Biden Bill to Define Addiction as Brain Disease

[Heretic.Ape.]

Feature: Is Addiction a Brain Disease? Biden Bill to Define It as Such is Moving on Capitol Hill

from Drug War Chronicle, Issue #497, 8/10/07
A bill introduced by Sen. Joe Biden (D-DE) that would define addiction as a brain disease is moving in the Senate. Treatment professionals, mainstream scientists, and recovery advocates see it as a good thing. There are some skeptics, though.

NIDA book cover, with brain scan image
The bill, the Recognizing Addiction as a Disease Act of 2007 (S. 1011), would also change the name of the National Institute on Drug Abuse (NIDA) 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. "Addiction is a neurobiological disease -- not a lifestyle choice -- and it's about time we start treating it as such," said Sen. Biden in a statement when he introduced this bill this spring. "We must lead by example and change the names of our federal research institutes to accurately reflect this reality. By changing the way we talk about addiction, we change the way people think about addiction, both of which are critical steps in getting past the social stigma too often associated with the disease. This bill is a small but important step towards stripping away the social stigma surrounding the treatment of diseases of addiction," said Sen. Biden.
The measure is garnering bipartisan support. It passed out of the Senate Health, Education, Labor and Pensions (HELP) committee in June with the backing of Sen. Mike Enzi (R-WY), the ranking minority committee member. "Science shows us the addiction to alcohol or any other drug is a disease," Enzi said in a statement marking the vote. "While the initial decision to use drugs is a choice, there comes a time when continued use turns on the addiction switch in the brain. That time can vary depending on factors ranging from genetics to environment to type of drug and frequency of use. Because of that and the continued stereotypes and challenges that are often barriers to people with addiction issues seeking treatment I am proud to support this legislation. Although the names of the Institutes will change, their mission -- preventing and treating drug and alcohol addiction -- will remain the same."
The politicians are taking their cue from neurological researchers led by NIDA scientists who have been working for years to find the magic link between the brain and compulsive drug use. Dr. Nora Volkow, current head of NIDA, has been leading the charge, and Biden and Enzi could have been reading from her briefing book.
"Drug addiction is a brain disease," said Volkow in a typical NIDA news release. "Although initial drug use might be voluntary, once addiction develops this control is markedly disrupted. Imaging studies have shown specific abnormalities in the brains of some, but not all, addicted individuals. While scientific advancements in the understanding of addiction have occurred at unprecedented speed in recent years, unanswered questions remain that highlight the need for further research to better define the neurobiological processes involved in addiction."
Not surprisingly, the treatment and recovery communities, anxious to see the social climate shift to one of more support and less punishment for the addicted, support the legislation. "Recognizing addiction is the next step forward," said Daniel Guarnera, government relations liaison for the NAADAC -- The Association for Addiction Professionals. "NIDA and its scientists have demonstrated overwhelmingly that addiction is not a behavioral trait, but rather is caused by physiological changes to the body that make people want to use addictive substances. This bill allows the terminology to catch up with the science."
Although the bill does little more than make a congressional pronouncement and rename a couple of institutes, it is still an important step, said Guarnera. "Yes, it's symbolic, but that symbolism is hugely important, because language should reflect medical knowledge, and medical knowledge has demonstrated that drug abuse is a physical phenomenon."
"We utterly endorse this bill," said Pat Taylor, executive director of Faces and Voices of Recovery, a treatment and recovery advocacy umbrella organization. "I think it's a great idea to rename the agencies. People with drug and alcohol problems can and do recover from addiction. Calling them 'abusers' just stigmatizes them."
Taylor and her organization are actively supporting the bill, she said. "We've sent letters of endorsement for the bill," she said. "People blame people for their drug and alcohol problems, so this is an important issue for the recovery community. We need to rethink how we talk about this."
Is addiction in fact a brain disease? Some researchers think that's too simple. Scott Lilienfeld, a professor of psychology at Emory University told ABC News last week: "What I find troubling with the brain disease rhetoric is that it's grossly oversimplified, it boils down an incredibly complex problem to not necessarily the most important explanation. You can view a psychological problem on many levels. Low level explanation refers to molecules in the brain. There are other levels including people's personality traits and moods, people's parents, environment. Higher level than this is community."
"Every level tells you something useful," Lilienfeld continued. "Brain disease is only one level among many and not even the most helpful. Implying it's the only level of explanation, that's counterproductive."
