Newsletter 0 f The American Society' of Addictionr, Medicine ' .- ' ; New President Says ASAM Has ·-~ ~ "Talent, Energy, Experience" to Mee1t Chal1enges G. Douglas Talbott, M.D. , FASAM I assume the Presidency of ASAM with hu AMA's Physicians Health Committee. I sub The Caduceus Foundation also has convened mility, excitement and a sense of exultation. sequently approached Drs. Gitlow and a number of expert meetings on caffeine, Seixas and the basis of the first Kroc Ranch chaired by Dr. Max Schneider. The findings To follow Dr. David Smith's Presidency is unity meeting was established. from these sessionii.were reported at the 1993 by definition a humbling experience. It is Medical-Scientific Conference in a sympo also humbling to be elected President of sium on the role of caffeine in addiction ASAM, for this is truly a great and unique treatment. organization. I exult in the richness of this history, and in Nor can I assume the presidency of this or the current accomplishments represented by ganization without exultation. I have been the ASAM Patient Placement Criteria un with ASAM from the birth of the Southeast der the leadership of Dr. David Mee-Lee and ern addiction movement, the California the efforts on tobacco, led by Dr. John Slade. movement, and the New York movement. The New York programs were much older Goals for the Future than the California and Georgia programs, As we look toward the future, I want to but I learned of the New York program dedicate my presidency to the establish through the work of Drs. Frank Seixas, ment of residencies in addiction medicine Sheila Blume, Stan Gitlow, and through my in a number of university medical centers. long-time fliend Max Weisman. At the Kroc With such residencies funded and imple Ranch unity meeting, we wrestled with no mented, specialization with certificates of menclature-! remember stumbling over the added qualifications can be effectively acronym "AMSAODD." I also rememb
of Few individuals in medicine have had the in defining what it means to practice addic opportunity to influence the development of tion medicine; third, achievements in the Addiction Medicine the profession, to actually define how medi integration of that basic and clinical science cine is practiced. Each ASAM member has into medical education and into the health 4601 North Park Avenue precisely that opportunity through your pur . care system. Upper Arcade, Suite 101 suit of AS AM's mission, which is unique in Chevy Chase, MD 20815 the history of medicine. That mission is: 0 DEVELOPMENTS IN THE SCIENCE: In recent years, we have demonstrated'tmd described ASAM is a specialty society of 0 To establish the prevention and treatment what characterizes addiction, through both physicians concerned about of addictive disorders as a basic health animal and human studies, as Dr. Ting-Kai alcoholism and other addictions and benefit (parity), and Li so clearly described in his lecture on ani who care for persons affected by 0 To establish the specialty of addiction mal models and alcoholism, and as Dr. these illnesses. medicine. Enoch Gordis and his colleagues presented ASAM News in their symposium on the Genetics of Al is an official publication of the WhileASAM's mission is historic, we are coholism during the ASAM Medical-Scien American Society of Addiction Medicine, in a period in the history of medicine in tific Conference. Th recent years, we have and is published six times a year. Please which treatment for all illnesses, includ shown how addictive substances act on the direct all editmial and advertising ing addictive disorders, is being rationed. reward center of the brain, the nucleus inquiries to ASAM News, We also are in a period in which specialty accumbens. We have learned that continued c/o the ASAM office. training is being de-emphasized, and assault of the brain with addictive drugs al training of generalists is being given ters brain circuitry and triggers a craving for Officers greater emphasis. All of this is being done more drugs. In short, we have shown that it President with almost total disregard for the conse is this biologically driven compulsiveness to G. Douglas Talbott, M.D., FASAM quences of these changes for patient care repeatedly consume the drug, despite physi President-Elect and the medical profession. cal or other consequences, that charactetizes Marc Galanter, M.D., FASAM addictive disorders. One of AS AM's proud Immediate Past President We live in harsh and brutal times, times that est 1996 achievements in linking the science David E. Smith, M.D., FASAM challenge the truth and validity of our mis and practice of addiction medicine was its Secretary sion and of our resolve to pursue our mis State-of-the-Alt Course in Addiction Medi Andrea G. Barthwell, M.D. sion. And so it is appropriate for us to ask: cine, chaired by Drs. Allan Graham and Treasurer Is ASAM's mission true? Is its attainment Terry Schultz. James W. Smith, M.D., FASAM feasible in bad times such as the present, as well as in the good? Is our resolve to pursue 0 ADVANCES IN DEFINING THE PRACTICE: The Chair, Publications Committee our mission firm? The answer to all these practice of addiction medicine has been a Elizabeth F. Howell, M.D. questions is "Yes." The evidence shows that reality since physicians first recognized in our accomplishments and our ability to en toxication and its consequences and tried to Newsletter Review Board vision goals for advancing even further to intervene and treat. But it is only in the past LeClair Bissell, M.D. ward attainment of our mission. few years that we have formally codified Sheila B. Blume, M.D., FASAM what constitutes the body of clinical knowl Max A. Schneider, M.D., FASAM Marvin Seppala, M.D. Accomplishments edge that we call addiction medicine. The Let us review our accomplishments in sev most complete description of the science and Executive Vice President/CEO eral areas: first, achievements in the science James F. Callahan, D.P.A. of addiction medicine; second, achievements Continued on next page
Founding Editor, 1985-1995 Lucy Barry Robe ASAM'S MISSION ,
Editor At its April 1997 meeting in San Diego, the ASAM Board of Directors Bonnie B. Wilford reaffirmed the following mission statement for the Society: Subscriptions The mission of the American Society of Addiction Medicine is to: Free to ASAM members; $25 a year (6 issues) to non-members. Order from the ASAM office at 0 establish medical education in prevention and treatment of addictive disorders as an 301/656-3920, or integral part of medical school, graduate and continuing medical education, and Fax 301/656-3815. E-mail: asamoffice@ asam.org 0 establish preventi~ and treatment of addictive disorders as a basic health benefit http://www.asam.org for all who suffer froln addictive disorders (parity).
ASAMNews 2 May I June 1997 EVP Report- Continued from previous page MANAGED CARE NEWS practice of addiction medicine is presented in Principles ofAddic JOINT STATEMENT tion Medicine, edited by Drs. Norman Miller and Martin Doot. APPROVED BY ASAM, AMBHA Further definition of the practice of addiction medicine is contained in the ASAM Practice Guidelines. Drs. Kasser Chris Kasser, Michael ASAM and the American Managed Behavioral Healthcare Asso Mayo-Smith, and the members of the Practice Guidelines Committee ciation (AMBHA) have developed the following joint statement, recently were infmmed that ASAM's practice guideline on Pharma which has been approved by the AMBHA membership and the cologic Management of Alcohol Withdrawal has been accepted for ASAM Board of Directors. publication in the Journal of the American Medical Association. Drafters of the stateme.ot were (fo!iASAM) Christine Kasser, M.D., I 0 INTEGRATION OF SciENCE AND PRACTICE INTO THE HEALTH CARE SYs David Mee-Lee, M.D., Michael M. Miller, M.D., Anthony Radcliffe, TEM: It is one thing to have demonstrated the scientific basis of a M.D., and Exe~utive Vice President James Callahan, p.P.A., and (for disorder and define how that disorder may be identified and treated. AMBHA) David Nace, M.D., Gary Petersen, M.B.A., E! Clarke Ross, It is still another thing to integrate teaching about that disorder into D.P.A., and Ian Shaffer, M.D. - the medical education system, and treatment of the disorder into the health care system. Over the past five years, ASAM has made Effective Treatment·of Addictive Disorders: significant strides in each of the following areas. A Basis for an AMBHA - ASAM Dialogue Sharing an interest in the delivery of high-quality, cost-effective In education and training, ASAM has published its Guidelines for treatments of addictive disorders, the American Managed Behav Fellowship Training Programs in Addiction Medicine, and has estab ioral Healthcare Association (AMBHA) agd the American Society lished AMA-policies calling for increased training in addiction medi of Addiction Medicine (ASAM) have entered into an ongoing dia cine in each of the primary care residencies. Several ASAM members logue and, as a beginning, make the following observations: have been key actors in the ASAM-supported establishment of the subspecialty of addiction psychiatry by the ABPN, and in the forma 1) Substance related problems span a range from problems associ tion of the subspecialty of addiction medicine by the American Osteo ated with use, misuse and addiction. Patients may present request pathic Academy of Addiction Medicine. ing care at any time during this spectrum.
To date, ASAM has certified 2,939 physicians. Every ASAM-certi 2) We accept the need to match the severity of patients' disorders fied physician will be pleased to know that the National Committee with appropriate interventions for that intensity of problem. for Quality Assurance (NCQA) revised its accreditation standards in 1997 to stipulate that managed care organizations must hire psy 3) Some individuals experience single or isolated episodes of ill chiatrists and/or physicians who are certified in addiction medicine ness; others experience periodic recurrences in their lifetimes; oth to treat the addicted patient. ers have severe and persistent addictive disorders. For some per sons with addictive disorders: especially those with severe and per 0 INTEGRATION OF ADDICTION MEDICINE TREATMENT INTO THE HEALTH sistent disorders, there is a need for ongoing management and peri CARE SYSTEM: The ultimate basis for assuring the practice and, there odic acute treatment interventions to appropriately respond to situ fore, the education, training and specialty of addiction medicine is ations of relapse. assuring that prevention and treatment of addictive disorders are a basic health benefit. We have accomplished the following in this 4) Addictive disorders are primary disorders which require their regard. 