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Feature: Is Addiction a Brain Disease? Biden Bill to Define It as Such is Moving on Capitol Hill

Submitted by Phillip Smith on (Issue #497)
Consequences of Prohibition
Drug War Issues
Politics & Advocacy

A bill introduced by Sen. Joe Biden (D-DE) that would define addiction as a brain disease is moving in the Senate. Treatment professionals, mainstream scientists, and recovery advocates see it as a good thing. There are some skeptics, though.

NIDA book cover, with brain scan image
The bill, the Recognizing Addiction as a Disease Act of 2007 (S. 1011), would also change the name of the National Institute on Drug Abuse (NIDA) to the National Institute on Diseases of Addiction, and change the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health.

"Addiction is a neurobiological disease -- not a lifestyle choice -- and it's about time we start treating it as such," said Sen. Biden in a statement when he introduced this bill this spring. "We must lead by example and change the names of our federal research institutes to accurately reflect this reality. By changing the way we talk about addiction, we change the way people think about addiction, both of which are critical steps in getting past the social stigma too often associated with the disease. This bill is a small but important step towards stripping away the social stigma surrounding the treatment of diseases of addiction," said Sen. Biden.

The measure is garnering bipartisan support. It passed out of the Senate Health, Education, Labor and Pensions (HELP) committee in June with the backing of Sen. Mike Enzi (R-WY), the ranking minority committee member. "Science shows us the addiction to alcohol or any other drug is a disease," Enzi said in a statement marking the vote. "While the initial decision to use drugs is a choice, there comes a time when continued use turns on the addiction switch in the brain. That time can vary depending on factors ranging from genetics to environment to type of drug and frequency of use. Because of that and the continued stereotypes and challenges that are often barriers to people with addiction issues seeking treatment I am proud to support this legislation. Although the names of the Institutes will change, their mission -- preventing and treating drug and alcohol addiction -- will remain the same."

The politicians are taking their cue from neurological researchers led by NIDA scientists who have been working for years to find the magic link between the brain and compulsive drug use. Dr. Nora Volkow, current head of NIDA, has been leading the charge, and Biden and Enzi could have been reading from her briefing book.

"Drug addiction is a brain disease," said Volkow in a typical NIDA news release. "Although initial drug use might be voluntary, once addiction develops this control is markedly disrupted. Imaging studies have shown specific abnormalities in the brains of some, but not all, addicted individuals. While scientific advancements in the understanding of addiction have occurred at unprecedented speed in recent years, unanswered questions remain that highlight the need for further research to better define the neurobiological processes involved in addiction."

Not surprisingly, the treatment and recovery communities, anxious to see the social climate shift to one of more support and less punishment for the addicted, support the legislation. "Recognizing addiction is the next step forward," said Daniel Guarnera, government relations liaison for the NAADAC -- The Association for Addiction Professionals. "NIDA and its scientists have demonstrated overwhelmingly that addiction is not a behavioral trait, but rather is caused by physiological changes to the body that make people want to use addictive substances. This bill allows the terminology to catch up with the science."

Although the bill does little more than make a congressional pronouncement and rename a couple of institutes, it is still an important step, said Guarnera. "Yes, it's symbolic, but that symbolism is hugely important, because language should reflect medical knowledge, and medical knowledge has demonstrated that drug abuse is a physical phenomenon."

"We utterly endorse this bill," said Pat Taylor, executive director of Faces and Voices of Recovery, a treatment and recovery advocacy umbrella organization. "I think it's a great idea to rename the agencies. People with drug and alcohol problems can and do recover from addiction. Calling them 'abusers' just stigmatizes them."

Taylor and her organization are actively supporting the bill, she said. "We've sent letters of endorsement for the bill," she said. "People blame people for their drug and alcohol problems, so this is an important issue for the recovery community. We need to rethink how we talk about this."

Is addiction in fact a brain disease? Some researchers think that's too simple. Scott Lilienfeld, a professor of psychology at Emory University told ABC News last week: "What I find troubling with the brain disease rhetoric is that it's grossly oversimplified, it boils down an incredibly complex problem to not necessarily the most important explanation. You can view a psychological problem on many levels. Low level explanation refers to molecules in the brain. There are other levels including people's personality traits and moods, people's parents, environment. Higher level than this is community."

"Every level tells you something useful," Lilienfeld continued. "Brain disease is only one level among many and not even the most helpful. Implying it's the only level of explanation, that's counterproductive."

Some mavericks go even further. "No, addiction is not a brain disease," said Dr. Jeffrey Schaler, a psychologist and professor in the Department of Justice, Law and Society at American University in Washington, DC, and author of "The Myth of Addiction." "Diseases are physical wounds, cellular abnormalities. Addiction is a behavior, something that a person does. Diseases are things a person has," he argued.

"You can't will away a real disease," Schaler continued. "But people will away behaviors they don't like all the time."

Others feel that the concept of addiction itself is too imprecise. "There is no clear conception of what people mean by the word 'addiction,' and there are numerous papers on this unsatisfactory concept," said Professor John Davies, head of the Center for Applied Social Psychology at the University of Strathclyde in Scotland, another prominent critic of the "addiction is a brain disease" model. Using drugs and 'addiction' are not synonymous," Davies continued, noting that many "fun drug users" become "addicts" as soon as they end up in court.

"Of course, people can and do get into an awful mess when they fail to manage their habit effectively," Davies concedes. "But look at the data. Harmful damaging drug use is heavily social-class related whereas drug use per se is less so. People give up the so-called 'disease' when their lives change, they get a new partner, a new job, a move of house."

"Sen. Biden's crusade is part of a decades-long, political struggle to isolate drug habits in users and to obscure the social and historical factors that ultimately underline so-called drug problems," said Richard De Grandpre, author of "The Cult of Pharmacology: How America Became The World's Most Troubled Drug Culture" (see review here next week), citing the case of the Vietnam war veterans who picked up opiate habits, but who, for the most part, rapidly shed them upon returning home.

"These vets used chronically and were said to be addicted. What happened to their addictions?" De Grandpre asked. "The feared epidemic did not materialize because the social factors that sustained heroin use in Vietnam had all but disappeared upon returning."

Davies sees the addiction label as having pernicious consequences for problem users as well. "It makes things far worse," he said. It makes people believe that the roots of their behavior are beyond their capacity to control, which is the last thing you need when you're trying to get someone to change their behavior."

How should drug policy reformers (e.g., those concerned first and foremost with loosening prohibitionist drug policies) respond to the Biden bill? Rhetorically, both the "disease" and "choice" models have been used repeatedly to justify draconian policies -- the former at drug sellers, who mostly are not kingpins or monsters seeking to addict children to their goods, but get charged as such in the court of public opinion -- the latter at problem users, or even users in general, because they should just stop, because it's a choice.

"I tend to think that language changes that reduce the fuel in the drug discussion will help rather than hurt our cause," said David Borden, executive director of Stop the Drug War (DRCNet, publisher of this newsletter). "Terms like 'Diseases of Addiction' pack less verbal or rhetorical punch than shorter ones like 'Drug Abuse,' and are less useful for purposes of political propaganda. If the names of the agencies shift, the language coming out of the agencies will also have to shift, at least somewhat, and that will help -- it will be harder for politicians to focus their rhetoric on nonsense statements like 'all use is abuse,' if 'abuse' is no longer the government-endorsed term of choice in the discussion."

