Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Is personal responsibility the most
important issue in addictive disease? This view, held since ancient times,
has scant empirical support. History is witness to many punitive strategies
for “holding the user accountable,” with a startling lack of success—and
more recently, a high societal cost of incarceration.1
Until the 20th century, this was also the attitude toward schizophrenia
and depression (sometimes with responsibility ascribed to parents). As the
neurochemical bases of these illnesses were demonstrated and effective biological
treatments arose, personal responsibility came to be seen as limited to only
a secondary role in self-management to sustain treatment benefits.
Gastfriend DR. Physician Substance Abuse—Reply. JAMA. 2005;294(4):426-427. doi:10.1001/jama.294.4.427-a