Is Addiction a Disease?

Addiction means different things to different people. To some it means a compulsion to use addictive and sometimes dangerous substances – compulsion being the key word. To others it’s an excuse used by addicts to shield themselves from blame for all the decisions they make to sustain their addiction.

So, who’s right?

In this article we’ll discuss both sides of the argument – addiction as a disease and addiction as a choice.

The Science Behind Addiction

When using an addictive substance before you are “addicted”, the only feeling you get is from the chemical substance themselves. For opiates this might be elation, for benzodiazepines – relaxation. For behavioral addictions (sometimes known as process addictions) such as sex and gambling addiction, that feeling might be excitement and distraction, or the rush of taking a risk. But when someone continues to use the substance to the point where they are addicted, their brain chemistry has changed.

The dopamine, which anticipation of substance misuse brings, can completely thwart the efforts of the angel on your shoulder, compelling you to ignore any reasons why this is a bad idea. Once the high has kicked in, your brain’s “reward circuit” produces chemicals that reinforce your need for more dopamine, better hits, and larger risks.

Not everyone who chooses to engage in drinking and drug taking has an “underlying reason” for doing so. It might be due to peer pressure, curiosity, or just seeking fun. But for those who go on to become addicted, there is often a reason why substance use goes on to become a problem. Childhood trauma, poor quality of life, and mental health problems can all be factors why someone might turn to substances – for a distraction from pain and negative emotions.

The Argument For – Drug Addiction is a Disease

The controversy behind addiction as a disease model often comes from moral grounds. Addiction is seen as a moral failing, or personal defect. The lies, deceit, and immoral behavior which an addict engages in brings pain to their loved ones. Families and friends who might try a good-natured attempt at bringing up the negative consequences of substance use are often subjected to anger, making it easy to blame the addict for “choosing” to be addicted.

It’s more complicated than that though. Lies, secrecy, and deceit are part of addiction – to avoid judgement and hide from the shame.  Their angry response to being challenged is often a defense mechanism, driven by powerful chemical changes in the brain, to stop anything from getting between the addict and their addiction.

Whether the beginnings of an addiction are due to nature or nurture, the disease model of addiction agrees that the use of an addictive substance starts as a choice. It isn’t until the behavior becomes compulsive that the story gets more complicated. By the time their brain chemistry has changed, the addicted person is still “choosing” to continue using addictive substances, but the choice is one made under duress from a compulsion brought about by chemical change in their brain.

Though there are some which go against the grain, the scientific community generally agrees that addiction is a disease much in the way that mental health illnesses are. Would you consider someone with bulimia, who binges on food and then throws up, to have made a choice to do so? I doubt it.

Addiction as a Family Disease

While the scientific community hasn’t found the exact reason why, those with family members who struggle with substance misuse are significantly more likely to misuse substances themselves. Your genes themselves can give you a predisposition to becoming addicted, and the environment you grew up in is a huge factor.

Family socioeconomic factors have a strong relationship with drug use. Those whose families were struggling financially or lived in poorer areas are much more likely to misuse drugs and alcohol at a young age. Growing up around drug and alcohol use is also a major factor in whether you will misuse addictive substances.

Your family dynamics in general can also weigh in. Children with parents who are struggling with active addiction are less likely to live in a stable family home. Trauma in childhood and adolescence is linked to mental health conditions and addiction and contributes to the view of addiction as a “family disease”.

The Argument Against – Drug Addiction is a Choice

There are many reasons why someone might believe addiction to be a choice. Sometimes it can come from a place of ignorance such as seeing someone continue to engage in harmful behaviors, and being unable to understand why that might be the case.

For some though, they see addiction as an excuse for the addicted person. They feel that the addicted person can use addiction a shield, preventing any personal blame for the hurt and pain that unhealthy behaviors associated with addiction can cause.

There is some debate within the scientific community as to how much choice is involved in addiction, and if the label of “disease” can be harmful. When classified as a disease, addiction is often placed among chronic conditions which cannot be cured. This mantra is also followed by fellowship groups such as AA.

“We in the fellowship of AA believe there is no such thing as a cure for alcoholism. We can never return to normal drinking, and our ability to stay away from alcohol depends on maintaining our physical, mental, and spiritual health.” Alcoholics Anonymous

Some health professionals feel that this label of uncurable disease hurts any efforts to treat addiction, and that treatment can sometimes successfully remove any compulsive behavior. If treated like “normal” conditions such as diabetes and asthma, you may be ignoring the fact that there are underlying psychological factors which triggered the addiction.

So, is addiction a disease, or is addiction a choice?

The debate on whether addiction is a choice or an addiction might be useful to the scientific community, but for the public it can reinforce negative stereotypes and prejudice. While using addictive substances for the first time is a choice, there’s good scientific evidence that once the addiction takes hold the associated behaviors become compulsive. Whether a choice or a disease, there’s one thing that both sides of the argument agree on – addicts need help.

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