The New Criminologist Published on 25 November 2005
Author PARKER, Janet Louise, D.V.M.,B.S.
The History of the American Society of Addiction Medicine or ASAM
By Dr. Janet Louise Parker
Why would 20 doctors, nurses and other health officials kill themselves after being treated by the American Society of Addiction Medicine program? The reason can be found in the history and philosophy of the ASAM (The American Society of Addiction Medicine). In spite of grave concerns regarding violations of confidentiality and informed consent and the proven coercion and abuse of patients, these boot camp like programs are forced on licensed medical professionals. The health professionals are threatened with expulsion from their professional employment and with not being certified which often means the loss of one’s professional career. The United States Public may not realize that Doctors are forced into mandated programs. There no longer needs to be proof of impairment, unsubstantiated claims or suspicions may be all that is needed to place an accused Doctor in the “program. Written charges of the accusations may not be provided to the accused Doctor. All that is needed for the Doctor to be involuntarily detained is the signature of one Psychiatrist. Isn't it illegal, or at best unethical to forcibly refer patients to yourself? But ASAM forcibly refers patients to its own treatment centers through Professional Medical Licensing Boards.
Consider the case of Dr. Leonard Masters who suffered false imprisonment and was held against his will for 4 months for an alcohol problem that was proven to be fabricated. He sued the Atlanta area mental hospital and won $1.3 million dollar judgment for malpractice, fraud, and false imprisonment. Whistleblowing doctors face real challenges and clear dangers when they come forward to provide information regarding criminal behavior which involves addiction treatment or mental health services. The backlash can be career ending or even life ending in the case of suicide.
Dr. G. Douglas Talbott is a physician who suffered from alcoholism and was the Medical Director of the Talbott Recovery Campus (TMRC) in Atlanta, Georgia. Dr. Talbott believes in confronting doctors, coercing and compelling them into treatment into his AA 12 step program. He set out to create a medical specialty society for addiction medicine and to change existing laws in order to coerce medical staff into treatment programs run by ASAM. Dr. Talbott was the previous President of ASAM from 1997-1999. He was in the forefront of the consolidation of various alcohol and drug treatment organizations into to the present American Society of Addiction Medicine (ASAM). In 1999 Talbott stepped down as president of ASAM, but only after a $1.3 million dollar judgment against him for his treatment of a patient, Dr. Leonard Masters, of Jacksonville Florida. Treatment by G. Douglas Talbott, MD, had been described by patients in court testimony, as being demeaning, coercive, and medically inappropriate.
In May, 1999, a jury awarded Dr. Leonard Masters the substantial judgment for malpractice, fraud, and false imprisonment, based on Masters' 1994 stay with Talbott at an Atlanta area mental hospital. Masters says they misdiagnosed him as an alcoholic and held him against his will for four months. Masters accused hospital officials of ordering him to undergo a four-day evaluation at Anchor in 1992 or lose his professional license following complaints that he was writing too many prescriptions for pain medication. An associate made an unfounded allegation. That evaluation turned into a four-month stay in which he was diagnosed as an alcoholic and forced into a treatment program, even though he tested negative for alcohol or narcotics. The former president of the ASAM, Dr. Anne Geller had to testify in court that Dr. Masters had been incorrectly diagnosed alcohol dependent. The panel ultimately found that Masters' diagnosis amounted to malpractice. The fraud claim was considered by the jury to be "intentional.”
But ASAM still kept G. Douglas Talbott as a member of ASAM's Board, even after that judgment. But to prevent any further successful lawsuits, ASAM made it a priority to change existing laws in all states, so that they could never be sued again. These new laws give them immunity for civil and criminal damages even in the case of a patient’s suicide while under treatment in one of their facilities. Thus granting them the power to “deputize” their agents and avoid the legal responsibility for their own actions. These laws prevent Doctors from bringing any legal action at the state level against the ASAM facilities or staff.
