According to their official website (www.aa.org):
"The origins of Alcoholics Anonymous can be traced to the Oxford Group, a religious movement popular in the United States and Europe in the early 20th Century. Members of the Oxford Group practiced a formula of self-improvement by performing self-inventory, admitting wrongs, making amends, using prayer and meditation, and carrying the message to others."
(See http://www.aa.org/aatimeline/ for full history)
Alcoholics Anonymous (AA) was founded in 1935 by failed New York stockbroker Bill Wilson (a.k.a. "Bill W."), a severe alcoholic with a high school education who believed that alcoholism is a spiritual disease and that successful recovery from alcoholism requires a person to, among other things, admit that he or she is powerless over the addiction to alcohol and to believe that only God or a "higher power" can restore the person to sanity. Co-founder Robert Holbrook Smith, MD (a.k.a. "Dr. Bob"), a deeply religious Ohio surgeon and severe alcoholic for thirty years, said that AA's basic ideas came from their study of the Bible and their experiences with a popular contemporary evangelistic Christian movement known as the Oxford Group.
The American Society of Addiction Medicine (ASAM) was started by Dr.Ruth Fox (founding president) in the early 1950's to promote AA and its spiritually-based 12-step treatment of alcoholism to doctors. The Federation of State Medical Boards (FSMB) first identified alcoholism and drug addiction as a disciplinary problem in 1958 and called for a model probation and rehabilitation program to be adopted by state medical boards. ASAM used this opportunity to broaden its power and influence among medical professionals, despite the fact that the American Medical Association (AMA) had previously gone on record as strongly critical of the unscientific basis of the 12-step approach promoted in AA's so-called "Big Book" as being "a curious combination of organizing propaganda and religious exhortation" and generally having "no scientific merit or interest." [Book review of "Alcoholics Anonymous", Journal of the American Medical Association, 1939;113(16).]
In 1960 AA-funded alcohol researcher E.M. Jellinek coined the expression, "the disease concept of alcoholism". In the late 1960's the "disease concept" was gradually expanded to include other addictions as well. In the 1970's, as the "disease concept" of alcoholism promoted by AA and ASAM took root, health insurance companies began to cover the costs of alcoholism treatment.
In 1973, the Journal of the American Medical Association (JAMA) published a landmark policy paper on "The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence". [Journal of the American Medical Association, 1973;223(6):684-687.] By 1980, less than a decade after the AMA's policy paper, all but three of the 54 U.S. medical societies of all states and jurisdictions had authorized or implemented impaired physician programs -- the majority of which were simply state branches of ASAM with slightly modified AA programs designed to rehabilitate and monitor physicians with drug or alcohol addiction.
In 1988, "Addiction Medicine" was declard a specialty by the AMA, and in 1990 ASAM was given voting rights within the AMA House of Delegates. That same year, the Federation of State Physician Health Programs (FSPHP) was created as an association of individual ASAM-based state physician health programs.
In 1991 ASAM first published its "Patient Placement Criteria" (PPC), which was designed for programs offering addiction treatment services. By 2001 the revised ASAM PPC-2R had adopted the increasingly prevalent term "Co-Occurring Mental and Substance-Related Disorders" in formal descriptions of diagnostic criteria and treatment recommendations. Throughout the text of the ASAM-PPC-2R, however, the term "dual diagnosis" is also used because it still has the widest recognition nationally.
In May 1993, Federation of State Medical Boards (FSMB) President Hormoz Rassekh, MD, established a special Ad Hoc committee on "physician impairment" in order to develop medical board strategies for identifying, evaluating, regulating, and managing "impaired" licensees. According to a 1995 FSMB policy statement, "After discussion of several forms of physician impairment, the committee elected to focus primarily on chemical dependency, because of its prevalence."
