Addiction Medicine: Closing the Gap between Science and Practice

it eventually may help practitioners diagnose
and address the disease of addiction and its
multiple manifestations in a more unified and
coherent manner in clinical practice.

Public Attitudes about Addiction .......................................................................................

Public attitudes about a particular disease or
health condition and the people who suffer from
it historically have been linked to the public’s
understanding of its causes and amenability to
treatment. This nation has a long history of
isolating and stigmatizing individuals with
health problems that were not well understood,
from tuberculosis to cancer, depression and
HIV-AIDS. Once scientific understanding of
the condition is solidified and the information
permeates public understanding, public attitudes
towards the condition and those who have it
often change. The availability of effective
treatments also can have a profound impact on
driving this change. Addiction is a prime
example of a disease where public attitudes have
yet to catch up with the science, although
attitudes are shifting.^196

A 2005 online survey of 1,000 adults ages 20
and older about addiction involving alcohol
found that 63 percent of the general public see it
primarily as a personal or moral weakness (19
percent) or equally as a personal or moral
weakness and as a disease or health problem (44
percent); only 34 percent see it primarily as a
disease or health problem. In contrast, only 11
percent of individuals who are managing the
disease (i.e., in recovery) see it either primarily
as a personal or moral weakness (two percent) or
as both a personal or moral weakness and a
disease or health problem (nine percent); 81
percent see it primarily as a disease or health
problem. This survey also found that 43 percent
of physicians consider addiction involving
alcohol to be a personal or moral weakness (nine
percent see it primarily as a personal or moral
weakness and 34 percent see it equally as a
personal or moral weakness and as a disease or
health problem); 56 percent see it primarily as a
disease or health problem.^197

A more recent survey of treatment providers in

the U.S. and the United Kingdom, published in

2011, found that the belief that addiction is a

disease is stronger among those who provide

for-profit treatment while the belief that

addiction is a choice is stronger among providers

of public or not-for-profit treatment* 198 --the

more common form of treatment in the United

States.^199

Results from a nationally representative survey

conducted in 2008 found that 44 percent of the

public believes that people with addiction

involving alcohol could stop drinking if they

had enough willpower (73 percent of young

adults, age 18 to 24, hold this view). Fewer

Americans think the same is true for addiction

involving other drugs (38 percent of the public;

66 percent of young adults).^200

A 2009 nationally representative survey of 1,000

adults ages 18 and older underscores the

tremendous stigma still associated with

addiction: individuals with addiction involving

alcohol or other drugs commonly were described

by respondents with words such as “sinner,”

“irresponsible,” “selfish,” “stupid,” “loser,”

“undisciplined,” “pathetic” and “weak.”^202

* Differences also were found between providers who

were members of a group of addiction professionals,

had been treating addiction for longer, had stronger

spiritual beliefs, had a past addiction problem and

were older (tending to endorse the belief that

addiction is a disease) versus those who were not

members of a group of addiction professionals, had

less strong spiritual beliefs and were younger

(tending to endorse the belief that addiction is a

choice).

The average person in the U.S. views addiction

with a sense of hopelessness. They realize that

not all users of alcohol or other addictive drugs

will become addicted. They know that some

users will become addicted but that others will

not. This creates a belief that the addict can--

and should--use willpower to stop using.^201

-- J. Paul Molloy, JD

Chief Executive Officer

Oxford House