New York Times: take it from America’s top drug expert, youth are doing better – if we distort findings, ignore surge in opioid deaths, hide the exploding youth substance use epidemic whose health effects eclipse those of all others combined

by Clark Miller

Published June 21, 2024

Historically speaking, it’s not a bad time to be the liver of a teenager. Or the lungs.

Regular use of alcohol, tobacco and drugs among high school students has been on a long downward trend. . . .

What’s the big picture on teens and drug use?

[Volkow] – “People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades. And that’s worth saying, too, for legal alcohol and tobacco.” . . .

Is it too simplistic to see the decline in drug use as a good news story?

[Volkow] – “If you look at it in an objective way, yes, it’s very good news. Why? Because we know that the earlier you are using these drugs, the greater the risk of becoming addicted to them. It lowers the risk these drugs will interfere with your mental health, your general health, your ability to complete an education and your future job opportunities. That is absolutely good news.

But we don’t want to become complacent.

The supply of drugs is more dangerous, leading to an increase in overdose deaths. We’re not exaggerating. I mean, taking one of these drugs can kill you.”

So you see? The news is very good overall, we’ve been  quite successful in reducing use and risks associated with use of mood-altering substances for teens and youth, and the evidence supports this. That’s  according to America’s top drug expert and as fact-checked by the national paper of record, the New York Times. 

Sure, there are some concerns and unpredictable changes in the trajectory of substance use by young people, including the doubling of opioid overdose deaths for teens from 2019. Reassuringly, America’s top drug expert has a response for that anomaly in an otherwise impressive picture painted for us of young people bucking epidemic trends and their worsening mental health trends to just say “no” to drugs: the message to those youth that using drugs is “dangerous”, and “taking one of these drugs can kill you”. So don’t do that! Right? That should actually help, right?

No disrespect, but another point on which America’s top drug expert and America’s top newspaper appear ungrounded, disconnected from reality and widely available evidence, that is, are engaging in reckless and lethal distortions – or, as a crude and uncivil person might say, lying to hide the abject failures of their institutions to understand and provide effective responses to worsening substance use epidemics – is the suggestion that the picture for youth regarding nicotine use, dependence, and potential for health costs has improved, with lowered risk of harm. 

Vaping teen

What does our top expert have to say?

What about vaping? It has been falling, but use is still considerably higher than for cigarettes: In 2021, about a quarter of high school seniors said that they had vaped nicotine in the preceding year. Why would teens resist cigarettes and flock to vaping?

[Volkow] – Most of the toxicity associated with tobacco has been ascribed to the burning of the leaf. The burning of that tobacco was responsible for cancer and for most of the other adverse effects, even though nicotine is the addictive element.

What we’ve come to understand is that nicotine vaping has harms of its own, but this has not been as well understood as was the case with tobacco. The other aspect that made vaping so appealing to teenagers was that it was associated with all sorts of flavors — candy flavors. It was not until the F.D.A. made those flavors illegal that vaping became less accessible.

My argument would be there’s no reason we should be exposing teenagers to nicotine. Because nicotine is very, very addictive.

It may be worth noting if not obvious from that exchange that it does seem that America’s top drug expert – apparently absent the capacity to integrate, critically think about, and offer insights directly related to forces contributing to problem substance use and its successful prevention and treatment – serves instead in the role of offering a jumble of factoids and what would have to be accurately described as a platitude –

My argument would be there’s no reason we should be exposing teenagers to nicotine. Because nicotine is very, very addictive.”

Whhaaat? That’s the “argument”? Because so many others these days are advocating that instead we should be “exposing teenagers to nicotine”? Because we have ways to either continue allowing or stop the  exposure of teens to nicotine? Is this real, these statements? 

