Public Policy Statements 1974 to 1985   Public Policy Statement Date Adopted or Revised   Before 1980 Abstinence September 1974 Labeling October 1979 Self-Help Groups October 1979   1980-1985 Increasing the Availability of Appropriate High-Quality Alcoholism Services to all Americans, Delivered in a Cost-Effective Way October 1980 Fetal Alcohol Syndrome May 1980 Treatment for Alcoholism and Other Drug Dependencies May 1980, September 1986 and October 1997 Medical Needs of the Public Inebriate September 1980 NIAAA and Alcoholism Research April 1982 State of Recovery February 1982 Advertising April 1983 Alcoholism as a Primary Disease October 1983 The Impaired Health Professional April 1984 Prevention October 1984 and September 1989 and November 1990 The Treatment of Patients With Alcoholism or Other Drug Dependencies, and Who Have or Are at Risk for Acquired Immunodeficiency Syndrome (AIDS) October 1985   Before 1980   Public Policy Statement on Abstinence In accordance with data currently available, the National Council on Alcoholism and its medical component, the American Medical Society on Alcoholism, take the position that:   1. Abstinence from alcohol is necessary for recovery from the disease of alcoholism. 2. Although abstinence is a means of achieving recovery, other factors by which a person's life are enriched are important; improved physical and emotional health, better work performance, more rewarding relationships with the family and society, and increased economic efficiency. 3. As in many other diseases, relapses may take place but must never be thought to indicate that recovery is beyond reach. Any improvement is positive and should recognized and encouraged as a prelude to recovery. 4. There is a need for responsible research into alternate approaches, carried out with proper controls as well as the judicious publication of results when pertinent. However, in the present state of our knowledge, we firmly believe and emphasize that there can be no relaxation from the stated position that no alcoholic may return with safety to any use of alcohol. Adopted by ASAM Board of Directors September 1974   Public Policy Statement on Labeling The American Society of Addiction Medicine firmly defends the public's right to know, and supports the adoption of all effective methods of public education on the potential dangers associated with the excessive use of alcohol, to encourage informed decision making by the public, and to reduce the incidence of alcohol-related problems. Although suitable scientific study is not now available to prove in advance the effectiveness of warning labels on alcoholic beverages, the American Society of Addiction Medicine, as expressed in a poll of its membership, believes that warning labels on alcoholic beverages has sufficient potential utility to warrant its adoption. Such adoption should be accompanied by carefully designed and adequately funded studies of the effectiveness of this program in improving public awareness of the hazards of excessive alcohol use.   The American Society of Addiction Medicine further recommends that any system of labeling adopted be applied to all alcoholic beverages and alcoholic beverage advertising, that the message include both specific and general information and that all alcoholic beverages be labelled to indicate their alcohol content in volume percent.   Adopted By ASAM Board of Directors 10/19/79   Resolution On Self-Help Groups WHEREAS, Alcoholism is a complex disease affecting the body, mind, family, occupational and social life of the person afflicted; WHEREAS, the treatment of the disease Alcoholism requires a cooperative effort involving many disciplines in addition to physicians; WHEREAS,self-help groups, particularly Alcoholics Anonymous, have been a tremendous help in recovery to many thousands of alcoholics, their friends and families; THEREFORE,be it resolved that the American Medical Society on Alcoholism encourages all physicians and the alcoholism treatment agencies with which they work to develop relationships of maximum cooperation with the self-help groups, such as Alcoholics Anonymous.   Adopted By ASAM Board of Directors 10/19/79   Increasing the Availability of Appropriate High-Quality Alcoholism Services to all Americans, Delivered in a Cost-Effective Way Position ASAM supports all measures which are aimed at increasing the availability of appropriate and high quality alcoholism services to all Americans, delivered in a cost-effective way. ASAM supports amendments to the Federal Medicare and medicaid laws to provide detoxification services in other-than-hospital settings as well as in hospitals. ASAM supports the provision of Medicare and Medicaid coverage for both rehabilitation and out patient alcoholism services since detoxification alone without further treatment is not adequate alcoholism treatment. ASAM opposes the adoption of amendments reducing the rate paid for hospital detoxification services following PSRO review, based on the unavailability of non-hospital-based detoxification. ASAM supports research into alcoholism services and their costs that will stimulate continued progress in shaping a humane and cost-effective treatment system.   