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The US happens to have a sort of medical-industrial complex that we believe is not in the business of healing but in the business of treating. People are used to taking a pill to make their problems go away.

If you go to another country, you’ll notice that access to opioids from doctors is a thousand times less than it is in the United States. They don’t prescribe opiates the way we do — not even close.

We know, based on court filings in cases against companies like Purdue Pharma and their partners and distributors, all the way down to the pharmacy level, that these drugs were known to be more addictive. They marketed them as less addictive, and they were overwhelmingly overprescribed. So why is that? It’s impossible, and very hard for many of us, not to be cynical about it.

There is no heroin in the United States anymore—it’s all mixed with fentanyl and other substances because heroin alone isn’t strong enough. Cartels and illicit drug manufacturers are not known for being stupid in their strategies for developing products that are very effective and addictive. That’s why you see fentanyl mixed with cocaine, and that’s why you see fentanyl mixed with ecstasy, it’s strong and more addictive.

Addiction is often, if you look carefully, a treatment for something.

We work carefully with an aftercare roadmap, a plan that maps all of their unmet needs — all the ways they’re behaving to satisfy those needs unconstructively. Then we figure out what they can do to fulfill their needs for a sense of adventure, community, intimacy, worthiness, and self-love. Everyone has those needs. Everyone’s needs are being satisfied somehow; it’s just that some people satisfy them in ways that wreck their lives.

All you need is to be with two friends, and one of you will have an addiction of some kind. It may not be a substance but a behavior. If you’re in a meeting, someone in that room has a chemical dependency, and everyone in the room knows someone who has chemical dependency. The crisis is getting worse.

If you take an addict and say, “Here’s a pill—it’ll make your addiction go away,” how long do you think that’ll last? There has to be a deeply meaningful transformation. They need to learn that all healing—whether it’s a scrape on your elbow or a wound in your soul—is healed by growth. The skin has to grow over, or you have to develop as a person.

The drug and alcohol rehabilitation sector within healthcare, with medication, is a $43 billion-a-year business. But 50% of the 2.5 million people who go into rehab in the US each year won’t stay. They’ll leave before they’re supposed to. Of those who stay, around 90% will report less-than-satisfactory results.

I’ve been sober since April 15, 1997. I had a bunch of surgeries in 2010, and they prescribed me a ton of Vicodin. After about three or four months, I thought, “You know what, I don’t want to be on this stuff anymore.” They said, “Oh, go on this instead,” and prescribed me Suboxone. I started taking it, and sure enough, it blocked cravings. I could live a normal life with it because I wasn’t really high. I was on a very low dose and maintained that low dose, but I couldn’t get off it. Twelve years later, I was still on it, and I realized it might be making me tired during the day. It felt like wearing a wet towel over my head. I got it down to 2 milligrams—a very low dose—but that last bit was impossible to quit. Everyone I spoke to said the same thing. It’s almost like it was designed by the drug companies to keep you hooked. It’s like Hotel California—once you check in, you never check out. It’s impossible not to be cynical.

Addiction doesn’t seem to affect the economy enough to motivate legislators to find a solution that truly works. But as we know, one out of three people at Thanksgiving dinner will have some form of addiction. COVID woke people up to the importance of mental health. Many people started using telemedicine and therapy. Some of that will lead to more compassion for family members and for themselves, regarding the suffering caused by addiction and trauma.

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