Pubdate: Fri, 29 Jun 2001
Source: Roanoke Times (VA)
Copyright: 2001 Roanoke Times
Contact:  http://www.roanoke.com/roatimes/
Details: http://www.mapinc.org/media/368
Author: Alan I. Leshner
Note: Alan I. Leshner is director of the National Institute on Drug Abuse 
at the National Institutes of Health, Bethesda, Md. A longer version of 
this article appears in the Spring 2001 Issues in Science and Technology.

Moral outrage is no solution

ADDICTION IS A BRAIN DISEASE - AND SHOULD BE TREATED AS SUCH

For many years, curbing illegal drug use has been one of the most 
contentious and complicated public-policy issues in this country. Everyone 
has an opinion. One side insists that we must control supply, the other 
that we must reduce demand. People see addiction as either a crime, a 
disease or a failure of will.

None of this bumper-sticker analysis moves us forward. The truth is that 
drug abuse is "all of the above." Progress in dealing with drug issues will 
come only when our national discourse and our strategies are as 
comprehensive and complex as the problem itself. Addiction is both a 
public-health and a public-safety issue, not one or the other. We must deal 
with both the supply and the demand with equal vigor.

Recent advances in scientific knowledge increasingly suggest that drug 
addiction - like Parkinson's disease, schizophrenia or clinical depression 
- - is a brain disease that develops over time. Repeatedly using drugs 
changes brain structure and function in fundamental ways that can persist 
long after the individual stops using them.

The evidence suggests that these long-lasting brain changes are responsible 
for the distortions of cognitive and emotional functioning that 
characterize addicts. It is as if drugs have hijacked the brain's natural 
motivational-control circuits, resulting in drug use becoming the sole, or 
at least the top, priority for the individual.

This brain-based view of addiction has generated substantial controversy, 
in part because some people wrongly think that it somehow absolves addicts 
of responsibility for their own behavior. But these people still believe 
that biological and behavioral explanations are alternative or competing 
ways to understand these phenomena. In fact, they are integrated and 
inseparable parts of the picture.

Individuals who have this brain disease certainly are not simply victims of 
their own genetics and brain chemistry. Although genetic characteristics 
predispose a person to be more or less susceptible to becoming addicted, 
genes do not doom one to become an addict. Addiction to illegal drugs 
begins with the voluntary behavior of drug use. This is one major reason 
that efforts to prevent drug use are so vital to any comprehensive strategy 
to deal with the nation's illegal-drug problems.

Moreover, all addicts can and must participate in and take some significant 
responsibility for their own recovery. This brain disease does not erase 
self-control, but it does significantly erode one's ability to exert 
control over his or her behavior. This helps explain why an addict cannot 
simply stop using drugs by sheer force of will alone and must have treatment.

Once one is addicted, the characteristics of the illness - and the 
treatment approaches - are not that different from those of other brain 
diseases. Research shows that the best drug-addiction treatment addresses 
the entire individual, combining medications, behavioral therapies, 
necessary social services and rehabilitation. These might include such 
services as family therapy to enable the patient to return to successful 
family life, mental-health services, education and vocational training, and 
housing services.

Accepting addiction as a brain disease also means that society should stop 
simplistically viewing criminal justice and health approaches as 
incompatible opposites. We know that between 50 percent and 70 percent of 
those arrested are addicted to illegal drugs.

Studies show that if addicted offenders are provided with well-structured 
drug treatment while under criminal-justice control, their recidivism rates 
can be reduced by 50 percent to 60 percent for subsequent drug use and by 
more than 40 percent for further criminal behavior.

The message from the now very broad and deep array of scientific evidence 
is absolutely clear. If we as a society ever hope to make progress in 
dealing with drug problems, we are going to have to rise above the moral 
outrage that addicts have "done it to themselves" and develop strategies 
that are as sophisticated and as complex as the problem itself.
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MAP posted-by: Beth