American Society of Addiction I ~ formerly American Medical Society on Alcoholism and OtjJer Drug Dependencies (AMSAODD) .'- Vol. V, No.4 July - August 1990 Published' Bimonthly

See survey on page 3 AMA Will Assign Code for to report problems with Addiction Medicine in '91 insurance coverage for Addiction medicine will join 85 other self-designated practice your specialties in the AMA Masterftle. The AMA House of Del­ egates approved ASAM's resolution (#72) on June 26. The AMA Board of Trustees is expected to act on it this summer. The code letters that will designate addiction medicine were not yet known when ASAM NEWS went to press. The implicit choice, 'AM,' is already used for aerospace medicine, 'A' stands for allergy, 'CD' for cardiovascular diseases. The AMA, forms with the new code will not be ready until early 1991. "This approval is a step forward in ac~nowledging addiction medi­ cine as a field of practice," ASAM executive director James F. Callah­ an, DPA, told ASAM NEWS .. ''The code will provide the public with access to who practice in addiction medicine, and will en­ able ASAM to gather reliable data on these physicians, and on their ed­ ucation and training. This information will help ASAM to develop courses and conferences on addiction medicine." "For years I've been an OS (other specialty)," said J. Thomas Payte, MD, of San Antonio. "It's exciting to know that I'll finally be able to state 'addiction medicine,' which I've been practicing all along anyway." • The AMA Physician Masterfile contains more than 600,000 physicians' records. Data are collected from U.S. and Canadian medi­ cal schools, and training institutions, medical societies, the National Board of Medical Examiners, state licensing agencies, Educational Commission for Foreign Medical Graduates, American Board of Medical Specialties, Federation of State Medical Boards, Sur­ geons General of the US Government, and from physicians themselves, according to Catherine M. Bidese of the AMAin the June AMWA Jour­ nal (American Medical Writers Association). ( conlinued on page 14)

ASAM is a specialty society of 3,600 physicians who are concerned about alcoholism and other drug dependencies and who care for persons ~fteCted by these Illnesses. ASAM NEWS • July-August 1990 p.2

ASAM Members Urged ers, keep a supply of these forms handy, to compile information that can facilitate to Report Denial of Care so that you can fill one out and mail it to remedial efforts by ASAM in the future. Dear ASAM Member: ASAM as soon as an incident occurs and The Standards & Economics of The Reimbursement Subcommittee the details are fresh in your mind. Care Committee believes it is vital for of the ASAM Standards & Economics of Issues we hope to address by this ASAM's membership to have this kind Care Committee is aware that difficulty process: of data base available. Your cooperation with reimbursement for care in addiction • To what extent are patients in with this project will be greatly appreci­ medicine is a major problem confronting America uninsured or under-insured for ated. ASAM's membership and the patients the treatment of the condition of che~i­ Subcommittee on Reimbursement I ~ we serve. At our meeting in Phoenix in cal dependency? ASAM Standards & Economics April 1990, we decided that we need a • To what extent is access to care of Care Committee solid data base by which to ascertain the being denied arbitrarily? ~ ~ magnitude of the problem, and from • Are there certain regions of the Please fill in your identifying_jnfor­ which we can focus our efforts to im­ country in which this is more of a prob­ mation at the top of the Incident-Report prove delivery of appropriate services to lem than others? Form and then make photocopies for fu­ our patients with the disease of addic­ • Are problems with reimbursement ture use, keeping that one as the tion. for care occurring at high frequency for original. We ask you to please take one or certain third party payers? • two minutes to fill out a copy of the • Are problems with restriction of form (on p. 3) each time one of your pa­ access to care happening at high fre­ PHYSICIAN tients is denied access to addictive dis­ quency with certain managed care enti­ to work in area of ease care which you think is clinically ties? substance abuse for rural upstate appropriate, based on your comprehen­ • What sort of credentials are held New York . sive and individualized assessment and by individuals who convey the message Salary and benefits competitive. care planning efforts. that access to care is being denied? Send CV to Box IJ, We suggest that you, and your staff The purpose of the form is not to ASAM NEWS, 15 Ridge Road, members who are in contact with man­ initiate intervention by ASAM in indi­ Cold Spring Harbor, NY 11724 aged care agencies and third party pay- vidual reimbursement cases. Rather, it is Our Experience Shows! We're Behavioral Health, Inc. of Louisiana.

Since 1976, we've nm free standing CD unils, managed CD and Psych treabnent ventures and cooperated in joint CD and Psych programs in hospital settings.

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Behavioral Health Inc. is a division of the General Health System ASAM NEWS • July-August 1990 p. 3

_ psychological denial/resistance to treatment _ intensity/chronicity of addictive disease process _ NO GROUNDS GIVEN by denying agent Other. ______

V. LEVEL OF CARE RECOMMENDED BY MANAGED (Please photocopy as needed) CAREAGFNCY _ Outpatient Detox YomNrune ______1 Residential Inpatient Rehab ' =Intensive Outpatient Rehab Yom State------_Residential Extended Care (Halfway House) ~~ Methadone Maintenance Clinic · ASAM/AMSAODD Certificate No.------_ Outpatient Ongoing Care and Addiction Medicine, with or without Pharmacotherapy Check if not certified by ASAM__ ***No Care in Addiction Medicine*** Other. ______Patient Age • Sex ___ Principal Diagnosis (ICD/DSM Code) ______VI. PATIENT'S TYPE OF REIMBURSfi:MENT Medicare I. PATIENT'S CURRENT LEVEL OF CARE (LOC) _ Medicaid/Medical Assistance _Outpatient Clinic: Gen Med/Smg/Psych Care _County/City Government Health Care Funds _Hospital Inpt: Gen Med/Smg/Psych Care _ Prepaid Capitated Care - e.g. HMO _Hospital lnpt: Addictive Disease Detox _Managed Indemnity Coverage - e.g. "Commercial lnsur- _Hospital Inpt: Addictive Disease Rehab ance" _Residential Inpt: Addictive Disease Rehab _Employer/Union Self-Insmed Plan _Addictive Disease Outpt Intensive Rehab _Uninsured Patient/Doesn't Qualify for Government _ Addictive Disease Outpt: Gen Add Med Serv Assistance ' (Outpatient Diag Eval or Ongoing Care) Other: ______VII. PARTY DENYING ACCESS TO CARE _ Medicare Gatekeeper II. ADDICTION MEDICINE LOC REQUESTED _ Medicaid/Medical Assistance Gatekeeper _ Inpatient Detox _ Local Government Agency Funds Gatekeeper ' _Outpatient Detox _ HMO Prior Authorization Agent _ Hospital Inpatient Rehab _ Managed Care Co. Subcontracted by HMO _Residential Inpatient Rehab _Commercial Insmance Prior Authorization Agent _ Intensive Outpatient Rehab _Managed Care Co. Subcontracted by Insurance Carrier _Residential Extended Care (Halfway House) _Employer/Union Benefits Manager or Benefits Dept. Methadone Maintenance Agent _Outpatient Ongoing Care _ Manag((d Care Co. Subcontracted by Employer/Union Other: ------• • Nrune of Third Party Payer______Ill. ACTION REQUESTED Nrune of Managed Care Agency ______Admit to Services Extension of Current Services Name of Person You Spoke With ______Credentials ofPerson You Spoke With: IV. STATED REASON FOR DENIAL OF REQUEST Certified ASAM Member _ Benefit not covered in policy (policy has no coverage for _Non-Certified ASAM Me~ber this level of care/type of service) _Physician · Benefit for this level of care exhausted: RN Dollar limits met _ Other (Specify):,______Days of stay limit met Is this person licensed? Yes __ No _Refused to tell __ _Level of care not medically necessary because of insuffi­ Med/Nmsing License No. ------cient degree of: Refused to tell _ _) _ biomedical comorbidity Date Denied Access to Care ______psychiatric comorbidity Return to: American Society of Addiction Medicine, _ frunily/occupational support system deficit 5225 Wisconsin Ave NW, Suite 409, Washington, DC 20015. _ environmentaVcultmal support system deficit \-"1...~ Phonet (202) 244-8948. ASAM NEWS • July-August 1990 p.4

