Alexander DeLuca, M.D.
Addiction, Pain, & Public Health website  
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References and Resources: The DeLuca Collection
 
Series:

Addiction Medicine // Columbia MPH-related / Public Health, Mostly // Published Journal Articles // Poetry / Miscellaneous // Smithers-related Work // War on Drugs, War on Doctors, Pain Crisis  - related

New! - Most recently added documents in 'War on Doctors' series: 2005-11-05 - New!

SERIES:
Addiction Medicine

Reflections on Traumatic AA Experiences, AA-Bashing in MM, and Effective Communication of Deeply Held Ideas...  by DeLuca and 'Harry R.'; Excerpt from MM listServ; 2004.

"What comes across to me is a person so enraged by a particular topic that he can barely speak coherently about it, or a person who can speak coherently but with such intense and unpleasant emotional overlay that most other people can't stand to listen to it. "
 

Dopey Doctors and Naltrexone Prescriptions (aka "Naltrexone FAQ"); Alex DeLuca; 2003. 

Includes:
Simple Truths About Naltrexone
//  Naltrexone as an Aid to Controlled Drinking // Resources and Links
 

Alcohol Abuse vs. Dependence and the Evolving Role of Naltrexone as Adjunctive Pharmacotherapy - a HTML slide-show lecture by Alex DeLuca, January 2002.

Considers the following questions and issues:
Are alcohol abuse and alcohol dependence part of the same continuum of illness or are they distinct disorders?
 
The problem with 'radical abstinence' as a universal treatment suggestion.
 
Abstinence vs Extinction theories of naltrexone are different and consequently lead to very different medication regimens.
 
[As of 3/18/02 - approximately 1/2 of the talk has lecture notes included.] 
 

Medications that might help problem drinkers achieve moderation goals by Alex DeLuca; 2001.

A patient hand-out regarding the use of naltrexone (ReVia) as an aid to early recovery for people with a goal of moderation rather than abstinence.
 

Some General Comments about Moderation Management by Alex DeLuca,  July, 2001 (Updated October 2002).

"The system we have fails to engage the majority. The system we have tends to push people away, to become potentially sicker. The system we have does a poor job of engaging people early on the continuum of illness as is standard medical practice for any of the other 'chronic, relapsing, diseases.'"
--
** July 21, 2004: Reformatted page to be much easier to read and Print Version added **

 

Experiences of Moderation Management members with naltrexone (ReVia) as an aid to moderate drinking. Edited by Alex DeLuca, 2000, 2001.

** June 25, 2004:  Reformatted page **
 

Buprenorphine for combined pain and heroin dependence by Alex DeLuca, 2001 / 2003.

"The pain/addict patients I treated with buprenorphine (n = 4) were all young, otherwise well, either working or students...  who could not afford either the time or expense of inpatient treatment. They were all able to discontinue heroin use without discomfort on relatively low doses that also provided excellent analgesia."

** July 26, 2004: Minor edits, reformatting, and print version fixed **
 

Collected experiences of Moderation Management members (from an MM listserv) with naltrexone (ReVia) as an aid to moderate drinking. Compiled by Alex DeLuca, M.D., 2000, 2001.
 
Abstinence vs. Harm Reduction: a False Dichotomy - by Alex DeLuca, 2000. -- "Only in addiction medicine is it insisted that patients and staff hew to a ‘philosophy’ of ‘total abstinence’ rather than support appropriately individualized  treatment goals."

This 'op-ed' length essay is one of the best I've ever written.  ..alex...
 

GHB Dependence, Withdrawal, and Detoxification by Alex DeLuca, M.D.; 2000.

Answer to a question posed by a person requiring doses of GHB every few hours. Review of (paltry) literature, discussion of several cases, and links to web resources.
 

Medications that can help us avoid relapse in early recovery. Alex DeLuca; 1996.

A patient hand-out regarding the use of Antabuse (disulfiram) and naltrexone (ReVia) as pharmacologic aids in early recovery from alcohol, cocaine, or opiate dependence. I just can't say this stuff any better.
 

Frequently Asked Questions (FAQs) About Naltrexone by Alex DeLuca, 2000, 2001, 2002, 2003, 2004.
Includes:
==> Dopey Doctors and Naltrexone Prescriptions
==> Simple Truths About Naltrexone

==> Naltrexone for Patients who Wish to Moderate or Control Their Drinking
==> See also: Naltrexone as an Aid to Controlled Drinking
==> Naltrexone References and Resources and Links
==> Why is there so little research on naltrexone as an aid to problem drinkers trying to moderate?
==> Problem drinkers, endorphins, naltrexone and testosterone - Part 1
==> Naltrexone use rarely associated with liver damage (Medline references)
==> Are there medications that can help me reach my sobriety goals?
==> I've heard that sometimes taking naltrexone at a dose of 100 mg or 150 mg is effective where 50 mg was not. Can these larger doses be taken all at once, and what time of day should I take it?
 

