In order to understand addiction it’s important to establish a baseline in defining a disease. A disease is a disorder of structure or function in a human, animal, or plant. Especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.
Most medical associations, including the American Medical Association and the American Society of Addiction Medicine, describe addiction as a chronic brain disease. Similar to other diseases- like diabetes, cancer, and heart disease- the cause comes from a combination of behavioral, environmental, and biological factors. In addition, genes account for approximately 50% of a person’s likelihood to develop addiction. The disease, brought on by substance use or pre-existing, changes the function of the brain.
The result of untreated addiction frequently leads to additional physical and mental health disorders that require medical attention. After that, it becomes more severe, debilitating, and even potentially fatal if left untreated.
The American Society of Addiction Medicine (ASAM) defines addiction 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.”
Volkow, Koob, and McLellan (2016) mention three primary symptoms in their summary on the disease model of addiction: (1) desensitization of the reward circuits of the brain; (2) increased conditioned responses related to the substance an individual is dependent upon; and, (3) declining function of brain regions that facilitate decision making and self-regulation.
How Use Changes the Brain
Experiences of pleasure occur when our basic needs are satisfied- hunger, shelter, and sex. The release of the chemicals dopamine, oxytocin, serotonin, and endorphins in the brain cause these feelings. Addictive substances hotwire the brain to release high levels of these chemicals.
The habitual release of these chemicals over time causes changes in the brains systems of reward, motivation, and memory. After these changes take place a person often needs substances to feel normal. Once addicted, the brain becomes hijacked and the substance takes on the role of a basic human need. This is why individuals go through cravings, an intense desire to use substances, and continue use regardless of harmful and adverse outcomes.
Why Some People Say Addiction is a Choice
There are a number of reasons why some people believe addiction cannot be a disease. Some of these arguments center on addiction being caused by a choice to use drugs or alcohol. Addiction is not transmissible or contagious, it’s not degenerative or autoimmune, and a person gives the condition to themself as a result of choices. While initial use may be a choice, once the brain undergoes changes from addiction, a person loses control of their behavior.
There are elements of validity to some of these opinions. For example, most substance abuse does begin with a choice (although this line of thinking ignores addiction starting with a prescription from a doctor and turned into abuse). The main flaw in this logic is that a choice does not determine if something is a disease. Heart disease, diabetes and various types of cancer are largely influenced by personal choices such as diet, exercise, and exposure. A disease is a disorder of structure or function frequently impacted by choice.
Another shortcoming to the “addiction is a choice” perspective is it seems impractical. Why would a healthy, rational person willingly choose to destroy their health, relationships, and virtually everything of significance in their lives? If addiction were a choice overcoming it would be as simple as choosing to stop. The problem would be much easier to tackle and relapse would be uncommon. How a person chooses to define addiction, as a choice or disease, is really irrelevant. What’s irrefutable is that addiction’s a growing problem affecting millions in the United States.