An Interview with Alan I. Leshner, Ph.D.
The following is the edited transcript of an interview by Bill Moyers with Alan I. Leshner, Ph.D., on the nature of addiction. Leshner is the director of the federal governmentís National Institute on Drug Abuse. Portions of this interview appear in the CLOSE TO HOME series.
Moyers: Neuroscience has revolutionized our understanding of addiction in the last ten years. How has your own understanding changed?
Leshner: Like most people in this country, I believed that addiction was just a lot of drug use. You use drugs and then you become addicted and you could move back to being just a drug user. And, you could just stop any time if you were really serious. A lot of people felt that way, especially about cigarette smoking, but the truth is addiction is not a voluntary circumstance. It's not a voluntary behavior. It's more than just a lot of drug use. It's actually a different state. It's hard for people to understand that, but if you take drugs to the point of addiction, functionally you move into a different state. A state of compulsive, uncontrollable drug use.
Moyers: So the addict has no choice?
Leshner: That's right.
Moyers: But the first time is a choice, surely?
Leshner: Yes. I think what is frequently confusing is that although initial drug use is a voluntary behavior, at some point when you move over into addiction, it's no longer voluntary. It's a change. A user has a choice about that next drug, but an addict does not.
Moyers: So what does this say about free will?
Leshner: Most people are able to control their initial drug use. They're able to exert their will over it, but once they are addicted, it's a myth that many people just decide to break their addiction. Very few people are able to just say, I'm done, I'm finished. Most people need treatment. Why do they need treatment? They need treatment to deal with the cravings. They need help to deal with the compulsive, uncontrollable drug use.
Moyers: So let's explore the scientific grounding for that. What, scientifically, is the essence of addiction?
Leshner: Well, each of those words I've just used is an important part of the definition of addiction. Compulsive and uncontrollable means that you can't exert your will over it. And using becomes the center, the essence of the person's life. People have a lot of confusion about what addiction actually is and what matters in it. I'm very frequently asked, "Is this drug addicting? Is this drug more addicting then that other drug?" and what people want to hear is whether or not it causes physical addiction. That means when you stop using it you go through these dramatic withdrawal symptoms we've all seen in the movies and on television like shivering, gastrointestinal problems, and cold sweats, but the truth is that doesn't really matter in addiction. What really matters is that the drug has become central to the addict's life. The physical symptoms can be managed relatively easily, and in fact for many drugs like crack and methamphetamine, there are no dramatic physical withdrawal symptoms. Two of the most addicting substances ever known to humankind really have very few physical withdrawal symptoms associated with stopping their use. On the other hand, crack and methamphetamine produce unbelievable craving. Unbelievable compulsion to use them, and that's really the essence of addiction. The psychological part, not that dramatic, cinematic withdrawal seen with alcohol or heroin.
Moyers: From the scientific perspective, what do we mean when we say someone is an addict?
Leshner: You are an addict because your brain has been changed by drugs. You're in a state where the drug has totally taken over your being.
Moyers: Would you call it a disease?
Leshner: Yes. Addiction is a brain disease. It's a chronic, relapsing disease. It's a disease because it's a result of drugs actually changing the brain in fundamental and long lasting ways, and it's a chronic, relapsing disease because, sadly but typically, people don't have only one one episode of addiction. They have repeat episodes. Even if they're treated successfully, often there will be occasional relapses. We need to conceptualize this disease more in the same way that you would think about diabetes -- it doesn't stop with one episode of treatment.
Moyers: So you take your insulin if you're a diabetic, but if you're an addict what do you do?
Leshner: In the case of diabetes, you take your insulin on a regular basis. Periodically you may have a crisis and you need to manage the crisis. If you're an addict you need to be given tools to manage the craving, to manage the compulsion, and every once in a while you may have a crisis and need reinnoculation, perhaps another treatment. You see, if it were only a brain disease, I could come up with a magic bullet. But itís far more complicated than that. Addiction is a result of a combination of historical factors, environmental factors, physiology -- these all come together through the brain to produce addiction, but it is not any one thing by itself doing it. So, if treatment doesn't, for example, deal with some of the life problems that might have initiated the drug use, we can't expect that person to go back into that same problem and not return to using. Even if we've given them the best tools and drugs we have to fight craving. You have to deal with the brain, but also the person.
Moyers: Tell me what happens to the brain when it changes under the influence of a drug.
