Is Addiction a Brain Disease?

A bill introduced by Sen. Joe Biden (D-DE) that would define addiction as a brain disease is moving in the Senate. Treatment professionals, mainstream scientists, and recovery advocates see it as a good thing. There are some skeptics, though.
The bill, the Recognizing Addiction as a Disease Act of 2007 (S. 1011), would also change the name of the National Institute on Drug Abuse (NIDA) to the National Institute on Diseases of Addiction, and change the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health.
"Addiction is a neurobiological disease -- not a lifestyle choice -- and it's about time we start treating it as such," said Sen. Biden in a statement when he introduced this bill this spring. "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. This bill is a small but important step towards stripping away the social stigma surrounding the treatment of diseases of addiction," said Sen. Biden.
The measure is garnering bipartisan support. It passed out of the Senate Health, Education, Labor and Pensions (HELP) committee in June with the backing of Sen. Mike Enzi (R-WY), the ranking minority committee member. "Science shows us the addiction to alcohol or any other drug is a disease," Enzi said in a statement marking the vote. "While the initial decision to use drugs is a choice, there comes a time when continued use turns on the addiction switch in the brain. That time can vary depending on factors ranging from genetics to environment to type of drug and frequency of use. Because of that and the continued stereotypes and challenges that are often barriers to people with addiction issues seeking treatment I am proud to support this legislation. Although the names of the Institutes will change, their mission -- preventing and treating drug and alcohol addiction -- will remain the same."
The politicians are taking their cue from neurological researchers led by NIDA scientists who have been working for years to find the magic link between the brain and compulsive drug use. Dr. Nora Volkow, current head of NIDA, has been leading the charge, and Biden and Enzi could have been reading from her briefing book.
"Drug addiction is a brain disease," said Volkow in a typical NIDA news release. "Although initial drug use might be voluntary, once addiction develops this control is markedly disrupted. Imaging studies have shown specific abnormalities in the brains of some, but not all, addicted individuals. While scientific advancements in the understanding of addiction have occurred at unprecedented speed in recent years, unanswered questions remain that highlight the need for further research to better define the neurobiological processes involved in addiction."
Not surprisingly, the treatment and recovery communities, anxious to see the social climate shift to one of more support and less punishment for the addicted, support the legislation. "Recognizing addiction is the next step forward," said Daniel Guarnera, government relations liaison for the NAADAC -- The Association for Addiction Professionals. "NIDA and its scientists have demonstrated overwhelmingly that addiction is not a behavioral trait, but rather is caused by physiological changes to the body that make people want to use addictive substances. This bill allows the terminology to catch up with the science."
Although the bill does little more than make a congressional pronouncement and rename a couple of institutes, it is still an important step, said Guarnera. "Yes, it's symbolic, but that symbolism is hugely important, because language should reflect medical knowledge, and medical knowledge has demonstrated that drug abuse is a physical phenomenon."
"We utterly endorse this bill," said Pat Taylor, executive director of Faces and Voices of Recovery, a treatment and recovery advocacy umbrella organization. "I think it's a great idea to rename the agencies. People with drug and alcohol problems can and do recover from addiction. Calling them 'abusers' just stigmatizes them."
Taylor and her organization are actively supporting the bill, she said. "We've sent letters of endorsement for the bill," she said. "People blame people for their drug and alcohol problems, so this is an important issue for the recovery community. We need to rethink how we talk about this."
