Quality & Science

Addiction: Character Defect or Chronic Disease?

by Richard G. Soper, MD, JD, MS, FASAM | March 13, 2014

Recently, numerous media sources have implied that "addicts" ought to make better choices; addiction science cautions that is not always possible. Describing addiction as a reflection of moral character and choice takes us back to an earlier, more ignorant time. Science now shows that addiction, including alcoholism, is not a simple phenomenon. It stems from multiple causes rather than character flaws.

Many of us as medical professionals use a medical model to understand addiction. Drugs, alcohol, and illicit substances activate reward systems in the brain, which cause people to feel pleasure and create memories. Each individual has a unique tolerance to drugs and alcohol; the effects of drugs and/or alcohol are individually specific. Individuals may have genetic predispositions and different brain inhibitory circuits. Addiction is a disease, just like asthma, diabetes and heart disease.

Most drug treatment professionals and facilities speak of stages of change. Those who suffer from substance use disorders are not necessarily aware of the disease of addiction. Recovery is a lifelong process. William White - addiction writer and author of Slaying the Dragon - talks about our need to focus more on recovery. Most people come into drug treatment in a state of unawareness or ambivalence. Stereotyping addiction sufferers as immoral characters is not helpful. It is a shame-based concept that perpetuates the addiction problem and discourages a person from reaching out for help. Who would choose to feel worse about themselves than they already feel? This is why it can be so hard to enter recovery programs.

It is deeply disappointing and disingenuous to see again how the media, professionals, and members of our society repeatedly demonize, marginalize and even re-criminalize a chronic, recurrent, progressive and ultimately fatal brain disease. A recent brochure advertising an upcoming medical professional meeting in my region has a workshop on discussion of medication assisted therapy becoming or being addicting. I respectfully ask again, are we, the addiction treatment professionals, part of the solution or part of the problem?

Richard G. Soper, MD, JD, MS, FASAM
Editor-in-Chief, ASAM Weekly

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  1. not my fault Jan 03, 2020 - 04:17 AM
    chacter flaw
  2. Abey82 Nov 01, 2019 - 10:45 AM

    i smoked  a pack and a half of cigarettes for 10 years before I quit.  My father smoked since he was 12 years old (and continues to do so in his 70s).

    I am cognizant of the fact that addiction is a disease.  What I will never understand, and struggle to support to this day is that my father couldn't bring himself to smoke outside, or pull over to have a smoke-break on our 3-hour drives to grama and grampa's house?   They were fully informed of the dangers of second hand smoke all of our lives.  Some could argue that he was so diseased that he couldn't push himself to get off his a×× to go outside for a smoke.  Either way, he was endangering his family (intentionally or not) and hence wasn't fit to provide the necessities for his children while he endangered their health.  Now in my late 30s I started to develop health issues (later in life) from the years me and my sibling's undeveloped bodies were exposed.


    Thanks dad

  3. Matt Oct 01, 2019 - 02:56 AM
    Man this is a fascinating discussion.  It is amazing that from what I'm reading, that medical professionals believe it is best to tell people that their addiction is the result almost everything but a personal choice?  I think your compassion is misguided if you aren't truthful with them. They're going to need that same will to get out of the mess they got themselves in. I'm sure when they recover you're not going to tell them that the reason that they recovered is because of everything but their choice?  You know sometimes stigma is a good thing. When we make poor choices we should feel bad about them and it's healthy for society not to accept our bad choices the damage us and them.  And hopefully that shame and guilt motivates us to do the right thing - especially when someone kind and compassionate (like y'all) comes along side and helps the addict to do the right thing. 
  4. Melissa Bowen Dec 06, 2018 - 05:33 PM
    someone in addiction,  addiction is a defect that effects the personality of the person. What happens here is those who cross their paths see addiction and focus on it and longer the person in addiction the more it is all that people see them as like a human disease when in fact there is the person in whole and only a part of that person has a defect which is addiction
  5. Susie Jul 15, 2018 - 11:07 PM

    My highly intelligent, drop dead gorgeous, physically fit 34 year old daughter needs 2   total hip replacements due to alcoholism. I wish there had been more information about how alcohol affects women. i would like to think she would've made better choices. Probably not.

