Nature Neuroscience 8, 1431 - 1436 (2005)

The infrastructure to treat addictive illness, when compared with treatment for other traditional medical illnesses, is lacking in the United States. This situation is tolerated by a public that views addiction more as a social problem than an actual disease, despite scientific evidence supporting a disease concept of addiction based on neuronal mechanisms, heritability, treatment responses and a characteristic progressive clinical course. Pejorative views toward addicted individuals also exist and contribute to policies that would be simply unacceptable if applied to 'real' medical disorders. These policies have created limited access, insufficient capacity and a dearth of trained providers in most geographical regions, especially for adolescent patients who might avoid progressive addiction with appropriate treatment. Even patients with access to treatment typically discover that its duration is severely limited by insurance company policies (managed care), even though addiction is a chronic illness requiring sustained aftercare. Imagine limiting treatment duration for diabetes, chronic heart failure or hypertension.