We are amidst an opi­oid epi­dem­ic. The great­est prob­lem, iron­i­cal­ly, with opi­oid (and oth­er psy­choac­tive) drugs is that they are so imme­di­ate­ly effec­tive in reliev­ing human phys­i­cal and psy­chic pain. They also can deliv­er surcease from a hard life with few prospects as well as, for oth­ers, trans­port them from the mis­eries and ennui that every­day life can pro­duce. Peo­ple who use drugs do so to meet spe­cif­ic needs. These sub­stances serve their needs, usu­al­ly the best solu­tion they have so far, until they don’t (when depen­dence sets in). Addic­tion is a chron­ic, relaps­ing brain dis­ease fos­tered and ampli­fied by psy­cho­log­i­cal and social forces, yet these bio­log­i­cal and behav­ioral dri­vers have not had cen­ter stage in con­sid­er­ing how to reduce drug use, deaths and the ille­gal sale of substances.

We have spe­cif­ic, evi­dence-based solu­tions for the pre­ven­tion and treat­ment of drug use, includ­ing cog­ni­tive ther­a­pies, exer­cise and oth­er mind-body inter­ven­tions, med­ica­tions, 12-Step pro­grams and com­mu­ni­ty-based sup­port ser­vices. These are what fam­i­lies and com­mu­ni­ties need, and I describe how they can succeed.