And can anyone please discern and describe how that statement – in the context of teen use of traditional cigarettes (“smoking”) having plateaued after decades of decline without further decline since vapes came on the scene; of 2 million young people having started use of vape devices to administer nicotine in much higher concentrations than received by smoking; of accumulating, consistent evidence that to the extent nicotine vaping is controlled and reduced, young people are returning to smoking (more below on all of these points) –  is any different from a more succinct rewording like, “We shouldn’t be having teens use nicotine! Drugs bad!”

Another rent, a tear, an unraveling in the Matrix, revealing what is behind it. 

The Matrix image

Let’s take a look at that substantive vacuum of a response in the context of what the evidence says about risks to youth regarding trends and factors related to use of nicotine by traditional means like combustible cigarettes as well as its administration using electronic devices to vaporize a soluiton (vaping). 

We wouldn’t want to be taken by surprise if a population become dependent on nicotine by methods advanced, enabled, and/or implemented by medical and health institutions as harm reduction or treatments created a latent nicotine epidemic with crisis-level health consequences.

That is, we wouldn’t want those institutions to repeat their roles in the opioid crisis, right?  

As Dr. Volkow accurately notes, nicotine whether delivered by inhaling the combustion products of tobacco in a traditional cigarette, as vaporized in an e-cigarette, or by other means is a powerful mood-altering substance whose compelled use easily, predictably leads to dependence. Not, of course, simply or largely by a neurochemical “hijacking” of the brain, a long-debunked fiction that has always been absurd on its face.  Instead, and overpoweringly so for youth especially, by a complex set of psychological associations, drives and needs tied to distorted beliefs and interpretations, adverse childhood experiences (ACE) including trauma, desperately felt, healthy social needs, and other factors. That is, focus on whose compelled use in “powerful mood-altering substance whose compelled use easily, predictably leads to dependence”, above. 

In fact, we do know quite a bit about the direct effects of nicotine in addition to its mood-altering contribution to dependence, and it’s not good. As explained and documented over past years in multiple posts here, a confluence of trends and factors has been driving a predicted, latent diabetes epidemic in young people –

–  Incidence of vaping nicotine has been exploding among youth for years, notwithstanding almost certain underreporting by self reports as “crackdown”, severe consequences are  increasingly threatened in schools and elsewhere. 

–  Delivered concentrations of nicotine are multiple times as great in the favored e-devices than in traditional cigarettes

–  Nicotine is established as directly affecting insulin resistance, and inhalation of nicotine is correlated with increased incidence of pre-diabetes and type 2 diabetes. 

So vaping, not so long ago in America’s top medical journal and persistently hailed as a form of harm reduction or falsely as effective means to stop use of cigarettes, instead has introduced (2 million and counting)  and resulted in dependence (for at least 25 percent of those 2 million who are daily users) on nicotine for a new generation of youth.  

Worse than that, as regulators belatedly and ineffectively crack down on flavored vapes, a body of evidence predictably accumulates affirming that nicotine vapers move back to use of traditional combustible cigarettes, that evidence outlined in the upcoming post “THE VAPE TRAP”.

That’s not smoking cessation, or treatment, or harm reduction.

teenaged girl vaping

So, populations of users, having become dependent on the relieving effects of a chemical substance, vulnerable to the absence of its effects, will actually  switch to alternate forms and sources, alternate formulations, forms and chemical cousins for gaining relief from that chemical substance? And switch again? Who knew? 

This does sound familiar doesn’t it? Harm reduction, addictive drugs to quit drugs, safer supply? A lethal trap. 

But what about those “long downward trends” 

that illustrate how much drug-related risk is lowering for youth?

They came from the Monitoring the Future report that surveys 8, 10 and 12th grade students in the U.S. each year. What does that report tell us about risk related to regular or problem use of mood altering substances by youth? 

I haven’t made a thorough reading or evaluation of the report, enough to see that that is not necessary. 

Some aspects of the methods include: 

–  Only young people attending school are included

– Surveys are completed in school during class hours, with unknown inclusion of students attending sporadically

– Students dropping out of school prior to graduation are excluded

– For minor students (less than 18 years of age)  signed informed consent is required by parent(s), with unknown filtering related to level of family stress and dysfunction; neglect; incapacity; or wariness, mistrust, or other inhibiting factor. 

