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The Contradiction of Addiction: Is it a disease, a choice, or a form of powerlessness?

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As an addiction specialist, one of the most common rebuttals I get from the general public and even those suffering from an addiction is the aversion to the belief of powerlessness.  No one wants to feel “powerless” over a substance like drugs or alcohol or to behaviors like gambling, eating, or sex.  We all want and inherently believe we make choices in life and need to be held accountable to them.

But therein lies the rub.  The core definition of addiction is doing something which negatively impacts you and your loved ones yet you can’t stop and continue to do so.  So how do we make sense of the nature of addictions?  Is it a disease, a choice, or are we simply powerless over them?

The original belief of addictions was one of morality or lack thereof as it pertains to alcohol.  In other words, people caught in addictions were due to their lack of morality (i.e. You’re a bad person who engages in alcohol due to your own depravity).  In the 1950s, the disease model of addiction sprouted and took root to help explain alcoholism as a medical condition of the brain as a means to destigmatize an addict so they realize it’s not because of a lack of willpower or one of morality.  While this was helpful in giving us an understanding that brain chemistry impacts addictions, it also gives people the impression that addiction doesn’t involve choice or responsibility and people may make excuses for their behavior as one of genetics.

Since then, we have learned it’s not about a person’s inherent character or lack of integrity that leads to addiction nor is it simply being born with a “bad” brain.  Instead, we have learned there is a complex array of biological, social, and psychological factors that can predispose someone to addictions (i.e. trauma, family history, neglect, etc.).

So do addicts have a choice or are they simply controlled by their drug of choice?  The answer is both yes and no.  It’s nuanced in the sense that before a person becomes addicted they did have a choice and “chose” to consume or engage in behaviors they found pleasure and/or relief in.  But the choice is stripped over time with continual usage.  In other words, they become enslaved to their addictions to the point that they are no longer in control and their brains and bodies have become dependent on the drug of choice to make them feel better.

In addiction recovery, it’s important to let clients know they have control to break out of their addictions but to also to validate how they have lost control through the years and their brains and bodies have been hijacked by their addictions, hence the seeming paradox and contradiction of addiction that one both has control and is powerless over it.

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