Is addiction in fact a brain disease? Some researchers think that's too simple. Scott Lilienfeld, a professor of psychology at Emory University told ABC News last week: "What I find troubling with the brain disease rhetoric is that it's grossly oversimplified, 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," Lilienfeld continued. "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."
Some mavericks go even further. "No, addiction is not a brain disease," said Dr. Jeffrey Schaler, a psychologist and professor in the Department of Justice, Law and Society at American University in Washington, DC, and author of "The Myth of Addiction." "Diseases are physical wounds, cellular abnormalities. Addiction is a behavior, something that a person does. Diseases are things a person has," he argued.
"You can't will away a real disease," Schaler continued. "But people will away behaviors they don't like all the time."
Others feel that the concept of addiction itself is too imprecise. "There is no clear conception of what people mean by the word 'addiction,' and there are numerous papers on this unsatisfactory concept," said Professor John Davies, head of the Center for Applied Social Psychology at the University of Strathclyde in Scotland, another prominent critic of the "addiction is a brain disease" model. Using drugs and 'addiction' are not synonymous," Davies continued, noting that many "fun drug users" become "addicts" as soon as they end up in court.
"Of course, people can and do get into an awful mess when they fail to manage their habit effectively," Davies concedes. "But look at the data. Harmful damaging drug use is heavily social-class related whereas drug use per se is less so. People give up the so-called 'disease' when their lives change, they get a new partner, a new job, a move of house."
Vietnam war veterans picked up opiate habits, but for the most part rapidly shed them upon returning home.These vets used chronically and were said to be addicted. What happened to their addictions?" "The feared epidemic did not materialize because the social factors that sustained heroin use in Vietnam had all but disappeared upon returning."
Davies sees the addiction label as having pernicious consequences for problem users as well. "It makes things far worse," he said. It makes people believe that the roots of their behavior are beyond their capacity to control, which is the last thing you need when you're trying to get someone to change their behavior."
"Those are political concerns, however, If 'disease' is a scientifically imprecise term for describing the set of conditions that are commonly known as 'addiction' -- and it seems to me that it probably is -- then Congress and NIDA probably shouldn't be using the term for that purpose. I'd be more comfortable with the bill if it used slightly different language." Still, he thinks it's probably a net positive. "I think the obvious message of the terminology shift would be to say that people with drug problems are not really criminals, and that's a good thing."
"Plus if addiction isn't a disease, there's still obviously some condition that some people have, physical for at least some of them, that makes it harder for them to make favorable choices," Borden added. "Otherwise I don't think there would be thousands of people risking arrest or overdose to inject themselves daily with heroin, or millions knowingly doing what they're doing to themselves with cigarette smoking. So I'm not sure that the imprecision in the term chosen for the discussion is such a big problem."
In principle, neither Congressional fiat, nor therapists' concerns over what the right message is to send to patients, nor advocates' concerns over what will ultimately lead to better policies, should take a second seat in this debate -- the question is fundamentally a scientific one, and a philosophical one. With Congress holding the purse strings for the bulk of addictions research in this country, however, Congress' choices now may indeed affect the language being used in the future for some time to come. And language can indeed have an impact in ways going beyond its initial purposes.
Source: Daily Dose 11th August 2007

