Biden Challenges Public Perception of Addiction

Sally Satel, a psychiatrist at the Oasis Clinic in Washington, D.C., doesn't question the science of addiction or the treatments offered. She does, however, worry about the public health message.

"I feel uncomfortable with calling it a brain disease. It's not a constructive public health message. Of course drugs affect the brain, otherwise why would people use them? I've never met a clinician who treats people like if they have a brain tumor. Not one treatment requires brain surgery," Satel said. "But that language can imply to the public that it's a hopeless situation, when, in fact, all treatments expect a person to take control of things themselves. All doctors expect people to martial their free will."

Scott Lilienfeld, professor of psychology at Emory University, also disapproves of the prevalent brain disease terminology.

"What I find troubling with the brain disease rhetoric is that it's grossly oversimplified," he said. "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. 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."

The best place to treat people is at the level of choices and behaviors, said Lilienfeld.

"For example, you get a new Microsoft Word, and there are a few bugs in it. What do you do? Ask the tech guy to rewire your computer? No. That won't make a difference if the problem is at the level of the programming. It's the wrong level of analysis."

Martin Iguchi, an adjunct senior behavioral scientist at the Drug Policy Research Center at Rand recognizes the importance of the issue. However, he is not convinced that Biden's legislation will achieve its objective.

"I'm not sure what the name change will do. Not sure that it will have more of an effect than continued advancement in treatment options and learning how the brain works," Iguchi said. "Most people don't know what NIDA and NIAA are. The science behind the name is much more important than the name change. It is continued hard work on the subject that will ultimately affect the public."

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