July 10th, 2020

Is Drug Addiction a Disease?

Three orange pill bottles filled with differently shaped pills.

The Centers for Disease Control and Prevention (CDC) define chronic illness as, “Conditions that last one year or more and require ongoing medical attention, limit activities of daily living, or both.” Notice that this definition deals with the effects of the illness, rather than its cause. In that context, addiction is definitely an illness.

Kolmac Integrated Behavioral Health Center Counselor Rennie Grant and Kolmac Psychiatrist Dr. Tony Massey state, “the disease model of addiction doesn’t dispute [that addiction starts as a choice]. But once a substance is introduced, a new dynamic occurs that has to do with the complex reality of brain chemistry.” The way the brain forms dependencies to substance and subsequently dictates behavior is also a critical informant of whether addiction is a disease or a choice.

Below, we discuss in-depth the definition of addiction, reasons why addiction is considered a disease, how addiction is related to brain function, and where the disease model of addiction can fall short.

Why is addiction considered a disease?

Kolmac’s counselor Rennie Grant explains, “Initial behavior is the choice, the following consequence is the disease model.” To break down what this means, we’re going to discuss what influences people’s choices to use, as well as how the chemical consequences of substance use on the brain and body remove choices from the equation.

How addiction starts

There are many behavioral, socioeconomic, and even genetic factors that can make a person more likely to develop substance use disorder. A study supported by the National Institute on Drug Abuse (NIDA) found that the children of people with substance use issues are twice as likely to develop their own addiction. And the history of substance use in America has always been tightly linked to socioeconomics. Another study, supported by NIDA and the National Institute on Alcohol Abuse and Alcoholism, studied substance use progression factors prevalent in the United States. It found that “Socioeconomic disparities in access, utilization, and quality of mental health care services are well-noted between substance use prevalence and patterns.”

The disease model of addiction implies that addiction is like such ailments as heart disease and diabetes. Like those diseases, addiction may result from a combination of genetic factors and lifestyle choices. So while we can pinpoint lifestyle choices as an initiation to addiction, remember that these choices are not made independently of the person’s culture, environment, or opportunities.

How addiction functions

In the article “How Addiction Hijacks the Brain,” Harvard Mental Health Letter breaks down three features of the brain that encourage chronic addiction:

  • The pleasure principle: The brain processes all pleasure, regardless of originating stimuli, in the same way — by releasing a controlled amount of dopamine. Addictive substances, such as drugs and alcohol, cause a surge in the production of dopamine, flooding pleasure receptors. The article goes on to state that “the likelihood that the use of a drug will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release.” The pleasure principle is most closely associated with what causes drug and alcohol addiction, but it is not solely to blame.
  • The learning process: The learning process is defined by how surges in dopamine interact with glutamate, the neurotransmitter that is responsible for remembering the stimuli that cause pleasure. When the dopamine from substance use overwhelms the brain’s pleasure center, glutamate forms a memory of the environmental markers — this could be a smell, a place, or even an emotion.

    When a person encounters these markers, glutamate is also in charge of motivating the brain to seek out the same source of pleasure via cravings. This is where the idea of having free will is removed from the disease model of addiction, as your choice to continually seek out a substance becomes dictated by neurotransmitters.

  • Tolerance and compulsion: The brain is not naturally wired for the dopamine surges caused by drugs or alcohol, which, according to the article in Harvard Mental Health Letter, can produce “two to ten times the amount of dopamine that natural rewards do.” Repeated exposure to these dopamine surges can overwhelm the brain, causing it to shut down dopamine receptors, or to produce less dopamine in general. This is where compulsion comes in.

    Despite a lessening in dopamine production, glutamate still triggers the same intensity of cravings when confronted with the environmental markers, which urges those who have used narcotics to use more, and in larger amounts to satisfy the craving. This not only helps form addiction, but it can impede rehabilitation or induce relapse.

These chemical effects can lead to permanent changes in brain function, even after one-time use of a drug. This is why the CDC’s definition of chronic illness is so important to understanding addiction. It is not the presence of these neurotransmitters but their outcomes that can cause long-term addictive behavior.

Where the disease model of addiction falls short

While the disease model of addiction can provide a lot of insight into how addiction begins, and the complex workings of addiction in the body, it is not perfect.

Many people fear that labeling addiction as a disease would mean that people who have substance use disorders have no responsibility for their actions. This is not true. Addiction affects how the brain makes choices and what it prioritizes. However, addiction does not affect the ability to distinguish between right and wrong, or to recognize when your actions are harmful to yourself and others.

The disease model of addiction also doesn’t provide a standard or straightforward treatment plan. There is no one-size-fits-all way to treat substance use. Finding a treatment approach that works for you can be an exhausting process that takes time and resources, which can be intimidating to those currently using.

Is addiction a choice?

Many people may believe that addiction is not a disease but a choice. Someone must choose to use a substance, which effectively means choosing to become addicted, right? Not necessarily.

This attitude is based on the idea that people can control the systems in which they live, and the ways in which their brain responds to stimuli. People struggling with addiction have the responsibility to seek professional help, just as those with diabetes have the responsibility to seek insulin, or those with heart disease have the responsibility to improve their lifestyle, or even those with the flu have the responsibility to seek medical care. The state of a person’s health is not always a choice; however, one can choose to try to maintain or improve one’s health.

The disease model of addiction

Nowadays, many people, including many major mental health organizations — such as the Substance Abuse and Mental Health Services Administration — endorse the disease model of addiction because it takes into account the things that cannot be controlled, such as socioeconomic factors and brain chemistry responses. While some are hesitant to call addiction a disease because addicts seem to have choices, and the ability to “just say no,” Grant and Massey both agree that willpower is seldom enough to prevent or stop repeated substance use.

Addiction and substance use disorder are not fully understood, as they can be caused by a complex combination of factors and can affect each person differently. But it’s crucial to continue to learn more about how substance use is introduced to certain populations, and what changes it causes in the brain in order to effectively help those affected by addiction.

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