Kali Macklin

Dean Leonard
ENG 1201.229
17 April 2017
Addiction: A disease or a choice?
Addiction is an issue that has been disputed for a very long time, and it is a problem that

affects almost every family in the United States. According to the Nation Institute on Drug

abuse, or NIDA, it is defined as a chronic disease characterized by drug seeking and use that is

compulsive despite harmful consequences. Many people debate whether addiction is a disease

or a choice, and through many years of research people are still very firm on their opinions. It is

a concern that is still studied, with about 570,000 casualties per year related to addictions

including substances such as alcohol, illicit drugs and prescription drugs (NIDA). The number is

growing every year, which is why more and more doctors and scholars are taking harder looks at

what really causes a person to lose control of their life to something as destructive as addiction.

Through my research, I have concluded that addiction is a matter of choice that ultimately leads

to physical dependency, causing a disease. Alongside the physical transformations, a persons

reward pathway and inability to assume responsibility for their actions can also explain why

addiction is a self-inflicted disease.

I was born and raised in Dayton, Ohio which is now the heroin capital of the United

States. I am only one of many that have known and lost people to addiction and after watching

this problem ascend so quickly I began to wonder why, too. Everyone has their own passions and

flaws, but it has always intrigued me that so many people are vulnerable to addiction. Some

people describe themselves as having an addictive personality, but I questioned if that was a

true condition and sought to find out what truly causes the relapsing, aggressive issue 1 out of

every 10 Americans struggle with every day (Harvard Health Publications).

Addiction is a complicated subject, many people feel that it is either strictly a choice or

strictly a physical disease, and neither of these claims are true. In the 1930s, when researchers
first began to investigate what caused addictive behavior, they believed people who developed

addictions were somehow morally flawed or lacking in willpower (Harvard Health

Publications). To say the condition is completely reliant on one stimulus is to be ignorant to the

surrounding influences every person has been presented. No one factor can predict if a person

will become addicted to drugs. A combination of factors influences risk for addictionfrom

family to friends to economic status and general quality of life (NIDA).

The causes of addiction vary, and the boundaries of what constitutes a disease have been

expanded, outside sources can influence the reward system when it comes to addiction, factors

such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental

guidance can greatly affect a persons likelihood of drug abuse and addiction (NIDA). This is

important because it takes in to account that emotional issues are also a just cause for people to

become addicted to drugs they want to block those negative emotional associations. Therefore,

drug abuse or addiction is not purely a disease or a choice, a choice turns into a chemical

dependency, leading to a detrimental addiction stemming from the general desire of pleasure.

The genotype and phenotype of a person may also affect their susceptibility to addiction.

According to NIDA, the genotype of your body is your complete heritable genetic identity

such as having a genetic link to diabetes and the phenotype is a description of your actual

physical characteristics, and the way you present yourself to the world. Phenotypes are usually

made up by your genotype and personal experiences. Environment also plays a part in this, and

all of these are factors to a persons phenotype and everyones is different. The combined result

of someones phenotype and genotype can gauge how they deal with negative emotions, and has

a large significance in someones chances of becoming addicted to drugs. Negative emotions are

a shared struggle amongst humanity, and finding healthy ways to deal with these emotions are

key to general well-being and becoming autonomous from this aggressive, advancing condition.
 Every human is a pleasure-seeker, in search of the things that fulfill us or feed our

passion. Whenever we interact with a pleasurable activity, or a person we like, the brain releases

its distinct signature for pleasurethe release of the neurotransmitter dopamine (Harvard

Health Publications). Neurotransmitters are chemical messengers that pass messages between

neurons, and dopamine is the chemical that relates to pleasure. Dopamine is released whenever

we do something we enjoy love, playing a sport, or listening to music. Every brain is equipped

with a reward pathwaythe reward pathway involves several parts of the brain (NIDA) and

these parts work together to stimulate the release of dopamine whenever a pleasurable

experience is taking place. The reward circuit in the brain includes areas involved with

motivation and memory, as well as with pleasure (Harvard Health Publications) meaning that

this circuit is essential to life otherwise we would not experience pleasures in eating, drinking,

or relationships which are necessary to sustain life. Drugs trigger the same neurotransmitters, but

reward system is flooded with and excess amount than usual and over time, the brain adjusts to

the excess dopamine, which reduces the high they felt when first taking the drug an effect

known as tolerance (NIDA). People often find themselves chasing that first high they achieved,

but after a person makes the constant decision to keep using the drug of their choice, their

ability to choose not to take drugs is compromised. This, in large part, is a result of the effects

of prolonged drug use on brain functioning, and thus on behavior (NIDA).

Different drugs affect people differently, and the likelihood that the use of a drug or

participation in a rewarding activity will lead to addiction is directly linked to the speed with

which it promotes dopamine release, and the reliability of that release (Harvard Health

Publications). Each person finds their escape in different chemicals, making each addiction case

specific to the person, and every treatment different.

 There are indisputable physical factors that affect whether a person is more apt to being

an addict, and even more physical transformations that happen to the body over the course of an

addiction. The genes that people are born with account for about half of that persons risk to

addiction (Tracy). Alongside the genetic influences, after one has consumed the drug enough

times, the original high is unattainable. The addiction changes the way the brain functions and

how the body perceives pleasure (Tracy). This happens because after repeated drug use, the

brain adapts and comes to expect, and depend upon, these drug induced highs (Wiens). By the

time an addiction has made the link from choice to physical dependency, going back to choice

reasoning is very difficult because your body begins to rely on this excess dopamine. This is why

people experience a condition called withdrawal which is a series of symptoms an addict

experiences after making the decision to quit using drugs. These symptoms can include fever,

vomiting, and increased heart rate. Withdrawal is extremely hard on the body and on the mind.

