Dramatic scientific advances over the past 2 decades have revolutionized our understanding of drug use and addiction. Foremost among these advances is a clear understanding that drug use is a preventable behavior and that drug addiction is a treatable disease of the brain. This paradigm shift in our understanding of drug use and addiction has come in large part because of the comprehensive research portfolio supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.
Research has shown that drug use is a double-edged health issue as well as a societal issue. It affects both the health of the individual and the health of the public. The use of drugs has well-known and severe negative consequences for both mental and physical health. However, drug use and addiction also have tremendous negative implications for the health of the public because drug use, directly or indirectly, is a major factor in violent crimes and is a vector for the transmission of serious infectious diseases, particularly AIDS, hepatitis, and tuberculosis. Because addiction is such a complex and pervasive health issue, we must include in our overall strategies a committed public health approach that includes extensive education and prevention efforts, treatment, and research.
Science is providing the basis for such public health approaches. For example, two large sets of multisite studies have demonstrated the effectiveness of well-delineated outreach strategies in modifying the behaviors of addicted individuals that put them at risk for acquiring HIV, even if they continue to use drugs and do not want to enter treatment. This approach runs counter to the broadly held view that addicts are so incapacitated by drugs that they are unable to modify any of their behaviors. It also suggests a basis for improved strategies to reduce the negative health consequences of injection drug use in the individual and for society.
NIDA, which supports more than 85 percent of the world's research on drug use and addiction, continues to identify and seize on new technologies and avenues for developing prevention and treatment approaches to reduce significantly the devastating health and societal effects of drug use and addiction. In addition to vigorously pursuing basic and emerging research opportunities, NIDA also ensures the rapid and effective transfer of its scientific findings to policymakers, drug addiction practitioners, other health care practitioners, and the general public. The Institute also seeks input from the users of its findings about the information that they need to do their jobs. NIDA accomplishes this in part by holding town meetings across the country and by hosting national conferences on topics such as heroin addiction, drug addiction treatment research, and addiction to nicotine.
At the policy level, understanding the importance of drug use and addiction for the health of both individuals and the public affects many of our overall public health strategies. An accurate understanding of the nature of drug use and addiction should also be reflected in our criminal justice strategies. For example, if we know that criminals are drug addicted, it is no longer reasonable to simply incarcerate them. If they have a brain disease, imprisoning them without treatment is futile, for if they are left untreated, their recidivism to crime and drug use are frighteningly high. However, NIDA-sponsored studies have shown that when addicted criminals are treated while in prison, both types of recidivism can be reduced dramatically.
At a more general level, understanding addiction as a brain disease also affects how society approaches and deals with addicted individuals. We need to face the fact that even if the condition initially comes about because of voluntary behavior-drug use-an addict's brain is different from a nonaddict's brain, and we must learn to deal with the addicted individual as if he or she is in a different or diseased brain state. For example, we have learned to deal with people in different brain states for schizophrenia and Alzheimer's disease. Recall that as recently as the beginning of this century we were putting individuals with schizophrenia in prisonlike asylums, whereas we know now that they require medical treatment. We now need to see the addict as someone whose brain has been altered fundamentally by drugs. Treatment is required to deal with the altered brain function and the concomitant behavioral and social functioning components of this illness.
Understanding addiction as a brain disease explains in part why historic policy strategies that focused solely on the social or criminal justice aspects of drug use and addiction have been unsuccessful. Research now shows why: They are missing at least half the issue. If the brain is at the core of the problem, attending to and treating the diseased brain needs to be the core solution.
As we move into the 21st century, everchanging drug use patterns, the continuing transmission of HIV infection among drug users, and the need to develop effective treatment and preventive interventions underscore the importance of research in finding new and better ways to alleviate the pain and devastation of addiction. Never before has there existed a greater need to increase our knowledge about drug use. I believe that science will continue to offer our best hope for solving the Nation's drug problems. Our continued commitment to medical research will help all Americans live healthier lives.
Donna E. Shalala
Secretary of Health and Human Services
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