Today, forty-six states now have physician health programs -- the majority of which are still simply chemical dependency treatment programs embellished and promoted ASAM. Forty-two of these programs are currently members of the FSPHP. Over the years, ASAM has continued to promote the AA position that alchoholism (and by inference, any other addiction or chemical dependency) "is an illness which only a spiritual experience will conquer". All addictions are believed by ASAM to be caused by a lifelong brain disorder ("chemical dependency") that can only be treated by complete abstinence from all mood-altering substances (except caffeine and nicotine, which for some strange reason are still permissible). The vast majority of ASAM fellows also still believe that the only effective treatment for addiction must include surrendering one's "will and life over to the care of God" and completely immersing the individual in some variation of AA's spiritually-based 12-step program.
ASAM is not recognized by the American Board of Medical Specialties (ABMS), which certifies all of the more than 130 conventionally recognized specialties and subspecialties in medicine (Internal Medicine, Psychiatry, Surgery, Anesthesiology, Pediatrics, Emergency Medicine, etc.). ASAM certification requires only a medical degree, a valid license to practice medicine, completion of a residency training program in ANY specialty, and one year’s full time involvement plus 50 additional hours of medical education in the field of alcoholism and other drug dependencies. ASAM does not require any specific formal training or experience in the diagnosis and treatment of physical or mental illness.
Because of their limited training and education, ASAM fellows tend to view all physical and mental health problems as “co-occurring” and secondary in importance to addiction problems. They freely apply various psychiatric labels to their "dual diagnosis" patients despite the fact that most ASAM fellows are not formally trained in the diagnosis and treatment of "mental disorders", and despite the fact that most ASAM fellows do not recognize that many psychiatric diagnoses are subjective, imprecise, and subject to change over time. They apply their limited knowledge of the DSM-IV-TR in cookbook fashion in the same way they apply their black-and-white thinking about addiction diagnosis and treatment: if a patient has a "dual diagnosis", then they require formal treatment for "the disease" of addiction.
In most of today's state physician health programs, "Regardless of setting or duration, essentially all treatment provided to these physicians (95%) was 12-step oriented." [DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the Standard for Recovery: Physicians' Health Programs, Journal of Substance Abuse Treatment. 2009;36:159-171.] In these programs, ASAM practitioners routinely impose their spiritually-based 12-step abstinence recovery program on licensees they have labeled with a "substance use disorder", "chemical dependency", or “dual diagnosis” regardless of whether or not there is clear evidence of addiction or even impairment. These programs forbid all access to medications ASAM considers to be potentially addictive -- even when appropriately prescribed by a physician or psychiatrist with more expertise in their given specialty, even when used safely and appropriately, and regardless of any other medical or psychological risks and benefits to the licensee. These programs also forbid any use of alcohol, even when consumed safely and appropriately, and regardless of any other medical or psychological risks and benefits to the licensee.
According to one widely read online publication known as the Orange Papers,
"There are no good studies or surveys that reveal what the suicide rate in A.A. really is, but there is quite a lot of anecdotal evidence that A.A. drives some people to suicide. A program that tells people that they are powerless over alcohol and hopeless and defective and sinful and full of moral shortcomings and cannot ever recover is just depressing enough to push some people over the edge into suicide. And then the crazy, dogmatic, true-believer sponsors telling people with mental problems to stop taking their doctor-prescribed medications has caused a lot of deaths." Orange Papers, on AA Effectiveness
Although the FSPHP was originally founded by ASAM in order to organize ASAM-based individual state physician diversion programs, over the years the FSPHP has gradually expanded its mission statement. According to a 2008 presentation on Physician Health Programs (PHP's) before the FSMB (Federation of State Medical Boards) at their 2008 annual meeting, given by 2009-2011 ASAM president Dr. Louis E. Baxter, Sr., MD (an addiction psychiatrist), PHP missions now include, "To provide a means to identify, evaluate, and treat physicians who have DISEASES OF IMPAIRMENT." (Physician Health Programs: How They Work, FSPHP Conference 2008) He goes on to define "diseases of impairment" as including alcohol and drug use disorders, psychiatric disorders, disruptive disorders, psychosexual disorders, metabolic disorders, and physical disorders (including diabetes, hypertension, and asthma). This expanded mission statement has not changed the fact that the majority of state PHP's are run by medical directors who are qualified only in "addiction medicine" (as defined by Bill Wilson in 1935 and as treated by the evangelistic 12 steps of Alcoholics Anonymous that Wilson and a friend invented in the 1930's) and have supervisory committees who are run by addiction specialists and people "in recovery" who need not be physicians at all.
