Is Addiction a Disease or a Choice?
Is drug addiction a choice or a disease? This is the question that keeps coming up in the addiction treatment community. Patients will often take one side or the other. Experts will debate the validity of addiction as a disease. Maybe you’ve even wondered the answer to this one yourself.
It’s best, to begin with learning what addiction is. At that point, the answer to the question, is addiction a disease or choice? becomes much more clear.
What is Addiction?
An addiction is something that occurs when someone ingests a substance or engages in an activity repeatedly. The substance or activity produces pleasurable sensations for the individual. Eventually, it becomes compulsive in nature. This is problematic because of how it interferes with the individual’s life. This can result in issues with the person’s:
When someone suffers from an addiction, they are usually not aware of how out of control their life is. In fact, people can remain in denial for years, assuring everyone around them that they’re in control.
When someone has an addiction, there are dramatic changes that take place in the brain. These changes occur regardless of the type of addiction the individual has. They usually refer to increased levels of dopamine and serotonin in the brain. These chemicals are responsible for helping people feel good and experience security. When addictions are present, substance or behavior becomes responsible for making these chemicals. The brain no longer makes them on its own.
A behavioral addiction is something that involves feeling compelled to engage in a particular behavior. The behavior does not involve using substances of any kind. The behavior is done repeatedly, and without concern for the harm, it is doing.
Over the years, a lot of research has been done on behavioral addictions. It is interesting to see how the brain changes similarly with behavioral addictions and substance addictions. Behavioral addictions are marked by withdrawal symptoms, tolerance and a feeling of discontent when not participating in them.
Some examples of behavioral addictions can include:
- Sexual addictions
- Shopping addiction
These and other behavioral addictions can be just as harmful as drug addictions. They cause a great deal of pain for the people who suffer from them. These individuals often wonder why they can’t just stop. They create problems for the addicts’ families as well. Fortunately, treatment options are also available for behavioral addictions.
Still, the question remains, is this type of addiction a disease or a choice?
Types of Addiction
There are so many different types of addictions. People often tend to think of addictions as pertaining to drugs or alcohol. The scope is actually so much larger than that.
Common substance addictions include:
- Alcohol addiction
- Cocaine addiction
- Marijuana addiction
- Heroin addiction
- Prescription drug addiction
- Meth addiction
- Hallucinogen addiction
Other types of addictions include:
- Food addiction
- Pornography addiction
- Love addiction
- Exercise addiction
- Internet addiction
- Video game addiction
It’s actually not uncommon for these conditions to manifest at the same time. When this occurs, this is known as having a co-addiction. People with behavioral addictions often struggle with substance abuse problems as well.
Is Drug Addiction a Disease or Choice?
Is addiction a disease or a choice? Up until relatively recently, individuals who suffered from substance abuse disorders such as alcoholism or drug addiction were viewed with suspicion and treated with derision. The prevailing notion was that they were morally weak or defective – that if they had enough self-respect and willpower, they could overcome their problem.
Fortunately, that antiquated idea is no longer held by most knowledgeable people.
Misinformation and ignorance can create barriers for someone seeking treatment for their substance abuse disorder, and the best way to break through these barriers is with FACTS.
“The mentality and behavior of drug addicts and alcoholics is wholly irrational, until you understand that they are completely powerless over their addiction, and unless they have structured help, they have no hope.”
So is Addiction a Disease or a Choice? What Do the Experts Say?
Dr. A. Thomas McLellan, Ph.D., former Deputy Director of the White House Office of National Drug Control Policy and co-founder of the Treatment Research Institute, had this to say –
“The emerging science shows this is a brain disease. It’s got the same genetic transmutability as a lot of chronic illnesses. And the organ that it affects is the brain, and within the brain it is motivation, inhibition, cognition, all those things that produce the aberrant, unpleasant behaviors that are associated with addiction.”
- In 1956, the American Medical Association made the declaration that alcoholism – the most common form of addiction –was an illness.
- In 1991, the AMA endorsed the International Statistical Classification of Diseases and Related Health Problems’ dual classification of alcoholism as both a psychiatric and medical condition.
- In 2004, the World Health Organization released a comprehensive report on alcohol and drugs, compiled by analyzing 30 years’ worth of information. The WHO concluded that “However, with recent advances in neuroscience, it is clear that dependence is as much a disorder of the brain as any other neurological or psychiatric illness.”
- Alcoholism is classified as a disease by such organizations as –
- The American College of Physicians
- The National Association of Social Workers
- The American Public Health Association
- The American Hospital Association
- The National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health, funds 90% of the alcohol-related research in the US, and their position is unequivocal – “…alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water.”
There Is No Difference between Alcoholism and Other Drug Addictions
When answering the question, “Is addiction a disease or a choice”, you must consider that both manifestations of Substance Abuse Disorder change the brain’s reward circuitry, thereby reinforcing that drinking and drug use are positive behaviors that should be repeated. The disease of addiction motivates the person to stay addicted.
