Our CDE Team
Gregory Skipper MD
Distinguished Fellow, American Society of Addiction Medicine, Board Certified Internal Medicine, Addiction Medicine
Dr. Skipper is a Fellow of the American Society of Addiction Medicine and a certified medical review officer. He previously served as medical director for the Alabama Physician Health Program and was on the council that created and oversaw the Oregon Health Professionals Program. Dr. Skipper was the primary innovator of ethyl glucuronide (EtG) testing and is an expert in alcohol biomarkers and drug testing. He was a principal investigator of the National Physician Health Program Blueprint Study, funded by a Robert Wood Johnson Foundation grant, and is the author of many articles regarding drug testing, physician health, and contingency monitoring. Dr. Skipper was formerly medical director of Springbrook Hazelden, and he was a chief advisor to the development of the professional’s program at Promises, Betty Ford Center and Bradford Health Services.
Matthew Goldenberg, DO
General and Addiction Psychiatry
Matthew Goldenberg D.O. is double board-certified in psychiatry and addiction psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and has provided addiction psychiatry consultations to some of the nation’s top addiction treatment programs. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He volunteers his time as a clinical instructor in the Department of Psychiatry at UCLA and is an assistant professor of psychiatry at Cedars Sinai Medical Center. Dr. Goldenberg completed an addiction psychiatry fellowship through UCLA, in Los Angeles, California, and psychiatry residency at Banner University Medical Center of the University of Arizona, in Phoenix, Arizona. He completed medical school at Midwestern University, Arizona College of Osteopathic Medicine, and is a native of Los Angeles.
Monica Faria, MD, FASAM
General and Addiction Psychiatry
Dr. Faria is Board certified in both General Adult and Addiction Psychiatry. She attended the University of Arizona College of Medicine, obtained her psychiatric training at Banner University Medical Center, and completed an Addiction Psychiatry Fellowship at UCLA. Dr. Faria is empathetic and highly skilled at treating individuals with substance use disorders and behavioral addictions such as gambling, sex and eating disorders. She understands the prevalence of trauma, mood, and anxiety disorders in patients recovering from substance and/or behavioral addictions. She advocates for the mental healthcare needs of physicians and healthcare professionals through various professional organizations, including the American Society of Addiction Medicine and the Federation of State Physician Health Programs. She is the former President of the Arizona Chapter of the Society of Addiction Medicine (AzSAM) where she emphasized prioritizing health and wellness in the healthcare professional community for several years.
Natalia Moss, PhD
Licensed Clinical Neuropsychologist
Dr. Moss is a licensed clinical neuropsychologist in California and New Mexico with extensive experience conducting neuropsychological and psychological evaluations across private practice, inpatient and outpatient hospital systems, and community health settings. She earned her B.A. in Psychology from UCLA, her M.A. in Psychology from Pepperdine University, and her Ph.D. in Clinical Psychology from the University of New Mexico.
Dr. Moss completed an APA-accredited predoctoral internship in neuropsychology at the University of New Mexico Health Sciences Center, where she conducted inpatient and outpatient neuropsychological evaluations and received specialized training in culturally informed assessment with Spanish-speaking individuals. She then completed a two-year postdoctoral fellowship in pediatric neuropsychology through The Help Group/UCLA Semel Institute for Neuroscience and Human Behavior within the David Geffen School of Medicine.
Dr. Moss approaches evaluations with a careful, collaborative, and evidence-based framework to help individuals and organizations make informed decisions and identify the most effective path forward.
Reuben Vaisman-Tzachor, PhD
Forensic Psychologist
Dr. Rueben Vaisman-Tzachor brings a wealth of experience and knowledge to the Center for Professional Recovery. He obtained his doctorate degree in clinical psychology from the California School of Professional Psychology in 1993 and has been a Licensed Psychologist since 1997. He has taught as an adjunct professor of clinical and forensic psychology at The Chicago School of Professional Psychology in Los Angeles and others for over 25 years and served as an Attending Psychologist at Cedars Sinai Medical Center in Los Angeles for 16 years.
