As he parks next to a large white farmhouse that would fit comfortably into a 19th-century still life, Richard Kelley smiles at a rust-colored retriever, an old friend that stirs from an early spring sunbath to greet him. Kelley knows this old place well. He’s been dropping by regularly to check on Joshua since the boy was little more than a month old, when his grandmother noticed that his body quavered slightly but uncontrollably.

A lifetime of work in the field of substance abuse has left Pat Santora, a veteran Johns Hopkins researcher, in the grip of her own emotional turmoil—frustrated that her patients are stigmatized, angered that the public still sees addiction as a moral failing rather than a treatable disease, and irritated that, despite her vociferous protests, “in a wonderful acute-care hospital like Johns Hopkins, we have thousands of people who are diagnosed with addictions to alcohol, tobacco, and illegal and/or prescription drugs,” she says. “And like so many acute-care hospitals, we focus primarily on treating the adverse medical consequences of the addiction—heart disease, cancer, cirrhosis—rather than treating the addiction itself.”

Kids with sickle cell disease (SCD) grow up facing a future of potential organ damage, vision problems, infections, and stroke. But perhaps the most agonizing part of living with the disease is dealing with the “crises”—unpredictable attacks of intense pain that take over little bodies, often sending them to a hospital for narcotics to curb […]