Review of Liquid Handcuffs: Policing and Punishment in Methadone Clinics and the Future of Opioid Addiction Treatment
So we have an old, unprofitable medication and a newer "blockbuster drug." Can you guess who's ended up on which one?
Latest
Review of Trial By Treatment: Punishing Illness in an Age of Criminal Legal Reform
If you're looking for a good celebration today, here's "250 Years of Resistance," recorded last night at the National Public Housing Museum. Bring a notebook and a cup of coffee. On to today's post... Trial By Treatment: Punishing Illness in an Age
My Provider Experience Reviewed: Private Insurers vs. Medicaid
My earlier post on retaining accessible providers in the addiction field mentioned insurance as a primary problem. That is, dealing with insurance companies is so burdensome and unpredictable that at this point many providers only take private pay– which places their care out of reach for most patients. I wrote
Depth Recovery and "Things I Must Earn"
Last weekend I attended a fantastic workshop introducing "Depth Recovery," an approach developed by presenter Corey Gamberg, LADC. Gamberg shared his lived experience with addiction and recovery and, like me, has been working in treatment for a long time. Unlike me, Gamberg also has credentials in Jungian psychotherapy,
The Factor of Shame
📋This topic was requested on my anonymous reader survey, which is still open. I'd love to hear from you, subscriber or not! 5-Question Survey Shame is the air we breathe in addiction treatment. It suffuses what is said, which words are used to say it, and especially
I Have a Brain Disease. It's Very Straightforward.
Typically I do not share much about my personal life. But I have one story that feels too apropos not to tell. It's about my high-stakes but totally straightforward experience of "brain disease." The model for understanding addiction that currently dominates policy discourse is a
Mother's Day Edition: "The Molecules Are Outstripping Our Categories"+ Honoring Marlene McNeill
🙏This topic was suggested by Noel Genova, PA-C. Do you have a question or topic to suggest? Use the Contact button above. My mom is a veteran physician assistant in internal medicine. She has worked with many patients with addictions, introduced me to tarot when I was a teen,
Residential Addiction Treatment: Who, How, Why
🙏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
Retention In The Addiction Treatment Workforce
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
What I Love About This Job, Part II + Fraud in Kentucky
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&
Weight Loss Pseudoscience Takes A Page From Addiction Treatment
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
Five and a Half Things I Love About This Job
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
Body Brokering: Less Outrageous Than It Should Be
🙏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
Substance Use and the Dignity of Risk
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
Mandated Treatment
Navigating Substance Use Services
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
Update(s): I'm in Abolitionist Perspectives in Social Work!
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
Special Edition: ICE Out of Wabanakiak
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
And The Problem Is...Syringe Litter?
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
Diagnosis Just Got Even Less Rigorous
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;
Reviews
Review of "Crooked Smile: What It Took to Escape a Decade of Homelessness, Addiction, & Crime"
🙏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
Insurance
Moral Injury: Now (Technically) in the DSM + Reader Survey
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,
Insurance
The Factor of Trauma + Some Good News
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
Mandated Treatment
How Treatment Coopts 12-Step Practices
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
Reviews
Review of "Rehab: An American Scandal"
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 "