\

American Society of

~ I Vol. VI, No. 1 January-February 1991 Publishec:J Bimonthly __

Coping with Managed Care President's Report on Specialty Status ASAM urges members to give by Jasper G. Chen See, MD } the new Policy Statement on Managed The last issue of ASAM NEWS reported that the ASAM Board has Care and to third adopted short term, intermediate, and long range goals for seeking spe­ party payers, including insurance com­ cialty status for addiction medicine. Let me outline the steps we will panics, HMO's, managed care agen­ Lake to implement the board's action. cies, and state legislators. Seep. 3 First, I should emphasize that ASAM will continue to offer certifi­ cation (and recertification) for the foreseeable future. Although there will be no 1991 exam, ASAM will contract with the National Board of Medical Examiners for the development and administration of the 1992 certification examination. Regarding our objectives for recognition of addiction medicine as a specialty, we will approach them incrementally. In the short term, through liaison with the specialty societies in the primary care special­ tics, particularly medicine, and , we will en­ courage and stimulate educational programs in addiction medicine for all . These efforts are in line with what is sometimes called the mainstreaming of addiction medicine: giving all physicians the knowledge and skills to identify addiction and intervene or refer as appropriate. In addition, ASAM will continue its efforts to foster fellowship training in the for those who seck a more focused clinical and/or research experience. Through all these effpns, we will try to encourage interest in the establishment of Certificates of Added Qualification (CAQ ) by Mem­ ber Boards of tJ1e American Board of Medical Specialties (ABMS). The American Board of Psychiatry and (ABPN) has already announced it will sc.ck ABMS approval for a CAQ in Addiction Psychi ­ atry. We have made great strides in advancing the field of addiction medicine and in promoting access to quality and c{fcctive care for the addicted patient, and we will continue to be advocates for education of all physicians because that is the most appropriate strategy to advance the field. Some society members believe this strategy will lead to (continued on P-?J

ASAM is a specialty society of physicians who are concerned about alcoholiSil,l~~nd ot~er dependencies and who care for persons affected by these illnesses. ASAM NEWS • January-February 1991 p. 2

These four physicians were elected to the ASAM Board by their respective regions. Terms: two years,1991-93.

Region VIII (West) Sandra Jo Counts, MD Barthwe/1, Graham, Seattle, WA New to Board ASAM Certification 1986 Specialty: AddictiQ~ Medicine Region VI (Midwest) Present Title: Medital D!rectot Residence XII; private practice. Andrea G. Barthwell, MD ASAM Board: Region VIii representative since 1985 ; Chicago, IL ASAM Cmtes: Chair, Section on Clinical Issuesi'\ ASAM Certification 1986 Member: Executive (since 1987), Constitution & 'Bylaws; Specialty: Addiction Medicine Former Member: Present Title: Medical Director, Credentialing, Interventions. Certification, ASAM Cmtes:Co-chair, chair, AIDS, . Chicago Review Course; Chair, Cross-Cultural Clinical Concerns; Co-chair, ·1991 State of the Art in Addiction Medicine (Orlan­ do); Member: Methadone; Review Course. Board, Illinois Society of Addiction Medicine (ASAM state chapter).

Region Ill (Northeast) Allan W. Graham, MD St. Johnsbury, VT ASAM Certification 1986 Specialty: , Family Practice Present Title: Associate Medical Director of Founders Hall, Region IV (Ohio + Pen·n.) and Drug Treatment Program named after Dr. Bob Peter D. Rogers, MD Smith. Youngstown, OH ASAM: State chair, Vermont; Chair, Region III Annual ASAM Certification 1986 Meeting 1988. Specialty: Addiction Medicine, and Present Title: Medical Director, Addiction Services, Belmont Pines . ASAM BQard: Region IV representative since 1988; ASAM Cmtes: Chair, Child/ Adolescent; Medical Conference on Adolescent Addictions (June 20-23, 1991, Atlanta) Member: Program Cmte; Joint ASAM/NAATP Task Force for Patient Placement Criteria. ASAM NEWS • January-February 1991 p.3

ASAM Public Polley Statement Position of ASAM h·_ , anaged Care and Addiction Medicine 1. Treatment costs should be carefully monitored by provid­ «:,, ackground ers, third-party payers, and managed care agencies, but the para­ Concern over rising costs of , coupled with a mount consideration in evaluating the need for any addiction perception that much care is unnecessary or provided inefficient­ treatment service should be the therapeutic value of the service at ly, has given rise to "managed care" as a way to control expenses a given time for a given patient. in both the public and private sectors. 2. Addiction medicine services should be provided in the In this context, "managed care" refers to mechanisms by most economical manner possible, consistent with the welfare which interested third parties, such as insurance carriers, seek to and well-being of the,patient and \l,fith effective treatment of his influence the treatment decisions of practitioners and patients. or her disease state. This means treatment should be individual­ The term has been applied to health maintenance and preferred ized to match patients to the most efficient treatme~plan, and provider organizations (HMO's and PPO's) whose payment sys­ patients should have timely access to levels and modalities of tems offer incentives for providers to increase efficiency. The treatment appropriate to their condition. The confidentJalii:y of effect of such systems is to reduce costs by reducing services. patient records should be safeguarded in all cases. Perhaps the most extensive form of managed care is utiliza­ 3. The long-term benefits of individualized, comprehensive tion review that occurs not after the completion of patient treat­ treatment should be taken into account by managed care agen­ ment, but during the time treatment is in progress. Pre­ cies, and be carefully compared to any short-term savings and admission, admission, and length-of-stay reviews may be con­ long-term costs that might result from car~ of substandard quali­ ducted by telephone, by mail, by on-site chart review, or by a ty. combination of these methods. 4. Peer review should be precisely that- review by one's ASAM has identified several pertinent issues in the relation­ peers. It should be performed only by persons who are experi­ ship of managed care to addiction medicine. enced in, and knowledgeable about, addiction medicine. Written 1. Cost considerations too often outweigh considerations of standards that are uniform to all managed care operations in the what might be the most efficacious treatment for the patient. Pol­ addictions field should be developed to delineate review proce­ icies and practices of insurers place arbitrary limits on number of dures and qualifications of personnel. admissions, patient days or visits. Services are then further re- 5. Insurance coverage and benefits should be available for ·ltricted in utilization review or other managed care procedures, all recognized clinical conditions and legitimate treatment modal­ }hen patients are most often assigned to predetermined catego­ ities and settings that are recommended by the patient's physi­ ries (e.g. cocaine users versus heroin users), than considered indi­ cian. Treatment planners should consider the extent of the vidually. Such practices, especially in pre-admission screening, patient's support resources; family and home environment; the tend to reinforce the reluctance of many·addicted persons to seek nature and severity of the patient's addictive disease; and any as­ necessary health care services in the first place, with a conse­ sociated physical or problems. quent negative effect on overall quality of treatment. 6. Review should be conducted in an efficient and equatable 2. In evaluating service costs, employers, payers, and man­ manner. Extensive documentation and frequent review discus­ aged care agencies tend to focus narrowly on short-term savings, sions detract from treatment intensity and therapeutic efforts of rather than broadly on long-term savings that are achievable providers and patients. Published clinical standards, guidelines, through successful treatment and recovery. Long-term savings and criteria that are promulgated and endorsed by responsible that may be realized, for example, in reduced spending for overall professional organizations in addiction medicine should be con­ health care of the patient and family, or through increased job sistently applied as the basis for utilization review. productivity, seldom are entered into the cost-benefit equation. Direct concurrent review discussion should be reserved only 3. Because of the relative scarcity of physicians and other for those cases where an individual is atypical, or when some ex­ clinicians who are skilled in addiction medicine, there has been a tenuating circumstances must be considered. tendency to allow determinations of the appropriateness of addic­ 7. National accreditation standards should be developed for tion treatment services to be made by persons who lack experi­ organizations and their personnel involved in managed care and ence in the addictions field. The credibility of managed care or­ review of addiction treatment services. ganizations among addiction treatment providers depends on 8. An expeditious and clearly delineated appeals process whether they employ qualified personnel who can make informed should be available which provides 'for an arms-length recommendations for coverage and reimbursement. independent professional assessment entity that is separate from, 4. The interface between cost containment decisions and but collaborative with, the managed care agency and third-party clinical decisions involves complex ethical and quality-of-care is­ payer. sues. Recommendations on length-of-stay and levels of care by 9. Appropriate governmental regulation of managed care managed care agencies often are tantamount to practicing medi­ agencies is recommended to assure that standards are maintained. -:ine. While physicians, , and other professional and in­ Adopted by the• ASAM Board ;;titutional providers are subject to credentialing, accreditation, Nov. 11, 1990 and other standards of practice and licensure, managed care agen­ (4,merican ~ociety ofAddiction Medicine) cies are not held to similar accountability. I p. 4