1 own unique and specialized treatment. Individuals with addictive disorders may also experience mental illness and may also experi Several states have told ASAM that they will use the ASAM Patient ence primary health problems. Placement Criteria, including Connecticut, Florida, Hawaii, illinois, Iowa, Virginia, Washington and Tennessee. All organizations doing 5) A purpose of managed behavioral health care is to deliver clini business in these states, including all managed care companies, will cally effective and cost efficient services within the constraints of be required to use the ASAM Criteria. finite resources. This involves using the least intensive available treatment setting, appropriate to the needs of the patient, while main In a major breakthrough, the Department of Defense recently is taining patient safety. As for all chronic medical conditions, pay sued its new policy on substance abuse treatment, which will estab ers/purchasers of addiction services have limited resources. Effec lish a continuum of care "compatible with the Patient Placement tiveness requires provider accountability for clinical outcomes that Criteria of the American Society of Addiction Medicine." This treat improve patients' health and provid Volume 12, Number 3 3 ASAMNews PRACTICE GUIDELINES APA TO PUBLISH GUIDELINE FOR NICOTINE DEPENDENCE The Ame1ican Psychiatric Association has announced that it will mine whether the relapse was due to withdrawal symptoms or publish a Practice Guideline for the Treatment ofPatients with Nico psychosocial problems. Recommended therapies include com tine Dependence. The guideline complements the advice developed bined nicotine patch and nicotine gum (II), clonidine (II), and by the federal Agency for Health Care Policy Research by focusing nicotine nasal spray (II), combined with intensive, individual on three specific groups of smokers: (1) smokers who have failed behavior therapy (III). initial treatments for smoking cessation and who need more inten sive treatment; (2) smokers who are being seen by a psychiatrist for For smokers who ru:e being treated for other psychiatric disorders, a psychiatric disorder other than nicotine dependence; and (3) psy the guideline recommends incorporating smoking cessation into all chiatric patients who smoke and who are temporarily confined to a treatment plans (I), motivating patients to stop s~king during non smoke-free inpatient or residential setting. Recommendations are crisis periods (I), and providing initial therapy (f). It also recom concrete and detailed and carry ratings from I to III based on the mends that physicians closely monitor those patients who do stop adequacy of the supporting data. smoking to detect any remission in psychiatric disorders or changes in blood levels of medications (II). The guidelines recommend 10 therapies (categories I or II), classifies 11 others as promising and possibly worthy of recommendation based For patients on smoke-free medical or residential units, the on individual circumstances (category Ill), and lists 21 others as not guideline recommends clear instructions about nonsmoking recommended. Evidence from studies other than randomized trials policies, advice to stop smoking, an-d, education about manage and clinical expertise are reflected in the recommendations, so that the ment of withdrawal (III). It also recommends behavioral strate resulting guidelines tend to recommend treatment more often and to gies (III) and use of nicotine gum or patch (II) to reduce with be more specific about recommendations than other guidelines. drawal symptoms. In treating smokers who have failed initial therapy (usually nico The approximately 40-page guideline will be published as a supple tine gum or patch and/or group behavior therapy), the guideline ment to the October issue of the American Journal of Psychiatry recommends assessing the adequacy of prior treatments, screen and can be obtained from the American Psychiatric Press by calling ing for psychiatric or addictive disorders, and trying to deter- 11800-368-5777. APA Guideline on Recommended Treatments for Nicotine Dependence. PSYCHOSOCIAL THERAPIES SOMATIC THERAPIES . Multicomponent behavior therapy (I) Nicotine gum (I) I - Skills training/relapse prevention (II) Transdermal nicotine (I) -Stimulus control (II) Nicotine gum or transdetmal nicotine plus behavior therapy (I) - Rapid smoking (II) Clonidine (II) Self-help materials (II) Nicotine nasal spray (II) Managed Care News -Continued from page 3 8) To successfully assess and treat individu 9) All providers should deliver treatment 10) Quality should be measured. Stan als with addictive disorders, providers must that is effective, efficient, and has value. dardized data sets, including adminis possess a core set of knowledge and experi This will require sophisticated screening, trative, clinical, and performance, ence. There are multiple and many profes assessing and tracking systems for mea should be developed. · AMBHA and sional providers of addiction services; each surement of outcomes and agreement on ASAM will strive to articulate possible must demonstrate that he/she individually common screening tools, diagnostic cri data set guidelines. AMBHA and possesses a core set of know ledge and expe teria and nomenclature. There is increas ASAM share the goal of seeing that rience. AMBHA and ASAM have a shared ing awareness that health plans, networks guidelines are produced to oversee the interest in articulating what a minimum and and individual prov:iders mu~t be more development, articulation and applica standardized set of knowledge and experi publicly accountable for the clinical out tion of data sets and data accumulation ence should be. comes they deliver. processes. I ASAM News 4 May I June 1997 A REPORT FROM THE PRESIDENT-ELECT MONEY FOR TREATMENT Marc Galanter, M.D., FASAM You don't have to look far in the daily ment of Defense, as well as some insurers. press or at your own practice to know that We need to develop further our strategies to American medical care is in a state of cri assure that the ASAM Criteria are applied sis. Attempts to cut back on rising medi so that all needed care is recognized as a cal costs have led to a topsy-turvy system medical necessity, not just the patients who in which corporate entities are doing art; at death's door. battle for the money that should be going for treatment. 0 ASAM has strong ties to a number of ' organizations with which we have collabo Nowhere is this more apparent than in the field rated to extend coverage for treatment. In of addiction medicine. What we need to do in order to enhance our influence, we will tum ASAM--and what I emphasized as our pri to these groups and extend our cooperation mary goal in my candidacy statement--is to with them. For example, we will need to use assure that our patients are provided with the our role in the American Medical Associa insurance coverage necessary to underwrite tion, which already has demonstrated value their needed care. This is a real battle for out in securing the identification of our specialty patients' welfare, and ASAM is involved in area. We will work with the National Coun many activities to promote this cause. We must cil on Alcoholism and Other Drug Depen now keep our current efforts focused on this dencies, whose Committee on Benefits is issue, and move on to secure the practice of formulating an approach to assuring appro addiction medicine. TheASAM Board of Di priate benefits for treatment. The National rectors will be meeting this October and will Institute on Drug Abuse, the National Insti review information on this issue, in order to tute on Alcohol Abuse and Alcoholism, and ascertain how we can best fight this battle for the Center for Substance Abuse Treatment our members and their patients. are valuable allies as well in providing re treatment is the result of inadequate cover search-based support to validate current and age. Some of these suits are already under ASAM already has articulated this issue in emerging treatment options. way, aided by other organizations. The re the policy on Core Benefits for Addiction markable success of class action suits in Treatment, which says that "no limits on 0 ASAM will focus on organizations rep changing the course of the country's rela numbers of treatment visits, days, or pay resenting managed care and HMOs to make tionship with nicotine addiction suggests that ments shall be applied, in the same manner our needs clear. These include the National this m,ay be a valuable and even promising as with any chronic disease." Council for Quality Assessment, a group that avenue for us to pursue. is developing standardized criteria for evalu Here are some relevant points: ating coverage by managed care providers, I look forward to bringing you periodic up and the American Managed Behavioral dates on this issue of vital interest to us all, 0 Health maintenance organizations and Healthcare Association, an industry organi on the efforts we undertake, and on what managed care plans have starved out cover zation for managed care, with which we have results we have achieved. I want to express age for all but the most acute and life-threat engaged in active discussions regarding the deep appreciation for the opportunity you ening consequences of addiction and, in need for better coverage (see the related story have given me to participate in ASAM's some cases, even those. Rehabilitation and on page 15). leadership, and look forward to a highly pro recovery are hardly supported at all. Our . ductive collaboration with you, the mem ASAM Patient Placement Criteria are di 0 Another major consideration is the pos- bers; with our President, Doug Talbott; with rected at defining appropriate levels of care, sibility of providing relevant case material our highly successful immediate Past Presi and have achieved wide acceptance, includ for attorneys who are formulating class ac dent, David Smith; and with the other offic ing adoption by seven states and the Depart- tion suits on behalf of patients whose poor ers of the Society. 1998 ASAM CERTIFICATION EXAM ANNOUNCED The next Certification/Recertification Examination for physicians be reviewed and candidates notified' by mail as to whether they in addiction medicine is to be offered Saturday, November 21, 1988, qualify to sit for the examination. at three sites: Atlanta, GA; Newark, NJ; and Los Angeles, CA. Physicians who pass the examination become ASAM Certified/ Physicians who wish to sit for the examination must complete Recertified in Addiction Medicine. Since the examinations first and submit an application. Applications will be available by July were offered in 1986, 2,939 physicians have passed the exami 1997, and will be sent automatically to all ASAM members. nation, including many of the nation's top addiction treatment Completed applications will be accepted on the following sched professionals. ule: Early Registration, through Friday, October 31, 1997; Stan dard Registration, through Friday, January 30, 1998; Late Reg for more information on ASAM Certification and the examina istration, through Thursday, April30, 1998. All applications will thm, conta~t John Keister at the ASAM office. I Volume 12, Number 3 5 ASAMNews MED-SCI REPORT ASAM CONVENES 28TH ANNUAL ASAM BOARD MEDICAL-SCIENTIFIC CONFERENCE APPROVES NEW IN SAN DIEGO LOGO ASAM's 28th Annual Medical Scientific Con the Ame1ican Osteopathic Academy of Ad At its April meeting, the ASAM Board of ference convened Aprill7-20 in San Diego, diction Medicine. Topics included a "Review Directors approved a new logo design pro CA. More than 700 physicians and guests par of Recent Advances in the Alcohol and Drug posed by the Membership Committee. The ticipated in the program of scientific sym Fields" by Marc Schuckit, M.D.; "Hot Top logo reflects ASAM's status within main posia, clinical courses and workshops, as well ics in Opioid Detoxification/Maintenance stream medicine as the national medical as special sessions sponsored by theNational Treatments" by Richard Schottenfeld, M.D.; - specialty society for addiction medicine. Institute on Alcohol Abuse and Alcoholism "Treatment of Pain and Addiction" by Karen Following a transition period, the new logo and the National Institute on Drug Abuse. The Lea Sees, D.O.; "Forensic Considerations in will be displayed on all A~M products, Medical-Scientific Conference was preceded Addiction Medicine" by William Vilensky, including ASAM Ne_ws and other publica by the Ruth Fox Course for Physicians, the D.O.; "Spirituality and Recovery" by Ganett tions, letterhead, and the Web site. ASAM Forum on AIDS and Addictions, and J. O'Connor, M.D.; "Taking the 'Duel' Out the ASAM Computer and Online Course. of Dual Diagnosis" by Daniel E. Wolf, D.O.; "Adolescent Substance Abuse" by Anthony Forum on AIDS and Addictions Dekker, D.O.; and "Max's Moments" by ASAM's first annual Forum on AIDS and Max Weisman, M.D. Addictions provided participants with up to-date information on current and future Awards Dinner research into HIV infection and AIDS, re