Addiction: Disease or Choice?
Many experts and organizations, including the American Medical Association and the World Health Organization, consider addiction to be a chronic illness—specifically a brain disease.
Navigation: Is Addiction a Disease or a Choice?, Drug Addiction as a Disease, Drug Abuse as a Choice, Why Are Drugs Addictive?, What Are the Symptoms of Substance Use Disorder?, The Risk Factors of Substance Abuse and Addiction, Protective Factors for Addiction, Addiction Treatment Options, Rehab Is Your Best Chance
Drug addiction is characterized by a strong compulsion to obtain and use substances even when the person is already experiencing its adverse effects. Addiction and drug dependency are both dangerous conditions that can lead to serious physical and mental health issues.
But even today there is still a debate going on about whether addiction is a disease or a choice. Because it typically starts with alcohol abuse, some people believe that addiction is a choice and is therefore the person’s fault.
This misunderstanding contributes to the stigma that continues to discourage people from seeking proper substance abuse treatment. And so it is important to talk about both sides of the debate, assess their validity, and learn more about drug and alcohol addiction. Let’s take a closer look.
Is Addiction a Disease or a Choice?
Addiction is commonly described as a chronic disease that changes a person’s behavior, preventing them from quitting a substance even when they are already suffering from its effects. As a medical disorder, addiction affects the brain and causes intense cravings.
A person can get addicted to any kind of substance including alcohol, prescription medications, illicit drugs, etc. Addiction is a complex condition, and that is why it commonly sparks debate over whether or not it is actually a disease or just a result of a person’s choices. Different perspectives exist due to the nature of addiction and its underlying causes.
Many experts and organizations, including the American Medical Association and the World Health Organization, consider addiction to be a chronic illness—specifically a brain disease.
According to this perspective, addiction is characterized by changes in the brain’s structure and functioning, which can result in compulsive drug-seeking behavior and a loss of control over substance use. The disease model emphasizes the biological and neurological factors that contribute to addiction, such as genetic predisposition and alterations in brain chemistry.
But on the other hand, some argue that addiction should be viewed as a matter of personal choice and individual responsibility. This viewpoint emphasizes the role of personal agency and free will in initiating substance use and continuing addictive behaviors.
Critics of the disease model argue that labeling addiction as a disease may undermine personal accountability and discourage individuals from taking responsibility for their actions.
In truth, addiction is influenced by a combination of genetic, environmental, psychological, and social factors. Here we will also explore the risk factors as well as the protective factors that influence a person’s risk of addiction.
Drug Addiction as a Disease
Different individuals, organizations, and medical professionals may have varying viewpoints when it comes to addiction, and this often influences its definition.
According to the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institutes of Health (NIH), addiction is a long-term and relapsing condition that is mainly characterized by compulsive drug-seeking behavior.
These organizations agree that addiction is a disease because this condition changes the way the brain responds to situations involving stress, self-control, and rewards. Addiction causes significant biological changes, especially within the brain’s structure.
Because of this, addiction can be compared to heart disease because it can disturb the regular functioning of a particular organ in the body. Both conditions also lead to increased risk of premature death and decreased quality of life.
Repeated exposure to addictive substances can alter the brain’s reward system, leading to persistent cravings and a loss of control over substance use. These changes can persist well after the person has stopped taking drugs.
Additionally, addiction is marked by periods of recovery and relapse, meaning it is similar to diseases like hypertension and diabetes. While these diseases are treatable, they are lifelong conditions that require continual effort in order to manage.
As a chronic condition, addiction often requires ongoing management and treatment to maintain recovery, just like other chronic conditions like diabetes or asthma.
Addiction’s status as a disease is further supported by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), meaning it is a diagnosable disorder by medical and psychiatric authorities. Drug and alcohol addiction are classified as substance use disorders (SUD).
The fact that people go through withdrawal whenever they try to stop or reduce their substance use means that it is a medical condition that causes physical and psychological effects. Various withdrawal symptoms can contribute to the cycle of addiction.
The most important thing to note here is that even though addiction is considered a disease, it is not meant to absolve individuals of responsibility for their actions. There are many other factors that contribute to the development and progression of addiction. Recognizing it as a disease is only meant to promote understanding, fight stigma, and encourage access to appropriate treatment and support for affected people.
Drug Abuse as a Choice
Addiction is not typically seen as a conscious or deliberate choice, but some people would still argue that it is. Addiction is a complex condition that affects every aspect of a person’s life. Its development also has several contributing factors.
Personal choice is one of those factors. There are many reasons why people may abuse drugs, and it’s usually a combination of factors such as escapism, self-medication, peer pressure, mental health issues, and even genetic factors.
