Addiction: Disease or Choice?

addiction[1]Dr. Somov grapples with the question as to whether addiction is a disease or a choice.  He summarizes his position by saying:

“The key humanistic challenge of recovery from substance use and other compulsive spectrum disorders is the Recovery of one’s Sense of Freedom to Choose, to act freely, to determine one’s behavior, and to control the controllable aspects of one’s life.”

This discussion keeps recurring it seems to me.  I have always wondered what is wrong with the position that addiction is a disease AND a choice.  Is it not useful to arrive at the position of:  “If I continue this behavior it will become out of control (as it has many times before), thus the correct course is to choose not to use and to pursue what I need to recover from my illness.”

Dr. Somov later states: “Open your mind to the possibility that you are not sick with an incurable disease – but just stuck in ineffective coping.”

I think this argument is a false dichotomy, but I would enjoy hearing the views of others…  I would tend to speculate that with addictions that have not had a chronic course, Dr. Somov’s approach may have merit.  Data would be useful in clarifying this, though.



Filed under Addiction

22 responses to “Addiction: Disease or Choice?

  1. Pingback: Addiction: Disease or Choice? « | health

  2. I have to agree with the mix of disease and choice. To be sure, once addiction occurs it is a disease almost impossible to beat without professional help.

    No one starts an addiction completely uninformed anymore though. Smoking used to be pervasive when the facts were hidden regarding its addictive nature and connection to cancer. Now the truth is out, but everyday people start smoking with that knowledge.

    How does one make such a flawed choice? How can someone look at what crack has done to people around them, then make the choice to start using it?

  3. lilacluvr

    I am not someone who has ever had an addiction to alcohol, smoking or drugs so I am not the best person to ask if it is a disease or a choice?

    But as omawarisan has pointed out – why do people choose to start drinking, smoking or doing drugs when they see the end results in other people?

    Does our brain tell us to not start but something else is telling us ‘why not’?

    Maybe this more a learned behavior – if your family has smokers, drinkers and drug addicts, then you’re more susceptible to this behavior?

    Maybe some people turn to addiction to ‘tune out the world’ and their problems?

    And, I must confess, after tangling with the CONS on the other blog, I am tempted to sit down and throw back a few brews – and I don’t even drink!

  4. I have had quite a bit of experience with addiction. There was a point in my life when quite a few people in my daily life were addicted to one thing or another. (I was married to an alchoholic for 14 years.) I have also observed certain tendencies in children that grew up to flirt with drugs and alcohol.
    I am no expert, but just have these observations:
    Some people seemed predisposed to “daredevil” behavior and are more apt to try things they are told are bad.
    Some people have compulsive behaviors that cause them to be addicted or obsessed and can easily become addicted or obsessed with just about anything (including work, sex, gambling, etc). Many people who start using drugs or alchohol don’t “believe” in depression, manic depression or anxiety, though they manifest the symptoms of these illnesses and tend to self-treat with drugs and alchohol.
    People with untreated depression tend to go for the “upper” type drugs (speed, methamphetamines), while people with untreated manic depression seem to prefer alchohol and cocaine in tandem or together.
    What I know from research into the subject is that, even with daily use of some prescription medications, once you start putting psychoactive drugs in your system on a regular basis, you begin to damage your neurotransmitters and that damage can sometimes be permanent. Damaged transmitters affect our ability to process and analyze, hence the bad decisions that people make once they start drinking or using drugs on a regular basis.
    It does seem to me that some people have psychological or behavioral addictions and that it is easier for those people to get help. And it seems to me that some people have actual physical addictions paired with pyschological addictions (bordering on a “mania”-think Toad of literary fame) that make it much, much more difficult for those people to kick the habit once they are hooked.
    People that you love become someone completely different when addicted.
    These are the things I know.

  5. I agree with Omawarisan that the word has gotten out on addiction. When you read the “Big Book” – AA’s book, which was first written in the 1930’s most all of the alcoholics were in a late stage of addiction requiring medically supervised detoxification.

    This fact (that the word is out) made me wonder if Dr. Somov’s points were more accurate than they used to be. Addictions can be caught at earlier points that what was true in the past.

    Paula – all of your points seem very good and accurate to me.

