EFFECTIVE SUBSTANCE USE TREATMENT REQUIRES ENDING ALL FUNDING AND TREATMENT FOR “ADDICTION”, A FABRICATED CONDITION THAT DOES NOT EXIST
By Clark Miller
Published October 18, 2018
Updated April 7, 2021; January 5, 2022
The fabricated condition (or “disease” or “disorder”) of “addiction” is a made-up fiction that represents no real condition; was never supported by evidence; drains and diverts public healthcare funds and resources away from longstanding, evidence-based psychotherapies to treat the forms of inner distress driving compulsive substance use; helping to fuel worsening, lethal public health epidemics – yet crucially protects and maintains harm-predicting entitlement programs including “rehab”, “addiction treatment” and “addiction medicine”.
That is to say, it is an indispensable, lucrative and unquestioned fabrication, like those generating and maintaining American Medicine and Big Pharma’s gold mine opioid crisis.
Addressing increasingly lethal substance use epidemics requires shutting down the criminal scams misusing public funds and then re-allocating resources to the longstanding evidence-based effective behavioral health and psychosocial therapies and supports, especially and increasingly focusing on indicated prevention strategies.
The predictable and avoidable Opioid Crisis and its causes (fundamentally the lapse and abdication of: ethical, professional, and social responsibilities for research-informed practice; for protection of public health; and for oversight and regulation of health practices) rather than fluke or exception are in fact part of a pattern of medical and managed care industry gross malfeasance that includes use of public funds and resources for
1) medical interventions to stop smoking that are ineffective and counterproductive
2) prescribed opioid substitutes for the opioid crisis that are not supported by research as treatment at all for problem opioid use and
3) a never-supported, fictional “disease” model of addiction, invalidated by all longstanding, relevant lines of evidence, and predicting treatment outcomes that are at best without benefit, or harmful, helping to fuel a national substance use epidemic.
But more fundamentally harmful than those assaults on public health is the falsehood that there exists a condition, or disease, or disorder – “addiction”
Harmful because that fabrication drives everything else:
public perception of the nature and effective treatment of addiction
diversion of public funds and resources away from potentially effective research, infrastructure, program development, community and most importantly prevention programs
identification and development of effective prevention campaigns, public health epidemics and outcomes, and more.
A previous post outlined the deconstructed and invalidated status of the fictional, constructed condition “addiction”. Part of that deconstruction is the status of the “disease” or “hijacked brain” fiction of problem substance use, invalidated by all lines of relevant evidence yet, like the odd, decades-old, and countertherapeutic prescriptions of a religious subculture, forming the dominant influence on use of resources and “treatment” approaches for a compulsive behavior – over the same period that national substance use epidemics have progressively worsened.
Previous posts at have explained why current, long-established components of addiction treatment are not treatment at all, instead predict no benefit, or harm – predict current, worsening public health crisis and substance use epidemics.
Here, we’ll focus on a preliminary outline of necessary changes in thinking, policy, and clinical practices to begin to move away from harm-creating entitlement programs and toward longstanding evidence-based psychotherapies to treat the behavioral health conditions driving the behavioral symptom of compulsive use of substances.
The fiction that there is a condition or disorder accurately and clinically describing compulsive substance use
and its causes has usefully enabled an associated fiction that has generated the current state of “treatment” as usual (TAU) and policy for substance use problems. Decades of implementation – funded by public healthcare resources – of those fictions as if they represented actual treatment approaches and whose purpose instead is to protect power, status, and control of healthcare resources, explain and predict histories of failed outcomes, lack of gains in understanding and treatments, instead continuously worsening public health epidemics and mounting deaths, concurrently with decades and $billions in public resources diverted to the dependent entitlement programs and criminal treatment scams.