"6892 Questionable Forad­ The medical community's response Doctors" dictionists, to addictive disease in its members in a by Penelope P. Ziegler, MD there are punitive rather than therapeutic manner, On July 5, 1990, the Public areas of con­ or failure to protest when others do so, Citizens Health Research Group cern about undermines efforts to bring all published "6892 Questionable Doctors," both of these chemically dependent patients into early a list of physicians throughout the Unit­ projects treatment and recovery. ed States who have been subject to offi­ which have , ~ Thi~ also promotes a political cli­ cial disciplinary action by their state not been addressed directly by the AMA. mate which advocates funding for law medical boards or by a federal agency. An unknown but probably substantial enforcement at the expen~ of treatment Predictably, the publication of this percentage of the doctors listed are programs. In parti.cular, we practitioners list has received widespread and dramat­ chemically dependent. Some of these who specialize in addiction meaicine ic attention in the media. For example, a ~ave entered recovery and may have h~ve a responsibility to speak. out in sup­ June 29 front page article in USA Today, been abstinent from alcohol and other port of treatment and recovery for our began, "If there are any bad doctors in drugs for years, practicing now with no colleagues, as well as our patients. town, their names are on a list and, for evidence of impairment. Others are cur­ Dr. Ziegle':_ is medical• director of the first time, anyone who wants it can rently in treatment and can be expected Bethany Center tn Honesdale, Pennsyl­ get it." - to resume practice in the future with no vania. She is a member of the ASAM The assumption that physicians risk to their patients. Still others are ac­ Publications Committee. whose names appear on the list are "bad tively addicted and impaired, and do ASAM NEWS welcomes comments. doctors" has led the American Medical present a danger to the public, as well as Please send your thoughts about this ar­ Association to express concern, since the to themselves. ticle to Lucy B. Robe, editor; we will list makes no attempt to distinguish be­ Unfortunately, neither the "Ques­ publish responses as space permits. tween those disciplined for serious tionable Doctors" list nor the Data Bank attempts to differentiate between the offenses and those cited for minor in­ Revised fractions. The doctor whose license has doctor who, due to active addiction or other impairment, is incapable of safe Review Course Syllabus been suspended for sexual misconduct or Available criminal negligence appears beside the and competent functioning, and the prac­ titioner who, through treatment, has been mid-September physician who was late filing Continuing Call ASAM Medical Education credits with the restored to health and full professional (212) 206-6770 board. The reputations and professional capacity. Both reinforce a moral model practices of physicians with medical which permanently labels and condemns records backlogs, or other matters not re­ alcoi1ol and drug "abusers." This model lated to clinical competence, could be is harmful, not only to addicted physi­ damaged by the indiscriminate nature pf cians but also to the general public. the listings. Heretofore, a chemically dependent Similar civil liberties, confidentiali­ physician usually has been in an ad­ ty, and privacy issues have been raised vanced stage of addictive disease before by the AMA and other medical organiza­ being reported to a medical boatd, tions in regard to the National Practitio­ impaired physicians' program, or other ner Data Bank. This congressionally disciplinary or advocacy organiza- mandated interstate computer system tion. Often the physician's will store information on malpractice colleagues,family members, and even payments and disciplinary actions in­ patients have been aware of the situation volving licensure and/or clinical privi­ for some time but did not want to report leges. The Data Bank, expected to start the individual, in part through fear that up in 1989 but delayed by bureaucratic the doctor would be punished rather than reviews, will at least contain some de­ helped. Therefore, the sick doctor tails about the nature of the physician's continued to practice in an impaired con­ problems, something which "6892 Ques­ dition, endangering his or her patients in tionable Doctors" does not attempt to do. the process. [The Data Bank will open Sept. 1, But now, the knowledge that once according to American Medical News reported, a practitioner will carry the on July 27. The AMA has published a permanent label of "bad doctor," can booklet for members to explain how the only lead to further ~elay in obtaining bank operates--Ed.] treatment for those in "need. / ASAM NEWS • July-August 1990 p. 5

IDAA 41st Annual Meeting Anon track; her talk drew hundreds from Boca Raton, Florida that group to the final section of the CME International Doctors in AA again ==~~U Program. offered a full ooncurrent track to Al-Anon Dr. Luke members at an annual meeting. Featured topics: Al-Anon's Again this year he wore his long, bright yellow ribbon, Steps I through XII, individually addressed over two days with GODFATHER in gold letters. The Newcomers Dinner (IDAA has long done this with AA's Steps), and "Sex and Inti­ crowd gave Dr. LukeR. standing ovations before and after his macy." In the evenings, "Alanonathons" ran parallel with 10-minute sJ)eech. Luke was secretary-treasurer of Inter­ "Alkathons." national Doctors in 'AA from 1900 until 1988. He was in a An estimated one-third of the 850 conference registrants at wheelchair, but the husky 'voice with the midwestern accent, the Boca Raton Resort and Club in Boca Raton, Florida, Aug. familiar to so many alcoholic physicians whom h~elped over 1-5, were spouses or significant others. the years, was as sure as ever. . ·, 875 at Newcomers Dinner "It does my good to see all these smiling faces, and A record 875 packed the Newcomers Dinner. This is to know I had a part in sb\rting many of you in AA,". he said. where first-timers at an IDAA annual conference introduce Luke got sober in AA 33 years ago. He first met AA's co­ themselves, give their sobriety date (which can vary from sev­ founder, Bill W., at an anniversary meeting in Akron, Ohio. "I eral days to many years) and make a few short remarks. Using learned early on not to argue with him," he said. What Luke two microphones and efficient stage management, 137 people really meant was that he learned not to..give in to Bill. (40 more than in 1989) spoke in 150 minutes! While most He reminisced again this year about how Bill W. tried re­ were physicians, these speakers included 11 new dentists; four peatedly to obtain IDAA's mailing list, in order to promote nia­ veterinarians; three psychologists; one pharmacist; three medi­ cin as therapy for alcoholics. [In the 1960s, there was a notion cal students. (IDAA membership is open to these disciplines that megadoses of vitamin B-3 could help alcoholics stay sober. and to other doctoral-level medical scientists, as well as to phy­ This was originally fostered by Drs. Hoffer and Osmond of sicians.) Again this year, the proportion of women newcomers Canada, through their work with schizophrenics who were also who addressed the dinner guests was low: only 12 of the 102 alcoholics.] Although he was in awe of AA's co-founder, Luke physicians were women. But this reflects IDAA's total mem­ refused to yield the IDAA list to Bill W. He described one cold bership: only about 350 of the 3,300 members are women. Ohio evening when Bill phoned before he had his overcoat and IDAA has always tried to offer "scholarships" to those galoshes off. One hour later, Luke was still telling Bill "no" who cannot afford to attend its annual meeting. This year the even though he hadn't as yet removed his coat! ••1 never did Florida conference hosts and donations by IDAA members give Bill our list of doctors because I felt anonymity was so nationally provided a record 76 scholarships. Donors' badges deadly important to physicians. But Bill never stopped trying!" sported a yellow sticker with a smiling face. Many at the New­ Luke stressed Bill's supportive attitude toward IDAA. comers Dinner microphones thanked IDAA for helping them to IDAA has never had any dues or fees, and at one point "We attend. were down to our last sheet of stamps and our last few enve­ Three athletic competitions were offered: golf and tennis lopes. Bill was at that meeting when I said we needed stamps. tournaments, and a 5-K run. Winners received prizes at the We collected $450, which bailed me out of that emergency. closing banquet. Non-competitive sports included air boat Bill was the most exciting, interesting, and brilliant man I ever rides, and deep sea fishing trips where a woman physician met His teaching and attitudes are important to us still." caught a 35-pound tuna. What Is IDAA? About 35 Alateens had abusy supervised program, and "The aims of International Doctors in AA are those of they attended the speeches at the Saturday night banquet Alcoholics Anonymous," states the organization's information­ Special mutual-help meetings included: women; gay/lesbi­ al letter written by Dr. Luke. "As an AA group, our primary an; veterinarians; psychologists; pharmacists; dentists; and purpose is in carrying the message to other alcoholics, particu­ chiropractors. larly alcoholic doctors." IDAA has a strictly confidential mail­ CMEProgram ing list (held by the secretary-treasurer) of over 3,300 names. The Scientific Session on Thurs. Aug. 2 was co-sponsored There are no dues. The membership requirements are the same by ASAM; all five speakers were Floridians. In "Addictions as for AA, plus a doctor's desire \o belong to IDAA. from A to Z," Fred Frick, MD, (ASAM member) focussed on Next year's IDAA meeting: Hyatt Regency Hotel, Van­ new information about serotonin transmission, genetics, and couver, , Canada, Aug. 1-4, 1991. ASAM nicotine addiction. In "The of Chemical Depen­ will again co-sponsor the CME portion of the program. dence," Wayne Siegel, MD, said that cocaine has a "profound IDAA' s current address: Box 444, Center City, MN effect on the heart that lasts for some time." Adverse effects 55012. Phone: (612) 835-4300. are much like those from alcohol and include: arrhythmia, cor­ IDAA 's new address: In October, 1990, the IDAA office onary spasm and decreased flow, decreased myocardial tonici­ will move to PO Box 199, Augusta, MO 63332. ty, and hypertension. "Sexuality and Intimacy Issues in Contact: Dr. Dick McK. Recovery" by Marilyn Volker, EdD, was included in the Al- ' (\..,. . l ASAM NEWS • July-August 1990 p. 6