The R. Brinkley Smithers Distinguished Sci viewed the efficacy of complementary treat entist Award was presented to Ting-Kai Li, ments for HIVI AIDS and addictions, and of M.D., Distinguished Professor of Medicine fered a special focus on the needs of HIVI and Biochemistry, Indiana University School AIDS-affected women and adolescents. of Medicine. Awards also were presented to Chaired by Mel Pohl, M.D., the. Forum's George D. Lundberg, M.D., Editor-in-Chief faculty included Andrea Barthwell, M.D., of the Journal of the American Medical As Brenda Chabon, Ph.D., Harry Haverkos, sociation, and to ASAM Past President Max M.D., Don Des Jarlais, M.D., Mark Katz, well N. Weisman, former head of the Alco M.D., Harold Kessler, M.D., and Larry holism Control Commission of the Mary Siegal, M.D. land Department of Health and Mental Hy ASAM WEB SITE giene. The Young Investigator Award was Ruth Fox Course for Physicians presented to Pamela Bean, Ph.D. and David If you've not browsed our site on the World Speakers during the Ruth Fox Course, which M. Gudeman, M.D. Wide Web lately, be sure to drop by http:// is dedicated to the founding President of www.asam.org. Our new and improved site ASAM, provided information on new direc Certificates of recognition also were pre gives you access to general information tions and concepts in clinical practice and sented to 108 ASAM Fellows, as well as to about ASAM and ASAM certification, text updates on selected areas of research. physicians who passed the 1996 Certifica only versions of the Journal of Addictive Chaired by Alan A. Wartenberg, M.D., th~ tion/Recertification Examination and those Diseases andASAM News, order forms for 1997 Ruth Fox Course was co-sponsored by who passed the MRO Examination. ASAM publications and staff E-mail. COMPUTER AND ONLINE COURSE Thomas L. Haynes, M.D. , FASAM The second annual Computer and Web), how to design a Web page, used last year. This year's faculty in Online Course was divided into two telemedicine, networking the medical cluded course director Stuart Gitlow, sessions. The morning session, which office, and issues of privacy and confi M.D., Thomas L. Haynes, M.D., r was for beginning computer users, ad dentiality, as well as virus protection. FASAM, Elizabeth F. Howell, M.D., dressed the elements of hardware and and Peter E. Mezciems, M.D., FASAM. software, bow to purchase a computer, Both PC and Macintosh equipment what types of software are commonly were used to demonstrate the material, The Communications Committee met im used by physicians, and an introduc and the presentation equipment in mediately after the course to review the tion to online services and the Internet. cluded a projection system that could feedback that we received from the ap The afternoon session addressed more be switched between two computers for proximately 70 participants, and to map out advanced topics, such as more in-depth quick comparisons and illustrations of the structure and content of the 1998 knowledge of the Internet and its com the topics being discussed. This was a course. Be sure not to miss it, because it ponents (especially the World Wide distinct improvement'!Qver the l'etup promises to be another good one! ASAMNews 6 I May I June 1 997 AWARDS DINNER RECEIVES GREETINGS Dr. Talbott- Continued from page 1 FROM NATIONAL DRUG POLICY DIRECTOR sions with some national foundations and Gen. Barry R. McCaffrey, Director of the Office of National Drug Control universities, in which we explored the Policy, sent the following message to ASAM at the Awards Dinner during possibility of creating a consortium of the Medical-Scientific Conference: universities to approach the national foun- dations for a three-year grant to fund five "The 1997 National Drug Control use to addiction. Additionally, the goals re- residencies in addiction medicine at each Strategy .. . organizes a collective American fleet the need for law enforcement to remove university. We are approaching this care effort to achieve a common purpose and pro violent and predatory criminals, and to ar- fully, to be certain that all the pieces are vides general guidance and specific direc rest, prosecute, and dismantle criminal drug in plac;e before we approach the founda tion for more than 50 federal agencies in networks at home and abroad. • tions. A 'rlumber of ASAM members are volved in the struggle against illegal drugs contributing their time. and expertise to and substance abuse. This Strategy also of "The goals demonstrate the importance of this effort. , fers a common framework to state and local providing treatment to those who use drugs ~I government agencies, to educators and and need help stopping. Finally, they aim to When I helped to organize and chaired the health care professionals, to law enforce reduce the supply of drugs to the U.S. first Kroc Ranch meeting, our objective ment officials and community coalition through coordinated domestic and compre was' to bring together the disparate orga groups, parents, religious organizations, hensive international programs .... nizations that both directly and indirectly mass media and American business to build touched on the then-infant field of addic a unified American counterdrug effort. The "Our country's drug problem cannot be tion medicine. I truly believed then, as I common purpose of that collective effort is solved overnight. Our task must be to break do now, that addh;tion medicine needs to to reduce illegal drug use and its conse the cycle of addiction so that we can signifi work in partnership with psychiatry, each quences in America .... cantly reduce both illicit drug use and its respecting the other's boundaries. I be consequences .... lieved then, as I do now, that we need to "The 1997 Strategy sets forth five strategic be related and to relate to the disciplines goals, intended to ensure that the message "The Strategy's goals and objectives require of family practice, internal medicine, pre of the Strategy is unambiguous and that our a long-term commitment to help ensure that ventive medicine, emergency medicine, commitment is clear. These goals clearly resources are brought to bear against the drug and more. Addiction medicine has much underscore our central purpose and mission problem in the most efficient way. The fo to learn from each of these specialties. -reducing illicit drug use and its conse cus must be on working hard, over a suffi quences. Further, these goals acknowledge cient span of time, to properly develop and In a second area of effort, we must that anti-drug efforts do not occur in isola implement programs .... progress in obtaining independent fund tion and must be long-term and global in ing of all of ASAM's projects. This must focus. Our efforts must be linked with com "I am honored to have been invited to ad be done to avoid the razor-edge budget panion efforts to curb the use of alcohol and dress the American Society of Addiction ing we now must practice in our central tobacco by those who are under age. We Medicine. I look forward to the next oppor office. A group of ASAM's officers are fully recognize the need for prevention pro tunity to be a part of your organization's anti being convened to explore these basic grams to deter first-time drug use among drug efforts. Your contributions twoard meet problems. adolescents and other high-risk populations ing the substance abuse challenge are impor and to reduce the progression from casu~l tant to our nation and our society." A third major theme I want to pursue in my presidency is suggested by Dr. David Smith's remark in his farewell address that "there is a light at the end of the tun nel, but the tunnel seems to be getting longer." I believe that we can and will make the journey to the end of that tun nel, but to do so we need to infuse young and energetic new members throughout the organization. I believe our Board of Directors should make a deliberate effort to engage young ASAM members in lead ership roles wherever possible. There are daunting problems on the hori zon. They include the fight for parity, dis crimination against our recovering broth ers and sisters, winning acceptance for the Patient Placement Criteria, and the cre ation of addiction medicine residencies and CAQs. Many of these problems seem tore sist solution, but I believe that we can ac Meeting to discuss future collaborative efforts between ASAM and are complish our goals. We in ASAM have the (left to right) ASAM EVP Dr. James Callahan, ASAM President Doug Talbott, M.D., talent, the energy, and the experience to do ONDCP Director Gen. Barry McCaffrey, and ASAM member Tom Kosten, MjJ. this. Impossible dreams do come true. Volume 12, Number 3 7 ASAMNews EVP Report- Continuedfrompage 3 Another significant advance in integrating 0 STATE CHAPTER- NATIONAL ASAM PART to establish training. Dr. Sid Schnoll has addiction treatment into health care has been NERSHIP: The next five years will be character agreed to chair the ASAM workgroup on ~. the establishment of a joint ASAM-AMBHA ized by a partnership between state chapters accredited training. workgroup. AMBHA, the Ame1ican Managed and the national ASAM organization. To Behavioral Healthcare Association, represents strengthen our chapters, Dr. Earley and the We will publish a second edition of Prin 19 major behavioral healthcare organizations State Chapters presidents will continue their ciples ofAddiction Medicine, with Drs. Allan that collectively cover 120 million lives. excellent work in increasing state and national Graham and Teny Schultz as Co-Editors, AMBHA has agreed to issue four papers with membership. Last year, 90 percent of our and Dr. Chris Kasser's conunittee will con ASAM on: (1) Fruity in Benefit Design, (2) members renewed their membership, 'and the tinue to publish practice guidelines. Treatment Protocols, (3) Treatment Outcome number of new members increased by 50 per" · Measures, and (4) Credentialing of Providers cent. At the national level, ASAM will fmm a 0 "PREVENTION OF ToBACCO UsE: I would of Addiction Services. If successful, the dia close working relationship with the National be remiss if I failed to mBption a special logue between ASAM and AMBHA can open Association of State Alcohol and Drug Abuse achievement and an ongoing goal to which doors that have long been closed to our pa Directors (NASADAD) and continue its col ASAM, in· the persons of Dr. rohn Slade tients and our members, so that our patients laboration with NCQA, AMBHA and other and the members of the Nicotine Depen will receive appropriate treatment, and our national associations. We will work closely dence Committee, has made a significant members will be given credentials to provide with the White House, the Institutes and contribution. I am speaking, of course, of treatment. ASAM members who are working CSAT, and with Congress to the extent that the recent advances in the prevention of with AMBHA are Drs. Christine Kasser, our chruter allows. We also will seek monies tobacco use, especially among young David Mee-Lee, Michael Miller, and Tony to fund the Parity Advisory Board, to be people. ···, Radcliffe. chaired by Senator George McGovern. ASAM's members include many who are gi Another significant advance in assuring ad 0 PAR1TY: Our goal is to establish theASAM ants in the field of addiction medicine pre diction treatment is the dialogue that Drs. Patient Placement Criteria as the national vention, research, treatment, education, train David Smith and Doug Talbott have under guideline governing decisions on need for ing and public policy. Scru·cely a week goes taken with the White House. Dr. David Smith treatment and level of treatment. We have by when I do not receive a call or letter from and I had the pleasure of an extended meet begun work on a third edition which will John suggesting that he take action inASAM's ing with General Barry McCaffrey, where include guidelines for dual diagnosis and