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Is Addiction a Disease or a Choice?

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Diseased or degenerate? Perceptions about the nature of substance use disorders hindered treatment for generations by stigmatizing dependency as the product of a weak will. Such perceptions limited availability to treatment. It also made those who were suffering hesitant to come forward until their problem reached crisis proportions.

Is addiction a disease or a choice? A case can be argued for both. Many people choose to use for whatever reason. When use becomes a habit, addiction sets in. No one ever thinks it can happen to them.

The Nature of Substance Use and the Disease Model of Addiction

Even in science, there are two schools of thought about the nature of addiction. Although the current disease model of addiction is backed by medical evidence, there are some in the “addiction is a choice, not a disease” camp who feel that classifying it as a disease over which the addict has no control removes personal responsibility from the equation. It is believed such a mindset promotes feelings of inevitability and hopelessness that can inhibit recovery.

Addiction as a biological condition is evidenced by studies conducted on the brains of substance users. According to studies conducted by the National Institute on Drug Abuse (NIDA), there are distinct alterations in the brain function of habitual substance users. Their studies discovered that drugs affect the brain in two ways.

  1. By sending false information that disrupts the brain’s normal function by mimicking its natural neurotransmitters.
  2. By overstimulating the pleasure centers in the brain, releasing an excess of dopamine and other “feel good” chemicals. This over-stimulation makes the brain’s normal activity unrewarding, causing the user to seek out intoxicating substances in order to feel that rush again. Soon, there is a vicious circle of pleasure-seeking, let down, withdrawal, and drug use that escalates until it spirals out of control.

The other part of the cycle of addictive behavior is the psychological component. There are risk factors that can form the foundation for an addiction under the right circumstances when not addressed. These are merely risk factors that can contribute to drug or alcohol dependency, not causes of drug addiction.

  1. Genetic background, such as a history of substance abuse in the family. Gender and ethnicity can play a part, too. For example, men have a higher rate of substance abuse disorders, but women are more likely to relapse after treatment. A personal history of mental health problems is also a risk factor, especially if they’re undiagnosed or untreated.
  2. Age of first use. Those who are exposed to drugs and alcohol at an early age are more likely to develop a dependency.
  3. Environmental factors. Dysfunctional family life, peer pressure, and socioeconomic status all have a part to play in substance use. Trauma and prolonged exposure to stress contribute to drug and alcohol abuse as well.

While no one can pinpoint the exact causes of drug addiction, there does seem to be a genetic disposition that differentiates the addict from the casual user. It’s similar to how one is at-risk for heart disease or diabetes, but the diseases usually only manifest when lifestyle choices trigger them. Taken with the other components of addiction, it explains why one person can experiment with drugs and walk away, another can experience addiction and quit cold turkey without looking back, and yet another can sink into addiction and need long-term recovery to manage the condition.

How Reclassifying Substance Use Changed Treatment

At a time when the prevailing opinion was that addiction is a choice, not a disease, there was shame and guilt attached to the disease of addiction. This resulted in people hiding their dependency and avoiding treatment. The results were often tragic for the addicts, their families, and the community. Criminalizing the behavior drove it even further underground. It wasn’t until science stepped in with definitive proof of physical changes in the brain that doctors and therapists began to devise ways of creating addiction treatments that addressed physical, psychological, and emotional causes of addiction.

The first known mention of alcohol and drug addiction as a treatable disease came in 1784. However, it wasn’t until the creation of Alcoholics Anonymous in the 1930s that the notion became widely considered in the world of science and in public opinion. This led to breakthroughs in research and treatment methods. It also allowed room for empathy and greater understanding of the nature of addictive and compulsive behaviors.

In the years since addiction treatment has transitioned to an evidence-based practice (EBP) model that incorporates a three-pronged approach to recovery based on:

  • The most current research on why and how a treatment is effective
  • Clinical evaluation of patient needs based on the counselor’s judgment and experience treating addictions.
  • The preferences and goals of the person seeking treatment for a substance use disorder

The Effectiveness of Substance Abuse Treatment

The EBP model of addiction treatment has evolved to include a wide range of holistic and traditional therapies. This customized approach has led to more effective rehabilitation programs and higher rates of success. In the end, the question of “Is addiction a disease or a choice?” may be rhetorical. It is a treatable condition with provable results. When the nature of the addiction and contributing risk factors are understood and addressed in a comprehensive manner, addiction specialists are better able to educate addicts and help them to help themselves.

In order for treatment to be effective, it must take a multilateral approach. First, medical supervision is needed to wean the person off of the drugs or alcohol and begin to restore normal brain function. Next, to address the root causes and contributing factors that led to addiction. Last, the work on a path to long-term recovery that combines practices like mindfulness, cognitive behavior therapy, and developing healthier coping tools. It also takes a commitment to remaining clean and sober.

There is Hope

No one starts out wanting to become an addict. If you or someone you care about is dealing with the disease of addiction, we can help. Lakeview Health is a resource for drug treatment options, and we’re available 24/7 to give you the support and guidance you need. Call 866-812-8231 today.

  • Our mission is to offer a safe, non-triggering, recovery-focused resource for anyone who has struggled with addiction or has helped someone who struggled. We aim to provide articles that help bring awareness to addiction as a disease and honor the recovery process through insightful and motivating topics. Together, we can all work to inspire each other and bring thoughtfulness and truth to the recovery journey.

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