Some people drink alcohol or use drugs to cope with stress, physical pain, or traumatic experiences. Others use it out of curiosity or as a form of recreation to experience the euphoric effects of several drugs. Others try drugs even if they don’t want to simply because their friends are doing it.
Some people may try drugs out of a desire to explore altered states of consciousness. They may be unaware of the potential risks and consequences associated with drug use, leading to abuse.
Living in an environment where drug use is prevalent or being exposed to drug-abusing family members or friends can increase the likelihood of drug abuse. Socioeconomic factors, such as poverty and lack of education, can also contribute to drug abuse.
Some people do not accept the idea that substance use disorder is a real disease. They say it’s because addiction is not transmissible, contagious, autoimmune, degenerative, or hereditary. Some say addiction is self-acquired, meaning the person gives the condition to himself.
But as you may notice, this line of thinking puts way more emphasis on social and environmental factors that contribute to addiction. However, addicted individuals do not simply get cured when they have no access to the substances. They forget that substance use disorder creates significant brain changes.
So while individuals may initially choose to experiment with substances or form bad habits, addiction itself is not solely a matter of choice. If addiction were that easy to stop, then relapse would not be as common and addiction itself would be much easier to address.
In fact, the American Psychiatric Association (APA) no longer refers to it as “addiction”. Instead, they have adopted the phrase substance use disorder to describe problems that are related to the compulsive use of substances. This is to help avoid the negative stigma associated with the word addiction.
Why Are Drugs Addictive?
Drugs can be addictive due to the way they interact with the brain’s reward system. When a person takes drugs, particularly those that are psychoactive or mind-altering, they can produce intense feelings of pleasure or euphoria. These drugs activate the brain’s reward pathway, which is involved in regulating feelings of pleasure, motivation, and reinforcement.
The reward pathway primarily relies on a neurotransmitter called dopamine. Dopamine is released in response to pleasurable experiences, reinforcing behaviors that contribute to survival, such as eating or engaging in social interactions.
When a person takes drugs, they can cause an excessive release of dopamine or interfere with its normal regulation, leading to an intense surge of pleasurable sensations.
Chronic drug use can impair the brain’s prefrontal cortex, which is responsible for decision-making, impulse control, and self-regulation. This impairment can lead to impulsive and compulsive drug-seeking behaviors.
Repeated drug use can lead to several changes in the brain that contribute to addiction. For example, when the brain adapts to the presence of drugs, the person may develop tolerance or even drug dependence.
Drug tolerance means you will have to take higher doses of the drug just to achieve the same level of pleasure. Of course, this puts you at a higher risk of addiction, dependence, and overdose.
Dependence is when the brain becomes accustomed to the presence of drugs and adjusts its functioning accordingly. When drug intake is suddenly stopped or reduced, it can lead to withdrawal symptoms, which can be highly unpleasant and uncomfortable. To avoid these symptoms, individuals may feel compelled to keep using drugs.
Many drugs also cause intense cravings. These cravings are triggered by various cues associated with drug use, such as the sight or smell of drugs or being in environments where drug use typically occurs. The intense desire to experience the drug’s effects can override rational thinking, making it difficult to resist using the drug again.
It’s worth noting that not all drugs have the same addictive potential. Some drugs, such as opioids, cocaine, methamphetamine, and nicotine, are highly addictive, while others may have a lower potential for addiction.
Understanding the complex interplay between biological, psychological, and social factors is crucial for developing effective prevention and treatment strategies for drug addiction.
What Are the Symptoms of Substance Use Disorder?
We already know that addiction involves compulsive drug use and intense cravings. But what are the other symptoms you need to watch out for?
While the specific symptoms can vary depending on the substance or behavior involved, here are some common signs and symptoms of addiction:
Loss of control: Difficulty in controlling or limiting substance use or engaging in the addictive behavior, often resulting in excessive consumption or time spent on the behavior.
Neglecting responsibilities: Prioritizing substance use or engaging in addictive behaviors over fulfilling work, school, or family obligations, leading to a decline in performance or neglecting important responsibilities.
Loss of interest: Losing interest in activities that were once enjoyable or neglecting hobbies and social activities in favor of substance use or addictive behaviors.
Secrecy and isolation: Engaging in addictive behaviors in secrecy, avoiding friends, family, or social situations to conceal the extent of the addiction.
Physical and psychological changes: Experiencing physical changes, such as weight loss or gain, changes in sleep patterns, deteriorating physical appearance, or displaying mood swings, anxiety, depression, or irritability.
Withdrawal symptoms: When the substance or behavior is discontinued or reduced, experiencing physical or psychological withdrawal symptoms, such as anxiety, irritability, restlessness, nausea, sweating, insomnia, or depression.