Task Force on Specialty Status Studies the Op­ AIDS & Chemical Dependency tions, Prepares Repon Proceedings of ASAM's 4th National Forum The ASAM Task Force on AIDS and Chemical Dependency, held last has evaluated the merits of February in Miami, have just been published in various alternatives for AIDS PATIENT CARE- A Journal for Health Care achieving specialty status for addiction medicine. The Task Professionals (vol. 4, #4, Aug~st 1990). Papers included: con­ Force has examined as many as 10 options from the perspective ference chairs Drs. Mel PPsychiatry and ; or under Nonmembers can contact the magazine's publisher: Mary two or more boards, either with different examinations, or the Ann Liebert, Inc., 1651 Third Ave, New York, NY 10128. same examination, as is done for the Certificate of Added Phone: (212) 289-2300. - ~ Qualifications in Geriatrics that is offered by the American • Board of Internal Medicine and the American Board of Family Child/Adolescent Practice. These options are being considered in combination A SAM's First National Medical Conference on Adoles­ with plans for ASAM to continue to offer certification. The list cent Addictions will be held June 20-23, 1991, in Atlanta. also includes options for the very long term, such as establish­ Conference co-chairs are Peter D. Rogers, MD (chair of this ment of a new conjoint (modified) board or a new primary spe­ committee) and Martha A. Morrison, MD. cialty board, either of which could be accepted as a member of • the American Board of Medical Specialties (ABMS). Ethics A final report and recommendation are being prepared for New ad hoc committee; chair is LeClair Bissell, MD. the ASAM Board meeting of November 11, 1990. Charged to develop ASAM Ethical Guidelines or Standards. (GBJ &EMS) International • • Conway Hunter, Jr.; MD, has announced the next com­ mittee meeting: Montreux, Switzerland, Oct. 7 . .

Medical Care In Recovery • New subcommittee: Chronic Pain and Addiction; its Public TV Show Features chair: Seddon R. Savage, MD, of . Four ASAM Physicians • Drs. LeClair Bissell, Anne Geller, Stanley E. Gitlow, MRO and Enoch Gordis were featured on "We Never Talked About New chair is Donald Ian MacDonald, MD, of Washing­ My Drinking", 1-hour documentary June 27 on Connecticut ton, DC, "taking over from Max A. Schneider, MD. Public Television. Focus: identifying and treating alcoholics in • general hospitals. Tape available from: Bibulophile Press, Nicotine Dependence PO Box 757, Bantam, CT 06750. Price: $35. Committee will meet in San Diego during ASAM's 3rd AA's 55th In Seattle National Conference on Nicotine Dependence this Sept. 6-9. N on-AA physician presenters at the International Con­ Chair: John Slade, MD. vention of Alcoholics Anonymous, which celebrated AA's 55th anniversary in Seattle July 5-8, included Drs. Gitlow and Trauma •' · Gordis. An estimated 45,000 attended the convention. New co-chair with Carl Soderstrom, MD, is Peter Schneider Wins Two Rostenberg, MD, of Connecticut. Max A. Schneider, MD, received two awards this sum­ mer: 1) the ninth annual Marty Mann Award for excellence in AMA Commends Bromley,• Smith alcoholism and addiction communication from the The A SAM's delegates to the AMA Jess Bromley, MD, and Counselor magazine and the Foundation for Alcoholism alternate David E. Smith, MD, were acknowledged at the AMA Communications, in June at NADAAC, and 2) the second House of Delegates meeting for having recruited 25 new mem­ Sidney Cohen Award from UCLA in July (the first was given bers to the American Medical Association from ASAM. last year to David E. Smith, MD).• I + ASAM NEWS • July-August 1990 p. 7

Letter a Recovering Patient Can Give to a Physician About Medications This letter does This letter comes from William H. C. Dudley, MD, of the not represent an effort Psychiatric Associates in Meridian, MS. A , Dr. to compromise your Dudley was certified by ASAM in 1986. own good medical Do other readers have 'Dear Doctor' letters they would judgment. My like to share? Please send for consideration to Editor, ASAM doctors here and I NEWS,15 Ridge Rd. Cold Spring Harbor, NY 11724. only hope that you Dear Doctor: will fmd the informa­ I am receiving [inpatient] [outpatient] treatment at tion about addiction ------· I have been diagnosed as medicine helpful. having the disease of addiction, and I accept this diagnosis. Respectfully, My doctors here have recommended that I ask you to make this letter a part of my medical record, to be available for your future reference. My drug of choice is . Howev- er, according to current knowledge of the disease of addiction, (the patient) any one of a variety of other drugs and medications which alter one's state of alertness, mood, or thought process could stir up • my nervous system in a way that might trigger a relapse. My doctors in addiction medicine offer the following sug­ gestions for managing my future medical problems: • Acute medical emergencies involving severe pain (ex­ Massachusetts General Hospital/ amples would be myocardial infarction, acute abdomen, trau­ Spaulding Rehabilitation HC)spital ma, post-operative situations) should be treated vigorously with Positions in ~ an effective narcotic type medication. I should not be deprived Affiliated in any way of the full benefits of pain relief. However, I should Programs ti be kept in the hospital until narcotics can be safely and hu­ · -;.,: . Affiliated Addictions Program manely withdrawn. I should not be sent home with or on any ASSIST ANT DIRECTOR tranquilizers, sleep medication, or opiate-related type of Full-time position for BC/BE Psychiatrist dedicated to excellence in the treatment medication. ofpatiefi!S with addictive disease. AssistantDirectorofmulti-disciplineinpatient • For chronic benign pain (examples would be chronic unit and '"Staff Psychiatrist in outpatient and consultation in general hospital. Competitive salary, excellent benefits; HaJVard Medical School appointment. back pain, arthritis, headaches) my symptoms should be Send 'curriculum vitae to: managed in a non-chemical fashion, with the exception of such Harold Rosenblatt, M.D. Director, Alcohol & Chemical Dependency Program drugs as acetaminophen, aspirin, or ibuprophen. I understand Spaulding Rehabilitation Hospital that I must put up with a certain amount of discomfort, but that 125 Nashua Street the harm from more powerful medication would far outweigh Boston, Massachusetts 02114 the good. Affiliated Addictions Program • For psychiatric problems, including anxiety and depres­ CHEMICAL DEPENDtNCE FELLOWSHIP sion, I should be referred for evaluation to a psychiatrist with Two full-time, one-year appointments for PGY-5 dedicated to excellence in !he treatment ofpatients withaddictivedisorders. Fellows will acquire special expertise in addiction. Generally speaking, a person broad expertise in addictions through comprehensive training in inpatient, with addiction should not have any kind of chemotherapy for outpatient, general hospital and consultative settings. Harvard Medical School appointment Opportunities for fellows to assist in training of medical students anxiety or depression, or for any psychiatric problem other than and residents and to conduct . the major psychoses, such as schiwphrenia and manic depres­ Curriculum vitae should be sent to: sive illness. Even then, these major psychoses should be diag- David Gastfriend, M.D. Chief, Alcohol & Drug Dependence Treatment Unit _.,., nosed only by the most rigorous criteria. Massachusetts General Hospital, ACC-812 Boston, Massachusetts 02114 For your reference, I am enclosing a list of medications We are an equal opportunity employer which my doctors here recommend that I avoid. ASAM NEWS • July-August 1990 p. 8