It is surprising that in spite of high levels of suicides from patients in the ASAM programs, United States medical licensing boards continue to order health care professionals into treatment with the ASAM. In one 4 year period at a Atlanta based facility run by Talbott, 5 health care professionals committed suicide. One doctor, Dr. Paul G. Cohen, who criticized Talbott’s programs found that Talbott retaliated by continually accusing him of drug or alcohol addiction. Dr. Cohen as a result of these false accusations, underwent at least five psychiatric evaluations and more than 30 drug tests, none of which revealed substance abuse. Further investigation showed that the allegations of drug abuse were totally unsubstantiated.
In spite of these abuses the ASAM seems to have suffered no professional repercussions. They have even published a volume, Principles of Addiction Medicine. In this book they outline their principles but never address ethical issues — such as violations of confidentiality and informed consent, and coercion and abuse of often highly vulnerable individuals.
Other patients of the ASAM program in Atlanta (TMRC) were required to give "first steps" in front of the entire client population. This involved humiliating the client in front of a room of strangers in order to force him/her to admit their “problem.” These sessions were even shared with staff from a visiting local university staff without the consent of the patient. These exercises involved very detailed and intimate accounts of the client's drug addiction. No releases for sharing of medical information were signed, a clear violation of patient privacy rights. If clients don’t admit to guilt they are told that they are in “Malignant Denial”. Treatment at the ASAM Atlanta program involved yelling at patients, pages of rules to follow, and punishments.
One TMRC patient who had a previous manic-depressive illness was prevented from having proper medication for his primary disorder and instead labeled as “Addictive Disease”. This emphasis meant that the entire “Master Treatment Plan” focused on Addiction and never addressed the bi-polar issue at all.
When the medical charts of the Dr. Talbott’s ASAM program were examined, it was found that 96% of those sent to Talbott Recovery Program in Atlanta would stay for OVER four months — some stayed two years — unless their insurance ran out. The treatment would last as long as the money was there to pay for it and the patient was not legally allowed to “opt out”. There was a lack of medical supervision of these lay addiction treatment team members. Doctors, the patients never met, signed off the medical charts. The ASAM staff made the primary diagnosis “Addiction” as that is the only specialty in which they could claim credentials. Therefore in order to bill for services rendered, a non attending Doctor with the right credentials in Psychiatry or Psychology, then signed off on the charts for billing purposes. This was a very lucrative fraudulent billing scheme.
The ASAM’s A Guideline for Credentialing and Privileging of Clinical Professionals for Care of Substance-Related Disorders: A Joint Statement of the American Society of Addiction Medicine and the American Managed Behavioral Healthcare Association allows persons without an MD degree to ascribe a “diagnosis to a patient” and then institute “treatment”. It states “Whether a non-physician can ascribe a 'diagnosis' to a patient he/she has assessed is determined by the professional practice acts of a given state of the union. “
Even after leaving the facility the Doctor’s patient rights would be violated. One physician patient indicated in court testimony that staff members contacted the _______ State Bar Association, to inform them that he had left the facility "AMA." (against medical advice). As you should know, such breaches of confidentiality are criminal in nature, punishable by substantial fines and even jail time.
State Licensing agencies in the United States state that participation is “voluntary” but threats of losing licenses amounts to intimidation. There is a coercive pressure, which is exerted through the licensing agencies, which mandate treatment at an ASAM facility. This effectively removes the patient’s absolute constitutional right to make his or her own choices regarding treatment or to refuse treatment. The ASAM seeks to remove from the patient their own right of autonomy and right to refuse treatment. This civil and human right is critical for any mental health patient.
Coercion plays a highly controversial role in the administration of mental health services including services for drug addiction or alcoholism. Involuntary commitment to mental hospitals -- and "voluntary" hospitalization to avoid imminent commitment may cause patients to be so alienated that they refuse to comply with treatment as soon as the coercion is lifted. Patients are also reluctant to seek voluntary treatment in the future for fear of being coerced again. Treatment outcomes produced by coercion may be very transitory.
Members of ASAM have no respect for patients’ point of view or alternative approaches to addiction or drinking problems. They are willing to rely on coercion and threats to get and keep patients in their program. If the targeted person doesn't own up, the addiction treatment team feels justified in applying, indeed obligated, to apply a range of coercive techniques, from peer group pressure, deception, entrapment, workplace bullying, social isolation and threat of removal of licensure. There is an assumption of guilt; the treatment system requires innocent people to prove that they are not guilty. Patients are forced into the 12-step precepts of confession and contrition.
