8 In the U.S., an estimated 14.8 million adults had an alcohol use disorder (AUD) in 2018. So if your contention is that any condition acquired by choices is not a disease, then you are wrong. The good news is that even the most severe, chronic form of the disorder can be manageable, usually with long-term treatment and continued monitoring and support for recovery. Your theory that substance addiction is not a disease is not supported by the definition of disease: “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” Meriam Webster’s online dictionary. The fact is that you can make the choices that develop cancer, but then the cancer has a life of it’s own, and you can’t choose to not have it in an instant. Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine. But every now and then I’ll take one. When using that drug is all you can think about and is all you do, then of course you’ll be branded as an addict, or as some put it, “recreational user”. Some day he will be unable to imagine life either with alcohol or without it. But what comes after detoxification is simply personal choices, and treatment programs actually discourage productive personal choices by attempting to control people and feeding them nonsense such as the disease theory and idea of powerlessness. I haven’t denied this. 2. The reality is that they can control themselves, but they just happen to see substance use as the best option for happiness available to them at the times when they’re abusing substances. Think about that possibility. Thus, drug-induced neural plasticity does not prevent quitting. I haven’t said that people make the choices that cause the disease of addiction. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs. Note that I have not attacked you personally, but I have found unwarranted personal attacks come from someone who has run out of arguments, often small minded people, the ones Randy Newman sung about (“Short People”) so long ago. If we’re trying to treat a disease, we are approaching substance use problems in the wrong way. Then he will know loneliness such as few do. I’ve lived it. To be clear I pass no judgment on these individuals in saying this. Here, Sharon Begley describes neuroplasticity: [2]. Sam Harris is wrong. That’s actually not true. It seems that you take a naïve or overly simplistic position here. Can an addict decide they not only want to quit but they want to become a brain surgeon and if they don’t it’s a matter of them not trying hard enough? The disease model of addiction describes an addiction as a disease with biological, neurological, genetic, and environmental sources of origin. In fact, each highly rewarding experience builds its own network of synapses in and around the NAC, and that network sends a signal to the midbrain: I’m anticipating x, so send up some dopamine, right now! Roisin Kiberd. It all starts with the fact that free will is not as strong as you think it is. Like the article shows, it does not have the characteristics common to a disease. What sane person would order a pizza cold with no toppings? Who are we going to believe? Hopefully though, you will find some information that helps you to believe that change is possible for you - that it is within reach. If so, I applaud your efforts. I think you could in fact find many a diabetic patient who has not “ceased any activity” to halt the progression of their disease or keep at bay the many complications that are more likely to result from poorly controlled diabetes, and any number of patients with COPD who do perpetuate their disease due to continued smoking. And then throw in the growing pain management clinics , whose sole job is to keep you on drugs or to offer an alternative, suboxone or methadone, both equally addictive. As I changed those ideas, things started to work better. Others argue that addiction is not a disease because some people with addiction get better without treatment. Is it all a choice because it is an addiction. My position IS that people are never truly addicted at any point. But again, I don’t personally think substance use is shame-worthy. I think you mean that those brain changes are predictable. But wait… there’s more! If the taxi driver became obsessed with learning and following route to the detriment of his health (eg: OCD) then that would be different: context is needed. Again, screaming at me about things like this when you could easily find out that I’ve walked in the shoes of an addict just makes your ignorant retorts that much more laughable. It’s the keystone of every 12-step program, an addict of the same kind can best understand another, that is why there isn’t just one 12-step program. I don’t expect myself to always be perfect, nor do I consider my mistakes as permanent stains on my character. I am a homosexual man. CHOOSE to quit (yes much harder with horrible habits) and your brain will REVERT to near normal. Did you miss the part that says the author is a former addict? Addiction is also considered a disease because it can cause changes to the brain. But let’s assume I am an SJW. I’ve sensed discovered that waves of “clean and sober” bliss are far more rewarding than whatever high I might have had with Jack and Mary. As with Marc Lewis, I suspect that Peter Cohen and I might have some substantial disagreements about the full nature of addiction and human behavior in general, but I think we at least agree that the changes in the brain of an “addict” do not necessarily represent disease, and more likely represent a routine process. I say the substance alters the brain by its interaction with the brain. Also, continuation of learned behavior may be functional in the eyes and experience of the person but less so in the eyes of the