Dear Dr. Bill,

In your columns you keep referring to addiction as a "disease." Can't this be used by addicts as an excuse to avoid responsibility for social misbehavior? Sort of like, " I can't help it because I'm sick?" Also, if our area's medical staffs and hospital administrators agree with you that addiction is a disease, wouldn't there be some responsibility for each to provide for the treatment of addicts? According to the yellow pages, in Bergen County, only the Pines and Hackensack have programs.....why?

Bewildered- Englewood

Dear Bewildered,

As for the second question, the answers are: "if you don't understand something, think of money! And "prejudice." Managed "care" or, more accurately, managed "cost" has resulted in a money squeeze at all hospital, but, especially, those which, in spite of reimbursement rates for addiction and mental illnesses being less than half that for other medical conditions, continue to recognize their responsibility to provide necessary treatment for these patients. Some time ago, I was medical director and administrator of a highly effective in-hospital detox and intervention program. Hundreds were steered to the path of recovery from addiction..but, no more..... the money crunch and prejudice against " those kind of people" won out.

As for your first question: identifying addiction as a brain disease in no way provides an"excuse" but it does offer a scientific "reason" for certain behaviors exhibited by addicts/ Once we are able to reduce the gigantic lag between scientific advances and the general understanding of the addiction process, attitudes may finally change enough to convince the public, the medical community, hospital CEOs and the insurance industry that addiction is a disease, the treatment for which should be as fully funded as that of any other medical condition.

Using as my primary resource the lead article by Alan. I. Leshner, Director of the National Institute on Drug Abuse in the Jan/Feb 1998 issue of ASAM News (the newsletter of The American Society of Addiction Medicine), in my next two or three columns I;, going to try to explain how, by recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug-seeking and use can impact society's overall health and social policy strategies and help to diminish the health and social costs associated with alcohol and other drug abuse an addiction.

The good news is that there have been dramatic advances over the past two decades in both the neuro and behavioral sciences which have revolutionized our understanding of drug abuse and addiction. Scientists have identified neural circuits that include the actions of every known drug abuse and they have specifies common pathways that are affected by almost all such drugs. Researchers have also identified and cloned the major receptors for virtually every abusable drug.

These identified receptors are cellular entities which act as intermediaries between the addictive drugs acting on nervous tissue and the physiological or pharmacological response. They have also been able describe in detail many of the biochemical responses within these cells that flow receptor activation by drugs. Research ha also begun to reveal major differences between the brains of addicted and non-addicted individuals and to indicate some common elements of addiction, regardless of the substance.

Again, I am confident that further research will add further evidence to my steadfast contention that victims of addictive illnesses deserve the same level of treatment support as do those with other medical conditions. That's the good news....next week, in this continuing series, I'll tell you some of the bad news.