ASAM members will choose seven of these 14 candidates for the board. Term: 1991-95. Ballots, sent in early February, are due at ASAM by March 15. Results in next newsletter Officers: President: Anthony B. Radcliffe, MD; President-Elect: Anne Geller, MD; Secretary: Jess W. Bromley, MD; Treasurer: William Hawthorne, MD. Term: 1991-93.

Name Specialty/Present Title ASAMBoard ASAM Committees (current)

Margaret Bean-Bayog, MD Psychiatry President: 1987-89 ,_ Chair: Nominations & Awards; Cambridge, MA Assistant Prof. of Psychiatry current member, Member:· Executive, ASAM Journal Harvard also in '80s Task Force

LeClair Bissell, MD Internal Medicine President: 1981-83; Chair: Ad Hoc ori Ethics; Sanibel, FL I Addiction Medicine current member, Member: Membership, Publications. author, lecturer, consultant also in '70s, '80s

Sheila B. Blume, MD Psychiatry President: 1979-81 Chair: Public Policy; Amityville, NY Director, , CD and current member, Member: Nomenclature, Publications, Cert. 1986 Compulsive Gambling Programs, also in '70s,'80s Task Force on ·specialty Status, South Oaks Hospital Joint NCNASAM Definition/Criteria

Dolores Burant, MD Addiction Medicine Chair: Fellowship; Goshen, IN Addiction Services Director, Member: Certification Council, Dual Cert. 1986 Oaklawn Hospital Diagnosis, Specialty Status Task Force.

P. Joseph Frawley, MD Internal Medicine Chair: State Chapters; Subcommittee Santa Barbara, CA Chief of Staff, Schick Shadel on Treatment Outcome; Cert. 1986 Hospital of Santa Barbara Former Chair: Finance Member: Finance, Depend., Resources & Development; Standards & Economics of Care President: CSAM.

David R. Gastfriend, MD Psychiatry Co-Chair: Members-In-Training; Boston, MA Chief, 11ass. Gen'l Hospital Member: Methadone Treatment Cert. 1988 Chemical Dependence Unit

Stanley E. Gitlow, MD Internal Medicine President: 1963-65 Chair: Publications; New York, NY Clinical Prof. of Medicine, .1971-73 Member: Constitution/ByLaws, Cert. Cert. 1986 Mount Sinai School of also member in Exam, Nomenclature, Public Policy, Medicine '60s, '70s,'80s Specially Status Task Force, ASAM Journal Task Force; NCNASAM Definition/Criteria. Recipient Annual ASAM Award '90

David Mee-Lee, MD Psychiatry/Addiction Medicine Regional Chair: &tandards & Economics of Marblehead, MA Assoc. Medical Director, Parkside Representative Care (close involvement with Cert. 1986 Medical Services Corp. (Northeast) NAATP in developing Criteria for Patient Placement) Member: Core Curriculum, Finance; Nominations & Awards; Nomenclature

J, T. Payte, MD Addiclion Medicine Chair: Methadone Treatment San Antonio, TX Medical Director, Drug Cert. 1987 Dependence Assoc. ASAM NEWS • January-February 1991 p. 5

~Name Specialty/Present Title ASAMBoard ASAM Committees (current)

Elmer Ratzlaff, MD Family+ General Medicine Former Regional Maui, Hawaii Solo private practice Represenrnti ve Cert.l986 (Canada)

Max A. Schneider, MD Internal Medicine! President: 1985-87; Chair: Constitution & ByLaws; Orange, CA Addiction Medicine current member, , ~ Member~· AIDS, CME, Executive, Addiction Medicine Medical Dir., St. Joseph Hosp. also in '70s,' 80s F-inance: International, MRO, Cert. 1986 Family Recovery Services Membership, Nicotine ~pendence, Clin. Assoc. Prof. Un. CaVIrvinc Nomination & Awards, PUblications, Ad hoc Physicians Health Customs, Task Force ASAM Journal; Joint ... NCNASAM Definition/Criteria

David E. Smith, MD Clinical Toxicology Current member; Chair: Nomenclature; San Francisco, CA Founder and Medical Director, also in '80s Member: AIDS, Executive, MRO, Cert. 1986 Haight-Ashbury Public Policy, T)sk Force Specialty Free Medical Srntus, Joint NCNASAM Defini­ tion/Criteria

James W. Smith, MD Family Practice/Addiction Med. Chair: Finance Seattle, WA Chief Medical Officer, Schick Member: Certification, Fellowship Cert. 1986 Health Services Former Chair: Washington srnte

G. Douglas Talbott, MD Internal Medicine/! Current member; Chair: Ad hoc Phys. Health Customs; College Park, GA Addiction Medicine also in '80s Member: Certification Council, Cert. 1986 President, Talbott Recovery Executive, International, Systems Nomination & Awards, Physicians ~ca~~~~~~~~~~~~~~~~~~~·~~~~~~~~~H~ea~lt~h,~T~~~k~F~or~c~e~S~pe~c~ial~~~S~rn~t~us~ PROPER PATIENT PLACEMENT an in-depth seminar on the new ASAM-NAATP Criteria for Chemical Dependency Admission, Transfer and Discharge March 14-15, 1991 Ritz-Carlton Hotel Atlanta, Georgia Southern California Permanente Learn: How uniform, reliable placement criteria can fa­ Medical Group (SCPMG) is the cilitate t>oth internal and external utilization review. nation's largest and most respected . -managed, multi-specially Participate: in hands-on exercises on how to apply the rned1ca! group. The following opportuniti.es are available in our criteria at each level of care, for adult and adolescent Chemical Dependency Recovery Programs (CORP). patients. TWO FULL DAYS OF TRAINING AND ADDICTION MEDICINE SPECIALIST: You will be responsible for ~roviding inpatient and outpatient detoxification DISCUSSION LED BY: care; part1c1pate 1n day treatment programs; serve as a member ol David Mee-Lee, MD, chair, ASAM Standards and an _InterdiSCiplinary case review team; and te.achfng of patients, res1dents and hospital staff. Economics of Care Committee Richard D. Weedman, MSW, FACATA, : Your time will be split between our CORP president, Healthcare Network, Inc. and general adult outpatient consultations. In conjunction with our CORP, you Will provide mental health evaluations; serve as a Registration Fees member of an interdisciplinary case review team; and teach patients and hospital staff. ASAM, NAATP Members $295. If you are inter~sted in exploring these opportunities, please call or Non-members $395. send your cumculum vitae to Irwin P. Goldstein, M.D., Associate (Fee includes a copy of the Criteria; workshop materials; Medical Director, SCPMG, Dept. 853, Walnut lunch and refreshment breaks. CME credit available.) Center, Pasadena, CA 91188-8013, 1-800-541-7946. ., TO REGISTER OR FOR MORE INFORMATION 1 I

