Much of the stigma surrounding addiction, whether to drugs alcohol or other substances, stems from the popular opinion that consumption of substances is a personal choice based on moral failure, personal irresponsibility, or hedonistic behavior. These opinions, however, are not based on fact.

In 2016, then U.S. Surgeon General Vivek Murthy released The Surgeon General’s Report on Alcohol, Drugs, and Health, in which he said Americans need to see addiction as a brain disorder instead of a moral failing.

“For far too long, too many in our country have viewed addiction as a moral failing,” Murthy wrote. “This unfortunate stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help.”

He went on to say that: “We must help everyone see that addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”

Murthy stated that his aim was to shift the way “our society thinks about substance misuse and substance use disorders while defining actions we can take to prevent and treat these conditions.”

Research demonstrating that addiction is driven by changes in the brain, Murthy said, helped to reduce the negative attitudes associated with substance use disorders and provided support for integrating treatment for substance use disorders into mainstream health care.

As individuals continue to misuse alcohol or other substances, he wrote, progressive changes, called neuroadaptations, occur in the structure and function of the brain. These neuroadaptations compromise brain function and also drive the transition from controlled, occasional substance use to chronic misuse, which can be difficult to control. Moreover, these brain changes endure long after an individual stops using substances.

Communities and populations have different levels of risk, protection, and substance use. Well supported scientific evidence shows that communities are an important organizing force for bringing effective Evidence-based interventions (EBIs) to scale, the report states. To build effective, sustainable prevention across age groups and populations, communities should build cross-sector community coalitions which assess and prioritize local levels of risk and protective factors and substance misuse problems and select and implement evidence-based interventions matched to local priorities.

While the 2016 Surgeon General’s report firmly established addiction, now referred to as Substance Use Disorder, as a medically defined brain disorder, six years later, outdated concepts and ideas about addiction still create stigma toward the disorder and those who experience it.

The New England Journal of Medicine released its own report, also in 2016, in which was stated that in the past two decades, research has increasingly supported the view that addiction is a disease of the brain.

The same report goes on to say that the concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act. In this view, addiction results from the repetition of voluntary behaviors.

“The concept of addiction as a brain disease has even more disconcerting implications for public attitudes and policies toward the addict,” the report states. “This concept of addiction appears to some to excuse personal irresponsibility and criminal acts instead of punishing harmful and often illegal behaviors.”

Murthy’s 2016 report, however, was not ground-breaking news. Nor was the report released by the NEJM. As the New York Times reported on Sept. 30, 2003:

“In other words, addiction is a brain disease, not a moral failing or behavior problem. People do not deliberately set out to become addicts. Rather, for any number of reasons — like wanting to be part of the crowd or seeking relief from intense emotional or physical pain — people may start using a substance and soon find themselves unable to stop.”