Heroin's Child: A shocking image of a lost innocence

A COMATOSE heroin addict sprawls in a school doorway with a needle by his side - as his toddler daughter cuddles him in a pitiful bid to stay warm. Just 10ft away, the man's six month-old baby daughter cries hysterically with no cover on her pram. The shocking pictures illustrate the grim reality behind damning statistics that show 120,000 children are living with addict parents.
Children's charities last night described the images as "appalling and frightening" And Justice Minister Kenny MacAskill said: "This shows the extent of the problem that drugs cause in our communities. When a wee toddler is discovered in circumstances like that, it is just so shocking.
"It really does highlight the tragedy and misery that drugs like heroin can bring." The father was found by a businessman alerted by the baby's crying. He said the toddler - dressed in pink tracksuit bottoms, pink and white trainers and a white T-shirt - was sound asleep but the baby looked distressed. The father's shirt sleeves were rolled up to reveal heavilytattooed arms. Around him lay the paraphernalia of drugs - discarded needles and a soup spoon for cooking heroin.
On the left of the picture, on the school step, a syringe and empty wrapper are clearly visible.
We are not naming the man because to do so would identify the vulnerable toddler and baby girl still in his care. But he remains the girls' legal guardian and lives with them and his wife in a house in Clackmannanshire. He is on a fast-track rehabilitation programme for heroin abusers and receives prescription methadone. The 39-year-old has a long history of drug abuse and was jailed for five years in 1994 for a serious sex assault. He claims the "drug works" were not his but admitted he had been drinking heavily with friends who were injecting heroin. On the day, he had appeared in court on another matter. He said: "I was told my dad was going to hospital and I wanted to take the children because my father loves them.
"I went to the Spar and got a half bottle and I also had a half bottle of vodka in the house which I had had a few out of. Me and the older child sat on the grass then I think I crashed out. I'm sorry for what has happened."
The businessman who took the photos on his mobile phone said: "He was gone. He had been that way so long that the girl was also asleep cuddled into him and the baby in the pram was crying her lungs out. He was dead to the world in broad daylight with two vulnerable children in his care. There is a busy road just a few steps away. It beggars belief that this idiot could still be responsible for these girls. The school where he was found is a notorious shooting-up location for addicts. There are new needles appearing there all the time."
Children's charity leaders described the case as "extreme" but said similar scenes were frequent behind closed doors across Scotland. Tom Roberts, head of public affairs at Children 1st, said: "It does paint a graphic picture of Scotland in 2007. "It is an appalling and frightening image. Services for addicts need to identify where children may live with someone misusing substances and ensure plans are put in place to protect them. We know with the right support, parents can overcome their addiction and maintain relationships with their children. However, we also know that support services are over-stretched and not always available when needed."
Last week chief medical officer Harry Burns revealed at least 120,000 children in Scotland live in homes blighted by drug and alcohol abuse. He warned: "Services are unable to prevent severe harm to many children. The Aberlour charity believes the real number of exposed children could be as high as 160,000. That is more than one in 10 children in Scotland, or three pupils in every class of 30. Aberlour said: "Parental substance use can affect children in many ways. The stigma can lead to isolation and susceptibility to bullying. Children may fear the family being split up by social services and may try to protect it by becoming withdrawn socially and conceal the harm they are experiencing."
Roberts said: "Many children in these situations assume a role as carer to their parents and siblings. Of the 2288 children on the child protection register in Scotland in March 2006, 45 per cent of these were categorised as having been neglected. We remain concerned that alcohol or drug misuse has pervaded Scottish culture and that this acts as a barrier to real change. Helping parents to stop misusing drugs or alcohol is the best solution for children, the best solution for communities and the best solution for individuals themselves."
It is not only the children left in the street as their parents lie comatose who are at risk. Children left in bedrooms as their parents lie unconscious through drink downstairs are in as much danger. But sometimes it can be hard to find help. A report by Children 1st stated: "People often have to wait weeks or even months to get the help that they need. This is especially regrettable given that pregnancy or parenthood can often be the trigger to encourage someone to end their drug or alcohol misuse." In the Central Scotland case, both girls are still at home with their father. This may appear to be a mistake by social services but they could also be at risk if put into public care. The report states: "The reality of our public care system is that it fails many of our young people, with outcomes such as low educational attainment, increased risk of drug use, mental illness, homelessness and offending, and a lack of identity and self-esteem. Before we can be confident of giving Scotland's most vulnerable children a safer, happier and more secure childhood, much more needs to be done to address the failings of our public care system."
Shown the pictures, Tory justice spokesman Bill Aitken said: "What an indictment of the society in which we live. These photographs are truly heart-rending." Labour justice spokeswoman Pauline McNeill said: "Sadly, there are cases like this and it will be shocking for people to read. We need more childcentred policies in government, we cannot tolerate this type of behaviour."
Clackmannanshire Council, who deal with the family, said: "Emergency duty social workers were involved in this case as soon as it came to light Social workers from Clackmannanshire Council's Child Care Service continue to be involved to ensure the future safety of the children."
This highlights the misery that heroin can bring It paints a graphic picture..an appalling and frightening image'
Source: Sunday Mail Nov. 25 2007

