Despite a large amount of accumulated scientific evidence, the debate as to whether or not addiction is a disease forges on. Those with firsthand experience (and those who have witnessed loved ones suffer at the hands of addiction), tend to strongly believe in the disease model. Those who lack experience (and those who are simply ignorant to the medical evidence supporting the fact) tend to strongly believe that addiction is a matter of choice; of weak moral standing and an unwavering, inherent selfishness.
So why the great divide?
On one hand, it can be difficult for some people to understand how something that once began as a choice somehow morphed into something uncontrollable and life-threatening. On the other hand, it can be difficult for someone who has personally experienced the devastating consequences of chemical and behavioral addictive disorders to even consider how some may mistake the condition for a matter of choice. Let us take a look at the evidence that supports the disease theory of addiction, and see what we can do to lay this futile argument to rest.
Addiction as a Disease
Addiction is known to be a complex disease of the brain and the body, characterized by the compulsive use of chemical substances (or compulsive engagement in behavioral patterns) despite negative physical, personal, and interpersonal consequences. The disease of addiction negatively impacts the areas of the brain that are responsible for motivation, reward, judgment, memory, and learning. Not only does addiction do severe damage to the physical body, but it severely damages interpersonal relationships, careers, financial stability, and self-esteem. Many individuals who suffer from addiction grow to violently despise themselves, and the anguished emotional state and deep-seated feeling of helplessness linked to active addiction will lead many addicts and alcoholics to self-harm and attempted suicide.
The more the disease of addiction progresses, the more that is lost as a direct result. And the more that is lost, the more desperate the active addict will become. In many instances, this desperation will appear to reflect a lack of self-control and a weak moral compass. The addict may steal from loved ones, manipulate figures of authority, and engage in harshly self-destructive behaviors (such as prostitution). However, it is important to keep in mind that this desperation stems from an overpowering and illogical mental obsession, which is often combined with a severe physical dependency. The addict is not capable of thinking rationally; of saying to him or herself, “Well, stealing is wrong, so I will just ride out the symptoms of withdrawal until I can save up enough cash to purchase more drugs.”
The neurological pathways of the afflicted individual are rewired, so that obtaining and using drugs or alcohol becomes top priority – even over all other basic, innate human instincts. Obtaining and using chemical substances becomes more important than sleep, shelter, food, and sex. The brain screams at the addict, “If you do not get high, you will die – you must get high at all costs.”
The Disease Model
The vast majority of American medical associations acknowledge the disease model of addiction. The American Medical Association and the American Society of Addiction Medicine define addiction as a diagnosable and treatable disease. Just like diabetes, heart disease, and cancer, addiction results from a combination of biological, environmental, and behavioral factors. In fact, genetic predisposition alone account for roughly half of the likelihood that an individual will develop an addictive disorder. While some cases of addiction are partially caused by substance abuse, many cases of addiction stem from pre-existing issues. For example, individuals who suffer from untreated depression, anxiety, or bipolar disorder are exceedingly more likely to turn to drugs and alcohol as a means of self-medication.
Because addiction is a long-term disease that can be controlled but not cured, it is defined as a chronic, relapsing condition. Fortunately, even the most chronic cases of addiction can be successfully managed. In most cases, long-term management begins with an extended stay at an inpatient treatment center, followed by a personalized plan of continuous aftercare (which may include 12-step program participation, regular psychiatric or therapeutic evaluations, and peer support).
The Issue of Will Power
Many people argue that addiction is a choice because it BEGAN with a choice – a conscious decision to use drugs or alcohol. It is true that the initial decision to use chemical substances reflects free-will. However, once the brain has been physically altered, willpower becomes severely impaired. The obsessive-compulsive disease takes hold, and the afflicted individual experiences a total loss of control. Also, I know when I was 15 years old and a high school friend offered me a hit off of his homemade apple bong, I didn’t think to myself, “Well, as much as I want to be socially accepted, I have a genetic predisposition to dependency so I should probably refrain.”
Yes, addiction is certainly a disease, and continuing to argue a well-known fact will only hinder those who are losing their lives to a treatable condition. Rather than waste time debating, we must actively seek a solution. Help is available to all those who need it.