In June, 2017, the Boston Globe ran a guest editorial piece written by Dr. Sally Satel, a resident scholar at the American Enterprise Institute (who also works part time in a methadone clinic in Washington DC) and Scott O. Lilienfeld, the Samuel Candler Dobbs Professor of Psychology at Emory University. The authors make a case for the proposition that calling addiction a disease might be hindering efforts to successfully treat addiction. Below is the beginning of that article. Use the link to read the entire article.


Calling it ‘brain disease’ makes addiction harder to treat

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

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

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

Before Leshner and his NIDA colleagues designated addiction a disease of the brain — meaning that addiction is fundamentally a drug-induced disorder of disrupted brain function — doctors and much of the public regarded addiction as a vague sort of “disease” that manifested as an uncontrollable drive to use drugs or alcohol. Leshner coined a durable metaphor, writing that drugs “hijack” the brain’s motivational and reward circuitry thereby making the condition involuntary. The brain disease model of addiction soon became orthodoxy in academic and research circles, which are heavily dependent on NIDA funding for training and research, and was also adopted by politicians, drug czars, public health officials, and the treatment industry. “Addiction is a chronic disease of the brain,” then-Surgeon General Vivek Murthy asserted in a report last year, “and it’s one that we have to treat the way we would any other chronic illness: with skill, with compassion and with urgency.” This idea has by now filtered into mass culture. “Opioid Addiction Is a Brain Disease, Not a Moral Failing — and We Have to Stop Looking At It That Way,” declares a headline from a popular fashion and beauty magazine.