Letter to the Editor: Is addiction a choice or a disease?

To the Editor:

Being that there are approximately 21.5 million Americans that struggle with addiction each year, one would venture to say that substance abuse is a relevant topic in today’s world. Even more troubling, 80% of those same people also struggle with an issue with alcohol. 8 million people struggle with what is called a co-occurring disorder, or “double trouble.” One question that continues to raise many arguments though, is addiction a choice? Or, is it something more?

The National Institute on Drug Abuse (NIDA], says that addiction is hardwired into our brains. Brains are wired to ensure that we remember and repeat things associated with pleasure and rewards. But what most people don’t know, abusing drugs and/or alcohol can literally rewire the brain. Over stimulating our brain with drugs and/or alcohol produces euphoric effects which strongly reinforce the behavior of drug/alcohol use - thus, teaching the user to repeat it. Over time, the brain begins to produce less and less dopamine than it once did causing the person to use more and more to feel “normal” again.

The National Council on Alcoholism and Drug Dependence (NCADD), says that genetics make up about 50% of the reason a person becomes addicted. The other half is made up of environment, expectancies of what drinking and using drugs will do, and a person’s natural response to substances. All of the above will determine if a person becomes physically addicted or not. Of course, there are plenty of people that have a family origin riddled with addiction and rose above it and live happy, healthy lives. Then again, there are people with seemingly no substance abuse history in their family, yet they still somehow formed an addiction.

The definition of disease is a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury. The definition of addiction is a compulsive physiological need for and use of a habit-forming substance (such as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal.

I understand, many people will argue and say that the first initial drink or drug is a choice, and I wholeheartedly agree. But what about the folks that have never struggled with any type of substance abuse? For instance, someone that has a major surgery is prescribed narcotics and trusting that their doctor will make the best decision in treating them, they take them as directed and become physically dependent? Was it a choice for them?

Consider for a moment, for argument’s sake, diabetes. It is caused partly by genetics and partly by poor choices. Many major preventative diseases include cardiovascular diseases, hypertension, and certain cancers. Many of these diseases can even be reversed by a healthier lifestyle. So, why do we look at addiction any different? We don’t look at someone diagnosed with lung cancer as a bad person, so why should we be any different with a addict/alcoholic? And we certainly don’t start blaming them for “choosing” this.

So, is addiction a choice or a disease? The American Medical Association (AMA) and the World Health Organization (WHO) recognize substance addiction, including alcoholism, nicotine and drug addiction all as diseases. My belief is that it’s a very serious, life-threatening disease that if left untreated, will eventually lead to death.

Mark Jacobson
Peer Support Specialist
Winona, MN

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