Adopted By ASAM Board of Directors 10/27/80   The Fetal Alcohol Syndrome Observations of human babies and of experimentally treated animals have made it clear that a mother's heavy drinking may severely damage her unborn child. We do not know the exact amount or timing of drinking that causes these effects. We cannot say whether there is a safe amount of drinking or whether there is a safe time during pregnancy. We do know that heavy drinking may be damaging. Women should, therefore, be especially cautious about drinking during pregnancy and when they are likely to be pregnant; however, because of the possibility of risk, and in order to be totally safe, a woman should not drink at all during her pregnancy.   Research is proceeding vigorously in this area. ASAM supports and encourages this important research and urges both public and private agencies to continue their support of research on the effects of alcohol on the fetus.   Adopted By ASAM Board of Directors 5/4/80  Treatment For Alcoholism and Other Drug Dependencies I. General Definition of Treatment Treatment is the use of any planned, intentional intervention in thehealth, behavior, personal and/or family life of an individual sufferingfrom alcoholism, and other drug dependence, designed to enable the affectedindividual to achieve and maintain sobriety, physical and mental health,and a maximum functional ability. II. Components of Treatment Treatment should include all or a combination of the following: 1. A thorough physical and psychosocial evaluation; 2. Detoxification; that is, the achievement of a state free of bothalcohol and any other addicting drug. Detoxification may be accomplishedon an inpatient or outpatient basis, and with or without the use ofpsychoactive drugs, depending on the physical, psychological and socialneeds of the patient. 3. Counseling, including education on: the nature of alcoholism and drugdependence as diseases; the need for long term abstinence; the need for aprogram of rehabilitation, including family involvement; the dangers ofswitching addictions and other related issues. 4. Medical treatment of the physical concomitant and complications ofaddictive illness including attention to nutritional needs. 5. Psychological assistance, for the patient and family throughpsychotherapy and /or counselling, along with involvement in self-helpgroups, depending on the needs and characteristics of the patient and thefamily. This assistance is aimed at sustaining motivation for sobriety,and helping the patient find alternative healthier ways of coping withpersonal, work, family and social problems without dependence on alcohol orother drugs. It is aimed at helping the family develop healthier, moresatisfying patterns of interaction which will in turn facilitate andreinforce the patient's abstinence. This includes help for the children ofpatients with these disorders aimed also at prevention of the disease inthis high-risk group. The prescription of a deterrent drug (e.g. disulfiram, naltrexone) oraversive counter- conditioning may accompany this phase of treatment as amotivational aid. 6. Treatment of any psychiatric illness which may accompany the alcohol orother drug dependence, such as affective disorders, anxiety disorders,personality disorders, etc. 7. Referral for help with social, legal, child care, vocational, spiritualor other associated problems to appropriate community resources. 8. Long term follow-up. Since alcoholism and other drug dependencies arechronic terminal diseases, treatment is generally conducted as a plannedprogram with a prolonged follow-up, or on an open ended basis. 9. Opioid maintenance therapy may be used in selected opiate dependentpatients. III. Length of Treatment Depending on the age of the patient, the stage of illness, the degree ofassociated physical and psychiatric disability, and the extent of social,family, vocational and legal problems, the length of the treatment andrehabilitation process will vary widely from case to case. In all cases,however, long term availability of social supports and medical supervisionare needed because of the severe nature of the illnesses and potential forrelapse. IV. Self-Help Groups Self-help groups for persons suffering from these disorders and for theirfamilies have been and remain a vital source of help in recovery. They represent a long term and ongoing source of psychological, social, andspiritual intervention and support, and are recommended as part of the planof treatment wherever possible. Adopted By ASAM Board of