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January 24/31, 2001

Drug Dependence as a Chronic Medical Illness—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;285(4):409. doi:10.1001/jama.285.4.407

In Reply: Mr Amerson and Dr Smith have failed to understand 3 key points in our article: (1) that substance-dependent individuals are responsible for the onset of their illness; (2) that they are also responsible for active participation in their recovery; and (3) that they should be treated because of the demonstrated public health and safety benefits of treatment, not merely because of compassion for those affected.

Responsibility for Onset of Illness. Addiction is initiated by a voluntary act—but it is also true that this initial voluntary behavior is shaped by preexisting genetic factors. These are also brain changes that begin with the very first drug or alcohol uses, which may evolve into compulsive drug taking that is less subject to voluntary control. We are not yet able to explain the brain and cellular changes that transform the initial, voluntary drug-taking behavior into a compulsion.