an name to prevent or reduce the use of tobacco we briefed him on ASAM's work, includ update of the adolescent guidelines. We also or to increasingly eliminate its harmful con ing the development of our state chapters. will produce an algorithm software version. tents. Dr. Slade played a major role in the dis In addition, Dr. Talbott and I have had an Our goal is to have each state chapter work closure of tobacco industry documents and in opportunity to meet President Clinton and with the governor's office or the director of helping to fmmulate the FDA regulations on give him greetings from ASAM. the state agency responsible for addiction advertising and marketing. treatment to assure the use of the ASAM Goals: 1997 - 2002 PPC-2. We will encourage our chapters to Conclusion I have spoken of our mission and our ac work with their state medical societies and ASAM has and will continue to commit complishments in pursuit of our mission. I state legislatures to pass laws mandating par itself to the only goal which will one day presented our accomplishments as evidence ity for addiction treatment. give addiction medicine both its rightful that our mission is true and realizable, even place at the table of medical specialties, in the painful times iny which we now li~e. 0 SPECIALTY: To promote recognition of the and provide the scientific and clinical con Before closing, I want to say a word about specialty of addiction medicine, we will tent from which general medical educa our goals, which I present to you both as work with each specialty to increase the tion can draw. That goal and that mission further evidence that our mission is attain teaching of addiction medicine icy residen is to define the specialty through defin able, and as evidence of our continued re cies and establish accredited residencies in ing the practice, and through assuring its solve to achieve our mission. We have much addiction medicine. Dr. Talbott has commit integration into all medical education and work to do. ted himself to raising the monies necessary health care. Jess Bromley, M.D., Elected Emeritus Member Long-timeASAM member Jess Bromley, M.D., was elected an Eme1itus Member dur ing the April Board meeting, in recognition of his outstanding service to the organiza tion as Delegate to the American Medical Association. Dr. Bromley currently is Del egate Emeritus and serves as Parliamentarian to the Board of Directors. Emeritus status is bestowed by vote of the Board of Directors to recognize the accomplish ments of senior members who have been ASAM members for at least 15 years, are at least 65 years old, and are retiring or retired from the practice of addiction medicine. Emeritus members have their member hip due waived and receive complimentruy subscription to ASAM News and the oGiety s Journal ofAddicrive Diseases. Nomina(ion forms, are avail able from the ASAM Membe1 hip Department at 30 l/656-3920. ASAMNews 8 May I June 1997 - -- - AI<:OHOL ------National Institute on Alcohol Abuse and Alcoholism No. 35 PH 371 January 1997 Alcohol Metabolism , _ .,, Metabolism is the body's process of converting ingested substances to other com pounds. Metabolism results in some substances becoming more, and some less, toxic Alcohol Alert, a pubfi&tion of than those originally ingested. Metabolism involves a number of processes, one of the National Institute on Alcohol which is referred to as oxidation. Through oxidation, alcohol is detoxified and removed Abuse and Alcoholism, provides from the blood, preventing the alcohol from accumulating and destroying cells· and timely information on alcohol organs. A minute amount of alcohol escapes metabolism and is excreted unchanged in research and treatment to health professionals and other the breath and in urine. Until all the alcohol consumed has been metabolized, it is dis interested people. This issue is tributed throughout the body, affecting the brain and other tissues (1 ,2). As this Alcohol the thirty/iffh 1n the series. Alert e? A Commentary by NIAAA Director Enoch Gordis, M.D ...... • 3 i_..- 4·· ' "'' ' ~····· U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES \ ...... ,, E.. Public Health Service • Nati onal Institutes of Health I Volume 12, Number 3 9 A~M~~ one standard drink, the amount of alcohol in the drinker's blood (blood alcohol concentra tion, or SAC) peaks within 30 to 45 minutes. (A standard drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits, all of which contain the same amount of alcohol.) The SAC curve, shown on the previous page, provides an esti mate of the time needed to absorb and metabolize different amounts of alcohol (5). Alcohol is metabolized more slowly than it is absorbed. Since the metabolism of alcohol is slow, consumption needs to be controlled to prevent accumulation in the body and intoxication. Factors Influencing A_lcohol Absorption and Metabolism ' Food. A number of factors influence the absorption process, including the presence of food and the type of food in the gastrointestinal tract when alcohol is consumed (2',6). Tl:le rate at which alcohol is absorbed depends on how quickly the stomach empties its contents into the intestine. The higher the dietary fat content, the more time this emptying will require and '\, the longer the process of absorption will take. One study found that subjects who drank alcohol after a meal that included fat, protein, and carbohydrates absorbed the alcohol about three times more slowly than when they consumed alcohol on an empty stomach (7). Gender. Women absorb and metabolize alcohol differently from men. They have higher Because women SAC's after consuming the same amount of alcohol as men and are more susceptible to metabolize alcohol alcoholic liver disease, heart muscle damage (8), and brain damage (9). The difference in differently from men, SAC's between women and men has been attributed to women's smaller amount of body women may be more water, likened to dropping the same amount of alcohol into a smaller pail of water (1 0). An vulnerable to liver and additional factor contributing to the difference in SAC's may be that women have lower heart damage. activity of the alcohol metabolizing enzyme ADH in the stomach, causing a larger propor tion of the ingested alcohol to reach the blood. The combination of these factors may ren der women more vulnerable than men to alcohol-induced liver and heart damage (11-16). Effects of Alcohol Metabolism Body Weight. Although alcohol has a relatively high caloric value, 7.1 Calories per gram (as a point of reference, 1 gram of carbohydrate contains 4.5 Calories, and 1 gram of fat con tains 9 Calories), alcohol consumption does not necessarily result in increased body weight. An analysis of data collected from the first National Health and Nutrition Examination S1,1rvey (NHANES I) found that although drinkers had significantly higher intakes of total calories than nondrinkers, drinkers were not more obese than nondrinkers. In fact, women drinkers Alcohol may lead to had significantly lower body weight than nondrinkers. As alcohol intake among men further weight gain increased, their body weight decreased (17). An analysis of data from the second National in persons who are Health and Nutrition Examination Survey (NHANES II) and other large national studies found already overweight. similar results for women (18), althCDugh the relationship between drinking and body weight for men is inconsistent. Although moderate doses of alcohol added to the diets of lean men and women do not seem to lead to weight gain, some studies have reported weight gain when alcohol is added to the diets of overweight persons (19,20). When chronic heavy drinkers substitute alcohol for carbohydrates in· their diets, they lose weight and weigh less than their nondrinking counterparts (21 ,22) . Furthermore, when chronic heavy drinkers add alcohol to an otherwise normal diet, they do not gain weight (21 ). Sex Hormones. Alcohol metabolism alters the balance of reproductive hormones in men and women (23-28). In men, alcohol metabolism contributes to testicular injury and impairs testosterone synthesis and sperm production (24,29). In a study of normal healthy men who received 220 grams of alcohol daily for 4 weeks, testosterone levels declined after only , 5 days and continued to fall throughout the study period (30,31 ). Prolonged testosterone Alcohol metabolism deficiency may contribute to feminization in males, for example, breast enlargement (32). In affects male and female addition, alcohol may interfere with normal sperm structure and movement by inhibiting the reproductive hormones. metabolism of vitamin A, which is essential for sperm development (30,33). In women, alcohol metabolism may contribute to increased production of a form of estrogen called estradiol (which contributes to increased bone density and reduced risk of coronary artery disease) and to decreased estradiol metabolism, resulting in elevated estradiol levels (28). One research review indicates that estradiol levels increased in premenopausal women who consumed slightly more than enough alcohol to reach th~ legal lill(it of alcohol (SAC of I 2 ASAMNews 10 May I June 1997 0.10 percent) acutely (28). A study of the effect of alcohol on estradiol levels in post menopausal women found that in women wearing estradiol skin patches, acute alcohol consumption significantly elevated estradiol levels over the short term (34).' Medications. Chronic heavy drinking appears to activate the enzyme CYP2E1, which may be responsible for transforming the over-the-counter pain reliever acetaminophen (Tylenol™ and many others) into chemicals that can cause liver damage, even when aceta minophen is taken in standard therapeutic doses (3,35,36). A review of studies of liver damage resulting from acetaminophen-alcohol interaction reported that in alcoholics, these effects may occur with as little as 2.6 grams of acetaminophen (four to fiv!3 "extra-strength" Medications may be pills) taken over the course of the day in persons consuming varying amounts. of alcoho,l rendered harmful or (35 ,37) . The damage caused by alcohol-acetaminophen interaction is more likely to occur' I ineffective as a result when acetaminophen is taken after, rather than before, the alcohol has been metabolized. of alcohol metabolism. Alcohol consumption affects the metabolism of a wide variety of other medications, increas ''\I ing the activity of some and diminishing the activity, thereby decreasing the effectiveness, of others (35). Alcohol Metabolism-A Commentary by NIAAA Director Enoch Gordis, M.D. ·--. The study of metabolism has both practical and broader scientific implications. On the prac tical side, information on how the body metabolizes alcohol permits us to calculate, for example, what our blood alcohol concentration (SAC) is likely to be after drinking, including the impact of food and gender differences in the rate of alcohol metabolism on SAC. This information, of course, is important when participating in activities for which concentration is needed, such as driving or operating dangerous machinery. With respect to its broader scientific application, metabolism, which has long been stud ied, is emerging with new implications for the study of alcoholism and its medical conse quences. For instance, how is metabolism related to the resistance of some individuals to alcoholism? We know that some inherited abnormalities in metabolism (e.g., flushing reac tion among some persons of Asian descent) promote resistance to alcoholism. Recent data from two large-scale NIAAA-supported genetics studies suggest that alcohol dehydrogen'ase genes may be associated with differential resistance and vulnerability to alcohol. These find ings are important to the study of why some people develop alcoholism and others do not. Studies of metabolism also can identify alternate paths of alcohol metabolism, which may help explain how alcohol speeds up the elimination of some substances (e.g., barbiturates) and increases the toxicity of others (e.g., acetaminophen). This information will help health care providers in advising patients on alcohol-drug interactions that may decrease the effec tiveness of some therapeutic medications or render others harmful. References (1) Bosron, W.F.; Ehrig, T.; & Li,T.