Nov 1, 2018 | By Tim Stoddart

Addiction – Choice Or Disease?

Addiction Resources

We’ve heard it over and over again – addiction is a disease. However, there has long been a debate about whether or not it is a choice. Some people feel that those addicted have made poor choices, and that it is a matter of willpower to break their dependence. Others feel that addiction is a disease that affects the brain, and that without professional help from addiction treatment experts it’s very hard to stop.

According to the a 2016 Surgeon General’s report, it finds drug and alcohol addiction to be one of America’s most pressing public health concerns.

“It’s time to change how we view addiction,” U.S. Surgeon General Vivek Murthy wrote in his landmark report. “Not as a moral failing, but as a chronic illness that must be treated with skill, urgency and compassion. The way we address this crisis is a test for America.”

However, while many researchers, scientists, and professionals do claim that addiction is a brain disease, there are others who negate the research and back it up with evidence that addiction ultimately comes down to a choice.

Here at Sober Nation, we want to take a bipartisan standpoint on the topic and break down the two beliefs and leave it up for you to decide – so let’s dig in.

The Definition Of Disease

Merriam-Webster defines the word disease as:

A condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms. 

The first time individuals drink or take drugs, they do so voluntarily, and they believe they can control their use. With time, more and more alcohol or drugs are needed to achieve the same level of pleasure and satisfaction as when they first started. Seeking out and taking the substance becomes a near-constant activity, causing significant problems for them and their family and friends. At the same time, progressive changes in the brain drive the compulsive, uncontrollable drug use known as addiction

When this happens, individuals can no longer voluntarily choose to not use drugs or alcohol, even if it means losing everything they once valued – impairing normal functioning and distinguished as symptoms of going to any lengths to get the drink or the drug, also known as the symptoms of abnormal functioning.

Why Addiction Is A Disease

Addiction is categorized as a long-term (chronic) disease, and like other chronic diseases, such as diabetes or cardiovascular disease, treatment and monitoring has to be maintained throughout the patient’s lifetime.

This disease concept of addiction is not new. Two centuries ago, in 1784, Dr. Benjamin Rush said that the condition is a disease and must be treated by a physician. However, that doctor wasn’t backed up until later in the 1930’s when the founders of Alcoholics Anonymous presented alcoholism as a disease of the mind, body, and spirit.

The American Medical Association and the American Society of Addiction Medicine defines addiction as a disease, and additionally, it’s also written in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5). Like other disease such as diabetes, heart disease or cancer, addiction is caused by a combination of behavioral, environmental, and biological factors. Additionally, genetic risk factors can account for about half of the likelihood that an individual will develop addiction.

New Research In The Brain

Over the last 20 years, new findings have convinced experts and American Society of Addiction Medicine (ASAM) members that the definition needed to be changed so that the focus not only is on what is happening with behaviors, but in the brain. And in 2011, after a four-year process, ASAM created a new definition with input from over 80 experts, including top addiction authorities, addiction medicine doctors, and eminent neuroscience scientists from across the USA, as well as every member of ASAM’s governing board, chapter presidents from several states, and experts from NIDA (National Institute on Drug Abuse).

ASAM determined that addiction is classified as a primary disease – not caused by something psychiatric or emotional.

ASAM’s website noted:

“Research shows that the disease of addiction affects neurotransmission and interactions within reward circuitry of the brain, leading to addictive behaviors that supplant healthy behaviors, while memories of previous experiences with food, sex, alcohol and other drugs trigger craving and renewal of addictive behaviors.”

Within the disease of addiction, the wiring in the brain that directs impulse control and judgement become altered and the person with addiction begins to have dysfunctional and maladaptive pursuit of rewards when seeking out alcohol and drugs. Those who are exposed to drugs and alcohol early, can be at higher risk of becoming addicted later in life due to the area of the brain still developing.

Choice Plays A Role In Getting Help

Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on the definition, said:

“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.

Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary.”

Former President of ASAM, Dr. Michael Miller who oversaw research to determine this conclusion, noted that:

“Many chronic diseases require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions. So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment.”

While the stigma of addiction can alter the perception of those that perceive that it is a moral failing, it can be said by the evidence above that addiction appears to be a brain problem whose behaviors manifest in all other areas of functioning. It also concludes by the evidence shown, that the disease of addiction is about underlying neurology instead of outward actions.

Why Addiction Is A Choice

On the flip side of the debate are researchers and people who believe that addiction is a choice. Some experts point out that any persistent change in behavior will cause changes in the central nervous system. Additionally, the argument is made that, for example, the brains of readers will be different than the brains of non-readers.

Harvard psychologist website noted dismantles this scientific assumption, arguing that addiction is first and foremost governed by personal choice, and does not therefore fit clinical conceptions of behavioral illness. While Heyman has done research on choice, cognition and drug use, he has also volunteered at methadone clinics and teaches courses on addiction at Harvard University. Heyman firmly believes that drug and alcohol users can voluntarily engage in activities that lead to long-term self-destruction.

Heyman’s analysis is based on the fact that there are always two “best ways” to make choices. He notes:

“We can take into consideration the value it has at the moment—the immediate rewards. Or we can consider this kind of circle of expanding consequences that each of our choices has. Your pattern of choices can be much different depending on whether you take into consideration this broader circle. A workaholic, for example, starts out taking into account only the immediate demands of working, dropping every other consideration. But he ends up, according to himself and everybody around him, working too much. The model just tries to formalize that idea, and it’s really just common sense.”

Heyman theorizes that when people are choosing the drug, they’re thinking that moment, or that day would be better if they did. He goes on:

“A chronic smoker will think that the next three minutes would be better with a cigarette than without. But after a year of smoking 20 cigarettes per day, adding up to 60 minutes each day, you might think, ‘I’d rather have the 60 minutes of not smoking each day.’ Unfortunately, you don’t choose 60 minutes at a time. You decide one cigarette—or three minutes—at a time, and that’s what makes this so difficult.”

Addiction May Not Be A “Chronic Relapsing Disease”

As Heyman did his research, he wanted to find out how drug use turned from a voluntary behavior to an involuntary one. As he taught his students, he wanted to give them some feeling of what addiction was like. From there, he began reading biographies, histories, and ethnographic of addiction. He explains:

“This data gave a very different picture than the one I expected. The literature on how addicted people behave showed they stopped using the drugs, and that they did so because of family issues, or there was a choice between their children and continued drug use, or they were moving on to an environment where it was disapproved of. In other words, the kinds of things that influence all of our everyday decisions were influencing people who are heavy, heavy drug users to stop using. And it was so consistent. Each report supported the other.”

“It’s Unhealthy”

Many argue that believing that addiction is a disease is not only incorrect, but it’s simply unhealthy. They point out that as humans, we always have a choice. They believe that if there really was no choice in the matter, then no one would recover from addiction. But people do recover, and that happens by choice.

Choice Or Disease?

While both sides have some impactful points, each individual has to make their own decision whether addiction or alcoholism is a choice or a disease. Perhaps you believe that it is a disease that can be triggered by a choice. If the potential addict never makes the choice to drink or use drugs, they will never become dependent on the substance. But if they do make the choice to use or drink, then they lose the power to continue to make the choice.

What are your thoughts? Choice or disease?