The ASAM has been proactive to have state legislatures enact laws that will completely remove any liability, criminal or civil, for the actions of members or deputized agents of ASAM. This means that no further damages will be awarded to the widows of those who commit suicide after treatment by the ASAM addiction treatment team. In addition ASAM has placed into practice laws that prevent patients from refusing treatment by the ASAM and allow coercive and forced treatment even when there is no proof of impairment (only suspicion). A statement of suspicion, without substantial proof is enough to cause a doctor to be threatened with removal of their license. In addition the ASAM has fostered laws in each state that allow their affiliated agencies to use state funds to gain proof of impairment of the patient through investigative techniques. In 2000 ASAM lobbied for mandated placement of all Medicaid clients into ASAM programs in Oregon thus replacing publicly funded and operated programs with the privately owned ASAM Contract organizations. ASAM has worked for legislation in every state to limit civil and criminal liability, increase options for the use of force and coercion, and increase publicly paid service provisions for addiction treatment. This maximizes the profit to the ASAM Doctors but limits their liability. These laws extend immunity for liability to contracted program staff in the private sector.
Due to recently passed laws, patients have no right of refusal, and no legal right to bring civil or criminal suit against the ASAM for abusive or harmful treatment. Any medical patient who attempts to whistleblow on abusive practices or excessive billing practices will suffer threats against their license. Patients who had witnessed abusive treatment of others, are fearful of coming forward because they might loose their own medical license, or be forced to stay longer in treatment as punishment for reporting.
Psychiatric care permits the doctor to act against the patient’s own wishes, even drugging them if the doctor dictates. Physical restraints, isolations and withholding contact with family members and friends, refusal to call a lawyer, involvement of employer and co-workers as spies, can force the patient into submission. As patients have no right to sign themselves out of treatment, they are kept often until the insurance runs out or until the time limit allowed for care has been exceeded. This marriage of privately owned profit making enterprises with state sanctioned immunity from civil and criminal prosecution makes this system perfect for medical fraud and illegal billing practices. Couple that with the power and authority of the medical licensing boards and the ability to use state funds for entrapping investigative practices. This coercive program can violate the most basic civil and human rights and removes freedom of choice from its patients especially in light of mandated treatment of Medicaid patients or licensed medical professionals.
In addition to the ASAM’s efforts to be the mandated provider of addiction treatment services for all Medicaid patients and all medical health professionals, ASAM had lobbied for increased monies from State and Federal sources for payment for extended treatment stays. The ability to obtain payment from governmental programs is often a matter of knowing how to fill out the paperwork to optimize the money available for payment for services. Ordinarily having increased money available would increase appropriate care but not when the patient is forced involuntarily into treatment and kept with coercive and intimidating psychiatric methods. Dr. Leonard Masters, of Jacksonville Florida was kept for 4 months against his will and treated for an addiction that he did not have. This is a highly effective program which can be used to silence a medical whistleblower.
Physicians already fear being targeted by fellow doctors through the process of Bad Faith Peer Review. The American Association of Physicians and Surgeons (4,000 members) says that the peer review panel consists mainly of physicians and the system is open to manipulation and needs reform. When allegations of poor care or other serious complaints against a doctor are decided in secret, fair due process is often denied to the accused Doctor.
False Allegations of drug abuse or alcohol abuse are easy to fabricate and the Mandated Impaired Provider Treatment by ASAM easily manipulated. Dr. G Douglas Talbott has devised a protocol for labeling a person as addicted, based on behavioral signs, even without any positive drug or alcohol testing. ASAM has pushed through legislation in many states to allow just a suspicion based on these behavioral signs to allow coercive measures to be used against medical professionals “suspected of impairment.”
The Semmelweis Society, whose members are mostly doctors who have been victims of "malicious peer review," say that the Peer Review process is used to damage competitors or punish whistle-blowers. The use of forced hostile psychiatric evaluations can silence medical whistleblowers. Atlanta, Georgia is where ASAM and Dr. G. Douglas Talbott had their addiction treatment center and is now the site of one of the largest medical corruption cases in years (Grady Hospital in Atlanta). Hostile psychiatric examinations were used to intimidate witnesses in that case.