Get the picture? Right, that’s called selection bias, and the ways these biases would affect outcomes seem predictable. 

Take a look at the drop-down in the interactive graphical collection of results for all substances surveyed for. Note that some substances that don’t appear are gabapentin, benzodiazepines, opioid, and fentanyl. 

That raises the question: How can we explain and award confidence to the external validity (accuracy) of the MTF survey results in the context of a doubling among teens in lethal overdose incidence from 2019 to 2020 and remaining at that level without the survey results indicating any increases in opioid use or other drugs? 

Because “fentanyl” or “opioid” were not surveyed? Because of inherent flaws in survey methods? 

From the NYT piece – 

There are some sobering caveats to the good news. One is that teen overdose deaths have sharply risen, with fentanyl-involved deaths among adolescents doubling from 2019 to 2020 and remaining at that level in the subsequent years.

For drugs that are prescribed vs illicit, students are asked to answer for their use if the substance was not prescribed to them, that is illicit use.

Here’s one substance that does not fit the long downward trend pattern – ADHD stimulants.  

graph of trends in illicit teenage use of ADHD stimulants

The scale for this graphic mutes what appears to be an uptick in prevalence of use beginning 2021 for both grades surveyed. 

That would appear to be congruent with longstanding, now rampant, misdiagnosis, misprescription, and abuse for these stimulant medications for youth and adults. 

There is another substance of abuse not included in the MTF survey,

and its compulsive use by young people is fueling two epidemics, the associated morbidity, mortality and public health costs eclipsing those of all other substances combined.

Food, particularly high-sugar, high-fat, high-calorie foods, used compulsively by youth and adults to provide soothing escape from inner distress – just like a “drug” – is driving youth obesity and diabetes epidemics in the U.S. and elsewhere in the world, with recent reports that in the U.S.  childhood obesity rose from 5 percent in the early 1960s to 19 percent in 2019, and that “some reports estimate 57 percent of children between the ages 2 and 19 will be obese as adults in 2050″.

obese child

It turns out, as is generally recognized without need for research, that “overeating”, binge  eating, eating compulsively with unwanted weight gain, are driven by emotional states and associated cognitive material that the ingestion of food and associated changes are soothing, providing moderation of the distressing inner state. And in fact, as explained in this post  from 2018, is no different than compulsive use of other substances, “drugs” – 

But it’s the Hidden Addiction 

that will overwhelm all others combined as measured by illness, deaths, public health costs, and contribution to a continually worsening national substance use epidemic – and in providing evidence for the lethal failure resulting from control of substance use understanding and treatment over past decades by the Medical Industry and Medical Model.

Considering the key features that describe a substance use disorder –

behaviors involved in use

primacy of and understanding of underlying distress or discomfort as driving the compulsive behavior

neurobiology – how the brain is involved

the psychology related to urges and associations

and types of associated emotional states and social distress

– compulsive use of the substance food leading to obesity and harmful health effects effects is not different from compulsive use of other mood-altering substances, recognized for some time, for example here:

Below are the diagnostic criteria for substance use disorder, from the DSM 5, or Diagnostic and Statistical Manual of the American Psychiatric Association – the criteria used to diagnose any substance use disorder from heroin to methamphetamine. In clinical interview, patients meeting a minimum of 2 of the criteria are diagnosed with the disorder, in this case Food Use Disorder, falling under the DSM 5 category of “Other Substance-Related Disorders”.

A substance use disorder is assigned a level of severity according to number of criteria met:  2 – 3 = LOW    4 – 5 = MODERATE    6+ = SEVERE.