Dr. Vaisman is a Fellow at the American College of Forensic Examiners Institute, a Diplomate of the American Board of Psychology Specialties in Clinical and Forensic Psychology, a Fellow at the American Psychotherapy Association and a Diplomate of the American Board of Certification in Homeland Security.
John Pustaver, MDiv, MA
Program Manager
John Pustaver, MDiv, MA, completed his undergraduate education at Arizona State University majoring in fine arts. Ordained to the priesthood in 1987, John served the Archdiocese of Los Angeles for ten years. Prior to electing to retire from the priesthood, John found his spiritual path within the 12-Step recovery community in 1992 while serving as spiritual director at the invitation of Patrick Carnes, PhD, at Del Amo Hospital's SDU unit (1992-1999). John then completed 60 hours of MFT coursework while working at the Betty Ford Center’s professionals program (2002-2014) He became the director of their Clinical Diagnostic Program after learning the science and art of conducting professional evaluations. John has been involved in professional assessments and treatment for 25 years and has found a unique way serving professionals in crisis. John’s responsibilities with the Center for Diagnostic Evaluations includes directing and overseeing our CDE process, the collection and review of collateral information, remaining in contact with referents and preparing the final summary report (Integrated Evaluation Summary) for the CDE Team.
The Center for Diagnostic Evaluations
Our Mission
At The Center for Diagnostic Evaluations, our mission is to provide thorough, medically sound and respectful evaluations for medical and other safety-sensitive professionals who are in need of a Multdisciplinary Comprehensive Diagnostic Evaluation. We strive to make our evaluees feel comfortable and cared for during every encounter.
Evaluation Goals
NATIONALLY RECOGNIZED
INDEPENDENT and UNAFFILIATED
(with any treatment program)
The goals of our Comprehensive Diagnostic Evaluation (CDE) process are threefold:
- Determine whether or not the evaluee meets current DSM criteria for any psychiatric disorder that may impact their ability to practice their profession with reasonable skill and safety.
- In the event the evaluee does meet current DSM criteria for a psychiatric, psychological, or cognitive condition, make appropriate treatment recommendations.
- Determine whether or not the evaluee is currently safe to practice or return to work.
Differential Diagnosis
Co-Occurring Substance Abuse and Mental Health Disorders
- Substance misuse does not occur in isolation for many individuals. It is common for substance use disorders (SUD) to coincide with other psychiatric disorders commonly known as a co-occurring disorder. Approximately 7.9 million U.S. adults were diagnosed with a co-occurring disorder in 2014, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Despite its prevalence, the complexity of symptoms in a co-occurring disorder requires expertise and experience with differential diagnosis.
Cause and Effect
- Determining how a co-occurring disorder develops can also be elusive. In some cases, the mental health disorder is present first, and the individual turns to drugs and alcohol as a means of managing their symptoms. Often referred to as "self-medicating," this process seems to offer some relieft - at first. However, if "self-medicating" with substances increases it will likely become its own problem, causing "the solution" to meet DSM criteria for SUD, mild, moderate, or severe.
Co-Occurring Disorders in the Professional World
- Medical professionals (physicians, dentists, pharmacists, nurses and physician assistants) usually struggle for some time to keep their difficulties a secret for many reasons including the fear of damaging their reputations. These individuals may be more apt to turn to drugs and alcohol in an attempt to manage the condition on their own. Once the substance use becomes problematic as well, a vicious cycle can ensue as the professional tries to hide both disorders from their peers, patients and clients. The consequences can be severe as many professionals find their careers and personal relationships in jeopardy over time.
Mental Health Disorders Commonly Seen with Substance Misuse
Depression
- This disorder is more than feeling “sad” or “blue” on occasion. Clinical depression is marked by extended periods of hopelessness and sadness, coupled with physical symptoms like lack of energy, sleep disruptions and chronic pain. Severe cases can also lead to suicidal thoughts and ideations. Substance abuse is a common byproduct as people struggling with depression might turn to stimulants to increase energy or alcohol, opioids or benzodiazepines to unwind after a busy day.
