We received numerous letters regarding 'The Recognizing Addiction as a Disease Act of 2007' sponsored by Sen. Joseph Biden (D-Del.) Below is part two in the series.

The current debate regarding name changes of federal agencies dealing with addiction reflects the sad confusion of the various professions that deal with addicted people. Both sides of the debate have valid points and it seems to me that neither side is willing to carry on a disciplined and closely reasoned discussion of this issue.

Those who call addiction a disease mean that there is a physical component to addiction. This is certainly correct. Certain parts of the central nervous systems are involved and certain genetic structures appear to predispose people to addiction.

Those who say that addiction is not a disease do not disagree with any of that.  Their point is that addiction is not a disease in the same sense that diabetes, tuberculosis, and HIV are diseases.  With these and other disorders that medicine calls diseases, it is possible to identify a clear constellation of symptoms (a syndrome), a particular part of the body that is affected, and a definite cause of the disorder. 

That third requirement is the problem. Addiction, like all other behaviors, has many causes, not one, and not even a clearly delineated set of causes. Behavioral disorders have roots in family relationships, enduring thoughts and feelings, cultural and social influences, spirituality, and sheer force of habit. In other words, people who insist that addiction is not a disease are pushing the point that human beings cannot be reduced to physiology or neurology.

It is unfortunate that this debate has been framed as a moral issue versus a medical issue. It is clearly both. People have no choice about their genes and chemistry and fundamental brain structure. Those (relatively few) people who were addicted to alcohol, for instance, after only one drink had no choice about the ways their bodies and minds would react to alcohol. But once they are addicted, they do have some choices about how they are going to deal with their addiction. 

It would be a great pity if compassionate people, who wish to remove stigma and shame, actually add to the sufferings of addicted people by reducing them to helpless and amoral creatures.

W. David Holden
Boone, North Carolina

Try using "Brain Dysfunction Disorder." It is a disorder, and that covers all levels, no stigma, and addresses the disease concept. The World Health Organization is way ahead on this.

David R. Berry
Muskogee, Oklahoma

The time has come for us to reduce the stigma and promote recovery for [those who]suffer from addictive diseases. [Sen.] Biden's bill/new legislation calls for renaming the National Institute on Drug Abuse as the "National Institute on Diseases of Addiction." Perhaps National Institute on Addictive Diseases and Recovery would be more in keeping with the Presidents' New Freedom Initiative that is currently being adopted as a blue print for transformation to recovery. 

Along those same lines, the National Institute on Alcohol Abuse and Alcoholism as the "National AIcohol Recovery Institute" would focus primarily on the issue of alcohol treatment and recovery initiatives. 

Addiction is a neurobiological disease. Biden gets it. Congratulations.

Ron Pounds
Atlanta, Georgia

By debating the issue whether substance use disorders are a "brain disease" or not, we continue to miss the most important message. Should we stop describing obesity, heart conditions and diabetes by the word "disease" then? All of these conditions can be significantly impacted by the behavioral choices of the person with the condition.

Empowering our citizens to take responsibility for their health, while supporting and gently guiding those who are struggling, would be the most effective use of our time and energy. When health behaviors are approached in this way, it reduces stigma. There are very few, if any of us, who cannot relate to the challenge of changing our behavior. Reflect on our own efforts to change behavior...and empathic humility follows.

Cheryl Lynn Martin
Rochester, New York

Just because addiction does not require brain surgery doesn't mean that it isn't a brain disease. Not all people with heart disease require surgery either.

Sue Brooks
Houston, Texas

Biden's suggestion is a positive move in terms of destigmatizing the issue and moving us in the direction of treatment. It should help to end the "War on Drugs" mentality that has filled the jails without decreasing the problem.

On the other hand, Biden's rationale for the conceptual change goes too far in endorsing 'broken brain' language that oversimplifies a complex problem. This conceptual framework of 'brain disorders' has not served well in helping people with other mental disorders. It has led to the overemphasis on psychiatric medication and retreat from behavioral, psychological and spiritual interventions that need to be utilized along with medication to improve life function.

Hopefully Biden will succeed with the worthwhile part of his efforts (destigmatization and shifting the focus to treatment) and reconceptualize the rest to include the complex mix of factors that lead to recovery from this disease.

David Doreau
Waterville, Maine

It is about time. As a recovering addict and an addiction professional it is hard to watch individuals suffer rather than seek treatment because of the stigma associated with addiction. In addition, the money and attention that has continued to be diverted from researching and promoting effective treatments for this disease will no doubt be utilized in a more productive manner with these accompanying changes. How many lives were lost due to this stigma? Many people I have loved for sure. Fighting these changes would only be out of a selfish need to keep in place traditions that have hindered rather than helped the people they were founded and funded to help.

Affirming that addiction is a disease will hopefully help to eliminate the notion that suffering must be part of the road to recovery and that if one can not bare to commit to a life-long process of suffering that they are some how weaker then those who have.

I am honored to live in these times and am glad to see the world finally coming to this realization. Perhaps this will help ease the hearts and pain of those who never could understand why their loved one didn't love them enough to stop.

Tia R. Potts
Los Angeles, California