Addiction Is a Disease and Needs to Be Treated as Such - NYTimes

3/12/2016 Addiction Is a Disease and Needs to Be Treated as Such NYTimes.com
http://www.nytimes.com/roomfordebate/2014/02/10/whatisaddiction/addictionisadiseaseandneedstobetreatedassuch 3/12
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Addiction Is a Disease and Needs to Be Treated as Such
David Sack, a psychiatrist, is chief executive of Elements Behavioral Health.
Updated February 11, 2014, 11:59 AM
Addiction has three main characteristics that cause it to be considered a disease. First, it has a lifelong course characterized by frequent relapses, cross addiction and
a common set of behavioral changes. Second, like other chronic medical disorders, genetics plays an important role is determining who is at risk to become addicted.
Finally, there are effective medications that treat drug addiction by blocking the rewarding effects of drugs and decreasing drug cravings. Let’s examine each of
these.
Research has shown that it has the properties of other medical disorders, including genetic links and a susceptibility to medication.
A recent study of heroin addicts found that at the end of one year, approximately 50 percent remained in treatment and more than 80 percent had used heroin
regardless of the type of treatment they received. By the end of three years, only 8 percent were continuously abstinent. Although outcomes for heroin are somewhat
worse than for other drugs, a large proportion of addicts continue to use in the years following treatment regardless of the particular drug involved. These outcomes
are not dissimilar to those observed in Type II diabetes, hypertension or asthma, where only a minority of patients achieve clinical control after extensive treatment.
In many individuals the risk to addiction appears to transcend the particular drug involved. Data shows that anyone who has been addicted to drugs has many times
the risk of becoming addicted to alcohol, and similarly, anyone who has been dependent on alcohol has a much higher risk of becoming addicted to another drug.
One interpretation of these observations is that once a person has become addicted to drugs, the changes that occur in the brainreward centers leave them vulnerable
to succumbing to a second addiction.
Numerous family and twin adoption studies have confirmed that genetics plays a powerful role in determining who is at risk to become addicted. The genetic risk for
the various drug addictions has been estimated to range from 40 percent to 60 percent for alcohol, and other common drugs of abuse. Genetic studies have been
interpreted to support the hypothesis that multiple genes contribute to this risk rather than a single recessive or dominant gene. Genetic variations in specific genes
offer an explanation of why some populations are so susceptible to alcoholism and others are not.
Over the last 25 years several medications have received F.D.A. approval to treat addictions. In most cases these medications work by blocking the rewarding effects
of addictive drugs or by decreasing drug cravings and other protracted withdrawal symptoms that occur after the drug abuse has stopped. Most recently, research
efforts have focused on developing vaccines to fight addiction. The vaccine that has moved closest to clinical approval is for the treatment of cocaine addiction. The
idea here is to use the body’s immune system to attack the drug and prevent it from reaching the brain.
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Topics: addiction, drugs
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Loriann Witte
California 19 August 2014
In my power as a human being and a clean addict, I forgive you and your past involvement in negative events. In the here and now it is right and just to make
amends then forgive yourself. People of our past may also be sick people, who are not ready to let the hurts go. You can be OK anyway. You do not have to wait for
others to give you their permission to recover. Know you have a Divine right to your pursuit of happiness. Wreckage of the past can be resolved with the use of the
12steps to set your heart free. https://www.facebook.com/AddictsDoRecover
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jean
New York 24 July 2014
Addiction is not a disease it is a maladaptive pattern of behaviors. A person with diabetes has low insulin production in cells or cells that don't use insulin properly.
In cancer cells mutate abnormally. In addiction there is no such physical disfunction. The brain scans that attempt to show abnormal functioning are not abnormal at
all. The normal brain changes from substance abuse. If you lock someone up with addiction it doesn't get worse without medical treatment. It stops from abstinence.
This is not the case with any other disease that requires medical treatment. This distinction is important because it shapes our treatment and public policy on
substance abuse.
