Our overarching concern is that questionable arguments against the notion of addiction as a brain disease may harm patients, by impeding access to care, and slowing development of novel treatments. There are certainly still behavioral risk factors, which come down to an individual’s likelihood to actively seek out substances as new experiences and try drugs or overindulge in alcohol. Even then, many of these behavioral risk factors can be connected to environmental or biological triggers. All of these can greatly influence an individual to substance abuse and potential addiction. Recent studies over the past couple decades have brought evidence to question that understanding, and now the nature of addiction has become a common point of debate among specialists and the public itself.

It thus seems that, rather than negating a rationale for a disease view of addiction, the important implication of the polygenic nature of addiction risk is a very different one. Genome-wide association studies of complex traits have largely confirmed the century old “infinitisemal model” in which Fisher reconciled Mendelian and polygenic traits [51]. A key implication of this model is that genetic susceptibility for a complex, polygenic trait is continuously distributed in the population. This may seem antithetical to a view of addiction as a distinct disease category, but the contradiction is only apparent, and one that has long been familiar to quantitative genetics.

Is Drug Addiction a Disease or a Choice? The Final Verdict

Therefore, taking a drug produces a euphoric feeling, which in turn strongly reinforces drug-using behavior. When this happens, individuals can no longer voluntarily choose to not use drugs or alcohol, even if it means losing everything they once valued. Understanding the brain’s role in addiction can help break the stigma surrounding the illness — and encourage individuals to seek help.

Similar changes have been recorded when people fall in love, become obese, gamble compulsively, or overindulge on the internet. And as a developmental psychologist (my other hat), I see addiction as an attitude or self-concept that grows and crystallises with experience, often initiated by difficulties in childhood or adolescence. Indeed, addiction is in some ways like a disease, but that’s only half the story.

Addiction causes the brain to ask for more

However, when physically dependent and in a state of withdrawal, their choice preference would reverse [102]. This was later also found to be the case for heroin [103], methamphetamine [104] and alcohol [105]. Early residential laboratory studies on alcohol use disorder indeed revealed orderly operant control over alcohol consumption [106]. Furthermore, efficacy of treatment approaches such as contingency management, which provides systematic incentives for abstinence [107], supports the notion that behavioral choices in patients with addictions remain sensitive to reward contingencies.

Inevitably, that entails that we must ourselves come under scrutiny; perhaps we need to change as much as she does. Dysfunction accounts come in two varieties, corresponding to the two competing philosophical analyses of function. On a selectionist account, expounded most influentially by Millikan (1984), a dysfunction occurs when something fails to play the role for which it was selected in the evolutionary history of the organism.

The (in)Significance of the Addiction Debate

Genetic variations in specific genes offer an explanation of why some populations are so susceptible to alcoholism and others are not. To achieve this goal, we first discuss the nature of the disease concept itself, and why we believe it is important for the science and treatment of addiction. This is followed by a discussion of the main points raised when the notion of addiction as a brain disease has come under criticism. In the process of discussing these issues, we also address the common criticism that viewing addiction as a brain disease is a fully deterministic theory of addiction.

Addiction also involves the biological or psychological need or compulsion for a specific substance, such as alcohol, or an activity, such as gambling. Lewis isn’t a fan of the word “recovery” because he believes it implies that the addict will return to the life he was living prior to addiction. This is problematic for many people after active addiction because, for many, their use of drugs and alcohol was triggered by the state of their life at that time. Many people first used substances to “self-medicate” untreated mental health symptoms or to escape the uncomfortable feelings caused by difficult issues in their lives (e.g., divorce, job loss, financial difficulty, etc.). No one wants to return to that, which is why Lewis prefers not to infer that addicts should want to “recover” their old lives.

Substance addiction: cure or care?

Addiction does not occur because of moral weakness, a lack of willpower or an unwillingness to stop. This finding stems from decades of work investigating the effects of substance use on the brain. The Joint Commission for the Accreditation of Healthcare Organizations evaluates quality of care provided by healthcare organizations.

Addiction has three main characteristics that cause it to be considered a disease. First, it has a lifelong course characterized by frequent relapses, cross addiction and a common set of behavioral changes. Second, like other chronic medical disorders, genetics plays an important role is determining who is at risk to become addicted. Finally, there are effective medications that treat drug addiction by blocking the rewarding effects of drugs and decreasing drug cravings.

Arguments Against the Disease of Addiction

What begins as innocent experimentation can lead to a devastating substance use disorder. The reward prediction hypothesis seems to explain addiction by understanding Top 5 Questions to Ask Yourself When Choosing Sober House it as a pathology of reinforcement learning. When the system is operating as it should, dopaminergic activation attenuates in response to expected reward.

• After a while, the brain will need greater and greater amounts of dopamine to get the pleasurable experience or even feel « normal. » This is known as tolerance.
• This allows them to meet with addiction treatment specialists during the day and learn about how healthy coping mechanisms and sobriety.
• No connection is made between choice processes and rule following, so it is not clear how the major argument about the role of choice in drug abuse connects to the prevalence of rule following.