Is Addiction a Disease or a Choice?

Disease Model of Addiction

Although the disease model of addiction emphasizes the need to treat substance abuse as a condition, the definition of addiction varies among people, organizations, medical professionals, and society. The National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institutes of Health (NIH) all describe addiction similarly as a long-term and relapsing condition marked by an individual compulsively seeking and using drugs despite the repercussions.¹

These organizations believe drug addiction is a disease because addiction changes how the brain responds to situations involving reward, stress, and self-control, and these changes are usually long-term and can persist even after the person has stopped using the substance in question. To better understand this concept, you could compare addiction as a disease to heart disease:¹

• Both addiction and heart disease impair the regular functioning of an organ in the body, the heart in the case of heart disease and the brain in the case of addiction.
• Both heart disease and drug addiction can lead to a decreased quality of life and an increased risk of premature death.
• Addiction and many forms of cardiovascular disease are preventable by following a healthy lifestyle and avoiding poor choices.
• Both conditions are treatable to avoid further damage.

What’s more, since addiction is often characterized by intervals of recovery and relapse (symptom recurrence), it resembles other diseases, such as hypertension and type-2 diabetes.² These are both life-long conditions that require consistent treatment and effort to manage.

Seeing Addiction as a Choice

On the other hand, many people would argue that drug addiction is a choice, not a disease, for several reasons:

• Addiction is not transmissible or contagious.
• Addiction is not autoimmune, hereditary, or degenerative.
• Addiction is self-acquired, implying that the person gave the condition to themselves.

Proponents of this side of the debate focused more on the social and environmental factors of addiction instead of the changes that occur in the brain as a result of substance abuse. Other schools of thought believe addiction treatment is little more than the person deciding to stop using drugs or alcohol.⁴

Specific points of these arguments are difficult to refute. For instance, most substance use disorders indeed began with a decision (although many began with a prescription from a doctor for a diagnosed medical issue that evolved into an addiction). However, while no one forced an addicted person to begin abusing drugs in the first place, it’s hard to imagine someone consciously choosing to ruin their health, relationships, career, and other major areas of their life.

If overcoming addiction were as simple as choosing to stop, then the problem of addiction would be much easier to address and rectify. We also want to point out that the idea that the “drug abuse is a choice” view is usually from an individual or small group standpoint.

There are few, if any, nationally recognized addiction-centered organizations whose views don’t fall into the addiction is a disease or choice side. The American Psychiatric Association (APA), for example, replaced “addiction” with “substance use disorders” to describe conditions associated with compulsive and habitual substance abuse. The change was made to avoid confusion about addiction and its uncertain definition, as well as the negative stigma attached to it.

Additionally, if we were to say that addiction is the result of the person’s initial choice to use drugs, then couldn’t we say the same about heart disease? Cardiovascular disease is often the result of poor choices like unhealthy eating habits, so if we used that same line of thinking, wouldn’t we say the same for this?

Just as cardiovascular disease can run in the family, there are also biological factors that increase the person’s risk of developing addiction between 40% and 60%, including:¹

• Genes
• Epigenetics (the way the environment impacts gene expression)
• Gender
• Ethnicity
• Stage of development

The person’s developmental stage is also important, considering teens who use drugs are more likely to develop an addiction and remain addicted into adulthood.¹ There are also protective factors and risk factors for addiction. The former protects the individual, while the latter makes it more likely that they’ll become addicted.

Risk factors include:

• Family history of addiction
• Family history of mental illness
• Dysfunctional home life
• Adverse childhood experiences (ACE), such as neglect or abuse
• Unsupportive community
• Easy access to drugs or alcohol

Protective factors include:

• No family history of addiction or mental illness
• Good physical health
• Healthy home life
• Access to positive resources and community support
• Academic success
• Strong impulse control

The risk of addiction also depends on how the drug is administered. Certain routes will produce stronger highs or side effects, such as injecting a drug versus smoking or swallowing it. Intense highs occur rapidly and dissipate quickly, further encouraging drug use. In the end, addiction becomes the most likely outcome.

Is Addiction a Choice or a Disease?

Ultimately, addiction can be seen as both a disease and a series of choices. Although the initial decision to use substances may not stem from a desire to become addicted, addiction often develops as a result. Long-term substance abuse can lead to neurological changes and significantly impact an individual's ability to make rational decisions and exert control over their behavior.

This perspective has led to a shift in how addiction is treated, with many experts advocating for a compassionate and holistic understanding that combines medical treatment, therapy, and support. Approaching addiction as a disease acknowledges the biological factors and aims to address both the physiological changes and the psychological and social factors that contribute to the development and duration of addictive behaviors.

It's important to note that this understanding of addiction has evolved as more and more studies regarding its contributing factors and long-term effects are conducted. It's recommended that individuals seeking information about substance use disorders and their treatment consult reputable experts to understand this issue and receive the care needed to recover.