Directors 5/4/80 Revised By ASAM Board of Directors 9/21/86 Revised by ASAM Board of Directors 10/5/97   Medical Needs of the Public Inebriate Recognizing that the public inebriate is often a person suffering from chronic late stage effects of alcoholism such as liver disease, damage to the central and peripheral nervous systems, hematologic, cardiovascular and pulmonary disorders, the effects of trauma and many other health problems, the American Medical Society on Alcoholism supports cooperative public and voluntary efforts to reach this difficult population with needed medical services. Arrangements for such services should be provided wherever the public inebriate interacts with the social system, including jails and police lockups as well as alcoholism treatment and social service agencies. Services should include mental health care for those who suffer from the multiple disability of alcoholism and mental illness. Health care providers should cooperate in efforts to establish appropriate staff community residences and other programs designed to interrupt the progression of alcoholism in this group.   ASAM also supports research into the drinking patterns and problems of the public inebriate, both male and female, into causal mechanisms and approaches to treatment of their alcohol-related illnesses, and into the effectiveness of models of the provision of alcoholism, general health and mental health services to this population. Adopted By ASAM Board of Directors 9/80   NIAAA and Alcoholism Research The American Society of Addiction Medicine welcomes the Administration's plan to increase federal support on alcoholism research. The proposed FY '83 research budget of $33 million of NIAAA is a major advance toward prevention and efficacious treatment of an enormous national health problem. NIAAA should maintain its current status and central role in the federal government's efforts to eliminate alcohol-related health damage, and the Institute's research program should continue to expand. It is imperative to control this disease that costs the nation $45 billion a year and is a major cause of death. The best way to achieve this goal is to maintain a determined, efficient, and well funded National Institute on Alcohol Abuse and Alcoholism.     Adopted By ASAM Board of Directors 4/5/82   State of Recovery "Cure" Alcoholism is a chronic disease. Because relapse is possible even after many years remission, we cannot use the term "cure." "State of Recovery" A patient is in a "state of recovery" when he or she has reached a state of physical and psychological health such that his/her abstinence from dependency-producing drugs is complete and comfortable. In practice, this judgment must be made on clinical grounds, based on the most complete assessment possible of the state and seriousness of the initial illness and the quality and length of remission. An alcoholic individual is in remission when he/she is free of the active signs and symptoms of alcoholism. This includes abstinence from the use of substitute sedative, stimulant or hallucinogenic drugs during a period of independent living. After a period of remission, which may vary for the individual, a state of recovery is achieved.   Indices of State of Recovery from alcoholism generally include:     1. Sobriety; comfortable abstinence from alcohol and/or other dependency-producing drugs. 2. Improvement in aspects of physical health previously adversely affected by alcohol use. 3. Improvement in family relationships and/or resolution of conflict in close relationships. 4. Improvement in functional responsibilities and self care. 5. Progress towards resolution of related emotional difficulties. 6. Willingness to share the recovering state. Application of this statement:   For particular socially defined purposes such as entry into training for a career as an alcoholism counselor, or returning physician or an airplane pilot suffering from alcoholism to full practice of his or her profession, standard minimum periods of remission might be established. These minimum periods will differ according to social purpose, but in any case of their application, individual clinical factors in each patient's illness and remission must be given due consideration.   