Author’s Declaration of Fair Comment: When you inject academic data into the public domain to influence national public health policy, you do not get to hide behind a clipboard when the data is forensically challenged. The following is a direct, First Amendment-protected critique of the study "Psychiatric comorbidities in substance use disorders: sex-based differences in a national real-world clinical sample" by Butelman et al., published in the American Journal of Psychiatry (2026), and subsequently promoted by Vivien Ciftci on The Mental Elf. As a published author, forensic expert witness across more than 4,000 legal cases, and a PhD-level addiction clinician with 20 years of practice, I possess the absolute right to mock, dismantle, and publicly debate deeply flawed academic methodology. If the authors dislike having their conclusions forensically eviscerated, someone else is welcome to debate my public domain entrance into this argument. No feelings here. Just facts.
Section 1: The Diagnostic Shell Game and the Academic
Vacuum
Two people walk into a
psychiatric clinic. One is male, one is female. Both are actively drinking,
shooting synthetic opioids, or smoking high-potency weed from dawn until dark.
The academic researchers—in
this case, Butelman et al., clutching their dataset of 58,000 state-funded
patients and looking through the lens of the American Journal of Psychiatry—gaze at them with
profound intellectual wonder and ask: “Why do these two individuals present with such starkly
different psychiatric comorbidities? Could it be biological? Societal?
Hormonal?”
Allow a clinician who actually
spent decades in the trenches to answer the question without charging taxpayers
a dime: They don’t have
mysterious psychiatric comorbidities. They have a central nervous system
drowning in chemicals.
If you pour half a gallon of
distilled ethanol into your engine every morning, you don’t need an engine
whisperer to diagnose why the exhaust is sputtering. If you put a heavy central
nervous system depressant into a person for 20 years, they are going to present
as profoundly depressed. If you pump 25 milligrams of Delta-9 THC into a
person, their oars are not going to be in the water. If someone has spent a
decade abusing opioids, they are going to walk through the clinic doors
emotionally and psychologically evaporated, completely drained of executive
function.
Yet modern state-run clinics,
operating under the gospel of the DSM and subsidized by bottomless Medicaid
streams, perform a magnificent piece of diagnostic sleight-of-hand. They look
at someone going through active toxicity or severe chemical withdrawal and
decide to throw a psychological hand grenade into the mix. They tell the
patient, "Since you drank
and used drugs to numb out, we are going to help you do that with a brand-new
pill. Oh, and we'll increase the dose in two weeks because, naturally, you're
not going to feel very good while your brain chemistry burns to the ground."
It is the old English medical
adage brought to horrific modern life: The operation was a success, but the patient died.
Translated into plain English:
“Congratulations! Meet your new
drug dealer, it’s called MAT (Medication-Assisted Treatment). By the way, your
doctor will be turning you into a vegetable today, enthusiastically supported
by the nurse practitioner and the LPN. And if you have any trouble getting what
you need from our clinic because we want to preserve our clean billing codes,
don't worry—we’ll refer you to a Telemed doctor who can ship you anything right
on up to Ketamine. Because if it can tank a 2,000-pound horse, it should do
wonders for a 175-pound addict.”
The single biggest flaw in the
Butelman argument—and the entire modern addiction apparatus they are
studying—is the sheer, breathtaking incompetence of the clinical assessment.
They treat patients in a complete vacuum, ignoring the origin story and discarding
every single genetic and psychiatric clue.
The current chemical
dependency assessment utilized across the Medicaid pipeline is little more than
a 17-question joke. It only asks about the last three years, tracking minor
usage just enough to generate a billing code.
Section 2: The Assessment Vacuum and the Death of the AMA
Standard
Before we dive further into
the comedic tragedy of this study’s “findings,” we need to establish exactly
how far the clinical standard has fallen. If you want to understand how a study
published in the American
Journal of Psychiatry can claim with a straight face that drug addicts are
suffering from sudden, sex-based outbreaks of schizophrenia and bipolar
disorder, you have to look at what they threw in the garbage to get here.
For 50 to 60 years, the gold
standard for treating addiction was established by the American Medical
Association (AMA). It relied on a rigorous, differential diagnosis of chemical
dependency. When you walked into a clinic during the Golden Age of Recovery,
you didn't get a 17-question checklist that only cared about the last three
years of your life so a billing clerk could code your chart. You sat down for a
grueling, comprehensive, two-and-a-half-hour forensic assessment.
We mapped everything. We
wanted to know what you took, how much you took, and exactly when you started
taking it. If you were sitting in my chair, I already knew you weren't an
amateur. People don't end up in an addiction therapist's office on a winning streak.
