ASAM Weekly is a publication of the American Society of Addiction Medicine (ASAM) circulated by E-mail to “more than 25,00 addiction professionals” every Tuesday. It provides timely news briefings of top stories related to addiction medicine. The current issue includes a National Survey on Drug Use and Health study correlating substance use with suicidal ideation; original research suggesting a strong link between alcohol use and”thwarted belonging” ( wanting and needing to be with others being socially isolated ) with both homicidal and suicidal ideation in a group under community corrections supervision by the criminal justice system; a study of privately billed services looking at the economic impact of the opioid epidemic on the healthcare system (Fair Health White Paper) which found a 1000% increase in opioid related treatment and service costs between 2011 and 2014; and an article written for the Huffington Post entitled “When ‘All or Nothing’ Means Life or Death” that questions the abstinence based model that currently monopolizes addiction treatment in the United States which the author notes “is not only harmful and killing people,” but also “defies much of what we know about addiction.”
In his weekly editorial Editor-in-Chief William Haning refers to prescription database finding that the number of opioid prescriptions written in Tennessee last year outnumbered the number of people in Tennessee. He appropriately notes this should “stun the readership” as it should. He notes several other articles this week “remind us that most of the public is not terribly interested in whether somebody has an addiction” or the socioeconomic impact of addiction. He states “the public really can’t be expected to care” is someone with a substance use disorder is using substance and may not even be “realistically expected to care very much” about those who recover.
“What they do and rightly care about,” Haning declares, “is the outcome of substance usage” and the public “is much more impressed by and will react to the consequences, ” As consequences he points to the two articles concerning suicidal and homicidal ideation and a report concerning sexual assault and violence from the University of Wisconsin . He goes on to state: “It causes an understandable lack of sympathy when a group of illnesses imparts injury to others.” He lists crime, trauma in the workplace, spread of infectious disease and impact of childhood development of the disordered family as additional outcomes or consequences.
Haning notes a dilemma for those in recovery–they want to advocate for others but do not want to draw attention to themselves as the attention is far different from a diabetic or parent of a child with muscular dystrophy pushing for increased research or approval of a new medication. He points out a national organization advocating for the treatment of the mentally ill exists (NAMI) that is comprised largely of those being treated but “no strong national equivalent exists for substance use disorder yet” with two “organized bodies” as exceptions: “physicians who have themselves entered recovery (IDAA), and another, smaller body of physicians in recovery who are engaged in the treatment of SUDs” These “organized bodies” have generally been focused on “ensuring identification of and care of their colleagues and patients” but have more recently become involved in the “pursuit of public policy changes.”
Propoganda, Truth and Credibility
In Propaganda: The Formation of Men’s Attitudes Jacques Ellul discusses the underlying assumptions and ideology that give rise to propaganda and the structures and belief systems needed for propaganda to flourish. Propagandists move with an “assortment of soothing and easily digestible notions.” He discusses how easy it is for most people to accept propaganda as the individual does not want information but only value judgments and preconceived positions. On the surface Haning’s proposal is rational and seems like a good idea. Who could argue with it?
It is important to recognize what Haning is referring to. IDAA is an acronym for International Doctors in Alcoholics Anonymous , an AA fellowship of more than 9500 doctors. The organized body focused on ensuring “identification” of “colleagues” are the state physician health (basically employee assistance programs for doctors). 47 of them are under the management of the Federation of State Physician Health Programs (FSPHP). The organized body focused on “care” of “patients is a group called Like Minded Docs (LMDs). Collectively these groups represent the physician health program model and it is being promoted as “gold standard addiction treatment” based on a 2009 study called the“PHP-blueprint” that reported remarkable success rates (80%). The high success rate is attributed primarily to close linkage with 12-step programs and the use of “residential and outpatient treatment programs that were selected for their excellence.”
