HOW MEDIA FUEL WORSENING SUBSTANCE USE EPIDEMICS
by Clark Miller
Published January 30, 2019
Updated April 8, 2021
Among conspiring factors driving America’s worsening substance use epidemics, media responsibility to provide investigation, accountability, exposure of harmful practices, and accurate information to a vulnerable public is both critical for change and largely unexamined.
There are a number of ways that U.S. media are vulnerable and predisposed to get things wrong about the nature of substance use and its treatment.
The phenomenon of compulsive problem substance use or “addiction” is complex and not understood. If that were not true, we would not likely be facing lethal public health epidemics despite allocation of decades of institutional and program development and billions of public healthcare dollars invested in related research.
Something about how those resources have been used has failed us,
failed to protect and provide gains against conditions and experiences that trap vulnerable Americans in the risks and costs of compulsive substance use.
Critically evaluating how those resources have been used, the claims and assertions about the nature of substance use, what leads to it and drives it, and how to effectively provide treatment for it requires background, competencies and training in key areas, just as competent critical evaluation of the nature of and effective treatment for infectious disease outbreaks and epidemics would require specialized knowledge, training, and competence.
For thinking and writing critically about problem substance use required areas of understanding include –
Human behavior and psychology
Human biology and the biology of effects of mood-altering substances
The basic language of research and research design
Most importantly the critical evaluation of research conclusions and claims informed by knowledge of
Human development and environmental effects on personality, behavior and mental health
The behavior (of individuals) and epidemiology (of populations) engaging in compulsive substance use
Research design and analysis including statistical analysis
Validity, quality, and meaning of research results
At exceeding small risk of misstatement, it is accurate to state that media writers on the subjects of addiction and America’s worsening epidemics do not have that background and those competencies allowing competent and credible evaluation of research and other claims. That leads to regular instances of egregiously unwarranted conclusions and interpretations presented for public consumption.
It would not be remotely reasonable to expect that they would –
they are writers, not research scientists who also have backgrounds in behavioral health, psychology, human development and social and environmental ecology, etc. Expecting, asking or encouraging those writers to interpret research, draw conclusions, offer suggestions about approaches and treatments would really be not different than asking them to review medical brain images and make treatment recommendations for patients based on their observations – that is, it would be inviting gross malfeasance and predictable harms and deaths.
Accordingly, writers reasonably, usually, approach the subject and their work by relying on information and interpretations provided them by recognized experts, almost always medical professionals, recognized medical authorities and recognized public health authorities.
Like the health care authorities and experts who helped to explain and support with research why opioid pain medications are safe and effective for all types of pain.
That’s where things get problematic, because it turns out that
There are no understandings of compulsive substance use from medical perspectives or from medically-trained professionals
Because compulsive substance use, as established by decades of complementary and congruent evidence, research, direct accounts of the patients, and supported by established psychological theory, is not remotely a medical condition
Which is why lethal epidemics have worsened over the same decades that enormous levels of public resources have been diverted to medical model research and control of programming
Including steadily increasing national dose of the “fix” and “anti-addiction drug” buprenorphine concurrently with rates of high risk opioid use and overdose deaths – the conditions that we are assured the medical fix is a cure for. The more medical fix dispensed, the worse the epidemics.
And is why traditional treatment (treatment as usual, TAU) driven by medically-overseen and medical/insurance industry managed care is a criminal scam predicting harm to vulnerable Americans
Those trusted professionals and authorities, trusted, relied on, and consulted by writers as experts.
So, it’s reasonable to accept that Americans, including media professionals, have been trained to trust and defer to medical institutions, authorities and practitioners as credible, knowledgeable and within scope of competence for any and all public health problems. American brains have been hijacked by that story.
But that doesn’t let media off the hook.
Because it’s their job to evaluate, to test assumptions, to investigate and expose untruth.
And those obligations became pressingly, profoundly important as responsibilities over the past years and decades during which it has become clear that those medical and pubic health experts and authorities –
Have failed to provide their long-standing promises – despite expenditure of decades of public trust and investment including billions in public healthcare funds – to establish medical treatments for what they continue to assure us is a medical condition
And have created – as documented by writer Sam Quinones in Dreamland – by a malfeasant and lethal combination of criminality, ignorance, and abdication of responsibility a lethal public health crisis.
And abdicated responsibility to understand and use evidence-based interventions in their field, to adhere to standards of safe and ethical practice, to advocate for and protect the safety of their patients whether or not they feel pressured by systems to place patients at risk, and to avoid practicing out of scope of competence, for example by medicating the non-medical problem of common chronic pain.
Information that vulnerable Americans trapped in substance use epidemics rely on for relief from risk, dependence and pain is coming from two groups of professionals – medical and mass media writers – each entirely out of scope of competence to understand, think about, and critically evaluate the problem, related research, and its solution. And whose collaborative track record includes creating the pure fictions that gave us the opioid crisis.
That might help explain certain problems.
That medical industry-generated opioid crisis is a development – the smoking guns increasingly described in accounts like Quinone’s Dreamland, Beth Macy’s Dopesick, and Chris McGreal’s American Overdose – that obligates journalists, engaging in journalism, to stop popularizing unsupported assumptions and medical/pharmaceutical industry distortions and deceptions that are linked to failed outcomes, rampant diversion and abuse of prescribed substitute opioids and perpetuation of problem opioid use – instead to question, investigate, expose, and take a lead role in a desperately needed 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.”
– 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.
Media failure is the norm,
essentially every piece on the subject exemplifying abdication of questioning, investigation and analysis, in favor of reward for roles as popularizers of medical and addiction industry doxa. That’s not to say there are no incisive examples of truth-seeking, like the work of Quinones, Macy, and McGreal for example.
