Miscellaneous links

[saramcgrail]

Bureaucracy is defined as "the structure and set of regulations in place to control activity, usually in large organizations and government."

AAAP is similar to IEEE or AAAS. Independent professional organizations. There is no "party line." There is certainly no one at the top handing out orders. Flow of scientific research into professional activity is the raison d'etre. We've seen broad changes to content as new technology has emerged. UK has a similar operation: SMMGP.

http://www.smmgp.org.uk/

http://www.smmgp.org.uk/html/catalogue.php

Great for hashing out practical medical issues. You don't need to be a medical doctor to understand the online conversations. Also, don't expect simple answers where problems get complicated. Its all about finding good answers.

No pharmas, no Humana, no government budget.

Having a small publishing staff on board does not make an organization a "health bureaucracy." That's more to NHS, hospitals, and your DAT's. This "M-Addiction" site is broader -- set up for public access instead of focusing to science. The three sites are complementary.

No Pharms, no Humana, no government budget  - just a lot of people with an interest in promoting the psychiatric medical model who have organised to train other people to think the way they do. Its cool and I'm not saying there is a problem in doing that, but to claim it is  - as you did - not controlled by a health bureaucracy - is daft. If it is anything like health professionals organisations in the UK it is in fact both a bureaucracy of its own and an integral part of a larger health bureaucracy.

[mcdermott]

Did AAAP really not come out in support of needle exchange until 2002? I note they aren't quite so backwards in coming forwards when it comes to an issue like parity -- the idea that there should be mandatory cover for addiction treatment that has parity with other psychiatric conditions.

One of the reasons that they lost this parity in the first place was the great treatment scam of the 80's, in which any child who had any condition that would be covered by insurance would be hospitalized for as long as your insurance lasted, and then discharged.

Smoked a bit of pot once, kid? You're in a psychiatric hospital until your insurance runs out, then you're on your own.

If they're anything like the American Society of Addiction Medicine, then the critical issue of how fast they can line their own pockets seems to be their number one advocacy item:

http://www.asam.org/Advocacy.html

[TuffsNotEnuff]

Both saramcgrail and mcdermott would have professionals and their professional organizations take sharp political positions. Indeed, failing to agree quickly is seen as a grave failing.

This is not the role of science. Science informs, it does not decide. Getting open discussion is the critical process for all of these organizations.

If you don't believe that scientific discussion is important -- informing the policy makers -- please have a look at Russia. That ignorant government offers nothing in the way of Methadone or bupe or even DHC. They will force a drop-dead detox on a woman 8 months pregnant. Meanwhile, heroin is at flood. The country has an estimated 4,000,000 - 7,000,000 HIV+. No science, not much humanity -- and soon/inevitably a medical disaster of biblical proportions.

The specific complaints -- "treatment scam," "promoting the psychiatric medical model " -- seem odd to me. I'm not a psychiatrist. However, it should be clear that psychiatrists and the addiction specialists, particularly, are not choosing the field because it is lucrative. Plainly, it is not.

The psychiatrists do bring a broad range of tools to these problems. M.D.'s have been through medical school. When I talk to a psychiatrist, I know that that person will have a detail-level training for anatomy and physiology -- including some part of cellular neurology. This expanded scientific knowledge is a strong base for practical observation.

The orgs encourage addiction care workers to acquire the related scientific knowledge and to read on what clinicians are seeing in the field. (IEEE is mentioned for computer database technology.) The Lancet is frequently wonderful. Addicts, as well, can read and will understand the better of the popularization articles at these publications. The further we all get from the Russian model, the better.

BTW: Methadone was 1937. Bupe, 1966. Blood level monitoring is older than that. Getting together a thorough system to support pregnancy -- try 2005 and the SMMGP for the impetus to finally get it all together. These are difficult problems, kiddos.

Going to the Moon was easy.

[saramcgrail]

Both saramcgrail and mcdermott would have professionals and their professional organizations take sharp political positions. Indeed, failing to agree quickly is seen as a grave failing.

I'm always amused when people I don't know and who don't know me try to impose on me, for the sake of argument, a set of beliefs or statements that serve to enable them to continue the argument in the direction they choose.

This was, as you know not what I was saying.

But never mind, you have your jolly old tilt and lets see where the windmill lands you.

Sara

[mcdermott]

Both saramcgrail and mcdermott would have professionals and their professional organizations take sharp political positions. Indeed, failing to agree quickly is seen as a grave failing.

On the contrary: I'm accusing these organisations of totally ignoring the science while vigorously pursing their self-serving economic interests. The evidence on the efficacy of needle exchange programmes in countering the spread of HIV and AIDS has been indisputable since at least the early 90's. That *any* organisation that purports to have the interests of people who are at high risk of contracting these conditions should ignore that evidence for over ten years tells me a lot about their particular weighting that they give to science, and that which they give to politics.

If they were quite so quick to advocate for genuinely unpopular positions that are supported by the science, as they are to advocate for lining their own pockets through the parity legislation, then I might have a little more respect for them. Until then though, I'll take my science direct from the scientists, and not from a lobby group for one particular factional interest, thanks.

You might want to check out a first-hand description of how some of the leading lights among these so-called 'professionals' actually run their operations. From Stanton Peele's website,

In the Belly of the American Society of Addiction Medicine Beast.

