Alcohol and drug addiction Disease or Choice?
Alcohol and drug addiction disease or a choice? Does somebody have the choice of being an addict/alcoholic or not being an addict? That sounds like a silly question. After all, who would want all of the misery and suffering that comes as a consequence of addiction? Still, depending on your own point of view, choice may play an important part in living the life of an addict.
There are two completely different camps on the subject whether addiction is a disease or a choice. One camp, represented by psychologist Dr. Jefferey A. Schaler in his book “Addiction is a Choice,” asserts that addiction is not a disease, but a choice in lifestyle. On the other hand, there are those who believe that alcohol and drug addiction is a disease, and that there is little or no choice for the one addicted, such as Dr. Alan I. Leshner, the chief executive officer of the American Association for the Advancement of Science and former director of the National Institute on Drug Abuse (NIDA).
Leshner, in his presentations to doctors and therapists, shows slides of the brain. What is seen on those slides contrast the user before addiction, and the user after addiction.
In the early stages there might be some choice involved, but once the addiction has set in, there is no choice and the slides clearly show a dramatic change.
Many people believe that alcohol and drug addiction is a disease
The non-disease position has many high-level supporters, as the medical and scientific community wrestles with this issue. Kirkis reviews, a New York book review company, was glowing in its approval of Schaler’s findings, writing:
“Psychologist Schaler argues convincingly that society has erred in giving in completely to the AA vision that addiction is a disease, that addicts can't help themselves, and that they need a higher power to be saved. . . his resulting suggestions for changes in public policy and for individual change demand consideration."
Likewise, the non-disease position is echoed by Joseph Gerstein, M.D., F.A.C.P Harvard Medical School, who supports the position, writing, “Schaler drives a stake into the heart of the 'disease' concept of addictions.
Millions of people have stopped smoking, abusing mind-altering drugs, and drinking addictively on their own, without the intervention of counselors or doctors or programs. Dr. Schaler explains persuasively how this happens, despite all the genetic and hormonal predispositions."
Addiction as a disease is not politically popular.
Dr. Sally L. Satel, a psychiatrist and lecturer at Yale University, claims that the disease position may be a result of public policy, not science. Calling addiction a disease, according to Satel, is actually softening the stigma of addiction. “I reject the notion that addicts fall under the spell of drugs and become a zombie and so are not responsible for anything they do,”says Satel.
Schaler furthermore asserts that approaching addiction like a disease might even encourage addition, because people are allowed to feel powerless over their addiction. The “powerless” position is at the hub of the Alcoholics Anonymous 12-Step program. The AA treatment begins with a person admitting their powerlessness over the addiction.
Brain is changed addict/alcoholic not in control
However, Leshner asserts that a "metaphorical switch in the brain" takes place and the addict/alcoholic is not in control, because the addict/alcoholic enters into compulsive behavior. Even if the addict/alcoholic is not using, according to Leshner, the changes in the brain are still there, which is why people relapse. Leshner believes alcohol and drug addiction should be approached like other chronic diseases, such as diabetes and high blood pressure.
Dr. Nora D. Volkow, who succeeded Leshner as director at the NIDA in 2003, observed that the frontal cortical area of the cocaine addict’s brain was disrupted, even after not using for 100 days. What is disrupted is dopamine, the neurotransmitter that regulates pleasure. While at the Brookhaven National Laboratory, Dr. Volkow found that:
“ the disruption of the dopamine pathways leads to a decrease in the reinforcing value of normal things, and this pushes the individual to take drugs to compensate."
Leshner and Volkow view addiction in terms of disease, because the brain of the addict/alcoholic is fundamentally different from that of a non-addict. Where they might agree with the non-disease camp is at the beginning of a person’s experience with drugs. When a person uses cocaine, for example, at the beginning there is no particular change in the chemistry of the brian. But as the person continues to use, that’s when the changes occur. That’s the “metaphorical switch” Leshner talks about.
Dr. Herbert D. Kleber, the medical director of the National Center on Addiction and Substance Abuse, sees addiction as a brain disease and adds:
“No one wants to be an addict. All anyone wants to be able to do is knock back a few drinks with the guys on Friday or have a cigarette with coffee or take a toke on a crack pipe. But very few addicts can do this. When someone goes from being able to control their habit to mugging their grandmother to get money for their next fix, that convinces me that something has changed in their brain.”
Treatment the only answer regardless
When the two camps meet, there is polarizing conflict. The debate has gone on for decades. While Schaler might be winning converts, Leshner has likewise convinced many people that addiction is a disease. The debate will continue, but what is important for the present is for people suffering from addiction to get professional help. Whether you believe it is a disease, or a flaw of character, addiction destroys lives, ruins health and impacts the entire community.
Treatment is the only answer.