On April 21, 2015, I posted an Open Letter to the 2016 Presidential Candidates that outlined 12 suggested strategies for responding to the devastating consequences of surging opioid use and opioid addiction in the United States.  Unfortunately, that most unusual of presidential campaigns provided few forums for substantive discussions of drug policy among our potential(……)

The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help.  The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance.(……)

“The best way to predict the future is to create it.” –Peter Drucker In 2003, Dr. Tom McGovern, the distinguished Editor of Alcoholism Treatment Quarterly, and I published an article offering some predictions on the future of alcoholism treatment in the United States. In spite of our long tenure as students of addiction treatment history, we(……)

The practice of administratively discharging people from addiction treatment, primarily for confirming their diagnosis (via continued alcohol or other drug use) or violating rules with little nexus to addiction recovery, has a long history within modern addiction treatment.  The authors’ calls to examine and alter this practice began a decade ago and have continued to(……)

“…a disease needs to be transformed politically before it can be transformed scientifically.” –Siddhartha Mukherjee, The Emperor of All Maladies (A Biography of Cancer) Ladies and Gentlemen,        As you are quickly discovering, the effects of opioid addiction on individuals, families, and communities will be a recurring issue in the 2016 Presidential campaign.(……)

I have spent more than four decades providing, studying, promoting, and defending addiction treatment, but remain acutely aware of its limitations.  As currently conceived and delivered, most addiction treatment programs facilitate detoxification, recovery initiation, and early recovery stabilization more effectively and more safely than ever achieved in history, but most fall woefully short in supporting(……)

A 1976 national survey of addiction treatment programs in the United States revealed a workforce of nearly 60,000 workers.  The treatment workforce at that time consisted of 31,000 full-time workers and 15,000 part-time paid workers.  The paid professional workforce included 20,000 counselors, 5,000 nurses, 3,000 social workers, 2,500 psychologists, and a small and slowly growing(……)

In 1935–the founding year of Alcoholics Anonymous, Portuguese neurologist Egas Moniz introduced a surgical procedure into psychiatry that came to be known as the prefrontal lobotomy (recall One Flew Over the Cuckoo’s Nest).   Drs. Walter Freeman and James Watts pioneered the use of this technique in the United States in 1936.  By 1960, 100,000 psychosurgery(……)

Parents who have lost children to addiction are speaking publicly in unprecedented numbers.  Their stories provide a biting critique of addiction treatment as a system of care–and suggestions that addiction treatment has yet to operate as a “system of care”.  They also provide painful accounts of how fiscal gatekeepers operate to restrict access to care(……)