Is Addiction a Disease or a Choice? Unraveling the Complexity

Various complex risk factors contribute to the likelihood of developing a substance use disorder, including genetic predispositions, environmental influences, and psychological components. This perspective emphasizes that individuals struggling with addiction face severe biochemical changes in their brains, making it challenging for them to control their behavior related to substance use IU Health. To achieve this goal, we first discuss the nature of the disease concept itself, and why we believe it is important for the science and treatment of addiction.

Is Your Parent in Need of a Prescription Drug Rehab?

Interpreting these and similar data is complicated by several methodological and conceptual issues. First, people may appear to remit spontaneously because they actually do, but also because of limited test–retest reliability of the diagnosis 31. Lifetime alcohol dependence was indeed stable in individuals recruited from addiction treatment units, ~90% for women, and 95% for men. In contrast, in a community-based sample similar to that used in the NESARC 27, stability was only ~30% and 65% for women and men, respectively. The most important characteristic that determined diagnostic stability was severity. Diagnosis was stable in severe, treatment-seeking cases, but not in general population cases of alcohol dependence.

• A disease label is useful to identify groups of people with commonly co-occurring constellations of problems—syndromes—that significantly impair function, and that lead to clinically significant distress, harm, or both.
• For further insights, explore our articles on breaking the cycle of addiction in families and the connection between OCD and addiction.
• One way to address stigma is through public awareness campaigns that promote accurate information about addiction and challenge stereotypes.
• Addiction changes the circuitry of the brain in ways that make it difficult for people to regulate through deliberative efforts the allure of a concentrated chemical rush of reward.
• Some worry it undermines personal agency, suggesting individuals are “powerless” over their addiction.

The Stigma Surrounding Drug Addiction

By recognizing that addiction is a multifaceted problem that requires support and treatment, we can create a more supportive environment for those seeking help. When it comes to addiction, understanding the underlying perspective of whether it is a choice or a disease has significant implications for treatment approaches. Recognizing the different viewpoints, let’s explore treatment approaches based on both choice and disease models. The initial decision to use drugs or alcohol may be a voluntary choice, but repeated substance use can lead to changes in the brain that diminish an individual’s ability to exert control over their drug use. As addiction progresses, the ability to make choices becomes increasingly impaired. One study published in the Journal of the American Medical Association (JAMA) used neuroimaging techniques to examine the brains of individuals with substance use disorders.

Can Addiction Be Considered a Disease? Exploring the Science and Debate

• The disease model of addiction frames addiction as a chronic, relapsing condition that can be managed but not always cured.
• According to the neuroscientist Dr. Marc Lewis, this argument is largely based on the idea that when a person carries out an activity that they enjoy, it triggers pleasure in the brain and over time becomes a habitual act.
• An individual who struggles with alcohol disorder could remit if they don’t have a relapse or prevention plan in place.
• By choosing this option, the user becomes locked in a progressive cycle of addiction.
• According to this model, addiction is not simply a matter of willpower or choice, but rather a complex interaction between genetic, environmental, and neurobiological factors.

The notion of addiction as a brain disease is commonly criticized with the argument that a specific pathognomonic brain lesion has not been identified. Indeed, brain imaging findings in addiction (perhaps with the exception of extensive neurotoxic gray matter loss in advanced alcohol addiction) are nowhere near the level of specificity and sensitivity required of clinical diagnostic tests. 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. Even among conditions where signs of disease can be detected using brain imaging, such as Alzheimer’s and Parkinson’s disease, a scan is best used in conjunction with clinical acumen when making the diagnosis.

Scientific Evidence Supporting the Disease Model

In 1956, the American Medical Association (AMA) classified alcoholism as a disease. The New England Journal of Medicine recently published a review of the “brain science” related to addiction and its management by Dr. Nora Volkow and her colleagues. Habits are behavioral routines that are repeated so often they get wired into the brain as a matter of efficiency. The brain is always changing and adapting to experience—even now, as you read this.

Medication-Based Treatments

Many individuals turn to drugs as a means of coping with underlying mental health issues such as anxiety, depression, or trauma. On the other hand, addiction is characterized by changes in the brain’s reward system and other neurobiological processes. These changes can lead to compulsive drug-seeking behavior and the inability to control substance use despite negative consequences. This neurobiological aspect of addiction supports the argument that addiction is a disease. Additionally, understanding addiction as a disease allows for evidence-based approaches to prevention, treatment, and recovery.

