The “PHP-Approved” Assessment and Treatment Center Gravy Train

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Related:  Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

Regulatory capture and the critical need for Federal Trade Commission (FTC) Investigation of Medical Licensing Boards

The Dictatorship of the Federation of State Physician Health Programs (FSPHP)


The Federation of State Medical Boards (FSMB)  House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting distinguishing “impairment” and “illness”  stating that Regulatory Agencies should recognize the PHP as their expert in all matters relating to licensed professionals with “potentially impairing illness.”  In 2011 The American Society of Addiction Medicine (ASAM)  issued a Public Policy Statement on coordination between physician health programs (PHPs), medical boards and treatment providers recommending  only “PHP approved” treatment centers be used in the assessment and treatment of doctors.   The Federation of State Physician Health Programs (FSPHP)  is an appendage of the American Society of Addiction Medicine (ASAM) that cultivated a relationship with the  Federation of State Medical Boards (FSMB) by offering  “treatment” rather than”punishment and their influence on regulatory medicine can be historically tracked  in the  Journal of Medical Regulation and similar  publications when they began touting grandiose success rates in treating “addicted doctors.” The  Washington  PHP claimed a success rate of  95.4%,  Tennessee   93% and Alabama  90%.   These breathtaking success rates were attributed to specialized treatment centers for doctors such as Ridgeview where they required inpatient stays lasting three times longer than average folks; cash-on-the-barrel and at three times the cost mind you. The truth is the majority of doctors referred for assessments do not meet the diagnostic criteria for problems they are receiving treatment.  It is unneeded. Very few are “addicts.”  Most of those being referred to these programs are like Leonard Masters who was accused of overprescribing and was told by the director of the Florida PHP he could either relinquish his license or have an evaluation. Masters chose the evaluation thinking he would be returning in 4-days.  but was diagnosed as an alcoholic and spent 4-months.  The man didn’t even have a drinking problem!   He successfully sued G. Douglas Talbott and the facility for false imprisonment, malpractice and fraud.

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What objective criteria are used in selecting these “PHP-approved” assessment and treatment centers?    According to a  Performance Audit of the North Carolina Physicians Health Program done by State Auditor Beth A. Wood that’s a good question.

The North Carolina State  Audit specifically noted the predominant use of these out-of-state treatment centers.   In addition to “creating an undue burden on” those being evaluated the audit states that:

 “Program procedures did not ensure that physicians received quality evaluations and treatment because the Program had no documented criteria for selecting treatment centers and did not adequately monitor them”

In fact the audit found no documented policy for selecting treatment centers.  The very organizations demanding documentation of policy for approval and charged with approving the treatment centers could not even give a comprehensible, plausible or even simple explanation for what any of  these things even mean.    

When the NC PHP was asked to define these characteristics they explained that they learned  of “new treatment centers through professional networks and other informal sources” and used the “treatment centers’ reputation as a basis for establishing a referral relationship.”      Staff credentials, quality of care, treatment methods and modalities, patient choice, follow-up data, outcomes and other objective information apparently took a back-seat to what appears to be ill-defined and subjective word-on-the-street.

None of these facilities take insurance.  It is all out-of-pocket with the average cost for a 4-day assessment $5K and another  $80-120K for at least three months of inpatient treatment   Reports of “diagnosis rigging” and unneeded treatment are rampant and if  my survey is an accurate reflection of what is occurring more than 90% of those treated do not even meet the diagnostic criteria for what they are being treated for.

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This  “failure to use FSPHP  recommended criteria to select treatment centers,” the Audit concluded “could cause the Program to enter into referral arrangements with service providers that do not meet quality standards”

Ironically the  NC PHP failed to follow guidelines they themselves introduced and demanded be followed but could produce no documented criteria they existed.    They could not even provide plausible criteria.   Professional networks, reputation and other informal sources are fine for some choices.  That’s how I picked out my first skateboard.     These resources can play in important role in choosing a shirt, new sneakers or even a car but they do not constitute selection criteria for an assessment in which the consequences and recommendations made for the person being assessed are significant, potentially life-altering and possibly permanent!

