A fundamental problem with Russ Gerber's "Is drug addiction a disease?" (Web, April 29) is the title of the piece. The question is not whether addiction is a disease or a choice, but rather why we are still asking this question.
There is unquestionable neuroscientific evidence attesting to the fact that addiction is a complex disease characterized by changes in the structure and function of the brain. In some cases, these changes are brought on by substance use and other behaviors; other times, it appears these structural and functional characteristics are pre-existing. The effects of addiction on the brain make conscious control over certain behaviors exceedingly difficult, and in most cases pharmaceutical and/or behavioral treatments are required to manage the disease.
We do not question whether people with heart disease exacerbated by behavioral choices linked to diet and exercise actually have the disease. The same should be true for addiction. As with other diseases, there are clear risk factors for developing addiction, such as a genetics, family history, easy access to addictive substances, low perception of risk, trauma and co-occurring health problems, such as anxiety and depression.
Addiction affects 16 percent of the U.S. population age 12 and older, more than the number of people with cancer, diabetes or heart disease. Failure to recognize it as a disease contributes to the unconscionable treatment gap that exists in this country, with only about 10 percent of those with the disease receiving any form of treatment. Compare that with the 70 percent to 80 percent who receive treatment for other diseases, such as hypertension and diabetes, which also may develop or be exacerbated by voluntary behavioral choices.
Addressing addiction as a disease does not absolve those with addiction of personal responsibility for harms they may impose on others as a result of their disease. It just acknowledges the substantial body of scientific evidence demonstrating that addiction is a medical condition for which there are effective treatments. Continuing that polarized debate about the nature of addiction is a harmful and costly distraction from the task of preventing and treating it and searching for a cure.
Associate director, Division of Policy Research and Analysis
The National Center on Addiction and Substance Abuse at Columbia University
New York, N.Y.
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