Patient Selection and Detoxification Protocols; by Alexander DeLuca, M.D.; Smithers Addiction Treatment and Research Center, circa 1999. --

"Expert detoxification is about more than the prevention of medical and psychiatric complications. It is the provision of non-judgmental, compassionate medical care. It is the reassurance of patients who are frightened and ashamed. It is the engagement of patients in a process of recovery that can spare them decades of pain and misery."
 

Outpatient Detoxification - Is This Really a Good Idea? by Alex DeLuca, M.D.; 2000.

From: Smithers Addiction News, Vol. 1, No. 1, Pages 1-2. Discussion of outpatient detoxification guidelines and controlling risks associated with outpatient detox procedures. [This was the only issue of Smithers Addiction News created, and it was never distributed widely, if my memory is correct.]
 

Inpatient vs. Outpatient Detox? Criteria for deciding by Alex DeLuca, M.D.; 1999.

How to use assessment tools like the CIWA and the ASAM Patient Placement Criteria towards making a rational decision.
 

Office-Based Opiate Detoxification - An Open Letter to the FDA by Alex DeLuca, M.D; 1998.

An analysis of the forces promoting the increasing use of outpatient treatment. Methods of opiate detoxification and medications are reviewed. Conclusion: proscription of all opioid medications in the treatment of opiate withdrawal is medically incorrect, ethically questionable, and socially counterproductive.
 

[END: Series - Addiction Medicine]

[Top of Page]

SERIES:
Columbia MPH-related / Public Health, Mostly
The War on Drugs, the War on Doctors, and the Pain Crisis in America:
Eighty Years of Naked Emperors

by Alex DeLuca, 6/4/2004; Revised: 8/13/2004
--
TABLE OF CONTENTS
--
"The myths of the criminal addict, of the perpetual drug crisis, and of  a prescription drug problem caused by venal pill-pushing physicians are deeply [rooted in our society]. This genie will not be put back in the bottle in anything like the four  years (1914 – 1918) it took to unleash it. "
--
** August 13, 2004:  Extensive edits; links in PDF fixed **
 
Is Sewage Sludge a Safe & Useful Commodity?
by Alex DeLuca - 2003
--
"Are we stuck with a mixed household-industrial wastewater stream into which we haphazardly dump everything and then hope we can get all the really dangerous stuff out later? Or should we start to do the large but eminently do-able job of fundamentally fixing our deeply flawed design?"
 
The Croton Watershed:
an Argument for Collaborative Resource Management

by Alex DeLuca - 2003

--
"We have a historic opportunity to demonstrate that sustainable development, development coexisting with watershed protection and enhancement, is achievable through collaborative resource management."
 

Impact of Workplace Drug Testing Programs
by Alex DeLuca, 2002
--
"Is it not economically unjustifiable and morally irresponsible to promote the often indiscriminant use of an intrusive, stigmatizing, very expensive and arguably unconstitutional drug-testing technology whose efficacy has never been demonstrated?"
 

A New Twist on an Old Injustice - The Impact of Genetic Testing in the Workplace
by Alex DeLuca, 2002
--
"Genomic technology and genetic testing offer great promise of better medical care and health. They can also be used to deny or limit health insurance, and by extension, employment...
The public perception of genetic discrimination, and the fear and anger it engenders towards employers and insurers, threatens continued rapid scientific progress.
"
 

[END: Series - Columbia MPH-related / Public Health]

[Top of Page]

SERIES:
Published Journal Article
New! - Combined Effects of Treatment Intensity, Self-Help Groups and Patient Attributes on Drinking Outcomes by S. Magura, ... & A. DeLuca; Journal of Psychoactive Drugs; 37(1); 85-92; March 2005 -- "[We] tested a set of hypotheses relating to the effects on drinking outcomes of treatment modality, matching, retention, aftercare, self-help participation & patient attributes... Study hypotheses were generally supported."

Comment:
Most recent of a series of studies stemming from the implementation of a research infrastructure within the clinical framework of what was then called Smithers Treatment Center, late 1990s.
 
