UN-MOTIVATED: MEDICAL INDUSTRY FIX FOR THE OPIOID CRISIS DISPLACES EVIDENCE-BASED TREATMENT BY DISPENSING DIVERTED, ABUSED OPIOIDS, MEDIA IGNORE PREDICTABLE OUTCOME FAILURES
Passive sham medical cures rob vulnerable patients of the key, necessary factor for wellness – motivation and confidence for change
By Clark Miller
Published May 7, 2021
Healthcare industries responsible for the opioid crisis have rushed to claim effectiveness for a medical fix for the medically-caused crisis: Medication-Assisted Treatment (MAT) which replaces street drugs with the man-made prescribed opioid Suboxone. But programs are leaving out the “Treatment” part of Medication-Assisted Treatment.
That’s not the real problem,
because provision of MAT is a predictably failed approach, that failure understood most fundamentally as established by longstanding bodies of research that exposure of problem substance users to medical models and services for substance abuse predicts harm and failure. That’s because the passive medical experiences and exposure to the fabricated deception that substance use is a type of medical condition that requires medical treatments hijack their brains, derail them from the psychological and supportive therapies that constitute effective treatment for substance use including therapies that instill the accurate beliefs: that the user is the source of change, not a pill; can effectively use resources for change; can freely choose change; and is capable of planning, initiating and making changes in his life, gaining a sense of self-efficacy.
That’s why belief, by someone with the behavioral symptom of compulsive substance use, in the invalidated disease fiction of “addiction” is a key predictor of relapse to problem use, based on the evidence. Belief that they have a “chronic disease of the brain“. Chronic.
That bears repeating
and additional consideration of the profound and harmful effects predicted for current medical model approaches to treatment and associated control of public health resources – individuals with problem substance use who are conditioned by the medical-media collusion to believe in the useful fiction that they have a disease, a “disease of the brain” are at higher risk of relapse. That makes perfect sense, because on simple reflection, someone deceived to believe she has a life-long, chronic disease of the brain – or in the parlance of the religious subculture driving the history of “addiction treatment”, is an “addict” and will “always be an “addict” – will be affected psychologically and emotionally, including effects on confidence and motivation for the personal growth and changes, through therapy, that are required and define effective therapies for recovery.
“I have a disease that is out of my control. I’m an addict and always will be” is a lethal, self-stigmatizing, self-defeating product of media-medical-religious subculture brainwashing with tragic results, over and over.
More than simply being established as ineffective and harmful, medical interventions for the non-medical symptom of problem substance use rob vulnerable victims of two essential factors for recovery – drive and confidence for personal change. Medical interventions for the non-medical behavioral symptom of compulsive substance use are barriers to change and treatment, predict harm and death as worsening lethal epidemics affirm.
Medical approaches have dominated public health approach to the opioid crisis and to other worsening, increasingly lethal substance use problems – at a cost of tens of billions over past decades – displacing evidence-based therapies and with predictable outcomes.
Popular media have followed along with reinforcement of the invalidated orthodox, establishment view
and promotion of medical fixes for the medically-generated opioid crisis, citing reduced overdose deaths due to illicit opioid misuse as definitive and sufficient evidence and support for effectiveness of MAT and Suboxone as the fix for the epidemic. Numerous print and online news sources are running feature articles and series on the crisis, like at Vox where the appearance of reduced heroin overdose deaths with increased use of “anti-addiction” opioids like subutex in France in the 1980s and 1990s is asserted as establishing buprenorphine-based MAT as both effective and a form of “treatment”, a fix for the opioid problem. As portrayed by popular addiction writer German Lopez at Vox: “France had a big heroin epidemic in the 1980s and ’90s. Here’s how the country fixed it.”
But the research evidence, competently evaluated and interpreted, is disconfirming rather than supportive of MAT.
A predictable feature of MAT programs and clinical trials is very low retention rates. That should raise questions about why patients lose motivation to remain in programs and gain the asserted benefits of Suboxone, for example as an alleged “anti-addiction” drug. It does raise serious questions about validity of interpretations and conclusions that Suboxone and MAT are established to provide significant benefit by reducing overdose deaths for those in programs – that benefit, if supported by the research, would only persist as long as patients remained and continued to use Suboxone as prescribed. In the study cited by a popular addiction writer as providing strong proof of benefit from MAT as evidenced by reduced overdose deaths, proportion of patients actually staying in the program (“retention”) was not recorded or reported, the authors (but not the popularizing writer) noting this as a factor limiting confidence in outcomes of the studies.
Any critical analysis of the research establishes that MAT and Suboxone are unvalidated approaches without prediction of benefit supported by research.
