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&
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
Let's get realistic about substance use treatment. Free weekly newsletter from longtime clinician Rosalie Genova, LCPC, CCS on what (usually) doesn't work and what it means to provide care
"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.
"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,
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
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
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. “Respectability politics” is a theory of putative worthiness from Black political struggles. The idea is that by dressing, speaking or
This is post 2 of 3 in a series on how we talk about addiction. Last week’s 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
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
Welcome! I’m Rosalie, or Rosey, and I’m a therapist in the specialty usually called “substance use disorders.” “Addiction” 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