Addiction: Disease or Personal Choice - Case Study Example

Addiction: Is it a Choice or a Disease Name Institution Course Date Addiction: Is it a Choice or a Disease? Addiction is an urgent public health emergency facing many societies. According to Buchman, Illes, and Reiner (2010), the urgency is that addiction as a human condition has been stigmatized along with mental illnesses. To reduce this stigma, many scientists have investigated the neurological reasons for addiction among humans (Hall, Carter & Morley, 2003). Recent neurological advances have suggested that addiction is a brain disease and that addicted brains have neurobiological differences (Nestler, 2005). However, there are contrary opinions, which suggest that addiction is a bad habit, a negative behavior or the result of lack of motivation (Lawn, 2011; Womer & Davis, 2013). Public perception on addiction has leaned towards choice argument rather when it comes to addictions positing that human behaviors are choices rather than diseases. The paper will compare arguments for and against addiction as a personal choice (pro-choice) versus disease (pro-disease) to prove that addiction is a disease. Moral Issues According to Womer and Davis (2013), there are moral claims that there is a rigid dichotomy between dependence and abuse. However, some scholars disagree with this assertion by claiming that addiction occurs in a continuum. The key difference is that the objections are based on the premise that an individual can move into addiction or out of addiction at any point in life. The continuum refers to the bio-psycho-social-spiritual model where the biological component shows the chemical impact and hereditary components associated with addiction, endorphin deficiency, and complex brain problems. The psychological component shows that the though process of addicted persons is different. People with addictions have irrational thought processes and symptoms of anxiety or depression. The social component shows that addictions have socio-economic consequences while the spiritual component shows that people with addictions have a sense of dependence where shame causes guilt and pain/suffering leads to more pain and stress which increases the risk of substance abuse (Womer & Davis, 2013). The moral perspective on addiction asserts that societal attitudes are based on human behaviors. These attitudes are influenced by the complex interactions among human beings and judgments on societal norms about certain behaviors. If a particular behavior contradicts these norms or appears to be foreign, the society would judge the person differently from others. People living with addiction face these judgments because their behavior is different from socially accepted norms (Link & Phelan, 2001; Stanbrook, 2012). They face marginalization, alienation, and stigmatization through loss of employment, social rejection, discrimination, and social alienation. Some authors posit that the marginalization, alienation, and stigmatization of people with addiction are due to society’s moral repulsion towards people living with infectious diseases (Buchman, Illes & Reiner, 2010). The drawback with this moral perspective is that it excludes people with addiction from engaging with the society. The repulsion against addiction causes members of the society to dissociate from addicted persons to prevent infection. Another reason for marginalization is the belief that addiction is a choice. The leaning towards addiction as a choice is based on society’s belief about the conscious and deliberate nature of addictive activities. This leaning emphasizes on the addict’s inability to stop pursuing the addiction (Schaler, 2009). For instance, a heroin user becomes an addict when he/she cannot stop self-injecting heroine. This belief causes people to marginalize persons with addiction because they perceive the addictive behavior as a choice, which could be changed or manipulated (Womer & David, 2013). The drawback of the pro-choice moral attitude is that it causes people to think that it can coerce addicts to change their behavior or make good choices. The strength of this moral approach is that it explains why human beings marginalize or isolate people who behave differently from the norm. Another drawback of the moral perspective is that it marginalizes people with addiction based on their behavior. As a result, the strengths-based approach was developed to address this weakness by teaching the practitioner to respect the rights of an individual to create and manage his destiny. It also teaches the medical practitioner to allow people with addictions to assume responsibility for their actions, such as reducing harm, making mistakes, or pursuing their own goals towards an addiction-free life (Womer & David, 2013). Medical Aspects Pro-disease supporters claim that addiction is caused by the brain’s response to addictive substances. Buchman, Illes, and