Love Protocols for Addiction Treatment

Given that humans and their brains have derived at least 7,000 languages to attempt to express what those brains experience, my next 1,000 words or so don’t stand a chance of conveying the complexity of one individual’s brain, much less the brains of humanity at large. However, when an individual comes to me and says, “Help me,” I need to be able to take action, right now, based on the best distillation of the best available information I can.

LOVE love, not tough love, treats addiction

I have been a ruthless, relentless, even desperate student of the research on addiction treatment for 4 years and 8 months. While I appreciate that writers like Marc Lewis and Carl Hart even engage in neuroscience research themselves to buttress their theories – and data begins as theories – in my view, currently only journalist Maia Szalavitz cites data for every assertion she makes. I have studied her latest book, her current writing, her former writing, and the research studies she cites.

In my rural area, addiction threatens premature death. I don’t have time for theories, opinions, “practice wisdom,” legacy “treatments,” or beliefs. I need to know what science says helps people with addiction and offer it right here, right now.

When I heard this podcast interview with Maia Szalavitz by Scott Barry Kaufman, released on 9/6/17, pieces fit together in a new way.

Here’s an attempt to write a brief, layperson’s version of the latest science on addiction and its treatment.

Addiction is defined as compulsive persistence despite negative consequences. Compulsively persisting is quite human and a strength when it comes to discovering a squalling infant’s needs and meeting them, talking with an upset teenager, cleaning up after a hurricane, or at any time when the going gets tough. Persistently engaging in the same behavior over and over again is a strength when one is learning to play the violin or to shoot a basketball.

The majority of people use any and all substances without negative consequences, i.e. without becoming addicted to them. That includes pain pills, cocaine, methamphetamine and heroin.

In people who may have any of this list of conditions or some combination of them – past trauma, mental illness, a state of despair, from existential to financial, inadequate social connection, or “social capital,” neuroatypical wiring, and youth – for reasons neuroscientists are beginning to fathom but cannot quite pinpoint, use of a substance can be experienced as what can be termed “love.” The reassurance, comfort and connection that love brings is provided by the substance.

Returning to use of a substance that offers this eased state makes sense, and could even be termed a “moral” action when it relieves suffering. For people with predisposing conditions, something in the brain’s neurocircuitry causes the brain to learn, to the point of over-learning, to persist despite negative consequences. But the person persists in that love for a substance, rather than in this love – for the self, for a person, for a community, beloved work, or with a beloved activity. Essentially, it’s “love gone awry.” Because substances are hard on the brain and impair cognitive functioning, dysfunctional behavior happens, negative consequences happen, but the use and the behavior persist.

Treatment for addiction therefore (this is where my eyes stung with tears of shock, sorrow and recognition when I heard Maia say this in her interview) begins with embracing addiction as an understandable, deeply human development. Splitting addiction off from the self denies the reality of the wholeness of the person’s inner system and causes psychological damage. Compassionately acknowledging and embracing what went down for the self to have gotten to this difficult place is where healing begins. Thus, the addiction-love-learning development is less a form of brain damage or a brain disease, but more what might be termed a brain over-development.

Healing would require a love-learning shift to happen from the problematic substance to something love-worthily meaningful to the individual. Evidence abounds with a bounty of methods that can assist with this shift. And treatment as usual, primarily involving confrontation and reprimand – “tough love vs. LOVE love,” is contraindicated. As Maia Szalavitz writes here, “To return our brains to normal then, we need more love, not more pain.”

For overuse of some substances, and for some individuals, medication may be useful or needed, perhaps lifelong. Because overuse of some substances can harm the brain, abstinence from problematic substances and/or harm reduction may be helpful. For some individuals, absolute abstinence may be in order. For others, some use at some times may be functional. (These decisions would be made by individuals and their medical care providers.) For substance addictions, how much of what can be used and under what circumstances for one individual cannot be generalized to all people.

For people with substance use disorders, then, straightforward goals would be to: 1) not persist in using a substance despite negative consequences, and 2) create healthy, functional, loving lives for themselves.

Extrapolating from there, the fundamental measurement criterion for successful treatment, given the definition of addiction, is reduction in harmful consequences to self and others. Not number of days abstinent.