-K. Genetic factors in alcohol metabolism and alcoholism. Seminars in Liver Disease 13(2):126-135, 1993. (2) Wallgren, H. Absorption, diffusion, distribution and elimination of ethanol: Effect on biological mem branes. In: International Encyclopedia of Pharmacology and Therapeutics. Vol. 1. Oxford: Pergamon, 1970. pp . 161-188. (3) Lieber, C.S. Metabolic consequences of ethanol. The Endocrinologist 4(2):127-139, 1994. (4) Benet, L.Z.; Kroetz, D.L.; & Sheiner, L.B. Pharmacokinetics: The dynamics of drug absorption, distribution, and elimination. In: Molinoff, P.B., & Ruddon, R.W .. eds. Goodman and Gillman's The Pharmacological Basis of Therapeutics. 9th ed. New York: McGraw-Hill, 1996. pp. 3-27. (5) Widmark, E. M.P. Die theoretischen Grundlagen und die praktische Verwendbarkeit der gericht/ich-medizinischen Alkoholbestimmung. Berlin: Urban and Schwarzenberg, 1932. (6) Fraser, A.G.; Rosalki, S.B.; Gamble, G.D.; & Pounder, R.E. Inter-individual and intra-individual variability of ethanol concentration-time profiles: Comparison of ethanol ingestion before or after an evening meal. British Journal of Clinical Pharmacology 40:387-392, 1995. (7) Jones, A.W., & Jonsson, K.A. Food-induced lowering of blood-ethanol profiles and increased rate of elimination immediately after a meal. Journal of Forensic Sciences 39(4):1084-1093, 1994. (8) Urbano-Marquez, A.; Estruch, R.; Fernandez-Sola, J.; Nicolas, J.M.; Pare, J.C.; & Rubin, E. The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men. JAMA 274(2):149-154, 1995. (9) Nixon, S.J. Cognitive deficits in alcoholic women. Alcohol Health & Research World 18(3):228-232, 1994. (10) National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert: Alcohol and Women. No. 10, PH 290. Bethesda, MD: the Institute, 1990. (11) Frezza, M.; Di Padova. C.; Pozzato, G.; Terpin, M.; Baroana, E.; & Lieber, C.S. High blood alcohol levels in women: The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. The New England Journal of Medicine 322(2):95-99, 1990. (12) Asn,ley, M.J.; 91in, J.S.; Le Riche, W.H.; ' 3 Volume 12, Number 3 11 ASAMNews Kornaczewski, A.; Schmidt, W.; & Rankin, J.G. Morbidity in alcoholics: Evidence for accelerated development of physical disease in women . Archives of Internal Medicine 137:883-887, 1977. (13) Krasner, N.; Davis, M.; Portmann, B.; & Williams, R. Changing pattern of alcoholic liver disease in Great Britain: Relation to sex and signs of autoimmunity. British Medical Journal1 :1497-500, 1977. (14) Morgan, M.Y., & Sherlock, S, Sex-related differences among 100 patients with alcoholic liver disease, British Medical Journal1 :939-941, 1977. (15) Saunders, J.B.; Davis, M.; & Williams, R. Do women develop alcoholic liver disease more readily than men? British Medical Journal282:1140-1143, 1981. (16) Norton, R.; Batey, R.; Dwyer, T.; & MacMahon, S. Alcohol consumption and the risk of alcohol related cir rhosis in women. British Medical Journal295:80-82, 1987. (17) Gruchow, H.W.; Sobocinski, K.A.; Barboriak, J.J.; & Scheller, J.G. Alcohol consumption, nutrient intake and relative body weight among U.S. adults. American Journal of Clinical Nutrition 42:289-295, 1985. (18) Colditz, G.A.; Giovannucci, E.; Rimm, E.B.; Stampfer, M,J,; Rosner, B.; Speizer, F.E.; Gordis, E.; & Willett, W.C. Alcohol intake in relation to diet and obesity in women and men. American Journal of Clinical Nutrition 54:49-55, 1991 . (19) Clevidence, B.A.; Taylor, P.R.; Campbell, W.S.; & Judd, J.T. Lean and heavy women may not use energy from alcohol with equal efficiency. Journal of Nutrition 125(10):2536-2540, 1995. (20) Crouse, J.R., & Grundy, S.M. Effects of alcohol on plasma lipoproteins and cholesterol and triglyc eride metabolism in man. Journal of Lipid Research 25:486-496, 1984. (21) Lieber, C.S. Perspectives: Do alcohol calories count? American Journal of Clinical Nutrition 54:976-982, 1991 . (22) Reinus, J.F.; Heymsfield, S.B.; Wiskind, R.; Casper, K.; & Ga_lambos, J.T. Ethanol: Relative fuel value and metabolic effects in vivo. Metabolism 38(2):125-135, 1989, (23) Andersson, S.; Cronholm, T.; & Sj6vall, J. Redox effects of ethanol on steroid metabolism. Alcoholism: Clinical and Experimental Research 10(6)(Suppl): 55S-63S, 1986. (24) Wright, H.l.; Gavaler, J.S.; & Van Thiel, D. Effects of alcohol <;>n the male reproductive system. Alcohol Health & Research World 15(2):110-114, 1991 . (25) Cicero, T.J., & Bell, A.D. Effects of ethanol and acetaldehyde .on the biosynthesis of testosterone in the rodent testes. Biochemical and Biophysical Research Communications 94(3):814-819, 1980. (26) Johnston, D.E.; Chiao, Y.B.; Gavaler, J.S.; & Van Thiel, D.H. Inhibition of testosterone synthesis by ethanol and acetaldehyde. Biochemical Pharmacology 30(13):1 827-1830, 1981 . (27) Chiao, Y.B., & Van Thiel;, D.H. Biochemical mechanisms that contribute to alcohol-induced hypogonadism in the male. Alcoholism: Clinical and Experimental Research 7(2):131-134, 1983. (28) Mello, N.K.; Mendelson, J.H.; & Teoh, S.K. An overview of the effects of alcohol on neuroendocrine function in women. In: Zakhari, S., ed. Alcohol and the Endocrine System. National institute on Alcohol Abuse and Alcoholism Research Monograph No. 23. NIH Publication No. 93-3533. Bethesda, MD: the Institute, 1993. pp. 139-169. (29) Van Thiel, D.H.; Gavaler, J.; & Lester, R. Ethanol inhibition of vitamin A metabolism in the testes: Possible mechanism for sterility in alcoholics. Science 186(4167):941-942, 1974. (30) National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert: Alcohol and Hormones. No. 26, PH 352. Bethesda, MD: the Institute, 1994. (31) Gordon, G.G.; Altman, K.; Southren, A.L.; Rubin, E.; & Lieber, C.S. Effect of alcohol (ethanol) administration on sex-hormone metabolism in normal men. The New England Journal of Medicine 295(15):793-797, 1976. (32) Bannister, P., & Lowosky, M.S. Ethanol and hypogonadism. Alcohol & Alcoholism 22(3):213-217, 1987. (33) Leo, M.A., & Lieber, C.S. Hepatic vitamin A depletion in alcoholic liver injury. The New England Journal of Medicine 307(10):597-601, 1982. (34) Ginsburg, E.S.; Walsh, B.W.; Shea, B. F.; Gao, X.; Gleason, R.E.; & Barbieri, R.L. The effects of eth.allol on the clearance of estradiol in postmenopausal women. Fertility and Sterility 63(6):1227-1230, 1995, (35) National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert: Alcohol Medica/ion Interactions. No. 27, PH 355. Bethesda, MD: the Institute, 1995. (36) Black, M. Acetaminophen hepatotoxicity. Annual Review of Medicine 35:577-593, 1984. (37) Seeff, L.B.; Cuccherini, B.A.; Zimmerman, H.J.; Adler, E.; & Benjamin, S.B. Acetaminophen hepatotoxicity in alcoholics: A therapeutic misadventure. Annals of Internal Medicine 104(3):399-404, 1986. Full text of this publication is available on NIAAA's World Wide Web site at http://www.niaaa.nih.gov All material contained in the Alcohol Alert is in the public domain and may be used or reproduced without permission from NtAAA. Citation of the source is appreciated. Copies of the Alcohol Alert are available free of charge from the National Institute on Alcohol Abuse and Alcoholism Publications, P.O. Box 34443, Washington, DC 20043. U.S. DEPARTMENT OF BULK RATE HEALTH AND HUMAN SERVICES POSTAGE AND FEES PAID DHHS/NIH PERMIT NO. G-763 Public Health Service National Institutes of Health Bethesda, MD 20892-7003 Official Business Penalty for Private Use $300 i ASAM News 12 May I June 1997 MEMBERS-IN-TRAINING NEW COMMITTEE ENCOURAGES STUDENT, RESIDENT INVOLVEMENT A small but enthusiastic group of medical stu residents who have an interest in addiction bers and are appointed by the ASAM dents, residents, and guests participated in the medicine but who are not yet ASAM mem Board of Directors based on a curriculum first-ever teleconference ofASAM's Members bers: vitae and a statement of interest. in-Training Committee. Participants in the March meeting included Sara Babai (student); 0 Writing to the Deans of medical schools Finally, participants in the conference call Chris Delos Reyes, M.D. (resident and Com to introduce ASAM, and to ask the Deans to discussed a strategy to join ASAM members mittee Chair); Mike Patterson, M.D. (resident); forward information on ASAM to their De in-practice with members-in-training. Too and Lauren Walton, M.D. (resident). Joining partments Of Psychiatry, Family Practice, • eften, stude'rjts and residents are confronted the call as quests were V' Anne Singleton, Family Practice, and/or Internal Medicine. with 11egative attitudes and therapeutic pes Training Coordinator for the "Summer Insti simism regarding patients w~ alcoholism tute for Medical Students" at the Betty Ford 0 Networking with larger student and and other drug addictisms. An PiS AM mem Center in Rancho Mirage, CA, and Dr. resident organizations to spread the word ber may be the only person to expose train Antoinette Graham, Associate Professor of aboutASAM (e.g., American Medical As ees to effective addictions treatment and the Family Medicine and Director of the HELP sociation, American Medical Student As possibility of long-term recovery. Program at Case Western Reserve University sociation, National Association of Resi in Cleveland, OH. dents and Interns, etc.); Participants in the "Sponsor-a-Student/Rec ognize-a-Resident" Campaign would pro Discussion centered around four main top 0 Writing letters-to-the-editor and/or ar vide mentoring an~ financial support to ics: (1) increasing communication among ticles for medical student/resident magazines trainees (e.g., pay for 'one year of member current student/resident members of ASAM; such as The New Physician and Resident & ship dues for the trainee). (2) increasing the visibility of ASAM to stu Staff Physician; dents/residents who have an interest in ad In return, sponsors would receive recognition diction medicine but are not yetASAM mem 0 Distributing ASAM materials to students in ASAM News and additional benefits (i.e. bers; (3) encouraging student and resident and residents participating in addiction medi discounts on conferences, publications, etc.). involvement in the American Medical Asso cine programs or fellowships (such as those Effm1s to gain and retain student and resident ciation; and (4) developing a campaign to link at the Betty Ford Center Summer Institute). members are crucial to ASAM's future as an ASAM members-in-practice with trainees. organization, as the trainees of today will be The Members-in-Training Committee is the leaders of ASAM and the "voice of addic Of ASAM's 3200 members, approximately one forum in ASAM that encourages stu tion medicine" in the 21st century. 