As the illness continues to progress, the sufferer to will begin to exhibit certain medically-diagnosable symptoms, as identified by the American Society of Addiction Medicine:
- An inability to ABSTAIN–the person cannot control the amount or frequency of use
- Impaired BEHAVIORAL control–the person has little to no control of their actions
- Increased CRAVING–the person becomes obsessed with drugs and/or alcohol and will compulsively seek them out
- DIMINISHED capability to recognize consequences–usually, substance abusers will deny that a problem exists
- A dysfunctional EMOTIONAL response–even as the disease worsens and consequences become more severe, the substance abuser will continue to use and/or drink unless motivated by external pressure
Dr. John Sharp, M.D., a faculty member at both the David Geffen School of Medicine at the University of California, Los Angeles and Harvard Medical School, said, “Alcoholism is an addiction – it’s just one type of addiction. When you break out the specific things that someone who is suffering from alcoholism contends with…they are no different from any other type of addict.”
How Do Drugs Change Your Brain?
Over the years, science has learned so much about what addiction is, and how it affects us. The brain’s reward center is profoundly affected once a person begins abusing substances. As you might guess, it is affected even more once addiction takes hold.
The part of the brain that drugs impact the most is called the reward pathway. This involves several different areas of the brain. These areas are commonly activated by certain reward stimuli, and food, water, and sex are the most typical. When the reward pathway is stimulated, information travels through it. This results in increased dopamine levels in the brain.
As a result, the individual looks at a rewarding experience as a positive one. The same thing happens when someone uses drugs. They are repeatedly activating that reward center, causing a pleasurable response. As time goes on, they grow to crave that response, and they don’t feel right unless they feel it.
The human brain is an incredibly complex organ. In fact, it is the most complex out of all the organs in the body. As someone repeatedly uses drugs, they are teaching their brain to expect and anticipate that pleasure. Overstimulating the brain can produce sensations of euphoria that cannot be matched any other way. This only reinforces drug use, and it’s why addiction has become such a major problem.
What Happens to the Brain After Continued Drug Use?
When someone only uses drugs for a short period of time, it can recover quite well. However, it’s much different for a long-term drug user. The brain normally produces adequate amounts of dopamine on its own. That’s one of its main jobs. However, when drugs cause dopamine to flood the system, the brain backs off.
It’s almost like the difference between a whisper and shouting into a megaphone. When the megaphone sounds (drugs), the brain turns down the volume on dopamine. It basically decides that it’s not needed to perform that job any longer. As a result, it stops, or it only produces very small amounts.
This is why people become depressed so easily once they stop using drugs. Even with short periods of abstinence, users will become flat. The things that they once enjoyed don’t seem as enjoyable or desirable any longer. They’ve lost their zest for life without drugs. This drives them to use again, and the cycle goes on and on.
The brain is immensely affected by the use of drugs. However, that doesn’t mean that it can’t recover. Some of what drugs do to the brain may not be reversible, the majority of it is. However, in order to heal, the individual must be in recovery from their addiction.
Why Is It So Important to Recognize Addiction as a Disease?
The mistaken belief that addiction is a choice – and therefore, a weakness – carries with it the twin burdens of guilt and shame. Far too often, those burdens prevent a suffering addict from admitting that they have a problem and need help.
When Should You Seek Help?
Where addictions are concerned, people often find themselves at a loss as to when to get help. This is usually because of a few different reasons. They may:
- Think that they have the situation under control.
- Mistake actual addictions for substance abuse or behavioral abuse patterns.
- Be in denial that the addiction is causing them any problems.
- Be afraid of what life will be like without the addiction.
- Be convinced that they can stop using or participating in the behavior on their own.
Unfortunately, people can remain in these various mindsets for years without doing anything about them. If you have subscribed to one of these thoughts, you need to know when the right time is to get help.
The Importance of Seeking Help for Addiction
When you suffer from an addiction, your condition actually has two different components. It is both physical and psychological in nature. The physical addiction is the part of you that craves using. It’s the part you experience when you wake up in the morning and need to use before you leave the house. It’s the part that doesn’t feel quite right until you’ve gotten high. This is the part that most people feel they need to treat.
The psychological part of your addiction is the one that started your addiction. It is the root cause of it, which is why you’re where you are today. For you to be able to recover, you need to identify what that root cause is. Addictions can be caused by many different things, including:
- Marital problems
- Family discord or disagreements
- Overall feelings of stress
- Medical problems, such as pain or insomnia
- Mental health issues, such as anxiety or depression
You most likely won’t be able to recover successfully unless you’ve addressed both areas. Most experts agree that this is best done in a professional setting.
How Drug Treatment Can Help You in Recovery
People frequently discount the value of professional treatment for addiction. This is usually because they just don’t understand the need for it. They don’t get how sitting down and talking about your addiction is going to help you stop using. Maybe this is how you’ve always felt as well.
It isn’t enough for you to simply stop using drugs. There must be a driving force behind your urges to use. It’s probably one of the items on that list. Counseling is essential in order to pinpoint what it is so that it can be treated.
Methods of Counseling and Therapy
There are all different types of counseling that are typically utilized when you’re in drug rehab. You will most certainly talk with a therapist about your addiction during personal counseling sessions. Your therapist will get to know you and work hard to understand your addiction experience. In doing so, they will be able to figure out what led to it.