Combining psychologist Alan Marlatt’s caution, “Do not attempt to take away a person’s main means of trying to cope with pain and suffering until you have another effective coping strategy in place,” with Maia Szalavitz’s conclusion, “The ability to persevere is an asset: People with addiction just need to learn to redirect it,” the ideal treatment for people with addiction would balance tapering out substances with tapering in what uniquely helps individuals feel engaged, connected, bonded, and functional.

When given a choice between substances and love, rats and voles choose love.

We don’t have addiction treatment protocols that help people love and feel loved. But the neuroscience of love and addiction reports that our treatment protocols would be evidence-based if we did.

The opinions expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

I Will Stand Up for Your Recovery with You

Everyone who has a substance use disorder, or loves, lives by, works with, or treats a person with a substance use disorder, and wants to do something about it, will not know what to do next. It’s no one’s fault. We – researchers, health care professionals, lawmakers, citizens – simply don’t know enough about what the problem is, or what solves it, to know what our next steps should be.

Who will stand up?

As Americans, I think we’re also uncertain about what constitutes a problem with substances. We don’t know, or don’t agree on, which substances, and how much of them, are okay to use. What are the criteria by which we’ll decide? Our dilemma is evident in the variety of U.S. marijuana laws. The current criterion for allowable marijuana use is where one lives.

We also don’t agree, as Americans, on how much pleasure is to be allowed and how much pain is to be tolerated. While we attach moral value to self-denial, we find ourselves fully human. Our brains are wired for pleasure and programmed to associate pain with threats to our survival. Naturally and logically, then, we want the former and don’t want the latter. What are the criteria be which we’ll decide what is enough and what is too much, for both pleasure and pain?

We also struggle with defining individual and societal control, freedom, and rights. What are the criteria by which we’ll decide when either the individual or society has gone too far?

Onto this stage, enter substance use disorder, popularly known as “addiction,” defined by the National Institute of Drug Abuse (NIDA), as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”

Science reveals to us that addiction is a brain thing. But in terms of what exactly is wrong, if anything (are we just seeing an extreme form of the brain’s ability to something or other?), and what exactly would cure or reverse what’s wrong back into what’s right, we actually aren’t sure how to define any of those terms, much less to take action on them.

As a counselor charged with providing care for people with substance use disorders, I find this imprecision daunting and dangerous. I am also a person with a substance use disorder. I am a person, not an alcoholic, addict or substance abuser. I happen to have a disorder. I need to take beneficial action on my own behalf, and describe beneficial actions my clients can take on their own behalves, all the while doing no harm. Yet, what to do – and what not to do – is ill-defined and unspecified.

Enter “evidence-based treatment.” In layperson’s terms, “evidence-based treatment” means that the treatment has been determined by research experiments to be of benefit to most people, most of the time, better than other treatments, and better than no treatment. Further, the experiments have met research criteria for design, presence of control groups, randomization, and bias-free samples, and can be repeated by other scientists doing the same experiment.

Treatment for addiction has been dominated in the U.S. for the past century by beliefs, opinions and theories. However, with publication in 2016 of Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, an attempt was made to compile a guide to effective, evidence-based treatment for addiction.

But now the plot thickens, and darkly. For a person with a substance use disorder, what would be considered the desired outcome of effective treatment?

The goal of any treatment for a person with a problematic condition would be to experience fewer symptoms, less often, over time, right? And for a problematic condition that manifests as behavior, we would aim for reducing harm towards self and others over time, right?

Ah, but for substance use disorders? By society, by lawmakers, by the criminal justice system, by child protective services, by employers, and by treatment providers, an on-demand, instantaneous cure is mandated.

Abstinence now!

For what other illness does manifestation of the illness’s symptoms result in arrest and incarceration, and deprivation of parental rights, voting rights, and driving and professional licenses? For symptoms of what other chronic illness of the body’s organs are patients denied medical care and medications, dismissed from treatment programs, and subjected to punishment as “treatment”?

The difference between abstinence from substances and evidence-based treatment for substance use disorders is not widely known or understood. This has resulted in infinite suffering for people with substance use disorders, for those who love them, and for society at large. The financial costs are in the billions of dollars and the personal, familial, and social costs are immeasurable.

For people with substance use disorders, I don’t see enlightened, compassionate care replacing mandatory abstinence any time soon. In fact, in the Philippines, they’re shooting their people with substance use disorders. My president described that leader’s efforts as a “great job.”

