Disease or Not, A Daunting Challenge

A staggering number of Americans are suffering from a devastating addiction of some sort, and far too little is being done about it.

Perhaps the most glaring example of an addiction is that of cigarette smoking. U.S. government statistics show that more than 16 million Americans are living with a disease caused by smoking, and cigarette smoking is responsible for more than 480,000 deaths per year in the United States. It isn’t merely the smokers themselves who are at grave risk. Exposure to secondhand smoke can cause serious diseases and death. Each year, some 88 million nonsmoking Americans are regularly exposed to secondhand smoke and more than 40,000 nonsmokers die from diseases caused by secondhand smoke.

Gambling is another devastating type of addiction that has enormous ramifications for both the gamblers and their families, and is barely addressed by the authorities.

Last week, for the first time, the United States Surgeon General issued a report addressing substance abuse and attendant health problems. And it revealed that not only are alcohol, prescription drugs and illegal ones taking a terrible toll on American society, but also that only a small fraction of addictions are being treated.

One in seven people in the United States, the report states, is expected to develop a substance-use disorder at some point in their lives. More troubling still is that only one in 10 is currently receiving treatment.

There is a longstanding controversy about how to understand addiction. The first reaction of most people is to regard it as a failure of will. But, as is widely recognized today, the reality is, at very least, more complicated.

Firstly, uncontrollable circumstances, social pressures and pre-existent emotional illness can, independent of one another or in tandem, lead people to make bad choices. So “failure of will” is an overly simplistic description of how some are led onto the path to addiction.

There are, moreover, it has been shown, genetic predispositions to addiction. What is more, chronic use of such substances seems to effect changes in the brain that may actually deprive addicted people of the ability to make reasoned choices. That has led some to the conclusion that addiction should be seen as a disease, and treated as such. Among the proponents of the “addiction as disease” model are the American Medical Association and the American Society of Addiction Medicine.

That approach was voiced, too, by the Surgeon General, Dr. Vivek H. Murthy, who called addiction “a chronic illness that must be treated with skill, urgency and compassion.”

The issue of substance abuse is, tragically, not only of theoretical concern to our community. That truth may be painful, but it is still a truth. According to the Amudim organization, which is doing remarkable work in helping individuals and families struggling with addictions, and various experts in the field, the ready availability of dangerous substances of varied types, unprecedented societal challenges and pressures — from peers and otherwise — all have combined to allow the plague of addiction to seep into our own world.

It is true that, just as the initial descent into addiction may involve a choice, some addicts — at least those whose addictions have not reached a certain intensity — may be able to change their behavior by sheer force of will. But the majority of those with addictions, and virtually all of those with long-term addictions, need counselling and medical interventions. Even such treatments cannot assure a cure for any particular individual, but they have been shown to be of tremendous help in many, if not most, cases. And it is a tragedy that so relatively few addicted Americans are in programs to help them overcome their challenge.

The new Surgeon General report comes at the tail end of the Obama administration, which asked Congress this year for $1 billion to fight the opioid epidemic. Congress, however, set aside only $181 million.

And it’s not only illegal substances, which largely are brought into our country by criminal elements. A major part of the epidemic is the overuse or misuse of legally sold alcohol and legally prescribed opioid painkillers. And so, we urge that allocating sufficient resources to help ensure that more Americans suffering from the effects of all types of addictions have easy access to treatment should be a major priority of the Trump administration.