Is addiction a choice or a disease?

By Sept.22.2014HOPE 07/11/18

Is addiction a choice or disease?


Being that there were 21.5 million Americans that struggled with addiction in 2014, I would venture to say that substance abuse is a relevant topic in today’s world. Even more troubling, 80% of those same people also struggled with an issue with alcohol. 8 million total struggled with what is called a co-occurring disorder, or “double trouble.” One question that has raised many arguments though, is addiction a choice? Or, is it something more? In this piece, I intend to provide you with enough facts to make an informed decision.


    The National Institute on Drug Abuse (NIH), says that addiction is hardwired into our brains. Brains are wired to ensure that we remember and repeat things associated with pleasure and rewards. But what most people don’t know, abusing drugs and/or alcohol can literally rewire the brain. Over stimulating our brain with drugs and/or alcohol produces euphoric effects which strongly reinforce the behavior of drug/alcohol use- thus, teaching the user to repeat it. Over time, the brain begins to produce less and less dopamine than it once did causing a person to use more and more to feel “normal” again. Our ability to even feel pleasure dramatically decreases. This is also called tolerance or, the ability or willingness to tolerate something. In short, we use because it feels good and we keep using because we realize it doesn’t feel as good as it used to and we want to feel that again.


    The National Council on Alcoholism and Drug Dependence (NCADD),  says that genetics make up about 50% of the reason a person becomes addicted. The other half is made up of environment, expectancies of what drinking and using drugs will do, and a person’s natural response to substances. All of the above will determine if a person becomes physically addicted or not. Of course, there are plenty of people that have a family of origin riddled with addiction and rose above it and live happy, healthy lives. Then again, there are people with seemingly no substance abuse history in their family, yet they still somehow formed an addiction.


     The definition of a disease is a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury. The definition of addiction is a compulsive physiological need for and use of a habit-forming substance (such as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal.


      I understand, many people will argue and say that the first initial drink or drug is a choice, and I whole-heartedly agree. But what about the folks that have never struggled with any type of substance abuse? For instance, someone that has a major surgery is prescribed narcotics and trusting that their doctor will make the best decision in treating them, they take them as directed and become physically dependent? Was it a choice for them?


     Consider for a moment, for arguments sake, diabetes. It is caused partly by genetics and partly by poor choices. Many major preventative diseases include cardiovascular diseases, hypertension, and certain cancers. Many diseases can even be reversed by a healthier lifestyle. So, why do we look at addiction any different? We don’t look at someone diagnosed with lung cancer as a bad person, so why should we be any different with an addict/alcoholic? And we certainly don’t start blaming them for “choosing” this.


    There was a TedTalk done by Johann Hari where he questions everything we think we know about addiction. He talks about a study done by Professor Bruce Alexander where he put a rat in a cage with two bottles, one with water and one with heroin water. The rat almost always drinks the heroin water until it overdoses. Then they did another, years later, called “Rat Park” where they put multiple rats in a cage. They also put toys and cheese and everything a happy rat would need in the cage, along with both bottles. They were astonished to find that the rats almost never drank the heroin water and never killed themselves. Obviously, rats are very different from us, but luckily a study was also done on humans around the same time that was eerily similar called the Vietnam War. A huge percentage of the American troops were using heroin and as a people, we were terrified that when the war was over, we would have thousands of addicts on our hands. But we didn’t. When the troops came home, they carried on with their normal lives without the use of heroin. This led Alexander to believe addiction was made up vastly by our ability to adapt to our surroundings. This experiment speaks wonders, I believe, about addiction and our so called treatment for it. Professor Peter Cohen says we shouldn’t even call it addiction, we should call it bonding. Because of our relational bonds we have, we either use or don’t use. When we have meaningful, healthy relationships, we don’t use. When we are isolated and cut off, we use. All as an adaptation to our surroundings.


    As stated above, the brain ensures that we repeat certain things that result in pleasure or rewards. So, when we have happy bonds in our lives we don’t need the use of drugs or alcohol. When we don’t have those bonds, our brain senses the pleasure in using and tells us this is what we’ve been needing all along.


    So, is addiction a choice or a disease? The American Medical Association and World Health Organization recognize substance addiction, including alcoholism, nicotine and drug addiction all as diseases. My belief is that it’s a very serious, life-threatening disease that if left untreated, will eventually lead to death.

References: NIH, NCADD, NSDUH, SAMHSA, TedTalks.



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