🙏This topic was suggested by Miranda DeNovo. Do you have a question or topic to suggest? Use the Contact button above. Addiction treatment is highly segregated by socioeconomic status– perhaps more so than any other type of health care. And one aspect of treatment in which class segregation is particularly
Working
This is the third and (for now) final post in an impromptu series about working in addiction treatment. The first and second posts were on what I love about this job. This week we're looking at retention: why so many front-line workers leave the field, and what it
Reader Requests
Why work in addiction treatment, with all its systemic problems? Part I of my answer was "Five And A Half Things I Love About This Job", and this is an addendum by request. I will address retention (keeping people in the field) more specifically next time. If you&
The weight loss industry, like the addiction treatment industry, is prone to overselling its treatments. But right now the weight loss business is seeing a major shake-up. Ozempic, Wegovy, etc.– we're talking about GLP-1 agonists or semaglutides that were initially developed for Type 2 diabetes but are also
Working
Wait– three posts in three weeks? Are we back to curing addiction every Saturday? Let's say mostly, or hopefully. Thanks for rolling with it. I recognize that this newsletter, along with most of my writing and teaching content, has a critical and somtimes angry tone. One attendee of
Insurance
🙏This topic was suggested by Laura. Do you have a topic to suggest? Post to the Comments or use the Contact button above. The addiction treatment industry is known for a number of unethical and illegal practices. Today we're looking at "body brokering," also known as
I've taken a pause on weekly posting to preserve time for revising my book manuscript. Thank you for sticking around in the meantime! When I gave my presentation on navigating substance use services, one of the concepts that provoked the most thought was the dignity of risk. The
Let's get realistic about substance use treatment. Free weekly newsletter from longtime clinician Rosalie Genova, LCPC, CCS on what (usually) doesn't work and what it means to provide care
I've taken a pause on weekly posting to preserve time for revising my book manuscript and activities related to ICE/CBP response here in Maine. Thank you for sticking around in the meantime! I realized I might as well share a presentation I developed (for the Health Care
Welcome briefly back, curers of addiction! I hope you feel alive; I know I do. I have paused my regular Saturday posting schedule to work on the ICE response here in Maine. (As anticipated, abductions and harassment continue despite Susan Collins' assurance that "enhanced operations" are over.
It feels like all eyes are on Minnesota right now, and for good reason. But this post is about the ICE surge in Maine– if only to explain why I won't be doing my regular weekly posts until conditions improve on the ground here. ICE launched "Operation
So much resentment toward people who use drugs comes down to public space. Even people with generally compassionate views on drug use, including some who have addictions themselves, can become outright angry at signs of substance use in public places. Some of this sentiment is simple disdain for unsightly poverty,
Last week's post discussed problems that arise when one particular experience of addiction is universalized to stand for all– a common problem in policy arguments. Public policy deals in population-scale solutions that approach people in categories. But not only do people have widely varying experiences of addiction; we
🙏This topic was suggested by Emily Birnbaum, FNP, PMHNP. Do you have a question or topic to suggest? Use the Contact button above. Crooked Smile: What It Took to Escape a Decade of Homelessness, Addiction, & Crime by Jared Klickstein, Bombardier 2024 👁️Bottom Line On Top: I recommend this book
Happy new year, curers of addiction! Are we all feeling fully refreshed and restored? 😉 Scroll down for our regular weekly topic post. First, a quick reflection and invitation for your input. I started this newsletter in August 2025. I had already been writing and teaching on these topics for years,
Scroll down some good news in treatment access. First, our weekly topic post. Discussions about substance use often turn toward trauma as a precursor to dependence and addiction. Both research and accounts of lived experience support this connection: some people with trauma histories come to rely on substances to regulate
Last week's review of Rehab: An American Scandal brought us to a topic I was already considering for a post: the relationship between 12-step groups and substance use treatment. As I wrote, the 12-step model is unworkable for many people, and has problems both in theory (such as
Rehab: An American Scandal by Shoshana Walter, Simon & Schuster 2025 ✅Bottom Line On Top: YES, I recommend this book. This book caught my attention because Walter is an investigative reporter focused on the criminal justice and child welfare systems. As she points out, the addiction treatment industry is "
I love that every subculture, no matter how small, seems to have its own special term for outsiders. In 12-step recovery culture, members typically self-identify as alcoholics and/or addicts. Other people with suspected substance use problems might be called "drinkers" or "one of us." And
Last week's post was about mental health struggles and moral degradation among "behavioral health" workers. Particularly in substance use treatment, poor quality care and abuse of patients is often blamed on minimal requirements for employment in the field. For example, Inside Rehab made lack of staff
