While many people experiment with substance use, not everyone develops an addiction. However, those who do face one of the most detrimental conditions. This leads us to the question, “Is drug addiction a disease or a choice?”

Throughout this article, we’ll address this controversial question. And we’ll do so by laying out how addiction works in the body and what you can do to stop it.

What is Drug Addiction?

Drug addiction is classified as a dependency on substances for a prolonged period. Users will continue chronic patterns of abuse even when they know it’s harming their health. ¹ These patterns are difficult to break due to fear of withdrawal or an inability to function without a substance.

While there are a variety of substances, the most commonly abused include: ²

• Alcohol
• Cannabis
• Ecstasy
• Opioids (i.e. heroin)
• Stimulants (i.e. cocaine)
• Tobacco

Is Drug Addiction a Disease?

The American Medical Association has long viewed it as a diagnosable illness. They’ve recognized alcoholism as a condition since 1956 (updating its classification in 1991) and opened the theory to other substance diagnoses in the 1980s. ³

That said, the majority of researchers agree that addiction is a disease.

However, these diseases vary depending on the substance of choice. Each substance will provide different psychological and physiological responses. As such, treating these conditions also varies.

The Disease Model of Addiction

When you follow the disease model, you can see how an addiction is formed and treated. While typically used in the medical community, it can be an effective way to understand the stages of addiction and recovery.

This model helps us visualize the three processes of an addiction cycle: ⁴

1. Binge/Intoxication – The euphoric effects while under the influence of a substance.
2. Withdrawal/Negative Affect – The aftermath when a drug’s effects are gone.
3. Preoccupation/Anticipation – The expectancy and effort to garner a substance.

1.) Binge/Intoxication

This phase of the model refers to the “high” users experience while under the influence of a substance. In most cases, this targets the reward centers of the brain, causing pleasurable effects. ⁵

The reason for continued drug use is to repeatedly hit this reward center in the brain. More specifically, we’re speaking of the:

• Basal ganglia
• Dorsal striatum sectors
• Nucleus accumbens

These areas are responsible for dopamine and serotonin formation, discharge, and regeneration. These natural hormones are what lead to pleasurable activity in the brain. For example, you may experience dopamine release when you accomplish a task.

When drug addiction hijacks the brain, it directly influences these receptors. As such, a person becomes dependent on a drug for continued dopamine and serotonin release. So much so that the brain forgets how to create its own hormones.

In the dorsal striatum, drug addiction then creates a habit. It makes addiction a routine which further makes it difficult to quit.

2.) Withdrawal/Negative Affect

When a person suddenly stops taking a drug, they’ll experience withdrawal symptoms. These are negative brain and body responses from a lack of the substance’s influence. ⁶

Withdrawal symptoms vary depending on the drug you’re addicted to. Still, the most common symptoms include:

• Aches and pains
• Anxiety
• Cravings
• Depression
• Diarrhea
• Fatigue
• Hallucinations (seeing things that aren’t really there)
• Inability to sleep
• Irritability
• Mood changes
• Nausea and vomiting
• Shaking
• Sweating

Withdrawal effects occur in the extended amygdala, an area of the brain responsible for emotional processes. This is why so many people experience anxiety and irritability when withdrawing from a substance.

Withdrawal response can be severely uncomfortable. Therefore, it’s in your interest to properly withdraw at a drug rehabilitation facility.

3.) Preoccupation/Anticipation

If you’ve ever been addicted to a substance, then you know that cravings will continue even months (or years) after you quit. This is due to the prefrontal cortex, an area of the brain responsible for thoughts and activities, including self-control.

The prefrontal cortex can make it difficult to stay away from a substance because of reduced impulse control. Drugs rewire the brain in a manner to encourage prior users to seek out the euphoria they previously experienced. ⁷

Other sectors of the brain will only make this process more difficult, including the basal ganglia and extended amygdala. Both areas create an anticipation reaction. Simply put, this is the brain jumpstarting the internal reward system when considering drug use.