The person will keep on taking the substance even when they are already experiencing health problems, relationship difficulties, financial issues, and legal troubles. They may repeatedly try to cut down their intake or quit entirely, but will be unsuccessful. Relapse is common among people who are recovering from addiction.
Not all individuals will exhibit every symptom. The effects of addiction may vary from person to person. The severity of the symptoms can also vary depending on the stage of addiction and the specific substance involved.
If you think someone you love may be abusing a drug or have developed an addiction, seek the help of medical professionals as soon as you can.
The Risk Factors of Substance Abuse and Addiction
Even if addiction were a personal choice, there are many factors that contribute to a person’s risk of making that choice in the first place. The more risk factors you have, the more likely it is that you will develop a substance use disorder at some point in your life. It is not a guarantee—but your risk is higher. On the other hand, being exposed to fewer risk factors is not a guarantee that you are immune to addiction either.
For starters, addiction is known to have a genetic factor. There is evidence to suggest that genetics play a role in addiction. This means individuals with a family history of addiction are more vulnerable to developing an addiction themselves.
Certain genes may influence the way substances are processed in the body or affect brain chemistry, making some people more susceptible to addiction.
A person’s childhood and environment can also influence their relationship with addictive substances. For example, people who went through traumatic experiences or were exposed to drugs and alcohol at a young age are more likely to develop addiction.
Early exposure to drugs or alcohol can increase the likelihood of addiction later in life. Adolescents and young adults are particularly vulnerable as their brains are still developing, and substance use during this critical period can have long-lasting effects on brain function.
Children who grow up in households with inconsistent discipline, lack of parental involvement, or poor communication are at higher risk of developing addiction.
Experiencing trauma, such as physical or sexual abuse, neglect, or witnessing violence, can increase the risk of addiction. Substance use may be a way to cope with the distressing emotions associated with trauma.
Similarly, people with mental health disorders such as depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), or post-traumatic stress disorder (PTSD) have a higher risk of developing addiction. Substance abuse may be used as a way to self-medicate or cope with underlying emotional or psychological issues. This is especially true for those who lack healthy coping skills that help them deal with stress and emotional pain.
A person’s social environment also plays a significant role in addiction risk. Individuals who grow up in environments where substance abuse is prevalent, such as households with substance-abusing family members or peer groups that engage in drug use, are at higher risk of developing addiction.
At the same time, peer pressure also plays a role. People may be more likely to engage in substance abuse if their friends or social circle encourages or normalizes it. Teens and young adults are particularly vulnerable to peer pressure.
Remember that there is no single cause of addiction and that everyone goes through it differently. Recognizing the genetic and environmental risk factors can help you protect yourself or someone you love from addiction, especially if you know someone is exposed to multiple risk factors.
Protective Factors for Addiction
Just as there are risk factors that increase a person’s likelihood of developing addiction, there are also protective factors that reduce this likelihood.
While no single protective factor can guarantee complete prevention, they play a crucial role in promoting resilience and reducing the risk of addiction.
Positive relationships with family members, friends, mentors, and other supportive individuals provide emotional support, guidance, and a sense of belonging. These connections can act as a protective factor by offering a buffer against stress and providing healthy coping strategies. They can also lend a listening ear so that people can vent and let out their negative emotions without resorting to substance abuse.
Active parental involvement, supervision, and clear communication can significantly impact a child’s development. When parents are engaged and aware of their child’s activities, they can provide guidance, set appropriate boundaries, and deter substance use.
There are also protective factors that are linked to one’s personality. For example, having a positive sense of self-worth and a strong sense of personal identity allows a person to make choices that align with their values and goals. Having a healthy self-image can act as a protective factor by reducing the likelihood of seeking validation or solace through substance use.
Those who are familiar with healthy coping skills are also able to handle life’s challenges and stressors without turning to illicit substances. This is an essential protective factor, and one that is taught in rehab.
Developing healthy coping skills such as problem-solving, relaxation techniques, exercise, and creative pursuits can reduce the risk of turning to substances as a means of escape or self-medication.
Education about the risks and consequences of substance use can also empower individuals to make informed decisions. Knowledge about the dangers of addiction and the availability of accurate information can serve as protective factors, promoting healthier choices and reducing curiosity about substances.
Beyond these factors, a person’s environment can also influence their relationship with drugs and alcohol.
A positive school environment and educational success can serve as protective factors. School engagement, involvement in extracurricular activities, and academic achievement can enhance a person’s sense of purpose, self-esteem, and peer connections, reducing their likelihood of substance use.
On a community level, adequate access to healthcare, including preventive care and mental health services, can help identify and address risk factors early on. Early intervention and treatment for mental health conditions, such as anxiety or depression, can reduce the risk of self-medication and the development of co-occurring disorders.