Note: The zip code for the Washington STAFF PHYSICIAN office is now 20015; it is no longer 20016. A position for a staff physician is open in the growing medical division of the nation's largest proprietary chemical dependency facil~y. Dually licensed for alcoholism and substance abuse services, Conifer Park is a modern facil~y on a campus setting, centered in a quiet area bounded by Saratoga Springs, the Adirondack Mountains, and the state capital which is the site of Albany Medical College: Please send resume to: FbBERT ,Q; O'CON.NOJ3 M.D., F.A.C.P. 1 Medical Director, Conifer Park, 150 Glenridt~e Road, Scotia, New York 12302 Editor: Lucy Barry Robe MEDICAL DIRECTOR Full-time Physician to head medical team of p'art-time Phy­ 15 Ridge Rd. sicians and full-time Physician Assistants. Free-standing facility of 100+ beds, with Cold Spring Harbor 20-year reputation serving chemically dependent adults and adolescents. Inter­ NY 11724 disciplinary team, individualized treatment, Twelve Step, biopsychosocial model. Phone: (516) 367-6692 Located in peaceful Central Pennsylvania, near Geisinger Medical Center and convenient to Hershey Medical College and Penn State . Required: ASAM -Washington: · BE/BC in internal medicine or family practice, experience in CD treatment. Pre­ James F. Callahan, DPA ferred: ASAM certification, experience interfacing with payor review organization. Executive Director CV to: Exec. Director, White Deer Koala Center, Box 97, Aflenwood, PA 17810. Suite 409 5225 Wisconsin Ave, NW Washington, DC 20015 Puget Sound Area Phone: (202) 244-8948 Large HMO in beautiful Puget Sound Area has a position open for a family FAX: 202-537-7252 practice physician interested in chemical dependency. The position would be a quarter time chemical dependency and three-quarters time family practice. The ASAM-New York: physician would develop and integrate chemical dependency treatment within the Claire0sman,.12 West 21St family practice department in the south region of the Puget Sound area. New York, NY 1QOtO Please send your resume to: PIJ'one: (212) 206 ~ 6770 Claire Trescott, M.D. ADAPT Admin., EHC111 'FAX: 2f2-627-9.54Q · 2700- 152nd Avenue SE, Redmond, WA 98052

ASAM News is published bimonthly:. Jan. ~ Fe.b. July-~ugust PHYSICIAN Mar. ~ ~prlf::. .Sepi.:.Oct. The Charleston VA Medical Center has an opening for family practice, May-June tiJov.-Dec. internal medicine, or psychiatric physician in the Advertising ~ates: AlcohoVDrug Dependence Treatment Unit. · .Start at $60. Calllwr~e Medical University of South Carolina faculty appointment involves Editor, or ASAM-New Yi;)rlt patient care, teaching and optional research. U.S. citizen only, BC/BE. Contact Bryon Adinoff, MD, (803) 577-5011, extension 7260. EOE. @American Society o.f Addiction· Medicine. · ALAN R. ORENBERG, PROFESSIONAL RECRUITER SPECIALIZING IN PLACEMENTS IN THE FIELD OF ISSN # 0889_-921'5 TRI;ATING ADDICTIVE DISEASES ANNOUNCES THE RELOCATION OF HIS OFFICE TO ASAM NEWS • Subscriptions 3 SOUTH PINCKNEY STREET (Newsletter is mailed free to members) SUITE824 $15/year (6 issues) MADISON, WISCONSIN 53703 (608) 255-1144 Name:. ______POSITION AVAILABLE- CHEMICAL DEPENDENCY FELLOWSHIP Organization:.______St. Vincent Charity Hospital and Health Center and Case Western Street:,______Reserve University School of Medicine are co-sponsoring a clinical and research fellowship in chemical dependency for primary care physicians. City/State: ------Applications for an immediate opening and a July 1, 1991 starting date are now being accepted. For information contact: Zip:.___ _ Ted Parran, Jr., M.D., Fellowship Director, Rosary Hall Make check payable to ASAM NEWS. St. Vincent Charity Hospital, 2351 E. 22nd St., Cleveland, OH 44115 Mail to: ASAM-New York Office '''-~ (216) 363-2625 ASAM NEWS • July-August 1990 p.9

prenatal and parenting classes, should be offered along with ASAM PUBLIC POLICY STATEMENT ON methadone maintenance. METHADONE TREATMENT 6. Methadone patients need access to inpatient and outpa­ Background tient treatment for medical, sUrgical, psychiatric, and non-opio­ Opioid dependence .is a complex disease involving physi­ id chemical dependency conditions without interrupi1~n of ological, psychological, genetic, behavioral, and environmental methadone maintenance. factors. It shares features of other drug dependencies but often 7. Physicians working in the field of addiction medicine requires WJ.ique treatment strategies. No single treatment ap­ require a thorough working lolowledge of both laboratory and proach is effective in all cases. Abstinence, usually accepted as clinical research which form the basis for methadone treatment. the primary goal of treatment, is not feasible as an exclusive 8. The medical direction of methadone treatment pro­ goal for all opioid dependent persons. grams should be provided by physicians who are competent in Methadone maintenance is effective and safe and is an in­ addiction medicine. ·-. tegral part of addiction medicine. Ideally, methadone treatment 9. Any regulations and guidelines pertaining to metha­ includes behavioral, psychodynamic, and 12-step approaches done treatments at the federal, state, or institutional level combined with pharmacologic interventions ro provide a broad should enhance quality of care, foster desligmalization, encour­ spectrum treatment for opioid-dependent patients. age the development of new clinical strategies, promote ASAM Suppotts the Following individualized treatment planning, and ensure patient rights. 1. For the majority of opioid-dependent patients, 10. Research related to methadone treatment should be supported, including work that will contribute to improve quali­ methadone maintenance is most effective as a long-term modal­ ty of methadone treatment. ity. Withdrawal from methadone maintenance carries substan­ tial risk associated with relapse to intravenous drug use. With- 1rawal should be attempted only when strongly desired by the rehabilitated patient, and with adequate supervision and sup­ Adopted by the ASAM port. Individuals who have withdrawn from methadone should Board of Directors be carefully followed in a clinical setting and encouraged to on April 25, 1990 participate in an ongoing program of recovery. In the event of relapse or impending relapse, additional therapeutic measures should be used including, when appropriate, rapid resumption Copies of this and other American Society ofAddiction of methadone maintenance and treatment Medicine position statements are available free by request, in writing ,from: 2. Methadone maintenance should inc;lude the following ASAM, 12 West 21 Street, New York, NY 10010. modalities in addition to the provision of the drug itself: psychological and vocational services, medical care, and • counseling. 3. Determination of methadone dosage by program policy is inappropriate. Dosage should be individually determined by a well trained clinician based on subjective and objective data, and be adequate for l:he individual patient in all cases. 4. Methadone treatment is a crucial resource to decrease the spread of HIV infection. Financial resources should be available to accommodate those seeking treatment, and to train staff to provide good quality comprehensive care. 5. Methadone maintenance is an established treatment for Edwin J. Schumack, MD, 49, a North Carolina ASAM pregnant opioid dependent patients and may be initiated at any member certified in 1986, died in Chicago on May 20 of com­ time during pregnancy. Methadone withdrawal is rarely appro­ plications due to AIDS. He had completed residencies in both priate during pregnancy. When attempted, methadone should psychiatry and family practice and belonged both to APA and be withdrawn slowly under close medical supervision and with to AAFP. Dr. Schumack is survived by his parents, a sister, ".areful fetal monitoring. Individual dose determinations are and his long time friend and companion, Jack Magness . .ore appropriate than arbitrary low-dose policies that often Donations will be welcomed for a memorial fund in his contribute to relapse to heroin use, polydrug, and alcohol abuse na~. c/o R. Sullivan, RN, Unit 11-West, St Joseph's Hospi­ during pregnancy. High risk prenatal care, proper nutrition, tal, 2!700 N. ilieshore Drive, Chicago, IL 60657. ongoing individual, family, or group counseling, to include ASAM NEWS • July-August 1990 p. 10

