Addiction Medicine

Physician health programs: ‘Diagnosing for dollars’?

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Source:  Clinical Psychiatry News

Please comment.

Publish date: December 5, 2017
By Dinah Miller, MD
As medicine struggles with rising rates of physician burnout, dissatisfaction, depression, and suicide, one solution comes in the form of Physician Health Programs, or PHPs. These organizations were originally started by volunteer physicians, often doctors in recovery, and funded by medical societies, as a way of providing help while maintaining confidentiality. Now, they are run by independent corporations, by medical societies in some states, and sometimes by hospitals or health systems. The services they offer vary by PHP, and they may have relationships with state licensing boards. While they can provide a gateway to help for a troubled doctor, there has also been concern about the services that are being provided.

stethoscope with lots of money

Physicians find their way to PHPs in a number of ways. A doctor whose behavior suggests impairment can be referred to the PHP by his employer, or by a licensing board, following a complaint. In these instances, participation often is a condition of employment or of continued licensure, and the PHP serves as an agent of the hospital or the state. Doctors may also be referred to PHPs for monitoring if they ascribed to having a diagnosis of psychiatric illness or substance abuse, either now or in the past, and are with or without obvious impairment. Finally, PHPs serve as a portal to treatment for physicians who self-identify and self-refer in an effort to get help. Their use is encouraged in an effort to prevent bad outcomes from mental health conditions, stress, and substance abuse, in those who are suffering in ways that would not otherwise call attention to their plights. In these situations, the PHP may serve as the agent of the patient or client, but there may remain dual-agency issues if the physician says something that leads the PHP to be concerned about the doctor’s fitness. Compliance with PHP recommendations, including drug screening, might be mandated, and physicians may resent these requirements.Louise Andrew, MD, JD, served as the liaison from the American College of Emergency Physicians (ACEP) to the the Federation of State Medical Boards from 2006 to 2014. In an online forum called Collective Wisdom, Andrew talked about the benefits of Physician Health Programs as entities that are helpful to stuggling doctors and urged her colleagues to use them as a safe alternative to suffering in silence.

More recently, Dr. Andrew has become concerned that PHPs may have taken on the role of what is more akin to “diagnosing for dollars.” In her May, 2016 column in Emergency Physician’s Monthly, Andrew noted, “A decade later, and my convictions have changed dramatically. Horror stories that colleagues related to me while I chaired ACEP’s Personal and Professional WellBeing Committee cannot all be isolated events. For example, physicians who self-referred to the PHP for management of stress and depression were reportedly railroaded into incredibly expensive and inconvenient out-of-state drug and alcohol treatment programs, even when there was no coexisting drug or alcohol problem.”

Dr. Andrew is not the only one voicing concerns about PHPs. In “Physician Health Programs: More harm than good?” (Medscape, Aug. 19, 2015), Pauline Anderson wrote about a several problems that have surfaced. In North Carolina, the state audited the PHPs after complaints that they were mandating physicians to lengthy and expensive inpatient programs. The complaints asserted that the physicians had no recourse and were not able to see their records. “The state auditor’s report found no abuse by North Carolina’s PHP. However, there was a caveat – the report determined that abuse could occur and potentially go undetected.

“It also found that the North Carolina PHP created the appearance of conflicts of interest by allowing the centers to provide both patient evaluation and treatments and that procedures did not ensure that physicians receive quality evaluations and treatment because the PHP had no documented criteria for selecting treatment centers and did not adequately monitor them.”

Finally, in a Florida Fox4News story, “Are FL doctors and nurses being sent to rehab unnecessarily? Accusations: Overdiagnosing; overcharging” (Nov. 16, 2017), reporters Katie Lagrone and Matthew Apthorp wrote about financial incentives for evaluators to refer doctors to inpatient substance abuse facilities.

Dr. Dinah Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press, 2016)

Dr. Dinah Miller

“Medical professionals who enter the programs must pay for all treatment out-of-pocket, which could add up to thousands of dollars each year. There are also no standards on how much treatment can cost.”The American Psychiatric Association has made it a priority to address physician burnout and mental health. Richard F. Summers, MD, APA Trustee-at-Large noted: “State PHPs are an essential resource for physicians, but there is a tremendous diversity in quality and approach. It is critical that these programs include attention to mental health problems as well as addiction, and that they support individual physicians’ treatment and journey toward well-being. They need to be accessible, private, and high quality, and they should be staffed by excellent psychiatrists and other mental health professionals.”

PHPs provide a much-needed and wanted service. But if the goal is to provide mental health and substance abuse services to physicians who are struggling – to prevent physicians from burning out, leaving medicine, and dying of suicide – then any whiff of corruption and any fear of professional repercussions become a reason not to use these services. If they are to be helpful, physicians must feel safe using them.

Dr. Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press, 2016).

“Weasel Phrases,” “Framing” and “Data-Dredging” is Not Science: Making the Data Fit the Hypothesis in the Rehab Racket

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Screen Shot 2014-12-30 at 1.12.01 AMPrinciples of Addiction Medicine devotes a chapter to Physician Health Programs. Written by Paul Earley, M.D., FASAM,1 Earley states that the lifetime prevalence of substance abuse or addiction in physicians found by Hughes2 is “somewhat less than the percentage in the general population reported by Kessler” of 14.6%.3

Although he specifies the numerical percentage “in physicians at 7.9%,”3 he avoids the use of numbers (14.6%) in the general population. He instead uses the qualifier “somewhat less.” Why is this?

My guess is because it understates the statistical fact that the prevalence found by Kessler in the general population was almost twice that found by Hughes in physicians.

You see, “Somewhat less” is a “detensifier.” It creates an impression of a small disparity between doctors and the general population.

In propaganda this is what is known as a “weasel phrase.”   Weasel phrases are used to obfuscate the truth.   Weasel phrases mislead those either without the time, or without the sense to see or look any deeper. The problem is it works.

“Methodologic differences may account for this difference,” Earley states, as the Hughes study “surveyed 9, 600 physicians by mail” and “relied on honest and denial-free reports by the physicians; the Kessler study utilized face-to-face interviews with trained interviewers.”1

This is an example of language framing. Language framing uses words and phrases to direct attention to a point of view to advance a vested interest.