ASAM is currently attempting to receive medical specialty recognition (and billions of health insurance dollars) for promoting AA's spiritually based 12-step recovery model to the American Board of Medical Specialties (ABMS), which certifies all of the traditionally recognized medical specialties and subspecialties (Internal Medicine, General Surgery, Psychiatry, Emergency Medicine, Anesthesiology, Pediatrics, Radiology, etc.). As part of its comprehensive long-term plan to obtain specialty recognition by the ABMS, in 2006 ASAM established the American Board of Addiction Medicine (ABAM). According to the official ASAM/ABAM website (http://www.asam.org/abam.html),
"Grandfathering is the pathway to acquire ABMS certification in a new specialty or subspecialty, without having to complete all of the training requirements that will eventually be established, such as completion of an ACGME-accredited residency program...For ASAM and ABAM certified physicians who are not already Diplomates of an ABMS member board, ABAM will facilitate and advocate for the establishment of non-onerous pathways for eligibility for an ABMS-recognized Addiction Medicine examination."
The recently released first draft of the DSM5 (DSM-V) -- the fifth edition of the American Psychiatric Association's (APA) authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM) -- is due for publication in May 2013. The DSM-V draft suggests "Eliminating the separate categories of Substance Abuse and Substance Dependence and replacing them with a single unified category of Substance Use Disorder" and "Labeling the overall section 'The Addiction and Related Disorders'...The combined result would be that someone now diagnosed with DSM-IV Substance Abuse would in DSM5 instead be diagnosed with Substance Use Disorder--and (given the title of the overall section) would be considered to have an addictive disorder". [http://www.psychiatrictimes.com/web/10168/login] This seemingly benign change has been cleverly designed and heavily promoted by ASAM/ABAM, whose members have tremendous financial incentives for further legitimizing their specialty and expanding their scope of practice (recall that they believe that addiction is a lifelong brain disorder requiring lifelong treatment -- often mandated by courts and professional licensing boards). ASAM's mission statement is "to establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers and consumers of health care services, and the general public.". ASAM's strategic plan boldly declares that "ASAM will define the basic and clinical science of Addiction Medicine as well as the scope of its practice".
ASAM/ABAM and the 12-step addiction treatment industry were instrumental in lobbying for passage of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which requires health insurance companies to cover addiction treatment on an equal basis as physical illnesses. The idea of a federal mental health parity law had been promoted to Congress for many years, but had not been seriously considered for approval prior to the last-minute inclusion of the multi-billion-dollar addiction treatment industry. With no meaningful opportunity for debate or dissent, ultimate approval of the Wellstone-Dominici Parity Act was quietly tied to President George W. Bush's hastily passed $700 billion financial bailout in October of 2008. The parity law took effect on January 1, 2010. ASAM/ABAM are getting closer to ABMS recognition each day.
Coerced religion in any form is a dangerous form of social control. The enemy here isn't religion (or AA, or Christianity), but dogma, the separation of humanity of virtuous Self from worthless, sinful Other. In organized medicine in general, and addiction medicine in particlar, mindful recognition of human limitations is a far more appropriate approach to treatment. Freedom of religion (including freedom FROM religion) is a fundamental human right, guaranteed in this country by the establishment clause of the first amendment of the U.S. Constitution. Unless we can do something to stop them, ASAM/ABAM are going to take that right away from us.
State physician health programs across the nation are currently under attack on numerous fronts: in the media, in state legislatures, in Congress, and in the courts:
- In California, the state medical board has already dropped its PHP entirely.
- In Oregon, the state legislature recently passed HB 2345 to drop its PHP at the end of fiscal year 2009-10, in a large part due to ongoing liability concerns.
- In Minnesota,
- In Nevada,
- In Texas,
- In Wisconsin, the state medical society has already dropped its PHP entirely.
This page is still under construction, last updated 5/24/2010