If your theory doesn't match the folklore, it's time to adjust your theory. The first time Norm said this to me I knew I was learning from someone who knew what they were talking about. Norm told me how, from an academic standpoint and from a research standpoint, the lives of large numbers of people … Continue reading Sentences to Ponder (Norman Hoffmann, PhD)
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A Metapsychology of Addiction, Addiction Recovery, and Human Beings
It seems to me that addiction: is dynamic has a form consumes energy and manages affects is influenced by genes and is also developmental has substructures that are simultaneously independent and interdependent adapts to reality. Let me expound each of those points in turn. Addiction is fluid, not static. Once in place it undulates within, … Continue reading A Metapsychology of Addiction, Addiction Recovery, and Human Beings
MOUD retention: 17 years, 212 days, 10 days
Earlier this week, a friend shared a really interesting table from the Treatment Episode Data Set (TEDS) 2023 annual report. I'm familiar with the TEDS, but I don't recall ever seeing this table of discharges by year of admission. What this table shows is that, of the 1.4 million discharges in 2023, 60 of them … Continue reading MOUD retention: 17 years, 212 days, 10 days
Lived experience and empirical knowledge: domination or integration?
I've been in and around professional addiction and recovery circles for more than 30 years. In that time, I've spent a lot of time in rooms where empirical knowledge was a suffocating force. It determined what and who was valued, heard, and respected in ways that did not lead us any closer to truth or … Continue reading Lived experience and empirical knowledge: domination or integration?
Public Interest or Industry Interest: the Economics and Politics of Minimizing Alcohol Harm
“Knowledge is in every country the surest basis of public happiness.” – George Washington, First Annual Message to Congress, 1790 Last January a report on alcohol and health was posted by the US Department of Health and Human Services for public comment, Draft Report: Scientific Findings of the Alcohol Intake & Health Study for Public … Continue reading Public Interest or Industry Interest: the Economics and Politics of Minimizing Alcohol Harm
The Concept of “Mental Relapse” Is Being Lost
During my first two and a half decades working in addiction treatment, I was surrounded by the term mental relapse. Let’s talk about that term. What is mental relapse? How is it defined? For starters, mental relapse frames relapse as a process, not an event. It’s the process that begins before using resumes. To be clear, mental … Continue reading The Concept of “Mental Relapse” Is Being Lost
Understanding Before Language
I did not grow up knowing what anything meant. I don’t mean that in a poetic or existential way. I mean it literally. I spent most of my childhood in Hong Kong in the 1970s. I was in the most densely populated place on earth, surrounded by a language that had no alphabet, no phonetic … Continue reading Understanding Before Language
You may have heard of “urge surfing”. Let’s add “recovery surfing”.
Some years ago, it dawned on me that we lacked a concept that seemed important. And that we also lacked a term for it. Or we at least lacked a concrete awareness of this idea with a shared language for it. My solution was to coin the term "recovery surfing" as the name for the … Continue reading You may have heard of “urge surfing”. Let’s add “recovery surfing”.
Will We Ever Move Beyond an Acute Crisis Orientation? The Absence of Recovery Research and Emerging Drugs
“What remains in diseases after the crisis is apt to produce relapses.” ― Hippocrates Our SUD evidence base tends to be myopic and crisis oriented. It is focused on first aid and short-term stabilization rather than on developing sustained recovery over time. Nowhere is this more evident than in our response to emerging drug combinations … Continue reading Will We Ever Move Beyond an Acute Crisis Orientation? The Absence of Recovery Research and Emerging Drugs
A brief overview of quality-related methodologies
Clinicians in our work are seldom, if ever, provided high-quality education or training by their own organizations on topics related to organizational leadership or administrative management. And most organizations also fail to provide training about how to lead or manage organizational change, even during or in preparation for a change project. So that's two problems … Continue reading A brief overview of quality-related methodologies
Recovery Review 