Course directors, Atlanta (Nov. 15-17): Terry A Rustin, ~ . MD, and co-director Ken Roy, MD. Administrator was Claire Osman; credentialing manager was Eshel Kreiter, both of ASAM's New York office. "The ASAM Review Courses are really becoming an im­ 1990 Certification Exam Results pressive, professional operation," .Anne Geller, MD, chair of the Review Course Committee, told ASAM NEWS. "Things go Of the 557 ASAM members who sat for ASAM's fourth very smOQthly. The content and delivery are very good, the certification examination on December 2nd, 494 passed and 63 slides are improv,ir_!g. Ove:rall •.the Review Courses were rated (11%) failed. The number of physicians certified by ASAM is extremely highly on evaluation forms. We try to select faculty now 2,320, which is over 60% of the membership. who are the most expert in each particular areadmd by and Letters will be sent to examinees by Feb. 20. large, we seem to have succeeded." . c The exam was 300 multiple choice questions. Some were This year (1991) there will be no ASAM exam. - ASAM field test items being evaluated for use as certification items in will offer one course in Orlando, Florida, Oct. 24-26. Dr. Geller the 1992 exam; these did not count in the scoring. (New ques­ said that "State of the Art in Addiction Medicine" will present tions are developed each year to keep the exam current.) "new ideas and different perspectives." The previous "State of Over half the items which counted in scoring the 1990 the Art" was given in Oct. 1989, also in Orlando. exam were used as certification items for the first time. Reminder: the 636-page Review~ourse Syllabus, which The Department of of the University of ASAM published in Oct. 1990 and ga~e ·with other course Southern California scored the exams, and reported the item materials to all registrants, is available from the ASAM Wash­ analysis to the ASAM Examination Commiuee at its meeting in ington office. Price: $50 ASAM members, $90 non-members, January, where each question was reviewed. prepaid. This was the final ASAM certification exam to be scored by a normative method -- that is, grading on a curve. In the Annual Meeting: Boston• in April normative method, the minimum pass level is set after the scores are reported and the mean is identified. ASAM policy Vincent P. Dole, MD, will open ASAM's 22nd annual has been to set the minimum pass level at 1.2 standard devia­ medical-scientific conference on Friday, Aprill9, in Boston tions below the mean. with a fust for the society: a Distinguished Scientist Lecture. Beginning in 1992, the exam will be scored by a criterion­ Dr. Dole's is titled "Heroin Addiction as a Prob­ referenced method. This means that before the exam is scored, lem." He received the 1988 Albert Lasker Medical Research the minimum pass level will be set by a standard sett.ing pro­ Award for his laboratory and clinical research on methadone cess which is commonly used in examinations for physicians at maintenance. the certification level. The popular Rulh Fox Course for Physi.cians, offered Why the decision to move from a normative method to a Thursday April 18, will for the first time include information criterion-referenced method? To bring the ASAM certification about deaf alcoholics. Other talks will include exam more closely in line with other certification exams used addiction and withdrawal, pathologic gambling, understanding in medicine. , transference: what the add.ictionisr needs to know, addiction ASAM wiiJ offer the next certification exam in Decem­ medicine education. ber, 1992. The criteria for sitting for that exam will be re­ Those who passed the 1990 ASAM Certification viewed by the ASAM Board this April, and announced in the Exam.ination will receive their certificates in a ceremony that spring. Applications will be mailed to ASAM members in the has become an ASAM tradition at the annual awards luncheon fall; the deadline for receipt of completed appHcations will be on Saturday, April 20. Former Senator Harold E. Hughes of January, 1992. [GBJ] Iowa ~ill be the featured speaker; the Annual ASAM Award and Young Investigator awards wiiJ also be given then . • For the first time in 22 years, ASAM will sponsor this Review Courses annual meeting without the affiliation of the National Council De pile the troubled economic conditions in tbe CD field, on Alcoholism and Drug Dependence. registrations numbered between 200 and 250 each at AS .AM'~ IDAA will coordinate the AA meetings every morning "Review Course in Addiction Medicine," held last year m Chi­ and evening. Al-Anon meetings will also be available, as will cago, New York, and Atlanta. The California Society of Ad.­ rooms for other groups that want to hold 12-Step meetings. diction Medicine, an ASAM state chapter, drew over 250 to JL<> Registration packets were sent to all ASAM members at review course Nov. 8-10 in San Francisco (see ASAM NEWS the end of January. Room reservaLion cutoff is March 27; November-December issue). conference manager Louisa Macpherson urges everyone to Course directors, Chicago (Oct. 11-13,): Andrea reserve rooms early at the popular Boston Marriott Copley Barthwell, MD, and co-director Amin N. Daghestani, MD. Place Hotel. For more information call her at (919) 452-4920, Course co-directors, New York (Oct. 25-27): James Fine, or Virginia RoberLS at ASAM headquarters (202) 244-8948. MD, and Stephan J. Sorrell, MD. • ASAM NEWS • January-February 1991 p. 7

