Is Addiction a Choice, a Disease, or Both?

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Addiction is claiming the lives of people at an alarming rate. The Centers for Disease Control and Prevention (CDC) reported 33,091 deaths from opioids in 2015. This number is largely reflected by an increasing use of synthetic opioids and heroin.

The Clean Slate

After going through 12 Step Processes and other recovery treatments to eventually overcome addiction firsthand, Steven Slate, who authored an addiction site named “The Clean Slate,” is starting new conversations on how we approach addiction. Slate is most famous for his TED Talk speech on "Addiction Is A Choice." Through the TED Talk and his organization “The Clean Slate,” he is advocating a deeper look beyond the age old debate of addiction as a disease vs. addiction as a choice.

Slate's website states regarding the addiction as a disease theory:

The great debate of addiction as a matter of choice or disease is ongoing. Steven Slate's controversial approach to addiction may be just the thing we need to help us stop judging addicts once and for all.

"On the issue of ‘addiction,’ you will change it when you cease to believe that heavy drug and alcohol use is your best option for finding happiness. Work on changing that belief if you want to change your habit.

Believing in the ‘underlying causes of addiction’ (and/or ‘self-medication’) model creates a more complicated problem. If you invest in this idea, then every time life sends a problem your way, or when you feel the very normal emotions of sadness, depression, stress, or anxiety – then you will feel as if you must use drugs and alcohol. If you cease to believe that heavy drug or alcohol use is your best option for happiness then you will cease the heavy use of drugs and alcohol – regardless of whether you continue to face depression, stress, anxiety, etc."

His site continues with the answer to a challenge his "choice" theory often faces:

"You say addiction is a choice, so what do you suggest people do, use willpower to quit?
‘Addicts’ have no less or no more ‘willpower’ than anyone else. Every behavior that every person makes at any given time is, in a sense, an expression of willpower. ... Essentially, if you choose to think differently about drugs and alcohol, and about how they fit into your life and competing goals, then your desire for them will change."

Although this may sound outrageously optimistic to some, Slate’s perspective on the issue is relevant to every psychiatrist, doctor, clinician and addict who may be in treatment. His site poses (and answers) the most important question of all—is our approach towards diagnosing addicts making them feel empowered or leaving them feeling powerless?

Pros & Cons of Each Viewpoint

When researching articles of addiction as a disease, it accurately argues the brain's physical changes in response to a drug. Addiction is the malfunctioning of brain and nerve endings due to excessive dopamine levels. A normal brain would respond "happily" to pleasurable things such as good food, healthy relationships, and rewarding experiences. However, an addicted brain sends signals to nerve endings that there is something wrong. What would trigger "happy" feelings for a normal brain is no longer enough for the addicted brain.

The pros of the "addiction as a disease" argument is that it circumvents the demonization of the drug user. On the other hand, this judgment can also lead to addicts indulging in self-destructive behavior because they feel there is something innately wrong with them. This viewpoint also sends messages that addicts are at the mercy of something bigger than them, and it may leave them feeling like a helpless victim stuck in a never-ending cycle.

Alternatively, the "addiction as a choice" viewpoint rightfully defends the addict as a person of will. This attitude translates into empowerment, and can boost the user’s confidence and self-esteem as they conquer the most unfavorable circumstances, symptoms, and mindsets. On the down side, this outlook can encourage a lack of compassion for addicts because they "could have done better."

The Verdict

All arguments aside, this ongoing debate concerning addiction highlights a significant flaw in our system; rallying for a label may be prioritized above rallying for the success of an individual. Instead of focusing on why someone becomes an addict, we need to redirect the conversation to how an addict can heal. No matter why or how someone gets to this point in their lives, our only job as professionals, friends and family is to love them unconditionally. Not to judge their choices or debate the root of their addiction. If you or someone you love is an addict, remind them that they aren't alone. Browse our directory of treatment centers to find one that may be a good fit, or call 800-772-8219 to speak to a treatment specialist.

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