No one would choose a plumber for brain surgery or bus driver as pilot for a trans-Atlantic flight, but for potentially life-threatening compulsive drug use a malpracticing, pretend “expert” will do

by Clark Miller

Published October 30, 2022

There can be no doubt about the expertise and quality of expert advice – addressing American youth increasingly trapped and at risk in increasingly lethal substance use epidemics, forces driving their behaviors and approaches needed to help them manage those behaviors to reduce their risk of harm – at this year’s American Academy of Pediatrics national conference.  The presenter is division chief of adolescent and young adult medicine at Massachusetts General for Children and Harvard Medical School. Who better than a trained medical doctor to provide understanding and guidance to prevent and treat the compulsive behaviors driven by complex family, developmental, psychological, emotional and psychosocial (especially for youth) factors contributing to problem use of mood-altering substances?

After all, the evidence should be clear – where would America be now in the pressing need to help vulnerable Americans against the risks of problem substance use without that type of American medical expertise and the $billions and billions in public health funding that has made possible the medical treatments and approaches for the compulsive behavior of problem substance use?

It’s unthinkable. Unsayable in any case.

From the Healio report – 

“The U.S. is silently about to surpass a really grim milestone, and that is that we’re about to experience our 1 millionth overdose death since the turn of the century,” Hadland said. “Last year, more than 100,000 Americans died of an overdose in this country, and as a pediatrician who takes care of young people who struggle with addiction in my practice, right in our primary care environment, I see the power that pediatricians can have to do their part to take this on.”

. . . Hadland suggested three ways to tackle the crisis head on in practices. The first is by having primary care physicians screen for substance use and use a validated tool to gauge a patient’s likelihood for any existing issues with substances. In his practice, patients privately fill out screening documents on iPads regarding how frequently they use alcohol, cannabis or tobacco upon arrival for their appointments. Use of these three substances “once or twice monthly” or “weekly” could indicate more serious issues, Hadland said

“[Opioid addiction] is exceedingly rare for a young person who has never tried tobacco, alcohol or cannabis, and so if a young person isn’t using any of those substances, just stop right there,” Hadland said. “But if they have used one of those substances [and] if they’re using monthly, that strongly correlates to them having a mild to moderate substance use disorder, and if they’re using weekly or more, that correlates to having a severe substance use disorder.”

In his reported comments and guidance, Dr. Hadland lets us know that what he urges pediatricians nationwide to provide to their young patients is not treatment at all, in fact not a thing, addiction” and “substance use” as a “disorder” or disease, or medical condition of any type established as manufactured constructs that have no grounding in evidence or human experience.  

Each of those fictions has profound and potent utility and value, not in any way toward preventing or treating compulsive substance use, instead by creating the lies that have allowed generation and protection of treatment industries (“rehab”, “addiction treatment”, “addiction medicine”) and careers in those entitlement systems along with the diversion of $billions yearly in public healthcare resources, while lethal substance use epidemics worsen. 

That’s why – supported by changes in the DSM 5 that generate substance use disorder (SUD) diagnoses essentially for any level of regular use of a mood-altering substance – the reported comments focus on inaccurately and countertherapeutically pathologizing the young person immediately with a SUD: mild to moderate if a young person once a month uses cannabis or alcohol with peers, “severe” if smoking weed once a week is reported. No, really – go back and read it. 

Tellingly, there is no allusion to ACE in the reported comments – Adverse Childhood Experiences the actual, factual, evidence-based understanding of development of the behavioral symptom of problem substance use and pointing to its effective treatment. Problem substance use as a behavioral symptom of underlying emotional/mental/psychic distress, injury, or unmet need is established as the evidence-based model and understanding of compulsive use of mood-altering substances

That is to say, a medically trained professional is entirely out of scope of competence and practice for providing advice or treatment for problem substance use. 

But therein lies the problem, of course – the accurate, evidence-based portrayal of problem substance use as an entirely non-medical issue, despite pointing to effective prevention and treatment for America’s increasingly lethal epidemics, would come at much too high a cost – would give the lie to and invalidate, cause to be dismantled, the $multibillion dollar economies of sham, lethal treatment industries that in their lethal failure, perpetuate their existence. That’s how that works. 

From a previous post – 

child sitting alone head bowed

They are right, and they are describing what has been known,

established by research to be the evidence-based understanding of compulsive substance use (“addiction”) for decades. That established understanding explains, has predicted, why never-supported medical “treatments” for a non-medical problem has led to and worsened substance use epidemics. The longstanding evidence-based treatments for chronic effects of trauma, ACE, and other stressors – those complex, individualized states of inner distress driving compulsive use of a mood-altering substance – are all psychological, behavioral, psychosocial therapies and supports that address those individual experiences of pain, inner distress, and distorted beliefs, and more importantly help parents manage inner distress to better control their behaviors, prevent exposure of their children to ACE, and break the amplifying generational chain of emotional harm and substance use.