"Those are political concerns, however," Borden pointed out. "If 'disease' is a scientifically imprecise term for describing the set of conditions that are commonly known as 'addiction' -- and it seems to me that it probably is -- then Congress and NIDA probably shouldn't be using the term for that purpose. I'd be more comfortable with the bill if it used slightly different language." Still, he thinks it's probably a net positive. "I think the obvious message of the terminology shift would be to say that people with drug problems are not really criminals, and that's a good thing."

"Plus if addiction isn't a disease, there's still obviously some condition that some people have, physical for at least some of them, that makes it harder for them to make favorable choices," Borden added. "Otherwise I don't think there would be thousands of people risking arrest or overdose to inject themselves daily with heroin, or millions knowingly doing what they're doing to themselves with cigarette smoking. So I'm not sure that the imprecision in the term chosen for the discussion is such a big problem."

Schaler disagrees. "Drug policy reformers play into the hands of the therapeutic state when they support the idea that drug addiction is a treatable disease," he said. "It means doctors have more power over people instead of just drug agents."

In principle, neither Congressional fiat, nor therapists' concerns over what the right message is to send to patients, nor advocates' concerns over what will ultimately lead to better policies, should take a second seat in this debate -- the question is fundamentally a scientific one, and a philosophical one. With Congress holding the purse strings for the bulk of addictions research in this country, however, Congress' choices now may indeed affect the language being used in the future for some time to come. And language can indeed have an impact in ways going beyond its initial purposes.

Permission to Reprint: This content is licensed under a modified Creative Commons Attribution license. Content of a purely educational nature in Drug War Chronicle appear courtesy of DRCNet Foundation, unless otherwise noted.


Anonymous (not verified)

The bill is a net-negative. Addiction is not a brain disease. That doesn't mean that one can't look at the brain of someone who is addicted and see a phenomenon that is different than a brain that is not addicted. But that is true of all kinds of phenomenon like learning. Much of what is meant by addiction is actually physical dependence, yet the purveyors of this brain disease model leave that crucial part out.

The problem is political because the disease model renders addicts mentally incompetent (remember, if you think you have it, you do...and if you don't think you have it, you certainly do) and diagnosable in a non-collaborative, unequal doctor-patient dynamic.
Because of the War on Drugs, there are real, dire civil liberty issues at stake here. We are not discussing this in a vacuum, but rather in the context of
drug courts (another abomination posing as an improvement) where "addicts" have no rights and are compelled through application of incarceration, to purify their addicted bodies. All in the name of Big Brother's coercive and loving relationship with us.
So no, this is a very bad idea and the Drug Policy World should get with the science and denounce and oppose this propaganda.
This effort by Volkow and others is as cynical and destructive as the junk science propagated by those who want to pooh-pooh global warming.
Please remember that the science of opioids has revealed that almost no one gets addicted to them.
This is a bad piece of news for the Federal apparatus, something they have been feverishly trying to undo with these doctor prosecutions, a new (deeply flawed) study that "reveals" that pain patients become "addicts" at a rate of four times greater than the rest of the population- and many other pr campaigns disguised as science, education and legislation, too numerous to name here.
So DPA! You have the big budgets and the lobbying capacity in DC. This is a crucial moment to shift back to supporting civil liberties as opposed to the drug control and addictions bureaucracy.
We would spearhead this effort but we simply do not have the resources to do it.
But you do!
Siobhan Reynolds

Fri, 08/10/2007 - 11:50am Permalink
Anonymous (not verified)

I agree, Siobhan(great Irish name), anything prohibitionists get up to should be viewed with suspicion at every level. And Dave, I don't think you should take this minor tack-change at face-value. You can bet these fuckers are up to no good, at all times.

Fri, 08/10/2007 - 12:50pm Permalink
Anonymous (not verified)

I have to agree with Ms. Reynolds. Simply calling someone a "mental patient/client" rather than an "addict" does not remove social stigma, it just gives them another label. A "mental patient/client" will not have any advantages over an "addict" in a job interview or a court room.

This bill is a step backwards. Medical patients and recreational drug users should have more options than imprisonment and financial restitution
or expensive rehabilitation. Conceding that drug users are not "criminals" or "addicts", but merely "psychologically imbalanced", is a back-handed compliment at best. At worst, this is just another method of isolating drug users from the rest of "normal" society, under the guise of a gentler, kinder re-classification. "Brain disease" can be as disempowering as "addiction" regarding self-esteem. The terminology invokes a "victim" mindset. Social sevices and treatment programs are available to those who believe they need them. I don't think they will disappear if Senator Biden's bill does not pass.

Chad Townsend
Tucson, AZ

Fri, 08/10/2007 - 12:51pm Permalink
Anonymous (not verified)

"Please remember that the science of opioids has revealed that almost no one gets addicted to them."

Huh? I thought opium, heroin and morphine were all pretty addictive?

Fri, 08/10/2007 - 1:29pm Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

What Ms. Reynolds is referring to is the fact that very, very few patients who are given opiates for pain relieve become addicted -- even chronic pain patients. As soon as the pain issues are resolved almost all of them happily dump the opiates.

And it is not the opiates are not wonderful. I've been hospitalized with badly broken bones and nothing in this world is as wonderful as that big shot of morphine.

Fri, 08/10/2007 - 2:22pm Permalink
Anonymous (not verified)

I don't like this. I remember being forced into "alcoholism treatment" for my "disease", told I was "in denial" when I stated (truthfully) that no, I wasn't out of control every time I drank, and so on. It was a nightmare. It made my life worse, not better.

Later, another counselor (outside the mainstream, "disease-based" treatment community) said. "You're not powerless. You're not addicted to alcohol. You have alcohol related problems because you drink too (expletive deleted) much!". It was like the light went on in a dark room.

By viewing my substance abuse as a personal weakness (and a moral problem, on a few occasions where I endangered others as a result) I was able to change my behavior. Treating it as a neurological disorder didn't work - it just set me up for discrimination as a genetically defective "alcoholic". Today, I drink much less than I used to but see no reason to quit completely. This isn't even possible according to the "disease concept" Biden wants to force on the public.

I think reforming the treatment industry - getting away from Total Abstinence as the only permissable goal, emphasizing personal responsibility instead of "powerlessness", prohibiting public funds for religiously based 12 Step programs (most of what is available) - should be a high priority and Biden's bill is just another small step in the wrong direction.

Fri, 08/10/2007 - 1:53pm Permalink
Anonymous (not verified)

I think you are so right.

I keep imagining that in George Bush-Future, like in old Soviet Union, how political dissidents were confined to mental hospitals, etc., we drug users here in U.S. would be sent to camps with addiction wards-our "diseased" status giving them all the right definitions to imprision and force treatment upon us as a threat to national security. I have seen many references to FEMA prision camps here in my own country, and I have no doubt that G.B. would play the Martial Law card to put us all there under God knows what sort of conditions; but isolation, and being deprived of our favorite drugs for sure-oh the pain!

My own experience with being defined and discredited by the The Diagnostic and Statistical Manual of Mental Disorders, and the implications of government control, leave me in fear of that book already! Remember, this is a War on Drug Users, and the tactics used by the FEDS must change with Orwellian precision, the language necessary to justify themselves in their propaganda.