These are dangerous times for people with substance use disorders.

I heard an earnest, well-meaning, public health official state, in public, just a few days ago that “addicted mothers” give birth to “addicted babies.” Our leading local public health official doesn’t know the difference between addiction and dependence?! This person also mentioned an “opioid epidemic.” Really? If opioid-related deaths can give us an epidemic, tobacco-related deaths should give us an apocalypse. What we have is less a spike in opioid use via pain pills or otherwise, but more an epidemic in poisoning via contaminants in street opioids. Doesn’t misinformation from public officials endanger our citizens? Is that person someone to whom a person with substance use disorder could trust to turn for evidence-based care?

Where can a person with substance use disorder turn for evidence-based care?

I appreciate that many people have experienced spontaneous recovery without treatment. For those for whom that has not yet occurred, or may not before this illness kills them, or may be continuing to experience those “harmful consequences” despite their best efforts, to whom can we turn?

Who knows enough about what we do know, and has the humility to acknowledge what we don’t know, to help people with substance use disorders meet reasonable treatment goals for their health, and pragmatically meet society’s unreasonable, even medically contraindicated, goal of abstinence?

“I will stand up for recovery with you,” former Surgeon General Vivek Murthy tweeted on October 4, 2015.

Here’s what I wish a health care leader would stand up and say today:

We don’t yet know what directly treats the brain for addiction, except for some medications for some forms of substance use disorder. Medical care, grounded in science and not clouded in belief and theory, can be hard to come by if you have health insurance. Medical care in any form is nearly impossible to get if you don’t.

Outside of medications and medical care, we do know some indirect things that research has found to help people drink and use less, less often, over time. Abstinence can be a cruel demand, but if it’s what you want or, unjustly, what you need to keep your freedoms and rights, or to try to get them back, I will try to offer what the evidence reports may be helpful to you to try to achieve that.

You have an individual case of addiction, but our research only speaks to what’s helpful to most people most of the time. This will be a trial-and-error effort with errors along the way, even ones that may tragically result in your premature death. We may not find what’s helpful to you in the time we’ve got. If you’re in, I’m in. In spite of all the odds against us, in spite of all the dangers, I will stand up for your recovery with you.

Image: iStock

The opinions expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Steal This Recovery

When I was a teenager, an older teenager in the neighborhood gave me a copy of Abbie Hoffman’s Steal This Book. Decades later, I continue to feel both affronted and enchanted by the dialectic of opposites both being true: a book that uses the convention of sentences to foment revolution is for sale, but directs readers to steal it.

I have been abstinent from alcohol for four years and eight months. That’s just over 1700 five o’clocks that have passed without me participating in happy hour.

Enjoy your movie with a glass of ethanol

Here is my status report:

  • My subjective experience is that I felt better while I was drinking.
  • The chemically-induced euphoria and sedation of alcohol are heightened states I have been unable to experience again naturally and organically.
  • I would prefer not to abstain from alcohol but to drink it as desired or needed.
  • I miss belonging to a majority culture, i.e. Americans who drink.
  • I miss being able to pay attention to my surroundings and the people in it without having my brain’s sensitivity to environmental cues overpower my attention and draw it the alcohol that is nearly ever-present in my town.
  • I have done everything I can think of, and has been suggested to me, to be able to say that my life is better without alcohol, but it is not.

That a beverage has achieved such importance in my life is appalling to me. Especially a beverage containing ethanol, a known neurotoxin, for which there may be no safe level of consumption.

On the ten-year anniversary of Kurt Cobain’s death by suicide, psychologist Alan Marlatt wrote, “Do not attempt to take away a person’s main means of trying to cope with pain and suffering until you have another effective coping strategy in place.”

That’s the down side of things. And that’s why we’re seeing suicides among pain patients cut off from pain medications. Ruggedly individualistic Americans don’t want to believe it, but there truly are unbearable things from which one cannot rescue oneself.

The upside matters, too. Humans feel feelings, think thoughts, and have experiences that result in fluctuating inner states. Ups and downs are normal. If a person experiences a substance as a remarkably efficient and effective lift from a down state, and repeatedly practices that method because it works better than others, the over-learning of addiction can occur. If that person is cut off from the substance, the person can become suspended in a down state with no hope of escape. Feeling unremitting, helpless despair is an unbearable, inhuman, inhumane state.