And to top it off the  Medial Director of the North Carolina PHP,  Dr. Warren Pendergast, was the  President of the FSPHP at the time of the audit.  PHPs are not clinical providers but monitoring agencies.  They meet with, assess and refer doctors for evaluations and and monitor doctors through drug and alcohol testing and the monthly reports of others.     As such the PHP is tasked with two jobs-referring doctors for evaluation and then monitoring them after they have been evaluated.  The fact that they could not produce the facts and reasoning of the very basis for which they exist is incomprehensible.   The President of the FSPHP being unable to define the selection criteria for approved and mandated facilities is like Anthony Bourdain being unable to explain the ingredients of an omelette.

To summarize, doctors in North Carolina were being forced by the PHP  to have evaluations at “PHP-approved” assessment and treatment centers but the PHP was unable to explain anything substantive in defining any of it.  Why?  Because no qualitative objective selection criteria exist and that is the case in every state. This is especially concerning when it is realized that these evaluations are limited to facilities and people  tied financially and ideologically to the groups and individuals who are mandating the referral.

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The Seedy Underbelly of Rehab Centers’ Online Marketing | World of Psychology

27e4e040-4c07-0132-0b27-0eae5eefacd91Just over a year ago, I wrote about the curious marketing of addiction treatment centers online, which used what I believed to be deceptive marketing practices. The email that arrived on Oct. 2, 2013 piqued my curiosity yet again. It was promoting a self-made infographic about “porn addicted” communities online.  It came from a website called “Project Know.” Sounds interesting, right? The email started my second investigation into the seedy underbelly of the online marketing practices of rehab and addiction treatment centers. You know the ones, as you’ve probably seen at least one of their advertisements on TV, too. For most people, recovering from addiction is a difficult and trying process — marked by failure as much as it is success. Lack of scientific evidence aside, residential treatment centers (also known as addiction recovery centers or rehab centers) purport to offer a safe, supportive treatment environment for a person to detox from their addiction, typically for up to 30

Source: The Seedy Underbelly of Rehab Centers’ Online Marketing | World of Psychology

Recovery Related Racket: The Federation of State Physician Health Programs (FSPHP) represents the drug and alcohol testing, assessment and treatment industry not us. We need to name the enemy.

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“It is easier to believe a lie one has heard a hundred times than a truth one has never heard before.” –Robert S. Lynd

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1980s–Your Money or Your Medical License

Ridgeview Institute was a drug and alcohol treatment program for “impaired physicians” in Georgia created by G. Douglas Talbott, a former cardiologist who lost control of his drinking and recovered through the 12-steps of Alcoholics Anonymous. Up until his death on October 18, 2014 at the age of 90, Talbott owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards today.

G. Douglas Talbott is a prototypical example of an “impaired physician movement”physician–in fact in many ways he may be considered the”godfather” of the current organization.  He helped organize and serve as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program.

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.1

In 1975 after creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program for the assessment and treatment of physicians. Founded in part because “traditional one-month treatment programs are inadequate for disabled doctors,” and they required longer treatment to recover from addiction and substance abuse.   According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike any other of the inhabitants of our society. Physicians are unique. Unique because of their incredibly high denial”, and he includes this in what he calls the “Four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”2   And these factors set doctors apart from the rest.

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves.“M-Deity” refers to doctors “being trained to think they’re God;”3 blinded by an overblown sense of self-importance and thinking that they are invincible-an unfounded generalization considering the vast diversity of individuals that make up our profession.   Screen Shot 2015-07-28 at 1.14.49 AM

Although this type of personality does exist in medicine,  it is a small minority -just one of many opinions with little probative value offered as factual expertise by the impaired physician movement and now sealed in stone.

