Disclaimer:  nothing in this post should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care.  In his 1916 article1 titled “Mourning and Melancholia” Sigmund Freud grappled with clarifying the differences between melancholy and mourning.  In his usage melancholy refers to what we would loosely call “depression” and mourning refers to … Continue reading Grief and Depression as Factors in Addiction Counseling

Our substance use care system workforce has long faced very high turnover rates. One of the studies from years ago that always stuck with me as framing out the challenges and value of working in our field, was from 2003, the toughest job you'll ever love: A Pacific Northwest Treatment Workforce Survey. It identified turnover … Continue reading Loss of Institutional Knowledge – a Critical Tipping Point in the SUD Workforce Crisis

A few weeks ago, while I was reading in the psychoanalytic literature, I saw that Freud (1915) abbreviates the Conscious mind with the initials “CS” and the Unconscious mind with the initials “UCS”.  To me this seemed like much too much of a coincidence.  Why did it seem like a coincidence?  From my rather extensive … Continue reading Rescorla is to Pavlov as Semiotics is to Freud

The question of how to describe and categorize addiction has been the subject of several of my recent posts. Some people scratch their heads about why I care so much about whether we think of it as a disease. Bill White summarized the stakes well here: If AOD problems could be solved by physically unraveling … Continue reading Is it harmful to frame addiction as a disease?

An interesting discussion with a passionate advocate for MAT expansion and the most prominent advocate for the "new paradigm": What is the process for successfully integrating these 2 approaches? What are the biggest hurdles providers face when accomplishing this goal?Dr DuPont: The biggest hurdle is the staff reluctance, even the staff distaste, for the integration of … Continue reading Integrating MAT, Abstinence-Based Approaches to Recovery 

https://twitter.com/KeithNHumphreys/status/1447351509658718210 As substance-free definitions of recovery are challenged, this article on Stanford's substance-free student housing community made me wonder if some recovering students will find more safety and support, and have more in common with fellow students in these communities than in collegiate recovery programs (CRP) that include students whose definition of recovery includes ongoing … Continue reading What’s the relationship between recovery, collegiate recovery, and substance-free student housing?

“. . . the individual, family and community are not separate; they are one. To injure one is to injure all; to heal one is to heal all. – from The Red Road to Wellbriety, 2002” – as quoted by William White, Recovery Rising Perhaps the most important insight in recent recovery history is that … Continue reading Headwinds for Recovery Community Self Agency

“I don’t even agree with myself 100% of the time” – me It is a tongue in cheek self-quote. Cheap, but true and relevant to the piece. Perhaps you may even identify with it. Afterall, we all hold views that seem contrary or in conflict with each other. It is the essence of the human … Continue reading Spanning the Chasm Between Us

If effectively addressing addiction was easy and straightforward, we would have done so already. In reality, it is a multifaceted condition that defies narrow solutions. There are complex genetic and environmental factors that lend themselves more to a continuum of use, problematic use and addiction that is not consistent with either / or check box … Continue reading Towards More Compassionate Care for Not Just Another Medical Disorder