Is Addiction a Disease or a Choice? Understanding the Science Behind Addiction

Is Addiction a Disease or a Choice?

Some cultures view addiction as a choice, while others see it as a moral failing. Does addiction stem from a lack of willpower? Is addiction a disease or a choice? Today, science gives us a clearer answer: addiction is a chronic brain disorder that alters how the brain functions.

While addiction can start with a choice, it quickly grows into something far more powerful. Once brain chemistry changes, quitting becomes incredibly difficult without help.

In this article, we’ll explore the science behind addiction, the role of genetics, and why willpower alone often isn’t enough to achieve recovery.

The Science of Addiction: How Addiction Changes the Brain

One of the reasons addiction is so powerful is because it physically changes the brain — especially the areas involved in decision-making, pleasure, and impulse control.

Dopamine and Addiction

When people enjoy activities, the brain releases dopamine, a “feel-good” neurotransmitter. This encourages repetition of rewarding activities.

While natural rewards like eating or exercise trigger dopamine release, substances like drugs and alcohol overstimulate the system, causing the brain to adapt by producing less dopamine over time.

The result:

People stop enjoying regular activities.
They crave the substance just to feel “normal.”

This cycle of tolerance and craving is a major part of why addiction develops.

Decision-Making and Impulse Control

Long-term substance use impacts the prefrontal cortex, the brain region responsible for decision-making and self-control.

Over time:

It’s harder to resist cravings.
Thoughtful decision-making weakens.
Impulse control deteriorates.

This brain rewiring helps explain why quitting isn’t simply a matter of choice once addiction takes hold.

Addiction as a Disease: The Medical Model Explained

The chronic disease model of addiction classifies it similarly to illnesses like diabetes or heart disease. It’s not a failure of character; it’s a medical condition.

Addiction alters brain chemistry in lasting ways, and like other chronic diseases, it requires ongoing management rather than a simple “cure.”

Addiction Versus Other Chronic Diseases

Similarities include:

Chronic Illness: Long-term management is needed.
Risk of Relapse: Just like a diabetic may face blood sugar issues, individuals with addiction may experience relapses.
Comprehensive Treatment: Recovery often requires medical treatment, counseling, and lifestyle changes.

What Science Says About Addiction Being a Disease

The American Society of Addiction Medicine (ASAM), the National Institute on Drug Abuse (NIDA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) all classify addiction as a “chronic medical disease.”

The ASAM defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences”. The NIDA and SAMHSA refer to addiction as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain,” adding, “It is considered both a complex brain disorder and a mental illness.”

All three organizations emphasize that addiction is a disease and should be treated like one.

The Role of Genetics and Environmental Factors in Addiction

People’s addiction journeys are different. Some individuals end up with substance use disorders (SUDs) because of their genes, others because of trauma, and some a combination of both. So, why do some people become addicted, while others don’t?

Genes: Family History and Inherited Traits

Genetics account for 40%-60% of a person’s risk.
If addiction runs in your family, you may be genetically predisposed — but it’s not guaranteed. Environment and choices still matter.

Environmental Risk Factors

People’s environments also play a large role in whether they develop substance use disorders. Environmental risk factors include:
Trauma: Experiencing trauma in your life, such as physical abuse or neglect, can increase your risk of developing a substance use disorder.
Mental Health Disorder: Disorders such as depression, PTSD, anxiety, and bipolar disorder can also increase your risk. People with mental health disorders often turn to substances to relieve their suffering.
Social Pressure and Influences: Peer pressure from friends or social groups can raise the risk of developing a substance use disorder.

Epigenetics

Recently, the study of epigenetics has shown that people’s genes can be turned on or off by their environments and behaviors. For instance, if an individual with a family history of addiction experiences trauma, their genetic predisposition may be turned on.

So, is addiction genetic or environmental? The truth is that addiction is a mix of a genetic addiction, your environment, and your behavior (how you react to different stressors in life). This combination gives a more comprehensive picture of the causes of addiction.

Addiction and Willpower: The Willpower Myth

Many people assume addiction stems from weak willpower. However, the science behind addiction shows that chemical brain changes weaken decision-making ability and enhance cravings.

This makes quitting without help extremely difficult — even for those who desperately want to.

The Danger of Cold-Turkey Quitting

Does addiction come from lack of willpower? Some people believe that sobriety should be as simple as quitting “cold turkey.” Unfortunately, for those with severe substance use disorder, this can be unrealistic and even dangerous. Some withdrawal symptoms are so extreme that they can be life-threatening. For this reason, having 24/7 medical support during detox is crucial.

Medical support is important for the following reasons:

Medications: Medications can help ease withdrawal symptoms and ease cravings, making it easier for individuals to detox.
Counseling: Individuals going through detox will often sink into depression or experience anxiety. Counseling can offer coping skills.
Support Groups: Individuals detoxing can find encouragement from others going through similar experiences. This feeling of camaraderie can make their journey easier.

Recovery and Brain Health: The Role of Treatment and Support

Recovery is absolutely possible. But like other chronic conditions, it requires ongoing management, not just willpower.

Medication-Assisted Treatment (MAT)

MAT is an important tool, as it provides medication to help people manage their withdrawal symptoms and cravings. These FDA-approved medications help balance people’s brain chemistries so they can focus on healing. Medications can also help with insomnia, anxiety, and depression.

Individual Therapy and Counseling

Individual therapy, such as cognitive behavioral therapy (CBT) is another important tool as it helps individuals discover the root causes of their addictions. In so doing, they can build strategies to prevent relapses when faced with stressors or triggers. There are plenty of mental, social, and physical benefits to counseling.

Support Groups

Support groups, such as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA), connect individuals with others who are experiencing similar struggles. These communities can offer encouragement and guidance during difficult moments.

Building healthy habits can — over time — help rewire your brain so that you strengthen the parts weakened by years of drug use. By slowly changing the brain with positive behaviors, like exercise and meditation, you can create lasting changes.

So, Is Addiction a Disease or a Choice?

The roots of addiction are complicated, stemming from one or many factors. The truth about addiction is that no matter its roots, it gradually rewires the brain, turning it into a chronic illness, similar to diabetes or heart disease.

Many people with SUDs are often blamed for not wanting to quit. However, it’s important to shift our perspective by understanding that addiction is an illness, not a moral failure. And to help treat addiction, it’s important to move past the addiction stigma and support science-backed treatments like MAT.

Addiction Treatment Options

If you or a loved one is suffering from a substance use disorder, contact our team at AppleGate Recovery. We offer evidence-based treatments, MAT, and help with common co-occurring mental health concerns. Our clients also have access to professional medical providers and addiction specialists in a nonjudgmental environment. Let us support you on your recovery journey.