It is gratifying to me that good work still flows from all that wonderful real-world data we collected in the latter 1990's at Smithers. <smile>


*Currently Abstract only - will obtain full text soonest*
 

A group motivational treatment for chemical dependency by Foote, J.; DeLuca, A.; Magura, S.; Warner, A.; Grand, A.; Rosenblum, A.; Stahl, S.; Journal of Substance Abuse Treatment; 17(3); 181-192; 1999.

"Patient “motivation” has been implicated as a critical component in addiction treatment outcomes. To date, treatments utilizing motivational elements have been conducted as individual interventions. We describe the development of a Group Motivational Intervention (GMI), a four-session, manual-driven group approach that employs key hypothesized motivational elements."
 

Polysubstance Abuse Among Alcoholics by  Staines, G.L.; Magura, S.; Foote, J.; DeLuca, A.; Kosanke, N.; J Addict.Dis.; 20(4); 57-73; 2001.

"Contemporary alcoholics often use multiple substances, but there is little systematic research on this. This study examines the drug use comorbidity of alcoholics (DSM diagnosis, frequency and quantity of drug use); the relationship between drinking and drug use; the relative severity of alcohol- and drug-related problems; and the validity of reports of illicit drug use. Data on substance use were collected from 248 treatment-seeking alcoholics using an expanded Time-line Follow-Back (TLFB) interview validated with biological (urine and hair) specimens."
 

Predictors of Drinking Outcomes in Alcoholics by Staines, G.; Magura, S.; Rosenblum, A.; Fong, C.; Kosanke, N.; Foote, J.; DeLuca, A.; Amer. J. Drug & Alc Abuse Vol 29, No 1, page 203.

"Two psychosocial predictors were significant... a treatment motivation index and an index of 12-step (self-help) participation..."
 

Predictive Validity of the ASAM Patient Placement Criteria for Naturalistically Matched vs. Mismatched Alcoholism Patients by Magura,S.; Staines,G.; Kosanke,N.; Rosenblum,A.; Foote,J.; DeLuca,A.; Bali,P.; Am J Addict.; 12(5); 386-397; 2003.
[Abstract]

"This study examined the predictive validity of the ASAM Patient Placement Criteria for matching alcoholism patients to recommended levels of care. A cohort of 248 patients newly admitted to inpatient rehabilitation, intensive outpatient, or regular outpatient care was evaluated using both a computerized algorithm and a clinical evaluation protocol to determine whether they were naturalistically matched or mismatched to care. Outcomes were assessed three months after intake... 
Corroboration by more research is needed, but the ASAM Criteria show promise for reducing both detrimental undertreatment and cost-inefficient overtreatment"

 

Feasibility of matching alcohol patients to ASAM levels of care by Kosanke N; Magura S; Staines G; Foote J; DeLuca A.; American Journal on Addictions 11(2): 124-134, 2002. (14 refs.). [Abstract]

"The study examined the feasibility of implementing treatment recommendations derived from the American Society of Addiction Medicine (ASAM) Patient Placement Criteria in an urban addiction treatment program (Smithers) that offered a continuum of levels of care (LOC)...
Overall, 88% of the applicants entered treatment, and 72% of these were matched to LOC vs. 28% who were mismatched. Presumptive overtreatment (59%) was more common than undertreatment (41%) among the mismatched patients...
These results indicate multiple barriers that need to be overcome to enable full implementation of the ASAM Criteria in real world program settings, even when a continuum of care is available." 
 

[END: Series - Published Journal Article]

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SERIES:
Poetry and Miscellaneous
How to understand chronic pain (a poem) by Alex DeLuca, 12/16/2003.
 

"This was Your memory not Chronic. Not your fault. We all share this Most Essential

 

amoebas too. The Unspeakable to which we Respond. Simply unless we are insane So damaged
civilization Failed."

 

A Public Health Moment Photo Essay [DeLuca, 2003]:
Importing Milwaukee sewage sludge into the Croton watershed
--
"The Finest Biosolids Milwaukee Strains to Produce"
 

The truth about Oxycontin from a medical point of view  (a poem) by Alex DeLuca, 2001.
 
"Making sick people jump through hoops is damaging to the souls of those who hold up the hoops."
--
** December 12, 2003: Page reformatted. **
 

Acute Abdomen Land Theme Park by Alex DeLuca, 7/5/1999.
 
"Of course, 'Pain' is not the only ride in Acute Abdomen Land.
There is [also] the 'Opiate Analgesia Roller Coaster'...
"
 

[END: Series - Poetry, ect.]

[Top of Page]

SERIES:
Smithers-related Work
Spotlight On: The Smithers Evaluation Unit - by Alex DeLuca - One of the very few pages salvaged from what was the Smithers website - A rational front-end for assessment prior to treatment (another 'radical' idea <g>) - DeLuca, Foote, Taylor, Wilkens, et al.
 

