Moral outrage is no solution

ADDICTION IS A BRAIN DISEASE - AND SHOULD BE TREATED AS SUCH

For many years, curbing illegal drug use has been one of the most
contentious and complicated public-policy issues in this country. Everyone
has an opinion. One side insists that we must control supply, the other
that we must reduce demand. People see addiction as either a crime, a
disease or a failure of will.

None of this bumper-sticker analysis moves us forward. The truth is that
drug abuse is "all of the above." Progress in dealing with drug issues will
come only when our national discourse and our strategies are as
comprehensive and complex as the problem itself. Addiction is both a
public-health and a public-safety issue, not one or the other. We must deal
with both the supply and the demand with equal vigor.

Recent advances in scientific knowledge increasingly suggest that drug
addiction - like Parkinson's disease, schizophrenia or clinical depression
- - is a brain disease that develops over time. Repeatedly using drugs
changes brain structure and function in fundamental ways that can persist
long after the individual stops using them.

The evidence suggests that these long-lasting brain changes are responsible
for the distortions of cognitive and emotional functioning that
characterize addicts. It is as if drugs have hijacked the brain's natural
motivational-control circuits, resulting in drug use becoming the sole, or
at least the top, priority for the individual.

This brain-based view of addiction has generated substantial controversy,
in part because some people wrongly think that it somehow absolves addicts
of responsibility for their own behavior. But these people still believe
that biological and behavioral explanations are alternative or competing
ways to understand these phenomena. In fact, they are integrated and
inseparable parts of the picture.

Individuals who have this brain disease certainly are not simply victims of
their own genetics and brain chemistry. Although genetic characteristics
predispose a person to be more or less susceptible to becoming addicted,
genes do not doom one to become an addict. Addiction to illegal drugs
begins with the voluntary behavior of drug use. This is one major reason
that efforts to prevent drug use are so vital to any comprehensive strategy
to deal with the nation's illegal-drug problems.

Moreover, all addicts can and must participate in and take some significant
responsibility for their own recovery. This brain disease does not erase
self-control, but it does significantly erode one's ability to exert
control over his or her behavior. This helps explain why an addict cannot
simply stop using drugs by sheer force of will alone and must have treatment.

Once one is addicted, the characteristics of the illness - and the
treatment approaches - are not that different from those of other brain
diseases. Research shows that the best drug-addiction treatment addresses
the entire individual, combining medications, behavioral therapies,
necessary social services and rehabilitation. These might include such
services as family therapy to enable the patient to return to successful
family life, mental-health services, education and vocational training, and
housing services.

Accepting addiction as a brain disease also means that society should stop
simplistically viewing criminal justice and health approaches as
incompatible opposites. We know that between 50 percent and 70 percent of
those arrested are addicted to illegal drugs.

Studies show that if addicted offenders are provided with well-structured
drug treatment while under criminal-justice control, their recidivism rates
can be reduced by 50 percent to 60 percent for subsequent drug use and by
more than 40 percent for further criminal behavior.

The message from the now very broad and deep array of scientific evidence
is absolutely clear. If we as a society ever hope to make progress in
dealing with drug problems, we are going to have to rise above the moral
outrage that addicts have "done it to themselves" and develop strategies
that are as sophisticated and as complex as the problem itself.