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“Read My Lips”—Empty Words: The Semantics of Institutionalized Flawing

Having been in the substance use epidemiology and prevention intervention field for over 50 years, I have observed much lip service given to a variety of issues related to prevention and treatment of substance use. What is particularly troublesome is the lack of understanding of the epidemiology of the range of substance using (including nonusing) behaviors, substance-using life styles and cultures and their implications for prevention, and treatment. This lack of understanding is not only on the part of policy makers but also by those who plan, deliver, and assess substance use prevention and treatment services. Let us start with examining the natural history and etiology of substance use. The expression “natural history of disease” refers to the progression of a disease process over time, in the absence of treatment. The United States Center for Disease Control and Prevention among others has shown this progression from stage of susceptibility or vulnerability1 through to exposure or onset to the development of symptoms and diagnosis to disability or death, or if treated to recovery2 Figure 1.