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Is substance abuse a disease?

"There’s no doubt that there’s strong physical changes that happen when someone becomes dependent on one of these substances," Kenneth E. Leonard, director of the University at Buffalo Research Institute on Addictions, says of drugs, alcohol and tobacco.
Charles Lewis/Buffalo News

By Scott Scanlon – Refresh Editor

Kenneth E. Leonard has spent the majority of his professional career studying the impact of alcoholism on families, but in his newest role as director of the University at Buffalo Research Institute on Addictions, he also helps oversee research on tobacco and drug abuse from the institute's offices on Main Street, along the downtown Medical Corridor.

He and about 30 other research scientists spend their time delving into substance abuse, seeking answers when it comes to cause and treatment – mostly treatment – and one of the questions they often are asked is this one:

Is substance abuse a disease?

Here’s what Leonard, the subject of today’s "In the field" story for WNY Refresh, had to say during a Q&A session we had last week:

Stress seems a thread that runs through a lot of diseases.

Some of the issues about dealing with stress relate to addictions, they relate to Irritable Bowel Syndrome, they relate to hypertension, they relate to diabetes, they relate to a lot of different diseases. That’s something that’s important to recognize.

One of the biggest challenges that run through a lot of interventions is that people don’t follow through. Across every kind of treatment, there’s often this problem of whether people will follow through with treatment as it’s specified.

There’s a lot of reasons why they might not, but one large one is the context of stress in everyday life. Negative affect interferes with the ability to follow through on a lot of things. At the very least, the stress has that thread of interfering with treatment.

Sometimes you even hear this about cancer. Do you find this more challenging as you’re posing this, at least to the public, that some people might not necessarily consider alcoholism or drug addiction, or even nicotine addiction, as a health condition?

I think (most people) recognize it as a health condition. I think you have to differentiate between whether it has health effects or whether it’s a disease. It’s difficult for them because the early parts of the disease seem to be according to peoples’ willful behavior. Before you become an addict, you choose to use those drugs or you choose to smoke or you choose to drink.

For a lot of these, there’s individual differences, so some people can develop the physical components to these drugs quicker and for some it takes a very, very long time, and some may be protected for some reason.

There’s no doubt that there’s strong physical changes that happen when someone becomes dependent on one of these substances. That change makes it very, very difficult for them to refrain from using that substance. I think people get distracted by whether that makes it a disease or not a disease. There’s very good evidence that there are strong neurological changes that then have an impact on behavior.

In the end, are these diseases like, say, diabetes?

There are long-lasting physical changes that, at the present time, it’s very, very difficult to reverse and they have  consequences for physical functioning and the ability to refrain from the use of substances.

In some ways, they’re comparable to diabetes. Diabetes is a disease, but there’s a lot of behavioral things you can do to make it better or worse. You can choose an appropriate diet. You can maintain a healthy weight ... be good about taking your insulin.

With addiction, some of these neuropsychological changes remain, and they can remain for a long time, but there are actions you can take that can help you maintain a safe distance from the substances you are addicted to.

There’s no really good analogy, completely, to addictions.

It doesn’t make any of these things more easy to deal with.

No. No. So you do have this strong physiological element, as well as the psychological, as well as the social. They all play a role. It doesn’t mean that this neurophysiological component is a determining factor. ... It’s something you have to deal with and address.

What your saying is it’s treatable?

It is treatable. It may take multiple times before treatment is successful, and it make take trying a variety of different kinds of treatments.

People can, and do, stop using these substances, or cut down on these substances, on their own, and they probably make up a majority, but we also know that among the people that are more severe that treatment is often necessary, and that we have things that will work. You just have to be persistent.

Leonard, 58, of Williamsville, joined the institute’s staff in 1986 and has led the place the last two years.

We also talked about several other facets of the institute and its work, including an ongoing study about children who grow up with an alcoholic father.

