Addiction science needs rehab

The science of drug use and addiction faces a crisis of credibility. Despite decades of progress, our field remains disproportionately focused on pathology, risk, and harm, treating ordinary substance use as inherently problematic while devoting comparatively little attention to its functional, pleasurable, and beneficial dimensions. It also repeatedly draws conclusions that exceed what its evidence can establish, privileges contested neurobiological explanations, and marginalizes forms of knowledge and human experience that challenge dominant assumptions. These problems reflect enduring conceptual, methodological, epistemological, institutional, and ethical biases that shape what is studied, how evidence is interpreted, which interventions are legitimized, and how people who use drugs are understood and treated. Drawing on nearly three decades of interdisciplinary academic and applied work together with living experience with drugs, this Perspective critically examines these tendencies, including conceptual imprecision and conflation, causal overinterpretation, the pathologization of ordinary substance use, asymmetrical attention to harms and benefits, the Brain Disease Model, and stigma. It advocates a broader and more balanced science that recognizes the normality and diversity of substance use, integrates biological, psychological, social, cultural, structural, and experiential forms of knowledge without granting any a priori explanatory primacy, and confronts the assumptions and structures that constrain scientific inquiry. Such a transformation is necessary for addiction science to understand the full complexity of human substance use and strengthen its scientific credibility and societal relevance.