Mechanics and Mentality
The “PHP-blueprint” is abstinence based and 12-step participation is mandatory. Random frequent drug and alcohol testing is used with zero-tolerance. A positive test results in an out-of-state “PHP-approved” assessment center and concepts such as “potentially impairing illness” and “relapse without use” are accepted. The core organizational structure includes the state PHP, commercial drug testing labs and a number of out-of-state “PHP-approved” assessment and treatment centers. The PHP’s have no regulation or oversight. The testing, assessments and treatment are out -of-pocket cash only.The assessment and treatment centers have very little oversight and because the commercial drug-testing labs use non-FDA approved laboratory developed tests (LDTs) they are not regulated. No agency exists to provide sanctions for faulty or even fraudulent testing. No internal or external avenues of complaint exist. It is essentially a closed system in which no outside opinion is acknowledged let alone addressed. Transparency and accountability are absent. Due process is absent. Every “PHP-approved” facility is represented by a Like-Minded Doc and many of the doctors involved in the drug-testing process are also on the list of LMDs. It is a rigged system and explained here. Choice in assessment and treatment is removed and the “PHP-approved” facilities engage in “diagnosis rigging” and are willing to label people with diagnoses when they do not in fact meet the diagnostic criteria for that
diagnosis. Pervasive problems include:
–Labeling normal variations in behavior as pathological
–Failing to receive proper diagnosis and effective treatment in those who need it
–Forcing unneeded evaluations and treatments including forced committment
Pervasive and Serious Concerns
Physician Health Programs- More Harm Than Good? was the first article critical of PHPs. “Physician health programs under fire” was recently published in the British Medical Journal (BMJ). The lack of accountability and financial and ideological conflicts of interest are addressed. Complaints include coercion, threats, “diagnoses rigging,” lab fraud and false diagnoses to to support unneeded treatment. The physician health program model is a major factor in the current suicide epidemic in doctors.
Profit Motive and Plans for Expansion
In his Editorial Haning mentions a “national organization for advocacy of treatment of the mentally ill” called NAMI and this stands for the National Association of Mental Illness (NAMI). It is considered a pharmaceutically funded front-group founded by Abott Labs, Pfizer, Eli-Lilly and pharmaceutical manufacturers. They all market drugs for mental illness. Mother Jones reported $11+ million over 5 years from Big Pharma, and an Eli Lilly executive directed operations from their headquarters.. A U.S. Senate investigation revealed Big Pharma contributed $23 million in a just two years and until forced by the Senate Finance Committee to identify its corporate donors had refused to do so. The “Campaign to Stop the Stigma of Mental Illness” was started by NAMI and the group claims one out of five adults will suffer some form of mental illness in their lifetime. The system is designed to provide a seemingly altruistic agenda but is in actual fact driven and funded by groups who profit from labelling more people mentally ill. It is, in fact, the very same business model as what we see here but the primary profiteers are not Big Pharma but Big Rehab -the multi-billion dollar drug and alcohol testing, assessment and treatment industry.
What is planned is explicitly spelled out in the ASAM White Paper on Drug Testing . This is a Trojan horse for expanding the “PHP-blueprint.” The business mode is similar to the razor or printer model. The razor or printer does not generate a profit, the razor and printer cartridge replacements do recurrently. PHPs are simply employee assistance programs (EAPs). Selling the PHP (i.e replacing an existing EAP) does not turn a profit, the non-FDA approved drug and alcohol testing does (and the referrals to the “approved” assessment and treatment centers. The New York Times reported that the size of the US drug-screening industry grew from $800 million in 2000 to $2 billion in 2013.
Infrastructure Already in Place
The drug and alcohol assessment, treatment and testing organizations are already present To replace an EAP with the PHP model it is only necessary to convince an employer or administrative agency in charge of professional licensure. If elected as public policy advocates for addiction treatment they will most assuredly be lobbying and working on state and federal laws and aligning themselves with licensing boards to remove due process and civil liberties by “medicalization”. This could impact anyone from our elderly, to our military, pregnant women, nursing mothers and school children. It is a testing and treatment Trojan Horse. They will be pushing public policy to coerce people into treatment who do not need treatment.