Tyson on Treatment there is no longer a family physician on that program committee. I am by Richard Tyson, MD (Dr. Tyson of Coral Springs is a former preside!ll of also aware that there is no family FSAM, the Florida state chapter of ASAM. This is a shortened physician on the ASAM Board, and version of an article in FSAM NEWS, October 1990.) few who chair ASAM committees. Since one-third of ASAM Larry Siegel recently asked me to recontact the eleven members are family physicians, the lack of family physician treatment centers which sponsored our 3rd annual conference participation on the annual meeting program committee and last January [1990] in Orlando. Most of these sponsors gave other committees represents a challenge to the current FSAM $1,000 each ... leadership of ASAM. Our steering committee met in Kansas But, in just the eight months since our conference, how the City last November and discussed the issues of in~vement economics of our field have changed! One sponsor is in bank­ with the AAFP (American Academy of Family Practice)_ as ruptcy. Another is selling off its facilities to raise c~sh. Two . well as within ASAM. We believe that unless famiiY,.physi­ are part of large chains which are in the midst of bemg consoli­ cians are involved in decision making, at both ASAM and the dated, or acquired, or merged, or are in trouble -- depending on AAFP level, it is unlikely that family medicine could be an with whom you talk. One facility just acquired additional fi­ equal partner in the plan to establish addiction medicine as a v!­ nancing to keep its operations running, but is losing a lot of able specialty or sub-specialty within psychiatry, internal medi- money. So far, five on this list have given their verbal support cine, and family medicine. ·.) for our 1991 conference, and the majority are psychiatric insti­ 1 sense that this is a critical time for ASAM. It is important tutions. for the society's leadership to recognize the increasing [Dr. Tyson told ASAM NEWS at the FSAM 4th annual frustration with the lack of primary care providers that is felt by conference, held January 18-20 in Orlando, that only two of both Congress and the public. The current system, with sub­ those five sponsors had contributed--Ed.] specialists providing much of the care, is perceived as not A large segment of our Florida membership had an addic­ meeting the health care needs of the average American. I think tion medicine practice as their principle means of support, but I the specialty of family medicine has a great deal to offer hear reports every day of salaries being chopped in half, of po­ AS AM, both at the level of the American Board of Medical sitions being consolidated, of practitioners getting out of the Specialities, as well as politically within Congress and federal field completely. policy makers. Is this the end of our field of addiction medicine as we Family medicine is likely to be an increasingly powerful have known it? While we've grappled with establishing na­ force within the medical profession and health care policy mak­ tional admission criteria, have managed care psychiatrists all ing groups. The American Board of Family Practice is the sec­ but stolen our ability to make decisions on patient care? ond largest voting block in the ABMS. Combined with the Should private inpatient treatment be allowed to wither while boards of internal medicine and , it controls more than we focus on publicly funded alternatives? Does outpatient half the ABMS votes. I think it would be to ASAM's advan­ treatment really work as effectively for most patients anyway? tage to facilitate family medicine becoming equal partners with Does treatment work? Is this all just a rrflection of the national psychiatry and internal medicine in the power structure of temperance mood? Are policy makers (whoever or wherever ASAM. they are) merely trying to force down the cost of treatment? I would like to suggest that ASAM consider the following: Within the context of these pressing economic concerns, I 1. Determine the number of family physicians who are on have to wonder what will happen to the momentum we seemed the ASAM Board of Directors, Annual Meeting Program to be gaining in our struggle to organize as FSAM (Florida So­ Commit-tee, and other ASAM committees. How does this ciety of Addiction Medicine) and to gain credibility and recog­ compare to the representation of other specialty groups? nition (through certification, training, and ultimately specialty 2. Appoint four or five family physicians to the program status). I urge you, the members to continue to support FSAM, committee for the 1992 annual meeting. Groom a family phy­ its goals, and its programs, through your direct participation. sician to chair the program committee of an annual meeting for the near future. Family Practice: • 3. Nominate a number of famhy physicians to run for the Call for Greater Role in ASAM ASAM Board of Directors. Invite some to chair ASAM by Michael F. Fleming, MD committees or subcommittees. (Dr. Fleming of Madison, Wisconsin, is chair of the new 4. Examine the distribution of specialty representation ASAM Family Medicine Specialty Section.) within the ASAM power structure. Determine that psychiatry, I want to share my concerns about family physicians' lack internal medicine, and family medicine will be, when feasible, of involvement in the decision-making structure of ASAM proportionately equal in ASAM. When a staff member at ASAM asked me to sign the I would be glad to work wilh the leaders of ASAM tore­ forms for family physicians to receive CME credits at the an­ cruit family physicians to become more active participants in nual ASAM meeting in Boston this April, I was informed that ''the leader,ship of the organization. + ASAM NEWS • January-February 1991 p.B

"Restore Your Life- a Living Plan for Sober People" by Anne Geller, MD, with M. J. Territo Publication Date: March 15, 1991 She does not use medical jar­ Bantam Books, 384 pages, $19.95. gon. Although in wide demand as a Once in a while a new book in the conference lecturer, and with a good CD field is so well written, so useful, number of publications and media and fills such an obvious need that the appearances to her credit, there is no reviewer wants to shout out the news. hint of her renown in this book. By Dr. Geller's target audience is the the end, the reader feels as if Dr. newly sober to those with three years' Geller is his or her friend and~ spon­ sor. , although she recommends the book "to anyone in recovery." Indeed, She begins the book with "What there is plenty of useful information for Happens to You Physically and Emo­ all recovering people, their families and tionally from the First Three Months friends. Through the Next Three Years" The book is disarmingly unpreten­ followed by ho,w alcohol and chugs tious. For example, her foreword affected the brairi, body, and emo­ tionallife; a living plan; establishing begins: "You're sober. You've stopped a stable mood; how to cope with drinking or using ... [which] stress; self-help groups; rebuilding family life; sober sex; sober friend­ took a great deal of courage. But did ships; jobs; relapse; physical health that single act make you a sober per­ and ; sleep; nutrition; ex­ son? ercise; smoking. The three "Speaking as a recovering appendices cover suggested reading; alcoholic, a physician, and the direc­ prescription and OTC medications to tor of the Smithers Center .. . my an­ avoid; 17 resources (mostly swer is no. To become a truly sober information centers for self-help person--someone leading a normal, groups) healthy, productive life without using I wish I'd had a copy of "Re­ mood-altering chemicals--you need a store Your Life" 23 years ago when I living plan ... a simple, organized sobered up .... [LBR] way to conduct your life ... " From there, Dr. Geller, whose • specialties are neurology and addic­ I t\...av..J~' '' Lo s s- of tion medicine, leads us through 17 Cov_ hal" ha.d todo chapters packed with information. wi+ k t\,t fo.d­ They can be browsed individually, or t{,..,. t w e Vlo ion read consecutively. She writes as a co.v-decid~ if' combination physicia, sponsor, and out- po..+i('....,ts ·~ ASAM NEWS • Subscriptions heed +o 1-e~Y~a.io, recovering friend. She illustrates her \ V'l ~e ~osp;to.l (Newsletter is mailed free to members) points with vivid, human anecdotes. ) $15/year (6 issues) Name:------Organization:.______

S1reet:, ______Stuart A. Copans, MD, a in Brattle­ City/State:------boro, VT,Jrequently contributes cartoons to Zip:____ _ ASAM NEWS such as Make check payable to ASAM NEWS. the one on the right. Mail to: ASAM-Washington Office ASAM NEWS • January-February 1991 p. 9

President's Report on Specialty Status ~ontinuedfromp . l) interest in CAQs in Addiction Medicine by ABMS-member Boards, while others believe that Boards, particularly Family Practice and Internal Medicine, do not wish to create any more CAQs than they already have. No one, however, can predict how the Boards will react as events unfold. We continue to keep our sights trained on ASAM's long term goal of seeking to establish a Conjoint Board (formed by two or more ABMS boards) under the auspices of the Ameri­ can Board of Medical Specialties; however the path to achiev­ ing an independent Board of this type is not clear at this time, even to our most knowledgeable observers. ASAM will pro­ ceed as I described above, reviewing and reevaluating our path as we move forward. Anne Geller, MD, chair of the Task Force on Specialty Status, has appointed a subcommittee of the Task Force to June 20 · identify the steps we will take. On the subcommittee, with Dr. June 23, 1991 Geller, are Drs. David Smith, David Lewis, Michael Fleming, J.W. Ma rriott Hotel at Lenox Anthony Radcliffe, and our executive director, Dr. James Cal­ Atlanta, Georgia lahan.

Note: names in boldface are ASAM• members. FORUM FACULTY CO·CHAIRPI!RSONS ·• Peter Rogers. M.D., FAAP ana Sandra Jo Counts, M.D. , FAAP

KEYNOTE SPEAl

Harrisburg, PA 17105-8820 •ooRE~;------EOE ... ASAM NEWS • January-February 1991 p. 10

