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Reviews | Should addiction be considered a disease?


For the editor:

Re “Calling addiction a disease is misleading”, by Carl Erik Fisher (opinion guest essay, Sunday Review, January 16):

Dr. Fisher’s opinion piece on 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 creators of the concept did not say that addiction was alone brain disease; we recognized the importance behavioral and social elements are to its development and recovery.

Also, the concept that substance use disorder is a disease of the brain in no way means that “drugs hold all the power.” No one would ever claim, for example, that people are powerless to change their hypertension or their diabetes by changing their behavior, as well as by taking their medications.

Let’s not revert to an outdated view of the drug problem as solely biological or behavioral and ignore the decades of scientific research that have led to combination treatments and policy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

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

For the editor:

Dr. Carl Erik Fisher is right that viewing addiction as a disease risks oversimplifying a very complex interplay of factors, placing too much emphasis on biological factors at the expense of the myriad of social and psychological factors that are also major contributors to addiction.

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

While the pendulum may have swung so far in the direction of biology that other important factors have been overlooked, it is important not to question the progress made over the past 50 years.

Michael B. Premier
Richard B. Kruger
New York
The authors are physicians from the Department of Psychiatry at Columbia University. Dr. First is the text editor of the upcoming Diagnostic and Statistical Manual of Mental Disorders-5.

For the editor:

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

But it wasn’t true. Many wanted to quit but couldn’t. By defining alcoholism as a disease, the shame of being an alcoholic has been removed. Alcoholics were no longer considered morally deficient. Alcoholism/drug addiction has nothing to do with morality.

This understanding of addiction as an illness has opened the door to recovery for many of us who might not have sought help for an illness if we thought we could “fix” it on our own – by simply being “better” people. We are not bad people. We are sick, deserving of help. Classifying addiction as a disease does not reduce the possibilities of recovery; it makes them bigger.

Vanessa S.
Oakland, California.
The writer, 35 years sober, requested anonymity in accordance with AA tradition.

For the editor:

I believe that Dr. Carl Erik Fisher is correct in saying that addiction is not just one thing, ie “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 always be considered and treated as a behaviour. And, like most behaviors, addiction has enormous sociological and economic implications.

To make medicine the primary gateway to treatment for any harmful behavior is seriously tying our hands as a society in search of a cure. As a practicing physician for 40 years, I might have felt a difference had we been more successful in treating behavioral issues as medical issues. We had our chance.

Opinion talk
The climate and the world are changing. What challenges will the future bring and how should we respond to them?

John R. Bennett
Snohomish, Wash.

For the editor:

Having lost a father (to alcoholism), a sister (to smoking and alcoholism) and a son (to opioid addiction), I think it would be a tremendous boon if research could determine the difference between those who can be successfully treated for their drug addiction and those who are not helped by current treatment methods.

Dr. Carl Erik Fisher concludes by saying that dropping the idea of ​​illness and opening up a fuller picture of addiction will allow for more nuance, care and compassion. I think there’s an abundance of them right now. What is needed is understanding the biology and differences that lead to addiction as a death sentence for some and a chronic disease for others.

Amie Schantz
Arlington, Mass.

For the editor:

One of the important reasons for calling addiction a disease is that it reframes the discussion away from the justice system/incarceration and towards treatment. This is extremely important because the United States leads the world in incarceration, much of which is related to illicit drug use or trade.

Steven Persky
Marina del Rey, California.

For the editor:

Regarding “Greenhouse gas emissions in the United States rebounded strongly in 2021” (press article, January 10):

Many Republicans oppose Build Back Better simply because Democrats support it, others because it limits the coal and oil industries, which they perceive as essential to their states. But many oppose it because it is a key culture war issue.

It and other initiatives like the Green New Deal represent what conservatives fear most: change, the substitution of a new order for the old, and the possibility of them losing their hard-earned place in the world.

Despite the climate disasters of the past year, programs that limit greenhouse gas emissions are going nowhere. The fact that the recovery of the economy is so closely linked to an increase in greenhouse gases is sobering and deeply worrying.

Climate change will soon be such a big issue that even conservatives won’t be able to deny it. It remains to be seen whether we can then do something about it.

For the editor:

Regarding “After January 6, the donor break was short” (Business, January 7):

As former chair of the political action committee of a major biopharmaceutical company and general counsel for the industry’s leading trade association, I appreciate the importance of contributing to supportive legislators, regardless of their positions on unrelated questions.

However, the continued strength of our democracy and the rule of law are not unrelated. They are as vital to the industry as prices and patents. No contribution should be made to legislators who refuse to recognize and act on threats to our Constitution.

Bruce Kuhlik
The author is former general counsel for Merck & Co. and Pharmaceutical Research and Manufacturers of America.

For the editor:

Regarding “To avoid the virus, Olympians lean back” (front page, January 24):

I laughed gratefully at the extensive restrictions Olympic athletes are putting on themselves to avoid being infected with Covid-19 before the Games start next month. This is how we seniors have been living for almost two years! I believe we deserve a medal.

Debbie Duncan
Stanford, California.

For the editor:

Dan Barry’s contemplative and healing story of outdoor winter solo basketball resonates with my lifelong passion for the sport (“A Story of Covid Exile, Told in Endless Arcs,” Sports, 18 January). The shoot-miss/shoot-swish beat soothes my soul in good and troubled times.

This phenomenon reached an unprecedented level ten years ago. After receiving a life-saving stem transplant, I was confined to weeks of isolation to prevent post-operative infection. Solo basketball on a neighborhood court was my refuge.

On my first outing, even though I missed most shots, I was overwhelmed with the emotion of a medical procedure made possible by an anonymous donor, a young student whom I met in person a year later. Weeping profusely, with the hoop as my witness, I pulled my heart out, overwhelmed with gratitude for life and for every hit, hit and miss.

Now in my seventies, I continue to play solo in freezing weather, warmed by the hoop and ball that have been my companions through the highs and lows of decades of a life well lived.

Allen White
Brookline, Mass.