AA (Alcoholics Anonymous) Lies

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Thursday, February 12, 2015

Addiction: On 'Trial'

The Disease of Addiction is on Trial

by Steven Kassels, MD | Dec 12, 2014

The recent Ebola “crisis” and some of our politicians’ knee jerk reactions unfortunately only serve to reinforce the notion that when we base decisions on fear, not fact; when we allow emotions and not science to dictate responses; or when we ignore reality for perceived political or financial gain, we do a disservice to our family, our friends, our neighbors, our communities and to the fabric of our society.

These types of reactions have been prevalent in our overall approach to the treatment of the disease of addiction for longer than I wish to remember. As a physician who spent his earlier years practicing emergency medicine, it became clear that during many ER shifts a large minority, if not a majority of the patients I treated in the emergency department presented with illnesses related to the disease of addiction. Sure there were the “drunks” who had fallen off the bar stools or been battered in an altercation, the PCP psychotic hypertensive crisis, the automobile accidents related to drugs or alcohol abuse, the opioid-addicted patient feigning hematuria. But when you add the children with asthma due to secondhand smoking, the unwanted teenage pregnancies from intoxication, cardiac arrhythmias or infarction or cerebral vascular accidents due to nicotine or cocaine, diabetes exacerbated by excessive food consumption, etc., etc., one begins to understand the magnitude of the relationship between medical, psychiatric and surgical illnesses and underlying addiction.

So I decided I would change attitudes - that I could make a difference. My first approach was a cerebral one—through science and logic. I expanded my medical life to include addiction medicine when it was still in its embryonic stages. And I gave lectures and presentations and round table discussions to police departments, to PTAs, to medical students and residents, and to just about anyone who would listen. But, there was a problem – who came to listen? It was like preaching to the choir! So nothing really changed – NIMBYism (“Not In My Back Yard”) continued and I was not making a difference.

We will not significantly change public opinion through traditional means. Put up an announcement at a local library for a talk about addiction and see how many people attend. Ask your patients to invite family members to discuss how and why addiction is a disease and do they come? Go talk to a group of local politicians and do you really change their minds? Sure they may “yes” you to death, but how do they vote; and how many politicians, even if they understand the disease of addiction, are willing to risk their political capital like Vermont’s Governor Shumlin and make a real difference?

So when I entered my more formative years, I decided on a new approach. I would enter the lion’s den – but not through the front door. We can change public opinion and help our patients by educating through the back door; by engaging on Twitter and on Facebook and on Instagram, and by illustrating the consequences of denial as it relates to the financial and societal costs of not more aggressively funding and treating the disease.
HIMS, Human Intervention Motivation Study, FAA, addiction, recovery, airline pilot, flying

I then went one step further and wrote Addiction on Trial: Tragedy in Downeast Maine (which could be entitled, Addiction on Trial: Tragedy Anywhere USA) as a murder mystery/legal thriller based on medical and legal truths to reach a wider audience and to change hearts and minds by destigmatizing and demystifying the disease of addiction. I believe I am making significant inroads by morphing my book readings into educational lectures about addiction as I travel around the country: educating by entertaining can make a difference. I have also expanded this approach by offering to Skype in to book club meetings to discuss the book’s characters, the community’s pain and whether Jimmy, the relapsed heroin addict from away really did murder Annette Fiorno. I hope others will join me in trying new ways to change opinions about a disease that has become the scourge of our cities and towns.

Steve Kassel, Addiction on Trial, HIMS, Human Intervention Motivation Study, airline pilot, aviation, flying
Dr. Steven Kassels
Steven Kassels has been Board Certified in Emergency Medicine and Addiction Medicine. He is a Co-Founder and Medical Director of Community Substance Abuse Centers, with treatment facilities located throughout New England. He has served as the Chair of the Massachusetts ASAM Public Policy Committee; a member of the ASAM Medical Specialty Advisory Group; and as CARF Expert Medical Consultant for Opioid Treatment Programs. When giving talks, he frequently donates his author proceeds to local treatment centers and he has personally subsidized the publishing costs to keep the price affordable. “Medicine has been very good to me and it is my way of trying to give back.” Steve will Skype into book groups and they can be scheduled through his website. The book is available at Amazon, iBooks and Barnes and Noble online.

Thursday, January 29, 2015

What Tangled Webs We Weave When We Place Profit Before People...