  6. Kerry Jul 15, 2018 - 10:26 AM

    Sonya, Kenneth and Lisa 

    You are among far too many ingorant out there about the medical illness of alcoholism and addiction. You are the kind of judgemental people that CAUSE PEOPLE to make the supreme sacrafice and die from alcoholism. If you even took a minute to think logically, which apparently you cannot, if an alcoholichad the “power of choice” to pick up a drink then alcoholics would simply choose not to puck up that drink that causes them debilitating medical emotionand severe consequences. Anyone with even 1/4 ofcommin sense would say yea if this thing is killing me Im not pucking that drink up. 

    People like you hold people back from trying to get help because of youre nasty judgements YOU are the people that create this idea if immoratlity, being “bad” and create even more guilt shame and remose hindering mire people to reach out for help.

    A lovely friend wife mother of 3 who adored her family just died at 34 years old because peope like you whi think you have a clue. So ince youre education or suffer frim the illness keep youre mopinions to yourself. Its hard enough already. Be humane you have no idea what others go through. 

  7. Karen Yochim, LPC Jul 05, 2018 - 03:33 PM
    Those who object to the term disease may find it more effective if it's written as Dis-ease. The alcoholic has a body/mind reaction to alcohol that makes cravings for it irresistible.  "One drink is too many, and 1000 drinks are not enough." I have known at least 24 people who have died of some form of liver disease, yet could/would not stop drinking until the end. The alcoholic has a different sort of metabolism from normal drinkers and it has little do with morals or will power. It has to do with genetics and triggering responses to ETOH through the abuse of it. A person can learn in childhood that heavy drinking is normal or they can learn that on their own later on in life with heavy drinking friends. Heavy drinking over a period of time may lead to alcoholism, or it might kick in right from the first drink, depending on the person.
  8. Liza May 01, 2018 - 11:00 AM
    I do not agree at all that drug addiction can be classified the same as type 1 diabetes. My young family member did nothing to cause t1d to occur in her body. On the other hand, there are people who get themselves into drug addiction because they make a choice to take that drug. When offered Oxycodone after a C-section a few years ago, I said "no." As a patient, we have a choice to refuse a prescription drug with addictive qualities. People also aren't forced to take heroin.  
  9. dh Dec 28, 2017 - 12:44 PM
    My daughter drinks. She'll be ok for a time but l can tell when she changes.  Its like a switch flips and she's scurrying around trying to hide from me that she's drinking. They have told her at Bradford that if you've had fevers or long term illness as a child that that can do something to you and cause you to drink. She was in and out of the hospital with asthma for a year at 2 years old. It's not necessarily an addiction to alcohol but the "need" to have a drink. I know that l'm new to this and you probably think l don't know what l'm talking about, and I really don't fully understand but idhn watching my daughter change her actions, l can tell in how she talks and acts that the switch has flipped. I'm new at this and dumb as  rock so l'm learning and am heartbroken that at some point she has been broken. She didn't start until 2008. So about 34 years old.
  10. Caroline Nov 20, 2017 - 03:12 PM
    I am a 17-year-old high school student writing a research paper on alcohol as a disease for my English 101 class. I have not been in classes debating over alcohol, I have not studied its effects, and I do not have a bunch of official titles behind my name BUT personally, I believe I know plenty about the effects alcohol has on someone to firmly believe it is a disease. For the last 10 years, I have grown up with an alcoholic father. I watched my dad going from (in most people's eyes) man of the year, active member in church, family, and society, best dad ever to a man I barely knew who stolen from his children's piggy banks in order to buy that next sip of alcohol as well as a man who committed suicide back in June. The wicked disease of alcoholism caused my dad to take his own life, therefore stealing him from mine.
  11. Tim M7CPH Williams Nov 10, 2017 - 01:09 PM
     I have been an alcoholic for over 25 years I always wondered whether it was really a disease , disease or mental illness or whatever . it's killing me. I do not hang out at bars I do not chase women I simply sit at home and drink and I hate the taste of it. after complicating suicide for the reason that I felt worthless that I was a bad person that can never get any better I decided to ignore those that made me feel so horrible about myself . both of my grandfathers died this week I was sober and headed in to visit the funerals I was told by my mom that she didn't want me there because I was an embarrassment. although I was sober because I did not want to go into the funerals intoxicated I just decided not to go anyways
  12. william wright Oct 26, 2017 - 09:56 PM