If you are sitting in that chair, you are in so much pain that you have finally
decided you are sick and tired of being sick and tired. You are ready to hear
the unvarnished truth about your disease, and you are ready to learn how to
recover. We traced genetic predispositions back two full generations—direct
lines through Mom, Dad, Grandma, and Grandpa—looking for the presence of
alcoholism, drug addiction, hypoglycemia, diabetes, and actual organic mental
illness.
Here is the absolute,
unbendable clinical rule that modern psychiatry has conveniently
"forgotten" to preserve their $1.5 trillion billing cycle: Every single sign and symptom of
drug use and chemical withdrawal mimics mental illness 100%.
If a patient did not have a
documented, severe psychiatric episode—like schizophrenia, manic depression, or
a psychotic break—two, three, five, or ten years before their very first use of an intoxicating
substance, and there is no two-generation genetic predisposition, there is
almost certainly no organic mental illness. You cannot accurately diagnose the
presence of a primary psychiatric disorder until the individual has achieved a
minimum of six months of continuous, long-term, abstinence-based recovery.
But the American Psychiatric
Association (APA) and the Medicaid billing machinery hijacked that standard.
The current system has had one job for the last 26 years: keep you addicted,
keep you sedated, and keep you walking through that revolving door of failure.
By eliminating the AMA's deep-dive assessment, the APA created a clinical
vacuum. They purposely ignore whether a patient was getting black-out drunk at
age 14 before they ever felt "depressed." They ignore it because
finding out that the drugs caused
the psychiatric symptoms ruins the justification for prescribing more drugs.
Which brings us to the
centerpiece of this spectacularly flawed article. The researchers boast about
analyzing a "large, real-world US clinical dataset" of over 58,000
adults with opioid, alcohol, or cannabis dependence. Where did they get this
data? Straight from "state-funded and state-run mental health
services."
According to their brilliant
analysis of this Medicaid mill ledger, a clear pattern emerged: Women had
higher odds of being diagnosed with anxiety, depression, and trauma-related
disorders. Men, on the other hand, had higher odds of being diagnosed with schizophrenia
or other psychotic disorders.
Let me save the researchers
their next million-dollar grant. There is no biological mystery here. You are
not looking at organic sex differences in psychiatric comorbidities; you are
looking at the gendered behavioral management of acute chemical intoxication,
disguised as diagnostic science.
Let's break down the sheer
absurdity of diagnosing "schizophrenia" in a man saturated in
synthetic opioids or high-potency cannabis. Delta-9 THC at modern, concentrated
levels induces acute paranoia, hallucinations, and psychotic breaks. Synthetic
opioids induce profound central nervous system depression, cognitive
detachment, and erratic neurological misfires.
When a drug-addicted male
presents at a state-run clinic acting erratic, aggressive, or paranoid because
his brain is literally swimming in neurotoxins, the clinic doesn't wait six
months for him to sober up to see if he has actual, organic schizophrenia. They
slap him with a psychosis billing code on day one. Why? Because a
"psychosis" or "schizophrenia" code is the golden ticket to
prescribe heavy, high-reimbursement antipsychotics like Seroquel or Haldol. It
chemically lobotomizes the aggression, makes the patient compliant, and creates
a highly profitable, permanent medical dependency.
Conversely, when a
drug-addicted female enters the same clinic—emotionally shattered, crying, or
suffering from the acute central nervous system blowback of alcohol or opioid
withdrawal—she is immediately rubber-stamped with "anxiety," "major
depressive disorder," or "trauma." Again, no one waits to see if
her brain recalibrates after detox. The clinic simply uses the depression and
anxiety codes to justify layering SSRIs, SNRIs, and benzodiazepines on top of
her existing addiction.
This isn't a study of how male
and female brains naturally develop mental illness. It is a ledger of how
Medicaid mills code different intoxication behaviors to maximize pharmaceutical
output. They took 58,000 people who were poisoned, looked at how the poison
made the men act versus how it made the women act, and then handed out lifetime
psychiatric labels to justify $14.2 trillion in MAT and polypharmacy cocktails.
The only "integrated care" taking place in these facilities is the
seamless integration of human suffering into a revenue stream.
Section 3: The Trauma Blindspot and the Chemical
Lobotomy
If you want to see exactly
where modern psychiatric research actively plays dumb to protect its funding,
look at how Butelman and his colleagues handle trauma.
In their analysis of these
58,000 Medicaid patients, they note that females exhibited higher adjusted odds
of "trauma- and stressor-related disorders"—running anywhere from 16%
to 32% higher depending on whether the primary substance was opioids, alcohol,
or cannabis. The authors then gaze thoughtfully at their data and write: "The dataset cannot tell us
which of these explanations... accounts for the findings," waving
their hands at some mysterious combination of biology, environment, and stigma.