  6. My youngest son is an alcoholic and maybe also a drug addict. His drug of choice is alcohol but once under the influence everything he can get his hands on is fair game.

    His reactions seem like allergic reactions. Where a person can have a drink, he can’t. Once he has a drink he reacts differently and doesn’t stop sometimes for days. He can go awhile (not sure how long but I suspect a few days) without drinking — not comfortably I think, but he can do it. But once he has that first drink there is no turning back from the drunk, the binge. He is a totally different person immediately — even his voice is different, his expressions, and there are no thought processes, no reasoning.

    If I could change him, I would gladly do anything up to and including giving up my life. I can’t change him. I love him and at his worst I attempt to allow him human dignity. Sometimes I’m not as successful as I want to be. Complaining seems to send him deeper into his misery, and lengthen his binge. He doesn’t like himself, although there is much to love and admire about him, he can’t seem to see it.

    • I have seen this too. I had a friend that was an alchoholic. She quit drinking for a while, but had a bachelorette party right before she was married for the second time. She begged me to have just one drink with her and I stupidly did it. She didn’t even finish that one drink when the bouncer told me that I had better get her out of the bar because she was starting trouble. I could not believe that she got drunk so fast! She was trying to take her clothes off and I had to literally drag her out of the bar, force her into the car and try to make it out of the parking lot with four sex-crazed guys banging on the car trying to get to her. She didn’t remember a thing.
      That has to be a chemical reaction, which would be physical addiction. I think it has something to do with the body’s inability to process alchohol and it stays in the blood stream and goes straight to the brain. (That’s my theory) My friend married someone who drank socially and insisted that she do the same. The marriage didn’t last very long, unfortunately as she fell off the wagon.

  7. wicked

    I don’t know, which means I’d have to guess. I think there are many more “addictive” things than alcohol, drugs, smoking, and that ilk. Habits often become addictions. Those would be the choice ones. Foods can be addictive. Let’s face it, sometimes I really do crave chocolate. 🙂

    Here’s a question. It’s been said that alcohol addiction can run in families. Is that true in some cases? At one point in time, one of my daughters was drinking steadily. She went on to drug use, and thankfully quit that, and she doesn’t drink much now. But I was told my birthmother’s father was an alcoholic, so I was very concerned when my daughter was drinking.

    I never used drugs. Don’t even like to take prescription meds, if I don’t have to. I tried weed once and didn’t like how it burned my throat. Besides, I decided that normal cigarettes were enough of an addiction, and I didn’t need to use drugs to “take me away”, only to be dumped back into reality when they wore off. With depression, sleeping worked better than drugs in that respect.

    • 6176746f6c6c65

      I believe there are studies which show, as to males at least, there are two kinds of alcoholics; one, with a genetic propensity who start drinking, etc., at an early age (12-14); the other, those who “develop” the addiction over time after beginning to drink at a more “normal” age. I think, based upon family history, etc., that there are genetic links. My dad was an alcoholic; I found myself heading down that road in high school and early college, which is when I decided I had to watch myself very carefully. Ask anyone who was present for the beer and eggs breakfast my third yr of law school what happens when I let go; no one had ever seen me drink much or any alcohol, and could not believe it when I started my seventh beer at 7:45 a.m. (the breakfast began at 7:00 a.m.). Not bragging; just stating the unhappy facts….

  8. I think both. An addictive personality is going to express that in some form, many detrimental. Finding and treating them at an early age should be a priority. Finding and treating at an age before addiction starts, while on the outside seeming to be intrusive, can lead that person to an addiction that benefits both the person and society.

    I’m not talking about drugs, such as Prozac, but early detection and specialized training. I’m guessing lesson plans can be written and implemented without putting a stigma on anybody.

  9. debs914s

    Personally, I think some are more pre-disposed to an addiction than others. Some people can drink without getting drunk, or use recreationally without becoming an addict. Others can’t without excess. I think we all have our own ‘poison’ whatever that may be for each of us.

  10. prairiepond

    Hi “deb”! Good to see you here.

    When I took seminars from Landmark Education, one of the things they said was that the number one addiction in America is an addiction to suffering.

