The case for treatment reform and improvements


Published Saturday, October 2, 1999
Notion of addicts hampers diagnoses

                  `Skid-row stereotype' is factor, expert says

                                     By KAREN GARLOCH
                                          Staff Writer

                  Too many health professionals have a stereotype of the kind of people
                  who abuse alcohol and drugs and are pessimistic about whether
                  addictions can be treated, a national addiction expert said Friday in

                  ``Many physicians will not make the diagnosis unless the person fits into
                  a skid-row stereotype,'' said Dr. John Chappel, a psychiatrist and
                  medical director of the addiction treatment program at the University of

                  Chappel spoke to substance abuse professionals at Behavioral Health
                  Center-Amethyst to kick off Substance Abuse Awareness Month in
                  Mecklenburg County.

                  To illustrate his point, Chappel recounted the life of Vincent van Gogh,
                  the 19th-century Dutch painter who cut off part of his ear in a fit of

                  With slides of van Gogh paintings flashing on a screen, Chappel
                  described the painter's frequent quarrels with his parents and teachers.
                  He drank too much and suffered from depression. And in his 30s, while
                  living near Paris, his bizarre behavior prompted neighbors to petition to
                  have him committed to a mental hospital. In 1890, he shot himself and

                  Chappel suggested that people reacted differently to van Gogh, just as
                  they do to people with addictions, depending upon how well they knew

                  ``As we get to know another person, we have much different feelings
                  about them,'' he said. ``Not everyone who comes into the emergency
                  room is Vincent van Gogh, but every individual who comes in there has
                  a history.''

                  Chappel also described his surprise at findings during the past decade
                  that ``drug-focused'' prevention programs don't work as well as
                  ``skill-based'' programs.

                  Drug-focused programs use authority figures, such as police officers, to
                  teach kids about drugs and how they work, topped with a strong
                  message not to use them.

                  Skill-based programs teach kids how to refuse drugs without being
                  rejected by their peers.

                  Researchers found that, with drug-focused programs, ``the percentage
                  of kids that will experiment will go up,'' Chappel said. ``We were

                  For information about Substance Abuse Awareness Month activities, call
                  375-DRUG (3784).

          RE: Fred- Maybe we should use this HOLOSYNC TECHNOLOGY !!
          Fri, 24 Dec 1999 08:02:49 -0500
          "Frederick Rotgers" <>
>From the SUBABUSE Email List:

Rich wrote:

 >Maybe  we  should  use  treatments  that  work,
 >before  doing  another  3000  research  projects.
 >Acupuncture  research also  seems  to  improve  the
 >recovery  rate for  alcoholics and drug  addicts.

Rich, I wholeheartedly agree that we should use treatments that work. In the
1989 first edition of "Handbook of Alcoholism Treatment: Effective
Alternatives" Hester and Miller present extensive reviews of treatments
that, at that time, more than 10 years ago, had demonstrably better efficacy
than most of what was currently (and still is) used in the US. We *know*
what treatments work--but it's not what we do!!! And, it has nothing to do
with Congress or the funding agencies--they were the ones that funded the
research to which Hester and Miller refer--it has to do with a hidebound,
quasi-religious ideology that has dominated the addictions field for
decades. That ideology has been adopted by supposedly broad minded advocacy
groups such as NCADD, and pushed to the detriment of the very people they
claim they want to help. Claiming to want science to guide what is done in
treatment, Paul Wood, the President of NCADD, has nonetheless spoken out in
public against one set of procedures (moderation training) that has a
massive body of research supporting its efficacy both in effectively
eliminating problem drinking and as a stepping stone to abstinence for
people who are not yet ready to stop completely! Why would he do that?
Because the hidebound ideologues oppose moderation approaches--despite the
fact that their adopted Messiah, Bill Wilson, harbored no such prejudices!

Thus, it has to do with the fact that people cannot or will not look beyond
their own experiences for ways to help people change addictions. And the
people who do that paradoxically prevent new technologies from being
used--even the ones that have shown strong research evidence for their
efficacy. Thus, in the 2nd Edition of the "Handbook of Alcoholism Treatment
Approaches", published in 1995, Hester and Miller lamented that since the
first edition, virtually nothing had changed--treatment providers still used
in droves the techniques that had little or no research evidence for their
efficacy, and did not use the ones that did!

So, rather than blaming Congress, NIH, or researchers for a failure to
integrate new, effective technologies into treatment, the field of
practitioners should be looking inward at their own prejudices and closely
held false beliefs!

Frederick Rotgers, Psy.D., Assistant Chief Psychologist
Smithers Addiction Treatment and Training Center
Phone: 212-523-6874 Fax: 810-958-7649

Hi Bert

Thanks for the note. Allow me to play the devil's advocate'll need to hear some of the other arguments though
you probably have all ready.

