Robert DuPont, The ASAM, FSPHP, Physician Health Programs and the “New Paradigm.”

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”-Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).

In 2012 Former White House Drug Czar (1973-1977) Robert Dupont, M.D. delivered the keynote speech at the Drug and Alcohol Testing Association (DATIA) annual conference and described a “new paradigm” for addiction and substance abuse treatment. The former National Institute on Drug Abuse Director proposed expansion of this paradigm to other populations including workplace, healthcare, and schools.

As a substance abuse treatment program that “sets the standard for effective use of drug testing,” the proposed new paradigm is based on the state Physician Health Program (PHP) model

Dupont wants to expand the PHP model to other populations. In an article published in the Journal of Psychoactive Drugs in 2012, he and co-author Greg Skipper, M.D, (Director of Professionals Health Care at Promises Treatment Center) describe the necessity for wider application of this new paradigm. They review the successes of similar programs monitoring commercial pilots, attorneys, probationers, and those in the criminal justice system, and proclaim the “need to reach more of the 1.5 million Americans who annually enter substance abuse treatment, which now is all too often a revolving door.”¹ They conclude:

This model of care management for substance use disorders has been pioneered by a small and innovative group of the nation’s physicians in their determination to help other physicians save their careers and families while also protecting their patients from the harmful consequences of continued substance abuse. In fulfilling the professional admonition “physician: first heal thyself,” these physicians have created a model with wide applicability and great promise.¹

“Based on abundant evidence, a “new paradigm” for substance abuse treatment has evolved that is the exact opposite of harm reduction. This paradigm enforces a standard of zero tolerance for alcohol and drug use that is enforced by monitoring with frequent random drug and alcohol tests. Detection of any drug or alcohol use is met with swift, certain, but not draconian, consequences.”

Straight, Inc. –Torture as treatment

In 1981 Dupont made similar claims about Straight, Inc., a non-profit teenage rehabilitation center.   The predecessor of Straight, Inc., the Seed, was started in 1970 in Florida with a start up grant of $1 million dollars from the federal governments National Institute on Drug Abuse (NIDA). Director of NIDA, Robert L. DuPont, Jr. had approved the grant.on the antidrug cult Synanon founded in 1958. Deemed a the “family oriented treatment program,” Dupont encouraged organization and expansion. Targeting the children of wealthy white families they exploited parents fears for profit. Signs for hidden drug use such as use of Visine, altered sleep patterns, and changes in clothing style were used as indications for referral. Any child who arrived would be considered an addict in need of their services. Coercion, confrontation, command and control as the guiding principles,. Submit or face the consequences. .We know what’s right. The idea was to strip the child of all self-esteem and then build him back up again in the straight image. Abused dehumanized, delegitimized, and stigmatized-the imposition of guilt, shame, and helplessness for ego deflation and murder of the psyche to facilitate canned and condensed 12-step as a preparatory step on the path of lifelong spiritual recovery.

Children were coaxed or terrorized into signing confessions, berated, and told they were in “denial. Inaccurate and false diagnoses were given to wield greater control. Reports and witness accounts now indicate that many of the kids did not even have drug problems but by creating a “moral panic” about teenage drug use they exploited parents fears for profit. Straight, Inc. became the biggest juvenile rehabilitation center in the world. Health officials in Boston cited Straight for treating a 12 -year old girl for drug addiction when her records revealed all she did was sniff a magic marker! Pathologizing normality.

Methodologically flawed research , deceptive marketing, and propaganda were all used to support the continuation of the program. Designed to be hidden from public view. Straight, Inc. had no regulation or oversight. These programs of torture and abuse resulted in many suicides, suicide attempts, post-traumatic stress disorder and other psychological   and grave psychological trauma. There is a FB page dedicated in memory to all of those who died.

The retrospective five year cohort study they published in 2008 is their flagship study about which they parade an 80% success rate.  It is  methodologically flawed in many ways with missing and incomplete information and misleading interpretation.  It’s all propaganda.

The 2008 Physicians Health Program study inexplicably excluded resident physicians because they “were both younger than the average practicing physician and therefore at higher risk of substance abuse.”  Other than cherry picking to favor success what is the logic behind that.

More importantly, however, is the 24 that “left care with no apparent referral” and the 48 that “involuntarily stopped or had their licenses revoked.”

It would seem logical that there must have been some major precipitating event leading to the 24 physicians who left care.   And what happened to the physicians who were removed from the programs and had their licenses revoked ?–event that could very well lead to feeling hopeless with no way out and precipitate a completed suicide.

They list only 6 suicides and it appears that the outcome suicide they are using is one that was done while being actively monitored in the program.  If they were removed from PHS or had their licenses revoked and subsequently committed suicide we don’t know.  The outcome seems to be the last recorded clerical status of the monitored physician.

Since this group is now lobbying to use this “blueprint” as a successful model applicable to other populations and may be involved in the assessment and monitoring of a much larger population should the random drug and alcohol testing of all physicians  come to be it is essential that who they are be exposed as well as the validity of the claims they make.   There are no evidence-based reviews of any of the ASAM studies including the junk science of the EtG and PEth tests that will surely be used in any physician monitoring program that were introduced and marketed by Greg Skipper yet he lists no conflicts of interest.     The 12-step evidence is self-evident in the “blueprint.”

Interestingly,  I cannot even find any criticisms of the design of the study and its flaws–only praise and sloganeering.   We need to speak up before the door closes for good..

The vast majority of people know little about Physician Health Programs. They seldom reach the threshold of public attention.

Unless specifically looking for information about them, little treatment community blandishment, there is a dearth of informative in depth analysis