Imagine a nation in which a deadly but treatable disease is taking its toll on more than five percent of the population. This disease is wreaking havoc with the lives of millions of men, women and children, but only 20 percent of the people who need treatment are receiving it.

That's the situation that prevails in the United States today. The disease is alcohol and drug addiction.

To bring attention to this national problem and to help improve access to addiction treatment, the Substance Abuse and Mental Health Services Administration (SAMHSA), an arm of the Department of Health and Human Services, is sponsoring National Alcohol and Drug Addiction Recovery Month in September.

SAMHSA cites three trends that contribute to this deteriorating situation:

• There has been a noticeable re-stigmatization of substance abuse and addiction as the great strides made during the "modern alcoholism movement" that gathered momentum during the 1970s have slowly dissipated.
• Substance abuse and addiction have moved further and further outside the medical realm as the idea of addiction as a disease comes under attack. This is alarming, given there is better information than ever before that addiction is a disease. Science has demonstrated that addiction is a medical problem, not a moral weakness. "It is a brain diseasebut not just a brain disease," says Alan Leshner, former director of the National Institute on Drug Abuse. "Addiction is the result of prolonged drug use that changes the brain. It is a biological disorder in that the brains of addicts are different from those of non-addicts. Addiction also has behavioral and social components that need to be addressed, and the best treatments address all aspects of the disease."
• There is a continuing criminalization of addiction. We are building more prisons and continue to incarcerate people with alcohol and substance abuse and addiction problems. In most cases, they receive no treatment while in prison. When released from prison untreated, they fall back in to old behaviors that begin the destructive cycle over again.

All these factors contribute to a tremendous cost to society -- an estimated $294 billion annually. What can be done to improve the climate for addressing addiction in this country? SAMSHA's Center for Substance Abuse Treatment two years ago convened a national panel of experts who developed a report called "Changing the Conversation: The National Treatment Plan Initiative to Improve Substance Abuse Treatment." The plan offered a range of guidelines for positive action, from increasing treatment capacity to urging insurers to provide coverage of addiction that is on par with coverage for other medical conditions. It also documented the problem of addiction and the cost-effectiveness of addiction treatment. For instance, for every $1 invested in addiction treatment, a return of up to $12 is gained in terms of reduced costs related to health care and crime, according to research.

But clearly the most important recommendation of the plan is the need to "change attitudes" about addiction. The premise of the "Changing the Conversation" report is to create "a society in which people with a history of alcohol or drug problems, people in recovery, and people at risk for these problems are valued and treated with dignity, and where stigma, accompanying attitudes, discrimination, and other barriers to recovery are eliminated."

Like the plan, Recovery Month encourages people in recovery, addiction professionals, and those who know that treatment works to help reduce stigma. "If we are to make real headway in treating addiction, then we must begin by recognizing that alcohol and drug dependence are not moral failings or a lack of willpower," said William C. Moyers, a recovering alcoholic and addict and vice president of External Affairs at Hazelden. "Addiction is a medical condition that requires effective treatment, just like any other chronic disease. And treatment for addiction is just as effective as treatment for other chronic diseases such as diabetes and high blood pressure."

A huge way to dispel stigma is to put a face on recovery. The recovering community is invisible, largely because of this stigma, said Moyers. "It is time for people in recovery to help change the way society views addiction," said Moyers. "The millions of people in recovery, who quietly work at improving their lives and communities, can open dialogue with neighbors, legislators and their workplaces to share their wellness. And they can reach out to people -- let them know that addiction is a disease and that treatment works -- without compromising the principles of Alcoholics Anonymous or other Twelve Step groups."

--Published September 9, 2002