FAA HIMS program Human Intervention Motivation Study (HIMS) himsprogram HIMS aviation HIMS pilot flying aviation medicine
Weyhrauch Law Group, LLP

Re-posted here, excuse any errors:

"This is a bit messy so bear with me: Dr. Donald E. Hudson, HIMS Program Manager, served as the Air Line Pilots Association (ALPA) Aeromedical Advisor from 1994 until 2010 when he was replaced by Dr. Quay Snyder. The Air Line Pilots Association (ALPA), which is basically a union that represents most pilots in the US, is the administrator of the FAA funded HIMS program. Interestingly, Dr. Hudson is also the owner of a private company: Aviation Medicine Advisory Service (AMAS), Englewood, CO. This company is part of Virtual Flight Surgeons Inc.(VFS), Aurora, CO. Dr. Quay Snyder, who replaced Hudson as the ALPA Aeromedical Advisor, is also President, CEO and co-founder of AMAS and also co-founder of VFS. Snyder also serves on the HIMS Advisory Board. (Note: from 1969-1994, Dr. Richard Masters, owner of Aviation Medicine & Prevention Associates - which later became AMAS, was also the ALPA Aeromedical Advisor. What we have here is a treatment and re-certification cartel ).

AMAS, the aerospace medicine division of VFS describes itself as: "...the world's premier resource for aeromedical information and FAA medical certification assistance." So, Hudson, whose HIMS Program Manager position is funded by the FAA, uses taxpayer funding to target and identify pilots with substance abuse problems. Once admitted into the HIMS Program and treated these pilots become customers of AMAS/VFS who provide FAA medical certification assistance. For a pilot with substance abuse problems, keeping FAA medical certification is a years long (sometimes career long) process. So once Dr. Hudson gets a pilot in his sights that pilot becomes essentially a customer for life.

The conflict of interest here should be obvious: the income of Hudson's (and Snyder's) private company depends on a steady stream of pilots with substance abuse problems who require FAA medical certification assistance AND Hudson's and Snyder's positions allow them to create and control a steady stream of pilots with substance abuse problems who require FAA medical certification assistance. In effect, Hudson and Snyder are acting like police officers who get paid to arrest drivers for a DUI and then get paid by the same drivers they arrested to represent them in court, keep them out of jail and get their drivers' license back.

What a scam! This is corruption plain and simple. But it's all done under the guise of helping pilots recover from alcoholism and keeping the skies safe so in the eyes of the FAA I'm sure Hudson and Snyder must seem like an altruistic, angelic heroes. It wouldn't surprise me if Hudson and Snyder also had a financial interest in the alcohol rehabs that are a required part of the HIMS program! HIMS has about 100 pilots go through the program every year and at $20k - $30k or more per 28 day stint that's a nice annual income. I really do feel sorry for any pilot who gets caught up in this scam. Anyone want to help take this issue online to the pilots forums?"

FAA HIMS program Human Intervention Motivation Study (HIMS) himsprogram HIMS aviation HIMS pilot flying aviation medicine
Weyhrauch Law Group, LLP

The FAA's HIMS Program -- Federally Funded Cult Induction?

An interesting perspective, re-posted here, with any errors:

"Thanks to JR Harris who's blog, www.orange-papers.org/forum/node/3254, alerted me to this. The FAA's HIMS(Human Intervention Motivation Study) program is a substance abuse program for flight crews. It is used and supported by all US airlines and is funded by the Federal Aviation Administration, i.e., our taxes. The HIMS program website,www.himsprogram.com, is incredibly disturbing. It is more pro 12-Step than AA's own website. It contains more medical misinformation about alcohol dependence than you will get at your average AA meeting.

Some examples are: "The disease of chemical dependency is chronic, primary, predictable, and contagious." "The consistency with which the disease manifests offers only three options to its victims: they wind up either locked up (incarcerated), covered up (buried), or they sober up (get into recovery)." "...denial is so strong, consistent, and common that it is considered a defining characteristic of the disease of Chemical Dependency." "...there is never a return to normal "social" drinking...Relapse means reactivation of the original disease..." The FAA's HIMS program involves identification and intervention by HIMS trained "peer monitors", i.e. HIMS graduates who are AA coworkers recruiting for the cult. This is followed by treatment without which employment is terminated. Then re-certification occurs if the pilot satisfies HIMS that they have submitted to the cult. "...28 days of inpatient treatment plus 90 days of daily Alcoholics Anonymous and/or Narcotics Anonymous meetings..." must be completed before an FAA special issuance airman medical certificate is even considered according to the HIMS website.

