Addiction: Disease or Choice


By: Leah Steele, MSW, LCSW, MPH

As an LCSW (Licensed Clinical Social Worker) for nearly 20 years, I have treated a multitude of clients who have battled addiction throughout their lives. The reality of substance abuse dependency is that it is, in fact, a battle; a lifelong struggle to abstain. Recovery is a word that is used by addicts long after they make changes to become “clean”. Recovery indicates that an addict is aware that he/she suffers from a disease and that the effort involved in abstinence is a continual process. My belief in such process is the reason I was disturbed by an article posted on Facebook recently entitled, “Addiction Begins With A Choice That You Make, That’s Why It Isn’t A Disease”. This is my rebuttal:

Merriam-Webster defines disease as, “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms; a harmful development.”

That the development of a disease process can occur secondary to lifestyle choices has been shown to be an unequivocal truth. Poor choices DO lead to addiction, just as tobacco use sometimes leads to not only nicotine dependence but cancer and heart disease as well.

What makes addiction a disease are the same factors that make diabetes, cancer, heart disease, stroke and arthritis diseases: it is chronic; it is progressive; it impairs normal functioning, including behavioral and biological and it is potentially fatal if untreated; it may be the result of genetic predisposition and it is treatable but typically incurable. I should also note that, like other diseases, addiction is subject to relapse, which is defined as, “a recurrence of symptoms of a disease after a period of improvement.”

Addiction is a complex disease of the brain and the body, the hallmark of which is loss of control over the offending substance(s). However, because it is primarily driven by behavioral manifestations, we have a proclivity to believe that it is merely a consequence of poor choices easily remedied by better ones. Anyone suffering from addiction will tell you that this is not so easily accomplished, although this contention is likely to be viewed with skepticism.

Many in our society are understandably reluctant to conceive addiction as a disease, as doing so is paramount to condoning the behavior of the addict and effectively letting him/her, “off the hook.” Truth be told, it is not surprising that some addicts will – and do – avail themselves of the designation of their addiction as a disease as justification for their behavior. Nonetheless, acknowledging addiction as a disease confers upon those afflicted with the disease of addiction responsibility for seeking appropriate treatment, NOT an excuse for continuing to perpetuate their self-destructive behavior.

Sadly, the above article, and those like it, do a great disservice to the afflicted and the affected alike. Such tomes presuppose that those engaged in addictive behavior need merely discontinue the offending behavior, and Voila! Problem solved! However, abstinence is only part of the solution, and the contention that an alcoholic (or other addict) is suddenly, “cured,” by being confined to a jail cell is not only ludicrous, but intellectually dishonest. What invariably happens when said alcoholic is released from jail (assuming he or she survives that long without dying from withdrawals, if the disease has progressed to that critical point)? It is merely a matter of time before such an individual resumes his or her dysfunctional drinking. The cycle continues, and uninterrupted, it can invariably be expected to result in incarceration, institutionalization and/or death. This is directly attributable to the disease process of addiction.

While society doesn’t typically stigmatize and blame those afflicted with cancer, congenital diseases and the like, it is more likely to employ these practices in the case of those afflicted with addiction. However, while those afflicted with addiction should most certainly be held to account for their harmful behaviors to self and others, stigmatizing and blaming them does nothing to improve the situation for them or society at large.

In the final analysis, those of us who have experienced addiction firsthand as well as those who have lived with, worked with and/or treated those with addictions recognize that addiction is not only a bona fide disease of mind, body and spirit but one for which there is no cure. Indeed, total abstinence from mind-altering substances and rigorous adherence to the principles of recovery are typically required for healing to occur.

Addiction Begins With A Choice That You Make, That’s Why It Isn’t A Disease

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