Anxiety Disorders
- Anxiety is a common byproduct of life, but when it starts to take over a person’s daily function, it may meet DSM criteria for a anxiety-related disorder. Anxiety disorders may be generalized, or they may pertain to fear of a specific event or object, such as a phobia. Severe cases may lead to a person avoiding certain places, things or situations to prevent the anxious feelings from surfacing. Professionals struggling with anxiety may find this disorder significantly impairs their ability to perform their jobs.
Bipolar Disorder
- Bipolar disorder is characterized by extreme mood swings, that might happen over a period of hours, days or months. High fluctuations or manic phases lead to increased energy levels, and possible irritability. Low swings or depressive phases might include decreased energy, feelings of hopelessness and thoughts of suicide in extreme cases.
OCD
- Obsessive-compulsive disorder or OCD is a condition in which a person is plagued with recurrent thoughts or obsessions. To control the thoughts, the person will adopt repetitive behaviors like handwashing, money counting or rechecking things. The actions are not welcome or pleasant, but they can become nearly impossible to stop without professional treatment.
PTSD
- Post-traumatic stress disorder or PTSD occurs after a life-threatening, traumatic event like an attack, vehicle crash or natural disaster. It is also commonly seen in war veterans that have experienced combat. The condition can appear months or even years after the event and is characterized by horrifying nightmares and flashbacks.
ADHD
- Attention-deficit/hyperactivity disorder (ADHD) are conditions that commonly present during childhood. However, the symptoms can persist into adulthood, making it difficult for some adults to maintain a steady job or have meaningful personal relationships. The presence of this brain disorder can also lead to low self-esteem and a lower quality of life.
Dr. Skipper's Publications
Dr. Skipper’s Publications
- Pham JC, Pronovost PJ, Skipper GE. Prevalence of Drug Testing Among Family Medicine Residents and Students: Much Needed Data. Journal of Graduate Medical Education March 2015, 128-130
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507906/ - Gordon A, Jaffe A, McLellan AT, Richardson G, Skipper GE, Sucher M, Tirado CF, Urschel H. How Should Remote Clinical Monitoring Be Used to Treat Alcohol Use Disorders?: Initial Findings from an expert round table Discussion. J Addict Med, 2017 Mar/Apr;11(2):145-153 2016 • Merlo LJ, Campbell MD, Skipper GE, Shea CL, DuPont RL. Outcomes for Physicians With Opioid Dependence Treated without Agonist Pharmacotherapy in Physician Health Programs. JSAT 64 (2016) 47-54
https://www.ncbi.nlm.nih.gov/pubmed/28157829 - Rose JS, Campbell MD, Yellowlees P, Skipper GE, DuPont DL. Family Medicine Physicians with Substance Use Disorder: A 5-Year Outcome Study. JAM 2016 6 pages 2015 • Yellowlees PM, Skipper GE, et al. Psychiatrists with Substance Use Disorders: Positive Treatment Outcomes From Physician Health Programs, Psychiatric Services in Advance, pgs. 1-4
https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201300472?code=ps-site - Skipper GE. The Impaired Professional Part III, Understanding Addicted Physicians, Counselor Magazine, October 2015, 17-18 2014 • Pham JC, Pronovost PJ, Skipper GE. California’s Proposition 46: A Wolf in Sheep’s Wool. Annals of IM, 16 December 2014, Vol 161(12), 913-914. https://issuu.com/hcibooks/docs/counselor_october_sneakpeek
- DuPont RL, Shea CL, Skipper GE, et al. The New Paradigm for Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatment. A White Paper Report of the John P McGovern Symposium. March 2014.
http://www.williamwhitepapers.com/pr/IBH%20Creating%20a%20New%20Standard%20for%20Addiction%20Treatment%20Outcomes%202014.pdf - Dammann G, Dursteler-MacFarland KM, Strasser H, Skipper GE, Wiesbeck GA, Wurst FM. Cannabis Use Among a Sample of 16 to 18 Year-old Students in Switzerland. Psychiatria Danubina, 2014:Vol.26, No. 1, pp56-65.