I appreciate the estimated 4-46% of people who recover from addiction spontaneously, the people who attribute their abstinence to 12-step recovery, and the small number of people who recover through rehab. In my personal experience, and in my work with others with substance use disorders – this is my opinion, not a report on the data – I see a subset of people with substance use disorders for whom life is not perceived as qualitatively better without the substance. I am a member of that subset.

What I learned from writing a memoir is that it’s no wonder I developed alcoholism and it just won’t give.

Resisting that reality, attempting to reverse that reality with beliefs – my own and others’ – wishing that reality weren’t true, pretending that reality didn’t exist, purveying the fake news that I am “fine” – these mythologies increased my suffering.

People have told me that if they had my level of on-going distress, they couldn’t stand it. I’m certainly not a fan of it.

What of my distress is due to residual brain impairments from having developed addiction to alcohol, a.k.a. feeling compelled to persist with drinking despite harmful consequences (falling down stairs, and imperiling myself and others while driving under the influence), fallout from what happened before I developed alcoholism, the u-curve in happiness at midlife, unexpectedly different life circumstances, brain challenges with developing addiction at 50 rather than at 20, the possibility that long-term anhedonia in some people with substance use disorders is also a brain thing? I don’t know.

While I appreciate dialectical behavior therapy’s concept of radical acceptance, I think, at least for the subset of people with substance use disorders for whom life is not experienced as better without the substance, the level of acceptance required to do without, to make do, to settle for less, to tolerate downness, requires an extreme, Steal This Book, post-apocalypticrevolutionary type of acceptance.

The kind of acceptance that lives with the possibility that things will never get better. 

That substance use disorders are disorders of the organ of the brain and, therefore, medical conditions for which medical care, including medications, is first-line treatment, is not widely known, understood, accepted – even allowed – by society at large, the health care industry, the addiction treatment industry, lawmakers, people with substance use disorders, or their partners, families or communities.

That not results in malpractice. From a volunteer survivor who advises people attending support groups, to a lawmaker whose bill creates wait lists for life-saving medications, to a treatment provider who admonishes a person for being unready for change, to a researcher who attempts, one more time, to prove that addiction is a personal problem – anyone who attributes addiction to the person, not to the person’s brain, in my opinion, is engaging in life-endangering malpractice.

In my personal experience, people’s beliefs about addiction, and about people who have addiction, and their refusal to look at the evidence, just won’t give.

At the end of the film, A Beautiful Mind, the main character, who suffers from paranoid schizophrenia, sees the entities who have plagued him, but does not engage with them.

In her DBT Training Manual, Marsha Linehan writes, “People may not have caused all their own problems, but they have to solve them anyway.”

I have had to steal the reality of my inner experience away from those who would deny it or fault me for it.

For me, moving from radical acceptance to revolutionary acceptance means:

  • My life is more than half over.
  • I need to protect myself from harm from those with good intentions or claims of expertise but who lack knowledge and understanding.
  • More disinformation about addiction exists than information and I need to practice ruthless discernment about what I let into my life.
  • I am the one who must seek and discover what the research says is effective, implement it for myself, and see if it’s effective for me.
  • I need to forgive myself for entrusting my recovery to others.
  • I need to forgive myself for developing alcoholism in the first place.
  • Some things just won’t give.
  • No matter what I say or what I do, someone, somewhere will disapprove or disagree.
  • Even as diminished as my life has become from alcoholism, even as problematic as my inner experience has become, I love it all, I want to have it all, and I want to keep it all, for as long as I can.

I’m stealing my recovery from addiction to alcohol back from those who would want to direct it. I am not a fan of stealing. But this is my life, my one life. It is precious to me.

A Recovery-Supporting Visit to Blacksburg, Virginia

If you’re in recovery from addiction and visiting the Blacksburg, Virginia area…

Here’s a list of local support groups with dates, times and locations. (If you need urgent support, here’s a list of our local substance use disorder resources. If you need emergency support, please dial 911 or head to the nearest emergency room. In Blacksburg, that’s here.)

For exercise, the easiest, drop-in place to go with the most options is The Weight Club.

The town pool, Blacksburg Aquatic Center, offers daily swimming passes.

