đThis 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 đď¸Bottom Line On Top: I recommend this book
Happy new year, curers of addiction! Are we all feeling fully refreshed and restored? đ 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 â 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
đThanks 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
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 groupsâsame for other intensive mental health services, including hospitalization. And itâs 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 âa growing opioid epidemic,â I didnât expect much nuance, but was I pleasantly surprised! If youâre not familiar with kratom, its
Mandated Treatment
Does this look like someone with too many rights? The notion of people âdying with their rights onâ comes from arguments for forced psychiatric hospitalization, dating back to the 1970s. As the rhetoric goes: a desperately sick person who refuses services, and doesnât meet criteria for involuntary admission, will
Last weekâs 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 clientsâ lives and ignored their wishes. Today weâre 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,
This is the third and final post in my series on how we talk about addiction. So far we have discussed Essentialism and Pity, and today we conclude with Respectability. âRespectability politicsâ is a theory of putative worthiness from Black political struggles. The idea is that by dressing, speaking or
Mandated Treatment
This is post 2 of 3 in a series on how we talk about addiction. Last weekâs post discussed the judgments and generalizations we are all familiar with. Today we turn to pity. Pity toward people with addictions may seem like an improvement over condemnation, but when translated into
Mandated Treatment
This post is first in a series on how we talk about addiction. Stigma and stereotypes are never helpful. While perhaps this should go without saying, a strong contingent in the public mistakenly believes that stigma (shaming, shunning, exclusion, judgment) discourages substance use. In fact, transnational comparative research shows that
Mandated Treatment
Welcome! Iâm Rosalie, or Rosey, and Iâm a therapist in the specialty usually called âsubstance use disorders.â âAddictionâ is a subjective experience, not a clinical label, and I find it more human than the diagnostic language my clients never use. I worked in treatment and recovery services for