Let me clear up the
"mystery" for them using 50 years of established clinical metrics
that the APA conveniently buried.
Between 60% and 80% of all
addicts and alcoholics who walk through the doors of a treatment facility have
been victims of sexual assault or severe, repeated trauma. They are
fundamentally broken on a spiritual and emotional level. The entire reason they
are pouring lethal amounts of fentanyl, alcohol, or cannabis into their bodies
is to self-anesthetize. They are desperately trying to turn off the horrific
reruns playing in their heads.
So, what does the modern MAT
clinic do when a severely traumatized victim walks through the door? Do they
treat the trauma therapeutically? Do they guide the patient through the
rigorous, painful, but ultimately freeing process of abstinence-based cognitive
and trauma therapies?
Absolutely not. That would
require a sober brain capable of executive function and processing power.
Instead, Dr. Stupid and the
billing department opt for a chemical lobotomy. They look at a patient who is
using street drugs to numb their feelings, and their brilliant medical solution
is to prescribe clinical
drugs to numb their feelings. They slap a "trauma-related disorder"
billing code on the chart and bury the patient under heavy psychiatric
tranquilizers, SSRIs, and synthetic opioids like Methadone or Suboxone.
It is the clinical equivalent
of watching a house burn down and trying to put out the fire with gasoline. No
matter how many psychiatric drugs you dump on top of that brain, you are only
keeping the trauma behind closed doors for a limited amount of time. The show
is going to come back on. It will play on rerun after rerun after rerun. And
when the trauma inevitably bleeds through the chemical haze, the clinic’s only
response is to up the dosage. Ultimately, that methodology leads to a single,
inevitable conclusion: respiratory failure and a casket.
But there is a darker, much
more sinister reality hiding behind these "trauma" billing codes that
the American Journal of
Psychiatry absolutely refuses to touch. Since the year 2000—when the APA
and CMS hijacked the addiction space and replaced abstinence with "harm
reduction"—an estimated 10.5 million sexual assaults have gone entirely
unreported by the treating psychiatrists, psychologists, medical doctors, and
social workers.
You cannot have a 60% to 80%
reported sexual abuse rate for 50 years and watch it magically dry up. If these
clinicians were doing their jobs and reporting the trauma that drove the
addiction, we would have 10.5 million police investigations. We would have
billing records for 10.5 million hospital rape kits. But we don't. The data is
suppressed, siloed, and ignored because reporting it requires actual trauma
intervention rather than writing a prescription and sending the patient out the
door.
Worse still, by chemically
lobotomizing these individuals, the system actively sets them up for further
abuse. As a clinician, I have investigated assaults occurring directly inside
fake "sober living" facilities. Patients are heavily sedated by the
MAT clinic's protocols, stripped of their cognitive defenses, and left
profoundly vulnerable. When they inevitably relapse or are victimized again,
the clinicians simply up the dose and ignore the assault. It is a traceable,
complicit pattern: from the judge, to the clinician, to the sober living house,
and straight to the grave.
Section 4: The “Integrated Care” Grift and the Section 13
Solution
Once Butelman et al. finish
scratching their heads over trauma and psychosis, they deliver the ultimate
punchline of the article. Citing Edmonds et al. (2024), they lament that "only 7% of US adults with
co-occurring substance use and mental health disorder receive integrated
treatment," using this as a rallying cry to expand their reach.
Let's translate
"integrated treatment" from academic grift-speak into plain English.
Integrated treatment means
expanding the pharmaceutical dispensary. It means ensuring that when you walk
into an addiction clinic for a drug problem, the psychiatrist is waiting right
down the hall to double-dip the billing codes and load you up with antipsychotics
and mood stabilizers before you ever reach 24 hours of sobriety. It is a
vertical monopoly on human suffering.
They want you to believe that
the $14.2 trillion they’ve already spent on MAT and psychiatric cocktails
wasn't enough. They want you to believe that the 600% increase in
deaths—culminating in 4.6 million bodies and 700 dead Americans a day—is just a
sign that we need more
funding, more integration,
and more drugs.
You cannot handle a drug
problem with drugs. You end up with a Lindsey Clancy. You end up with a Matthew
Perry. You end up with a nationwide string of corpses.
This article is an absolute
gold standard of why the current system must be dismantled, and the blueprint
to do it already exists. As the Congressional Relator of Record, I have already
submitted the complete, comprehensive investigative dossier—The Assassination of Recovery—to
the United States Congress, the Senate, and the Executive Branch.
Included in that dossier is
the Section 13 Rescue Package: a fully drafted, legislative framework designed
to rip the financial incentives away from the CMS billing mills, defund the
polytoxic MAT pipelines, and restore the 91% success rate of abstinence-based,
clinically sound recovery. We do not need more "integrated care" to
pump narcotics into pregnant women and traumatized addicts. We need to shut the
cartel down.