What we accomplished at Smithers Treatment Center 1990-2000 - by Alex DeLuca, M.D.; 1998 & 2000; Smithers Addiction Treatment and Reseach Center.  -- Strategic plan leads to profitable research institute integrated into clinical services... Then all hell broke loose.

The following three works, though written at different times for different purposes together tell the story of what we intended to do, and what we actually accomplished, at Smithers 1990-2000:

Growth & Development of Smithers Treatment Center, 1990 - 1998 - - by Alex DeLuca, M.D., 1998 -- Our strategy and what we actually accomplished. This document was prepared for new incoming hospital administration so they would know what we were about so as not to ruin us. So, do you think it worked? <g>

And the following chart, which can be seen as a sort of epilogue to the Growth & Development piece:

Smithers Grants Obtained or Under Review as of July 7, 2000 when DeLuca was Fired

and the sick, sad postscript:

The Abstinence vs. Harm Reduction Follies of Summer 2000! (OR - Addiction Medicine Shoots Itself in the Foot, Again) - Compiled by Alex DeLuca, 2000. -- DeLuca's firing from Smithers, Kishline's MVA,  Corporate Cowards!, Tyrannical Philanthropists!, and the rise of Moderation Management in NYC.  

 

Is Smithers using "moderation management" in inpatient treatment? by Alex DeLuca, M.D.; 7/9/2000. [This was the last Smithers Ask-An-Addiction-Doc Q & A]

Note:
Before this site was doctordeluca.com, it was the unofficial website of Smithers Addiction Treatment & Research 1998-2000 when I was Chief and Medical Director there. Anyway, at that time, I offered a free 'Ask-an-Addiction Doctor' service; this document is the very last Ask-a-Doc answer, written and posted by me 7/9/2000 in the evening. I walked into work on the next morning, July 10, 2000, and was summarily fired and told to leave the premises. <sigh> I renamed the site domain doctordeluca.com, and the rest is, ahh, history. <g>
..alex...

The question and answer are, in their own right, interesting and worth reading perhaps, on the topic of "trials of controlled drinking" and peripherally about the dark alarms of intolerance that were sounding then, early in the summer of 2000.
 

[END: Series - Smithers-related Work]

[Top of Page]

SERIES:
War on Drugs, War on Doctors, Pain Crisis in America
Revised! - 2005-12-25
Opiate Rotation, Incomplete Cross-Tolerance, and Hyperalgesic Metabolites – Alexander DeLuca; 2001

Comment:

A brief essay describing the technique of 'opiate rotation' for chronic pain patients and the theory of hyperalgesic metabolites and 'incomplete cross tolerance' which underlie it. References given and discussed. Links to relevant articles provided.
 
See also:
Opioid Rotation in Patients with Cancer Pain - Bruera et al.; Cancer; 78(4); 852-857; 1996
Psychostimulants as Adjuvant Analgesics Bruera and Watanabe; J Pain Symptom Manage.; 1994
 
Revised! - 2005-11-05
Understanding Drug War Statistics #6: FLASH TRASH -
Alex DeLuca, M.D., MPH; 2004 / 2005
--
Flash Trash:  The use of suggestive or provocative numbers or statistics, usually presented as true prima facie, which, when analyzed using algebra, do not in fact support the implied conclusion. Flash Trash is inherently and purposefully misleading.
 
Comment:
Re-written with new introductory paragraph and a table with new examples of Flash Trash from modern cases in the War on Doctors, including Latimer, Hurwitz, and Edwin.
 
SARAM: the Society for the Abdication of Responsibility for Addiction Medicine - Alexander DeLuca, M.D., MPH; 2005-10-10 --
"[ASAM's silence in the face of] the complete abandonment of substance users and pain patients in the wake of Katrina confirms the American Society of Addiction Medicine’s absolute irrelevance to the public health, medical, and drug policy issues that ARE the substance abuse and pain crisis problems in America."

See also:
"Katrina Causes Wave of Addiction Problems"
and,
"Emergency Withdrawal from Pain Medicines in the Wake of Katrina"
 

Buprenorphine for combined pain and heroin dependence by Alex DeLuca, 2001 / 2003 / 2004.

"The pain/addict patients I treated with buprenorphine (n = 4) were all young, otherwise well, either working or students...  who could not afford either the time or expense of inpatient treatment. They were all able to discontinue heroin use without discomfort on relatively low doses that also provided excellent analgesia."

