Addiction is a Disease, Not a Choice

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Beer TapAddiction has been a problem in society ever since humans learned to brew mead oh so long ago, but we’ve only recently begun to really explore the mechanisms driving addiction and why it is so hard to abstain from our vices, specifically the behavioral control and cravings that drive people to relapse. As Dr. Dennis M. Shaughnessy put it, “it is one thing to quit, the problem is staying quit.” That understanding of addiction as not just a temporary issue with self-control but a life-long disease is very new compared to our detailed history of exploring addiction, but it also explains why users find themselves struggling with their addictions to gambling, drinking, drug use, and sex throughout their entire lives, even after years of abstinence.

While the social conversation about addiction usually addresses the behavioral problems we associate with addiction, it is in medical laboratories where we’ve really discovered that these behavioral problems are the manifestations of lurking disease that affects several areas of the brain, and the current American Society of Addiction Medicine (ASAM) definition of addiction reflects that.

The definition, established in 2011, states: “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.”

We must stop looking at addiction as simply a behavioral, social, or immoral condition. Dr. Shaughnessy explained the biomechanical conditions stemming from addiction that lead to behavioral problems on MyWestTexas.com recently, and I urge you to read his detailed portrayal of what is happening within the brain when addicts “act out”. But, if you have to cut it down to a simple fact, Dr. Raju Hajela puts it best when he said, “addiction is not a choice.”

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