Why Is Drug Addiction a Disease and Not a Choice?
What's In This Article?
Is drug addiction a disease or a choice? This is a question you frequently hear and it’s often debated. The medical community believes addiction is a disease, but it’s one that’s very complex. Different factors contribute to addiction, so to just say addiction is a disease with no further explanation doesn’t provide enough background on the topic.
What Do People Get Addicted To?
Along with alcohol, people can develop an addiction to certain substances. Some of the substances people are most commonly addicted to include:
- Hallucinogens like LSD
- Opioid pain relievers
- Sedatives such as sleep aids and acute anxiety treatments
- Stimulants like cocaine and methamphetamine
Questions Covered in This Guide
The following guide gives an overview of what drug addiction is, and answers the age-old question of is drug addiction a disease, and if so, why. Specific questions answered in this guide include:
- Is drug addiction a disease or a choice?
- Why is drug addiction considered a disease?
- How is drug addiction a disease?
What Is Addiction?
Addiction is characterized as a brain disease. The primary symptom of an addiction to any substance or behavior is compulsively using that substance or engaging in a particular behavior. Someone with an addiction isn’t able to control their compulsion, even when there are known negative consequences.
When someone is addicted, they are unable to focus their attention on anything beyond the substance they’re addicted to. Addiction eventually takes over a person’s entire life if it isn’t treated.
In spite of knowing it causes problems or could lead to death, someone with an addiction isn’t able to stop.
The Effects of Addiction
Addiction to drugs or other substances takes over a person’s life and also their physical and mental health.
The Symptoms of Addiction
Addiction affects thinking, body functions and behavior. Addiction symptoms can be grouped into four general categories.
- Impaired Control: These symptoms are the cravings and urges a person has to keep using a substance even when the consequences are negative. Someone with addiction will often have multiple failed attempts to cut down on the substance they’re addicted to or stop using it.
- Social Problems: As with the other effects of addiction, the longer someone goes without treatment, the more severe and pervasive social problems are likely to become. This can include problems at school or work and complete breakdowns in relationships.
- Risky Use: When someone has an addiction they will put themselves and possibly others in risky situations either while they’re under the influence or to get more drugs. They know what they are doing is risky, but they continue anyway.
- Drug Effects: Certain drug effects occur such as tolerance and physical dependence. When someone is tolerant to a substance, they need more for the same effects. Physical dependence means someone will go through withdrawal if they stop using a substance suddenly.
What Do Drugs Do the Brain?
A part of understanding why drug addiction is a disease and answering “how is drug addiction a disease” relies on understanding how drugs affect the brain.
Drugs primarily affect the reward circuit in the brain. When someone first uses an addictive substance, it can activate certain receptor sites in the brain.
Addiction and the Brain’s Reward Cycle
This activation triggers an artificially high release of certain brain chemicals and in particular, dopamine. Dopamine is a neurotransmitter that makes us feel good. That release of huge amounts of dopamine is what creates a high when someone uses addictive drugs.
The dopamine release triggers the brain’s reward system. The reward system is triggered by normal activities such as eating and sex. With drugs when this reward system is triggered, it leads to a cycle of continued drug use.
The brain’s reward cycle wants more of what led to the high and the release of dopamine. It’s drugs, so the brain compels someone to use more and more of the drug to continue getting the reward response.
Changes in Brain Function Occur Over Time
Over time with repeated exposure to the addictive substance, the brain’s functionality changes. The brain will produce less of its own chemicals in the reward circuit, so it becomes difficult for someone to feel pleasure or happiness without the drug. It also becomes impossible to feel the same initial high that occurred one someone first used a substance, and that’s a drug tolerance.
Long-term drug use has ongoing effects on learning, judgment, decision-making, and memory.
With addiction, a person eventually isn’t using the substance to feel good or get high. They’re using it to feel normal because of the effects of the substance on the brain.
Addiction to drugs and alcohol can cause changes and impaired functionality in the prefrontal cortex as well. The prefrontal cortex typically helps a person understand the consequences of their risky or harmful behavior.
The Moral Model of Addiction
In the past, before there was research and a lot more was known about addiction, there was something called the Moral Model of Addiction. Remnants of this remain, and lead people to question is drug addiction a disease or a choice.
