The great debate for a long time has been whether addiction is a choice or a disease.  The question seems to be one of how much control and responsibility does an individual have over a destructive habit. Addiction is an extremely complex matter, and trying to categorize it as simply a disease or a choice does little to help understand or solve the problem.

Addiction is a Choice

Certainly, the use of any illicit substance or addictive activity begins with the choice to use it the first couple of times. Repeated use becomes a habit, and for things that do not cause physiological addiction, many people will develop habits that do not cause them harm, so we would not call these addictions. However, when the habit starts causing problems such as neglecting or destroying important relationships, missing work or losing your job, creating financial problems, ruining your health – then we should consider this to be an addiction.

The essence of the addiction as a choice argument is simple: doing drugs is a choice, continuing to do drugs is a choice, and not doing drugs anymore is a choice. Being in a state of addiction is a horrible experience, and it takes mountains of effort and willpower to overcome, but the entire process is still voluntary. If a person can commit to quitting and getting treatment, they can eventually cure themselves.  

A disease causes some physiological abnormality and the effects of addiction on your body. Cancer causes cells to mutate; Diabetes has decreased insulin and so on and so forth.  Anyone with these diseases cannot choose to stop having them.  Yes, addicts exhibit some physical changes, particularly in the brain, but this does not change the fact that they can still choose to change their behavior in spite of those changes. There wouldn’t be a single case of an addict recovering otherwise.

Proponents of this viewpoint are primarily concerned that labeling addiction as a disease will give addicts the idea that they are powerless to change. Already in a state of lethargy and decreased mental faculties, the last thing an addict needs to hear is that they have a serious disease because the word “disease” implies it’s not under their control.

Addiction is a Disease

The model of addiction being a disease focuses on changes in the brain that occur with chemical dependency. Once these changes occur, choice is essentially no longer an option.Once your body becomes physically dependent on drugs or alcohol, you can no longer choose to stop using; you must feed the beast.

It may be true that the initial ingestion of a substance is voluntary, but the consequence to follow are almost entirely uncontrollable. Cravings deteriorate a person’s ability to function in society. Repeated use of an addictive substance will change brain structure in negative ways lasting well after a person stops using. Distortions in both emotional and cognitive functions ensue.  The essence of the addiction is a disease argument centers on experts emphasizing the physical and psychological symptoms of withdrawal. Many of these symptoms can be treated with non-addictive medication, and there are clinics specially designed to assist with coping.

Many experts believe the real issue to focus on is the uncontrollable craving for the drug and the lengths that addicts will go to in order to obtain it, even when faced with the negative health, professional, and social consequences that follow.

In this context, drug addiction is placed side-by-side with other diseases such as depression, stroke, Alzheimer’s, and schizophrenia, all of which have social and behavioral consequences. Taking drugs may be a voluntary decision and not all who try them become addicts, but the degree and speed of addiction still depend on a person’s physiology, environment, and genetic history.

While drug use may be a choice, drastic changes in an addict’s behavior most certainly are not. Substance abusers don’t ask for hallucinations, seizures, increased aggression, shaking, mood swings, and the many other physical ramifications that come with the territory.  People who advocate for addiction being a disease concede that using drugs for the first few times is a choice. However, once someone is addicted, they then have a disease. It doesn’t matter how they got there. All that matters is getting the proper treatment, just like any other disease victim.

The Bottom Line

Perhaps the best way to understand the overlap of choice and disease is to look at how these addictions are treated. Psychological addictions are largely treated through intense counseling and behavioral modifications. The addict must understand that they can choose each minute of each day to avoid the substance and behavior. Abuse of substances that are physiologically addictive generally involves some form of medical treatment, as well as treating the psychological aspect of the addiction.

Based on several debates by organizations and researchers, it seems that both aspects hold some truth. Most people have the choice to decide whether to take a drug or substance, and their knowledge and instincts can inform them of whether this would be the best choice given the dangers and risks involved. A series of uninformed choices can cause chemical changes in the brain which may further inhibit someone from stopping their addictive behavior, especially if they have a psychiatric illness that further perpetuates and triggers feelings that lead back towards the substance that is giving them feelings of contentment and happiness.

I think it is harmful to think of any addiction as entirely as disease process, because no addiction can be conquered just by taking a pill in the way one might treat a disease. You need to address the psychological component which empowers the addict to change their behaviors and their choices. However, it would be equally unfair to deny that many addictions involve a physiologic component that requires more than just telling someone to make better life choices.


Crystal Hampton is a 37-year-old avid writer from South Florida. She loves snuggling with her teacup Yorkie Gator and boyfriend Adam. She works for a digital marketing company that advocates spreading awareness on the disease of addiction. Her passion in life is to help others by sharing her experience, strength, and hope.


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