The crisis of addiction continues to affect millions, yet despite decades of investment in treatment infrastructure, our success rates remain dismally low. Chapter Two of Prelude to a Paradigm Shift for Addiction highlights why. It calls for a bold reassessment of the conceptual foundation upon which addiction treatment is built, exposing the inadequacy and dangers of the current medical-disease model that dominates our industry. In this blog post, I will summarize and expand on the ideas in Chapter Two, explaining how a flawed set of assumptions underlies our treatment approaches and why a true shift in understanding is urgently needed.

At the heart of effective treatment lies one non-negotiable requirement: an accurate understanding of the problem. If our assumptions about addiction are wrong, our solutions will be wrong as well. Chapter Two begins with a critical truth: treatment methods emerge from a conceptual framework that defines how we perceive addiction. If that framework is fundamentally flawed, as I argue it is, the resulting interventions will inevitably be inadequate.

Despite decades of effort, the outcomes of addiction treatment are bleak. Relapse rates are high, long-term sobriety is rare, and many individuals cycle endlessly through detox, treatment, and relapse. The problem is not merely in the implementation of treatment but in its very design. Before we can develop effective interventions, we must first examine the beliefs that guide our understanding of addiction.

The current addiction paradigm rests on four primary assumptions:

1. Drugs and alcohol are inherently addictive.
2. Addiction is a disease.
3. Addiction is not a choice, and individuals are not responsible.
4. There is no cure for addiction.

These presuppositions have shaped the way addiction is treated and perceived by professionals, programs, and society. However, each of these assumptions is either oversimplified, misleading, or entirely false—and together, they form a dangerously flawed foundation for treatment.

The belief that certain substances are inherently addictive suggests that addiction is caused primarily by the chemical properties of the substance. This viewpoint supports the idea that anyone exposed to drugs or alcohol long enough will inevitably become addicted. But this is not universally true. Not everyone who uses substances becomes addicted, and many people recover without formal treatment.

This belief overshadows psychological, emotional, and existential factors that drive substance use. It locates the problem in the substance, not in the person, which prevents us from understanding the deeper psychological mechanisms at play.

The disease model of addiction is widely accepted by the medical establishment. It assumes that addiction is a chronic brain disease, rooted in genetic or neurological abnormalities. This model removes agency from the individual and suggests that treatment must focus on symptom management rather than psychological transformation.

But viewing addiction as a disease minimizes the possibility of true healing. It implies permanence and encourages resignation. If we tell clients they are diseased and always will be, we strip them of hope and the possibility of full recovery.

Another dangerous assumption is that individuals are not responsible for their addiction. While it is true that many factors—trauma, environment, family history—can influence substance use, this belief encourages a victim mindset. It removes accountability and the empowering recognition that people have the ability to choose, change, and recover.

Responsibility does not mean blame. It means recognizing the power to transform. Without this, the treatment process becomes passive, externalized, and ultimately disempowering.

Finally, the belief that addiction has no cure promotes a lifetime of struggle. This view is central to many 12-step programs, which emphasize perpetual recovery rather than actual healing. It is a philosophy rooted in fear and resignation. If clients believe they are forever broken, they may stop striving for a better life.

The idea that recovery must be managed “one day at a time” indefinitely prevents individuals from experiencing lasting transformation. True healing is possible—but only if we believe it is.

These four presuppositions have given rise to treatment systems that are not only ineffective but, in many cases, harmful. Interventions focus on symptom management, crisis control, and behavioral compliance rather than deep psychological change. The most influential component of these programs is the 12-step model, which reinforces the assumptions outlined above.

The 12-step model, widely used in detox, residential, and outpatient programs, is not inherently clinical. It is based on a spiritual and peer-support philosophy, not on empirical psychological theory. Yet it has become the dominant approach in treatment centers worldwide.

Why? Because many professionals in the industry are themselves in recovery and have benefited from 12-step programs. They naturally promote what worked for them. Unfortunately, this means that treatment is often based on personal experience rather than scientific validation.

The result is a model that promotes powerlessness, lifelong struggle, and dependency on meetings and sponsors. Clients are encouraged to surrender, admit powerlessness, and believe in an external higher power—all of which may conflict with the principles of self-responsibility, agency, and transformation.

Most treatment programs begin with detox, a medically supervised process to help individuals withdraw safely from substances. While necessary in some cases, detox is purely physiological and rarely includes any meaningful psychological work.

From detox, clients enter residential treatment, where they receive group therapy, limited individual counseling, and exposure to various alternative modalities. However, the core philosophy remains 12-step based. Even when other therapies are offered—such as art, music, or yoga—they are often superficial and not integrated into a coherent clinical strategy.

After residential treatment, clients are encouraged to attend outpatient programs or simply return to 12-step meetings. Very few continue with individual counseling. Thus, the entire trajectory of treatment often becomes a prolonged engagement with the 12-step philosophy, rather than a journey of personal discovery and healing.

Unlike other areas of healthcare, addiction treatment lacks standardized, evidence-based protocols. There is no consistent clinical model, and treatment strategies vary widely between programs. The result is a fragmented and inconsistent system driven more by marketing than by science.

Counseling services are often dictated by what insurance will cover and what licensing boards require—not by what actually works. Programs use group therapy not because it is best for clients, but because it is cost-effective. Individual therapy is rare, and long-term psychological work is almost nonexistent.

Medication-Assisted Treatment is now widely used, particularly for opioid addiction. Drugs like methadone, buprenorphine, and naltrexone are prescribed to reduce cravings and prevent relapse. While MAT can stabilize individuals during withdrawal, long-term use may dull cognitive and emotional processes essential for meaningful therapeutic work.

Once again, MAT reflects a medicalized, disease-based approach to addiction. It treats symptoms without addressing the underlying causes. It manages behavior rather than supporting transformation.

Most treatment programs claim high success rates, yet national statistics tell a different story. Relapse is common, and long-term sobriety is rare. Why the discrepancy? Many programs measure success only at discharge, not over time. Few conduct rigorous outcome studies, and fewer still adjust their methods based on data.

In truth, the current treatment system is failing. But instead of changing the model, the industry continues to promote the same ineffective solutions—largely because they are familiar, marketable, and profitable.

The real issue is epistemic: a lack of true understanding about the nature of addiction. Without a unifying theory rooted in psychological insight, treatment will continue to be fragmented and ineffective. We need empirically validated protocols based on a comprehensive understanding of the human mind and spirit.

What is missing from the current model is the belief that people can change—fully, permanently, and from within. We must move away from a philosophy of disease, powerlessness, and dependency, and toward one of transformation, self-awareness, and personal responsibility.

Chapter Two of Prelude to a Paradigm Shift for Addiction makes one thing clear: the current addiction treatment system is broken, not because of a lack of effort, but because of a lack of insight. We are using the wrong map to navigate the territory of human suffering and healing. Until we replace our outdated and harmful assumptions with a new paradigm rooted in responsibility, choice, and self-image transformation, we will continue to fail those who come to us for help.

The time for change is now. Not just a change in techniques, but a change in thinking. A true paradigm shift begins when we stop asking how to manage addiction and start asking how to heal the person who suffers from it. That shift is not only possible—it is necessary.

Let this be the foundation upon which we build the future of addiction recovery.

Dr. Harry Henshaw is a licensed mental health counselor with over 40 years of experience in addiction treatment and transformational counseling. He is the author of the groundbreaking book, Prelude to a Paradigm Shift for Addiction, and the founder of Enhanced Healing Counseling.

Dr. Harry Henshaw

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