The research is ongoing, but Leonard did feel comfortable saying that strong mothers in such family dynamics can protect children from a great deal of lifelong baggage that can come with being the child of an alcoholic.

Here are other excerpts from our conversation:

Some of the researchers here, including you, have worked in the field for decades. How have things changed?

There used to be a few people who had some knowledge of alcohol and drugs to the point that now there are a number of people who are devoting lives and careers to understanding it. I started college in ‘72, about the same time that the institute developed. ... Back then, the number of people (across the country) who were really focused on alcoholism as a problem, and doing research on alcohol and alcoholism, was relatively small and they didn’t always stay focused on that.

Both of those disorders – alcohol and drug abuse – really require a interdisciplinary understanding in order to address them. There are biological components. There are neurological components. There are developmental components. There are social components. And all of those play into the person developing significant problems with alcoholism or drug abuse, and all of them play into the recovery, as well.

The ability to have what we often refer to as ‘the informal college of alcoholism’ or the ‘informal college of drug abuse,’ really allows us to sustain focus on these issues.’

What sort of research is the institute conducting on tobacco and what are some of the findings?

One is looking at the development of children who were prenatally exposed to nicotine, as well as postnatally exposed. We do know that nicotine probably has one of the most significant prenatal effects of the drugs that we study. It is robustly associated with low birth rate. Low birth rate creates a variety of problems as a child develops. One of the studies we’re looking at is what sort of treatments can be developed that are suitable for pregnant women – mindfulness, meditation. The result are currently being written up.

One of the other things we’ve been doing is looking at trying to address anger in the context of smoking. One of the things we know is that people often relapse in reaction to strong negative emotions. So we have two different studies that are attempting to address that. One is when there are anger problems, whether you can treat the anger like you treat depression or anxiety; the other study is looking at how self-regulation of stress might be related to relapse of smoking.

What would you say to a young man who parties several times a week and has already been in a few bar fights?

I have this view that there are certain mistakes that you can’t make once. So, drinking heavily a couple times a week, that can have some negative impacts on you. To the extent that influences your school work, your job, that’s going to have long-lasting consequences you can’t see now. Of larger concern are things like driving while intoxicated, drinking large quantities of alcohol, and alcohol poisoning. I talk about those as being the mistake you can’t make once, because the risk of that is so great that it could change your life forever with one misstep.

Does it help that you’re downtown on the Medical Corridor?

It does help that we’re downtown. It’s estimated that 40 percent to 50 percent of hospital beds are used as a result of alcohol, drugs or tobacco, which means that as the medical school gets down here, there’s going to be an increased interest in addressing addictions in the health-related sciences, and more and more opportunities for us to collaborate with physicians and understand how alcohol, drugs and tobacco impact disease and how we might be able to treat some of the patients who have these problems. (The clinical research center studies all are confidential).

What are some of the departments you’re touching with UB?

We have a lot of collaborations with psychology. We have contacts with social work, sociology, pharmacology and toxicology, School of Public Health – particularly the Department of Community Health and Health Behavior.

What is your vision for the institute?

There are 30 researchers here who do addictions work, but across campus we’re probably one of the strongest campuses in the country in terms of a variety of different types of addictions work. We have probably in the range of 80 or 90 scientists – faculty members, research scientists – who address some aspect of addictions work. If you add Roswell Park into the mix, we are unique in the country in our ability to address alcoholism, smoking, drug abuse.

RIA really looks to partner with these individuals to really make this the center of addictions work.

How can people plug in to what you’re doing?

They can go to our website,, which will launch Nov. 13.


Twitter: @BNrefresh

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About The Refresh Buffalo Blog

Scott Scanlon

Scott Scanlon

Scott Scanlon is an award-winning reporter and editor who has covered various topics in his quarter-century as a journalist in South Florida, Syracuse and Buffalo. He is aiming to pass along what he is learning these days about health, fitness, nutrition and family life.

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