    It’s the Trauma Stupid

    When alcoholism (addiction writ large) is labeled a moral failure, the down-and-out addict is motivated (feared) by shame to stop the substance abuse.  Indeed, the Big Book of AA cites “moral” 35 times.  Shame, while very effective, is also very destructive.

    Unfortunately, society jumps on this ignorance: after all, shame emboldens the ego of the shamer; it is easy to shame, and it feels good to the Righteous One (and Righteous Many) to do so.  Amen!

    The result, in my experience, is that the addict who makes it to sobriety - in most cases - remains ignorant of what got him/her to addiction in the first place.  And while this addict in recovery may have stopped abusing alcohol and/or drugs, the untreated trauma manifests in other ways, such as incessant smoking, excessive caffeine consumption, overeating, unrestrained sex and other high-risk behaviors.  On top of that, the addict receives daily reminders of shame through a laundry list of “defective” behavior characteristics.  Since the addict lacks an authentic orientation to these behaviors, this daily reminder reinforces their worthlessness, which amplifies the effects of the trauma and solidifies the addict as a second, third or fourth class citizen (depending on how society views the addict sans addiction).  This ignorance perpetuates onto the addicts’ children, and the cycle of dysfunction continues.  It’s multigenerational!

    Perhaps a better way to characterize this sad phenomenon is to consider studies using rats and mice: Rats and mice are mammals, like humans.  These fury little rodents have genetic, biological and behavior characteristics that closely resemble us.  Additionally, many symptoms of our human condition can be replicated in them, and they reproduce quickly and have a short lifespan, so generations of these critters can be observed in a relatively short period of time.  Many studies of addiction using rats and mice readily exist. 

    How do you suppose researchers breed addiction in rats and mice?

    Wait for it…

    Excessive stress!  

    The more stress the more pronounced the addiction.

    No stress, no addiction, as rats and mice prefer good food and water to alcoholic beverages, cocaine, etc.

    Said another way, at what point when the rodent develops addiction, should they admit their powerlessness and turn their will and their lives over to the care of God?  

    Likewise, how should we perform a “moral inventory” on a rat?


    Help the addict eliminate the conditions for the excessive stress and educate the addict on the pervasive effects of excessive stress.  In addition, since stress and addiction have wreaked havoc on the addict’s organs and central nervous system (and ability to generate brain chemicals, like serotonin, dopamine, oxytocin, et. al.), also help the addict understand that these bodily systems require long-term holistic rehabilitative care.  As for the addict’s dysfunctional coping behaviors, educate the addict on the nexus of these destructive behaviors: they were once required for their survival, because of dysfunctional conditions that no longer need to exist.


    Labeling the addict morally deficient is far easier than helping the addict with what the addict really needs.  Governments know this, as it is a terrific way to “manage” an increasingly larger segment of the population, since the universe of addiction includes the dysfunctional family in the collective.  More specifically, you cannot wage war on inanimate objects: it’s not a war on drugs; it’s an all-out war on drug addicts.

    So, either continue to keep the addict down and out, or find the compassion to consider the addict is truly a victim.  Then, find the strength to lead the addict out of his/her misery beyond the shame.