Dr. Robert Lifton labeled this extraordinarily high degree of social control characteristic of organizations that operate reform programs as their totalistic quality (Lifton 1961). This concept refers to the mobilization of the entirety of the person's social, and often physical, environment in support of the manipulative effort. This can be called brainwashing and is often used in cults.
Considering this drug addiction treatment philosophy, it is concerning that licensed medical providers (Doctors, Nurses, Dentists, Chiropractors, Pharmacists, Veterinarians) in most states face ASAM mandated professional providers. Doctors are kept silent about the fraudulent billing practices because of concerns for their professional careers. To what extent Doctors who might know about medical fraud or criminal behavior, are intimidated by threats from a mandated professional provider system will never be fully known. Silence is the unspoken rule.
Many doctors who have been exposed to the ASAM 12-step program will recognize these techniques of coercion/persuasion. One has to question the use of these coercive methods in conjunction with state sanctioned immunity for civil and criminal liability for any harm done to the patient. Historically there have been many instances of outright mistreatment in drug treatment and mental health facilities. There is also a pattern of using Bad Faith Peer Review, Forced Involuntary Hostile Psychiatric Evaluations and of False Allegations on Whistleblowing doctors. If patients are denied their own rights and the ethical doctors are prevented from whistleblowing through threats and intimidation, the system is ripe for fraudulent billing practices. In light of this knowledge it is particularly concerning that American doctors in Washington State face a Washington Physicians Health Program that has state sanctioned civil and criminal immunity for harm done to patients in their programs. Under such a system how can a Doctor be a whistleblower on abusive practices, corruption or fraud.
Dr. Lifton always maintained that such coercion used by these drug treatment programs could only influence short-term behavior, not permanently change long term behavior, beliefs or personality. .Dr. Lifton identified eight themes or properties of reform environments that contribute to their totalistic quality:
Control of communication
Emotional and behavioral manipulation
Demands for absolute conformity to behavior prescriptions derived from the ideology
Obsessive demands for confession
Agreement that the ideology is faultless
Manipulation of language in which cliches substitute for analytic thought
Reinterpretation of human experience and emotion in terms of doctrine
Classification of those not sharing the ideology as inferior and not worthy of respect
Robert J. Lifton, Thought Reform and the Psychology of Totalism (1961), ISBN 0807842532 pp. 419-437, 1987
In the USA (Washington State), these two laws passed by the Washington State House and Washington State Senate that changed the legal aspects of the ASAM program (Washington Physicians Health Program)
Washington State HOUSE BILL REPORT HB 1618 As Reported By House Committee On: Health Care, Title: An act relating to treatment programs for impaired physicians. Brief Description: Modifying certain aspects of programs that treat impaired physicians.
The "impaired physician program" is changed in several respects. Regulated health professions may contract with the Medical Quality Assurance Commission for providing services to other impaired health practitioners.
The requirement that the physician be verified as impaired before the commission can intervene is expanded to provide the commission with the ability to intervene when a non-compliant or non-cooperative physician is suspected of impairment.
Immunity from civil and criminal liability is provided for commission members and staff under the "impaired physician program" and extended to program staff for information submitted to the disciplinary authorities.
Testimony For: The authority of the impaired physician program needs to be updated to reflect current usage and terminology. Immunity from legal liability needs to be clarified and extended to program staff.
Testimony Against: Immunity from liability should not be extended to contracted program staff in the private sector.
Testified: Representative Skinner, prime sponsor; Lynn Hankes and Andy Dolan, Washington State Medical Association (pro); and Ron Weaver, Department of Health (con).
Washington State SENATE BILL REPORT SB 6545, As Reported By Senate Committee On: Health & Long-Term Care, February 6, 1998 Title: An act relating to treatment programs for impaired physicians. Testified: Lynn Hankes, M.D., WA Physician Health Program (pro).
“The impaired physician's program includes extension of immunity to the entity that runs the impaired physician's program……… The scope of the impaired physician's program is broadened to include treatment and assessment of reports of suspected impairment…. The impaired physician program is given authority to select treatment programs for its patients.”
