Is Addiction a Disease or a Choice?

The stigma and shame of addiction has much to do with the perception that people with substance use disorders are weak, immoral, or simply out for a good time at society’s expense. Understanding that addiction impairs the brain in many important ways may reduce such stigma. What’s more, the specific type of brain dysfunction may help identify a range of effective interventions and preventions. For example, during adolescence, the brain is at its most plastic — and vulnerable.

Comparative Approach with Other Chronic Diseases

It also occurs in mice that have virtually no mesolimbic dopamine due to neurochemical lesioning. Further, activation in the ventral pallidum, downstream of the mesolimbic dopamine system, is stronger in response to a second, redundant, predictor of reward than in response to the first. Since the second predictor adds no new information, we ought to expect a smaller response to the second predictor than to the first if the dopamine system was itself a reward prediction system. The New England Journal of Medicine recently published a review of the “brain science” related to addiction and its management by Dr. Nora Volkow and her colleagues. Uncover five simple yet impactful ways you can guide your teen to build resilience, make smart choices, and steer clear of the dangers of substance abuse. Habits are behavioral routines that are repeated so often they get wired into the brain as a matter of efficiency.

Rethinking Treatment: The Disease Model in Action

Berridge, 2007 suggests that the role of dopamine is incentive salience, not learning. Berridge points out that learning about the relationship between a stimulus and a reward can occur without dopamine. In mice genetically engineered to be unable to synthesize dopamine, normal learning seems to occur.

Is Addiction a Disease? Expert Views on Age-Old Debate

Increasing access to treatment and support is crucial for individuals with addiction to recover. This can include improving insurance coverage for addiction treatment, expanding the availability of medication-assisted treatment, and increasing funding for community-based support programs. Blaming and punishing individuals with addiction is not effective and can be harmful.

The Road Ahead: Hope in Understanding

In scientific and clinical usage, addiction typically refers to individuals at a moderate or high severity of SUD. This is consistent with the fact that moderate-to-severe SUD has the closest correspondence with the more severe diagnosis in ICD 117–119. Nonetheless, akin to the undefined overlap between hazardous use and SUD, the field has not identified the exact thresholds of SUD symptoms above which addiction would be definitively present. 2Suppose, however, that impairment is caused by a dysfunction plus social conditions we cannot alter, or altering which would be prohibitively costly, but those social conditions are unjust.

On one side, proponents argue that addiction is indeed a disease, much like diabetes or heart disease. This view is supported by a substantial body of research that shows addiction impacts brain chemistry and functioning. When a person repeatedly uses a substance, the brain undergoes changes in areas responsible for judgment, decision-making, and impulse control. This alteration leads to a compulsive need for the substance, despite knowing the harm it causes. Advocates for the disease model emphasize that these neurological changes make it nearly impossible for an individual to stop without help, much like it’s challenging for someone with diabetes to control blood sugar without medication.

• Easier said than done, she admits, but a highly successful treatment strategy (and something every alcoholic knows) is that to not relapse into drinking, one should not visit a pub.
• However, this criticism neglects the fact that neuroimaging is not used to diagnose many neurologic and psychiatric disorders, including epilepsy, ALS, migraine, Huntington’s disease, bipolar disorder, or schizophrenia.
• This perspective emphasizes that addiction is rooted in complex interactions of genetic predispositions and environmental influences.
• Sessions include text chat, video chat, and telephone, making it possible for individuals to receive discreet and confidential treatment.

• When present in a patient, however, such as course is of clinical significance, because it identifies a need for long-term disease management 2, rather than expectations of a recovery that may not be within the individual’s reach 39.
• This approach not only benefits individuals with addiction but also society as a whole.
• By emphasizing the medical aspect of addiction, society is encouraged to approach addiction treatment with the seriousness and support it deserves, thus paving the way for recovery-oriented policies and initiatives.
• Drug addiction, in the simplest terms is the strong compulsion to get and use substances, even though a number of undesirable and dangerous consequences are likely to occur.
• In practice, many treatment approaches blend both perspectives, recognizing the physiological aspects of addiction while also promoting personal responsibility.

Therapy can help individuals address the underlying issues that contribute to their addiction and develop healthy coping mechanisms. Medication-assisted treatment can help individuals manage cravings and reduce the risk of relapse. Support groups, such as Alcoholics Anonymous or Narcotics Anonymous, can provide individuals with a sense of community and support. Medications can help manage withdrawal symptoms, reduce cravings, and restore balance to the brain’s chemistry. It’s like giving a boost to the brain’s natural healing processes, helping it regain its footing after being knocked off balance by addiction.

After all, let us not forget that addiction is a condition that affects thousands, if not millions, of individuals worldwide. To strive for a universal model and application of it, therefore, does not do justice to the heterogeneity of the individuals involved. As Heyman outlines, the current costs of drug abuse are enormous, including costs of enforcement and lost productivity, as well as incarceration, which has increased 10-fold since 1980. Importantly, he reminds us that drug abuse is a behavioral, or psychiatric, disorder.

A significant alternative is the focus on community-based support systems that foster social connections and empowerment. These approaches suggest that personal autonomy plays a vital role in the recovery process. Thus, as originally pointed out by McLellan and colleagues, most of the criticisms of addiction Sober House Rules: What You Should Know Before Moving In as a disease could equally be applied to other medical conditions 2. This type of criticism could also be applied to other psychiatric disorders, and that has indeed been the case historically 23, 24.

Arguments Against the Disease of Addiction

Their conclusion was that addiction should be insured, treated, and evaluated like other diseases. This paper, too, has been exceptionally influential by academic standards, as witnessed https://yourhealthmagazine.net/article/addiction/sober-houses-rules-that-you-should-follow/ by its ~3000 citations to date. What may be less appreciated among scientists is that its impact in the real world of addiction treatment has remained more limited, with large numbers of patients still not receiving evidence-based treatments.

Synthesized, the notion of addiction as a disease of choice and addiction as a brain disease can be understood as two sides of the same coin. Viewed this way, addiction is a brain disease in which a person’s choice faculties become profoundly compromised. Evidence of generally intact decision making does not fundamentally contradict addiction as a brain disease. Changes in brain function and structure in addiction exert a powerful probabilistic influence over a person’s behavior, but one that is highly multifactorial, variable, and thus stochastic. Philosophically, this is best understood as being aligned with indeterminism, a perspective that has a deep history in philosophy and psychology 84. For the foreseeable future, the main objective of imaging in addiction research is not to diagnose addiction, but rather to improve our understanding of mechanisms that underlie it.

But the brain changes are not a malfunction of biology, which is the defining feature of disease. Rather, the brain changes of addiction reflect the normal plasticity processes of the brain, its every-day capacity to change in response to experience, the basis of all learning. The fact that addiction changes the way the brain works lends credibility to the idea of a lifelong disease, even though, according to the National Institute of Drug Abuse, the changes are “persistent”—which is not the same as permanent.

Some people believe that because of their decision to try a substance; they are now responsible for the way addiction can take control of the mind and body. While early decisions made to ingest substances are certainly a deliberate action in the first stages of misuse, the way drugs change the person’s brain chemistry soon becomes out of their control. Just as with all chronic diseases, addiction can never be fully “cured.” Commonly, addiction is compared to cancer where many people can go into “remission” but never be fully cured. As with unfortunate cancer diagnoses, people will addiction may relapse and return back into their addiction. Usually, this happens because of the long-term psychological effects that stay in the brain of someone with a substance use disorder.