Letter of Thanks: Recognition of Addiction Medicine

Signing Ceremony for the transfer of the ASAM Certification Examination to ABM, April 30, 2009.

As two Past Presidents of ASAM who are Directors of the American Board of Addiction Medicine (ABAM) and The Addiction Medicine Foundation, we wanted to share a few thoughts about the recent inclusion of addiction medicine as a subspecialty recognized by the American Board of Medical Specialties (ABMS).

We both got involved with our Society in the 1980s, at a time when ASAM set a central goal to achieve recognition of the specialty field of addiction medicine. This work began before ASAM was even called ASAM and was re-started with the formation of ASAM’s Medical Specialty Action Group (MSAG). MSAG later spearheaded the creation of ABAM, which then took the reins in a march towards ABMS recognition. Quite frankly, in the wake of this achievement, ASAM will need to rewrite a line in its Mission Statement because an aspirational target has been reached!

The targeted journey towards recognition of addiction medicine by ABMS began when Dr. Beth Howell, DFASAM, became ASAM’s President in 2005. Dr. Howell created presidentially-appointed action groups to work across committee and council structures in achieving specific and focused goals. MSAG was one of the first four action groups formed, and was charged with addressing the recognition of addiction medicine as a medical specialty. Dr. Howell turned to Dr. Michael Miller, DFASAM, who was at that time ASAM President-Elect, and Dr. Kevin Kunz, MPH, to Co-Chair MSAG. The two were ideally suited for this role, Dr. Miller having been long active in public policy activities and with the AMA, and Dr. Kunz having been a leader among ASAM state chapters and head of ASAM’s grant-supported State Medical Specialty Societies project. The MSAG initiative (like the others started by Dr. Howell, including achieving parity for addiction services), as led by Dr. Miller and Dr. Kunz and assisted by countless others, has been transformative to the field of addiction medicine.

ASAM’s MSAG group had excellent staff support from ASAM’s former CEO Jim Callahan and the Director of ASAM’s Certification Program, Christopher Weirs. In less than two years after its founding, MSAG presented its proposal to the ASAM Board in April 2007 that ASAM go forward to “encourage and assist” in the creation of a stand-alone board of addiction medicine. The ASAM governing board agreed, by a unanimous vote. ABAM, as it became called, would conduct the certification of individual physicians and work to secure a decision by the ABMS to have its own certification program for physicians – from any primary specialty – in addiction medicine. ABAM was incorporated that summer, and a search began for an initial eight directors from key specialties to lead the organization.

At this same time, Dr. Miller became President of ASAM and Dr. Martha Wunsch, FAAP, DFASAM, stepped in to join Dr. Kunz as a Co-Chair of MSAG in overseeing the appointment of Honorary Directors of ABAM. The Honorary Directors served transitionally so that ABAM would have a defined governance when it received its articles of incorporation. The Co-Chairs identified eight specialty directors to take over governance of ABAM, and they in turn selected seven more at-large Directors. The “talent search” for these directors involved MSAG reaching out directly to the ABMS member Boards and their related Societies or Colleges, and asking “Who are your top few people in addiction in your specialty?”

Chuck O’Brien was approached as a leader in the specialty field of psychiatry, but was busy chairing the DSM-5 committee on Substance Use Disorders and trying to wind down a bit in his most illustrious career; he suggested Kathleen Brady, MD, PhD, and Dr. Brady (with the credibility she has attained in the APA and in AAAP) proved to be a marvelous specialty director in ABAM for several years. For all the other specialties, MSAG secured agreements from similarly outstanding individuals to serve with ABAM and devote their energies to its mission. Among the seven at-large directors, two were identified as being practitioners of addiction medicine and well connected to ASAM: Dr. Howell and Dr. Miller.

The 15 Directors then conceived and established a program to accept into ABAM its initial 2,000 Diplomates. These physicians received their addiction medicine certification via an ABAM “grandfathering” program, which created a pathway to recognize ASAM certified specialists. Dr. Louis Baxter, Sr., MD, DFASAM, as ASAM President, and Dr. Jeffrey Samet, as ABAM President, also signed documents to transfer the ASAM certification exam to ABAM. As a result, in 2010, almost 500 new ABAM Diplomates became certified via the first ABAM exam, adding to the 2,000 “grandfathered” ABAM Diplomates.

More important to us than sharing with you this history and this timeline, is to thank each and every one of you who became ABAM Diplomates, and the majority of you who are participating in ABAM’s Maintenance of Certification Program (MOC). We know that it is important to you to have this important credential. You have been the first cohort of “board-certified” addiction medicine specialists. But we also know that we would not have gotten to this historic point of having addiction medicine enter the collection of ABMS-recognized specialties and subspecialties, without the financial investments you made in the certification and MOC processes of ABAM. The income ABAM collected from individuals participating in ABAM’s certification and maintenance of certification programs allowed ABAM to operate, to produce and offer the exam, to credential individuals to sit for the exam, and to take the steps to secure the agreement of an ABMS member Board to present an application to the ABMS for the new certification process. That applicant, and the ABMS Board that will administer the new certification process, is the American Board of Preventive Medicine (ABPM).

