He also points out an interesting exception; American military men who served in Vietnam showed an astonishing 40% rate of addiction to opiates following their use. One, the high rate of opiate addiction among Vietnam veterans highlights the fact that understanding a drug’s action at the neuronal level is not sufficient to account for the facts of drug abuse. Two, and this comes later in the book, opiate addiction in Vietnam veterans may have implications for the study of addiction https://northiowatoday.com/2025/01/27/sober-house-rules-what-you-should-know-before-moving-in/ in broader populations.
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. The view that substance addiction is a brain disease, although widely accepted in the neuroscience community, has become subject to acerbic criticism in recent years. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic. Here, we therefore address these criticisms, and in doing so provide a contemporary update of the brain disease view of addiction.
Is Addiction a Disease or a Choice? Debunking Common Misconceptions
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Stigma and Misconceptions
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Drug addiction. Is it a disease or is it based on choice? A review of Gene Heyman’s Addiction: A disorder of choice.
The notion of addiction as a brain disease is commonly criticized with the argument that a specific pathognomonic brain lesion has not been identified. Indeed, brain imaging findings in addiction (perhaps with the exception of extensive neurotoxic gray matter loss in advanced alcohol addiction) are nowhere near the level of specificity and sensitivity required of clinical diagnostic tests. However, this criticism neglects the fact that neuroimaging is not used to diagnose many neurologic and psychiatric disorders, including epilepsy, ALS, migraine, Huntington’s disease, bipolar disorder, or schizophrenia.
- The only implication of this, however, is that low average effect sizes of risk alleles in addiction necessitate larger study samples to construct polygenic scores that account for a large proportion of the known heritability.
- Some people who believe addiction is a choice also don’t take into consideration that some people are addicted to opioids because of a painkiller prescription that was given to them by their doctor.
- That does not in any way reflect a superordinate assumption that neuroscience will achieve global causality.
- Critics question the existence of compulsivity in addiction altogether 5–7, 89, typically using a literal interpretation, i.e., that a person who uses alcohol or drugs simply can not do otherwise.
- A key player in all this is the reward system, a network of brain regions activated by pleasurable experiences, including addictive behaviors and substance use.
- This affects their ability to make sound decisions and exercise self-control, perpetuating the cycle of addiction.
First, people may appear to remit spontaneously because they actually do, but also because of limited test–retest reliability of the diagnosis 31. This is obviously a diagnosis that, once met, by definition cannot truly remit. Lifetime alcohol dependence was indeed stable in individuals recruited from addiction treatment units, ~90% for women, and 95% for men. In contrast, in a community-based sample similar to that used in the NESARC 27, stability was only ~30% and 65% for women and men, respectively. The most important characteristic that determined diagnostic stability was severity.
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Another advantage to virtual therapy is that most types of insurance cover it. Tom Holden argued in his piece published in the CMAJ editorial that addiction wouldn’t meet the criteria for a disease. Holden claimed that addiction is not like a disease that’s contagious or can be transmitted. Also, he noted that addiction treatment is not the same as treatment for cancer. Addressing the root causes of addiction, such as poverty, trauma, and lack of access to healthcare, is also important. By addressing these underlying issues, we can reduce the risk of addiction and improve the overall well-being of individuals and communities.
Understanding these brain alterations helps clarify how addiction can be viewed as a chronic disease. A diagnosis of substance use disorder requires meeting two or more of these criteria within a 12-month period. The severity of the disorder is determined based on the number of criteria met, classifying the disorder as mild, moderate, or severe. This clear definition and criteria comprehensively frame the debate on whether addiction should be viewed as a disease.
Diagnosis was stable in severe, treatment-seeking cases, but not in general population cases of alcohol dependence. This disease model underscores the compulsive nature of addiction, driven by neurological changes, making it challenging for individuals to abstain without professional help. The disease model of addiction—based on a medical standpoint—classifies substance-use disorders as a chronic disease that needs ongoing management, much like diabetes or heart disease. According to this model, addiction is a brain disease that is often progressive and fatal if not treated. Even when someone enters recovery, these changes can impact the brain long-term, calling for professional addiction treatment that involves a whole-patient approach including medication and psychotherapy.
They worry that it might discourage individuals from believing in their ability to change. The truth is, addiction is a complex beast, born from a perfect storm of biological, psychological, and social factors. It’s not just about the substance itself, but about how that substance interacts with an individual’s unique makeup and life circumstances. Well, imagine trying to treat a broken leg with prayer or willpower alone. By recognizing addiction as a disease, we open the door to more effective treatments, reduced stigma, and a chance for millions to reclaim their lives from the clutches of substance abuse. Chapter 2 presents epidemiological findings about the development and characteristics of drug addiction.
The reason for this comes from three key points regarding how addiction affects an addict. The third point of note is that a person’s risk of addiction rises based on hereditary factors. If addiction were purely a choice, these three points would not exist altogether. Much of the argument that addiction is a choice stems from misconceptions about the types of people who suffer from addiction. This is tied to the stigma of addiction, which developed as a result of the individuals who were affected by addiction, such as people from specific social classes or ethnicities. Throughout history, substance abuse was most common among “lesser” classes and people with lower levels of education.
Whether it’s drugs, alcohol, sex, gambling, or any number of substances or activities, the addiction lies in repeated use despite awareness of the harm it’s causing. If opioid addiction is impacting your life or the life of someone you care about, reach out to our treatment center. We are here to provide the support and care you need to take the first step toward recovery.
If we continue to view addiction as a moral failure, we risk isolating those who need help the most. But if we embrace the disease model, we open the door to more compassionate, effective approaches to treatment and recovery. Support systems such as 12-step programs or peer recovery groups provide individuals with the connection and accountability they need to stay on track. Just like managing other chronic conditions, recovery from addiction involves setbacks and progress, making long-term support essential. Despite the scientific evidence, not everyone agrees that addiction should be classified as a disease. Some argue that labeling addiction as a disease removes personal responsibility, making it harder for individuals to recognize their role in recovery.
Clients work with licensed clinicians who are knowledgeable in treating these areas. Gambling disorder is a chronic mental health problem that can affect several aspects of an individual’s life. It develops into an addiction when the individual loses control of their gambling habits.
“I often ask about the reliability of the science when I am making decisions (in court).» Politics and pontification aside, am I really so sure that addiction is NOT a disease? I’m used to arguing cleverly that the «disease Living in a Sober House: Fundamental Rules concept» of addiction is really just a metaphor, and a sloppy one at that. It helps us refrain from beating ourselves up if we think we’ve got a disease.