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Is Addiction a Choice or Disease?

Why Addiction Is Not a Choice

Addiction is not a choice but life-threatening disease. Unfortunately, many people still believe addiction is a choice - and it's a serious problem. It's this belief that is the foundation for the stigma of addiction.

The Stigma of Addiction

Until people embrace the disease concept, addicted people will be treated poorly by others who believe addiction is a choice. If addiction is a choice, then it follows that the people who make that choice are either bad people or people who make bad decisions. Either way, it doesn't reflect too highly on the addict. That is why the idea that addiction is a choice is the basis of the stigma attached to addiction.

Addiction Stigma Prevents People from Getting Help

As a society, we need to embrace the disease concept! The stigma of addiction makes it less likely people will seek help. After all, who wants to show up at a treatment center or tell their family and friends that they are either bad or make bad decisions?

For more addicts to get treatment, it is imperative that more people accept that addiction is a disease.

The disease concept clearly removes some of the stigma from addiction. If addiction is a disease, how can people look down on someone affected by it? We don't treat diabetics that way or people with other conditions.

Think about the comparison for a minute. Type II diabetes may be caused by overeating and not getting enough exercise. But just like addiction, we don't know for a fact what causes type II diabetes. Imagine that instead of treating diabetics professionally, they faced scorn from the medical community and the general public. How many diabetics would go for treatment if they knew people would blame them for their disease? Not many, I imagine.

This is exactly what happens to addicts on a daily basis. Doctors and other medical staff make assumptions that they are drug-seeking even when the addicted person is actually in pain. Family members and friends aren't supportive because they don't believe there's any hope for the addict. The justice system treats them like they are criminals. And the general public treats them like they are social piranhas.

8 Reasons Why Addiction Is Not a Choice

  1. Even if the first time a person takes a drug is a choice, that does not make the person responsible for becoming addicted.
  2. The person who becomes addicted doesn't realize they are making a life-altering decision when they take the first drug.
  3. Most addictions begin before the brain is fully matured when the brain processes information based on feelings, not logic.
  4. After a person becomes addicted to a drug, their brain changes in significant ways.
  5. The reward center of the brain is re-wired, so the person is only rewarded for continuing the addiction.
  6. Some drugs create extra receptors for the drug, which can lead the addicted person to continue to crave the drug even years after the drug is no longer taken.
  7. When a drug is stopped, the addicted person goes through withdrawal. The discomfort of withdrawal keeps many addicts from stopping their drug use.
  8. While most people think addicts continue using drugs to get “high,” many drugs have a tolerance level after which the addicted person no longer experiences the pleasurable effects.

With Time, Addiction Sneaks In

I understand how people came to the conclusion that addiction is a choice. When an addicted person took that first drug, it may have been a choice. However, there may be a genetic predisposition and social/environmental factors that led the person to make that choice.

Let's say for a minute that we do accept that addiction and type II diabetes both begin with a choice. With addiction, the choice is to take the first drug or perhaps to take the drug, the person becomes addicted too. With type II diabetes, the choice is to eat too much sugar and carbohydrates and to be inactive.

Keep in mind, the people affected obviously don't realize they are making a life-altering decision at the time. After all, why would anyone choose addiction or type II diabetes? Plus, if you think about it, it's more like they make a lot of decisions that seem small but add to a problem over time.

Type II diabetes isn't caused by one choice. People don't get diabetes because they chose to eat a doughnut one day instead of a salad. It happens because they make a lot of little choices that might not be so bad on their own. But when you add them up, those choices lead to type II diabetes.

It's the same with addiction. People don't become addicted to opiates just because they smoked marijuana when they were 14. It works more like the type II diabetes example. They make a lot of small choices that lead to worse choices and eventually all of those choices lead to addiction. On their own, none of the choices would necessarily make someone an addict. After all, some people who make those same choices don't become addicts.

Indeed, both the people who become addicted and the people who become type II diabetics know the choices are bad when they make them. But they couldn't foresee that those decisions would add up to addiction or type II diabetes. So, is it really fair to blame them for the end result?

Young People Make Poor Choices

On top of all that, the decisions that lead to addiction and type II diabetes often start early in life. Most addictions, as well as poor eating habits and not exercising, begin when people are young adults, teenagers or even younger. People who become addicted rarely start using drugs when they're adults. It's just like most people start eating unhealthy and inactive lifestyles when they're young.

Our brains don't fully mature until we are about 25 years old. Before that, most people make at least a few poor choices because they just haven't developed the ability to reason and think logically the way you can once your brain has fully developed.

We've learned through research that an adult's brain works differently from a young adult, teenager or child's brain. Before age 25, the part of the brain called the amygdala is more active. Adults use the prefrontal cortex more. The amygdala is the emotional part of the brain. The prefrontal cortex is the part of the brain that is responsible for sound judgement and the part that considers the long-term consequences of our actions.