In this case the use of the phrase “honest and denial free” in the context of physician reporting imparts associative meaning to the reader.

As denial is a recurring motif and cardinal attribute of physician addiction according to the paradigm, the connotation is that the reports by physicians may have been influenced by dishonesty and denial while face-to-face interviews done by “trained” interviewers were not.

“Framing” is another propaganda technique designed to tell the audience how to interpret the information given through context.   The message here is that the somewhat less lifetime prevalence of substance abuse and addiction in physicians found by anonymous mail survey may be underreported as a result of both methodology and denial.

But in actual fact there is a large body of research regarding “social desirability bias” that shows the converse to be true.

One of the most consistent findings of studies of this kind is that socially desirable responding is significantly more likely with face-to-face administered data collection compared with self-administered anonymous modes.4-6

Tourangeau et al. reviewed seven studies comparing self-reports of drug use in surveys conducted in different modes. For each estimate obtained in the studies they calculated the ratio of drug use reported in self-reported surveys to the corresponding estimates in interviewer administered surveys and found that 57 of 63 different comparisons showed higher levels of reporting of drug use in the self-reported mode.7

The principal cause of social desirability bias is the level of perceived anonymity of the reporting situation.7

Evidence-based research does not support Earley’s claim that methodological differences in study design explain the difference in reported lifetime prevalence of substance abuse or addiction between physicians and the general population in these two studies.

Evidence based research would, in fact, make the findings more robust.

Moreover, I find it hard to comprehend the psychodynamics, motivation, and logic of denial and dishonesty in influencing an anonymous survey. So too would anyone else who dare peer beneath the veil. It is, in fact, a Potemkin village. In reality the emperor has no clothes.

  1. Earley PE. Physician Health Programs and Addiction among Physicians. In: Ries R, Fiellin D, Miller S, Saitz R, eds. Principles of Addiction Medicine. 4 ed. Baltimore: Lippincott Williams & Wilkens; 2009:531-547.
  2. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. Jun 2005;62(6):593-602.
  4. Sudman S, Bradburn NM. Response effects in surveys: A review and synthesis. Chicago: Aldine Publishing; 1974.
  5. Tourangeau R, Smith TW. Collecting sensitive information with different modes of data collection. In: Couper MP, Baker RP, Bethlehem J, et al., eds. Computer assisted survey information collection. New York: John Wiley & Sons, Inc.; 1998.
  6. Dillman DA. Mail and telephone surveys: The total design method. New York: Wiley-Interscience; 1978.
  7. Tourangeau R, Rips LJ, Rasinski KA. The Psychology of Survey Response. Cambridge: Cambridge University Press; 2000.
  8. American Society of Addiction Medicine: Patient Placement Criteria. Chevy Chase, MD: American Society of Addiction Medicine; 2000.
  9. Merlo LJ, Gold MS. Successful Treatment of Physicians With Addictions: Addiction Impairs More Physicians Than Any Other Disease. Psychiatric Times. 2009;26(9):1-8.

The “Impaired Physician Movement” Takeover of State Physician Health Programs (PHPs)

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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 Cyril Marcus brought the problem of impaired physicians into the public eye. IMG_0940Leading experts in the field of Infertility Medicine, the twin gynecologists were found dead in their Upper East Side apartment from drug withdrawal that New York Hospital was aware of but did nothing about. Performing surgery with trembling hands and barely able to stand, an investigation revealed that nothing had been done to help the Marcus brothers with their addiction or protect patients. They were 45 –years old.

Top: Twin Gynecologists Stewart and Cyril Marcus Bottom: The Movie

Although the New York State Medical Society had set up its own voluntary program for impaired physicians three years earlier, the Marcus case prompted the state legislature to pass a law that doctors had to report any colleague suspected of misconduct to the state medical board and those who didn’t would face misconduct charges themselves.

Physician Health Programs

Physician health programs (PHPs)  existed in almost every state by 1980. Often staffed by volunteer physicians and funded by State Medical Societies, these programs served the dual purpose of helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referral.

As an alternative to discipline the introduction of PHPs created a perception of medical boards as “enforcers” whose job was to sanction and discipline whereas PHPs were perceived as “rehabilitators” whose job was to help sick physicians recover. One of many false dichotomies this group uses and it is perhaps this perceived benevolence that created an absence of the need to guard.

Employee Assistance Programs for Doctors

Physician Health Programs (PHPs) are the equivalent of Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess, and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems.

Most EAPs, however, were developed with the collaboration of workers unions or some other group supporting the rights and best interests of the employees. PHPs were created and evolved without any oversight or regulation.

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The American Society of Addiction Medicine can trace its roots to the 1954 founding of theNew York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D whose husband died from alcoholism.

The society, numbering about 100 members, established itself as a national organization in1967, the American Medical Society on Alcoholism (AMSA).

By 1970 membership was nearly 500.

In 1973 AMSA became a component of the National Council on Alcoholism (NCA) in a medical advisory capacity until 1983.

But by the mid 1980’s ASAM’s membership became so large that they no longer needed to remain under the NCADD umbrella.

In 1985 ASAM’s first certification exam was announced. According to Dr. Bean-Bayog, chair of the Credentialing Committee, “a lot of people in the alcoholism field have long wanted physicians in the field to have a high level of skills and scientific credibility and for this body of knowledge to be accredited.”2 And in 1986 662 physicians took the first ASAM Certification Exam.

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By 1988 membership was over 2,800 with 1,275 of these physicians “certified” as “having demonstrated knowledge and expertise in alcoholism and other drug dependencies commensurate with the standards set forth by the society.”3 “The formation of State Chapters began with California, Florida, Georgia, and Maryland submitting requests.4

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In 1988 the AMA House of Delegates voted to admit ASAM to the House. According to ASAM News this “legitimizes the society within the halls of organized medicine.”2

By 1993 ASAM had a membership of 3,500 with a total of 2,619IMG_8919certifications in Addiction Medicine. The Membership Campaign Task Force sets a goal to double its membership of 3,500 to 7,000 by the year 2000 to assure “the future of treatment for patients with chemicals. It represents a blueprint for establishing addiction medicine as a viable entity.”5

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Many of these physicians joined state PHPs and over time have taken over under the umbrella of the FSPHP.

