Disease or Choice? The Debate Surrounding the Origin of Addiction

Hazardous (risky) substance use refers to quantitative levels of consumption that increase an individual’s risk for adverse health consequences. Clinically, alcohol consumption that exceeds guidelines for moderate drinking has been used to prompt brief interventions or referral for specialist care 112. More recently, a reduction in these quantitative levels has been validated as treatment endpoints 113. Only a tiny percentage of people addicted to alcohol or drugs take medication for it.

The role of social and psychological factors

While agreeing that treatment relapse is common, Heyman notes that treatment itself is not common. To answer this question, Heyman analyzes the available epidemiological data on addicts in general, and comes to the conclusion that the majority of all drug addicts eventually cease their addiction according to accepted criteria. In estimating current rates of drug addiction Heyman appears to overstate the case. He argues from cited research that about 30% of American adults have met diagnostic criteria for alcohol abuse or dependence at some time in their lives. Examination of the research cited (Hasin, Stinson, Ogburn, & Grant, 2007; Stinson, Grant, Dawson, Ruan, Huang, & Saha, 2005) however, does not appear to support that estimate. Hasin et al., for example, report about 18% lifetime prevalence for abuse and 12% for dependence, two percentages that ought not to be summed.

Lessons from genetics

It originates from within the scientific community itself, and asserts that this conceptualization is neither supported by data, nor helpful for people with substance use problems 4,5,6,7,8. As briefly touched upon earlier, it is not inconceivable that the BDM and the CM are essentially referring to distinctly different ‘types’ of addicts. Whereas the previous claim suggests that, on a theoretical level, the two models tend to be more similar than they appear at first sight, this second claim relates to the most appropriate conceptualisation of addiction on an individual level. For some addicts, the view of addiction as proposed by the CM may accurately describe their situation and their concurrent responsibility, whereas, for others, the view as proposed by the BDM sober house may be more appropriate.

• 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.
• On the basis of this kind of evidence, many researchers have come to believe that the mesolimbic system is a reward prediction system (Montague et al., 1996; Schultz et al., 1997).
• Few, if any healthcare professionals continue to maintain that schizophrenia, rather than being a disease, is a normal response to societal conditions.
• If anything, this evidence suggests a need to increase efforts devoted to neuroscientific research on addiction recovery 40, 43.

Q: Is Addiction a Brain Disease or a Moral Failing? A: Neither

It is true that a large number of risk alleles are involved, and that the explanatory power of currently available polygenic risk scores for addictive disorders lags behind those for e.g., schizophrenia or major depression 47, 48. The only implication of this, however, is that low average effect sizes of risk alleles in addiction necessitate larger study samples to construct polygenic scores that account for a large proportion of the known heritability. In his classic 1960 book “The Disease Concept of Alcoholism”, Jellinek noted that in the alcohol field, the debate over the disease concept was plagued by too many definitions of “alcoholism” and too few definitions of “disease” 10. He suggested that the addiction field needed to follow the rest of medicine in moving away from viewing disease as an “entity”, i.e., something that has “its own independent existence, apart from other things” 11. Thus, he concluded that alcoholism can simply be defined as changes in structure or function of the body due to drinking that cause disability or death. A disease label is useful to identify groups of people with commonly co-occurring constellations of problems—syndromes—that significantly impair function, and that lead to clinically significant distress, harm, or both.

• In mice genetically engineered to be unable to synthesize dopamine, normal learning seems to occur.
• While there are differing opinions on whether addiction is a disease or a choice, it is important to recognize that addiction is a chronic, relapsing brain disease that requires medical intervention and support.
• The neuroadaptations characteristic of addiction are longlasting; it is for this reason that the Alcoholics Anonymous slogan “once an alcoholic, always an alcoholic” has more than a grain of truth to it.
• This can be achieved through education and awareness campaigns that challenge misconceptions and stereotypes surrounding addiction.

Surely, if overcoming addiction were as easy as simply choosing to stop, the problem of addiction would be much easier to address and relapse would not be as common. Chung Jung Mun, an assistant professor in the Edson College of Nursing and Health Innovation, said that pharmaceuticals, such as opioids, are common treatments for pain but have led to record-breaking drug abuse. Growing up in a household where substance abuse is normalized, experiencing trauma or abuse, living in poverty, or being surrounded by peer pressure can all contribute to the development of addiction. It’s like trying to stay https://northiowatoday.com/2025/01/27/sober-house-rules-what-you-should-know-before-moving-in/ dry in a rainstorm without an umbrella – possible, but incredibly challenging. Some people seem more susceptible to addiction than others, and this is where genetics come into play.

How does AA’s view align with current scientific understanding?

• After all, let us not forget that addiction is a condition that affects thousands, if not millions, of individuals worldwide.
• It is important to recognize that recovery is a lifelong process and that individuals with addiction may require ongoing support and treatment.
• That, of course, begs the question of how choice can lead to the problem in the first place if choice is, in fact, the avenue to recovery.
• These data suggest that commonly used diagnostic criteria alone are simply over-inclusive for a reliable, clinically meaningful diagnosis of addiction.

A common criticism of the notion that addiction is a brain disease is that it is reductionist and in the end therefore deterministic 81, 82. As indicated above, viewing addiction as a brain disease simply states that neurobiology is an undeniable component of addiction. A reason for deterministic interpretations may be that modern neuroscience emphasizes an understanding of proximal causality within research designs (e.g., whether an observed link between biological processes is mediated by a specific mechanism). That does not in any way reflect a superordinate assumption that neuroscience will achieve global causality. On the contrary, since we realize that addiction involves interactions between biology, environment and society, ultimate (complete) prediction of behavior based on an understanding of neural processes alone is neither expected, nor a goal. Because of this, neurobiology is a critical level of analysis for understanding addiction, although certainly not the only one.

He also notes that drug abuse is the only psychiatric disorder that has two Federal research institutes dedicated to it, namely the National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA). Those who believe that addiction is a choice may not understand that simple “willpower” is not enough to overcome the drastic changes that drugs cause in the brain. In fact, the most identifying difference between drug misuse and a substance use disorder is a loss of control over drug use. For people with addiction, even the awful consequences are not enough to stop them from using; this is usually caused by the way the addicted brain prioritizes drug use above all else.

Is Alcoholism A Mental Illness? What Is The Best Treatment For Alcoholism?

The brain science behind these observed and measurable processes in addiction helps to clarify the goals of treatment. Agonist medications (such as methadone and buprenorphine) can stabilize the craving brain while the planning and reasoning processes get back in shape. Finally, we argue that progress would come from integration of these scientific perspectives and traditions. Wilson has argued more broadly for greater consilience 109, unity of knowledge, in science. A plurality of disciplines brings important and trenchant insights to bear on this condition; it is the exclusive remit of no single perspective or field. Moreover, those who suffer from addiction will benefit most from the application of the full armamentarium of scientific perspectives.

What alternatives exist to the disease model in understanding addiction recovery?

In a healthy brain, these messengers, particularly dopamine, help regulate our mood, motivation, and sense of reward. But when drugs enter the picture, they flood these pathways with an overwhelming surge of feel-good chemicals. An addict may suffer an impairment, caused by a dysfunction of the dopaminergic system, and yet be able to maintain homeostasis.