It’s been more than 100 years since Congress passed the Harrison Tax Act starting the process of changing society’s view of addiction from chronic disease of deficiency to willful anti-social act. In that 100 years we’ve come full circle to the point where modern neuroscience has confirmed the view taken by 19th century physicians, that addiction is a chronic, and still, incurable illness different from voluntary abuse of substances. The evidence shows that more of the variance of who becomes addicted has to do with genetics than choice of drug and that the illness can exist even when no “drug” is used. Still, however, society and the law treat addiction and substance abuse as the same thing.
I have a hard time imagining a topic that is more likely to be agreed to in a bipartisan, tripartisan, or omnipartisan way than the need to recognized and treat addiction. Yet, no matter what political party is in power, there seems to be a collective mental block to seeing it for the disease it is. From the stand point of a party that wanted to fix societal ills with government power, it’s a no brainer to diagnose and treat addiction as it contributes or causes the top three or four causes of death in the country. From the stand point of a party that wanted to limit government spending, it’s a no brainer because there’s more waste and non-productive societal cost from addiction than nearly any other single cause and every dollar spent treating addiction saves about $7 in costs to the larger community. Even for a party that puts individual liberty first as the highest goal, it’s a no brainer as treatment returns personal liberty to a person who has been enslaved by the illness. So why is it that this no brainer idea never gets accomplished?
The largest single reason I see is that we were all raised to believe addiction and substance abuse are the same thing. We were all raised to believe that people with addiction are normal people who chose to start using something, like it, and start misusing it, and selfishly continue to do so even past the point of hurting others and themselves. While there probably are people with addiction who were normal to start with, it’s not my experience that they represent the majority of the people with the illness. I’ve written on this topic so much that to try to show you the evidence here, yet again, would be beside the point.
The point today is that I just finished reading a list of proposed laws for this up coming legislative session in my state, Louisiana. Remember that all these bills are being proposed by educated representatives of the people. And yet, in spite of their education, or because of it, most of these bills seem to continue to be based on the identity of addiction and substance abuse. There seems to be no recognition that addiction is a brain illness that creates symptoms, and that it is those symptoms that lead the person to the characteristic seeking of reward. (Please see ASAM’s definition of addiction at asam.org) Rather, addiction seems to be seen as having been caused by the drug use, and so all the attention falls to the use and the behavior. I wonder how much longer we’ll continue to try to punish away behavioral result of this illness, jailing its victims, and being addicted ourselves to an increasingly non-functional solution to our most expensive problem.
© Howard C Wetsman MD FASAM