Others became medical directors of treatment centers such as Hazelden, Marworth and Talbott.

  1. The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA : the journal of the American Medical Association. Feb 5 1973;223(6):684-687.
  2. Four Decades of ASAM. ASAM News. March-April 1994, 1994.
  3. . American Medical Society on Alcoholism & Other Drug Dependencies Newsletter. Vol III. New York, NY: AMSAODD; 1988:12.
  4. . AMSAODD News. Vol III. New York, NY: American Medical Society on Alcoholism & Other Drug Dependencies; 1988.
  5. Membership Campaign Update. ASAM News. Vol VIII: American Society of Addiction Medicine; 1993:11.

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johnnyLawrence

Fellows of ASAM–From Medical Whistleblower Advocacy Network

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Screen Shot 2015-10-08 at 12.21.49 AMFrom Medical Whistleblower Advocacy Network

Members of the American Society of Addiction Medicine (ASAM) can be recognized by the letters “FASAM” as part of their professional credential, with the “F” designating “Fellow of.”   ASAM supports research that furthers their financial goals and expands use of the ASAM principles of addiction treatment.  The ASAM wanted to create a new “Board” specialty in order to control federal grant funds and other public financing.   American Society of Addiction Medicine certification (FASAM) is not equivalent to medical board certification. On their website the ASAM admits that its “examination is not a Board examination. ASAM is not a member of the Board of American Board of Medical Specialties, and ASAM Certification does not confer board Certification.” [i]

The American Society of Addiction Medicine (ASAM) is has never been recognized by the American Board of Medical Specialties (ABMS) as a board specialty. There are professional organizations which provide “Board Specialty” training in medicine and psychiatry.  These organizations have clear and stringent guidelines as to who earns the honor and professional status as a “boarded” expert. Credentialing in these specialties as an MD is a challenging process that weeds out those without adequate clinical or academic skills. These ABMS recognized medical specialties include: pediatrics, geriatrics, surgery, psychiatry, neurology, internal medicine, urology, cardiology, anesthesiology, gastroenterology, emergency medicine, radiology, respiratory medicine, endocrinology and many others.

The field of psychology also defines strict guidelines for board certification.  The American Board of Professional Psychology was incorporated in 1947 with the support of the American Psychological Association. The ABPP is a unitary governing body of separately incorporated specialty examining boards which assures the establishment, implementation, and maintenance of specialty standards and examinations by its member boards. Through its Central Office, a wide range of administrative support services are provided to ABPP Boards, Board-certified specialists, and the public.  Specialization in a defined area within the practice of psychology connotes competency acquired through an organized sequence of formal education, training, and experience.  In order to qualify as a specialty affiliated with the ABPP, a specialty must be represented by an examining board which is stable, national in scope, and reflects the current development of the specialty.  A specialty board is accepted for affiliation following an intensive self-study and a favorable review by the ABPP affirming that the standards for affiliation have been met. These standards include a thorough description of the area of practice and the pattern of competencies required therein as well as requirements for education, training, and experience, the research basis of the specialty, practice guidelines, and a demonstrated capacity to examine candidates for the specialty on a national level.

In contrast to these accepted board credentials, ASAM certification [ii] requires only a medical degree, a valid license to practice medicine, completion of a residency training program in ANY specialty, and one year’s full time involvement plus 50 additional hours of medical education in the field of alcoholism and other drug dependencies.  ASAM does not require any specific formal training or experience in the diagnosis and treatment of physical or mental illness.  But regardless of the lack of training in these fields, the state physician health programs have extended their outreach into areas in which they have no professional qualifications.  In most of today’s state physician health programs, “Regardless of setting or duration, essentially all treatment provided to these physicians (95%) was 12-step oriented.” [iii]  In these programs, ASAM practitioners routinely impose their spiritually-based 12-step abstinence recovery program.  This system is imposed on medical professionals through threats to remove medical licenses or curtail practice or hospital privileges.

[i] American Society of Addiction Medicine, ASAM.org,http://www.asam.org/ExamHistory.html.

[ii]  The ASAM certification process now included board certification by the ABAM. http://www.asam.org/Certification_home.html  In 2009, The American Society of Addiction Medicine (ASAM) transferred the certification examination to the American Board of Addiction Medicine (ABAM), and the next examination will be offered by ABAM on December 1, 2012 and in subsequent years.  A physician certified by ABAM is board certified. For More information please visit the ABAM Web site at www.abam.net.

[iii] DuPont, R.L.; McLellan, A.T.; White, W.L., Merlo LJ, Gold MS.  Setting the Standard for Recovery: Physicians’ Health Programs, Journal of Substance Abuse Treatment.  2009;36:159-171.

Transparency and Legitimacy Needed in Addiction Medicine—Answerability and Accountability Absent in Current Paradigm

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The Medical Profession, Moral Entrepreneurship, Moral Panics, and Social Control.

 “Few, no matter how desperate, seek help of their own accord.”  says Dr. Marv Seppala, M.D., Chief Medical Officer at Hazelden, one of the “PHP-approved” drug and alcohol assessment and treatment centers located in Center City, Minnesota.  “Physicians are intelligent and skilled at hiding their addictions.”

“They’re 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.”

In reality this is ludicrous–knee slapping absurd.   If the results of this authoritative opinion were not so dire these statements would, in fact, be comical.   Such is not the case, however, and opinions like Seppala’s have been taken at face value and, as a result, the aftermath has been and continues to be tragedy.IMG_0706

Addiction, alcoholism and substance abuse to any significant degree produce both physiological and behavioral manifestations in the user. It is cause and effect.  Pathophysiology conforms to law of nature and not the whims of the impaired physician movement.

What anomalous  aspect of intelligence or special skill set would enable a doctor to hide an addiction?

The ASAM definition of addiction is characterized by cognitive, behavioral and emotional changes which include “impaired control” so how would intelligence rein it in?  Furthermore, what unique logical, rational, analytical, factual, abstract, intuitive or objective aspect of intelligence is responsible for this preternatural fortitude?

