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Is Addiction a Disease or a Choice?

The majority of people with an addiction, choose to start drug use. But when the habit grows and strengthens, does the element of choice remain, or does the use stem from a disease process?

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It’s an argument raging within the medical and neuroscience industries. There are three main camps.
  • Addiction is a disease. People in this group point to brain changes caused by addiction that hinder free will. They also cite studies of the genetics of addiction.
  • Addiction is a choice. Those in this group say addictions stem from behaviors, not disease processes. They also say addictions don’t always require treatment for recovery to begin.
  • Addiction is influenced by disease and choice. Organizations that fall in the middle suggest that addictions do have a brain and chemical component, but that they’re reinforced by societal problems, like poverty.

Let’s dig deeper into each argument, so you can form a deeper understanding of what might influence your recovery.

Yes: Addiction Changes Brain Chemistry

We all believe in free will. But we use our brain cells to make decisions, and damage to crucial parts of the brain can cloud our thinking and push us toward decisions we wouldn’t otherwise make.

The American Society of Addiction Medicine says that recurrent drug use can harm portions of the brain in charge of:
These parts of your brain highlight moments that feel good, and they can prompt repeated behavior.
Damage here can shift you away from self-care and into destructive behaviors.
Family Therapy
You’ll bring your loved ones to meetings with a therapist, and you’ll all talk about addiction recovery together.
Drugs can create links between external cues and the recollection of drug use. It feels like a craving.

When the brain is damaged, people experience an inability to control their impulses, make good decisions, and move forward despite the knowledge of drug’s damaging impact.

It’s the damage, experts say, that keep people using even when they don’t want to do so. Since behaviors are sparked by cell damage, addiction can and should be defined as a disease of brain chemistry.


Yes: Relapse Rates Are Similar to Other Diseases

Most diseases come with a self-care component. You must make changes in your habits to ease your symptoms, and if you don’t, the disease worsens. When you step away from these shifts, it’s known as a relapse. These are common among all chronic conditions, and it’s an attribute that suggests addiction is a disease.

The National Institute on Drug Abuse (NIDA) says relapse rates for addiction are similar to those seen in diabetes, asthma, and hypertension. Just as we don’t blame people with diabetes for stepping away from their plans on occasion, we shouldn’t blame people with addictions for falling back into their habits. They don’t make a choice. It’s a side effect of a longstanding disease process.

If addiction wasn’t a disease, one could argue, people wouldn’t relapse so frequently. They would choose to stop and make it stick. Since they don’t, a disease is at play.

Yes: There Is a Genetic Component

NIDA says about half of addiction risk resides in the genes. This has been proven with twins studies. While the exact “addiction gene” hasn’t yet been found, researchers have identified clusters of DNA that can influence how strongly drugs work, and that could spark compulsive use.

Genes aren’t destiny. But they can deeply influence choices.
Genes also play a role in plenty of other diseases, including the following:
  • Cancer
  • Schizophrenia
  • Cystic fibrosis
  • Sickle cell anemia
  • Down’s syndrome

If we can lay blame for these diseases at the feet of genes, we should be able to do the same for addictions, some experts say.

No: Addiction Stems From Behaviors

Some diseases are easy to see with a lab test. When we see a lump in a mammogram, a needle aspirate could confirm cancer or suggest the bump is benign. There is so such test for addiction, people in this camp say. Addiction is defined by what people do, not how they change. And that makes the condition a choice.

Analysts who fall into this camp say that addictions don’t stem from:
  • Infections, as we might see with Lyme disease.
  • Biologic degeneration, as we might see with Alzheimer’s disease.
  • Pathologic biology, as we might see in diabetes.

Instead, addictions are defined by the bad choices people make daily. If they made different choices, they say, the disease will disappear. And all lab tests would remain the same.

No: Recovery Is Personal

Most diseases are attached to accepted treatment protocols. When you’re diagnosed, your doctor knows where to start to help you get better. Addictions are more complex, and some people get better without much treatment at all. That makes addictions voluntary, say people in this camp.

Authors who believe in this concept remind us that treatment for addiction often means little more than convincing people to stop doing something. If a person with an addiction is kept away from that drug (by jail, for example), the condition will magically disappear.

If someone with cancer were kept from treatment, the disease would worsen.

That contrast convinces people in this group that addiction stems from choice and not a disease process.

It’s About Opportunity

For some addiction experts, the question is nuanced. They know that addictions can change behavior and make good decision-making tough. But they say that the environment in which addiction blossomed can help or harm recovery.

For example, substance abuse is often tied to:
  • Unemployment. Habitual drug use clouds thinking and takes time to maintain. That can leave little left over for work.
  • Poverty. Selling and using drugs represents a livelihood for some families. When addictions begin, it’s easy to use up the entire stock.
  • Violence. Getting drugs means walking into dicey neighborhoods. And some drugs are so expensive that people steal to get them.

To address addictions, these experts say, we must ensure that people have opportunities, jobs, and stable communities. When that happens, drug use won’t seem like a necessary escape from a difficult life.

Where Do You Stand?

Do you think addiction is a disease? Or do you think it’s about choices? Or does it matter to you?

Researchers, pundits, and other experts can argue about how addictions develop all day long. But if you’re living with an addiction, this can be little more than background noise to you.

Addictions feel urgent, and you do need quick care. When you stop, your brain cells can heal, you can make better habits, and you can improve your life.

That’s true whether an addiction is a choice or a disease.

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