The Medium is the Message:

Medical Visits and Advice for Substance Use, Common Chronic Pain, and Depression Cause Harm

And Drive Lethal Epidemics

by Clark Miller

August 7, 2019

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.

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.

shutterstock_doctor patient pills

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.

 

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 painagainst 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.

The uninformed, evidence-free diversion of public health resources to a medical “fix” for the non-medical condition of compulsive substance use and, more importantly, branding and marketing to vulnerable Americans the never-supported deception that “addiction” is a biomedical condition with medical treatments  has been predictably lethal.

Via mass media, medical and pharmaceutical industry advertising and dissemination, assertions of medical professionals outside of scope of competence yet constructed as knowledgeable authorities on behavioral health issues, and themes firmly enmeshed in popular culture, Americans have been effectively trained, over decades, to access a medical visit for entirely non-medical problems with the expectation of a, quick, easy fix, a prescription, a pill, that serves as treatment for everything from low mood to the complex, psychosocial-driven, life-threatening behavioral symptom of compulsive substance use including of opioids, alcohol, other substances. And for common (non-cancer) chronic pain, a psychogenic condition (generated by unbalanced, distressing mood and thinking states).

And Why Not?

If there are pills that treat the condition of compulsive substance use, have been demonstrated – over the decades that billions and billions of public healthcare funds have been diverted to their development and use – to have lasting effectiveness, who wouldn’t choose to take a pill or two a day to fix their life-threatening addiction problem, or chronic pain? America’s most knowledgeable and trusted health authorities assure trusting, vulnerable patients daily, each visit, that there are such medical fixes. The “medium”, the visit itself, instills and reinforces that message and belief in a medical fix for depressed mood, addiction, chronic pain,  Americans assured of  that by authorities, major media, in advertising, in entertainment and cultural themes.

The alternatives to those quick, passive, medically-recommended cures are the longstanding evidence-based psychotherapies excluded from standard, universal treatment for “addiction” that are supported by decades of research to provide durable relief for those problems. Durable relief for the distorted patterns of inaccurate, emotion-laden thoughts and mood disturbances driving behavior of compulsive substance use, causing common chronic pain, and constituting depressed mood.

But that’s all about therapy, talking, feelings, and making changes. Why all that, when a pill a day will do?

shutterstock_man with pill

Because Medicines don’t treat these conditions at all

Instead they tweak brain chemistry to shut down, block from awareness, mask the symptoms – symptoms that are signals to the organism to do something about the problem, about the inner states causing the symptoms, do something about the condition itself – diverting patients away from real treatments for those conditions. Then America’s puzzled journalists, thought leaders, experts grimly ponder Why, why are substance use and depression epidemics raging, killing us? For them a profoundly confounding mystery, to be solved by increased dispensing and funding for more and more of the same harm-predicting medical cures.

Because after all these are medical problems. That Goes Without Saying.

As more and more of the medical cures are dispensed, the epidemics worsen and worsen – a pattern apparently insufficient to instill the insight that the cures aren’t working. While America gets sicker and sicker.

Overdose deaths US trend The Guardian

(from The Guardian – November 29, 2018)

SAMSHA bupe client trends2

Chronic Pain

Almost all chronic pain (non-cancer pain lasting more than 6 months after an injury, with no identified associated tissue damage or inflammation) is non-medical, with no biophysical cause, instead generated by inner states including mood and beliefs. Accordingly, there are no biomedical interventions supported by evidence as effective for centralized chronic pain, instead cognitive behavioral therapy (CBT), providing durable relief.

Every visit to a medical office for centralized chronic pain predicts harm, instilling false belief in ineffective biomedical remedies and diverting patients away from the effective treatments.

Smoking

The same is true for smoking cessation. Research has never supported clinically significant benefit from interventions prescribed by medical providers – nicotine replacement therapy (patches, gum, etc.) or medications that ease cravings, and recent research fails to detect any benefit at all. Instead, individual counseling using cognitive behavioral strategies (CBT) and motivational interviewing (MI) are supported as predicting clinically significant benefit.

Every visit to a medical office for smoking cessation causes harm by instilling false belief in a passive, ineffective medication or nicotine replacement fix, disincentivizing patients engaged in a potentially lethal compulsive behavior away from engaging in the evidence-based, more intensive, active work of counseling and behavioral changes.