    In closing, consider that the addict most often suffers from interpersonal trauma, typically going all the way back to those sensitive developmental years of early childhood and adolescence.  This trauma creates a unique vulnerability to shame: shame, like the trauma that drove addiction, keeps the addict in deep emotional pain, and while the addict might stop abusing themselves with alcohol and drugs, the shammed addict is unlikely to lead to healthy emotional life or grow beyond the trauma.  

    Peer-reviewed medical research studies show that multigenerational effects of trauma perpetuates as family dysfunction and addiction, in perpetuity.

  13. Kevin F Aug 04, 2017 - 07:23 AM
    Disease is too broad of a definition. Without sounding too harsh, it takes some responsibility away from the addict, himself, to stop his behavior. While it might be a disease, it's too easy to accept this as a final outcome. In other words, I have people who are enabled because addiction is treated as a disease where all responsibility and fault is outside the addict's purview because he is the victim instead of taking responsibility and starting the journey to recovery. Perhaps it lies in between the broad definitions of disease and character flaw. Without the addict taking responsibility and being the one who starts the road to recovery, all the talk, studies, and rationalizations are useless. You're back at square one.
  14. Steven Jun 08, 2016 - 12:08 AM
    AA calls alcoholism as a disease, then in their 12 and 12, Bill Wilson says it is due to defects of character.
  15. Edward L. Mar 29, 2016 - 10:47 PM
    Speaking as an alcoholic, from the horses mouth: Calling it a disease seems the most apt description.  My last relapse, I walked to the store, bought a bottle of liquor, sat in bed, and drank, and that whole time had absolutely no control over my faculty.  A dark passenger walked my legs and handed the clerk my credit card.  In my head I was saying "I don't want this, this is bad" and I drank.  For whatever reason, AA has been helpful in keeping this in check and helping me stay sober.  I sort of take offense to anyone who claims this is "a choice"; I certainly have my flaws like any other human, but when my depression hits, if I'm not in a safe environment, I become confused, unaware of consequences, and in extreme emotional pain.
  16. Mike B Mar 29, 2016 - 02:41 AM
    Hey Sonya you are not a doctor right?..so how could you be in any state of mind to say addiction is not a disease? The disease is passed down from generation to generation and if it wasn't , no one would have this disease or problem yet we do. Not all cancer patients are born with the disease , which is highly relatable to addiction . When someone is born an addict then they have no choice . When someone is not born an addict they still have no choice because our brains at such a young age do not perceive the fact that what we are doing is wrong. People do not chose to be cancer patients , nor do addicts chose to be  addicts. If it wasn't a disease why would it be killing off humans the way it does ? Obviously you are not drinking or drugging as soon as you come out of the womb, because we as humans have morals. No one in their life chooses to bring that to the hospital or wherever because they don't plan on having a child that has to live that life. I did not choose to be an addict , that is the life I live and have to always remember that. I do not choose to have cancer so how is it any different . We cannot just stop like you a non addicts . We cannot just stop like these non addict doctors. Everything happens for a reason to make you who you really are. And if you are not here for a reason then why do we exist. Maybe one day a close relative or family member will unfortunately pass away from this DISEASE to make you realize that the disease does not discriminate . Maybe one day these doctors will not be in it for the money aspect and something in their life will make them realize how important this disease really is. Obviously you run on self-will and closed mindedness that is why you justify your excuse . You think you have control when you do not. If you have so much control how about you hold your breathe and see how long you last. I have no control over anyone or anything not even myself and when I think I do my life is over. Maybe you should broaden your horizons and do some important research before you react, because obviously you know everything . One day you will realize that your life happens 1 day at a time. Yesterday is dead, the future is untouchable, you only live 1 day at a time.
  17. John Feb 29, 2016 - 07:46 PM
     I bet Sonya, From July 7th, 2014, is an addict in denial.  I know first hand what it's like to want to stop, but can't. Who ever thinks treatment is a waist of time, is narrow minded if it didn't help them. If it wasn't for treatment, I would probably be dead right now.
  18. Kenneth Anderson Feb 26, 2016 - 11:57 PM
    It was an earlier, LESS ignorant time when we understood that addiction was a choice. The ONLY way to kick an addiction is by choosing to quit; treatment is a worthless waste of time that adds nothing. The good news is that the epidemiological data shows that over 90% of people with addictions successfully quit, the majority without treatment. There is no more success among those who choose to waste their money on treatment than those who choose to quit in their own.
  19. Brandi Roberson Jan 21, 2015 - 07:39 PM

