Is Addiction a Disease or a Choice?

It can be debated whether diagnostic thresholds “merely” capture the extreme of a single underlying population, or actually identify a subpopulation that is at some level distinct. Resolving sober house this issue remains challenging in addiction, but once again, this is not different from other areas of medicine see e.g., 12 for type 2 diabetes. Longitudinal studies that track patient trajectories over time may have a better ability to identify subpopulations than cross-sectional assessments 13. Among high-risk individuals, a subgroup will meet criteria for SUD and, among those who have an SUD, a further subgroup would be considered to be addicted to the drug.

Understanding the Importance of Cultural Competence in Treatment

By promoting awareness and disseminating knowledge about these disorders, public health campaigns can encourage individuals to seek help, establishing a more supportive environment for treatment and recovery. Successful treatment is essential for managing addiction, which is increasingly recognized as a complex disease that requires ongoing care. Key components of effective treatment for substance use disorders include medication and counseling, as well as plans for managing relapses. Beyond making the case for a view of addiction as a brain disease, perhaps the more important question is when a specific level of analysis is most useful.

• Continued use of a drug increasingly dysregulates reward, motivation, and executive control systems.
• While there are differing opinions on whether addiction is a disease or a choice, it is important to recognize that addiction is a chronic, relapsing brain disease that requires medical intervention and support.
• It is true that a large number of risk alleles are involved, and that the explanatory power of currently available polygenic risk scores for addictive disorders lags behind those for e.g., schizophrenia or major depression 47, 48.
• For designing policies, such as taxation and regulation of access, economics and public administration provide the most pertinent perspectives, but these also benefit from biological and behavioral science insights.
• It’s like having a team of cheerleaders rooting for your recovery, offering support, understanding, and accountability.

What alternatives exist to the disease model in understanding addiction recovery?

Every person experiences natural rewards in their life like a delicious meal, a favorite song, the pleasant feeling following exercise, or the happiness after sex, but drugs offer something more. The high that comes from using drugs is bigger, brighter, louder, and more gratifying than any natural reward, and it can make natural rewards seem small, dim, and quiet by comparison. But while no one forced an addicted person to begin misusing a substance, it’s hard to imagine someone would willingly ruin their health, relationships, and other major areas of their lives. Surely, if overcoming addiction were as easy as simply choosing to stop, the problem of addiction would be much easier to address and relapse would not be as common. Chung Jung Mun, an assistant professor in the Edson College of Nursing and Health Innovation, said that pharmaceuticals, such as opioids, are common treatments for pain but have led to record-breaking drug abuse.

• Moreover, to suggest that somehow the long-term benefit afforded by following rules reinforces rule following is also glib.
• In the context of addiction, willpower alone often isn’t enough, which can feel confusing.
• For example, knowing the stages of addiction can aid parents in recognizing warning signs early on 6.
• However, this perspective often overlooks the intricate psychological and biological factors that contribute to addiction.
• The present paper is a response to the increasing number of criticisms of the view that addiction is a chronic relapsing brain disease.

Addictive substances can lead to excessive dopamine surges, reinforcing substance-seeking behaviors and making natural rewards less appealing. Prolonged substance use can decrease the brain’s ability to respond to dopamine, leading to increased cravings and compulsive behaviors. This neurobiological perspective shifts the view of addiction towards a chronic disease needing ongoing management rather than a temporary condition resulting from poor decision-making. It is important to challenge misconceptions and stereotypes surrounding addiction in order to reduce stigma and improve access to treatment and support.

Contemporary neuroscience is illuminating how those factors penetrate the brain 77 and, in some cases, reveals pathways of resilience 78 and how evidence-based prevention can interrupt those adverse consequences 79, 80. In other words, from our perspective, viewing addiction as a brain disease in no way negates the importance of social determinants of health or societal inequalities as critical influences. In fact, as shown by the studies correlating dopamine receptors with social experience, imaging is capable of capturing the impact of the social environment on brain function. This provides a platform for understanding how those influences become embedded in the biology of the brain, which provides a biological roadmap for prevention and intervention.