[Jim]

Sara and Peter I think you are being a tad harsh on this poster.  Although I obviously feel flattered that they are trying to emulate SMMGP (even though I no longer work for them).  If they are similar to SMMGP they would not consciously be advocating a medical model even when the main membership is doctors and smmgp has virtually no beurocracy.  However I do take the point that by its very nature it is going to be medically influenced. 

Anyway SMMGPs influence (if anything) is the general medical model and specifically not the psychiatric medical model.  Given that tuffsnotenuffs organisation mainly represents addiction psychiatry perhaps the UK organisation they would be closest to is SCAN (Specialist consultants in Addiction Network) rather than SMMGP (Substance Misuse Management in General Practice).

[TuffsNotEnuff]

...If they are similar to SMMGP they would not consciously be advocating a medical model even when the main membership is doctors and smmgp has virtually no bureaucracy.  However I do take the point that by its very nature it is going to be medically influenced....

The professional groups publish summary articles. Popularizations. They also do newsy pieces, useful. Same for the modern blogging. The "hard core" scientific journals -- not made accessible for lay people -- use the complex vocabularies of the medical specialties and the neurosciences generally.

Similarly, political work is done outside the professional organizations. The example of needle-exchange In fact, AAAS took a lead, here, getting our national government to change policy. AAAS got the science out to the significant political stakeholders. www.aaas.org AAAS is an affinity group, not a specialized professional organization.

saramcgrail and mcdermott do not seem to like doctors. It happens. Using SMMGP, AAAP, AAAS, IEEE, The Lancet -- whatever -- for information That' what they're there for. And they do get peer review on the published work.

[saramcgrail]

Sara and Peter I think you are being a tad harsh on this poster.  Although I obviously feel flattered that they are trying to emulate SMMGP (even though I no longer work for them).  If they are similar to SMMGP they would not consciously be advocating a medical model even when the main membership is doctors and smmgp has virtually no beurocracy.  However I do take the point that by its very nature it is going to be medically influenced. 

Anyway SMMGPs influence (if anything) is the general medical model and specifically not the psychiatric medical model.  Given that tuffsnotenuffs organisation mainly represents addiction psychiatry perhaps the UK organisation they would be closest to is SCAN (Specialist consultants in Addiction Network) rather than SMMGP (Substance Misuse Management in General Practice).

The poster claimed that the organisation he was promoting was uninfluenced by health bureaucracy. My argument - and it was in passing - was that  the Association of Addiction Psychiatrists, or whatever its called,  is - by virtue of its membership and orientation -  a part and an expression of health bureaucracy. I don't think it occupies the same space as either SCAN or SMMGP. Its origins are very different, its operation is different and its orientation appears different too.

But then- this wasn't a discussion about SMMGP.

SMMGP is something the poster introduced to the title of the thread simply to reinforce his own arguments and twist the discussion to something he felt would garner him more support on the forum.  He's simply indulging in a piece of sophistry to extend his own argument and reinforce his own position. Its tedious and disingenuous.

Sara

[saramcgrail]

saramcgrail and mcdermott do not seem to like doctors. It happens. Using SMMGP, AAAP, AAAS, IEEE, The Lancet -- whatever -- for information That' what they're there for. And they do get peer review on the published work.

I'm just trying to decide whether to have pilchards on toast or beans on toast for my tea. Seeing as you know so much about my preferences, maybe you could advise me.

[TuffsNotEnuff]

On the contrary: I'm accusing these organisations of totally ignoring the science while vigorously pursing their self-serving economic interests....

Personal experience with GPs and psychiatrists who work with addicts is that they deserve no part of this attack. No one does this work in public institutions for "economic interest." The organizations, themselves, have made life better for addicts, so far a possible. AAAS and AAAP have begged money to lobby for political change, where science spoke clearly to the issues. (These are not "my" organizations. Trust their publications ? Well, that has been earned.)

http://www.aaap.org/news/methadonia.pdf

Laurence M. Westreich, MD, offers a 2005 review of the New York film Methadonia. One might expect that many Methadone patients will see this film, sooner or later. This link gives access to a competent and scientifically accurate personal response. Action summary :::

Recommended Action [for physicians/clinicians]:

AAAP and other addiction treatment advocates should respond to the movie as follows:
1. Carefully identify what is good and accurate about the movie: the addicts are respectfully
treated, and the sadness and involuntariness of their daily lives come through.
2. Agree with the director’s own admission that he has not made a balanced, wellresearched
film, nor had he intended to.
3. Clearly state the facts about methadone: HIV Prevention, return to healthy relationships
and work, etc.
4. Point out that the movie depicts the sad outcomes of a tiny minority of methadone
patients, who are in the worst prognostic category.
5. Consider mentioning that the methadone treatment system is broken, and that
methadone itself is unfairly blamed.

[Jim]

It seems like we have a bit of a culture clash going on here.  In talking about 'economic interest' profession over here we are talking about increasing the amount of work that 'cornered' by a  profession as opposed to individuals directly getting more cash.  This must be a product of the 'free at the point of delivery' NHS where money is not handed over for treatment either by individuals or insurance companies.  So whilst in the states it will be seen as virtuous that people who are working in public programmes such as drug treatment centres don't get paid att he point of delivery, that is the norm over here.  Perhaps a better way of talking about it is professional protectionism.  Goes on a lot in the UK all over public services.

[usandthem]

A great website that gives service user voice and like the alliance - offers advocacy for those who do not get heard up the chain. Link below.

http://www.voiceability.org/