You could also be involved in several other different types of therapy. Group therapy is extremely important, and research shows that it is an essential part of treating addictions. Not only do you get the chance to talk about your feelings, but you can also hear from others. You never know when another person’s experience is going to speak to you about your own.
Finally, it’s important to remember the impact your addiction has had on your family. They are your largest support system. They’re on your side, and you need them in order to move forward. Your relationships with the ones you love most have probably been harmed by drug use. Family counseling can help to bring you back together and heal any wounds that drugs have created.
Your treatment plan may look different from someone else’s. This is because you’re an individual with your own, personal needs. Rest assured that the type of therapy you receive will be targeted toward you.
Identifying Your Own Addiction
It’s not easy to identify your own addiction. Chances are pretty good that others will recognize it before you will. Still, there are some classic addiction signs you can look for. These might give you an indication of your relationship with the substance or behavior.
Common addiction signs include:
- Thinking about drugs or a certain behavior a lot.
- Trying to cut down or stop, but finding that you just can’t.
- Feeling convinced that you need to use drugs or participate in a certain behavior to enjoy life.
- Using drugs or participating in behavior to help yourself feel better.
- Taking a drug in order to get over the effects of another one.
- Making mistakes at work or at school because of substance abuse.
- Being afraid of not having access to a particular substance or not being able to engage in certain behavior.
- Having legal problems because of substance abuse or behavioral patterns.
Have you noticed any of these in your own life? If you have, an addiction could be the culprit. If you’re still not sure, consider taking an addiction quiz. That might give you a better indication of whether or not you are addicted to a substance or behavior.
Helping an Addict
If you are the family member of someone you believe to be an addict, life is probably difficult for you. It’s hard for you to watch your loved one succumb to addiction time and time again. You feel powerless, and you’re not quite sure how to help, or even if you can.
Unfortunately, there are so many families who feel the same way that you do. It’s important for you to know what you can do in this type of situation.
Consider Talking with Your Loved One
This will certainly not be the easiest conversation you will ever have with your loved one. In fact, it will probably be one of the most difficult. Still, it’s important to bring the situation into the light. You may find out that your family member has known about the addiction all along. He or she just didn’t know what to do.
You may also find that your loved one becomes angry when the subject of addiction comes up. You should try to prepare yourself for this reaction. It will be hard for you to hear his or her angry response, but please know the anger really isn’t toward you.
Consider Setting Some Rules and Eliminating Enabling Behaviors
You may have been enabling your loved one for quite some time without realizing it. So many families participate in enabling, and most of the time, they don’t know they’re doing it. This is because there are no rules in place for the addict.
If your loved one is refusing to listen to you, you need to put some rules in place. It’s OK for you to tell him or her that you are:
- No longer going to watch their children for them so they can use
- No longer going to prepare food or purchase groceries
- No longer going to offer financial support
- No longer going to take on their responsibilities
- No longer going to make excuses for them with friends and family
Consider an Intervention
When the above tactics have failed, you need to take different steps. Something you might want to consider is an intervention.
An intervention is a professionally-led meeting that consists of your addicted loved one, you and other friends and family. The purpose of the meeting is to intervene regarding the addiction. The meeting is kept a secret until it takes place. Prior to the meeting, you’ll get coaching and advice about what you and other participants should say.
Interventions are often very successful. It’s touching for the addict to be surrounded by so much love and caring from the people in their lives. They will often agree to treatment directly afterward.
Finding Treatment for Addiction
If you are an addict – whether it’s a behavioral addiction or a drug or alcohol addiction – getting help is important. In fact, it’s the best gift you can give to yourself moving forward. Addiction treatment will give you more freedom in your life than you could possibly imagine.
The question is, what type of treatment do you need? There are several different options you can consider. These include:
- Detoxification treatments
- Inpatient treatment
- Outpatient treatment
- Residential treatment or long-term rehab
- Intensive outpatient treatment
- 12 Step programs
- Addiction counseling
The right treatment for you will be discussed with you, based on your unique needs. All patients are different, just like all addictions are different. What would work for you, might not work for someone else in your situation.
The key is to get the right kind of targeted treatment that will meet your needs. The professionals you speak with will help you determine what that means for you.
If you are struggling with a substance abuse disorder manifesting as alcoholism or drug addiction there is no reason for you to feel guilty about a disease that is beyond your control. The professional addiction specialists at Northpoint Recovery make no judgments and don’t care where you’re from or what you’ve done – they are only here to help you learn how to manage your illness and the negative effects it can have on your life.
Northpoint Recovery is the #1 drug and alcohol rehab program in Idaho, providing individualized Evidence-Based Treatment plans to individuals and families across the state and throughout the Inland Northwest region. Check out our addiction guides for more information.
Is Addiction a Disease or a Choice?
An addiction is a disease, and it is not a choice. The behaviors that lead up to addiction are chosen by the individual. However, what once began as abuse can quickly develop into an addiction. Quite often, the person isn’t even aware this is happening.
Do you have additional questions about whether or not you have an addiction? Are you interested in finding out more information about treating your addiction professionally? We can help you with that. Please contact us right away and we’ll discuss your options.