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

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 article is licensed under a modified Creative Commons Attribution license.
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borden's picture

Ron, P.J, Do you actually

Ron, P.J,

Do you actually think that having people continue to sit in prison for decades is preferable to having them let out on pardons? People who as you've pointed out didn't commit real crimes?

David Borden, Executive Director
StoptheDrugWar.org: the Drug Reform Coordination Network
Washington, DC

The Road to Hell

When dealing with some authentic biochemical addiction, a paradigm other than the disease model is essential if society and the judicial system is to ultimately sever itself from all the misinformation and mental manipulations that the drug warriors have developed and used for the last hundred years to justify their own existence. At the moment, going down the disease-model path is fraught with disaster.

Few things better illustrate the problem than the individual who wrote that addiction is a “spiritual disease” that causes a person to lose their soul. Aside from the fact that I don’t think there is such a thing as a soul, nor do I use that term to describe emotions and human interactions, it is important to look back a few centuries to when the Holy Office of the Inquisition justified its entire existence precisely on the claim that it was saving people’s souls.

The consequence of the Inquisition’s soul-saving agenda was a bloated and self-serving religious bureaucracy that funded itself in part by confiscating the total assets of anyone it accused of heresy before they were even convicted. It made the job of inquisitor one that could be inherited by a son from his father, and one that could be purchased at a cost far above the salary the position paid. The old adage that says “the road to hell is paved with good intentions” was written by a 15th century English jurist, Sir John Fortescue, who was discussing the Inquisition at the time he wrote it.

Today, there is a new inquisition sporting a new and plausible disguise. Once again, it is made up of ignorant, intolerant, authoritarian and self-serving careerist bureaucrats who believe themselves so morally superior to the drug culture heretics they’ve dedicated themselves to stamping out that they can justify emasculating the Fourth Amendment in order to violate a person’s right to privacy and thereby intervene in their lives. This is not to mention every other legally disruptive thing the drug warriors do to reduce our civil rights.

Preventing or treating disease in this matter is a drug warrior obfuscation designed to compensate for the fact that so few drug users come forward to claim they are victims or, for that matter, have a disease. The court system has to deal with this problem. Particularly as it applies to marijuana, there are no drug user victims acting as plaintiffs in their own drug trials. Instead, the so-called victims are the defendants, people who are sought out by the authorities well before it can be determined that a crime has occurred. As real victims go, these are frequently the ones who are being legally coerced into becoming informants to help the drug warriors create more victims. The result is that in marijuana and most other drug cases, there is no victim until the law intervenes.

The disease model, in this case, is just one more tactic in the game that will be used to make it appear as if all drug users are in denial about having a disease, whether or not that is the case, which in turn means that unsolicited and forceful interventions into people’s lives can continue to be justified by the drug warriors.

Dave, the issue about

Dave, the issue about petitioning the president for pardons in not about me thinking it's better for people to sit in prison for decades being preferable to having them let out on pardons. It's about you being so naive as to think the puppet masters will let their puppet president grant a single pardon to a drug war prisoner. And, it's about asking a president who most people recognize as a bufoon and mass murderer, to agree with a point of view that a drug war prisoner shouldn't be in prison.
Don't you understand the U.S.government with this president as their figure head has declared war on the freedom of the American people? Nothing anyone in the government does, especially their commander in chief can seem to deviate from winning that war.
When that piece of shit Bill Clinton pardoned a few drug war prisoners, it was great for the few he pardoned, and I was glad for them, but it hurt everyone else because that made it seem like the tens of thousands that didn't receive pardons didn't deserve them.

Won Over. . . ?

Dave, There's little to add to what Ron and Giordano have just said. I can only hope you've changed your mind about support for this potentially pernicious bill.

Missing the point

Why is it that in all these discussions about drugs that almost everyone misses the fundamental point? All the official talk, from every avenue, is how we can help addicts (and users period) by making them stop using drugs, the ultimate goal is always to stop using, to "help" the addict. The real point is that not only arte users and addeicts NOT criminals, they have an inalienable right to harm themselves if they want, hence, if I wanted to, I could skydive, eat a diety of big-macs and shakes, drink liqour and smoke tabbaco, but it's somehow not my right toget high, even if it dammages my life? it is MY life, right?

Well. . Yes. . .

