM has and will continue to commit itself to the only goal
which will one day give addiction medicine both its rightful place at the
table of medical specialties, and provide the scientific and clinical content
from which general medical education can draw. That goal and that mission
is to define the specialty through defining the practice, and through assuring
its integration into all medical education and health care.
Joint Statement: Approved by ASAM, AMBHA
ASAM and the American Managed Behavioral Healthcare Association (AMBHA)
have developed the following joint statement, which has been approved by
the AMBHA membership and the ASAM Board of Directors.
Drafters of the statement were (for ASAM) Christine Kasser, M.D., David
Mee-Lee, M.D., Michael M. Miller, M.D., Anthony Radcliffe, M.D., and Executive
Vice President James Callahan, D.P.A., and (for AMBHA) David Nace, M.D.,
Gary Petersen, M.B.A., E. Clarke Ross, D.P.A., and Ian Shaffer, M.D.
Effective Treatment of Addictive Disorders: A Basis for an AMBHA - ASAM
Dialogue
Sharing an interest in the delivery of high-quality, cost-effective treatments
of addictive disorders, the American Managed Behavioral Healthcare Association
(AMBHA) and the American Society of Addiction Medicine (ASAM) have entered
into an ongoing dialogue and, as a beginning, make the following observations:
1) Substance related problems span a range from problems associated with
use, misuse and addiction. Patients may present requesting care at any time
during this spectrum.
2) We accept the need to match the severity of patients' disorders with
appropriate interventions for that intensity of problem.
3) Some individuals experience single or isolated episodes of illness; others
experience periodic recurrences in their lifetimes; others have severe and
persistent addictive disorders. For some persons with addictive disorders,
especially those with severe and persistent disorders, there is a need for
ongoing management and periodic acute treatment interventions to appropriately
respond to situations of relapse.
4) Addictive disorders are primary disorders which require their own unique
and specialized treatment. Individuals with addictive disorders may also
experience mental illness and may also experience primary health problems.
5) A purpose of managed behavioral health care is to deliver clinically
effective and cost efficient services within the constraints of finite resources.
This involves using the least intensive available treatment setting, appropriate
to the needs of the patient, while maintaining patient safety. As for all
chronic medical conditions, payers/purchasers of addiction services have
limited resources. Effectiveness requires provider accountability for clinical
outcomes that improve patients' health and provide acceptable consumer satisfaction.
6) The history of addiction expenditures is one characterized by stigma,
prejudices, and biases which have led to inadequate treatment resources
and a misallocation of resource use.
7) Managed behavioral health care is attempting to build organized and integrated
delivery systems targeted to a population-based approach. But treatment
must also be individualized and tailored to each individual's unique situation
and needs.
8) To successfully assess and treat individuals with addictive disorders,
providers must possess a core set of knowledge and experience. There are
multiple and many professional providers of addiction services; each must
demonstrate that he/she individually possesses a core set of knowledge and
experience. AMBHA and ASAM have a shared interest in articulating what a
minimum and standardized set of knowledge and experience should be.
9) All providers should deliver treatment that is effective, efficient,
and has value. This will require sophisticated screening, assessing and
tracking systems for measurement of outcomes and agreement on common screening
tools, diagnostic criteria and nomenclature. There is increasing awareness
that health plans, networks and individual providers must be more publicly
accountable for the clinical outcomes they deliver.
10) Quality should be measured. Standardized data sets, including administrative,
clinical, and performance, should be developed. AMBHA and ASAM will strive
to articulate possible data set guidelines. AMBHA and ASAM share the goal
of seeing that guidelines are produced to oversee the development, articulation
and application of data sets and data accumulation processes.
The mission of the American Society of Addiction Medicine is to:
o establish medical education in prevention and treatment of addictive disorders
as an integral part of medical school, graduate and continuing medical education,
and
o establish prevention and treatment of addictive disorders as a basic health
benefit for all who suffer from addictive disorders (parity).
The American Psychiatric Association has announced that it will publish
a Practice Guideline for the Treatment of Patients with Nicotine Dependence.
The guideline complements the advice developed by the federal Agency for
Health Care Policy Research by focusing on three specific groups of smokers:
(1) smokers who have failed initial treatments for smoking cessation and
who need more intensive treatment; (2) smokers who are being seen by a psychiatrist
for a psychiatric disorder other than nicotine dependence; and (3) psychiatric
patients who smoke and who are temporarily confined to a smoke-free inpatient
or residential setting. Recommendations are concrete and detailed and carry
ratings from I to III based on the adequacy of the supporting data.
The guidelines recommend 10 therapies (categories I or II), classifies 11
others as promising and possibly worthy of recommendation based on individual
circumstances (category III), and lists 21 others as not recommended. Evidence
from studies other than randomized trials and clinical expertise are reflected
in the recommendations, so that the resulting guidelines tend to recommend
treatment more often and to be more specific about recommendations than
other guidelines.
In treating smokers who have failed initial therapy (usually nicotine gum
or patch and/or group behavior therapy), the guideline recommends assessing
the adequacy of prior treatments, screening for psychiatric or addictive
disorders, and trying to determine whether the relapse was due to withdrawal
symptoms or psychosocial problems. Recommended therapies include combined
nicotine patch and nicotine gum (II), clonidine (II), and nicotine nasal
spray (II), combined with intensive, individual behavior therapy (III).
For smokers who are being treated for other psychiatric disorders, the guideline
recommends incorporating smoking cessation into all treatment plans (I),
motivating patients to stop smoking during non-crisis periods (I), and providing
initial therapy (I). It also recommends that physicians closely monitor
those patients who do stop smoking to detect any remission in psychiatric
disorders or changes in blood levels of medications (II).
For patients on smoke-free medical or residential units, the guideline recommends
clear instructions about nonsmoking policies, advice to stop smoking, and
education about management of withdrawal (III). It also recommends behavioral
strategies (III) and use of nicotine gum or patch (II) to reduce withdrawal
symptoms.
The approximately 40-page guideline will be published as a supplement to
the October issue of the American Journal of Psychiatry and can be obtained
from the American Psychiatric Press by calling 1/800-368-5777.
| Psychosocial Therapies | Somatic Therapies |
Multicomponent behavior therapy (I) - Skills training/relapse prevention (II) - Stimulus control (II) - Rapid smoking (II) Self-help materials (II) |
Nicotine gum (I) Transdermal nicotine (I) Nicotine gum or transdermal nicotine plus behavior therapy (I) Clonidine (II) Nicotine nasal spray (II) |
You don't have to look far in the daily press or at your own practice to
know that American medical care is in a state of crisis. Attempts to cut
back on rising medical costs have led to a topsy-turvy system in which corporate
entities are doing battle for the money that should be going for treatment.
