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Disease or Choice? The Debate Surrounding the Origin of Addiction

by Ashley Smith

Does an illness or bad decisions cause addiction? There is division on this issue, despite convincing scientific studies that sway the argument towards addiction being an illness. Some people argue that poor choices mainly cause addiction and that willpower is the only cure to overcome misuse of a substance. Others have looked into how addiction and substance misuse affects the brain, making it very difficult to stop without professional medical assistance. It’s important to look at both sides of this argument to understand the different attitudes towards addiction that people hold in society today.

Disease Model of Addiction

The American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) classify addiction as a disease. When compared to other diseases like heart disease, diabetes type 2, and cancer, addiction is also made up of a combination of environmental, behavioral, and genetic or biological factors. Just like with other hereditary diseases, genetic links account for about half of the likelihood of developing an addiction.

Another aspect of understanding substance use disorders is looking at how drugs affect and rewire the “reward pathway” of the brain. Humans generally feel satisfied when their basic needs are met: hunger, sleep, thirst, sex, and so on. When these needs are fulfilled, the brain releases a wave of dopamine, which signal “reward” to the body. When someone misuses drugs, particularly opioids, the release of these chemicals happens, but at about 1000 times the normal intensity. This is what gives the intense feeling of euphoria. With prolonged use, people build up so many opioid receptors in the brain that the natural “reward” feeling is no longer sufficient to feel normal. This rewiring of the brain causes people to continue to seek out these substances, despite the possible negative consequences. The mind begins to prioritize drugs over all else, sometimes even normal things like hunger, hygiene, and other daily functions.

Even when someone enters recovery, these changes can impact the brain long-term, calling for professional addiction treatment that involves a whole-patient approach including medication and psychotherapy. Thankfully, successful recovery is possible for people with substance use disorders, and many programs have been carefully created to help rebuild the parts of the brain that were damaged by drug misuse.

Just as with all chronic diseases, addiction can never be fully “cured.” Commonly, addiction is compared to cancer where many people can go into “remission” but never be fully cured. As with unfortunate cancer diagnoses, people will addiction may relapse and return back into their addiction. Usually, this happens because of the long-term psychological effects that stay in the brain of someone with a substance use disorder. A relapse can be caused by various kinds of triggers that will vary from person to person. However, with a strong support system, professional therapy, and careful monitoring, addiction recovery can be managed long-term.

Arguments Against the Disease of Addiction

When someone first tries drugs or alcohol, it’s a decision they’ve made to ingest a certain substance. Some people believe that because of their decision to try a substance; they are now responsible for the way addiction can take control of the mind and body. While early decisions made to ingest substances are certainly a deliberate action in the first stages of misuse, the way drugs change the person’s brain chemistry soon becomes out of their control. Using the previous example of heart disease, diabetes type 2, and cancer, it may be someone’s choice to eat poorly, not exercise, smoke cigarettes, and indulge in unprotected sun exposure, but when the following disease becomes apparent, it is no longer a choice.

Some people who believe addiction is a choice also don’t take into consideration that some people are addicted to opioids because of a painkiller prescription that was given to them by their doctor. Due to the addictive nature of these medicines, they unwillingly became dependent on these powerful drugs by following their doctor’s orders.

Those who believe that addiction is a choice may not understand that simple “willpower” is not enough to overcome the drastic changes that drugs cause in the brain. In fact, the most identifying difference between drug misuse and a substance use disorder is a loss of control over drug use. For people with addiction, even the awful consequences are not enough to stop them from using; this is usually caused by the way the addicted brain prioritizes drug use above all else. Simple willpower is not enough to overcome something that has been rewired in the human brain.

One of the dangerous aspects of denying addiction as a disease is the continued stigma that this attitude brings upon those who are suffering. People who are not able to “will” their way out of their addiction are often blamed and shamed for their disorder, causing them to feel worthless or broken. Treating people with substance use disorders this way is immoral since it would be appalling to treat someone negatively just because they have heart disease, diabetes type 2, or cancer. With these negative attitudes, people are less likely to seek treatment for their addictions, potentially leading to more senseless and preventable overdose deaths.

Disease or Choice, Does it Matter?

Whether someone wants to believe that addiction is a choice or a disease, the glaring statistics of the opioid epidemic that has been sweeping America for the better part of two decades has called for a public health state of emergency. This debate can continue to divide people, but the focus should be on those who desperately need help and treatment for their addiction. It’s important for drug treatment such as MAT, or medication-assisted treatment, to be an accessible form of recovery for people who are struggling with substance use disorders. When someone is deep into addiction, willpower simply will not be enough to change the way their brain is telling them how to live and what to do. Shaming people who are dealing with addiction is not the answer, but offering science-backed methods of treatment will help get them back on the track to healthy living!


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Medically Reviewed By:

Health Care Resource Centers Clinical Team

Health Care Resource Centers Clinical Team

Health Care Resource Centers Clinical Team

The Clinical Team at Health Care Resource Centers is our team of physicians and medical directors within the organization. HCRC is a CARF accredited organization and has been providing addiction treatment services for over 32 years in the New England area.

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