Is Addiction a Disease or Choice?
Addiction itself is often misunderstood. Some people argue that it is a personal choice, and therefore anyone who is addicted to a substance has ended up there because of the lack of self-discipline or morality. Meanwhile others argue addiction is a disease, and as a result cannot be cured entirely or even resisted by discipline alone. The first view has been the most common understanding of addiction throughout history, and as a result there is a stigma surrounding people who struggle with drug abuse that often prevents them from willingly seeking help.
Recent studies over the past couple decades have brought evidence to question that understanding, and now the nature of addiction has become a common point of debate among specialists and the public itself. Does a person become locked into addiction because it is a choice that they are making and continue to make, or is it a disease that warps their brain and takes choice out of the equation? These are the two sides of the addiction debate, and which side wins plays a critical role in how medical professionals should approach addiction treatment.
The Misconception of Addiction
Much of the argument that addiction is a choice stems from misconceptions about the types of people who suffer from addiction. This is tied to the stigma of addiction, which developed as a result of the individuals who were affected by addiction, such as people from specific social classes or ethnicities. Throughout history, substance abuse was most common among “lesser” classes and people with lower levels of education. Given that the scientists and researchers of the time were from a more prominent social class where addiction was less common, they drew a connection that poverty and a lack of education was the reason that these individuals were more likely to develop an addiction.
While this stigma is still common today, modern addiction can affect any person regardless of their socioeconomic class, ethnicity, and background. One use is all it takes for some drugs to set a person on the wrong course, and even legal drugs such as prescription opioids can easily catapult addiction if they are misused. This means that anyone with access to medical care is potentially at risk, and so long as old misconceptions continue to prevail, they are in greater danger than they would otherwise be.
Addiction as a Choice
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. One of their most common arguments shines light on social media addiction. As social media has become a staple in modern society, many people have become hooked on this growing trend.
According to the neuroscientist Dr. Marc Lewis, this argument is largely based on the idea that when a person carries out an activity that they enjoy, it triggers pleasure in the brain and over time becomes a habitual act. Similar to how a person who wakes up at the same time most days for work, these processes easily become habit over time.
The main difference though is that that since it is connected to pleasure, which is the brain’s natural agent to tell the body what is good or bad for survival on a primal level, these habits form quicker and become more powerful than they otherwise would. A key point is that pleasure in this case does not necessarily need to be pleasure in the traditional sense, rather would be more accurately described as positive stimuli. This means that activities that do not cause pleasure but provide relief from negative feelings also present a strong habit-forming risk.
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. Since drug use frequently causes a wave of pleasure or at the very least relief from a negative feeling, these behavioral scientists argue that addiction is a case of repeated choice rather than a disorder. If an addict finds the self-control to stop using their chosen substance, the expected result of this belief system is that the brain can fully recovery from addiction and eventually proceed in life as if it never occurred.
Addiction as a Disease
In recent decades, researchers began to label addiction as a disease rather than a behavioral choice. This decision stems primarily from how addiction affects the brain by changing it, progressively forcing an individual to crave the drug until use eventually becomes an unconscious act rather than a conscious choice.
When a person begins abusing a substance or regularly uses prescription drugs for too long, their body will begin to adapt itself to account for its presence in order to maintain homeostasis, or balance. Over time, this leads to what is known as tolerance, which is when the body has adjusted itself enough that the individual will need to take more of their chosen drug in order to experience the same effects. This encourages them to further abuse the drug, and as this is happening, the individual’s brain will also be rewiring itself to desire more.
Eventually this leads to the development of dependence, which means that their body has been altered so much that it loses the ability to function normally without their chosen substance. If use stops, they will experience a series of painful side effects known as withdrawal, until either their body returns to its normal state without drugs or when they use again. The first option may take several days or weeks to accomplish, so many people opt for the latter as it is less painful. By choosing this option, the user becomes locked in a progressive cycle of addiction.
During this point, the part of the brain responsible for deciding to take the drug also shifts from the front of the brain to the back, which is the area in charge of regulating unconscious acts like breathing and blinking, as well as basic desires like hunger. As a result, drug abuse becomes fundamentally linked to their brain and is no longer a free choice.
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.
Addiction is a complicated subject filled with debate between researchers and scientists from a variety of backgrounds, and these debates have only grown as the years progress. Despite the complexity of the situation however, new evidence reveals the truth of the matter. While an addiction may begin from an individual’s personal choice, addiction itself is a mental disease rather than a continued choice.
The reason for this comes from three key points regarding how addiction affects an addict. The first of which is that a mental disease alters an individual’s brain and impacts their ability to function normally, and the second is that instead of returning to “normal” after treatment, a recovered individual will have to consciously work toward remaining sober each day, as relapse is always a possibility. The third point of note is that a person’s risk of addiction rises based on hereditary factors. If addiction were purely a choice, these three points would not exist altogether.
Behavioral researchers like Dr. Lewis try to argue this by acknowledging that the brain does change during addiction, but they view it as a situation like playing with clay. The brain is altered by drugs, making poor choices more likely, but they believe that if the drugs are removed, the brain will eventually “remold” itself back to its normal shape.
However, many scientists now know that this does not happen, which is where this argument quickly falls apart. Instead of returning to normal and no long being a problem, addiction is a process of ongoing recovery. Even years after being sober, a person who was once an addict will be at a higher risk for drug abuse than their peers who were never addicted. This is because the brain only reverts to normal functionality, but its makeup remains changed enough that recovering individuals can always struggle with temptation.
Choice arguments are also unable to account for the role of heredity in a person’s risk factors for developing an addiction. Once again, if it were solely choice based, addiction would affect each person as an individual and their family history would play no significant role.
As a disease, addiction is more difficult to treat than it would be if it were purely a choice. However, by recognizing it for what it really is, medical professionals can develop treatment plans that are more effective for helping their patients.
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