'Health disaster' fear as pupils turn to cocaine

Drug dealers are targeting schools and a "worrying number" of youngsters are trying cocaine, an expert warned yesterday. As a result, the country is heading for a health care disaster, Prof John Henry, the UK's leading expert on illicit drug use, told The Daily Telegraph. He predicted a dramatic rise in heart attacks, strokes and neurological problems among young people. He spoke as a new report said that almost one in five secondary school pupils in England, some as young as 11, took illegal drugs last year.
The number of children aged 11-15 dabbling in drugs was contributing to an increase in the number of adults addicted to Class A drugs such as cocaine, with massive knock-on costs for the NHS. Hospital admissions linked to illegal drugs have tripled in five years.
The report was published by The Information Centre for Health and Social Care, a Government-funded body. The number of pupils who told researchers that they had used drugs in the previous month had fallen slightly over a five-year period. But the report said that the numbers who took cocaine or ecstasy in the past year have not dropped and represent four per cent -- or around 140,000 children.
Around 17 per cent of pupils took some kind of illegal drug, rising to 29 per cent among 15-year-olds. Nearly one in five at secondary school were offered Class A drugs such as ecstasy, LSD, heroin, cocaine, crack, magic mushrooms, and amphetamines.
The report, which also looked at adult drug-taking in England and Wales, found that the number of cannabis users was down, from 10 per cent to eight per cent, but cocaine was the second most common drug.
Those taking Class A drugs rose in the past eight years from 2.7 per cent to 3.4 per cent, about 1.4 million adults, mainly due to an increase in cocaine use. Prof Susan Paterson, a toxicologist at Imperial College, London, who works with coroners on heroin deaths in the capital, said: "Ten years ago we hardly saw cocaine. Now it is commonplace."
Prof Henry said: "If dealers can find a new audience they will go for it. It is very brutal, very aggressive. "If you have a large number of people trying cocaine, you will have more people addicted." Cocaine usage had peaked in the US but was still on the rise here "which means the worst is yet to come, we're going to see more severe addiction, more strokes and heart attacks in young people, and more of the other complications linked to its usage".
There were 171 deaths from cocaine in 2005, up from 19 in 1996, but the professor said the figure was a gross underestimate because many cocaine users died of heart attacks and strokes. Prof Henry said: "We did research into people with chest pain and we found that about 30 per cent of people coming into hospital under 40 had taken cocaine." Cocaine use has been boosted because it has become more socially acceptable and the supply is more plentiful. A gram wrap costs as little as £45 and experts fear its use will soar until it reaches a peak, as it did in the 1990s in the US, where there are now 25 million users and two million addicts. According to the report, three per cent of pupils who said they had taken drugs in the past month were just 11 or 12 years old.
In 2006, 17 per cent of boys had taken drugs in the past year and 10 per cent in the past month. The figures for girls were 16 per cent and eight per cent respectively. Meanwhile, the numbers of adults in hospital where drug use is a factor has risen nearly threefold in 10 years to 38,364, while drug treatment centres are overwhelmed, with 181,390 drug users visiting them last year - up 13 per cent in 12 months. Some 8,200 pupils in 290 schools completed questionnaires last autumn for the survey.
Source: Daily Telegraph April 2007

Letter from GP to an MP in Australia

Mr. Alan Cadman,
Federal Member for Mitchell,
Your Ref.: 4th October 2007

Dear Mr. Cadman,
re: NDARC Output

Thank you for your considered and thought provoking letter of 4/10/07 which arrived today. In the middle of what is obviously a frantically busy time for you, I very much appreciate your taking the time and trouble to reply in person and in detail. Thank you so much.

The output from NDARC @ UNSW can be easily measured and quantified. They are an academic research institute of PSYCHOLOGISTS whose business is simply publication. Their output may thus be easily determined by going to the NDARC home page and clicking on the link to publications. On the left are the are the various headings of the categories of papers they produce, namely reports (N=287), monographs (N=61), articles (877), books (355), resources (27), the centreline magazine (17), theses (21) and annual reports (6), a total of 1651 pieces (tabulated below).

However of far more importance is to ask “What do they all mean?” Remember that these are psychologists. They are not basic scientists or biologists, so they cannot explore much at all, will never discover a new cell pathway, or a new molecule which we can treat with a drug to make addiction better in some way. Not only will they never achieve this, as their qualifications are not in the basic sciences they do not even understand the journals which are working in these areas. And in the areas where they should have alerted the nation to the link say between cannabis and mental ill health they have deliberately misled the country since their inception. This is explained by the fact that the institute is the brain child of Dr. Alex Wodak, who as we know only too well has left nobody in any doubt as to where his sympathies lie in the drug debate.

