Taboo topics in addiction treatment, clinical folklore

Taboo topics in addiction treatment. An empirical review of clinical folklore. – PubMed – NCBI – J Subst Abuse Treat. 1993 May-Jun;

This article reviews 11 taboo topics, that is, research findings that question traditional assumptions and teachings of addiction treatment.

Though written over 20 years ago, this article makes it clear there has been virtually no progress in addiction thinking or treatment.

These same “taboos” are still open questions, while the addiction treatment industry refuses to acknowledge any doubt. Addiction treatment failure is almost guaranteed while the recovery industry keeps its head firmly planted in the sand.  

These topics include:

  1. the lack of empirical support for the Minnesota Model;
  2. questions about:
    1. the necessity of Alcoholics Anonymous for maintaining abstinence;
    2. the existence of spontaneous remission;
    3. the detrimental aspects of labeling;
    4. the value of addicted individuals’ self-reports;
    5. the lack of empirical support for the addictive personality concept;
    6. cue exposure as an underutilized intervention;
    7. the interactional nature of motivation;
    8. the value of smoking cessation in early recovery;
    9. the overuse of the addiction concept; and
    10. the lack of empirical support for the disease concept of codependency.

Misconceptions arise due to the lack of communication between disciplines and the experiential bias of current addiction treatment modalities.

Emphasis is placed on the importance of empiricism in order to advance the addiction field beyond faith and supposition.

Still, the addiction field is ruled by the never-proven abstinence model, which irrationally refuses to consider any partial steps, like harm reduction

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2 thoughts on “Taboo topics in addiction treatment, clinical folklore

  1. Kathy C

    Thanks Zyp!
    I read the Abstract to this Piece. I have been following some of this. I happen to live in one of the worst areas for Addiction. The Addicts here are generational, there is a subculture of addiction and despair in this part of the country. In 2014, our Governor shut down the behavioral Health and the few “treatment” facilities they had, and there was a spike in opiate Related deaths. In one town the numbers have not decreased after the “Crackdown.”
    This Article ties into an observation I have had, which is that there has been no progress. I have had the experience of meeting, or having to deal some of these “Addicts”, One has since relapsed, having replaced here addiction with religiosity. Apparently one of the narratives they use is the “I found god” story. The treatment available here is a mix of Religion, and 12 Step. We have a bunch of Programs, with former addicts, who claim they are the ones who know how to deal with this “Disease.”
    The other “Treatment” is basically a Methadone maintenance Program, with essentially no Therapy or monitoring. Certain more pathological addicts, use the Methadone as an addition to their drug consumption. There are probably some that this works for, but i met the worst of the worst. Apparently the claim that they are “in Treatment” gives them a free pass to cause trouble. It appeared to me that this group would never be “Out of treatment” they were just gettign maintenance doses, to supplement their other noxious behaviors. This also run by former Addicts. It seems that this is now a route to a career.
    In one of the Towns most affected, they rail about the opiate epidemic, and the “tragic deaths” while right there on the Main drag through town is a closed treatment program. The building still has the signage. A depressing falling down building that used to house a “Treatment Program.” The building should have been condemned in the 90’s, It shows just how concerned they were with this problem.
    In the Local Media, Doctors saying they won’t prescribe Pain Medication, and hyping “Napro Therapy” another new Age version of Chiropractic. The Local Religious Non Profit hospital, has billboards claiming they can “Cure” pain. This is highly unlikely. They re branded their Steroid Shot Clinic. Every New Paper Article re-iterates the “Pain Clinics Everywhere Narrative.” There is no basic in fact for this, The only Pain Cures advertised, are Chiropractors and other types of practitioners. The New Age Pseudo Science has found a real opportunity here. This has been Profitable, they can make some good money off of desperate people. I was one of them.
    When they made that announcement about the influx of money from Congress, to “Stem the Opiate Crisis.” The same bunch of “Treatment Providers” began hawking their “programs.” The 12 Steppers and Religion based ones. Apparently anyone who knew someone or had a cousin overdose, is now an “Expert.” Even after all of this, they continue to close any remaining facilities. One of the last overnight treatment facilities for teens was closed. They claim it was not needed. They have an Orwellian System of referring, for example a Licensed Mental Health Professional would have to provide the referral. So if a teen got in trouble, they would not be referred. They have created some serpentine “rules” to make it impossible for someone to be referred. This is the State way of saving money, and possibly funneling these people into the Criminal Justice System. It is Kafka esque. The only “News” the public gets are the stories that fit a certain narrative. The “I took pain pills and now I an an addict” narrative.
    They never mention how many people are exposed in jail. Recently a young man OD’d in Jail. He was there on an unrelated charge. Somehow he got a hold of some Fentanyl from another inmate. So he was not a habitual drug user, but he got drugs in jail, and died. Of course this was barely covered, it is not the narrative they promote. I sat on a Grand Jury years ago, it seemed like many of the cases we heard were all about Illegal Drugs, smuggled into the Jail. Not only are people being expose dot heroin for the first time in Jail, bu they are also getting Hep C, and possibly Aids. This is another Off Limits Story. Instead we get the grieving parents, and the child who died. So many problems, it is easier to blame this on Pain Medications, instead of the relatives that shot up in front of the kid.
    The thing I have observed is that they have continued to play the False Narrative of the Pain Medication. Addicts will take anything to get high, including available pain Meds. There is no “New Improved Treatment”, no Evidence Based treatment. One Town Autopsied the Overdose Cases. Half of the Dead had anti depressants and things like Statins, in their Systems. They were under the care of a Physician and likely had an underlying Medical Condition. This was not mentioned, it indicated they sought some kind of “Help.”
    The pernicious individuals “In Treatment” at the local Methadone Clinic, were all able to get a range of abusable Psycho Pharmaceuticals. Some are lethal in combination with Methadone, yet they were freely prescribed. There was no resource to deal with any of this. These people were able to cause all kinds of trouble, appear wasted, and because they were “In Treatment” they were able to work the System. There was no community resource to deal with any of this. There was no Resource for people with Mental Illness either. They keep going on about an “Opiate Epidemic, and an Increase in Mental Health Problems, while they under fund and undermine the System. There seems to be a Mythology here in Place of Science. The Local Mental Health Clinic a National religious Non Profit, is now unable to hire Licensed Professionals, they are now hiring “Peer Councilors” instead. This is the same Clinic that prescribes the Abusable Medications to the Addicts. They have been here for Decades and the problems have only gotten worse. They are Politically Connected, and part of a Billion Dollar National Religious “Non Profit.” The same with the Local Hospital, a National Multi Billion Dollar Corporation. Both have been Providing care in this area for decades, and yet not one Metric improved. They have enough money to avoid any kind of Scrutiny. Something is wrong here. They are above any kind of accountability.

    Liked by 2 people

    Reply
    1. Zyp Czyk Post author

      Wow, I can see you’ve really thought this through. Anyone who reads more than the headlines can quickly figure out that this whole opioid crisis is a manufactured crisis. There are so many more people dying from other preventable reasons, like the over 1,000 people per DAY that die from medical errors.

      Of course, there are others too,but I like using the example of medical errors because those that should be offering us medical treatment of pain has thrown us into the arms of any self-appointed expert in “alternative” medicine – I don’t know how they dare call these slipshod unprofessional treatments “medicine”.

      I’ve found you can unravel many strange policies by just following the money. Everything is affected by money and there are many winners profiting from our pain.

      Liked by 1 person

      Reply

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