Of course, users-will have no say, no voice at all, only the so-called experts-paid quacks-as during my SSI hearing before an administrrative judge, where in order to counter this lying charltan who was not my treating physican, in anger and fustration, I was forced to use outbursts of contempt and insult to shut him up! All resistance is futile, and abnormal as well.

Fri, 08/10/2007 - 2:36pm Permalink
Anonymous (not verified)

At any rate, however you want to hash this around and around, people who are addicted to substances are addicts and are already victims. They need help to learn how to function without these substances. They are human beings. Our society has labelled substance abusers as criminals and not as addicted victims who need help. Substance abusers are not criminals and do not belong in the prison system. Fully 90% of prison inmates are there due to drug related charges. And the prison corporations of amerika are making money hand over fist off the miseries of fellow human beings. Anything that gets these people out of the prison system and onto the road to substance-free life is worth a try. Good for Senator Biden for recognizing that addiction is a problem for mental health professionals and not for prisons. Especially since almost all addicted persons have dual diagnoses (ie. addiction PLUS another mental health diagnosis such as bipolar disorder, depression, schizophrenia, or any number of personality disorders)

Fri, 08/10/2007 - 2:59pm Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

Victims are victims until they choose to become survivors. Even being a survivor can have a negative stigma depending on what one has survived, especially among non-survivors. Our society has labeled substance users(not only abusers) as criminals. Biden's bill does not distinguish between "addicts" and users. Telling medical patients and responsible drug users they are addicts/victims based on "scientific evidence" serves only those who profit from creating and selling treatment programs. Recreational users and medical patients should not be subjected to the public mental health system based on simple possession or blood/urine metabolite analysis(DUID). Being transferred from Leavenworth to Belleview or even mandatory out-patient drug rehab is not an acceptable solution for incarcerated non-violent drug offenders. I doubt a majority of the 90% drug-related convicted prison population are mentally ill. I don't believe renaming the NIDA is intended to reduce the prison population. Changing from "Drug Abuse"(a conscious, yet foolish choice) to "Disease & Addiction"(an unchosen, and possibly contagious, affliction or fate) gives an individual seeking treatment less personal responsiblility for their self-inflicted circumstances and less personal power and sense of accomplishment in their recovery.

Chad Townsend
Tucson, AZ

Fri, 08/10/2007 - 4:26pm Permalink
borden (not verified)

In reply to by Anonymous (not verified)


Where in the Biden bill does it say what you attributed to it, that all users are addicts? I don't see that anywhere.

The Biden bill, rightly or wrongly, defines drug addiction as a disease. It says nothing to the effect of all drug use being the same as addiction. The fact that the bill doesn't distinguish between addicts and users is not equivalent to labeling all users as addicts, as you seem to be implying.

I'm not saying that Biden is our friend by any means, but I also don't see how the language of this bill says what you seem to perceive it as saying. There's a difference between not saying something that we would like to hear (as is the case with this bill), and saying the opposite of it that we don't like (as is not the case here).

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Fri, 08/10/2007 - 6:44pm Permalink
Anonymous (not verified)

Your reasoning seems suspect, at best, A1;59; are you saying the 90% should be under a psychiatric regime rather than a penal one? If you are, I'd suggest, with respect, you're the one with the intellectual disorder.

Fri, 08/10/2007 - 4:51pm Permalink
Anonymous (not verified)

I tried a substance-free life and I didn't like it. I was just using the wrong substances, until I tried them all and found ones that made me feel happy, without impairment. Why is it that non-users always seem to believe all the rest of us are better off without, as well?
Why do the non-users of the world set the rules, and believe they have the emphirical right over the rest of us to do so? Tyranny is tyranny, and neither prision or forced treatment is freedom. Leave me alone, I have smoked pot for many years, and I have no problem managing my daily affairs-in fact, I credit marijuana for helping me quit tobacco while I was still young enough to easliy break the habit. I am nobody's victim, unless or until I am set-up, busted, and then my abilities are taken from me while a whole bunch of bureacrats in the jail and treatment system earn their dinners? Hell no! Don't you think all this depends upon which drug we're taking about? Which drug always gets the AD Councils dys-information campaign humming? POT.
My preferences certainly do not include opiates, nicotine, or alchol. So, who are non-users to judge what I experience while using what I may use occasionally? My use is very political and dutiful, as well as my choice of anti-anxiety. And if I have an addiction to it , that's okay for me, too. What's your treatment for that, huh? Pills? No thank you, I function quite well, now.
When did my mind, now supposedly guilty of Crimethink, become your territory? What's my disease? My dis-ease lies within the loss of freedom to believe in my self as the only expert about me, and what's best for my life.

Fri, 08/10/2007 - 5:00pm Permalink
Anonymous (not verified)

Since my previous post was somewhat ambiguous, I should clarify. Said 90% should be as free as you or I, A1;59. That's the fact of the matter.

Fri, 08/10/2007 - 5:04pm Permalink
Anonymous (not verified)

It is most disturbing to see that David Borden doesn't recognize the disastrous implications in labeling drug use a brain disease.
It's already a fact that people who don't obey drug laws are not criminals. Yet, there is an advantage to being classified a mental patient instead of a criminal by the real criminals?! I've been to Springfield Medical Facility for mental evaluation, and let me tell you, the last thing you want is to be locked up as a mental patient.
Get stuffed Biden!

Fri, 08/10/2007 - 5:53pm Permalink
borden (not verified)

In reply to by Anonymous (not verified)


The bill doesn't label drug use as a disease. It labels drug addiction -- the apparent inability of some people to desist from drug use that is harming them -- as a disease. That's a big difference. It still might not be a great word to use, but it's not at all the same as the way you described it.

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Fri, 08/10/2007 - 6:32pm Permalink
Anonymous (not verified)

Siobhan is totally correct. Addiction is a neurological disorder (and even then it shouldn't be treated completely as such, or as how disorders are treated modernly), and this is just another way for the government to make drug users seem like the dregs of society.

Regardless or not as to whether or not addiction is a disease, in the case of alcoholism, when it isn't seen as one it's treated better because of the negative connotation and outlook a disease has, and that it can't just be treated like a disease. Some psychologist wrote about that, but I can't find the source :(

Fri, 08/10/2007 - 5:57pm Permalink
borden (not verified)

In reply to by Anonymous (not verified)

If addition is a disorder, that supports the point I made in the article -- even if disease is the wrong word, denying that there is something going on that is making things difficult for people doesn't make sense either. Does the difference between the word disease and the word disorder, then, make a gigantic difference?

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Fri, 08/10/2007 - 6:36pm Permalink
Giordano (not verified)

From abusers to lepers. Wonderful. Thanks a big bunch, Biden.

The drug warrior culture will not exhibit any additional compassion for drug users if they go from being called “abusers” to being isolated and ostracized as “the diseased.”

How compassionate was the federal government during the beginning stages of the HIV/AIDS crisis in the 80s? Drug law reformers since then have had to fight hard to get needle-exchange programs implemented to prevent the spread of AIDS and Hepatitis C, even when the merits of such a health policy should have been obvious to anyone.

If the National Institute of Drug Abuse (NIDA) is to be renamed, let’s call it the National Institute of Drug Research (NIDR). Let’s stipulate that the goal of the NIDR is to research both aspects of illicit drugs, the good and the bad. In fact, let’s make it a felony for any NIDR researcher or staff member to ignore, toss out or obstruct the collection of any research data that could make an illicit drug appear beneficial.

