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Addiction: Choice vs Disease Explained

To really delve into this question of why we do think of addiction as a disease, I spoke to Dr. Keith Humphreys, a Professor of Psychiatry at Stanford University, and a leading commentator on the addiction epidemic. This is from Our Neurons to Yours, a podcast from the Wu Tsai Neurosciences Institute at Stanford University. On this show, we crisscross scientific disciplines to bring you to the frontiers of brain science. However, saying that there is choice involved in addiction by no means implies that addicts are just weak people, nor does it imply that overcoming addiction is easy. It is incredibly hard, and for some people, practically impossible to undo years of habit. Parents have to make difficult choices when putting boundaries in place for adolescents.

is addiction a disease debate

Any meaningful discussion of remission rates needs to take this into account, and specify which of these two populations that is being discussed. Beyond the stigma, there is a branch of modern researchers that strongly insists that addiction is a choice and uses evidence to support their argument. The primary figures on this side are behavioral scientists, and their belief is based on the idea that any activity capable of stimulating a person for pleasure or stress release holds a risk for addiction. This means that almost anything can potentially lead to an addiction, be it taking drugs, eating, or simply spending time on the internet.

Opposing Sides of the Debate

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. Simple willpower is not enough to overcome something that has been rewired in the human brain. I hope for my patients that understanding that there is biology somewhere down deep in these problematic and often life-threatening behaviors can mitigate the self-loathing and guilt that is nearly universal among people with addiction. And to understand that it may even go deeper, to the genes and experiences over which they had no control, may also help.

is addiction a disease debate

First, people may appear to remit spontaneously because they actually do, but also because of limited test–retest reliability of the diagnosis [31]. This is obviously a diagnosis that, once met, by definition cannot truly remit. Lifetime alcohol dependence was indeed stable in individuals recruited from addiction treatment units, ~90% for women, and 95% for men. In contrast, in a community-based sample similar to that used in the NESARC [27], stability was only ~30% and 65% for women and men, respectively.

The Great Debate: Is Addiction a Disease?

To further complicate matters, some people are more prone to addiction than others. One of the most common signs for determining if someone is as risk for addiction is to uncover whether there is a history of past addiction in their family. This supports the argument that addiction is a disease because if choice was the main factor in addiction, a person’s family history would have little bearing on their chance for becoming addicted as well.

Evidently, a classification concerning the capacities of addicts, such as impulsivity, may be highly useful in certain fields dealing with addicts. Criminal justice systems, for example, may benefit from such a distinction, which may aid the correct legal approach of addicted offenders. Interpreting these and similar data is complicated by several methodological and conceptual issues.

A brain disease? Then show me the brain lesion!

Like other chronic diseases such as diabetes and heart disease, experts are still learning about how and why the disease develops. This blog post will help you understand addiction and how IU Health addiction treatment can help those struggling. These prejudices lead us to view the behaviours of smokers, alcoholics and other substance users as moral and lifestyle choices,3 rather than to see them through the lens of disease biology.

  • If not from the brain, from where do the healthy and unhealthy choices people make originate?
  • From a psychological standpoint, when this happens the brain has created special pathways for the activity to make it an easier trigger for that positive stimuli within the individual.
  • A particular opportunity for imaging-based research is related to the complex and heterogeneous nature of addictive disorders.
  • Alcohol or drug addiction, also known as substance use disorder, is a chronic disease of the brain that can happen to anyone.

He was among the hopefuls that took the stage Wednesday night for the third debate, this time in Miami alongside Florida Gov. Ron DeSantis, former South Carolina Gov. Nikki Haley, South Carolina Sen. Tim Scott and entrepreneur Vivek Ramaswamy. The field is down to five and while former Gov. Chris Christie isn’t leading any polls, he continues to qualify for the Republican presidential debates. As the debate over the drug’s cost-effectiveness rages, we’re sure there will be no shortage of creative ideas about how to pay for them.

Christie on Social Security

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 [4–8]. Addressing these critiques requires a very different perspective, and is the objective of our paper. We readily acknowledge that in some cases, recent critiques of the notion of addiction as a brain disease as postulated originally have merit, and that those critiques require the postulates to be re-assessed and refined. In other cases, we believe the arguments have less validity, but still provide an opportunity to update the position of addiction as a brain disease. Our overarching concern is that questionable arguments against the notion of addiction as a brain disease may harm patients, by impeding access to care, and slowing development of novel treatments. Another effect that the view of addiction as a disease has on treatment is that it makes addiction more likely to be seen as a chronic condition that requires ongoing treatment.

In addition, members of the public, who are likely to view addiction as a moral failing, are less likely to support policies that help drug addicts with recovery. For example, nearly half of people in a survey indicated that they did not feel that individuals with addictions should have the same health insurance benefits as the general public. It is clear that negative attitudes toward addiction, such as the view that addicts are morally weak, can harm treatment outcomes.

Causes & Risk Factors of Addiction

I thought addiction was an extreme mental illness — a “disease,” as I learned in medical school and later, in rehab. I understood addiction as a damaged condition that neatly divided me from the normal population. The Vietnam experience highlights the significant role that factors other than human biology and the nature of the addictive agent play in addiction. Environments and opportunities for other experiences matter—they also shape brain pathways of reward.

Willpower and shaming won't undo the changes in the brain and cure addiction. There is no cure, but treatment helps you manage and successfully live with the disease. Yeah, it helps you get a certain amount of compassion when you recognize that everybody makes bad behavioral choices. I mean, half of Americans Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden PMC are overweight and yet we have a certain amount of mercy. It's like we're all pretty frail, we're all, in my view, sort of fundamentally flawed. We can be disappointed in ourselves and others when they engage in bad behavior but still say but we're still going to show some compassion to you.

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