Membership Notice from the Washington Office Effective immediately, the ASAM membership records Mediplex/Koala have been transferred from New York to our Washington office. Addiction Medicine Specialists Along with this move, the membership data base is being redesigned to reflect accurate, up-to-date information on all • Experieqs_ed Primary Care Physicians & members. These two events have resulted in a delay in pub­ Psychiatrists Ne.eded toWork in Several of lishing the ASAM Membership Directory. Although we regret Our Facilities the postponement, we are confident that when you receive the • Competitive Salary and Benefits 1 directory you will be pleased with it, and with the new features ! • SendResumeorcalll-800-423-9499 we plan to add. Address Correction Requested Please check the address label on this newsletter. If William Hawthorne, M.D. there are any changes, complete and return this form and your Medical Director current mailing label as quickly as possible to: Mediplex/Koala ASAM • 5225 Wisconsin Ave. NW, Suite 409, Phillips Point, East Tower Washington DC 20015. Suite900 ' We appreciate your patience during this transition from 777 South Flagler Drive New York to Washington. (JmS) Name:·------~~&"::ltlex Address: ______

City: ------State: __ Zip: ___

Phone: ______~------New Assistant Director in •Washington Jeanne-marie Smith is ASAM's new assistant director. The James A. Haley Veterans Hospital and the Uni­ She is a CAE (Certified Association H.ecutive--1978) who versity of South Florida Department of Psychiatry comes to ASAM from the Institute of Business Designers in are seeking a psychiatrist to help us develop our Chicago. That and other executive jobs have involved her expanding substance abuse treatment program. extensively in running an association, including membership, ~esponsi?ilities include program man'agement, dlreGt pat1ent care, as well as teaching and research. chapter development, budget and finance, publications, board Ti~e to support these latter activities is provided. and committee liaison. The successful applicant must qualify for an aca­ In addition to a 1986 MBA from DePaul University, Ms. demic appointment at USF. Demonstrated research Smith has a 1970 master's degree in music from Villa Schi­ interest and board eligibility are required. Mentor fanoia in Italy; her instrument is the piano. relationships for new investigators are available in a variety of ongoing research projects. The James A. Journals Popular at ASAM• Haley Veterans Hospital ~perates 150 acute psychi­ The most popular discounted subscriptions ordered by atric beds, 30 of which are devoted to substance ASAM members when paying their 1990 dues were: abuse treatment, as well as a full range of outpatient American Journal of Drug & Alcohol Abuse ...... 125 and partial hospitalization mental health services. Recent Developments in Alcoholism book series ...... 116 Journal of Psychoactive Drugs ...... 108 Interested parties please send CV or contact Dennis R. Journal of Substance Abuse Treatment ...... 107 Brightwell, M.D., Chief, Psychiatry Service, James A Advances in Alcohol & Substance Abuse...... 92 Haley Veterans Hospital, 13000 Bruce B. Downs Blvd., Alcoholism: Clinical & Experimental Research ...... 63 Tampa, FL 33612, 813-972-7665. VA is an EOE. Journal of Substance Abuse . . •...... 57 ASAM NEWS • July-August 1990 p. 11

~~ Everything You Need to Know About The Caregiver's Journey: · Chemical Dependence·· Vernon When You Love Someone Johnson's Complete Guide for Families with AIDS by Johnson Institute by Mel Pohl MD, The Johnson Institute is best known for pi­ Deniston Kp.y, PhD, and Doug Toft oneering intervention on alcoholics ("meaningful people pre­ As more and more CD and other patients contract AIDS, senting reality to a person in a receivable way") in the 1960s, the need increases for people who care for these patients at and for recognizing the importance of educating family mem­ home to know how to _cope. Its p1,1blisher reports that this bers of alcoholics about the disease. clear, complete handbook is the first AIDS resource to specifi­ Vernon Johnson's book/' II Quit Tomorrow is still a clas­ cally explore the "caregiver's" role: Of interest to - ~SAM sic in the field. JI has published many widely-read booklets members, the authors compare copmg as an. AIDS c1tregiver written by other experts. Dr. Johnson's comprehensive new with recovering from chemical dependency. One examp1e: book includes material from 17 of these publications. ASAM ''The Twelve Steps for People with HIV Illness," (adipted from authors represented are: Sheila B. Blume, MD (women); the Twelve Steps of AA in "the HIVIES Manual.) Tim men L. Cermak, MD (co-dependence); Anne Geller, Dr. Mel Pohl is chief of clinical services at PRIDE Insti­ MD (anxiety; sexual performance); Maxwell N. Weisman, tute in Minnesota, and has chaired ASAM's 3rd and 4th Na­ MD (relapse/slips); and Lucy Barry Robe (relapse/slips; tional Forums on AIDS. PRIDE's "Letter an HIV Positive Pa­ blackouts). tient Can Give to a Physician" was in ASAM NEWS, Novem­ Although long, the book is well organized and pertinent ber-December 1989 (p. 5). information is easy to find. Five "Parts" cover: Chemical Each chapter begins with beautifully written anecdotes Dependence in Individuals; Effects of Chemical Dependence at about three families: a gay couple, an extended Latino family, Home and at Work; Children of Alcoholics; Intervention or and a pair of heterosexual grandparents. Every family has lt How You Can Help Someone Who Doesn't Want Help; How least one AIDS patient. Parents Can Prevent Chemical Dependence in their Children. Part I, "Discovering-- Learning the Painful Truth" de­ Ordering info: Johnson Institute, 7151 Metro Blvd, scribes the many problems that face an AIDS caregiver, Minneapolis, MN 55439-2122. v (800) 231-5165. In Minn.: including codependence. 1 (800) 247-0484. Part II, "Adapting-- Building a New Life" includes who Price: $19.95 (495 pp.) pub. 1990 (LBR) has the right to know; "coasting;" facing crises. Part III, ''Tools for Acceptance" offers myriad sugges­ The Western Journal of Medicine• tions. Many parallel recovering from CD. For.example, "One "Addiction Medicine" issue· May 1990 of the most powerful things we can do is focus on whatever is Most of the articles in this special issue are by ASAM happening today ... To live in the moment means ~eeing that members: the people we care for are not dying today. They are here with David E. Smith, MD, guest editor, Addiction Medicine us, and that is enough. That is living with AIDS one day at a and the Primary Care Physician; John Q. Osterloh, MD and time." Charles E. Becker, MD, Chemical Dependency and Drug Excerpt from Part IV, ''Tomorrow": "We can remind our­ Testing in the Workplace; H. Westley Clark, MD, JD, The selves that the person we care for is more than a condition Role of Physicians as Medical Review officers in Workplace more than a diagnosis. The person with AIDS is a person 'first - Drug Testing Programs; Lori D. Karan, MD, Primary Care for - not a problem to solve, not a predicament to fix. Perhaps, in AIDS and Chemical Dependence; Martha A. Morrison, MD, the end, caregiving means only being present, listening, giving Addiction in Adolescents; Steven L. Batki, MD, Drug Abuse, attention, loving, and remaining open. And in that state of Psychiatric Disorders, and AIDS--Dual and Triple Diagnosis; mind, the answers will come to us in each moment, as we need Georgeanne Hoegerman, MD, Sidney H. Schnoll, MD, et al, them." Drug Exposed Neonates; Walter Ling, MD, and Donald R. The book is written clearly enough for a reader of any ed­ Wesson, MD, Drugs of Abuse--Opiates; Wanda A. Taylor, ucational background. Its sections encourage browsing yet fa­ MD and Mark S. Gold, MD, Pharmacalogic Approaches to cilitate finding pertinent material f~t. This handbook could be the Treatment of Cocaine Dependence; Karen Lea Sees, DO, useful to any physician whose practice includes AIDS. The au­ Cigarette Smoking, Nicotine Dependence, and Treatment; thors obviously care deeply about AIDS patients and their Donald R. Wesson, MD, Expert Systems in Treating Sub­ loved ones, and their compassion radiates throughout the book. stance Abuse; J. Thomas Payte, MD, et al, Methadone Main­ Ordering info: Hazelden, PO Box 176, Center City, MN tenance in the Treatment of Opioid Dependence--A Current 55012-0176. Order No. 5115A. v (612) 257-4010. - Perspective. Price: $9.95 (249 pp.) pub. 1990. (LBR) ~ Ordering info: The Western Journal of Medicine, PO Box • 7602, San Francisco, CA 94120-7602. v (415) 882-7602. Note: names in boldface are ASAM members. Price: $5.00 (175 pp.) Vol.• 152, No.5, May 1990. 1\,l...c ASAM NEWS • July-August 1990