Nowhere is this more apparent than in the field of addiction medicine. What
we need to do in ASAM--and what I emphasized as our primary goal in my candidacy
statement--is to assure that our patients are provided with the insurance
coverage necessary to underwrite their needed care. This is a real battle
for out patients' welfare, and ASAM is involved in many activities to promote
this cause. We must now keep our current efforts focused on this issue,
and move on to secure the practice of addiction medicine. The ASAM Board
of Directors will be meeting this October and will review information on
this issue, in order to ascertain how we can best fight this battle for
our members and their patients.
ASAM already has articulated this issue in the policy on Core Benefits for
Addiction Treatment, which says that "no limits on numbers of treatment
visits, days, or payments shall be applied, in the same manner as with any
chronic disease."
Here are some relevant points:
o Health maintenance organizations and managed care plans have starved out
coverage for all but the most acute and life-threatening consequences of
addiction and, in some cases, even those. Rehabilitation and recovery are
hardly supported at all. Our ASAM Patient Placement Criteria are directed
at defining appropriate levels of care, and have achieved wide acceptance,
including adoption by seven states and the Department of Defense, as well
as some insurers. We need to develop further our strategies to assure that
the ASAM Criteria are applied so that all needed care is recognized as a
medical necessity, not just the patients who are at death's door.
o ASAM has strong ties to a number of organizations with which we have collaborated
to extend coverage for treatment. In order to enhance our influence, we
will turn to these groups and extend our cooperation with them. For example,
we will need to use our role in the American Medical Association, which
already has demonstrated value in securing the identification of our specialty
area. We will work with the National Council on Alcoholism and Other Drug
Dependencies, whose Committee on Benefits is formulating an approach to
assuring appropriate benefits for treatment. The National Institute on Drug
Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the Center
for Substance Abuse Treatment are valuable allies as well in providing research-based
support to validate current and emerging treatment options.
o ASAM will focus on organizations representing managed care and HMOs to
make our needs clear. These include the National Council for Quality Assessment,
a group that is developing standardized criteria for evaluating coverage
by managed care providers, and the American Managed Behavioral Healthcare
Association, an industry organization for managed care, with which we have
engaged in active discussions regarding the need for better coverage (see
the related story on page 15).
o Another major consideration is the possibility of providing relevant case
material for attorneys who are formulating class action suits on behalf
of patients whose poor treatment is the result of inadequate coverage. Some
of these suits are already under way, aided by other organizations. The
remarkable success of class action suits in changing the course of the country's
relationship with nicotine addiction suggests that this may be a valuable
and even promising avenue for us to pursue.
I look forward to bringing you periodic updates on this issue of vital interest
to us all, on the efforts we undertake, and on what results we have achieved.
I want to express deep appreciation for the opportunity you have given me
to participate in ASAM's leadership, and look forward to a highly productive
collaboration with you, the members; with our President, Doug Talbott; with
our highly successful immediate Past President, David Smith; and with the
other officers of the Society.
The next Certification/Recertification Examination for physicians in addiction
medicine is to be offered Saturday, November 21, 1988, at three sites: Atlanta,
GA; Newark, NJ; and Los Angeles, CA.
Physicians who wish to sit for the examination must complete and submit
an application. Applications will be available by July 1997, and will be
sent automatically to all ASAM members. Completed applications will be accepted
on the following schedule: Early Registration, through Friday, October 31,
1997; Standard Registration, through Friday, January 30, 1998; Late Registration,
through Thursday, April 30, 1998. All applications will be reviewed and
candidates notified by mail as to whether they qualify to sit for the examination.
Physicians who pass the examination become ASAM Certified/Recertified in
Addiction Medicine. Since the examinations first were offered in 1986, 2,939
physicians have passed the examination, including many of the nation's top
addiction treatment professionals.
For more information on ASAM Certification and the examination, contact
John Keister at the ASAM office.
ASAM's 28th Annual Medical Scientific Conference convened April 17-20 in
San Diego, CA. More than 700 physicians and guests participated in the program
of scientific symposia, clinical courses and workshops, as well as special
sessions sponsored by the National Institute on Alcohol Abuse and Alcoholism
and the National Institute on Drug Abuse. The Medical-Scientific Conference
was preceded by the Ruth Fox Course for Physicians, the ASAM Forum on AIDS
and Addictions, and the ASAM Computer and Online Course.
Forum on AIDS and Addictions
ASAM's first annual Forum on AIDS and Addictions provided participants with
up-to-date information on current and future research into HIV infection
and AIDS, reviewed the efficacy of complementary treatments for HIV/AIDS
and addictions, and offered a special focus on the needs of HIV/AIDS-affected
women and adolescents. Chaired by Mel Pohl, M.D., the Forum's faculty included
Andrea Barthwell, M.D., Brenda Chabon, Ph.D., Harry Haverkos, M.D., Don
Des Jarlais, M.D., Mark Katz, M.D., Harold Kessler, M.D., and Larry Siegal,
M.D.
Ruth Fox Course for Physicians
Speakers during the Ruth Fox Course, which is dedicated to the founding
President of ASAM, provided information on new directions and concepts in
clinical practice and updates on selected areas of research. Chaired by
Alan A. Wartenberg, M.D., the 1997 Ruth Fox Course was co-sponsored by the
American Osteopathic Academy of Addiction Medicine. Topics included a "Review
of Recent Advances in the Alcohol and Drug Fields" by Marc Schuckit,
M.D.; "Hot Topics in Opioid Detoxification/Maintenance Treatments"
by Richard Schottenfeld, M.D.; "Treatment of Pain and Addiction"
by Karen Lea Sees, D.O.; "Forensic Considerations in Addiction Medicine"
by William Vilensky, D.O.; "Spirituality and Recovery" by Garrett
J. O'Connor, M.D.; "Taking the 'Duel' Out of Dual Diagnosis" by
Daniel E. Wolf, D.O.; "Adolescent Substance Abuse" by Anthony
Dekker, D.O.; and "Max's Moments" by Max Weisman, M.D.
Awards Dinner
The R. Brinkley Smithers Distinguished Scientist Award was presented to
Ting-Kai Li, M.D., Distinguished Professor of Medicine and Biochemistry,
Indiana University School of Medicine. Awards also were presented to George
D. Lundberg, M.D., Editor-in-Chief of the Journal of the American Medical
Association, and to ASAM Past President Maxwell N. Weisman, former head
of the Alcoholism Control Commission of the Maryland Department of Health
and Mental Hygiene. The Young Investigator Award was presented to Pamela
Bean, Ph.D. and David M. Gudeman, M.D.
Certificates of recognition also were presented to 108 ASAM Fellows, as
well as to physicians who passed the 1996 Certification/Recertification
Examination and those who passed the MRO Examination.