The fiction associated with and dependent on the made-up falsehood that there is a “condition” or disease, or disorder (“addiction”) is that there exist appropriate and effective treatments – standardized, non-individualized, medical, medication, non-professional, and religious faith-healing (yes, in fact the 60-year-old religious prescriptions of a religious subculture form the dominant treatment approach in the U.S. multibillion dollar criminal treatment scam) approaches, generalized interventions provided all individuals with the fictional “condition” as treatment for the “condition”, failing to provide the required personalized, individualized treatments for the individuals whose life-threatening compulsive use of substances are driven by unique, complex sets of inner and environmental stressors and circumstances.
So, if treatments are falsely, against all evidence, promoted as standardized, for a generalized, single condition = “addiction”, then policy, clinical practice, and the controlled funding that pays for it all (the force behind all things, determining what forms of “treatment” are available to vulnerable Americans trapped in lethal public health epidemics) combine to determine that what gets paid for and implemented as “treatment” are the harm-predicting, one-size-fits-all sham treatments fueling worsening substance use epidemics, never supported by research evidence despite decades and $billions diverted to them.
These standardized, generalized, “treatments” for the fictional “condition” of “addiction” that are universally provided and paid for – 1) one-size-fits-all group therapy, 2) medications, 3) bizarre religious prescriptions, and 4) “counseling” by non-professionals with no relevant training or competence – have no research base or support for effectiveness, but that’s entirely beside the point. They fuel multibillion-dollar entitlement programs.
Americans trapped and dying in lethal substance use epidemics are expendable, vulnerable, and without the cultural capital and media collaboration to message their interests . Entitlement programs employing the professional class and multi-billion dollar “treatment” and medical industries are not.
“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.”
– Pierre Bourdieu Outline of a Theory of Practice (1972)
In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.
Heterodoxy, antidote to doxa, uses research and evidence –
critically analyzed, understood, and placed in context – as powerful tools for social justice and the collective good. Used to expose what lies beneath accepted “knowledge” – beneath the fabricated sheen of broadcast “truth” made up to serve the interests of those with the cultural capital to create that appearance.
In the world of knowledge validated by evidence, It is established by longstanding, congruent and mutually reinforcing evidence from research, consistent direct patient report, psychological theory, human development and neurobiology, psychiatry, behavioral health practice theory, other areas that problem, compulsive substance use is a
Behavioral symptom not condition or disorder
Driven by compelled need to attempt to moderate, escape from, or stop distressing inner states.
As a symptom, it is not a disorder or condition, medical or otherwise. A symptom is neither a disorder nor a medical disease.
Treatment of a symptom, in and of itself, predicts continuation and worsening of the underlying condition driving the symptom.
And predictably – continuously worsening, lethal substance use epidemics in the U.S under medical treatment for a non-medical condition.
Analogously, treatment of the symptom of pain driven by dental decay, in and of itself, predicts continuation and worsening of the underlying condition of dental decay, partly by reducing motivation to access effective treatment for the underlying condition – decay – driving the symptom, pain.
Treating the underlying conditions for substance use problems – the underlying conditions driving the behavioral symptoms of compulsive substance use – requires a radical shift in approaches, thinking, policy, and funding for substance use problems and public health epidemics caused by lethal, fictional medical models of “addiction” as a condition.
Where and How Does That Change to Effective Treatment Start?
It starts with a research-based understanding of the nature of problem substance use and with the question –
What do we know?
WHAT DO WE KNOW?
1. Problem substance use (PSU) is a compulsive behavior.
How Do We Know It?
By direct observation
By consistent, reliable reports of individuals experiencing it
And because we have no reason to doubt their reliable reports
What else do we know?
2. The compulsive behavior is driven by, is an attempt to moderate – is a symptom of – unwanted, distressing, poorly-regulated and poorly-tolerated inner states that are individual, complex, and linked to fused thoughts/beliefs/emotions/sensations.
How Do We Know It?