Creating Bogus Risks of Danger
Linking patient harm to “impaired” doctors is one of the primary propaganda techniques used by the FSPHP to forward the assessment, testing and treatment agenda. Be creating fear in hospital administrators, medical boards and the public ( “The Junkie in the O.R.” ) This appeal to consequences (argumentum ad consequentiam) is suggested by Haning in the editorial. He states the public will react to consequences such as crime, trauma in the workplace, spread of infectious disease and “impact of childhood development of the disordered family “as potential consequences. The PHP system uses a medical license as “leverage” but any other license or benefit provided by the state could be used in the same manner. This is what is called “contingency management” and how this is done is discussed in the ASAM White Paper on Drug Testing.
FSPHP/FASAM/LMD
The primary architects of this system can be found on a list of Fellows of the American Society of Addiction Medicine. The list can be seen here and includes G. Douglas Talbott, Robert Dupont, and Paul Earley whose contributions to the current paradigm I have detailed in previous posts. The list also includes Greg Skipper who introduced the first non-FDA approved laboratory developed test for alcohol and is currently promoting Soberlink -another junk science gadget that is prominently advertised as the top header in the current issue of ASAM Weekly.
The list of like-minded docs was taken down from the website several months ago. Below is a screenshot taken the week prior. On this list are Dupont, Earley, Skipper and the medical director’s of every single “PHP-approved” assessment and treatment center and it must be a small world after all because if you look at this list it has the name “Bill Haning” on it. You will also find him on the list of ASAM Fellows.
Disrupted Physician 
It will be interesting to follow the development of jurisprudence emerging from the drugs courts springing up around the country. Medical and legal frameworks for understanding the same events usually produce conflicting interpretations. If ASAM dominates the reasoning of these new drug courts, then they may prove to have far-reaching and deleterious effects on public policy.
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Reblogged this on jonathandillard and commented:
Excellent journalism and research.
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[…] contracts with the license as leverage and any violation adds YEARS to the contract. (see disruptedphysician.com ) Doctors, nurses, pilots who have lost their livelihood, when they don’t kill themselves, […]
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Thank you for this – and for what you have taken on in this blog. Although I rarely comment, you may have noticed that I have read and “liked” much of what you have written or posted since I became aware of your site. I am compelled to ring in on this post, however.
While I also empathize with the struggles of addiction, I am personally concerned with the black and white manner in which addiction is conceived in America for another reason: the harm caused to non-addicts by the black and white DEA response, policies and regulatory efforts.
The War on Drugs has *created* much of the pain and suffering of the victims of chronic pain.
The misguided policies of its official henchmen, the DEA, are directly responsible when lives fall apart whenever those who need Scheduled medication to FUNCTION cannot obtain them — or when doctors are so afraid of the impact of a DEA audit that they avoid prescribing certain meds-classes altogether.
God Bless America – it certainly needs God’s blessings these days (although I’m not too sure it deserves them).
xx,
mgh
(Madelyn Griffith-Haynie – ADDandSoMuchMore dot com)
– ADD Coach Training Field founder; ADD Coaching co-founder –
“It takes a village to transform a world!”
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Thanks Madelyn– what people can’t seem to grasp ( even experts in this area) is that this is a “business” model not a “medical” model that is driven by the drug and alcohol assessment, treatment and testing industry and their lobbying budget is essentially unlimited. Until the power structures and their levers are recognized the train wreck is only going to get worse.
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No doubt you are right about WORSE. “Business” seems to have gone over to the dark side. When capital interests rule, tyranny rides the wake.
God help us ALL!