SECAD 1990 in Atlanta was at the American Embassy. In 1988, a group start- The 15th annual Southeastern ed in Moscow, and in 1989, one in Kiev. By April ~ Conference on Alcohol and Drug 1990, there were 40 AA groups. Abuse, sponsored by Charter Medical One problem with AA in has been the Corporation, drew 1,400 to Atlanta issue of spirituality. AA groups close their meetings Nov. 28- Dec. 2, 1990. Over 100 registrants were physicians, with the following prayer, in lieu of the traditional Lord's as were 12 of the faculty. There were 160 exhibit booths. Con­ Prayer: ference chair was Thomas Hester, MD, of Charter Peachford "I put my hand in yours and together we can do what we Hospital. Lecture topics included psychodrama, food, elderly, could never do alomV No longer is there a sense of hopeless­ Soviet Union, AA and CD facilities, CoA's, , ness. No longer must we each depend upon our own unsteady the 12 Steps, physician's view of CD, lesbian/gay men, legal­ will power. We are all together now, reaching out'Qur hands ization of drugs, Van Gogh slide/music presentation, women, for power and strength greater than ours. And as we join family, co-dependency and violence, Afro-Americans, EAP's. hands, we find love and understanding beyond our wildest Father Martin spoke on the 12th Step, Suzanne Somers on her dreams." childhood in an alcoholic home, there were meetings of AA, Bissell, Schneider, Continue Drug Debate ACoA, NA, OA, CA, CoAnon, IDAA, and IPA (International "If just legalizing drugs were all we did, I would say no to Pharmacist Anonymous). it. My daydream: give us half the dollars being spent in the so­ Audio and videotapes of SECAD are available from called war on drugs and spend it on real-ly skillful propaganda Audio Master, 85 Queen Drive, Mableton, GA 30059. Program which we'd call education."-- Dr. Bissell No. 1128-90. Phone:(404) 948-2475. "Who would control drugs? The feds? The states, with The 16th SECAD will be Dec. 4-8, 1991, again in Atlanta. 50 different laws? Who would be liable for accidents? For Schuckit's New Data on o.d.'s? For quality control? Just fighting drug pushers is not the Sons of Alcoholics answer. We need more money for treatment and prevention, "There is very good data to make it highly likely that Grades K through 8." -- Dr. Schneider alcoholism is a genetically influenced disorder," said Marc The debate between LeClair Bissell, MD, and Max A. Schuckit, MD, of San Diego, in his first SECAD appearance. Schneider, MD, on the pros and cons respectively of legalizing He began researching sons of alcoholics (CoA's) in the late drugs, continued on November 29, moderated this time by 1970s by studying 475 men, average age 20-21. He found no John Chappel, MD. The first debate was in Phoenix at difference in how fast CoA's and controls absorbed or ASAM's annual meeting April27, moderated by Sheila B metabolized alcohol. However, CoA's did not feel as drunk Blume, MD. An estimated three-hundred were in the Atlanta after three drinks, they stayed high less long, and had high audience; participation was again enthusiastic. Highlights fol­ tolerance: 40% of them could drink their peers under the table low. (Audience comments and questions are in italics.) as teenagers. On what causes people to use drugs? Dr. Schuckit recently located 469 of the original men. Of "People use drugs because they work. When you try to these, 98% have agreed to be followed VP· He has preliminary tell people they don't work, you're just conning them." --Dr. data on 81 men: 33% of the CoA's, vs. 12% of the controls, Schneider have alcohol problems. "It looks as if the intensity of reaction On drug dealers' chief market for illegal drugs being the to alcohol is a predictor of severe problems," and that unemployed and uneducated. How would this change? "alcoholism is a genetically influenced disorder. Tell your "Rai~ing prices beyond a certain point makes drugs worth­ patients and your kids. A child with a hollow leg will be at while for the . Lowering them below a certain greater risk if trying to drink like his or her peers." point increases use. A kid won't drop out of school to run a AA In USSR pack of cigarettes -- the profit wouldn't be enough. If we Last spring Maxwell N. Weisman, MD, a former ASAM legalized a more serious drug, it would have to be readily avail­ president, went to Russia for two months at the behest of the able and quite cheap." -- Dr. Bissell Caron Foundation to train a team to use a 12-Step On public participation in legalizing drugs. model program for treatment of alcoholism. The hospital had "How many have voted to K_et tobacco vending machines 6,600 beds and treatment was where "the U.S. was 40 or 50 off the streets and out of shops were kids can buy cigarettes? years ago." An tab use and acupuncture were in use, there was Probably very few of you, yet here's a way to control this legal some individual counseling, almost no family treatment, and a product." -- Dr. Schneider. generally punitive attitude. Relapse could mean a labor camp "Something that interests me is the clean needle issue. I for two years. "Family involvement was the most difficult con­ wouldn't want a fancy distribution system. I'd leryour comer cept to get across," he said. "Denial and co-dependency are ex­ druggist sell them; they do anyhow, to diabetics. We could ask tremely strong in Moscow. Previously, families had had no for a 25¢ deposit on each, so people including diabetics would contact with treatment of their alcoholic." bring them back. There's no evidence from the states where Although an estimated 14,000,000 Russians belonged to ·!.,it's legal to own your own works that there's more of an the official Temperance Society in 1987, that year the only AA I (continued on p. 11) ASAM NEWS • January-February 1 991 p. 11

(conlinuedfromp.JO) ~ddiction problem."-- Dr. Bissell ~ CHEMICAL DEPENDENCY · Do you think the political process can turn around the al- cohol and tobacco industries? ~ FELLOWSHIP "If we could agree on what exactly we would like our The State University of New York-Health Science Center at Congress to do that might be practical, and sent them these Brooklyn announces the expansion of Its Addi.ctfve Disease results; if we made it clear that we would vote for what they fellowship through an affiliation w:lth t he Brooklyn VA Medical Center. The Addictive Disease Hospital at the SUNY-HSCB do; if they heard from us the way they hear from the alcohol constitutes one of the oldest and largest chemical dependency and tobacco companies, if we sent them money the way the centers 1n the United 'States. It corisfsts of 12 d1lferent cltnJcal programs providing vtrtualfy the entire spectrum of alcohol and tobacco companies do, they'd listen. -- Dr.Bissell addiction treatment with special emphasis of dual ~dieted "We should support both NCAdd (National Council on patients and is responsible for the care of 1,500 patnl.nts. Alcoholism and Drug Dependence) and SOAR (Society of The Brooklyn VA Medical Center has 7 cliniCal programs­ Americans for Recovery)."-- Dr.Schneider including a specialized PTSD for substance abusJ: and a dual addle ted day trcatme11t center. What about kids that don't use drugs and are either in jail Research opportunities are unsurpassed and Include the or live in a crack house? They're drug-related. genetics of alcobollsm with Dr. H. Beglelter and a variety of on· "A New York City school dropout working as a lookout going addiction, AIDS and PTSD stucfles. Fellows will rotate fhrough both clinical sites and a sl~cant portion of time will can easily get $100 to $200 a day. His father may earn a frac­ be devoted to research. Facully inc.fude I}ationally known tion of that running an elevator or parking cars. As long as this clinicians and researchers In the field of a'd~lction. enormous money is available in the drug trade, and the drug The fellowship Is consistent with the guidelines developed by A.S.A.M. and fellows would be supported and encouraged to heroes have the gold chains and the fancy cars, it's hard to per­ seck A.S.A.M. Certification. Persons who will have completed a suade kids that virtue is its own reward. Decriminalization P03 year or an approved residency in Psychiatry are invited to without legalization leaves the profit motive sky high." --Dr. apply. Please contact: Dr. James Fine Bissell Director of Addictive Diseases Hospital Which drugs should be legalized? Who allowed to buy ? 718-270.1094 "I'd stick to some of the regulations we already have. If DEPARTMENT OF VETERANS you're going to drink and use, don't do anything that will en­ AFFAIRS VA MEDICAL CENTER danger other people because we'll try to stop you. We'd arrest BOO POLY PlACE, BROOKLYN, NY 11209 'drugged drivers and take licenses away from them. I don't be­ An Equal Opportunty Employer lieve in letting doctors operate drunk even though alcohol is a legal drug. We should think this through, drug by drug: what the dangers are and how we might manage. If you're going to do drugs, no using in the work place, or before you do any Massachusetts General HospitaV skilled task, such as pilots and air controllers. "We are making very good gains on tobacco by making it Spaulding Rehabilitation Hospital uncool to smoke. We have a great deal to learn from that. We're not just preaching at people to ch'ange their behavior, Positions in we're actually getting addiction counselors to feel a little bit self-conscious talking about addiction while smoking!"-- Dr. Affiliated Bissell Programs "The most important step in the last year or two: people are beginning to look at the issues. But we cannot change until Affiliated Addictions Program we have a plan. There's a morality issue: the health of people. We should be at the forefront of examining what needs to be ASSISTANT DIRECTOR done and seeing that it becomes done. We should get our own Full-time position for BC/BE Psychiatrist dedicated to ex­ organizations involved, or we're only paying lip service to the cellence in the treatment of patients with addictive disease. problem while saying someone else ought to do it."-- Dr. Assistant Director of multi-discipline inpatient unit and Staff Schneider Psychiatrist in outpatient and consultation in general hospi­ To Be Continued In Boston tal. Competitive salary, excellent benefits; Harvard Medical The drug legalization debate between Drs. Bissell and School appointment. Schneider will continue in Boston on April 18 at the Ruth Fox Send curriculum vitae to: Course for Physicians, moderated by Dr. Sheila Blume. Harold Rosenblatt, M.D • Director, Alcohol & Chemical Dependency Program Names in boldface are ASAM members.• Spaulding Rehabilitation Hospital 125 Nashua Street Boston, Massachusetts 02114