Some mavericks go even further. "No, addiction is not a brain disease," said Dr. Jeffrey Schaler, a psychologist and professor in the Department of Justice, Law and Society at American University in Washington, DC, and author of "The Myth of Addiction." "Diseases are physical wounds, cellular abnormalities. Addiction is a behavior, something that a person does. Diseases are things a person has," he argued.
"You can't will away a real disease," Schaler continued. "But people will away behaviors they don't like all the time."
Others feel that the concept of addiction itself is too imprecise. "There is no clear conception of what people mean by the word 'addiction,' and there are numerous papers on this unsatisfactory concept," said Professor John Davies, head of the Center for Applied Social Psychology at the University of Strathclyde in Scotland, another prominent critic of the "addiction is a brain disease" model. Using drugs and 'addiction' are not synonymous," Davies continued, noting that many "fun drug users" become "addicts" as soon as they end up in court.
"Of course, people can and do get into an awful mess when they fail to manage their habit effectively," Davies concedes. "But look at the data. Harmful damaging drug use is heavily social-class related whereas drug use per se is less so. People give up the so-called 'disease' when their lives change, they get a new partner, a new job, a move of house."
"Sen. Biden's crusade is part of a decades-long, political struggle to isolate drug habits in users and to obscure the social and historical factors that ultimately underline so-called drug problems," said Richard De Grandpre, author of "The Cult of Pharmacology: How America Became The World's Most Troubled Drug Culture" (see review here next week), citing the case of the Vietnam war veterans who picked up opiate habits, but who, for the most part, rapidly shed them upon returning home.
"These vets used chronically and were said to be addicted. What happened to their addictions?" De Grandpre asked. "The feared epidemic did not materialize because the social factors that sustained heroin use in Vietnam had all but disappeared upon returning."
Davies sees the addiction label as having pernicious consequences for problem users as well. "It makes things far worse," he said. It makes people believe that the roots of their behavior are beyond their capacity to control, which is the last thing you need when you're trying to get someone to change their behavior."
How should drug policy reformers (e.g., those concerned first and foremost with loosening prohibitionist drug policies) respond to the Biden bill? Rhetorically, both the "disease" and "choice" models have been used repeatedly to justify draconian policies -- the former at drug sellers, who mostly are not kingpins or monsters seeking to addict children to their goods, but get charged as such in the court of public opinion -- the latter at problem users, or even users in general, because they should just stop, because it's a choice.
"I tend to think that language changes that reduce the fuel in the drug discussion will help rather than hurt our cause," said David Borden, executive director of Stop the Drug War (DRCNet, publisher of this newsletter). "Terms like 'Diseases of Addiction' pack less verbal or rhetorical punch than shorter ones like 'Drug Abuse,' and are less useful for purposes of political propaganda. If the names of the agencies shift, the language coming out of the agencies will also have to shift, at least somewhat, and that will help -- it will be harder for politicians to focus their rhetoric on nonsense statements like 'all use is abuse,' if 'abuse' is no longer the government-endorsed term of choice in the discussion."
"Those are political concerns, however," Borden pointed out. "If 'disease' is a scientifically imprecise term for describing the set of conditions that are commonly known as 'addiction' -- and it seems to me that it probably is -- then Congress and NIDA probably shouldn't be using the term for that purpose. I'd be more comfortable with the bill if it used slightly different language." Still, he thinks it's probably a net positive. "I think the obvious message of the terminology shift would be to say that people with drug problems are not really criminals, and that's a good thing."
"Plus if addiction isn't a disease, there's still obviously some condition that some people have, physical for at least some of them, that makes it harder for them to make favorable choices," Borden added. "Otherwise I don't think there would be thousands of people risking arrest or overdose to inject themselves daily with heroin, or millions knowingly doing what they're doing to themselves with cigarette smoking. So I'm not sure that the imprecision in the term chosen for the discussion is such a big problem."
Schaler disagrees. "Drug policy reformers play into the hands of the therapeutic state when they support the idea that drug addiction is a treatable disease," he said. "It means doctors have more power over people instead of just drug agents."
In principle, neither Congressional fiat, nor therapists' concerns over what the right message is to send to patients, nor advocates' concerns over what will ultimately lead to better policies, should take a second seat in this debate -- the question is fundamentally a scientific one, and a philosophical one. With Congress holding the purse strings for the bulk of addictions research in this country, however, Congress' choices now may indeed affect the language being used in the future for some time to come. And language can indeed have an impact in ways going beyond its initial purposes.