xx,
mgh
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[…] Source: ASAM Editor-in-Chief recommends organizations managing Physician Health Programs (PHPs) assume natio… […]
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Michael, I applaud your efforts to fight for the rights of us all. As you are testimony to, literally any physician can have their lives ruined by little more than a disgruntled coworker. And as I recently learned, courtesy of your blog, medical students are now under attack for treatment they receive that may consist of certain controlled substances. The state PHP’s insinuating themselves into a legally protected relationship based on trust, offer unsolicited medical advice with a power differential that amounts to a threat, dictate non-evidence based “treatment” which is not covered by insurance and extremely expensive (and conveniently obviates the need for further “testing” as you accurately describe, at 80.00 test x 2-3 per week over 5 years 50-60,000 from each participant in the PHP) and this assault that is committed in the name of benevolence is criminal. And the slope is very, very slippery. The flagrant misconduct you have highlighted is rampant and just SOP for those involved at all levels in the administration of these programs. You have done the victims of these programs a great service by shedding light on this “industry”. I will try to dovetail the information you have uncovered with my personal experience in a PHP. I thought that my experience was aberrant and a casualty of the nation’s failed “war on drugs” policy. My experience is a real-life example of this ideology in motion and offers varying perspectives on several of the issues you touched on. The medical profession should be talking and debating the legitimacy of PHP’s as many of the foundational beliefs are at odds with basic values and in several instances basic human rights. We are too afraid to talk about it. I am too afraid to talk about it. In the future, I may want to pursue reinstatement of my license and the medical board is not fond of those that disagree. I will publish this comment anonymously….and I don’t even have a license anymore! What more can be taken from me? I want to lend credence to the accusations you have stated so that those who are naive, as I once was, get the message that PHP’s are a very real threat and are not going away. The manner in which they can insinuate themselves into one’s life may be occult and triggered by a forgotten comment, insignificant encounter, an anonymous complaint to hospital administration, a disgruntled coworker, a DUI arrest, a health survey, a drug test that reveals a legitimately prescribed medication….anything. And, once you have been targeted, it is almost impossible to extricate yourself. Even when a physician is facing an acknowledged mental health or substance abuse diagnosis the protocols are universally applied, dictatorial, intrusive and violate the sacrosanct nature of the doctor-patient relationship and even more despicable, are employed to generate revenue for those unelected”benevolent” few who have obliged themselves of the power to mandate this “treatment”. The conflict of interests abound. Physician Health Programs have absolutely nothing to do with health. Further, the groundwork for the entire enterprise is based on unfounded anecdotal nonsense.
I could go on a tirade, and I just may. I have seen example after example of illegality, jaw-dropping ethical breaches committed by PHP administration, treatment facility staff and the laboratories that collect and process these drug tests. It is an industry, do not be fooled. I have perhaps a unique perspective in that I was a PHP participant ( whose human rights were leveraged and threatened) and later, when forced to surrender my license, was forced to fall back on a Master’s degree in psychology to pay the bills as I was employed by a major ridiculously expensive “PHP-approved” treatment center in Southern California. I was so disgusted by myself as I explained the “treatment” we offered for the value price of 30,000 per month. Never before in my life had I described a treatment plan devoid of any evidence -based principles, clinical trials data or any rigorous scientific examination. The 96-hour evaluation I scheduled for 4500.00 would be “credited toward treatment” and was a foregone conclusion. No one EVER escaped without a cookie-cutter diagnosis, that coincidentally required the unique services offered by our program. To disagree or even offer testimony of expert physicians who were not in agreement with the “PHP- approved” providers actually REINFORCED the made-up diagnosis…..Denial! Despite my genuine need for a gainful employment….I was forced to quit. The despair in the voices of the physicians who were engulfed in this nightmare was almost too much to bear. Suicide is a real consequence of participation in a PHP and one I considered many times.
There are just so many facets of ” the PHP experience” that erode an individual on a personal, professional, financial and emotional level and foster hopelessness, lead to suicide or, just to give up on a situation that has left you uniformly spent. And there is a cost to all humanity. In my PHP, several acclaimed physicians who were known to me prior to entry due to their exceptional talents and reputations. Physicians whom I had long admired and I KNOW were among the very best, like I, could no longer afford the 1500-2000 monthly cost of drug testing and mandatory group”therapy” ( which was a 2-hour session of venting that could have been facilitated by a third grader) that ensued for a minimum of 5 years. The financial cost of this “maintenance” on the heels of the 60-90,000 spent for the “treatment” which has no foundation in science. The lawyers, who are recommended by the therapist as the only hope of not losing your license, you also just wrote a check for 15,000 to garner this sweet…. essentially also PHP approved! Ome might consider getting a moonlighting gig to pay for all of this, but even if you could spare the time between the daily AA and the driving to therapy and drug testing facilities, often not local, you are forbidden by the PHP. Anyone who disregards the financial motives of the PHP “industry” have not seen it up close, from both sides as I have. Just as a point of fact, last year Cigna sued Promises, with a “Physicians program” for violation of Anti-kick back statute violations. It’s parent company, Elements Behavioral Health, was the majority shareholder in the drug testing lab, for patients receiving treatment, including PHP participants. This testing protocol was determined to be excessive and a verdict of healthcare fraud was found with damages of several million awarded to Cigna. The patients who paid cash like PHP participants are unable to question these methods as they are deemed “non-complaint” or in “denial” for questioning the methodology of frivolous testing. Michael, your situation regarding the post-hoc “update” of the test class from clinical to forensic…. is so much more devious, but not surprising. These types are very ballsy. A thief who steals your money has not “updated” your bank account balance to reflect the crime. The violations in many ways are so blatant it is truly stunning.
