They might not have full control over their addiction, but when sober, they can make certain choices to reduce their risk of relapse. Much of the argument that addiction is a choice stems from misconceptions about the types of people who suffer from addiction. This is tied to the stigma of addiction, which developed as a result of the individuals who were affected by addiction, such as people from specific social classes or ethnicities.

These changes contribute to the compulsive drug-seeking behavior that is characteristic of addiction. I thought addiction was an extreme mental illness — a “disease,” as I learned in medical school and later, in rehab. I understood addiction as a damaged condition that neatly divided me from the normal population. Addiction is a natural language concept, etymologically meaning enslavement, with the contemporary meaning traceable to the Middle and Late Roman Republic periods [115]. As a scientific construct, drug addiction can be defined as a state in which an individual exhibits an inability to self-regulate consumption of a substance, although it does not have an operational definition. Regarding clinical diagnosis, as it is typically used in scientific and clinical parlance, addiction is not synonymous with the simple presence of SUD.

Are addictions diseases or choices?

They were seen as people who were out for their own pleasure without regard for anyone else. And then, global commerce so that if you had a particular taste for cocaine it would not have mattered through 99% of human history unless you happen to live in the Andes, but now, of course, cocaine is a global commodity. All that together means 30 Powerful Womens Recovery Memoirs to Inspire Your Own Journey this weakness in our design which did not matter much suddenly matters a whole lot, to the point that about one in six deaths on this planet is attributable to the use of a substance. Hazardous (risky) substance use refers to quantitative levels of consumption that increase an individual’s risk for adverse health consequences.

is addiction a disease debate

Epidemiologically, it is well established that social determinants of health, including major racial and ethnic disparities, play a significant role in the risk for addiction [75, 76]. 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. For alcohol addiction, meta-analysis of twin and adoption studies has estimated heritability at ~50%, while estimates for opioid addiction are even higher [44, 45].

Is Addiction a Disease?

And one of the reasons for that is that we have a very serious workforce crisis among all of behavioral health care. We’ve poured many millions of dollars into addiction treatment research over the past half century. And it has yielded lots of insights about behavioral therapies and also treatments, medication treatments like methadone and buprenorphine. And it turns out that when you use those things correctly, you can actually make a difference.

This genetic choreography suggests that while your genes affect how your brain develops, which genes are turned on or off when you are learning new things is dynamic and adapts to suit your daily needs. Each of your brain cells has your genetic code stored in long strands of DNA. This is achieved by winding the DNA around “spools” of protein called histones. Areas where DNA is unwound contain active genes coding for proteins that serve important functions within the cell. BetterHelp can connect you to an addiction and mental health counselor. Drug addiction also shrinks and weakens the ACC portion of the brain.

Box 1 What’s in a name? Differentiating hazardous use, substance use disorder, and addiction

We don’t usually consider mental health problems, such as depression or anxiety, as a disease, even though they have biological (including neurological) aspects to them. Each person will have a number of biological and environmental risk and protective factors.1 A risk factor is something that puts the individual in more danger of becoming addicted, while a protective factor is something that minimizes that danger. 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 abusing 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.

That history deepened my understanding of addiction and helped me make sense of my own experiences. 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].