Addiction: Choice vs Disease Explained

This is in important ways different from the meaning of compulsivity as commonly used in addiction theories. In the addiction field, compulsive drug use typically refers to inflexible, drug-centered behavior in which substance use is insensitive to adverse consequences [100]. Although this phenomenon is not necessarily present in every patient, it reflects important symptoms of clinical addiction, and is captured by several DSM-5 criteria for SUD [101].

  • This is extremely important as the United States leads the world in incarceration, much of which is related to illicit drug use or trade.
  • This is obviously a diagnosis that, once met, by definition cannot truly remit.
  • A particular opportunity for imaging-based research is related to the complex and heterogeneous nature of addictive disorders.
  • It is recognized throughout modern medicine that a host of biological and non-biological factors give rise to disease; understanding the biological pathophysiology is critical for understanding etiology and informing treatment.

In recent years, researchers have started to term drug addiction as a disease other than a simple behavioral choice. This decision has largely been influenced by overwhelming evidence showing how addiction affects brain function by changing it and progressively forcing a person to crave more of the substance. Scientists don’t know why some people can successfully quit using drugs on their own, and others can’t. For most people, recovery takes intervention with things like Indiana inpatient substance abuse treatment, behavioral therapy, and medications to help control cravings and encourage the brain to adapt to functioning without drugs.

A neuromarker for drug and food craving distinguishes drug users from non-users

Epidemiologically, it is well established that social determinants of health, including major racial and ethnic disparities, play a significant role in the risk for addiction [75, 76]. Contemporary neuroscience is illuminating how those factors penetrate the brain [77] and, in some cases, reveals pathways of resilience [78] and how evidence-based prevention can interrupt those adverse consequences [79, 80]. In other words, from our perspective, viewing addiction as a brain disease in no way negates the importance of social determinants of health or societal inequalities as critical influences. In fact, as shown by the studies correlating dopamine receptors with social experience, imaging is capable of capturing the impact of the social environment on brain function.

This further supports the argument that addiction is a disease because if it were a choice, one’s family history wouldn’t have any significant bearing on their chances of developing addiction. It implies that substance abuse becomes linked to one’s brain and is no longer a free choice they can make consciously. If the person is on a recovery path and no longer using the substance, it may take several months before the whole body system adjusts back to normalcy. 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. 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.

The Disease Model of Addiction

The suffering that comes along with addiction can be immense, but treatment offers a ray of hope for the future. People who have an intensely good experience their first time using begin to learn that drugs can make them feel great, and the foundations of addiction are set. There is no single cause of addiction; people begin using substances for many reasons and one person’s path to addiction may look What is a Halfway House? What to Expect in Halfway Housing drastically different from that of another. They will hold your hand and be there for you right from the start to the end. Contact us to learn more about our opioid addiction treatment options and how they can help you. Even though science provides evidence that addiction is more of a disease than a choice, a significant number of people still believe that it is one’s choice to develop an addiction.

is addiction a disease or choice debate

The reason for this comes from three key points regarding how addiction affects an addict. The third point of note is that a person’s risk of addiction rises based on hereditary factors. If addiction were purely a choice, these three points would not exist altogether.

Causes of Substance Use Disorder

“He’s shown himself to be completely self-centered, completely self-consumed,” Christie said of Trump. He was among the hopefuls that took the stage Wednesday night for the third debate, this time in Miami alongside Florida Gov. Ron DeSantis, former South Carolina Gov. Nikki Haley, South Carolina Sen. Tim Scott and entrepreneur Vivek Ramaswamy. By Sherry Christiansen

Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer’s research. Marc Lewis, PhD has been a professor of developmental psychology and neuroscience for over 20 years and is the author of Memoirs of an Addicted Brain and The Biology of Desire. The moody, angry dropout who survived overdoses to get caught breaking into cars wasn’t the boy she raised.

  • According to the American Medical Association, addiction refers to a “chronic disease” that results from long-term changes in one’s neural connections and pathways.
  • In the meantime, you’d be stuck with a habit that is dangerous to your survival but difficult to override.
  • However, this criticism neglects the fact that neuroimaging is not used to diagnose many neurologic and psychiatric disorders, including epilepsy, ALS, migraine, Huntington’s disease, bipolar disorder, or schizophrenia.
  • Behavioral researchers like Dr. Lewis try to argue this by acknowledging that the brain does change during addiction, but they view it as a situation like playing with clay.