Also, let’s add a sunset clause to the bill that says if the NIDR fails to meet the objective of converting from a propaganda mill to a reputable research facility within some turnaround time, that the NIDR then be dissolved, its researchers and personnel scattered to the winds, and all further research on illicit drugs be funded by the National Institute of Health (NIH) in grants to independent university researchers who are given a means to obtain their drugs for testing from local police evidence vaults.

Imagine that a research institute such as the NIDR had been implemented two decades ago, and that we had found out then what we know today about the human body’s endocannabinoid biology. Untold amounts of suffering from diseases such as multiple sclerosis, et al., could have been avoided. Even lives could have been saved had the critical research on medical marijuana not been stifled by the drug warriors. Senator Biden’s proposed cosmetic change for the NIDA will accomplish nothing.

Fri, 08/10/2007 - 6:39pm Permalink
borden (not verified)

In reply to by Giordano (not verified)

NIDR would be a good neutral name.

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Fri, 08/10/2007 - 7:44pm Permalink
Anonymous (not verified)

Dear Sir or Madam,
I have been involved with the program of Alcoholics Anonymous since 1990. While in treatment, I learned that the American Medical Association has termed Alcoholism a disease. Treatment is important, but it is merely education about the disease of addiction, and it is of most importance that an alcoholic (alcohol IS a drug) or addict to any other substance attend and work a 12 step program for recovery from the disease. At A.A., we call upon a "Higher Power" or God, to keep us from drinking or using every day, one day at a time. We must have eternal vigilance when working our programs. I believe that addiction is a disease of the body, mind and soul. We admit that we are "Powerless over Alcohol or Drugs and that our lives have become unmanageable." in Step One. There are statistics about other diseases responding to prayer, such as cancer. You may refer to the Book, Alcoholics Anonymous and read the "Doctors Opinion". Any 12- step program is based on the "maintenance of our spiritual condition." In my opinion, Addiction IS A DISEASE, that ONLY GOD CAN HEAL.
We alcoholics and addicts are sick people who are getting well. We are not bad people becoming good. We do not break the laws intentionally. We are suffering from a disease, not a behavioral problem. I would like to know what I can do to help this movement.

Sincerely yours,
...............Erin M.
Montgomery, Alabama

Fri, 08/10/2007 - 9:10pm Permalink
Anonymous (not verified)

In reply to by Anonymous (not verified)

I have been working (as a Therapist) for 15 years within the alcohol & drug related problematic area. Our philosophy is that of the Socially Learned Behaviour model (the preferred treatment in Britain) which believes that a person has learned to use a drug of their choice and can re-learn and adopt a different way of living without the harmful use of substances. People use drugs, and I include alcohol because this is a drug, for a reason, and through indepth client centered counselling can come to terms with the reason they started in the first place. When this happens I have known many of my clients to return to harm reduced use, especially alcohol. You must treat people as an individual and treat the initial problem that brought about the addiction. If you label and stigmatise them as an 'alcoholic' they will remain in that 'stuck' position for the rest of their lives which will be more than likely a very miserable existence.
As for A.A. and the Minisota model et al I believe that the success rate is about 5% which doesn't say much for the 'disease' model. Diseases, on the whole have a cure and unless you allow access to that cure then that person will always be 'in recovery'. Relying on a 'god' or 'superior being' to turn to is not the answer and takes away CHOICE. Initially, on first meeting a client, I have often been told that 'I can't do anything about it 'cos I've got a disease', this is 'learned behaviour, learned from attending AA meetings and the like: this attitude changes over time when people come to realise that they DO have choices and with help can make significant changes in their lifesyle.
I could go on ad infinitum but that's enough!

Barrie Hull
Therapist & Training Co-ordinator
Pen Yr Enfys
Cardiff S.Wales

Sat, 08/11/2007 - 4:14pm Permalink
Anonymous (not verified)

Giordano, what makes you think "us" as in "let's", can have anything with re-naming or exerting any kind of control over the National Institute of Drug Abuse?

Fri, 08/10/2007 - 9:27pm Permalink
Giordano (not verified)

In reply to by Anonymous (not verified)

True. Obviously it will be Congress that renames the NIDA, if they do.

My use of the word "let's" was intended to be a kind of literary construct, as in "let's consider this example...", etc. Or if we identify as members of an American democracy, then "let's" is inclusive of all citizens in the country, including Joe Biden, Ted Kennedy, Senator Enzi, etc.

Fri, 08/10/2007 - 11:45pm Permalink
Anonymous (not verified)

Erin, here's a news flash. AA is a scam, and there are no gods to petition for favors. The laws have nothing to do with those habits you form. If you want to think of yourself as a powerless cripple, that's your business, but wanting to join a movement that makes your way of thinking the norm is not. If you've been in AA for 17 years and still consider yourself a powerless victim, how can you possibly think your way could be good for anyone?

Fri, 08/10/2007 - 10:06pm Permalink
David Dunn (not verified)

People become addicted to nicotine or other mind-altering substances (notably alcohol) because intensive, long-term use burns physical pathways into their brains. But science is revealing ways to fix these problems. Earlier this year researchers announced that damage to the insula, a tiny interior portion of the brain, made heavy smokers suddenly forget they'd ever craved a cigarette, suggesting the possibility of surgery to cure otherwise intractable addictions.

"Build a Better Brain" By Charles Siebert (Reported in Men's Journal, June 2007, p. 74, unavailable on-line) - Men's Journal

The question is, will the bill "Recognizing Addiction as a Disease Act of 2007" S. 1011 authorize American universities to grow, research and test their own cannabis to treat a variety of illnesses, including addiction?

The December 2004 issues of Scientific American reported that:

Research into natural chemicals that mimic marijuana's effects in the brain could help to explain--and suggest treatments for--pain, anxiety, eating disorders, phobias and other conditions.


The cannabinoid THC may also be useful in treating addiction. In the past,

Cannabis was reported to be effective in treating tetanus, convulsive disorders, neuralgia, migraine, dysmenorrhea, post partum psychoses, senile insomnia, depression, and gonorrhea, as well as opium or chloral hydrate addiction.

Marijuana Library

With the discovery of cannabinoid receptors in the brain and body, it would seem that American universities should be allowed to grow, research and test their own cannabis. Why? Brain's Receptors Sensitive To Pot May 'open Door' In Treating Drug Dependence, Brain Disorders, Medical News Today

Too, research into addiction should include researching Ibogaine as a treatment for addiction and other disorders.

Ibogaine, an indole alkaloid derived from an African plant source, is widely noted for its ability to interrupt chemical dependence. That is to say, ibogaine can be taken by an individual to help break his or her addiction to things like heroin, methadone, cocaine, crack cocaine or alcohol. The drug has also been noted to have psychotherapeutic potential, specifically relating to release from the effects of trauma and conditioning.


Is Sen. Biden, a Democratic presidential candidate, willing to amend S. 1011 to allow American universities to grow, research and test their own cannabis for its anti-addictive potential in addition to its many other uses? And allow them to research Ibogaine for its anti-addictive potential?

If not, then perhaps Sen. Biden should withdraw running for president of the United States. Why? Evidently he is not interested in American values of the care of human life and happiness. That's why government was instituted.

