We have no more reason to doubt the reliable, consistent reports of problem substance users about the drivers and underlying sources of their compulsive behaviors than we do individuals experiencing and responding to chronic pain, never constructed as a disease of the brain. 

by Clark Miller

Published October 23, 2018

Updated April 7, 2021; November 11, 2021

Truism – a statement that is so obvious or said so often that its truth is not questioned

Cambridge Dictionary

Doxa – what “Goes Without Saying” (accepted as true without question ) because it “Comes Without Saying” (because its truth has never been examined, its falsity never exposed)

Pierre Bourdieu

The Matrix image

One of the ways that ongoing public harm generated by healthcare practices and systems – including worsening crisis and lethal epidemics – may be thought of accurately is as the lethal power of the truism, more formally sociologist Pierre Bourdieu’s Doxa or the Illusory Truth Effect, used to opportunistically hijack vulnerabilities in the human mind to create “facts” or “knowledge” through the repetition of falsehoods which nevertheless become held as beliefs.

With contributing vulnerabilities and effects of Group Think and deference to constructed authority figures, demonstrably invalid, unsupported, and harmful practices can become acceptable, unquestioned, even a “gold standard” – the prime example for our time provided by a lethal opioid crisis that was entirely predictable and avoidable, the use of opioid pain medications for common chronic pain invalidated by all relevant lines of evidence that was longstanding, established for years and decades prior to the runaway over-prescription of those medications.

Rather than being a fluke or exception, the opioid crisis and its causes (fundamentally the abdication of: ethical, professional, and social responsibilities for research-informed practice; for protection of public health; and for oversight and regulation of health practices) are in fact part of a pattern of medical and managed care industry gross malfeasance that includes use of public funds and resources for 1) medical interventions to stop smoking that are ineffective and counterproductive 2) prescribed opioid substitutes for the opioid crisis that are not supported by research as treatment at all for problem opioid use and 3) a never-supported, fictional “disease” model of addiction, invalidated by all longstanding, relevant lines of evidence, and predicting treatment outcomes that are at best without benefit, or harmful, helping to fuel a national substance use epidemic.

But more fundamentally harmful than those assaults on public health is the falsehood that there exists a condition, or disease, or disorder at all, that is “addiction”.

Harmful because that fabrication drives everything else:

public perception of the nature and effective treatment of problem compulsive substance use

diversion of public funds and resources to related research, infrastructure, program development, community and most importantly prevention programs

identification and development of effective prevention campaigns, public health epidemics and outcomes, and more.


Part – but not the most important – of the deconstruction and invalidated status of the fictional, constructed condition “addiction” 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.

Dr. Nora Volkow holding model of human brain

In this remarkable, socially unjust and criminal context –

a surrealistic and lethal hijacking of the public mind by fictions that on examination were never supported by research or evidence – it is revealing and important to point to and use discrepancies, rips in the Matrix, to unravel the sheen of false authority and legitimacy that protects controlling industries and institutions from accountability and scrutiny while public health epidemics worsen under their care.

So the unguarded, fundamentally invalidating remarks by Surgeon General Vivek Murthy that belie, contradict the fictional “chronic brain disease” model are notable, important, insightful, incriminating, and a revealing rip, an unraveling of the Matrix.
His relevant comments begin at about 4:00 into this PBS News Hour video.

Murthy, unwittingly, and also here overtly serving through the interview as a tool and press secretary for the Medical Industry, nevertheless offered authentic observations and assertions.

At about 4:05 in, he was asked, “What is it that we know that can be done to help people to stop these [substance abuse] problems from developing?” Murthy, who had dutifully endorsed the “chronic brain disease” model, went on to contradict that fiction, avoiding any mention of medications, inoculations, any biomedical treatments or preventative measures at all that would be appropriate for a neurological or “brain” condition.

Instead, he focused helpfully and accurately on inner distress, both “emotional pain” and more generally “stress”, or anxiety as the drivers, the causes underlying compulsive use of substances or “addiction”, “If we can teach young people to deal with stress in a healthy way we can go a long way toward preventing substance use disorders.”

Brain scans

He went on to discuss “treatments” and the need for more training of clinicians to provide treatments, but still no mention of medications or biomedical treatments, again focusing on teaching “young people” to manage stress without use of mood-altering substances, and adults as well, in “community-based programs that focus on dealing with stress in a healthy way”.

That is, Dr. Murthy addressed treatment and prevention of substance use problems only in terms of therapy, or psychosocial interventions – behavioral health interventions that address belief systems, self-management of emotional states, behaviors. He was right on target and did not seem to realize that he was completely undermining the disease model.