Regional Campaign Leaders Reg. I (NY) Co-chairs: Drs. Norman S. Miller, John P. Morgan, Stephen B. Shapiro,Bruce E. Taylor James F. Considine, George A. Constant, Roy D. Clark, Jr., MD Reg. II (CA) Eugene A. Degner, Samuel B. Ganz, Jack B. Sandra Jo Counts, MD Chair: Barry M. Rosen, MD Hillman, Malcolm K. Lyon, Alipio B. Mas­ Andrew Di Bartolomeo, MD Reg. Ill (N.E.) carenhas, Anand W. Mehendale, Chandramo­ Paul H. Earley, MD Chair: David Mee-Lee, MD han D. Mudaliar, Edgar P. Nace, Jack R. Pe­ Charles John Engel, MD State Captains: :r:uett, Samuel T. Remer, Francis E. Seale, ~Anne Geller, MD CI: Peter Rostenberg, MD Helen Sullivan, GeorgeS. Tyner, Hulse Thomas L. Haynes, MD ME: George K. Dreher, MD Wagner, Lawrence H. Wharton Roland E. Herring~ MD MA: Norman Alpert, MD Reg. VIII (West) . Gordon L. Hyde, MD NH: Edward Maloney, MD Clwir: George W. Nash, MD Christine L. Kass~er• . MD­ RJ: William Griffith, MD State Captains: David Mee-Lee, MD ' . VI: William E. Hodgkin, MD AZ: Lisa Sparks, MD. James P. Miller, MD Reg. IV CO: Dawn Obrecht, MD Norman S. Miller, MD Chair: Andrew DiBartolomeo, MD HI: William F. Haning, ill, MD Garrett O'Connor, MD State Captains: ID: Richard W. Gerber, MD Roland F. Pike, MD NJ: Herbert I. McBride MT: Ronald K. Hull, MD Barry M Rosen, MD OH :Chris L. Adelman, MD NV: Donald D. VanDyken, MD Peter Rostimberg, MD PA: Bruce Branin, DO NM: Morris L. McEwen, MD John Saalwaechter, MD Mark R. Publicker, MD OR: Walton Edward Byrd, MD Stephen B. Shapiro, MD Reg. V (S.E.) UT: Ray J. Middleton, MD Timothy L. Sharma. MD Chair: Paul H. Earley, MD WA: Richard E. Tremblay, MD Richard E. Tremblay, MD AL: Jack Whites, MD WY: James C. Haller, MD Penelope P. Ziegler, MD FL: Richard Tyson, MD Area Coordinators: CO -Drs. H .. Blair Carl­ Donors' Circle: GA: James P. Miller, MD son, Caroline Gellrick, Michael I. Michalek; Gertrude Anthony MD: Rodney V. Burbach, MD WA- Drs. Roy D. Clark, Jr., John T. Cox, Judith Arthur MS: H. Thomas Milhorn, Jr.,MD Steven M. Juergens, Carol & Robert Sexton Margaret Bean-Bayog, MD SC: James F. Graham, MD Reg. IX (Canada) Lo.uis H. Beechnau, DO Milton Birnbaum, MD WV: Mary Elizabeth Myers, MD Clwir: T. Edward Yielding, MD LeClair Bissell, MD Reg. VI (MidW.) Donors by Category Rodney V. Burbach, MD Chair: Gordon L. Hyde, MD Benefactor's Circle : Judith M. Dischel, MD State Captains: R. Brinkley Smithers Bud Dickson, MD IL: Marla Kushner, DO Founder's Circle: George K. Dreher, MD IN: John Saalwaechter, MD William B. Hawthorne, MD Daniel K. Flavin, MD KY: Verner Stillner, MD President's Circle: Marc Galanter, MD Ml: Thomas L. Haynes, MD Jasper G. Chen See, MD Stanley E. Gitlow, MD MN: Marvin D. Seppala. MD Lynn Hankes, MD Enoch Gordis, MD ND: Daniel W. Goodwin, MD Michael J. Healy, MD William L. Griffith, MD Joseph R. Cruse, MD SD: Conway Hunter Jr, MD William E. Hodgkin, MD Christine L. Kasser, MD TN: George W. Nash, MD • Eshel Kreiter Drs. Robert W. Area Coordinators: TN- Anthony B. Radcliffe, MD Michael R. Liepman, MD Booher, Roland W. Gray, Charles B. Herrin, Max A. Schneider, MD Virginia Lott Reaves Lee, Kenneth F. Tullis, George W. James W. Smith, MD Louisa & Ian Macpherson Vick Leadership Circle: Theresa McAuliffe WI: Charles I. Engel, MD Ted E. Ashcraft, MD Claire Osman Reg. VII (S. W.) Leta Cram well Thomas P. & Katherine Pike Chair:: Michael J. Healy, MD Edward H. Maloney, MD Lucy Barry Robe State Captains: Elmer H. Ratzlaff, MD· Peter D. Rogers, MD AK: Ted E. Ashcraft, MD Ken Roy, MD Luanne Ruona. MD /A : F. William Bennett, MD G. Douglas Talbott, MD Jacqueline Schneider KS: David L. Trudeau, MD David L. Trudeau, MD David E. Smith, MD LA: Louis Cataldie, MD Circle of Friends: Lisa Sparks, MD MO: David L. Ohlms, MD Raymond C. Anderson, MD E. M. Steindler NE: John J. Hoesing, MD F. William Bennett, MD Charles L. Whitfield, MD OK: J. Darrel Smith, MD Sheila B. Blume, MD Leah E. Williams, MD TX: Timothy Sharma. MD Bruce Branin, DO T. Edward Yielding, MD Jess W. Bromley, MD Area Coordinators: AK- Drs. Harley Harber, Total Pledged (as of Aug. 15): James Merritt; TX- Drs. Thomas A. Blocher, Gene E. B~e. MD Duark Bole, Gene E. Burke, James F. & C1aife L. CiJ.lahan $302,560 ASAM NEWS • July-August 1990 p. 13