It makes a lot of sense that young people make poor choices when you know they process information based more on feelings than logic and judgement like an adult. If an adult (who has never used drugs) is offered drugs, he or she is more likely to think about how that choice could affect their body, lead to other poor choices and have lasting consequences. Young people are more likely to think about how that drug will make them feel.

If you only think about how a drug will make you feel and you don't think about the long-term effects, it only makes sense that young people are more likely to try drugs for the first time.

When addictions do begin in adulthood, it's rare to find no history of drug use before age 25. And addictions that begin in adulthood are more likely to begin with prescription drugs. It is quite possible for an adult to use reasoning and still make a poor choice when they put too much trust in a doctor. Many people have the mistaken belief that their doctor would only do what is best for them. While this may be true for many doctors, as with any profession, there are bound to be a few bad apples. There are many doctors who are more interested in making money or who just don't care.

The Brain Changes

Even if we accept that the addicted person makes a choice the first time they take a drug that doesn't mean the person is responsible for becoming addicted. At some point, something happens in a person's brain that changes everything. And after a person becomes addicted to a drug, their brain changes in even more significant ways. In fact, once a person becomes an addict, their brain will encourage them to continue their addiction.

The brain will encourage the addict to continue an addiction in many different ways depending on the drug the person is addicted to. One way is that the reward center of the brain is re-wired, so the person is only rewarded for continuing the addiction.

Usually, we get rewarded for survival behaviors like eating and sex. Eating keeps us alive, and sex propagates the human species. Our brains reward us with dopamine for such behaviors that we need to repeat to survive as an individual and a species.

Dopamine makes you feel good, which encourages you to repeat these behaviors. The whole process is a little more complicated than that, but for the purposes of this article, it's important to note that the addicted person is rewarded for continuing the addiction.
With opiate addiction, as the person takes more opiates, the brain makes more receptors for opiates. Opiates fit into the same receptors as endorphins. Endorphins are the body's own natural painkillers. Endorphins take away the pain and leave a pleasurable feeling when they are released.

Because the addicted person has additional receptors for opiates, they will continue to crave opiates to fill those receptors. This continues for a person's whole life. Those receptors never die. That is why an addict can stop using opiates for years and still return to them.
Nicotine addiction works in a similar way. Nicotine is shaped like the neurotransmitter acetylcholine. It fits into the same receptor as acetylcholine. These receptors are called nicotinic acetylcholine receptors.

When nicotine enters the brain, it acts just like the natural neurotransmitter acetylcholine. Both nicotine and acetylcholine affect heart rate, breathing, muscle movement and memory.

Nicotine also increases the amount of dopamine in the brain. Remember that dopamine is the neurotransmitter that makes you feel good so you'll repeat behaviors like eating and sex. Since dopamine is increased by nicotine, the person who uses nicotine is rewarded for using it, which encourages it's continued use.

As you can see, once a person becomes addicted to a substance, their brain changes to accommodate that substance. The body is designed to maintain homeostasis. It regulates functioning to maintain this stability. Temperature is a good example of homeostasis. The body works to keep an average temperature of 98.6. With an addicted person, the body works to maintain the addiction because not doing so would be disruptive to the body.

The Fear of Withdrawal

When a person who is addicted to drugs fights against this and stops taking the drug, their body goes into withdrawal. Withdrawal is painful and uncomfortable for the addict. It can include a variety of symptoms depending on what drug the person is addicted to. But no matter what the symptoms, the discomfort keeps many addicts from stopping their drug use.

The fear of withdrawal can keep many addicted people on a drug long after the pleasurable effects wear off. And the pleasurable effects of drugs don't continue for the person who has been addicted for a long time. Most people probably think addicts continue to use drugs to get “high,” which is what we call the pleasurable effects of a drug. But many drugs have a tolerance level after which the addicted person no longer experiences the pleasurable effects.

Because of tolerance, you can be addicted to a drug that no longer even makes you feel good. Tolerance means you need more and more of a drug to get the same results. Since it is rarely possible to keep taking more of a drug, many addicts will get to the point that they take enough of a drug to avoid withdrawal symptoms.

Cigarettes are a good example of how tolerance keeps the person from experiencing the pleasurable effects of the drug. If you've ever known anyone who smokes, most of them will tell you that smoking doesn't make them feel good.

After years of smoking, most people develop a lingering cough and get out of breath easily. Most people don't even like smoking after they've been doing it for many years. But they'll continue to smoke. They often continue more out of fear of the withdrawal symptoms than any pleasurable effects from smoking.

As a society, we need to embrace the disease concept and stop treating addicted people like they are bad people. The only thing that treating them poorly accomplishes is to keep addicted people from getting the treatment and support they need to recover.

MSED, NCC, LPC
Counselor/Therapist

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