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Addiction MDs seek to become a force

May 15, 2011
by Gary A. Enos, Editor
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What physicians are saying as they assume a more prominent role in the addiction treatment community

Mark Kraus, MD, once sported a ponytail and sandals and never dreamed he one day would regularly visit Capitol Hill in a suit. Louis E. Baxter, Sr., MD, admits he once dismissed advocacy work among physicians as a waste of time.

On an early Saturday morning in April when many doctors likely were planning tee times, these leaders of the American Society of Addiction Medicine (ASAM) were urging colleagues to get involved politically and to help shape the changes surely coming to addiction treatment.

Many other professional groups in the addiction field see physicians as becoming central to treatment practice under parity and health reform. But it is also clear that many questions remain about how the changes actually will play out, and ASAM's April 14-17 Medical-Scientific Conference illustrated that addiction medicine specialists have as many questions as everyone else.

“Parity has been passed but it has no teeth,” remarked Kraus, co-chair of ASAM's Public Policy Committee and assistant clinical professor of medicine at the Yale University School of Medicine. “It will be worthless unless we put some teeth back in.”

Kraus was joined by outgoing ASAM president Baxter (executive medical director of the Professional Assistance Program of New Jersey) and other panelists at an April 16 conference plenary session on policy issues. The session also featured remarks from David K. Mineta, MSW, deputy director of demand reduction at the federal Office of National Drug Control Policy (ONDCP), but the overriding theme of the session was that doctors in their home communities need to drive the changes that will define a new era in treatment.

“We've been able to make a significant impact,” said Baxter. But he added that even if the addiction physician workforce were to grow by 200 members a year for each of the next 10 years, there still wouldn't be enough supply to meet service needs as parity and the Affordable Care Act converge to identify more potential patients.

ASAM's advocacy presence has grown markedly in recent years, with an in-house public policy function and the consulting assistance of the District-based lobbying firm Capitol Decisions. During give-and-take between the plenary panel speakers and physicians in the audience at the ASAM session, it became obvious that advocacy still represents new territory for many addiction specialists.

Panelists urged physicians to get to know their members of Congress, and to write newspaper letters to the editor to highlight addiction issues. New ASAM president Don Kurth, MD, mentioned that the society probably will need to establish a political action committee before long.

And David C. Lewis, MD, professor emeritus of community health at Brown University and founder of Brown's Center for Alcohol and Addiction Studies, had some important words for a group that was focusing much of its discussion on federal policy. “Where the action's going to be is at the state level, with insurance commissioners and state legislators,” Lewis warned. Physicians need to enter the conversation about health insurance exchanges in the states, he said, because it is in the regulations governing those structures where addiction treatment benefits will take shape.

CORRECTION: Erik Roskes, MD, who was quoted in the January/February 2011 issue article on traumatic brain injury, is presently Director of Forensic Services for Springfield Hospital Center. He is a former, not current, chief psychiatrist at the Maryland Department of Public Safety and Correctional Services.

Gary A. Enos, Editor Addiction Professional 2011 May-June;9(3):12