How is the intelligence of a doctor any different from the intelligence of any other human being?  And what prodigious abilities do doctors have that enable them them to cloak the  behavioral manifestations and stave off the physical consequences chemical addiction to such a degree that they are able to maintain the facade of being  “described as the best workers in the hospital?”  Is it an innate inborn endowment or an esoteric knack acquired during medical training?

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What ability and artistry would allow a profession to weave such a web of fortitude that they can convincingly shroud the myriad signs and symptoms of drug and alcohol abuse unlike the regular folk?    Perhaps access to ophthalmic vasoconstrictors and beta blockers to temper the pupillary dilation and tremulousness associated with stimulants or botox and a testosterone patch to mask the skin changes and maintain lean muscle mass in the throes of alcoholism?

How does overworking “protect their supply” and why would they keep it at the hospital?  These people have prescription pads and last I checked there were no cocktails shakers or bottles of Jameson in the doctors lounge.

And for the life of me I cannot comprehend why an alcoholic or addict doctor would sign up for extra call and show up for rounds on his day off.  What would be the point?

In reality a doctor with a drug or alcohol problem would be erratic with call and show up late for rounds.

This is just another example of authoritative opinion with no substantive value. It is moral entrepreneurship at its finest; the fallacy of appeal to authority and secret knowledge.

If Seppala were asked to provide the evidence-base and rationality of these statements he would be hard pressed to do so.  The question would be met with deflection, logical fallacy, references to the opinions of like minds and thought-stopping memes.  “You need a check-up from the neck up,”  your best thinking got you here,”  there is no “I” in “team,” “denial isn’t just a river in Egypt.”  Oh, yeah?   well “Rogue” isn’t just a river in Oregon and, while we are at it, “Boring” isn’t just a town!

It is this type of misinformation and propaganda that allows the “impaired physician movement” to  drag away the “best worker in the hospital” and deem him “in denial.”

“We were so surprised. We didn’t even know he had a problem”  say the nurses, patients and colleagues left behind.

Well the truth is he probably didn’t!

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Blind-faith and unquestioning allegiance to expert authority deflects scrutiny and analysis.  Few red flags are raised as this type of moral preening promotes misguided plausibility and complacency in the belief that these are indeed experts with good intentions. This needs to be addressed.

But if you look at any of the current “moral panics” that are being used to suggest random suspicion-less drug testing of doctors or promoting the Physician Health Programs as successful and replicable models, you will inevitably find a doctor on this list behind it. It is a given.

And the invitation goes out to Seppala to debate this in a public forum on a level playing field.    Not gonna happen because it would be impossible for him to address and answer the questions rationally,  directly and with any tiny scrap of evidence based data.  This is being shown clearly on Medscape as both the Federation of State Physician Health Programs (FSPHP) and the American Society of Addiction Medicine (ASAM) remain silent despite the mounting horror stories from doctors diagnosed with pathology when none existed who were forced into treatment they did not need.  Diagnosis rigging, forensic fraud, lack of due process and all manner of abuse are being reported but as an organization with power maintained by by lack of accountability and secrecy they will not and cannot answer.  It is time we identify these groups as illegitimate and irrational authority and demand transparency and legitimacy.

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Robin Williams Melancholy Suicide–Hopelessness, Helplessness and Defeat

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Published one year ago on DisruptedPhysician.com/blog.  Although more details have been revealed the premise of the post remains the same. Depression, as with any mental illness, needs to be diagnosed, monitored and treated by educated, trained and experienced experts in depression. Not self-proclaimed experts.  
 
There’s something in his soul
O’er which his melancholy sits on brood,
And I do doubt the hatch and the disclose
Will be some danger—which for to prevent,
I have in quick determination……..
It shall be so.    Madness in great ones must not unwatched go.
—Hamlet Act III, Scene 1
According to Radar Online Robin Williams is looking “grim and focused.”  Grim? Yes. Focused? No.  His visage is one of entrapment, despair, and dread.
In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”   This is not focus but melancholia–hopelessness, helplessness, and defeat.
In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract.”  Williams’ face  is weighted with melancholy. Not focus.

Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life  experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

As in all suicidal tragedies, the role of addiction and mental illness has been posited as the cause. Although depression and substance abuse are the two biggest risk factors for suicide, neither explains  completion of the act–the descent from ideation and planning to finality and oblivion.  Saying suicide is caused by depression and drugs is like claiming marijuana is a “gateway drug” to heroin.  It may be a a common related  pre-conditional occurrence but it is not the cause.  It is a non sequitur.   And just as most marijuana users never develop an inclination to stick an opiate filled needle into their veins, the majority of depressed individuals and substance abusers do not kill themselves.   One does not lead to the other.

And as we have seen in the reports of bullied teenagers who have died by suicide, it is all too often the bullies themselves who are quickest to pronounce this conclusion.   Attributing suicide to mental illness and substance abuse deflects culpability.  It negates the need for further inquiry.  It creates an absence of the need to change.   The rationalization diffuses both individual and collective blame.   It scatters  responsibility and guilt.  It is both an individual and community defense mechanism.  Incessantly and chronically shaming, humiliating, and degrading another person because of race, body type, sexual preference or whatever perceived eccentricity or non-conformity threatened the community herd was irrelevant.  It played no role.  It was drink, drugs, or depression–the unspoken understanding is  they would have done it anyway.   And no one stops to ponder that said depression or desire to alter ones mental state just might in actual fact be a symptom of the humiliation and shame they themselves created.   And it works.  The bullies are never held accountable. But it is nevertheless they who figuratively loaded the gun, placed it in the victims mouth, and pulled the trigger.

The  link between bullying and suicide is well known,  especially when combined with entrapment and the feeling there is no way out.  “They would have done it anyway.” No, they would not have and a modicum of perceived support, concern, kindness and understanding  from others may have prevented it.

Dr. Drew Pinsky seemed omnipresent in discussing Williams suicide; delivering authoritative pronouncements with seeming omniscience and certainty.     “The death of Robin Williams has led me to this plea — let’s loudly and seriously address something that’s still hidden, stigmatized and even ignored in this country: Mental illness,” Pinsky writes on his blog.  I don’t see the logic here.  How is exposing mental illness a product of Williams suicide.  He was  open, unashamed, and forthright about his prior addictions and depression.  He was not hiding it.  Neither is the 21st century for that matter.