outsider. One person may have strong compulsions, or shame, or something else, and another may not. Addiction is a treatable disease. I am not alone in having bad experiences with addiction treatment and rejecting it’s views. I unfolded the wax bags the heroin came in, dumped the powder into a spoon, and mixed them up with water then injected them, without ever technically touching them. A specific area of the brain’s hippocampus is associated with creating directional memories and a mental map of the environment. There is too much to unpack within what people believe is contained in the statement “choose to change.” I have tried to address some of that here in the past, but I realize this article is not the place to do that. Do you actually expect me to reprint that in a blog post? It requires medicine or a fluke of a miracle to reverse/stop the progression. I have a family member with an addiction and now understand their struggle, and why enabling only makes it worse for the user. Don’t want a methadone clinic in your neighborhood? Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. According to the National Health Service in the UK, an estimated 70% of people with alcohol-related liver disease suffer from alcohol dependency. When they get that ‘urge to use’ (ie. They talked to counselors. People with cancer that is caused by chemicals(CARCINOGENS) made a choice to smoke but did not make a choice to have cancer. Nor do I have only 3 professionals who agree – here is a list of 94 signatories to a statement rejecting the brain disease model of addiction, published in the Journal Nature – Addiction: not just brain malfunction. I started questioning the possible motives for such an opinion. That's nuts. I don’t expect people to snap their fingers and cease to feel addicted/attracted to substances. Most people who engage in substance use do not develop addiction. I consider this being human. If someone dedicated a large portion of their life to seeking and using drugs, and their brain didn’t change – then that would be a true abnormality. Getting involved and connected to healthy things and activities that help the brain to build new pathways is the right answer. Would you inject yourself with a needle filled with drugs? In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. And in truth, all the brain disease jargon aside, when I first felt I needed to reach out for ‘help’ with my ‘addiction’, I wish someone would have convinced me of the rubber duckeys, would have been more efficient, less time consuming by far. What sane person would purposefully hike Mount Everest? Good day to you sir, and stay sober. The ones repeating the “disease” model just use it as a reason they CAN’T help themselves. First, most addicts quit. )- he (Gene Heyman PhD) said this, as of 2013: There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. I just saw a medical doctor this morning and mentioned this website and philosophy to him. Here's my critical analysis of the brain disease model of addiction. Just call yourself lucky that you grew up in an environment that gave you the opportunity to be strong willed enough to not touch drugs. The individual may experience intense desires or cravings for the substance and will continue to use it despite harmful or dangerous consequences. EVERYONES brain changes with habits and mere repetitive thoughts! He notes that they start with assumptions that certain patterns of behavior (e.g. Ultimately, Sam Harris’s case against free will rests on what many have realized is a misinterpetation of Benjamin Libet’s experiments. Beautifully stated. But that doesn’t make it a disease. I am only looking to explain the nature of a relentless desire for substance use. That’s wonderful – but it also means that the NIDA’s assertions that “Addiction means being unable to quit, even in the face of negative consequences”(LINK) and “It is considered a brain disease because drugs change the brain… These brain changes… can lead to the harmful behaviors seen in people who abuse drugs” are dead wrong. The problem is believing their effects to be extremely meaningful. Addiction to alcohol = all of your organs will be damaged over time. I originally published this article on September 25, 2010. A team of researchers scanned the brains of London taxi drivers and compared their brains to non-taxi drivers. A condition?? That is the point of this article. By Marc Lewis. But we wouldn’t want to call learning a disease. Probably not since psychologically you know the consequence of doing it. Your arguments have validity, but there are so many factors that are in play here. The psychiatric establishment and rehab industry in the Western world have branded addiction a brain disease. Addiction involves changes in the functioning of the brain and body due to persistent use of nicotine, alcohol and/or other substances. Is there a really difference between an involuntary act or lacking the will power to just say no? Addiction is a Disorder, not a Disease. at me about things like this when you could easily find out that I’ve walked in the shoes of an addict just makes your ignorant retorts that much more laughable.”