Addiction: Is it a Disease or a Choice?

by Mia Williams, MS |

Is Addiction a Disease or a Choice?

An Alcoholic Who Is Struggling To Refrain From Drinking Representing The Question Of Whether Addiction Is A Disease Or A Choice

Old School Thought

Most people who have been to a treatment center are familiar with the disease model of addiction. Many interventions are based on the evidence that it is a disease. Belief that addiction is a disease is based on findings that it begins early and advances gradually.

A person is vulnerable to becoming addicted if they begin using during teen years, while the brain is still being developed. Once they have become addicted, the belief is that there to brain chemistry has been altered as well as the brain itself, making it extremely difficult to stop using, even in the face of serious consequences.

To Choose or Not to Choose

If you think back to when you were sober, you’d find that you did not consciously make a choice to struggle with addiction—that is not what the choice theory is about. No one sets a goal to be an addict. The choice model does not look at addiction from a biological point of view, but from your thought processes. Your thoughts affect your actions. Environmental factors such as learned behavior may impact those who struggle with addiction. If you are in a household where you saw those using alcohol or drugs as way to cope, then it may increase your chances of using. The choice model also considers environmental factors such as poverty, which can substantially increase a person’s vulnerability to use drugs.

Does It Matter?

What difference does it make? It can make quite a bit of difference. What you believe may affect how you view yourself and your sobriety. For example, if you think that substance abuse is a disease, it may lessen your sense of guilt, or if you think it is a choice this may deepen your guilt. On a larger scale, it can impact and change interventions as well as drug policies.

There are some who believe that addicts who have accepted it as a disease are holding on to an excuse. With some, it may encourage helplessness and their sense of responsibility. Whether the belief is that it is a brain disease or a choice, the addict must take steps to control and stop the addiction.

If addiction is a disease, it can be compared to other diseases such as diabetes, heart disease, or cancer. In other words, you don’t necessarily get to choose whether you become chemically dependent. It may have more to do with your genetics than other factors. The addict is exempt from being labeled as weak, deficient, or lack a moral compass because they are considered sick. It is less about self-will and determination.

Physician Heal Thyself?

A Man Struggling To Understand Whether Addiction Is A Disease Or A ChoiceUnderstanding addiction from a disease perspective may take the burden off you by understanding that it changes how your brain functions, which is why will power and just stopping cold turkey almost never works.  A reason why some don’t buy into this theory is that they think using drugs cannot be compared to cancer or diabetes or heart disease, since a person cannot often predict whether you will get these diseases.

A Treatable Illness

Although diseases like cancer, diabetes and heart disease often cannot be predicted, there is a predisposition to developing them.  There are risk factors. Experts state that if you have family members who have been chemically dependent, then you are more likely to suffer from addiction. There are things that you can do to lessen those chances, such as not drinking or using drugs at all. Some experts think that if it is a disease, then you can be treated for it, just as any other illness.

If addiction is a choice, you are not relying on chemical changes that take place in the brain.  Good or healthy choices result in favorable circumstances where good decisions are made. Poor choices equal negative consequences. Healing depends on making better choices and changing environmental factors.

Choices may stem from peer pressure and the desire to deal with negative emotions and stress. Many other risk factors such as dysfunction in families and other stressors, such as divorce and other family issues.

What to Believe

Despite the evidence, your own personal experience and worldview can shape what you will believe about addiction being a disease or a choice. Your view can empower you by giving you the keys to understanding how addiction works. Knowledge in this case is power.  Research indicates that treatment and changes in policy are likely to result from whether addiction is a disease or not.  Although the experts have their view, remember that your view is the one that can impact you the most.

  • Sources
    • Gleason, G. (1990). The facts about drinking: Coping with alcohol use, abuse and alcoholism. Mount Vernon, N.Y.
    • Lawford, C. (2013). Recover to live: Kick any habit, manage any addiction. Benbella Books, Inc., Dallas TX.
    • Lewis, M. (2015). The Biology of desire: Why addiction is not a disease
    • Sheff, D. (2013). Clean: Overcoming addiction and ending America’s tragedy. Houghton Mifflin Harcourt. Boston, NY.
    • Volkow, N., Koob, G., & Mclellan, T. (2016). Neurobiologic Advances from the brain disease model of addiction. Doi: 10 1056/NEJMra1511480., pg. 1-6.
Photo of Mia Williams, MS

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