I am the daughter of two alcoholic parents—one in recovery and one not. I started showing signs of addiction in my teens. Yet, I still have conversations with family members who think that addiction is a choice. Not only is that hurtful—because it implies that I chose addiction—it is factually incorrect. There is an increasing body of scientific evidence which proves that addiction is a disease and not a moral failing. However, rather than arguing over something that is unlikely to be resolved, recovery has shown me how to cope with this while still feeling heard.
Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine. Scientific and psychological evidence tells us that it is caused by a combination of behavioral, environmental and biological factors. As a matter of fact, genetics account for about half of the likelihood that an individual will develop addiction.
I didn’t stand much of a chance!
Scientifically, just last month, psychiatrist Richard Friedman—who wrote the popular New York Times article, What Cookies and Meth Have in Common—stated that while no one would choose drug addiction—or their consequences—humans have created the perfect environment for it. He said that addictive substances (drugs, alcohol, and certain foods) have the same effect of stimulating the brain’s reward center through the release of dopamine. The brain remembers that reward and seeks it out again by repeating the behavior. It is an ingrained part of who we are—seeking reward dates back to pre-historic times.
There are also environmental factors at play—such as stress, which can biologically affect the brain in a way that can lead to addiction. Friedman highlights that we don’t all have the same amount of dopamine receptors in our brains; those who have higher amounts are more likely to have a natural level of stimulation and pleasure, and are less likely to seek addictive substances. In fact, he points out that stress and the use of addictive substances contribute to lower levels of dopamine receptors. That deficiency continues long after you stop using drugs too, with former users being less motivated and discontent—leading to the desire to seek reward chemically.
It is only in the initial stages of drug use that a person has free choice. Once the brain has been changed by addiction, that choice, or willpower, becomes impaired. The rational brain (the prefrontal cortex)—the area of the brain that is responsible for rational thought, the ability to think critically, and where we exercise restraint—is impaired and free choice isn’t an option.
I am not saying that me (or anyone else who suffers with addiction) are absolved of any responsibility, what I am saying is that we are not responsible for the brain condition/disease which affects how we respond to drugs, and the impairment to make informed choices once drugs have been ingested.
I, amongst many millions of others, are an example that recovery is possible, and that we took responsibility for it. It isn’t easy, but it is possible. Through continued abstinence, and a solid program of recovery, I believe that any person has the power of choice to not take that first substance.
But as far as saying people who suffer with an addiction don’t have a disease because it is caused by their choice to use—that ultimately they do have the power of choice—I don’t agree with. The body of evidence demonstrates otherwise. Who is anyone to say there is a choice element to suffering with a chronic health condition? Do people who suffer with cancer choose to get cancer? Or those with diabetes? Or any other chronic condition? I didn’t choose to become addicted; I had a genetic predisposition. I had mental health disorders and stress that lead me to self-medicate in such a way that I altered my brain chemistry so significantly that I became addicted. I lost the power of choice in my teens.
Thankfully, I found recovery.
And recovery gives me choices. It gives me the choice to stand up for my beliefs. It gives me the platform to speak and express my feelings. It also gives me the ability to choose my battles—and I have learned that the hard way.
I have had heated discussions with friends and family about whether addiction is a disease. Most recently, I suggested that we need to intervene in the correctional system to get offenders into treatment programs so they get the help they need. I was not suggesting we absolve them of the crimes committed, but simply that the need to address their chronic condition was far greater than justice—which could ultimately be served more effectively, following successful treatment. We don’t prevent the treatment of cancer patients, or those with heart conditions because justice is more important—those people would die—so why is it any different for those who suffer with addiction, which is also a chronic disease?
During this debate, I paused for reflection. I realized that recovery represents space to me—it provides a gap between someone’s behavior and my response. Very quickly I realized that my love for this family member was greater than something we fundamentally will always disagree on. I had made my point and I had expressed myself—there was nothing more that could’ve been achieved in this situation. I have provided contrary information, what they choose to do with it is up to them. I have no control over anyone but myself.
There are far larger platforms to encourage others to consider their narrow, and scientifically incorrect, point of view that addiction is a choice and somehow a moral failing. Today, I choose to do this by being open about my recovery, writing on a worldwide scale about addiction and all its facets (food, drugs, alcohol, smoking), and all of the different ways we can recover.
I choose to support the growing movement that is speaking up about their addiction, that is demonstrating that recovery is possible, and that is publicizing the evidence to suggest this is a fatal disease and it is a world-wide epidemic that needs greater resources for treatment, and less stigma attached to those suffering. We can make a difference, we can also choose our battles. Recovery gave us our power of choice back.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.