Is addiction a disease or choice

Many people view addiction as a moral failure. Therefore, whenever they see someone struggling with addiction, they may think that they’re too weak to do what’s right. But science disagrees.

Addiction is a complex brain disease that provokes a person to use drugs despite the consequences of their actions. Although their initial use may be voluntary, the subsequent processes occurring in their brains prompt them to increase their use.

Dr. Jillian Hardee from the University of Michigan clearly explained the scientific nature of addiction when she said, “Addiction is a chronic illness accompanied by significant changes in the brain. It does not occur because of moral weakness, a lack of willpower, or an unwillingness to stop.”

This is why you’ll see addicts dreading their actions yet seem to have no ability to resist a drug. But since they don’t understand its nature, some get wrapped up in shame and get deeper into addiction. Even worse is the stigma they experience from people who view them as mentally fragile.

But if you are in a position to help, you need to understand what you’re dealing with. So read on to find out how addiction affects the brain and choose what you can do about it.

3 Reasons Why Addiction Is a Disease, Not a Choice

The American Society of Addiction Medicine (ASAM), National Institute on Drug Abuse (NIDA), and other addiction authorities1 define addiction as a chronic but treatable medical disease that manifests in compulsive behaviors of seeking and using drugs regardless of its negative effects.

These addiction-conversant organizations don’t aim to alienate personal responsibility as Tim Holden, a psychiatrist, and professor claimed in a journal entry in 2012. They illustrate that while getting into addiction involves consent, the addiction process itself involves numerous complex processes that make up a severe disorder.2

So, addiction is a disease due to the following reasons:

It changes the functioning of the brain

Normally, the brain produces pleasure-causing chemicals after certain appealing activities such as sex, eating, and dancing among others. The production of these chemicals to certain extents is shaped by many things including our belief systems of what feels good and what doesn’t.

Therefore, when you use a drug for the first time and feel good about it, you naturally feel like doing it again. At this time, you aren’t an addict yet but as you continue rewarding yourself with these feel-good chemicals, an addiction develops.

Moreover, you need to realize that common addictive drugs release more pleasure chemicals than normal substances and activities.

As you continue using the drug, the functioning of the brain alters as a result of the changes in what feels like normal levels of pleasure. This is why you’ll see addicts increasing their dosages in an attempt to feel the same high they used to feel when their brain was used to the lower dosage.

But the tolerance keeps changing as the brain evolves and later, the addict might overdose as they try to restore the previous levels of ecstasy. This recurring loop is what makes addiction a disease needing expert treatment.

The cycle of addiction clearly defines the stages of this disease. If you were to get into alcohol addiction, the following are the stages of the addiction cycle you’ll go through:

  • Initial use: This could be in the form of a celebratory drink.
  • Abuse: This is the harmful use of a substance that can turn occasional drinking into binge drinking. You might land in this stage while trying to numb a certain pain.
  • Tolerance: Your body seems “immune” to the four beer bottles a day and needs more to make you high.
  • Dependence: Your body now depends on the daily intake to function optimally.
  • Addiction: Your brain prompts you to do anything so you can get the drug. Your willpower is deeply impaired that you find it challenging to rethink moral decisions where alcohol is involved.
  • Guilt: You’re plagued by guilt as morality thoughts kick in.
  • Cessation: The guilt is too much so you want to do the right thing. So you stop using the drug.
  • Relapse: A mistake happened and the relapse prevention measures you practiced weren’t effective. You get back to initial use and the addiction cycle begins again.
addiction cycle
Image by author

As you can see, the initial use of a substance isn’t entirely harmful. Furthermore, bingeing on a certain drug to alleviate issues like stress is quite common. But that simple action can spiral to addiction – a disease that can make you defy your strongest values.

The changes are long term

Even when an addict stops using a particular drug, the prior modifications in their brain don’t diminish instantly. They have to unlearn the thought patterns that are now deeply reinforced. And since their willpower is impaired, they’ll need support and care just like most patients in recovery.3 4

An addict who stopped using recently will have to go through withdrawal symptoms which could occur physically, mentally, and emotionally. This might get them back to the self-treatment they only knew of but if they get professional treatment, they might successfully stop addiction and mitigate the damages it has already done.

It’s similar to other diseases

Although many people don’t realize it, addiction doesn’t differ much from other diseases. However, because other disorders are more conventional than compulsive substance use, some people regard all cycles of addiction as a matter of choice.

Here are similarities between addiction and other diseases:

  • Like diabetes, heart disease, and other common diseases, addiction is hugely influenced by choices. When one doesn’t eat healthily, they might get heart disease and when one doesn’t stop self-treating stress with alcohol, they might develop an addiction.
  • It disturbs the functioning of the body mainly the brain just like other diseases disturb some main body organs.
  • It occurs in stages, progressing as time goes — the same happens for other diseases.
  • They are both are treatable.
  • Environmental factors can contribute to the development of addiction and other diseases.
  • Many diseases involve recovery and relapse (symptom recurrence) just like addiction does.

From addiction to recovery, components of addiction reveal it’s a disorder.5

Closing Thoughts

Addiction is a disease, not a choice. Although  one of its causes is the choice to indulge in an activity that involves dire consequences, it develops into a serious disorder. This is information many people need to understand so they can approach addiction treatment more effectively.

Moreover, if you have a loved one who is an addict, you need to help them get out of this disease to improve their quality of life. Instead of shaming them and constantly telling them to stop, determine the best treatment that mitigates their problem in the long term.

Addiction is a manageable disease like others. Find professional help and deal with it the right way.


1. Substance Abuse and Mental Health Services Administration, SAMHSA)

2. US National Library of Medicine

3. American Addiction Centers

4. Special Care

5. ASAM, NIDA, National Council of State Boards of Nursing (NCSBN), Recovery Research Institute)