For years, drug addiction was seen as a weakness of character — that the person who was substance-dependent only had to decide to stop when they wanted to. It also meant that continuing to use drugs was a moral failing, with the user being solely to blame for all the ill behavior. However, research challenges this claim, providing proof that addiction is a brain disease that can be treated by science. It also demonstrates that the actions related to the addiction are beyond a person's control.
This article discusses the nature of substance abuse disorder. Is addiction a choice or a disease? Read on to find out.
What is Addiction?
There is significant evidence pointing to addiction being a chronic brain disorder that's similar to diabetes and hypertension. The American Medical Association refers to addiction as a "chronic disease" resulting from long-term changes in neural connections and pathways. The American Psychiatric Association has a similar definition, calling addiction a "severe substance use disorder that impairs a person's ability to function in day-to-day life."
Many terms are thrown around to refer to persons suffering from substance use disorder. But in 1964, the World Health Organization recommended the use of "dependence" instead of "habituation" or "addiction" to refer to people who have an overpowering desire to use tobacco, alcohol, and psychoactive drugs.
On the other side of the spectrum, there are doctors and scientists who say that managing addiction like a brain disease is false and misleading. Psychiatrist Dr. Sally Satel and psychologist Dr. Scott Lilienfeld co-authored several papers and books against the brain disease model of addiction, focusing instead on choice, response to incentives, and mental health issues like depression.
But what is addiction, really? The best way to understand how it happens is to see what it does to a person’s brain and cognitive functions.
How Substance Abuse Alters the Brain
Drugs are chemicals. When a person puts these substances into the body, these chemicals disrupt how the nerves cells send, receive, and interpret signals, eventually changing the brain's communication system.
Drugs operate in two ways: 1) they overstimulate the brain's reward circuit, and 2) they mimic natural neurotransmitters — like dopamine — to send false and abnormal signals to the brain. It is the overproduction of dopamine, which creates that "high" or euphoric state, that compels a person to aggressively seek ways to repeat such pleasurable feelings.
Dopamine is commonly referred to as the "feel good" neurotransmitter. The brain releases it in large amounts whenever a person has feelings of satisfaction and pleasure. Having low levels of dopamine has been linked to poor memory, lack of motivation, and foul moods.
Repeated substance abuse also disrupts the brain's normal function repeatedly. As a person's tolerance to the drug increases, so does the urge to consume larger amounts of it. Over time, the brain's mechanism is impaired, causing physical, psychological, and interpersonal problems.
Is Addiction a Choice?
Based on the evidence of how addictive substances can impair brain function and affect one’s ability to make sound decisions, scientists conclude that addiction has very little to do with choice.
Dr. Satel and others panning the disease model argue that addiction isn’t a disease. They say that drug abuse starts with the decision to use substances as a result of societal factors or inner turmoil — and they do make sound points. However, there is overwhelming empirical evidence showing that while it IS a choice in the beginning, the compulsion to repeat and increase usage — the very definition of addiction — is due to a chemical-induced brain dysfunction.
Why is Addiction Considered a Disease?
So why is addiction a disease that’s comparable to diabetes and not solely a mental health problem? Drug abuse and mental illness often exist on the same plane. In some cases, mental disorders can happen before one becomes addicted to a substance, but in other instances, it goes the other way — addiction can trigger or worsen mental health conditions. It can also lead to lung disease, stroke, cardiovascular disease, and hepatitis.
Addiction is considered a disease because it alters how the body normally functions and can lead to other even more harmful and destructive effects. It is also a disease because it is something that can be prevented and treated.
Can Addiction Be Overcome By Willpower Alone?
Research shows that once a person enters into a state of addiction, it is difficult to recover from sheer willpower alone. Because the substances have already altered how the brain and neurotransmitters function, research has shown that the most effective way to address addiction would be to use a combination of medical and therapeutic interventions.
Take a Safe Path to Recovery With MATClinics
MATClinics takes a science-based approach to dealing with substance use, particularly opioid addiction. Each patient is carefully assessed in the beginning so we can create a customized treatment program covering a mix of medical, case management, and counseling sessions. Suboxone® treatment is one part of our recovery plan.
Learn more about the different treatment options at any of our outpatient centers throughout Maryland or get in touch with us today.