Why federal addiction programs keep underperforming

America just put an extraordinary price tag on a form of addiction that does not come in a bottle, pill, or syringe.Meta has agreed to pay up to $17.1 billion in a multistate settlement resolving claims that features of Instagram and Facebook encouraged compulsive use among children and contributed to mental health harms. A separate Texas agreement brings Meta’s total payout to roughly $18 billion. The company denies wrongdoing. The settlement also imposes striking behavioral safeguards, including a two-hour daily limit for minors, nighttime restrictions, and limits on notifications during school hours. Whatever one thinks about the litigation, its larger significance is difficult to miss. America is confronting addiction-like behavior without an intoxicating drug. That should force Washington to ask a larger question: What if we have organized addiction policy around the object of addiction when we should also address the vulnerability of the person seeking the reward? Federal policy is largely organized around opioids, alcohol, stimulants, nicotine, gambling, and other individual problems. These disorders and behaviors are not identical and do not require identical treatments. But they can involve overlapping brain systems governing reward, motivation, and self-control.Reward Deficiency Syndrome offers another way to think about addiction. Instead of asking only what a person is addicted to, it asks why that person remains vulnerable to addiction in the first place.Research suggests that for some people, ordinary rewards may provide insufficient reinforcement while drugs or highly stimulating behaviors produce much stronger signals. Genetics can contribute to this vulnerability, but genes are not destiny. Environment, trauma, stress, mental illness, and social conditions also matter. RDS does not mean dopamine explains every addiction or that opioid-use disorder, alcoholism, gambling, and compulsive digital behavior are the same disease. They are not. Rather, it suggests that different addictive behaviors can sometimes be different expressions of an underlying vulnerability in the brain’s reward system.This may help explain a familiar problem: stopping one addiction does not necessarily eliminate vulnerability to another. A person may stop drinking but begin gambling compulsively. Someone recovering from drug use may develop another compulsive behavior. The target changes; the susceptibility may not.Evidence-based medications save lives and behavioral therapies work. They should remain central to treatment. But lasting recovery requires more than separating someone from a particular substance. It also means helping that person build a life in which healthy activities can compete with pathological rewards.Federal policy does not consistently reflect that reality. Funding, regulations, and measures of success remain divided by drug, agency, and treatment setting. Opioids are separated from alcohol. Addiction treatment is often separated from mental-health care. Behavioral addictions occupy still another category. The bureaucracy separates these addictions. The brain does not.A reward-centered approach would not eliminate drug-specific treatment, enforcement, regulation, or harm reduction. The point is not to replace what works but to broaden what we are trying to accomplish.Federal addiction policy should ask not only, “Did this person stop using this substance?” but also, “Is this person recovering the ability to live without continually seeking an unhealthy source of reward?”That means combining proven medications when appropriate with behavioral and mental health care, physical activity, healthy sleep, stress management, family and social connection, and continued research into biologically informed treatments.IS SLEEP APNEA WORTH MORE THAN AN AMPUTATION? VETERANS DESERVE BETTER THAN THE VFW’S STANCEThe Meta settlement should be understood as more than a reckoning over social media. It is another reminder that compulsive reward-seeking can move across substances, behaviors, and technologies while our policies remain confined to categories.If we continue treating only what people are addicted to, we may continue missing why they remain vulnerable to addiction in the first place.Kenneth Blum, PhD, is a neuroscientist and researcher in addiction biology. Kai-Uwe Lewandrowski, MD, PhD, is a spine surgeon and clinical researcher. Morgan P. Lorio, MD, FACS, is a retired spine surgeon and former president of the International Society for the Advancement of Spine Surgery.