Leshner: Well, people take drugs initially because they like what they do to their brains. Drugs -- including alcohol and nicotine -- cause a whole series of brain changes, one of which is a surge in a neurotransmitter substance called dopamine. If a drug really produces a sharp spike in dopamine, the odds are phenomenal that people will like it, they'll experience it as pleasurable, and it will be addictive. Dopamine is also important because it is the brain chemical which seems to be involved in signalling most of the normal pleasurable experiences we have. Sex, eating, smoking, getting high -- all of these affect dopamine levels. But after someone's been using a drug for a long time, and this is true for all addictive substances we know of, they actually go into a state where dopamine is lowered. For some people that produces dysphoria or depression. So, there's something about these biological changes that are going on at the cellular level that gets translated into compulsive, uncontrollable drug use on the behavioral level. What addiction really is, then, is a result of brain changes which over time get translated into behavior changes.
Moyers: How long do those changes last?
Leshner: Some of the changes we see that accompany addiction seem to be relatively short-lived. Others persist for a very long time, and we're not here talking about brain damage in the traditional way that people think of it. Of course, some drugs like inhalants can literally destroy brain cells -- but usually what's happening is a much more subtle kind of a change, which can be reversed over time, but which doesn't change overnight. For example, if you take amphetamine heavily for long periods, it lowers dopamine. You stop taking amphetamine -- the dopamine is still down. It could take six months, a year or longer for dopamine levels to go back up.
Moyers: And during that time of lowered dopamine you would feel depressed?
Leshner: Changes in dopamine levels seem to be related to our ability to experience pleasure. Normal dopamine function is essential for the normal experience of pleasure, and so when you can't respond to a good experience with a positive change in dopamine levels, because you've used drugs and depleted it, we believe that then results in an inability to feel good. We haven't yet proven all the aspects of it, though.
Moyers: So this is what draws the addict back to the drug even when he knows it could kill him, just trying to feel normal pleasure?
Leshner: Absolutely. People who are addicted initially take the drug because it makes them feel good, but over time they just take it to return to normalcy. Heroin addiction is a wonderful example. Initially, people take heroin because they like the high, but over time they keep taking it to avoid withdrawal sickness. If you saw the movie TRAINSPOTTING, you saw a great example of somebody who didn't get high anymore when he took the drug, he just became what junkies call "straight," which is not sick, but not high either.
Moyers: Doesn't every experience change our brain? When you learn that the Normans invaded England in 1066, your brain changes because somehow, you don't forget that. It's stored somewhere, something's different to code that.
Leshner: Yes. The truth is, people need to think of life as a dynamic process of brain/behavior/environment interaction that constantly goes through changes where each of those things -- brain, behavior, experience -- modify each other. So every experience you have changes you, and it changes you in a way that persists. Now in the case of addiction, it's a very dramatic change.
Moyers: Alcohol, tobacco, cocaine, heroin -- is there some common essence to all of these addictions?
Leshner: We've learned just over the last six months that biologically there are common mechanisms in the brain that are triggered by every major addicting substance. We've come to suspect that this may represent the common biological essence of addiction. Of course, you would expect a common biological essence, because there's a common behavioral essence.
Moyers: What do you mean?
Leshner: Compulsive, uncontrollable drug use is a phenomenon that's universal in addictions, not unique to a specific drug. So if there's a common behavioral pattern, shouldn't there also be a common brain mechanism that underlines that common behavior pattern?
Moyers: What about the differences? Are there differences?
Leshner: All drugs of abuse affect dopamine levels, but each drug has its own individual effects as well.
Moyers: So when we use a drug we're putting something into a vital part of our being?
Leshner: Absolutely. The act of taking a drug is in effect pushing your dopamine levels up and that has very dramatic and pervasive effects, not only on the immediate experience, but potentially in the longer run as well.
Moyers: Aren't there variables from person to person in what a drug or drugs do to the dopamine?
Leshner: There's tremendous variability among individuals in what we call their vulnerability to becoming addicted. There are tremendous individual differences in everything. And accompanying those individual differences are differences in the way our brain is wired and the way our brain is rewired after we take drugs. I mean, there are individual differences in hair color, eye color, height, weight. Why shouldn't there be differences in the vulnerability of your brain to being addicted by a drug?
Moyers: What affects vulnerability?
Leshner: One of the major predictors of the tendency to become addicted is how much stress you are under. The more stress, the more likely it is you will get addicted. In addition to that, people are responsive to things like their genetic backgrounds, their environment and the social context in which drug use is occurring. It's a complex interaction between what the drug is doing to the brain, and what the state of the brain was when you started using the drugs.
