Editorial Comment 3/3/2020: Recovering Healthcare Professionals with Addiction

Editorial Comment 3/3/2020: Recovering Healthcare Professionals with Addiction

On 06 February, ASAM posted “Public Policy Statement on Physicians and Other Healthcare Professionals with Addiction”, acknowledged in the ASAM Advocate and by the Federation of State Physician Health Programs, and linked here: https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2020/02/07/physicians-and-other-healthcare-professionals-with-addiction .  While it addresses the practice and recovery environments for healthcare professionals as of 2020, the policy invites a review of the role of recovering physicians in developing the very specialties that many of them come to practice, Addiction Medicine and Addiction Psychiatry.  I was recently reminded of a review written by Christopher R. Freed in 2007, made public access in 2018, Addiction medicine and addiction psychiatry in America: The impact of physicians in recovery on the medical treatment of addiction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042874/pdf/nihms-976425.pdf .

Central to the paper were 24 semi-structured interviews of addiction physicians, qualified in either or both Addiction Medicine (AdM) and Addiction Psychiatry (AdP).  The author identified controversies faced by those physicians, with no attempt to conceal the friction between participants in both AdM and AdP as  well as between recovering and non-recovering physicians.  A Venn diagram that would result from plotting the occupational and philosophical elements and their overlapping fields almost defeats written description. It serves at least to suggest how those controversies so easily arise, with possession of the field of addiction being claimed by so many sets:  AdM physicians, AdP physicians, physicians recovering from addiction, physicians not recovering from addiction (needful/not needful).  The diagram becomes a chrysanthemum of elements, if to it are added certification statuses (ASAM, ABAMF, ABPM-AM, AdP, AOA-AM, MRO, DEA-waivered, and none); and this is of course without consideration of the many other non-physician healthcare professionals. The Venn diagrams quickly burgeon into fractals. 

Freed’s article reads well at a distance of 13 years, even while many of the controversies detailed persist and ramify.  An indication of this is not only the proliferation of organizations seeking to advance discrete objectives, with acronyms such as AAAP, ASAM, AMERSA, AOAA, CCPD, ISAM, IDAA, and more; but also the increasing openness of these organizations to a variety of healthcare professions.  The link above leads to a full-text PDF.  For those whose interest is stimulated, William L. White’s writings, cited here previously, go fathoms deeper in examining the relational dynamics:  http://www.williamwhitepapers.com/  Finally, ASAM has initiated a writing committee for a text on ASAM’s role in the history of addiction treatment; publication is anticipated 2021-2022.

- Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM