Our disease debate (now on YouTube) and why it might not matter

Just got back from the US the day before yesterday, and I’m mostly trying to reset my body clock, nine hours ahead of where it was in California, or maybe behind, or is it ten hours with Daylight Savings…? I haven’t quite got it worked out.

debate liveAnyway, just this morning it occurred to me that I forgot to let you guys know that the Great Debate is finally available on YouTube. Here it is. Thanks to Shaun Shelly for crunching all those gigs into something relatively bite-sized (pun intended?) and doing whatever he had to do to dampen background noise. The sound quality isn’t bad for a talk in a theatre.

I’ve got lots more to share with you from my time in the US. I continue to love Americans, loathe their politics, and try to stay afloat in that peculiarly American miasma made of equal parts hope and despair. The societal challenges are so huge. How will they ever be resolved?

But the biggest challenge I witnessed, up close, in my face, was the suffering and anxiety, the attempts to come to grips with mortality rates and the loss of friends and loved ones, that continue characterize the opioid epidemic. Overdose deaths are still the leading cause of death in Americans under 50. And suicide is a close second (in some reports), exacerbated not only by substance use but prevalent during periods of abstinence. The system (if we can even call it that) is completely broken.

I gave a talk in Long Island and did some version of my usual spiel about the “disease” label and the problems it creates, in our scientific and social understanding of addiction and in the twisted ethos of a treatment industry powered by profit and offering little more than a quick fix for a problem with deep roots. But the day after my talk, something changed. I sat on a panel with the program directors of several community and state organizations tasked with helping addicts survive and, ideally, stop using. The meeting and discussion were hosted by THRIVE, a community-based organization  (note: this is not the for-profit rehab by the same name) that describes itself this way:

Why THRIVE is Different
Launched in response to our community need for a safe, substance-free place, THRIVE is the first and only of its kind on Long Island. Members of the recovery community and their families can pursue better skills, better relationships, and ultimately better lives.

THRIVEteamBut  THRIVE really isn’t much different from hundreds of similar organizations springing up around the US, largely in response to the opioid/overdose epidemic. THRIVE mainly helps steer users and families to nonprofit organizations (supported by public funds and donations) dedicated to rehab, recovery, abstinence and above all harm reduction. These are incredibly dedicated groups, and the four people selected to speak for them were smart, passionate, hugely knowledgeable and deeply concerned. For the many people crowding the room — the wasted looking former or “recovering” addicts who’d been driven too far down for too long, the people of all ages with half a spark in their eye who’d remained alive and involved thanks largely to methadone and Suboxone, the family members still brimming with hope or anguish and sometimes gratitude, the teachers from local colleges, the front-line workers and those in training to become addiction workers, organizers and lobbyists, cops who cared, even government people (there was a state senator in attendance, and everyone seemed to know him because he was something of a regular) — for all those people, THRIVE and its tributaries were the main act. Not NIDA or ASAM or the Center for Disease Control, not AA or SMART, not Drug Courts, not psychologists (like me) or psychiatrists who think they might help explain things better. The main act was the community, right there in that room, palpable as a community, whose only goal was to help.

methadone lineupSo this is what I learned from the mind-boggling accounts of the obstacles people STILL face getting methadone or Suboxone (without long waits, trails of paper work, or intolerable commutes) or half an hour methadone handoutwith a counselor who actually cares. What I learned is that my arguments about the “disease” label of addiction were entirely context-specific. They may have their place with scientists, doctors, and policy makers. But here on the street, the disease label meant nothing more than a ticket to get help. The word was simply a currency, coinage — and if you had to use it to qualify for treatment, then so be it.

Mike AshtonI’ll end with a historical note that shows where we’ve come from (in drug treatment policy), where we’ve arrived, and how little has changed in the meantime. (This comes from Mike Ashton’s marvelous site with its collection of facts and figures related to drugs, alcohol, and addiction in general.)

Writing in 2010, years after his tenure at NIDA had ended, Dr Leshner revealed that his depiction and promotion of the [brain disease] model owed much to its public relations utility. He had appreciated its “powerful potential to change the way the public sees addiction”, and sought a resonant metaphor to realise that potential. The solution was to liken changes in brain structure and functioning caused by repeated drug use to a ‘switch’, transforming what was voluntary into compulsively involuntary drugtaking – a metaphor which he admitted was chosen without too much regard to the reality of neural functioning.

In other words, calling addiction a brain disease never meant much of anything to begin with, except as a prod for public health awareness and access.

So if that’s what we have to call it to get people what they need, in a country whose healthcare system is almost entirely lacking in rationality or compassion, then that’s just the way it is.

36 thoughts on “Our disease debate (now on YouTube) and why it might not matter

  1. matt March 17, 2018 at 6:43 pm #

    There is always another way to look at it. Framing it as a disease does give people access to services, which still perpetuates the juggernaut of overmedicalization to some degree. But if that leads to the ancillary benefit of getting more funding for (accountable) treatment services, I too, say so be it. But sometimes even compassion can go awry. In my experience at the street level, I run a very small group at a large center for veterans who have become homeless. I used to have a large group there. At that time, in order to reside at and obtain services from the center, vets had to follow certain rules and obligations, like attending groups appropriate for there needs. Like help managing substance misuse and other life issues. But now word has come down in response to harm reduction, that the residents can’t be obligated to go to groups as a requirement for residence and obtaining services. So a well-intended, albeit wrongheaded, compassionate interpretation of harm reduction, is potentially leading to more harm, the counselors are tearing their hair out and more people are dying. Until we get a handle on the social dimension you alluded to above, it’s gonna be a long haul, and we’re gonna need a lot more dedicated folks who’ve been there to change the public perception of addiction.

    • Donnie Mac March 18, 2018 at 4:23 pm #

      Making people “Sing for there supper” is draconian . Just wondering if you have to “attend groups and obtain services” to keep your home ?
      I live in Vancouver , British Colubia , Canada , home to Insite/Onsite North Americas first safe injection site . These “well intended ,wrongheaded,compassionate interpretation of harm reduction” have actually produced statistics on their “Rightheaded , pragmatic use of harm reduction. Here’s just one :

      “More than 3.6 million clients have injected illicit drugs under supervision by nurses at Insite since 2003. There have been 48,798 clinical treatment visits and 6,440 overdose interventions without any deaths.”

      Your post wreaks of losing control of what was and possibly your job .

      Like Bob Dylan sang ” You better start swimming or you will sink like a stone for the times they sre a changing”

      Have a Great Day

      Donnie Mac / 18

      • matt March 18, 2018 at 9:57 pm #

        Hi Donnie

        Maybe I need to clarify what I meant by my comment. First, I am completely in favor of harm reduction approaches. It is what I spend my days doing as a volunteer. I am heartened they are increasing in scope. The model programs you and Marc describe are what harm reduction is meant to be, and they further destigmatize substance misuse.

        Not all interpretations of harm reduction are the same, particularly in certain administrative arms of the government. The interpretation I am talking about is in one organization in one city. In most people’s view, the purpose of harm reduction is to limit and prevent harm, not absolve individuals of their social responsibility. This interpretation and implementation of harm reduction at this center is not helping the people it was intended to help. Many of the residents, placement and recovery counselors agree. They also feel it is undermining morale, personal safety and their reputations, as well as the center’s. I’m not worried about losing my job because I am a volunteer and am there at the behest of the center. This is not about making people “sing for their supper.” It’s about helping them to get their lives back and feel safe doing it— not worrying about drug deals going on in the next bunk.

        • matt March 19, 2018 at 9:43 am #

          The particularities of implementing overwhelmingly positive philosophies can have unintended consequences we might never have imagined— until they happen.

  2. Carlton March 17, 2018 at 9:44 pm #


    Although most people no longer believe that earthquakes are caused by the anger of the Gods, earthquakes still endanger and kill people as they always have, and as they always will.

    So what was the value of pursuing, and finally understanding that earthquakes are actually the action of plate tectonics, if people are still being endangered and killed?

    And another consideration;

    Understanding plate tectonics has indeed led to the LOWERING of potential deaths… and continued understanding willl help lower the rate more and more in the future.

    The point is, there is reason and need for experts,(such as you) in their \specific fields, to pursue, present and stand by what they discover.

    Eventually, it leads to a true understanding, which leads to other understandings, as things progress.

  3. Scott Knapp, LPCC-S, LICDC-CS March 18, 2018 at 4:41 am #

    Opioids are not the only addictive substance out there, but they’ve sure taken the limelight. We still shouldn’t compromise reality that addiction isn’t merely biological, simply because one addiction with prominent biological solutions currently has center stage.

  4. Colin Brewer March 18, 2018 at 5:06 am #

    Last July, I was invited to a NIDA one-day symposium that seemed to be a response to the overdose epidemic. My main role was to describe simple 24-hour techniques for opiate detox and naltrexone induction, including the ‘Asturian’ domiciliary version developed in northern Spain and further improved with some joint research that I did with our Spanish colleagues. Much as I like NTX, it’s obvious that neither Vivitrol nor the 6-month Australian NTX implants that NIDA are now interested in developing can make more than a small dent in the OOD statistics but I suggested that a maintenance preparation combining very small doses of NTX with buprenorphine might maximise BPN’s overdose-reducing effects (for both BPN itself and other opiates) without reducing BPN’s attractiveness as a maintenance drug. It might also be a useful emergency drug to administer to addicts who come into the ER unconscious after an overdose and then promptly discharge themselves as soon as naloxone wakes them up.
    I said that it shouldn’t need many laboratory rats** for a simple ‘proof of concept’ study but I haven’t heard anything since. Of course, most good ideas in medicine turn out not to work, or to have unexpected adverse effects but I think it is worth a try. When the heroin-blocking effect of 6-month implants wears off, the persisting low levels of NTX in the long pharmacological ‘tail’ protects against OOD for at least the next 3 months.

    **Or, of course, lawyers. As the old joke goes, there are more lawyers than rats and there are some things that rats won’t do.

    • Marc March 18, 2018 at 7:54 am #

      Colin, I would imagine that your idea didn’t fly for a very simple reason: the balance between pleasure and just-survival had better not tip too far in favour of pleasure in this puritanical country. That would be wrong.

      It’s also well known that for some people opioids are far more effective than any other drug (e.g., SSRIs) as antidepressants. (both produce significant withdrawal symptoms) The only problem is that opioids might make you feel a little bit NICE.

      • Angela G Nolan March 28, 2018 at 12:16 pm #


        I appreciate your work very much and read your blog regularly. I have just gotten around to ordering your book and very much look forward to reading it. I don’t comment here because I’m not a professional and feel like most people engaging in the comments are a lot smarter than me, but this post really hit home for me and I wanted to specifically ask you about the comment above. I live in the US, in NW Montana. I’m 56 year’s old and have struggled with multiple substances over the years. A long cocaine run led me to treatment in 1988 and subsequently six year’s of abstinence in AA. I had become very disillusion within AA and started drinking again, thinking I would be able to handle it. But I didn’t handle it well and over the years have had some periods of abstinence always followed by relapse again. I’ve always struggled with depression and have been on anti-depressants for years. Beginning in 2015 I have had both hips and one shoulder replaced. I was in terrible pain until I could have the surgeries and still struggle with a lot of pain. I get 30 7.5mg hydrochodone a month and am on an anti-inflammatory called diclofenac which works well for me. But honestly, the only time I feel good out of the month is when I have the hydro’s which I will take 3-4 in a day. I’ve never heard before the opioids are good for depression, better than anti-depressants, but that is my experience. Of course, doctors here are so freaked out about providing prescriptions for them, they’re very hard to come by and I feel lucky to get what I can. Could you direct me to any studies regarding the efficacy of opioids for depression?

        Also, I wanted to say that this “opioid epidemic” is not really that. Opioids have been around for a long time without prompting an epidemic. It’s the fentanyl-laced heroin that is killing people left and right. I believe it is much more of a societal problem here which you unflinchingly and heartbreakingly described in your post. American government could give a crap about its citizens and people are falling further and further into poverty, lack of meaning, no empathy for their fellow human beings, political in-fighting among citizens. It is truly an awful place to live in this time. My grandparents and parents had good quality of middle-class life. That is gone.

        I think also for people like me who watch the climate science it’s all too easy to fall into nihilism and want to just crawl under a rock and die sometimes. Living in Montana for 15 years I can see it with my own eyes.

        Thank you again for your excellent work and continuing to fight the good fight.

        • Greg Pharmacy Student April 3, 2018 at 11:00 am #


          I don’t think opioids for depression are a good idea. See: https://www.psycom.net/depression.central.opioid.abuse.html In the short term it’s clear that opioids, mask depression and pain.

          As you mentioned you have 2 diseases which are not adequately treated: depression and pain. Both are helped by a change in perspective. Mindfulness about depression and pain can help a great deal; as much as medications. Consider that medications may only help about 50%. Meaning there is about 50% of the work to make up for. What this will looks like for you I cannot say. Consider setting functional goals and reducing inflammation: http://www.mdmag.com/peer-exchange/managing-chronic-pain/setting-realistic-functional-goals-in-chronic-pain-treatment-agreements

          Set small goals you know you can achieve, but do them everyday. Once you have a routine you can say, “I’m comfortable with what I currently do; it’s time to do more.”

          You can be more effective than medications (boost serotonin and dopamine) by growth: building new habits.

        • Marc April 11, 2018 at 5:59 am #

          Hi Angela. Sorry it’s take awhile for me to reply. I don’t know offhand of studies comparing opioids to SSRIs for efficacy in controlling depression. I suppose I could look, but I very much doubt there are such studies, since no one in the medical community seems to want to even consider the possibility that opioids are useful against depression. It seems obvious to me. I’ve heard countless stories from acquaintances, clients, blog contacts and my clients in psychotherapy. I’ve been there myself. Why do people imagine that people LOVE opioids so much? Because they make you feel better. And that’s exactly their biological function: to reduce stress and to soothe. Of course they work for depression!

          Obviously there is danger in the capacity of opioids to make us feel better. That’s why they’re addictive. But if people are already really suffering, then is “being addicted” so bad? Is it any worse? And it’s well known that people get addicted to antidepressants of any sort.

          Personally, if I were in pain and depressed and lived in the US, and could not get opioids from a doctor, I’d seriously consider “registering” as an addict — however that takes place in one’s local community — and getting on methadone or Suboxone. Lucky for me I don’t have to make that choice.

          By the way, you’re absolutely right that the opioid “crisis” is 90% an outcome of fentanyl-laced heroin. See previous posts.

          I am truly sorry to hear how discouraged you are with life in the US. Frankly I don’t blame you. I was just there for two weeks, and you’re right, the culture is really broken….in many ways. But there is still hope, so don’t hide under a rock. Americans, despite being generally misguided about the distribution of wealth, the value of a social safety net, guns, and a few other fundamentals, have a great deal of energy, creativity, and I would say a real pull toward wanting to get things right. In Europe, where I live, people are more passive about societal ills. They figure there’s not much point trying to change things. But in the US people talk and meet and form lobbying groups and expend a lot of effort to make things better. And these efforts really do produce results.

          The society is changing fast. You had a black guy as president for two terms — who would have imagined that even 25 years ago! So, please, don’t give up hope.

          And by the way, if you need a bit more opioid in your system, I might recommend kratom, an herb with a low addiction potential, perfectly legal almost everywhere in the US.

          Best of luck to you!

          • Carol Myers May 1, 2018 at 2:01 pm #

            Angela, CBD is a compound found in cannabis (marijuana) with low THC and tremendous benefit for pain and depression without the risk for addiction. Due to the fact that cannabis is still illegal according to the federal government, research is limited in the efficacy of cannabis for the treatment of depression and pain. I work in healthcare, and several of my patients who have used CBD for pain, anxiety, and depression reported anecdotally great relief from CBD. CBD as we understand works on reducing inflammation, and enhancing our own endocannabinoid system. Israel has done some good research on CBD, and has published their results. It’s worth investigating as a safer alternative to opioids.

  5. Mark March 18, 2018 at 5:50 am #

    “… then that’s just the way it is.”

    Up to now. Science and health care policies can change … one funeral at a time!

  6. Annette Stewart March 18, 2018 at 6:52 am #

    Addiction policy is reflective of commercial and political policy: short term and a “sticking plaster” approach, which leads to shattered families and multiple deaths.

    My question is – who’s looking at the wider and deeper picture of why people misuse? I don’t care about the substance, but I’ve noticed that when people lose hope in things and people they’d formerly trusted, there’s a need to obliterate/numb. All my friends who have/had alcohol misuse problems had family and work problems going on, and booze was their crutch. Partly because our deluded societies no longer want to talk about what’s really ailing them: Perfection is all! That’s as much a tragedy as the injuries/deaths/suicides resulting from misuse.

    Community, along with Honesty, is where healing begins and can flourish. It was great to read about THRIVE: clearly doing a great job.

    Today, there are multiple online forums now for peope quitting their substances. Here in the UK, there’s Club Soda on Facebook, which is so helpful to heavy drinkers. We know we’re not alone! As we make progress and climb out of misuse, back to healthier thinking and belief patterns e.g. Life was better and less complicated without booze/drugs, and we connect with each other socially, as well as online, Recovery is possible and restorative. Each person restored lights a candle for others on the journey…..

    I hope that ‘experts’ will see that community holds the power these days, as there’s nothing better and (usually) far less judgmental than a recovered substance user. And we MUST listen to recovering users’ views of what a good life looks like to THEM i.e. my brother was a registered methadone addict, who held down a responsible job when he was in a loving relationship. When he wasn’t, everything fell apart.

    That’s why Portugal’s solution to addiction is so much more compassionate – decriminalise drugs, see it as a health issue and let users have access to the drugs they need in safe environments, to get on with their productive lives. This is the very opposite of a “tick box” approach to addiction…..

    • Marc March 21, 2018 at 10:18 am #

      It seems your perspective is very similar to mine and to that of many experts in the addiction world and many readers of this blog. So when you say “who’s looking…?” at the wider picture, the answer is: most of us! Gabor Mate, Carl Hart, Maia Szalavitz, Johann Hari, Bruce Alexander, Lance Dodes, Vera Tarmen, the community organizers in the room with me that day, and the sponsor for my Long Island speaking tour, Doreen Guma, with her “Time to “Play” organization encouraging a shift of attention to positive rather than negative facets of today’s societal challenges. Even Nora Volkow is starting to talk about social disintegration and family strife as preludes to addiction. Prevention is the number 1 aim for almost every serious person in the addiction field. That’s who’s looking.

      So you might well ask a more pointed question: knowing what we know, saying what we’re saying, why are governmental funding bodies, drug reform committees, and policy makers not listening. Why are people supporting a president who thinks that restrictions of prescribed opioids (like Suboxone?) should be curtailed and more people should be incarcerated or, if we really don’t like them, killed. Thanks Duterte for being such a role model. What’s lacking is political will and action. Those of us who study addiction are yelling for societal/social solutions as loud as we can.

      • Annette Stewart March 21, 2018 at 10:59 am #

        Thanks, Marc – point made! I liked Johann Hari’s excellent book “Chasing the Scream” re the history of it all. Humanity has wanted to get high since time immemorial, but God help us if it becomes a problem. People with addiction problems are the most scapegoated people on earth, after homeless people.

        Governments have to have scapegoats, I suspect 🙁 People must not enjoy themselves as it means they’re not working, or buying useless tat!

      • Chad Davis April 10, 2018 at 9:39 pm #

        Marc I LOVE IT! You just needed to end it with “mic drop” lol.

        And your question was right on point ~ “knowing what we know, saying what we’re saying, why are governmental funding bodies, drug reform committees, and policy makers not listening” I’ve been asking the same question, and I’ve only been at it for about 4 years now! One of my professors says he’s been at it for over 40, so I don’t feel so bad now lol.

        It IS a really sad thing. I stepped out of the mental health and recovery field because I couldn’t tell the lies my employees wanted me to tell. Even showing the doctors in current addiction text books what I was saying was right off of treatment pages, they didn’t want anything to do with it.

        Ignorance? Apathy? Arrogance? A combination of life and mental issues lol? How do we change a system that already knows it’s doing things incorrectly?

        Thank you for the time!

    • Chad Davis April 10, 2018 at 9:43 pm #

      Hello Annette!

      I understand your initial ideas! And I believe a major issue with the majority of treatment programs out there is that they misunderstand what the opposite of addiction really is. Most believe that abstinence is the opposite of addiction. I believe they are wrong.

      My version of recovery is based on my understanding of what the opposite of addiction is to me. And addiction in my current understanding is “hate” … I hate myself, my life, my job, my blah blah blah. The opposite of hate is love. Once you love yourself and the world you are in … addiction seems to fade; in my experience anyway.

      Thanks for sharing your thoughts!

      • Annette Allen April 11, 2018 at 4:05 am #

        Hi Chad, my perspective comes from 50 years of observing this at close quarters, with my younger brother (addicted to heroin, then a registered methadone user from his late 20s. He took his life at 54.)

        I observed the arc of my father’s mental illness and the resulting anxiety in the 3 of us kids (my mother tried to run away from home several times – unsurprisingly). My younger, playful brother was the scapegoat….

        I have two older half sisters who were at boarding school and who witnessed it all too. They aren’t damaged in the way we were.

        I also saw my younger brother’s deep empathy with Nature and animals. he was gay at a time when most didn’t come out of the closet. He represented love to me, even though society put him in the “addict” box.

        As an adult I drank too much, which affected my mood and caused me to hate life. I was a great employee because work meant I didn’t need to face reality! My parents and both brothers died too young from their addictions – for a long time, I was angry ad grief-stricken. That meant I became frozen, which is NO way to live.

        I quit, cold turkey, 3 years ago. I now love Life most days, which is OK, you know!

        ISOLATION and loneliness are the real killers, so I reach out most days and run a Social Club in my local town – a Godsend for the bereaved and those whose partners would rather sit at home in front of a square box 🙁 I’ve spent 3 months in the US over the past 20 years and seen the dysfunction close at hand: a beautiful country, but people been taught to judge and divide and that you are only as good as what you produce. That’s makes my soul ache……

        In the meantime, it’s worth checking out the work of Dr. Judith Landau: trauma and addiction. Very impressive!

        In my world, humans are meant to be free and express themselves in their myriad, quirky ways, as long as no harm is caused to others. I’m still a hippy, I guess 🙂

        • Chad Davis April 11, 2018 at 11:08 am #

          Wow! what an amazing and powerful story! You should get all that down in a book, if you haven’t already. It would help many people I’m sure!

          I would say I’m “sorry” for your loss and hardships, but they have made you who you are today … so I will simply say, I’m glad you are who you are inspire of all the reasons that you could choose to be otherwise and voice that we need many more like you!

          I’m also with you 100% in that as humans we are meant to be free and express ourselves; and that much in the US makes my soul ache as well. There are so many things that are “broken” and we seem to know that they are … yet nothing is done to fix it or change it, as its making someone too much money the way it is.

          My current “tag line” if you will is: Get Loud! As yes, the isolation, loneliness are when your mind can do the most damage on itself. If silence equals death, then the louder we all get the more lives we should save!

          Thank you for the reference on Dr. Landau. Her name sounds familiar, but I will look into her more for sure!

          Choose to have a wonderful day! And thank you for the sincere conversation! I hope to see you around the virtual block 🙂

  7. Dor March 18, 2018 at 9:54 am #

    I’m not sure that our medical system is the problem with untreated addiction. I agree that long term care covered by insurance would help a lot. But I’ve seen harm reduction do more “harm” than good. Suboxone should be used short term, if at all. It is often abused as much as other opiates (I’ve seen this first hand on Long Island, where I am from). The only way my son got clean was through long term care (he’s 5 years sober). For younger people, a 12 month program should be a minimum amount of time to clear the brain and start to make it heal. It can be expensive, but there are also free programs in our community too (Hope House, etc). Then it is a lifetime maintenance program with meetings and spiritual support from family and friends.

    • matt March 18, 2018 at 11:12 am #

      Hi Dor

      I totally agree with you about long term treatment with gradual re-entry and ongoing maintenance for young people who have been misusing substances for years. But I also have multiple examples of young people for whom nothing worked, and suboxone was the linchpin that helped them succeed… if they were serious about stopping to begin with. But if someone is misusing their suboxone or selling it on the street so they can buy heroin, I would argue that that person is not ready to stop using. MAT only works if someone is following their treatment plan. We don’t want to throw the baby out with the bathwater.

  8. John Whelan March 19, 2018 at 7:46 am #

    Good morning Marc: I have been following your book and presentations
    and wanted to write to say thank you and to keep it up!

    I am a psychologist and began my work over 30 years ago in director
    roles for several addiction treatment centers dominated by the disease
    model. For most of my career in medical institutions/systems, I worked
    as a ‘wolf in sheep’s clothing’ in terms of the conflicts between the
    medicalized, brain disease model and what we know from psychology
    (even before the advances from brain physiology).

    Attempting to make changes for a reasonable articulation of addiction
    and informed help for those struggling was extremely challenging. I
    finally gave up and opened a private clinic to focus on addiction from
    a developmental perspective (the vast majority of people I have
    treated, including veterans with PTSD and addiction, have experienced
    significant developmental disruptions). A number of years ago, I
    relied on Lance Dode’s work (Heart of Addiction) to develop a
    treatment approach that offered help to clients but a model which drew
    the chagrin of medical folks and even other psychologists.

    Thank you for again voicing an alternative informed model of addictive
    behavior. I am fascinated by the role of addiction (and even PTSD) in
    providing people a substitute for genuine social connection. My
    research and books focus on these areas in the context of military
    personnel and first responders.

    My fear is that psychiatry (representing a dominant medical pathology
    focus) has finally won and that we are caught up in a complicit
    lock-step between clinicians (including psychologists who should know
    better), third party insurers, and the medical industry without a way

    Thanks for reminding me that all is not lost ….

    Best in your efforts,


    • Carlton March 19, 2018 at 8:08 am #

      And to add to that from a Laymen/Ex-addicts POV;

      Is there a pathology for the feelings, desires and attraction to music, sports, friends family and country?

      And when they change, is it considered “instantaneous remission”, or something else?

      As Stanton Peele described it, “it is is hard to hammer the definition of addiction into the smaller hole of the dedinition of a disease” (sic).

    • Marc March 21, 2018 at 12:25 pm #

      John, Thank you for introducing yourself, your work, and your concerns, and for identifying our common ground. No, I don’t think all is lost…. You might feel more optimistic if you viewed the US as lagging behind other developed nations when it comes to the interface of deep societal problems with what psychiatry likes to identify as mental illnesses or disorders (including addiction) located within the individual. You guys are stuck in the grinding gears of a medical community that is intermeshed with structures of unbridled capitalism (e.g, the insurance industry and the rehab industry) and a right-leaning political system, making progressive thinking slow and cumbersome. In Europe, the UK, Canada, and Australia psychiatrists are far less likely to see addiction as a disease; we don’t need the disease label to try to help people in addiction, and attention to family and cultural dysfunction is growing rapidly. I’ve been invited to conferences where psychiatrists and doctors in general are looking critically at their own professional habits and trying to bridge their thinking with that of the communities and individuals they serve. So…my work is linked with the more global tendencies for psychiatry and addiction medicine to reconfigure itself. All is definitely not lost.