http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol26_no1/dnb_vol26_no1_56.pdf - Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular Photo Digital Breathalyzer for Monitoring Alcohol Use: A Pilot Study. Eur Addict Res 2014:20:137-142. Curriculum Vitae: Gregory E. Skipper, M.D. 7 of 21 pages • Rose JS, Campbell M, Skipper GE. Prognosis for Emergency Room Physicians with Substance Abuse Recovery: 5 Year Outcome Study. Western Journal of Emergency Medicine. Vol XV, No 1, Feb 2014. 2013
https://www.ncbi.nlm.nih.gov/pubmed/24335415 - Pham JC, Pronovost PJ, Skipper GE. Identification of Physician Impairment. JAMA. 2013;():1-2. doi:10.1001/jama.2013.4635. • Skipper GE. Substance Disorders: Best Practices in Drug and Alcohol Testing Across a Continuum of Care. Alere Toxicology. Monograph 2013.
https://www.ncbi.nlm.nih.gov/pubmed/23629590 - Wurst FM, Rumpf HJ, Skipper GE, Allen JP, Kunz I, Beschoner P, Thon N. Estimating the prevalence of drinking problems among physicians. Gen Hosp Psychiatry. 2013 Jul 5. doi:pii: S0163-8343(13)00139-4. 10.1016/j.genhosppsych.2013.04.018. [Epub ahead of print]
https://www.ncbi.nlm.nih.gov/pubmed/23835083 - Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: The Potential Role in Further Evaluating Low Positive Urinary Ethyl Glucuronide and Ethyl Sulfate Results. Alcohol Clin Exp Res. 2013 Sep;37(9):1582-6 doi: 10.1111/acer.12121. June 3
https://www.ncbi.nlm.nih.gov/pubmed/23731162 - Skipper GE. State Physician Health Programs Protect the Public – And Save Careers. Federation of State Physician Health Programs Newsletter. Feb 2013. Vol 18. Pgs. 4-5. 2012
http://www.fsphp.org/sites/default/files/pdfs/acfrogc0xziawry1re9ghkqebqwsy6upc9exddrgpg53k8xmy99yzsdzsw8n0yvptvq4autw25wds39kxvs80u8vxcdlauobj7a742mqraq7h504mtxkmn3r2v8xl-e.pdf - Skipper GE, Schenthal S. Special from Missouri Physicians Health Program. Sexual misconduct by professionals: a new paradigm of understanding. Mo Med. 2012 MayJun;109(3):184-6. No abstract available.
https://www.ncbi.nlm.nih.gov/pubmed/22860280 - Dupont RL, Skipper GE. Six lessons from state physician health programs to promote long-term recovery. J Psychoactive Drugs. 2012 Jan-Mar;44(1):72-8.
https://www.ncbi.nlm.nih.gov/pubmed/22641968 - Skipper GE, Williams J. Failure to Acknowledge High Suicide Risk among Veterinarians. Journal of Veterinary Medical Education, Issue 1, 2012, p.-1.
https://www.ncbi.nlm.nih.gov/pubmed/22433743 - Skipper GE, DuPont R, Martin D. A New Challenge for Drug-Free Workplace Programs. Journal of Occupational Health and Safety. Occup Health Saf. 2012 Feb;81(2):32, 34. Curriculum Vitae: Gregory E. Skipper, M.D. 8 of 21 pages 2011
https://ohsonline.com/Articles/2012/02/01/A-New-Challenge-for-Drug-Free-Workplace-Programs.aspx - Skipper GE, DuPont RL. The Advantages of Long-Term Monitoring. Addiction Professional. July 2011.