Although alcohol abuse has been documented from time to time for centuries, abuse of other drugs is a relatively recent phenomenon. Heyman notes that the first “epidemic” in the United States occurred in the late 19th century, before legal prohibitions were established. In addition to the perennial problems with alcohol abuse, the period was noted for abuse https://www.falntyna.com/overwhelmed-by-the-complexity-of-this-may-help-4/ of opiates. Some of that abuse was centered in the wealthy “opium eaters” who abused laudanum.

• Understanding the complexities of this issue involves examining both the disease model and the choice argument.
• As problematic as the consequences can be in someone’s life, the process can, through effort, be reversed.
• Medication-based treatments have been highlighted as the most effective solution for conditions like opioid use disorder.
• No matter how one defines addiction or what term is used, what is clear is that addiction is an enormous problem in the U.S. that affects millions.

Your experiences and viewpoints may guide you in deciding which perspective feels most accurate. In Chapter 5 Heyman addresses the disease model more fully by examining the arguments and data supportive of that perspective. First, those in support of drug abuse as a disease point to the demonstrated role of genetic factors in addiction. Heyman acknowledges genetic https://www.watchuonline.com/2023/11/15/news-for-this-month-16/ contributions, but points out that genetic influence is not a sound basis for concluding that drug abuse is a disease process. He notes, for example, that there is a genetic association for religious choice between identical twins reared apart (Waller, Kojetin, Bouchard, Lykken, & Tellegen, 1990). Beyond making the case for a view of addiction as a brain disease, perhaps the more important question is when a specific level of analysis is most useful.

Hazardous (risky) substance use refers to quantitative levels of consumption that increase an individual’s risk for adverse health consequences. Clinically, alcohol consumption that exceeds guidelines for moderate drinking has been used to prompt brief interventions or referral for specialist care 112. More recently, a reduction in these quantitative levels has been validated as treatment endpoints 113. AA’s spiritual focus, particularly its reliance on a “higher power,” can alienate non-religious individuals. Critics also argue that its emphasis on powerlessness risks disempowering people, contradicting evidence-based therapies that build self-efficacy. Additionally, AA’s abstinence-only approach clashes with harm reduction strategies.

Contrastingly, the choice argument asserts that addiction is a series of decisions made by individuals rather than an uncontrollable condition. Proponents of this perspective argue that everyone has the capacity to choose whether or not to engage in substance use. They suggest that people who choose to consume drugs or alcohol bear responsibility for the consequences of their actions, including addiction. However, many scientists now know that this does not happen, which is where this argument quickly falls apart. Instead of returning to normal and no long being a problem, addiction is a process of ongoing recovery. Even years after being sober, a person who was once an addict will be at a higher risk for drug abuse than their peers who were never addicted.

And we all need support from time to time, whether it’s with a big challenge or a small struggle. Let’s talk about “isolation.” Isolation means being disconnected from others, either physically or emotionally. In real life, isolation isn’t always obvious—it can be the feeling of being alone in a crowded room or scrolling through social media and realizing you don’t really feel connected. Next is “willpower.” Willpower is the inner strength we rely on to make tough decisions, like saying no to dessert or getting out of bed early.

How to Talk to Your Child About Drugs

In the last part of the chapter, Heyman attempts to make a case for the importance of what he calls prudential rules in preventing drug abuse. No connection is made between choice processes and rule following, so it is not clear how the major argument about the role of choice in drug abuse connects to the prevalence of rule following. Heyman argues that most people do not become drug abusers because they follow established societal rules. The noted failure of the “Just say no” movement to combat drug abuse (Lynman et al., 1999; Rosenbaum, 2010; Rosenbaum & Hanson, 1998) certainly indicates that getting people to state rules and say that they will follow them is not very effective. Moreover, to suggest that somehow the long-term benefit afforded by following rules reinforces rule following is also glib.

In scientific and clinical usage, addiction typically refers to individuals at a moderate or high severity of SUD. This is consistent with the fact that moderate-to-severe SUD has the closest correspondence with the more severe diagnosis in ICD 117–119. Nonetheless, akin to the undefined overlap between hazardous use and SUD, the field has not identified the exact thresholds of SUD symptoms above which addiction would be definitively present.