The question is can we classify addiction as a disease or is it a harmfully repetitious choice that individuals make? Does that mean addicts and alcoholics are weak-willed? How does the distinction from choice and disease affect how a person receives treatment or recovers? Psychology and psychiatry haven’t any easy answers, and professionals are having a tough time when it comes to knowing the exact the answer.
By the strict definition that’s provided by Google, addiction does not constitute a disease – but many professionals do consider it a disease. Why? There’s a rich history associated with this shift in thought.
Mental health hasn’t always been kind to individuals. Centuries ago, those suffering from mental disorders were regarded much differently than they are today. Specifically, addicts were seen to have extreme moral failings and made the irresponsible choice to drink solely of their own volition. The problem with a social stigma like this is that if someone spends their whole life being told they are immoral and irresponsible, they will invariably believe it. It’s damaging to a person’s chances of recovering. In this climate of harmful thought, Benjamin rush wrote An Inquiry into the Effects of Ardent Spirits Upon the Human Body and Mind, which was the first-time addiction was regarded as a ‘disease’ and the only partially the sole responsibility of the addict.
Thus, begun the shift from the addict being looked upon as a criminal, or a sinner, or a monster to someone who was suffering from a sickness.
Since the shift from moral failing to disease, there have come two schools of thought that surround this issue.
Position #1: It’s a Choice
Looking from the outside in, when you see a friend, family member or even a stranger on the street pick up a drink or a drug, it appears to be a choice. At some point, it very likely was. At the beginning of the cycle of addiction, people make the conscious choice to take drugs or have a drink, and when people stop they are making the conscious choice to stop. There are studies to support the idea that people are guided by their choices when they engage in addictive behaviours:
“The relevant research shows most of those who meet the American Psychiatric Association’s criteria for addiction quit using illegal drugs by about age 30, that they usually quit without professional help.”
This would lead us to believe that we choose to use, and we choose stop using when the right factors come into play. Those who believe in the disease model of addiction, think in slightly different terms.
Position #2: It’s a Disease
When a person takes drugs habitually, there are significant changes that occur in the brain – enough to disrupt the way a person thinks. In simplistic terms, when a person uses a drug, it floods the brain with reward chemicals. The brain, sometimes desperately, wants to do things that provide it with more of those reward chemicals, and this creates the craving for more of the drug. When the brain’s chemical function changes, those who subscribe to the disease model of addiction believe that choice no longer defines a person’s actions – it’s now compulsion. Many of us have been in a situation when we are inebriated that we do and say things we wouldn’t normally do, and have experienced the feeling that apparent loss of choice can give us. When an addict is stuck in the throes, getting out isn’t easy.
With the disease model of addiction, the chance for intervening in the compulsion for someone who is a genuine addict typically only comes through great pain or the loss of ability to do the drug. This could be the feeling of pain that one has caused their family or losing money to the point of not being able to afford to use anymore.
The repercussions of modelling therapy around one position or the other changes the approach that professionals take to assist their patients.
The terminology that we use for addiction means more than how we refer to it in literature or in therapy. Terminology can help define public opinion, allocate government resources and methods of treatment offered to addicts. So, when we choose one or the other, we are sending ripples through the community and those associated with it. But we can all agree on one thing.
The definition we use, the associated therapy approaches and professionals are there to help.
The ultimate goal is to fix the problem. Addicts and alcoholics that want to stop desire the best chance for a meaningful life free from using, so our approach is to help and heal. Some of those in the ‘addiction is a choice’ camp believe that calling it a disease removes the power of change from the individual, relegating themselves to lifetime of addictive behaviour. The other end of the spectrum is that calling it a choice paints it as a weakness, a moral failing and may not provide the best self-image for recovery.
There are benefits and drawbacks to each school of thought, and there aren’t any straightforward answers. For the time being, it’s imperative to keep an open mind, learn as much as you can about what differentiates the two, how it affects you and which one helps you the most. After all, the science behind the thought and method is there to support you and your choice for a better life.