The second annual Computer and Online Course was divided into two sessions.
The morning session, which was for beginning computer users, addressed the
elements of hardware and software, how to purchase a computer, what types
of software are commonly used by physicians, and an introduction to online
services and the Internet. The afternoon session addressed more advanced
topics, such as more in-depth knowledge of the Internet and its components
(especially the World Wide Web), how to design a Web page, telemedicine,
networking the medical office, and issues of privacy and confidentiality,
as well as virus protection.
Both PC and Macintosh equipment were used to demonstrate the material, and
the presentation equipment included a projection system that could be switched
between two computers for quick comparisons and illustrations of the topics
being discussed. This was a distinct improvement over the setup used last
year. This year's faculty included course director Stuart Gitlow, M.D.,
Thomas L. Haynes, M.D., FASAM, Elizabeth F. Howell, M.D., and Peter E. Mezciems,
M.D., FASAM.
The Communications Committee met immediately after the course to review
the feedback that we received from the approximately 70 participants, and
to map out the structure and content of the 1998 course. Be sure not to
miss it, because it promises to be another good one!
Gen. Barry R. McCaffrey, Director of the Office of National Drug
Control Policy, sent the following message to ASAM at the Awards Dinner
during the Medical-Scientific Conference:
"The 1997 National Drug Control Strategy.organizes a collective American
effort to achieve a common purpose and provides general guidance and specific
direction for more than 50 federal agencies involved in the struggle against
illegal drugs and substance abuse. This Strategy also offers a common framework
to state and local government agencies, to educators and health care professionals,
to law enforcement officials and community coalition groups, parents, religious
organizations, mass media and American business to build a unified American
counterdrug effort. The common purpose of that collective effort is to reduce
illegal drug use and its consequences in America..
"The 1997 Strategy sets forth five strategic goals, intended to ensure
that the message of the Strategy is unambiguous and that our commitment
is clear. These goals clearly underscore our central purpose and mission--reducing
illicit drug use and its consequences. Further, these goals acknowledge
that anti-drug efforts do not occur in isolation and must be long-term and
global in focus. Our efforts must be linked with companion efforts to curb
the use of alcohol and tobacco by those who are under age. We fully recognize
the need for prevention programs to deter first-time drug use among adolescents
and other high-risk populations and to reduce the progression from casual
use to addiction. Additionally, the goals reflect the need for law enforcement
to remove violent and predatory criminals, and to arrest, prosecute, and
dismantle criminal drug networks at home and abroad.
"The goals demonstrate the importance of providing treatment to those
who use drugs and need help stopping. Finally, they aim to reduce the supply
of drugs to the U.S. through coordinated domestic and comprehensive international
programs..
"Our country's drug problem cannot be solved overnight. Our task must
be to break the cycle of addiction so that we can significantly reduce both
illicit drug use and its consequences.
"The Strategy's goals and objectives require a long-term commitment
to help ensure that resources are brought to bear against the drug problem
in the most efficient way. The focus must be on working hard, over a sufficient
span of time, to properly develop and implement programs..
"I am honored to have been invited to address the American Society
of Addiction Medicine. I look forward to the next opportunity to be a part
of your organization's anti-drug efforts. Your contributions twoard meeting
the substance abuse challenge are important to our nation and our society."
If you've not browsed our site on the World Wide Web lately, be sure to
drop by http://www.asam.org. Our new and improved site gives you access
to general information about ASAM and ASAM certification, text only versions
of the Journal of Addictive Diseases and ASAM News, order forms for ASAM
publications and staff E-mail.
ASAM
Board: Approves New Logo
At its April meeting, the ASAM Board of Directors approved a new logo design
proposed by the Membership Committee. The logo reflects ASAM's status within
mainstream medicine as the national medical specialty society for addiction
medicine. Following a transition period, the new logo will be displayed
on all ASAM products, including ASAM News and other publications, letterhead,
and the Web site.
Long-time ASAM member Jess Bromley, M.D., was elected an Emeritus Member during the April Board meeting, in recognition of his outstanding service to the organization as Delegate to the American Medical Association. Dr. Bromley currently is Delegate Emeritus and serves as Parliamentarian to the Board of Directors.
Emeritus status is bestowed by vote of the Board of Directors to recognize
the accomplishments of senior members who have been ASAM members for at
least 15 years, are at least 65 years old, and are retiring or retired from
the practice of addiction medicine. Emeritus members have their membership
dues waived and receive complimentary subscription to ASAM News and the
society's Journal of Addictive Diseases. Nomination forms are available
from the ASAM Membership Department at 301/656-3920.
A small but enthusiastic group of medical students, residents, and guests
participated in the first-ever teleconference of ASAM's Members-in-Training
Committee. Participants in the March meeting included Sara Babai (student);
Chris Delos Reyes, M.D. (resident and Committee Chair); Mike Patterson,
M.D. (resident); and Lauren Walton, M.D. (resident). Joining the call as
quests were V'Anne Singleton, Training Coordinator for the "Summer
Institute for Medical Students" at the Betty Ford Center in Rancho
Mirage, CA, and Dr. Antoinette Graham, Associate Professor of Family Medicine
and Director of the HELP Program at Case Western Reserve University in Cleveland,
OH.
Discussion centered around four main topics: (1) increasing communication
among current student/resident members of ASAM; (2) increasing the visibility
of ASAM to students/residents who have an interest in addiction medicine
but are not yet ASAM members; (3) encouraging student and resident involvement
in the American Medical Association; and (4) developing a campaign to link
ASAM members-in-practice with trainees.
Of ASAM's 3200 members, approximately 150 are students or residents. Suggestions
for increasing communication among current ASAM student/residents included:
a "Members-in-Training Column" in each issue of ASAM News and
an e-mail directory of student and resident members.
The following ideas were suggested as means to engage the interest of medical
students and residents who have an interest in addiction medicine but who
are not yet ASAM members:
o Writing to the Deans of medical schools to introduce ASAM, and to ask
the Deans to forward information on ASAM to their Departments Of Psychiatry,
Family Practice, Family Practice, and/or Internal Medicine.
o Networking with larger student and resident organizations to spread the
word about ASAM (e.g., American Medical Association, American Medical Student
Association, National Association of Residents and Interns, etc.);
o Writing letters-to-the-editor and/or articles for medical student/resident
magazines such as The New Physician and Resident & Staff Physician;
o Distributing ASAM materials to students and residents participating in
addiction medicine programs or fellowships (such as those at the Betty Ford
Center Summer Institute).
