We’ve all had the cautionary tales of how using abusing said substances will lead us down a path of turmoil and despair. While most of us may experiment here and there, it doesn’t necessarily mean we will develop a dependency. However, for those that do, it can be a detrimental spiral that can be incredibly difficult to pull out of. Therein lies a debate about substance abuse: is drug addiction a disease or a choice?
We’re going to explore this controversial question, taking a deep dive into what drug addiction is and how it develops. We’ll lay out the ways in which addiction is seen as a disease and you can decide for yourself.
What is Drug Addiction?
Drug addiction is classified as a dependency on substances for a prolonged period. It’s defined as a chronic pattern of use and abuse of substances that are known to the user to have a negative impact on their body and their health. ¹
The user feels as though there is no way to cease the use of the stuff that they are consuming, either for fear of withdrawal or not being able to function properly.
These addictive substances can include the following: ²
- Opioids (i.e. heroin)
Is Drug Addiction a Disease?
Understanding what drug addiction is and how it manifests, can the action turn into a disease? Seemingly so, as most of the leading medical and mental health professionals have agreed that it is.
The American Medical Association has long viewed it as a diagnosable illness. They have been recognizing alcoholism since 1956 (updating its classification in 1991) and opened the theory to a diagnosis of substances in the 1980s. ³
Today, most researchers and physicians agree that addiction is a disease. Research has narrowed down particular psychological and physiological responses of those that are long-term substance abusers. Such responses have defined a wide-ranging spectrum of symptoms, interactions, and motivations that composes a categorized disease model which explains addiction and its impact.
The Disease Model of Addiction
Disease models allow those diagnosing to see how a certain illness forms, develops, and aids in creating a proper treatment plan. However, that isn’t to indicate that disease models are only for the benefit of those medical minds, it’s vital to educate the patient about how their disorder functions and how it progresses.
Looking at the standard disease model for addiction is enlightening to see the biological, and behavioral implications substance abuse has on the sufferer.
So, what is the disease model of addiction? It consists of three main cycles of responses and their impact on both the brains and bodies of the user. The three cycles of responses are as followed: Binge and Intoxication, Withdrawal Affect and Preoccupation, and Anticipation Reaction. ⁴
Binge And Intoxication
The Binge and Intoxication phase of the disease model of addiction refers to the user utilizing intoxicants such as drugs or alcohol to experience its rewarding or pleasurable effects.
Continued use and abuse in the pursuit of receiving an uplifting effect begin to alter the chemistry of the brain. The specific regions of the brain that are affected are the basal ganglia, the nucleus accumbens, and the dorsal striatum sectors.
These components are responsible for forming, discharging, and regenerating the pleasure centers which contain dopamine and serotonin receptors.
Drinking and using drugs accelerates and hijacks these dopamine receptors. Continued abuse can deplete the natural resource of organic pleasure for the brain.
Furthermore, substance abuse also alters the dorsal striatum which is responsible for habit formation. Alteration of the dorsal stratum can accelerate addiction, making routine use a habit that becomes hard to kick. ⁵
Withdrawal symptoms are a common concern for those considering or going through sobriety.
The withdrawal effect, which is the physical and psychological ramifications of trying to cease a pattern of behavior that brings pleasure to the user, is not only a common experience but can be the most difficult to endure in trying to end addiction.
Withdrawal effect are so potent because they’re driven by the extended amygdala. The extended amygdala process all emotions. This includes anxiety and irritability, both of which both are which are the main emotions that those experiencing substance withdrawal suffer from.
These responses can often become increase in their intensity and can lead to discomfort. Thus those with addiction seek drugs to get temporary relief. ⁶
Former addicts will be the first to tell you that even months or years after ceasing an addictive tendency, their desire still lingers.
This is makes sense given the interior chemistry and processing of the brain. The prefrontal cortex is responsible for the brain’s processing of thoughts and activities, which include self-control.
The prefrontal cortex compels a user to continue compulsively with reduced impulse control. When that user becomes sober, their decision to resist the drugs that made them an addict may still be firm but the inner wiring of that use is still intact. ⁷
Behavioral processing occurs in the prefrontal cortex and is backed by the other previously mentioned sectors, the basal ganglia, and the extended amygdala can complicate the sobriety process and creates an anticipation reaction.
An anticipation reaction is when the brain jumpstarts the internal reward system due to a craving or a chance to reintegrate the use of substances that the neurological chemistry believes are beneficial because it’s pleasurable.
In those that have ceased regular use and abuse of substances, it is anticipation reactions that cause the majority of relapses. This is either because of craving or due to an environment wherein the use of the substance is occurring that the addict is trying to abstain from. ⁸
It’s important to note that between 40% to 60% of addicts will experience relapses when trying to become sober. ⁹
Why Do Drugs and Alcohol Cause Addiction
Addictive substances bring about addiction through the internal properties that cause them to be taken in the first place. They create an uplifting or state-altering effect that shifts the user away from their rational reality and allows them to escape.
The use of these things can begin as a recreational activity. However, if there lies a vulnerability to addictive tendencies, it’s not long before a dependence can build up.