For Food Use Disorder, there is lack of clarity about the potential for tolerance and the experience of withdrawal symptoms, due to lack of research and barriers to recognition as an included, named disorder – barriers unrelated to the evident nature of compulsive, maladaptive use of food as a substance use disorder like any other, instead  understandable on other grounds, cultural and institutional.

The DSM 5 criteria:

1  The substance is often taken in larger amounts or over a longer period than was intended.

2  There is a persistent desire or unsuccessful effort to cut down or control use of the substance.

3 A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.

4  Craving, or a strong desire or urge to use the substance.

5  Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.

6  Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.

7  Important social, occupational, or recreational activities are given up or reduced because of use of the substance.

8  Recurrent use of the substance in situations in which it is physically hazardous.

9  Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

10  Tolerance, as defined by either of the following:

    • A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of the substance.

11  Withdrawal, as manifested by either of the following:

    • The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance).
    • The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.


Healthcare professionals and nonprofessionals will recognize that for adults, adolescents, and children commonly encountered and struggling with obesity or overweight, many or most of the criteria for a substance (food) use disorder will be met, indicating diagnosis of Food Use Disorder.

But Food Use Disorder, a clearly valid DSM 5 diagnosis under published criteria, is never, that I have observed, (apart from in my own assessments) diagnosed. Why not? – more about that in an upcoming post.

“Stress eating” is established in children and adults

Jääskeläinen et a l. Stress-related eating, obesity and associated behavioural traits in adolescents: a prospective population-based cohort study. BMC Public Health 2014, 14:321

Sominsky L, Spencer SJ. Eating behavior and stress: a pathway to obesity. Frontiers in Psychology. 2014;5:434. doi:10.3389/fpsyg.2014.00434.

Haines et al. International Journal of Behavioral Nutrition and Physical Activity (2016) 13:68 DOI 10.1186/s12966-016-0393-7

Critically, the social and healthcare costs of Food Use Disorder are and will increasingly eclipse and overwhelm systems, social resources, and effects of all other substance use disorders combined – more so the longer it remains hidden, denied – for the obvious reasons that don’t require links to research: the consequences of an obesity epidemic for a range of serious health  risks and illnesses, including as a primary risk factor for diabetes, now predicted to become the greatest healthcare epidemic ever.

Back to our current post – 

If there is concern that the concept of “food addiction” or “food use disorder” is suspect because it is outside of orthodox scientific, medical, institutional, media-messaged,  and cultural understandings of truth and legitimacy – that is, outside of American institutional and cultural pathology – corrective facts awarding it legitimacy and validity inlude that  it definitely is outside of orthodoxy, of doxa, and its proponents represent and are relegated to a small segment of marginalized heterodox thought precisely because their formulation and s assertions are grounded in evidence and capacity for critical thought and intellectual courage. As here – 

The authors reason – 

In the evolving landscape of mental health diagnostics, the Diagnostic and Statistical Manual of Mental Disorders (DSM) stands as the cornerstone. While it is far from a perfect tool, its revisions shape clinical practice and legitimize acceptance of mental health conditions that affect large numbers of patients. Without an accurate diagnosis, patients will continue to experience undue stigma, misdiagnosis, and poor prognosis.

With DSM-6’s anticipated release in the next few years, there is an urgent need to legitimize food addiction — also known as ultra-processed food addiction (UPFA), or the preferred term for DSM-6, ultra-processed food use disorder (UPFUD) — under the current substance- and addiction-related disorders category. . . .

Research using neuroimaging techniquesopens in a new tab or window has revealed neural responses to highly palatable foods similar to responses to addictive substances like cocaine and heroin.

Moreover, individuals with food addiction often exhibit behavioral patternsopens in a new tab or windowconsistent with addiction, such as tolerance (needing more of the substance to achieve the same reward), withdrawal symptoms (negative emotions or physical symptoms when cutting back), and continued use despite negative consequences (such as disordered eating, depression, or obesity-related health issues). These parallels underscore the urgent need to recognize food addiction as a legitimate psychiatric disorder deserving of research, public policy changes, clinical attention, and treatment.

