The question is a loaded one – loaded enough to spark a firestorm of heated argument and debate, to bring the usually passive listeners out of the woodwork with fierce opinions and confident theories. Regardless of whether or not their lives have been touched by addiction, everyone seems to have what to say on this incredibly nuanced topic.
It’s one of the topics that never get tired. And it’s a topic that is so far-reaching - it touches on the larger picture of free will and human choice, self-determination, ethos, morality, and more. It’s a seemingly small question, but the answer carries waves of implications that ripple far and wide.
So, what’s the story? Is addiction a choice, or not?
Many people say that addiction is NEVER a choice, since it has been scientifically proven to change brain chemistry and damage the reward circuit – essentially stripping people of their ability to make intelligent choices. Think about it – who in their rational mind would choose to destroy their lives and lose their relationships, job, finances, health, and emotional wellbeing?
Others are of the opinion that - true, a person deep in active addiction might be unable to make the best choices, but every addiction begins with one bad choice. It all started with one poor decision to take that puff, snort, drink or pill – and then it all spiraled downwards from there.
And then some people take it a step further: Yes, addiction is a choice. Yes, every moment of continued use is a choice. No matter the scientific theories that abound, a person remains a rational and intelligent being with the ability to make wise decisions. If we do not believe in our innate quality of free choice, then what exactly distinguishes man from every other beast that walks this planet?
Let’s explore each side of the conversation in depth.
Opinion #1: Addiction is a disease
Almost every medical and psychological expert views addiction as a brain disease, just as diabetes, heart disease, asthma, and high blood pressure are physical conditions for which we would never blame anyone. According to the National Institute on Drug Abuse, substance use disorder is a “chronic, progressive and relapsing disorder” which involves compulsive substance use despite negative consequences. Substances like alcohol or opioids have been proven to hijack the brain’s reward system - over time, drugs and alcohol change the brain circuits that control pleasure, stress, and self-control. These physical changes make it indescribably difficult to just quit through sheer willpower alone.
(To learn more about the science of addiction and what exactly it does to our brains, you can subscribe to our email series here: Is My Addiction All My Fault? The Science of Addiction in Plain English. For a more scholarly explanation of the science of addiction, you can read our in-depth resource article here: Addiction and the Brain
Another important point is that addiction shares many characteristics with physical diseases like diabetes or heart disease, and mental illnesses like schizophrenia and bipolar disorder – both which involve alterations in brain chemistry. Just like those physical conditions, addiction has a definite genetic factor and can run in families, and needs long-term maintenance rather than a simple one-time cure. Relapse rates for addiction are actually quite similar to other chronic diseases – if someone doesn’t stick to their treatment plan or healthy lifestyle, symptoms of the disease (in this case, drug use) can return. Brain scans of people struggling with addiction have also shown physical changes in the areas responsible for judgement and self-control.
Viewing addiction as a disease is also a powerful first step towards reducing stigma. If we acknowledge that a person struggling with addiction isn’t “bad” or “weak” but rather battling a serious disease which needs professional treatment, we will treat them with the compassion and understanding we have so readily available for those suffering from physical conditions. And when we successfully reduce stigma, we effectively remove a huge barrier which prevents those suffering from addiction from reaching out for the help they so need.
Opinion #2: Addiction is a choice
Other people say that calling addiction a “disease” is misleading, since they believe that addiction is ultimately driven by personal choices and habits. After all, they argue, no person is born with an addiction. It always begins with someone voluntarily choosing to use a substance for the first time, for whatever reason.
Critics also point out that addiction doesn’t really fit the typical disease profile:
- It’s not contagious
- It’s not an autoimmune disorder
- It’s not a degenerative condition (Like Alzheimer’s or dementia)
(It is important to point out here, though, that addiction does meet many other criteria of a disease - such as its ascending stages and severity, noticeable symptoms, risk factors, and strong impact on many life areas.)
Instead, they view addiction as a behavior which starts (and can also stop) through personal choice – which is why addiction is sometimes called a “self-acquired problem”.
A huge element of the “addiction is a choice” view is personal responsibility. Surprisingly, there is real-world evidence of people overcoming addiction through the decision to change. Some individuals manage to quit their addiction without undergoing formal rehab – a process called “natural recovery”. There is recorded evidence of smokers and drinkers who managed to stop using through choice alone, or with additional non-professional support from groups like AA. It would be hard to find a person who simply decided to cure themselves of cancer, diabetes, or heart disease on their own, without medical help – but with addiction, you will find stories of people who decided and managed to stop through their own free will.
Many people who view addiction as a choice don’t deny that quitting is unbearably hard. Instead, they believe that presenting addiction as a disease might strip away a person’s sense of self-control. If a person is taught to believe that they are helpless victims of an illness and a doomed fate, they will never feel accountable for their actions or empowered to change in any way. If we believe that humans are simply pre-programmed machines with no choice, and pressing certain buttons will result in an automatic outcome, then what distinguishes us from any animal around us? Our free will, and ability to make positive choices despite adversity, are the crucial and crowning factors which elevate and designate us as the highest form of life in this world.
The Final Message: RECOVERY is a Choice
Regardless which view of the topic we choose to take, one fact can’t be debated: Recovery is a choice. Even when held firmly in the grips of addiction, no one is stripped of their free will. Every person can make the one decision to get the help they need and embrace a lifestyle of recovery. Recovery is the most courageous and admirable choice that a person can make, and its effects can change the destiny of generations.
People struggling with addiction are not morally defective OR hopeless cases. The road of recovery is open to anyone willing to put in the work, no matter how long they may have been using or how much they’ve lost because of their addiction.
To sum it all up: Is addiction a choice or a disease?
We’re not here to decide – but one thing we know for certain: Recovery is a choice, the most brave, beautiful choice there is. It’s a gift that keeps on giving; today, tomorrow, and every day of our sober lives.
Today, what do you choose?
If you or a loved one are suffering from drug and/or or alcohol addiction, know that hope and help are always available. Reach out to Avenues Recovery Center today to speak with one of our skilled, friendly treatment specialists, who can help you explore your options and guide you to the program which best meets your needs. We’ve helped over 40,000 people find their way home, and we can help you too!
What has recovery given you?