As we have discussed previously, the prolonged use and abuse of illicit and legalized substances can impact the mind and the body. There are three distinct classifications of symptoms that affect the user and can cause further complications if they’re not addressed.
The three categories of symptoms are behavioral, physical, and psychological impacts. We are going to break these three subsets and take a look at what those individual symptoms look like. ¹⁰
- Neglecting personal and professional responsibilities
- An increase in risk-taking behaviors
- Behaving in a secretive or suspicious manner
- Isolating oneself from friends and activities and hobbies that bring joy
- Changes in appearance in body and eye appearance include having bloodshot eyes, larger or smaller pupils, or dramatic differences in overall physical appearance than the norm
- Unusual odors on breath, clothing, or body
- Difficulties in coordinating movement or speech
- Complications in maintaining appetite, sleep schedule
- Shifts in mood or temper
- Increase in dissociation, seeming increasingly “spaced-out” from time to time
- An exacerbation in overall paranoia, anxiety, or delusion with no explicit explanation
How to Treat Addiction
So, the question that is commonly asked is whether drug addiction is a treatable disease. The answer is yes, but it’s a complex situation to try and treat. Drug addiction is an all-encompassing ailment that involves a physical and mental health response. Therefore, it requires treatment in a multifaceted way.
The first facet of the condition that most providers try and tackle first is detoxing the patient. This involves decreasing or completely eliminating the substance use. This can create a substantial physical reaction called withdrawal symptoms. Withdrawal symptoms are usually: ¹¹
- Changes in sleeping behaviors such as increased sleep, fatigue or insomnia
- Mood shifts include irritability, depression, and anxiety
- Aches and pains
- Changes in appetite with a decrease or increase in eating with nausea
- Substance cravings
So, is Addiction a Disease or a Choice?
After all of that explanation, the question still lingers: is drug addiction a disease or a choice?
The best way to answer is by understanding that the initial inclination to try a substance may very well be a choice and the subsequent experimentation may also be a choice as well. However, after a certain point, the user becomes an abuser, and the habit morphs into an addiction.
To answer definitively: addiction is not a choice. It’s a behavioral affliction that is driven by a neurological need, a chemical dependency that radically alters the brain and its chemistry.
Although there are those who will argue that addiction isn’t just black and white sort of situation, there exist shades of grey complexity. Psychologist and author Gene Heyman argue in his book, Addiction: A Disorder of Choice, that substance addictions aren’t just a choice or a disease but a spectrum that feeds into its own downfall. ¹²
This belief that addiction is a disorder of choice is a popular one and initially does have some credence. The debate still exists however the research that has been done to show addiction’s impact on the brain and its internal chemistry has largely ruled out that addiction is overall a situation of continuous choice.
Rather most medical and psychological minds agree with Gene Heyman’s theory that addiction disorders do start with an intentional choice. Still, it starts to move away from a choice-based action the longer said substances have the time to affect the brain and body’s internal mechanisms.
No matter what some’s opinions on drug addiction are, it’s still a matter that needs to be addressed. The severity of the situation is such that if it’s not intervened early on it can exacerbate and intensify.
Arguing whether or not addiction is a choice or a disease is best left up to the researchers. If you or someone you know is struggling with substance abuse the very thing to do is to take action.
Admitting that you have an addiction is the first step into the brave new world of sobriety. It may be difficult but with the right support system and proper treatment, relief and recovery bacn become your reality.
Do you still have questions about whether drug addiction is a disease or a choice?
We invite you to ask them in the comments section below. If you have any further knowledge to share – whether personal or professional – we’d also love to hear from you.
¹ Mayo Clinic: Drug Addiction – Overview
² Australian National Government – Office of Health & Care: Drug Types & Classifications
³ Substance Abuse and Mental Health Services Administration: “Why Addiction is a “Disease”, and Why It’s Important” – A Guide
⁴ Hazelden Betty Ford Foundations via Butler Center for Research: The Brain Disease Model of Addiction
⁵ National Library of Medicine: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and HealthChapter 2 Neurobiology of Substance Use, Misuse and Addiction – Section 4 Binge/Intoxication Stage: Basal Ganglia
⁶ New England Journal of Medicine: Neurobiological Advances from the Brain Disease Model of Addiction – Stage Two Withdrawl and Negative Effects
⁷ Springer Nature Portfolio – Journal of Neuropsychopharmacology: Addiction as a brain disease revised: why it still matters, and the need for consilience
⁸ Dove Medical Press: Role of Anticipation in Drug Addiction and Reward
⁹ National Institute on Drug Abuse: Drugs, Brains, and Behavior: The Science of Addiction -Treatment, and Recovery – Section 3 Does relapse to drug use mean treatment has failed?
¹⁰ State of Tennesee’s Department of Mental Health and Substance Abuse Services: Warning Signs of Drug Abuse – Common Symptoms of Drug Abuse
¹¹ Australian National Government – Office of Health & Care’s HealthDirect: Addiction withdrawal symptoms
¹² National Library of Medicine: A Review of Heyman’s Addiction – A Disorder of Choice