Reiner (2010) posit that addiction has its origins in biology, neuroscience and pharmacology. They describe addiction as a neurobiological condition in their brain disease model. The model shows differences in the neurological identities of normal people and addicts. It shows that addicts have different neurobiological mechanisms for physical dependence (tolerance). The advantage of the brain disease model is that it proves that addiction is a disease since it is a neurobiological condition (Goldstein & Volkow, 2002). Secondly, the model provides a way for modeling language on addiction by implying that addiction is a brain disease and that people suffering from it need equal access to healthcare and compassion from the society just like those suffering from other medical diseases (Buchman, Illes & Reiner, 2010). This language has helped shift societal thinking about mental illness from the confusion caused by moral discourse of addicted persons. The strength of the pro-disease medical argument is that it emphasizes the need to address language concerning addiction so that addicted individuals can be recognized as people suffering from brain disease and socially accepted to reduce the stigma associated with addiction (Nestler, 2005). The second strength is that it provides a more humane response for addition. This response makes addiction less punitive and improves financial support for addiction treatment programs (Hall, Carter & Morley, 2003). Pharmacological Effects Addiction is a disease owing to its pharmacological effects on individuals. According to pro-disease proponents, alcohol is a disease because there have been advances in the management of alcohol and drug problems in the past 10 years (Jarvis, Tebbutt, Mattick & Shand, 2009). The increased interest in treatment philosophy among practitioners and researchers has broadened the range of pharmacological interventions for people who are at risk of affecting their health by using psychoactive substances such as alcohol and drugs. The strength of pro-disease interventions is that it seeks to help addicts to manage their conditions just as health care practitioners help patient deal with mental disorders. Moreover, developments in clinical pharmacotherapies suggest that addiction is a disease and not a choice. In addition, the developments in drug and alcohol treatments as well as national support by bodies such as the National Drug and Alcohol Research Centre (NDARC) have focused on the effectiveness of these treatments in reducing alcohol and substance abuse (Jarvis, Tebbutt, Mattick & Shand, 2009). The focus on addiction treatment shows that addiction is a disease that needs treatment and not a choice that an individual can make and unmake. Psychological Impact Pro-choice arguments oppose psychotherapy for patients. Proponents describe addictions as bad habits that can be overcome through willpower. For instance, Prochaska, Norcross, and DiClemente (2010) argue that an individual can quit smoking and recover from their addiction by following a six-step program. They assert that psychotherapy is not necessary for managing bad habits because individuals can be taught to overcome these habits by changing their climate, maintaining their positive motivation, turning their setbacks into growth, and making new good habits. Similarly, pro-choice arguments from Committee on Addictions of the Group for the Advancement of Psychiatry (2002) assert that addictions can be managed by making addicts aware of their addiction, understand the genetic predisposition of addiction, providing an adequate support network, balancing the need for substance abuse with the social cultural environment, and understanding the environmental impact on addiction. However, the Centre acknowledges that addiction needs medical treatments for chemical dependency to improve the addict’s tolerance to drug use. The premise of the pro-choice argument is that addictions are not permanent and can change if they have the willpower to modify negative habits (Lawn, 2011). The strength of pro-choice view is that it describes different ways in which practitioners can address the psychological impact of addiction on people. It promotes behavioral changes which would have a positive psychological impact on people with addictions such as maintaining a positive mindset, changing their environment and focusing on their progress rather than setbacks. The drawback of this approach is it propagates the societal perception that people who suffer from addictions are lazy and do not take responsibility for their actions (Prochaska, Norcross & DiClemente, 2010). It desensitizes the community from offering health care services (such as alcohol treatment centers) and compassion for people with addictions. On the other hand, pro-disease supporters posit that psychotherapy is necessary because addiction is a brain disease. They argue that the brain is a sensitive organ which is vulnerable to addictive substances such as drugs and alcohol (Urschel, 2010). The brain is vulnerable because alcohol and drugs disrupt the brain by damaging the memory center and the dopamine system (reward circuits). This damage magnifies problems for people with addictions and makes it difficult for them to cope with life issues. Supporters of psychotherapy for addiction (as a brain disease) liken the brain’s vulnerability to chronic mental diseases such as bipolar disorders and schizophrenia that need treatment, can recur when proper treatment is not administered, and that need to be managed throughout the patients’ lives. Pro-disease supporters claim that cognitive-behavioral therapy is an important intervention for people with addictions. This is because addiction is caused by cognitive impairments (Campbell, 2003). Cognitive therapies such as the twelve-step recovery program apply cognitive-behavioral therapy to treat the patients’ mood disorders, prevent relapse, and set goals for individual recovery (Urschel, 2010). Such programs combine a number of therapies for treating the cortex and limbic region of the brain. Therapies for cortex seek to improve the patient’s decision-making, rationalization, and reasoning. They include individual and family-based therapy, faith-based guidance, stress management, and alcoholics anonymous. Cognitive-behavioral psychotherapies for treating the limbic region seek to improve drive generation and include dual disorder medications and anti-addiction therapy (Hasman & Holm, 2004; Urschel, 2010). The strength of this approach is that it looks at addiction as a disease and psychotherapy as an intervention for helping people to recover from their addictions. It recognizes that addictions are a complex disorder associated with neurobiological dysregulation, nutritional deficits and dysfunctional behavior (Goldstein & Volkow, 2002). This recognition allows cognitive-behavioral psychotherapists to treat neurobiological dysregulation with pharmacotherapy, dysfunctional behavior with psychosocial treatments and nutritional deficits with dietary supplementation. Social Consequences Opinions on the social consequences of addiction are similar. Pro-choice supporters argue that the choice to become addicted has negative social consequences on individuals and the community (Schaler, 2009). One negative consequence is that an addiction progresses to other addictions. For instance, a social alcohol drinker can gradually become a heavy drinker while heavy drinking could also progress to substance abuse such as cocaine. Pro-disease supporters also agree on the negative social consequences of addiction. The difference between the two arguments is that pro-choice supporters posit that addictions can fade gradually. They argue that addictions such as heavy drinking can be moderated gradually by choice once the addict understands that his or her addiction is caused by fondness for something or someone. This fondness causes the addict to treat the thing or person as valuable or sacred. Arguments for choice suggest that addictions can be treated by showing the addict how to reduce their value for an activity or person from whom they derive pleasure (Committee on Addictions of the Group for the Advancement of Psychiatry, 2002). The strength of this pro-choice argument is that it attempts to simplify the reasons for addictive behavior. Secondly, the argument for choice acknowledges that addictions can have negative social consequences on the addict. The drawback of this argument is that it asserts that addictions are a part of human life (Levy, 2013). It does not provide mechanisms for choosing between right or wrong addictions. Moreover, this argument presumes that addictions make life fulfilling for people. This leaves the assumption that drinking fulfills an alcoholic’s needs and therefore indispensable. It does not explain how children and adolescents can differentiate between addictions, which are approved by society (virtues) and disapproved by society (vices) (Schaler, 2009). Lastly, pro-choice arguments do not recognize the difficulty experienced by addicts in quitting their addictive behavior and the self-control techniques that pro-disease supporters use to help addicts to quit (Gruber & Koszegi, 2011). Based on the arguments, addiction is a disease. Pro-choice scholars have argued that addiction is a choice rather than an in voluntary behavior. They reject neuro-scientific assertions that addiction is a disease or involuntary behavior because they believe these explanations create a false dichotomy (Lewis, 2011). Pro-choice arguments focus on the decision-making behavior of addicts but cannot explain why addicts make the choice to engage in an addictive behavior. These assertions do not have scientific basis like neuro-scientific studies, which describe addiction as a disease (White, Boyle, and Loveland, 2003). Addiction is a disease