[Nagognog2]

Great. The Republascists will go along as long as lobotomy is brought into consideration as a "cure."

[Heretic.Ape.]

Yeah, the thought did cross my mind that this could go the wrong way... wards of the state such as people committed can be in a worse situation that someone put in prison, their "treatment" and the duration of their being a guest of the state can be indeterminate and left to the whim of doctors. But maybe I'm just thinking that way because I just reread One Flew Over the Cuckoo's Nest recently, lol.

[Nagognog2]

A an old friend of mine's mommy was a head nurse at a psychiatric (state) hospital. She fully identified with Nurse Ratchet. Her kids were nuts and drugged out of their skulls on Ritalin.

[rxbandit]

Was she as glee and giddy about lobotomy's to cure oppositional behavior?

Biden is one of the few honest politicians I have met. His plans and propositions actually make sense. Addicts should not clutter the jails but recieve help.

"I think the obvious message of the terminology shift would be to say that people with drug problems are not really criminals, and that's a good thing."

Its a step in the right direction.

[Woodman]

I am all for recovery programs, but drug addicts clearly do not suffer under the burden "disability" when they have a choice to either use, diminish use, or abandon drug use altogether.

A child born with MD, MS, CP, etc. has no such option.

This is legislation designed to allow drug addicts to funnel money AWAY from people who are TRULY disabled by putting them in the same category.

Addiction as a "disease" is nothing more than a politically correct, pop-culture fad, like eating chocolate ants, wearing feathered hats, or walking around with pants falling halfway down your ass and thinking it's "cool".

Real addiction is a condition, not a disease.

Not that addiction should not be treated, but it certainly should not be used as the object of political pandering to syphon money away from the less fortunate among us who are far more deservant of receiving it.

[Felonious Skunk]

^^^^ Are you willing to argue that heart disease caused by overingestion of saturated fats and lung cancer induced by tobacco smoke are "conditions" and not diseases?

[Woodman]

Where the fuck do you get "heart disease" from to apply to this topic?

People who eat get heart disease. It's not like they can just stop eating.

Now if you're referring to that particular fat bastard who spends 8 - 12 hours a day laying on the couch, watching TV, and stuffing his oversized face with all manner of junk food until his ass is so fat that he can barely move, then I say Fuck Him! Let the fucker suffer a massive heart attack and be done with him.

If you try to subsidize him by sending him a government check, you know damned well that fat fucker is just going to use it to buy more food.

That lung cancer victim who smokes like a chimney will do the same, only with cigarettes instead of food.

...and you still haven't answered for those little kids with M/S, M/D, C/P, etc.

So while you're busy about feeding someone's fat uncle to the point of making him a "shut-in" because his ass is too fat to fit through the door, or buying more cancer sticks for your dying mother-inlaw, are you going to look your child (or anyone else's kid) in the face and say, "Sorry, Tommy. You can't have any medicine today because grandma needs the money to buy Marlboros."?

[rxbandit]

Yes, but a brain disease is a far different classification then a genetic terminal illness...

All this notion says is that it would be classified with anxiety disorders, anorexia and those other pyscological disorders that seem odd and unnecessary to those that don't have them. Alcoholics arent entirely demonized but offered help and sympathy. alcoholism is considered a mental condition why not legally categorize addiction in the same manner. I agree that people with addictive tendencys arent ill on the same level as someone with MS but they also need treatment to learn effective coping strategys and possibly medication. Most people don't ask to be addicts and certainly do not deserve imprisonment because they are lacking in self control and coping strategys.

The money given to such a program would likely cut down on the money used to house, feed and take care of an inmate rather then overtax the health care system. I think offering medication and treatment rather then a lengthy stay in a prison payed for with tax dollars is a more cost effective strategy.

