I'm a clinical counselor, educator, writer and tarot reader. My specialty is substance use, but I no longer work in the treatment industry due to creative differences. My practice website: welcome.genova-lcpc.com
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&
Mandated Treatment
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
Reader Requests
🙏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
Publishing News
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
Reader Requests
"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.
Insurance
"I have tried so many times..." I feel really bad about the fact that I don't take Medicaid. (Here we call it MaineCare.) Providers and facilities not accepting Medicaid has created an artificial shortage of care for Medicaid members. It also creates class-based segregation in care,
Mandated Treatment
The classic visual for addiction treatment is a circle of chairs, like so: As little as most people know about our world, pop culture has this one right! Just about everything is done in groups—same for other intensive mental health services, including hospitalization. And it’s absolutely for reasons
The Kansas City Star just published a series on 7-OH, which is a gray market synthetic derivative of the opioid kratom. When I saw the headline about “a growing opioid epidemic,” I didn’t expect much nuance, but was I pleasantly surprised! If you’re not familiar with kratom, its
Mandated Treatment
Does this look like someone with too many rights? The notion of people “dying with their rights on” comes from arguments for forced psychiatric hospitalization, dating back to the 1970s. As the rhetoric goes: a desperately sick person who refuses services, and doesn’t meet criteria for involuntary admission, will
Last week’s post was about moral injury in addiction treatment. Earlier in my career I did not yet have this term to describe my distress, but I recognized that the system I worked in devalued my clients’ lives and ignored their wishes. Today we’re picking up where that
Mandated Treatment
Moral injury is the psychological or spiritual pain of your morality being violated. Whether you have actively participated in, allowed, or only witnessed the acts in question, you are morally injured if you feel ongoing distress in conviction that the acts were (or are) wrong. It may bring guilt, despair,