The American Society of Addiction Medicine (ASAM) has created a new Associate Membership category for non-physicians. This is an important development. Forming a unified, broad base of addiction treatment professionals is critical if an effective change is going to occur.
For centuries, some physicians have been willing to treat people with addictive disorders. Benjamin Rush, considered to be the father of American psychiatry, as well as being a signer of the Declaration of Independence, considered alcoholism to be a disease that was within the purview of medical practice. Most doctors, however, have avoided this group of patients. In my own medical training, I heard much criticism of these patients from my teachers and had little success in treating them using traditional treatment methods. I had no intention of working with them until I had the good fortune to see alcoholics recover in the Navy’s residential treatment program, which used a different approach that I later used as the basis for developing the Kolmac outpatient program.
In reaction to the disinclination of the profession to treat them and the lack of success of those who did, addicted people began to band together to find their own effective interventions. The most well known were Bill Wilson and a physician, Dr. Bob Smith, who founded Alcoholics Anonymous in 1935. They did benefit from important assistance from physicians, such as Drs. Charles Towns, William Silkworth, and Harry Thiebout. As the efforts of AA members expanded into formal treatment programs, such as Hazelden, non-medical alcoholism counselors often assumed leadership positions in these programs. Similar developments occurred in regard to non-alcohol drug addiction.
As physicians began to return to the field of addictions in larger numbers, professional medical societies began to be formed, the largest and oldest being ASAM. I joined in 1973 when the organization was six years old and have learned an enormous amount about addictions through my affiliation. Gaining respect within the general medical community has not been easy for us, and some have argued that the best strategy to achieve this would be to restrict membership to physicians. One of the negative consequences of this approach, however, has been to create a divide between physicians and the non-physicians in the field who have been so critical to its development and current operation.
Only after considerable internal debate was the decision made last year, as ASAM was nearing its 40th year of existence, to allow non-physicians “into the tent.” Throughout the country, I have encountered considerable misunderstanding of and resistance to treatment, as opposed to primarily criminal justice, approach to addictions. Efforts to form the type of grassroots support groups that have led to progress in the understanding and treatment of other chronic illnesses have been not been as successful when it comes to addictions. This needs to change.
As the new president of MDSAM, the Maryland State Chapter of ASAM, my top priority for this year is to promote the new Associate Membership category. I urge you to consider joining. Those that do join will find their investment of time and money to be well rewarded with the opportunities for educational and advocacy activities that they will find available.