    I actually have a video on my youtube page that I entered in the contest on ATTC website about addiction and mental health. I am in college getting my Bachelor of Science in Psychology because I want to help people like me, and raise awareness. I am all for Addiction being a disease because I am in recovery. I know first hand. I am also bipolar. If people could look at it like they do people with mental illness, then maybe they will see. If they can believe that mental illness is because of a chemical embalance and it is not a persons fault, then why can they not believe that Addiction is the same. It messes with the chemicals in our brains to where each time we have to have more and more until the chemicals in our brain are so low that we need it to replace them. Does this sound like a good question and argument Doctor?? I am writing a paper on it for just that.

    and to Sonya who posted in July saying that we learn from our surroundings....fine. But there is a difference in us learning and you learning. The difference is when we pick up that drink or drug, like you other people do, our brain does not let us stop like you who socially do it. There is something different that you totally do not understand. 

  20. Steven Slate Jul 13, 2014 - 01:14 AM

    Assuming someone is freely choosing to use massive amounts of substances on a daily basis - what about that makes them a bad person?

    Why is it that those who believe addiction is a disease are stuck on believing that heavy substance use necessarily implies badness or immorality if it's freely chosen?

    I resent, and take offense to the notion that heavy substance users could only be diseased or bad. And that definitely is the foundational assumption of this article. 

    It's a false dichotomy that smuggles in a bunch of judgments about how other people should be living their lives. It smuggles in a bunch of moralizing - and then attributes these actions to those who believe "addiction" represents freely chosen behavior. In fact, it's the disease-mongers who are judging and moralizing.

    The disease model is built on the assumption that the sober or moderate user's lifestyle is right and good - and the heavy substance user's lifestyle is wrong and bad. It's the assumption that no sane, non-sick, mentally healthy, good person would do such a thing as heavy substance use, so it must not be freely chosen. Isn't that a bit judgmental?

    The disease model is built on busybodyism. It comes from people sticking their noses into other people's lives, and deciding for them how they should be living. This is nowhere more apparent than in the act of "confronting denial."

    There are people who are happy with heavy substance use. Leave them be. Then there are people who are dissatisfied with the negative consequences of it, yet they continue. Both of them are doing what they believe is their best feasible option for living a happy life. They are both freely choosing. The former might tell you they can't control themselves - in order to get you off their back and be able to keep doing what they want. The latter are truly conflicted, and may feel genuinely out of control, and tell you as much. However, it's hard to know whether they would've come up with this idea of being out of control, if you hadn't provided them with it in the first place.

    The only way either of them will change is if they come to believe they have a better feasible option than heavy substance use. Even when things get really bad, if they still believe it's the best shot they have at enjoying life, they'll continue to do it - despite the consequences.

    As far as I'm concerned, that's their right, and it's none of our jobs to say they're bad for doing so. It's their life - not ours. But for those who are dissatisfied - identifying the behavior/desire as a stable unchangeable part of themselves (i.e. admitting you have an imaginary disease) doesn't seem like it points the way to happier life options. It certainly doesn't offer hope, or a sense of self-efficacy. It offers doom and gloom. And as they battle this boogie monster of a disease, they necessarily aren't focused on developing more satisfying life options.

    What those who want to change need is a way to expand their perceived feasible life options, so that they might find something better. If they are convinced that they've got better choices available to them, they will be motivated to change.

    As it stands, addiction treatment takes the motivation to use substances as a given that can't be changed. It then focuses people on schizophrenically fighting this motivation to use.

