Volume 11, Number 2
Bridging the "Great Disconnect"
By Dr. Alan I. Leshner, NIDA Director
As I talk with people - health professionals, legislators and policymakers, and the general public - I am struck by what we have come to call the "great disconnect," the large gap between the public's perception of drug abuse and addiction and the scientific facts. I believe that if we are to make real progress against this public health problem, we must bridge this great disconnect.
NIDA's goal is to increase the public's understanding of drug abuse and addiction. We need to take every opportunity to make the public aware of the research we have gathered over more than 25 years, which provides unequivocal evidence that drug addiction is a chronic, relapsing, and treatable illness. I am constantly amazed that despite this phenomenal scientific base, the public's views of drug abuse and addiction are often based on myths and long-held mistaken beliefs. Our challenge then is to find ways to use scientific evidence to clear up these widely held misconceptions.
Through the years, many people have come to view drug abuse and addiction as strictly a social problem. They tend to characterize people who take drugs as morally weak or as having criminal tendencies. They believe that drug abusers and addicts should be able to stop taking drugs but are unwilling to change their behavior. These myths have fueled the great stigma that drug abuse and addiction have historically carried. This stigma affects not only those afflicted with drug-related problems, but their families, their communities, and the health care professionals who work with them.
Unfortunately, the repercussions from this type of thinking go further. Even though drug use is a widespread problem and is increasing among our youth, people question the need for treatment. Instead, the public would prefer to see tax dollars being used to build new jails rather than funding more drug abuse research, prevention, and treatment. But we in the health community know that incarceration without treatment and followup only continues the cycle of despair and does nothing to help the drug abuser return to a healthy, productive life.
Addiction does begin with drug abuse, when an individual makes a conscious choice to use drugs. And this is a preventable behavior. Results from NIDA-funded prevention research have shown that comprehensive prevention programs that involve the family, schools, communities, and the media are effective in reducing drug abuse. NIDA has launched a number of multifaceted public information programs to talk about drug abuse and how to prevent it. For example, NIDA is taking the lead role in the Department of Health and Human Services' Marijuana Use Prevention Initiative, providing scientifically based messages about the dangers of marijuana use to the public and, especially, the Nation's school systems. We need to keep sending the message that it is better not to start at all than to have to pick up the pieces of a shattered life if addiction occurs.
Unfortunately, some individuals will not heed this warning and will choose to abuse drugs. And, at some point, fundamental changes occur in the brains of drug abusers that turn drug abuse into addiction, a disease state that, at present, has no cure. Addiction is not simply a lot of drug use; it is a disease of the brain that is expressed through behavior and influenced by the social context in which it was developed.
How do we know that addiction changes the brain? Technological advances have allowed us to see images of the living human brain. With these scanning tools, we can look at how the brain functions under normal conditions and compare it with what happens to the brain during and after the time drugs are used.
Recent scientific research provides overwhelming evidence that not only do drugs interfere with normal brain functioning, creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity as well. What happens is that at some point, drugs change the way the abuser's brain is functioning. When that point is reached, it's as if a switch is thrown in the brain, thereby resulting in addiction. This modified brain may help explain why many addicts say they are unable to control their desire or craving for drugs.
One might ask where voluntary drug-taking behavior ends and the compulsive disease of addiction begins. And can't addicts talk themselves out of this craving?
The answer is "no." By definition, an addict suffers from compulsive, uncontrollable drug craving and use. Treatment is necessary and effective.
Treatment uses a variety of approaches to help patients deal with these cravings and possibly avoid relapse to drug use. NIDA research shows clearly that addiction is treatable. Through treatment that is tailored to individual needs, patients can learn to control their condition and live relatively normal lives.
Treatment can have a profound effect not only on drug abusers, but on society as a whole by significantly improving social and psychological functioning, decreasing related criminality and violence, and reducing the spread of AIDS. It also dramatically reduces the costs to society of drug abuse. A comprehensive report by the Public Health Service found that the costs of drug abuse treatment were less than half those for incarceration.
Drug abuse and addiction comprise a public health problem that affects many people and has wide-ranging social consequences. Understanding drug abuse and addiction from a public health and disease perspective allows people to think about them in a new light. Like so many other chronic diseases such as diabetes and asthma, drug addiction cannot be cured yet, but it can be managed with a good deal of success.
Drug abuse and addiction are complex and have no easy solutions. Therefore, we have begun to form partnerships with others with a common interest in drug abuse to get the scientific message out. Early this year, NIDA staff met for the second time with representatives from more than 40 organizations in the scientific, practice, and advocacy communities that share our goal of changing the public's views of drug abuse and addiction. We continue to work together to craft the clearest messages and to develop the most effective vehicles to educate the American people about the disease of addiction. (See "Constituent Groups Join Forces With NIDA to Bridge the 'Great Disconnect'). But this is just the start.
We also have begun to hold meetings around the country with local coalitions, health professionals, and policymakers to address this great disconnect. In addition, we continue to sponsor events, such as this past summer's conference on marijuana use, to explain and disseminate the science.
Because of the wealth of scientific research that we have amassed, we have a tremendous opportunity to try to change the way in which the public sees and talks about drug abuse and addiction. Overcoming misconceptions and replacing ideology with scientific knowledge is our best hope for bridging the great disconnect and bringing the full power of science to bear on the problem of drug abuse and addiction.
From NIDA NOTES, March/April, 1996
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