The Members-in-Training Committee is one forum in ASAM that encourages student
and resident involvement in the American Medical Association. Students and
residents, who are interested in learning about and creating national AMA
health policy, are invited to represent ASAM as a Delegate or Alternate
Delegate at the June and December Assembly meetings of the AMA. Delegates
and Alternate Delegates must be AMA members and are appointed by the ASAM
Board of Directors based on a curriculum vitae and a statement of interest.
Finally, participants in the conference call discussed a strategy to join
ASAM members-in-practice with members-in-training. Too often, students and
residents are confronted with negative attitudes and therapeutic pessimism
regarding patients with alcoholism and other drug addictions. An ASAM member
may be the only person to expose trainees to effective addictions treatment
and the possibility of long-term recovery.
Participants in the "Sponsor-a-Student/Recognize-a-Resident" Campaign
would provide mentoring and financial support to trainees (e.g., pay for
one year of membership dues for the trainee).
In return, sponsors would receive recognition in ASAM News and additional
benefits (i.e. discounts on conferences, publications, etc.). Efforts to
gain and retain student and resident members are crucial to ASAM's future
as an organization, as the trainees of today will be the leaders of ASAM
and the "voice of addiction medicine" in the 21st century.
Individuals interested in participating in the Members-in-Training Committee
are encouraged to contact Theresa McAuliffe at the ASAM office (phone: 301/656-3920,
ext. 108; E-mail: tmcau@asam.org) or Chris Delos Reyes, M.D. at 10007 Parkview
Ave, Garfield Heights, OH 44125; E-mail:
chris.delosreyes@uhhs.com.
Presentations include:
Domestic Violence, Child Development, Case Management, Methamphetamines
and Violence, Nutrition, Anger and Addiction, Adolescent Treatment, Criminal
Justice, Spirituality, Dual Diagnosis, Co-Dependency, Prostitution, and
Stress Management. Keynote speakers include David E. Smith, M.D., FASAM,
the founder and Executive Editor of the Journal of Psychoactive Drugs, and
the Immediate Past President of the American Society of Addiction Medicine,
speaking on "Current Trends in Addiction," Earnie Larsen, M.R.E.,
M.S., author of "Stage 2 Recovery: Life Beyond Addiction," and
Ron Potter-Efron, M.S.W., Ph.D., CADCIII, author of "Anger, Alcoholism
and Addiction: Treating Individuals, Couples and Families."
For more information or to rent an exhibit table for your agency, please
contact Mary Jane Miller at Haymarket Center (312) 226-7984, ext. 378.
California: Chapter President: William S. Brostoff, M.D., FASAM, Regional
Director: Gail Shultz, M.D.
President William Brostoff, M.D., is representing CSAM on a California Medical
Association Technical Advisory Committee on Medical Marijuana. ASAM Immediate
Past President David Smith, M.D., also is a member of the committee. A CSAM
Task Force on the same subject is drafting a White Paper.
CSAM's 1997 survey of members asked "What is the one most important
thing this state chapter can accomplish for its members in the next 12 months?"
Answers included: "Helping physicians measure quality in their workplace
so that we may truly measure the effect of managed care (good or bad)!"
"Upholding standards of practice in addiction medicine." "Promote
the position that physician leadership is necessary in creating and maintaining
acceptable quality in our treatment programs." "Set standards
for what quality chemical dependency treatment should cost." "Validate
modalities of therapy so that inpatient admission, where justified, is accepted."
"Educate residents." "Refocus awareness of chemical dependence
issues to the public." "Work toward a credible means of converting
currently antidrug, punitive government policy to one of identifying problems,
education and treatment." "We need to advocate for our patients.
Very few people have coverage for treatment for chemical dependency."
Florida: Chapter President: Richard Keesal, M.D., Regional Director: Rick
Beach, M.D.
FSAM and ASAM jointly sponsored the 10th Annual Conference on Addictions
in January at Walt Disney World Village. ASAM guest speaker Andrea Barthwell,
M.D., addressed "Cultural Issues to be Considered in Treatment of the
Chemically Impaired." Other speakers included Richard J. Bagby, M.D.,
President of the Florida Medical Association, on "Directions in Managed
Care" as it relates to the treatment of our special population of patients.
FSAM members Ronald Catanzaro, M.D., John Eustace, M.D., Michael Newberry,
M.D., and Vineet Mehta, M.D., discussed treatment modality issues in spirituality,
pain management, and working with the challenging patient. The conference
ended with a special guest presentation on "Sexually Compulsive Behaviors"
by Bonnie Saks, M.D., Psychiatrist and Fellow of the American Psychiatric
Association, and Associate Professor at the University of South Florida
and Founding Fellow American Academy of Clinical Sexologists.
The Florida chapter elected the following new officers to two-year terms:
Richard Keesal, M.D., President; John Eustace, M.D., President-Elect; Michael
Newberry, M.D., Treasurer; Paul T. Nakule, M.D., Secretary; Marilyn C. Moss,
M.D., Immediate Past President; Vineet Mehta, M.D., Chair, Scientific Planning
Committee; and Kenneth W. Thompson, M.D., Legislative Representative.
The chapter holds its annual meeting and conference each January in Orlando,
and invites members of other chapters to join them. Breakout sessions will
be provided for other state groups. Information is available from Robert
Donofrio at the FSAM office, 904/484-3560.
FSAM continues to work to have the ASAM MRO certification approved under
new Florida state law. (Chapter leaders were assured that this would happen
when the law was adopted in 1996, but ASAM was omitted from the list of
approved MRO certifications.)
Hawaii: Chapter President: Gerald McKenna, M.D., FASAM, Regional Director:
Richard Tremblay, M.D., FASAM
HISAM jointly sponsored a two-day meeting in Honolulu in January, to provide
an update on addiction issues for primary care physicians. This annual medical
track meeting is part of the Pacific Institute of Chemical Dependence Annual
Meeting. ASAM members from around the state presented.
HISAM plans to repeat the conference in January 1998. To allow more physicians
to attend, the 1998 meeting will be scheduled for a Friday and Saturday.
A preliminary agenda will be available by summer, enabling mainland members
to attend.
Illinois: Chapter President: Martin Doot, M.D., FASAM, Regional Director:
Norman Miller, M.D., FASAM
ISAM and the National Institute on Drug Abuse will co-sponsor a Town Meeting
on Addictions May 30 at the Hyatt Regency Chicago. The chapter's next Annual
Meeting has been scheduled for November 21-22, 1997, at the Radison Hotel
in Rosemont, IL. Additional information is available from Hermese Bryant
by phone at 630/968-6477 or via Fax at 630/968-5744.
Maryland: Chapter President: John Steinberg, M.D., Regional Director: Paul
H. Earley, M.D., FASAM
The Maryland Chapter has scheduled a July 12, 1997, CME conference on "The
Return to Work: Impaired Health Professionals." A chapter business
meeting will follow. Registration information is available from the ASAM
Office.
