In the midst of a growing crisis, a revolution is quietly emerging. It is a revolution of thought, of understanding, and of healing—a paradigm shift that seeks to fundamentally redefine how we view and treat substance use disorders. Dr. Harry Henshaw, in the first chapter of his groundbreaking book Prelude to a Paradigm Shift for Addiction, offers a powerful challenge to the dominant medical and disease-based model of addiction. He proposes a new way forward—one grounded in responsibility, choice, and the transformative power of self-image.

Throughout history, moments arise when our collective understanding of the world no longer aligns with reality. In science, these moments mark the end of one era and the beginning of another. Thomas Kuhn, in The Structure of Scientific Revolutions, called them “paradigm shifts”—epistemic breaks from the old way of thinking to something entirely new. Today, such a shift is urgently needed in the field of addiction treatment.

Despite decades of effort, billions in funding, and a wide array of therapeutic models, addiction remains a devastating public health crisis. Overdose deaths continue to rise. Relapse rates remain staggeringly high. And yet, the prevailing treatment models have changed little in decades. It is not simply that the system is failing; it is that the very assumptions on which the system is built may be fundamentally flawed.

The statistics are sobering. According to the CDC, over 100,000 individuals died from drug overdoses in 2022 alone. The year prior saw nearly the same number, and the trend shows no signs of slowing. These numbers are not just data points—they are lives lost, families shattered, and communities torn apart. Despite this, the dominant narrative remains fixed: addiction is a brain disease, an irreversible condition rooted in biology and neurochemistry. The individual is powerless, forever tethered to their affliction.

But what if this model is not only inadequate—it is part of the problem? What if continuing to treat addiction solely as a medical disease is blinding us to more effective solutions?

As Dr. Henshaw explains, our current paradigm rests heavily on the assumption that addiction is a physiological disease. This belief, though widely accepted, is not without its consequences. If addiction is purely a matter of brain chemistry, then the individual is reduced to a passive recipient of treatment. They are not responsible. They did not choose their behavior. They are powerless.

Yet this model has produced dismal outcomes. Studies suggest that between 60% and 90% of individuals relapse within the first year of treatment. Many treatment programs shy away from reporting accurate data, fearful of financial repercussions. The uncomfortable truth is that what we are doing is not working—and has not worked for a very long time.

Einstein once said, “Insanity is doing the same thing over and over again and expecting different results.” In this case, insanity might be defined as doubling down on a paradigm that has failed to yield significant or lasting change.

Dr. Henshaw proposes a bold alternative: a psychological, not physiological, foundation for understanding addiction. In this new paradigm, addiction is not the result of a diseased brain but of distorted thinking—particularly, the beliefs and thoughts an individual holds about themselves. At the heart of this framework lies the concept of self-image.

According to Henshaw, it is our self-image—our beliefs about our value, worth, and identity—that determines how we behave, what we choose, and what we believe we deserve. A negative self-image, often formed early in life, becomes the fertile ground for addiction. The substances are not the root cause but the symptom, a coping mechanism for deeper psychological pain.

In this view, addiction is not a fixed condition. It is a maladaptive strategy that can be unlearned and replaced. And most importantly, the power to change lies within the individual.

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The new paradigm is structured around three interdependent concepts: responsibility, choice, and power. These principles are more than motivational slogans—they represent a radically different way of approaching recovery.

• Responsibility: The individual is entirely responsible for their experiences, including their addiction. This is not about blame—it is about reclaiming authorship over one’s life.
• Choice: Every thought, every belief, every behavior is a choice. Even in the depths of addiction, choices are being made—though they may be unconscious or habitual.
• Power: Because individuals are responsible and because they have choice, they also have power. They can change. They can transform. They can heal.

These ideas run counter to much of the addiction treatment industry, where the prevailing belief is that the addict is powerless and must surrender to a higher power. Henshaw does not reject spiritual transformation; rather, he relocates it within the individual. The “higher power,” in this case, is the individual’s own mind and capacity to reshape their self-image.

The implications of this shift are profound. If addiction is psychological—not physiological—then the path to healing lies not in medication or disease management, but in transformation of thought. In particular, the transformation of one’s self-concept is essential.

This means teaching individuals how to think differently about themselves. How to cultivate a sense of worth. How to reject the toxic internal narratives of shame and self-hatred that fuel the addictive cycle. Recovery, then, becomes not just about abstinence but about awakening—to a new vision of self, a new experience of life, and a new level of personal power.

Henshaw’s paradigm is not only curative; it is preventative. He argues that if young people are taught to build a strong, healthy self-image from an early age, the chances of developing addictive behaviors could be significantly reduced. The cause of addiction, in this view, is not drugs and alcohol themselves, but the inner void that drives the desire to escape.

Imagine a society where children are taught emotional resilience, where they learn to love and accept themselves, and where their thoughts are trained to align with self-worth rather than self-judgment. In such a world, the allure of drugs and alcohol would lose its grip. Prevention, then, is not a matter of policing substances—it is a matter of nurturing minds.

Many professionals argue that addiction is complex. And indeed, it often appears so. But Henshaw challenges this belief. He suggests that the appearance of complexity is a result of looking in the wrong place. If we shift our focus inward—toward the mind, the thoughts, the beliefs—we may find that the truth is far simpler than we imagined.

The story of Dr. Wayne Dyer dropping his keys inside his house but searching outside because that’s where the light was serves as a metaphor for our current approach. We keep looking outside—for external causes, external treatments, external explanations—because that is where our current paradigm shines its light. But the real answers lie within.

Dr. Henshaw is clear: we must change the conversation. The paradigm shift begins not with new drugs or better funding, but with a new dialogue. A dialogue that honors the inner power of the individual, that emphasizes personal responsibility, and that frames recovery as a journey of transformation—not disease management.

This new conversation challenges us to let go of cherished beliefs. It calls out the financial interests and institutional inertia that keep ineffective systems in place. But most of all, it invites us to hope again—to believe that real, lasting recovery is possible. Not through submission, but through awakening.

The first chapter of Prelude to a Paradigm Shift for Addiction is just that—a prelude. It is the opening movement in what must become a symphony of change. As with any revolution, there will be resistance. But the stakes are too high to remain silent. The current system is failing. People are dying. Families are suffering.

The time has come for a new understanding. One that places the individual at the center. One that sees addiction not as a disease to be managed, but as a psychological condition to be transformed. One that believes in the power of thought, the necessity of self-love, and the infinite capacity of the human spirit to heal.

Let this be the beginning. Let the conversation continue. Let the paradigm shift begin.

Dr. Harry Henshaw

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