Okay, we get it! Terry Cline, PhD, is very well qualified to lead the Substance Abuse and Mental Health Services Administration, but in the March Monitor article “A chance to help many,” I would have liked to have learned a little bit about his clinical opinion on substance abuse treatment itself, as well as how he thinks recovery will be best achieved at the patient level.

It is admirable, of course, for him to seek a “radical transformation,” which will build “people’s resiliency” and promote their “recovery” from substance abuse and mental health issues, but I’d love to hear how he has seen that done well or successfully, either through his own clinical work, or through those he’s supervised. I’m a psychology intern at a large facility where substance abuse treatment is critically important and much debated, and I am still searching for answers. More money to hire experienced clinicians will help, but does Cline subscribe to a particular effective treatment, and what is it?

Emily Britton
Berkeley, Calif.

Trauma diagnosis

The article “A new diagnosis for childhood trauma?” in the March Monitor describes a very important proposal to address the damaging effects of severe trauma on children.

It is thus particularly disappointing to notice that in the attached listing of current trauma diagnoses there is no mention of Acute Stress Disorder, a Diagnostic and Statistical Manual (fourth edition) diagnosis that bydefinition requires trauma and that can be applied to children, nor of the various dissociative disorders, which have been consistently associated with trauma in dozens of studies with children and adults. The research and clinical work by Frank Putnam, MD, Glenn Saxe, MD, Lenore Terr, MD, and many others on the dissociative post-traumatic sequelae on children bear mention in this regard.

The fact that there is also no mention of dissociation in the discussion of dysregulation is also bewildering. We hope that future discussions about this important proposal will show greater awareness of the cardinal aspect of dissociation as a potentially pathological reaction to trauma among children.

Etzel Cardeña, PhD
Lund University, Sweden

Peter Barach, PhD
Case Western Reserve University School of Medicine, Cleveland

Lisa Butler, PhD
Stanford University

Catherine C. Classen, PhD
University of Toronto

Christine A. Courtois, PhD
Washington, D.C

Robert Geffner, PhD
Alliant International University, San Diego

Frank W. Putnam, MD
Mayerson Center for Safe & Healthy Children, Cincinnati Children’s Hospital Medical Center

Joyanna Silberg, PhD
Sheppard Pratt Hospital, Towson, Md.

David Spiegel, MD
Stanford University

Onno van der Hart, PhD
University of Utrecht, Netherlands

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