What Is the Moral Model of Addiction?
The following are some of the key facts about the Moral Model of Addiction:
- The Moral Model of Addiction was popularized in the early 19th century and was touted by religious leaders and people in favor of temperance
- People who drank excessively or used substances compulsively were viewed as “deviant” under this model
- The idea was that alcoholism and addiction grew from industrialization and a move from family values
- Under this model, substance abuse was entirely attributed to the moral weaknesses and the personal failings of the individual. People with drinking or substance use problems were seen as immoral and lacking in willpower.
The Introduction of Alcoholics Anonymous
It wasn’t until Bill Wilson started putting together the Alcoholics Anonymous program that this started to shift. AA was one of the first groups to view alcoholism as a disease rather than a personal failing. Under this concept, addiction was also something that was treatable.
Why Do Some People Become Addicted to Drugs and Others Don’t?
When learning more about the idea that drug addiction is a disease, you may wonder why some people become addicted and others don’t.
As with other chronic diseases, there isn’t one specific, single factor that determines if someone becomes addicted. However, when answering “is drug addiction a disease” or “why is drug addiction considered a disease,” it’s important to look at the different factors that play a role.
Addiction Risk Factors
There are certain risk factors for addiction. The more risk factors a person has, the more likely they will become addicted to a substance. The same can be said for conditions like diabetes and heart disease. These are considered diseases, even though there is a combination of behavioral and lifestyle factors that increase the risk of developing the conditions.
Factors that increase the risk of addiction developing include:
- Biology: There are genetic components that increase the likelihood someone will develop an addiction. In fact, genes make up around half of a person’s risk for addiction. That doesn’t mean there’s one specific gene that causes addiction necessarily, but if you have a direct family member with an addiction disorder, you may be at a greater genetic risk for becoming addicted as well. Gender and co-occurring mental health disorders can also impact the likelihood of developing an
- Environment: Your environment is the sum of the influences you’ve been exposed to in your life. For example, trauma and early physical or sexual abuse can make it more likely that you develop an addiction disorder later. If you grew up in an environment where your parents or caretakers drank a lot or did drugs you may be more likely to develop an addiction.
- Development: The younger someone is when they first use drugs or alcohol, the more likely they are to become addicted. This can be especially true if someone begins using drugs in their teen years when the brain is developing.
Think about diabetes, which is one of the most common chronic disorders. With Type II diabetes a person may be genetically more likely to develop the disease because of family history. Then, if they eat a certain diet or engage in particular behaviors, this also increases their risk, much as is the case with addiction.
Is Drug Addiction a Disease or a Choice?
People often wonder is drug addiction a disease or a choice. As we’ve said, drug addiction is a disease, but there is a choice component that comes into the equation.
When Is Substance Use a Choice?
Someone initially chooses to use drugs or alcohol. That first time they use a drug or have a drink is a choice, but many people drink or use substances without becoming addicted.
There are people who might have a glass of wine with dinner nearly every night, yet their drinking isn’t compulsive and doesn’t cause negative consequences. Repeated exposure to alcohol doesn’t lead them to continue drinking even when they don’t want to.
A person can very easily take a substance including a prescription drug such as opioids or have a drink without realizing the fact that they will develop an addiction. No one uses a substance initially thinking they will become addicted, but their brain chemistry and function along with other factors can lead to that.
The disease component of addiction isn’t that first choice. Rather it’s how their brain responds to the drugs or alcohol that is a chronic disease or disorder.
How Else Is Drug Addiction a Disease?
When exploring the concept of addiction as a disease, there are other reasons researchers view it this way.
One reason is that as with chronic recurring disorders, it’s possible to treat addiction but not cure it. Going back to the diabetes example—someone with diabetes can treat their symptoms with insulin or other medications, but the disease isn’t cured.
Additionally, there is the potential to be in remission with addiction. Remission is the time when someone isn’t actively using drugs or alcohol. Relapse can also be part of the process, as is the case with other chronic disorders.
How Is Addiction Diagnosed?
When you consider the fact that drug addiction is a disease, you also have to consider how it’s diagnosed and treated. So is drug addiction a disease? Yes. Can it be diagnosed using medical criteria? Also yes.