    In fact the motivation to use is the basic human desire to be happy - and it can be redirected (rather than fought), if we accept it, and ask ourselves if their are happier possibilities, and whether we think those possibilities are feasible for us.

    None of this needs to enter the realm of determining whether a person is good or bad - yet it's all about choices, and finding the choices that work best for the individual.

    BTW - the brain disease model of addiction doesn't add up: http://www.thecleanslate.org/myths/addiction-is-not-a-brain-disease-it-is-a-choice/

    -Steven Slate

  21. Sonya Jul 07, 2014 - 07:22 PM

    Im not a doctor pardon me but I completely disagree with addiction being a disease. It is not something you are born with. You dont come out of the wound drinking alcohol and doing drugs you learn from your surroundings   I disagree with it being a disease and taking a lifetime to get over. You people are all programmed and think the same you are the reason addicts stay addicts " addiction is a disease"is a metaphor just like saying "jealously is a disease". Addiction and disease do not run hand and hand maybe hand and foot.  

  22. Joeg Voll Apr 03, 2014 - 02:44 AM

    Jim Clark, that was an excellent continuation of this article. I felt the same way and you put what I was thinking into words. 

  23. Steve Snyder Mar 24, 2014 - 10:28 PM

    I, like Dr. Mott, am involved with Lifering Secular Recovery. We support the latest in biomedical research, and the findings it is already delivering, such as the first generation of anti-craving medications, as well as ongoing research on the neurochemistry of addiction. We also support whatever new findings and research come along about the help that professional, informed, psychological counseling may offer.

     We welcome medical professionals and the general public to learn more at http://lifering.org.

  24. Joseph A. Mott, M.D., J.D. Mar 24, 2014 - 08:36 PM

    I very much agree with Dr. Soper.  In an secular society increasingly disillusioned with organized religion, I think it's time for our professional societies to embrace secular alternatives to 12-Step, which is a program -- despite all objections by adherents to the contrary -- with deep roots in evangelical Christian theology (i.e., the Oxford Group).  There are secular mutual aid groups like LifeRing (I am on the board of directors of this organization) that completely avoid the notions of higher powers and character defects, confession and amends, sponsors and prayer, and focus instead in a very present-centered way on the practical challenges of "not using or drinking, no matter what."  

  25. Jim Clark Mar 24, 2014 - 11:38 AM
    As a person in long term recovery, clean and sober 29 years, and an addictions counselor, my experience tells me that both "factions" are correct.  Addicts have a brain disease, and need to be treated for, and encouraged to acheive abstinence, and to continue the maintainance stage of change.  This stage includes, for most  long term recovered persons, significant and deep change of behaviors, beliefs, intentions, as well as approach to life.  These changes are predicated on some form of inventory, I do not like the wording "defects of character" however rather than rebel against that, have come to understand it simply means elimination of,or modification of actions and attitudes that do not benefit and enhance my recovery, and my personal value system.  So while there are actions that are out of alignment with my core beliefs and values, and require change, that does not imply that I, or any diseased person , is defective.  Let us not let semantics keep us from the truth that any person facing a life threatening illness, needs to adopt attitudes and changes that support complete recovery and enhancement of quality of life, for that is the reward for doing the recovery work- greater enhancement and enjoyment.
  26. Roy D. Clark, Jr., M.D. Mar 22, 2014 - 11:14 AM
    Always disappointing when prevention of addiction is not mentioned.  Those at risk who "Just Say No" do not become addicted. This is different from  the other disease examples mentioned - even those at high risk of diabetes mellitus who maintain suggested diet, weight, and exercise goals still progress to the disease at about 15%. 
  27. Edward H Katz MD Aadictionologist Mar 22, 2014 - 10:37 AM

    Drug or alcohol dependency has a unique set of symptoms signs and course fitting the definition of a disease state. A person inflicted with a terminal disease must understand it , and accept it, before givin the course of treatment. In my experience was the gravity of untreated substance disorder only than can a person inflicted make the correct choice.in ordere to cure or place in remission the unshaken reality no longer should be debated..


