Point/Counterpoint: Is Addiction a Disease or a Choice?

The debate’s as old as opium itself. It divides households, decides political stances and determines treatment options. The pendulum has swung to both extremes in our society over hundreds of years.

On one side, people believe addiction is an uncontrollable illness that requires medical treatment. On the other side, people believe addiction is a result of poor choices – and those choices have created a state of dependency that could be easily broken.

So, here’s the question: Which side are you on?

Point of View: It’s a Disease

This isn’t a new concept; in 1784, Dr. Benjamin Rush said this condition is a disease – one that should be treated by physicians. However, the idea didn’t gain much traction until the founding of Alcoholics Anonymous in the 1930’s. Today, most healthcare professionals agree that addiction is a disease.

The disease model of addiction focuses on changes in the brain that occur with chemical dependency. Once these changes occur, choice is essentially no longer an option.

Benjamin, a gentleman who firmly believes that addiction is a disease, recalls his struggle:

“28 years ago I went to my first AA meeting and asked for help. I haven’t had a drink or drug since. For whatever reason, I really didn’t have all that much trouble quitting the drugs when I got married and wanted to straighten up, but I could not quit drinking. In fact, I think my alcoholism became much more pronounced when I quit the drugs.

For me, there was no choice. I drank. It’s who I was. It stopped being fun somewhere along the way and, instead, became necessary. I tried every way possible to control my drinking – or stop all together by myself – but failed consistently. Not until I went to AA could I have a choice in whether I drank or not. I still have that choice, and now I choose sobriety!”

Once your body becomes physically dependent on drugs or alcohol, you can no longer choose to stop using; you must feed the beast. Here, a woman named Lylla relates how she came to view addiction as a disease:

“During the turmoil of life with an addict and the temptation to blame all of my pain on him, there came a day when I realized in my heart that no one would choose addiction. It’s a disease. Recovery is a choice that requires a daily – or hourly – act of courage by a person of character and faith.”

 

Disease…in Your DNA?

The disease view argues that addiction, like diabetes or cancer, is caused by a combination of issues, including genetic risk factors. Studies have shown that roughly 10 percent of the population is genetically predisposed to addiction. Licensed Professional Counselor, Donna Newbold, notes:

“Some people will say it’s a choice because, in identical twins, there are cases of one twin being addicted and one not. At this point, we know our genes interact with our environment. There are identical twins where one has Alzheimer’s and one doesn’t. There is no debate that Alzheimer’s is a disease.”

 

Medical Support

In the 1950’s, the medical field ramped up its support for the disease side of this argument. The American Medical Association, the American Public Health Association and the American Society of Addiction Medicine all strengthened their positions on the disease of addiction in both their definitions and treatment methods.

Over the last few decades, neuroscience, pharmacology and psychology have also focused on gaining a better understanding of the physical side of addiction. The most recent examples come from the American Board of Medical Specialties. On March 14, 2016, they recognized the field of Addiction Medicine as an official medical sub-specialty.

Point of View: It’s a Choice

On the opposite side of this debate, those who believe chemical dependency is a choice point to research and reports that label addiction as a behavior. Since it’s something we do, it’s therefore a choice.

Many of those same people refer to studies that demonstrate drinking levels can be modified, indicating that choice is involved – at least on some level.

Gene Heyman, Ph.D., author of Addiction: A Disorder of Choice, points out that the changes in brain structure and function are the main argument for classifying addiction as a disease. He counters that:

“Any persistent change in behavior is going to be associated with changes in the central nervous system, because the nervous system participates in behavior. One might as well conclude, say, that reading is a disease because the brains of readers necessarily differ from those of non readers.”

 

Choice…a Ray of Hope?

Many argue that viewing addiction as a disease isn’t only incorrect, it’s also unhealthy. They insist, as humans, we always have a choice. Taking things a step further, they also point out that, if we really had no say in the matter, no one would ever recover. But they do recover and it’s made possible by knowing that we have a choice to stop using.

As James Frey, author of A Million Little Pieces, notes:

“You can’t tell people, ‘This is all your fault and there’s nothing you can do about it. You have to tell them, ‘This is all your fault and you can make it all better if you want to.”

Dr. Marc Lewis, author of The Biology of Desire: Why Addiction is Not a Disease, and expert Pro Talk contributor tends agree. He argues that the disease label leads to fatalism and the thinking becomes “I have a disease – what can I do? If I can’t get better, it’s because I have a disease, not because of anything I’m doing wrong.” He stresses that behaviors become compulsive and hard to control. Automatic responses, on the other hand, are over-learned, but they are not a disease.

Jill, a writer and researcher, poses her own set of questions, observations and concerns:

“How could it not be a choice? It’s an external behavior. It requires the choosing of certain actions. Addiction isn’t something that simply sneaks up and attacks the body. It may become internal, as it changes a person’s physiology over time. Yes, these changes can make it hard to quit. But, everyone has a choice to take that first drink, or pop that first pill. And, every day, people make the choice to stop.”

 

The Heavy Weight of Public Opinion

When it’s all said and done, the addiction debate rages on among policy makers, physicians and the public. No matter which side you take in the end, it’s clear that something has to give.

Millions of people are struggling with addiction and, whether it’s their choice or not, they need help. What we do today could prevent anyone else from starting down the same dark path.
Additional Reading: Addiction: Is it My Mind…Or My Body?

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