Opinion | Should Addiction Be Viewed as a Disease?

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To the Editor:

Re “Calling Addiction a Disease Is Misleading,” by Carl Erik Fisher (Opinion guest essay, Sunday Review, Jan. 16):

Dr. Fisher’s opinion piece about addiction was misleading and polarizing. His arguments ignore decades of biomedical and behavioral research that have taught so much about the nature of substance use disorder, as it is now called, and what to do about it.

First, the originators of the concept did not say that addiction is only a brain disease; we acknowledged how important behavioral and social elements are to its development and to recovery.

Moreover, the concept that substance use disorder is a brain disease does not at all imply that “drugs hold all the power.” No one would ever assert, for example, that people are powerless to affect their hypertension or diabetes by changing their behavior, as well as taking their medicine.

Let’s not revert to an outdated conception of the drug problem as only either biological or behavioral and ignore the decades of scientific research that have led to combined treatments and policy approaches that work far better than either alone.

Alan I. Leshner
Potomac, Md.
The writer is former director (1994-2001) of the National Institute on Drug Abuse, National Institutes of Health.

To the Editor:

Dr. Carl Erik Fisher is correct in arguing that thinking of addiction as a disease has the risk of simplifying a very complex interaction of factors, overemphasizing the biological factors at the expense of the myriad social and psychological factors that are also major contributors to addiction.

However, emphasizing the fact that addiction, like other mental disorders such as depression, has a significant biological component has served to reduce the stigma and shame surrounding addiction and increased individuals’ willingness to seek treatment.

While the pendulum has perhaps swung so far in the direction of biology that other important factors are being overlooked, it is important not to jeopardize the headway made over the past 50 years.

Michael B. First
Richard B. Kruger
New York
The writers are doctors with the Columbia University Department of Psychiatry. Dr. First is the editor of the forthcoming Diagnostic and Statistical Manual of Mental Disorders-5 text revision.

To the Editor:

Dr. Carl Erik Fisher did not mention the most important reason that alcoholism was classified as a disease. Before Alcoholics Anonymous, alcoholism was widely considered a human failing, a weakness of character, a sin. These people could stop drinking if they wanted to!

But this was not true. Many wanted to stop but could not. By defining alcoholism as a disease the shame of being an alcoholic was removed. No longer were alcoholics seen as morally deficient. Alcoholism/addiction has nothing to do with morals.

This understanding of addiction as a disease has opened the door of recovery wide to many of us who may not have sought help for an affliction if we thought we should be able to “fix” it by ourselves — by just being “better” people. We are not bad people. We are sick people, deserving of help. Classifying addiction as a disease does not narrow the opportunities for healing; it expands them.

Vanessa S.
Oakland, Calif.
The writer, 35 years sober, requested anonymity in keeping with A.A.’s tradition.

To the Editor:

I believe that Dr. Carl Erik Fisher is correct in his view that addiction is not just one thing, which is to say “a disease.” There are certainly medical elements, for example our imperfect but growing understanding of the genetics of addictive behavior. But, in essence, addiction must still be seen and treated as a behavior. And, as with most behaviors, addiction has huge sociologic and economic inputs.

By making medicine the principal portal for accessing treatment of any harmful behavior is to seriously tie our hands as a society seeking a cure. As a practicing physician of 40 years, I might feel differently if we had had more success treating behavioral problems as medical problems. We’ve had our chance.

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