In the last year of his medical residency, on his way home from the hospital in Johnson City, Tenn., Stephen Loyd stopped his truck at a red light in front of a liquor store. He flipped open the glove compartment. Inside were some Vicodin pills. “I broke one in half,” he recalled years later, “and I threw it in my mouth.”
Loyd was just a few miles down the road from the Appalachian hamlet where he’d grown up. No one in his family had attended college, let alone medical school. He had a wife and two young children. “My daddy was an over-the-road truck driver, my mom worked for the postal service, and I’m going to get to be a doctor. I worked my whole life for that,” he recalled.
But his addiction grew, and three years later, while working in the hospital’s medical step-down unit and ICU, he was popping up to 100 pills of OxyContin a day. Thinking back to that time, he wondered: “How could this little thing be controlling my life? I used to get up every morning wanting to quit more than anything in the world.”
Loyd eventually went to detox, finding effective treatment for his addiction and for the physical and sexual abuse he’d suffered as a child that had heightened his risk. Today he directs West Virginia’s Office of Drug Control Policy. “I caught a big break,” he said. “I got the best care in the world.” In the U.S. today, millions of people struggling with addiction do not.
According to the 2024 National Survey on Drug Use and Health (NSDUH), roughly 48 million Americans—about one in six people age 12 or older—met the criteria for a substance use disorder. Many never receive effective treatment, a gap that contributes to a staggering national death toll. In recent years, addiction-related causes have claimed about 730,000 American lives annually—almost 70,000 from drug overdoses, roughly 480,000 from tobacco and second-hand smoke and approximately 180,000 from excessive alcohol consumption. Despite the recent decreases in deaths from drug overdoses, the annual toll is still nearly twice the number killed in traffic accidents and remains higher than it was a decade ago. Moreover, sociopolitical changes, such as the legalization and decriminalization of cannabis and the increased accessibility and popularity of online gambling, create new avenues for addiction.
Consequently, Ali Rezai, the neurosurgeon and addiction researcher who leads West Virginia University’s Rockefeller Neuroscience Institute (RNI), says “Addiction remains one of the most urgent public-health challenges of our time, and too many people are affected by it.”
Rezai and Loyd were speaking at a recent event in Washington, D.C., entitled “Hope on the Horizon: The Science and Communities Redefining Addiction Care,” which was hosted by Scientific American Custom Media, in partnership with RNI. More than a dozen speakers (see the list below) explored paths to a better addiction-care system, one that incorporates both rigorous, data-driven research and compassionate, accessible care.
In an elegant room at historic Union Station, just a few blocks from the Capitol, Rezai framed the discussion by describing the challenges in addiction care today. “Our system of care, despite best attempts, is fragmented, episodic, and we have limited and costly outcomes. It’s not designed for long-term recovery of people with addictions and needs to treat addiction as chronic brain disorder,” he said. “We need better solutions, and the time to do it is now.”
As became clear across the event’s three sessions—The Patient at the Center of Care, Moving Toward a Better Health System for Addiction Care and The Innovations Moving Us Forward in Addiction Care—meaningful progress against addiction will require a broad coalition of patients and advocates, clinicians and scientists, and policy makers willing to reshape the nation’s approach to treatment and recovery.
Uncontrollable Cravings
Rezai set the stage for the afternoon event, describing an addiction-care system that RNI has developed and is scaling across West Virginia, and that can become a model for other states and regions. Peer recovery-support specialists are particularly important to help patients and their families navigate the care system. “They are on the front line taking care of patients and their families and are out in the community,” Rezai said. In RNI’s addiction management ecosystem, these specialists are equipped and empowered with dashboards and apps linked to wearables and digital-health technologies that use AI to predict the cravings and anxiety that can lead a patient to relapse.
Moreover, Rezai’s team has pioneered a new nonpharmacological neuromodulation treatment using focused ultrasound energy directed to the brain’s reward and addiction center. This 20-minute outpatient procedure provides an immediate and sustained reduction in drug and alcohol cravings, even in people who have been addicted to opioids and other drugs for years. These technology breakthroughs—demonstrated on the CBS television network’s 60 Minutes in 2024—are now being adopted and have spawned focused-ultrasound clinical trials at multiple sites at U.S. universities and in foreign countries, including Canada, South Korea and Israel.
Gerod Buckhalter was one of those people who received nonpharmacological neuromodulation therapy—deep-brain stimulation—for his drug addiction. At 16, the former high-school football star got addicted to pain killers following a shoulder injury. His top priority was playing college football, and he had scholarship offers but couldn’t keep his grades up. Later, after years of addiction, his family cut him off. He even risked a $100,000-a-year job in the coal mines of Pennsylvania.
