Is Addiction Really a Choice?

When you see your spouse choose the bar over your daughter’s birthday party, or when you see your son use their paychecks at the ABC store over their bills, you may think that their actions are all a choice. You may see them as choosing their addiction over their responsibilities or choosing their substance over you.
The reality is that these aren’t exactly choices; these are the product of a chronic disease. Many times, when we don’t understand something, we resort to our preconceptions about it. Most people say that addiction is a choice based on poor decisions and a lack of willpower; however, the reality is that there’s an evidence-based science to addiction as a disease, not a choice, and it’s more complicated than just “choosing to get drunk/high.”
So, what does this mean?
Addiction is a Brain Disorder
The answer is: Addiction is a disease. Let’s break down addiction on a scientific level. In the brain, the “feel good” hormones like dopamine undergo what is called a “delayed reaction” of pleasure; in other words, the “reward” in a typical brain comes after a period of time. We often get these hormones when we eat our favorite foods, hug a loved one, or spend time on an enjoyable hobby.
However, with drug and alcohol use, that gratification feeling comes instantly, and that’s what leads to continuous, uncontrollable usage. We get a flood of the feel-good chemicals that interact with the decision-making function of our brain. Over time, we become dependent on this instant gratification, and, as a result, our brain needs more of the drug or alcohol to get that “instant high” rush. This vicious cycle leads to addiction.
When this instant pleasure comes into play, the value we place on the drug can consume our thoughts and desires. The drug interferes with and disrupts the parts of the brain that make decisions and shifts the value we place on primal needs, like food, shelter, safety, and community. The substance becomes a “need” over a “want,” and that’s what causes the chemical imbalance of a disease.
Addiction is Like Any Other Chronic Disease
When someone we love is diagnosed with something like cancer, diabetes, Alzheimer’s, or schizophrenia, we call those “chronic diseases.” Addiction is no different. The feelings are just the same: denial of the disease, sympathy for the person, and fear of how to move forward.
On an interpersonal level, we need to acknowledge the similarities of addiction to these common illnesses. And just like with these chronic diseases, it can progress if not treated.
Think about if your sibling was diagnosed with severe bipolar disorder; would you say their mania or depression is a “choice?” Would you label them as “weak” for not being able to control their emotions? Or would you acknowledge the biological factors of their disease or think about the environment they grew up in that may have contributed to it?
Your loved one may have had the choice to take that first sip of alcohol or that first puff of a drug, but the snowball effect of everything that’s lead up to that is what makes addiction a chronic disease. Understanding this is crucial to finding solutions.
Calling Addiction a “Disease” is Not Enabling the Behavior
Many times, people think calling addiction a “disease” is just misdirecting the blame from the person and enabling their behavior. The truth is that addiction disrupts so many neurological parts of the brain; their decision-making functions, their pleasure receptors, and their primal needs are in a state of dysfunction, just like how depression or anxiety affects the brain similarly.
Enablement, on the other hand, is ignoring, excusing, or rationalizing dangerous patterns of behavior. For instance, enabling would be covering your friend’s shift at work when you know they’re out using, or paying your daughter’s bills when you know where their money is actually going; these actions are enablement. You’re just protecting the disease, not the person.
Accepting addiction as a disease rather than a choice is not enabling, but rather shifting the perspective from something unfixable to something treatable.
Finding Peace with the Disease of Addiction
You don’t tell someone with depression to just “stop being sad,” and you don’t tell someone with diabetes to just “eat healthier/exercise more.” It’s the same way with addiction; you don’t tell someone to “just stop using,” because the reality is that there’s an underlying biopsychosocial component to the illness that makes it a disease.
It’s important to remember that addiction does not mean the person has a “weakness” or a morally deficient nature; it’s a product of a neurological and chemical imbalance in the brain, no different than depression, eating disorders, or schizophrenia.
We know it still hurts to see your loved one go through something so painful, but acknowledging their disease brings you one step closer to finding true recovery and getting your loved one back. And, despite the nature of addiction as a disease, it’s treatable over time. With this, your loved one can live a long, fulfilling life, so long as they invest themselves in their recovery.
Acceptance of addiction goes both ways; the person with the addiction, and you—the person who wants to see them get better. Once you understand this, you can begin your own journey to compassion and truly supporting your loved one.
To get help or information on addiction in the family, explore more resources for yourself, including addiction books and videos, a community support group database, and therapy for families on our Family & Friends page. You can also learn more about the science of addiction in our webinar recording, “Common Addiction Myths—Busted!”
About Master Center for Addiction Medicine
Master Center for Addiction Medicine is a groundbreaking addiction treatment program headquartered in Glen Allen, Va. Based on a vision of comprehensive outpatient care, Master Center was launched in 2016 and now includes locations throughout the Commonwealth.
Master Center offers a coordinated, multidisciplinary approach rarely seen in the outpatient setting, staffed by experienced addiction physicians, psychiatrists, counselors, therapists, and peer recovery coaches.
Give us a call today at 804.332.5950 to schedule an appointment or learn more about us.