www.addictionpro.com/article/advantages-long-term-monitoring - Wurst FM, Thon N, Yegles M, Halter C, Weinmann W, Laskowska B, Strasser J, Skipper G, Wiesbeck GA, Dursteler-Macfarland K. Optimizing heroin-assisted treatment (HAT): Assessment of the contribution of direct ethanol metabolites in identifying hazardous and harmful alcohol use. Drug Alcohol Depend. 2010 Dec 7. (Epub ahead of print)
https://www.ncbi.nlm.nih.gov/pubmed/21145180 - Skipper GE, DuPont RL. The Physician Health Program: A Replicable Model of Sustained Recovery Management. (Chapter 17 pgs. 281-299) In: J.F. Kelly and W.L. White (eds.), Addiction Recovery Management: Theory, Research and Practice, Current Clinical Psychiatry, DOI 10.1007/978-1-60327-960-4_15, Springer Science+Business Media, LLC 2011
https://link.springer.com/chapter/10.1007/978-1-60327-960-4_15 - Skipper GE, DuPont RL. US Physician Health Programs: A Model of Successful Treatment of Addictions. Counselor: The Magazine for Addiction Professionals. Dec 2010. Vol 11(6) 22-30.
- Skipper GE. Medical Malpractice: Anatomy of a Lawsuit and Malpractice Stress Syndrome. Newsletter of the Missouri Physician Health Program. March 2010. Pgs. 2-8 2009
- Skipper GE. Confrontational approach has no role in addressing physician addiction. Mayo Clin Proc. 2009 Nov;84(11):1042-3.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770919/ - Skipper GE. In Response to letter to the Editor. Anesthesia and Analgesia. Volume X. Number X. 2010, pg. 1
https://journals.lww.com/anesthesia-analgesia/fulltext/2015/05000/Anesthesiologists_and_Substance_Use_Disorders___An.41.aspx - Skipper GE. The value of physician health programs. Alabama Board of Medical Examiners Newsletter and Report. October – December 2009, Volume 24, Number 4, pgs. 1-4
http://www.albme.org/Documents/Newsletters/2009V24No4.pdf - Skipper GE, Campbell MD, DuPont RL. Anesthesiologists with Substance Use Disorders: A 5- Year Outcome Study from 16 State Physician Health Programs. Anesth & Analg 109(3), Sept 2009, 891-896.
https://www.ncbi.nlm.nih.gov/pubmed/19690263 - Skipper GE, DuPont RL. Anesthesiologists Returning to Work after Substance Abuse Treatment. Anesthesiology, V110, No 6, June 2009 1426-28.
https://gregskippermd.weebly.com/uploads/7/4/7/5/74751/anesthesiologists_returning_to_work.anesthesiology.lte.skipper.only.pdf - DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of physician health programs. JSAT 37 (2009) 1-7.
https://www.ncbi.nlm.nih.gov/pubmed/19482236 - Skipper GE, DuPont RL. What about Physician Health Programs. The New Republic. January 18, 2009 Curriculum Vitae: Gregory E. Skipper, M.D. 9 of 21 pages
- Skipper GE, Liepman M, Wurst FM, Weinmann W. Breathing Vapor of Ethanol-Based Hand Sanitizing Gel Vapor Causes Positive Alcohol Marker, Ethylglucuronide (EtG), and Positive Breathalyzer. (Accepted for publication by Journal of Addiction Medicine 11/25/2008)
https://gregskippermd.weebly.com/uploads/7/4/7/5/74751/ethgelpaperjam.pdf - Skipper GE, Schenthal SJ. Professional Sexual Misconduct: A new paradigm of understanding. Alabama Board of Medical Examiners Newsletter and Report, 23(3), July-Sept 2008, 1-6.
https://gregskippermd.weebly.com/uploads/7/4/7/5/74751/psm.albme.pdf - Physicians and Medical Workers, Substance Abuse Among. Encyclopedia of Drugs, Alcohol & Addictive Behavior, 3rd ed., Macmillan Reference USA, 2008, Vol 3, pages 242-251
- McLellan AT, Skipper GE, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008 Nov 4;a2038, doi:10.1136.a2038.
