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Navigation: Understanding Drug Abuse, Choice or Mental Illness?, Who is Most At Risk of Substance Use Disorder?, Why Do Mental Illnesses and Substance Use Disorders Co-Occur?, Treatment Options for Drug Addiction, Conclusion


Drug abuse is a serious problem that affects millions of people around the world. Its effects impact individuals, families, and even their communities.

We all know how substance abuse profoundly affects the health and well-being of those involved. It is associated with severe health complications, including addiction, overdose, mental health disorders, and even death. We also know that it has effects on society as a whole, leading to the breakdown of family structures, destruction of relationships, and the cycle of dysfunction that affects generations. [1]

But beyond the physical, mental, and social effects of drug abuse, there are still several things we do not understand about this. Substance abuse is a complex issue and it gets even more complicated once it develops into a full-blown addiction.

One of the most debated topics surrounding drug abuse is whether it is a choice or a mental illness. In this article, we will explore this question and provide some insight into the best ways to address drug abuse.

Understanding Drug Abuse

Before we can determine whether drug abuse is a choice or a mental illness, we need to understand what drug abuse actually is.

Drug abuse is the excessive and harmful use of drugs, whether they are legal or illegal. This can include prescription drugs, over-the-counter medications, and illicit substances like heroin, cocaine, or methamphetamine.

Any time a person takes a drug for a different purpose than intended, or in excessive amounts, this is considered substance abuse. There’s a misconception that prescription drugs cannot be abused because they are given by doctors. However, substance abuse includes both illicit and prescription drug abuse. Even medicines given by doctors can pose a threat to your health if misused. [1]

One of the most concerning aspects of drug abuse is its potential to lead to addiction. Continued and prolonged use of substances can alter brain chemistry, leading to dependence where the person feels a compulsive need to use the drug despite knowing—and experiencing—its harmful effects.

This dependency can spiral into a cycle of addiction, where quitting becomes incredibly challenging without proper support and intervention. Additionally, drug abuse doesn’t just affect the individual. As we mentioned, it can have ripple effects on families, communities, and society at large, impacting relationships, employment, and public health.

Drug abuse often manifests through various signs and symptoms, including changes in behavior, neglect of responsibilities, physical health deterioration, withdrawal from social activities, and an increased tolerance for the substance. It can lead to a range of negative consequences, including physical and mental health problems, strained relationships, and legal issues.

Because substance abuse is such a complex issue, dealing with it requires a comprehensive approach involving education, prevention, intervention, and treatment strategies.

Choice or Mental Illness?

The debate over whether drug abuse is a choice or a mental illness has been ongoing for decades. Some argue that people make a conscious decision to use drugs and therefore it is a choice.

In “Addiction: A disorder of choice”, Gene Heyman says that drug addiction is a result of natural processes that involve voluntary behavior, specifically choice. [2]

Others argue that drug abuse is a result of underlying mental health issues and should be treated as a mental illness.

The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), for example, define drug addiction as a “chronic and often relapsing brain disease” that is comparable to diabetes, asthma, or heart disease. [2]

The truth is, drug abuse can be both a choice and a mental illness. While some people may choose to use drugs, others may have a predisposition to addiction due to genetic or environmental factors.

At its onset, drug use often involves a voluntary decision. A person may choose to experiment with substances out of curiosity, peer pressure, or to cope with stress or emotional pain. However, this initial choice doesn’t necessarily mean that subsequent abuse or addiction is solely a matter of continued free will.

As drug use continues and dependence develops, changes occur in the brain’s structure and function. These alterations affect decision-making, impulse control, and reward mechanisms, shifting the perception of choice.

The compulsive nature of addiction impairs the person’s ability to simply stop using drugs despite adverse consequences. This shift highlights the involvement of mental health in substance abuse. Addiction is often classified as a mental illness due to its impact on brain function and behavior.

So while the initial decision to use drugs may involve choice, the progression to abuse and addiction is influenced by both biological and psychological elements, blurring the lines between choice and illness.

To this day, the debate regarding this subject persists.

Recognizing both elements is crucial for effective prevention and treatment strategies, emphasizing a need for compassion, support, and a multidimensional approach to address both the psychological and physiological aspects of substance abuse disorders.

Who is Most At Risk of Substance Use Disorder?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), risk factors are biological, psychological, family, community, or cultural characteristics that are associated with a higher likelihood of negative outcomes. [3]

In the context of substance abuse, people who are exposed to more risk factors have a higher risk of engaging in drug abuse. They are also more likely to develop an addiction if they participate in substance abuse.

With that in mind, it is important to note that risk factors do not mean you will automatically develop an addiction. It only means you have a higher risk of it. It also does not guarantee that you are safe from addiction if you don’t have a lot of risk factors.

Substance abuse and addiction can affect anyone, regardless of their background, age, gender, or socioeconomic status. Here are the most common risk factors for substance abuse:

Genetics: A family history of addiction can predispose someone to a higher risk of developing addiction themselves.

Environment: Growing up in an environment where substance abuse is prevalent or where there’s easy access to drugs or alcohol can increase the likelihood of substance abuse.

Mental Health: Conditions like depression, anxiety, trauma, or other mental health disorders can contribute to substance abuse as some people may turn to substances as a way to self-medicate.

Peer Pressure: Being surrounded by friends and colleagues who use drugs or alcohol can influence a person to start using as well. Teens and younger adults are more susceptible to this as they want to fit into more social circles.

Early Exposure: Starting substance use at a young age increases the risk of developing an addiction later in life.

Stressful Life Situations: High stress due to personal, family, work-related issues, or traumatic experiences can lead some individuals to turn to substances for relief.

