Abstract
Any discussion of law, ethics, and policy regarding substance-use disorders, or SUDs, is situated in cultural, historical, and legal contexts too often informed by deeply held but factually incorrect belief systems. These
mistaken beliefs implicate the nature of addiction (now known as a severe SUD), the “character” of the individual with SUD, the meaning of suffering and “willpower,” and the appropriate roles of health care providers, peers, family members, and colleagues.
The law has reinforced these mistaken beliefs and
perpetuated the quite harmful idea that treatment of SUD is separate from the rest of health care. A foundational
Supreme Court case in 1919, United States v. Dormeus, concluded that addiction treatment wasn’t the legitimate practice of medicine. Even now, federal law literally separates the medical treatment of opioid-use disorders, called OUDs, which are a subset of SUD, from the treatment of all other health care problems, including common co-morbid conditions such as serious mental illness.
In the last three to four decades, ideas about abstinence,”
“tough love,” “rock bottom,” and 12-step programs alone have infected popular and professional thinking. In reality, these beliefs aren’t merely incorrect; they deter treatment-seeking behavior and the provision of evidence-based care. Maia Szalavitz’s Unbroken Brain: A Revolutionary New Way of Understanding Addiction [https://amzn.to/2m1VINr] offers an excellent examination of the ways in which mythology, rather than evidence, permeate these discussions.