150 are students or residents. Suggestions dent and resident involvement in the for increasing communication among cur American Medical Association. Students Indiviquals interested in participating in the rent ASAM student/residents included: a and residents, who are interested in learn Meinbers-in-Training Committee are en "Members-in-Training Column" in each ing about and creating national AMA com·aged to contact Theresa McAuliffe at issue of ASAM News and an e-mail direc health policy, are invited to represent theASAM office (phone: 301/656-3920, ext. tory of student and resident members. ASAM as a Delegate or Alternate Del 108; E-mail: [email protected]) or Chris egate at the June and December Assem Delos Reyes, M.D. at 10007 Parkview Ave, The following ideas were suggested as means bly meetings of the AMA. Delegates and Garfield Heights, OH 44125; E-mail: to engage the interest of medical students and Alternate Delegates must be AMA mem- chris.delosreyes @uhhs.com. Haymarket Cente.:: presents The Third Annual Summer Institute on Addiction at The Hilton Hotel, Lisle, Illinois June 23-25, 1997 Presentations include: Domestic Violence, Child Development, Case Management, Methamphetamines and Violence, Nutrition, Anger and Addiction, Adolescent Treatment, Criminal Justice, Spirituality, Dual Diagnosis, Co-Dependency, Prostitution, and Stress Management. Keynote speakers include David E. Smith, M.D., FASAM, the founder and Executive Editor of the Journal of Psychoactive Drugs, and the Immediate Past President of the American Society of Addiction Medicine, speaking on "Current Trends in Addiction," Earnie Larsen, M.R.E., M.S., author of "Stage 2 Recovery: Life Beyond Addiction," and Ron Potter-Efron, M.S.W., Ph.D., CADCIII, author of "Anger, Alcoholism and Addiction: Treating Individuals, Couples and Families." For more information or to rent an~xhibit ta,ble for your agency, please contact Ma1y Jane Miller at Haymarket ,.Center ( 312) 226-7984, ext. 378. Volume 12, Number 3 13 ASAMNews CHAPTER UPDATE California South Florida and Founding Fellow Ameri Hermese Bryant by phone at 630/968-64 77 Chapter President: can Academy of Clinical Sexologists. or via Fax at 630/968-5744. William S. Brostoff, M.D., FASAM Regional Director: Gail Shultz, M.D. The Florida chapter elected the following new Maryland officers to two-year terms: Richard Keesal, Chapter President: John Steinberg, M.D. President William Brostoff, M.D., is represent M.D., President; John Eustace, M.D., Presi Regional Director: ing CSAM on a California Medical Associa dent-Elect; Michael Newberry, M.D., Trea Paul H. Earley, M.D. , FASAM tion Technical Advisory Committee on Medi surer; Paul T. Nakule, M.D., Secretary; cal Marijuana. ASAM Immediate Past Presi Marilyn C. Moss, M.D., Immediate PastPresi- The Maryland Chapter has scheduled a July dent David Smith, M.D., also is a member of dent; Vineet Mehta, M.D., Chair, Scientific ~ 12, 1997,'CME conference on "The Return the committee. A CSAM Task Force on the Planning Committee; and Kenneth W. Thomp- to Work: Impaired Health Professionals." A same subject is drafting a White Paper. son, M.D., Legislative Representative. chapter business meeting will follow. Reg istration information is avai~able from the CSAM's 1997 survey of members asked The chapter holds its annual meeting and ASAM Office. "What is the one most important thing this conference each January in Orlando, and state chapter can accomplish for its mem invites members of other chapters to join Michigan bers in the next 12 months?" Answers in them. Breakout sessions will be provided for Chapter President: cluded: "Helping physicians measure qual other state groups. Information is available Thomas L. Haynes, M.D., FASAM ity in their workplace so that we may truly from Robert Donoftio at the FSAM office, Regional Director: measure the effect of managed care (good 904/484-3560. Norman Miller, M.D., FASAM or bad)!" "Upholding standards of practice in addiction medicine." "Promote the posi FSAM continues to work to have the The Michigan chapter will hold election of tion that physician leadership is necessary ASAM MRO certification approved un officers in July 1997. in creating and maintaining acceptable qual der new Florida state law. (Chapter lead ity in our treatment programs." "Set stan ers were assured that this would happen Missouri dards for what quality chemical dependency when the law was adopted in 1996, but Chapter Representative: Winston Shen, M.D. treatment should cost." "Validate modalities ASAM was omitted from the list of ap Regional Director: Ken Roy, M.D., FASAM of therapy so that inpatient admission, where proved MRO certifications.) justified, is accepted." "Educate residents." Jack L. Croughan, M.D., an ASAM mem "Refocus awareness of chemical dependence Hawaii ber and Director of the Missouri Program issues to the public." "Work toward a cred Chapter President: for Impaired Physicians, presented a grand ible means of converting currently antidrug, Gerald McKenna, M.D., FASAM round at Saint Louis University Medical punitive government policy to one of iden Regional Director: School in January. Dr. Croughan educated tifying problems, education and treatment." Richard Tremblay, M.D., FASAM the audience, mostly medical students, about "We need to advocate for our patients. Very getting help for substance abuse problems. few people have coverage for treatment for HIS AM jointly sponsored a two-day meet chemical dependency." ing in Honolulu in January, to provide an The program was co-presented by Hershel update on addiction issues for primary care P. Wall, M.D., of Memphis, who discussed Florida physicians. This annual medical track meet addictive disorders among physicians and Chapter President: Richard Keesal, M.D. 1 ing is part of the Pacific Institute of Chemi medical students. Regional Director: Rick Beach, M.D. cal Dependence Annual Meeting. ASAM members from around the state presented. New Jersey FSAM and ASAM jointly sponsored the Chapter President: lOth Annual Conference on Addictions in HISAM plans to repeat the conference in John J. Verdon, Jr., M.D., FASAM January at Walt Disney World Village. January 1998. To allow more physicians to Regional Director: ASAM guest speaker Andrea Barthwell, attend, the 1998 meeting will be scheduled R. Jeffrey Goldsmith, M.D. M.D., addressed "Cultural Issues to be Con for a Friday and Saturday. A preliminary sidered in Treatment of the Chemically Im agenda will be available by summer, en At the New Jersey chapter's meeting in San paired." Other speakers included Richard J. abling mainland members to attend. Diego during the ASAM Med-Sci Confer Bagby, M.D., President of the Florida Medi ence, chapter constitution and Bylaws were cal Association, on "Directions in Managed Illinois a main topic of discussion. Chapter mem Care" as it relates to the treatment of our Chapter President: bers expressed their appreciation to David special population of patients. FSAM mem Martin Doot, M.D., FASAM I. Canavan, M.D., of the Physicians Health bers Ronald Catanzaro, M.D., John Eustace, Regional Director: Medical Program of New Jersey for his sup M.D., Michael Newberry, M.D., and Vineet Norman Miller, M.D., FASAM port of chapter activities, particularly the Mehta, M.D., discussed treatment modality mailing of minutes and memoranda. issues in spirituality, pain management, and ISAM and the National Institute on Drug working with the challenging patient. The Abuse will co-sponsor a Town Meeting on New York conference ended with a special guest presen Addictions May 30 at the Hyatt Regency Chapter President: Merrill Herman, M.D. tation on "Sexually Compulsive Behaviors" Chicago. The chapter's next Annual Meet Regional Director: R. Jeffrey Goldsmith, M.D. by Bonnie Saks, M.D., Psychiatrist and Fel ing has been scheduled~for Noverpber 21- low of the American Psychiatric Association, 22, 1997, at the Radison Hotel in Rbsemont, The New York chapter held its Annual CME/ and Associate Professor at the University of IL. Additional information is failable from Business Meeting in March. Guest Presenter ASAMNews 14 May I June 1997 CHAPTER UPDATE Herbe1t Peyser, M.D. discussed "Managed Chapter business meetings were held in scientific meeting in March, at which speak Care and Substance Abuse." The lively meet March and May at the Oklahoma State ers discussed "Rational Recovery" and "The ing featured stimulating discussion of addic Medical Association. Members are pro Medical Quality Assurance Commission." tion issues. The chapter is committed to en ceeding with formation of an official The group agreed to buy a fax machine to hancing its linkage with the Medical Soci ASAM chapter in Oklahoma (OKSAM). facilitate distribution of information to mem ety of the State of New York. It also is in the Information is available from the ASAM bers in a timely fashion. final phases of incorporation. Office. Region Ill · Ohio Oregon Chapter Regional Director: Chapter President: Ted Hunter, M.D. Chapter President: Alan Wartenberg, M.D., FASAM Regional Director: Douglas Bovee, M.D., FACP I R. Jeffrey Goldsmith, M.D. Regional Director: Regi'onal Director Alan Wartenberg, Richard E. Tremblay, M.D., FASAM M.D., reports that early pl~ning is tak The Ohio chapter has scheduled a general ing place for a Regi~mal Me'gting in No membership business meeting for Saturday, The April Oregon chapter meeting featured vember 1997, tentatively set for a north July 26, in conjunction with the Summer Steve Gallon, Ph.D., speaking on "Motiva ern New England location. The last Re Institute of Addiction Studies of Ohio State tional Interviewing." The next meeting, gion' III meeting, chaired by Dr. P. University. Information on the meeting is scheduled for June 17, will feature Marshall Kishore, was very successful. available from Stan Soteren, M.D., at Bedder, M.D., speaking on "Rapid Anesthe 6141868-6710. sia Assisted Opioid Detoxification INTERNATIONAL (RAAD)." The Ohio State Medical Association cur Iceland rently is engaged in several projects that in Lee McCullough, M.D., has been elected to Contact: volve addiction medicine. The Ohio the five-member ORSAM Board, replacing Gudbjom Bjomsson, M.D. chapter's Board encourages any ASAM Phil Unger, M.D., who gave many years' Regional Director: member who has the interest in OSMA to service to ORSAM. Peter Mezciems, M.D., FASAM become involved. Washington State Two Icelandic Members of ASAM were Oklahoma Chapter President: in attendance at the 28th Annual Med-Sci State Contact: Linda Gore-Lantrip, D. 0. Steven Juergens, M.D., FASAM Conference in San Diego. An international Regional Director: Ken Roy, M.D., FASAM Regional Director: conference, the "SAA 20th Anniversary Richard E. Tremblay, M.D., FASAM Conference on Alcohol and Substance ASAM members in Oklahoma have been Abuse," is scheduled for Reykjavik, Ice working hard and meeting regularly. The Washington chapter met for a business/ land, October 16-18, 1997. LETTERS THOUGHTS ON ASAM BY AN OLD ADDICTIONIST James H. Sanders, Jr., M.D. It has always been that those vitally inter on AA, to the exclusion of other ideas. We of dual diagnosis patients. [However] we ested in severe, difficult-to-treat illnesses were too rigid in trying to eliminate the use have now swung overboard in the other work out a treatment regimen that seems best of any "addictive drugs" in the add~cted. direction .... Even though we are doing a and then promote it with almost religious better job of coordinating different lev zeal. I had a child with cystic fibrosis and I don't think the new age of addiction treat els of inpatient and outpatient treatment, the treatment regimen with mist tents, chest ment is an improvement. AA has been re managed care limitations dictate that we clapping and prophylactic antibiotics was placed by drugs as the new savior of patients. often have the patient treated by one treat rigid and accepted by faithful physicians, Methadone clinics, which were controver ment team for a very short period. families, and patients. Now, advances in sial, are not advocated unconditionally. Some knowledge about the disease and new treat think they are successful if the patients on During and immediately after detoxifica ments have changed the picture and a new methadone are not injecting heroin or other tion, psychological and psychiatric ex regimen is accepted by the faithful. drugs, even if they are smoking marijuana aminations are done and drug treatment and crack cocaine. AA is honored by quot of depression and personality disorders is This has happened in the treatment of ad ing statistics showing its effectiveness, but started immediately. Reevaluation of diction. When I started in the field over 15 its principles are in the background now. these tentative diagnoses and prescrip years ago, AA and AA principles were the tions later in treatment by aiwther physi cornerstone of treatment. We worked on Researchers have made great strides in cian is problematical. It doesn't take a detoxification regimens, debated the efficacy making addiction medicine a more scien genius to see that the number of drugs of of each, and worked on various types of in tific discipline. Neurochemistry is giving all kinds prescribed to addiction patients patient and outpatient treatment programs, us more knowledge about how addiction is completely out of hand. but AA was promoted with religious zeal. works and what drugs ·should be, tried in In retrospect, there was too much emphasis treatment. It is also helping with tieatment Continued on page 17 Volume 12, Number 3 15 ASAMNews AMA DELEGATION REPORT AMA GRAPPLES WITH PHYSICIAN WORKFORCE, ACCREDITATION ISSUES Michael M. Miller, M.D. , FASAM The American Medical Association held its have to be accompanied by the development are addicted to alcohol or other drugs. Both year-end 1996 meeting in Atlanta. Attend of practice guidelines so that there is a bench resolutions were referred for further study ing for ASAM were Delegate Michael mark against which to measure physician and are to be returned to the House for ac Miller, M.D., Alternate Delegate David petformance. tion at the June 1997 meeting. Smith, M.D., President G. Douglas Talbott, M.D., andEVP Dr. James Callahan.ASAM Physician Workforce ' .