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Greg
Ohio 24 December 2014
No, actually if you lock an addict up and do not treat them, it does get worse. That's why they have treatment programs in prison. That's why statistically those that
participate in the treatment programs have a higher chance of maintaining sobriety and living a healthy life than those that don't when they get out. If you take the
cancer cells away from a patient, they won't get cancer. Just like if you take drugs away from a person and lock them up, they won't be able to abuse them and cause
physical damage to their body. Still, with or without access to drugs the incarcerated person is an addict. And though cancer may go into remission, it can come
back. The problem with labeling addiction as a "disease" is that people tend to think it's an excuse for the addict. It's not an excuse. They must treat their disease as if
they have a cancer or perhaps diabetes. If the addict fails to take their medication, which should be counseling along with medication if needed, they will likely not
be able to control their disease. Just as a diabetic and a cancer patient will need to control their disease as well.
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Ben
Ohio 20 February 2015
Actually, in addicted individuals, the drugs trick the brain into thinking it's producing too much dopamine, so it stops dopamine production, to the effect that in order
to feel good the addict must take more of the drug. In diabetes there is an insulin deficiency, in addiction, there is a dopamine deficiency.
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Kaetlyn Hernandez
Lockport Township High School 23 April 2014
Formed through witnessing the effects of drug addiction, I agree with Mr. David Sack's opinions on addiction. In today's world, it has been made obvious that drug
addiction is a serious rising problem. Addiction is considered a disease because it is linked to the brain. It has been said that addiction is related to genetics and I also
agree with this statement. As stated above, there has been studies to prove the relationship. Drug addiction and addiction to legal products can not be compared due
to the fact that they do not have the same effects on the brain. Drug addiction is a result of a rapid release of dopamine. Once the receptors of dopamine are worn
away, there is no medical treatment to repair them. For this reason, drug addiction is lethal. This is why it is imperative that drug addiction is treated and responded
to as a disease.
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Bulgakov's Cat

Bean fields to the left, corn to the right 16 February 2014
Sack & ASAM paint a scientific façade about addiction/rehab to the public, yet treatment they usually sell to coerced "clients" are usually based on the sin
redemption model of AA. Per Marvin Seppala, 9 of 10 Hazelden clients are there under duress (courts, employers, family, etc.). Sack is involved with ASAM, which
advocates drug testing to spread an everextending dragnet to catch more "clients" for coerced "treatment." The DSM5 will help.Sack,Robert DuPont (exNIDA who
personally profits from his drug testing venture) et al wrote this paper:
http://www.asam.org/docs/defaultsource/publicypolicystatements/pdf....
Some quotes:
"Arbitrary limits on reimbursement and restrictions on drug testing can interfere with a physician’s judgment and instill discriminatory limits on addiction care."
"The consequences and costs of not doing drug testing, or doing inadequate testing, may be substantial, if indirect, as clinicians will forfeit potentially important
information about their patients’ health status."
Sack's Elements Behavioral Health partners with Promises, directed by Greg Skipper. Skipper, DuPont, and William L. White, all advocate for expanded testing and
work for and/or advocate for 12Step programs, which a reputable Cochrane study, as well as research by William R. Miller & Reid K. Hester, have found to be
comparatively ineffective. Yet it's a religious movement as well as industry, so those in the "Recovery Movement" are wellpaid for their devotion.
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AaronS
Florida 14 February 2014
I submit that we would have the same problem with crime if we made coffeeor Coca Colaillegal. There would spring up a black market. The cost of the product
would be much higher than normal, of course, so people would perhaps resort to unsavory things in order to acquire another "hit."
I think many people are just as addicted to TV shows, coffee, Coke, cigarettes, or what have you, as someone addicted to painkillers. The cigarette addict, however,
knowing that he can easily and freely get more cigarettes, functions just fine. Make them illegal, and he'll spend a far greater percentage of his time planning on how
to find or buy a cigarette.
Very simply, we don't even recognize that we are addicted to certain things. Why? Because we can easily get more. But make those things illegal, and suddenly, for
heaven's sake, we have the shakes! We are experiencing withdrawal symptoms! We can barely function at work! We start doing things we've never done before!
When painkillers are perfectly legal and easy to obtain, I have a feeling that much of the sorrow that comes from addiction will vanish. That person that sits around
strung out can now go back to work. Why? Because the worry had been taken away from them.