This is what leads to the majority of relapses. Cravings can be powerful. If a person is not in the right environment, they can be easy to give into. ⁸ This is part of the reason 40% to 60% of those who struggle with addiction will relapse. ⁹

Why Do Drugs and Alcohol Cause Addiction?

While drug use may begin as a recreational activity, we’ve displayed how it can hijack the brain and lead to the disease of addiction.

This disease will result in symptoms that further complicate addiction. These symptoms are divided into the following three categories: ¹⁰

1.) Behavioral Impacts

• Behaving in a secretive or suspicious manner
• Increase in risk-taking behaviors
• Isolation from friends, family, and activities you once enjoyed
• Neglect of personal and professional responsibilities

2.) Physical Impacts

• Changes in physical appearance (i.e. bloodshot eyes, larger or smaller pupils, etc.)
• Difficulties in movement or speech coordination
• Problems with appetite or sleep schedule
• Unusual odors on breath, clothing, or body

3.) Psychological Impacts

• Anxiety, delusions, and paranoia for no explicit reason
• Mood or temper shifts
• Symptoms of dissociation

So, is Addiction a Disease or a Choice?

To answer definitively: addiction is not a choice. It’s a behavioral condition driven by a neurological need to continue substance abuse for normal functioning.

Still, some researchers argue that addiction starts with a choice. You can choose whether or not you want to try a substance. While this is true, nobody chooses to become addicted to a substance.

Admittedly, addiction is a very complicated process. Psychologist and author Gene Heyman argues in his book, Addiction: A Disorder of Choice, that substance addictions aren’t just a choice or a disease. Instead, they’re a spectrum that feeds into its own downfall. ¹¹

References

¹ Zou Z, Wang H, d’Oleire Uquillas F, Wang X, Ding J, Chen H. Definition of Substance and Non-substance Addiction. Adv Exp Med Biol. 2017;1010:21-41. doi: 10.1007/978-981-10-5562-1_2. PMID: 29098666.

² Gossop M. Classification of illegal and harmful drugs. BMJ. 2006 Aug 5;333(7562):272-3. doi: 10.1136/bmj.38929.578414.80. PMID: 16888294; PMCID: PMC1526938.

³ Leshner AI. Addiction is a brain disease, and it matters. Science. 1997 Oct 3;278(5335):45-7. doi: 10.1126/science.278.5335.45. PMID: 9311924.

⁴ Hall W, Carter A, Forlini C. The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises? Lancet Psychiatry. 2015 Jan;2(1):105-10. doi: 10.1016/S2215-0366(14)00126-6. Epub 2015 Jan 8. PMID: 26359616.

⁵ Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 2, THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424849/

⁶ Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 2, THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424849/

⁷ Heilig M, MacKillop J, Martinez D, Rehm J, Leggio L, Vanderschuren LJMJ. Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacology. 2021 Sep;46(10):1715-1723. doi: 10.1038/s41386-020-00950-y. Epub 2021 Feb 22. PMID: 33619327; PMCID: PMC8357831.

⁸ Balodis IM, Potenza MN. Anticipatory reward processing in addicted populations: a focus on the monetary incentive delay task. Biol Psychiatry. 2015 Mar 1;77(5):434-44. doi: 10.1016/j.biopsych.2014.08.020. Epub 2014 Sep 10. PMID: 25481621; PMCID: PMC4315733.

⁹ Peele S. What works in addiction treatment and what doesn’t: is the best therapy no therapy? Int J Addict. 1990-1991;25(12A):1409-19. doi: 10.3109/10826089009088552. PMID: 1966834.

¹⁰ Ali S, Mouton CP, Jabeen S, Ofoemezie EK, Bailey RK, Shahid M, Zeng Q. Early detection of illicit drug use in teenagers. Innov Clin Neurosci. 2011 Dec;8(12):24-8. PMID: 22247815; PMCID: PMC3257983.

¹¹ Kurti AN, Dallery J. REVIEW OF HEYMAN’S ADDICTION: A DISORDER OF CHOICE. J Appl Behav Anal. 2012 Spring;45(1):229–40. doi: 10.1901/jaba.2012.45-229. PMCID: PMC3297350.