So, its either AA or the pilot doesn't fly - EVER! Monitoring of the pilot goes on for a minimum of 2 years (sometimes for the rest of their career). This is carried out by among others "peer monitors", i.e., AA coworkers who ensure, it is assumed, that the pilot is "working a strong program". The medical misinformation and general ignorance regarding alcohol dependence starts right at the top of the organization. Dr. Donald E. Hudson: HIMS Program Manager, ALPA Aeromedical Officer "...the person who's afflicted has no conscious understanding that the substance is actually causing his problems and that's what we call denial..." "...the prognosis of addiction, untreated, is grim ... leading eventually to death. This is a fatal disease if left untreated."

Our taxes are paying the wages of this medical moron! This a medical doctor, addiction expert, and head of a federally funded substance abuse program who doesn't know the basic facts about addiction. 1. Denial is not a fundamental characteristic or symptom of addiction - this is a medically proven fact. Among others, the US government's NIAAA has proved this. See www.orange-papers.org/forum/node/2902. 2. Untreated alcohol dependence is not fatal! Over 75% of those who recover from alcohol dependence do so without medical intervention or attendance at AA. The NIAAA has also proved this, repeatedly. How can one section of government, the FAA's HIMS program, not be aware of the research results of another section of government, the NIAAA?

Dr. Lynn Hankes, HIMS consultant, addiction expert, Clinical Professor Emeritus at the University of Washington School of Medicine: "AA is empirically validated as the best form of maintenance treatment developed to date." This is a downright lie! An overwhelming amount of research has proven this to be false. The World Health Organization stated that AA was ineffective in 2009. The University of Columbia's National Center on Addiction and Substance Abuse stated in 2012 that "...mutual support programs such as AA or NA...are not evidence based treatments for the disease." Dr. Hankes also states that: "...that's where the intervention process is so important, somebody's got to bring reality into that individual's life, 'cause they can't see it themselves...", and "Denial is the chief symptom and major obstacle to diagnosis and treatment, so intervention becomes necessary."

This is completely untrue - as shown above denial is a myth. This shows Dr. Hankes fundamental ignorance of the medical facts about alcohol dependence. Yet again, our taxes are paying this medical moron's wages! Some graduates of the HIMS program who are also non-anonymous AA members are: First Officer Dana Archibald: American Airlines(JFK), Past Chairman of HIMS Program, alcoholic, AA cult member and cult recruiter. Capt. Chris Storbeck: Delta Airlines, current HIMS Chairman, alcoholic, AA cult member and cult recruiter. So who's at the controls of your flight - somebody who's willing to "Let go and let God"? I hope not."

Sunday, January 25, 2015

The FAA: Misguided In Their "One-Size-Fits-All" Approach to the HIMS Program

More evidence that the FAA is misguided in their 'one-size-fits-all' approach in administering the HIMS (Human Intervention Motivation Study) program...

DOI: 10.1176/appi.pn.2014.12a9

Psychiatrists Describe Trends in Medications to Treat Addiction

Vabren Watts 

AbstractThough there are multiple pharmacotherapy options available to treat substance use disorders, some addiction experts maintain that these medications are often underutilized. 

Though large population-based surveys by government agencies and academic institutions report high and sometimes rising rates for substance use disorders (SUDs) such as alcohol and opiate dependence, these disorders are too seldom treated with pharmacotherapies approved by the Food and Drug Administration (FDA), some addiction experts maintain.

This fall, leading clinicians and researchers in addiction psychiatry provided insight on issues and trends regarding use of illicit drugs, including medications to treat them, at APA’s Institute on Psychiatric Services in San Francisco.

“For a while, until 2000, the United States was seeing a marked decrease in heroin use” that spanned a period of nearly 10 years, said Petros Levounis, M.D., M.A., chair of the Department of Psychiatry at Rutgers New Jersey Medical School, at the symposium. “Then we had the explosion of prescription opioid use, which became an epidemic.”

According to the Centers for Disease Control and Prevention, from 1999 to 2008 there was a dramatic increase in deaths due to overdose of prescription painkillers that paralleled the 300 percent increase in sales of the potentially addictive opioid receptor agonists. In 2013, the National Survey on Drug Use and Health showed that heroin use more than doubled over a five-year span, with 669,000 people in the United States reporting current heroin use in 2012, compared with 373,000 in 2007.

In an interview with Psychiatric News, Levounis stated that because heroin has become less expensive, and sometimes easier to acquire, than prescription opiates, heroin has become the drug of choice for some addicts and accounts for the rapid spread of its use throughout the country in the last few years. This shift is also blamed for a large increase in the number of people showing up in emergency rooms suffering from heroin overdoses and needing addiction treatment.

