“New Paradigm” is a business model not a medical model

“I’m only here for a four day evaluation”– T-shirt sold at Talbott Recovery CenterReblogged on WordPress.com

Source: “New Paradigm” is a business model not a medical model

The  New York Times article below written by Robert Dupont advocates coercion to facilitate addiction treatment.

Inherent in the current chronic brain disease model of addiction is the importance of external control.  The addict has an uncontrollable brain disease and in denial so we must make decisions for him.   Coercion is certainly justifiable in some cases.  Someone deep in the throes of addiction or alcoholism may  indeed require coercion to get the help they need.  Coercion could save their life.

But that is not what we are talking about here. Claiming that the addict has an uncontrollable disease is increasingly being used to to exert control over individuals regardless of whether they need to be treated.  The “I’m only here for a four-day evaluation” T-shirts were sold at Talbott Recovery Center, one of the specialized assessment and treatment centers. It is a joke because most doctors assessed at Talbott end up staying for about four-months not four-days.

 In state physician health Programs (PHPs) the concept of denial is being used to dismiss oppositional opinion and fact and coercion is being used to provide unneeded treatment is  to individuals  who do not even come close to meeting  the diagnostic criteria for substance use disorder.

 An article entitled    “Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon”is typical of the alarmist propaganda used to promote these programs.

“Physician access to medications through prescriptions, networks of professional contacts, and proximity to hospital and clinic supplies” gives them “rare access to powerful, highly sought-after drugs” says Marvin D. Seppala, chief medical officer at Hazelden. This access “sets them apart” and “not only foment a problem” but”perpetuate it” says Seppala. “Access “becomes an addict’s top priority” and they “will do everything in their power to ensure it continues.” He states:

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

This is pure preposterous nonsense.  The entire purpose of this vignette is to temper the responses of others when the best worker in the hospital is hauled away and coerced into treatment for a non-existent disease. It is to deflect inquiry, skepticism and doubt about the event.

The Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual that approved the concept of “potentially impairing illness” and “relapse without use.”   PHPs can now coerce doctors into treatment for “relapse” to a disease that they never had in the first place. “Relapse without use” is a 12-step concept G. Douglas Talbott defines as “stinkin thinkin.” The Federation of State Medial Boards provided “regulatory sanctification” to an A.A. concept.

A February 2016  “Physician Health News”article written by Dupont  entitled  “An Outsider Looks at PHP Care Management”  is analogous to Willy Wonka writing a paper called “An Outsider Looks at Chocolate Factories.” Dupont notes “many physicians entering into PHP care are angry and feel beleaguered because they do not think they have problems or need treatment.”

The simplistic binary chronic relapsing brain disease model as defined by the American Society of Addiction Medicine (ASAM) is the foundation for this model.

They have been given the power to coerce and control physicians, They also force 12-step ideology and force doctors to to accept ideas that are anathema to them.

The concept of denial is used to force people into treatment and justify abuse during treatment.   The chronic recurring model as espoused by 12-step justifies both ongoing drug and alcohol testing and a revolving door of treatment.    They have been given the power to coerce physicians to accept ideas that are anathema to them.

Designating abstinence as the only acceptable treatment outcome is also a necessary component.

Cui bono?  The drug and alcohol assessment, treatment and testing industry to which Dupont has strong ties.

Dupont and former DEA head Peter Bensinger run a corporate drug-testing business. Their employee-assistance company, Bensinger-Dupont is the sixth largest in the nation.

It is important to recognize that this is not a medical model but a business model.  No research, information, logic or anything else is going to change the business plan. PHPs are essentially employee assistance programs (EAPs) for doctors. They are selling an EAP (the PHP-blueprint) and the junk-science non-FDA approved drug and alcohol testing that goes along with it.

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

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

(2) Thorough evaluation and patient-focused care;

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

(4) Effective use of leverage;

(5) Defining and managing relapses; and

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

This is a business model plain and simple and all the trumpeting of success and glory is based on a single retrospective poorly designed bullshit study of 16 state PHPs rife with conflicts of interest.  The “PHP blueprint” needs to be attacked.

Reflecting on Lord Acton’s observation that “absolute power corrupts absolutely” the American philosopher Eric Hoffer added that “Those in possession of absolute power can not only prophesy and make their prophecies come true, but they can also lie and make their lies come true.”    The “PHP-Blueprint”  is   being brandished by Dupont as the  “new paradigm” of substance abuse treatment but the majority of doctors being monitored do not meet the criteria for substance use disorder.   This system is not designed to help doctors or protect the public.  It is designed to profit and line the purses of the drug and alcohol assessment, testing and treatment industry.   This needs to be recognized and addressed before the new paradigm expands to other occupations, college students and kids.

Drug Addiction Recovery Often Starts With Coercion

Robert L. DuPont

Robert L. DuPont, a psychiatrist, is the president of the Institute for Behavior and Health Inc. He was the director of the National Institute on Drug Abuse from 1973 to 1978.

UPDATED NOVEMBER 12, 2015, 12:52 PM

Addiction hijacks the brain. Families dealing with addicted loved ones know this. Research shows that 95 percent of people suffering from substance use disordersdo not think that they have a problem or need treatment. Few addicts enter treatment without meaningful coercion, most often from families or the criminal justice system.

The challenge in responding to this seemingly simple question about coerced treatment is in the details. Surely not everyone who is addicted to drugs should be committed to treatment. The opposite is also true. Some addicts should be committed to treatment against their will. Not all coercion is commitment and not all commitment has the force of law.

Programs with effective coercion and serious consequences, such as HOPE Probation and Physician Health Programs, often produce excellent outcomes for most participants.

Two good examples of effective coercion that overcome addiction are HOPE Probation and the state-based Physician Health Programs, both of which are enforced by intensive random monitoring and permit no use of alcohol or other drugs. While these two programs share many similar features, they deal with very different populations of serious substance users: one with convicted felons on probation and the other with physicians. Both are voluntary in the sense that individuals can choose to not abide by the program requirements, but in both cases the consequences may be serious. For probationers in HOPE, the risk of failing is prison and for physicians in P.H.P., it is the loss of a medical license. Both programs produce excellent outcomes for most participants.

Families faced with addiction often reluctantly, and only after many failures, use “tough love” to promote treatment and recovery while insisting that their addicted loved ones be drug-free. Families usually have to use a significant measure of coercion not only to get addicts into treatment but also to keep them there and to prevent relapse upon discharge.

As a psychiatrist specializing in the treatment of addiction, I am struck by the stark contrast between addicted people who are using alcohol and other drugs actively and those who are in stable recovery. In the process of recovery there is a transition from near-universal denial of problems and rejection of treatment to gratitude for and acceptance of the coercion that got them on that path. The addict’s will is different when using drugs and when in recovery.

Recovery from addiction may or may not involve treatment. It takes years of hard work – usually with the sustained support of recovery communities. Because of the denial that characterizes the cunning, baffling and powerful disease of addiction, recovery often starts with substantial coercion.

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One thought on ““New Paradigm” is a business model not a medical model

  1. I have also known many heavy drinkers who quit. All voluntarily, as a personal autonomous choice. Coercion is a human rights abuse and has been shown time and time again to be counterproductive. Deception is also abuse. It is a human rights violation to court-order a person to AA (also a religious imposition on human rights) or court-order or otherwise force or coerce into a “facility.” I don’t see it as a “brain disease” either. I also believe that compulsion to drink alcohol is not necessarily a permanent condition. I have a few friends who decided it is best not to take chances, so they stay away from booze. By personal choice.

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