This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”1

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals4 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”5“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.3

The constitution did a series of reports after five inpatients died by suicide during a four-year period at Ridgeview.6 In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.1

Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.”3

According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”3

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,7 and other lawsuits initiated on behalf of suicides were settled out of court.6

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.”8 The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”8

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after her death in 2008 per her request.   Noting that her book Alcoholism in the Professions9“ remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population; to which she replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”10


1995 –The Big Con

In 1995 the impaired physicians movement gained an uninvited seat at the table of power. They accomplished this by offering “treatment” as an alternative to “discipline” and reporting remarkably high success rates.  Talbott reported a “92.3% recovery rate according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”11

A 1995 issue of The Federal Bulletin: The Journal of Medical Licensure and Discipline, published by the Federation of State Medical Boards, contains articles outlining impaired physician programs in 8 separate states. Although these articles were little more than descriptive puff-pieces written by the state PHP program directors and included no described study-design or methodology the Editor notes a success rate of about 90% in these programs and others like them 12 and concludes:

“cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” 12No one bothered to examine the methodology to discern the validity of these claims and it is this acceptance of faith without objective assessment that has allowed the impaired physician movement through the ASAM and FSPH to advance their agenda;  confusing ideological opinions with professional knowledge.

“There is nothing special about a doctor’s alcoholism,” said Bissel

“These special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”10“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”10Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.13  Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”13

The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.14

The fraud finding required a finding that errors in the diagnosis were intentional. Masters, who was accused of overprescribing narcotics to his patients was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation.

Masters agreed to the latter, thinking he would have an objective and fair evaluation. He was instead diagnosed as “alcohol dependent” and coerced into “treatment under threat of loss of his medical license. Staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice,”14  the equivalent of professional suicide.

Masters, however, was not an alcoholic.

According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 15

He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license.

Talbott faced no professional repercussions and no changes in their treatment philosophy or actions were made. They still haven’t.  They have simply tightened the noose and taken steps to remove accountability.


2011–The Federation of State Medical Boards (FSMB)  as Pawn of the  Federation of State Physician Health Programs (FSPHP)

 Up until his death, Talbott continued to present himself and ASAM as the most qualified advocates for the assessment and treatment of medical professionals for substance abuse and addiction.16

The 2011 FSMB Policy on Physician Impairment identifies, defines, and essentially legitimizes “potential impairment” and “relapse without use.”

A PHP Should be empowered to conduct an intervention based on clinical reasons suggestive of potential impairment.  

Unlike the Board which must build a case capable of withstanding
legal challenge, a PHP can quickly intervene based on reasonable concern."

“Empowered” to conduct an “Intervention” for reasons “suggestive” of “potential” impairment means a doctor can be pulled out of practice for anything.  It essentially gives them carte blanche authority. The disregard for physician rights, due process and validity is self-evident.

in 2011 The ASAM issued a Public Policy Statement on coordination between PHPs, regulatory agencies, and treatment providers recommending  that  only “PHP approved” treatment centers be used in the assessment and treatment of doctors.  A recent audit of the  North Carolina PHP found financial conflicts of interest and no  documented criteria for selecting the out of state treatment centers they used.  The common denominator the audit missed was that the 19  “PHP-approved” centers were all ASAM facilities whose medical directors can be seen on this list.

The FSMB House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting distinguishing “impairment” and “illness”  stating that Regulatory Agencies should recognize the PHP as their expert in all matters relating to licensed professionals with “potentially impairing illness.”

In most states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview.

There is no choice.   In mechanics and mentality, this same system of coercion, control, and indoctrination has metastasized to almost every state only more powerful and opaque in an unregulated gauntlet protected from public scrutiny, answerable and accountable to no one.  Laissez faire Machiavellian egocentricity unleashed.    For what they have done is taken the Ridgeview model and replicated it over time state by state and tightened the noose.  By subverting the established Physician Health Programs (PHPs) started by state medical societies and staffed by volunteer physicians they eliminated those not believing in the mentality of the groupthink.   They then mandated assessment and treatment of all doctors be done at a “PHP-approved” facility which means a facility identical to Ridgeview.  This was done  under the scaffold of the Federation of State Physician Health Programs (FSPHP).  They are now in charge of all things related to physician wellness in doctors.

G. Douglas Talbott defines  “relapse without use”  as  “emotional behavioral abnormalities” that often precede relapse or “in A A language –stinking thinking.”  AA language has entered the Medical Profession and no one even blinked.  It will get worse.