Touring sounds of Blacksburg at Hahn Gardens

Recovery-friendly church services are offered at edges. edges is affiliated with the local Methodist church. Anyone of any faith – or of uncertain, little, or no faith – is welcomed.

The Blacksburg Meditation Group meets every Sunday from 7:30 – 8:30 PM.

Interesting, pleasant, quirky events are held at the library.

NextThreeDays offers a list of current things to do in Blacksburg (incluces many menu specials from local restaurants). Some local events are included in the Roanoke calendar of the Roanoke Times.

In case of rain or snow, try a supportive self-care practice.

On your own…

If you like coffee, something interesting to do might be to taste all the coffees in the local coffee shops and discover your preference. (This is a dialectical behavior therapy-informed activity because it engages the senses, focuses attention, and asks for discernment. DBT is an increasingly evidence-based therapy for supporting abstinence for people with substance use disorders.) Several shops offer locally-roasted beans.

If pizza is more to your taste, there are several, one-of-a-kind pizza shops to try.

In addition to trying out the tastes of Blacksburg, taking other sensory tours of Blacksburg’s offerings could be recovery-supporting.

Sights:

Smells:

Touch:

Sounds:

Kinesthetic:

For more ideas, Melody Warnick features Blacksburg, Virginia in her book This is Where You Belong: The Art and Science of Loving the Place You Live.

If you would like or need a support person in the Blacksburg, Virginia area, feel free to call or text me, Anne Giles, 540-808-6334.

Enjoy your visit!

Photo: Z. Kelly Queijo, founder of Blacksburg Lodging and Smart College Visit.

What I Know and Don’t Know About Addiction

“we want ppl writing about their experience of adxn, but it’s important to know what you don’t know & really hard to achieve ;-)”
– Maia Szalavitz, Twitter, 8/23/17

I write about my experiences with addiction with these imperatives and caveats:

  • Do no harm.
  • Report what the data says.

Do no harm.To the best of my ability to do so, I do not express opinions, views or perspectives. If I am expressing an opinion, I say so. Instead, I express my personal experience as anecdotal evidence – from which no general conclusions can be drawn about other individuals or groups – then report the empirical evidence published in research literature, which, because of the rigors of the scientific method – has been found to hold true for most people, most of the time, better than other treatments, and better than no treatment at all.

To the best of my ability to do so, for everything I utter and write about addiction, I can cite an authoritative, empirical source. Neither my personal experiences, nor my logical deductions, are empirical sources.

I link to the most authoritative sources I can find, unless, I judge, based on my training and experience as a teacher, counselor and writer, a complex subject requires a simpler source. I link to reports Laurel Sindewald and I have written because I can know, first-hand, that they are based on exhaustive literature reviews and ruthless determination to excise bias. This report, for example, has been one of the most controversial we have issued, but we talked about its content for several years, and spent 3-4 months researching it and writing it. Laurel wrote the final draft and I reviewed and edited it. I trust its findings.

To meet author Maia Szalavitz’s criterion for writing about addiction, I want to summarize what I know and don’t know. In order to do no harm, I must achieve that.

First, a brief overview of the context:

  • In 2012, I found myself compelled to continue to drink alcohol despite harmful consequences – the definition of addiction.
  • I thought I was treating myself to gold standard treatment for alcoholism by abstaining and attending a 12-step support group. To my bafflement, horror and shame, I continued to suffer and failed to thrive.
  • My father, a retired professor, hired two researchers, and the four of us began to study the research literature on addiction. We began to find that twelve-step approaches are not evidence-based treatments for addiction.
  • I began to research, then compile, evidence-based guides to addiction treatment for myself and others. I learned to differentiate between treatment, support, and self-help. (I continue to update this guide to evidence-based self-care.)
  • Maia Szalavitz’s book came out in early 2016, and Dr. Vivek Murthy’s report came out in late 2016, and the secret world of belief-based practices was exposed. <– That’s my opinion. I no longer felt like the lonely Lorax, speaking on behalf of the “trees,” i.e. on behalf of the people with substance use disorders, like I am, who need and deserve evidence-based treatment.
  • I finished my memoir (the conclusion is scheduled to be published by The Fix on 8/29/17) and want to return to advocating for evidence-based treatment.
  • As of this writing, for 4 years and nearly 8 months, I have been abstinent from ethanol, an identified neurotoxin, a substance legally available for consumption in my country. <–These are facts, not opinions. But this is where things get interesting. Instead of “ethanol” – which is startling – I could have written “wine, beer and other alcoholic beverages” – which is commonplace. I am aware of my word choice. I know what I am doing. I am writing. Writing is a skill, an art, and a power.  I must do no harm with it.