. Again, your anger is going is probably already consuming you. A full year after the program, the voucher group had double the success rate of those who received only counseling (80% to 40%, respectively). CASAColumbia. That’s what the disease recovery culture does, de facto, when they present the false dichotomy of ‘diseased or bad’. Others argue that addiction is not a disease because some people with addiction get better without treatment. But the new diseases wouldn’t stop there. Its like being on a never ending episode of the twilight zone. Many nurses remain silent about their addiction to mood-altering substances for a number of reasons. The human belief system is incredibly powerful. They also CHOOSE to exchange sexual favors for their drugs. In conclusion, after reviewing the available research from both sides of the debate, the belief in the disease of alcoholism (addiction), causes the disease. A person never chooses which thoughts occur in his mind. It means only that I chose to drive to the store for some food. I can’t stress the significance of this enough: their brains were not medically treated. And the longer you use drugs, the more your brain changes. You stand by your argument as if you are the sole authority on substance abuse, ie the disease of addiction. We have to do better about allowing people to feel they have the right to feel sorry for themselves for choices that they make. I have dealt with it firsthand. Regarding your earlier post, it was AA that put forth the disease theory of addiction. I wrote a 450 page book fully explaining addiction and quitting in depth. A disease is what happens in the body as a result of those choices. In this way, they are saying the disease is a product of routine neuroplastic processes. No single treatment is appropriate for everyone. Explains the disease of alcoholism and addiction very well. My husband (a doctor with two college degrees and 18 years of practice), is doubled boarded in emergency medicine and addiction medicine. To categorize addiction as a disease is an insult to those with muscular dystrophy, cystic fibrosis, cancer, diabetes and thousands of other diseases, for which there is no known cure. Addiction is NOT a disease, but can be the cause of some diseases. Addiction Center does not endorse any treatment facility or guarantee the quality of care provided, or the results to be achieved, by any treatment facility. I do not think this. Some people just choose to use drugs. I still see anger and vitriol in your posts, not unlike Mr. Slate’s. On my FAQs page I make a big point against this argument, it starts out like this with me paraphrasing people who express that position sincerely thinking they are in agreement with me: “I agree with you Steven, people choose to get addicted. I made a choice to stop point-blank, and then I did. There are alternative views and methods of change which I hope you’ll take the time to learn about on The Clean Slate Addiction Site. To say that addiction is chosen behavior is simply to make a statement about whether the behavior is within the control of the individual – it is not a judgment of the morality of the behavior or the individual choosing it. Research shows that the offer of this choice leads to cessation of substance abuse. 2) Sharon Begley, Scans of Monks’ Brains Show Meditation Alters Structure, Functioning, Wall Street Journal, November 5, 2004; Page B1, 3) Gene Heyman, Addiction: A Disorder of Choice, Harvard University Press, 2009, 4) Sharon Begley and Jeffrey Schwartz, The Mind And The Brain, Harper Collins, 2002. I choose to continue to do it because it has yet to harm me in any way, and I like it. We know of people remaining married in spite of-in the eyes of a beholder- a very bad marriage. But not a disease. So you see, this is a personal issue for me too. I wish you the best and hope you get help with your anger problem, I’ve been there! Are the millions of bacteria in our guts a disease? -Melissa, proud lesbian and someone who struggles with alcohol use. But then I started to find my way out of those beliefs, which led me to make different substance use choices. I realize this isn’t a question, but it’s a frequent comment that I need to address. But the depths to which the brain disease theory of addiction can be negated go even further, because the basic theory of addiction as representing uncontrolled substance use has never been explained. I believe it is my right to use whatever drugs I want to use; that drug use is a victimless behavior; and that acting by your own judgment is the ultimate virtue even if your own judgment sometimes leads to bad consequences. If you even suggest that eating disorders are a choice, I can’t believe you work at slate. 1) NIDA, Drugs Brains and Behavior: The Science of Addiction. Addiction that’s left untreated can lead to long-term consequences. Certain factors, such as a family history of addiction, trauma or inadequately treated mental health disorders such as depression and anxiety, may make some people more susceptible to substance use disorders than others. My position IS NOT that people make choices that result in addiction (as one makes the choice to smoke, resulting in emphysema or cancer). One may choose to begin using drugs for many reasons, such as injury or illness, recreation, escape, a coping mechanism, peer pressure, etc. Has it ever occurred to you that narcotic addiction causes the brain to malfunction, thus constituting a “disease?”