Two recent case studies from NDARC are worth noting. The foundation director is Prof. Wayne Hall. When he realized that the epidemiological and basic neurosciences studies were strongly implicating cannabis in mental health – he had to leave not only his position at NDARC and UNSW, but even left the state, and has come to Queensland! Having been the front man for the legalization push for “weed” in NSW he has now published several papers in reputable journals on its dangers! To me this shouts as loudly as possible that the truth on addiction will not be tolerated in Sydney. As our nation’s leading city this is a clarion trumpet wake up call to all parents concerned about the obvious unravelling of youth culture. The second classic example is A/Prof Louise Degenhardt who I am now advised is a principal researcher on three NHMRC grants, and whose PhD thesis is listed near the top of the NDARC Theses page as being on cannabis and mental health. She has authored a number of papers on this subject. She has steadfastly covered up the true associations throughout her career – but has been honoured by at least three grants!

Mr Cadman, may I reiterate my urgent plea, in as strong terms as I may, that this nation can no longer afford to continue without basic sciences research in the addictions field. As I have mentioned to the FHS committee chaired so enviably by Mrs. Bishop, the dishevelled appearance of most addicts is legendary, and bespeaks an acceleration of the ageing process from which we might learn a great deal, which is directly applicable not only to other mental illnesses but also to the host of degenerative disorders to which an ageing society will increasingly become subject.

I should therefore be ever so grateful if you might please organize an URGENT appointment with the Honourable the Prime Minister so I can put my research proposal for a suite of studies along these lines to him, as per the document supplied to your committee and attested with distinction by several world leaders in these fields internationally.
Yours sincerely

Dr. A. Stuart Reece,
Visiting Scientist,
Senior Lecturer, Medical School, University of Queensland
Queensland Institute of Medical Research,
Brisbane, Queensland, Australia.

NDARC @ UNSW Academic Output as per publications website[1][1].

Journal Articles 877, Books 355, Reports 287, Monographs 61, Resource Sheets 27,
Theses 21, 'Centrelines' Magazine Issues l7. Total 1645

More help asked for cannabis addiction

UTRECHT –The use of cannabis remained stable between 2001 and 2005, but the number of requests for help with addiction to the substance rose 12 percent in 2005 alone. This has emerged from the annual report 2006 published by the National Drug Monitor on Tuesday.
The percentage of cocaine users also remained stable, while the number of users that reported to addiction treatment centres for help fell for the first time in years, by 2 percent. Cocaine use is significantly more prevalent among young people who frequent nightlife spots than in other segments of the population, the Monitor reported.
The number of ecstasy users also remained stable.
The number of consumers who used alcohol remained stable as well, though there are significant differences between age groups when it comes to heavy drinking. Men aged 18 to 24 drink the heaviest and are more likely to engage in binge drinking. The percentage of school students that start using alcohol at a young age increased between 1999 and 2003. Many of these children start drinking between the ages of 11 and
The number of 12-year-old who use alcohol decreased between 2003 and 2005 however. More and more young drinkers are drinking at home before going out (to save money). And binge drinking seems to be the rule rather than the exception in this group. Despite a legal ban on sales to under-16s young people have little trouble getting alcohol.
Of the 1.2 million problem drinkers only a small percentage turns to the addiction treatment services for help. In 2005 31 thousand people were treated for a drinking problem, up 5 percent from 2004.
Source: Expatica News. August 2007

