Introduction
The topic of drug addiction has always been a controversial one as it involves individuals making a choice to try addictive substances, resulting in them being unable to stop using them. Drug addiction is defined, in simpler terms, as a strong urge or compulsion to get access to and use substances despite the undesirable and dangerous consequences. The consequences and the environment affecting a person may be conducive to drug taking, which is why individuals of lower socioeconomic status, such as homeless people or those involved in gang activity, are more likely to get addicted. Therefore, there is a misconception that the removal of an individual from harmful conditions could “cure” them from addiction successfully and long-term. However, this perspective does not consider the fact that when an individual is addicted to drugs, significant changes in the brain occur that cannot be fixed by changing only environmental circumstances.
First Argument: Drug Addiction is a Disease
Drug addiction causes chemical changes in the brain, affecting an individual’s response to various situations, including stress, rewards, and self-control, with changes persisting for some time after a person stops using addictive substances, making drug abuse a disease. The comparison of substance addiction to heart disease may be an illustrative example showing why drug addiction is defined as a disease by many scholars (Lautieri, 2022). Specifically, both drug addiction and heart disease cause disruptions in an organ’s regular functioning – the heart for heart disease and the brain for addiction. Both conditions result in a decreased quality of life and contribute to increased risks of premature death (Stanbrook, 2012). Addictions and different types of heart disease are overall preventable through engaging in a healthy lifestyle and avoiding making poor choices. Finally, both conditions are treatable in order to prevent further damage to the body.
Moreover, because addiction to substances is characterized by periods of recovery and relapse, which involves the recurrence of symptoms, it is similar to other diseases such as hypertension and type II diabetes. The mentioned diseases affect people throughout their lives and require from people continual efforts to manage them. It is notable that symptoms are likely to return during periods in which compliance to treatment is either absent or low, while the same symptoms may alleviate when compliance to treatment begins and is strong.
Opposing Argument
The opposing argument suggests that because drug abuse is not transmissible, cannot be hereditary or degenerative, and because it is self-acquired, implying that an individual gives the condition to themselves, drug addiction is a choice and not a disease (Holden, 2012). Those supporting the view that addiction is not a disease emphasize the social and environmental causes of addiction (Holden, 2012). No one is forcing an individual to be misusing substances and willingly ruin their health, relationships, and other areas of their lives. There is a view that addiction could be “cured” by isolating addicts from their environment in a location where there would be no access to substances, not considering the brain changes involved in substance abuse.
Some schools of thought viewed treatment for addiction as little more than simply the decision to stop. For instance, scholars argue that addiction begins with a decision; however, overcoming the problem is not as easy as simply choosing to stop, which is why it remains hard to stop the addiction, and relapse takes place to people regularly (Volkow, 2020). Therefore, addiction as a choice in this perspective cannot be addressed in a one-dimensional way because of the abundance of factors involved in influencing individuals to engage in harmful behaviors.
Analysis of Competing Arguments
Among the two arguments explaining drug addiction, the first one, which classifies addiction as a disease, appears to stand more ground because of several reasons. Specifically, the majority of current nationally recognized substance abuse-focused organizations do not treat the issue as merely a choice. For example, the National Institutes of Health (2020) views the perspective that drug addiction is a moral lapse of judgment as an outdated and poorly-informed relic of the past. According to the Substance Abuse and Mental Health Services Administration (2022), it is important to treat drug abuse as a disease because it is categorized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Another piece of supporting evidence in favor of drug addiction being a disease is that the American Psychiatric Association no longer uses the term “addiction” for diagnosis and has adopted the phrase “substance use disorder: to describe issues related to “compulsive and habitual” use of substances (Robinson & Adinoff, 2016). Thus, the changes in the issue’s classification in current scholarly contexts point to approaching substance addiction as a disorder.
