Chemical Addiction

People often take positions in the debate about substance abuse and dependence by choosing one factor over another in a very complex problem.  Some individuals will take the position that the use of drugs and alcohol is a choice.  Others will maintain that a substance-dependent person has lost the ability to make choices because of neurological changes that have taken place in the brain.  And still others will insist that substance abuse and dependence is a reflection of the social influences that impinge on the individual. 

Who is right?

The Biological Perspective:

The American Medical Association defines substance dependence as a chronic relapsing disease.  Drug addiction has many factors in common with other chronic illnesses. There is definitely a genetic factor.  As with diabetes, high blood pressure, asthma and depression, substance abuse and dependence tends to run in families.  We also know that as with other chronic illnesses the earlier the onset (the younger a person is when the illness begins) the more serious the illness is likely to be.  Over time, the abuse of drugs and/or alcohol leads to permanent changes in the structure and functioning of the brain.  These changes are evident in changes in behavior and in cravings for the drug.

http://www.drugabuse.gov/NIDA_Notes/NNVol15N5/Cues.html
http://pathwayscourses.samhsa.gov/vawp/vawp_2_pg7.htm
http://gslc.genetics.utah.edu/units/addiction/

The Social / Environmental Perspective:

For over twenty years we have had good research that supports the idea that environmental and social factors play an important role for many individuals in the development of substance abuse.  It makes intuitive sense that children that grow up in a social environment that encourages drug and alcohol misuse are at more risk than those who grow up in an environment that discourages substance misuse. 

Risk factors are those characteristics of the social environment that condone, encourage or make available substances of abuse.   Examples include growing up with a substance abusing parent, having antisocial friends, cultural norms that encourage substance misuse, school failure, or living in a stressful environment.  Risk factors do not negate choice.  People who grow up in the presence of many risk factors do not necessarily turn to drugs, but risk factors make substance misuse more probable.

Protective factors are those characteristics of the social environment that discourage substance misuse and that promote pro-social behavior.  Examples include having positive bonds with pro-social parents and peers, growing up in an environment that encourages abstinence or responsible use, positive adaptation to school and living in a stimulating but low-stress environment.  Again, protective factors do not prevent substance misuse, but they encourage healthy choices.

http://www.oas.samhsa.gov/NHSDA/NAC97/appendd.htm
http://www.drugabuse.gov/NIDA_Notes/NNVol16N6/Risk.html

The Psychological or Temperamental Perspective:

Each of us is endowed with a particular temperament, a bio-psychological template from which our personality evolves.  Some of us enjoy the surge of adrenaline with risk-taking while others of us avoid risk.  Some are more outgoing.  And some of us learn more easily from observation and instruction while others of us seem to need to "learn the hard way".  None of these temperamental predispositions (and many others) are in themselves good or bad, but they make us more-or-less vulnerable to life's opportunities and problems. 

http://www.drugabuse.gov/NIDA_Notes/NNVol10N1/Earlychild.html
http://www.drugabuse.gov/DirReports/DirRep204/DirectorReport5.html

We now understand that substance-use disorders are usually paired with other mental illnesses.  Depression, AD/HD, anxiety disorders and other mental illnesses are commonly co-occurring with substance abuse and dependence.  When you think about it, it makes sense that the brain neurological pathways and brain chemistry involved in substance abuse, are the same as those implicated in other brain disorders.  And, all of these illnesses are manifest behaviorally. 

http://www.oas.samhsa.gov/2k4/coOccurring/coOccurring.pdf
http://www.drugabuse.gov/PDF/Perspectives/vol3no1/MoodDis.pdf


So, who is right in the debate as to whether substance abuse and dependence is a disease or a choice?  Substance dependence is a disease that is expressed in distorted thinking and behavior.  It is a disease that diminishes choice.  Treatment, whether it is through medication or talk therapy, is designed to restore choice and freedom.
 
http://www.drugabuse.gov/NIDA-Notes/NNVol16N2/DirRepVol16N2.html