A never-ending debate among treatment professionals is over whether addiction is a choice or a disease.
Some say those who engage in substance abuse are in complete control over their actions. That’s the “choice and personal responsibility” theory. Others disagree. They feel the substance abuser has no control over this kind of harmful behavior. They believe the biology of addicts compels them to seek drugs. They follow the “neuroscience and disease” model. Which one is right?
Well, they both are. Habit formation and substance use are often intertwined.
With my clients, I typically like using the act of crossing the street as an example. In the United States, people look to the left before they cross the street. Why? Because our society taught us to do so. Over time, this pattern of looking left, right, and left again, becomes an automatic response, wired into the brain, that prevails over all other decision making efforts. In neuroscience we call this a “prepotent response.”
But looking to the left is the wrong response in a country where people drive on the other side of the road (like England). If you moved to such a country, you’d have to change your habit, which isn’t easy. It would require deliberate action (the decision to change) and ongoing practice (diligence). Only then could the brain rewire itself and create a new automatic response—and even that would take time. In the meantime, you’d be stuck with a habit that is dangerous to your survival but difficult to break.
How does this apply to the argument of whether addiction is a choice or a disease?
Substance use often begins as a simple rewarding experience, which through repetition and the rewiring of the brain’s learning and reward circuits can become habitual. If that habit escalates into problematic substance use, we can end up with something that our society has called addiction. Changing that automatic response would require a similar approach to the one it took to adjust our ritual of crossing the street: deliberate action (the decision to break the habit) and ongoing training (diligent adherence to a treatment program). Eventually, the brain would rewire itself and create a new, healthier automatic response.
You may have noticed something missing from that discussion, namely judgment. At Alternatives, we don’t wonder why clients behave the way they do any more than we wonder why they look left when crossing the street. In the end it comes down to learning, and if we want to end up with a different set of behaviors, we have to understand the mechanisms and processes that got us there and lay the groundwork for making a change.
Like I said, un-learning an automatic response isn’t easy. But it can be done. The brain is highly adaptable. If you work with it rather than against it, the brain will respond favorably.