Adopted By ASAM Board of Directors 2/5/82   Advertising WHEREAS: The incidence of alcohol abuse and dependency is a major national public health problem and on the increase, particularly among adolescents; and,   WHEREAS: People in general, but particularly children and adolescents, are strongly influenced by what they see on television or hear on the radio; and,   WHEREAS: Radio and television advertising of wine and beer is a major force in the promotion of the use of alcohol;   THEREFORE BE IT RESOLVED: That the American Society of Addiction Medicine oppose continued use of the airwaves to promote drinking, and the advertising of alcoholic beverages on radio and television; and,   BE IT FURTHER RESOLVED: That this position be forwarded to appropriate legislators and transmitted to the ASAM State Chairpersons to be relayed to each state's Senators and Congressmen. Adopted By ASAM Board of Directors 4/14/83   Alcoholism as a Primary Disease Based on many years of clinical experience, reinforced by recent and continuing research into the genetic, biochemical and physiological aspects of the effects of alcohol on living systems and of alcoholics and their families, the American Society of Addiction Medicine finds that alcoholism is a complex primary physiological disease, and neither a primary behavior disorder nor a symptomatic manifestation of any other disease process. Adopted By ASAM Board of Directors 10/14/83   The Impaired Health Professional Whereas, alcoholism and other chemical dependence are chronic progressive and often fatal diseases if untreated; Whereas, effective treatment is available for these diseases; Whereas, if effectively treated, impaired health professionals are able to return to and resume functioning as valuable members of the health care community, ASAM supports the following: 1. Recognition of their impairment caused by these diseases; 2. Early referral into appropriate treatment; 3. Effective monitoring long term; 4. Sharing among health disciplines of effective intervention, rehabilitation and monitoring approaches. Adopted By ASAM Board of Directors 4/12/84   Prevention The American Society of Addiction Medicine supports a wide variety of measures to prevent alcohol- and other drug-related problems in contemporary society, understanding that: A comprehensive and coordinated national program involving a combination of approaches will be required to combat these serious and complex problems. Extensive public education about the nature, causes, and prevention of alcoholism and other drug dependencies, and about the full range of alcohol- and drug-related problems, will be required by both the public and private sectors to develop support for comprehensive prevention. Physicians have an indispensable and ongoing role in this public education. Sound scientific research into the causes of these problems, and the careful evaluation of prevention measures undertaken, are needed in order to improve the fund of knowledge upon which more effective prevention strategies may be based. The American Society of Addiction Medicine, therefore, recommends that such research be given high priority by government, universities, foundations, and other research institutions.   The American Society of Addiction Medicine supports prevention policies and programs that include, but are not limited to, the following: 1. Control of quality, availability, advertising and promotion of tobacco products and alcoholic beverages. Such controls should include:   a) Establishing a national legal purchase age of 21 years for all alcoholic beverages. b) Curbs on advertising of all alcoholic beverages and tobacco products, including the voluntary elimination of radio and TV advertising, and intermediate measures, such as the establishment and enforcement of national standards for radio, TV and print advertising which eliminate use of young people, athletes, persons engaging in risky activity, and sexual innuendo. c) Eliminating sponsorship of youth-oriented concerts and all sports events by tobacco and alcoholic beverage manufacturers. d) Eliminating alcohol advertising and promotion on college campuses, where a high proportion of the audience reached is under the legal drinking age. e) Eliminating alcohol advertising and promotion that portrays activities that can be dangerous when combined with alcohol use. f) Banning special low-price promotions, such as cut rate "happy hours," "two-for-the-price-of-one drinks", or free drinks for female patrons. g) Counter advertising, through paid and public advertising, including health warnings about alcoholism and alcohol-related problems, nicotine dependence, and tobacco product related health problems. h) Requiring that alcoholic beverage containers display all ingredients and alcoholic content by volume, in addition to a rotating series of health warnings on: Drinking and driving Drinking and pregnancy Alcohol and drug interactions Links of excessive alcohol use to health-related disorders, including alcoholism cirrhosis, heart disease and cancer. i) Health warning posters at point of sale. j) Eliminating the sale of alcoholic beverages by gasoline retailers. k) Adjusting taxes on beer and wine to equate with those for distilled spirits, and adjusting taxes on all alcoholic beverages for inflation experienced since 1951. l) Devoting significant additional funds derived from increased taxes to the support of prevention and research.   