A full-scale campaign is under way to change the public perception of drug addiction, from a moral failing to a brain disease. Last spring, HBO aired an ambitious series that touted addiction as a "chronic and relapsing brain disease." In early July, a Time magazine cover story suggested that addiction is the doing of the neurotransmitter dopamine, which courses through the brain's reward circuits. And now Congress is weighing in.
A new bill sponsored by Sen. Joe Biden, D-Del., would change the name of the National Institute on Drug Abuse 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. Called the Recognizing Addiction As a Disease Act of 2007, it explains, "The pejorative term 'abuse' used in connection with diseases of addiction has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual's decision to seek treatment." Addiction should be known as a brain disease, the bill proclaims, "because drugs change the brain's structure and manner in which it functions. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs."
As a psychiatrist who treats heroin addicts and a psychologist long interested in the philosophical meaning of disease, we have chafed at the "brain disease" rhetoric since it was first promulgated by NIDA in 1995. Granted, the rationale behind it is well-intentioned. Nevertheless, we believe that the brain disease concept is bad for the public's mental health literacy.
Characterizing addiction as a brain disease misappropriates language more properly used to describe conditions such as multiple sclerosis or schizophrenia—afflictions that are neither brought on by sufferers themselves nor modifiable by their desire to be well. Also, the brain disease rhetoric is fatalistic, implying that users can never fully free themselves of their drug or alcohol problems.Finally, and most important, it threatens to obscure the vast role personal agency plays in perpetuating the cycle of use and relapse to drugs and alcohol.
It is true that a cocaine addict in the throes of a days-long binge or a junkie doubled over in misery from withdrawal can't reasonably be expected to get up and walk away.
Yet addicts rarely spend all of their time in the throes of an intense neurochemical siege. In the days between binges, cocaine addicts make many decisions that have nothing to do with drug-seeking. Should they try to find a different job? Kick that freeloading cousin off their couch for good? Register for food stamps? Most of the patients one of us treats hold jobs while pursuing their heroin habits.