  28. walid mikhail Mar 19, 2014 - 08:28 PM

    excellent editorial. continued perception problem in the medical community and a lack of understanding between how addiction and dependence are different, (a diabetic is dependent on insulin... not addicted to it..etc)


  29. Timothy Lee MD Mar 19, 2014 - 07:38 PM

    I agree with Merens that ultimately it is about developing healthier ways of coping with life's adversities. 

  30. Greg Merens Mar 18, 2014 - 08:42 PM
    The disease model will ultimately be regarded a failed approach to addictive disorders. It is too simplistic, rigid, and not reflective of actual client experiences.  Why are so many opposed to seeing substance users as thinking,  Even with addiction clouding thought processes, substance users act decisively in behaviors we addiction professionals regard as manipulative, calculating, and even relentless.  When confronted about their behaviors they acknowledge these tendencies.  They know why these behaviors result in condemnation.  OK, yes, their brain chemistry is out of whack; they have become maladaptive in regard to healthy coping systems, but we should consider that self-defeatism is driven mostly by the mood irregularities that produce dysphoria and anhedonia. Our clients are looking for relief from the stresses of life and the stresses of early recovery, which they will almost all describe (and clearly) the consequences of continuing addictive behaviors.   For the addiction field to evolve, we must move into holistic treatment regimens that reinvigorate and normal brain activity.  We need a dramatic increase in the number of sober living residential options to support the holistic practices long-term.  We need ways to keep people away from the environments and people that continually trigger maladaptive thinking and engender relapse.  To date, we've only scratched the surface in developing such a comprehensive, long-term, addiction treatment philosophy and system.  This is where we should be going, not arguing about whether addiction is a disease.  Ultimately, addicts and alcoholics will have to develop healthy systems of living to overcome the life area impacts their faulty thinking and compulsive behaviors have brought them.
  31. Kevin Kirby Mar 18, 2014 - 03:09 PM

    When I read the title of your piece, I was disappointed in ASAM for encouraging yet another author to suggest that there is even an issue here.  I was pleased that you quickly moved on to a discussion of the disconnect between reality and perception.  As CEO of an organization (www.wefaceittogether.org) working to, among other things, mainstream addiction care into primary care, we are learning that nobody is immune to the shroud of ignorance surrounding addiction.  We don't and can't hold medical professionals to a higher standard of comprehension than the general public because our medical schools have largely ignored this disease.  One of our greatest challenges as we build an addiction chronic care model in partnership with health care systems is to educate medical professionals.  For that, we lean significantly on The ASAM Criteria.    

  32. Keith Flower, MD Mar 18, 2014 - 02:20 PM

    The choices we humans make cause or exacerbate numerous diseases, e.g., cardiovascular disease, diabetes mellitus, and cancer.


    We do not ordinarily characterize these diseases as indicative of some moral failing. As Dr. Soper points out, it's not *effective* to do so. Why then is addiction singled out as reflecting some defect in character?



  33. Lyndee Retzlaff Mar 18, 2014 - 12:47 PM

    I did not read anywhere in Dr. Soper's article that twelve step programs promulgate that addiction is a character defect, so I am unsure of where a couple of commenters are coming from.  AA & NA state plainly that addiction is a disease. I would recommend the book "Alcoholcs Anonymous" by Bill W. to anyone wanting more information.

    I agree with Dr. Soper 100%, especially this quote ".Recovery is a lifelong process."  We are too concerned with getting treatment "over and done with" and pay little attention to the aftercare needed. I would like to think that I am part of the solution,  I try to be part of the solution, but the success rate for treatment is low. The reasons for that include the moral judgements made by society, and the media, that a recovering individual has to deal with at the same time as making major changes in his or her life. Sadly, those judgements are also made by professionals who should know better.

