Is Addiction a Disease or a Choice?

At Rehab 4 Alcoholism, we live and breathe addiction recovery. We’ve met thousands of people in the recovery field over the last decade, and one issue that tends to polarise people is the question whether or not addiction is a choice.

Whilst this discussion could equally apply to drug addiction, we have chosen to focus on alcoholism because this website is mostly concerned with alcohol addiction and not drug addiction.

One school of thought firmly places all the blame on the shoulders of those affected by addiction. These people believe those affected by addiction are morally responsible for their plight. Surprisingly, many people who are in recovery hold this belief.

The other competing school of thought is that addiction is a disease, and so those affected by addiction are not morally responsible for their plight. The disease school of addiction originated in academia.

The case against the disease theory

Some believe it’s unfair to ‘diminish’ other diseases such as cancer or Alzheimer’s into the same category as an addiction to drugs and alcohol. Some may feel it’s disempowering to believe that they didn’t have a choice when it came to their drug and alcohol use. The notion that addiction isn’t a choice may also seem self-loathing and self-absorbing for some.

Making the case for the disease theory

Those affected by alcoholism display very different behaviours compared to those that don’t experience alcoholism. Sometimes, these behavioural differences are subtle and may be experienced early on in life before alcoholism is developed.

For instance, those affected by alcoholism may be unable to end a night out because alcohol is available. They are also much more likely to drink alone. This willingness to drink whilst alone is one hallmark of alcoholism.

One must ask, why is it that the majority of people know when enough alcohol is enough when another small minority of people do not?

Could it be that the latter group exhibit characteristics that force them to continue to drink alcohol even in situations where they consciously or subconsciously would prefer to stay sober or to drink moderates amount of alcohol?

If the answer to this question is yes, then this would surely be evidence in support of the disease theory of addiction.

People addicted to alcohol or with the potential to become addicted to alcohol often plan their lives so they will not be without alcohol. For instance. These people often plan their life around alcohol so alcohol is never too far away or never completely inaccessible. Often, this complex planning is conducted on a subconscious level without much conscious thought.

As somebody who has faced alcoholism myself, I can honestly say that I displayed this sort of behaviour without really realising it. In fact, I even experienced denial when my friends and family members pointed out to me that I was behaving in such a manner.

I was well known for getting so drunk that I simply couldn’t remember what I was getting up to. Surely, if I could not remember what I was doing, I wasn’t really making a ‘choice’ to drink alcohol.

If you have experienced alcoholism, then you will know that no person with alcoholism really wants to be addicted to alcohol. The vast majority of people with alcoholism say they wish they could take a ‘magic pill’ and never drink alcohol again. Surely, this makes the case for the ‘choice theory’ of addiction less credible.

Clearly, when it comes to the propensity to develop alcoholism, God clearly hasn’t dealt us all the same hand.

What if addiction isn’t a disease nor a choice?

Some experts believe this dichotomy between ‘choice’ and ‘disease’ is entirely unhelpful. Some even argue that addiction is neither a disease nor a choice. If alcoholism really was a disease, these experts say it would not be irreversible without medical intervention. This isn’t the case, these experts point out, because many people are able to overcome alcoholism without any medical treatment whatsoever.

Experts also take swipe at the idea that alcoholism is a choice since a choice implies conscious and rational decision-making on behalf of those affected.

When alcoholism arises, the brain’s fundamental chemistry is out of alignment. Under these conditions, how may anyone be able to claim that those affected by alcoholism are capable of making conscious and rational decisions for themselves?

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