Image Credit: Screenshot (ABC’s This Week, 6/25/17)

During an appearance on ABC’s This Week, Kellyanne Conway suggested that the government doesn’t need to spend money on addiction treatment. Rather, she said, people with substance use disorders just need more “will” to overcome addiction.

The exchange took place after ABC’s George Stephanopoulos questioned Conway on the recently released Senate health care bill, which guts Medicaid — the single largest payer of substance abuse treatment — and allots only $2 billion to fight the opioid crisis, leaving a shortfall of at least $188 billion over the next ten years. Pressed to explain how the health care bill would fulfill Donald Trump’s campaign promise to address the opioid epidemic, Conway suggested that money for treatment isn’t the answer:

STEPHANOPOULOS: This week, the commission had a hearing and the experts who testified at that commission said that these cuts in Medicaid are going to have a devastating impact. Again, even the Republican senators most affected, Rob Portman in Ohio, Shelley Capito in West Virginia, say you’re going to need to add far more money, $45 billion, to begin to address the opioid addiction problem. This bill doesn’t do that. CONWAY: And George, I would point out that President Obama, through ObamaCare and elsewise, poured money into crises like this and where are we? You can fill up every seat in Yankee Stadium and that accounts for the number of people who died of drug addiction in this country just last year. Thirty-three thousand of whom were opioid-related. It’s a gateway to heroin use, fentanyl, carfentanil. It’s all of these problems. And so pouring money into the problem is not only answer. We have to get serious about in-facility treatment and recovery. It… STEPHANOPOULOS: That takes money, Kellyanne. CONWAY: It takes money and it also takes a four letter word called will.

The Willpower Myth

The idea that addiction stems from a lack of willpower is a dangerous and pervasive myth that ignores the modern science of addiction. While much remains to be learned about the processes involved in addiction and recovery, the research is clear on one thing: Addiction is a brain disease, not a character flaw. Those who have studied addiction and/or worked in addiction recovery centers know that most people struggling with substance use disorders want to quit. In fact, most people with addictions try to quit (often repeatedly) on their own, but without the appropriate support systems, behavioral treatment, and/or medication assistance, almost all of them will promptly return to substance use. Willpower alone is simply not enough to overcome the disease of addiction.

“Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain — they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.” -National Institute on Drug Abuse

The myth that addiction is a problem of willpower reflects a belief that people are to blame for their own addiction — that substance use disorders are the result of bad choices and can be solved by just trying harder. In reality, addiction is the product of a combination of factors including genetics, brain chemistry, developmental stage, familial influences, social and environmental context, and exposure to addictive substances. Anyone who has ever smoked a cigarette, had a few glasses of wine, or taken an extra dose of a narcotic painkiller after surgery is potentially at risk of developing a substance use disorder (though most will not). No one plans to become addicted to drugs or alcohol, and no single factor can determine whether a seemingly innocuous exposure to an addictive substance will spiral into addiction.

“When drug abuse takes over, a person’s ability to exert self control can become seriously impaired. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.” -National Institute on Drug Abuse

Put simply, addictive substances alter the way our brains work, leading to intense cravings, impulse-control problems, and a compulsive drive to continue substance use. Research on the biologic basis of addiction has led to groundbreaking discoveries, including the development of medications targeting key processes involved in addiction. For example, agonist medications (such as methadone and buprenorphine) can stabilize cravings while the brain’s planning and reasoning processes are restored to a non-impaired state of functioning. During the acute withdrawal phase, these medications can mean the difference between relapse and recovery.

With a growing opioid epidemic gripping the nation, the science of addiction has never been more important or more necessary. Kellyanne Conway’s dangerously misguided advice simply has no place in the debate over how to deal with an overdose crisis that killed as many as 65,000 Americans last year.