Highlighting the problematic rush to adopt a yet unvalidated medical fix for the medically-generated problem, one powerful study with high confidence in external validity provided additional invalidating results:
At 180 days, retention by subjects in programs were 20% and 30% for subutex and Suboxone, respectively, and clearly trending downward – take a look at graphic results below. Of the 30% remaining in MAT for Suboxone, 11% were using other opioids, 20% other mood-altering substances. For the 20% retained with subutex those figures were 21% and 45%.
Take a look –
Some key features to note about this study:
Across 34 natural community settings, external validity should be relatively high
Urine drug screens were provided over the 6-month study period, testing for not only other opioids, also other mood-altering substances
The large majority of subjects were self-pay, with prediction of relatively high motivation for desired outcomes
Consider that last point. Nearly all patients were spending their own money to be in the program, requiring frequent visits to a medical provider and, in most programs, with support staff of some type – expensive treatment, and therefore predicted to provide high incentive to gain from the experience what was desired from it, to get one’s money’s worth.
How to understand these results, congruent with additional MAT trials with treatment failure due to lack of retention?
The explanation and key is almost certainly motivation for change – a therapeutic and complex psychological concept that has dominated research and theory in evidence-based practice (EBP) for substance use and other health problems for decades, forming the core factor in Motivational Interviewing, perhaps the most strongly-supported therapy and intervention providing benefit for substance use problems.
Among other things, Motivational Interviewing (MI) says that adaptive (beneficial in the patient’s life, as experienced by the patient) change is most strongly predicted by a complex set of styles of therapeutic interactions in individual therapy, and by complex sets of influences shaping to what extent a patient’s thoughts, moods and behaviors are driven by extrinsic motivators (like court orders, threats from significant others, imposed choices and treatments) versus intrinsic motivators (the personally-held, freely arrived-at convictions, values, reasons that the individual has for making changes).
Motivational Interviewing, as a therapy treatment for problem substance use is
Highly effective, with a large supporting research base
Established as effective when provided by skilled, advance-practice therapists in individual therapy, not group therapy
Not a set of techniques, exercises, or strategies, instead a complex, challenging therapy orientation and highly skilled interaction, instead requiring advanced level skills by mental health therapists
Patient-centered, its effectiveness undone by approaches that are directive, authoritative, educational, or advice-giving
A process for change, occurring over repeated individual therapy sessions
That is, MI is a highly effective therapy for positive change for problem substance use, and as provided effectively predicting benefit is essentially absent from addiction treatment as it is known, as “treatment as usual” (TAU). It is not provided in standard treatment settings by addiction professionals (like “chemical dependency professionals”, CDP, or “certified alcohol and drug counselors”, CADC) who are not trained to provide behavioral health therapies.
Simply and most accurately, MI and additional psychological therapies and supports, described here, are supported by decades of research as the effective treatments for the behavioral symptom of compulsive substance use – they are the effective treatment. MAT and other medical interventions for the non-medical condition of problem substance use are not treatments, instead demonstrably function as psychological barriers to treatment and predict harm.
Motivation for change is formed of multiple components,
multiple inner states affecting drive to make changes that may lead to wellness. One is desire to change, the felt impetus to make things different in a life, the impetus connected with values, aspirations, and discomfort with current status and functioning.
Another element is confidence for change, the set of beliefs, often distorted, about how capable of change one is, how likely efforts, changes, disruptions, discomfort of engaging in change, will be rewarded with positive results.
Typically there are psychological barriers to change tied to a negative, self-defeating sense of self formed by experiences, especially early experiences, that operate deeply and are effectively addressed in therapy – not treatment as usual (TAU), or the sham programing of “addiction treatment”, but real therapy.
Confidence for change, or expectation for change, is also predictably degraded by exposure to medical treatments and treatment as usual, or “addition treatment”, “rehab” – because they fail.
Each of those experiences of failure in the revolving door of rehab, exposure to medical practice, to “addiction treatment” sham programming increasingly reinforces the belief that the user cannot be helped, cannot gain wellness.
In practice –
literally in practice, the practice of evidence-based psychotherapies that form the effective treatments for compulsive behaviors like substance use – patients will recount the series of failed attempts to gain help and support for their problem substance use from the sham, fabricated-as-effective cons and entitlement programs that cannot do other than fail: medicine; “addiction treatment”; rehab; AA. They are at times astonished and relieved to learn and experience that there were effective therapies all along, hidden from them.
Sent to those bogus programs as mandated by a court, or because they don’t know what else to do, or because everywhere they look, they are exposed to the necessary lies advertising the scams as beneficial.
Diverted and victimized, their brains hijacked.