By consistent, reliable reports of individuals experiencing it
And because we have no reason to doubt their reliable reports
And because that behavioral/psychological picture of direct reports and observations of compulsive substance use is congruent and consistent with similar, related phenomena including: 1) pain behavior and symptoms reliably reported as compulsive and driven by inner experience of “pain” = underlying inner states that are individual, complex, and linked to fused thoughts/beliefs/emotions/sensations 2) compulsive, harmful use of substances, including food, recognized and formalized as behavioral symptoms of underlying inner states, like depressed mood and 3) compulsive, repetitive harmful behaviors driven by underlying apprehensive, distressing inner states, intended to moderate or relieve the inner distress and understood as symptoms of the underlying condition rather than the condition itself – in Obsessive-Compulsive Disorder. In none of these phenomena are the symptomatic compulsive behaviors constructed as medical conditions, or a disease, or a psychiatric disorder, instead of accurately as symptoms of underlying conditions, or states.
Consider compulsive use of food – a condition that aligns with and represents the standard psychiatric criteria for and understanding of a substance use disorder as accurately and legitimately as any other.
And the public health costs of which – directly linked to a diabetes epidemic and other major health problems – are set to eclipse those of all other substance use problems combined. Social and cultural understandings of compulsive food use as a substance use problem are clear and represented by social meanings of common utterances like “comfort food” and “emotional eating”, affirmed by strong research as congruent with the established model of problem substance use as a behavioral symptom driven by underlying emotional/psychic distress.
Yet, astoundingly, (or perhaps predictably) the substance abuse problem posing the greatest threat to public health has never been formally constructed as a medical condition or behavioral condition. And for important reasons: in every aspect, compulsive use of food radically is inconsistent with any constructed disease or medical model, affecting cultures differentially, reaching epidemic proportions among children, etc.
And, importantly, stressors driving compulsive use of food are clearly unique to the individuals engaging in it, affirming it as a behavioral symptom of underlying states, without any remote semblance of having a medical basis or indicated treatments, and demanding individualized therapy (behavioral, individual, family, and other) interventions for treatment.
What else do we know?
3. Problem substance use (PSU) is the behavioral symptom of underlying psychic (mental/emotional/sensory) states.
How Do We Know It?
By Points 1 and 2 above – as established by research and related evidence.
What else do we know?
4. The conditions driving problem substance use (PSU) are not in any sense general or types, or definable groups or categories of states driving the compulsive behaviors, instead are as multiple and unique as there are individuals experiencing problem compulsive substance use, complex, and demanding individualized treatment for each individual –
Because
the inner stressors (histories of ACE and circumstances defining uniquely distorted beliefs, vulnerabilities, triggers, sense of self and reactions to the world, driving uniquely distorted interpersonal perceptions and functioning); and environmental stressors (unique set of problems, barriers, and stressors in each individual’s environment) interacting with inner distortions and driving the compulsive behavioral symptoms of problem substance use require use of therapies and supports keyed directly to those individualized challenges for treatment to be effective.
Traditional, one-size-fits-all treatments, including “rehab”, “addiction treatment” and all medical approaches are radically at odds and inappropriate to these individualized treatment demands, predicting their established failures and harms.
How do we know it?
By consistent, reliable reports of individuals experiencing problem substance use
And because we have no reason to doubt their reliable reports
And because those reports, gathered and skillfully elicited by advanced practice behavioral health professionals, credibly identify and point to the unique, individualized internal and external stressors as compelling the need to use “mood-altering substances”.
More simply,
consider a typical and realistic case example of an adult seeking help with compulsive substance use creating problems in her life.
She is a middle-aged woman who has struggled with problem alcohol use much of her adult life and beginning in teen years, also persistently struggling with disturbed sleep, being “on edge”, anxiety, sadness, and problems in relationships, including problems with intimacy. She was drawn to alcohol use and likes it because it helps her forget, feel numbed to, less distressed by memories of traumatic experiences and her anger that the wrongs have never been acknowledged, owned up to, along with self-defeating beliefs that she must not or cannot change those situations. She never feels quite safe, and doesn’t know how to change that, but the alcohol makes that seem to matter less, or fade away.
