What’s in a name?

An editorial in Addiction reviews the arguments for and implications of renaming the National Institute on Drug Abuse (NIDA) to the National Institute on Diseases of Addiction (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to the National Institute on Alcohol Disorders and Health (NIADH).

…an argument is put forward that the proposed name change for NIDA ‘removes the pejorative term “abuse”’ and thus separates abuse from ‘diseases of addiction’. Further, the name change links conceptually the concepts of disease with addiction and, as stated in the press release, ‘identifying addiction as a neurobiological disease will diminish . . . social stigma, discrimination, and personal shame . . .’.

For NIAAA, a different explanation is put forth in the Biden press release. The press release argues that NIAAA’s current name is an awkward remnant of their organizational past, when the agency was housed within the former Alcohol, Drug Abuse and Mental Health Administration (ADAMHA). Today, NIAAA’s research function is under the aegis of the National Institutes on Health (NIH). Moreover, there is a growing sense that ‘excessive alcohol use and alcohol dependence (alcoholism) are not separate diagnostic categories, but exist along a single continuum of alcohol-disorders associated with increased frequency of a harmful drinking pattern’. Thus, the proposed NIDA name change affirms the view that the term ‘abuse’ is no longer a useful or informative way to describe the goals or functions of the agency. In this regard, some have suggested that ‘alcohol abuse’ may not even appear in the next iteration of the DSM, which is due within the next 5 years.

Another explanation, not necessarily mutually exclusive from the first, is that NIDA and NIAAA are responding to pressures within the NIH to view their purpose and mission as primarily biomedical, or as stated in Biden’s press release, ‘neurobiological’.

Without taking a position, the editorial points out that an outcome of this (possibly unintended) would be to institutionalize a micro approach to drug and alcohol problems.

What is notable about all the potential reasons for the name changes discussed above is that they all appear to produce a ‘win–win’ situation for those who see drug and alcohol issues exclusively through the quite narrow lens of addiction and disease. The ‘losers’ in this tale will be those who adhere to a broader public health framework that encompasses individual issues as well as larger, social policy and environmental concerns.