Levounis noted that there are currently three pharmacotherapies to treat opiate dependence that have been approved by the Food and Drug Administration (FDA)—methadone, buprenorphine, and naltrexone/naloxone—and stressed that “there is no ‘one-size fits-all’ treatment, … [and] efficacy of the treatments may vary from person to person.”

Levounis pointed out that there are no “new” medications in the drug-development pipeline to treat opioid addiction, but there are newer formulations of FDA-approved drugs, such as probuphine, which is an implantable, long-injection version of buprenorphine that helps patients adhere to their addiction-treatment regimen.

Other topics discussed at the symposium included treatment of alcohol use disorder (AUD) and certain types of stimulant use disorders.

“Pharmacotherapies for AUD are highly underutilized. Only 8 percent of adults with AUD are currently being treated for the illness” with these medications, said Steven Batki, M.D., a professor of psychiatry at the University of California, San Francisco, who pointed out that there is no universal treatment that is as effective in all patients with AUD.

“There is a lot that goes into prescribing the best medication for an individual patient,” Batki said. “We have to ask patients if they are abstinent [from drinking], currently drinking, … on an opioid or not on an opioid, … and whether they have liver disease.” Batki stressed that asking patients these questions is critical to reducing the risk for potential multidrug interactions and adverse events. Currently, he noted, there are three FDA-approved medications for AUD—disulfiram, naltrexone, and acamprosate.

Larissa Mooney, M.D., an assistant professor of psychiatry at the University of California, Los Angeles, provided an update on trends in cocaine and methamphetamine use and the medicines used to treat addiction to those drugs. She pointed out that there are no FDA-approved medications for these addictions, but other FDA-approved drugs such as mirtazapine, bupropion, and naltrexone are being studied in clinical trials as potential therapies for methamphetamine addiction, as is a vaccine for cocaine use.

Giving her perspective on the symposium, Mooney, who also served as its chair, told Psychiatric News that since drug addictions are very common disorders in both general and psychiatric patient populations, she hoped the session succeeded in “conveying some important messages about the treatment of addiction” that psychiatrists could take home and use in their practices.
FAA's HIMS Program Human Intervention Motivation Study (HIMS) himsprogram

As a "HIMS Pilot," your Medical Certificate will be annotated with, "Not Valid Past ____________." Anyone who requests to see your Medical Certificate (e.g., a future employer, the FAA, a Check Airman, etc.) will know you are operating on a Special Issuance Medical Certificate. How? If you are under the age of 40, which they will know by your birth date on your Airman Certificate, your Medical Certificate is valid for 12 calendar months; not 6, as is clearly stated on your newly minted, Special Issuance Medical. Bottom line, think twice about participating in HIMS if you are under the age of 40 and/or you anticipate switching employers. Regardless, you should be thinking twice about it anyhow, but if you fall into the above category, it may be in your best interest to avoid HIMS at all costs.

FAA's HIMS Program Human Intervention Motivation Study himsprogram
Weyhrauch Law Group, LLP

Saturday, January 24, 2015

FAA's HIMS Program Human Intervention Motivation Study (HIMS) himsprogram HIMS aviation HIMS pilot
Weyhrauch Law Group, LLP

Please see below for an example of a 'Special Issuance' letter from the FAA, outlining some of the basic requirements for maintenance of a Medical Certificate once the pilot has been "medically cleared" by all parties involved in his/her 'case.' Please also know that this process, leading up to the pilot applying for a 'Special Issuance,' may take several YEARS to accomplish. During this time, there is almost always NO salary, the costs associated with it are NOT reimbursed, and it MUST occur if the pilot ever wishes to [legally] fly again and/or return to work. As you will notice, the pilot has little choice (read: no choice, unless you wish to risk retaliation by your medical providers, the FAA, or your airline) among medical providers and/or treatment modalities. It is, quite literally, the FAA's way, "or the highway." In effect, the pilot is beholden to his/her assigned medical providers (about whom she has no choice) and treatment philosophy. In this case, Alcoholics/Narcotics Anonymous (which we believe has many therapeutic benefits) has been, and remains, the FAA's sole treatment modality. By default, this becomes the pilot's only mode of maintaining sobriety, and the only method about which she can be forthcoming; other modes of maintaining sobriety will elicit suspicion, and delay issuance of the below:

 Human Intervention Motivation Study HIMS Program FAA's HIMS program himsprogram HIMS aviation HIMS pilot

FAA's HIMS Program ALPA Air Line Pilots Association himsprogram Human Intervention Motivation Study