"The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government."

— Thomas Jefferson

Fri, 08/10/2007 - 11:15pm Permalink
Anonymous (not verified)

In reply to by David Dunn (not verified)

Ironically, in the early '90's Joe Biden took a pass on ibogaine in favor of development of buprenex -- which was designed to solve the problems with methadone. It does nothing to address the underlying disorder. That can only be done by turning on an autoregulating loop involving the neurotropin GDNF, which in the absence of additional ibogaine rapidly regenerates extensions of the ventral tegmental axon to the nucleus accumbens, obviating the need for continuous elevation of dopamine at the "switch" that governs "impulse" for drugs, sex, food, etc.

Now, with the crystal meth crisis, some version of ibogaine, probably the synthetic 18 MC developed with NIDA grants, will finally come into accepted use. But it raises the interesting question of why people like Biden would choose to maintain people in a diseased state when the only thing blocking an actual cure is government reluctance to admit they made a mistake when they made ibogaine Schedule I to begin with.

And BTW, ibogaine is being used to drastically reduce the amount of opiates chronic pain patients need to get relief. Check with Preston Peet of High Times & -- he's become something of an expert.

Dana Beal

Sat, 08/11/2007 - 3:37pm Permalink
Anonymous (not verified)

I just came back to this article and found this fantastic discussion!
What is even more impressive than the fact that pain patients don't get addicted is that users, i.e. "abusers" don't either. 250,000 GIs in Vietnam used heroin regularly and the vast majority of them, over 90 percent simply stopped when required to.
Only a tiny fraction had used again two years later. Think about that! This data was known to Richard Nixon when he started the War on Drugs as we know it, and has been available to Drug Policy Alliance et al who have chosen to keep it underwraps in order to favorably compare marijuana with opioids to say something like "let's make sure to legalize MJ because those rotten pharmaceutical companies are "pushing" dangerous opioids on us, when they knew it wasn't true!

Sure pharma companies are self-serving, welcome to the real world. But it has been wrong for drug policy to play this issue this way when they knew the powerful truth.

Over at PRN we have wondered who that tiny percentage of users is who can't put it down and we surmise that they must have some kind of endogenous opioid deficiency. How come other body systems can be in legitimate need of replacement therapy like insulin or hormones but not endogenous opioids, known as endorphins? Isn't it unbelievably perverse that what may very well be a boring physical ailment that merely needs addressing with opioids has been morphed into this HUGE problem and then advocated for in this ass backwards way?

What are we as a country doing, passing legislation that announces that any class of people have a spiritual "disease"? A disease that makes them subject to incarceration.
How sick are we, anyway?
Pain Relief Network

Sat, 08/11/2007 - 4:00am Permalink
Anonymous (not verified)

Siobhan, Your opening comments set the bar so high, everyone aspired to your level of cogency; surgical procedures may have been interrupted, artistic endeavor curtailed and scientific discoveries delayed all because of your post.
'But seriously, my interest in this comes from a firm belief that marijuana is the most near-perfect palliative substance *and* the most near-perfect recreational drug and, now, THC's anti-cancer activity has given the medical profession a mandate for intensive investigation but unjustified prohibition is still blocking what may be vitally important research.
I found, in '74 that marijuana cured intractable insomnia and since then marijuana has enhanced my life in various ways.
Biden's bill would escalate the war on smoke and Dave is displaying some naivete on the issue.

Sat, 08/11/2007 - 9:58am Permalink
Anonymous (not verified)

The debate about "treatment" vs. incarceration misses the whole point. Why should anyone be locked up - in either a rehab or a jail - just for getting stoned? Where does the constitution mandate the Federal Government to carry out a War on Drugs, or even discourage drug use?

I think addicts should get help, but they are a minority of the many people who sometimes choose to use mind altering substances. I think recreational drug abuse (that which is actually harmful) should bring down fines and community service, not prison. And people who aren't hurting themself or others should be left alone.

Sat, 08/11/2007 - 10:30am Permalink
Anonymous (not verified)

I'd say, people whose drug habits cause them actual harm lead pretty stressed lives without the added problems of State pilfering and enforced meaningless, degrading tasks. The harm they do themselves is more than enough.

Sat, 08/11/2007 - 12:40pm Permalink
Anonymous (not verified)

Unfortunately, the social addictions of Biden (government) and the president (religion) will go undiagnosed & untreated.

The 2 most addictive drugs are historically 'social narcotics' that hide in plain sight.

Government & Religion plagues the vast majority of Americans and will be extremely difficult to eradicate in these self delusional times!

It will be impossible to have a lawful, rational, constitutionally based society if Government & Religion are allowed to continue their unlawful dictates & actions.

DO NOT tolerate any gov't or religious agent intent on violating your rights... including your right to a pain free existence & death with dignity! Bottom Line:
Their life is not worth your life,
their life is not worth your liberty,
their life is not worth your happiness,
their life is not worth your legally aquired property,
their life is certainly not worth your pity!

Fuck Em All
Billy B Blunt
Tacoma, WA

Sat, 08/11/2007 - 12:57pm Permalink
Anonymous (not verified)

Hi. I am not disputing that MJ is good medicine. It just isn't THE medicine for severe chronic pain. Opioids are. I was calling out all the drug warriors for continuing to demonize opioids however it suits their purpose.
The problem with Dave's or DPA's backing of this bill is that they are indeed backing legislation that is pure propaganda that is injurious to the pain movement. I just spoke before the House and delivered testimony to the Senate Judiciary Committee and we are working hard to stop a national public health disaster that is claiming the lives and civil liberties of people in severe pain. Prior to the Bush crackdown an estimated 10 million people were trying to live in out-of-control pain, because we don't keep suicide statistics on how many people kill themselves because they can't get care, nor do we ever attribute any death to untreated pain, when we know that pain does, in fact, kill people, we, as a nation are participating in a silent genocide. Pain patients, from the government's point of view are addicts. Opioid users are to be despised, hunted, and kept from their "dope." And those of us who consider ourselves to be enlightened, get to play the role of feeling sorry for these poor "addicts" who have no free will. The political alignments here are terribly injurious to people in pain and must be addressed. The drug warriors would never get anywhere without the help of the "good guys" who try to ameliorate the situation by agreeing to more anti-scientific, drug war empowering declarations and "improvements."

At last, we have been getting some response from the Congress on this issue. And now, here is Biden participating in the liberal/NIDA pact that continues to further the drug warrior's goals. So much Federal money goes to undermining the solid science about the safety and efficacy and non-addictiveness of opioids, further erroding the social position of opioid users i.e. addicts, if such a thing can be imagined. The pressure on people in pain is an absolute disgrace.

This bill is typical of the kinds of things we see proposed by the well meaning people. But rather than really address the source of the stigma, the Controlled Substances Act, or the horrific unintended consequences of it, the wholesale destruction of patients in pain, and the pollution of the doctor/patient relationship, Biden, NIDA and the drug reform people, get on board for passage of a bill which only further reifys the fallacy at the heart of the entire so-called War on Drugs. This approach has been worsening the situation and not improving it, for decades now, but that doesn't seem to slow anyone down.