The more important issue that I see needs pleading, is that mental illness be properly, accurately, and thoughtfully diagnosed and treated.

Depression, as with any mental illness, needs to be diagnosed, monitored, and treated by educated, trained, and experienced experts in depression.   Not self-proclaimed experts.     Pinsky’s specialty is “addiction medicine” and he is “board certified” by the American Board of Addiction Medicine (ABAM).

The American Society of Addiction Medicine can trace its roots to the 1954 founding of the New York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D.,  whose husband died from alcoholism. This  group promoted the concept of alcoholism as a chronic relapsing brain disease requiring lifelong spiritual recovery through the 12-steps of AA. And the primary goal of the ASAM is and always has been the acceptance of 12-step doctrine, lifelong abstinence, and spiritual recovery as the one and only treatment for addiction.  It always will be.

This philosophy and guiding doctrine stems from the “impaired physician movement”, a group that,  according to British sociologist G.V. Stimson: ” is characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”  This group grew in numbers, organized, and eventually became the ASAM.

The American Board of Medical Specialties (ABMS)  recognizes 24 medical specialties and subspecialties. Addiction Medicine is not one of them. The only ABMS recognized subspecialty is Addiction Psychiatry and it requires a four-year psychiatric-residency program followed by a 1-year Fellowship focusing on addiction in an accredited training program.

In contrast, ABAM certification requires only a medical degree, a valid license to practice medicine, and completion of residency training in ANY specialty.

Hazelden, the facility where Williams was admitted in July is an ASAM facility.  And the  Medical Director, Marvin Seppala is a Like-Minded Doc.   Unlike most ASAM physicians, however, Seppala is a psychiatrist. But he is a psychiatrist brought up in the folds of ASAM ideology. He was, in fact, the first adolescent graduate of Hazelden in the 1970s when he completed the program at the age of 19.

Pinsky, predictably goes on to state that “Williams had a brain disease, ” He posits it against demons or devils as if it is either/or.  This concrete splitting of complex subjects into two separate entities to claim only one correct is just one of many simplistic and misleading “false dichotomies” used by the ASAM.     Of course addiction is a brain disease.    But in reality the definition is unhelpful unless we are living in the Victorian era. It’s like saying Gonorrhea is a genital disease  not  venereal (from Latin venereus “of sexual love”).  In reality it involves a number of factors including both psychosocial and medical.  Cornering a definition does nothing to advance knowledge and care.

Addiction is multifactorial and diverse. Simplifying it into binary options does little to advance understanding.   And it too involves a variety of issues including the situational, the psychosocial, the genetic and the biochemical.   Like every other medical issue there are a number of factors to be taken into consideration.  And imposing the 12-steps to salvation on all-comers is not only illogical, but anti-science, and downright improper.    It can also be deadly.  Especially when the the person it is imposed on is not a full-blown addict but a substance abuser. an experimenter, a dabbler, or someone who has simply had a “lapse.”

The ASAM emphasizes that addiction is a “brain disease” and not a “moral failing” in a mutually exclusive construct that allows either one or the other but not both.  It is presented as a dichotomy in which the promotion of one both precludes and dismisses the other.  It is either black or white. Period.

But substance use, abuse, and addiction comes in every color, saturation, hue and shade.   Psychosocial, behavioral, and social factors play a role in the actions and deeds of everyone including those addicted to alcohol and drugs.  The disease concept neglects this multifactorial confluence of factors that ultimately produce a given behavior by viewing all behavior a product of the “disease.”   Any and all behavior is simply a product of a “brain disease” in the addicted individual who cannot be trusted to make decisions on his own but has to be told what to do as part of the treatment.   A danger to himself and others  the addict cannot be trusted to make his own decisions, so we must make them for him.

The chronic brain disease model is an oversimplification of the complex and a false dichotomy–so too is bifurcating  “recovery” and “relapse,” treatment” and  “discipline,”  and “confession”and “denial.”  Anything less than total abstinence constitutes an illness.

One true dichotomy  that exists among the proponents of the chronic brain disease model of addiction with  lifelong abstinence and spiritual recovery is  a  person is either “with them” or “against them.”

Dr. Drew Pinsky notes “there were a number of factors” that contributed to William’s condition.  He states “alcoholism is certainly one. He may have had a genetic potential for depression. Addiction and depression can be an easily fatal combination.”    Non-sequitur.

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Depression needs to be treated by thoughtful, educated, competent and trained experts in depression not self-declared experts.    ASAM doctors are not “real” experts.  They are pretend experts trumpeting one frozen paradigm while dismissing or ignoring others.  It is expert opinion where the goal is not new knowledge and and new discovery. The die  is cast.  And most of the “research” put out by this group consists of methodologically unsound studies published in their journals in which an attempt is made to make the data fit an already determined hypothesis.

Point being that depression needs to be evaluated and treated by trained professionals who understand depression. Psychiatrists, psychopharmacologists, neuropsychologists, and psychologists schooled in a broad spectrum of treatment modalities.   Numerous depression treatments are available.  If one treatment fails or is ineffective then others must be tried.    Most depression is treatable, especially subacute or acute depression.  SSRIs, SNRIs SNDRIs, tricyclics, MAOs, and atypical antidepressants are available. Different types of psychotherapy are available–cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, mindfulness therapy, and Jungian psychoanalysis can be beneficial for people suffering from depression.  And ECT and TMS can also play a role in depression refractory to medications and psychotherapy.

Depression is extremely common in Parkinson’s disease but due to the dopamine loss it requires special consideration of what drugs to use and not use.  SSRI’s can sometimes worsen the condition.   Consultation with a knowledgable and experienced neurologist is critical.

I do not know what assessments or treatments were being tried in Robin Williams.   But the treatment modalities offered by ASAM physicians are usually few to one.

The majority of “addiction medicine” specialists are not psychiatrists.   For all you know you may find yourself being treated by an addiction  “specialist” who was a practicing proctologist just a few years prior; and perhaps not even a good one at that.

Moreover, many of the ASAM physicians are “anti-medication” and may take people off medications that have been helping them and that they need.   And the devastating results are often  seen after the patient has been discharged home.

