The Puzzle

Once a child’s logic puzzle (I used to make them up for my daughters when they were learning algebra), now an Internet meme, Einstein’s riddle is far older than Albert Einstein. It’s being repeated on the Internet that only 2% of the world’s population can solve this puzzle, and that Einstein invented it when he was a child. I don’t think that’s true, because the puzzle is really a subset of multivariable algebra, which has been around for more than a thousand years.

But it was recently put forward as the single best interview question in the technology field. It really is the best interview question in healthcare too. If you want to try it out, click the first link (the second link tells you the answer). Go ahead, I’ll wait.

See, it’s just logic. I can’t believe that only 2% of the world’s population can solve it. Really, if taught logic, nearly 100% of the world’s population can solve it given a pencil and some paper. What may be true is that only 2% of the world’s population would solve it, because not many people resort to logic to solve problems. And this brings me to addiction treatment.

Have We Been Using Logic?

For over a hundred years we’ve been trying to solve this country’s drug problem with a combination of punishment, disincentives, interdiction, and prohibitions. All we’ve gotten in return is a series of drug crises, one after the other, which I’ve often referred to as a societal game of whack-a-mole. No matter how quickly we handle one drug crisis with increased minimum sentencing or shooting down drug smugglers, it is followed by another. We keep using the same set of solutions believing that each of these crises are separate, unrelated, and have nothing to do with a brain illness called addiction. There’s another old line attributed to Einstein about the definition of insanity that comes to mind here. Man, that guy got around, didn’t he?

Perhaps to Einstein, not using logic was insanity. In any case we’ve all assumed that addiction is too hard to solve, much as 98% of the population thinks that Einstein's riddle is too hard to solve. Well addiction is too hard to solve the way we’ve been doing it, just as the puzzle is too hard to solve by just randomly guessing. But by using logic, they both become simple. Not easy, simple.

And the biggest step you have to take if you’re going to solve something logically is to be very clear about your assumptions. In a puzzle, we don’t bother with assumptions because they are given as facts. The writer of the puzzle tells us to assume that this man smokes Cools and this other man drinks coffee. And we do assume it, and assuming it, we are able to solve the puzzle. In life, however, things that look like facts often aren’t, so we need to call them assumptions.

Assumptions

Once we call them assumptions, we’re able to respond to failure by looking at them. We are open to changing them. We understand what all doctors understand about treatment: that if I give a patient a treatment for what I think he has and it doesn’t work, I have to consider that my diagnosis was wrong. In medicine we keep the diagnosis loose. Assuming this patient has strep throat, I should give him a shot of penicillin, and he should get better. If he doesn’t get better, I have to call my diagnosis into question.

Think what it would be like to go to a doctor who tells you that you have an ulcer? He gives you an anti-ulcer medicine, but it doesn’t work. You go back to him. He tries another anti-ulcer medicine, and it doesn’t work. You and he repeat this process 3 or 4 more times over the next year. Finally you go to a different doctor who tells you that you have stomach cancer, which would have been treatable if only you’d come to him a year ago. I bet you’d be pretty angry. Now imagine that on a country wide scale. That's what we're doing with addiction.

The country went to a group of medical experts. The epidemiologists said there was no such illness called addiction, that drug use was all about economics, and that using disincentives would do the trick. The psychiatrists said there was an illness called addiction, but that drugs caused it, and that the epidemiologists had the right idea about prevention. We did that with the opioid epidemic in the late 1800’s, the use of alcohol in the early 1900’s, the use of cocaine in the 1920’s, the use of cannabis in the 1930’s, the use of sedatives in the 1950’s (we took the 40’s off to have a world war), the use of cannabis again (along with everything else) in the 1960’s, back to opioids in the 1970’s, cocaine again in the 80’s, and on and on until now we’re doing it again with opioids...for the third time. We keep looking at the assumptions we started with as facts that can’t change. From those we logically derive the answer to the puzzle. When we keep getting the wrong answer, we ought to figure out that it’s our assumptions that are wrong. But we don’t, because we call them facts.

It isn’t the difficulty of solving the problem of addiction that is in our way. It’s our own thinking. The words we use that reinforce our assumptions (substance abuse, substance use disorder, etc) don’t let us look for a different assumption. It’s hard to call something an assumption and question it when everyone thinks it’s a fact.

Maybe Einstein’s puzzle should be the single best interview question for whomever we want to hire to solve the problem of addiction in America. If so, that gives me hope, because I know my daughters can do it.