Substance use

Just as the evidence-free, medical/pharmaceutical industry constructed lie  that common (centralized) chronic pain is a biomedical condition that could be medicated effectively has led to enormous harms in the form of the Opioid Crisis, longstanding worsening substance abuse epidemics are driven by diversion of healthcare resources to promised medical fixes for the entirely non-medical condition of compulsive substance use, with no bodies of evidence to support medical treatments, instead for longstanding evidence-based psychotherapies and psychosocial supports.

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.

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.

The deceptions operate psychologically

It turns out that pattern of “relapse” (return to a pattern of problem substance use after quitting) is NOT explained or consistent with the required assumptions and features of the long-invalidated medical “hijacked brain” or disease model of addiction – the research clearly invalidates that. Instead, key predictors include belief by the user in that fictional model, belief that the user’s compulsive substance use is a medical disease. If I have a disease (a brain disease!) after all, that’s something out of my control, out of my understanding and ability to do something about.

 

Nothing to do for it but trust the medical experts for the only types of treatments that would be treatment for a disease, a medical condition – medical treatments.

Whatever my doctor recommends.

STAT opioid deaths

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.

Learned Helplessness . . . or Trained Helplessness ?

Those disincentives, barriers to effective treatment, on the promise of quick, easy, passive fixes, are congruent with research pointing to another generalized effect – Americans with chronic medical conditions and who believe (possibly defensively) the condition is caused by factors out of their control (e.g. My obesity, hypertension, etc. is genetic) are less likely to engage in lifestyle changes that are sustained, active and involve effort and engagement in change (e.g. in diet, activity level) required to predict return to greater health or that would have been preventative –

Overall, the 1,959 healthy adults (ages 25 to 40) who completed the survey asking about their health, their habits, and their beliefs thought the way they lived was the main cause of any health problems they had. They also were more interested in receiving information about healthy behaviors: 67 percent said it was very important to learn about healthy behaviors, vs. 56 percent who said it is very important to learn about genetic risk factors.

But the adults with the least-healthy habits didn’t fit this pattern, found scientists led by Suzanne O’Neill of Georgetown University. The unhealthier people’s habits were, the more they latched on to genetic explanations for diseases (in particular, colon cancer, skin cancer, hypertension, and lung cancer). “Those most at risk are often the most likely to downplay and distance themselves from threatening health information,” the scientists conclude.

They suspect that this was a defensive reaction, in which people knew at some level that they were engaging in behaviors likely to lead to illness down the road (remember, these were all healthy adults at the time of the survey) but wanted to blame potential health problems on factors beyond their control. In the study, 25 percent of the participants were smokers, another 25 percent were not physically active five days a week, and 36 percent had a body-mass index above 30. If you think your plaque-clogged arteries, uncontrolled diabetes, or lung cancer will be caused by genes in the fertilized egg that became you—rather than your junk-food diet and two-pack-a-day habit—it absolves you of blame.

That’s bad enough. But people with the least-healthy habits were also least interested in learning about ways to live healthier. If DNA is destiny, they apparently figured, why bother learning about healthy alternatives to doughnuts for breakfast, Big Macs for lunch, and three hours of evening TV? Blaming DNA—a message we are hearing more and more as personal genomics spreads—bodes ill for efforts to get people to adopt healthier habits.

Bourdieu Chronic Pain Research Says

Doxa

It is critically important to recognize and understand the importance and impact of related cultural and learned fictions supporting and reinforcing these useful medical fabrications that are psychological barriers instilled by accepted disinformation, by doxa.

Faith Healing

In a cultural phenomenon that can only be best accurately expressed by the recent popular expression You just can’t make this stuff up, the core component of traditional, essentially universal, standard “treatment” for substance use disorders in the U.S. – the treatment paid for and provided in “rehabs” and outpatient treatment programs everywhere, and endorsed and referred to by the medical and “addiction medicine” industries, and unconstitutionally forced on individuals with the medical “brain disease” – are the bizarre, 50-year-old, established-as-ineffective-by-decades-of-research prescriptions of a religious subculture – Alcoholics Anonymous.