The alcohol releases checks on that anger, often resulting in outbursts and poorly-controlled behaviors she later regrets and that don’t help with the mood and relationship problems.
She discloses a life history of early physical abuse and exposure to violence between adults, also being the victim of domestic violence in a series of volatile and unsuccessful relationships. She thinks she may have been sexually abused, is not sure. She tends to avoid behaviors and situations that consciously or unconsciously bring up a sense of fear, of danger, like speaking up, expressing her needs and boundaries, objecting, saying “No”.
There are individuals in her life, some supportive and some she feels obligated to stay attached to, but who in a variety of unique and powerful ways trigger, bring up, strong negative feelings, each in a different way: by doubting her, ignoring her, not listening to important things she wants to say, touching her in ways she doesn’t like. Something keeps her afraid of saying and doing things to change that, keeping her stuck in a longstanding pattern of reacting with resentment, frustration, hurt, anger and sense of incompetence and weakness, stuck with alcohol her only escape.
She often thinks of a wish and maybe ways to get away, detach from or somehow change the painful or hurtful things in her relationships, but doesn’t know how, or feels trapped, without options or means or skills to make the changes, also confused and frozen by guilt, self-doubt, the expectations of others. Each relationship is different, each setting and circumstance needing change in order to relieve the triggered negative responses that make her want to escape with alcohol – each uniquely dependent on specific changes to more adaptively and therapeutically feel stronger and safer and heal, to take control of and manage the demons driving compulsive use of alcohol – each uniquely requiring something new and different to be said, to be done, some unique, situational way to be assertive, to set boundaries, to change the things distressing her and keeping her feeling unsafe. Or some stressor or trigger in her environment, driving strong, reactive feelings that compel alcohol use, requiring the intensive, constantly adjusting and re-assessing, skilled reformulation of inner belief models, coupled with interventions like the highly planned, intentional work of progressive desensitization to that stressor in her natural environment. A purely unique, individualized, treatment problem and intervention.
Pathologically incompetent and malfeasant medical industry: We will soon have a pill for that! Trust us. We just need to stay in control of public funds for research and treatment. To build on the progress we’ve made.
Inviting and supporting the difficult disclosure and insightful identification of those unique individual stressors and how they are linked to the problem alcohol use requires hours of work, in individual therapy sessions with a skilled therapist, to simply establish the way forward, the blueprint for changes required, necessary to manage the inner distress and life situations driving the compulsive substance use.
Motivating and building confidence for, providing the continued insight and skills for, and conveying the effective psychological, or cognitive, reframing and changes supporting lasting changes in beliefs about self and others to support those changes requires additional hours of work, in individual therapy sessions with a skilled therapist, work that will not be the same as for any other unique individual struggling to overcome the behavioral symptom of problem, compulsive substance use driven by that set of complex stressors unique to that individual.
There is no substitute for this intensive, individualized process of healing and change, no other form of indicated and effective treatment.
The promised medical treatment that is “just around the corner”, that surely will emerge any time now, the reward for decades and billions in public funds diverted to research driven by a fictional medical model never supported by evidence or logic?
“Education” in a treatment group, on the harmful effects of using drugs?
The bizarre prescriptions of a religious subculture? To “give it over” to your Higher Power?
Expectations and public messaging that those one-size-fits-all sham “treatments”, for a constructed, fictional condition, would ever have provided relief for Americans trapped in lethal substance use problems are best described as illusory, malfeasant, criminal.
And we know that –
5. Problem substance use (PSU) is not a medical condition or disease and is without effective medical treatments.
How do we know it?
And we know that –
6. Problem substance use is not a psychiatric disorder.
How do we know it?
A behavioral symptom of an underlying condition is not a psychiatric disorder, it’s a symptom.