We are an equal opportunity employer ASAM NEWS • January-February 1991 p. 12

Dear Editor: Dear Editor: I read with great interest 'Letter a Recovering Patient Can I attend­ Give to a Physician about Medications" written by William H. ed the Drug C. Dudley, MD. (ASAM NEWS July-August 1990, p. 7). I Policy believe this letter contained many important points relevant for Foundation'­ the recovering addict seeking medical care. s Fourth Annual Conference in Wash{ngton, D.C., last Oct. 31 - I fully support Dr. Dudley's recommendation that an ad­ Nl'v. 4. The foundation is an international, interdisciplinary or­ dict should not be deprived "in any way of the full benefits of ganization that seeks to temper the present network of punitive, pain relief," and that" (the addict) should be kept in the hospi­ prohibitionist "drug laws." . These laws are destructive to civil tal until narcotics can be safely and humanely withdrawn," and liberties, traditional crops, social users, as well as uninvolved I share his concern about the use of narcotics for chronic pain. bystanders, and are plainly not only ineffective, but"also However, one statement raised my concern: "Generally contribute to the spread of addictions. · speaking, a person with addiction should not have any kind of To my knowledge, only three other ASAM members for anxiety or depression or for any psychiatric were among the 300 registiants. This is unfortunate, in my problem other than the major psychoses ... " seems scientifically opinion, because ASAM needs DPF to help prevent the "war unsupportable to me. The medical literature by and large sup­ on drugs" from killing many of our patients before they have a ports the concept that recovering addicts and alcoholics are at chance to even decide to seek help, and from killing or other­ higher risk for developing dependencies to . wise destroying the lives of many who are not addicted. DPF Chronic administration of these or other - to also needs ASAM to counteract the small but extremely mili­ recovering addicts is fraught with difficulties, and is analogous tant minority of its membership which believes that chemical to the use of narcotics for chronic pain. dependency is not a disease, and that the "disease concept" was However, as there is acute physical pain, so is there acute invented and is pushed by venal physicians seeking money and psychic pain. I have treated many recovering alcoholics and power. addicts who were admitted to hospitals with extreme agitation Conference speakers included a mayor, a federal judge, and acute, unbearable anxiety, in the presence of acute suicidal­ several professors of law and medicine, the director of ACLU, ity, extreme grief reactions associated with the death of a loved and a woman in the Italian parliament who was arrested the fol­ one, or other acute, serious psychiatric syndromes. Their lowing week in New York City for "unlawful possession" anxiety typically included extreme levels of motor agitation, while trying to present Mayor David Dinkins with a set of clean with such dramatic behaviors as banging their heads against hypodennic syringes and needles to help him combat the AIDS walls and hyperventilating to unconsciousness. epidemic in New York . The acute, time limited (measured in hours) judicious use The foundation is a far from monolithic organization. Pro­ of benzodiazepines can dramatically relieve such symptoms posals for changes varied widely from decriminalized "ration­ more effectively than other agents. Unwanted in­ ing" of substances along with rationing of advertising, to total duced by antihistamines, neuroleptics, or other classes of drugs decontrol with free drugs on demand. However, I heard no pro­ are completely avoided. To completely remove these drugs posals for free alcohol or free nicotine on demand! from the therapeutic arena is both unscie~tific and nihilistic. Proponents of decriminalization of hemp pointed out that I have often worked with acutely and severely psychiatri­ the entire oil dependency syndrome in the U.S. could be solved cally disturbed inpatients who are recovering addicts. Acknow­ by growing hemp (instead of tobacco and other unneeded but ledging their recovering status, and an unwavering dedication subsidized .crops) and converting the pulp to methanol. Others to the goal of discharge from the hospital free of benzodiaz­ recalled that the wholesale destruction of poppy fields, and the epines or any other addicting medications, when presented to destruction of large supplies of opium and heroin, only adds to patients early in the hospitalization, helps to alleviate their suf­ a projected shortage of for medical pain control. The fering, while simultaneously supporting their recovery. latter may become a serious problem for military medicine and Denying anti- medications (which are non-ad­ civilian disaster relief, should war break out. dicting) to patients who have life threatening major depression [This letter came to ASAM NEWS before the Persian Gulf cannot be considered an acceptable part of contemporary psy­ War began--Ed.] " chiatric practice. American psychiatry in the 1990s is making The worldwide use of "illicit" heroin has steadily escalat­ tremendous strides in caring for patients who suffer from ad­ ed since 1923, after the total ban on heroin and the severe laws diction and along with other psychiatric problems. restricting other opiate use were put into effect. We who are both psychiatrists and addiction medicine Ann Birch, MD specialists have a particular obligation to promote, protect, and­ Seneca Falls, NY support our patients in recovery, and to educate them and our non-psychiatric colleagues to the contributions we can make. In Memoriam: • Kevin W. Olden, MD, President-Elect Grosvenor W. Bissell, MD, internist of Saginaw, Michi­ California Society of Addiction Medicine 'gan, died pn Jan. 23. He was in his 70s. San Francisco, CA • ASAM NEWS • January-February 1991 p. 13