A disclosure of my opinions:

  • Defining terms is critical. If we don’t have mandated definitions, or co-agree on what definitions we’re going to use, we will not communicate and not achieve intended ends.
  • Each individual is unique, or different enough from other individuals, to have a unique case and need individualized, customized care.
  • Given limited resources and the urgency of the condition, individualized, customized care is impossible. Therefore, algorithms must be derived that, based on the data, help most people most of the time. We’ll miss some people. This is a hard truth to bear.
  • When people take adamant positions, regardless of how crystalline their logic, underneath is probably fear. “What might I/you/we be afraid of?” is a useful question to ask when discussions shift from cognitions to emotions.
  • If addiction is a disorder of the organ of the brain, then let’s attribute addiction to that organ. Anything that attributes addiction to the person, and not to the organ of his or her brain – to the person’s morals, character or willpower, to the person’s mental, emotional, cognitive, behavioral, psychological and/or spiritual problems or deficits, to the person’s lack of motivation or “readiness for change,” even to the person having “learned” addiction – perpetuates malpractice and stigma.
  • Malpractice and stigma can, and do, kill.
  • Given that death rates due to opioid use disorder, alcohol use disorder, and tobacco use do not move lawmakers, insurance companies, medical boards, and society at large to institute evidence-based treatment for people with substance use disorders, I do wonder if the secret, unspoken belief is that people with addiction deserve to die. Is it “Good riddance to bad rubbish”? Edit: First, suffer as punishment for perceived sins. Then die.
  • Abstinence-based outcomes, as measured by negative urinary drug screens, are criminal malpractice. For no other medical conditions are people mandated to the criminal justice system, denied custody of their children, or denied employment because of fluctuations in a chronic health condition.

What I don’t know about addiction:

  • What it really is.
  • What really causes it.
  • What the definition of “treatment” is, what really “treats” addiction, and what would satisfy us as “good enough” results from the treatment, even if we did know what it was.
  • Why some people “spontaneously recover” and some don’t.
  • Why the people in my town with opioid use disorder do not have ready access to methadone and buprenorphine, the only known treatments to cut the death rates by half. Unless the secret intent is for them to suffer and die. Because that is happening.
  • If addiction is a medical condition, what a counselor without medical training is supposed to do for people with addiction.

Here’s what I think I know about addiction:

  • No one really knows what addiction is and what lessens it, reverses it or cures it. To some extent, we’re all f*ed.
  • What is known is readily available, even in an easy-to-read format.
  • Belief-based, theory-based, practitioner experience-based, and personal experience-based methods dominate addiction treatment.
  • Beliefs, theories, and experience with addiction by persons or observed in others, dominate public discourse and policy.
  • Medical science is full of uncertainties. Chemo or radiation for cancer? What else to do but IV fluids and oxygen for someone with ebola?
  • My case is one case, no more and no less. What worked for me cannot be generalized to others. What didn’t work for me cannot be dismissed as unworkable for others.
  • If addiction is defined as the compulsion to continue to drink, use or do despite harmful consequences, abstinence is not a treatment for addiction. Abstinence creates the conditions under which a compulsion becomes nearly involuntary, automatic, reflexive, instinctual.
  • If the end in mind of addiction treatment is to decrease the number of premature deaths and to decrease harmful consequences for individuals and society, then what supports handling abstinence or harm reduction – rather than achieves them – needs to be the focus of “treatment.”

Finally, I study epistemology and acknowledge the limits of my ability to know what I know.

My awareness of what I know and don’t know continues to evolve. I purposely and purposefully seek out the latest published research on addiction and review the clinical studies ahead.

If fault is found with anything I’ve written, I’d be glad to learn of it – if sources are cited. My opinion is that I don’t have time for opinions. The stretchers are lining up at the addictions treatment tent. What does the data say about how we shall care for our citizens and, all the while, do no harm?

Photo: Greg Kiebuzinski

The opinions expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends.  This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.