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Addiction Unveiled: A Multifaceted Phenomenon Beyond Disease or Choice

Addiction Unveiled: A Multifaceted Phenomenon Beyond Disease or Choice

In a world where lines blur between biology and behavior, where choices shape destinies and diseases strike unexpectedly, one question stands at the crossroads of science, ethics, and personal responsibility: Is addiction a disease carved into genetics or a series of choices etched by willpower? The most prevalent view of addiction today is that it is a disease - a chronic relapsing brain disorder (Vintiadis, 2018). While it is hard to deny that behaviors such as addiction have neural correlates and change brain chemistry, it is also hard to ignore the role of choice in addiction, given that addicts both choose to start using substances and quit. While both views express valid points, addiction should not be reduced to a mere matter of disease or choice; it is a combination of learned behavior influenced by many biological, sociological, psychological, and environmental factors.


Researchers of various disciplines have attempted to understand the nature of substance abuse for centuries, with the concept of addiction having evolved over time from moral and spiritual explanations to more scientific and medical understandings. During much of history, there was limited scientific understanding of addiction and its underlying mechanisms. As a result, societal perceptions of addiction were heavily influenced by moral and philosophical viewpoints. Excessive substance use was often seen as a moral failing and a lack of control. Although they may not have known it back then, future research would suggest that this lack of control was due to the changes in brain chemistry caused by using substances – a critical factor in both the disease and choice models.

According to Nathan et al. (2018), one of the first people to proposition addictions as a medical disease was Benjamin Rush, an American physician and member of the Constitutional Congress. Rush was an early and influential advocate of the idea that alcoholism is a medical condition rather than the result of poor choices or moral failure (Nathan et al., 2018, p. 32). 1748, Rush published the first edition of his famous pamphlet titled An Enquiry into the Effects of Spirituous Liquors upon the Human Body and Their Influence upon the Happiness of Society (Katcher, 1993). His goal in publishing this pamphlet was to inform the nation of the harmful effects of alcohol and to encourage abstinence. Although Rush wrote this pamphlet in a time of scientific limitations, he went into detail on the effects of alcohol on the body and mind, many of which are still relevant today.

Currently, the most prevalent and widely accepted model is the medical model, the Brain Disease Model of Addiction (BDMA). Most central psychiatric organizations, such as the National Institute on Drug Abuse (NIDA) and the American Society of Addiction Medicine (ASAM), support this model. NIDA is a reputable organization dedicated to advancing the scientific understanding of addiction and substance abuse. According to NIDA (2020), addiction is characterized as a persistent, recurring condition marked by the uncontrolled pursuit and consumption of drugs, even in the face of detrimental outcomes. This is recognized as a neurological disorder since it entails alterations in brain circuits related to reward, stress, and self-regulation. These alterations may endure long after an individual has ceased drug use (NIDA, 2020, para. 1). This definition underscores addiction as an intricate condition that affects both behavior and the brain, emphasizing the role of neurobiology in addiction's development and persistence. It also highlights the chronic nature of addiction and its potential for relapse.

Another way people portray addiction is that it is a choice, a view often referred to as the Moral Model of Addiction. This perspective posits that the primary reason for addiction lies in an individual's intrinsic moral shortcomings and a deficiency in self-control. Despite a lack of supporting evidence, this perspective has been extended to specific communities and even racial groups. This form of moral judgment often links substance use and 'addiction' to sinful or malevolent behavior (YouthAUD Toolbox, n.d.). When individuals with problematic drug use perceive themselves as inherently flawed or devoid of worth, they often encounter little challenge in locating validating proof for these beliefs. This further strengthens the inclination of many individuals dealing with substance issues to blame themselves, harbor self-loathing, and experience an acute sense of powerlessness. These convictions can instill a sense of 'learned helplessness' and hinder the potential for authentic transformation by diminishing their motivation.

Another notion about addiction is that it depends on learned behaviors and perception of rewards. This perspective is often defined as the Learning Model of Addiction. The core concepts of this perspective emphasize that drug use is acquired through learning and serves a purpose. This model focuses on how the environment, the individual, and the substances interact to comprehend the intricate nature of substance-related experiences (YouthAUD Toolbox, n.d.). It does not consider any single factor adequate for comprehending drug use or the challenges individuals or society face. In this model, addictive behavior is acquired and reinforced through influences from peers, parents, partners, and the media. The decision to use substances is seen as weighing out the rewards and costs, considering factors related to the drug itself, the individual, and the surrounding environment.

Addiction’s Multifaceted Explanation

The primary notion of those who believe addiction to be a disease is that addictive drugs change brain chemistry, addiction is substantially heritable, and substance use disorders are highly heritable (Cloninger, 1987; American et al., 1994; Robinson et al., 2001, As cited in Heyman, 2013). These notions are cited as proof that addiction is a disease. It is true that when a person repeatedly uses a drug, neural processes and chemical reactions cause lasting brain changes; however, these changes are not the hallmarks of a disease.

Nora Volkow, one of the most prevalent advocates for the BDMA, claimed that, much like addiction, obesity should be considered a brain disease, given that consuming high-calorie food triggers a rapid dopamine surge in the brain's reward system (Heather et al., 2013). Over time, this overrides the body's natural regulation of food intake, causing persistent alterations in brain structure and function. These changes result in a lack of control over overeating. This model is backed by evidence showing that obesity is linked to brain changes related to reward sensitivity, motivation, and self-control, which resemble those seen in addiction (Volkow et al., 2013, As cited in Heather et al., 2018). The BDMA posits that brain changes leading to addiction occur following repeated use of addictive substances. These changes are distinct from regular, repeated consumption of natural rewards like food, warmth, and sex.

