The Ongoing Debate – Disease or Choice?
Dr. Bob Silkworth named alcoholism a disease in the Big Book of Alcoholics Anonymous in 1939. Since then, there have been two opposing sides when it comes to the nature of addiction. One side believes addiction is a disease. The other side insists it is a choice. And both sides are equally passionate about their particular position.
Since AA was founded in the 1930s, there have been a number of other 12-Step programs that have also adopted the disease concept, including Narcotics Anonymous – which has been around since the 1980s. However, only in recent times have addiction experts been able to back the so-called “disease concept” with scientific data and extensive brain research.
Before, it was easy for uninformed people to jump on the “addiction is a choice” bandwagon. Today, we no longer have to theorize about the nature of addiction. We have reputable proof that addiction is, in fact, a disease. This claim is backed by science.
At New Directions for Women, we have been helping women get sober for more than 40 years. We KNOW addiction is a disease and not a choice. In this article, we intend to provide information to help eliminate the stigma around addiction.
First Things First: Defining Addiction
Addiction is not a choice. It is a sickness of the mind, body, and soul. It is important to note that addiction is defined as a disease by every reputable medical authority in the United States – including the American Medical Association.
In the medical community, addiction (which, by the way, is now referred to as a “substance use disorder”) is treated as an illness. It is not perceived as a failure of willpower, a lack of moral character, or a sin. These are antiquated views that must be dispelled if we are to make forward progress in the face of our country’s current addiction epidemic.
The National Institute on Drug Abuse (NIDA) provides the following definition:
“Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness. Addiction is the most severe form of a full spectrum of substance use disorders, and is a medical illness caused by repeated misuse of a substance or substances.”
NIDA – one of the country’s most prominent addiction information sources in the United States – has studied the science of addiction and drug use. We believe that anyone who enters into the debate about whether addiction is a disease or a choice should be able to respond intelligently. This authoritative definition is straightforward – addiction is a disease!
What Makes Addiction a Disease?
We have told you that every medical authority in the U.S. agrees that addiction is a disease. We have also defined addiction. We believe this is enough to prove to you that addiction is an illness. But, we recognize that you might need a little more convincing. Let’s go a little deeper into how addiction experts arrived at the conclusion that addiction is an illness and not a choice.
Chronic disease is usually progressive, and often fatal without treatment. This means that the disease (if left untreated) persists and reoccurs, gets worse with time, and can cause premature death.
Take a moment to think about diabetes and cancer. These are two very well-known diseases. They are both chronic, progressive, and can be fatal. No one argues that these conditions fit the diagnostic criteria to be classified as a disease. Why is it, then, that so many people have such a difficult time when it comes to identifying addiction as a disease?
Addiction is chronic – which means that it persists for a long time or it is constantly reoccurring. Addiction is progressive – it gets worse and worse with time, which is evidenced by the physical deterioration of someone in the later stages of addiction. Addiction is fatal. The Centers for Disease Control and Prevention (CDC) reports that approximately 70,200 people died in 2018 from deadly drug overdoses.
Addiction is a disease. Period.
Yeah, But People Choose to Get High – It is a Choice, Right?
We will not argue against the obvious. Most people make the free will choice to experiment with drugs and alcohol. (In some cases, people are forced to use drugs – victims of sex trafficking, for instance). They decide they want to try a certain substance because they are curious about it, or because they believe it will in some way, numb their physical or emotional pain.
Every person who tries heroin, cocaine, prescription painkillers, alcohol, or any other drug for the very first time CHOOSES to do so. What happens as a result is really what we are talking about.
People do not choose to become addicted. They do not choose to be addicts. Addiction is the result of continued substance abuse among those who are genetically predisposed to the disease of addiction. What begins as innocent experimentation can lead to a devastating substance use disorder.
Addiction Robs an Individual of Their Own Free Choice
NIDA explains it this way:
“Even if taking a drug for the first time is a free choice, the progression of brain changes that occurs after that involves the weakening of circuits in the prefrontal cortex and elsewhere that are necessary for exerting self-control and resisting the temptations of drug use. Once addiction takes hold, there is greatly diminished capacity, on one’s own, to stop using.”
Remember, addiction is a disease of the brain. It causes profound and detrimental changes to an individual’s neurobiology. At some point, addiction becomes a matter of survival, which has nothing to do with choice. When the human brain is under the influence of powerfully addictive substances, the addicted person is no longer capable of making sound, rational decisions.
Just think of the crystal meth addict who lives on the streets. She is homeless. She is skin and bones. Her face is marred with sores. She is missing teeth. She panhandles, steals, or prostitutes herself to get money to shoot meth into her arm. She is NOT choosing to live this way. Her chronic and progressive disease is in complete control. She has lost the power to exercise free will. Think about it….. why would anyone make this choice?
How the Disease of Addiction is Treated
There is no cure for addiction, but the disease can be arrested and recovery is then possible. Recovery from a substance use disorder is achieved through ongoing, continuous sobriety. This means no drugs – not even weed or alcohol.
In order for someone to find freedom from the bondage of a substance use disorder, they will need to get treatment. This might include a detox for women, residential rehab, or an Intensive Outpatient Program (IOP).
If addiction were a choice, those who are struggling with it would just be able to choose to stop. But, this just doesn’t work. Most addicted people will tell you that they have tried and tried again to stop drugging or drinking – but they just can’t. This is where substance use disorder treatment becomes so important.
At our women’s only rehabilitation facility, we offer life-changing addiction treatment services. If you or a woman you care about has an addiction to drugs or alcohol, we are here to help.