- The AMA<;ouncil on Medical Education pre also was represented by Stuart Gitlow, M.D., Development sented a report on physicians without specialty AS AM's Delegate to the AMA's Young Phy The Physician Workforce Development board certification. The repoJ.trecommended sician Section (and a member of the Section project involves the AMA, the National that the AMA reaffipn its po'licy that deci Governing Council); Cluistina Delos Reyes, Medical Association, the American Osteo sions regarding staff appointment ~hould be M.D., ASAM Delegate to the Resident Phy pathic Association, the Institute of Medicine, based on the training, experience and dem sician Section; and Sarah Babai, ASAM and other organizations, including those rep onstrated competence of candidates, and Delegate to the Medical Student Section. resenting schools of medicine and osteopa should not rely exclusively on the presence thy. In order to avoid antitrust implications, or absence of board certification; that third Two major AMA initiatives on the meeting the only mission of this consortium at party payers not exclude non-cettified physi agenda were tl1e American Medical Accredi present is to provide advice to the federal cians as a class from participating in their pro tation Program (AMAP) and a work group government with regard to mechanisms by grams without regard to their training, expe on federal supp01t of physician workforce which the government supports graduate rience and cunent competence; and that the development. medical education. AMA continue to develop and implement its proposed AMAP program. Dr. Miller testi American Medical Variables to be explored in the future include fied on behalf of ASAM in favor of the rec Accreditation Program an analysis of actual marketplace needs for ommendations in this report. AMAP is to be the first national program physician supply. A preliminary report re that certifies individual physicians. It will leased in September 1996 concludes that ASAM also testified in support of a resolu involve a comprehensive set of standards that there either is, or soon will be, an oversup tion introduced by the American Associa will lead to recognition of physicians who ply of physicians in the United States. tion of Public Health Physicians concern meet or exceed professional and practice ing intravenous drugs use, syringe and requirements in the areas of credentials, per These issues have huge implications for cur needle availability, needle exchange pro sonal qualifications, clinical performance, rent and future residents and medical stu gram ~ and HIV prevention, and other efforts and patient care outcomes. A standard port dents, as well as for physicians practicing in by state and local health departments to as folio of information on applicant physicians areas such as California, where marketplace sure the safe disposal of used syringes and would incorporate data on clinical outcomes forces are actively reducing the size of the needles. This issue was referred by the and patient satisfaction as well as "structural physician workforce. A three-hour open House for further study. aspects of quality" such as licensure, board hearing on physician workforce matters certification, and the like. heard testimony from dozens of organiza The Minnesota Medical Association submit tions; ASAM was one of 80 organizations ted a very creative resolution suggesting that The activity would be physician-led and that submitted written testimony. tobacco companies by required to accurately would be designed to reduce costs by re label the nicotine content in tobacco prod placing existing duplicative and frag ASAM Resolutions ucts, and that they be required to reduce the mented physician credentialing and re ASAM presented three resolutions to the nicotine content in tobacco products by an view processes. AMA expects thatAMAP AMA House of Delegates. The first relates to appropriate, graduated, incremental reduc will win universal recognition and accep identification of physician specialty in the in tion process so that tobacco products would tance by physicians, hospital medical formation included in physicians' personal be nicotine-free within six years. ASAM staffs, managed care organizations, regu Web pages. (AMA members can set up per supported the labeling provisions, which lators and consumers. sonal Web pages, free of charge, that include were adopted as AMA policy. ASAM also a photo and current information on the provided scientific testimony regarding the This AMA-sponsored activity is to be a joint physician's training and current practice.) benefits of nicotine replacement therapy via undertaking of all the members of the Fed ASAM's resolution asked that ASAM mem more predictable nicotine delivery systems eration: theAMA, state medical associations, bers be allowed to include this information in (e.g., transdermal patches) instead of inha and special societies such as ASAM. ASAM their Web pages. The House approved this lation of tobacco smoke. The House of Del will follow the development with great in action. egates referred this item for further study. terest. The impression of the ASAM delega tion is that the clinical performance variables Other ASAM resolutions asked the AMA to Other Resolutions developed for AMAP will have to take into endorse a reversal of 1996 Congressional A number of resolutions focused on managed account the types of patients and conditions decisions to terminate the Social Security care. There was much debate regarding Medi treated by the physician, as well as the care and disability benefits of individuals suffer care, RBRVS and fee structures, HCFA, environment in which the physician prac ing from addictive disorders, and tq support tices. Moreover, the AMAP credential will employment protections for individ'uals who Continued on next page ASAM News 16 I May I June 1997 AMA Report- Continued from previous page COMMITTEE NEWS telemedicine, genetic testing, and genetic infmmation and insurance AD HOC COMMITTEE ON _ coverage. A feature of importance to ASAM included findings of AMA's Study of the Federation of Medicine. A feature of importance FORENSIC ADDICTION MEDICINE to ASAM included ballots ASAM members were asked to complete Robert L. DuPont, M.D., Chair in late 1996 concerning the specialty society they designated to repre sent them in the Federation of Medicine. (Hopefully ASAM members AS AM's Ad Hoc Committee on Forensic Addiction Medicine got off all voted "425" for ASAM!). to a fast start with a well-attended threechour component session at the 1996 Medical-Scientific Conference in Atlanta. (Building on the ASAM continues to work closely with other medical organizations outstanding performance of the Medical Review Officer Committee through its contact at the AMA. We discovered that one of the ma led by Donald Ian Macdonald, M:Dr, the committee held an initial jor initiatives of the American College of Emergency Physicians is one-day training session in Washington, D.C., in January 1997.) to improve the training and practice of emergency physicians with regard to substance abuse and addiction. Members of the ASAM The Ad Hoc committee focuses on court-related asp)cts of addic delegation meet regularly at AMA meetings in caucuses with del tion medicine, including workplace drug testing and return-to-work egations from Preventive Medicine, Occupational and Environmen issues (hence the active connection withASAM's MRO activities), tal Medicine, Psychiatry, Child Psychiatry, Insurance Medicine and as well as a wide range of civil and criminal issues, including claims the U.S. Armed Forces and Public Health Services, as well as rep of diminished capacity secondary to intoxication-a major issue in resentatives of other medical specialty societies and state medical death penalty cases-and liability issues related to rcent use of al associations. cohol or other drugs. ... ASAM members have a broad expertise in these areas, which are AMA SEEKS ASAM INPUT proving to be of interest to many members as American society IN REVISING GUIDES begins to shed its denial of the effects of addiction and begins to TO PERMANENT IMPAIRMENT confront the remarkably diverse problems caused by addiction. The American Medical Association has asked ASAM to partici pate in revising AMA's Guides to the Evaluation of Permanent Impairment to produce a fifth edition. The Guides have been widely adopted by state Workers' Compensation Commissions and other official bodies as a standard reference in evaluating workers' disability claims and establishing fitness for duty crite na. At AMA' s request, ASAM has nominated the following experts to participate in the advisory panel to the revision: G. Douglas Talbott, M.D., FASAM, Andrea G. Barthwell, M.D., Sheila B. Blume, M.D., FASAM, Marc Galanter, M.D., FASAM, and David E. Smith, M.D., FASAM. - --cASAM Members of the new AMA also has invited ASAM members' to submit their com Ad Hoc Committee on Forensic Addiction Medicine meet in San Diego: ments about the book through the AMA Web site at www.ama (bottom row, left to right) H. Westley Clark, M.D., J.D., M.P.H. and Robert L. assn.org (go to the Medical Science and Education section). Al DuPont, M.D., FASAM, committee chair; (top row) ASAM Meetings Coordina ternatively, ASAM members can obtain a survey questionnaire tor Linda Fernandez, NormanS. Miller, M.D., FASAM, committee organizer William Vilensky, D.O., R.Ph., FASAM, conference speaker Robert Willette, via fax or mail by calling 1/800-937-8783. Ph.D., Raymond M. Deutsch, M.D., David E. Smith, M.D., FA SAM, and ASAM Meetings Manager Sandy Metcalfe, Letters- Continued from page 15 It would appear that the leadership and direc Years ago I realized that I was isolated from of addiction medicine than I have before or tion of ASAM have passed from those treat my colleagues in addiction medicine. I was since. Those of us in the boondocks make ing addiction, who were from many different medical director of a small treatment cen pilgrimages t-o the Ivory Towers. Maybe if medical backgrounds, to psychiatrists who are ter in a small town and I had no peer review those in the towers could come to the sticks, primmily researchers in neurochemistry. In of my work. After several years of delays not just to lecture, but to see what we do, we recentASAM review courses and the certifi locally and then by ASAM, Dr. Christine could all benefit. cation examination, the emphasis was on theo L. Kasser, a member of the ASAM board, ries of neurochemistry in addiction and very visited our treatment center to review our I mn not