Murthy went on to focus on what he called a “key point”, people developing substance use problems when they “begin trying to medicate some kind of pain . . . it may be emotional pain . . . it may be stress”.

There are a number of ways that Murthy’s accurate observations undermine and invalidate the “chronic disease” or “hijacked brain” and “addiction” existing as any type of condition at all.

One of those ways is recognizing that when a problem is caused by, maintained, and is about behaviors driven by inner emotional states, and the indicated treatments are individualized behavioral health therapies to manage anxiety or “emotional pain” or other distress –

That’s not a disease, let alone a brain disease.

Brain diseases are treated with medications, surgeries, other biomedical interventions. The treatments described by the Surgeon General are what we call skills training and psychotherapies for anxiety, depression, or other emotional disturbance, and it turns out that is the evidence-supported treatment model for all substance use problems, the subject of multiple posts for example here, here and here

Another, independent invalidation of the “chronic brain disease” fabrication that emerged from his comments is about cause-and-effect, because causes can’t work backward in time.

The “hijacked brain” story holds that the chronic brain disease of “addiction” is caused by extended regular use of a substance, causing over time changes in the brain that then impair functions like impulse control and emotional regulation, increasing impulsivity and causing abuse of substances.

But that leaves out something critical –

and falsifying. What was driving in the first place the extended regular use of an addictive substance – not moderately but in great enough quantity that over time caused the brain changes severe enough to produce a disease state? Was it the brain disease causing the initial period of regular use required to cause the brain disease? The logic just doesn’t work out.

If, in other words, it takes a period of time of compulsive, problem substance use to cause the disease (the disease of compulsive, problem substance use), then what caused the initially “causing” compulsive, problem substance use? A different brain disease with different causes?

Actually, we know exactly what caused it

because extensive evidence and models of human development and psychology tell us that Dr. Murthy is right – problem substance use starts and is driven by attempts to alter mood (hence “mood-altering substance”) or inner distress of some type:

The behavior is a symptom, the underlying distress the cause. There is no brain or other disease state involved, because individuals struggling with the behavioral symptom of compulsive substance use reliably, consistently tell us, describe their condition as the compelled, repeated use of substances intended to relieve and driven by underlying inner states of discomfort and distress – that is, as symptoms of underlying inner emotional/psychological states.

We have no more reason to doubt the reliable, consistent reports of problem substance users about the drivers and underlying sources of their compulsive behaviors than we do individuals experiencing chronic pain. We have no need or evidence to concoct unsupported theories about diseased brains, or learning, or genetic causes, to explain the symptomatic pain behaviors – we have no reason to doubt the reliable reports of patients experiencing pain and can relate to their reports through personal experience. The same is true for patients describing compulsive substance use.

Consider Chronic Pain

We know that centralized chronic pain is a condition in which patients have the inner experience (always involving complex, integrated perception of sensations, emotional states, and thoughts) of “pain” as real as any pain. And we know that it is psychogenic – generated or associated with those inner states, by definition not by physical conditions like damaged tissue, inflammation, the physical impact of a tumor on nerve endings.

woman in chair with back pain

We also know from those patients’ consistent reports – which we have no reason to doubt, do not doubt, and have experienced ourselves – that compulsive pain behaviors, like wincing, grimacing, moaning, changing body position, restricting movement, “favoring” body areas, etc., are compelled by those inner states that include beliefs, or thoughts about the sensations.

We do not and never will construct their behavior, reports, and symptoms of pain behaviors as “a chronic disease of the brain” or as some fabricated “condition” analogous to the fabrication of “addiction”, because we know that is not supported by the evidence – at all.

That would make no sense.

It is clear that they are engaging in self-defeating behaviors – including limiting their activity and compulsive, harmful use of substances – as driven compulsively by distressing, discomforting inner states we call “pain”. It is clear that the self-defeating behaviors, including misuse of substances, are behavioral symptoms compelled by distressing, unwanted inner states.

Just as there is no catch-all, diagnosable, clinical, evidence-based, sensical condition to identify and point to as a common condition, disorder or treatment for observed chronic pain behaviors – because each individual’s psychogenic meaning, understanding, and needs for resolving that psychogenic pain is unique  – likewise there is no such thing as “addiction”. No medical condition, no psychiatric disorder, no condition at all. Because compulsive substance use is a behavioral symptom of something else, of underlying distress, unmet needs, and distorted, self-defeating beliefs, those complex sets of inner drivers as unique, numerous and variable as there are individuals, with their individual histories, circumstances and stressors, who struggle with problem substance use, requiring – demanding – for effective treatment, the comprehensive and thorough assessment and clinical formulation of each individual’s history, environment, social world, and inner life.