http://www.bmj.com/content/337/bmj.a2038 - White, W.L., DuPont, R.L., Skipper, G.E. (2008). Physician health programs: What counselors can learn from these remarkable programs. Counselor Magazine, June 27, 2007, 44-51
http://www.williamwhitepapers.com/pr/2007PhysicianHealthPrograms.pdf - Skipper GE, DuPont RL, White WL. Testing for Recent Alcohol Use. Perspectives – the Journal of the American Probation and Parole Association. 2008(32)3, 38-45
http://www.williamwhitepapers.com/pr/2008RecentAlcoholTesting.pdf - DuPont RL, Skipper GE, White WL. Testing for Recent Alcohol Use. Student Assistance Journal. Spring 2008 12-18
http://www.williamwhitepapers.com/pr/2008RecentAlcoholTesting.pdf - DuPont RL, Skipper GE, White WL. Testing for Alcohol Use. Counselor Magazine. April 2008(9) 44-51. • DuPont, R.L., Skipper, G.E. & White, W. L. (2007). Testing for recent alcohol use. Employee Assistance Digest, Winter2007,28(1), 15-21 2006
https://www.researchgate.net/publication/265480652_Testing_For_Recent_Alcohol_Use - Skipper GE, Schenthal S. Professional Sexual Misconduct – A Primer. Published on the Web, www. Professionalboundaries.com 2005
http://www.themphp.org/Archive/Articles/tabid/98/ArticleID/214/Professional-Sexual-Misconduct-A-new-paradigm-of-understanding.aspx - Skipper GE, Brase DA. Tramadol Abuse and Dependence among Physicians. JAMA. 2005; 293:1977-1978 2004
https://www.ncbi.nlm.nih.gov/pubmed/15494578 - Skipper GE, Fletcher C, Rocha-Judd R, Brase D. Tramadol Abuse and Dependence among Physicians. JAMA. 2004;292:1818-1819
- Skipper GE, Weinmann W, Wurst FM. Ethylglucuronide (EtG): A New Marker to Detect Alcohol Use in Recovering Physicians. Journal of Medical Licensure and Discipline, 2004,90(2), 14-17
http://www.ushealthtests.com/etg-testing-for-recovering-physicians.pdf - Skipper GE, Weinmann W, Theirauf A, Schaefer P, Wiesbeck G, Allen JP, Miller M, Wurst FM. Ethyl Glucuronide: A Biomarker to Identify Alcohol use by Health Professionals Recovering from Substance Use Disorders, Alcohol Alcohol. 2004 Sep-Oct;39(5):445-9. Epub 2004 Aug 2. Curriculum Vitae: Gregory E. Skipper, M.D. 10 of 21 pages
https://academic.oup.com/alcalc/article/39/5/445/203846
Wurst FM, Alexson S, Skipper GE, Wiesbeck G, Wolfersdorf M, Marques P, Metzger J, Gilg T, Weinmann W (2004) Fatty acid ethyl esters, ethyl glucuronide and methanol in the serum of alcoholics during detoxification. Alcohol Clin Exp Res 28:157A
https://hero.epa.gov/hero/index.cfm/reference/details/reference_id/1156005 - Skipper GE, Schaefer P, Thierauf A, Weinmann W, Allen JP, Miller M, Wiesbeck GA, Wurst F M (2004) Detection of Surreptitious Alcohol Use Among Health Professionals Recovering from Substance-Related Disorders Using a New Marker, Ethyl Glucuronide. Addiction (submitted 12/03; #03/427)
https://www.sciencedirect.com/science/article/pii/S1044030503007657 - Wurst F M, Skipper GE, Weinmann W (2003) Ethyl glucuronide – the direct ethanol metabolite on the threshold from science to routine use. Addiction 98 (Suppl 2) 51-61
https://www.ncbi.nlm.nih.gov/pubmed/14984242 - Wurst F M., Vogel R., Jachau K., Varga A., Alling C., Skipper G.E., Alt A. (2003) Ethyl glucuronide detects recent alcohol use in forensic psychiatric inpatients. Alcohol Clin Exp Res 27: 471-476
https://www.ncbi.nlm.nih.gov/pubmed/12658113 - Journal highlight ACER 03/2003, Feature story: www.eurekalert.com. (American Association for the Advancement of Science)
https://etg.weebly.com/uploads/7/4/7/5/74751/etg_advisory.2005.09.pdfWe are committed to serving our community. That's why we offer a variety of outreach programs, including health fairs, free screenings, and educational events.