In my case I surrendered my license after I was put into a situation in which I saw no other avenue. I entered the PHP to after I had begun abusing pain medication after a fracture that was complicated by compartment syndrome, a fasciotomy and resultant CRPS. I entered the PHP with the idea that if the incident ever came to the attention of the board, it was favorable to have sought guidance and treatment. I had never placed a patient in peril nor had so much as a complaint from a patient or colleague. I recently recertified and scored in the 90th percentile on boards, been featured in a major newspaper for saving a 9-year-old girl and held a faculty position within a prestigious medical school. I had was in entering my second year in the PHP when I suffered a major trauma, falling down a cliff while hiking, sustaining a broken and dislocated shoulder and a terrible trimalleollar fracture which requires ORIF with 2 plates and 16 screws. Upon arrival to the ED, of course, I am in significant pain. I politely decline the IV dilaudid the ED physician orders and explain that I am in a PHP and the details of the program. I request a UDT and ask if he would be able to discuss my injury and treatment plan with my PHP contact, whose qualifications include an RN license and “personal recovery experience” as someone who is a “survivor” of a tumultuous divorce, for which she sought treatment in “co-dependents anonymous”. Swear, I cannot make this up. I am now some 2 hours into this trauma, with my left shoulder still out of socket, the ankle unrecognizable and I am in tears. The ED physician again attempts to convince me to allow a single milligram of IV Dilaudid sothat he can attempt to put my shoulder back into socket. I tearfuly decline knowing that I must get the approval of the nurse in the PHP, despite an emergency situation in which a licensed physician wants to administer an appropriate medication to facilitate a required procedure, my shoulder reduction. The physician pages the PHP nurse and orders a stat consult from Pain Management and Orthopedics. The physician team comprised of the specliasts confer about my case with the PHP nurse. I get on the phone with Ann, the nurse to detail what has occurred and my plan for treatment. To my utter amazement, the nurse informs me that I will be in “noncompliance” if I allow any medication for pain. I ask the physicians who are ordering the pain medication to describe my injuries and treatment plan as well as alternatives to care. The physicians who are caring for me advise me to go against the nurse recommendations as ” it cannot be valid” and reassure me that come Monday, they would clarify the obvious misunderstanding with the “powers taht be” at the PHP and this will all be worked out, as this was “obviously wrong”.
The treatment team and myself clarified that the position of the PHP was that a.) despite being admitted for the broken and dislocated shoulder( about to be reduced without benefit of pain medication if she had her druthers) and the b.) the impending ORIF of the ankle, if I were to take any prescribed narcotics, the board……”will begin preparations to revoke my license”.
I thankfully accepted the medications and my shoulder was reduced. The anke required ORIF as it was a trimalleolar and totally unstable. Surgery on the ankle required ORIF with 2 plates and 16 screws for a total of 14 days in the hospital was to have occurred sans any narcotic pain control and utterly unfathomable. Upon discharge, with my wristband still intact and on the wrist of my fractured left arm, I was visited by 2 board investigators in my home to inform me that my license was suspended. I informed them, as I was quite incapacitated, I could scarcely negotiate the restroom and had no intentions of working at that moment. Revocation proceedings ensued, and after a 10 month battle with the board, I could no longer afford the attorney fees, especially since I could not work. I was broke and beaten down. I felt little choice but to surrender my license.
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Can we do this a guest post ?
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Yes. I dont know what that entails but you can fill me in.
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Reblogged this on Disrupted Physician.
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