What we need are hearings into the entire mess. We, of course, propose to focus on the Federal crackdown on pain treating physicians and the crisis in the undertreatment in pain. Out of this should come the political will to protect these people from the dangerously powerful and out-of-control DEA.
When a good friend like Dave buys into something like this, I can only think he hadn't understood the implications. But I can only be concerned with how entrenched the drug policy opposition is when we look up and find them working against us, time and again. It sure would be nice, if for once, we were all playing on the same side.
Siobhan Reynolds
Pain Relief Network

Sat, 08/11/2007 - 1:20pm Permalink
borden (not verified)

In reply to by Anonymous (not verified)


I haven't backed the bill, and as I stated in the article I think the disease concept probably is not a sound one. But I do question some of your reasoning here. The idea some people have that addicts are people who should be despised and hunted, is opposite to the idea promoted by the bill that addiction is a problem from which people are suffering. At least it really seems opposite to me -- both concepts can be misused, but they are opposite. And the fact that pain patients and other non-addicted users of drugs are getting misclassified and mistargeted under the current system is a separate issue, unless one is going to go so far as to argue that addiction doesn't even exist (which I don't buy and it doesn't sound like you are saying either).

One of the reasons opiate prohibition came into being is that doctors didn't stand up for their right to continue to hand them out to any user who needed them after the passage of the Harrison Narcotics Act, instead caving in to the wave of arrests and prosecutions when the government decided to warp the meaning of the law to suit their will. The medical profession as a group responded by disavowing any role in helping people who have substance issues. It took Richard Nixon half a century later to even get us to methadone. That disavowal contributed to the demonization of drugs users, and to the opiophobia affecting pain treatment now.

You pointed out that more than 90% of soldiers who had routinely used heroin while in Vietnam just stopped after they came back from the US, a fact also discussed by one of the researchers quoted in the article. Well, 10% or any number near it getting hooked is still a large number of people. I completely agree with you that making opiates available at least to addicts would turn their problems into something readily manageable in the vast majority of cases. Undoubtedly most of them wouldn't even need any doctors' help with that if they could just buy the stuff legally at an affordable price on their own.

But opiates are the easiest addictive drug to manage through maintenance. Maintenance therapy for cocaine or methamphetamine addiction, for example, is a lot more tricky -- necessary, they are trying it now in Vancouver, but tricky. What about heavy drinkers who are destroying their livers and can't function for their jobs or families? That's a much more difficult problem than opiate addiction under legalization would be too.

One of the reasons I'm really skeptical that the disease concept has all the insidious effects you are claiming is something I saw several years ago, when the group Physician Leadership on National Drug Policy came out with their first statement about treating addiction as a medical issue. (I don't remember offhand if they used the word disease or not, but I think they did.) It was organized by David Lewis at Brown University, who was and is DPA-involved. It got on Nightline, and there were mainstream people including the head of NIDA, AMA people and others whom I really don't trust, but who for their own reasons were saying things like relapse is normal, we don't put people in prison because they have cancer, etc.

When it got to the discussion part of the show, Ted Koppel interviewed Jim Ramstad, a Republican congressman from Minnesota who has talked about his struggles with alcoholism. Immediately Koppel asked him, if we're saying that addiction is a disease to be treated, doesn't that mean we should decriminalize drugs? This was the first day the group's statement had gotten major press coverage, and immediately one of the most prominent reporters in the country was raising the issue of decriminalization on the most widely-watched news shows in the country. Ramstad looked like a deer in the headlights, and while he didn't say yes, amazingly to me he also didn't say no.

Anyway, that was the last time I remember the disease concept of addiction getting major national press coverage, and the fact that it immediately led to a discussion of decriminalization of drugs on the most widely-watched news magazine on TV, and with no one saying that they shouldn't be decriminalized, impressed me and affects my views on this now.

So there's some concrete evidence. Show me some evidence that the disease concept will be any worse in practical terms than the concepts that are already out there and widely accepted now. My instinct is that for all its flaws it is has more likelihood of leading to things like increased insurance coverage for voluntary drug treatment and for reducing some penalties than it has of taking things in the opposite direction. I am just not seeing a likely chain of events that would lead from the disease model to increased persecution of addicts, pain patients, recreational users or others -- given how effectively the current set of ideas has caused all of those things to happen. We're not talking about a societal shift away from a legalization system and tolerance and well thought out science to something worse. We are living under prohibition and the harshest war on drugs in history, and so the disease model to an extent has to be compared with that, not with our ideal way of understanding things.

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Sat, 08/11/2007 - 4:46pm Permalink
Anonymous (not verified)

Giordano, there's the problem. You're thinking like you were taught in school, that the congress represents the people, so the people have a say in the law that are passed. Wrong! Congress is made up of politicians who represent the government, not "we" the people. They are interested only in staying in power. You want to talk about addictive drugs..."power" is the most addictive. If any politician says anything about drugs other than, if they are elected they will do away with drug prohibition, then they are power junkies looking to hold on to their supplier.

Spiritual Person. All that mumbo jumbo about spirits, and souls, is part of religion, which is used to control the masses. Religion seeks to keep you in eternal childhood, never knowing what's going on, and always dependant on ...who the "church" tell you to be dependant on. Grow up, and realize you can figure it all out by yourself if you take spirituality out of the equation.

Siobhan, your posts are spot on.


Sat, 08/11/2007 - 4:33pm Permalink
Anonymous (not verified)

I agree, Siobhan, the opioids *are* the most potent analgesics we have, but I think what puts marijuana in a class of its own is the wide range of its (largely untapped) therapeutic potential. I agree with Ron too, in his criticism of religion and "spirituality" in general. Religion gave us the Inquisition and facilitated Witch Hunts. It is certainly now one component of the warondrugs, which is a greater evil than the other two combined. No amount of *mad* unbridled drug abuse could cause a fraction of the damage enforced prohibition does.
It is nothing short of a *global* catastrophe.
I can't get my head around the fact that society has allowed this shit to happen.

Sat, 08/11/2007 - 7:10pm Permalink
Anonymous (not verified)

I really see all of this very differently than you do. First, as to the Vietnam studies, 90 percent had no trouble stopping initially, but it was a tiny figure that had used a year later, way less than ten percent, less than two percent I think. This study turned our notions of addiction on their head; the drugs are not responsible for addiction, and there is far less addiction, even with ongoing exposure, than we would have thought, like 99 percent less. But how many people even know this?

This figure is backed up by the studies on people in pain receiving opioids for their pain. A tiny number of people, those with a genetic predisposition or who, perhaps, have an endogenous opioid deficiency, find that they function well on these medicines and want to continue taking them, despite what law enforcement or their friends and families have to say about it. This is what we call addiction. You say "it" can be managed with maintainence, but wouldn't it make more sense to see it as some kind of deficiency state, a very rare one, a private matter, rather than a condition that demands intervention etc and quit acting like it runs out-of-control unless managed? What runs out of control, it seems to me, is our tendency to try to control "the other" and we have narrowed this compulsive need down to gleefully hunting, punishing, intervening on the "addicts." It isn't ok to do this to overtly to blacks any more but it is all fine to do to "addicts." This blood sport is all over the court system, all over the celebrity culture, all over the television. Addict hunting, and not baseball, is our national past time.

The disease model, which supports this hunt, is full of bunk. It says that people have this disease despite abstaining, that this disease is progressive, that it takes away one's free will-a very dangerous notion as someone in your article pointed out.
But this is all about this tiny percentage of people....those who react positively to opioids. All of this is quite obviously very deleterious to them.

