The tragedy of Whitney Houston's early passing has once again ignited the public's appetite for salacious television and print stories depicting celebrities "out of control." Unfortunately, this thirst for the sensational displays a profound misunderstanding of the disease of addiction and adds to the stigma attached to the disease already hidden behind a curtain of silence and a wealth of misunderstanding.
For all of the celebrities -- think Amy Winehouse, Heath Ledger, Jimi Hendrix, Janice Joplin, Elvis Presley -- who have suffered from addiction and are immortalized after death, there are tens of thousands of ordinary Americans who die each year from the same disease and who will never become icons grieved by millions worldwide. Yet their deaths bring the same shock and despair to their families and communities.
Today approximately 16 percent of the U.S. population meets medical criteria for addiction to alcohol, nicotine, prescription or illicit drugs. This is the largest preventable, most costly public health problem we face as a nation.
Approximately 30 percent of our health care spending is driven by this disease. Across all government spending, the total financial cost is nearly $500 billion annually. And the human misery is incalculable.
It is long past time for public understanding of the disease of addiction to catch up with the science of this illness. Here's just a bit of what we now know:
Advances in neuroscience clearly demonstrate that addiction is a complex brain disease with significant behavioral characteristics. If untreated, it can become a chronic and relapsing condition that all too frequently ends tragically.
All addictive substances -- tobacco, alcohol, marijuana, opioids, stimulants, central nervous system depressants -- affect our brains.
More than 90 percent of Americans who meet the medical criteria for addiction started smoking, drinking, or using other drugs before age 18. Because the teen brain is still developing, addictive substances physically alter its structure and function faster and more intensely than in adults, interfering with brain development, further impairing judgment and heightening the risk of addiction.
Certain individuals have personal characteristics or life circumstances that place them at even greater risk, including those with a genetic predisposition or a family history of addiction, those who have experienced abuse, neglect or other forms of trauma, and those with other mental health or behavioral conditions.
Culture, broadly defined, can increase the risk that individuals will use addictive substances. A wide range of social influences subtly condone or more overtly encourage use, including acceptance of substance misuse by peers, parents and communities; pervasive advertising of legally available products; media portrayals of substance use as benign or glamorous, fun and relaxing; and easy access to addictive substances.
Yet even with all of this knowledge, addiction can be prevented, treated and managed effectively. But, as with other diseases, no one approach will work for all. New research results are enabling medical providers to tailor both pharmaceutical and behavior treatments according to the age, gender, disease severity, co-occurring conditions and the social and cultural circumstances of the affected individual. As with treatment for other diseases, this tailoring is critical to treatment success.
Although our scientific understanding of this disease has evolved, public attitudes and health care practice have not kept pace with this understanding. The time has come to stop regarding addiction as a character flaw -- a personal and moral failing -- and to provide the treatment people suffering from the disease deserve, including long-term management for those with the chronic form of the disease, just as we do for hypertension or diabetes or cancer.
Why would we not do so? Imagine saying to a cancer patient: "We'll give you one course of treatment and if your cancer is not gone forever it's your fault." How many more of us must die before we strip the shame from the disease of addiction and properly respond to it as a debilitating and life-threatening medical problem?
Jeffrey B. Lane is Chairman of the Board at The National Center on Addiction and Substance Abuse at Columbia University.
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