The nature of addiction as a disease of choice

The debate continues as to whether or not Substance use Disorder (or addiction / dependence) is to be considered a disease. On the one side, individuals claim that substance use is a behavior. Since it is a behavior, it is therefore possible to consider that it is a choice. On the other side, there are those who hold to the disease model of substance use that leads toward poor choices.

The founders of Alcoholics Anonymous focused on how alcoholism was a disease. In Chapter 2 of the Big Book, it is referred to as an illness.

We read this section from the Doctor’s Opinion:

We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.

Whether we refer to substance use disorder as an illness, an allergy, or a disease, we ought to contend with the idea of how people come to see addiction as a choice rather than a disease.

Choice argument

The foundation of this argument rests on the idea of volition. As human beings, we have a moral ability to make choices. This includes whether or not we choose to drink and use. In the  documentary, Pleasure Unwoventhe scene is a saloon in the wild west. An alcoholic has a shot of whiskey placed before him. He is given the choice to drink. If he chooses to drink, he may very well be shot. Or, he has the choice to not drink and save his life.

Understanding the Disease Model

What makes it a disease? Today, modern medical science treats specific issues from the disease model.

The American Society of Addiction Medicine also provides this definition:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

This is where we come to understand how individuals succumb to a lifestyle where they are powerless and are incapable of managing their own life. The myth people attach to the disease model is that it diminishes human accountability and responsibility. It recognizes the powerful pull of substance use in the life of the individual suffering.

A Spiritual Disease of Choice

Substance use is more than a disease of choice that impacts human behavior. It is also a spiritual disease in the lives of those suffering. What this means is that a person loses their understanding of meaning and purpose. They lose understanding of values and beliefs that help guide them. An individual literally becomes enslaved to their own illness.  As a person enters into recovery, they realize that they struggle to make appropriate and healthy choices. They deal with strong cravings that influence their ability to make decisions. An individual needs a greater power than themselves to bring them back to a place of sanity, restoration, and peace of mind.

Diseases that are choice based

When we discuss the issue of whether addiction is a choice, based on evidence of behavior, or a disease that influences one’s behavior; we tend to see the comparison of substance use with those diseases of diabetes, cancer, sexually transmitted diseases. If we were to keep with the understanding of the choice argument, we may very well also relegate type II Diabetes, Cancer, and STD’s as choices. They all involve behavior.

All behavior begins with choice, and therefore, we may conclude that a person is capable of choosing whether or not they contract diabetes, cancer, and STD’s. The issue (and probably the reason these are referred to as diseases) is that many of them stem from some form of addiction. Unless treated properly, the individual will suffer. Therefore, the Rx for these diseases is to seek out appropriate treatment in order to live a healthier lifestyle that promotes healthier choices.


Is addiction a matter of choice or a disease? The medical evidence we have show that substance use disorder is a disease and that this influences one’s choice. It influences our ability to choose because all behavior stems from our own thoughts and feelings. Here, we come to understand that substance use of alcohol and/or drugs really are mind and mood altering as they affect the way the brain’s neurotransmitters operate.

However, this does not excuse the individual from being accountable and responsible for their own behavior. Part of a healthy recovery is to come to terms with the negative impact substance use has caused in an individuals life and to seek forgiveness by confessing and taking responsibility for their actions.