Addiction: White House Seeks “Third Way”

Abstract

AS THE US POLICY DEBATE ABOUT drug abuse careens between old approaches that have led to incarceration of many for drug-related crimes and emerging ones that seek to legalize marijuana, the White House has released a new drug control policy (http://1.usa.gov/ZvNdGA) that administration officials describe as a “third way” to address substance abuse. The new strategy emphasizes evidencebased approaches to prevent and treat substance abuse disorders. “It’s very much time for a new approach,” said R. Gil Kerlikowske, director of the Office of National Drug Control Policy (ONDCP) and former police chief of Seattle, during a press briefing in April. Kerlikowske explained that like many in law enforcement, he long believed that drug dependence reflected moral failing and a lack of willpower. But an increasing body of scientific evidence suggests that substance abuse causes changes in the brain that make it difficult for individuals to stop using and that treatment can help curb these behaviors. “Addiction is a disease,” Kerlikowske said. “It can be diagnosed; it can be treated.” Addiction’s economic toll on the country is massive, costing $193 billion in lost productivity, health care, and criminal justice, he said. Given the complexity of the problem, Kerlikowske said, simple “bumper sticker” answers won’t work. “We are not going to solve the problem with legalization or incarceration,” he said. Instead, the new policy suggests a dual approach, emphasizing prevention and treatment for individuals as well as criminal justice efforts to curb the national and international drug trade. The report lays out a strategy that increases funding for programs to prevent youth from starting drug use, supports expansion of drug courts to shift individuals with substance abuse disorders out of the criminal justice system and into treatment, and promotes screening and early intervention for such disorders in primary health care. Additionally, the ONDCP has created the first office dedicated to supporting individuals in recovery from substance abuse disorders and recommends several specific changes to laws that, in their current form, may hamper recovery efforts. “It’s a significant break from the idea that substance abuse is strictly a criminal justice problem,” said A. Thomas McLellan, PhD, chief executive officer and cofounder of the Treatment Research Institute in Philadelphia and a former deputy director of the ONDCP. “It’s trying to strike a balance between public safety and public health.” The new direction is rooted in the emerging evidence based on the neurological underpinnings of addiction and evidence supporting prevention and treatment strategies, according to Kerlikowske. Nora Volkow, MD, director of the National Institute on Drug Abuse, explained at the briefing that until recently, the health care system had distanced itself from addiction because of the stigma associated with the disorder and the misconception that drug dependence was a voluntary behavior and moral failure. But studies of addiction suggest that chronic drug use damages the brain in ways that cause changes in behavior and impair an individual’s self-control. “In order to be able to control your urges, your brain has to work properly,” Volkow said. Additionally, research has suggested that both genetic and social circumstances may con-