As outlined in a following post, effective treatment follows that assessment with evidence-based behavioral and psychological therapies provided by qualified behavioral health professionals. That picture of problem substance use and its treatment is fully aligned with what informs us from the extensive bodies of research related to trauma, especially adverse childhood experiences (ACE) and associated developmental neurobiology.

We know that compulsive substance use is a symptom of underlying distress as surely and as confidently as we know that patients exhibiting pain behaviors (for example wincing, grimacing, shifting positions, expressing pleas for relief, restricting movements and activities, etc.) and who explain to us that those behaviors are compulsive and represent their reflexive reactions to the inner experience of perceived pain – truly are experiencing pain and compulsively engaging in the symptomatic behaviors related to that experience, behaviors that seem or are believed to somehow moderate or protect from the pain experience. We have no more reason to doubt the reliable, consistent reports of problem substance users about the drivers and underlying sources of their compulsive behaviors than we do individuals experiencing chronic pain.

We have no need or evidence to concoct unsupported theories about diseased brains, or learning, or genetic causes, to explain the symptomatic pain behaviors – we have no reason to doubt the reliable reports of patients experiencing pain and can relate to their reports through personal experience. The same is true for patients describing compulsive substance use.

To Summarize so Far – 

Problem substance use is not a condition at all, because it is a behavioral symptom, a compulsive response to inner distress, unmet needs, intolerable mood and thought disturbances which are the underlying conditions driving the symptomatic behaviors. Those conditions are as unique, individual, and numerous as there are individuals struggling with compulsive substance use, requiring rejection of all standardized “treatments” for any made-up condition, like “addiction”, and replacement by individual therapies tailored to each individual’s unique history, environment, and inner life.

Problem substance use is not a disease or medical condition because behavioral symptoms are not medical conditions, they are behavioral symptoms. Treating problem substance use as a condition, rather than symptom, was never more likely to provide benefit than treating the pain associated with dental decay as the identified condition, perhaps with pain medications, rather than as a symptom of an underlying condition requiring entirely different treatment. Nor is problem substance use a psychiatric disorder because symptoms are not psychiatric disorders. The harms, failures, and worsening public health epidemics driven by “addiction”, “addiction medicine” and other fictions were predictable.

As a reality check on the fabrications that have driven decades of malfeasant and criminal “treatment” for problem substance use and worsening public health epidemics, we might reasonably ask for evidence of gains from those models in understanding of causes (“etiology”) and progress in treatment of these problems under psychiatric and medical models.



The profound failure and harm done

by existing models of substance use and its treatment is explained largely by this historical fiction of “addiction” and is largely driven, perpetuated, by the need to protect status and power of the oxymoron and entitlement program “addiction medicine”, dismantled here. When we resist and reject the fictional account of “addiction”, fabricated to protect and preserve control of cultural capital and social resources for gain, it is clear that effective treatment of substance use is as or more challenging than treatment of medical conditions by a licensed medical professional (LMP), because it requires effective clinical formulation and associated treatment for each unique individual struggling with substance use and including understanding of that individual’s history, personality, psychology, inner emotional world, and social and material environments and functioning. That type of work – the effective treatment of substance use problems – sets a standard of practice for treatment as requiring advance practice behavioral health professionals like psychologists and clinical social workers. It is well beyond scope of competence for individuals trained to repair biophysical problems.

Science Daily No magic pill to cure alcohol dependence yet

Finally, Consider: Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by inner distress in the form of distorted apprehensions and fears about bad things happening driving compulsive behaviors that can have serious physical effects, like skin abrasions from compulsive washing, and/or serious, clinically significant adverse effects on functioning, like excessive time spent ordering or checking things, or spent in mental agitation, worry and distraction related to compelled behaviors driven by the underlying distorted apprehensions. Effective treatment for OCD does NOT target the behavioral symptoms, for example by punishing them or rewarding alternative behaviors, instead targets the distorted underlying beliefs and associated emotional states driving the compelled behaviors. The appropriate, effective treatments are types of psychotherapy, by advanced practice behavioral health clinicians, that identify and target the underlying apprehensions, unmet needs, discomforts and sources of fear (including from early experiences) driving the symptoms (behaviors).

Attempting to treat or manage the behaviors themselves without addressing those underlying obsessions driving them would predict treatment failure. Obsessive-compulsive disorder may be thought of as representing inner distress (in OCD in the form of severe anxiety driven by distorted thoughts), with behavioral symptoms expressing compulsions to attempt – unsuccessfully and maladaptively, with negative physical and functional consequences – to moderate, escape, or relieve the distressing inner state.

Just as in problem substance use.


Related post: Effective Substance Use Treatment Requires Ending All Funding and Treatment for Addiction, A Fabricated Condition that Does Not Exist

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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