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“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”
Universal Declaration of Human Rights
The DSM-IV - The Manual for Diagnosing Mental Disability
The DSM-IV is a categorical classification that divides mental disorders into types based on criteria sets with defining features. This naming of categories is the traditional method of organizing and transmitting information in everyday life and has been the fundamental approach used in all systems of medical diagnosis. A categorical approach to classification works best when all members of a diagnostic class are homogeneous, when there are clear boundaries between classes, and when the different classes are mutually exclusive. Nonetheless, the limitations of the categorical classification system must be recognized.
In DSM-IV, there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways. The clinician using DSM-IV should therefore consider that individuals sharing a diagnosis are likely to be heterogeneous even in regard to the defining features of the diagnosis and that boundary cases will be difficult to diagnose in any but a probabilistic fashion. This outlook allows greater flexibility in the use of the system, encourages more specific attention to boundary cases, and emphasizes the need to capture additional clinical information that goes beyond diagnosis. In recognition of the heterogeneity of clinical presentations, DSM-IV often includes polythetic criteria sets, in which the individual need only present with a subset of items from a longer list (e.g., the diagnosis of Borderline Personality Disorder requires only five out of nine items.)
Lack of adherence to accepted standards regarding DSM-IV-TR diagnostic criteria
Many state Physicians Health Program “agents” do not have any qualifications other than those to do substance abuse treatment “peer mentoring” through A.A. or 12-step programs. PHP or ASAM medical professionals may have limited licensure, may be monitored themselves by state medical boards, and may not have access to a DEA controlled drug box because of previous drug infractions. Their scope of practice may have been curtailed by the state medical board to only include working with persons with addiction problems or doing workplace or workmen’s compensation evaluations, so as to limit their contact with patients.
Because of their limited training and education and the limits set by the state medical boards that monitor their own scope of practice, ASAM fellows tend to view all physical and mental health problems as “co-occurring” and secondary in importance to addiction problems. With disregard to professional standards of practice, “dual diagnosis” of psychiatric labels are freely applied to patients in spite of the fact that most ASAM fellows are not formally trained in the diagnosis and treatment of “mental disorders.” [i] ASAM does not acknowledge that many psychiatric diagnoses are subjective, imprecise, and subject to change over time.[ii] They apply their limited knowledge of the DSM-IV-TR without supervision or accountability to professional standards. All patients are assumed to have a diagnosis of the disease of addiction – even when no evidence of addiction is present. According to the A.A. or 12-step model, the patient is in that case just in denial. The client is always guilty of addiction and in need of expensive monitoring and treatment or he/she will lose their medical license. This was true in the case of Dr. Leon Masters MD when he was threatened professionally and then falsely diagnosed as having an addiction problem, falsely imprisoned at Talbott Marsh Recovery Center in Atlanta GA and had his professional reputation as a doctor destroyed by then ASAM president George Douglas Talbott MD.
George Douglas Talbott MD wrote his own criteria of what constitutes addiction, based on the A.A. and 12-step model.[iii] When examining this diagnostic protocol, it becomes evident that the symptoms described actually represent symptoms consistent with Post Traumatic Stress Disorder. ASAM Fellows of the FSPHP base their diagnostic criteria for addiction on symptoms that the valid application of the criteria in the DSM-IV-TR might instead attribute to Post Traumatic Stress Disorder (Acute and Complex).
The ASAM and the FSPHP never confer a diagnosis that does not include addiction as a co-occurring and predominant diagnosis. Charting two co-occurring diagnosis increases revenue with little increase time spent.
PTSD can be related to a child’s experience in a Straight-like copycat program. Maia Szalavitz reported that psychiatrist Dr. Jay Kurdis recently provided expert testimony in the 2003 civil trial against Miller Newton (former Straight, Inc. National Director), which revealed that:
“Post-traumatic stress disorder (PTSD) can occur when someone is confronted by an overwhelmingly scary, actual real threat to life and limb, or to something as important as that, and in the face of that threat, [finds himself] helpless to do anything about it. The diagnosis was first introduced in relation to Vietnam veterans, some of whom had had terrifying combat or prisoner-of-war experiences that left them anxious, depressed, paranoid, over reactive to loud noises, and susceptible to vivid nightmares and flashbacks of the traumatic situation. Research shows that the longer that people feel helpless in frightening situations, and the less control they feel they have, the more likely they are to develop PTSD.” [iv]
One of the hallmarks of all the Straights and Straight, Inc. descendant programs, such as Kids Helping Kids, KIDS of New Jersey (KIDS), etc. was that the whole program was deliberately designed to make participants feel powerless.