This suggests that not all repetitive behaviors result in the same brain alterations associated with addiction. So, proposing that comparable brain changes could occur with repeated exposure to food means moving away from the previous assertion that addictive drugs uniquely cause brain disease in vulnerable individuals when consumed excessively. Therefore, saying that brain changes are proof that addiction is a disease seems highly inaccurate.

Furthermore, the role of choice in addiction has sparked extensive debate among researchers. In his book Addiction: A Disorder of Choice, Gene Heyman (2009) argued that addiction stems from natural processes involving voluntary behavior, specifically, choice (Branch, 2011, para. 2). Heyman (2009) contended that individuals do not choose to develop an addiction, but they do choose to continue daily drug use. Additionally, Heyman presented robust evidence that around 80% of people who become addicted to substances recover by 30 (Heyman, 2013). The exact correlates involved in quitting drugs are the very correlates that contribute to the decision to start using drugs. This further supports the claim that brain changes involved with substance abuse are not attributable to addiction.

Although addiction includes several biological factors, it is not enough to say it is a disease. Additionally, choice does play a significant role in addiction. However, those choices depend on a complex combination of other factors and motivations. In contrast to the disease and moral models, the biopsychosocial model offers a holistic and comprehensive framework for grasping the essence of addiction. This model recognizes a multitude of factors that heighten an individual's susceptibility to addiction, encompassing them within its scope (Giordano, 2021). Those who have embraced this viewpoint on the nature of addiction acknowledge the intricate nature of the condition and are more inclined to offer well-rounded explanations that include but are not limited to biological, social, and psychological factors.

When considering biological factors, it is important to include genetics, developmental stage, gender, and ethnicity. According to Giordano (2021), an expert in addiction counseling and associate professor at the University of Georgia, research including twin studies, adoption studies, family studies, and, more recently, epigenetic studies indicates a genetic component in addiction. All these factors are pivotal in whether a person develops an addiction.

Psychological factors include personality traits like a propensity for seeking sensations and impulsive behavior, mental disorders like anxiety or depression, psychological concepts like self-esteem and self-worth, and the influence of life experiences, including exposure to traumatic events (Giordano, 2021). These psychological factors can determine the onset and severity of addiction and predict the likelihood of recovery.

Social factors encompass various elements, including the environment, prevailing social norms, substance availability and legality, role modeling, personal expectations, societal acceptance, and cultural beliefs (Giordano, 2021). These factors, when intertwined, contribute to the distinctiveness of each addiction case among different individuals.


In conclusion, the debate over whether addiction is solely a disease or a matter of choice is far too simplistic to encapsulate the complex nature of this phenomenon. Instead, as explored throughout this essay, addiction is a multifaceted issue intricately woven from a tapestry of biological, social, psychological, and environmental factors. It defies categorization into a neat box, demanding a nuanced understanding that transcends traditional boundaries.

Biologically, genetic predispositions and neurobiological changes play a significant role, but they do not tell the entire story. Social factors, encompassing the influence of the environment, societal norms, and cultural beliefs, deeply affect addiction's development and progression. Psychological factors, including personality traits and mental health conditions, contribute to the intricate web of addiction. Environmental factors, such as availability and accessibility, create fertile ground for addictive behaviors to flourish. Moreover, learned behaviors and life experiences are pivotal in shaping addiction trajectories, often leading individuals toward patterns of use and dependence.

Moving forward with understanding addiction, it is crucial to acknowledge this complexity and foster a more holistic approach to prevention and treatment. Future directions should prioritize interdisciplinary research that explores the interplay of these factors, seeking to unravel the intricate mechanisms underpinning addiction. Moreover, it is essential to emphasize education and public awareness to promote informed choices and reduce addiction stigma. Doing so will create a more effective intervention that recognizes addiction's multifaceted nature and provides hope for those who grapple with its challenges. Ultimately, one can genuinely address addiction's intricate and evolving landscape through a comprehensive understanding and compassionate response.


Branch, M.N. (2011). Drug Addiction. Is it a disease, or is it based on choice? A review of Gene Heyman’s addiction: A Disorder of Choice. Journal of the Experimental Analysis of Behavior, 95(2), 263-267.

Giordano, A.L. (2021). What exactly is the biopsychosocial model of addiction? Psychology Today.

Heather, N., Best, D., Kawalek, A., Field, M., Lewis, M., Rotgers, F., Wiers, R.W., & Heim, D. (2018). Challenging the brain disease model of addiction: European launch of the addiction theory network. Addiction Research and Theory, 26(4), 249-255.

Heyman, G.M. (2013). Addiction and choice: theory and new data. Frontiers in Psychiatry, 4(31).

Katcher, B.S. (1993). Benjamin Rush's Educational Campaign against Hard Drinking. American Journal of Public Health, 83(2).

Nathan, P.E., Conrad, M. & Skinstad, A.H. (2015). History of the Concept of Addiction. In The Annual Review of Clinical Psychology.

NIDA (2020). Drug misuse and addiction. National Institutes on Drug Abuse.

Vintiadis, E. (2018). Is addiction a disease? Scientific American Mind, 29(22), 47-50.

YouthAOD Toolbox (n.d.) Introduction to Understanding AOD Use. YouthAOD Toolbox. Retrieved January 20th, 2023, from

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