We shouldn't forget that all substances humans ingest are foods of one kind or another. The fact that we take them into our bodies, by whatever route, to satisfy some appetite for them, *makes* them foods.
Since the pangs of physical hunger are removed by eating, the food then serves as an analgesic of sorts.
When I smoke a joint it's to satisfy a psychical appetite for a good night's sleep and for pleasurable avenues of thought. If I were in severe, chronic pain, I'd obviously have some appetite for *potent* analgesics.
The concept of the forbidden fruit/food is a stinking fruit of organised superstition and should always be seen for the illogical obscenity it is.
Are we Homo Sapiens or Homo Stupidicus, that's the question?
Enlightenment my ass!
(I've just noticed incidentally, my captcha validation is "BATS". I kid you not!)

It's not your life.

If you owned your life, (think, your body is your property), then there would be no argument that you have the freedom to do with it as you please, as long as you didn't infringe on someone else's freedom to do the same. But we obviously don't hold title to ownership of our bodies. Equally obvious is that the government does, because the government does not give us the freedom to damage their property. In fact, the notion that,people can own anything is a myth. You rent everything from the government, including the freedom to privacy. If you don't make your payments, "taxes", the government steps in and the taxpayers makes the payments for you, while you become a slave in their prison gulag. We've been taught that tattooing prison numbers on people was the ultimate insult, however we think nothing of the Social Security number we must get from the government so that the government can keep track of us. I've heard it said that the government prohibits marijuana because they can't tax it. The bigger picture is that the government is in the drug business itself, and uses prohibition laws as a way to deal with the competition.

Calling "addiction" a

Calling "addiction" a "disease" will not keep people out of the prisons, "therapeutic" communities, forced druggings (to 'cure' the disease) and state sanctioned rehabilitation and treatment--in fact, it widens the net of the government, and encourages fanatical, crusade-like actions.

(What color ribbon will the Walk to Cure Addiction use? How often will we need to be tested for addiction? What kind of preventative drugs must we take if we are found to be genetically likely to have addiction? What about requiring pre-natal testing that will tell if your baby will have addiction? And then what will the government require done to a baby that tests positive for addiction?)

I prefer not to have my language defined by Joe Biden and the spineless lap dogs of Congress--nor by drug policy reformers who are so desparate for change they'll bend-over for a table scrap they know isn't good for them.

addiction is a brain disease (wrong).

Dear People,
There has been a concerted effort to paint marijuana users as addicts, so that they can be stygmatized as deviant, rather than as normal. The problem with that is the medical definition of addiction which basically says that a doctor can unlaterally call whatever you do different from his highly subjective norms of behavior an addiction or whatever disease he wants to call it. Notice how much this culture hates hippies and other outgroups; no help available at all really (who's the psychopath now?). Rather than play endless games of labelling and backbiting, let's just legalize because there is no provable physical addiction to cannabis hemp that requires inpatient medical support in order to beat it. In other words, only psychological habituation is possible with marijuana, and a person affected as such needs to deal with the root psychological issues driving their self-medication and get their diet right for their body/mind type and they recover.
Additionally, child addiction statistics were padded by the fact that many adolescents are labelled addicts and court ordered into treatment when all they really need is a good psychologist in order to process out the root problems. Also ADDICTION is both a disease of the body and the soul whose causality lies primarily with the culture; seeing as so much of what affects our lives these days is systemically out of our control, then the responsibility lies both with the individual and the society to solve the problems respecting, for a change, what the individual has to say about their health care choices.




Cure Herpes

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Spiritual disease? There is no such thing.

The phrase "spiritual disease" is often used, but never defined in any way that makes sense,by Alcoholics Anonymous. It has never had any currency in medical circles and it is not in gerneral use. Diseases are not attributed by modern science to supernatural causes and they do not have "spiritual" symptoms.Using this stupid and meaningless term debases the discussion. It has no validity in terms of medicine. If it is just used as a vague and casual metaphor it only confuses the issue. The bogus invented terminology of AA has held back understanding of addiction and how it can be overcome precisely because it is rooted in superstitious quasi-religious ideas.

lovely conservative post

This is a perfect example of right-wing spin... " Lets find one bozo quack Psychologist from Emory who has published nothing on Addiction science to say  something to the effect of "the jury is still out".  Perhaps this is the best example of right wing spin I have seen outside of the global warming issue....  "Yea, if we can get a couple of quack "scientists" to say they disagree, then we can say that science doesn't agree... so why should continue to fund a moral problem of free-will"   Of course the Professor's comments could also have been framed out of context.."    You sick F's....    Silly human race.... teh teh


The Addiction Professor.

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