Addiction Is a Disease; A Chemical Phenomenon
I see addiction as a disease—as many scientific resources would agree. Addiction is a chemical phenomenon. Someone encounters a stressful stimulus, discovers a coping mechanism, and turns to that same modus operandi as the stimulus continually arises. Many people believe that addicts are attached to alcohol, sex, or whatever commodity they obsess about. In reality, their bodies become dependent on these “tools” to receive pleasure and relief. Their brains crave the rush of endorphins to de-escalate. It’s not voluntary—it’s a survival mechanism.
Addiction is a Disease of Choice
We have come to believe addiction is a disease of choice. The addicted personality loses the power of choice once the addiction has been triggered or once they have ‘crossed the invisible line’ as we like to call it. The addict/alcoholic may have had a choice up to that point, but once they have crossed over to addiction, they become powerless to choose not to use. That part of their rational mind has been completely altered.
The argument for the choice theory is that if you put a gun to the head of an addict and say, ‘if you use that drug or take that drink, I will blow your brains out,’ the addict/alcoholic generally will not use, proving they have a choice!
The trouble with that argument is that maybe it’s true in the short term, but what it fails to take into account is what’s going on in the head and body of the alcoholic/addict. They will often become incredibly irritable, and angry until they reach the point where they won’t care if you shoot them.
To me, this highlights the difference between the two very strongly opposed beliefs of abstinence recovery and harm minimization treatments. Abstinence recovery believes the powerlessness/lack of choice is caused by a problem that centers in the mind and can be overcome with working the 12-step program and other therapeutic help. This allows the alcoholic/addict to have their rational mind become empowered again and be able to choose not to use or drink.
The harm minimization concept believes that this is not possible and the kindest thing you can do is help the addict/alcoholic control their drug use. Abstinence-based recovery coincidently is also about controlled drug use, in a different way – it believes you keep your addiction under control by not doing it!
A good treatment provider will help you understand that as long as you look after your mental health by using the recovery program and other therapeutic help, the power to choose not to drink or use will be restored.
Unconscious and Conscious Choice of Being Addicted
There are many factors, including cultural, socioeconomic, and biological variables that impact addiction. Although some believe addiction is a choice, some individuals may not be able to control their environmental influences, which may place them at a higher risk of developing addiction over time. Addiction changes how the brain responds when triggered, and eventually, the behavior of seeking out a particular substance may become unconscious compared to a conscious choice.
Substance Use Diagnostic Is a Diagnosis In the DSM5
This is a great question, but there are far too many studies on the hijacked brain that speaks to how this is far beyond choice and is a disease. Substance Use Disorder is now a diagnosis in the Diagnostic Statistical Manual 5th edition also known as the DSM 5. But if we look at this from a practical standard and say it’s a choice, then we wouldn’t have people who know in advance that their work will test for drugs, yet they still lose their jobs.
Offenders violate parole and probation to return to a state of incarceration due to the inability to control their use. Husbands, wives, parents, and children destroy homes and family relationships due to this lack of control or choice.
If addiction to gambling, sex, drugs, shopping, working, eating, drinking, and the list goes on, were a choice, no one would deliberately choose death or destruction for their lives or the lives of their families. But because we don’t have a choice once the disease is fed in spite of catastrophic consequences, the addict will continue to make a decision that feeds the addiction while consciously robs their own lives of what’s best.
It’s a Mental Illness Supporting the Disease Model of Addiction
Suggesting that addiction is a choice is known as the moral model of addiction. It insinuates that the addict’s problem is nothing more than a lack of willpower and an unwillingness to change their lives. By definition, addiction is an unhealthy behavior that is repeated despite the detrimental impacts it has on the sufferer. From the outside, it can appear that a person just needs to exercise some control but it’s unfair to say that the sufferer just doesn’t want to get better.
Oftentimes, this model of addiction stating that it is a choice adds layers of guilt and anxiety to their existing problem preventing them from reaching out and getting the necessary help they need. This does by no means absolve the addict of their responsibility to make healthy choices, but strongly suggests that there are other forces at work here.
The disease model of addiction is the theory that addiction is the manifestation of cognitive dysfunction. More specifically compromises the pleasure-seeking and reward centers of the brain. Over the years there is far more evidence to suggest that the disease model of addiction is responsible.
Researchers have investigated hundreds of thousands of addicts who desperately want to recover but cannot get clean. This validates that something other than willpower is at work. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) used by doctors, therapists, and healthcare professionals to diagnose addiction, defines addiction and compulsive substance use as a mental illness heavily supporting the disease model of addiction.
In this respect, the biological explanations of addiction remove the stigma that addiction is simply a choice. However, addiction has been known to drive people to commit morally reprehensible things such as theft, robbery, and prostitution which are believed to be influenced by the discomfort of withdrawal symptoms and moral misjudgment.
Viewing It as Disease Makes It Easier to Treat
There is still a debate about whether addiction is a disease or a choice, and I don’t know if this will ever be resolved. In my experience, though, viewing it as a disease makes it easier to treat, and improves recovery outcomes.
One of the main reasons for this is that by seeing addiction as an illness, rather than a moral failing, shame is taken out of the narrative. Shame is debilitating, and it does not motivate people to make lasting changes. If anything, shame further intensifies the feelings, struggles, and beliefs which contribute to addiction developing in the first place.
By treating addiction as an illness, those suffering are given greater dignity, respect, and encouragement, rather than experiencing blame, shame, and judgment. It can also help to separate a person from their behavior, and by doing this, enable them to form a newer, healthier identity.
A compassionate, empathic approach can certainly aid recovery, but it’s hard to adopt this stance if we assume an addict is making these choices on purpose, that they lack willpower, or have bad judgment. Seeing addiction as a straightforward choice also fails to account for the multitude of social, economic, and genetic factors which can influence addiction. Viewing addiction as a disease reduces stigma, supports self-compassion, and promotes sustainable recovery.
Addiction Is a Choice, But It Is Not a Conscious Decision
Addiction is a way for the brain to cope with difficult situations. Many people who are addicted turn to substances or other behaviors to cope with stress or a difficult situation, which leads to a cycle of addiction. Addiction is a choice, but it is not a conscious decision. To see addiction as a disease, you must see addiction as a mental condition that causes a person to behave in a certain way and cannot be controlled.
Addiction is a complex and personal issue that is best addressed by a professional. Addiction is something that is happening to you that you cannot control, and you are powerless to change it. Some aspects of addiction have to do with the dopamine release in the brain, which comes with the feelings of reward. Addiction has many rewards, so it is hard to stop.
Deciding to choose something or someone is not a way to stop addiction. It is a way to find your way out of addiction. When you stop relying on substances to feel better, you are deciding for yourself. When you make that decision, you choose not to rely on substances to feel better. When you make that decision, you are creating a new life that is not reliant on drugs or alcohol. When we’re addicted to something, that’s when we’re giving it power. So when deciding to stop, we’re giving that word the power.
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