Michigan: Chapter President: Thomas L. Haynes, M.D., FASAM, Regional Director:
Norman Miller, M.D., FASAM
The Michigan chapter will hold election of officers in July 1997.
Missouri: Chapter Representative: Winston Shen, M.D., Regional Director:
Ken Roy, M.D., FASAM
Jack L. Croughan, M.D., an ASAM member and Director of the Missouri Program
for Impaired Physicians, presented a grand round at Saint Louis University
Medical School in January. Dr. Croughan educated the audience, mostly medical
students, about getting help for substance abuse problems.
The program was co-presented by Hershel P. Wall, M.D., of Memphis, who discussed
addictive disorders among physicians and medical students.
New Jersey : Chapter President: John J. Verdon, Jr., M.D., FASAM, Regional
Director: R. Jeffrey Goldsmith, M.D.
At the New Jersey chapter's meeting in San Diego during the ASAM Med-Sci
Conference, chapter constitution and Bylaws were a main topic of discussion.
Chapter members expressed their appreciation to David I. Canavan, M.D.,
of the Physicians Health Medical Program of New Jersey for his support of
chapter activities, particularly the mailing of minutes and memoranda.
New York : Chapter President: Merrill Herman, M.D., Regional Director: R.
Jeffrey Goldsmith, M.D.
The New York chapter held its Annual CME/Business Meeting in March. Guest
Presenter Herbert Peyser, M.D. discussed "Managed Care and Substance
Abuse." The lively meeting featured stimulating discussion of addiction
issues. The chapter is committed to enhancing its linkage with the Medical
Society of the State of New York. It also is in the final phases of incorporation.
Ohio : Chapter President: Ted Hunter, M.D., Regional Director: R. Jeffrey
Goldsmith, M.D.
The Ohio chapter has scheduled a general membership business meeting for
Saturday, July 26, in conjunction with the Summer Institute of Addiction
Studies of Ohio State University. Information on the meeting is available
from Stan Soteren, M.D., at 614/868-6710.
The Ohio State Medical Association currently is engaged in several projects
that involve addiction medicine. The Ohio chapter's Board encourages any
ASAM member who has the interest in OSMA to become involved.
Oklahoma: State Contact: Linda Gore-Lantrip, D.O., Regional Director: Ken
Roy, M.D., FASAM
ASAM members in Oklahoma have been working hard and meeting regularly. Chapter
business meetings were held in March and May at the Oklahoma State Medical
Association. Members are proceeding with formation of an official ASAM chapter
in Oklahoma (OKSAM). Information is available from the ASAM Office.
Oregon Chapter: Chapter President: Douglas Bovee, M.D., FACP, Regional Director:
Richard E. Tremblay, M.D., FASAM
The April Oregon chapter meeting featured Steve Gallon, Ph.D., speaking
on "Motivational Interviewing." The next meeting, scheduled for
June 17, will feature Marshall Bedder, M.D., speaking on "Rapid Anesthesia
Assisted Opioid Detoxification (RAAD)."
Lee McCullough, M.D., has been elected to the five-member ORSAM Board, replacing
Phil Unger, M.D., who gave many years' service to ORSAM.
Washington State: Chapter President: Steven Juergens, M.D., FASAM, Regional
Director:
Richard E. Tremblay, M.D., FASAM
The Washington chapter met for a business/scientific meeting in March, at
which speakers discussed "Rational Recovery" and "The Medical
Quality Assurance Commission." The group agreed to buy a fax machine
to facilitate distribution of information to members in a timely fashion.
Region III: Regional Director: Alan Wartenberg, M.D., FASAM, Regional Director
Alan Wartenberg, M.D., reports that early planning is taking place for a
Regional Meeting in November 1997, tentatively set for a northern New England
location. The last Region III meeting, chaired by Dr. P. Kishore, was very
successful.
Iceland: Contact: Gudbjorn Bjornsson, M.D., Regional Director: Peter Mezciems,
M.D., FASAM
Two Icelandic Members of ASAM were in attendance at the 28th Annual Med-Sci
Conference in San Diego. An international conference, the "SAA 20th
Anniversary Conference on Alcohol and Substance Abuse," is scheduled
for Reykjavik, Iceland, October 16-18, 1997.
It has always been that those vitally interested in severe, difficult-to-treat
illnesses work out a treatment regimen that seems best and then promote
it with almost religious zeal. I had a child with cystic fibrosis and the
treatment regimen with mist tents, chest clapping and prophylactic antibiotics
was rigid and accepted by faithful physicians, families, and patients. Now,
advances in knowledge about the disease and new treatments have changed
the picture and a new regimen is accepted by the faithful.
This has happened in the treatment of addiction. When I started in the field
over 15 years ago, AA and AA principles were the cornerstone of treatment.
We worked on detoxification regimens, debated the efficacy of each, and
worked on various types of inpatient and outpatient treatment programs,
but AA was promoted with religious zeal. In retrospect, there was too much
emphasis on AA, to the exclusion of other ideas. We were too rigid in trying
to eliminate the use of any "addictive drugs" in the addicted.
I don't think the new age of addiction treatment is an improvement. AA has
been replaced by drugs as the new savior of patients. Methadone clinics,
which were controversial, are not advocated unconditionally. Some think
they are successful if the patients on methadone are not injecting heroin
or other drugs, even if they are smoking marijuana and crack cocaine. AA
is honored by quoting statistics showing its effectiveness, but its principles
are in the background now.
Researchers have made great strides in making addiction medicine a more
scientific discipline. Neurochemistry is giving us more knowledge about
how addiction works and what drugs should be tried in treatment. It is also
helping with treatment of dual diagnosis patients. [However] we have now
swung overboard in the other direction..Even though we are doing a better
job of coordinating different levels of inpatient and outpatient treatment,
managed care limitations dictate that we often have the patient treated
by one treatment team for a very short period.
During and immediately after detoxification, psychological and psychiatric
examinations are done and drug treatment of depression and personality disorders
is started immediately. Reevaluation of these tentative diagnoses and prescriptions
later in treatment by another physician is problematical. It doesn't take
a genius to see that the number of drugs of all kinds prescribed to addiction
patients is completely out of hand.
It would appear that the leadership and direction of ASAM have passed from
those treating addiction, who were from many different medical backgrounds,
to psychiatrists who are primarily researchers in neurochemistry. In recent
ASAM review courses and the certification examination, the emphasis was
on theories of neurochemistry in addiction and very little about detoxification,
medical complications and treatment problems..ASAM members who practice
outside major medical centers are becoming more isolated and are increasingly
not having our problems addressed by our Society. Membership is become less
relevant to our practice.
