Pubdate: Thu, 22 Jun 2017
Source: Boston Globe (MA)
Copyright: 2017 Globe Newspaper Company
Authors: Sally Satel and Scott O. Lilienfeld


AT LAST official count, in 2015, over 33,000 people have died from
opioid painkillers, heroin, and fentanyl - twice the number killed by
guns - and the number of fatalities is rising. Health officials,
police chiefs, employers, welfare workers, and politicians at all
levels of government are desperately calling for more effective drug
treatment, better prevention, smarter opioid prescribing, and improved
pain management.

Urgent attention is being devoted to every facet of the epidemic
except one: how to think about drug addiction itself. As the opioid
crisis deepens, it's time to examine whether current thinking about
addiction limits our understanding of the epidemic and impedes our
efforts to contain it.

Within the medical and research communities, the dominant narrative
holds that that addiction is a "brain disease." In a seminal article
published 20 years ago in Science, "Drug Addiction is a Brain Disease
and it Matters," Alan Leshner, then director of the National Institute
on Drug Abuse, or NIDA, proclaimed that addiction was a brain disease
on the ground that "addiction is tied to changes in brain structure
and function."

Before Leshner and his NIDA colleagues designated addiction a disease
of the brain - meaning that addiction is fundamentally a drug-induced
disorder of disrupted brain function - doctors and much of the public
regarded addiction as a vague sort of "disease" that manifested as an
uncontrollable drive to use drugs or alcohol. Leshner coined a durable
metaphor, writing that drugs "hijack" the brain's motivational and
reward circuitry thereby making the condition involuntary.

The brain disease model of addiction soon became orthodoxy in academic 
and research circles, which are heavily dependent on NIDA funding for
training and research, and was also adopted by politicians, drug
czars, public health officials, and the treatment industry. "Addiction
is a chronic disease of the brain," then-Surgeon General Vivek Murthy
asserted in a report last year, "and it's one that we have to treat
the way we would any other chronic illness: with skill, with
compassion and with urgency." This idea has by now filtered into mass
culture. "Opioid Addiction Is a Brain Disease, Not a Moral Failing -
and We Have to Stop Looking At It That Way," declares a headline from
a popular fashion and beauty magazine.
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