I strongly encourage every
citizen, taxpayer, and family member who has watched a loved one be chemically
lobotomized by this system to get The Assassination of Recovery into your legislator's
hands. Demand the implementation of the Section 13 Rescue Package. It is time
to stop subsidizing the world's biggest drug dealer.
Section 5: The Psychiatry
Grift, the Marijuana Myth, and the $35.9 Trillion Reckoning
If we step back from the
academic hand-wringing of this article, we have to ask the most fundamental
question of all: Why are we treating chemical dependency—which is a medical
disease concept, fourfold in nature—with psychiatrists in the first place?
The brutal reality is
that modern psychiatrists operating in the MAT pipeline are not treating
addiction. They are modern-day pill pushers. They hang a shingle with an
"MD" after their name, and that shingle serves as a direct,
frictionless pipeline: from the pharmacy, to the patient, to the Medicaid
billing department, and straight into their pockets. Mental health is being
abused for money, and intentional misdiagnosis is the name of the game. Who is
going to fight it? After all, they are the "experts."
But the fraud goes much
deeper than the doctor’s chair. Walk into any modern MAT facility running an
Intensive Outpatient Program (IOP), and look at who is actually running the
groups. It is often a "peer support specialist." This is someone who
holds a meaningless 16-hour certificate, is usually taking MAT drugs or heavy
psychiatric cocktails themselves, and is actively high while sitting in the
facilitator's chair.
The clinic pays that peer
support stoner $12 to $18 an hour. Meanwhile, the facility turns around and
bills Medicare and Medicaid at a Master’s or PhD clinical level—anywhere from
$245 to $565 an hour. That is a 200% to 400% fraudulent markup. Independent
journalists like Nick Shirley recently discovered "learning centers"
that were billing the government for phantom children, defrauding taxpayers of
$20 billion. In the addiction space, $20 billion isn’t even a rounding error.
It is a drop in the bucket compared to the $35.9 trillion financial extraction
we have forensically documented in the dossier.
And then there is the
article’s casual inclusion of "cannabis dependence," treating it like
just another mild comorbidity. Let's talk about modern marijuana. Today's
cannabis is genetically modified to be up to ten times stronger than what existed
decades ago. In March, the largest study ever conducted on emergency room
visits for marijuana overdose was published, and the results should terrify
every parent and lawmaker in the country: 70% of those patients went on to
develop early-onset Alzheimer's within five years. We are talking about 30- and
35-year-olds walking around with the brain function of a 70-year-old. We broke
this down entirely in our piece Are You Stoned or Stupid, which you can
find at help2LIR.
The academic authors of
this article, and the psychiatric system they represent, do not know what they
are doing because they shouldn't be doing it in the first place. This disaster
will never stop until a power greater than these clinical grifters is exercised.
The very people who created this problem over the last 26 years—the Congress,
the Senate, and the Executive Branch—are the only ones who can bring it to a
screaming halt.
If they do not act,
predictive modeling shows that the current body count of 4.6 million is going
to look like child's play within the next four years. We are losing 700 lives a
day. We are burning $4.1 billion a day. The only things this system is producing
are runaway inflation and death. If you have ever looked at the $40 trillion
national debt clock and wondered where the money went, we found $35.9 trillion
of it hiding in the medical billing silos.
All the money in the
world will not bring back your wife, your husband, your son, or your daughter
from this system's "care." If you have a family member who has been
grossly harmed or killed by these protocols, you need to consult an attorney specializing
in Constitutional violations and medical malpractice. We have provided enough
verified data, billing codes, and historical metrics in our publications that
any competent attorney can walk right into a courtroom and tear these clinics
apart.
So, to the researchers at
the American Journal of Psychiatry and The Mental Elf, thank you
for providing the perfect case study of a system entirely disconnected from
clinical reality.
We hope this introduction
to your new drug dealer, Dr. Stupid, and the clinical assessment at your local
MAT clinic has shown you the truth: if you walk through those doors, you are
walking into a predictable failure. The only solution is true, abstinence-based
recovery.
We strongly encourage you
to get the comprehensive investigative dossier, The Assassination of
Recovery: The Whistleblower's Dossier on the $35.9 Trillion Extraction and
America's Deadliest Medical Fraud, into the hands of your legislators.
Visit us at help2LIR to learn the truth, share the truth, and make a
difference.
There is an old saying in
recovery: When the pain of what you're doing outweighs the pain of change,
you'll change.
Help us make a
difference. Drop the book or our links to your Congressman or Senator.
Read The Assassination of Recovery: The Whistleblower's Dossier on the $35.9 Trillion Extraction and America's Deadliest Medical Fraud.
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