1.) We have a  self-insured medical plan. For many years it
saved us some money while still providing for adequate health
care. As you know in the past few years health care costs
have risen while we in the manufacturing industry are getting
squeezed by globalization.  In addition, we now have 2 people
with very expensive problems(breast cancer and Hep C). We
can't get out of this self-insured plan now because fully
insured programs want us to pay a huge premium because of
these 2 high risk people. So we look at reducing other costs
or else we have to drop the entire plan. One program we look
at is our exposure to mental health/SA . We were at a max
$20,000. Even though we've only had one person to ever use
all of that in 10 years, we say cut that back to $5000
exposure. That reduces our exposure. That may be a cold
approach but that's the though choices we have to make.
   I think that's the way many of us poor cousins in small
business look at this problem. We're not big like Kosa or
Freightliner nor wealthy like some company. We're
trapped like a rat and it's not fun. Consequently, unless  the
unaffordable cost of overall health insurance is included in
your arguments you can exclude us poor cousins out. so I
wish you a heck of  alot of luck.
  2.) However, we have not completely left our employees out
in thc cold. We have contracted with a local group(The Next
Step in Salisbury) for an EAP program. It costs us $1 per
employee per month. To say that's really cheap is an
understatement but they have been working with 3 of our
employees in the past year. How effective are they? Who
knows? How effective is the 28 day standard in-house
treatment program that costs $20k? Probably not much
higher. That's a chink in the SA armor which is accountability.
My first experience with an SA provider was a God awfull
experience. It's what gives this industry a black eye.
3.) Faith based treatment- I know one young fella who spent
60 days at Bethel Colony in Lenoir and he's doing great.
That got me curious and when they were invited to a local
church sponsored event (there was about 50 of them) I went. I
was impressed..very... though I'm not  a structured religious
person. You know that the cost for this was $25! That's it and
I kick myself daily for not getting my son into that program.
That's not to say that they don't have a failure rate. I don't
even know what it is but I'd bet good money that its just as
good as for-profit SA centers.

So that's a couple of good points to ponder upon. Again I wish
you the best of luck on your'll need it!

got to run..cheatin my employer again.

mike J

"Selbert M. Wood, Jr." wrote:

  I'm flying up to Boston to survey a methadone program and
  reread you post
  and wanted to comment on the insurance parity/premium
  I agree with you that the cost for health insurance is
  ridiculously high and
  prescriptions costs are driving it now.  BCBS wanted to raise
  our rates 18%
  and settle for 13% this year for a total of $191 per
  employee.  I'd tell you
  how much I pay for family, but I'd get depressed.
  YET - the actuarial numbers for MH and SA parity
  demonstrate what good
  business it is.  Mental health parity would only raise the
  cost/premium 1.3%
  and substance abuse ONLY .5% (some estimates as low as
  .3%).  Even the state
  auditor's report coming out sometime very soon will note the
  poor substance
  abuse services in our state and the repercussion on all
  other systems
  (emergency rooms, courts, businesses) for untreated
  Well - hope/think I'm preaching to choir . . . getting ready to
  land in
  windy/snowy 'beantown.'
  Take care -

  Selbert M. "Bert" Wood, Jr.
  336.725.8389 x257

            Re: Deprogramming from Alcoholics Anonymous
            Fri, 24 Dec 1999 10:42:47 -0500

Where can one read something about your program in Maine??I understand
what you are saying about other ways
to treatment and it makes a lot of sense.  What we are currently doing is
not working.  Will medical
assistance fund such a philosophy if treatment providers embrace it. It
is much like harm reduction. I know I
found the moderation management site and used it for DUI classess I
teach. This population is in such denial
and not all are addicted they just have to make better decisions.
Moderation Management has a chart that I
use in which one looks at their drinking during the week and figures out
their BAC level.  I had the class
fill this out each week and it certainly made them more aware of their
drinking behaviors.  I never once
mentioned abstinence just self assessment.  It seemed to work very well.
I also talked about AA stating that
just like nicotine addiction there are many ways for an individual to
stop, the patch, tobacco cessation
etc.   Each person has their own path to whatever works for those who
feel that need to stop and have a


Frederick Rotgers wrote:

> >From the SUBABUSE Email List:
> Mike,
>         A colleague from Canada and I have just finished the first
phase of
> designing a comprehensive, research evidence-based, assessment driven
> treatment system for the State of Maine Department of Corrections.
Maine has
> already implemented a therapeutic community and will begin implementing
> remainder of the five tiered treatment system we have developed in
> Fred
> Frederick Rotgers, Psy.D., Assistant Chief Psychologis