This is a tough one. We are struggling as a community and as a health system to deal with a public health crisis. Deaths from drug overdoses were 31 percent higher than deaths from motor vehicle crashes in 2013. Rates of heroin use among females and among young adults age 18-25 doubled from 2002 to 2013 (Centers for Disease Control and Prevention). Of course, a host of unhealthy trends afflicts our culture, but this one is particularly troublesome because the medical community offers so little in the way of relief.

Consider the findings of a 1998 review conducted by the Federal Substance Abuse and Mental Health Services Administration: “Treatment for opioid addiction reduces heroin use by about 14 percent, while inpatient rehab reduces heroin use by 27 percent.”

Outpatient methadone reduces use of non-opioid drugs, but not heroin. Is this really the best we can do? This year, the Federal Government will spend $30 billion on drug control, for a 14 percent reduction in heroin use? Is it not time to start questioning some of the fundamentals of our approach? As Albert Einstein so wisely put it: “We can not solve our problems with the same thinking we used when we created them.”

One of the basic assumptions the medical community uses in approaching substance abuse and mental illness is that there is a fundamental malfunction in the brain that is causing the maladaptive behavior, but that model is a relic of the Marcus Welby era. It’s based on bad science … a bit like observing that 100 percent of women over 55 who drink green tea do not get pregnant—then concluding that green tea prevents pregnancy. We see patterns of brain chemistry, scans, and genetics of people with addiction that are different from people without addiction, but those patterns didn’t cause the heroin use!

Addictive behaviors are unhealthy coping responses that emerge when we fail to develop appropriate social connections … addiction is more an injury than it is a disease. If we continue to ignore the roots of the injury, while spending billions in the search for solutions in a pill bottle or a prison cell, we’ll keep getting what we’ve always gotten: about 14 percent.

There is no question that addiction is real. It causes real suffering, and in 2013, overdoses killed 46, 471 people in the U.S. But labeling it as a “brain disease” sets us up for permanent failure. It creates an identity of illness when what we need is an identity of wellness.

People with addiction are injured, and in order to heal, must have, above all, healthy social bonds that stimulate them to want recovery. As author Johann Hari said: “The opposite of addiction is not sobriety; the opposite of addiction is connection.”


— Dr. Didden is Jefferson County’s health officer.

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