Dear Mr. Edwards,
I again want to comment on your column, this time in the September issue of Behavioral Healthcare (my previous letter was published in the June issue). This time I agree with your premise; in fact, it is an idea that I have personally wanted to write about for some time.
I entered the addiction field only three years ago (mostly fiscally), and I think this affords me an “outsider's” look at public perception. We have seen, ad nauseam, the importance placed on public perception through the course of the political campaigns. Every word is carefully considered and spun by both parties to convince the public that they best represent the values of Americans. Here, we learn that saying something does not make it true, and being true does not mean that people believe it.
Professionals in the field argue that addiction is a “disease” which, by most medical standards, it is. Less favorably, it seems, addiction is referred to as a drug or alcohol “use disorder.” Although I am less favorable to the term “use disorder,” I am not inclined to argue the validity of the words; rather, the issue is the perception of the terminology, and whether the funding public “buys” it.
Although I think many people now believe that addiction is a disease, many still do not. Worse, I think there is almost a “Bradley effect” on the subject: The public might admit it is a disease when surveyed, but privately they still see it as a choice or character flaw. The anonymous nature of treatment and protected health information of clients do not aid in public acceptance. Yet perceptions can change; just consider the gay rights movement.
I think addiction professionals have worked long and hard at reducing the stigma attached to the type of treatment they provide. However, the point is that it will not be accepted or funded, until it is presented in a manner that the public will endorse. We do not get to insist that it is true because we say so; it is only true when the public accepts it. Adamantly maintaining that addiction is a disease when the public largely defines a “disease” as an illness suffered independent of conscious decision making is, in my opinion, actually detrimental to the cause. There are many examples of nonacceptance such as, famously and satirically, garbagemen referred to as “sanitation engineers.”
Finally, on a side note, and speaking of politics, I am surprised that the “Joe six-pack” campaign of vice-presidential candidate Sarah Palin has gone unscathed by the addiction field. The inference, of course, and related to the above premises, is that drinking is a part of the ordinary life of an ordinary person. Advocates of addiction treatment, and the dangers of addiction, should be offended.
Rob Swindell, MBA, Associate Director, Alcohol and Drug Addiction Services Board of Lorain County, Lorain, Ohio
Behavioral Healthcare 2008 November;28(11):6