[Felonious Skunk]

To get semantics out of the way, here's how the medical community defines it:

Disease can be defined in three ways:

1. An interruption, cessation, or disorder of body functions, systems, or organs.
   Synonym: illness, morbus, sickness.
2. A morbid entity characterized usually by at least two of these criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomical alterations.
   See also: syndrome.
3. Literally, dis-ease, the opposite of ease, when something is wrong with a bodily function

So that physiological process by which, for example, the brain compensates for excess dopamine in the synaptic cleft of cocaine users by reducing the number dopamine transmitters is called neuroadaptation and results in a state where the user is dopamine-depleted when cocaine is not available. There are clear and identifiable changes in brain structure and function, so cocaine and other addictions indeed fall under all three tenets of the above definition.

Woody, to address your main complaints, if drugs were decriminalized and the money spent on the current "drug war" was redirected to treating the brain disease of addiction, I have no doubt that there would be plenty left over to address the genetic disor...uh, diseases of the little kids who seem to have become your cause celebre for this thread.

But I totally agree with you on your views regarding personal responsibilty and lifestyle choices as they relate to diseases caused by smoking, overeating, and drug use. It's just that it's hypocritical to separate drug-use mediated phsysiological processes from those that arise as a result of overconsumption of tobacco, alcohol, or red meat.

[Woodman]

You don't seem to follow.

Once it is classified, legislatively, as a "disease", it qualifies for federal funding.

Nevermind webster's or oxford definition. This is all about MONEY!

If drug addiction is caused by "disease" (as defined in legislation), then the victim can qualify to receive disability money from the government on that basis.

Again, I am all for recovery programs, but drug addicts clearly do not suffer under the burden "disability" when they have a choice to either use, diminish use, or abandon drug use altogether.

IMO, it's just a bunch of fucking users taking money away from the people who REALLY need it.

[Felonious Skunk]

What I don't follow is that people have been receiving disability for lifestyle-related diseases even since they started handing out the checks.

Why should drug addicts be singled out amongst the whole lot of obese, chain-smoking alcoholics who don't take their insulin?

I also don't understand why you think there's a direct link between disability payouts and research into genetic diseases.

If you think that society doesn't spend enough on such things, it would be better to examine why 95% of the nation's wealth is in the hands of 5% of its citizens, because you will undoubtedly find some of those in the 5% group making some fat dough off of the "drug war."

As I mentioned above, society would do better to halt this "drug war," cease making payments to the parasites that feed off of it, and instead use the money to not only treat drug addicts, but also use what's left over to further research into other health issues.

Please, if you find this line of thinking to be absurd, try one more time to enlighten me. Dude, teach me...

[Broshious]

Originally Posted by Felonious Skunk

What I don't follow is that people have been receiving disability for lifestyle-related diseases even since they started handing out the checks.

Why should drug addicts be singled out amongst the whole lot of obese, chain-smoking alcoholics who don't take their insulin?

I also don't understand why you think there's a direct link between disability payouts and research into genetic diseases.

If you think that society doesn't spend enough on such things, it would be better to examine why 95% of the nation's wealth is in the hands of 5% of its citizens, because you will undoubtedly find some of those in the 5% group making some fat dough off of the "drug war."

As I mentioned above, society would do better to halt this "drug war," cease making payments to the parasites that feed off of it, and instead use the money to not only treat drug addicts, but also use what's left over to further research into other health issues.

Please, if you find this line of thinking to be absurd, try one more time to enlighten me. Dude, teach me...

I'll do my best to tell you what problems I have with it. First off I'm a Libertarian so I think we shouldn't be paying for anyone's medical treatment so that makes it a bit hard for me.

Secondly, I feel that there IS a difference between behavior caused diseases and classifying addiction as a disease. As far as I know stopping smoking won't cure the cancer while stopping drugs will lead to a reversal of the changes in your brain if not stopping all craving. Secondly it seems to me that one can get heart disease/cancer without ever having smoked a day in their life but I don't believe you can become addicted to something without having taken it first.

[Nagognog2]

Dogfood. The Bush Regime will pay the $$$ out to Christian groups to help the addicts. The taxpayers are funding state-ordained religion. It's a fucking scam. We should set up our own organizations to help those who seriously want to quit. Cut out the criminal element altogether.

[Beanfondler]

Heaps of money are already being thrown to improperly combat the drug problem. How would it be rational to object to classifying addiction for what it is and using a fraction of the drug war funds to treat the drug problem rather than fuel it?