What is apparently not so obvious, is that patients in the pain community are suffering under a propaganda attack that is, as usual, cloaked as something that is good for us. Doctors terrified of the government-and there are only a very few who prescribe anymore, btw-are looking to exclude patients from care. They are using criteria that, as I said in my first post, allow them to make this diagnosis in a non-collaborative fashion.

We have seen that academic medicine, largely funded by NIDA and Robert Wood Johnson, has been trying to justify withholding care to patients who have "symptoms of the disease of addiction" like using alcohol, smoking, being defiant, losing a prescription, having a criminal history, asking for more medicine, being late to appointments-I kid you not-the melding of this notion of disease with non-compliance has moved pain doctors over into the very dangerous territory of selecting who shall live and who shall die. Look at the addiction zealots who graced us with their philosophy on this board. This is a cult ideology masquerading as a medical model and the DOJ has real honest -to- goodness doctors enforcing it, when the science says that almost NO ONE gets addicted.

Compliance has been supplanted by coercion. And this is a direct result of the application of Federal criminal sanctions to the practice of medicine. We must not forget that authoritarian systems have, for the last one hundred years at least, required doctors to make evil choices as a way to break the doctor away from his role as protector of the weak-and by extension as the protector, if you will, of the body politic.

If you are diagnosed as having the disease of addiction, you are given your buprenorphine or your methadone-a different kind of medicine even, special for addicts! your pain requirements be damned. This is killing people, Dave, lots of em, and doctor's offices are these hellish places where all the patients are being treated as potential addicts-the academics calling this sytematized abuse "universal precautions" as if this "disease" were catching. "Addicts" whatever they are, should not be treated in this way, but now, due to this years long crackdown that has gone almost entirely unopposed, people merely unlucky enough to be in pain are prisoners of their doctors too. All of this is a result of the fear that has been generated by the brutality of the DOJ, and now they are following up by legislating the big lie. And the nice guys are always happy to participate in this part of the dance....but we always find ourselves deeper in hell with less and less civil liberties.

Dave, addiction is simply not, in and of itself, such a terrible problem. It is entirely manageble and treatable. Assuming the "addict" wants help. This is the most bizarre thing. Can you imagine forcing people to quit smoking when they dont want to, watch them go back to it, over and over again and then use their repeated return to smoking as evidence that the smoker doesn't have free will? OF COURSE he has free will, he is merely choosing to exercise it in a manner that those who are trying to force him to quit disagree with. In what other area of life do we agree that people can torment each other into doing what we want them to do? This is pure madness.

One need not take away the autonomy of people who use drugs, patients, users, "addicts" etc. and call them diseased, in order to deal with this problem responsibly.
As I have said, I know that this effort is well intentioned by those who propose it, but they do not understand that it further marginalizes people in pain and makes a mess of our society in general.

But even more importantly, it perpetuates a myth that has justified this brutal prohibition regime. One cannot advocate an anti-scientific position just because one thinks it might soften things up a bit-this approach simply lacks integrity and has proven to be disasterous over and over again.

One must confront the lies with the truth, the myth with the reality, if one hopes to have any moral force.
We will never end this if we agree to the evil molecule myth at the center of this madness. And that is what the disease model advocates.

Sat, 08/11/2007 - 8:17pm Permalink
borden (not verified)

In reply to by Anonymous (not verified)


Why do you see the disease model as feeding the addict hunt? The only "disease hunts" I can think of in our society are of people with infectious diseases like HIV that people are afraid of catching. The driving force in them is people's fear that they could catch the disease. Since very few people think of addiction as infectious, I don't see why calling it a disease, rightly or wrongly, leads to more people wanting to see addicts hunted down. After all, the police aren't out there hunting down people for cancer or emphysema or glaucoma, are they? Those are diseases! Why aren't there widespread calls for people with those diseases to be hunted down and treated whether they like it or not, if the disease concept leads to that?

I repeat my piece of evidence, a time when the addiction-as-a-disease concept was discussed on a very prominent news venue, Nightline -- the only such time I can remember -- and it immediately led to a discussion, not of mandatory treatment and not of increased targeting of drug users, but of decriminalization of drugs, which I think is what we all want here. That is a concrete piece of evidence, from the real world, which supports my analysis and not yours. One piece of evidence isn't enough, but it's one more than you've provided. So show us your concrete evidence to the contrary, because so far every argument you've made about this has been theoretical.

I also have to disagree with your downplaying of the reality or seriousness of addiction. Sometimes addiction is a minor matter, but sometimes it's not. Prohibition makes it all much worse than it would be otherwise. But I know too many people who are living with HIV from their needle sharing days, or who screwed up jobs they loved because of alcoholism, or who knowingly gave themselves cancer by smoking -- I've met people who used to sell their bodies for crack cocaine -- for me to believe that addiction doesn't really exist, or that it's extremely rare, or that it's not that serious, or that it would just go away if only people would stop making drug users feel helpless by telling them they're addicted.

Furthermore, I believe that taking such positions would be a great way to make the public perceive us as unrealistic, which in turn would undermine our ability to win them over on policy (and it is policy after all that we are trying to change). It's necessary to win our arguments in the face of the reality of addiction. For example, pain patients very rarely get addicted, and they have the right to medication regardless of anyone else's drug problems, those arguments ought to be enough to win on.

I am by no means saying that we should jump all over the addiction-is-a-brain-disease argument, and that's not something we're planning to do at DRCNet. I don't consider "disease" to be a sufficiently precise term to describe the variety of issues that are thought of (also imprecisely) as "addiction." But I'm really hard pressed to see it as the evil that you do, and I think it does have the potential to help, albeit in an imperfect way. (And yes, it also has the potential to do harm, but I don't believe that is inevitable.)

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Sun, 08/12/2007 - 1:24am Permalink
Anonymous (not verified)

Hi Dave,

Your following statement articulates a fundamental misconception about the way the medical professions functions within society.

"One of the reasons opiate prohibition came into being is that doctors didn't stand up for their right to continue to hand them out to any user who needed them after the passage of the Harrison Narcotics Act, instead caving in to the wave of arrests and prosecutions when the government decided to warp the meaning of the law to suit their will. The medical profession as a group responded by disavowing any role in helping people who have substance issues. It took Richard Nixon half a century later to even get us to methadone. That disavowal contributed to the demonization of drugs users, and to the opiophobia affecting pain treatment now."

The implication is that the medical profession might be expected to affect social policy based on science. This is a pleasant notion, but in the real world it doesn't happen that way. Instead, medicine takes place within the context of what the government allows. Inside the box, if you like.

This situation is a corrollary to the understanding that people get the government they deserve. It turns out that the medicine they get is part of the package.

It has been distressing to observe as the leadership of academic medicine recants the science surrounding the treatment of pain with opioid analgesics, and the bugaboo of addiction. Your failure to be scientifically rigorous about these issues demonstrates that you too are caught up in facilitating the process that is shredding the fabric of our society. This confirms my perception that the drug policy "reform" movement is nothing more than a cog in the wheel of the cult of drug prohibition.

And by the way, how did Richard Nixon become a hero?

Best Regards,
Frank B. Fisher, M.D.