Taken off drugs while in rehab and sent home without them, the beneficial effects may wear off gradually. And as they do mental conditions may deteriorate.   Manic episodes, paranoid psychoses, extreme anxiety, and profound depression can all occur well after someone has been discharged home.   So can suicide.

And when this happens the ASAM doctors  blame it on their fatal “disease” when, just as is seen with the suicides of bullied teens, it was actually they  who put the gun to their heads and pulled the trigger.

Depression needs to be treated by experts in depression.   Putting someone in a one-size fits all shackled and frozen mold can be fatal.  And calling them  helpless addicts with a chronic disease who have no control due to character defects adds kindling to the fire.  Depressed people need empowerment not powerlessness;  self-esteem not shame.  Shame is devastating. It goes right to the core of the person’s identity making them feel exposed, inferior, and degraded.  Dehumanized, delegitimized, and vulnerable.  The link between bullying and suicide is clear.  And this is especially true when combined with entrapment.  The feeling there is no way out.

When society gives power of diagnosis and treatment to individuals  within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.   And it can be fatal.

Under a dictatorship everything else becomes subordinated to the guiding philosophy of the dictatorship.   Corresponding doctrine replaces ethics as well as professional guidelines, standards of care, and evidence based medicine.  Ideology usurps critical thinking.  Having only a hammer, everyone is seen as a nail  A symphony with just one note.

And faith in institutions demands mass adherence to faith in that authority. Direct challenge to the status quo undermines the publics blind faith. The biggest obstacle is thimages-4at this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration.

All of medicine needs to be predicated on competence, thoughtfulness, good-faith, civility, honesty, and integrity. This is universally applicable.  All specialties of medicine are required by that specialty to practice evidence based medicine and avoid conflicts of interest except one–addiction medicine.  Due to a confluence of factors they have been given a pass.

But the validity and reliability of opinions lie in their underlying methodology.  Reliance on the personal authority of any expert or group of experts is a logical fallacy.

And in order to save American Medicine this  problem needs to be clearly recognized.  The ASAM has a monopoly on addiction medicine. Treatment of substance abuse in this country is, in fact, defined by the impaired physicians movement paradigm.

A paradigm that is in actuality rife with methodologically flawed studies, cherry picking, bias, and cognitive distortion.  A paradigm that places expert opinion, ideology, and doctrine above critical thinking and evidence base.   Coercion and control are placed above patient autonomy and individual choice because the patient has a “disease” and can’t think for himself.  So we’ll think for him.    The  conflicts of interest are many and complex. They would be unimaginable in other fields of medicine.

But  I agree with Pinsky on one point.  His  comment that addiction and depression can be a deadly combination is true. And this is especially so when treatment of the addiction is the primary focus and consists of imposed 12-step indoctrination and the depression remains untreated or ineffectively treated.    That is a deadly combination indeed–and one that can easily lead a person down the road of hopelessness, helplessness, and despair. And it is time the medical field as a whole shined some light on this.  Let’s hold addiction medicine to the same standards of conduct and care as the rest of the profession.

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Question Authority: The Need for Anti-Authoritarians in the Medical Profession

mllangan1 15 Comments
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Anti-authoritarians question whether an authority is a legitimate one before taking that authority seriously.  images-24To evaluate the legitimacy of  an authority it is necessary to:
1. Assess whether they actually know what they are talking about.   2. Assess whether the authorities are honest in their intentions.
When anti-authoritarians assess an authority to be illegitimate, they challenge and resist that authority.
There is a paucity of anti-authoritarianism in the medical community concerning groups that have gained tremendous sway in the regulation of the medical profession.    There is, in fact, an absence of anti-authoritarian questioning  of  what is essentially illegitimate and irrational authority.
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Most doctors are unaware of the impact these organizations have had on both the regulation of the medical profession and social control of individual doctors.  Through “moral entrepreneurship” and “bent science” these groups have successfully swayed both policy-makers and the public to support an agenda not supported by reality testing or critical thinking.  This acceptance without investigation has led to a deterioration of professional ethics and evidence-based decision making in the regulation of the medical profession.
 In order for these organizations to maintain power it is necessary that their authoritative opinion remain unquestioned and unchallenged.  Consciously manufactured propaganda has persuaded regulatory and public opinion of their value and to maintain power it is necessary that this authority remain insulated from outside evaluation because the entire system is based on assumptions that can be aptly characterized as “illusions.
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The dogmatic statements and abusive generalizations do not conform to reality.
Everything is adapted to an existing stagnant cognitive system that falls far off the map of the scientific approach to information and evidence based medicine.  Perceiving only confirmations the physician health paradigm embodies and expresses preconceived ideas, values and mentalities based on certitude and absolute truth.

If one looks behind the curtain there is not much there.   Screen Shot 2015-06-16 at 3.39.59 AM

Historical, political, economic and social analysis can all show how the construct that exists today came to be.   This can be factually ascertained by simple reasoning and examination of the documentary evidence.

Any one of these analyses would reveal that the “PHP-blueprint” is a false-construct built on circumnavigation and obfuscation.

An evidence-based scrutiny of the literature would reveal it to be invalid and of little probative value.  A public policy analysis would reveal the logical fallacies involved in trumpeting  their positions including exaggerated rhetoric and  fear monitoring strategies designed to inspire moral panics and exploit fears to further an underlying political agenda

Any critical analysis would reveal cherry picking. proof by anecdote, deceptive propaganda, double talk, contradictory, illogical and incomprehensible jabber,  unprovable and  un-disprovable statements and a panoply of logical fallacy.

These groups  misrepresent, censor and suppress. They  nit pick and split hairs.  Screen Shot 2015-06-16 at 3.40.37 AMThe concept of denial is not just used to force people into treatment and justify abuse during treatment but  to suppress specific questions and deliberately avoid key facts.

So why are we not questioning this “authority?”     They have been left alone and basically thrown in the backyard left to proliferate like feral cats.

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We need anti-authoritarians and we need them now.

I need allies before the door closes for good. And that door may be closing a lot sooner than you think!