At least that's how I have seen it through my own dealings with painkillers. For ME (maybe not for everyone), they made me feel wonderful. But, to be fair, in six
months I might have not felt the same way. But who knows?
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Ray Deller
Vancouver Island Canada 14 February 2014
I am a mere lay person who spends a lot of time Volunteering for SMART Recovery as a meeting Facilitator. I have read many articles questioning weather
addiction is a "disease" or not, AA uses the "disease " model as do many other 12 step groups. I personally am undecided but one thing I do know is that we should
find another word to replace "disease", It is very self deeming for the addicted person to be told that they have a "disease" and reduces the amount of support an
addicted person may receive from friends and family because some of the people believe that because it called a "Disease" it might be catching just like the Flu!
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Claire S
Pittsburgh 13 February 2014
As someone who quit drinking 15 years ago following a 25 year addiction to alcohol, I'm well acquainted both with serious addiction and solid recovery both in
myself and othersand I submit that we will never agree on whether or not addiction is a disease until we agree on what we mean when we use the word "disease."
Do we mean a hijacked brain, which has lost its power of choice? A spiritual malady from which addicts only get a daily reprieve from God? A physical disease,
where the body of an addict processes alcohol or drugs differently from that of a "normal" person?
We must also think about the usefulness of the word in the lives of people who suffer from addiction. Is it helpful for us to think of ourselves as diseased? Are we
more or less likely to recover if we believe that that our addictive behaviors are essentially involuntary? What are the moral implications of insisting that individuals
wear the "addict" label permanently? Is it appropriate to insist on such labeling with some types of addictions (alcohol, drugs, sex, gambling) but not others
(smoking)?
I don't pretend to know the answers to these questions. I am only one person with only my own experience to share. But I can say that none of the definitions fit my
own experience of addiction and certainly not of recovery. If I was ever diseased, I certainly am not today: I'm healthy, happy and do not define myself in relation to
a problem I haven't had since the last century.
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AaronS
When I felt I HAD to have narcoticsfirst for pain, then, later, because I wanted to keep feeling a certain wayI used a considerable amount of my mental
bandwidth on thinking about the next pill(s). Vacations concerned me. Would I have enough while I was gone? When the pills got low, I was concerned. Would the
doctor give me more? I no longer needed them as badly as I had before, but I WANTED them!
Had I had to get my pills illegally, the issue would have been a 100 times more demanding. Now I would have to think of how to score another "hit," coupled with
the stress of dealing with unsavory characters, all on top of the stress of knowing I could be arrested, jailed, humiliated. Add to that the risk premium you pay for
illegal drugs.
If you are "addicted" to coffee, you apparently are able to still do you job. Or if you are addicted to exercise, you can still function in society. But we are told
wronglythat someone on narcotics cannot function. This is wrong. I know, because I went to work and occasionally had to take a pill for the enormous pain.
But if I'd had to plan a trip to the bad side of town, risk arrest, or being poisoned, etc., but illegal drugs, I would have been unable to function. But would have spent
most of my time working on plans for the next pill. READ THE STUDY about heroin addicts who were given heroin when needed. They began to come alive again,
because the were no longer being consumed with extensive planning for the next hit.
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Andy Greenberg
NYC 13 February 2014
I have real trouble with the "addiction is a disease" model because something drove that person to try such and such drug. The average person doesn't run into meth,
or heroin, or oxy, and they typically don't think of these drugs as the answer to their problems. Something was wrong prior poor selfesteem, anxiety seem the
usual and the drugs made it temporarily better. But that first try was a choice. A bad choice, granted, but a choice nonetheless.
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Andrew C
14 February 2014
I have to disagree at least as far as addiction to legal drugs, most alcoholics did not consume their first drink to try and escape from something that went wrong but
the effect on the reward center of the brain is much different. I feel this can be applied to painkillers and other drugs that may have initially been prescribed but once
the supply runs out addicts are pushed to find other means to attain a 'fix'
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RT
Boulder Co. 13 February 2014
It's never about the drug. It's about your pain. Until you deal with what is causing your pain, your only putting a bandaid on it. I drank hard for twenty years. I was
offered treatment at Hazelton but decided to dive into my pain first. I spent over 100 hours with a trusted psychologist over about 18 months. I have been sober for 9
years now with one lapse and have never been happier. My pain who cares. It's just a story now.
