I wrote the book on the back of my PhD. I think the purpose was to get the message out there — and to have it in print, on the record.
After eight years researching co-existing mental health and substance use, I felt that no one was saying clearly what the challenges actually were. The book is my attempt to do that.
I also felt that the ideology around neoliberalism hadn’t been directly connected to the challenges healthcare systems are now facing — particularly in mental health and substance use.
The central claim is that pain comes first, drugs come later. That is everything. It always has been. In almost twenty years of working with people, I’ve never known anyone who didn’t suffer pain first — and the substance use was merely an attempt to manage that pain.
The book also argues that services are built on this individualistic ideology. And that abstinence-based frameworks are often unrealistic, and do not take into consideration the complexity of a person’s life.
I initially thought the book was probably going to be for academics, since it came on the back of my PhD. But as I was writing it, I wanted it to be readable to anyone really — people with lived experience, practitioners, and so on. I appreciate some of the wording can be difficult and some of the philosophical terms may be new to people. I hope it resonates.
Our systems are not failing because of a few bad policies or underperforming services; they are failing because they are built on a broken ontology. This is not an individual failing. It is design. And design can be changed.— From the Preface