Moyers: And that has to do with our history, with our environment, with other forces. Not just the cells themselves, right?
Leshner: Absolutely, because the brain is constantly changing as a function of the experiences one has, you have this constant interplay. So it's very unpredictable. Even if you knew your genetic vulnerability, which none of us really knows, unless you knew everything about the context in which you were using drugs, you couldn't predict whether or not or how quickly you might become addicted.
Moyers: Do you know, as a scientist, that the brain of the non-addict is different from the brain of the addict?
Leshner: Yes, the brain of an addicted person is literally different from the brain of non-addicted person. Now, we don't know that in nearly the level of detail that we'll need to know it in order to understand the entire process. And we don't yet know whether there are differences in the brains of vulnerable people before they ever try a drug. But we do know, of course, the opposite: that once someone is addicted, their brain is quite different from the brain of an individual who is not addicted. And if your brain is changed, your behavior can be changed.
Moyers: Do we know when a user becomes an addict?
Leshner: It's very difficult to know the precise point in time when that happens. It's not literally a switch in the brain. That's a good metaphor and a concept for what's going on, because it's as if you move from one state into another state. Now, that switch probably moves gradually, not precipitously. It doesn't occur in one split second in time, but it is literally a changed state both biologically in the state of the brain, and behaviorally in terms of the state of the individual.
Moyers: And the drugs are causing the change?
Leshner: There's no question that prolonged drug use changes the brain in fundamental and long-lasting ways and that those changes are characteristic of the addicted state in all individuals.
Moyers: You said earlier that your whole being is changed. I hadn't heard that before from anyone. What did you mean?
Leshner: I think that most people don't fully understand what it means to be an addict. To be an addicted person doesn't mean that one part of your life is changed. When you speak to addicts about their experiences, they'll tell you that there is nothing in their life but drugs. There is no motivator more powerful then the drug craving, than that need. Many people do things they wouldn't ordinarily do. After all, some have sold their children for drugs, so what you have is literally a changed being. People frequently talk about self-esteem, and they say, Oh, the self-esteem of the addict is low and that's why they're an addict. That's not true. That may be why they took the drug in the first place, but once they're taking the drug compulsively, self-esteem is irrelevant. It doesn't matter whether it is high or low; all the addict can see is the need for the drug.
Moyers: So loyalty is not important anymore. The job is not important anymore. Family is not important. Nothing matters but satisfying that physical need for that next round?
Leshner: If you speak to addicts about the nature of the experience, drugs are their whole world. All that matters, all that consumes them is drug seeking and drug using.
Moyers: And that happens because . . .
Leshner: Because the drug is literally changing the brain so that it goes into a different state. People are able to understand this now when they think about schizophrenic people who act in very bizarre ways. Why are they acting so weirdly? Because there's something wrong with their brain. That's exactly what's happening in addiction.
Moyers: Why do people take the chance, if they know they could become addicted?
Leshner: Most people believe that they're invulnerable. They see themselves individually as strong, powerful people, who won't be affected by the drug and who won't get hooked. It is true that not everyone will get addicted and not everyone will get addicted equally easily, but you have no way to know whether you're the one that's going to be addicted easily or you're the one who is relatively difficult to hook. It is a very big risk.
Moyers: Do you think most of us have in common a desire for what drugs do to us?
Leshner: I think there's no question that everyone would like the experience of what a drug of abuse does. That's why we call them psychoactive drugs. Pretty much everybody enjoys having their dopamine levels shoot up dramatically. That happens during sex, for example, but that doesn't mean that everybody likes the experience so much that it consumes them.
Moyers: I . . . my own brother was a chronic smoker, and I remember him saying, "I've got to have a cigarette. I know it's going to taste awful, but I got to have that cigarette," and he took it. Finally, smoking killed him.
Leshner: That's what addiction is about. Addiction is about compulsive, uncontrollable drug seeking and use, even in the face of negative social consequences or health consequences. Most people think they smoke because it's a habit. The truth is people smoke because they love the dopamine surge when nicotine hits the brain.
Moyers: But some people do just walk away from it . . .
Leshner: Some people break addictions without help, but many cannot. That's why we've developed nicotine patches for cigarette smoking to give people tools with which they can help break their addictions. For other kinds of addictions, you have to have more elaborate treatment approaches.
Moyers: Do you think we will find the equivalent of the nicotine patch for cocaine?
