Preview – Effective Substance Use Treatment Requires Ending All Funding and Treatment for Addiction, A Fabricated Condition that Does Not Exist

by Clark Miller

September 27, 2018

Full post to come.

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”.

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.

. . . .

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.

Additional posts at A Critical Discourse 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.

. . . .

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.

. . . .

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 the 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.

. . . .

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.

A pill?

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?

“Processing” with a group of strangers in a “treatment group” led by someone with a year or two of training in “addiction treatment” ?

“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.

Full post to come at A Critical Discourse.