addictions. • Development of strong state chapters in each state. • Development of What Is the Endowment Fund? productivity. Your gift will ensure that treatment guidelines ASAM members share a com­ quality treatment, provided by and protocols. mon vision: to provide effective treat­ physicians who are knowledgeable about , ~ • Partidpa~ion in ment for all who suffer from alcoholism addictions, would be available to all who clinical research on and other drug dependencies. Attaining seek it. treatment outcome that vision will profoundly influence Among the benefits to be derived and effectiveness. many areas of medicine, and will affect from a fiscally strong ASAM are the fol­ • Publication of a Ruth Fox, MD. nearly every family in America. lowing. national clinical ASAM founder, However, in order to support the ASAM'S Goals and Benefits journal of addiction 1st president many activities involved in this vision, • Mainstreaming of teaching in addiction medicine. ASAM must be fiscally sound and medicine. • Publication of a bimonthly newsletter. strong. Therefore, the society has em­ • Fellowship, residency and other gradu­ • Publication of m_onographs in areas of barked on an endowment campaign in ate training in addiction medicine. clinical concern tb members. memory ofits founder, Ruth Fox, MD. • American Board of Medical • National and international conferences The goal: to raise one million dollars Specialties' recognition of addiction with the most eminent specialists in the from ASAM members and friends medicine. clinical and research fields. between April1990 and April1991. • Representation in the AMA House of • A membership of 5,000 by 1992. Why Should I Contribute? Delegates. Each member of ASAM will bene­ Your contribution to the endow­ • Representation in deliberations of na­ fit from a strong endowed society, so too ment is an investment in your personal tional accrediting organizations such as will the members' patients and col­ future, in the future of American medi- theJCAHO. leagues. A fiscally strong ASAM will ·,. cine, and in the health and well-being of • Representation to government offices also profoundly influence many areas of your current and future patients. One in in Washington including the Congress, American Medicine. This is a strategic three American families is affected by the White House, NIAAA, NIDA, moment. And this moment is not for addiction, and the American Medical ADAMHA, FDA, and other agencies. ASAMalone. Association has recognized the disease • Representation by addictionists serving The campaign is being organized of addiction as currently the most serious on boards and committees of national nationwide as follows: regional chairs, health problem in the . medical specialties. state captains, area coordinators, team Too many alcoholics and other • Advocacy for adequate public and pri­ leaders, and solicitors. The latter will chemically dependent people still lack vate health msurance for addiction treat­ contact donors directly beginning in adequate and effective care. Most physi-' ment. September. cians do not feel confident about • Legal advocacy in promoting equitable Campaign goal: to raise diagnosing or treating addictive disease. and adequate medical care for addiction. $1,000,000. Each member will be asked When appropriately treated, such • Legal advocacy on issues affecting the to contribute $3,000 over a three-year as by physicians with training in addic­ practice of addiction medicine, such as period, or whatever his or her means will tion medicine, thousands of chemically managed care. · permit. dependent individuals and their families • National representation in advocating Campaign co-chairs are Jasper G. have been restored to good health and public and corporate policies that impact Chen See, MD, ASAM president, and upon the health problems resulting from William Hawthorne, MD, ASAM trea­ surer. Call for Help Development Director is Claire The goal of the Ruth Fox Memorial Endowment Fund is to help Osman of ASAM's New York office. ASAM achieve its long-term goals by giving the society solid financial resources. We are putting out a call to you, our members, to help us • WESTERN PENNSYLVANIA to identify the foundations, corporations, and treatment centers which Two Family Practitioners seeking a are potential sources for contributions to the endowment. third. Special interest in Addiction ASAM needs your help and participation to make this important Medicine. Please send resume to: campaign be a success. If any member knows of an organization we Bonnie Youngblood can contact, please write to the New York ASAM office, or contact Suite 240 The Medical Center East Ms. Claire Osman directly at (212) 206-6770. 211 North Whitfield Street Please let us hear from you. Pittsburgh, PA 15206 (800) 438-2476 ASAM NEWS • July-August 1990 p. 14

AMA Masterfile addiction has been declared by this self-designated specialty areas which are (continued from page 1) House to be the most important public assigned a code in the AMA Physician The four-volume American Medical health problem in the United States and Masterfile. Directory includes the 85 self-designat- Whereas, the diagnosis and treat- ed practice specialties. Specialty Pro- ment of alcoholism and other drug • files offers extensive data analysis on addiction as disease has been recognized The Kaiser Permanente Perspective: these specialties. by the AMA and other reputable medical organizations as a legitimate form of Exceptional Health Care For example, in 1970, only 8% of In An Exceptionale Locale. the 334,000 physicians who were listed medical practice; and in Masterfile were women, vs. 19% of Whereas, an increasing number of Kaiser Permanente offers the ca reer stability and ~up~ort of the largest pre-paid grObp medical prac­ the 586,000 listed in 1988. Primary physicians are responding to the addic- tice 1n America. Excellent opp ortun1lles exist now tion problem by devoting an appreciable with us for internal medicine and family _practice Care Specialties (FP, GP, Ped, IM, physicians, board certified (or eligible) with expe­ Ob/Gyn) has remained at about 40%; Pa- amount of practice time to diagnosis and rience/training in addiction "treatment/ We offer a • growing emphasis toward addiction medicine plus tient Care (vs. Non-Patient Care) at treatment of addictive disease; and an active outpatient program and more. Whereas, these physicians represent about82%. ADDICTION MEDICINE --ALCOHOL a range of specialties including addiction ASAM's delegates to the AMA are & CHEMICAL DEPENDENCY Jess Bromley, MD, ASAM treasurer, medicine; and THION THERE IS OU B IDEAL LOCATION. and alternate David E. Smith, MD, Whereas, codes are provided by the In northeastern Ohil1you will enjoy a thriving met­ AMA so that physicians can self desig- ropolitan setting. an Ideal housing market ac­ ASAM board member. claimed symphony orchestra, theatre, ballet. Great For information about the AMA nate one or more areas in which they Lakes recreation, and a growing service base of 210.000 members in the Cleveland-Akron area. Physician Masterfile contact: spend a significant number of practice If you share our perspective. contact us. We offer Dept of Physician Data Services, hours, and relocation programs, attractive salary, superb bene­ fits. shareholder status, paid retirement plans and American Medical AssoCiation, Whereas, identification in the AMA full malpractice coverage. Please send your res- Masterfile of physicians who treat addic- ume to: Ronald G. Potts, M.D., Medical Director 515 North State St, Chicago, ll.. 60610. Ohio Permanente Medical Group, Inc., Dept: Phone: (312) 464-5000. tive disease would serve the needs of HRASAM. 1300 E. 9th Street, Suite 1100, Cleve­ land. OH 44114. Or call us at 1-800-837-0PMG/ Code for Addiction Medicine both patients and referring physicians; (216) 623-8770. EOE. (Resolution No. 72. A similar reso- now, therefore, be it lution was also submitted by the Califor- Resolved: That the American Medi- ••• nia Delegation to the AMA.) cal Association Board of Trustees add ~~' ~ Whereas, chemical dependency/ Addiction Medicine to the ·I

Scripps Memorial Hospital in La Reach 3,600 Physicians Jolla, California, has embarked on a major project to establish a , PSYCHIATRIC top level behavioral health ser- with your ad vices institute and is currently ac- in CONSULTATION cepting resumes for the full-time ASAMNEWS PART TIME position of medical director. . A Nationally recognized Alcohol & Prices start at $60 . Drug Rehabilitation Facility with The successful candidate will be 98 Adult&32 Adolescent Beds seeks for an ad 1/3 this size a psychiatric physician experi- a part-time Psychiatrist to perform enced in chemical dependency comprehensive Psychiatric assess­ rehabilitation and mental health Call or write: ment Responsibilities include; dic­ programs for both adolescents Lucy B. Robe, tation of consultation reports with and adults. Applicants must be Editor & Advertising specific t~;eatment recommendations board certified in psychiatry and 15 Ridge Road for multidisciplinary team interest eligible for California licensure. Cold Spring Harbor, NY 11724 and experience in treatment of (516) 367-6692 additive illness necessary. We offer For an information package and a pleasant working environment, application, send resume and Beginning mid-October 1990: competitive reimbursement includ­ include salary expectations to: 303D Sea Oats Drive ing in-house recreational facilities. Bill Hardie, Director of Personnel Juno Beach, FL 33408 Send resume and or C.V. to: Scripps Memorial Hospital (407) 627-6815 Dr. Timothy Rowe Director of 9888 Genesee Avenue ~~\ ; Psychiatric Services P.O. Box 28 Or call ASAM's New York office: La Jolla, CA 92037 (212) 206-6770 ASAM NEWS • July-August 1990 p. 15