Drug legalisation is playing Russian roulette

Willem Buiter's proposal on these pages last week for the European Union (and the world) to legalise all drugs, including heroin and cocaine, is a one-way ticket to destroying millions of children, increasing violent crime and pushing up healthcare costs.
Like most legalisation buffs, Professor Buiter suggests a regulated system where access to drugs would be prohibited for minors. Our experience with laws restricting access by children and adolescents to tobacco and alcohol makes it clear that keeping legal drugs away from minors would be an impossible dream. Teen smoking and drinking are at epidemic levels in the US and across much of the European continent. In Great Britain, keeping bars open has led to an explosion of drunkenness among teens so widespread that the government is likely to return to limited hours for pubs.
Today, the US has some 60m regular smokers, up to 20m alcoholics and alcohol abusers and about 6m illegal drug addicts. Experts such as Columbia University's Herbert Kleber believe that, with legalisation, the number of cocaine addicts alone could leapfrog beyond the number of alcoholics. The experience of European nations that have tried various shades of legalisation bears him out.
Switzerland's "Needle Park", touted as a way to restrict a few hundred heroin users to a small area, turned into a grotesque tourist attraction of 20,000 heroin addicts and junkies. It had to be closed before it infected the entire city of Zurich.
In the Netherlands, anyone over the age of 17 can drop into a marijuana "coffee shop" and pick types of marijuana just as they might choose flavours of ice-cream. As crime and the availability of drugs rose, and complaints from angry residents about the decline in their quality of life multiplied, the Dutch parliament trimmed back the number of marijuana shops in Amsterdam and the amount that can be sold to an individual.
Under decriminalisation in Italy, possession of a few doses of drugs such as heroin has generally been exempt from criminal sanction. Today, Italy has about 200,000 addicts, the highest rate of heroin addiction in Europe. Most Aids cases in Italy are attributable to drug use. England's foray into allowing any doctor to prescribe heroin was curbed as heroin use increased. Professor Buiter would have legalisation occur across all of Europe so there are no countries that are enclaves of drug use. In other words, if you like what's happened in Switzerland, the Netherlands and Italy, you'll love legalisation across the European Union.
Easy availability of drugs will increase criminal activity. Most violent crimes, such as murders, assaults and rapes, occur when the perpetrator is high or drunk, and much of property crime involves people seeking money to buy drugs. In the US, half the beds in most hospitals are filled with people sick or injured as a result of drug use, drinking and smoking.
Professor Buiter promotes "our cigarette manufacturers, [as] well-positioned to enter this trade" of selling heroin, cocaine, marijuana, methamphetamine and designer drugs such as ecstasy. Talk about letting the fox loose in the chicken coop! For decades the nicotine pushers like RJ Reynolds, Brown and Williamson, and Philip Morris have been hawking their wares to kids. Twenty years ago the cigarette company Reynolds Tobacco (RJR) created a cartoon character called Joe Camel and so heavily promoted him that more children recognised him than Walt Disney's Mickey Mouse.
Only after years of complaints from public health advocates and parents, and the threat of legal action by the Federal Trade Commission, did RJR shut down its Joe Camel campaign. RJR tried to push candy-flavoured cigarettes that mask the harshness of natural tobacco for young first-time users.
Does the world want to create a Philip Morris for weed? An RJR for cocaine? Do we want cigarette companies that by their own admission seek "replacement smokers" for those who die or quit smoking, seeking "replacement drug addicts" for those who shake their habit?
There is no basis to assume that cigarette companies will take a different approach when selling drugs. After all, these are the guys who continue to promote a product that, when used as intended, kills and maims millions of people across the world.
Professor Buiter touts taxes on the sale of illegal drugs as a great source of revenue for public purposes. This blithely ignores the history of tenacious opposition to tax increases that has marked the tobacco and alcohol companies. As a result, taxes collected on the sale of these products cover only a small fraction of the costs in healthcare and criminal justice attributable to smoking and drinking.
Legalisation assures greater availability, and availability is the mother of use. That poses a clear and present danger to our children. Research at the National Center on Addiction and Substance Abuse at Columbia University has found that an individual who gets to the age of 21 without smoking, using drugs or abusing alcohol is virtually certain never to do so. Every drug-dealer, cigarette manufacturer and spirits company knows this - and acts on it. Viewed from this perspective, substance abuse and addiction are diseases typically acquired during childhood and adolescence.
Today most kids do not use illicit drugs, but all of them, particularly the poorest, are vulnerable to abuse and addiction. Russian roulette is not a game anyone should play. Legalising drugs is not only playing Russian roulette with children, it is slipping a couple of extra bullets into the chamber.
Joseph Califano
Source: www.FT.com Aug.16th 2007