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Addiction is a Disease of Choice

Updated on April 13, 2017

How is Addiction a Disease?

One of the most controversial subjects of discussion rests on whether or not Addiction is considered a disease. This is an important question to answer. Not from opinion. It is a question needing to be answered from medical facts and empirical evidence. There are individuals who still view addiction as either a choice an individual makes. Or, as other's promote, substance use disorder follows all the parameters of the disease model. The focus here is to bring about a simple understanding of how addiction is considered a disease. Following this, the remaining information provided will not only substantiate the evidence of how it is considered a disease, it will provide insight into the reality that this is a disease of choice.

NIDA Director Dr. Nora Volkow and NIAAA Director Dr. George Koob had published a paper in the The Lancet Psychiatry on July 29, 2015. This publication supports the disease concept of Addiction:

The two NIH Institute Directors point out that animal and human studies have shown that critical brain structures and behaviors are disrupted by chronic exposure to drugs and alcohol. These findings, along with ongoing research, are helping to explain how drugs and alcohol affect brain processes associated with loss of control, compulsive drug taking, inflexible behavior, and negative emotional states associated with addiction.

According to the American Society of Addiction Medicine, addiction is defined as:

...a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Therefore, the scientific evidence shows how substance use disorder (addiction) may be considered a disease. Based on the traditional disease model that appears to have been developed by noted Psychiatrist E. M. Jellinek. Dr. Jellinek. He served as Yale's Medical School's Center for Alcohol Studies in 1940.

Disease Model theory of Addiction

A slideshow presentation of Abuse and Dependency
A slideshow presentation of Abuse and Dependency | Source

Addiction is a disease of Choice

In 2009, Dr. Kevin McCauley produced a documentary entitled Pleasure Unwoven. He is also the founder of The Institute of Addiction Studies. His second documentary, Note to Self, focused on his own journey and understanding of the struggle with addiction. In his documentary, Dr. McCauley posits two theories. Addiction as a Choice, or, Addiction as a Disease. Towards the end of Pleasure Unwoven, he remarks how it is more than just a disease. His conclusion establishes that substance use is really a disease of choice because one's decisions are based on seeking out, obtaining, using, and recovery from substances. What drives this choice? Intense cravings.

Hypofrontality in Addiction

The reality of the Opioid epidemic in the United States

The American Society of Addiction Medicine published a fact sheet titled The Opioid Addiction 2016 Facts & Figures.

Here are two significant findings:

  1. Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain.
  2. Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.

The Huffington Post published an startling article of how Louisville, Kentucky experienced 52 overdoses within 32-36 hours. In the Seattle/King County area, there is the Heroin and Prescription Opiate Task Force. In July 2015, the Center for Disease Control published a brief article (with infographics) regarding the rise in the opiate epidemic.

Infograph on Opiate Addiction and Withdrawal


Addressing the Opiate Epidemic

Within the past year, several photo's have gone viral. These photo's have accompanied news stories of couples found passed out, overdosing, or a child coming to school and reporting her parents were not able to be awakened. Public outcry ensued and many individuals have commented on various social media outlets. It appeared that the majority of those having participated in the discussion of these news stories have had more of a negative, and highly emotionally charged, response.

Understanding how Opiate, and other substances, alter the way an individual's brain functions; one may begin to see that these individuals are suffering. They are driven to engage in seeking out, obtaining, and using these powerful substances. Not because they have the capacity to choose whether they are going to use (Choice argument); it is because they are obsessive in their drive to use (disease of choice) despite any potential negative consequences.

And, while it is emotionally distressing how this impacts other individuals, especially children, we are to do well to move away from emotionally embittered judgment and begin focusing on finding practical solutions in order to help those suffering. In other words, we will do well to put aside the pitchforks and torches in our witch hunt to dehumanize and degrade those individuals suffering from opiate substance use disorder.

Here are ways communities nationwide may address the opiate epidemic. The first practical solution, of course, is to move away from the false bravado of "not in my backyard". This is because people who are using opiates are already in your neighborhood. Thus, focus on ways to bring in agencies that will work with people in need of treatment and recovery support. This may include allowing Methadone clinics to operate. In addition, support suboxone treatment.

Second, get involved with community efforts to focus on meeting those who are in need of services. Many people who suffer chronic substance use disorder are also in need of housing and other social services.

Third, educate on the reality of substance use disorder. Become informed, become active, engage in donating (time, money, and other such things) to non-profit and social service agencies. The more the community comes together to help support, and engage in providing services, the better the community be become in addressing the epidemic in their own neighborhood.

Finally, come to accept the reality that this is a real epidemic and disease that not only plagues individuals. It is a disease that plagues our overall society and culture. Work with your local, county, state, and national governments to address and provide much needed funding to continue to assist those in need of treatment and support.

Recovery is possible for people suffering from substance use disorder, however, it is only possible when there are adequate services in place to provide and meet the needs of individuals struggling with addiction.

Heroin At Home: A Community Discussion

Concluding Remarks

Here are the simple facts this article presents:

  • Addiction is a disease of choice as it alters the functionality of brain and brain reward pathway
  • The Opiate/Heroin Epidemic is continuing to increase and impact communities nationwide
  • Communities may do well to begin addressing and implementing ways to support treatment and various recovery services to address opiate substance use disorder
  • Opiate Substance Use is a community disease as well as an individual disease

Call to Action

There were two principle concepts of this article. The first is to provide information on how addiction is considered a disease of choice. The second principle focused on a brief summation of how individuals, and communities, are able to take necessary action to engage in conversation and addressing the rise in opiate substance use disorder.

As previously stated, while the individual suffer's from this disease, the epidemic has a significant impact on the community overall. It is a community disease as well because there is significant social and economical impacts that each of our local cities, counties, and states. As the rise in opiate substance use continues to increase, so also is the rising costs in dealing with substance use disorder.

Therefore, begin seeking out ways to become more involved in working with local programs to help address substance use disorder. Because, merely ignoring it, or, providing arm chair emotional degrading commentary, will not bring about practical resolutions to an ongoing problem that impacts everyone.


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    • Kylyssa profile image

      Kylyssa Shay 6 weeks ago from Overlooking a meadow near Grand Rapids, Michigan, USA

      I think a lot of opiate addiction comes from the way American doctors are required to prescribe pain medication. My doctor admitted to me he literally could not prescribe narcotic pain medication the way he preferred to, to be used only as needed, but was required to prescribe it to be taken x number of times per day instead. The rationale is that putting patients on a schedule rather than allowing them to use the medication only when they have pain allows doctors to drug test and determine if pills are being diverted. However, making patients take the medication whether they need it or not creates addictions.

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