Leshner: We have the equivalent of the nicotine patch for heroin addiction right now. It's called methadone, and what it does is occupy the receptors in the brain that heroin would normally occupy. It helps people deal with the craving.
Moyers: But aren't people then just addicted to methadone?
Leshner: Absolutely it's an addiction, but it's not bad to be addicted in and of itself. It's only bad if the addiction interferes with functioning in one way or another. Methadone doesn't.
Moyers: So do you think you will find a methadone for cocaine?
Leshner: Right now I believe that the single most important tool we're missing in our tool box for addiction is an anti-cocaine medication. We have no medication for cocaine overdose. We have no medication to help people stop taking cocaine, and we have no medication to keep people off cocaine. So we may actually need three medications. But what would be best is a non-substitute medication. It's been so difficult to get the public to understand and accept methadone, which is a very effective medication for heroin addiction, that frankly I'm concerned that a cocaine substitute would evoke a similar response and stigma. So we're looking for other kinds of mechanisms of action as well as looking for a medication that would work basically in the same ways as cocaine.
Moyers: What can you say scientifically about why people binge?
Leshner: It's interesting. Only in the last six months have we actually come to understand the phenomenon of binging on drugs. And some of it has to do with this spike in dopamine levels produced by drugs of abuse. When you take crack cocaine, for example, it quickly rushes to the brain and then it causes a spike in the dopamine level. And with crack, that spike goes up very fast and it comes down very rapidly as well. So what the addict is trying to do when he or she binges is keep dopamine levels up. So they're literally pushing the dopamine spike. Now, when you take a substance where dopamine falls off more gradually, like methamphetamine, you don't need to binge because the dopamine is staying up for a longer period of time. So the difference between binging and not binging has to do with whether that particular drug keeps dopamine levels up or you need to keep taking it in order to keep those levels high.
Moyers: But if you talk to kids at . . . at a fraternity party, they won't say, "Well, let's push our dopamines up."
Leshner: That's true. Most people are not aware that it's their dopamine level going up when they get high and coming down when they crash. But they are aware when the high has worn off. The drug made 'em feel good, now they don't feel so good anymore. And we know this because if you block that spike, and we only have done this in animals so far, but if you block that dopamine spike, the animal stops taking the drug.
Moyers: I was taken this morning when one of the students said to you, "Doctor Leshner, everyone can become addicted because there's no perfect human being." It was as if she were casting it as a moral matter.
Leshner: One of the biggest issues of concern to those of us who deal with the treatment of drug abuse and addiction, is this moral overlay that people constantly impose. They see being addicted as a sin, a crime, a weakness. They don't understand that it's actually a disease. Now, it's true that becoming addicted occurred through a voluntary act. That is, someone voluntarily took a drug and they could have chosen not to. But, you know, that's the same way you get lung cancer. You voluntarily choose to smoke. But you don't choose to get lung cancer. And you don't choose to become addicted. If some people become addicted and others don't, doesn't that suggest that those who do aren't choosing it? Why would they choose it? People have a lot of trouble understanding that addiction is not an issue of choice or will or morality. When you get into an addicted state, it's a disease. And if you want to deal with it, you have to deal with it as a disease.
Moyers: But are you saying that the addict has no moral responsibility? No moral accountability?
Leshner: Everybody has moral responsibility and moral accountability for everything they do. However, we need to understand that if we want to deal with the addict, punishment doesn't cure the disease. Our problem as a society is we need to get these people to be productive members of society. We can worry about their moral failure and focus on punishing that. But if that doesn't get them to stop using drugs, it's not very productive. Science teaches us to focus on what works and what we can change. What we can change is the brain state. We can provide treatment that will help people survive their addiction and return to full, productive life in society.
Moyers: But help me to understand . . . how, if your brain is changed by drugs, can you change it back?
Leshner: Think for a minute about the old dualism of having a separate mind and a body. People always seem to have trouble with this point. But the truth is, you don't have a mind floating around outside your body somewhere. It's part of your physical being. In order for drugs to change your mood or perception, they have to be doing it by changing your mind. And where do we see drugs working, on what part of your body? That's the brain. People take drugs to modify their brains. Now, where it gets interesting is that there are at least two ways to change the brain -- you can change it with drugs, or you can change it with behavior, by learning or getting support. And we've actually found that a behavioral treatment like talk therapy, when successful, can change the brain exactly the way a drug like an antidepressant can. We've seen this in a study which compared the brain changes found in people who were successfully treated for obsessive-compulsive disorder with drugs and with talk therapy. The changes were the same. There's no difference between a behaviorally induced brain change and a biologically produced brain change. It's still brain change.