  34. Allen Lapin MD Mar 18, 2014 - 12:38 PM

    Have you seen Dr. Satel on Heritage Foundation sponsored programs and C-SPAN promoting her book that addiction is not a brain disease? The conservatives like that kind of talk from doctors-a psychiatrist no less. And she even works or has worked in Methadone clinics!! Addiction specialists must fight this thinking or they will lose the battle to continue treatment.  Alcohol, tobacco and obesity are what are really killing us.   Most of the country are in denial of what really causes diseases and drives up medical costs 

  35. GORDON HYDE MD Mar 18, 2014 - 11:07 AM


  36. Paul Thomas MD ABAM Mar 18, 2014 - 10:12 AM

    For those tempted to think addiction is a moral defect, then they should also consider that along those lines of thinking, so is poverty, obesity, heart disease, cancer and most chornic diseases we all eventually die from.  Reason: all these conditions, including addiction, involve genetic vulnerabilities and environmental factors.  We don't choose our genetics, we don't choose the environment we are born into, we can learn to reduce risk factors, eat better, avoid toxins, avoid substances of addiction.  For most of our addicts and substance - dependent patients, they were well past the point of choice, by the time they realized there was a problem.  Much like it is for all of us with diseases that are chronic. 


  37. Carol Rogala D.O. Mar 18, 2014 - 10:11 AM

    I agree with your statements; however, when it comes to the attitudes of others about addiction, you will simply have to be more understanding of  human nature.  I have been an Emergency Physician for 20 years.  There are still doctors who don't believe it is a 'real' specialty and think anyone can do it. Despite the number of female physicians, there are still plenty of male physicians and patients who treat us differently.  And what about the attitudes towards gays by certain political and religious groups in this country?  In these  examples, it is not as bad as it was 20 years ago, but it seems to take a long time for attitudes to change. Because of the recent media attention towards prescription drug abuse, now would be excellent timing to bring Addiction Medicine doctors and nurses into the high schools for lectures and to have public service announcements describing it as a brain disease and how to get help.   Since CNN is hell bent on promoting marijuana for seizures, why not have ASAM approach them to have a segment on current trends of addiction in high school and the heroin epidemic?   Or approach Oprah to do a segment on her cable network show, The Next Chapter.  We have to start somewhere with public education and we have to have patience. 

  38. Rick Campana, MD Mar 18, 2014 - 09:06 AM
    I agree 100% w Dr. Soper! I have always taken issue with the 12 step program that claims addiction is a character defect. Addiction is a chronic progressive brain disease, and as such, must be approached and treated like any other chronic progressive disease! Unless we educate our fellow colleagues, the legal profession and the general public at large of this fact, addiction will be destined to remain in the dark ages of ignorance, stigma and under treatment.
  39. Steven Kassels, MD Mar 18, 2014 - 07:26 AM
    As a physician with 30 years of practicing Emergency Medicine and Addiction Medicine, it is unfortunate how little progress has been made to demystify the disease of addiction. There are endless commercials about medications for erectile dysfunction, but when was the last time there was a public service announcement about addiction as a chronic disease or the benefits of medication management.  Over the years, when I would give a lecture on addiction, whether to medical students/residents or the local PTA, it was like preaching to the choir.  We must implore our public officials to to advocate and educate and the medical community must think of more creative ways to reach people who would not willingly choose to read or listen to topics related to this brain disease. I wrote Addiction on Trial as a way to reach a wider audience, to lend support to our patients, to assist them in educating family members and to use it as a resource to educate through the "back door".  I encourage others to do the same. http://addictionontrial.com/
  40. James Clarke Mar 18, 2014 - 06:39 AM
    I agree with the understanding of the disease concept and that many entering our facility do not know they are having difficulty with substances.  Their environment adds to the issue. Many grew up with people using all around them. That's "normal" for them.  Increasing the awareness of what is a Substance Use Disorder is the first part.  Brain Chemistry is another.  Anyway that we can assist in changing the thought process is a possibility of recovery and allowing that person to be in life.

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