Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.

This article examines 'the NIDA paradigm', the theory that addiction is a chronic, relapsing brain disease characterized by loss of control over drug taking. I critically review the official history of the National Institute on Drug Abuse (NIDA) paradigm and analyze the sources of resistance to it. I argue that, even though the theory remains contested, it has yielded important insights in other fields, including my own discipline of history.

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All researchers agree that individuals can become intoxicated by and dependent on alcohol, tobacco, and other psychoactive drugs. But they have disagreed over whether, and to what extent, drug pathologies comprise a unitary medical problem. Most critically, does addiction have a biological common denominator? Consensus on this question has shifted back and forth. In the late nineteenth and early twentieth centuries, physicians often studied and treated various drug addictions together, working under the "inebriety" paradigm. By the mid-twentieth century the inebriety paradigm had collapsed. Tobacco and alcohol had split off, both in the medical research community and in western popular culture. This article argues that neuroscientific, genetic, epidemiological, and historical evidence helped to reunify the addiction field in the late twentieth century. A new unifying paradigm emerged, variously called chemical dependency, substance abuse, or simply ATOD-alcohol, tobacco, and other drugs. When you write global drug history, you quickly discover the limits of your knowledge, and you rely on the work of others. Many of the scholars whose research has guided and inspired me are present this evening. I first want to express my debt to you and my gratitude for the opportunity to address you. I am truly honored. My title, "Mr. ATOD's Wild Ride," is an anagrammatic play on a celebrated episode from Kenneth Grahame's The Wind in the