because there is diverse neuro-scientific literature supporting these claims. It is a chronic medical condition, which has been traced to compulsive disorders characterized by obsessions, anxiety, repetitive behaviors, and addictive activities to relieve the stress or anxiety (Moal & Koob, 2007). Addiction is a disease because chronic use of drugs and alcohol has irreversible effects on the users. For instance, chronic cocaine use affects the brain control mechanism by over-activating dopamine molecules and inhibiting transportation of neurotransmitter chemicals such as serotonin and neropinephrine. These changes affect the neural circuit of the brain and lower the brain’s ability to survive relapses (Nestler, 2005). Treatments for addictions depend on the addict. Some addicts benefit from outpatient programs while others benefit from inpatient programs, which combine detoxification, twelve-step programs, and cognitive behavioral psychotherapy. Cognitive-behavioral psychotherapy prescribes interventions for improving the cognitive centers of the brain and correcting cortex problems such as limited abstract thinking, impulse behavior and high primal drive (Simon, Mendez & Setlow, 2007). In addition, the psychotherapy helps correct problems with the limbic system by re-creating emotional connections, which previously associated substance abuse with pleasure. Looking at addiction as a disease helps counselors to understand why people with addictions find it hard to resist the urge to turn to alcohol, food, drugs or other addictive behaviors. It would also provide greater insight into the reasons why 12.5 percent of the American population has sought addiction treatment programs and why the success rate for addiction treatment is 30 percent or less (Urschel, 2010, p.23). This understanding also helps addicts to understand why they cannot control their addictions during therapy and why their risk of relapsing during recovery is very high considering that the success rate for addiction treatment. References Buchman, D. Z., Illes, J., & Reiner, P. B. (2010). The paradox of addiction neuroscience. Neuroethics, 1-12. doi:10.1007/s12152-010-9079-z Campbell, W. G. (2003). Addiction: A disease of volition caused by a cognitive impairment. Canadian Journal of Psychiatry, 48, 669-674. Committee on Addictions of the Group for the Advancement of Psychiatry. (2002). Responsibility and choice in addiction. Psychiatric Services, 53(6). doi:10.1176/appi.ps.53.6.707 Goldstein, R., & Volkow, N. D. (2002). Drug addiction and its underlying neurobiological basis: Neuroimaging evidence for the involvement of the frontal cortex. American Journal of Psychiatry, 159(10), 1642-1652. Gruber, J., & Koszegi, B. (2001). Is addiction “rational”? Theory and evidence. The Quarterly Journal of Economics, 116(4), 1261-1303. Hall, W., Carter, L., & Morley, K. (2003). Addiction, neuroscience and ethics. Addiction, 98, 867-870. Hasman, A., & Holm, S. (2004). Nicotine conjugate vaccine: Is there a right to a smoking future? Journal of Medical Ethics, 30, 344-345. doi:10.1136/jme.2002.001602 Jarvis, T.J., Tebbutt, J., Mattick, R. P. & Shand, F. (2009). Treatment approaches for alcohol and drug dependence: An introductory guide (2nd ed.). West Sussex, England: John Wiley and Sons. Lawn, S. (2011). Habit or addiction: The critical tension in deciding who should enforce hospital smoke-free policies. Canadian Medical Association Journal, 183(18), 2085-2086. Levy, N. (2013). Addiction is not a brain disease (and it matters). Frontiers in Psychiatry, 4(24), 1-7. Link, B., & Phelan, J. (2001). Conceptualizing stigma. Annual Review in Sociology, 27, 363-385. Moal, M., & Koob, G. (2007). Drug addiction: Pathways to the disease and pathophysiological perspectives. European Neuropsychopharmacology, 17, 377-393. Nestler, E. (2005). The neuroscience of cocaine addiction. Science & Practice Perspectives, 4-9. Prochaska, J., Norcross, J., & DiClemente, C. (2010). Changing for good: A revolutionary six-stage program for overcoming bad habits and moving your life positively forward. US: Harper Collins. Schaler, J. A. (2009). Addiction is a choice (7th ed.). Peru, IL: Open Court. Simon, N., Mendez, I., & Setlow, B. (2007). Cocaine exposure causes long-term increases in impulsive choice. Behavioral Neuroscience, 121(3), 543-549. Stanbrook, M. (2012). Addiction is a disease. We must change our attitudes towards addicts. Canadian Medical Association Journal, 184(2), doi: 10.1503/cmaj.111957 Urschel H. C. (2010). Healing the addicted brain: The revolutionary, science-based alcoholism and addiction recovery program. Naperville, IL: Sourcebooks. White, W., Boyle, M., & Loveland, D. (2003). Addiction as chronic disease: From rhetoric to clinical application. Alcoholism Treatment Quarterly, 3/4, 107-130. Wormer, K., & Davis, D. (2013). Addiction treatment: A strengths approach (3rd ed.). Belmont, CA: Brooks/Cole-Cengage Learning. Read More

