Addiction Is a Disease of Choice
Is Addiction a Disease or a Choice?
The question of whether addiction is a disease is a controversial one. In order to answer this question, it is important that we not rely on opinion or belief; instead, we must carefully review medical facts and empirical evidence.
Some people view addiction as a choice an individual makes. Others say that substance use disorder follows all the parameters of the disease model.
In this article, I will focus on providing a simple understanding of how addiction is considered a disease. Following this, I will provide insight into the reality that addiction what we might call a disease of choice.
The Disease Model of Addiction
Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), and Dr. George Koob, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), published a paper in The Lancet Psychiatry on July 29, 2015. This paper supports the disease concept of addiction:
"The two NIH Institute Directors point out that animal and human studies have shown that critical brain structures and behaviors are disrupted by chronic exposure to drugs and alcohol. These findings, along with ongoing research, are helping to explain how drugs and alcohol affect brain processes associated with loss of control, compulsive drug taking, inflexible behavior, and negative emotional states associated with addiction."
According to the American Society of Addiction Medicine, addiction is defined as:
"...a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
"Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."
Therefore, the scientific evidence supports the idea that substance use disorder (addiction) may be considered a disease. The traditional disease model for alcoholism was developed by noted psychiatrist E. M. Jellinek, who served at Yale Medical School's Center for Alcohol Studies in the 1940s.
Disease Model Theory of Addiction
Addiction as a Disease of Choice
In 2009, Dr. Kevin McCauley, founder of the Institute of Addiction Studies, produced a documentary entitled Pleasure Unwoven. His second documentary, Note to Self, focused on his own journey and understanding of the struggle with addiction.
In Pleasure Unwoven, Dr. McCauley posits two theories: addiction as a choice versus addiction as a disease. Towards the end of the documentary, he remarks how it is more than just a disease. His conclusion is that substance use is really a "disease of choice" because one's decisions are based on seeking out, obtaining, using, and recovering from substances. What drives this choice? Intense cravings.
Hypofrontality in Addiction
The U.S. Opioid Epidemic
The American Society of Addiction Medicine published a fact sheet titled: "The Opioid Addiction 2016 Facts & Figures."
Here are two significant findings:
- Opioids interact with receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain.
- Of the 20.5 million Americans age 12 or older who had a substance use disorder in 2015, 2 million were addicted to prescription pain relievers and 591,000 were addicted to heroin.
There is no doubt that opioid addiction is on the rise in the United States. The Huffington Post published a startling article about how the city of Louisville, Kentucky, experienced 52 overdoses within 32-36 hours. In the Seattle/King County area, where I live, the county has created a new body called the Heroin and Prescription Opiate Addiction Task Force. In July 2015, the Center for Disease Control published a brief article (with infographics) regarding the rise in the opiate epidemic.
Infograph on Opiate Addiction and Withdrawal
Addressing the Opiate Epidemic
Within the past year, several photos have gone viral online. These photos have accompanied news stories about couples found passed out, overdosing, or a child coming to school and reporting her parents were not able to be awakened. A public outcry ensued, and many individuals have commented on various social media outlets. The majority of those who participated in the online discussions had negative, and highly emotionally charged, responses.
Once you understand how opiates and other substances alter the way an individual's brain functions, however, you may begin to see that these individuals are suffering. They are driven to engage in seeking out, obtaining, and using these powerful substances—not because they have the capacity to choose whether they are going to use (choice argument), but because they are driven to use, despite any potentially negative consequences (disease of choice).
And while it is emotionally distressing to see how this impacts other individuals, especially children, we would do well to move away from emotionally embittered judgments. Instead, we should begin focusing on finding practical solutions in order to help those who are suffering. In other words, we would do well to put aside the pitchforks and torches in our witch hunt to dehumanize and degrade those individuals who are suffering from opiate substance use disorder.
Here are some ways communities nationwide may address the opiate epidemic. The first practical solution, of course, is to move away from the false bravado of "not in my backyard." This is because people who are using opiates are already in your neighborhood. Thus, focus on ways to bring in agencies that will work with people in need of treatment and recovery support. This may include allowing methadone clinics to operate. In addition, we could support suboxone treatment.
The second practical solution is to get involved with community efforts to meet those who are in need of services. Many people who suffer from chronic substance use disorder are also in need of housing and other social services.
Third, become educated on the reality of substance use disorder. Become informed, become active, and start donating your time and/or money to local non-profit and social service agencies. The more the community comes together to help support and engage in providing services, the better the community will be able to address the epidemic in their own neighborhood.
Finally, accept the reality that this is a real epidemic. It is a disease that not only plagues individuals, it also plagues our society as a whole. Work with your government, at the local, county, or state level, to provide much-needed funding and support to assist those in need of treatment.
Recovery is possible for people suffering from substance use disorder. However, it is only possible when there are adequate services in place to meet the needs of these individuals.
Heroin at Home: A Community Discussion
To sum up some of the main points of this article:
- Addiction is a disease of choice in that it alters the functionality of brain and brain-reward pathway.
- The opiate/heroin epidemic is continuing to increase and impact communities nationwide.
- Communities may do well to begin addressing and implementing ways to support treatment and various recovery services to address opiate substance use disorder.
- Opiate substance use is a community disease, as well as an individual disease.
Call to Action
There were two principle concepts of this article. The first is to provide information on how addiction is considered a disease of choice. The second is to provide a brief summary of how individuals and communities can take necessary action to address the rise in opiate substance use disorder.
As previously stated, while it is individuals who suffer from this disease, the epidemic has a significant impact on the community as a whole. It is a community disease, as well, because there are significant social and economical impacts within our local cities, counties, and states. As opiate substance use rises, so does the cost of dealing with its impact.
Therefore, begin seeking out ways to become more involved in working with local programs to help address this disorder. Ignoring it—or writing negative comments online—will not bring about practical or effective resolutions to an ongoing problem that impacts all of us.