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Joseph A. Califano Jr. Headshot

The Greatest Failure of the Medical and Public Health Professions

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The greatest and most costly failure of the medical profession and public health community is their failure to explain to the American people that addiction to alcohol and other drugs is a disease.

Against the scientific knowledge we now have, physicians' refusal to give alcohol- and other drug-addicted patients the same medical care and attention they provide individuals with other chronic illnesses like hypertension and diabetes is inconsistent with their Hippocratic oath to "prescribe regimen for the good of my patients...and never to do harm to anyone." The harm due to this long term failure of the medical profession and public health community is measured in untold lives lost and ruined and the incalculable human misery of families, friends and colleagues of alcoholics and drug addicts.

Why has this happened?

Twenty years ago, former First Lady Betty Ford said to me, "Joe, if our nation does nothing else, if we can only get the stigma off this disease, we will have accomplished a great deal."

At the time I didn't realize how prescient the former First Lady was. As many will remember, Betty Ford revealed her own addiction to mood altering prescription pills and alcohol in an effort to put an end to the stigma that clings to this disease.

Well, over these years I think we've made progress and become better informed about how drug and alcohol addiction causes and exacerbates just about every social problem the nation faces -- crime, health care costs, lousy public schools and besotted college campuses, domestic violence, child abuse, teen pregnancy, homelessness -- and developing effective prevention and treatment programs for the most vulnerable in our society, like high risk children and mothers on welfare. But we haven't peeled the stigma off this disease of addiction.

I now believe we won't be able to do that until the medical and public health professions accord addiction to alcohol and other drugs the respect they pay to other chronic illnesses. Addiction ranks as the nation's most prevalent ailment. Indeed, if ten percent of our people had the flu or measles, we'd all call it a monstrous epidemic and pull out all the stops to confront it. Yet that many people in our country -- some 30 million -- are likely addicted to alcohol, prescription and illegal drugs and steroids, and we ignore this elephantine epidemic.

Why?

Because so many Americans don't consider addiction to alcohol or illegal or prescription drugs a disease. They think it's just a personal indulgence or a moral failing that the addicted individual ought to be able to shed like a winter coat in warm weather.

Well, I hold the medical and public health professionals responsible for that gross misunderstanding and the havoc it wreaks.

Remember AIDS? Most Americans considered AIDS a social curse for homosexuals. Then the doctors and the public health pros mounted an all-fronts education campaign, and in just a few years Americans accepted the fact that AIDS was a serious disease -- and acted on that fact raising money for research and volunteering to help afflicted individuals.

Remember when smoking was a common practice everywhere? Well, it took a little longer, but the public health community organized a relentless education campaign and doctors urged their patients to quit -- and now all except the hard-core nicotine pushers like Altria (nee Philip Morris) and Brown and Williamson accept that nicotine addiction can be cured with pharmaceuticals and attentive physician care. And the smoker who once said, "Would you like a cigarette?", now asks, "Do you mind if I smoke?", and most people respond, "You bet I do!"

Well the time has come for physicians and public health professionals to say to the American people, "Addiction to alcohol and other drugs is a disease, and we are going to accord it the same medical attention we accord other chronic diseases." Setting that example in their own practices, the doctors will have the credibility needed to support a massive public health campaign to get our people to understand that addiction is indeed a disease and a preventable and treatable one.

It will take years, perhaps a generation as it did with smoking (I started the national anti-smoking campaign in 1978), but eventually as we curb this disease we will sharply reduce the consequential crime, health care costs and other social ills, shut down the huge market for illegal drugs that exists in our nation and spawns so much violence in other nations like Mexico, and save millions of lives and the related misery for the families and friends of those who suffer from the disease of addiction.

Joseph A. Califano, Jr., Founder and Chair of The National Center on Addiction and Substance Abuse at Columbia University, was Secretary of Health, Education, and Welfare in the Carter Administration.