One Year of Curing Addiction
My baby turns one this month! I started this newsletter in August 2025, and though I'm busy with other writing goals I wanted to take the occasion to reflect on what I've learned.
A Cure For Addiction was and is meant to be the public-facing, accessible front for what is a larger, longer-term project of writing, teaching, and bringing together disparate critical perspectives in substance use. Three years in, I consider it still in its beginning phase, including ongoing trial-and-error in terms of reaching people and finding my audience. Four findings thus far:
1) No one is defending the treatment industry. Nooobody!
Working in treatment agencies, I got used to being silenced. It felt like there was no room for questioning how my employers operated, much less the larger systems within which we worked. So when I began teaching and writing on addiction treatment from a critical stance, I expected to be attacked early and often. I even looked proactively for those rebuttals, because I genuinely wondered how we've continued so long with a set of practices that typically don't work, or even backfire. Was I missing something? As it has turned out, I heard one defensive voice in my 2023 CE training on moral injury– a manager defending only herself and her organization– and nothing since, even after several more courses and publications in the same rebellious vein.
This tells me that what I thought was a vacuum of original thinking across the entire field was really just repressive bosses who wanted me to shut up. And managers who are pleased with the status quo apparently still don't care what I have to say, because I am not hearing from them. Meanwhile, people from all other stakeholder groups are responding positively: patients (current, former, prospective), clinicians, people in other social service jobs, policymakers, activists, and people affected by loved ones' addictions. Literally everyone other than those at the top of treatment organizations is ready to talk about this industry's dysfunction. (Do we also have a few rogue supervisors on board? Yes, we do.)
2) What people "get" is not necessarily what I thought I "gave." Funny things happen when my writing ends up in front of other people!
Often when people reflect to me on something I wrote, they emphasize a point that I didn't think was very important. Sometimes they even credit me with a statement that wasn't in the piece at all– or at least, not intentionally– though thankfully it's never been anything I disagree with. I shouldn't be surprised, because this happens all the time with clients: they "remember" me saying something I'm pretty sure I didn't say, or they later interpret a comment or even a facial expression in a way that I didn't intend. I guess I thought written words, in their permanence and precision, would retain their meaning more reliably.
As a writer, I've come to accept this, as I accept it as a therapist. I don't try for a do-over because people's experience of my work belongs to them. It reminds me of the famous Maya Angelou quotation about people forgetting everything except how you made them feel. It suggests that my tone and presence are more important than my words– which is both disappointing and reassuring.
Rosalie Genova
3) I may be paying a steep price for boycotting Substack. You may not have noticed, but this newsletter is hosted by Ghost, an open-source Substack competitor. Substack has become effectively synonymous with "newsletter," as in "I read your Substack." But I don't use it because the company treats hatred as if it deserves a platform. Obviously we all make compromises as workers and as consumers, but it was an easy decision when I chose to start a newsletter: Substack does not get my content or my money.
But network effects are real. This is a Meta property, after all! The majority of writers and readers who might be interested in A Cure For Addiction still seem to be on Substack, all "re-stacking" each other where Ghost does not have the same infrastructure to boost exposure. I'm not changing my mind– meaningful boycotts require sacrifice. Hopefully Substack will eventually fumble its monopoly like Facebook did. In the meantime, as always, your subscribing to and sharing this newsletter helps me to reach more people.
4) Social media is a poor venue for challenging ideas. Not exactly a revelation, I know. Scrolling and ❤️-ing may be the opposite of engagement and learning. Ideas on social media that are actually arguable (i.e. interesting) are attacked immediately by people who didn't even necessarily read the post. Every social media account I've appreciated for educational value or critical discussion on a high-stakes topic like addiction, even at a high follower count, has either 1) stopped sharing challenging content, or 2) shut down completely.
Social media moves too quickly, in the sense that everything has to be ulta-short and zingy for the feed. But it also moves too slowly in that ideas I've known about in analog space for many years, like moral injury in health care, are only just beginning to get likes. Anything more sophisticated, or targeting an audience with existing knowledge, is too far ahead of the algorithm. Books, talks and meetings are very dynamic on this topic; social media is dumbed-down and boring. (Again, I certainly could be missing something! Please post your substance use faves if you think I'm being unfair.) So I don't put much effort into promoting my work on social media. It seems that the people interested in complex ideas on addiction self-select into formats that ask more both of the creator and the audience.
Moving into the second year of this newsletter, my goals are to reach more readers and get a book contract. I will keep teaching, publishing articles, and above all learning from the precious ones who show up in my office and who respond to my writing, each in their own way.
