Dear Bewildered- Englewood,

This is Part II of a continuing series in an attempt to help you and other interested readers see how the recognition of addiction as a brain disorder can impact the misguided health and social policies which presently are doing relatively little to diminish the nation's health and social costs associated with alcohol and other drug abuse and addiction. I will continue to borrow heavily from an article by Dr. Alan Leshner, Director, National Institute on Drug Abuse in the newsletter of the American Society of Addiction Medicine, Vol. 13, No. 1, 1998).

Last week I briefly described the good news that more and more scientific facts support the conclusion that addiction is a brain disease...a disease which I know can be successfully treated. However, the bad news is that there is a wide breach between the scientific facts and public perceptions about drug abuse and addiction. Most people still see addiction and abuse as social problems requiring social solutions, particularly through the criminal justice system (jails, jails, jails) wile science is teaching what I am trying to bring to your attention in these columns....that addictions are as much health problems as they are social problems. There is no doubt that the inability to close this gap is a major reason to why America consistently retains the dubious honor of having more drug addiction than that found in any other country in the world. Par of this lad and resultant disconnection comes from a normal delay in transferring scientific knowledge into practice and policy.

This gap in knowledge transfer, however, 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, and addict. The most beneficent public view of drug addicts and alcoholics 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 and the "chronic illness sufferer" view is tremendous. Many people believe that addicted individuals do not even deserve treatment (e.g., the previously mentioned hospital CEO who doesn't want "those kind of people" as patients). This prejudicial moralistic brading 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 must 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. The Institute is one of them.

To quote Dr. Leshner, "These difficulties notwithstanding, I believe that we can and must bridge this information gap if we are going to make (any) real progress in controlling drug abuse and addiction. It is time to replace ideology with science." Boy, do I pray that I will see more of this happen during my lifetime!!