The Early Days – Founding of CSAM
[The following notes – drawn from a longer article by Steve Heilig, recount some of the early years of the organization.]
CSAM grew out of the need to get the treatment of addiction into the medical mainstream and to remove legal restrictions that prevented physicians from treating addicts. “State law at that time was still a holdover from the early 1900s …At the time we were getting organized, doctors treating opioid addicts were technically in violation in the law – its language stated that no doctor could treat addicts outside of a state or county hospital or jail,” CSAM’s founder, the late Jess Bromley recalled in CSAM News.
When two doctors in Riverside County were charged for secretly admitting heroin addicts to a community hospital to manage their withdrawal, Bromley called David Smith, founder of the then newly founded Haight-Ashbury Free Medical Clinics. “I was sitting in the detox clinic when Jess Bromley called and told me two doctors had just been arrested for doing what I do every day. That really got my attention,” Smith remembered.
With the help of the CMA, Bromley and others authored a bill in 1971 to change the restrictive state drug laws. “We got about 20 people together and drove back and forth to Sacramento to lobby for change. Senator George Moscone became an ally and the CMA was on our side. We took the issue to one of the early Haight-Ashbury Free Medical Clinic Conferences and got grass roots support. We got the law changed at last,” Bromley recalled.
CSAM’s efforts to move the treatment of addiction into mainstream medicine involved both getting recognition within the CMA and also getting support for the new organization within academic medicine.
The connection with CMA was strengthened by Gail Jara who had joined the CMA staff in 1972 after the successful lobbying partnership. “We carried the resolution to the CMA to form a specialty society, and we were very well received,” Bromley recalled. “There were many visionary people there at the time who saw this as an important field needing more medical involvement.”
In the academic arena, people like Charles Becker of UCSF, George Lundberg of USC, Joe Takamine and Tom Ungerleider of UCLA and Joe Zuska of the Navy all played important roles. “Here was someone who brought the imprimatur of the university to add to the recognition that we weren’t just a bunch of quacks. Chuck Becker did that for us. We had our first meeting at his house in Tiburon,” recalled Jack Gordon.
“I recognized that there was no teaching about chemical dependency in the medical school, while that was the root of so many of the problems we saw in the clinics,” Chuck Becker recalled. “I was lucky there was this very good group of practicing physicians getting organized. But I have to say that the guru was Gail Jara, who helped us to formulate regular protocols and was an administrator of great skill and compassion. She brought practice, research and treatment all together.”
Not everyone was initially enthusiastic about mainstreaming addiction medicine. “I had initially been alienated from the mainstream,” recalls David Smith. “Jess Bromley and Gail Jara convinced me that we had to work for change from within organized medicine – if only to keep from getting arrested.”
There were other organizations in existence at that time – the American Medical Society on Alcoholism (AMSA) founded in 1954 by Ruth Fox and the National Council on Alcoholism founded in 1944 by Marty Mann – but CSAM stood apart from then, because it focused on the role of the physicians who treated all drug dependence. It did not endorse the separation between alcohol and other drugs.
“As an internist you had to keep very busy and see a lot of patients in those days,” Jack Gordon recalls. “Getting together with these great folks was almost like a form of recreation, for it was fun and they were on to something very worthwhile. The biggest debates I recall in the beginning were over what to name the new group. It was born as the California Society for the Treatment of Alcoholism and Other Drug Dependencies, and everyone called it the California Society.”
The first formal meeting of the Society was held on April 23, 1973 at the San Francisco Hilton. At the next meeting the first slate of officers was proposed. Charles Becker was chosen as the first president of the new organization. The first annual meeting was held on March 3, 1974 in conjunction with the CMA’s Annual Scientific Assembly. The first issue of the newsletter, edited by David Smith was distributed at that meeting.
The rest, as they say, is history.
CSAM / ASAM History
- New York Society on Alcoholism started as meetings in Ruth Fox’s living room in 1960s.
- The New York Society on Alcoholism grew into American Society on Alcoholism (AMSA), then AMSAODD (American Society on Alcoholism and Other Drug Dependencies), then ASAM. Name changed to American Society on Alcoholism (AMSA) – still focused on alcoholism only and still an east coast phenomenon.
- CSAM started as the “California Society on the Treatment of Alcoholism and Other Drug Dependencies” in 1972 independently of AMSA and AMSA had very few members outside the eastern seaboard states. Californians were Max Schneider and Joe Zuska. California Society on the Treatment of Alcoholism and Other Drug Dependencies was not associated with AMSA because AMSA said they didn’t want to be associated with those who were treating other drug dependence – which at that time meant primarily heroin (and the newly emerging methadone treatment programs which had a shady reputation.) AMSA was on record as not wanting anything to do with other drugs. Californians formed a new and separate organization in order to address all drugs;
- In 1985 CSAM developed the Certification Exam and gave it to ASAM at no cost;
- In 1987 the Executive Council decided to apply to be recognized as a state chapter of the then-named ASMAODD;
Awards presented that have honored the profound contributions one has made to the field of addiction medicine – CSAM Recipients
(CSAM Collaborations with ASAM over the years)
CSAM initiated ASAM’s AMA Membership: ASAM recognized by the AMA with membership in the Specialty Society Delegation to the AMA House. The Specialty Society Delegation had one or two seats (votes) in the House and CSAM had a role in making this happen through its members Dr. Jess Bromley and Dr. David Smith.
CSAM Created the Review Course: CSAM created the Review Course and after ASAM took over the exam, it began offering its own Review Course during the same year as CSAM’s. In 2012, CSAM had 850 attendees at its Review Course, the highest attendance of any Review Course including ASAM’s. Those who have attended CSAM’s Review Course in prior years have had a higher pass rate than those who attended other courses including ASAMs.
CSAM Created the Certification Exam: The exam was put in motion when the law was passed in California to create a new category of hospital licensure, the Chemical Dependence Recovery Hospital / Chemical Dependence Recovery Program (CDRH / CDRP). The law required a medical director “knowledgeable about diagnosis and treatment of alcoholism and other drug dependence.” Therefore, the State surveyors for the Dept of Health Services licensing would have to have a method of determining if the CDRH/CDRP had a medical director who was “knowledgeable?” CSAM used that requirement as the impetus to develop the exam, providing a certificate to attest to the fact that the physician had demonstrated that he/she was knowledgeable. Negotiations to make the exam a national one resulted in CSAM being willing to give it to ASAM for no reimbursement. CSAM was hired and paid to administer the exam project for ASAM for several years. 1985 was the transition year and no exam given.
CSAM Created the State of the Art Course: CSAM gave the first State of the Art Course (Garrett O’Connor’s idea) 1986 first national exam; first ASAM Review Course—patterned after the CSAM Review Course design (John Chappel, adult learning model). Both ASAM and CSAM gave Review Courses every exam year after that. 1989 second State of the Art course. ASAM started giving State of the Art courses also after that.
CSAM Initiated Buprenorphine Training: CSAM offered the first course about buprenorphine before anyone could legally prescribe it — CSAM was ahead of the curve – teaching about what was coming. The CSAM course on Buprenorphine was not a course that qualified people to get the waiver. It was a precursor. Then ASAM got the national waiver and used the curriculum. ASAM always was one of the 5 organizations named in the federal law authorized to offer the 8-hour course required for physicians to get the waiver needed to prescribe buprenorphine.