By Clark Miller

Published April 1, 2020

Updated April 16, 2021


As more and more public funds are diverted to “treatments” established as ineffective at best and harming vulnerable Americans by displacing longstanding evidence based behavioral health therapies for the compulsive behavior of problem substance use – “treatments” that are worsening lethal crises – deaths and public health costs mount in uncontrolled substance use epidemics.

Precisely as in the pathological collaboration to fabricate and publicize medical deceptions needed to rationalize runaway medical dispensing of addictive opioids against all lines of longstanding relevant evidence for the non-medical condition of common chronic pain, evidence and the responsible, competent, critical evaluation of evidence are disruptive threats to the business of American Medicine and Healthcare.


In that collaboration – of America’s top medical institutions, journals, universities, authorities, in cooperation with the pharmaceutical industry and American corporate media – facts, knowledge, research evidence, truth have no roles in allocation of resources to protect public health, to protect Americans from harm.


Instead they pose potential barriers to the free operation of manufactured fact and fabricated knowledge driving healthcare funding streams – streams that confer status and privilege and require protection of the cultural capital and mass media compliance they depend on.

No one seems to be catching on. So it’s working, the collaboration, a triumphant and increasingly lethal collusion to continue diversion of public resources to the trusted healthcare industries and authorities that lied and fabricated to generate the lethal opioid epidemic.


New federal funding in additional billions of dollars is being allocated to entrenched medical approaches to worsening substance use epidemics,  approaches that have been allowed to worsen those public health threats over decades despite billions spent without progress and which are established by longstanding and consistently emerging evidence as invalidated, never supported by evidence, and predictably harming the vulnerable, trusting Americans increasingly trapped in problem substance use.

Some of those funds will be used in Maine, at the University of New England, UNE, so that graduating medical students will be prepared to join the ranks of American medical professionals “who can treat opioid users”. Joining the ranks of their colleagues who have been over past decades treating opioid users in their work to stem the increasing lethality of the medically-generated opioid crisis – treating by dispensing addictive, diverted, and abused “substitute opioids” that are fueling economies of illicit substance use and worsening the crises.
That makes sense. In a pathological way.

University of New England receives grant to train medical students to treat opioid use disorders

BIDDEFORD — The University of New England has received a federal grant to train medical students to treat opioid use disorders. Students will learn to use FDA-approved medications in combination with counseling and behavioral therapies. This approach to treatment, known as Medication-Assisted Treatment, or MAT, has been scientifically proven as the best practice in treating opioid use disorders.

The UNE College of Osteopathic Medicine was awarded a $450,000, three-year grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to adopt a national model for training students that is currently in development. This model will provide the necessary training to medical students prior to graduation, so they can receive their license to treat patients as soon as they begin their medical residencies.

“The opioid epidemic is the worst public health crisis I’ve seen in my adult life, and we need an all-hands-on-deck effort to fight back,” said Senator Angus King, I-Maine. “Addiction is not a death sentence — treatment works. Unfortunately, we just don’t have enough treatment professionals. This grant will allow UNE to bolster our ability to help Maine people reaching out for support, allowing those struggling with substance use disorders to access the proven treatment techniques that can help them face their disease, enter recovery, and make important contributions to their communities.”

 .  .  .

The project will also update curriculum in UNE’s medical and physician assistant programs, to provide better substance use disorder training throughout students’ educational experiences. A goal of this enhanced training is to de-stigmatize substance use disorders so that students are open to providing MAT when they become physicians, and that all graduates of these programs understand that addiction is a chronic brain disease, not a moral failure.

There are problems.

 As distinct from “scientifically proven”, MAT is not a form of treatment, is not and has never been supported by research as providing benefit for compulsive opioid use, instead is established as fueling the worsening epidemic and increasing risk of harm and death.

There is no “disease” state, “hijacked” brain, or medical condition at all that explains or is remotely related to “addiction” that is, to compulsive substance use. The universally instilled belief in the fabrication that substance use is a disease places vulnerable Americans at risk of trusting in use of medications or other sham, never-evidenced medical “treatments” for compulsive substance use, diverting them away from longstanding evidence-based therapies .

Belief in the fictional disease model is a key predictor of return to problem substance use, “relapse”.

The inappropriate provision of medical treatments (opioid pain killers that are no more effective than over-the-counter medications) for the non-medical condition of centralized chronic pain – against all relevant, longstanding lines of evidence – predicted and generated the worsening opioid crisis.

In an apparent learning, institutional, intellectual and ethical vacuum, the U.S. public health response to that lethal, medically-generated crisis – following signs of failed outcomes in the French decades-long experiment and mounting consistent evidence of failed outcomes in the U.S. – remains on track for continued misuse of public funds  and contribution to mounting deaths. That’s because substitute addictive opioids don’t serve as “treatment” at all for problem, compulsive opioid use, instead as established by mounting, diverse lines of evidence,  are driving mass-scale diversion, abuse, economies of opioid abuse, and other harms.

There are deeper, more fundamental problems.

Longstanding research paints a clear picture: the compulsive behavior of problem use of mood-altering substances as well as most chronic pain (centralized, non-cancer chronic pain) are psychogenic (driven by distressing and unbalanced inner states including thinking and feeling) and psychosocial (driven by outside stressors and effects of past disturbing events) in nature, not biomedical (physical), the indicated treatments are longstanding evidence-based effective psychotherapies like cognitive behavioral therapy (CBT) and psychodynamic therapy to address the emotional, environmental and cognitive deficits and disturbances driving them, with no effective medical treatments supported by evidence.