“Halfway through the day, I was in a bathroom getting high,” Buckhalter recalled at the event. “I thought I could control the disease, and I did everything but that.”
Addiction as a brain disease
Not too long ago, many considered such uncontrollable cravings as a moral failure, and some sought to punish people struggling with addiction—a line of thinking that helped lead to failed policies like the War on Drugs, which was launched by President Richard Nixon in 1971. But addiction, like Parkinson’s or Alzheimer’s, is a brain disease, and such cravings grow powerful because of changes to brain circuits, as explained by Nora Volkow, director of the National Institutes of Health’s National Institute on Drug Abuse. “Drugs have the capacity to strengthen certain circuits and weaken others,” she said.
Understanding not just the biology but also how psychological and social factors, such as adverse childhood experiences and trauma, predispose people to those changes provides knowledge that could fuel new prevention and treatment strategies, including personalized interventions, Volkow added.
“The innovation that is going on in science is extraordinary,” Volkow said. That includes good science on interventions, such as clean syringes for addicts that can prevent the spread of HIV and hepatitis B. “We have evidence-based prevention interventions that work, and we’re not applying them,” she said.
A major reason for that is stigma. “Our society treats addiction as a crime,” argued Josiah D. Rich of Brown University, a physician whoco-founded a center that focuses on the intersection between addiction, infectious disease and incarceration. “Europeans look at us and think: Are you guys crazy? Don’t you know punishment doesn’t work in addiction?”
Preventive Policy
What does work in addiction, or could if it were widely implemented? “A lot of the solutions came from the ground zero that we experienced in West Virginia,” Senator Shelley Moore Capito of West Virginia said at the symposium. These include treating pain through nonaddictive pain medicines and volunteer community response teams for not just patients but their families. “A kid comes in, their mom and dad’s been picked up by the cops because they’ve overdosed or there’s some violence in the home, then the county deputy can call the teacher and say, Johnny’s had a traumatic event in his life; handle him with care.”
Children as young as five or six could be taught coping skills for emotional regulation, which could prevent addiction later, said Laura E. Kwako, acting director of NIH’s National Institute on Alcohol Abuse and Alcoholism. Medical training would start covering how to treat substance use disorder, and addiction would be treated as the disease it is rather than criminalized, Rich said.
Former representative of Rhode Island Patrick Kennedy, a scion of the famous political family, shared how he wrestled with addiction and went to rehab nine times during his 16 years in office. During that time, he became a dedicated champion of better mental health and addiction care, as well as addressing the associated comorbidities, and in 2008 he spearheaded passage of the Mental Health Parity and Addiction Equity Act, a federal law that prohibits health insurers from imposing more restrictive financial requirements or treatment limitations for mental health and addiction care than they would for medical or surgical care.
“If you add up the cumulative cost across the system, it’s a no-brainer to spend what it takes early to get people on their path,” Kennedy said.
Rezai called for the assembled experts to start forming partnerships and taking renewed action. “We have a clear opportunity to fundamentally rethink how addiction care is delivered in this country and beyond,” he said. The lives of nearly 50 million Americans—and hundreds of millions of people struggling with addiction in other countries—depend on a new and better solution.
Event Participants
Jeremy Abbate, Publisher, Scientific American
Dr. Emily Baxi, Program Director, BD² Integrated Network
Dr. James H. Berry, Chair Behavioral Medicine, WVU Rockefeller Neuroscience Institute
Daniel Blaney-Koen, Senior Attorney, American Medical Association
Gerod Buckhalter, Program Coordinator and CommunityRelations, Wise Path Recovery Centers
U.S. Senator Shelley Moore Capito, Senior Senator, West Virginia
Dr. Roger Hanshaw, Speaker of the House, West Virginia
Patrick J. Kennedy, former U.S. representative and co-founder of two prominent mental health–advocacy organizations: The Kennedy Forum and One Mind
Dr. Laura E. Kwako, Acting Director, Division of Treatment and Recovery, National Institute on Alcohol Abuse and Alcoholism
Dr. Stephen Loyd, Director, Office of Drug Control Policy, West Virginia
Dr. Clay Marsh, Chancellor and Executive Dean of the WVU Health Sciences Center
Dr. Ali Rezai, Executive Chair, WVU Rockefeller Neuroscience Institute
Dr. Josiah Rich, Professor of Medicine and Epidemiology, Brown University; Attending Physician, The Miriam and Rhode Island Hospitals
Dr. Nora Volkow, Director, National Institute on Drug Abuse, National Institutes of Health
Explore research at WVU Rockefeller Neuroscience Institute here, learn about the institute’s new models of addiction care here and explore its addiction research here.