Moyers: But can an addict's brain go back to normal?
Leshner: I think that what we can do is either of two things. Either return the brain to a normal state through some kind of intervention, or we can compensate in some way for that specific brain change, by perhaps strengthening other aspects of brain function. And, of course, that can be done either biologically or behaviorally.
Moyers: Talk to me about craving. Someone said to me, "Craving is the best memory I have." Is he saying something biologically?
Leshner: Craving is either the best memory or the worst memory that someone has. But there's no question in my mind that the craving is the result of the biological change that's been produced by prolonged drug use. It's the expression of the biological change that's occurred. And it is an all-consuming sensation.
Moyers: When I crave, is it the kind of memory that is working when I was taught in tenth grade history by Valerie Harrell, the Normans invaded England in 1066? Is the use, the experience of the high, the ecstasy one gets from that first drug, is that now a permanent part of one's memory?
Leshner: We don't think actually that what people are doing when they are craving is recalling their initial experience. They are experiencing a gut-level, emotional behavior of wanting, seeking, craving that drug. It's not just that they remember the drug. They developed the ability to crave in the same way that you develop memories. But the experience of craving itself is a very powerful, unique emotional experience, a unique motivator of behavior.
Moyers: Exactly, scientifically, what is a gut-level emotional memory?
Leshner: It's very hard to explain. But you can think about other gut-level emotional experiences. Like love. People talk about having a warm glow of love. And then you say to them, "Could you tell me what that was? Could you tell me where in your body that warm glow occurred?" Think about that when you think about craving. It's an overwhelming emotional experience that takes over your body. It consumes you.
Moyers: Sounds like a formidable opponent, if you're trying to retrain your brain. What have you learned about how to treat that craving?
Leshner: We actually have a tremendously wide range of effective drug treatments in our clinical toolbox which are very effective. Some to deal with the immediate craving. Some to deal with other aspects of it, like difficult emotional states which can prompt craving, or cues like the sight of drug paraphernalia which can make someone want to get high. One of the major functions of treatment is to help the addict learn the skills to resist craving. A second part of treatment that is very important to deal with has to do with helping the addict return to normal functioning in society. Being an addict ruins someone's life. It interferes with their ability to function in the family, at work, in the community. And a part of treatment actually has to be rehabilitating the individual. Just to deal with the drug use, per se, won't do it. We need to help people. And we need to have the patience to help people learn how to return to being a full productive member of society. People also have to learn how to care for other people again. They have to learn or relearn normal social skills. Some have to learn how to be a responsible employee. And sometimes people have to learn work skills that they never acquired very well in the first place. We can't put people, some of whom took drugs because they had life failures, back into a failure situation and expect them not to use drugs again.
Moyers: There is a widespread belief amongst the public and politicians that treatment just doesn't work. They say, you know, a big percentage of the people who stop smoking are using again one year later. Or half of the people who come out of a treatment center have relapsed in the first however many months. And people kind of shrug their shoulders and say, It doesn't work, why should we pay for it?
Leshner: What we really need is a more realistic set of expectations for drug treatment. For many, many people, even after successful treatment, ultimately, they may relapse again. Then they'll need another treatment episode. Like any chronic relapsing disorder -- we don't give up on people if they have a crisis with diabetes. We know it's chronic. It's not reasonable to expect that with the first treatment experience everyone will get total abstinence for the rest of one's life. That just isn't a reasonable outcome with a chronic condition.
Moyers: Is that a scientific statement you're making?
Leshner: That's absolutely a scientific statement. The outcome can't always be total abstinence. Because it's a relapsing disorder. But once we recognize that it's a relapsing disorder, we can manage it. And the goal of treatment has to be, first of all, to reduce drug use. And ultimately, abstinence, total abstinence. But we need to reduce drug use and increase the intervals between relapses. That's what'll make people able again to function in society. It's also what will keep people coming back to treatment when they need it, so that ultimately we can get to that goal of total abstinence.
Moyers: Is it like cancer and remission? That you don't . . . not treat the person again when the cancer reappears?
Leshner: Yes. It's also like depression in remission. Some people are cyclic depressives; they become depressed over and over again. Each time they get depressed they need new treatment. Same is true for drug addiction. Now, we're trying to increase the interval between relapses. But it's very difficult, particularly from a first treatment episode, to get total abstinence for the rest of someone's life.
