vineri, septembrie 22, 2023

Classifying Addiction as a Disease Could Save Billions

Romania’s ministries of Finance, Health, Education and Social Work would all save money if they classified addiction as a disease – surely a good idea in a time of recession. If addiction was recognised as a disease and proper treatment was offered to alcoholics, drug addicts and those who bankrupt families by compulsive gambling, these ministries could save millions of Euros that they currently spend on treating the result of addiction: serious illnesses, crime, traffic and industrial accidents.  They could also find a reason behind homelessness, suicides, work and school absences and domestic violence.

But since when has addiction been classified as a disease? We need to go back to 1956 when the American Medical Association declared that alcoholism was a disease. I’m not sure that addiction was ever formally accepted as a disease in Romania, but hopefully one of our highly intelligent commentators will inform us about this. In Romania, alcoholism tends to get ignored and drug addiction is treated as a criminal rather than a health problem.

“For many decades it’s been widely accepted that alcoholism (or addiction) is a disease.”writes Dr Lance Dodes writing in Psychology Today (USA), “The ‘disease concept’is taught in addiction training programs and told to patients in treatment programs.  It is unquestioned by public figures and the media…That meant that people with addictions weren’t bad, they were sick.  In an instant this changed everything.  Public perceptions were less judgmental.  People were less critical of themselves.”

Unfortunately there is very little awareness in Romania that addiction is a disease and this has two negative consequences: the Ministry of Health have made almost no effort over the last 20 years to develop treatment programmes to help addicts and there is an acute shortage of treatment facilities in Romania.  As a result, doctors don’t know what to do with patients who are addicted.  The second problem is that if people are not aware that addiction is a disease then addicts and their families will blame themselves, creating really bad feelings within the family network.

But this problem is not restricted to Romania. In the USA, and many EU Member States, there is a reluctance on the part of the health authorities to recognise addiction as a disease. Politicians seem to prefer to deal with the consequences of addiction rather than offering treatment and preventing the problem from becoming bigger and more expensive.

In a letter to the American Presidential Candidates Susan E. Foster of Columbia University believes that “Treating addiction as a disease is America’s greatest single opportunity to reduce costs to taxpayers, improve health and reduce crime…This relatively simple policy change also would improve the health and productivity of Americans across the country. It’s a no-brainer.”

Foster explains that addiction to drugs, alcohol and tobacco damages 40 million Americans, more than are affected by diabetes and heart disease. She quotes a study from Columbia University that shows that less than 11% of those with addictive diseases are offered any kind of treatment as compared to the 70 to 80% who are offered treatment for the better known diseases.  “Rather than providing treatment for addiction,”she writes, “we turn a blind eye to the symptoms and instead cope with the costly consequences.”

Susan E.Foster’s main point is that both the American presidential candidates agree on one thing and one thing only: the need to cut spending. So why not both agree to classify addiction as a disease? According to a 2009 study, American government agencies spent at least $467 billion each year in dealing with the consequences of addiction (10% of the federal budget), but only 2% of this money was spent on prevention and treatment.

The main costs of addiction are in healthcare and crime. In the US a third of all hospital costs can be attributed to addiction, and more than 70 diseases are caused by substance abuse.  It costs on average $25,000 a year to imprison a drug offender in the US, and they don’t offer addiction education thus ensuring that they will re-offend.

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  1. I agree totaly with your point of view. It’s about accepting the real social implications of a individual medical problem.
    Helping to deal with that problem from society, with a scientifical metodology (doctors) and social workers can save money, family and lifes.
    Some examples. For SMURD for example, 30% percentage of interventions (in areas strikes by poverty) have clients peoples who drunk to much.Another example. Everybody knows for example the hospitals are under assault in Christmas time, because of the alcohool and exagerating eating pork fat. It’s socially accepted that tipe of exageration. For not mentioning the accident caused by Impaired Driving +Miserable Infrastructure (signalisation, absence of highways)
    Public campaigns about moderation are more than necessary. But everybody is focused on Post-Intervention(healthcare and social public ministers) and not Prevention. And unfortunately the costs of not having a good and consistent strategy in prevention(buget for education and public communication) at the Public Minister level is more expensive at the buget level every year.

  2. Thank you for your article. Reading it I felt that some distinctions were necessary. If you think they are justified, maybe you will clarify your stand on them.

    „In Romania, alcoholism tends to get ignored and drug addiction is treated as a criminal rather than a health problem.” I would like to believe that treatment is given where it’s due regardless of the semantics. I presume that a person has access to proper healthcare (or should have) based on his physical condition and not depending on how we name it – disease or simply addiction.

    „people with addictions weren’t bad, they were sick” I think we have to draw the line somewhere. Said like that it doesn’t feel right. Wouldn’t there be dangerous moral implications by absolving the addicted of any poor/wrong judgment? After all when you catch a cold is most of the time your fault.

    As I read your article, the reason for calling addiction a disease would be two-fold: moral and financial. The don’t sit well together! I think that there should be either one or the other. If it’s morally wrong, you don’t change it on grounds of financial opportunities. If it is financially desirable, it’s not reason enough to force semantics. In the end, I presume your main reason is moral, but then the financial reason it not relevant to the discussion, or, better said, is another discussion.

  3. Very nice article, I teach my children that smoking is a disease in order for them to treat it like any other disease. It sure didn’t help that my parents told me that smoking was bad, while being chain smokers themselves.

    Too bad such lessons are not taught in school.

  4. What about other forms of addiction, say sexual addiction? Was Casanova an addict? (most probably, yes). Or for that reason a David Duchovny? Shall our society spend on curing sexual addiction? Is it worth or advisable doing this? I think the discussion here is going to be more circumvented, veiled or, you name it…

  5. I remember that i have read, two or three years ago, some studies by RAND Corporation, about drug addiction, wars on drugs and so on. There i read for the first time about this approach. And yes, in the same time, in Romania some drug addicts were simply sentenced to prison for possesion….

  6. Tutunul, cafeaua dar si alcoolul au in spate culturi, chiar industrii intregi, datorita carora o multime de oameni isi intretin propriile familii. Industriile acestea s-au dezvoltat in cadru legal si au contributii economice importante. Pe de alta parte, privitor la oameni, exista cercuri vicioase si cercuri virtuoase. Incit, dependenta este si ea de multe feluri. A vorbi despre orice fel de dependenta ca despre boala, e deplasat. Exista, as spune, doua mari categorii de dependenta: sa le numim dependente bune si dependente rele. Cele rele sint cele in care se intra usor sau relativ usor si de care se scapa foarte greu sau deloc. Cele bune sint cele in care ajungi greu si in care te mentii facind mereu un efort intelectual nemijlocit – si creator –, si chiar fizic. Dependenta de alcool sau tigari intra, fireste, in prima categorie, in timp ce dependenta de jogging e in a doua. Sa luam acum dependenta de cafea: desi pare simplu, anume ca aceasta ar face parte din categoria dependentelor facile sau rele, lucrurile nu sint simple. Exista cazuri de oameni care au murit datorita excesului de cafea, dar ele sint cu mult mai rare decit ale celor ce ajung in coma alcoolica. Sau: desi cu totii sintem intr-un anumit sens dependenti de mincare, nu ajungem cu totii sa suferim de bulimie sau sa fim obezi. Bulimia are cauzele ei care tin de spectrul psihologic, obezitatea le are si ea pe ale ei, dintre care unele tin probabil de fondul genetic.


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Rupert Wolfe Murray
Rupert Wolfe Murray este consultant independent pe probleme de comunicare. Scotian cu resedinta la Bucuresti

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