The argument suggesting that addiction is a choice presents problems in terms of the negative stigma of individuals who require serious treatment interventions to alleviate the burden of symptoms. Drugs release between two and ten times the amount of dopamine compared to the rewards released by natural triggers such as food. How much is released relies on the type of drug being used; for instance, amphetamines release more dopamine compared to cocaine (Ashok et al., 2017). If substance use continues, the brain learns to produce less dopamine, required to increase dosages to sustain the same levels of pleasure long-term. It is often not a matter of choice but rather systemic chemical changes in the brain calling for increasing drug use (Koob & Volkow, 2016). Thus, approaching addiction as a disease eliminates a degree of uncertainty that could limit the effectiveness of treatment and cause individuals to avoid finding help.
Personal Argument on the Issue
Drug addiction should be seen as a disease because the choice to use drugs is not the primary reason to use, but it is the chemical changes in the brain that dictate individuals’ use of substances, causing pressure to increase use over time to maintain high dopamine levels over time. When drugs enter the brain, they can mimic naturally present brain chemicals, trigger their release in large amounts, and prevent brain damage (U.S. Department of Health and Human Services, 2020). The continuous release of dopamine into the brain makes the experience of using drugs pleasant, causing the situation to repeat over and over, making the brain value chemical triggers more than natural rewards.
If an individual makes an intentional choice to stop using drugs, they will instantly feel depressed and emotionally drained. If a person does not have a plan of intervention on how they can address the symptoms of withdrawal and battle addiction, they will more likely return to drug use to supplement the lack of dopamine produced by natural rewards. Over time, the desire for drugs transforms into a learned reflex, with various triggers contributing to the increased use of substances. The brain-induced cravings for drugs may feel uncontrollable. They can persist years after an individual gets sober, supporting the argument that drug addiction is not a choice but a severe disease requiring dedicated and high-quality treatment.
Objection to the Personal Argument
Even though the argument that addiction is a brain disease is widely accepted by scholars working on the topic, there is a significant objection, pointing to the contrary. Those opposing the view that addiction is a disease that requires treatment argue that the presence of a neural dysfunction leading individuals to continue using drugs is not sufficient for the classification of disease (Levy, 2013). For instance, it is claimed that the “neural dysfunction” inherent to addiction is insufficient for impairment “because people who suffer from that dysfunction are impaired, sufficiently to count as diseased, only given certain features of their context” (Levy, 2013, para. 1). Hence, in this argument, addiction is not a disease of a brain and should not be classified as such in clinical research.
Other opposers of the view that addiction is a disease suggested that the reliance on drugs as a mechanism to spike the release of dopamine is a result of deep learning triggered by alienation and stress. Addiction can duly be unlearned by developing stronger synaptic pathways through better habits and improved life choices. The longer a time an individual spends in the addictive state, the more cues associated with a drug of choice are going to trigger the dopamine response. Moreover, the increased activity associated with dopamine spikes decreases judgment and decision-making ability. However, the same or very similar responses are triggered by such all-consuming actions as gambling, Internet gaming, sex addiction, falling in love, or religious conversion (Valentish, 2015). Overall, because the responses of the brain to the increase of dopamine are similar in drug use and other actions, there is a view that addiction to substances should not be seen as a disease that requires treatment. The argument in support of “unlearning” behaviors goes back to the logic that the use of substances is a choice of an individual and the repetition of the same choice being made as a response to the brain’s message of needing more dopamine instead of resisting it.
Conclusion
To conclude, there is evidence for both perspectives on drug addiction. On the one hand, the chemical changes in the brain that occur when a person uses are similar to the changes in the heart in disease. On the other hand, drug addiction is considered not a disease because it results from a choice, cannot be inherited, or is not contagious. However, reducing the addiction to substances to behavioral and lifestyle choices is ineffective and conducive to social stigma and limited desires of addicted individuals to seek help and treatment. There is substantial agreement among modern scholars and drug addiction-focused organizations that drug addiction should be referred to as substance abuse disorder, allowing for the formulation of effective diagnostic and treatment procedures as a result of improved classification. It is important to approach addiction as a disease to allow individuals struggling with it seek help without the fear of being stigmatized or not taken seriously.
References
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