The ASAM has  monopolized addiction treatment in the United States.   It has imposed  it on doctors through the FSPHP.  The FSPHP political apparatus exerts a monopoly of force. It selects who will be monitored and dictates every aspect of what that entails.  It is a, in fact, a  rigged game.


PHPs no longer represent the interests of doctors or the public but the interests of the drug and alcohol testing, assessment and treatment industry.

It is important to recognize that PHPs do not represent the interests of doctors or the public.  PHPs represent the interests of the “recovery industry” including the multi-billion dollar drug and alcohol testing, assessment and treatment industries. Claiming an 80% success rate in doctors this system of institutional injustice is being brandished as the “new paradigm” of addiction treatment. Claiming it a replicable model, the plan is to convince other employee assistance programs to implement the “PHP-blueprint.”

There is enormous inertia—a tyranny of the status quo—in private and especially governmental arrangements. Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes politically inevitable.-Milton Friedman

  1. Durcanin C, King M. The suicides at Ridgeview Institute: Suicides mar success at Ridgeview with troubled professionals. Atlanta Journal and Constitution. December 18, 1987, 1987: A13.
  2. Gonzales L. When Doctors are Addicts: For physicians getting Drugs is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.
  3. King M, Durcanin C. The suicides at Ridgeview Institute: A Doctor’s treatment program may be too tough, some say. Atlanta Journal and Constitution. December 18, 1987a, 1987: A12.
  4. Bissell L, Royce JE. Ethics for Addiction Professionals. Center City, Minnesota: Hazelden; 1987.
  5. Addiction Scientists from the USA: LeClair Bissell. In: Edwards G, ed. Addiction: Evolution of a Specialist Field. 1 ed: Wiley, John & Sons, Incorporated; 2002:408.
  6. Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
  7. Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
  8. King M, Durcanin C. The suicides at Ridgeview Institute: Many drug-using doctors driven to Ridgeview by fear of losing licenses. Atlanta Journal and Constitution. December 18, 1987b, 1987: A1.
  9. Bissell L, Haberman PW. Alcoholism in the Professions. Oxford University Press; 1984.
  10. White W. Reflections of an addiction treatment pioneer. An Interview with LeClair Bissell, MD (1928-2008), conducted January 22, 1997. Posted athttp://www.williamwhitepapers.com. 2011.
  11. Williams c. Health care field chemical dependency threat cited. The Tuscaloosa News. January 16, 1988, 1988: 16.
  12. Schneidman B. The Philosophy of Rehabilitation for Impaired Physicians. The Federal Bulletin: The Journal of Medical Licensure and Discipline. 1995;82(3):125-127.
  13. Peele S. In the Belly of the American Society of Addiction Medicine Beast. The Stanton Peele Addiction Website (accessed March 28, 2014)http://web.archive.org/web/20080514153437/http://www.peele.net/debate/talbott.html.
  14. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report. May 12, 1999b 1999.
  15. Ursery S. I was wrongly held in alcohol center, doctor charges. Fulton Count y Daily Report. April 27, 1999a 1999.
  16. Parker J. George Talbott’s Abuse of Dr. Leon Masters MD (http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters ). Medical Whistelblower Advocacy Network.

Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

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Three shells and a pea–ASAM, FSPHP, and LMD.

“PHP-Approved” Assessment and Treatment Centers

On the above list  can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities.  I did not make up this list.  An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved”  assessment and treatment centers are represented on this list.    State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations.  PHPs are non-profit tax-exempt organizations.  They do not evaluate or treat patients.   If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement.    Evaluations are constrained to one of these facilities.   It is mandated.   No bargaining.  No compromises. No choice.  In other words it is a coercion.

“What’s wrong with that?” some may ask.  These facilities are all recognized as top-drawer and first-class.  Perhaps they were hand-picked on objective criteria and the PHPs are just making sure that doctors get the best assessments money can buy– decision making by experts based on knowledge and experience–picking a winner so you don’t have to.

via Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers.

In Mechanics and Mentality the Physician Health Program “Blueprint” is Essentially Straight, Inc. for Doctors.

