Ask Dr. Bill

Dear Readers,
In January, I told you that I was going to discuss two important facets of the addiction process: its inheritability, which I have already discussed, and the science which shows that addiction is a medical disease which results in definite changes in the brain of its victims. A wide breach remains between the scientific facts and public perception about abuse/addiction to alcohol and other drugs.  Hopefully,these columns will help some of you to fill that void.

This gap in knowledge transfer of information from the scientists to the public is compounded by other factors unique to the field of alcohol and other drug abuse. Perhaps the worst factor blocking appropriate treatment is the tremendous stigma attached to being a drug user or, worse, an addict.  The most beneficent public view of  people addicted to alcohol or other drugs is that they are victims of their social situation.   A more common view is that addicts are "weak" or "bad" people who are unwilling to lead moral lives and to control their behavior and gratifications.   On the contrary, addiction is actually a chronic, relapsing illness, characterized by compulsive drug seeking and use.  ( Note:  When I write about "drugs" in this context, I  am including the licit drugs: alcohol as well as addictive prescription medications.)  The gulf in implications between the "bad person" view (learned) and the "chronic illness sufferer" view (disease) is tremendous.  Many people believe that addicted individuals do not even deserve treatment (e.g., hospital CEOs who don't want "those kind of people" as patients).  This prejudicial, moralistic branding of addicted individuals overlays all decisions that relate to drug use and drug users.

Another factor which can be a barrier to closing the gap between science and practice is that many drug abuse workers are former drug users who have had personal success with one particular treatment method and zealously defend a single approach, even in the face of contrary scientific evidence.  The Van Ost Institute avoids this by insisting that its professional staff be credentialed in the field and by requiring them to update their knowledge by  regular participation in professionally-led continuing education programs.  The fact remains, that there are many drug and alcohol treatment programs that have shown to be effective through clinical trials. So-called Moderation Management is not one of them and, therefore, the technique is not advocated by the Van Ost Institute.  Simply put, non-addicted people have no need to "manage" their usage....for  those who have been accurately diagnosed as being addicted to a certain substance, such as alcohol, to pick up again is far too risky.....abstinence is the only safe route for them...that one drink, that one snort or injection can soon add up to the many which can lead to death or injury to themselves or others.

Addiction to alcohol and other drugs has tremendous implications for the health of the general public.  Directly or indirectly, it is a major cause of violent deaths and injuries and is now recognized as a major cause of the spread of many serious infectious diseases, particularly AIDS, hepatitis, and tuberculosis.  The problem is complex and pervasive, yet present funding of the so-called "drug war" still concentrates on punitive measures with too little committed to  public health strategies such as sufficient financing for education, prevention, treatment and research.