Supportive and inclusive communities that offer opportunities for involvement, such as sports teams, clubs, religious or spiritual groups, and volunteer organizations, can provide individuals with a sense of belonging, purpose, and connection. Strong community ties can act as protective factors against substance use.
Protective factors are interconnected and can reinforce one another. Generally speaking, people with good physical health, strong impulse control, no family history of addiction or mental illness, healthy relationships, and access to positive resources in the neighborhood are much less likely to become addicted. However, people may have different combinations of protective factors, and their effectiveness may also vary depending on personal circumstances.
Addiction Treatment Options
Whether addiction is a disease or a choice is not really mutually exclusive. It begins with a combination of risk and protective factors that influence a person’s choice to start using drugs and alcohol. It then leads to a medical condition that changes the way the brain operates and prevents them from quitting.
It should also be noted that for some people, their development of addiction began with a doctor’s prescription. So in some cases, using drugs is not even their choice. Illicit and prescription drugs alike can be equally addictive.
Addiction medicine is all about addressing the physical and mental health effects of substance use disorder, regardless of the circumstances that led to its development.
There are several addiction treatment options available to individuals struggling with substance abuse or other forms of addiction. The choice of treatment depends on the specific needs and circumstances of the individual. Here are some common addiction treatment options:
Detoxification (Medical Detox): This is typically the first step in addiction treatment. Detox helps patients safely and gradually withdraw from the substance they are dependent on, while managing withdrawal symptoms. Medical supervision will ensure that the person is safe and comfortable during this stage of recovery. Medical professionals may administer medications to keep cravings and withdrawal symptoms under control.
Medication-Assisted Treatment (MAT): MAT combines medication with counseling and behavioral therapies to treat substance use disorders, particularly for opioids, alcohol, and nicotine addictions. Medications such as methadone, buprenorphine, naltrexone, or disulfiram may be used to reduce cravings, manage withdrawal symptoms, and support long-term recovery.
Inpatient Rehabilitation: Inpatient or residential rehabilitation programs require recovering individuals to live at a treatment facility for a specified period. These programs provide intensive therapy, counseling, and a structured environment where patients can focus on their recovery. This is ideal for those with more serious addictions. There are 30-day, 60-day, 90-day, and even longer programs. It all depends on the patient’s needs.
Outpatient Rehabilitation: Outpatient programs offer treatment and support while allowing patients to live at home and keep up with their responsibilities. These programs involve scheduled therapy sessions, counseling, and support group meetings. The patient can go to work, attend classes, or take care of their kids while still receiving the care that they need to get sober. Outpatient treatment may be more suitable for those with milder addictions or those who need a step-down treatment option following inpatient rehab.
Cognitive-Behavioral Therapy (CBT): CBT is a widely used therapeutic approach that focuses on identifying and changing negative patterns of thinking and behavior. It helps individuals develop coping strategies, improve problem-solving skills, and build resilience so they can minimize the risk of relapse even after leaving rehab.
Individual Counseling: One-on-one counseling sessions with a therapist or addiction counselor can be beneficial. It allows recovering individuals to explore underlying issues that contribute to their substance abuse. They can also set goals and follow a personalized strategy for their recovery. Alternatively, there are also group therapy and family therapy sessions that help recovering individuals repair strained relationships and make new connections.
Support Groups: Support groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) provide a supportive community of individuals who share their experiences, challenges, and strategies for recovery. These groups offer peer support, accountability, and guidance in maintaining sobriety.
Holistic Approaches: Holistic treatment approaches focus on addressing the whole person—mind, body, and spirit. These may include practices like mindfulness meditation, yoga, acupuncture, art therapy, and physical exercise to promote overall well-being during the recovery process.
Aftercare and Continuing Support: Recovery is an ongoing process, and aftercare is crucial for maintaining sobriety. Aftercare services may include ongoing counseling, participation in support groups, sober living arrangements, and access to relapse prevention resources.
It’s important to note that treatment effectiveness can vary for each individual, and a combination of different approaches may be necessary. Consulting with healthcare professionals or addiction specialists can help determine the most suitable treatment options for an individual’s specific situation. Look for a rehab near you today to learn more.
Rehab is Your Best Chance
Treatment is an addicted individualʼs best option if they want to recover. Beating an addiction not only requires eliminating the physical dependence, but also addressing the behavioral factors that prevent them from wanting to get better. Simply quitting may not change the psychological aspect of addiction. Some people quit for a while, and then take drugs or alcohol again, only to overdose because they did not detox properly. Recovery involves changing the way the patient feels, thinks, and behaves.