The debate on whether addiction is a choice or a disease has spurned a number of controversial positions and the means with which to provide supporting evidence to the contention of whether addiction is a disease or a choice. Both sides have valid arguments in espousing that addiction is a choice and that it is a qualified disease (Hyman & Malenka, 2001).
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Moralists who take the philosophical view says that addiction is a choice because man is endowed with free will, and despite the obvious harmful consequences of substance abuse, man still willingly use the drug of choice (Schaler, 2000). Addiction is therefore not a disease because there is nothing wrong with the person, biological processes are not impaired and there is no immediate threat of death. Moreover, if addiction is a disease, then why it is that some addicts are able to stop and resume their lives normally.
The medical model does not offer a single explanation of why addiction is a disease. All signs point to the fact that it is the decision of the individual to start using a substance, that it is his choice to continue abusing a substance despite the harm it brings and it is also his choice to stop or to continue it.
Some of the treatment approaches of addiction have focused on it’s being a disease and hence treats drug abuse with other drugs, while a more effective approach would be to help the addict gain control over his life and the choices he makes (Schaler & Schaler, 1998).
The addiction is a choice groups have said that unless a person decides and is willing to stop his addiction, any treatment would be doomed to failure. Some psychotherapy approaches have emphasized the need of the addict to be internally motivated to change his behavior. This approach has been called motivational interviewing, and even if psychology is predisposed to accepting the medical view, this perspective says that addiction is a choice.
The medical model of addiction expresses the view that addiction is a disease. The argumentis backed by experimental studies of drug addiction in humans and animals. They say that addiction is caused by the process wherein drugs alter the components of neurons and receptors in the brain (Robinson & Kolb, 1999).
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Moreover, they say that genetics, environmental factors and physiological factors increases thepredisposition to addiction. In twin studies, it was found that those who had parent with a history of substance abuse were more likely to have depression and be addicted to a specific substance even if twins are reared apart (Tsuang, Lyons & Eisen, 1996).
The medical approach also espouses that treatment of addiction should be a combination of medical, psychological and social factors. The addiction is a disease position basically says that an addict no longer has the control and willpower to stop and change his behavior, because the prolonged use of drugs have reprogrammed his brain and body that craving for the addictive substance is similar to hunger, a physiological need that has to be satisfied.
It is my belief that addiction is a disease but it is not merely the alteration of neurological receptors but it is both a physiological and psychological addiction. It is evident that most substances abused and misused bring about different states of consciousness and psychological experiences. It is also true that for some substances, the addiction is psychological because it is the emotion, the quality of experience and the feeling of “high” that is craved for rather than the biological aspect.
And with this position, one can also argue that there is an element of choice in whether a person decides to be consumed by his/her addiction or not. If the addiction is driven by the need to cope with life’s difficulties, then choice was involved. Thus, the debate on whether addiction is a choice or a disease is the new nature and nurture paradox which would probably take years until the opposing views will be resolved.
Hyman, S. & Malenka, R. (2001). Addiction and the brain: The neurobiology of compulsion and
its persistence. National Review of Neuroscience, 2;10:695-703.
Robinson, T. & Kolb, B. (1999). Alterations in the morphology of dendrites and dendritic spines
in the nucleus accumbens and prefrontal cortex following repeated treatment with amphetamine or cocaine. European Journal of Neuroscience, 11;5:1598-1604.
Schaler, J. (2000). Addiction is a Choice. Chicago: Open Court.
Schaler, J. & Schaler, M. (eds). (1998). Smoking: Who has the right? New York: Prometheus
Tsuang, M., Lyons, M. & Eisen, S. (1996). Genetic influences on DSM-III-R drug abuse and
dependence: A study of 3,372 twin pairs. American Journal of Medical Genetics, 67;5: 473-477See More on Medical, Moralists