And we know that –
7. There is no such thing, no such condition as “addiction”.
How do we know it?
As established by points 1 – 6, above
And we know that –
8. Correlates (and predictors) of risk for development of persistent PSU include
ACE,
trauma,
other forms of inner distress and
psychosocial (life) stressors
How do we know it?
From extensive, longstanding lines of research including epidemiology, developmental psychology and neurobiology.
And we know that –
9. Sham treatments that target fictional conditions, like “addiction” predict and have resulted in no benefit, harm, and historically worsening public health epidemics.
How do we know it?
From extensive, consistent evidence establishing failure of psychiatric, medical, medication, group therapy, “rehab” all traditional treatments for the non-existent condition of “addiction”, instead constituting criminal treatment scams that predicted outcome failures and public health epidemics.
And we know that –
10. The complex, individualized, inner emotional/mental states and associated stressors driving the behavioral symptom of compulsive substance use require the indicated appropriate treatments – psychotherapies and associated psychosocial/community supports provided and facilitated by advance-practice behavioral health clinicians using longstanding evidence based practice (EBP) individual therapies.
Those include primarily:
The Contextual Model of Psychotherapy (CMP),
or Common Factors Approach, accounting for the major share of beneficial effect in any behavioral health counseling interaction and always in individual modality
Motivational Interviewing (MI),
a difficult, advanced, highly intentional psychotherapy approach provided in individual modality and addressing inner (mental and emotional) barriers to change
Cognitive Behavioral Therapy (CBT)
encompassing a broad and varied spectrum of therapies for behavioral health conditions
Community Reinforcement Approach (CRA) –
the assistance in varied forms and ways of helping individuals to identify, access and engage in valued and rewarding (therapeutic) activities and connections in their natural environments, including employment and safe and stable housing
Psychodynamic and trauma-informed therapies
that target self-defeating inner psychic models and symptoms related to earlier experiences that are highly correlated with emotional health challenges and problem substance use
Family Therapies
like CRAFT to address family-related stressors driving substance use and to strengthen natural support in families for overcoming substance use problems
And skills training
to strengthen problem-solving, interpersonal, emotional regulation, other skills that decrease risk of problem substance use by reducing inner distress and strengthening sense of self-efficacy, established as effective as protective against problem substance use
How do we know it?
From decades of extensive research establishing effectiveness for those approaches.
And we know that –
11. A strongly-supported psychology practice theory exists that forms the practice theory for the most strongly supported evidence-based (EBP) individual therapies (CMP and MI) for inner conditions driving compulsive substance use:
Self-Determination Theory
How do we know it?
From the research base for Self-Determination Theory
And from the research base for effective therapies driven by principles of SDT, including Motivational Interviewing
And from evidence supporting the overlapping and mutually-supporting elements of SDT and MI.
And we know that –
12. Longstanding and emerging research supports the effectiveness of behavioral health therapies as treatment for individualized inner distress and deficits driving compulsive substance use – predicting prevention, cessation or moderation of problem substance use.
How do we know it?
Individual therapy is effective for PSU, and primary (“common”) therapeutic factors (CMP) in individual therapy derive from patients gaining relief from inner distress from experience of increased sense of alliance, support, supported autonomy, relatedness.
Effectiveness of MI is derived from gains in inner sense of competence, confidence for change, autonomy, self-efficacy
Established reviewed research and evidence links relief from chronic stress symptoms to reduced PSU.
The choices are clear:
continuation of control – by medical industry fictional models and associated criminal treatment industries generating public health crises – of resources and cultural capital needed to address worsening, lethal substance use epidemics,
OR begin radical change to adopt and implement longstanding, evidence-based therapies that treat the underlying conditions driving the behavioral symptoms of problem substance use and associated epidemics. Then, critically, to increasingly focus resources on prevention efforts targeting established risk factors driving problem substance use: ACE and the social stressors inherent in pathologically unjust and dysfunctional economic, political, and social systems
