is addiction a disease or a choice

Addiction – A Disease or a Choice?

August 3, 2017 88 6 No Comments


What is Addiction?
Every year in America, over 90,000 Americans die from illicit and prescription drugs as well as alcohol, and it costs America more than $700 billion a year.

Addiction has been the focus of a lot of research but also a lot of controversies because of its high consequences.

According to the National Institute on Drug Abuse , “addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequence.” In other words, by this definitionaddiction is where an addict is unable to stop themselves from using even when they know the costs greatly outweigh the benefits.

But is this truly the case? Is addiction really a disease? Or are we, as a society, fooling ourselves in believing that addiction is nothing more than a choice?

Truth is, it’s a little bit of both.


How do you know if someone has an addiction?
Those who are addicted and experience substance use disorder show behavioral, cognitive and social impairments and distress. They also show signs of at least two of the following criteria:

  1. Increasingly taking the substance in large quantities or continuing to take the drug over a longer period of time than intended.
  2. Wanting to quit or at least control their drug use but are unable to do so.
  3. Spending a majority of their time trying to obtain the drug, use the drug or recover from the drug’s effects.
  4. Intensely craving for the substance at any point in time, but especially when around environments where the drug was used or obtained previously.
  5. Unable to contribute to school, work or home obligations because of the drug use.
  6. Continuing to use the substance despite having problems in their social life and interpersonal skills which were caused or worsened by the substance in the first place.
  7. Giving up or withdrawing from previous important social, work or recreational activities.
  8. Using the substance even while in risky situations that are physically dangerous.
  9. Continuing to use the substance even while knowing that the drug has caused or worsened a physical or psychological problem.
  10. Increasing tolerance against the drug which may be where there is a need for increasingly higher doses to achieve the same effect previously or where there is a decreased effect or “high” while using the same amount of the drug previously.
  11. Manifesting withdrawal symptoms which are characterized separately for each substance in the Diagnostic and Statistical Manual of Mental Disorders.


Is addiction a disease?
Why would anyone choose to become a drug addict?

People usually don’t choose to be drug addicts, and thus drug dependency is defined as the “loss of control, compulsive drug taking, inflexible behavior, and negative emotional states”. Even if the addict were to want to try and stop, he or she is unable to do so.

Even after detoxification of an illicit substance, a former addict has a tendency to relapse and crave said drug very intensely mainly because substance use disorders are characterized by an “underlying change in brain circuits” that continue even beyond stopping the drug use.

This is because dependence on illicit substances changes the brain at both the synaptic and circuitry level. Addicts show observable physical changes in the brainspecifically in areas that control judgment, decision-making, learning, cognition, and behavior-control. Using drugs produce such an intense activation of our brain’s pleasure system and reward system that the pleasure—the high—overrides rational thinking and practical behaviors.

It was acknowledged that there are certain characteristics that are genetically passed on. One of those characteristics is self-control. This is where the term “addictive personalities” come from. Those with lower levels of self-control which a person may be genetically predisposed to are more susceptible to addiction.

It’s no surprise that that addiction is considered a disease by many by the large amount of evidence showing that addiction erodes a person’s self-control. After all, how can we show self-control if the sections of our brains that are in charge of that aspect are being destroyed by drugs?

What’s the difference between addiction and some of our other habits?
Humans are creatures of pleasure-seeking habits. People often pursue activities that brings us pleasure or rewards and continue to pursue these activities which turn into habits of behavior.

Think about that last spending spree you had, or the last time you binged on ice cream and pizza. These activities start off highly rewarding. They give you a little peak of satisfaction in your brain. But how did going shopping turn into a spending spree, and how did eating a slice of pizza followed with ice cream turn into binging? That’s because they become habits, and habits form from repetitions of highly rewarding behavior.

Think about the last time you fell in love. Do you remember doing so? The neuroscience behind love and the concept of falling in love is rife with similarities with addiction. When you take a look at your lover’s face, look upon their actions with fond eyes and see their behaviors as unique and endearing, your dopamine levels have increased. The initial changes in your brain is highly similar with those who use drugs. Your early interactions with your lover is filled with rewarding outcomes, and the same chemicals being released and increased in your brain are the same chemicals in addicts. As Lewis says“if addiction is a disease, then so apparently is love.”

Is addiction a choice?
So then why is there such an emphasis on the idea that addiction is a disease?

The reason the disease model of addiction had so much traction and support was because empirical research, up until the 70s, had a specific set of participants. Specifically, they studied only the individuals who were already in treatment or had been in treatment. These individuals were often either in prisons, psychiatric hospitals or other similar institutions. The demographics of these participants included high arrest records, poor social relationships and lower than average educational achievement which match the demographics of those who are more likely to be unable to quit. Because of such a limited participant pool, this gave rise to the credence that addiction should be a disease. is addiction a choice?

Then addiction started appearing amongst those who were of the opposite demographics–low arrest records, employed, great social relationships, well-educated. And these individuals fit the description of many addicts today.

Due to the pressures of practical and moral reasons such as sustaining family life, keeping up with work relationships, maintaining school grades, etc., and after the realization that the cost of getting high so greatly outweighed the benefits, addicts started to shift their priorities. Quitting became an option–a choice.

So the main question becomes: do addicts use drugs compulsively?

Compulsion is defined as repeated patterns of behaviors that are involuntary. Unfortunately for those of the pro-disease-model camp, the disease model of addiction fails to account for when an addict does manage to quit on their own without the help of professional therapists or treatments. As such, the word “compulsive” does not encompass all addicts, since there are many addicts who manage to stop their substance use on their own. Quitting became voluntary–a choice.

Addicts usually become dependent on an illicit drug around the age of 20. A study by Heyman shows that, in general, as an addict ages, dependence on the drug decreases. Furthermore, addicts usually quit without the help of professionals.

Drugs changes the brain, yes. But they do not prevent the possibility of quitting.

Why not both?
The positive effects of the disease model of addiction:

  1. It has provided society with a well of knowledge.
  2. It has provided a research base for developing the right strategies and medicine to help counteract the physical changes that substance use has made to the brain.
  3. It has decreased the stigma attached to those who are addicted.
  4. The thought that addicts are “morally-deficient” is challenged under the notion that addiction is a disease, thus allowing for public sympathy and support for the addicted and reducing addicts’ feelings of isolation and overwhelming shame.
  5. Public policy has progressed under the disease model. Treatment and help for those who struggle with addiction are becoming mandatory such as the passing of the parity law that required for medical insurance in the USA to cover the treatment of addiction in their policies.

The continuation of drug use does support the theory of addiction being a disease as there are individual variations amongst drug users who continue their use even as they age.

At the same time, we must understand that because addiction is considered by most nowadays a disease, this takes away the addicts’ part in responsibility for their own recovery and leads to a sense of helplessness. Quitting is usually down to a person’s choice—in the end they are the ones choosing to stop their drug use.

Overcoming addiction is a hard, but worthwhile road to take
Addiction is treatable.

There is plenty of research that outlines the various treatment strategies and their results, most of which show that “prevention programs involving families, school, communities, and the media are effective for preventing or reducing drug use and addiction” as stated on the National Institute on Drug Abuse.

Overcoming addiction is a long, hard road, but a road that is necessary to truly experience life. We at TherapyCable fully believe that addiction is treatable, and though relapses and cravings may be an occurrence after detox, this does not mean that you have failed. It just simply means that the treatment plan needs to be modified and readjusted to truly fit your needs.

If you would like to learn more about addiction and watch videos with addiction specialists, please visit: 

To find addiction resources immediately, please visit:

How to overcome addiction


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