Talking With Alan I. Leshner, PhD, National Institute on Drug Abuse Director

BETHESDA, MD—Since Alan I. Leshner, PhD, took the helm of the National Institute on Drug Abuse (NIDA) in 1994, the agency’s annual budget has nearly doubled, to $781 million, supporting much of the world’s research on the biology of addiction, genetic and environmental risk factors, and addiction prevention and treatment. Of the two dozen institutes that comprise the National Institutes of Health (NIH), NIDA is in a unique position. Addiction is, arguably, more politicized than any other medical issue, putting Leshner and his views under a spotlight. He is quoted almost weekly in major newspaper and magazine articles as the authority on the subject. Such visibility comes with a price, though, as Leshner has been attacked on all fronts—for being both too soft and too harsh on drug issues. Before joining NIDA, Leshner enjoyed a highly regarded research career, which largely focused on the biology of behavior. He has also served as acting director of the National Institute of Mental Health (NIMH) and earlier worked at the National Science Foundation, Bucknell University, the Postgraduate Medical School in Budapest, Hungary, and the Wisconsin Regional Primate Research Center in Madison. He has a PhD in physiological psychology. JAMA: I’ve heard you say that one of the things you’d like to do is “change the national discourse” about illicit drug abuse and addiction. Does this mean making addiction more of a medical problem and less of a criminal problem? Dr Leshner: No, no. I am ferociously against polarizing the debate. I think that’s one of the terrible problems we’ve made with this issue. People say that it’s either a public health or a public safety issue. The truth is, it’s both. And it begins with a voluntary behavior: people choose to use drugs. I don’t call it morality, but I call it voluntary. And there’s no question it’s a medical illness and once you have it, it mandates