The fact that significant numbers of individuals exhibit a chronic relapsing course does not negate that even larger numbers of individuals with SUD according to current diagnostic criteria do not. For instance, in many countries, the highest prevalence of substance use problems is found among young adults, aged 18–25 [36], and a majority of these ‘age out’ of excessive substance use [37]. It is also well documented that many individuals with SUD achieve longstanding remission, in many cases without any formal treatment (see e.g., [27, 30, 38]).

Addiction as a brain disease revised: why it still matters, and the need for consilience

Choice arguments are also unable to account for the role of heredity in a person’s risk factors for developing an addiction. Once again, if it were solely choice based, addiction would affect each person as an individual and their family history would play no significant role. When a person begins abusing a substance or regularly uses prescription drugs for too long, their body will begin to adapt itself to account for its presence in order to maintain homeostasis, or balance. Over time, this leads to what is known as tolerance, which is when the body has adjusted itself enough that the individual will need to take more of their chosen drug in order to experience the same effects.

is addiction a disease or choice debate

Unfortunately, at the very same time, it prods people to see themselves as hapless victims of a process beyond their control. Addiction is definitely difficult to understand, because it starts out as a voluntary activity but, for many people, the brain adapts so quickly to that activity it becomes difficult to control. Changes in neural circuitry make the reward extra compelling; it becomes difficult to pay attention to anything else and difficult to stop, even when use creates problems and there is a desire to quit. Addiction is considered a disease largely as a way to remove stigma, guilt, moral blame, and shame from those who use substances or certain behaviors repeatedly to feel intense euphoria and as a way to encourage humane treatment. It is also viewed as a disease in order to facilitate insurance coverage of any treatment.

Evidence of generally intact decision making does not fundamentally contradict addiction as a brain disease. For the foreseeable future, the main objective of imaging in addiction research is not to diagnose addiction, but rather to improve our understanding of mechanisms that underlie it. The hope is that mechanistic insights will help bring forward new treatments, by identifying candidate targets for them, by pointing to treatment-responsive biomarkers, or both [52]. Developing innovative treatments is essential to address unmet treatment needs, in particular in stimulant and cannabis addiction, where no approved medications are currently available. Although the task to develop novel treatments is challenging, promising candidates await evaluation [53]. A particular opportunity for imaging-based research is related to the complex and heterogeneous nature of addictive disorders.

is addiction a disease or choice debate

One of the important reasons to call addiction a disease is that it reframes the discussion away from the court system/incarceration and toward treatment. This is extremely important as the United States leads the world in incarceration, much of which is related to illicit drug use or trade. The main difference though is that that since it is connected to pleasure, which is the brain’s natural agent to tell the body what is good or bad for survival on a primal level, these habits form quicker and become more powerful than they otherwise would. A key point is that pleasure in this case does not necessarily need to be pleasure in the traditional sense, rather would be more accurately described as positive stimuli. This means that activities that do not cause pleasure but provide relief from negative feelings also present a strong habit-forming risk. The reasoning is based on the idea that people can control their thinking, where they live, and how their brain responds to different stimuli.

Disease Model of Addiction

Scientifically, the contention that addiction is a disease is empirically unsupported. Addiction is a behavior and thus clearly intended by the individual person. What is obvious to common sense has been corroborated by pertinent research for years (Table 1). Many activities that are not themselves diseases can cause diseases, and a foolish, self-destructive activity is not necessarily a disease. When we find a parallel between physiological processes and mental or personality processes, we can mistakenly assume the physiological process is what is really going on, and the mental process is just a passive result of the physical process. And the prefrontal cortex, the area of the brain responsible for rational decision-making, judgment, and control of behavior gets weakened, its connections to other parts of the brain pruned away.

  • This provides a platform for understanding how those influences become embedded in the biology of the brain, which provides a biological roadmap for prevention and intervention.
  • They overstimulate your brain’s reward system, and two, they tend to mimic the natural transmitters such as dopamine to send false signals to the central nervous system.
  • People who are not able to “will” their way out of their addiction are often blamed and shamed for their disorder, causing them to feel worthless or broken.
  • Scientists don’t know why some people can successfully quit using drugs on their own, and others can’t.
  • We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic.

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