Years ago I realized that I was isolated from my colleagues in addiction
medicine. I was medical director of a small treatment center in a small
town and I had no peer review of my work. After several years of delays
locally and then by ASAM, Dr. Christine L. Kasser, a member of the ASAM
board, visited our treatment center to review our work. She was thorough
and took time before, during and after her visit to make an expert assessment
of the medical care in our facility.
I learned more from that experience and make more positive changes in my
practice of addiction medicine than I have before or since. Those of us
in the boondocks make pilgrimages to the Ivory Towers. Maybe if those in
the towers could come to the sticks, not just to lecture, but to see what
we do, we could all benefit.
I am not discouraged. Great strides have been made in addiction medicine.
It is vital, however, that we not lose sight of the forest as we concentrate
on our favorite tree.
AMA Grapples with Physician Workforce, Accreditation
Issues
The American Medical Association held its year-end 1996 meeting in Atlanta.
Attending for ASAM were Delegate Michael Miller, M.D., Alternate Delegate
David Smith, M.D., President G. Douglas Talbott, M.D., and EVP Dr. James
Callahan. ASAM also was represented by Stuart Gitlow, M.D., ASAM's Delegate
to the AMA's Young Physician Section (and a member of the Section Governing
Council); Christina Delos Reyes, M.D., ASAM Delegate to the Resident Physician
Section; and Sarah Babai, ASAM Delegate to the Medical Student Section.
Two major AMA initiatives on the meeting agenda were the American Medical
Accreditation Program (AMAP) and a work group on federal support of physician
workforce development.
American Medical Accreditation Program
AMAP is to be the first national program that certifies individual physicians.
It will involve a comprehensive set of standards that will lead to recognition
of physicians who meet or exceed professional and practice requirements
in the areas of credentials, personal qualifications, clinical performance,
and patient care outcomes. A standard portfolio of information on applicant
physicians would incorporate data on clinical outcomes and patient satisfaction
as well as "structural aspects of quality" such as licensure,
board certification, and the like.
The activity would be physician-led and would be designed to reduce costs
by replacing existing duplicative and fragmented physician credentialing
and review processes. AMA expects that AMAP will win universal recognition
and acceptance by physicians, hospital medical staffs, managed care organizations,
regulators and consumers.
This AMA-sponsored activity is to be a joint undertaking of all the members
of the Federation: the AMA, state medical associations, and special societies
such as ASAM. ASAM will follow the development with great interest. The
impression of the ASAM delegation is that the clinical performance variables
developed for AMAP will have to take into account the types of patients
and conditions treated by the physician, as well as the care environment
in which the physician practices. Moreover, the AMAP credential will have
to be accompanied by the development of practice guidelines so that there
is a benchmark against which to measure physician performance.
Physician Workforce Development
The Physician Workforce Development project involves the AMA, the National
Medical Association, the American Osteopathic Association, the Institute
of Medicine, and other organizations, including those representing schools
of medicine and osteopathy. In order to avoid antitrust implications, the
only mission of this consortium at present is to provide advice to the federal
government with regard to mechanisms by which the government supports graduate
medical education.
Variables to be explored in the future include an analysis of actual marketplace
needs for physician supply. A preliminary report released in September 1996
concludes that there either is, or soon will be, an oversupply of physicians
in the United States.
These issues have huge implications for current and future residents and
medical students, as well as for physicians practicing in areas such as
California, where marketplace forces are actively reducing the size of the
physician workforce. A three-hour open hearing on physician workforce matters
heard testimony from dozens of organizations; ASAM was one of 80 organizations
that submitted written testimony.
ASAM Resolutions
ASAM presented three resolutions to the AMA House of Delegates. The first
relates to identification of physician specialty in the information included
in physicians' personal Web pages. (AMA members can set up personal Web
pages, free of charge, that include a photo and current information on the
physician's training and current practice.) ASAM's resolution asked that
ASAM members be allowed to include this information in their Web pages.
The House approved this action.
Other ASAM resolutions asked the AMA to endorse a reversal of 1996 Congressional
decisions to terminate the Social Security and disability benefits of individuals
suffering from addictive disorders, and to support employment protections
for individuals who are addicted to alcohol or other drugs. Both resolutions
were referred for further study and are to be returned to the House for
action at the June 1997 meeting.
The AMA Council on Medical Education presented a report on physicians without
specialty board certification. The report recommended that the AMA reaffirm
its policy that decisions regarding staff appointment should be based on
the training, experience and demonstrated competence of candidates, and
should not rely exclusively on the presence or absence of board certification;
that third-party payers not exclude non-certified physicians as a class
from participating in their programs without regard to their training, experience
and current competence; and that the AMA continue to develop and implement
its proposed AMAP program. Dr. Miller testified on behalf of ASAM in favor
of the recommendations in this report.
ASAM also testified in support of a resolution introduced by the American
Association of Public Health Physicians concerning intravenous drugs use,
syringe and needle availability, needle exchange programs and HIV prevention,
and other efforts by state and local health departments to assure the safe
disposal of used syringes and needles. This issue was referred by the House
for further study.
The Minnesota Medical Association submitted a very creative resolution suggesting
that tobacco companies by required to accurately label the nicotine content
in tobacco products, and that they be required to reduce the nicotine content
in tobacco products by an appropriate, graduated, incremental reduction
process so that tobacco products would be nicotine-free within six years.
ASAM supported the labeling provisions, which were adopted as AMA policy.
ASAM also provided scientific testimony regarding the benefits of nicotine
replacement therapy via more predictable nicotine delivery systems (e.g.,
transdermal patches) instead of inhalation of tobacco smoke. The House of
Delegates referred this item for further study.
Other Resolutions
A number of resolutions focused on managed care. There was much debate regarding
Medicare, RBRVS and fee structures, HCFA, telemedicine, genetic testing,
and genetic information and insurance coverage. A feature of importance
to ASAM included findings of AMA's Study of the Federation of Medicine.
A feature of importance to ASAM included ballots ASAM members were asked
to complete in late 1996 concerning the specialty society they designated
to represent them in the Federation of Medicine. (Hopefully ASAM members
all voted "425" for ASAM!).
ASAM continues to work closely with other medical organizations through
its contact at the AMA. We discovered that one of the major initiatives
of the American College of Emergency Physicians is to improve the training
and practice of emergency physicians with regard to substance abuse and
addiction. Members of the ASAM delegation meet regularly at AMA meetings
in caucuses with delegations from Preventive Medicine, Occupational and
Environmental Medicine, Psychiatry, Child Psychiatry, Insurance Medicine
and the U.S. Armed Forces and Public Health Services, as well as representatives
of other medical specialty societies and state medical associations.