** July 26, 2004: Minor edits, reformatting, and print version fixed **
 

Towards a Coalition of People Oppressed by Prohibition DeLuca, Tartarsky, Cannon; 5th Nat. HR Conf.; 11/13/2004. -- "Pain patients, drug users, their doctors, people with alcohol problems and the general population who might someday suffer chronic pain or mental illness, are in common persecuted and discriminated against. How might we go about forming a socially and politically powerful coalition of people oppressed by prohibition?"

Comment:
Major Session presentation to 5th National Harm Reduction Conference in New Orleans. See also:

5th National Harm Reduction Conference Agenda
 

The War on Drugs, the War on Doctors, and the Pain Crisis in America:
Eighty Years of Naked Emperors

by Alex DeLuca, 6/4/2004; Revised: 8/13/2004
--
TABLE OF CONTENTS
--
"
It is argued here that prescription drug abuse is a trivial problem compared to under-treated chronic pain in this society, and one that would largely disappear were doctors permitted to freely treat addiction and pain... The myths of the criminal addict, of the perpetual drug crisis, and of  prescription drug problem caused by venal pill-pushing physicians are deeply [rooted in our society]. This genie will not be put back in the bottle in anything like the four years (1914 – 1918) it took to unleash it. "
--
** August 13, 2004:  Extensive edits; links in PDF fixed **
 

Understanding Drug War Statistics by Alex DeLuca, 2004  -- How the government justifies and makes drug policy by misrepresenting data, junk science, and very bad statistics.

UNDERSTANDING DRUG WAR STATISTICS - Table of Contents:
 
#1-Declare a Perpetual Crisis;  #2-Big Lies and Bullies;  #3-Junk Science Drives Policy;  #4-Outcome Obfuscation;  #5-Denominator Abuse;  #6-Flash Trash;  #7-Shock Schlock

 

Abstinence vs. Harm Reduction: a False Dichotomy by Alex DeLuca, 2000. --"Only in addiction medicine is it insisted that patients and staff hew to a ‘philosophy’ of ‘total abstinence’ rather than support appropriately individualized  treatment goals."

Written from the eye of a media firestorm in a moment of clarity and submitted to the NYT as an Op-Ed piece that was not accepted. This is when I stopped feeling bad and started feeling angry.
In my opinion, one of the best papers I've ever written. 
 ..alex...

 

Impact of Workplace Drug Testing Programs by Alex DeLuca, 2002. -- "If there is no workplace drug problem worthy of a costly response like national drug testing, or if significant problems exist but drug testing does not address them, then from a human relations point of view employee testing programs must be rejected as harmful, invasive and without redeeming merit. Is it not economically unjustifiable and morally irresponsible to promote the often indiscriminant use of an intrusive, stigmatizing, very expensive and arguably unconstitutional drug-testing technology whose efficacy has never been demonstrated?"
 

All the 'analysis'  the NY Times article, "Boon for Pain Suffers, and Thrill Seekers" deserves. by Alex DeLuca, 12/19/2003. Revised: 8/18/20004.

Comment:
My dopey, darkly humorous commentary is interspersed into the copy of this example of trash journalism.
See also:
Here is the article by David Musto  as published by the NY Times this  on 12/17/2003 (without my dopey comments)

--
** August 18, 2004:  Edits & extensively reformatted for  much improved readability. Print version also improved. **
 

"Analysis of a Wall Street Journal article: "Federal Agencies Seek to Curb Abuse of Potent Painkillers" by Alex DeLuca, 12/05/2003. "I have yet to see any evidence that this country has a "rising problem of abuse and addiction" of any sort, but particularly one related to the treatment of pain. 'DAWN mentions' and the like without appropriate denominators, which are not proper rates, are at best suggestive and are not 'evidence' of anything."
 

Analysis of "The Myth of the "Chilling Effect" by Alex DeLuca, 12/6/2003. -- a DEA News Release, 10/30/2003. -- I take this document as tangible evidence that advocacy groups like the Pain Relief Network and the Pain Patients Coalition are starting to make DEA a little nervous. "The title-statement is false, because the denominator chosen to compute rate statistic that it is based on is incorrect, an example of 'Denominator Abuse.' One can only conclude that this DEA press release is grossly and purposefully misleading."
 

Banging the Drums of the War on Drugs - SAMHSA's  misleading "analysis" of the 2001 DAWN Survey. by Alex DeLuca, 1/24/2003
 
[END: Series - War on Doctors]

[End]

 

Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM

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Originally posted:  2004-10-15

All Email to: adeluca@doctordeluca.com 

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Most recently revised: 2005-11-05
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