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“Addiction Medicine” is not recognized by the American Board of Medical Specialties (ABMS)–It is a “self-designated-practice specialty” (SDPS) and indicates neither knowledge nor expertise.

mllangan1 6 Comments

V0011377 A quack doctor selling remedies from his caravan; satirizingEducational and Professional Standards in Medical Specialties and Subspecialties

The increasingly rapid growth and complexity of medical knowledge in twentieth century American medicine resulted in the creation of specialties and subspecialties.

A related development was the creation of “boards”  to “certify” physicians as  knowledgeable and competent in the specialties and subspecialties in which they claimed to have expertise.   The American Board of Ophthalmology, organized in 1917, was the first of these.

As the number of medical specialties proliferated an umbrella organization was formed to accomplish this task. The Advisory Board for Medical Specialties was created  in 1933 and reorganized as the American Board of Medical Specialties (ABMS) in 1970.  This non-profit organization oversees board certification of all physician specialists and sub-specialists in the United States.

The ABMS recognizes 24 medical specialties in which physicians can pursue additional training and education to pursue Board Certification.Screen Shot 2014-11-07 at 7.44.56 PM

In 1991 the American Board of Medical Genetics was approved as the 24th ABMS board and these 24 boards grant the  37 general certificates and 88 subspecialty certificates available to medical specialists today.

The ABMS Member Boards are responsible for developing and implementing the educational and professional standards for quality practice in a particular medical specialty or subspecialty and evaluate physician candidates for Board Certification.  They set the bar of knowledge and competence for their given area of expertise.

All of the ABMS Member Boards are:

“committed to the principle of examining doctors based on six general competencies designed to encompass quality care: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.”

These areas have been collectively identified by the ABMS, the American College of Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) in order to standardize graduate medical education in any specialty  from medical school graduation through retirement.1

One of the  24 medical specialties ABMS recognizes in which physicians can pursue additional training and education and pursue Board Certification is Psychiatry.

Founded in 1934, The American Board of Psychiatry and Neurology (ABPN) is one of the 24 ABMS specialty boards. In 1959, the ABPN issued its first subspecialty certificate in Child and Adolescent Psychiatry and was the only ABNP subspecialty until 1991 when the first examination in Geriatric Psychiatry was administered.4 Addiction Psychiatry became a subspecialty of ABPN in 1993.

The ABPN governs the specialty of Psychiatry, of which Addiction Psychiatry is a subspecialty.   Board Certification in Addiction Psychiatry requires a four-year psychiatric-residency program for training in the prevention, diagnosis and treatment of mood, anxiety, substance-abuse as well as other psychological and interpersonal problems followed by an additional year of training in one of the 40 accredited Addiction Psychiatry Fellowship programs. The Accreditation Council for Graduate Medical Education (ACGME) is the professional organization responsible for the accreditation residency education programs in the US for ABMS specialty and subspecialty areas of medicine. Addiction Psychiatry training programs are governed by the ACGME and graduates are eligible for ABPN Certification in Addiction Psychiatry.

When this rigorous education and training is complete a candidate is Board Eligible and can then take the subspecialty certification exam. The exam assesses competency in the dand consultation, pharmacotherapy, pharmacology of drugs, psychosocial treatment and behavioral basis of practice to be Board Certified in the subspecialty of Addiction Psychiatry by the ABPN.

Candidates must then be assessed in  a number of areas including psychiatric evaluation and consultation, pharmacotherapy, pharmacology, toxicology, psychosocial treatment, behavioral basis of practice, and many other areas in which for the past half-decade they where taught and apprenticed.

The current structure of residency training is little changed from when it was conceived originally by William Stewart Halsted in the late 19th Century.  Physicians acquire knowledge and skills necessary to safely and competently manage patients through apprenticeship. Training in a specialty area provides a comprehensive platform that allows medical school graduates to apply a body of knowledge to patient care and the treatment of disease. This forms the foundation of our Guild–undifferentiated and general but pluripotential.

The American Academy of Addiction Psychiatry (AAAP) is the only professional organization in the US focused on the subspecialty of Addiction Psychiatry.   The AAAP Mission Statements are to: 2

  • PROMOTE HIGH QUALITY EVIDENCE-BASED SCREENING, ASSESSMENT AND TREATMENT FOR SUBSTANCE USE AND CO-OCCURRING MENTAL DISORDERS.
  • TRANSLATE AND DISSEMINATE EVIDENCE-BASED RESEARCH TO CLINICAL PRACTICE AND PUBLIC POLICY.
  • STRENGTHEN ADDICTION PSYCHIATRY SPECIALTY TRAINING AND FOSTER CAREERS IN ADDICTION PSYCHIATRY.
  • PROVIDE EVIDENCE-BASED ADDICTION EDUCATION TO HEALTH CARE TRAINEES AND HEALTH PROFESSIONALS TO ENHANCE PATIENT CARE AND PROMOTE RECOVERY.
  • EDUCATE THE PUBLIC AND INFLUENCE PUBLIC POLICY FOR THE SAFE AND HUMANE TREATMENT OF THOSE WITH SUBSTANCE USE DISORDERS.
  • PROMOTE PREVENTION AND ENHANCE ADDICTION TREATMENT AND RECOVERY ACROSS THE LIFE SPAN.
  • PROMOTE RESEARCH ON THE ETIOLOGY, PREVENTION, IDENTIFICATION AND TREATMENT OF SUBSTANCE USE AND RELATED DISORDERS.

Self-Designated Practice Specialty :  An AMA Census Term Indicating What a Group of Doctors are Calling Themselves.