Some authors posit that the marginalization, alienation, and stigmatization of people with addiction are due to society’s moral repulsion towards people living with infectious diseases (Buchman, Illes & Reiner, 2010). The drawback with this moral perspective is that it excludes people with addiction from engaging with the society. The repulsion against addiction causes members of the society to dissociate from addicted persons to prevent infection. Another reason for marginalization is the belief that addiction is a choice.

The leaning towards addiction as a choice is based on society’s belief about the conscious and deliberate nature of addictive activities. This leaning emphasizes on the addict’s inability to stop pursuing the addiction (Schaler, 2009). For instance, a heroin user becomes an addict when he/she cannot stop self-injecting heroine. This belief causes people to marginalize persons with addiction because they perceive the addictive behavior as a choice, which could be changed or manipulated (Womer & David, 2013).

The drawback of the pro-choice moral attitude is that it causes people to think that it can coerce addicts to change their behavior or make good choices. The strength of this moral approach is that it explains why human beings marginalize or isolate people who behave differently from the norm. Another drawback of the moral perspective is that it marginalizes people with addiction based on their behavior. As a result, the strengths-based approach was developed to address this weakness by teaching the practitioner to respect the rights of an individual to create and manage his destiny.

It also teaches the medical practitioner to allow people with addictions to assume responsibility for their actions, such as reducing harm, making mistakes, or pursuing their own goals towards an addiction-free life (Womer & David, 2013). Medical Aspects Pro-disease supporters claim that addiction is caused by the brain’s response to addictive substances. Buchman, Illes, and Reiner (2010) posit that addiction has its origins in biology, neuroscience and pharmacology. They describe addiction as a neurobiological condition in their brain disease model.

The model shows differences in the neurological identities of normal people and addicts. It shows that addicts have different neurobiological mechanisms for physical dependence (tolerance). The advantage of the brain disease model is that it proves that addiction is a disease since it is a neurobiological condition (Goldstein & Volkow, 2002). Secondly, the model provides a way for modeling language on addiction by implying that addiction is a brain disease and that people suffering from it need equal access to healthcare and compassion from the society just like those suffering from other medical diseases (Buchman, Illes & Reiner, 2010).

This language has helped shift societal thinking about mental illness from the confusion caused by moral discourse of addicted persons. The strength of the pro-disease medical argument is that it emphasizes the need to address language concerning addiction so that addicted individuals can be recognized as people suffering from brain disease and socially accepted to reduce the stigma associated with addiction (Nestler, 2005). The second strength is that it provides a more humane response for addition.

This response makes addiction less punitive and improves financial support for addiction treatment programs (Hall, Carter & Morley, 2003). Pharmacological Effects Addiction is a disease owing to its pharmacological effects on individuals. According to pro-disease proponents, alcohol is a disease because there have been advances in the management of alcohol and drug problems in the past 10 years (Jarvis, Tebbutt, Mattick & Shand, 2009). The increased interest in treatment philosophy among practitioners and researchers has broadened the range of pharmacological interventions for people who are at risk of affecting their health by using psychoactive substances such as alcohol and drugs.

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