      Remember, the Temperance movement, Prohibition, and the War on Drugs all triggered rebound effects that got people thinking about substance use in more progressive ways. This pendulum swing too shall pass.

    • Marc March 21, 2018 at 12:27 pm #

      PS. Please read Chasing the Scream if you haven’t already. A good cure for your understandable pessimism.

  9. Carlton March 19, 2018 at 5:34 pm #

    Your wrote “What I learned is that my arguments about the “disease” label of addiction were entirely context-specific.”

    I am sure many ex-addicts who considered taking their own lives due to the profound feelings of hopelessness and destitution that being addicted generated, would agree with you on this.

    Many of the your “arguments” are neither arguments, nor owned by anyone.

  10. Mark Gilman March 23, 2018 at 2:05 pm #

    I started work in the UK ‘addictions’ arena in 1984 and there was very little funding (less than £20 million?). By the time I retired in 2015 the funding had risen to £1 billion. Yes, that’s £1 billion in 30 years. The problem was that the funding was all based on FEAR. We had to fund services to protect ‘us’ from ‘them’ as ‘they’ might spread HIV or break into our houses. The problem with Fear Driven Funding is that it disappears as soon as the fear goes away. ‘We’ are not frightened of ‘them’ any more as ‘they’ are dying off so the funding is down to around £700 million now in the UK, this is still enough to fund the essentials (NSP, OST and Naloxone) if we had the humility to accept that these are the essentials. Beware of Fear Driven Funding.

  11. Mark March 23, 2018 at 2:17 pm #

    Looks like Nora Volkow is moving more and more towards the middle … https://blogs.scientificamerican.com/observations/what-does-it-mean-when-we-call-addiction-a-brain-disorder/

    • jeremy thompson March 23, 2018 at 9:40 pm #

      Sure does.

  12. Carlton March 25, 2018 at 11:22 am #

    Marc, It seems Nora is no longer claiming addiction is a “LIFE LONG” disease. It is a small change, but game-changer, and breaks away from absolute thinking.

    When a person does NOT believe the world is flat, or does NOT believe in a Santa Clause, they don’t have to “Prove” it.

    Marc, In the same way, saying addiction is NOT a disease, may no longer be necessary.

  13. buy Careprost online April 5, 2018 at 3:34 am #

    But the biggest challenge I witnessed, up close, in my face, was the suffering and anxiety, the attempts to come to grips with mortality rates and the loss of friends and loved ones, that continue characterize the opioid epidemic. Overdose deaths are still the leading cause of death in Americans under 50. And suicide is a close second (in some reports), exacerbated not only by substance use but prevalent during periods of abstinence. The system (if we can even call it that) is completely broken.This part of your topic I really like.

  14. Sharon McPherson April 15, 2018 at 3:16 am #

    The provence of Ontario now allows people to learn to use naloxine to anyone like social service workers. However that agency would not be allowed to be given any naloxine kit. First it was only drug users who got it. Then if you do not use drugs and get trained you could get a injector kit if you then went to a drug store for training but only injectable. Why didn’t they give us the spray which I wanted because it was easier for me to use. Now the government is allowing everybody to go to the drug store to get trained to use the spray and they can get a kit. This government wants the police to have naloxine kits when people who use options do not want the police to come around when they want help. They would get arrested. The government is causing a barrier to services.

  15. Carlton April 17, 2018 at 5:13 pm #

    Interesting..a group at Walter Reed Hospital is working on a “vaccine”


  16. Mark Brady April 24, 2018 at 6:05 am #

    Neuro link between PTSD and addiction … https://www.sciencedaily.com/releases/2018/04/180423135051.htm

  17. Athanasius May 8, 2018 at 4:56 pm #

    You’re darn right about opioids being a far more effective antidepressant for some people than the standard pills for depression. I’ve been taking one sort of antidepressant or another for most of my life now, with only some small relief. Recently, I’ve had some access to opioids due to a herniated disc, and the antidepressant relief I feel from them is greater than anything else.

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