    They say that pain comes into every life, but suffering is optional. It’s a choice. I agree, but it’s not so easy putting that into practice.

    I also agree we all have our own poison. I can pick up or put down cigs or alcohol. Food and weed are another matter! I seem to have no control with either of them. I could enjoy both of them to death. Literally!

    • 6176746f6c6c65

      Ditto on food, prairiepond, for me. That’s why trying to stick to the ADA 1800 calories/180g carbohydrates per day diet is about to do me in (although I’ve lost >40 lbs in the last five months). I’ve “fallen off the wagon” thrice, with no apparent bad effects; damn, it felt good!

  11. prairiepond

    Heheheh 617. And it’s not helpful being a great cook. Whatever I’m hungry for, I can fix! Provided the fixin’s are in the pantry. Which they always are. For me, it’s a hell of a long drive to the store, so I have to stay stocked up.

  12. I recall the two types of alcoholics – there is a sizeable research literature on them – I believe they are called Alpha and Beta types – the Alpha being the earlier developing type and more severe course – with a greater family history of alcoholism.

    I periodically work on a computer simulation that models the research on the family incidence of alcoholism. And a second module will model the adoption and twin studies literature on alcoholism. For males, at least, there is a clear genetic role in the transmission of alcoholism. For females the data are less clear. There is a strong cultural prohibition against alcoholism for women. As a friend of mine used to say – “The hand that rocks the cradle, better not be drunk.” My theory (meaning speculation only) is that the cultural prohibition moderates the genetic expression of alcoholism for women.

  13. “They say that pain comes into every life, but suffering is optional. It’s a choice.”

    Profound wisdom! And as you said, difficult to put into practice but always worth it if you can get there. It’s the difference in wallowing or gettin’ on with it. One will keep you there and the other gives you the chance to move beyond.

  14. debs914s

    So if suffering is optional, does that give us license to self medicate? Funny how my back quits hurting after I have a couple of cocktails.

    Howdy to you too Prairie….LTNS. but I thought you didn’t like cigs? or was that just when you had the restaurant? A stocked pantry is a must but I’m pretty creative when it comes to pulling a decent meal together when it’s getting low.

  15. debs914s

    I also think that some people choose to be victims. Their life sucks because (insert reason here). I have a sister who is an alcoholic and she always says “Well Mom drank a lot, Grandpa drank a lot, so now I’m an alcoholic, it runs in the family”. I tell her if that is the case all the rest of us should be too. It falls back to playing the victim card, you can choose to be a victim or you can choose to rise above it.
    And now I should take my own frickin advice and quit smoking…. but…but Mom did it! : )

  16. I have five sisters and one brother — all younger. One sister is who we all worry about and her life is always full of things worrisome. Recently her hubby lost his job and the whole family went into overdrive with the worrying. My hubby asked, “Why do we always worry about Connie & Mike?” He went on to remind me that my brother is single and lives on one income, the other five siblings (including our family) have at most one income earner.

    It was an eye opener! And it was easy to diagnose why we always worry about Connie & Mike once the question was asked. It’s because they are and have always been victims. They’ve lived their whole lives suffering. The rest of us tell each other about our problems, but with everyone else we understand this is a temporary time while we get our thoughts together and before we begin tackling it. The first step for everyone else is deciding being a victim isn’t helpful. That doesn’t mean there isn’t sympathy, empathy, love, encouragement, but there isn’t doom and gloom. Connie & Mike dwell on their problems and play the victim — every time. The only way one incident ends is when the next replaces it.

    It’s been a great relief to me to understand this. I would help in any way I could, but I will no longer participate in the pity party, the constant worry. I even said out loud to Connie last time she complained, “Welcome to the situation everyone else faces daily.” Connie is an RN and her one income is higher than some of our siblings one incomes. I pointed that out too! Our call didn’t last as long as usual and I found out later she had called another sister so she could whine.

    Don’t get me wrong — I love my sister, but I needed this understanding. She needs it too, and maybe by not letting her be a victim she will realize there are other things to talk about, other ways to feel.

  17. lilacluvr

    Some people get their kicks off being a victim. My mother-in-law was a professional at being the one being crucified. The joke of the family was who was going to tell her first to ‘get off the cross because someone needs the wood’.