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To the Editor: In his Editorial on physician substance abuse,¹ Dr Gastfriend states that "Addiction is a disorder of the brain’s reward system. Functional imaging shows the vulnerable circuitry for addiction originating in the paleocortex." In describing addiction as a disembodied physical condition of the brain, he ignores the most important element of drug abuse and dependence: it is a behavioral condition of the whole person, not simply the brain. A person is capable of making a choice about continued substance use, depending on what that person believes is at stake. Unless the role of personal responsibility in addiction is acknowledged, the best interventions—which entail holding the user accountable—will be underutilized.

Financial disclosures: None reported.

Sally Satel, MD
Slsatel@aol.com
Oasis Drug Treatment Clinic
Washington, DC

1. Gastfriend DR. Physician substance abuse and recovery: what does it mean for physicians—and everyone else? JAMA. 2005;293:1513-1515. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294:426-427.

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