2. Control of the quality, distribution, and availability of psychoactive drugs, including:   a) Measures to prevent the manufacture, importation and sale of illicit drugs. b) Programs to prevent diversion of licit drugs for illicit sale and use. c) Discouraging the inclusion of alcohol as an ingredient in the formulation of medicines, beyond the minimum required as a solvent. d) Promoting safe and appropriate prescribing practices for drugs that may produce dependency. e) Warning labels on prescription and over-the-counter drugs that describe possible adverse interaction with alcohol and other drugs. Warning labels that indicate the potential of drugs to produce dependence. f) Programs to educate health professional about identifying drug-abusing, manipulative patients who seek psychoactive drugs for inappropriate use. 3. Scientifically sound education for all segments of society, including:   a) Age-appropriate education about the nature and effects of alcohol and drug use, including alternatives to such use, throughout the school curriculum. b) Public education about the nature and causes of alcoholism and other drug dependence, the interaction of alcohol and other drugs, alternative techniques of managing stress, and the effects of alcohol and other drugs on health and safety. c) Adequate professional education about alcohol and other drug problems in all programs which prepare students for careers in health, human services, teaching, the clergy, police, public administration, and law. d) Programs to keep practicing health professionals abreast of new knowledge, and current laws and regulations, that relate to alcohol and other drugs. e) Avoidance by the media of glamorizing tobacco, alcohol, and other drug use. f) Accurate reporting in print and broadcast news of the adverse societal consequences of alcohol and other drug use. g) Special programs aimed at populations known to be at high risk, including children of alcoholic and drug-dependent parents, pregnant women, medical, dental, nursing, pharmacy and veterinary students, health professionals, persons recovering from alcohol or other drug dependence, persons undergoing stressful life situations, and others. h) Education, for bartenders and others who serve alcoholic beverages (including social hosts and hostesses), about safe serving practices and preventing harm to an alcohol-impaired person. i) Including accurate information about alcohol and other drug use in all health prevention programs j) Measures to discourage or deter the manufacture, sale, and promotion of drug paraphernalia (products designed to process, prepare and administer illegal substances). Adopted By ASAM Board of Directors 10/19/84, Revised By ASAM Board of Directors 9/25/89, Revised By ASAM Board of Directors 11/11/90   The Treatment of Patients with Alcoholism or Other Drug Dependencies and Who Have or Are at Risk For Acquired Immunodeficiency Syndrome (AIDS) The American Society on Addiction Medicine (ASAM) recognizes that some patients in need of treatment for alcoholism and/or other drug dependencies may have Acquired Immunodeficiency Syndrome (AIDS), AIDS Related Complex (ARC), or may have a positive test for HTLV-III antibodies. Intravenous drug users are a high-risk group for AIDS. The use of mood altering drugs (i.e. alcohol, marijuana and perhaps others) may depress the immune system and affect prevention and treatment of AIDS.   ASAM strongly recommends that physicians, other health professionals, and programs for the treatment of alcoholism and other drug dependencies provide treatment for these patients. Case by case assessment of the medical status of each patient should be made to determine physical capacity to undergo treatment for alcoholism and other drug dependencies. Continuing medical follow-up by a physician familiar with AIDS is recommended. Currently there is anxiety among staffs and other patients about associating with AIDS patients. All personnel, including clinical, dietary, maintenance and housekeeping, should be educated with the latest medical data. Patients with AIDS do not require isolation techniques any different from patients with active Hepatitis B. Guidelines for the protection of staff and other patients from Hepatitis B should be followed. Caps, masks, gloves and other kinds of protective wear are not necessary in routine contact, e.g., blood pressure checks and group therapy. Continued medical monitoring after detoxification period is recommended for these patients. The principle of confidentiality, critical to all aspects of alcoholism and other drug dependencies treatment is particularly important with these patients. Adopted By ASAM Board of Directors 10/21/85 American Society of Addiction Medicine, 4601 North Park Ave, Arcade Suite 101, Chevy Chase, M.D. 20815, Fax 301/656-3815, Online address: ASAMOffice@AOL.com , Telephone 301/656-3920 ASAM Home Page Updated December 2, 1997