Exposure to those bizarre prescriptions predicts return to problem substance use at failure rates of 85 to 95 percent, among other problems. Prescriptions like asking a magical higher power for forgiveness for moral failures, instilling a sense of “powerlessness” and dependence on higher authority, not self, to cure the disease. AA fully embraces the fictional disease model, its orientation remarkably similar to the medial industry instillation of dependence – on a magical higher power or on a magic potion, respectively.

You can’t make this stuff up.

Either Or

As currently culturally constructed, there are two – just two – extremes, or poles on a continuum or cultural and scientific progression of understanding of “addiction” – from an early belief in addiction as a “moral failure” of the individual user to the modern medical understanding of addiction as a brain disease.

Neither are or have ever been supported by research, by critical evaluation of evidence and the key sciences of human behavior, choice, development and psychology, instead the medical model invalidated by all lines of relevant evidence.

Doxa, the constructed cultural fiction defining acceptable and allowable understandings of compulsive use of substances and the associated worsening, lethal epidemics Americans are increasingly trapped in, allows two possible explanations for those phenomena: the rightly rejected, false, and unacceptable and stigmatizing view of addiction as a moral failing, and addiction as a disease of the brain.

That is, there is only one acceptable, allowable way to view addiction – as a medical condition, a disease of the brain.

That constructed and accepted “knowledge”, a hijacking of the American brain, is tragic on multiple counts:

Trapping affected Americans in a false belief that predicts relapse and diverts them away from evidence-based treatments – psychotherapies

Robbing Americans of understandings of compulsive substance use that are, in contrast, supported by longstanding evidence – driven by complex inner states of distress formed by early experiences including trauma and emotional injury and by other internalized stressors and thinking and mood disturbances

And from all evidence, substituting ineffective medical “treatments” for those evidence based psychotherapies, the medical approaches a waste of public healthcare resources and driving worsening lethal epidemics

Self-efficacy: The Opposite of Helplessness and Powerlessness

Another, complimentary 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.

Depressed mood

Research invalidates effectiveness of antidepressant medications as treatment for depression with durable benefit and apart from placebo effect. That’s established.

And, just as established research and knowledge had no impact, no protective effect against the constructed lies that enabled the lucrative and lethal medically-generated opioid crisis, America continues to be increasingly dosed with “antidepressant” medications while prevalence of depressed mood and associated costs mount.

We didn’t need research

The characteristic behaviors and inner thought and feeling states constructed as the psychiatric disorder “Depression” (or absurdly as a brain or biochemical condition) are reliably reported as tied to, representing characteristic associated experiences, the common theme of loss, also social, interpersonal and situational conditions, to beliefs, to psychological associations.

No pill for those. Longstanding evidence-based psychotherapies yes, but no pill.

In fact, persistent and pervasive use of antidepressants may likely cause harms.

Antidepressant medications mask symptoms, symptoms that function as signals to the organism to engage in behaviors, shaped by millions of years of natural selection, which are adaptive – designed by evolution to promote survival. Loss triggers retreat, a slow-down, healing, rest, opportunity for regrowth, re-assessment, reflection, repair, healing. No pill for that.

Pathology

In the profoundly and overtly inept, malfeasant, and intellectually cowardly conspiracy of incompetence, group think, media failure, and public betrayal that allowed runaway prescription of opioids for chronic pain and generated the lethal opioid crisis longstanding, multiple lines of evidence were ignored, had to be ignored in order to rationalize practices that enriched medical and pharmaceutical industries and relieved medical prescribers of the discomforting task of practicing ethically.

There was never any indication, let alone body of evidence, to support chronic centralized pain as a medical condition or condition that would be safely and effectively managed with addictive opioid pain killers. All lines of evidence indicated against that.

None of that mattered, and none of that has helped America learn.

There is no more evidence for the constructed fictions of compulsive substance use, or depressed mood as medical or biological conditions with medical treatments than there was for common chronic pain.

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, are diverted, away from longstanding evidence-based psychotherapies for the behavioral symptoms of compulsive substance use and to constructed fictional medical approaches, deaths mount.

Chronic pain, compulsive substance use, depressed mood

Every medical visit for those overtly, demonstrably non-medical conditions causes harm, hijacks American brains, diverts trusting, vulnerable Americans from real treatments for those conditions, year by year, decade by decade, Americans sicker and sicker.

 

The evidence lies all around on a national crime scene.