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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.

A similar transition is under way in the realm of addictive behaviors. Research findings from various methodologies (from molecular genetics to functional imaging) show remarkable concordance across the various substances of abuse in both animals and humans. The genetic vulnerability for alcohol dependence is roughly 50%, similar to that for . . . [Full Text of this Article]

David R. Gastfriend, MD
david.gastfriend@alkermes.com
Massachusetts General Hospital
Boston

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