Ad Hoc Committee on Forensic Addiction Medicine
Robert L. DuPont, M.D., Chair
ASAM's Ad Hoc Committee on Forensic Addiction Medicine got off to a fast
start with a well-attended three-hour component session at the 1996 Medical-Scientific
Conference in Atlanta. (Building on the outstanding performance of the Medical
Review Officer Committee led by Donald Ian Macdonald, M.D., the committee
held an initial one-day training session in Washington, D.C., in January
1997.)
The Ad Hoc committee focuses on court-related aspects of addiction medicine,
including workplace drug testing and return-to-work issues (hence the active
connection with ASAM's MRO activities), as well as a wide range of civil
and criminal issues, including claims of diminished capacity secondary to
intoxication-a major issue in death penalty cases-and liability issues related
to rcent use of alcohol or other drugs.
ASAM members have a broad expertise in these areas, which are proving to
be of interest to many members as American society begins to shed its denial
of the effects of addiction and begins to confront the remarkably diverse
problems caused by addiction.
The American Medical Association has asked ASAM to participate in revising
AMA's Guides to the Evaluation of Permanent Impairment to produce a fifth
edition. The Guides have been widely adopted by state Workers' Compensation
Commissions and other official bodies as a standard reference in evaluating
workers' disability claims and establishing fitness for duty criteria.
At AMA's request, ASAM has nominated the following experts to participate
in the advisory panel to the revision: G. Douglas Talbott, M.D., FASAM,
Andrea G. Barthwell, M.D., Sheila B. Blume, M.D., FASAM, Marc Galanter,
M.D., FASAM, and David E. Smith, M.D., FASAM.
AMA also has invited ASAM members to submit their comments about the book
through the AMA Web site at www.ama-assn.org (go to the Medical Science
and Education section). Alternatively, ASAM members can obtain a survey
questionnaire via fax or mail by calling 1/800-937-8783.
The American Medical Women's Association has selected LeClair Bissell, M.D.,
as 1997 recipient of AMWA's prestigious Elizabeth Blackwell Award. In announcing
the award, AMWA noted that "Dr. Bissell's life as innovator, researcher,
author, teacher, and social activist embodies the very spirit of the Blackwell
Award. She has dedicated her life to healing the impaired physician and
has contributed a wealth of information for the training, treatment, and
understanding of the addicted patient, particularly women."
J. Thomas Payte, M.D., is editor of the new Journal of Maintenance in the
Addictions, published by The Haworth Medical Press.
Described as focusing on "innovations in research, theory and practice,"
the journal's first issue features a commentary by Dr. Vincent Dole defining
methadone maintenance treatment, a report by Czechowicz, Hubbard et al.
on NIDA's Methadone Treatment Quality Assurance System (MTQAS), as well
as a study by Rowan-Szal, Joe et al. on increasing early engagement in methadone
treatment.
Future issues are to include articles on useful predictors of outcome in
methadone-treated patients, a clinical perspective on dose in methadone
maintenance, and a comparison of two methods for estimating the costs of
drug treatment.
With the addition of the 18 Fellows listed below, a total of 108 physicians
who are members of the Society have been elected Fellows of the American
Society of Addiction Medicine. All the Fellows were recognized at ASAM's
1997 Annual Medical-Scientific Conference. ASAM inaugurated the Fellow program
in 1996 to recognize substantial and lasting contributions to the Society
and the field of addiction medicine. Candidates must meet certain criteria
to quality for Fellow status: they must have been an ASAM member for at
least five consecutive years; (2) they must be ASAM-certified; (3) they
must have taken a leadership role in ASAM through committee service, or
have been an officer of a state chapter; and (4) they must have made and
continue to make significant contributions to the addictions field.
The following new ASAM Fellows were presented certificates denoting their
achievement during the Awards Dinner in San Diego:
Richard Artis Beach, M.D., FASAM
Gulf Breeze, FL
John N. Chappel, M.D., FASAM
Reno, NV
Robert A. Collen, M.D., FACP, FASAM
Fountain Valley, CA
Donald Cornelius, M.D., FASAM
Clayton, GA
Louis Edward Deere, D.O., FASAM
Dallas, TX
Anthony Dekker, D.O., FASAM
Kansas City, MO
Anne Geller, M.D., FASAM
New York, NY
Caroline M. Gellrick, M.D., FAAFP, FASAM
Lakewood, CO
Douglas Graham, B.Sc., M.D., FASAM
Victoria, British Columbia CANADA
William Hazle, M.D., FASAM
Los Gatos, CA
Conway W. Hunter, Jr., M.D., FASAM
Sea Island, GA
Geoffrey P. Kane, M.D., M.P.H., FASAM
Nashua, NH
Michael R. Liepman, M.D., FAPA, FASAM
Worcester, MA
J. Paul Martin, M.D., FASAM
Ashville, NC
Michael M. Miller, M.D., FASAM
Madison, WI
Seddon Savage, M.D., FASAM
Lebanon, NH
James W. Smith, M.D., FASAM
Seattle, WA
Lance S. Wright, M.D., FAPA, FASAM
Darby, PA
o Julian Keith, M.D., ASAM member and Director of the North Carolina Division
of Mental Health, Developmental Disabilities and Substance Abuse Services,
initiated a meeting with Drs. Enoch Gordis (Director of the National Institute
on Alcohol Abuse and Alcoholism) and Alan Leshner (Director of the National
Institute on Drug Abuse) and Mr. David Mactas (Director of the federal Center
for Substance Abuse Treatment) to discuss how to reach consensus on the
definition of alcoholism, as a necessary step in achieving parity in addictions
treatment.
o Dr. Michael Miller is working with the Managed Care Coalition on Substance
Abuse Disorders (MCCSUD) to foster the development and common adoption of
treatment guidelines.
o Dr. David Mee-Lee recently met with representatives of the Department
of Defense and of the branches of the military to discuss implementation
of the DOD's newly enacted TRICARE addictions treatment policy, which calls
for use of criteria that are compatible with the ASAM Patient Placement
Criteria in determining the need for treatment of military personnel and
their six million dependents. Among those representing the military services
at the meeting were Drs. Terry Schultz and Ken Hoffman.
Position: Physician, Psychiatric Specialist
Location: Orofino, in scenic North Central Idaho
Idaho Department of Health and Welfare, State Hospital North, is recruiting
a staff psychiatrist for its 60-bed Adult Psychiatric Hospital and Drug
Dependency/Dual Diagnosis Program components. The Hospital will hire a Board
Certified or Board eligible psychiatrist who is seeking an opportunity for
a progressive and innovative practice in the treatment of patients who are
severely mentally ill and drug dependent. A physician with expertise in
addictions treatment is desired.