Lewis emphasizes that addiction arises from ‘deep learning’ processes, suggesting that the brain changes resulting from substance use can mirror those observed in various goal-oriented activities. This challenges the notion that drug addiction is unique or strictly related to brain pathology. Research supported by the WHO highlights that biological factors, including genetics, contribute significantly to addiction risk. About 40% to 60% of an individual’s susceptibility to addiction stems from hereditary influences. Additionally, environmental factors play a crucial role; exposure to social pressures and the availability of drugs can significantly affect an individual’s likelihood of developing substance use disorders. On the other side of the debate, the choice model of addiction argues that addiction is a result of personal choices and behaviors.

Treatment

Conversely, exposure to high-stress environments, familial substance use, and lack of emotional support can lead to increased vulnerability to addiction. Overall, these definitions and impacts form the backbone of the ongoing discussion regarding the answer to is addiction a disease? Understanding addiction in this way frames it as an intricate health condition requiring attention and treatment similar to other chronic disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), separates substance use disorders into nine categories, indicating varying criteria for diagnosis. The severity of addiction can then be classified as mild, moderate, or severe based on the number of criteria fulfilled. The changes in brain function resulting from chronic substance use can further contribute to mental health issues.

Why do some experts argue that addiction is not a brain disease?

By recognizing addiction as a chronic, relapsing brain disease, we can shift the focus from blame and punishment to treatment and support. This approach not only benefits individuals with addiction but also society as a whole. At the heart of our new understanding lies the brain disease model of https://yourhealthmagazine.net/article/addiction/sober-houses-rules-that-you-should-follow/ addiction.

Brain imaging studies have illustrated physical changes in the brain areas essential for judgment, decision-making, learning, and behavior control in individuals with addiction 2. Changes in brain function and structure in addiction exert a powerful probabilistic influence over a person’s behavior, but one that is highly multifactorial, variable, and thus stochastic. Philosophically, this is best understood as being aligned with indeterminism, a perspective that has a deep history in philosophy and psychology 84.

Genome-wide association studies of complex traits have largely confirmed the century old “infinitisemal model” in which Fisher reconciled Mendelian and polygenic traits 51. A key implication of this model is that genetic susceptibility for a complex, polygenic trait is continuously distributed in the population. This may seem antithetical to a view of addiction as a distinct disease category, but the contradiction is only apparent, and one that has long been familiar to quantitative genetics. However, a heritability of addiction of ~50% indicates that DNA sequence variation accounts for 50% of the risk for this condition. Once whole genome sequencing is readily available, it is likely that it will be possible to identify most of that DNA variation.

How much of addiction can be attributed to genetics4 has long been a topic of scientific debate. “Even the most extreme environmentalists along the nature-nurture continuum in psychology now acknowledge that genes often contribute to individual differences in behavior,” says neuroscientist and behavior geneticist Dr. John C. Crabbe. While there is an element of choice in substance use, the neural actions of dopamine tilt the brain to be so interested in the immediate reward that it can’t even contemplate longer-term goals or exert control. That is why those who are addicted repeatedly act against their own best interests, frustrating everyone around them—and themselves.

Recovery from addiction is nearly impossible without support—whether it’s from family, friends, or community groups. And we all need support from time to time, whether it’s with a big challenge or a small struggle. Reducing stigma is also essential for individuals with addiction to seek help without fear of judgment or discrimination. This can be achieved through education and awareness campaigns that challenge misconceptions and stereotypes surrounding addiction.

• Tobacco alone is like 8 million people a year, alcohol’s not far behind it, and then you have the illicit drugs killing about 600,000 people a year, which is an extraordinary amount of mortality.
• Just as other diseases like heart disease persist even after stopping harmful behaviors, addiction can be long-lasting, impacting the brain long after substance use has ceased 2.
• It is not the only lens, and it does not have supremacy over other scientific approaches.
• These elements form the core of what makes addiction so challenging to overcome, and understanding them is crucial for effective treatment.
• Drug addiction, in the simplest terms is the strong compulsion to get and use substances, even though a number of undesirable and dangerous consequences are likely to occur.

This underlying brain change is why addiction requires ongoing management and support for long-term recovery. In the last part of the chapter, Heyman attempts to make a case for the importance of what he calls prudential rules in preventing drug abuse. No connection is made between choice processes and rule following, so it is not clear how the major argument about the role of choice in drug abuse connects to the prevalence of rule following. Heyman argues that most people do not become drug abusers because they follow established societal rules.