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In 2012 former Nixon Drug Czar Robert Dupont, MD delivered the keynote speech at the Drug and Alcohol Testing Industry Association (DATIA) annual conference and described a “new paradigm” for addiction and substance abuse treatment. He advocated zero tolerance for alcohol and drug use enforced by monitoring with frequent random drug and alcohol tests. Detection of any substances is met with “swift and certain consequences.”

And then he proposed expansion of this paradigm to other populations including workplace, healthcare, and schools.

Robert Dupont was a key figure in launching the “war on drugs” — now widely viewed as the failed policy that has turned the US into the largest jailer in the world.

Screen Shot 2014-02-23 at 8.06.56 PMIn the 1970s, Dupont administered the experimental drug rehab program called “The Seed” – that was later deemed by congress to use methods similar to those used on American POW’s in North Korea. He would later go on to consult for “Straight, Inc”, a rehab program that treated troubled teens as “addicts”, often for minor infractions or normal teenage behavior.

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Deemed the “family oriented treatment program,” Dupont encouraged organization and expansion. Targeting the children of wealthy white families parents fears were used to refer their kids to the programs. Signs of hidden drug use such as use of Visine, altered sleep patterns, and changes in clothing style were used as indications for referral. Any child who arrived would be considered an addict in need of their services. Coercion, confrontation, command and control were the guiding principles. Submit or face the consequences. We know what’s right. The idea was to strip the child of all self-esteem and then build him back up again in the straight image. Abused, dehumanized, delegitimized and stigmatized-the imposition of guilt, shame, and helplessness was used for ego deflation to facilitate canned and condensed 12-step as a preparatory step on the path of lifelong spiritual recovery.

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Children were coaxed or terrorized into signing confessions, berated, and told they were in “denial.” Inaccurate and false diagnoses were given to wield greater control. Reports and witness accounts now indicate that many of the kids did not even have drug problems but by creating a “moral panic” about teenage drug use they exploited parents fears for profit. Straight, Inc. became the biggest juvenile rehabilitation center in the world for rehabilitation and treatment of addiction.

12 year old girl admitted to inpatient addiction rehabilitation for sniffing a “magic marker”–Once!

A Deficiency Correction Order was issued by the Executive Office of Human Services, Office of Children, Commonwealth of Massachusetts Services to Straight, Boston in 1990 that read in part:

“Although Straight’s statement of services states that Straight serves chemically dependent adolescents, a review of records and interviews with staff demonstrate that Straight admits children who are not chemically dependent. For example, one twelve-year-old girl was admitted to the program although the only information in the file regarding use of chemicals was her admission that she had sniffed a magic marker.”

Straight was always making outlandish claims of success but there was no scientific evidence based data to support it. In September 1986 USA TODAY ran an article headlined:  DRUGS:  Teen abusers start by age 12 which opened with:  “Almost half of the USA’s teen drug abusers got involved before age 12…”Screen Shot 2015-05-15 at 12.51.23 AM

The article was based on a study conducted by Straight, Inc.

Many former patients of Straight were so devastated by the abuse that they took their own lives. Since then, Dupont has been a key figure in the proliferation of workplace drug testing programs, and once advocated for drug testing anyone in the workplace under the age of 40.1,2Screen Shot 2015-05-15 at 1.47.15 AM

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The Physician Health Program (PHP)  blueprint is essentially Straight, Inc. for Doctors in both Mechanics and Mentality

The “new paradigm” Dupont speaks of before the Drug and Alcohol Testing Industry Association is modeled after state physician health programs (PHPs) and as was done with Straight, “remarkable” claims of success are being made.3-6 Promoted as “Setting the standard for recovery” PHPs are now being pitched to other populations7

0 Dupont and Dr. Greg Skipper proclaim the “need to reach more of the 1.5 million Americans who annually enter substance abuse treatment, which now is all too often a revolving door.”8 They conclude:

This model of care management for substance use disorders has been pioneered by a small and innovative group of the nation’s physicians in their determination to help other physicians save their careers and families while also protecting their patients from the harmful consequences of continued substance abuse. In fulfilling the professional admonition “physician: first heal thyself,” these physicians have created a model with wide applicability and great promise.8