Screen Shot 2014-03-18 at 5.22.16 PMThe American Medical Association records a physician’s Self-Designated Practice Specialty (SDPS) in response to an annual credentialing survey. According to the AMA, SDPS are “historically related to the record-keeping needs of the American Medical Association and do not imply ‘recognition’ or ‘endorsement’ of any field of medical practice by the Association. SDPS refers to a self-designated specialty and this is not equivalent nor does it imply ABMS [American Board of Medical Specialties] Board Certification.a_meissen_group_of_harlequin_and_the_quack_doctor_circa_1741_faint_blu_d5585085_001h

“The fact that a physician chooses to designate a given specialty/area of practice on our records does not necessarily mean that the physician has been trained or has special competence to practice the SDPS.”3

Physicians have been able to list addiction medicine as a self-designated area of practice using the specialty code “ADM” since 1990.Screen Shot 2014-11-07 at 7.45.43 PM

In contrast to these accepted board credentials, American Board of Addiction Medicine (ABAM)  certification requires only a medical degree, a valid license to practice medicine, completion of a residency training in ANY specialty, and one year‘s full time involvement plus 50 additional hours of medical education in the field of alcoholism and other drug dependencies. The majority of American Society of Addiction Medicine (ASAM) physicians meet these requirements by “working in a chemical dependency treatment facility, taking continuing medical education courses in addiction, or participating in research.”6

The American Society of Addiction Medicine’s mission is to “establishScreen Shot 2014-11-07 at 7.47.55 PM addiction medicine as a specialty recognized by professional organizations, governments,, physicians, purchasers, and consumers of health care products, and the general public.’5   They have succeeded in doing this as many consider them to be the experts in addiction medicine including regulatory agencies.

The goal of the American Board of Addiction Medicine (ABAM) Foundation is to “gain recognition of Addiction Medicine as a medical specialty by the American Board of Medical Specialties (ABMS).”

But Addiction Medicine is currently not recognized by the ABMS.  It is still a a Self-Designated Practice Specialty and the ABAM is a Self-Designated Board.  So too is the American Academy of Ringside Medicine and Surgery, the American Academy of Bloodless Medicine and Surgery and the Council of Non-Board Certified Physicians.   But these Self-Designated Boards do not have the multi-billion dollar drug and alcohol testing and treatment industry supporting them. Addiction Medicine has deep pockets, and if the November 2014 issue of the Journal of the American Medical Association (JAMA) is a harbinger of what’s to come, this self-designated practice specialty currently being certified by a self-designated Board and bereft of anything resembling the the educational and professional standards for quality practice in a particular medical specialty or subspecialty may soon robber baron its way into acceptance by the American Board of Medical Specialties.

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One thing is for certain.  When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.  The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.

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  1. Stevens RA. In: Stevens R, Rosenberg C, Burns L, eds. History and Health Policy in the United States: Putting the Past Back in: Rutgers University Press; 2006:49-83.
  2. American Association of Addiction Psychiatry Website http://www.aaap.org/about-aaap/mission-statement (accessed 4/2/2014).
  3. American Medical Association. List & Definitions of Self-Designated Practice Specialties. August 21, 2012 http://www.ama-assn.org/ama.
  4. Juul D, Scheiber SC, Kramer TA. Subspecialty certification by the American Board of Psychiatry and Neurology. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. Spring 2004;28(1):12-17.
  5. http://www.asam.org/about-us/mission-and-goals.
  6. Tontchev GV, Housel TR, Callahan JF, Kunz KB, Miller MM, Blondell RD. Specialized training on addictions for physicians in the United States. Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. Apr 2011;32(2):84-92.
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“mail order” expertise; Diploma Mill

Irrational authority and the 21st Century Witch-Prickers

Asidemllangan1 Leave a comment

cropped-images-4.jpegThe best available evidence shows little support for any of it yet the alarmist calculations of denizens of impaired and disruptive doctors wreaking havoc on the exam floor have institutionalized the tinker toys of these self-appointed “experts.”

It is imperative the greater medical community be awakened to the actual nature of the ASAM FSPHP state physician health program agenda and apprehend the true significance of this spirituality based nanny statism. Unfortunately it may be too late as it is. Strange days have tracked us down.

Disrupted Physician

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Image“Spirituality can go hand-in-hand with ruthless single-mindedness when the individual is convinced his cause is just”

― Michela Wrong, In the Footsteps of Mr. Kurtz: Living on the Brink of Disaster in Mobutu’s Congo

The New York City Medical Society on Alcoholism  was started in the 1950s by Dr. Ruth Fox to promote AA and 12-step to doctors. This organization subsequently became the American Medical Society on Alcoholism (AMSA) and eventually the American Society of Addiction Medicine (ASAM).  Like the National Council on Alcoholism and Drug Dependence (NCADD), an organization that promotes the A.A. yet claims to have no formal ties, the ASAM is considered by many to be a front-group that purports to represent one agenda while in reality serving other interests. The ASAM can be considered both a political (prohibition, 12-step spiritual recovery) and corporate (inpatient rehabilitation facilities, drug testing industry) front group in this regard.

ASAM physicians have…

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Making the Data fit the Hypothesis is not Science: The American Society of Addiction Medicine (ASAM), “Weasel Phrases,” “Framing” and “Data-Dredging.”

mllangan1 1 Comment

This is an example of language framing. Language framing uses words and phrases to direct attention to a point of view to advance a vested interest.

In this case the use of the phrase “honest and denial free” in the context of physician reporting imparts associative meaning to the reader.

As denial is a recurring motif and cardinal attribute of physician addiction according to the paradigm, the connotation is that the reports by physicians may have been influenced by dishonesty and denial while face-to-face interviews done by “trained” interviewers were not.

“Framing” is another propaganda technique designed to tell the audience how to interpret the information given through context. The message here is that the somewhat less lifetime prevalence of substance abuse and addiction in physicians found by anonymous mail survey may be underreported as a result of both methodology and denial.

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AMSA is now known as the ASAM

But in actual fact there is a large body of research regarding “social desirability bias” that shows the converse to be true.

Disrupted Physician

Screen Shot 2014-12-30 at 1.12.01 AMPrinciples of Addiction Medicine devotes a chapter to Physician Health Programs. Written by Paul Earley, M.D., FASAM,1 Earley states that the lifetime prevalence of substance abuse or addiction in physicians found by Hughes2 is “somewhat less than the percentage in the general population reported by Kessler” of 14.6%.3

Although he specifies the numerical percentage “in physicians at 7.9%,”3 he avoids the use of numbers (14.6%) in the general population. He instead uses the qualifier “somewhat less.” Why is this?

My guess is because it understates the statistical fact that the prevalence found by Kessler in the general population was almost twice that found by Hughes in physicians.

You see, “Somewhat less” is a “detensifier.” It creates an impression of a small disparity between doctors and the general population.

In propaganda this is what is known as a “weasel phrase.”   Weasel phrases are used to obfuscate the…

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