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There is a stigma attached to addictions, specifically ones associated with drugs. People often think that those who use drugs lack self-control or willpower and that addiction is a choice. They believe that since drug addicts chose to start using drugs, those individuals could stop whenever they want. The reality of drug addiction is far more than that. Addiction is a severe and lifelong struggle. It doesn’t just affect the person but everyone around them. Once the person has become addicted, chemical changes in the body occur. The condition can get much worse if the user quits the drug immediately or “cold-turkey.” 

This situation is why so many drug addicts find it difficult to stop. If left untreated, the person’s body, relationships, and even life could be in danger. 

Is addiction a choice or a disease? Read on to find out more. 

What Is Drug Addiction?

Addiction is a severe, lifelong condition characterized by a person continually seeking and compulsively using a drug. The user does so, regardless of the adverse consequences. These consequences can include organ diseases, cancer, mental illness, and even death.  

Although the initial decision to use the drug or drugs is voluntary, even just one use can lead to changes in that person’s brain. These chemical changes make it difficult for the person to stop. Repeated drug use interferes with a person’s self-control and ability to resist urges for the drug. 

Addiction can be the result of several things, including biological and environmental factors. Scientists have studied how a person’s family history affects addiction. They have concluded that the person’s ability to develop addiction links to their genetic makeup.  

Similarly, a person’s environment can lead to addiction. External factors can all affect the likelihood of a person developing an addiction, such as family members, friends, personal history, and socioeconomic status. 

How Drugs Affect the Brain

Most addictive drugs affect the brain’s “reward center.” When the reward center is working, it releases dopamine.  

Dopamine causes euphoria and encourages the person to repeat pleasurable behaviors. Activities that stimulate the reward center include eating and spending time with the people they love.  

However, repeated surges of dopamine in the brain’s reward center can reinforce behaviors that cause pleasure but are unhealthy. Taking drugs is one of these behaviors. In time, this takes a toll on mental health. 

As the person continues to use the drug, the brain must make specific adaptations. It does this by reducing how well the cells in the brain’s reward center respond to the drug. As a result, the brain needs more of the drug to achieve the same effects it felt the first time a user took the substance. This need is what creates tolerance.  

An unfortunate side effect of tolerance is that the person may also find less and less pleasure in other activities they enjoyed, such as eating or social events. This change affects a person’s mental health. In dire circumstances, it can contribute to conditions such as heart disease. 

Long-term drug use can change the brain in other ways as well. Ongoing drug use impacts learning, judgment, decision-making, memory, and behavior. Over time, drugs become a need rather than a want.  

When it is an addiction, a person might have triggers, such as places or interactions linked to their drug use. Cravings can last for years and feel uncontrollable even if and when the person becomes sober. 

Drug abuse is a “relapsing” condition: Although sobriety is possible, people in recovery have a high risk of returning to drug use even if they haven’t used it in years. A person’s mental health may recuperate, but the person may still have relapses.  

Relapses are possible and even common, but this doesn’t mean that treatment has failed. Similar to other chronic health conditions, ongoing treatment is a must. A recovering user needs a tailored approach, depending on how the patient is responding. 

Is Drug Addiction a Disease or a Choice?

Addiction constitutes a brain disorder that changes how the brain responds to situations that involve stress, rewards, and self-control. These brain changes aren’t just long-term. They can persist for months (even years) after the person has kicked their substance use problem. They can cause disturbances in the functioning of organs, lead to decreased quality of life, and increase the risk of premature death. For these reasons, many argue that addiction qualifies as a disease. 

However, some people argue that addiction is not a disease but a choice. Proponents of this argument say that addiction is not transmissible or contagious, autoimmune, hereditary, or degenerative. Therefore, it is not a disease. Others argue that since the person had made the original decision to take the drug, addiction is a self-acquired condition. Once the addicted person no longer has access to the substance, they can stop. 

These two sides of the debate are polarizing. Although most substance abuse cases indeed begin because the person decided to take the drug, most treatment centers and researchers consider it a disease. They argue that if overcoming substance abuse were as simple as taking away the drug, the global problem of addiction would be much simpler to address.  

Per the Disease Model of Addiction, drug abuse classifies as a disease because it’s a chemical and biological issue that will get worse over time. So the truth is, drug addiction is a disease, not a choice.  

Choice cannot be the determining factor in diagnosing a disease. Several diseases, such as heart disease and diabetes, involve personal decisions such as diet and exercise. “Disease” is what happens to the body due to substance use and abuse. 

For example, take someone who has received a diagnosis of skin cancer from too much sun exposure. The person could have stayed out of the sun more, but the disease was not the person’s choice.  

The person who chooses to use the drug the first time may do so willingly, but they do not wish to become addicted. 

It is rare to find a nationally recognized substance abuse recovery organization that views addiction as a choice rather than a disease. The “addiction is a choice” viewpoint is mostly from individuals and some smaller grounds groups.  

The American Psychiatric Organization has changed its rules to describe problems regarding chronic substance use. It does not use the term “addiction” at all. Instead, it uses “substance use disorder” to avoid confusion around the word “addiction” and its negative stigma. 

Conclusion

The first use of a drug is due to addiction, but once the drugs have altered the brain, it becomes challenging for that addicted person to stop. Substance abuse is an ongoing issue. There is an argument that addiction is not a disease “because people have recovered without treatment.” Everyone is different. People with mild addictions may recover with very little or no treatment, but people with more severe forms of addiction may need intensive treatment along with a lifelong treatment plan that continuously evolves. Since there is no one-size-fits-all solution to solving addiction, people affected by the disease of addiction should seek professional addiction treatment – if we can not help someone due to them needing a higher level of care, our addictionologists have a nationwide network of inpatient treatment centers that can help individuals with dual diagnosis, eating disorders, depression, anxiety, and more – we do this through our treatment matching and referral program. . Contact an expert with Master Center for Addiction Medicine to figure out a plan that works for you.

National Institute on Drug Abuse: Understanding Drug Use and Addiction DrugFacts