More Tennesseans died of opiate overdoses in 2014 than in motor vehicle accidents. The rate of fatal opiate overdoses has risen every year since 2011, according to the state Department of Health, and the increase of intravenous drug abuse has contributed to a Hepatitis C epidemic on top of the rising rate of addiction.

But the crisis is not Tennessee's alone to bear. Nationally, more than 16,000 people died due to opiate painkiller overdoses in 2013, and nearly 7,000 people are treated every day in emergency departments for drug misuse, according to the Centers for Disease Control and Prevention.

"Oxycontin is probably the biggest offender," says Michael Cartwright, CEO of addiction treatment services company AAC Holdings. "There's too much prescription medicine being prescribed and abused. People are finding they can get heroin cheaper and easier, and a lot of our patients have switched over. Young kids -- I'd never seen that in the industry, a 19-year-old college kid strung out on heroin."

From this landscape has sprung a burgeoning addiction treatment services industry, with AAC aiming to become one of the first national players. But substance abuse treatment is a mosaic of providers, with most treatment facilities operating independently of each other and the rest of the health care system. Care can come from hospitals, outpatient clinics, community groups and faith-based efforts, creating a complicated web to navigate.

Companies both public and private continue to see opportunity in the space, which the Substance Abuse and Mental Health Services Association estimates represents a $35 billion industry. AAC is effectively the first addiction treatment services company to go public, and with several acquisitions under its belt since its IPO last year, the company expects to be operating 1,200 beds by the end of 2016.

On a smaller scale, another Brentwood venture, JourneyPure, entered the space this year, landing initial funding in the spring and soon after acquiring a four-facility portfolio. Of course, the giant in the behavioral health game is Acadia Healthcare, which has several substance abuse treatment options, including residential facilities as well as inpatient and outpatient services.

This fragmented market -- research firm IBISWorld says almost 80 percent of all U.S. substance abuse treatment clinics have a single location -- presents opportunity for consolidation, which investors seem inclined to support. A scalable addiction treatment model could lead to more comprehensive and coordinated services, which is good for patients and payers alike.

"There will be larger players like [AAC] that aggregate the space," Cartwright says. "There are positives to mom-and-pop providers. They have a passion in helping individuals with addiction. But I do think there needs to be a lot more professionalism and resources in training and education. HCA is a good milestone -- what they did and where the hospital industry is today compared to the '70s. I think that's where we are now with the addiction industry."

More and better drug treatment options are positive developments, but questions remain for investors, patients and payers on outcomes. Opiate addiction, like any substance abuse concern, comes with a very possible chance of relapse. With the development of value-based care, both government and commercial insurers are increasingly paying based on better results, which could challenge the profitability of these companies.

But Cartwright says AAC welcomes the growth of value-based care. He says relapse is a part of recovery, but adds that treating addiction is similar to treating diabetes or other chronic conditions: It requires major lifestyle changes that take time. To prepare for value-based reimbursements, the company is initiating its own outcome studies, and Cartwright says the addiction treatment industry needs increased funding and research to further its efforts.

"We've come a long way, but we have a long way to go," he says. "We do need more outcome studies. We do need to look at the different components of drug treatment and dig down and look at effective ways of treating people. This is one of the most underfunded diseases out there, in my opinion."

The profitability and success of the addiction treatment industry is certainly an important piece of reversing the rising rates of addicted Americans. But beyond company endurance are larger questions about the complicated nature of addiction, and addiction treatment, in America.

Most drug treatment is still based on 12-step programs, which are recommended by many leading addiction specialists, including the aforementioned SAMHSA. However, an increasing number of critics have studied the success rates of these programs and many have claimed they lack evidence and can even hinder patients' path to sobriety by eschewing medical approaches in favor of moralistic methods.

"There are new medications for addiction treatment that 12-step programs are not embracing, but I am," Cartwright says. "Twelve-step programs have helped many people get sober for many years, but I do think there's a place for medication. They go hand in hand, as well as with faith-based groups, and I don't know why they need to be separate."

Opiate addiction is a complicated public health issue, as it involves physical care and mental health treatment, as well as more social aspects like family, employment, housing and often the legal and criminal justice system.

A wide-scale approach has not yet been successful in uniting the disparate pieces of the addiction puzzle, nor in tapering off usage statistics or overdoses. However, individual communities have seen some success with innovative approaches.

One approach that has received particular attention involves the Gloucester Police Department in Gloucester, Massachusetts. Facing opiate overdoses as the leading cause of death in the state, a city police department took an innovative stance on its role in treating the addiction crisis. Under the ANGEL Program, any addict who comes into the Gloucester PD with drugs or paraphernalia and seeking help will not be charged or arrested. The Department has connected with local providers at Lahey Health Behavioral Services to provide the patient with an "angel" to walk them through the detox and recovery system.

The program has been in place since June and has received public support from the Office of National Drug Control. As of late October, the city has directed 260 people into treatment and seen a 23 percent drop in quality-of-life crimes. According to the Gloucester PD, initial statistics also show it costs the department 75 percent less to direct addicts to treatment than it does to arrest them.

Compare that to a recent legislative approach in Tennessee: In 2014, the state passed a bill that permits law enforcement agencies to criminally charge new mothers who used illegal drugs while pregnant. The mothers could face jail time. The law was highly criticized by health advocates, who said it actually incentivized addicted pregnant women to avoid treatment for fear of incarceration. Further, the law did not address prescription opiate use, which a Vanderbilt University Medical Center study found was behind many of the state's cases of neonatal abstinence syndrome. The law will face renewed scrutiny in the upcoming legislative session, when legislators must decide whether to adjust it or let it expire in 2016.

But whether lawmakers take a tough-on-crime approach as in Tennessee or a more decriminalized course of action as in Massachusetts, the opiate crisis will continue until the stigma around addiction and treatment is reduced.

The scaling of treatment services through companies such as AAC looks like a step in the right direction, especially if the industry is successful in its research and educational efforts. But without a comprehensive approach that ties together the medical nature of addiction with its substantial societal elements, the numbers of addicts and overdoses may continue on their current, upward trajectory.

"This is a societal problem and it's taken over America," Cartwright says. "I do believe if we focus our efforts and intentions on the best possible ways to treat someone, we'll get better as a country and overcome this disease. But it is complicated."