Biden Challenges Public Perception of Addiction

Joe Biden wants name change for addiction centers. Some doctors disagree.

January 8, 2009, 1:07 AM

Aug. 3, 2007 — -- As starlets head in and out of rehab, everyone from gossip columnists to housewives are voicing their opinions on what defines addiction. Now, even politicians are weighing in on the debate.

Sen. Joe Biden, D-Del., is introducing legislation that portrays addiction as a preventable, treatable brain disease.

"Addiction is a neurobiological disease -- not a lifestyle choice -- and it's about time we start treating it as such," Biden said in a statement. "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."

Under the Recognizing Addiction as a Disease Act of 2007, which Biden sponsored, the National Institute on Drug Abuse will become the National Institute on Diseases of Addiction, and the National Institute on Alcohol Abuse and Alcoholism will become the National Institute on Alcohol Disorders and Health.

The debate over whether addiction is a brain disease or a moral failing is not new to the scientific or medical community. Most would agree that addiction is in fact a brain disease.

However, many are concerned that society continues to unfairly stigmatize those affected, thus rendering them unwilling to seek the treatment they need. They view Biden's legislation as an important step toward educating the public.

"In sum, we believe that language matters. We believe these seemingly small changes represent a large step in the right direction as we work together to chip away at the misconceptions -- and discrimination -- associated with addiction," explained Lewis Gallant, executive director of the National Association of State Alcohol and Drug Abuse Directors, in a letter of support addressed to the HELP Committee.

David Gastfriend, vice president for medical affairs at Alkermes, agrees.

"Name change will make people more aware. We're in a new era of understanding and treatment. It begins the process of extending effective treatment to everyone who needs it," Gastfriend said. "Eliminating word abuse takes away the notion that it's willful misconduct. It's inappropriate to term this 'abuse.' Ten percent of [the] population [are] unknowingly vulnerable to alcoholism when they drink. They can't be held to be immoral for developing that illness."

Supporters of the bill hope it will more accurately reflect the modern face of addiction.

"People think of an addict as a bum or a homeless person," said Cynthia Moreno, executive director of the Association for Addiction Professionals. "Over 70 percent of drug addicts hold down very responsible jobs, have homes, and 2.3 children. They're your average person. The image of drug addict as a bum prevents people like that from seeking treatment because of the stigma attached."

According to the Substance Abuse and Mental Health Services Administration's latest figures, 23.2 million Americans are affected by addiction, but only about 10 percent receive appropriate treatment.

Despite strong support for the bill, its critics say a public message that characterizes addiction as a brain disease could cause more harm than good.

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."