California Society of Addiction Medicine is the California branch of ASAM
Washington Physicians Health Program is actually a renamed version of WASAM (Washington Association of Addiction Medicine) and is a branch of ASAM http://wsam.org/
Stanton Peele “A Prototypical Case of Alcoholism Treatment and Coercion: G. Douglas Talbott “http://www.morerevealed.com/books/resist/r_chap_6.htm
In the Belly of the American Society of Addiction Medicine Beast http://www.peele.net/debate/talbott.html Threats and Indoctrination at Talbott Recovery Campus Reactions to the ASAM/Talbott Trial http://www.peele.net/debate/talbott.reactions.html
ASAM Takes No Action as Founder, Past President, and Board Member Held Liable for Fraud and Malpractice http://www.peele.net/debate/asam.html
Dave Williams, “Doctor wins his lawsuit; Says hospital misdiagnosed him” The Florida Times-Union (Jacksonville, FL) May 25, 1999 Tuesday, City Edition METRO; Pg. B-3 http://www.schaler.net/talbott.html
Dr. Salvo, “The Harbinger consists of area faculty, staff and students, and members of the Mobile community.” The Harbinger, Mobile Alabama, The Harbinger is a non-profit education foundation http://www.theharbinger.org/salvo/950221.html
Joe Sharkey, Bedlam: Greed, Profiteering, and Fraud in a Mental Health System Gone Crazy , St Martins Pr; 1st edition (April, 1994) ISBN: 0312104219 In 1993 a FBI investigation revealed $1.74 billion Medicare- and Medicaid fraud by 86 Psychiatric hospitals in Texas (National Medical Enterprises and others). Some hospitals used questionable or totally unethical marketing practices, going so far as to offer bounties of up to $1500 for referrals.
Dean Anason, “IN DEPTH: HEALTH-CARE QUARTERLY” November 8, 1996 print edition Biz Journals
Anchor and Talbott-Marsh treat addicted professionals
ASAM’s A Guideline for Credentialing and Privileging of Clinical Professionals for Care of Substance-Related Disorders: A Joint Statement of the American Society of Addiction Medicine and the American Managed Behavioral Healthcare Association http://www.asam.org/ppc/Credentialing.htm
On Coercion, Attitude Change and Mental Health Services
Richard J. Ofshe, Ph.D. “Coercive Persuasion and Attitude Change” Encyclopedia of Sociology Volume 1, Macmillan Publishing Company, New York http://www.rickross.com/reference/brainwashing/brainwashing8.html
THE MacARTHUR COERCION STUDY, May 2004 John Monahan, School of Law, University of Virginia, 580 Massie Road, Charlottesville, Virginia 22903-1789 (e-mail: firstname.lastname@example.org).
Bennett, N., Lidz, C., Monahan, J., Mulvey, E., Hoge, K., Roth, L. and Gardner, W. (1993). Inclusion, motivation, and good faith: The morality of coercion in mental hospital admission. Behavioral Sciences and the Law, 11, 295-306.
Dennis, D., and Monahan, J. (Eds.). (1996). Coercion and Aggressive Community Treatment: A New Frontier in Mental Health Law. New York: Plenum Publishing Corporation.
Hoge, S., Lidz, C., Mulvey, E., Roth, L., Bennett, N., Siminoff, L., Arnold, R., Monahan, J. (1993). Patient, family, and staff perceptions of coercion in mental hospital admission: An exploratory study. Behavioral Sciences and the Law 20, 281-293.
Hoge, S., Lidz, C., Eisenberg, M., Gardner, W., Monahan, J., Mulvey, E., Roth, L., and Bennett, N. (1997). Perceptions of coercion in the admission of voluntary and involuntary psychiatric patients. International Journal of Law and Psychiatry, 20, 167-181.
Lidz, C. (1998). Coercion in psychiatric care: What have we learned from research? Journal of the American Academy of Psychiatry and the Law, 26, 631-637.
Lidz, C., Mulvey, E., Arnold, R., Bennett, N., and Kirsch, B. (1993). Coercive interactions in a psychiatric emergency room. Behavioral Sciences and the Law, 11, 269-280.