State Hospital North is one of two state hospitals in Idaho, and an important
link in the State and Regional Mental Health network. The Hospital values
participative and collaborative management, and team approach to treatment.
The Hospital is located on a beautiful campus in a modern facility less
than two years old. Orofino is an attractive rural community located on
the Clearwater River at the base of the Selway-Bitterroot Wilderness Area.
Professionals enjoy a quality lifestyle and outdoor recreational activities.
The compensation package includes competitive salary, relocation assistance,
and excellent State benefits. For more information, contact: Debbie Manfull,
Assistant Administrator, State Hospital North, 300 Hospital Drive, Orofino,
Idaho 83544, Phone: 208/476-4511.
Jefferson Medical College is seeking an academically credentialed psychiatrist, established in the substance abuse field, to assume the position of Director of the Division of Substance Abuse Programs, Department of Psychiatry and Human Behavior.
Responsibilities include teaching, training, and supervision of medical
students and residents; ant the administration of methadone, cocaine, and
outreach drug-free drug and alcohol clinics. There are research projects
being conducted in all clinics, with funded biological, genetic and clinical
outcome investigations ongoing. Faculty rank and compensation commensurate
with qualifications.
The position will be available on July 1, 1997 and selection will be based
on experience and accomplishments in administration, teaching, patient care,
and research.
Send resume to: Dr. Stephen P. Weinstein, Chair, Search Committee , Division
of Substance Abuse Programs, 1201 Chestnut , Street, 15th Floor, Philadelphia,
Pennsylvania 19107, Fax: 215/568-3596.
Seattle Area: Non-Profit Organization, No State Income Tax
Salary practice opportunity for primary care physician, must be ASAM certified
and team plaayer. Interest in program development and cummunity liaason.
In total confidence our toll free number 800/833-3449 or fax c.v. 360/647-8006,
Eva Page & Associaties, Physician , Recruiting
Published six times a year for 3,500 physicians specializing in addiction
medicine. For rates and deadlines, call the ASAM office: ASAM, Publications
Manager, 301/656-3920
ASAM members are invited to recognize the accomplishments of senior members
of the Society by nominating them for Emeritus membership. Emeritus members
have their membership dues waived and receive complimentary subscription
to ASAM News and the society's Journal of Addictive Diseases.
Emeritus status is bestowed by the ASAM Board of Directors, which reviews
all nominations. To qualify, a nominee must be: (1) an ASAM member for at
least 15 years; and (2) at least 65 years old; and (3) retiring or retired
from the practice of addiction medicine. (However, in special cases, the
Board reserves the right to bestow Emeritus membership independent of any
of the criteria listed.)
Nomination forms are available from the ASAM Membership Department at 301/656-3920.
| ASAM MRO Conference | July 18-20 | Dallas, TX |
| IDAA Medical-Scientific Conference (Jointly sponsored by ASAM) | August 6-10 | Minneapolis, MN |
| South Africa People-to-People Conference (jointly sponsored by ASAM) Contact Max A. Schneider, M.D., FASAM |
September 6-21 | Fax: 714/639-0062 E-mail: Alexron@aol.com |
| SAA 20th Anniversary Conference on Alcohol and Substance Abuse |
October 16-18 | |
| ASAM 10th Annual Conference on Nicotine Dependence | October 16-19 | Minneapolis, MN |
| State of the Art in Addiction Medicine | October 23-25 | Washington, D.C.20 Category 1 CME credits |
| Adolescent Substance Abuse and Addiction Conference | October | 14 Category 1 CME credits |
| 5th Annual Southeast Regional Addiction Conference |
October | |
| CSAM State of the Art Course | November 6-8 | San Francisco |
| ASAM MRO Conference | November 14-16 | Seattle, WA |
| ASAM 29th Annual Medical-Scientific Conference | 1998 | New Orleans, LA |
| ASAM 30th Annual Medical-Scientific Conference | 1999 | New York, NY |
In addition to accessing ASAM's web page, members can reach any ASAM staff
member via E-Mail, at the following addresses:
| James F. Callahan, D.P.A. | Exec. Vice President/CEO | JCALL@ASAM.ORG |
| Bill Brown | Accountant | BBROWN@ASAM.ORG |
| Catherine Davidge | Assistant Director of Membership | CDAVI@ASAM.ORG |
| Mark Douglas, C.P.A. | Director of Finance | MDOUG@ASAM.ORG |
| Linda Fernandez | Asst. Director of Meetings & Conferences | LFERN@ASAM.ORG |
| Joanne Gartenmann | Exec. Assistant to the Exec. Vice President | JGART@ASAM.ORG |
| John Keister | Credentialing Project Manager | JKEIS@ASAM.ORG |
| Theresa McAuliffe | Director of Membership | TMCAU@ASAM.ORG |
| Sandy Schmedtje Metcalfe | Director of Meetings and Conferences | SMETC@ASAM.ORG |
| Bonnie B. Wilford | Editor, ASAM News | BBWILFORD@AOL.COM |
Detoxification: Principles and Protocols
Published by the American Society of Addiction Medicine, Detoxification:
Principles and Protocols
is your authoritative guide to the management of one of your greatest clinical
challenges.
8-1/2 x 11", 3-hole drilled, 52 pages, charts and tables, authoritatively
referenced.
Price: ASAM members $15, Non-members $20.
Order your copy today!
ASAM " P.O. Box 101 " Annapolis Junction, MD 20701-0101
PHONE 800/844-8948
4601 North Park Avenue
Upper Arcade, Suite 101
Chevy Chase, MD 20815
ASAM is a specialty society of physicians concerned about alcoholism and other addictions and who care for persons affected by these illnesses.
ASAM News is an official publication of the American Society of Addiction
Medicine, and is published six times a year. Please
direct all editorial and advertising inquiries to ASAM News, c/o the ASAM
office.
Officers
President
G. Douglas Talbott, M.D., FASAM
President-Elect
Marc Galanter, M.D., FASAM
Immediate Past President
David E. Smith, M.D., FASAM
Secretary
Andrea G. Barthwell, M.D.
Treasurer
James W. Smith, M.D., FASAM
Chair, Publications Committee
Elizabeth F. Howell, M.D.
Newsletter Review Board
LeClair Bissell, M.D.
Sheila B. Blume, M.D., FASAM
Max A. Schneider, M.D., FASAM
Marvin Seppala, M.D.
Executive Vice President/CEO
James F. Callahan, D.P.A.
Founding Editor, 1985-1995
Lucy Barry Robe
Editor
Bonnie B. Wilford
Subscriptions:
Free to ASAM members;
$25 a year (6 issues) to non-members.
Order from the ASAM office at 301/656-3920, or Fax 301/656-3815.
E-mail: asamoffice@asam.org
http://www.asam.org