In “Six lessons from state physician health programs to promote long-term recovery” Dupont and Skipper attribute this success rate to the following factors:8

(1) Zero tolerance for any use of alcohol and other drugs;

(2) Thorough evaluation and patient-focused care;

(3) Prolonged, frequent random testing for both alcohol and other drugs;

(4) Effective use of leverage;

(5) Defining and managing relapses; and

(6) The goal of lifelong recovery rooted in the 12-Step fellowships.8

Slide27As with Straight, the majority of those admitted to PHPs are not even addicts.  The Federation of State Physician Health Programs (FSPHP) was able to convince Federation of State Medical Boards, to adopt the notion of “potentially impairing” illness and “relapse without use” to promote early intervention using the same false logic as Straight, Inc. and the 12-year old with the magic marker.  ( i.e. teen drug abuse starts by age 12 and that any sign or symptom inexorably progresses to impairment justifying  “treatment”).

Signals for “impairment” can be as benign as not having “complete, accurate, and up-to-date patient medical records.”  according to Physician Health services, the Massachusetts Physician Health Program and subsidiary of the Massachusetts Medical Society.

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Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since, as Associate Director of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.”

 It is a false premise “feel-good fallacy” with faulty conclusions.  And because it is being perpetrated on doctors (and those in the criminal-justice system) no one seems to care.   But this is merely a wedge for a grander plan.

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Dupont has  been heavily involved in studies using non-FDA approved laboratory developed tests and other devices of unknown validity on doctors in PHPS and promoting the use of these tests for forensic monitoring.9,10   

And they want to bring these tests to you. Propaganda and misinformation has been designed to sway public opinion.

A Medscape article from   “Drug abuse among Doctors: Easy, Tempting, and Not Uncommon” is a prototypical example of the propaganda and misinformation being used to sway public policy and opinion.  Focusing on a small study  ( n =55) done by Lisa Merlo (Director of Research for the Florida PHP). Dr.Marvin Seppala  states in the article that impaired  doctors are:

“….often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.” Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.”

There is no evidence base for a hidden cadre of drug-impaired doctors causing medical error. A critical review of the literature reveals no evidence base exists.  Moreover, this blather does not even comport with reality.  It defies reason and even basic common sense.

Screen Shot 2014-03-15 at 5.09.11 PMBut through misinformation and deceptive propaganda similar to that used by Straight these groups have created “moral panics” aimed at physicians designed to separate them from everyone else.

To be sure, doctors who are practicing impaired due to substance abuse need to be removed from practice both to get the help they need and to protect the public. But that is not what is happening.   Instead, what is occurring is that doctors can get caught up in this system for any number of reason. Indeed, some of these physicians have no history of drug-addiction—they are the equivalents of the 12-year-old girl caught sniffing a magic marker.

And this is how the scam works.

When doctors monitored by their PHP test positive they are forced to have an evaluation at a “PHP-approved” treatment center.  In 2011 the American Society of Addiction Medicine (ASAM) issued a Public Policy Statement recommending physicians in need of assessment and treatment be referred only to “PHP approved” facilities.  The medical directors of the “PHP-approved” facilities can be found on this list of “Like-Minded Docs”.

In 2011, The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness.” and the Orwellian notion of drug “relapse without use.” 

This implies that they will be able to ruin any doctor who does not comply or who is found guilty, even if fraudulently.

The question might be, “Why?” As with anything, we have to think about who profits.

Indeed, Dupont has remained a vocal and influential spokesman for drug and alcohol testing. But he along with former DEA head Peter Bensinger run a corporate drug-testing business. Their employee-assistance company, Bensinger-Dupont is the sixth largest in the nation.

Now, they also want to extend these tests to drivers.11,12 and Federal Workplace Drug Testing Programs.

They would like to replace the current system used in pilots, bus drivers, and Federal Employees with “comprehensive drug and alcohol testing.”13 AND THEY ARE promoting hair testing, 14Their goal is 24/7 sobriety with complete abstinence 15, and zero tolerance.16

Their claims of success are based on a single retrospective cohort study looking at the outcomes of 904 physicians monitored by 16 different State PHPs.17

An 80% success rate is claimed but 102 of the 904 participants were “lost to follow up” and of the remaining 802, 155 failed to complete the contract.