~Today the Nation, velop into a national model, or may _:romorrow the State allow for implementation of national Staff Physician by P. Joseph Frawley, :MD guidelines or recommendations at a state (Dr. Frawley is chair of ASAM' s new level. But, the more active the state or- ganization, the more it costs to maintain At the Behavioral State Chapters Committee. He is also Research U~it, Johns Hopkins it. president ofCSAM (California Society University School of Medicine and of Addiction Medicine.) A review of six national medical Francis Scott Key Medical Center, ASAM is evaluating conjoint mem­ organizations, all about ASAM's size, Baltimore, MD. An active and pro- bership. This would mean that members shows that three do not require dual du_!::tive ~eademic clinical research of the national society would have to membership; one varies by state; and and' treatment setting specializing in join the state chapter, if there is one, and two others require it. One of the latter substance abuse. Intake ~,sess- collects dues nationally and distributes ments and continuing health monitor- vice versa. ing and care of clinical research- The arguments for mandatory joint them locally. Joint membership has only recently been required by the other. vo.lunteers. Outpatient methadone membership center around ASAM's clinic plus residential unit. A super- About half of ASAM members be- need for a constituency to make vised position appropriate for an indi- significant changes in policy and fund­ long to their state chapter, if there is one. vidual in recovery or seeking clinical ing of addiction medicine treatment and Dues range from $35 to $150. The or research training and experience research. A national body can represent services and programs vary. So do the in drug abuse. Available immediate- the views and wisdom of its members, states' numbers of members and their ly. Stipend: $30,000. geographies. but with broader perspective and more The State Chapters Committee plans Contact: credibility than a local body. A national to give its recommendations to the Herbert Ladder, Director body may be more necessary than ever ASAM Board in time to vote in April. BPRU in addiction medicine now, as forces We would appreciate input from ASAM D-5-West, FSKMC converge to cut costs and provide docu­ 4940 Eastern Avenue members as soon as possible. Please mentation of what is truly necessary. To Baltimore, MD 21224 write me at 45 East Alamar Ave, Santa accomplish this, national membership Barbara, CA 93105., telephone me at must be supported. But gainers from I (805) 687-2411, or contact Jeanne-marie national efforts should not be exempt Smith at the ASAM Washington office. ALAN R. ORENBERG from paying for these gains by joining pROFESSIONAL RECRUITER only the local organization. 90% of state • SPECIALIZING IN PLACEMENTS chapter members belong to ASAM. Internist/Family Practitioner IN TREATING ADDICTIVE Why the need for strong state chap­ Immediate openings at this VA DISEASE ters? Few people enter a field at the na­ Medical Center in nationally 3 SOUTH PINCKNEY STREET tionallevel. They often join recognized substance abuse SUITE 824 organizations to change something that program, including detox unit, MADISON, WI 53703 bothers them. Making something work' full-time board certified and (608) 255-1144 locally is easier and faster than experience working with addicted beginning nationally. Many addiction patients in multidisciplinary set- 4th National Conference on Sexual Compulsivity/Addiction medicine physicians do not have there­ ting preferred. Competitive salary San Francisco- Cathedral Hill Hotel sources to go to national meetings, and plus incentive pay with malprac- state chapters may pay the way of a tice coverage and excellent May 19-21, 1991 Eli Coleman PhD • Patrick Carnes PhD member who wants to work actively on fringe benefits. Located in beauti- committees, but who cannot afford the ful historic Chester County in the Program in Human Sexuality travel . Brandywine River Valley with Department of Family Practice Many physicians enter the CD field horse farms, excellent schools University of Minnesota· 612/626-7600 through their own or a family member's and diverse outdoor recreational "· recovery. They often come from other opportunities. Near Pa. Dutch specialties. The initial commitment to country, only minutes from Reach thousands of become involved may be part time, or downtown Philadelphia and for a specific issue. Since health care is medical schools. physicians regulated by the states, certain issues Send resume and names of with your ad. that need expertise or a constituency of three references to: Only $60 for this size. concerned physicians will require state James J . Nocks, MD, Chief of Call/write: Lucy B. Robe, Ed. ASAM representation. These provide opportu­ Staff, VAMC, Coatesville, PA News, 303D Sea Oats Drive, Juno Beach, FL 33408 nities to be involved in state policy 19320. 'D' (215).383-8219. n (407) 627-6815 development, which may ultimately de- An EOE M/F/H/V I ASAM NEWS • January-February 1991 p. 14

TENNESSEE

Goal: $1,000,000 Addiction 1st Opportunity for a family practitioner with certification or experience in substance abuse treatment to associate with an It gives us great pleasure to announce establi,.shed family practitioner in that we have gone over our halfway Kingsport, Tennessee, an ex­ mark on our goal of $1 million. As of panding family commt_tnity at the February 8, 1991, we have received foothills of the Great Smokey $519,746 in pledges. Mountains. Excellent opportunity We want to thank ASAM members for established referral tiase and who have already made their pledges, $750,000 call coverage. and want to express our appreciation and gratitude to our campaign leaders and CONTACT: staff for their commitment and support. Valerie Faro Just a reminder that Charter Member­ Hospital Corporation of America ship in the Ruth Fox Memorial Endow­ One Park Plaza ment expires in April1991. We urge P.O. Box 550 you to make your pledge before the Nashville, Tennessee expiration date. You may call (212) 37202-0550 206-6770; or FAX 212-627-9540; or 1-800-251-2561 (Outside of mail your pledge. You may make a Tennessee) pledge over a 36-month period, which tl $500,000 1-800-342-2110 (Inside of can be spread over four tax years. A Tennessee) pledge enables you to make a maximum contribution with minimum fmancial strain. The schedule of payments can be arranged at your convenience and ex­ tended times can be provided, if neces­ ADDICTION CENTER sary. DIRECTOR Outstanding opportunity to become You may use one of the following the Medical Director for a chemical ways to plan your gift to ASAM: cash; dependency program in a major 450- appreciated stocks, bonds or real estate; 1 bed hospital in southern Georgia. life insurance; corporate giving; employ­ We seek a BCIBE psychiatrist with ee matching gifts program; bequests. II $250,000 significant experience in Chemical ASAM is a 501 (c)(3) non-profit organi­ Dependency and other addictions. zation and all gifts are tax deductible to This physician will be Director of the the full extent of the law. CD unit and will also have opportuni­ ty for private practice. The practice is The Ruth Fox Memorial Endowment located in a dynamic community of Reception for Charter Members will be 115,000 which is 2-112 hours from held Friday, April19, 1991, in Boston. Atlanta and 3 hours from the beach­ Invitations will be going out the end of es of Florida. Excellent housing, February, 1991. schools, cultural and recreational ac­ We will continue to solicit tivities are available. Competitive corporations/foundations. We have re­ compensation is offered. ceived some support in this area. Give your society financial security to Contact:: Teresa Owens Tyler & Company carry out its goals for the future -- please 9040 Roswell Road make your pledge now! Suite 550 Jasper G. Chen See, MD Atlanta, GA 30350 William B. Hawthorne, MD National Co-Chairmen Phone: 1-800-223-3659 Claire Osman Pledged: $51~,746 404-641-6518 Development Director (as of Feb. 8) ASAM NEWS • January-February 1991

