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
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
Mandated Treatment
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.
Publishing News
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,
Mandated Treatment
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
Reviews
🙏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
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
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
This week I'm turning behavioral pathology back on those of us who work in mental health. I basically specialize in unpopular and uncomfortable topics, so it's a natural fit! I recently finished the excellent We've Been Too Patient: Voices From Radical Mental Health. It&
The addiction treatment industry just can't quit coercion. Mandated (forced) treatment is a staple topic here because the industry relies on it, both financially (guaranteed revenue) and politically (offering a "more humane alternative" to incarceration). Today I'm looking at arguments against mandated treatment, specifically
🙏Thanks for this topic request to my friend and former coworker Chris Holloway, LCSW. Do you have a question or suggestion? Post it in the comments or email me. This is not a topic I would have chosen! Adolescent substance use work can come with unique complications--which is probably why
Have you heard? Maybe not, especially if you work in abstinence-based substance use treatment. In a September post about the false distinction between recreational and therapeutic drug use, I said I'd come back to the topic of pleasure. I've found it's pretty taboo in
Typically we only cure addiction on Saturday mornings, but I have some special news today! My long-form essay Substance Use and Autonomy in Word and Deed is up on the Institute for the Development for Human Arts (IDHA) blog. It's about common pitfalls in language and how to
"It was as if they were trying to use the techniques on clients, trying to hoodwink them into changing. The words were there, but the music was wrong." -William R. Miller, 2023 William Miller originated the technique he called "motivational interviewing" (MI) in the early 1980s.