Vulnerable Americans trapped in opioid, substance use, and depression epidemics have been effectively domesticated as reliable consumers for decades by learned internalization of the long-invalidated fabrications that those conditions are medical, with medical treatments, discouraging their use of and diverting them and public health investment away from the evidence-based treatments. The consistently worsening epidemics and public health costs over decades and billions diverted to medical approaches point to the harms imposed by medical approaches for the non-medical conditions.

Science Daily No magic pill to cure alcohol dependence yet

The massive, expensive entitlement systems and criminal scams – “addiction medicine”, “rehab”, “addiction treatment” – that are failing to provide effective treatments for Americans trapped in compulsive substance use, instead fueling worsening lethal epidemics, require constructed fictions to maintain status and control of public healthcare resources. The most undermining and damaging fabrication is that there is a medical condition, “addiction” with medical treatments – pills for cravings and prescribed addictive substances as substitutes, that are supported by research as effective for treating substance dependence.

But as detailed here and in related posts the research tells an entirely different story. Research distorted, ignored, and spun by those industries and media popularizers to support fictions – just as for the fabrications that created the worsening opioid crisis.  As explained in this post with links to primary research, relapse (return to a harmful pattern of compulsive substance use after a period of having stopped) is not caused by cravings per se instead by other factors including belief in that very “disease model” of addiction and lack of sense of self-efficacy – a sense of self-confidence and associated motivation for change that is built over extended periods in psychotherapy relationships with reflected-on experience of successes and cognitive restructuring of associated beliefs and moods using evidence-based therapies.


Self-efficacy: The Opposite of Helplessness and Powerlessness

The central therapeutic factor strongly supported by extensive research as protective against relapse and required generally for change is self-efficacy, or sense of confidence in one’s own choices, abilities, and effectiveness to make the changes needed to resolve a problem or regain health and safety.

Self-efficacy is developed, reinforced, experienced and strengthened in a process of interaction with skilled therapists over which experiences that include active changes (not passive changes like taking a pill) are experienced as effecting positive changes in the patient’s life and resolution of problems.

That is, a key factor established by research as required to stop and protect against return to problem substance use requires work in therapy over time in order for patients to internalize, own, and self-affirm personal agency and effectiveness, control, in behavioral and other changes that protect against problem substance use.

Medical visits and the sham “treatments” are a barrier to self-efficacy, that is a barrier to healing and wellness. That process is subverted when vulnerable patients are reinforced, by medical visits for a non-medical problem – in the false belief of a passive fix for substance use, a pill.

The trained belief in a non-existent condition “addiction” as a medical condition with medical treatments was predicted, all along, to generate illness, “treatment” failures, ultimately lethal epidemics.

Working against, countering and diverting substance users from that required engagement in personal change and process of evidence-based psychotherapies: every visit to a medical setting for the entirely non-medical condition of compulsive substance use causes harm – instills belief in lack of control and personal ineffectiveness against a “disease of the brain” that requires medical treatments, and instills passive dependence on those cures – pills and substitute addictive substances – that have no research base for effectiveness and are associated with epidemics that have worsened over decades of increasing dose provided. Every medical visit helps hijack trusting brains, helps fuel worsening epidemics.

Doctor with patient discussing medication
The Hill Study: Opioids could kill nearly 500k Americans in the next decade

Every visit to a medical office or provider for a substance use problem causes harm by instilling and reinforcing false belief in a passive, ineffective medication, a pill for a complex, individualized inner reality of potent early experiences, psychological injury, distress, distorted beliefs and associated mood states – an individualized inner reality with only collaborative, extended work in psychotherapies as indicated treatments – disincentivizing patients engaged in a potentially lethal compulsive behavior (the symptom of that inner reality) away from engaging in the more intensive, active work of counseling and behavioral changes. Predicting continued distress, illness and harm.

Americans have been trained by deceptions over decades, provided drugs for which there is no evidence base (no body of adequately designed random controlled trials (RCTs) supporting effectiveness), deceived about the meanings of the outcomes research, assured of benefit by their medical providers to whom they entrust their wellness – professionals lacking the training, competence, and capacity to evaluate and think critically about research, research claims, and practices required to evaluate effectiveness of treatments and avoid harm.

The distorted, misused research and predictably harmful outcomes are documented, with links to primary research and other materials in multiple posts here at A Critical Discourse.




That false, ingrained, trained belief leading vulnerable Americans to access medical visits for those non-medical problems is associated with immeasurable public health costs and harms. The Opioid Crisis the most visible and attention-grabbing example. Costs including the enormous waste of public and private resources for biomedical “treatments” with no benefit, and no predicted benefit supported by research, for example: $ 90 billion annually for ineffective, inappropriate biomedical interventions for lower back pain.

Crooked by Cathryn Jakobson Ramin

More fundamentally and pervasively – because those beliefs drive emotional states and behavior, choices – the deceptions, wildly lucrative and beneficial to medical, pharmaceutical, and “harm-reduction” industries, are effective psychological barriers between trusting, vulnerable Americans and real, effective evidence-based treatments for those non-medical conditions.

Instilling belief in a fictional medical condition explaining relapse is a deception critically important to validate and enrich entitlement systems like “addiction medicine” and “harm reduction” that divert public healthcare funds away from evidence-based treatments. As such it has been ingrained, trained into trusting, vulnerable Americans for decades, every single visit to a medical provider or office to address smoking or any other substance use problem further reinforcing the lethal deception that there is a pill or medical treatment, a passive easy fix, that can replace the work of therapy and change and serve as treatment for a compulsive behavior driven by inner emotional distress and distorted beliefs.

As the population dose, over past decades, of the medical fix for the non-medical condition of compulsive substance use increases, lethal epidemics worsen.

As billions and billions of public healthcare dollars over past decades continue to be diverted, away from longstanding evidence-based psychotherapies for the behavioral symptoms of compulsive substance use, instead to constructed fictional medical approaches, deaths predictably mount.

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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