“We Haven’t Yet Begun
to Fight!”
Carlton Erickson, Ph.D.
Director, Addiction Science Research and
Education Center
University of Texas at Austin
2003
There once was a
disease…..
• people who had it were disgraced
• sufferers felt isolated and alone
• sufferers had permanent psychological
damage
• the disease had insufficient funding for
treatment
• there was poor understanding about
the cause
That disease was…
POLIO
(50 years ago)
If we had continued to only treat
polio, today we would have
computerized iron lungs!
But now polio is only a memory
Today we face a
challenge…..
• we’re trying hard to help people with drug
problems, but we can’t help them all
• why?
- we hang on to outmoded beliefs
- we don’t have all the answers
- to policy makers, we appear to not know
what we’re doing - but there is a solution
S.P.A.M.
• Stigma
• Prejudice
• Anger
• Misunderstanding
This has led to discrimination
against addicts and inadequate $$
for treatment, education, research…
Strange “addictions”
• cell phone
• Thomas Kincaid
• television
• Ben & Jerry’s
• exercise
• “other people”
• internet
• A.A. meetings
• shoes
• cars
• Disneyland
• chocolate
We must clarify the
words “addiction” and
“alcoholism”
Leshner (1997)
According to DSM-IV*:
• substance (drug, chemical) abuse overuse of drugs in cases where people
are making poor choices about drug use:
“a problem to solve”
• not a minor problem, since drug abusers
produce a major economic impact on
society
* Diagnostic and Statistical Manual-IV-TR (DSM-IV-TR)
But this is the disease
• substance (drug, chemical) dependence impaired control over drug use, probably
caused by a dysfunction in the brain’s
“pleasure pathway”
(“a disease to conquer”)
• this requires twelve-step or other
programs (“treatments”)
• dependence = addiction; alcohol abuse
is not “alcoholism”
We must let people know
clearly what we do
• we don’t treat “substance abusers”
• we treat chemical dependence
• we don’t treat gambling addictions
• we treat compulsive gambling
behaviors
• what other disease……..?
We need more research!
• There is lots of disagreement and
misinformation in this field.
• This is a result of not having all of
the facts.
• Facts come from good scientific
research.
• Facts reduce stigma!
Risk of Dependence
• data from National Comorbidity Survey
(n= 8,100), ages 15-54 y-o (both genders)
• dep occurrence in 10 years: cocaine,
15-16%, alcohol, 12-13%; marijuana, 8%
• cocaine: 5-6% dep in 1st year of use,
80% within 3 years
Wagner & Anthony, 2002
Important Point!
Dependence is not a loss of “will
power”, for two reasons:
• The main problem with dependence
lies in the subconscious MFB.
• Problems with the frontal cortex
produce a pathological impairment of
decision-making.
Thus, dependence is not primarily under
conscious control!
Today’s Options
(It’s all about options….)
• traditional: 12 step programs (abstinence)
• talk: inpatient/outpatient/aftercare
• misunderstood: harm reduction, MM
• new: brief motivational counseling, CBT,
MET, SO-involved therapy, vouchers
• medical tx: new medications to enhance
abstinence - anticraving meds, methadone,
buprenorphine, vaccines
(MM= Moderation Management, CBT= cognitive behavioral therapy,
MET= motivational enhancement therapy, SO = significant other)
What are we doing?
• are we trying to help people with the
disease? (yes)
• are we trying to help all people with
drug problems? (sometimes)
• are we pushing one agenda at the
expense of other agendas? (often)
• are we really trying to work together?
(today, yes - after today……….)
It’s About Time….
..that we put away our differences
and focus on helping those who
are suffering
…it’s not about one way (of
helping) versus another way
…it’s about helping sufferers in
whatever way we can…..
It’s Our Responsibility to….
• be research pushers
• be treatment/recovery pushers
• be prevention pushers
• be education pushers
• not argue about which one of the
above is most important
• consistently push our importance
• while we disagree, people are dying…
Can we focus more on
broad-based research?
• like the organizations that
promote research on “good
diseases” (cancer, heart, AIDS)?
• to reduce stigma (with facts)?
• to find more treatments to help
more people?
There are websites that you can
access for more information.
www.niaaa.nih.gov
www.nida.nih.gov
www.utexas.edu/research/asrec