Donors ·w Category denefactor's Circle: R. Brinkley Smithers Founder's Circle: Gordon L. Hyde, MD* Irving Cohen, MD David Myers, MD William B. Hawthorne,MD* Christine L. Kasser, MD* Stuart A. Copans, MD* Mary Elizabeth Myers, MD* President's Circle: Elizabeth T. Khuri, MD* Joseph R. Cruse, MD Kevin O'Brien, MD* Jasper G. Chen See, MD* S. Reaves Lee, MD* Anthony Dekker, DO Robert D. O'Connor, MD Joseph E. Dorsey, MD* David Mee-Lee, MD* Bud D. Dickson, MD Claire Osman Lynn Hankes, MD Charles S. Lieber, MD Judith M. Dischel, MD Anne R. Patterson, MD Michael J. Healy, MD* Gabriel Mayer, MD Walter Dorus, MD Gary Patzkowsky, MD Conway Hunter Jr, MD James M. Merritt, MD* George K. Dreher, MD* Steven Pickert,'¥D George W. Nash, MD* Michael I. Michalek, MD Steven Eickelberg, MD* Thoma~ P. & Katherine Pike I. Thomas Payte, MD James P. Miller, MD John Femino, MD Melvin Pohl, MD Anthony B. Radcliffe,MD Michael M. Miller, MD* I ames Fine, MD Craig T. Pratt, MD Max A. Schneider, MD NormanS. Miller, MD* Daniel K. Flavin, MD Richard D. Roark, MD I. James W. Smith, MD AI Mooney, MD Keith G. Foster, MD Lucy Barry Robe Richard Tyson, MD* John P. Morgan, MD Marc Galanter, MD Peter D. Rogers, MD Leadership Circle: Richard Morin, MD* Donald M. Gallant, MD Alan Rubin, MD* Ted E. Ashcraft, MD* Garrett O'Connor, MD David R. Gastfriend, MD Luanpe Ruona, MD Leta Cromwell Roland F. Pike, MD Caroline Gellrick , MD* James Russell, Md Edward H. Maloney, MD* Lori Poss, MD Stanley E. Gitlow, MD Percy E. Ryberg, MD Elmer H. Ratzlaff, MD Mark R. Publicker, MD Lee Gladstone, MD Jacqueline Schneider Ken Roy, MD Bruce J. Relyea, MD* Danikel W. Goodwin, MD Francis E. Seale, MD G. Douglas Talbott, MD Barry M. Rosen, MD* Enoch Gordis, MD Edward E. Seelye, MD David L. Trudeau, MD* Peter Rostenberg, MD* Allan Graham, MD Robert & Carol Sexton, Circle of Friends: John Saalwaechter, MD* I ames Graham, MD* MD's* Raymond C. Anderson, MD Stephen B. Shapiro, MD* Roland W. Gray, MD Joyce Shaver, MD Andrea G. Barth well, MD Timothy L. Sharma, MD* Cecilia Gregory, MD* R. Keith Simpson, DO F. William Bennett, MD* John E. Shields, MD William L. Griffith, MD* John Slade, MD David G. Benzer, MD Jack C. Smith, MD James A. Halikas, MD David E. Smith, MD Irvin L. Blose, MD Robert D. Sparks, MD I. Christopher Hastings, MD Doyle P. Smith, MD Sheila B. Blume, MD John Steinberg, MD William E. Hodgkin, MD Philip A. Snedecor, MD Robert W. Booher, MD Jokicbhi Takarnine, MD Thomas Hogarty, MD Lisa Sparks, MD* Thurman Booker, DO* Richard E. Tremblay, MD* Shirley Hunter, MD James M. Squve. MD Bruce Branin, DO* Kenneth F. Tullis, MD* Charles H. Johnson, MD Harvey R. St. Clair, MD Jess W. Bromley, MD Alan W artenberg, MD I anet King Johnson, MD E. M. Steindler Donald G. Browning, MD Herbert C. White, MD* Theodore Johnson, MD Verner Stillner, MD* Gene E. Burke, MD* T. Edward Yielding, MD* Steven M. Juergens, MD* William M. Sullivan, MD Walton Byrd, MD Pendope P. Ziegler, MD Bobbe J. Kelley, DO George Ubogy, MD Donors' Circle: James F. & Claire L. Callahan Thomas A. Kerns, MD Donald D. VanDyken, MD* Chris L. Adelman, MD* H. Blair Carlson, MD* Lucy Jane King, MD George W. Vick, MD Louis L. Cataldie, MD Mohan Advani, MD Larry Kirstein, MD Albert Waldman, MD Roy D. Clark, Jr., MD Amelia A. Alderman, MD Neil J. Kluger, MD Kevin R. Wandler, MD Sandra Jo Counts, MD James F. Alexander, MD Eshel Kreiter Maxwell N. Weisman, MD John T. Cox, MD* William C. Anderson, MD Marla Kushner, DO Henry Weyers, MD Douglas F. Crane, MD Gertrude Anthony Thomas E. Lauer, MD Jack C. Whites, MD* Robert W. Dail, MD Judith Arthur Michael R. Liepman, MD Charles L. Whitfield, MD Lionel Deutsch, MD William I. Barakett, MD John N. Loomis, MD Leah E. Williams, MD Andrew DiBartolomeo, MD E. Joan Barice, MD Virginia Lott Dennis Wolf, MD David T. Dodd, MD Margaret Bean-Bayog, MD Louisa & Ian Macpherson Marigail Wynne, MD '. Martin C. Doot, MD Louis H. Beechnau, DO John Manges, MD George Drake, MD Milton Birnbaum, MD Willy Mautner, MD * Participants of the Ruth Fox Paul H. Earley, MD* LeClair Bissell, MD Justin May, MD Endowment Campaign Charles John Engel, MD* Duard Bok, MD* Theresa McAuliffe • Jean L. Forest, MD William M. Bolman, MD Morris L. McEwen, MD* Anne Geller, MD Albert Browne-Mayers, MD George J. Mellendick, MD Karl V. Gallegos, MD Dolores Burant, MD Raymond Middleton, MD* Elizabeth H. Gordon, MD Rodney V. Burbach, MD* H. Thomas Milhorn, Jr, MD, Harley I. Harber, MD Daniel Cameron, MD PhD Thomas L. Haynes, MD* David I. Canavan, MD Martha Morrison, MD William D. Clark, MD Roland E. Herrington, MD · ·· •. William t.'furphy, MD ' ASAM NEWS • January-February 1991 p. 16

Meetings sponsored or co-sponsored by ASAM (one-time listing for co-sponsored conferences) For conference listing on this calendar, please send infor­ mation directly to Lucy B _Robe, Editor, at least two months in advance. 0 ASAM 1st National Medical Conference on For information about ASAM co-sponsorship Adolescent Addictions: Atlanta, June 20-23, 1991 of conference~·. contact Claire Osman, A SAM-New York. MTS, Conference Information (Ado!.), PO Box 81691, CaL) • Atlanta, GA 30366 tr (404) 458-3382 U ASAM 5th National Forum on AIDS & Chemical Dependency: 0 ASAM 4th NatioAal Conferellfe• on : San Francisco, Feb. 21-24, 1991 Raleigh, NC, ~pt. 13-!5, 1991' (Info ASAM Washington office) MTS, Conference Information (AIDS), PO Box 81691 . . Atlanta, GA 30366 tr (404) 458-3382 . 0 ASAM Co-Dependency Conference: Warrenton, VA, Oct.17-20, 1991 0 Texas Medical Professional Group• Annual Spring Meeting Steven J_ Wolin, MD, 5410 Connecticut Av~, 1\'W, San Antonio, Texas, March 6-10 (corrected dates) Washington, DC 20015. ASAM CME's March 8. 98591-11 10 W, #301, San Antonio, TX 78230 0 ASAM State of the Art in Addiction• Medicine: tr (512) 691-1802 (6:00-10:00 PM Central Time) Orlando, FL, Oct. 24-26, 1991 ll ASAM/NAATP Criteria Conference• "Proper Patient Placement" 0 California Society of Addiction• Medicine State of the Art: Atlanta, March 14-15, 1991 San Diego, CA, Nov. 21-23, 1991 ASAM, 5225 Wisconsin Ave NW, Washington, DC 20015 • -~ I 11' -(202) 244-8948 0 Florida Society of Addiction Medicine (FSAM) Annual Meeting: Orlando, FL, Jan. 17-19, 1992 . 0 ASAM Board Meeting: Boston,• Wed. Apr. 17 0 Ruth Fox Course: Apr. 18 0 ASAM Board Meetings: • 0 ASAM 22nd Annual Medical Scientific Conference: Dallas, Oct. 5-6, 1991 Bos.ton, Apr.18-21, 1991 Washington, DC, Apr. 1, 1992 Cluny Conference Services (Louisa Macpherson) Site TBA, lsi Oct. weekend 1992 1013 Rivage Promenade, Wilmington, NC 28412 Los Angeles, Apr. 28, 1993 11' (919) 452-4920 • Site TBA, lsl Oct. weekend, 1993•

First Class Mail ASAM - Suite 409 US Postage Paid 5225 Wisconsin Ave NW Jupiter, FL 33458 Washington, DC 20015 Permit No.8

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