Accessibility: Easy access to prescription drugs, especially opioids or other addictive medications, can lead to abuse and addiction.

Lack of Support: Not having a strong support system or access to resources for coping with life’s challenges can increase the vulnerability to substance abuse.

Personality Traits: Certain personality traits like impulsivity, sensation-seeking behavior, or a lack of self-control can contribute to a higher risk of substance abuse.

These factors also tend to influence one another. Targeting only one risk factor will not address the entire picture. These risk factors do not exist in isolation. [3]

Prevention efforts often focus on addressing these risk factors and promoting protective factors like strong social support, coping skills, and education about the risks of substance abuse.

Why Do Mental Illnesses and Substance Use Disorders Co-Occur?

While drug addiction can be considered a form of mental illness, it can also co-occur with other mental illnesses. In fact, the relationship between mental disorders and drug addiction is just as complex and multifaceted as the debate we talked about earlier.

According to reports published in the Journal of the American Medical Association, an estimated 50 percent of individuals with severe mental disorders are also affected by substance abuse. [4]

People with mental disorders may turn to substance abuse as a way to self-medicate and alleviate the distressing symptoms they experience.

For instance, someone grappling with depression or anxiety might use drugs or alcohol to temporarily numb their emotional pain or quiet their anxious thoughts. This can create a cycle where the person becomes dependent on substances to cope with their mental health challenges, leading to addiction.

There’s also evidence suggesting that certain mental health conditions and substance use disorders share underlying risk factors.

The genetic and environmental factors we mentioned can apply to both mental illnesses and substance use disorders. Changes in brain chemistry or imbalances in neurotransmitters might predispose someone to both mental health issues and addictive behaviors.

Similarly, traumatic experiences or chronic stress can increase the vulnerability to both mental disorders and substance abuse, creating a complex interplay between the two.

These two conditions have a bidirectional relationship, meaning they tend to affect and even worsen one another. So while they may not also cause each other, they can still co-occur and create more devastating problems.

When you have both of these conditions at the same time, it is called a co-occurring disorder or dual diagnosis. This makes it even more difficult to recover without professional assistance because both conditions have to be tackled simultaneously. If you treat one condition while ignoring the other, then the problem will simply persist. [4]

Treatment Options for Drug Addiction

Regardless of whether drug abuse is a choice or a mental illness, seeking help is crucial for recovery. The first step is acknowledging that there is a problem and being open to getting help. This can be a difficult and emotional process, but it is necessary for long-term recovery.

Once you’ve gotten over that barrier, you can start looking for resources and treatment programs that help those with substance use disorders and addiction.

Treating substance abuse and addiction often involves a combination of approaches tailored to an individual’s needs. Here are three main types of treatment options:

Medical Detox

Medical detox is often the first step in a comprehensive addiction treatment program. It involves gradually lowering the patient’s drug intake while their withdrawal symptoms are managed by healthcare professionals. This is important because withdrawal symptoms can range from uncomfortable to life-threatening.

Detox programs are designed to help patients overcome the symptoms of alcohol or drug withdrawal. Detox programs may last a few days to weeks. The patient may transition to the next step of treatment once they have stabilized. [5]

Behavioral Therapies

Addiction is not just a physical condition. Therefore you can’t just treat its symptoms without dealing with its underlying causes.

Behavioral therapies focus on changing the attitudes and behaviors related to substance abuse. Cognitive-behavioral therapy (CBT) is commonly used, aiming to identify and modify thought patterns and behaviors associated with substance use.

Contingency management, another effective approach, uses positive reinforcement to encourage sobriety. Motivational interviewing helps individuals find internal motivation to make positive changes in their behavior. These therapies can be conducted in individual or group settings and are often part of both inpatient and outpatient treatment programs.


Medications can be an essential component of treatment, especially when dealing with substances like opioids, alcohol, or prescription drugs.

In medication-assisted treatment (MAT), medications are used to manage withdrawal symptoms, reduce cravings, and prevent relapse. For instance, methadone, buprenorphine, and naltrexone are used for opioid addiction, while medications like Acamprosate and disulfiram are used for alcohol dependence. The effectiveness of medication-assisted treatment is often enhanced when combined with behavioral therapies.

Support Groups and Aftercare

Support groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), provide a supportive environment where individuals can share experiences, seek guidance, and find accountability in maintaining sobriety.

Aftercare programs, including sober living homes or continuing therapy sessions, are crucial in preventing relapse by offering ongoing support and guidance as patients transition back to their daily lives post-rehabilitation.

Successful treatment often involves a combination of these approaches, customized to the person’s specific needs and the type of substance abuse.

It’s important to consider factors such as the severity of addiction, any co-occurring mental health issues, and the patient’s social support network when determining the most effective treatment plan. The best rehab programs use a personalized approach since everyone experiences addiction differently. There is no one-size-fits-all solution when it comes to addiction treatment.


Drug abuse is a complex issue that cannot be simply categorized as a choice or a mental illness. It is important to understand that drug abuse can be both of those things. In any case, seeking help is crucial for recovery.

Addiction is not a moral failing or a sign of weakness. Seeking treatment is a sign of strength. If you or a loved one is struggling with drug abuse, know that there is help available and recovery is possible. By addressing the root causes of drug abuse and making positive changes, patients can overcome this challenge and lead a healthy and fulfilling life.

Look for a rehab near you today to learn more about the available treatment options. The road to sobriety begins here.










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Fel Clinical Director of Content
Felisa Laboro has been working with addiction and substance abuse businesses since early 2014. She has authored and published over 1,000 articles in the space. As a result of her work, over 1,500 people have been able to find treatment. She is passionate about helping people break free from alcohol or drug addiction and living a healthy life.

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