discouraged. Great strides have been little about detoxification, medical complica work. She was thorough and took time be made in addiction medicine. It is vital, how tions and treatment problems .... ASAM mem fore, during and after her visit to make an ever, that we not lose sight of the forest as bers who practice outside major medical cen expert assessment of the medical care in our we concentrate on our favorite tree. ters are becoming more isolated and are in facility. creasingly not having our problems addressed I [Replies to Dr. Sanders' letter are welcome by our Society. Membership is become less I learned more from that experience and and should be addressed to the Editor, relevant to our practice .... make more positive changes i}my practice ASAMNews.] Volume 12, Number 3 ASAMNews MEMBER NEWS DR. BISSELL TO MEMBERS ELECTED ASAM FELLOWS RECEIVE AMWA AWARD With the addition of the 18 Fellows listed below, a total of 108 physicians who are members of The American Medical Women's Associa the Society have been elected Fellows of the American Society of Addiction Medicine. All the tion has selected LeClair Bissell, M.D., Fellows were recognized at ASAM's 1997 Annual Medical-Scientific Conference. ASAM as 1997 recipient of AMWA's prestigious inaugurated the Fellow program in 1996 to recognize substantial and lasting contributions to the Society and the field of addiction medicine. Candidates must meet certain criteria to qual ity for Fellow status: they must have been an ASAM member for at least five consecutive years; (2) they must be ASAM-ce1tified; (3) they must have taken a leadership role in ASAM through committee service, or have been an officer of a state, chapter; and (4) they must have made and continue to make significant contributions to the addictions field. The following new ASAM Fellows were presented certificates denoting thei?'achievement during the Awards Dinner in San Diego: · Richard Artis Beach, M.D., FASAM William Hazle, M.D., FASAM Gulf Breeze, FL Los Gatos, CA John N. Chappel, M.D., FASAM Conway W. Hunter, Jr., M.D., FASAM Reno, NV Sea Island, GA --} RobertA. Collen, M.D., FACP, FASAM Geoffrey P. Kane, M.D., M.P.H., FASAM Fountain Valley, CA Nashua, NH LeClair Bissell. M.D. Donald Cornelius, M.D., FASAM Michael R. Liepman, M.D., FAPA, FASAM Elizabeth Blackwell Award. In announc Clayton, GA Worcester, MA ing the award, AMWA noted that "Dr. Bissell's life as innovator, researcher, au Louis Edward Deere, D.O., FASAM J. Paul Martin, M.D., FASAM thor, teacher, and social activist embod Dallas, TX Ashville, NC ies the very spirit of the Blackwell Award. She has dedicated her life to healing the Anthony Dekker, D.O., FASAM Michael M. Miller, M.D., FASAM impaired physician and has contributed a Kansas City, MO Madison, WI wealth of information for the training, treatment, and understanding of the addicted Anne Geller, M.D., FASAM Seddon Savage, M.D., FASAM patient, particularly women." NewYork,NY Lebanon, NH Caroline M. Gellrick, M.D., FAAFP, FASAM James W. Smith, M.D., FASAM Lakewood, CO Seattle, WA DR. PAYTE EDITS Douglas Graham, B.Sc., M.D., FASAM LanceS. Wright, M.D., FAPA, FASAM NEW MEDICAL JOURNAL I Victoria, British Columbia CANADA Darby, PA J. Thomas Payte, M.D., is editor of the new Journal of Maintenance in the Addictions, published by The Haworth Medical Press. MEMBERS IN SERVICE TO ASAM Described as focusing on "innovations in 0 Julian Keith, M.D., ASAM member and Director of the North Carolina Division of research, theory and practice," the journal's Mental Health, Developmental Disabilities and Substance Abuse Services, initiated a first issue features a commentary by Dr. meeting with Drs. Enoch Gordis (Director of the National Institute on Alcohol Abuse Vincent Dole defining methadone mainte and Alcoholism) and Alan Leshner (Director of the National Institute on Drug Abuse) nance treatment, a report by Czechowicz, and Mr. David Mactas (Director of the federal Center for Substance Abuse Treatment) Hubbard et al. on NIDA's Methadone Treat to discuss how to reach consensus on the definition of alcoholism, as a necessary step in ment Quality Assurance System (MTQAS), achieving parity in addictions treatment. as well as a study by Rowan-Szal, Joe et al. on increasing early engagement in metha 0 Dr. Michael Miller is working with the Managed Care Coalition on Substance Abuse Disor done treatment. ders (MCCSUD) to foster the development and common adoption of treatment guidelines. Future issues are to include articles on use 0 Dr. David Mee-Lee recently met with representatives of the Department of Defense and ful predictors of outcome in methadone of the branches of the military to discuss implementation of the DOD's newly enacted treated patients, a clinical perspective on TRICARE addictions treatment policy, which calls for use of criteria that are compatible dose in methadone maintenance, and a com with the ASAM Patient Placement Criteria in determining the need for treatment of mili parison of two methods for estimating the tary personnel and their.·six million dependents. Among those representing the military costs of drug treatment. services at the meeting were Drs. Terry Schultz and Ken Hoffman . • ASAM News 18 May I June 1997 Jefferson Medical College is seeking an academically credentialed psychiatrist, Position: established in the substance abuse field, to assume the position of Director of the Physician, Division of Substance Abuse Programs, Psychiatric Specialist Department of Psychiatry and Human Behavior. Location: Responsibilities include teaching, train Orofino, in scenic ing, and supervision of medical students North Central Idaho and residents; ant the administration of methadone, cocaine, and outreach drug Came. ~ctice Psychiatl'J in Idaho Department of Health and Wel free drug and alcohol clinics. There are fare, State Hospital North, is recruit research projects being conducted in all ·- the BeautUul Southwest ing a staff psychiatrist for its 60-bed clinics, with funded biological, genetic ''>:. Adult Psychiatric Hospital and Drug and clinical outcome investigations on Remuda Treatment Center is a p~ogressive Dependency/Dual Diagnosis Program going. Faculty rank and compensation facility located on a guest ranch setting components. The Hospital will hire a commensurate with qualifications. 50 miles northwest of Phoenix. Remuda Board Certified or Board eligible psy individualizes TX for eating disordered chiatrist who is seeking an opportu The position will be available on July 1, females meeting medical, nutritional & psychological needs blended with a nity for a progressive and innovative 1997 and selection will be based on ex perience and accomplishments in admin Biblical perspective. We are seeking a practice in the treatment of patients BC/BE psychiatrist interested in eating who are severely mentally ill and drug istration, teaching, patient care, and re disorder treatment. We, offer a charming dependent. A physician with exper search. resort town atmosphere, excellent salary tise in addictions treatment is desired. and very predictable schedule. E.O.E. Send resume to: State Hospital North is one of two Dr. Stephen P. Weinstein, Call or FAX your CV to state hospitals in Idaho, and an im Chair, Search Committee Linda Hughes portant link in the State and Regional Division of Substance Abuse Programs Remuda Ranch Center Mental Health network. The Hospi 1201 Chestnut Street, 15th Floor 1 E. Apache St. Wickenburg, AZ 85390 tal values participative and collabo Philadelphia, Pennsylvania 19107 (520) 684-4244 FAX (520) 684-4247 rative management, and team ap Fax: 215/568-3596. proach to treatment. The Hospital is located on a beauti SEATTLE AREA ful campus in a modern facility less · Non-Profit Organization than two years old. Orofino is an at ASAM ACCEPTS No State Income Tax tractive rural community located on NOMINATIONS FOR the Clearwater River at the base of EMERITUS MEMBERSHIP the Selway-Bitterroot Wilderness Salary practice oppmtunity for primary care ASAM members are invited to recognize physician, must be ASAM certified and Area. Professionals enjoy a quality the accomplishments of senior members team plaayer. Interest in program develop lifestyle and outdoor recreational ac of the Society by nominating them for ment and cummunity liaason. tivities. Emeritus membership. Emeritus mem bers have their membership dues waived The compensation package includes In total confidence our toll free number and receive complimentary subscription competitive salary, relocation assis 8001833-3449 or fax c.v. 360/647-8006 toASAM News and the society's Journal tance, and excellent State benefits. For more information, contact: ofAddictive Diseases. Eva Page & Associaties Physician Recruiting Emeritus status is bestowed by the ASAM Board of Directors, which reviews all nominations. To qualify, a nominee must Advertise in be: (1) an ASAM member for at least 15 ASAMNews! years; and (2) at least 65 years old; and (3) Debbie Manfull retiring or retired from the practice of ad Publisped six times a year for Assistant Administrator diction medicine. (However, in special 3,500 physicians specializing in State Hospital North cases, the Board reserves the right to be addiction medicine. 300 Hospital Drive stow Emeritus membership independent of any of the criteria listed.) Orofino, Idaho 83544 For rates and deadlines, call the ASAM office: Nomination forms are available from the ASAM Membership Department at ASAM 3011656-3920. Publications Manager Phone: 208/476-4511 301/656-3920 I Volume 12, Number 3 19 ASAMNews ASAM STAFF NOW ONLINE CONFERENCE In addition to accessing ASAM's web page, members can reach any ASAM staff mem cASAM CALENDAR ber via E-Mail, at the following addresses: 1 9 9 7 James F. Callahan, D.P.A. 1 9 9 7 Exec. Vice President/CEO JCALL@ ASAM.ORG July 18-20 October ASAM MRO Conference Adolescent Substance Abuse and Bill Brown Dallas, TX Addiction Conference Accountant 14 Category 1 CME credits [email protected] August 6-10 1 ' Catl;erine Davidge IDAA Medical-Scientific Conference October Assistant Director of Membership (Jointly sponsored by ASAM) 5th Annual Minneapolis, MN Southeast Regional CDAVI®ASAM.ORG '~, Addiction Conference Mark Douglas, C.P.A. September 6-21 Director of Finance South Africa People-to-People Conference November 6-8 MDOUG@ ASAM.ORG Uointly sponsored by ASAM) CSAM State of the Art Course Contact Max A. Schneider, M.D., FASAM San Francisco Linda Fernandez Fax: 714/639-0062 Asst. Director of Meetings & Conferences E-mail: [email protected] November 14-16 LFERN@ASAMitORG ASAM MRO Conference October 16-18 Seattle, WA Joanne Gattenmann SAA 20th Anniversary Conference Exec. Assistant to the Exec. Vice President on Alcohol and Substance Abuse 1998 JGART@ ASAM.ORG ASAM 29th Annual Medical-Scientific John Keister October 16-19 Conference Credentialing Project Manager ASAM lOth Annual Conference on New Orleans, LA [email protected] Nicotine Dependence Minneapolis, MN 1999 Theresa McAuliffe ASAM 30th Annual Medical-Scientific Director of Membership October 23-25 Conference [email protected] State of the Art in Addiction Medicine New York, NY Washington, D.C. Sandy Schmedtje Metcalfe 20 Category 1 CME credits Director of Meetings and Conferences [email protected] Bonnie B. Wilford Editor, ASAM News For additional information, call the ASAM;office at 301/656-3920. [email protected] New from ASAM! Publis~ed April1997 The Principles Update Series Topics in Addiction Medicine Detoxification: Principles and Protocols Published by the American Society of Addiction Medicine, Detoxification: Principles and Protocols is your authoritative guide to the management of one of your greatest clinical challenges. 8-112 x 11 ", 3-hole drilled, 52 pages, charts and tables, authoritatively referenced. Price: ASAM members $15, Non-members $20. Order your copy today! ASAM • P.O. Box 101 • Annapolis Junction, MD 20701-0101 PHONE 8))'0/844-8948 •