Physical addiction is the easier part of the equation. It's the emotional deep dive that needs to be made to come out the other side. Thanks JH. I owe you my life. My
path did not follow the norm ( by rejecting treatment) but it worked for me. Follow your pain. It will give you the road map out of your addiction.
In closing, I choose to stay sober for me. It's not for my wife, or baby girl. I'm the best me I've ever been. It took a long time to realize that there was nothing wrong
with me just the way I am.
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Marty K.
Conn. 13 February 2014
I am an alcoholic, and I have come to believe that anyone addicted to anything, is trying to escape from something, and until that is addressed, recovery is
impossible.
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Ray Deller
Vancouver Island Canada 14 February 2014

You are not an "Alcoholic" you are a person like me who has a problem with Alcohol. When we first started drinking we did it because we liked it, it was the thing
to do, we had to keep up with the crowd. Eventually we lost control and the Alcohol (Drugs or Activities) took over, and then came the problems, so we used more
to alleviate those problems. By changing our thinking (SMART Recovery) we can get into recovery and face the problems in a sober frame of mind. The important
thing to do is to loose the "Labels" Alcoholic, Drug Addict, Sex Addict etc. once we do that we are on our way to a better life and lifestyle. For Information I used
alcohol from the age of 12 to the time I was 69.
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Newbie
US 13 February 2014
Drug addiction that matters, is a physical symptom. A serious addict might as well be dead or ready for the struggle of their life everyday. 12 step programs are for
some people, most people it will never ever.
There are some drugs that don't even count. There are some that do.
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LordByron
Manhattan 13 February 2014
Obviously, someone in the medical community will continue to insist that this is a disease. But the hard truth of it is that addiction is a behavioral choice and what is
the initial motivation for such activities? Indulgence. It's a completely selfish act, and the true effects of drugs are long reaching and long lasting.
There's simply not enough time to properly explain why addiction continues to grow, it's better suited for someone with more time and more intelligence than
myself. But as our society and culture becomes increasingly selfentitled and selfabsorbed, you're likely to see such devastating behavior continue. The continuation
of the "me decade", the fad of selfanalysis during the 1960s psychiatric boom, the social media "selfies" generation of today all of these are culprits in why people
find the rationalization to get themselves wasted; and the romanticized aspect of the junkie struggling to overcome his/her "demons" is both juvenile and should be
retired. Get over yourself, and be the best individual you can be. Contribute to society, contribute to your community, be aware of the people around you. Calling
drug addiction a disease is enabling people to believe such a thing. Cerebal Palsy, AIDS, Cancer, MS these are diseases. And those people were not afflicted with
them because they wanted to shoot up. Sympathy should be accorded fairly to those who suffer unfairly. I do not find the plight of the addict unjust at least, not
towards the addict.
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peg delprete
albany 12 February 2014
ADDICTION, SOMETHING YOU HAVE NO CONTROL OVER. WHETHER IT BE ALCOHOL, DRUGS,EATING, GAMBLING, SHOPPING, YOU SIMPLY
CANNOT STOP. YOU HAVE CHOICES, AND YOU HAVE TO WANT TO STOP. YOU WANT THIS CHOICE FOR YOU, NOT STOPPING FOR
SOMEONE,SOMETHING, YOU HAVE TO WANT THIS CHANGE.
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Tuner38
Iowa 12 February 2014
I have an essay entitled "Its not addiction its choice" in my book "Thoughts and Commentary" available on Amazon. I have presented this thesis to college students
and after they have seen what rational versus irrational decision makings consists of they have overwhelmingly recognized addiction as simply a matter of making an
irrational choice.
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slposton
Los Angeles 13 February 2014
Turner38, your definition is missing an important component of addiction recognizing and being aware that you're making a bad choice but doing it anyway.

