Is Addiction A Disease or a Choice?

As a recovering addict, I wholeheartedly adhere to the disease model of addiction; many of us addicts do. The disease model believes that alcoholism and drug addiction are chronic brain diseases characterized by chemical malfunctions in the frontal lobe, mid-brain, certain neurotransmitters, reward structures, motivation and memory.

Many people who have not struggled with addiction, do not believe that addiction is a disease. They argue that the disease model of addiction is an “excuse” or “justification” for inappropriate behavior. They say that addiction can’t be classified as a disease because diseases happen to us, out of our control, while addiction is a condition of a bad choice that we have control over. I’ve heard countless arguments from those who have battled cancer or other devastating diseases saying, “I didn’t chose to get cancer, it just happened. You chose to drink. You chose to put drugs into your body.”

While I understand the arguments against the disease model, I feel it necessary to point out a few crucial aspects that are often overlooked.

The disease model of addiction does not absolve the addict of responsibility.

Claiming that my addiction is a disease does not mean I’m not responsible for the choices I made while using or the choice I made to start using. The disease model is not a free pass nor an admission of hopelessness, in fact, it’s quite the opposite. Addicts are absolutely responsible for the choice to pick up in the first place. But, many people can drink or recreationally use drugs a few times without becoming addicted. Those people do not have the disease of addiction. I chose to drink alcohol when I moved to Europe at 18 years old but I didn’t choose for my brain to react differently to alcohol than non-alcoholic brains. When I ingest alcohol, it produced a phenomenon of craving that does not occur in “normal” drinkers. This phenomenon of craving makes it nearly impossible for me to stop drinking after I’ve started; essentially, I lose the aspect of choice once the substance is present in my body. For a more elaborate explanation of what happens inside the addict brain, read this.

The disease model of addiction gives addicts hope.

I know that I would not be clean and sober right now if I had not learned about the disease model of addiction. The addiction cycle is perpetuated by guilt and shame and if my addictions were simply continued bad choices that had no explanation aside from me just being a horrible person (a belief that many non-addicts hold), I would not have been able to break the cycle. But here’s the truth: addicts are not bad people, we are sick people. Our brains are sickened each time our addictive substance enters our bodies. The disease model affords us the opportunity to get well. It gives us hope that as long as we don’t pick up the first drink or drug, our disease cannot continue to destroy us or our loved ones.

The disease model of addiction does not mean the addict doesn’t have a choice to treat it.

Accepting the fact that I have a chronic and progressive disease is not the same as allowing my addiction to continue. I have a choice every single day whether or not I want to treat my disease. The first step in treating my addiction was putting down the drugs. And yes, alcohol is a drug. The only way for an addict to arrest the disease of addiction is complete abstinence. But just because I stay away from a drink or a drug, one day at a time, this does not mean that my disease is cured and I will never be an addict again. There is no cure for addiction. No matter how much time passes between me and my last drink, I will always have a brain that reacts differently to alcohol than normal people. This means I can NEVER safely use alcohol or drugs in any form if I want my addiction to remain dormant.

Abstinence is not the same as recovery though. Addiction recovery means so much more than just not picking up the first drink or drug. Recovery is about clearing the wreckage of the past; we make amends for harms done to those around us while we were in active addiction. We learn coping skills and continue to work on the underlying issues that caused us to turn to drugs and alcohol in the first place. Many of us struggle with depression, anxiety, low self-esteem, and co-dependency; issues that don’t just go away on their own. Recovery affords us the opportunity to address our deficiencies and help us learn how to live a healthy life. Accepting that addiction is a disease is not the easy way out, it’s the first step in a recovery journey that requires a lifetime of hard work and dedication. Work that is made possible and attainable by the disease model.



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