opinion | Should Addiction Be Considered a Disease?

About the publisher:

On “Calling Addiction a Disease Is Misleading” by Carl Erik Fisher (guest post, 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’s called today and what to do about it.

First, the originators of the concept didn’t say that addiction is just a brain disease; We recognize the importance of behavioral and social elements in his development and recovery.

Furthermore, the concept that a substance use disorder is a brain disorder does not mean at all that “drugs have all the power”. For example, no one would ever argue that people are powerless to control their high blood pressure or diabetes by changing their behavior and taking their medication.

Let’s not revert to an outdated view of the drug problem as just either biological or behavioral, and ignore decades of scientific research that has led to combined treatments and policies that work far better than either alone.

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

About the editor:

dr Carl Erik Fisher is right when he argues that the notion of addiction as a disease risks oversimplifying a very complex interplay of factors and exaggerating the biological factors at the expense of the myriad social and psychological factors that are also major contributors to addiction overemphasize

However, emphasizing that addiction, like other mental disorders such as depression, has a significant biological component has helped reduce the stigma and shame associated with addiction and increase people’s willingness to seek treatment.

While the pendulum may have swung so far in the direction of biology that other important factors are being overlooked, it’s important not to jeopardize the advances of the last 50 years.

Michael B. First
Richard B. Krueger
new York
The authors are physicians in the Department of Psychiatry at Columbia University. dr First is editor of the forthcoming revision of the Diagnostic and Statistical Manual of Mental Disorders-5.

About the publisher:

dr Carl Erik Fisher failed to mention the main reason alcoholism was classified as a disease. Before Alcoholics Anonymous, alcoholism was generally considered a human failure, a weakness of character, a sin. These people could stop drinking if they wanted to!

But that wasn’t true. Many wanted to quit but couldn’t. Defining alcoholism as a disease removed the shame of being an alcoholic. Alcoholics were no longer seen as morally inferior. Alcoholism/addiction has nothing to do with morality.

This understanding of addiction as a disease has opened wide the door to recovery for many of us who may not have sought help for an ailment when we thought we should be able to “cure” it ourselves – by simply being “better” people. We are not bad people. We are sick people who deserve help. The classification of addiction as a disease does not limit the possibilities for healing; it expands them.

Vanessa S
Oakland, California
The writer, 35 years sober, asked for anonymity in keeping with AA’s tradition.

About the publisher:

I believe that dr. Carl Erik Fisher is correct in his view that addiction is not just one thing, it is “a disease”. There are certainly medical elements, for example our imperfect but growing understanding of the genetics of addictive behaviors. But essentially, addiction still needs to be seen and treated as a behavior. And like most behaviors, addiction has enormous sociological and economic influences.

By making medicine the primary portal of access to treatment for harmful behavior, we seriously tie our hands as a society seeking a cure. As a practicing physician for 40 years, I might think differently if we had had more success treating behavioral problems than medical problems. We had our chance.

opinion interview
The climate and the world are changing. What challenges does the future bring and how should we react to them?

John R Bennett
Snohomisch, Wash.

About the publisher:

Having lost a father (to alcoholism), a sister (to cigarette smoking and alcoholism), and a son (to opioid addiction), I think it would be a great boon if research could tell the difference between those who are successful for themselves addicts and those who are not helped by current treatment methods can be treated.

dr Carl Erik Fisher concludes by saying that abandoning the notion of illness and opening a broader picture of addiction will allow for more nuance, caring, and compassion. I think there’s a lot of that at the moment. What is needed is an understanding of the biology and the differences that lead to addiction for some and chronic illness for others.

Amie Schantz
Arlington, Mass.

About the publisher:

One of the important reasons for calling addiction a disease is that it shifts the discussion away from the court system/incarceration and towards treatment. This is extremely important as the United States leads the world in incarcerations, much of which are linked to illicit drug use or trafficking.

Steven Persky
Marina del Rey, California

About the publisher:

On “US greenhouse gas emissions made a strong recovery in 2021” (News article, January 10):

Many Republicans oppose Build Back Better simply because Democrats support it, others because it restricts the coal and oil industries they see as critical to their states. But many reject it because it’s a central theme of the Kulturkampf.

They and other initiatives like the Green New Deal represent the things conservatives fear most: change, a replacement of the old with a new order, and the possibility of losing their hard-earned place in the world.

Despite the climate catastrophes of the past year, programs to limit greenhouse gas emissions have come to nothing. The fact that economic recovery is so closely linked to increases in greenhouse gases is sobering and deeply concerning.

Climate change will soon be a problem so big that even conservatives cannot deny it. Whether we can do anything about it remains to be seen.

About the publisher:

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

As a past Chair of the Political Action Committee of a major biopharmaceutical company and General Counsel of the industry’s premier trade association, I know the importance of making contributions in support of legislators, regardless of their positions on unrelated issues.

However, the continued strength of our democracy and the rule of law are not independent matters. They are as important to the industry as awards and patents. No contributions should be made to legislators who refuse to recognize and respond to threats to our Constitution.

Bruce Kuehlik
Washington
The author is a former General Counsel of Merck & Co. and Pharmaceutical Research and Manufacturers of America.

About the editor:

On “Olympic athletes bend backwards to avoid virus” (front page, January 24):

I chuckled in appreciation at the extensive restrictions Olympic athletes are putting in place to avoid contracting Covid-19 ahead of next month’s Games. This is how we seniors have been living for almost two years! I think we deserve a medal.

Debbie Duncan
Stanford, California

About the publisher:

Dan Barry’s thoughtful, healing story of winter outdoor solo basketball reflects my lifelong passion for the sport (“A Story of Covid Exile, Told in Never-Ending Arcs,” Sports, January 18). The shoot-miss/shoot-swish rhythm soothes my soul through good times and turbulent times.

This phenomenon reached an unprecedented peak a decade ago. After receiving a life-saving stem transplant, I was isolated for weeks to prevent post-procedure infection. Solo basketball on a neighborhood field was my refuge.

During my first outing, even as I missed most of the footage, I was overcome by the emotion of a medical procedure made possible by an anonymous donor, a young college student I would meet in person a year later. I cried profusely, with the tire to witness, and shot my heart out, overcome with gratitude for life and for every shot made and missed.

Now a seventy-year-old, I continue to play solo in cold weather, warmed by the hoop and ball that have been my companions through the ebb and flow of decades of a life well-lived.

All white
Brookline, Mass.

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