Addiction is a disease: We must change our attitudes toward addicts PMC

Sober living

In support of this interpretation brain imaging studies often reveal differences between the brains of addicts and comparison groups (e.g., Volkow et al., 1997; Martin-Soelch et al., 2001) However, these studies are cross-sectional and the results are correlations. There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. For example, in a frequently referred to animal study, Robinson et al. (2001) found dendritic changes in the striatum and the prefrontal cortex of rats who had self-administered cocaine. They concluded that this was a “recipe for addiction.” However, they did not evaluate whether their findings with rodents applied to humans, nor did they even test if the dendritic modifications had anything to do with changes in preference for cocaine in their rats. In principle then it is possible that the drug-induced neural changes play little or no role in the persistence of drug use.

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is addiction a disease or choice debate

Hence, there is no theoretical obstacle to acknowledging the fact that thoughts, desires, values and other mental phenomena can dominate bodily functions. Suppose that a man’s mother dies, and he undergoes the agonizing trauma we call unbearable grief. There is no doubt that if we examine this man’s bodily processes we will find many physical changes, among them changes in his blood and stomach chemistry.

Online Gambling Addiction: the Relationship Between Internet Gambling and Disordered Gambling

is addiction a disease or choice debate

Of course, addicts may switch drugs rather than quit drugs, but other considerations indicate that this does not explain the trends displayed in Figure ​Figure1.1. For example, dependence on any illicit drug decreases markedly as a function of age, which would not be possible if addicts were switching from one drug to another (Heyman, 2013). Just as with all chronic diseases, addiction can never be fully “cured.” Commonly, addiction is compared to cancer where many people can go into “remission” but never be fully cured. As with unfortunate cancer diagnoses, people will addiction may relapse and return back into their addiction. Usually, this happens because of the long-term psychological effects that stay in the brain of someone with a substance use disorder. A relapse can be caused by various kinds of triggers that will vary from person to person.

  • Perhaps it will lose specificity as such, but since addiction is a highly heterogeneous disorder that requires an individual approach to the cause and course of the disease, it may very well be left more general.
  • Hence, the BDM holds the view that self-control is impaired, which is a reasonable conclusion.
  • The findings have persuaded experts and the public that drug use in addicts is compulsive.
  • It originates from within the scientific community itself, and asserts that this conceptualization is neither supported by data, nor helpful for people with substance use problems [4–8].

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This paper, too, has been exceptionally influential by academic standards, as witnessed by its ~3000 citations to date. What may be less appreciated among scientists is that its impact in the real world of addiction treatment has remained more limited, with large numbers of patients still not receiving evidence-based treatments. Addictive drugs change the brain, genetic studies show that alcoholism has a substantial heritability, and addiction is a persistent, destructive pattern of drug use (e.g., Cloninger, 1987; American Psychiatric Association, 1994; Robinson et al., 2001). In scientific journals and popular media outlets, these observations are cited as proof that “addiction is a chronic, relapsing brain disease, involving compulsive drug use” (e.g., Miller and Chappel, 1991; Leshner, 1999; Lubman et al., 2004; Quenqua, 2011). However, addiction is “disease-like” in the sense that it persists even though on balance its costs outweigh the benefits (e.g., most addicts eventually quit). Thus, in order to explain addiction, we need an account of voluntary behavior that predicts the persistence of activities that from a global bookkeeping perspective (e.g., long-term) are irrational.


Why does my 9-year-old know more about the risk factors for addiction than most college students? As a clinical psychologist specializing in evidence-based addiction treatment, I’m trying to raise addiction-resistant kids. I fully accept the likelihood that they will use alcohol or other drugs at some point.

But There is a Genetic Predisposition for Addiction

  • Importantly, he reminds us that drug abuse is a behavioral, or psychiatric, disorder.
  • This detracts from the discussion on what is likely meant by calling addiction involuntary, namely difficulty in controlling behaviour.
  • As the typical onset age for dependence on an illicit drug is about 20 (Kessler et al., 2005a), the results say that most people who become addicted to an illicit drug are “ex-addicts” by age 30.
  • Nonetheless, akin to the undefined overlap between hazardous use and SUD, the field has not identified the exact thresholds of SUD symptoms above which addiction would be definitively present.
  • This decision stems primarily from how addiction affects the brain by changing it, progressively forcing an individual to crave the drug until use eventually becomes an unconscious act rather than a conscious choice.

Discussing addiction-related capacities, especially regarding impaired control, rather than the assumed juxtaposition of the two models can be considered the true addiction debate. More insight into the extent to which the capacities of the addicted individual were affected would be highly useful in various other areas, especially legal responsibility. In this chapter Heyman also examines factors related to the incidence of drug abuse and finds several that support his view that drug abuse results from normal choice processes. Sober House For example, he notes that drug abusers tend to be unmarried, with the implication that presence of a marriage partner, that is, a potent source of social consequences, provides alternatives that can compete effectively with other alternatives like drugs. In an additional salvo against the disease model, Heyman notes that marriage is not protective with respect to several other psychiatric maladies including schizophrenia, depression, and obsessive compulsive disorder, among others (Robins & Regier, 1991).

  • Instead, it perpetuates a cycle of shame and guilt that can make it even more difficult for individuals to seek help.
  • This disease model underscores the compulsive nature of addiction, driven by neurological changes, making it challenging for individuals to abstain without professional help.
  • Thankfully, successful recovery is possible for people with substance use disorders, and many programs have been carefully created to help rebuild the parts of the brain that were damaged by drug misuse.
  • Regardless, however, of which estimates are correct, the absolute number of current and former addicts is very large.
  • Indeed, substance use is influenced both by the availability of alternative reinforcers, and the state of the organism.
  • Because assessing benefits in large patient groups over time is difficult, diagnostic thresholds are always subject to debate and adjustments.

Perhaps the most interesting proof of the curability of addiction came from a natural experiment, when soldiers returned home to America from Vietnam, where heroin use and addiction were widespread, affecting 15 to 35 percent of enlisted men. Heroin use was so common that soldiers were required to be tested for heroin addiction before being allowed to depart Vietnam. Consuming certain substances or engaging in certain activities is so pleasurable for some people they are driven to repeat the experience. Habits make behaviors near-automatic in response to any elements related to that activity—in other words, hard to control.

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