Addiction: Disease or Choice? Rethinking Recovery

I just read this really interesting article on addiction. It discussed whether addiction should be considered a disease or not. Click the link above to read it for free.

That is because, unlike diseases such as Alzheimer’s or bone cancer or Covid, personal choice does play a role, both in starting and ending drug use.

I’ve always had a hard time accepting that addiction is/was a disease. When I read the sentence that is quoted above, it clicked that that is why. There is personal choice in addiction. I’m not saying that making the socially acceptable choice is easy, but the choice is still there. I think this point is lost especially when people consider addiction a disease.

I think it’s also important to remember that while choice plays a part in the initial imbibing in addiction. But after that, the drug takes hold as you use it more and more. I think the choice becomes less of a factor. During my experiences with addiction, there were plenty of addicts that I met. Some of them were addicted to substances, some of them were addicted to other things. One thing I realized through my interactions with them is that many of them didn’t even realize they had an addiction. Many didn’t recognize their addiction. If they did, they certainly did not understand how to stop it.

When I was in treatment, we learned about something. I forgot the exact name, but it had the word “chain” in it. We had to go through a thought experiment. We wrote down every step we took from the urge to use through getting the product, to then using. Every step, from thinking, to grabbing the phone, sending a text or calling, getting in the car, going to the ATM, etc. Then we had to come to terms with the fact that at every step of the process, it is an opportunity to stop and re-evaluate our decisions.

The reason I bring this up, and have spoken about it previously is because I think it’s a crucial step in recovery. So many addicts I know are on auto-pilot. Even when confronted with the chain, they’re confused as to how it helps in recovery until explained in very simple terms. It’s almost like the autopilot doesn’t want to lose its job. The first decision to use is important because every time you decide to use after that, the decision is being made for you more and more. Eventually, you’re not even in the pilot’s seat anymore, but merely a passenger on the plane and that is a scary realization.

“I don’t think it helps to tell people they are chronically diseased and therefore incapable of change. Then what hope do we have?”

While addiction takes control, it takes making a choice to do something different that causes one to break free of the cycle. Without making the choice, the person won’t recover. One of the biggest lessons that the family members of someone with addiction must learn is that if the person is unwilling to change, they are not going to do it. They will not go into recovery. No matter how hard you try to convince them otherwise.

I think Smith is exactly right when she says that taking the choice out of the equation makes it a hopeless endeavor. It’s important to empower someone to change for the better, right? We shouldn’t diminish their ability to change just because it seems insurmountable. So did going to the moon at one point, right? Just like someone going to the moon, or climbing Mt. Everest, recovery requires a few things:

1. The choice to become healthier
2. Determination
3. Support network
4. Healthy coping mechanisms
5. Structure & Routine
6. Access to resources
7. Hope
8. Willingness to learn & grow

There are many other things that are needed in recovery, these are just some parallels between recovery and other insurmountable challenges. The reason I draw these parallels is to convey just how deeply difficult it is to turn from addiction.

I have a friend who went through many of the same addictions I’ve experienced, and they say they were able to turn away from addiction just by making the choice one day. That one day, they woke up and just stopped feeding their addiction. I read an article somewhere that said there is a sliver of a percentage of people that are able to such a thing, but for the majority of people it isn’t as simple.