The lethal, empirically invalidated, and never-held-to-account folklore of addiction and its sham treatment is constructed and disseminated as true, as necessary to protect massive entitlement systems and their funding. It is fabricated, false knowledge, “doxa”, that goes without saying because it comes without saying, without competent, open examination of its grounding in evidence or of its or truthfulness or of health benefit, because public health benefit is not the purpose the “knowledge” serves. In that folklore, the compulsive use of substances – opioids, methamphetamine, alcohol, tobacco, food – is a disease of the brain, requiring medical treatments that have never provided relief and are established as invalidated, their use indicated against, while they fuel continuously worsening epidemics.

There seems no cure for the pathological drives that persistently defend, promote, and protect continued provision of invalidated, lethal medical “treatments” to vulnerable Americans, even as deaths mount the more medical fix is applied to diseased brains.

The evidence is clear.  

Yet the numbers climb. 

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.

Back to American expert medical guidance

for worsening youth substance use epidemics – 

He next recommended that primary care practitioners focus on delivering evidenced-based care such as addiction treatment, overdose prevention and harm reduction through their own practice or through referrals.

“Ideally, [evidence-based treatment for opioid use disorder] should include medication,” he said, and named naltrexone and methadone, both FDA approved for people aged 18 years or older, and buprenorphine, which is approved for use in patients aged 16 years or older.

Unfortunately – actually tragically, and criminally – it is established that 

Precisely as in the collusion of fabrications generating American Medicine’s opioid crisis, there has never been evidence to support MAT or other medications as effective or supportive in the treatment of the behavioral symptom of compulsive substance use. 

Instead, evidence consistently and congruently establishes harm, perpetuation and worsening of lethal epidemics by promotion of medication use and their provision. 

That medical provision of Schedule II addictive substances has continued over decades of an increasingly lethal epidemic by doctors knowing it was indicated against, knowing they were not able to evaluate and monitor high-risk use, choosing to not use databases designed to avoid high-risk use, and without providing the basic patient right of informed consent – i.e. to discuss the risks of harm (Upcoming Post: DOCTOR NONCOMPLIANCE CONTINUES TO FUEL THE OPIOID EPIDEMIC).

That’s incompetence at best and at worst malpractice, lethal malpractice. 

The evidence is sufficient to invalidate the fictions of medical treatments for the entirely non-medical condition of compulsive substance use but not necessary – a moment or two of reflection is all that’s needed. You are being asked to believe that over decades of increasingly lethal substance use epidemics, there have been medications that serve as treatments for “addiction”. Those medications are, in fact, prescribed and essentially universally available from MAT programs, other medical providers, your family doctor, your pediatrician, also easily purchased on the street. A pill each day for treatment, to become free of the risk of loss of functioning, of family, of employment, of home, of health, of life. Simply by taking the cure, the medication, prescribed by a doctor. 

Americans trapped in lethal epidemics No thanks, I’d rather end up on the street, ill, homeless, miserable, at risk of death than take an effective, prescribed pill each day.


Suboxone ad on a billboard

Finally, Hadland recommended using nonstigmatizing language when working with children or families affected by substance abuse, including reducing the use of problematic terms such as “substance abuser,” “substance abuse” and “clean” and replacing them with the preferred terms “person with substance use disorder,” “substance use/misuse” and “in recovery.”

That’s precious. Non-stigmatizing language for the young person who’s been diagnosed with a “severe substance use disorder” conceptualized medically as a disease of the brain, and referred to an addiction treatment program and “recovery” that will include the universally integrated provision of the meetings, prescriptions, and practices of the religious subculture AA or NA where he or she will be required – 

to utter, over and over again, “I’m an addict”

to see himself as “powerless” against a lifelong disease that will require a lifetime “in recovery”

to become abstinent of all substances  (with one exception, below) including THC and alcohol, as an addict with an addict personality

to be exposed to the normalized, encouraged, socially reinforced, regular social use, at these treatment meetings, of arguably the most addictive, harmful substance of abuse – cigarettes

To work the 12-Steps requiring self-shaming of her “defects of character” and – for a young person who’s typically experienced ACE (abuse) at the hand of others – identifying and paying penance to all those she has harmed


That’s American “addiction treatment” and “recovery” but not treatment, 

instead pathological and imposing forms of psychological, emotional and developmental assault that predict harm and worsened risk of continued problem substance use. 

More like a death sentence

More on young people at risk of harm from exposure to medical care at this upcoming post –


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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