There are a few medical professionals willing and with the clinical and ethical competence and courage to put forward the heterodox truth that predicts harm to kids exposed to dominant medical model approaches – about as many as there have been willing to expose their true role in the opioid crisis.

As here.  

The utter, lethal failure of America’s medical healthcare model and its experts to explain or provide effective prevention and treatment approaches for youth problem substance use, as illustrated by the reductionist,  biomechanical factoids and fabrications deconstructed in this post, likewise drives adult opioid and other crises worsening by medicalization of entirely non-medical conditions. That failure is intractably tied to evidence-free constructions of mechanistic fictions of “drugs” “hijacking brains” to cause a condition “addiction” – usefully and lethally hiding the latent youth, and adult, compulsive substance use problem that is eclipsing all others combined. Because that medical model does not recognize substances concocted in labs and manufactured for ingestion with high, harm-predicting levels of refined sugars, fats, flavorings and calories to manage, moderate a compulsive need to soothe inner distress – does not recognize those as “drugs”.

A drug affecting a brain, like a cue ball affecting an 8 ball, our experts and institutions can understand, but the real, complex, developmental, psychological, psychosocial, individually unique sets of factors compelling kids and adults to use substances and behaviors in self-defeating and lethal ways are completely beyond them. 

We are “exposing teenagers to nicotine”, everywhere they look, largely by virtue of  years of expert and public health campaigns that promote vaping normalized as harm reduction. Exposing them in real and virtual worlds alike, adults exposing them, modeling the new trend, engaging in the lethal “harm reduction” championed by the same consensus of  experts, institutions and media that gave us and is worsening the opioid crisis.

But the exposures that ultimately explain compulsions to use dangerous substances lie deeper, have developmental histories, and are not exposures to the substances themselves or their use. Essentially all kids in our world and culture are exposed to problem substance use directly in their families, or other social settings, everywhere in media,  and to violence, real and dramatized. Only a minority will go on to engage in persistent, serious problem substance use and a smaller minority in violence. That should drive our understanding of the non-medical condition. 

It’s not the modeled nicotine use or its brain effects, instead the inflicted and internalized psychological and emotional injuries, insults, and developmental deprivation of capacity for self-soothing. It’s the deprivation of learned immunity by self-reguilation to desperate compulsions to ingest, inhale or inject something to escape inner distress. It’s the need to demonstrate and assert in reactive ways deprived autonomy and control, drives that are fundamentally healthy and too often ultimately self-defeating.  

For kids, not so much the nicotine exposure as their exposure to their own families enacting adverse childhood experiences  (ACE) that generate vulnerability to problem substance use. And exposure, everywhere they look, to signs of the adults in control of things, adults trying to control them, while altering their own moods with their misprescribed Adderall, Seroquel, gabapentin, opioids, other drugs, adults recklessly destroying the cultural and natural worlds they brought children into, signs every day in kids’ media feeds.

child sitting alone head bowed

Family, developmental, and social pressures and insults are already overwhelming and instilling developmental and psychological vulnerabilities in kids, then increasingly intensified by exposure to, for example, the rank hypocrisy of adults “cracking down” on youth vaping while engaging in their own substance use driving runaway epidemics, or getting their kids  their own misprescribed Adderall so they can settle down, preform better, be less trouble, and avoid uncomfortable real treatments for the real anxiety and PTSD arising in the family. 

The kids are not feelin’ the love, or confidence in much of anything in the world adults have created for them – they see the news too – and they are sending you a message, louder the more unheard, while parents try to medicate away something that cannot be medicated.

Their deepest inner drives – for love, attention, respect, affirmation, safety, and autonomy – are healthy and when denied and unmet get expressed behaviorally with understandable defiance, escape, compulsive altering of mood, opposition, and anger, the more they are neglected, denied, blocked. 

When’s the last time a medical professional or addiction expert talked to you about that? 

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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