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So what happened to the 24 of who “left care with no apparent referral,” the 85 who “voluntarily stopped or retired,” and the 48 who “involuntarily stopped” or had their “license revoked.”  Whether you leave a PHP voluntarily, involuntarily, or with no apparent referral it is the end.. The plug is pulled. Game over.   Comparing this to other populations where the consequences are not as terminal is like comparing apples to oranges.

But the bigger question is what happened to the 157 physicians who left or stopped? How many of those killed themselves. The study reports 6 suicides, 22 deaths, and another 157 who are no longer doctors.   How many of the 22 deaths were suicides and what happened to the 157 who stopped for no apparent reason?   Using the last recorded clerical status as an endpoint obfuscates the true endpoints.  Where are they now?  Alive or dead?

Propaganda and misinformation is  designed to sway public opinion and it is all hidden from public view and scrutiny. Absolutely no oversight or regulation from outside agencies exists for PHPs and very little exists for the “PHP-approved” up-front cash only assessment and rehabilitation facilities.  The commercial drug-testing labs using non-FDA approved LDTs have no accountability either.  No agencies exist to hold them accountable for errors or even intentional misconduct.  The College of American Pathologists (CAP)  is the only avenue for complaint and CAP is an accreditation agency that can only “educate” not “discipline.”  It is a system that fosters and fuels misconduct as no consequences exist for wrongdoing and they built it that way.

The American Society of Addiction Medicine erected this scaffold state-by-state. And that is how it must be removed. It is a system of coercion, control, and fear. Crimes like the ones being committed here in Massachusetts must be investigated as crimes. The perpetrators must be held accountable.

It is a system of institutional injustice that is killing physicians by driving them to hopelessness, helplessness, and despair. The general medical community needs to awaken to the reality of the danger to expose and dismantle it at the State level.  And many of the doctors caught in this maw do not even have an addiction or substance abuse issue –equivalent to the 12-year old girl in referred to Straight for sniffing a magic marker.  On the other hand many of those in charge of the administration of these programs have engaged in egregious even horrific misconduct and have a history of manipulating the system.

Secondly, all of the so-called “research” must be subject to evidence base review. It is not there.

And thirdly, the numerous, intertwined and myriad conflicts of interest must be addressed – because it’s money that is the big driver of this “benevolent” interest in whether or not you are sober.

With over 20 years experience as Associate Directors of the Massachusetts PHP, Physician Health Services, Inc. (PHS,inc.), Dr.’s J Wesley Boyd, MD, PhD and John R. Knight of Harvard Medical School published an Ethical and Managerial Considerations Regarding State Physician Health Programs pointing out serious conflicts of interest and ethical issues involving PHP programs and the need “to review PHP practices and recommend national standards that can be debated by all physicians, not just those who work within PHPs.”

They recommend ethical oversight of PHPs, a formal appeals process for physicians, periodic auditing, a national system for licensing, and recommend “the broader medical community begin to reassess PHPs as a whole in an objective and thoughtful manner.” Unfortunately, this has not occurred.  It urgently needs to.  Because the Physician Health Program “Blueprint” is essentially Straight inc. in both mechanics and mentality. and those killing themselves are the equivalent of the 12-year old girl caught sniffing a magic marker.

Unlike Straight, inc.,  no FaceBook site dedicated to the  “memory of those gone” yet exists for the many many doctors killed and being killed  by the “PHP-blueprint.”   It should and someday, believe me, it will.

