Page 14
However, the more common view is that drug addicts are weak or bad people, unwilling to lead moral lives and to control their behaviors and gratifications. To the contrary, addiction is actually a chronic, relapsing illness, characterized by compulsive drug seeking and use. The gulf in implications between the “bad person” view and the “chronic illness sufferer” view is tremendous. As just one example, there are many people who believe that addicted individuals do not even deserve treatment. This stigma, and the underlying moralistic tone, is a significant overlay on all decisions that relate to drug use and drug users. Ingrained Ideologies Another barrier is that some of the people who work in the fields of drug abuse prevention and addiction treatment also hold ingrained ideologies that, although usually different in origin and form from the ideologies of the general public, can be just as problematic. For example, many drug abuse workers are themselves former drug users who have had successful treatment experiences with a particular treatment method. They therefore may zealously defend a single approach, even in the face of contradictory scientific evidence. In fact, there are many drug abuse treatments that have been shown to be effective through clinical trials. These difficulties notwithstanding, I believe that we can and must bridge this informational disconnection if we are going to make any real progress in controlling drug abuse and addiction. It is time to replace ideology with science. At the most general level, research has shown that drug abuse is a dual-edged health issue, as well as a social issue. It affects both the health of the individual and the health of the public. The use of drugs has well-known and severe negative consequences for health, both mental and physical. But drug abuse and addiction also have tremendous implications for the health of the public, because drug use, directly or indirectly, is now a major vector for the transmission of many serious infectious diseases—particularly acquired immunodeficiency syndrome (AIDS), hepatitis, and tuberculosis—as well as violence. Because addiction is such a complex and pervasive health issue, we must include in our over all strategies a committed public health approach, including extensive education and prevention efforts, treatment, and research. Science is providing the basis for such public health approaches. For example, two large sets of multisite studies have demonstrated the effectiveness of well-delineated outreach strategies in modifying the behaviors of addicted individuals that put them at risk for acquiring the human immunodeficiency virus (HIV), even if they continue to use drugs and do not want to enter treatment.