The chemical changes your brain undergoes can be persistent, which is why drug addiction is

considered a relapsing disease people in recovery from drug use are at increased risk for

returning to drug use even years after not taking the drug (NIDA). Relapse can happen at any

point in a recovering addicts life, but relapse to drug addiction is most likely to happen in the

first 3-6 months of abstinence (Meyer). Relapse is often marked by psychological

abnormalities, mood dysregulation, and various somatic symptoms (Meyer) such as insomnia or

bad dreams.
It must be understood that a persons initial choice to take the addictive substance is

inevitably a factor in addiction, nobody starts out intending to develop an addiction, but many

people get caught in its snare (Harvard Health Publications). Many people start using drugs to

cope with stress or painan effect of drug addiction is creation of a cycle where anytime the

user encounters stress or pain they feel the need to use the drug(Tracy) this means it is a
chemical and emotional dependency. A persons mindset can change everything, there is no

theoretical obstacle acknowledging the fact that thoughts, desires, values and other mental

phenomena can dominate bodily functions (Tracy). For example, if a mans wife passes away,

and he soon becomes sick we say that grief is the cause of his physical ailment. Grief is an

emotion that is strong enough to physically change the body chemistry of somebody; therefore

thoughts can have a huge impact on your body. Emotions are in fact thoughts, and the common

disease concept of addiction is misleading to addicts. Many of these people tend to blame their

addiction on the proposal the condition is a disease, which completely excuses them of taking

any personal responsibility for their actions. This is simply wrong, they know what they are

doing (Heyman) and if an addict could change their view on addiction and accept their actions

they would be much more successful in recovery.

An addict must have the desire to get rid of their physical dependency and change their

life. Recovery is a long process for most people, and the initial decision to take drugs is

voluntary for most people, but repeated drug use can lead to brain changes that challenges and

addicted persons self control and interfere with their ability to resist intense urges to take

drugs(NIDA). Another aspect of recovery that is often overlooked is that an addict is not only

giving up a substance, but they are most likely also giving up the people they shared the problem

with and the physical environment that they were usually in. This can be difficult too, for only

drug-like affects can account for the tendency of alcoholics and addicts to return to high-risk

setting where they have previously been intoxicated (Meyer). This is a huge transition for

people, so attempting to stay away from past environments or people involved will play a big

part in recovery. There is no true cure for addiction. There is treatment though, and addicts tend

to find friends and family one of the top support systems in overcoming their addiction. Classes

such as Alcoholics Anonymous and Narcotics Anonymous consist of 12 step programs that
have been reported to help many people heal. Finding healthy outlets is a fantastic way to help

someone recover. Recovery can be a difficult time, but also a time of learning about yourself.
Developing an addiction is easy, but overcoming it is hard. The only definite way to

prevent a chemical dependency is to refrain from them completely. If one never makes the initial

choice to use, they will never face the consequences. Many people try drugs to experiment, and

while that is only curiosity they must be careful to not let that become their source of happiness

or their main escape from stressful situations or problems. Once someone starts looking for relief

in chemical substances, the body cannot help but to fall victim as well as the mind. As people

work on overcoming this disease, we can continue studying the factors that cause addiction and

search for more, helpful cures that will be practical for different people.

Works Cited
Abuse, National Institute on Drug. "Understanding Drug Use and Addiction." NIDA, URL

Accessed 29 Mar. 2017.

Bower, Bruce. "The Addiction Paradox: Drug Dependence Has Two Faces - as a Chronic Disease

and a Temporary Failure to Cope." Science News, vol. 185, no. 6, 22 Mar. 2014, pp. 16-

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doi:10.1002/scin.5591850615.
Heyman, Gene M. "Addiction and Choice: Theory and New Data." Frontiers in Psychiatry.

Frontiers Media S.A., 6 May 2013. Web. 29 Mar. 2017.

Meyer, Roger E. "The Disease Called Addiction: Emerging Evidence in a 200-Year Debate."

Lancet, vol. 347, no. 8995, 20 Jan. 1996, p. 162. Academic Search Complete, EBSCOhost,

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Schaler, Jeffrey A., PhD. "Addiction Is a Choice." Addiction Is a Choice: Psychiatric Times.

Psychiatric Times, 01 Oct. 2002. Accessed 29 Mar. 2017.

 Wiens, Thomas K. and Lawrence J. Walker. "The Chronic Disease Concept of Addiction:

Helpful or Harmful?." Addiction Research & Theory, vol. 23, no. 4, Aug. 2015, pp. 309-321.

Academic Search Complete, EBSCOhost, doi:10.3109/16066359.2014.987760.

Tracy, Natasha. "Effects of Drug Addiction (physical and Psychological) - Drug

Addiction - Addictions." HealthyPlace. N.p., 20 June 2016. Web. 19

"Understanding Addiction." Understanding Addiction: How Addiction Hijacks the Brain.

Harvard Health Publications. Accessed 19 April 2017.