  1. Engs RC. Mandatory random testing needs to be undertaken at the worksite. Controversies in the Addiction Field. Vol 1. Dubuque, IA: Kendall/Hunt; 1990:105-111.
  2. Dupont RL. Never trust anyone under 40: What employers should know about Molly Kellogg in the workplace. Policy Review. Spring 1989:52-57.
  3. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of Physician Health Programs. Journal of substance abuse treatment. Jul 2009;37(1):1-7.
  4. White WL, Dupont RL, Skipper GE. Physicians health programs: What counselors can learn from these remarkable programs. Counselor. 2007;8(2):42-47.
  5. Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesthesia and analgesia. Sep 2009;109(3):891-896.
  6. Yellowlees PM, Campbell MD, Rose JS, et al. Psychiatrists With Substance Use Disorders: Positive Treatment Outcomes From Physician Health Programs. Psychiatric services. Oct 1 2014.
  7. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  8. Dupont RL, Skipper GE. Six lessons from state physician health programs to promote long-term recovery. Journal of psychoactive drugs. Jan-Mar 2012;44(1):72-78.
  9. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results. Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  10. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study. European addiction research. 2014;20(3):137-142.
  11. Voas RB, DuPont RL, Talpins SK, Shea CL. Towards a national model for managing impaired driving offenders. Addiction. Jul 2011;106(7):1221-1227.
  12. DuPont RL, Voas RB, Walsh JM, Shea C, Talpins SK, Neil MM. The need for drugged driving per se laws: a commentary. Traffic injury prevention. 2012;13(1):31-42.
  13. Reisfield GM, Shults T, Demery J, Dupont R. A protocol to evaluate drug-related workplace impairment. Journal of pain & palliative care pharmacotherapy. Mar 2013;27(1):43-48.
  14. DuPont RL, Baumgartner WA. Drug testing by urine and hair analysis: complementary features and scientific issues. Forensic science international. Jan 5 1995;70(1-3):63-76.
  15. Caulkins JP, Dupont RL. Is 24/7 sobriety a good goal for repeat driving under the influence (DUI) offenders? Addiction. Apr 2010;105(4):575-577.
  16. DuPont RL, Griffin DW, Siskin BR, Shiraki S, Katze E. Random drug tests at work: the probability of identifying frequent and infrequent users of illicit drugs. Journal of addictive diseases. 1995;14(3):1-17.
  17. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.Screen Shot 2014-02-25 at 1.06.55 PM

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Disrupted Physician 101.4–The “Impaired Physician Movement” takeover of State Physician Health Programs

These ASAM “addiction experts” have become so numerous they have been able to take over almost all the state Physician Health Programs (PHPs). Their national association—the Federation of State Physician Health Programs (FSPHP)–has a stated goal of universal acceptance of the 12-step doctrine: lifelong abstinence, and spiritual recovery as the one and only treatment, as spelled out in the “PHP Blueprint.”

Very much like Straight, Inc in the 70s and 80s, they have cast a wide net with doctors to ensnare them in an endless loop of drug testing and rehab—whether the tests are fabricated or not. The doctors will enjoy no sympathy from the public, and complaining about it is deemed a sign of your “disease.” Furthermore, ASAM recommends that physicians only be referred to “PHP approved” facilities.

The medical directors of these facilities can all be found on this list of ”Like-Minded Docs.” Surprisingly, many Like-Minded Docs were former addicts and alcoholics, some even with criminal backgrounds. There are felons and even double-felons on the list.

It’s a rehab shell game. Heads I win tails you lose.

And the program is expanding. The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness” and the Orwellian notion of “relapse without use.”

Signals for “impairment can be as benign as not having “complete accurate, and up-to-date patient medical records” according to Physician Health Services, the Massachusetts PHP. Despite the overwhelming amount of paperwork Doctors now have, incomplete or illegible records could be construed as a red flag, since as Associate Direct of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.” The question is, who is next?”

Disrupted Physician

Forget what you see
Some things they just change invisibly–Elliott Smith

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Physician Impairment

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published by the American Medical Association’s (AMA) Council on Mental Health in The Journal of the American Medical Association in 1973,1 recommended that physicians do a better job of helping colleagues impaired by mental illness, alcoholism or drug dependence. The AMA defined an “impaired physician” as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or abuse of drugs, including alcohol.”

Recognition of physician impairment in the 1970s by both the medical community and the general public led to the development of “impaired physician” programs with the purpose of both helping impaired doctors and protecting the public from them.

IMG_1010The 1975 media coverage of the deaths of Drs. Stewart and…

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