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.