PTSD is a diagnosis that has been historically best treated with psychotherapy. Acute PTSD can be treated with Cognitive Behavioral Therapy (CBT) and the patient can recover to full function without further need for monitoring or further psychiatric treatment. PTSD also has been proven to respond best to psychotherapy not medication, although some medications have shown to have limited application. It is important to recognize the difference between PTSD, which is a psychiatric injury, and other clinical conditions of mental illness. This is a legal as well as a medical concept with enormous implications. For example, a sole diagnosis of PTSD would permit a sexual assault victim or domestic violence victim to testify in a court of law as a credible witness.
[i] Pathway family Center listed in on the Dual-Diagnosis Drug-Rehab, National Family Center, Pathway Family Center is located at 6405 Castleplace Court, Indianapolis, IN 46250. Pathway Family Center claims to do primary services dual diagnosis, Substance abuse treatment and drug rehab. Type of care: Dual Diagnosis Rehab , Residential short-term sober living drug treatment (30 days or less), Residential long-term drug rehab treatment sober living (more than 30 days), Outpatient drug rehab, Partial hospitalization drug program/substance abuse day treatment. Services provided at Pathway Family Center are dual diagnosis drug rehab with a primary focus on substance abuse treatment and drug rehab.
[ii] Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision, American Psychiatric Association, pages xxxi, xxxii. Limitations of the Categorical Approach:
[iii] ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders (2nd ed., Revised). Chevy Chase, MD: American Society of Addiction Medicine.
[iv] Maia Szalavitz, Help at Any Cost: How The Troubled-Teen Industry Cons Parents and Hurts Kids (New York: The Penguin Group, 2006), p. 221.
Altering the diagnostic criteria of the DSM-V
The American Psychiatric Association publishes an authoritative manual regarding diagnosis of mental disorders. This manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM) is periodically updated to reflect the most recent findings in the field. A newly revised first draft of the DSM-V or the fifth edition of the American Psychiatric Association's [i] (APA) DSM is due for publication in May 2013. In this new DSM-V draft it is suggested that “Eliminating the separate categories of Substance Abuse and Substance Dependence and replacing them with a single unified category of Substance Use Disorder” and instead labeling the overall section ‘The Addiction and Related Disorders’. This was a change in wording which the ASAM/ABAM heavily lobbied for as it would change the diagnosis of Substance Abuse (in the DSM-IV) to instead Substance Use Disorder under the section heading of addictive disorder.[ii] This simple change would have the result of further legitimizing ASAM and their new ABAM specialty and expanding their scope of practice.[iii] ASAM fellows support A.A. and 12-step program principles and maintain that addiction is a lifelong brain disorder requiring lifelong treatment. This treatment bolstered with a DSM diagnosis is often mandated by court orders and censure by professional licensing boards. The financial benefits to the newly established ABAM would be enormous.
[ii] The Federation of State Physician Advocacy Groups claims to be an informal group of concerned and dedicated medical and legal professionals who wish to remain anonymous, in order to reduce our exposure to retaliation or slander because of the controversial nature of our free speech. The Federation of State Physician Advocacy Groups (FSPAG) was founded in late 2007 as an independent physician-run alternative to the Federation of State Physician Health Programs (FSPHP). The FSPHP is an independent nonprofit corporation which controls the vast majority of standard "Physician Health Programs" (PHP's) operated by medical licensing boards in all 50 states. Also known as "diversion programs,” PHP's were originally designed to provide a therapeutic avenue for physicians with "chemical dependency" (alcoholism and drug addictions) to access confidential treatment with protection from professional investigation and/or disciplinary action. Many PHP's have gradually expanded their missions to include monitoring and treatment management for physicians with mental illness, and some are now expanding even further to encompass monitoring and treatment management for all physicians with possible “diseases of impairment” (defined as alcohol and drug use disorders, psychiatric disorders, disruptive disorders, psychosexual disorders, metabolic disorders, and physical disorders -- including diabetes, hypertension, and asthma). These increasingly broad missions have not changed the fact that the majority of state PHP's are still run by medical directors who are qualified only in "addiction medicine" and have supervisory committees largely staffed by addiction specialists and members of the general public who are “in recovery” from various addictions and who need not be physicians at all.
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― Leo Buscaglia
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"Never impose on others what you would not choose for yourself." Confucius
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."
Roosevelt- Excerpt from the speech "Citizenship In A Republic",
delivered at the Sorbonne, in Paris, France on 23 April, 1910