Moyers: Because our bodies have been so changed by the drug?
Leshner: Partly because our brains have been so changed by the drugs. Partly because the pressures on the individuals remain very high. Partly because the individual will be exposed to those cues which cause craving again when they return to the same people, places and things where they first used drugs.
Moyers: You said to the kids this morning that the issue is to match the appropriate treatment with the appropriate patient, and to apply treatment long enough to have an effect. How do we do that? I mean, you're talking about what sounds like a very expensive and time-consuming process.
Leshner: We ought to bring the same standards to the treatment of drug abuse that we bring to the treatment of any other disorder. We ought to be looking to match the perfect treatment, or the best treatment for an individual, just like we do to match the right treatment for someone who has high blood pressure. There's no cookie cutter of high blood pressure treatments; there should be no cookie cutter of drug treatments. You would never say to somebody, "Take your antibiotic for one day and it'll get rid of your cold." The doctor always says, "Take all the pills that are in that bottle." Well, that's what we have to do with drug treatment. We have to treat people long enough for the treatment to take effect.
Moyers: But treatment is not a pill.
Leshner: Treatment is like a pill, actually. Treatment is doing, in effect, ultimately, the same thing that a pill is doing. It's changing the functioning of your body. In this case it's changing the functioning of your brain. And if you want your brain changed, you're gonna have to work at it for a while, 'cause it won't be changed instantly.
Moyers: So what do we need to learn? What are you looking for?
Leshner: We're trying to understand drug abuse and addiction in all of its aspects. I'm fond of saying, "The mission of my institute is to bring the full power of science to bear." We need to understand everything, from the molecule to managed care. Because if we look for a silver bullet, or a magic bullet, we will fail. This is the most complex phenomenon that's facing our society. And our strategy for dealing with it has got to be equally complex. We have to bring a multidisciplinary approach to the problem. And that's what I hope the science will give us. We know more about drug abuse and addiction than we've ever known in history, and we know more about what to do about it. Now our task is not only to generate that interesting scientific data, but to make it both useful and used. So among the things we are trying to do is to educate -- lay public, policymakers, professionals in the field -- about what we do know about drug abuse and addiction, so we can bridge that terrible disconnect between what the public believes and what the scientific findings are actually showing us.
Moyers: You said to the kids that the public doesn't know what we scientists know about addiction. What, in essence, would you like the public to know?
Leshner: I would like the public to understand that this is not just a social issue. This is not just an issue of will, or failure of will. This is a very complex phenomenon that has social aspects, of course, but that has very important health aspects as well. People need to understand that although drug abuse is a preventable behavior, addiction is a treatable disease. It's different. It's not just a lot of drug use. I would like people to understand as much as they can about the complexity of the issue, so that they stop looking for intuition-based or ideology-based solutions. And then they can seek the scientific solutions that have been so successful for helping us deal with heart disease, cancer, schizophrenia, other kinds of disorders where science has been hope, and science has provided the answers. That's what we want to do. We want to be the source of hope about addiction for this country.
Moyers: What would be our public policy on addiction if Alan Leshner could make it happen?
Leshner: I believe that the complexity of this problem requires an equally complex strategy, that employs social solutions, criminal justice solutions, and health solutions. From my own point of view, I would like to see more and more investment in the health aspects, in prevention, in treatment, in research, to educate people about what drugs do. So that we take and we use the full armamentarium, the full toolbox that we have available. No simple solution, no simple strategy is gonna work on this problem.
Moyers: Why is the addict so stigmatized? Because that's one of the reasons we don't have a different drug policy.
Leshner: The stigma associated with drug abuse and addiction is one of the biggest problems we have in dealing with it. People hate addicts. Some addicts commit crimes. People are nervous that addicts are going to do something to them. The truth is, though, an addict has an illness. Whether you like that person or not, you've gotta deal with it as an illness. So that the stigma, which typically is that people think the addict is just morally weak, the stigma interferes with getting people treatment. Either they don't want to help the addict because they don't like the addict, 'cause the addict did something bad to them, or they think the addict is just a weakling, and, therefore, doesn't deserve treatment. But this has to be viewed from a societal perspective. Even if you don't care about the addict, you should care about the addict's family, the addict's community. And until we see this and approach it as a health problem, where we provide treatment to addicted individuals, we're never going to get their families back together and we're never going to heal society either.