. My boys did not use this drug but I am seeing an alarming rise in the use of it. They concluded that this was a “recipe for addiction.” However, they did not evaluate whether their findings with rodents applied to humans, nor did they even test if the dendritic modifications had anything to do with changes in preference for cocaine in their rats. I have always felt the use of drugs/alcohol to be a choice, like everything else in life. All the information on every life destroying drug is out there. BY MARC GRIFELL, CARL L. HART, Addiction is NOT a Brain Disease, It is a Choice. But we don’t need to frame that help as “treatment” for a nonexistent disease. “There was, they said, no such thing as the personal conquest of this compulsion by the unaided will.” 12&12, pg. Haha! Lol. 1/ I appreciate this as a more accurate frame of what can be done. If I have an addiction to something, (which we ALL do) I will seek help when ready. That is, correlation is not causation: With the exception of alcohol, addictive drugs produce their biological and psychological changes by binding to specific receptor sites throughout the body. If you change your thoughts, you change your brain physically – and this is voluntary. This is a process which continues throughout life, there is nothing abnormal about it. I have chosen to link only to books I personally approve of to fund the upkeep of this website ethically. They faced a choice between jail and abstinence. Yes, addiction is certainly a problem, but I think it is different from a disease. Genetic risk factors account for about half of the likelihood that an individual will develop addiction. I only know that it is what I like, and like drug use, I do not think that it is inherently bad/immoral, nor that it has any victims. And again. In principle then it is possible that the drug-induced neural changes play little or no role in the persistence of drug use. You choose to pick up the drink, the needle or pills. Be careful in any way you may play a role in someone who is already sensitive emotionally and may be feeling suicidal. Your email address will not be published. 4. Is that an empowering, success type mindset that he can draw hope and courage from? Does this mean that piano playing is a disease called Pianoism? I am quite calm. I agree that it is better to understand. Everyone is different. I am dedicated to presenting information about addiction from a non-disease perspective, so that people can learn how to feel free and in control of their substance use, and be empowered to change it to whatever degree will make them happiest in their lives. Furthermore, follow up studies showed that this led to long term changes. I personally find this slogan to be offensive to myself and others who actually suffer from LEGITIMATE diseases. https://www.youtube.com/watch?v=wxiKVQR90VM&list=PLYCfN98iD1frkbkvTVjKr2U2KciDMMtWy. And you are forced to disagree and to arrogantly tell me to read things I’ve already read. If you’re looking for information on alcoholism, the same theories and logic discussed here are applicable; wherever you see the term addiction used on this site, it includes alcoholism. Why don’t you start working *with* the disease model folks to develop a better model that helps instead of wasting time and resources in a pointless debate about who’s right and who’s wrong? Choice does not determine whether something is a disease. My family and my husband’s family have a long history of alcoholism. In all cases, professional treatment and a range of recovery supports should be available and accessible to anybody who develops a substance use disorder. Based on this sentence fragment “Invalidation in addiction awareness , saying it is all a choice ( thus shaming the addict).” your logic seems to be that to point out that a behavior/preference is not a disease is to shame people who engage in that behavior/hold that preference. Your words: “The only thing ever offered is subjective reports from drug users themselves that they “can’t stop.” How about the compulsion is so strong, the habit so ingrained, that they “feel” or “believe” they can’t stop? Then they watch your TedTalk. All rights reserved. Cigarette packs have had the Surgeon General’s warning for decades, but people still die and suffer other substantial ailments from their smoking. Still, about 25-50% of people with a substance use problem develop a severe, chronic disorder. You may say you don’t believe addiction is a disease, but YOU BELIEVE IN EXACTLY THE SAME THING. It means they’re constantly looking for that ultimate high they first experienced.). Once again, the kids that take the drugs are choosing to take it and choose to continue to take it. Read the DrugFacts . The person may also prefer the substance to other healthy pleasures and may lose interest in normal life activities. “Length of time spent as a taxi driver correlated positively with volume in…the right posterior hippocampus,” found the scientists. In the case of cancer, it would be mutated cells which we point to as evidence of a physiological abnormality, in diabetes we can point to low insulin production or cells which fail to use insulin properly as the physiological abnormality which create the harmful symptoms. I realize this, but I chose to change, and in reality everyone who moves beyond problematic substance use chooses to change as well. However, the authors mistakenly let a big cat out of the bag with this one – because the brain wasn’t treated at all. The logic makes no sense whether it’s a “disease” or not. Pot, wine, music…they don’t turn your crank so much; but cocaine sure does. One size does not yet fit all. The prevalent theory in the United States, and to some degree in Australia, is that addiction is a chronic brain disease – a progressive, incurable condition that can be kept at bay only by fearful abstinence. This can be said for ANYTHING that we like. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Yikes! I still see anger and vitriol in your posts, not unlike Mr. Slate’s. Some people with addiction can get better without formal medical treatment and some people can have a spontaneous remission(albiet rare) from cancer. I strongly believe it all start as a simple choice or urge, but eventually, once it triggers your body organs to begin to react differently causing your brain to control the rest of your body, then it has turn out to be a medical problem regardless how anybody see it. Here is a much better article on the topic written by a neuroscientist: Is Drug Addiction a Brain Disease? And having those kinds of connections are anti-recovery. Does my death mean that logically I didn’t choose to drive to the store? Some of you might be wondering whether I know about all the scientific proof that addiction is a brain disease. Now, they need to take drugs just to try and bring their dopamine function back up to normal. The very evidence used to demonstrate that addicts’ behavior is caused by brain changes also demonstrates that they change their behavior while their brain is changed, without a real medical intervention such as medication targeting the brain or surgical intervention in the brain – and that their brain changes back to normal AFTER they VOLITIONALLY change their behavior for a prolonged period of time. Many argue that viewing addiction as a disease isn’t only incorrect, it’s also unhealthy. Addiction As An Allergy – Loss of Control, Moderation Management Is Dangerous Because The Founder Drove Drunk. I am not ashamed of my past heavy substance use, and I know that even when I was inject heroin and cocaine dozens of times a day, I was in full control, not diseased, doing exactly what I believed I needed to do at the time. To say that our choices are “influenced by everything around us” is accurate in my opinion, but to say that we don’t have choices and that free will is an illusion is a totally different sort of proposition, and one with which I disagree. They literally wouldn’t have been able to stop for 14 months without a real physical/biological medical intervention. Whenever we practice doing or thinking anything enough, the brain changes – different regions and neuronal pathways are grown or strengthened, and new connections are made; various areas of the brain become more or less active depending upon how much you use them, and this becomes the norm in your brain – but it changes again as you adjust how much you use those brain regions depending on what you choose to think and do. In the most chronic form of the disease, a severe substance use disorder can cause a person to stop caring about their own or others’ well-being or survival. I’m not saying everyone is not capable of quitting, but I’m simply noting that the problem of addiction is not one that can be solved with a one dimensional approach and viewpoint like this as it’s a multi dimensional problem. Taking things a step further, they also point out that, if we really had no say in the matter, no one would ever recover. Studies have shown that roughly 10 percent of the population is genetically predisposed to addiction. As a person who has and still does smoke pot, has consumed alcohol, cigarettes, cocaine, and crack, I have let various habits form and broken them all, completely on my own. 3. Priming dose experiments have found that alcoholics are not triggered into uncontrollable craving after taking a drink. There doesn’t seem to be any explanation or evidence that substance use is involuntary. I have since added some significant supporting work I was able to find over the years, and those additions are noted. Those who suffer debilitating diseases would do anything — or cease any activity — if that would make their diseases go away. Addicted nurses also experience shame and guilt that drive the addiction underground. are what addicts are trying to prevent and take more of the drug so they won’t be “sick”. Who is right? I pray you never meet this disease face to face through the painful eyes of a loved one. A chronic disease is a long-lasting condition that can be controlled but not cured. Walk a mile in an addict or alcoholic’s shoes: “The admonition to walk a mile in someone else’s shoes means before judging someone, you must understand his experiences, challenges, thought processes, etc.” It takes one to know one….. And now your whole argument has fallen apart. Just because it’s not the answer you want, doesn’t make it wrong. So when I talk about that stuff, I’m actually describing ‘Brain Disease’ recovery in detail. A-D-D-I-C-T-I-O-N! Nor does it logically follow from my position that drug-taking is voluntary. If you’d like to keep going, I can continue this forever. You’re right, of course. As someone in recovery from anorexia and hospitalized 8X, your addiction comments are invalidating and I would be careful with what you say because you have an online public blog attached to a genuinely respected company ( slate ) and so your words can cause someone to truly beat themselves up over an addiction ( and disease). Please educate yourself more properly before using your public platform to shame those already hurting. And the changes in the brain that occur because of addiction are not irreversible. If someone were to come up with indisputable evidence that homosexuality is a choice, I would not feel ashamed, nor would I choose to stop being homosexual. In 2011 the American Society of Addiction Medicine (ASAM) joined the AMA, defining addiction as a chronic brain disorder, not a behavior problem, or just the result of making bad choices. So you either got the power to kick the habit or Joe Smith with 67 years in the AA basement will be your doorway to it, after you confess your sins to him of course. Here’s a simple hole in that statement: you absolutely can make choices that bring cancer upon yourself. His new book, The Biology of Desire: Why Addiction Is Not a Disease, cements his image as a rock star of neuroscience by loudly challenging the status quo. Organizations and institutions that promote the disease theory are, in many cases, doing irreparable harm to the individual and performing a disservice to the population as a whole. In fact, my life experience says the writer is absolutely right. Strangely nicotine and caffeine have some mood altering effects, but they are not classified as narcotics.