And there are examples like this, from the Dayton Daily News, reporting on discrepancies and problems in use of public Medicaid funds to address problem opioid use, following a celebratory piece in the NY Times that missed those problems and missed a return to increased overdose deaths in the Dayton area.
The strengths and public value in the accounts of observers like Macy, Quinones and McGreal are in describing, laying out, the events, connections, course, human foibles and cultural and institutional pathology in generation of the epidemic.
It’s when writers without capacity to understand, evaluate, contextualize in related sciences, and think critically about the related research and treatment issues offer interpretations and suggestions about the nature of problem substance use and its treatment that harm is predicted.
Writers, for example, popularizing opioid substitute therapy (OST) – buprenorphine prescribed in medication assisted treatment, MAT – engaged in the most basic of research interpretation errors, attributing cause-and-effect benefits in reduction of opioid-related overdose deaths to bupe based on longitudinal (“before-and-after”) observations, when in fact competing explanations unrelated to OST are supported and OST is not.
That’s a big deal, as OST continues to fail, overdose deaths mount, and the Trump administration collaborates with the medical/pharmaceutical industry and its popularizers to divert increasing public funds to the unsupported programs and away from evidence-based practices for substance use problems.
But chronic, day-to-day harm, a hijacking of American brains by misinformation, is generated pervasively, uniformly in diverse media outlets, from city papers to the NY Times where the folklore and constructed mistruths comprising public understanding – mistruths invalidated by longstanding bodies of research and popularized not just in traditional news outlets and online sources but as well and extensively in entertainment and popular culture – are constructed, instilled by repetition, normalized, validated by authority, as if the fabrications were real and supported by evidence.
Just as media as public protectors and watchdogs, in a complete abdication of those roles of investigation, challenging and questioning, were along for the ride, complicit, in the lethal, opioid-crisis-generating lies messaging to a trusting public that –
common chronic pain is a biomedical condition
that there are effective biomedical treatments for
including addictive, schedule II opioids (by definition with high potential for abuse)
that can be used effectively and safety on a broad scale
Along for the ride? Not just the nation’s leading medical authorities, institutions, researchers and peer-review scientific journals, but major media – the New York Times, Scientific American, Time magazine, and lessor public guardians.
The claims, both at the time and in retrospect, had no grounding in science or scientific research.
The broader fabrications include all of the core useful fictions that comprise the public understanding of “addiction” and its treatment, that comprise doxa –
1) that compulsive substance use is a medical condition
2) a disease of the brain, caused by “hijacked brains”
3) for which there are medical treatments
4) that have provided gains in understanding and treatment outcomes
5) including effective treatment of opioid dependence with substitute opioids
6) and tobacco use with anti-craving medications and nicotine replacement therapy (NRT)
7) In “rehab” (residential) and outpatient addiction treatment programs, beneficial treatments are provided.
8) Relapse and continued use are caused by avoidance of withdrawal symptoms and cravings to use, both effects generated by “hijacked” brains.
9) Group therapy is a type of treatment that benefits individuals with compulsive substance use.
10) The 12-Steps of the Alcoholics Anonymous religious subculture and meetings of AA and Narcotics Anonymous (NA) provide benefit for problem substance use.
11) Addiction professionals working and providing group and individual counseling in programs are qualified and competent to provide treatments for the complex, life-threatening condition of compulsive substance use.
12) There exist professionals who are “peer supports” or “peer mentors” providing “peer support” that is beneficial to individuals with compulsive substance use.
Those are the accepted traditions, the truths, well-established knowledge, so well established that it “goes without saying” – that is, the useful constructed fabrications, the doxa – driving treatment approaches that have gotten us, over past decades, to where we are now – incompetently and blindly enabling the deaths and suffering of millions of Americans.
It may be worth asking,
What does the unreported research say?
1) On any informed and competent review and consideration of the longstanding evidence, the behavioral symptom of compulsive substance use does not remotely constitute a medical condition.
3) There are no bodies of replicated RCTs (randomized, controlled trials, or experiments) that support clinically significant, durable benefit from any medication for substance use. Or are there? Please provide them. Research aside, that claim turns out to be absurd on its face.
4) Disease models of compulsive substance use are invalidated by all lines of relevant, longstanding research and evidence; outcomes of those models and medical “treatments” are worsening lethal public health epidemics.
5) The medical industry gold standard and fix for problem opioid use – prescribed substitute addictive opioids – is not and has never been supported as providing overall benefit, is invalidated by mounting evidence.
6) There are no bodies of replicated RCTs to support clinically significant benefit from medical-model smoking cessation interventions – medications or nicotine replacement.
7) The core elements of “treatment” provided almost universally as addiction treatment in the U.S. are invalidated by longstanding bodies of evidence, instead predict harm.
8) Patterns of relapse to problem substance use predicted by and required to support any “hijacked brain” model of “addiction” are invalidated by available research.
9) With very limited exception, group “therapy” is not supported by research as a beneficial therapy.
10) The features and odd prescriptions of the religious subcultures AA and NA are established as harm-predicting by longstanding research.
11) The “addiction professionals” paid to provide “treatment” in U.S. addiction treatment programs are not competent, trained, or qualified to provide treatment.
12) “Peers” are even less qualified than addiction professionals to provide guidance and therapeutic interactions with persons trapped in complex, potentially lethal conditions of compulsive substance use.
There is a way out
of America’s worsening lethal substance use epidemics – by use of the evidence-based psychotherapies and psychosocial supports established by decades of research as effective – a way that remains intentionally hidden, marginalized, covered by the constructed fictions required to protect status and control of public health resources by the industries with media-endowed cultural capital to create those fictions.
The more gold standard medical fix prescribed for diseased brains, the more deaths.