We received numerous letters from readers regarding 'The Recognizing Addiction as a Disease Act of 2007' sponsored by Sen. Joseph Biden (D-Del.) A representative sampling of the comments begins below, part 1 in a series.

I was gratified when I read the headline that stated, "Biden wants to clarify the language and call addiction a brain disease." I was let down when I read further (I am paraphrasing) and read that an addiction professional thought that language was an oversimplification. 

I am an addiction professional and I am a person in recovery. I hold close to the AMA declaring addiction as a disease many years ago. It meets all criteria.  It is predictable, it is treatable, it is chronic, it is primary and it is terminal. 

When people with this disease are taught that they have a treatable disease, they can respond in such a way that is more easily understood. 

I specialize in helping people with the disease of opiate addiction. I agree very strongly with the importance of language. A large part of maintenance therapy, whether buprenorphine or methadone, is urine treating. Unfortunately, even many clinicians today still use language that is harmful. A person that has a urine sample that tests positive for cocaine, is called "a dirty urine." How can you make urine dirty? The list goes on and on. 

People who are treated for this disease, even in a hospital environment, are not treated like the "normal" hospital patients. Why? Perhaps if attitudes would change, the recovery rate would be higher. 

Those of us working in the field must truly "Join Together" and keep treatment moving forward. Accepting new innovation and ideas is key to better outcomes. Years ago, Dr. Alan Leshner and his "famous brain slides" made it obvious that addiction is a brain disease. How come there are those among us, calling ourselves treatment professionals, who still debate the findings of good science?

Barry Schecter
Owego, New York

While it may be an over-simplification to call addiction a brain disease, Scott Lilienfeld's reference to rhetoric overlooks the fact that the term "substance abuse" is also a gross oversimplification. The reality is that many complex topics and concepts become accessible to people only through simplification. Choosing thoughtfully which simplified message we send is important. Changing our terminology to promote a societal understanding of addiction as a disease is a constructive step. 

Rebecca Ruggles
Baltimore, Maryland

Addiction is a primary, chronic and treatable disease, characterized by impaired control over the use of a psychoactive substance and behavior. Addiction affects people along neurological, physiological, psychological, sociological and spiritual aspects. Diseases such as cancer, AIDS, and diabetes change peoples' brains, bodies, relationships, behavior, and spirituality ... Pharmacology and brain changes are more powerful than volition. Treatment would be inane and morally reprehensible to focus upon any one of these and ignore the other factors -- as all addiction clinicians know.

I agree [that we should] remove "abuse" from NIDA and NIAAA and replace it. David Gastfriend's comment, "Eliminating the word 'abuse' takes away the notion that it's willful misconduct" reveals that vexing paradox: addicted people lose rational, conscious, and moral choice ("free" will), yet they are accountable for their choices.

We should join the disease vs. disorder debate; it's interesting the legislation calls for renaming the National Institute on Drug Abuse as the "National Institute on Diseases of Addiction," and the National Institute on Alcohol Abuse and Alcoholism as the "National Institute on Alcohol Disorders and Health. Why do they not agree on a disease or disorder?

Peter Venable
Winston-Salem, North Carolina

"Abuse" is pejorative and hardly supports a person entering the treatment and recovery process. It tends to perpetuate the stigma.

I totally agree with and commend Senator Biden for his legislation … I totally agree that addiction is a neurobiological disease, but it's much more than that.  It is also psychological, social, cultural, and spiritual in its development and probably its etiology. To be effectively treated, a holistic approach is essential … To speak of addiction solely as a "neurobiological or a brain disease" is too limiting in its definition, diagnosis, and hence its treatment.  

In February 2007 we changed the name of our … ministry from Substance Abuse Ministry to Substance Addiction Ministry (SAM). I am hopeful that this name change will make SAM more inviting to those whom we serve.

Erik A. Vagenius
Palm Beach, Florida

I have researched and lectured on the disease concept of addiction for many years. Addiction is a bio-psycho-social-spiritual disorder, which for the sake of its complexity may be more qualified as a disease than most other ailments. Its symptoms cross all four of the aforementioned domains, creating progressive impairment and, if unchecked, leading to an untimely death.

Adhering to the belief that the simplest explanation is often the best, I offer that the simplest definition for disease is an absence of health. I further contend that health can reasonably be separated into at least four basic domains, which include biological, psychological, social, and spiritual.

The simple question arises, "Can addiction create deficits in theses areas of health?" You don't have to be formerly afflicted, as I am, to see that none of these domains of health is impervious to the effects of addiction. With the devastation to health in all of its forms being as comprehensive as it is with addiction, can there be any reasonable refutation of the disease concept? It is not merely "addiction," but "disease" as well, that needs a campaign of new thinking and terminology.

I am aware of the perception that the disease label somehow absolves a person of responsibility regarding the loss of control over the consumption of substances. I traveled through this territory on my way to a more progressive viewpoint. At the first 12-step meeting I attended, a person approached me during a break and said, "You aren't immoral and you aren't crazy, you have a disease." I imagine my face showed disagreement because that is what I was feeling. For the first time in my life I was in enough pain to accept responsibility for my situation and I wasn't looking for someone to give me an excuse.

The next thing this person said was, "Now that you know that, it is also important to realize that only you can keep this disease in remission." That was the opening of the door to my acceptance of the disease concept.

It is perhaps short-sighted to call this a brain disease, but it is that, among other things. What we currently know about addiction should be levied against what we currently know about the insurance industry's policy of denying treatment to maximize the corporate bottom line. This opens the door to understanding the efforts to minimize the disease concept. 

Don Fultz
Oroville, California

Senator Biden's proposal to use the words 'Diseases' and 'Disorders' in the names of these institutes is a step in the right direction. Language does matter.

However, I strongly agree with Professor Lilienfeld of Emory University that the problem is incredibly complex, as he says, and should not be oversimplified or boiled down to any one level, such as brain disease.

Arthur Kilduff
New York, New York