Is Addiction a Disease?

If you are in recovery and believe addiction is a disease, saying that it is not may irritate you. I am not trying to attack your recovery or take away anything that is working for you. If you are sitting there reading this, you may think like I used to that addiction has to be one of two things: either it is a disease or it is a choice. For a long time, I believed those were the only two possibilities. Eventually, I came to the conclusion that it was neither.

For a long time, I thought addiction had to be either a disease or a choice. I came to the conclusion that it was neither.

This question aggravated the hell out of me for years. I listened to all kinds of people, read everything I could find, and chased explanations in every direction. When I eventually went back to college to become a therapist, I used every opportunity I had to dig into it again. If I could write a paper on addiction, I did. I read research, looked at statistics, and kept expecting to eventually find the thing that would make all of it fit together. I never did. What I finally had to accept was that there was no single answer that explained addiction for everyone, everywhere, all the time.

This is usually where the misunderstanding begins. I am not saying addiction is a choice. I have experienced addiction, and I have seen the mental and emotional pain that people go through while they are actively using. I cannot see how anyone could look at that kind of suffering and conclude that somebody simply chose it. I spent a long time desperately wanting to stop and being unable to make that happen. That is not the same thing as choosing to be an addict.

Wanting desperately to stop and still being unable to stop is not the same thing as choosing addiction.

The word disease became tied to addiction almost 100 years ago. I think much of that was simply a convenience of language. Doctors needed a way to explain to families, employers, and other people affected by addiction what was happening to the person they were treating. At the same time, they were beginning to see that some of the treatments they were using were helping. This was a different time, and these words did not always mean exactly what they mean to us today. I think calling addiction a disease simply gave them a way to say that something real was going on, even though they did not fully understand it.

I also do not believe that people who use the word disease to describe addiction are trying to remove accountability or responsibility from the addict. I actually believe the opposite. Doctors, counselors, and other mental health professionals understand the enormous amount of work that has to be done by a person suffering from addiction if they are going to return to a healthy and functioning life. The solution does not change depending on who was responsible for how the addiction developed. The addict still has to learn a different way of living.

I did not have to decide whether addiction was a disease or a choice in order for my recovery to be my responsibility.

When I was early in recovery, I spent a lot of time trying to make sense of what had happened to me. Part of that was looking for somebody or something to blame, but another part of it was fear. I needed some sense that I had control over what happened next. The question I kept coming back to was simple: if this was not my fault and it was not my choice, then how was I supposed to make sure I did not do it again?

A lot of the answers I heard at the time seemed to come down to some version of God would save me. I understand why that gives many people hope, but at that point in my life it did not feel hopeful to me. It felt like one more thing that was outside of my control. If I could not choose my way out of addiction and the solution depended entirely on something outside of me, I was not sure where that left me.

That is one of the reasons I started leaning toward the idea that addiction had to be a choice. It gave me some sense of agency. If I chose it, then maybe I could choose not to do it again. Over time, though, that explanation stopped making sense to me too. The more I looked at addiction, the more I saw that genetics, environment, and trauma all matter, along with many other things, but none of them explain every person.

For the person in early recovery, I think the important thing is to move away from the debate and move away from the blame. You do not need to solve the mystery of how you became addicted before you can begin recovering from it. There is no getting around the work that has to be done, and that work is usually sitting right in front of you.

I also believe there is a spiritual part of recovery that cannot simply be removed. I am not saying everyone has to believe the same thing or practice religion the same way. I am saying that recovery eventually has to become about something larger than simply not using. If the entire goal is just to avoid drugs or alcohol, then recovery can start to feel like nothing more than a life built around what you are not doing.

At some point, recovery has to start moving toward things that have meaning or purpose. The important thing is that there eventually has to be a reason to stay present in your own life. That is when recovery becomes something more than simply surviving another day without using.

You may eventually understand more about why addiction happened to you, and some of that understanding may be useful. Therapy can help you look backward more clearly and recognize things you could not see before. But looking backward only helps when it gives you something useful to do with today.

And once I understood that, I did not need addiction to be a disease or a choice anymore.