Sun, 08/12/2007 - 10:26am Permalink
borden (not verified)

In reply to by Anonymous (not verified)


I don't have that misconception, rather I think your argument only further makes my point about what happened.

Also, I have specifically said -- over and over, in the article and in the comments -- that I don't think the disease concept is scientifically rigorous and that I'm not comfortable with the language. And that DRCNet isn't backing the bill. So I don't see how I can reasonably be accused of not being scientifically rigorous. I didn't write the Biden bill, after all, did I?

To call the drug policy reform movement a cog in the wheel of drug prohibition takes some really wild leaps of logic. We're just a group of people doing what we can to undo a vast prohibition edifice that has a century of entrenchment and the government on its side. We don't know with any certainty what what will work or where any particular step will lead -- but neither do you. The difference, apparently, is that I know that I don't know.

Who called Richard Nixon a hero? Would we be better off not even having methadone maintenance?

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Sun, 08/12/2007 - 9:21pm Permalink
Anonymous (not verified)

I am also concerned that this will eventually come back to bite us in the butt.

My fear is that the pain medication argument will devolve from;

a. Having pain and taking opiates to relieve that pain - a physical illness

to --

b. Being accused of imagining/creating pain in order to obtain opiates to medicate a mental disease -- a mental illness

Currently, if you are a in pain and want opiates you are highly suspected of being an addict or criminal.

This may allow them to categorize you as being mentally ill instead.

Everyone I have met who has had long term chronic pain has had the experience of being told by some medical person that "it's all in your mind" and then given a prescription for a depression medication. If they persist in requesting opiate medication they are suspected of being a drug addict. That's bad enough, but is being defined as mentally ill instead of a drug seeker any better?

I understand the appeal of this law change -- to recognize addiction as a disease may result in decriminalization.

But as a mental illness it would give the government even more power to control and/or lock people away "for their own good." What if the government decides that this "disease" is "contagious" and spreading as an epidemic? Our prisons are bad enough but do we want to see millions of people -- including a high percentage of chronic pain patients -- locked up in forced drug asylums? Think it can't happen?


Sun, 08/12/2007 - 12:56pm Permalink
Anonymous (not verified)

I have explained how the doctors are using the addiction as a disease model on the ground right now, how the doctors are taking "universal precautions". You apparently dont want to think about how insane it has really gotten out there.
In contrast, you are talking about what happened on Nightline.
Apples and Oranges. I wonder how you feel about the fact that there is a big push on by NIDA, big pharma, and ONDCP to blur the distinction between addiction and dependence. Is that good too?

I am glad to hear that you aren't backing this bill. We will see what DPA does, if anything, about it.
As to your assertion that I am "downplaying" addiction. That is poppycock. I have made many arguments, explained a great deal and offered a different perspective on it from the canned stuff we are all used to thinking and saying.
I don't think that anything I said can be fairly characterized as downplaying addiction.
I guess the bottom line here, is that lots of people have had an opportunity to think about these issues and that is good.
They have also had an opportunity to hear about what is going on out there in terms of the wholesale destruction of people in pain.

Sun, 08/12/2007 - 1:08pm Permalink
borden (not verified)

In reply to by Anonymous (not verified)


I'm keenly aware of how insane things have gotten out there. What I am questioning is the role you are attributing to the disease model. We don't have a medical model in practice (disease or otherwise); we have a criminalization model. All the evils you have described have occurred under what is primarily a criminalization model.

The fact is that people are scared of what these drugs can do to people -- more scared than they ought to be, and in the wrong ways, but nevertheless -- and they are scared that it could happen to someone they know. It is that fear that is at the root of all the drug war evils, including what the government is doing to pain patients and doctors.

In my opinion, minor changes in terminology will have almost no effect on that. I agree with Ryanne that terminology is important. But the Biden bill would merely change one flawed term into another flawed term. And the fears that people about drugs are not based on the specific terms being used. It's all in the way the terms have been demonized. If it weren't just a move from shit to shit, my views might be closer to yours on this particular question.

We know that the term "drug abuser" has been very heavily demonized. Just maybe switching to another term that hasn't been demonized yet (and that to me appears harder to demonize) will clear the air a little. At least that is what seemed to happen at least one time on Nightline when it came up. I also think it could be really useful when people go in to lobby Congress, for them to be able to say, "Your boss voted for this legislation which said that drug addiction is a medical matter and not a criminal one. And so I'm asking Rep. so and so to vote to eliminate such and such penalty that is unfairly punishing people over a medical issue." Policies ultimately change based on specific votes and decisions that policymakers make, and politicians are more likely to take votes that we want them to if they have already done something that they see as pointing in the same direction.

I do agree that the disease model could possibly make it harder to win the very end stages of the fight for full legalization. But that's a long way off, and none of us have a crystal ball to be able to predict all the things that will happen affecting our issue between now and then.

Again, we're not advocating for this bill, but I'm hard pressed to see it as the evil that you do.

David Borden, Executive Director the Drug Reform Coordination Network
Washington, DC

Sun, 08/12/2007 - 10:52pm Permalink
Anonymous (not verified)

In my years in AA, I was told that the "disease" of addiction affects people equally regardless of race, socioeconomic background, age, gender, etc.'s not true. Factually, that's just not true! Some races have a significantly lower incidence of alcoholism, and impoverished peoples always show a higher rate of addiction.

Why is this important? Because it's FACT. As a nation, we have become far too easily swayed by easy-to-digest sound bites, instead of asking whether we're getting the runaround. Can you say Patriot Act?

I was twenty-three and acting out like a lot of young people, yet when I got a DWI, I didn't receive facts. I was shuffled into a religion-based, superstitious "program" which suggested that I had the only disease for which spirituality was the cure. Huh?

This is not to bash AA, because it seems to help the people who are predisposed to religiosity. But as free thinking people, we must begin to resist the temptation to accept ideas which SOUND true over ideas which ARE true.

Addiction and dependence are not diseases; they are maladaptive psychological responses. Some would argue, "it's just a matter of semantics," and I would say, "yes, it is a matter of semantics and semantics are very important."

Stanton Peele's book, Diseasing of America, is a good eye-opener on this topic.

Sun, 08/12/2007 - 2:25pm Permalink
Anonymous (not verified)

Perhaps an even better "eye-opener" is Dr. Gracer's book A NEW PRESCRIPTION FOR ADDICTION. It is based on scientific evidence and not opinions or the rhetoric of abstinence based rehabs.

Sun, 08/12/2007 - 3:01pm Permalink
Anonymous (not verified)

Dave, you evidently don't know what the hell you're talking about and Siobhan and most of the other people posting here do.
It does make sense however for you to defend your position if, as Dr. Fisher points out, " the drug policy "reform" movement is nothing more than a cog in the wheel of the cult of drug prohibition." A suspicion I also began to have when you insisted that petitioning president Bush for pardons for drug war prisoners was a good idea.

Sun, 08/12/2007 - 3:39pm Permalink
Anonymous (not verified)

I too, though petitioning for pardons questionable, when no crimes were committed in the first place.
I think you should harden your stance, Dave, the soft approach won't acheive antyhing worthwhile. The drug warriors are our implacable enemies. Give 'em hell!. . .As for your question, midpage, which I've just now seen, I think Ryanne answered it fairly comprehensively.

Sun, 08/12/2007 - 5:48pm Permalink

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