One of the reasons our field is in this sorry state is because we are quick with the blaming game and unwilling to make inward changes. We keep comparing addictions to cancer, diabetes and a host of other chronic conditions but fail to mention that we do not offer treatments appropriate treatments for addictive disorders. Why have we not made an attempt to treat addictive disorders like we treat diabetes or cancer? Tom McClellan, the former Deputy Drug Czar put it very nicely when he spoke at a drug treatment conference in St Louis. Praphrasing his talk: Imagine if you were diagnosed with diabetes and told that if  you need insulin you go to a clinic five miles North, if you need oral hypoglycemic agents, go the clinic five miles South and if you need to learn about diet and exercise go to the clinic five miles West!  Do we treat cancer or diabetes this way? Do we tell a smoker diagnosed with lung cancer to go to a self-help group for treatment?  Do we have clinics at Wash U. or SLU or other teaching hospitals treating addictive disorders? How many social workers are familiar with MAT and anticraving medications? How many methadone clinics offer their patients buprenorphine and naltrexone as a choice? How many physicians who have obtained the DEA waiver to prescribe buprenorphine offer comprehensive treatment that includes counseling? Many addictions like alcoholism, smoking, marijuana, cocaine occurred in a non-iatrogenic manner, i.e. without doctors prescribing these or similar drugs. Professors from medical school fell over each other to become speakers for drug companies singing the praises of opioids and reassuing physicians that there is little or potential for addiction when opioids are used for treating ‘chronic’ pain. How many of them apologized and donated the honoraiums? Unless we standardize treatment and establish evidence-based treatment and break down the silos, the future looks bleak.]]>