Dear Editor: -~ I am not a word buff. I do not run around correcting j,oople when they misuse a word. However, when I hear a word so inappropriately, and incorrectly, used that it costs hospitals and patients hundreds of thousands of dollars, I take monitoring. He would also have avoided IV fluids, IV medi­ notice and protest cations and restraints, and several tho~sand dollars worth of Such a word is "detoxification" or its abbreviation care. Instead of thanks, third party payers would have labeled "detox." Whether modified by "subacute" or by "acute," it has this "subacute,detox" and said, ''I'm sorry, we don't cover no medical meaning, describes no clinical process, and, in fact, subacute detox." , ; · \ is totally misleading. The conclusion, of cour~. is to make a late diagnosis of Detoxification is a natUral biological process by which acute withdrawal and to keep an open bed in ICU . . various chemicals that are toxic are treated by the body, usually Paul Russell, MD ~ in the liver, to nullify or block their chemical action on the Traverse City, MI body, and/or to prepare them for excretion by the kidney. It is [Stanley E. Gitlow, MD, chair of ASAM' s Publications not a medical treatment and has nothing to do with alcohol Committee, comments:] Rather than "Detox," I used to call withdrawal. In fact. only after the body has detoxified alcohol this "Treatment (prevention?) of the (acute?) Withdrawal Syn­ is there danger of withdrawal. drome." Does Dr. Russell have his own preference for pre­ Alcohol withdrawal can be trivial or severe, beginning as ferred nomenclature? How about other ASAM NEWS readers? a simple hangover and advancing to life-threatening seizures or . -~ delirium. Dear Editor: I recently saw a patient in ICU -- post-op from cervical I am medical director of an adolescent chemical dependen­ fracture after falling off a ladder. He was in full blown deliri­ cy unit. Almost all of our adolescent patients smoke while in um tremens; hallucinating, fighting restraints, etc. Over the the hospital, but our hospital is going smoke-free on July 1 ... next 24 hours he consumed over 1000 mgs of IV diazepam be­ This question is for Dr. Slade, regarding his article in the fore we were able to remove restraints. January-February issue of ASAM NEWS (p. 9). Has anyone This same patient, were he admitted for acute alcohol approached the AMA about declaring nicotinism or nicotine withdrawal, would have received on the first day sufficient di­ dependence as a diagnosis or as a classical disease? If so, what .flZepam to avoid the severe withdrawal that he suffered post­ attempts have been made and what has happened with these at­ operatively; however, he would have required the same hourly tempts? Paul D. Coleman, MD. Barberton, OH DENVER, COLORADO [John Slade, MD, chair ofASAM' s Nicotine Dependence Kaiser Permanente Medical Care Program, at the Committee, replies:] Although it has not directly addressed Dr. foot of the Rocky Mountains in Denver, seeks full Coleman's question, the AMA has used the fact that nicotine is time permanent alcohol/chemical dependency a drug of addiction in its advocacy work on tobacco. For in­ physician. The primary responsibility of this posi­ stance, in its 1988 petition asking the Food and Drug Adminis­ tion is to work with our administrafive and clinical tration to classify the pseudo-cigarette, Premier, as a drug, the staff in expanding our alcohol/chemical depend­ AMA repeatedly refers to nicotine as an "addicting substance." ency programs. Other responsibilities include Since 1980, nicotine dependence has been officially rec­ program development, patient care, provider and ognized as l! medical condition in the American Psychiatric member education, liaison role with community Association's DSM (Diagnostic and Statistical Manual). contracted providers, quality assurance and The relevant,codes in DSM III-Rare: utilization management. 292.00 Nicotine Withdrawal 305.10 Nicotine Dependence. Kaiser Permanente is the largest prepaid group • practice in Colorado with over 225,000 members Dear Editor: and 280 physicians. I found Peter Rostenberg, MQ's, Letter to the Editor about required BAC's and drug screens for all trauma For information, please contact: admissions at the Danbury Hospital, extraordinarily interesting. [See ASAM NEWS, January-February 1990, p. 15.] V. A. LaFleur, M.D. I have strongly recommended that the St. Joseph's Hospi­ Colorado Permanente Medical Group, P.C. tal Emergency Room in Tucson consider instituting mandatory 1 0350 East Dakota Avenue drug screening. Denver, CO 80231 William Masland, MD Tucson, AZ (303) 344-7294 • EOE ASAM NEWS • July-August p. 16

Meetings sponsored or co-sponsored by ASAM (one-time listing for co-sponsored conferences). For information about ASAM co-sponsorship For conference listing on this calendnr, please of conferences, contact Claire Osman, ASAM­ send information directly to Lucy B. Robe, Editor, at New York. least two months in advance.

0 ASAM 3rd National eo"nference on Nicotine 0 ASAM Region Ill Annual Meeting: Worcester, MA, Dependence: San Diego, Sept. 6-9 Dec. 8 (new date) Meetings Unlimited, 6429 West North Ave, Ste 102, Michael Liepmap.i MD, CD S~rvices, OPD-2, MCCM Memorial, Oak Park, IL 60302. 119 Belmont St, Worcester, MA 01605 1r (508) 793-6170 1r (708) 848-6050 \ . 1 0 Chapter of ASAM •2nd Fall Conference: 0 Florida Society of Addiction Medicine (FSAM) Annual Pine Mountain, GA, Sept. 21-23 Meetlrig: Orlando, FL, Jan. 18-20, 1991 - Georgia ASAM, Ste 104, 1996 Cliff Valley Way, Larry Siegel, MD, 520 Southard St, Key West, FL 33040 Atlanta, GA 30329 1r (305) 296-8593 . • 0 5th Annual Cape Cod Symposium• on Addictive 0 ASAM 5th National Forum on AIDS & Chemical Disorders: Hyannis, MA, Sept. 20-23 Dependency: San Francisco, Feb. 21-24, 1991 Jane Arena, North River Foundation, Inc., 475 Furnace St, MTS, Conference Information (AIDS);)'O Box 81691, Marshfield, MA 02050 Atlanta, GA 30366 . 1r (404) 458-3382 1r (617) 834-0005 • 0 AMERSA National Conference• on Medical Education and 0 ASAM 22nd Annual Medical Scientific Conference: Research In Drug And Alcohol Abuse: Boston, Apr. 18-21, 1991 Rockville, MD, Nov.13-16 Cluny Conference Services, (Louisa Macpherson) Susan Paquin Simpson, AMERSA Coordinator, Brown 1013 Rivage Promenade, Wilmington, NC 28412 University, Box G, Center for Alcohol & Addiction Studies, 1r (919) 452-4920 Providence, Rl 02912 o Ruth Fox Course: Apr. 18 0 ASAM Board Meeting: Boston, Wed. Apr.17 o ASAM 19.90 Review Courses:• Chicago: Oct. 11-13 New York: Oct. 25-27 0 ASAM 1st National Medical• Conference on San Francisco: Nov. 8-10 Atlanta: Nov. 15-17 Adolescent Addictions: Atlanta, June 20-23, 1991 0 ASAM 1990 Certification Examination: Sat. Dec. 1 MTS, Conference Information (Adol.), PO Box 81691, Chicago; Newark, NJ; San Francisco; Atlanta. Atlanta, GA 30366 ASAM, 12 West 21 St, New York, NY 10010. 1r (404) 458-3382 1r (212) 206-6770 0 ASAM Board Meeting: San Francisco, Sun. Nov.ll 0 ASAM State of the Art in Addiction• Medicine: • Orlando, FL, Oct. 24-26, 1991

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