The monies made available to ABAM and what was then called The ABAM Foundation were also used to develop the field itself. You supported: outreach to ABMS and its member Boards; diffuse communication and new marketing strategies for the exam, which increased the number of successful examinees by three-fold; the developing of the infrastructure to establish fellowships; the establishing of fellowships; the developing of MOC from scratch; and the birth of a cohort of new leaders, spreading enthusiasm for the addiction medicine field as never before – right up to a White House Symposium on the need for the subspecialty with representatives of all sectors affirming the need for the subspecialty.

Though the ABAM Foundation applied for and received significant financial grants from major foundations and both NIAAA and NIDA - such that ABAM needed to supply less than a third of the funds for TABAMF to carry out its work - 100% of the funding for ABAM came from ABAM Diplomates themselves (about 75% of whom were dues-paying members of ASAM through this entire span of years). Some ABAM diplomates participated in the grandfathering and MOC programs of ABAM and incurred those financial obligations even though they held the addiction psychiatry (ADP) subspecialty credential and were responsible for MOC fees in ADP. This is breathtaking to consider, and why we felt the need to send you this “Thank You” letter. Your support brought us to where we are today, and leaders are recognizing what we have accomplished together—what NIDA Director Dr. Nora Volkow penned in letter that was posted on Huffington Post last week as “a major step forward for addiction medicine.”

We would like to thank as well the two CEO’s of ABAM – first, Dr. Jim Callahan, and, after his retirement, Dr. Kunz. Dr. Callahan believed that addiction medicine needed a specified body of knowledge to define the field, and that the ABMS goal would be impossible to attain without the development of credible post-residency fellowship training programs in our discipline. The independent ABAM Foundation (now renamed The Addiction Medicine Foundation, TAMF) was led by the same directors and staff who led ABAM. A key function of support of ABAM’s mission was to develop Educational Objectives for training programs in addiction medicine and program accreditation requirements. In the past seven years, TAMF has accredited 40 training programs in addiction medicine. Transitioning these programs from TAMF-accredited programs to ACGME-accredited programs will be an important process. TAMF applied for and has received significant grant support from NIH institutes (NIAAA, NIDA) and private philanthropic entities to support its work and the establishment and operation of the National Center for Physician Training in Addiction Medicine.

Again, we want to thank you for your participation in the MOC Program that ABAM has operated under the leadership of current ABAM President Dr. Robert Sokol, FACOG, and our superb staff, and especially ABAM’s MOC Director Lia Bennett. Time-unlimited Diplomates of ABAM have participated in Part I of MOC at essentially a 100% rate. Those conferred time-limited certificates by ABAM have participated in Part II and Part III at an extraordinarily high rate. This is because this credential is clearly important to those who have earned it. We feel a need to offer you our heartfelt thanks for your participation in MOC and for paying the annual fees which have been used to support the MOC program.

We now have more than 3900 certified Diplomates and 40 accredited fellowships. These impressive numbers contributed to the credibility and worthiness of the application ABPM submitted to the ABMS. It was unprecedented that our application to ABMS was approved unanimously by ABMS at the “first reading” of the application. We did our homework, learned what we needed to do, and we did it. We did it only because your sacrifice enabled us to do it. We not only did this for you, the Diplomates – we did this because we believe that when a physician stands up to ignorance and stigma for the benefit of patients, everyone is better off – patients and families, medicine and society.

Dr. Kunz frequently remembers back to the initial face-to-face meeting of the MSAG when 40 physicians gathered in a space generously provided by The Hazelden Foundation on a freezing single-digit December weekend in 2006 in Center City, MN. Dr. Kunz recalls the now immortal words of the late Dr. Jim Smith, who had served multiple terms as an officer of ASAM. Back then we didn’t know enough to know what to seek and plan for, whether some sort of primary specialty certification, or a subspecialty certification program like the one which was recently approved by the ABMS. As we considered various pathways to recognition of our field, Dr. Smith said, “Whichever path we choose, let’s choose the one that saves the most lives.”

This notion has always been core to the resounding mission of ASAM, and was so with our focus on bringing recognition to our specialty field. From the start, this endeavor was about the patients, and their affected family members. It was about building a workforce of trained and certified expert clinicians who would Treat Addiction and Save Lives™. We are today at a point in time, in a process begun by Dr. Ruth Fox and her colleagues in her apartment in New York City over 60 years ago, on the way to a future that we see clearly.

But truly, the future will hold things that we can’t imagine now. We know that the attainment of our collective dream involved very concrete steps, and it took very specific actions, and it took the resources to engage in activities that have been absolutely necessary to get us to this point. You have not just been benefactors, in a way, of the process; you have been participants in and contributors to the process. So as you smile your thousands of smiles of satisfaction, we didn’t want to let the moment pass without saying, “THANK YOU!”