Back in 1975, when he was working toward a master's degree in public health administration at Johns Hopkins University, Howard "Chip" Silverman wrote a thesis on "The Function of the Bureaucracy on the Treatment of Drug Abuse."
"It was a piece that showed the frustration, the cynicism and the folly of some of the ways that the bureaucracy was treating what's become the No. 1 public health crisis in this country," says the 48-year-old Baltimore native, who worked for the last 20 years in the state bureaucracy.
To be fair, Mr. Silverman, who until last month was Gov. William Donald Schaefer's adviser for substance abuse policy, found his years with the state fulfilling and only occasionally frustrating.
So why leave the governor's office to direct policy and planning for chemical dependency programs at Green Spring Mental
Health Services Inc. in Columbia?
"You have to go back a little bit in time," he begins.
Beware when Chip Silverman says that: the answer could take some time. A natural storyteller, the part-time journalist and TV producer recently published "Diner Guys," an account of his years growing up with the Forest Park gang that inspired Barry Levinson's movie, "Diner."
He's still more comfortable telling stories than explaining career decisions.
But the long and short of it is that he sees the drug problem as resistant to any one treatment, and he thinks Green Spring, a Blue Cross subsidiary, has the right approach.
Green Spring handles mental health, alcohol and substance abuse the way health maintenance organizations began handling other illnesses decades ago: It subjects doctors' treatment decisions to the review of managers, with an eye toward providing the proper care and cutting costs. That often means a mix of treatments for a patient, rather than the traditional 30-day hospital stay.
Critics, including some private psychiatric hospitals, say that approach ignores patients' needs in the quest to save money. And they bristle at Green Spring's practice of both reviewing doctors' treatment decisions and providing treatment on its own.
The potential conflict, they say, is that Green Spring, the reviewing agent, could deny inpatient treatment for patients and then send them to Green Spring, the outpatient mental health care provider.
Mr. Silverman says that when Green Spring reviews treatment decisions for a patient, it does not recommend its own facilities.
"I think one of the reasons I was brought on board was to kind of work with these [critics]," because of his reputation in the public sector, he says.
Mr. Silverman joined the state health department in 1970, rose to deputy director and then director in 1985 of the state's Drug Abuse Administration.
In 1987 he became acting director of the merged Alcohol and Drug Abuse Administration before he joined the governor's office in 1988.
He says he'll also be doing some lobbying in Annapolis for Green Spring.