Lidz, C., Hoge, S., Gardner, W., Bennett, N., Monahan, J., Mulvey, E., and Roth, L. (1995). Perceived coercion in mental hospital admission: Pressures and process. Archives of General Psychiatry, 52, 1034-1039.
Lidz, C., Mulvey, E., Hoge, S., Kirsch, B., Monahan, J., Eisenberg, M., Gardner, W., and Roth. (1998). Factual sources of mental patients' perceptions of coercion in the hospital admission process. American Journal of Psychiatry, 155, 1254-60.
Lidz, C., Mulvey, E., Hoge, S., Kirsch, B., Monahan, J., Bennett, N., Eisenberg, M., Gardner, W., and Roth, L. (1997). The validity of mental patients' accounts of coercion-related behaviors in the hospital admission process. Law and Human Behavior, 21, 361-376.
Lidz, C., Mulvey, E., Hoge, S., Kirsch, B., Monahan, J., Bennett, N., Eisenberg, M., Gardner, W., and Roth, L. (2000). Sources of coercive behaviors in psychiatric admissions. Acta Psychiatrica Scandinavica, 101, 73-79.
Monahan, J., Hoge, S., Lidz, C., Roth, L., Bennett, N., Gardner, W., and Mulvey, E. (1995). Coercion and commitment: Understanding involuntary mental hospital admission. International Journal of Law and Psychiatry, 18, 249-263.
Monahan, J., Hoge, S., Lidz, C., Eisenberg, M., Bennett, N., Gardner, W., Mulvey, E. & Roth, L. (1996). Coercion to inpatient treatment: Initial results and implications for assertive treatment in the community. In D. Dennis and J. Monahan (Eds.), Coercion and Aggressive Community Treatment: A New Frontier in Mental Health Law. New York: Plenum Publishing Corporation (pp. 13-28).
Monahan, J., Lidz, C., Hoge, S., Mulvey, E., Eisenberg, M., Roth, L., Gardner, W., & Bennett, N. (1999). Coercion in the provision of mental health services: The MacArthur studies. In J.Morrissey, and J. Monahan (Eds), Research in Community and Mental Health, Vol. 10: Coercion in Mental Health Services -- International Perspectives. Stamford, Connecticut: JAI Press (pp. 13-30).
For criticism of Alcoholics Anonymous and its 12 step program see the following website:
For additional information on Robert Jay Lifton
Robert J. Lifton, Thought Reform and the Psychology of Totalism (1961), Robert Jay Lifton is a Visiting Professor of Psychiatry at Harvard Medical School. And over his long career, he's studied the New Global Terrorism, the aftermath of the Hiroshima bomb, Nazi doctors, and the Aum Shinrikyo cult that released poison gas in the Tokyo subway. He is, one of the world's foremost experts on the disturbing violence of our times. ISBN 0807842532 pp. 419-437, 1987
Cult Formation Lifton outlines the eight psychological themes that distinguishes a cult from a mere political, religious, or social grouping. http://www.csj.org/studyindex/studycult/study_lifton2.htm
Evil, the Self, and Survival: A Conversation with Robert Jay Lifton, M.D.In this "Conversation with History" from the Institute of International Studies, UC Berkeley, Robert J. Lifton explains his intellectual journey from his childhood home of Brooklyn to his groundbreaking studies in the scientific field of psychohistory. Discussion themes vary from death and the continuity of life; psychic numbing; the survivor motif; the socialization to evil; doubling; and terrorism, as these concepts interact and explain the more devastating events of the 20th century. http://globetrotter.berkeley.edu/people/Lifton/lifton-con0.html
For additional information on The Grady Hospital Corruption Case, Atlanta, Georgia
Summary of corruption unearthed by the New Criminologist and the Atlanta whistleblower team.Published on 15 September 2005 Author/Source: TNC Staff reporter Atlanta
#HCA, inc. Facing massive liability associated with Medicaid fraudJune 30, 2005 Author/Source: Grady Coalition
Atlanta Corruption: New Whistleblower Emerges with Damning EvidenceApril 24, 2005 Author/Source: Christopher Berry-Dee