Is addiction in the head or is it an inescapable condition of the body? Experts have raved about this question for years with no definitive, all-encompassing answer. There is merit to both opinions. Addiction to a substance causes chemical imbalances that physically change the brain, much like other diseases such as cancer or HIV that cause harmful changes in the body. On the other hand, a person can’t become addicted to a substance without first making the conscious choice to obtain it, consume it, and then repeat the process.

Merriam-Webster defines disease as “an illness that affects a person, plant or animal: a condition that prevents the mind or body from working normally.” Based on this, it seems fair to qualify addiction as a disease.  Substance abuse destroys lives because addicts can’t function normally.

However, Merriam-Webster has a second definition for disease: “A problem that a person, group or society has and is unable to stop.” This meaning changes things. No one is forcing drugs down anyone’s throat. A person cannot get addicted to drugs or alcohol unless they first choose to take drugs or alcohol. It may be extremely difficult, but an addict can technically stop of their own volition.

Further examination is needed before any conclusions can be drawn.

Addiction as a Disease

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. The Institute of Medicine, American Medical Association, and The American Psychiatric Association all agree that the magnitude of the addiction is what truly matters. They define addiction as a brain disease manifested in compulsive behavior. Developing an addiction and recovering from it depends on factors like behavior, social context, and biology.

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.

Addiction as a Choice

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. No one is researching that legendary “miracle” cure for addiction—as is being done with cancer and AIDS for instance—because it’s not necessary. If a person can commit to quitting and getting treatment, they can eventually cure themselves.

A disease causes some physiological abnormality in the body. Cancer causes cells to mutate; Diabetes has decreased insulin…etc. 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.

Brain scans have showcased differences in a sober person’s brain as opposed to an addict’s. Modern science has shown that the brain always changes in response to a repetitive activity or line of thinking. Different areas of the brain function less when on drugs, but they (mostly) go back to normal when the abuse stops.

Dr. Caroline Leaf’s book, Switch on Your Brain, is all about the power of our thoughts on the mind. More than a motivational title, Switch explains in scientific detail how the more people think a certain thought, the more their brain opens up new neural pathways to handle this new sphere of thinking. Working out your mind with positive thoughts is as important as working out your body with exercise. Stop working out and the neural pathways disappear. This logic is applied to addiction and the brain.

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.

The Bottom Line

Both sides have valid points. For one person, addiction may be a disease that they cannot willfully control. For another, it may be a conscious choice that they refuse to change. Either way, the documented changes the body experiences points heavily toward substance addiction being an illness. No doubt the debate will continue.

Regardless of which camp you support, one thing is certain: it is possible to overcome addiction. Seek help immediately if you or someone you know has a substance abuse problem. We’re here to help you get started.