With that being said, diagnosing addiction can be a challenge in some situations because it relies on either the person with the addiction or the people close to them recognizing a problem exists, and that treatment is needed.
Addiction Diagnostic Criteria
The following are the official criteria that are used to diagnose a substance use disorder.
- Regularly using larger amounts of a substance than intended, or using a substance for longer than intended
- Trying to stop using or cut down on the intake of a substance, but not being successful in doing so
- Spending a significant amount of time and energy trying to get more of a substance or to recover from its effects
- Extreme cravings or a strong desire to continue using a substance
- Not meeting obligations at school, work and home
- Continuing to use a substance regardless of issues it causes or worsens
- Giving up social activities, hobbies or interests because of the use of the substance
- Putting oneself in dangerous situations while using a substance
- An increased tolerance
- Withdrawal symptoms if not on the substance
For someone to be diagnosed as having a substance use disorder, they would have two or more of the above symptoms.
How Severe is the Addiction?
Similar to how other disease conditions can be characterized based on severity and the extent of the disease progression, the same is done when diagnosing an addiction.
An addiction can be diagnosed as mild, moderate or severe. Generally, the longer someone goes without treatment, the more severe the disease of addiction becomes.
When someone has mild symptoms of addiction, it can be easier to treat the disease proactively.
Treating Addiction As a Disease
Since addiction is a disease according to the medical community, it’s treated as such. With addiction treatment, a person typically can’t just stop using drugs after a few days of treatment or abstinence. Since addiction is a chronic disease, treatment is usually long-term and ongoing.
What Is an Effective Addiction Treatment Program?
The goal of an addiction treatment program should be to help someone stop using drugs but also remain drug-free. Effective addiction treatment programs should also aim to help an individual be productive in their lives.
Principles of Effective Treatment
The following are what is defined as the principles of effective treatment, according to the NIH National Institute on Drug Abuse:
- Addiction is a complex but also a treatable disease that affects the function of a person’s brain and their behavior
- There’s not one single or specific treatment that will work for all addicted people
- Having easy, fast access to treatment is essential
- An effective addiction treatment program should address all of a person’s needs. This can be called holistic addiction treatment.
- It’s essential that a person stays in treatment for long enough.
- Treatment usually includes a combination of behavioral therapy and mediation.
- Treatment plans should be regularly evaluated to ensure they are continuing to meet the needs of the patient
- Co-occurring mental and physical health disorders have to be addressed during treatment.
- Detoxification is not a treatment for addiction—it’s just the first step of addiction treatment.
- A person doesn’t have to go to treatment voluntarily for it to be effective.
- Monitoring for drug use has to be ongoing.
Frequently Asked Questions About Drug Addiction As a Disease
The following are some of the most frequently asked questions about drug addiction as a disease, to sum up the key points mentioned throughout this article.
Is Drug Addiction a Disease?
Yes, drug addiction is a disease. Addiction is considered a chronic disease, and this is the commonly accepted concept among most medical and psychological professionals.
How Is Drug Addiction a Disease?
Drug addiction is a disease because like other chronic disorders, it arises from a combination of factors. There isn’t typically one specific factor that leads someone to develop a substance addiction. For most people, the development of substance addiction is linked to genetic, environmental and developmental factors.
Why Is Drug Addiction a Disease and Not a Choice?
Drug addiction starts as a choice. Someone does make a choice to use alcohol or drugs. However, the addiction develops because of their brain’s response to that substance use. Many people use alcohol and even drugs without becoming addicted.
Is Drug Addiction Curable?
Like other chronic diseases such as diabetes, addiction isn’t curable. It is treatable and manageable, however. A person can go into remission from addiction. This is the time when they are no longer in active addiction. Relapse is possible and even likely, but even after relapsing with proper treatment a person can go back into a period of remission. Many people are in remission from addiction for their entire life after they receive treatment.
The Bottom Line—Addiction is a Disease
Understanding that it is true that drug addiction is a disease is important in many ways. It helps guide medical care and treatment and improve the effectiveness of both. Learning that drug addiction is a disease is also important to reduce the stigma and help remove obstacles to people receiving treatment.
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