Addiction is mind fueled illness followed by a routine action. Neurologically speaking, an action potential has no perspective on rational/irrational, and the firing of
specific neurons is the root of what we call "behavior." In short, you're taking a moralistic POV, not a biological POV.
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AaronS
It should not be wrong to feel wonderful. During my time of legitimate need for narcotics, I believe that I would have been able to function very well in the
workplace (and did!), the home, etc. I purposely did not drive under the influence. Not because I thought I was incapable, but because of the chance that I might not
indeed react as fast as possible, I simply don't risk my family's life. As you can see, I was thinking perfectly logically then.
Consider that if we made coffee illegal tomorrow. There would be millions of criminals. Why? Well, because we "said" that coffee was illegal. I'm not convinced
that narcotics are the supposedly utter evil we think they are. What we seethe crime and painare almost always associate with the fact that we have "deemed"
narcotics illegal. Make them legal, and that person whose life revolves ONLY around this hit and the next one...will begin to function normally. Why? Because they
now know that they don't HAVE to think about that anymorethey will be able to get what they need when they need it. That will change everythingand it is the
dark key to understanding the addict's life, I think.
There will ALWAYS be abusers. Just as there are with cigarettes and alcohol. But you will unleash more people into actually living life...if you ensure they are not a
criminal for simply wanting to feel good, to feel better, to enjoy whatever it is that narcotics do for them.
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AaronS
I cannot say that I was addicted. Neither can I say that I was not. I was in utter agony at surgical complicationso much that the nurse station actually called my
room. It was Saturday. The doctor would have to be paged. All while I was in the worst agony of my life. When dilaudid was finally added to my IV, the pain was so
far ahead that I had to wait another four hours (for the next dose) to finally fall into an exhausted sleep.
But in that moment when the dilaudid hit for the first time, I had a moment of clarity. In that single moment, I understood why people would fall under the spell of
narcotics. I desperately needed it for physical pain. But I instinctively knew that there were many other kinds of pain that caused people to reach for someany!
relief. A dead child. A broken heart. An ongoing handicap. Depression. On an on.
For some months I was on hydrocodone and oxycodone. I truly needed it. But I also got to where I felt that I was "the best version of me" I'd ever been. I was
gentler, sweeter, more loving, more thankful. Perhaps I was experiencing what Native Americans experience with peyote. My prayers seemed so much more sincere.
And when it was finally over, the physical healing complete, I was utterly depressed that I would not longer get to be "the best version of me" any longer. I finally
got past it. But if I found a bottle of hydrocodone, I'm afraid that you'd find me gentler and more sincere than usual.
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Ron Mitchell
Dubin, CA 12 February 2014
Man is genetically predisposed to become addicted to various substances. For some, that first snort of cocaine is so powerful they spend the rest of their lives trying
to recreate that feeling. For others, there is nothing. For some it is marijuana for others it is tobacco. It is a crapshoot for every person about which substance will
trigger their addiction. Just as some people exposed to carcinogens do not develop cancer and others do, we can not be sure what will happen when we first
experience a mind altering substance.
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Bill Flynn
Chicago 12 February 2014
I have not read all the comments, but I have read many in an attempt to find one that agrees with me. So I think this is a little different. My own addiction(s) come
from my inability to deal with my feelings. Those unconscious bodily reactions that take place as I observe the outer world. I never learned how to deal with them as
a child, so I adopted distractive behavior to escape the need to deal with those feelings.
As an adult I realized alcohol was not my friend but my enemy. Coming from a recovering family I chose to stop before becoming an addict. I didn't know then,
however how to deal with my feelings and managed to find other forms of distraction. While none reached the habitual state, the truth of my life is that I was still
miserable, unable to move myself forward. I decided to enter recovery and after almost 30 years of working on myself and with others I have come to the conclusion
that I grew up in an alcoholic family who didn't know how to deal eith their feelings, thus couldn't teach me. I think this covers the genetic component. Maybe it's
DNA, maybe it's not, but I am still able to learn to take care of myself.
Yes it's spiritual, but not in the Western model of Creed and Creation but in the Eastern tradition of harmony and compassion. These are not laws, but states of being.

Addiction Is a Disease and Needs to Be Treated as Such - NYTimes

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