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Would You Choose Chaos over Serenity? The Controversy Behind Addiction as a "Disease" Vs. a "Choice"

The recent deaths of actors Phillip Seymour Hoffman and Cory Monteith have stirred up public discussion about why such successful celebrities would seemingly “throw it all away” by “choosing” to take drugs, and ultimately overdose on heroin. Some discussions even went so far as to debate whether the entertainment industry should honour the memory of these actors at all. The underlying tone of such sentiments suggests that individuals such as Hoffman and Monteith (and countless others) chose their addiction over their success, their families and ultimately their lives.

What is Addiction?

While the debate about the causes of addiction is not new, a recent definition put forth by the American Society of Addiction Medicine (ASAM) has begun to challenge the notion that addiction is a behaviour problem based on an individual’s poor choices in life. According to ASAM (2011) addiction is more than a behavioural issue or disorder. It is described as a primary neurological disease affecting brain reward, motivation, memory and related circuitry. As a chronic brain disease, it requires treatment, management and monitoring over a lifetime. As such, addiction is comparable to other chronic conditions such as diabetes or heart disease.

What factors contribute to developing an addiction?

Just as certain risk factors can lead an individual to develop diabetes (e.g. genetics, poor diet) so too can risk factors increase the likelihood that an individual will have problems with substance use. These factors can include:

  • Genetics 
  • Family history, 
  • Social and Cultural factors
  • Mental health issues 
  • Other individual experiences such as trauma

However, what is important is the notion that addiction is not a behaviour problem, but a brain problem. What initially may have begun as a maladaptive coping strategy has ultimately changed the brain’s chemistry to produce powerful and enduring effects on the individual’s cognitions, processing and memory, emotions, and in turn – their behaviour. In addition, like other diseases, addiction is progressive and if left untreated, can lead to premature death.

Addiction is not choice, but recovery is…

Historically, addiction and substance misuse has been viewed as a “moral deficit,” “flaw” or “weakness” of the individual. It has taken some time and an extensive amount of research in order to challenge these views. While the research no doubt helps, working with addicts also reveals that no individual sets out to become addicted to anything. No person would choose a life of ill health, broken relationships, financial ruin and ultimately death. While a poor choice may have led an individual to initially pick up a substance, it is illogical for an individual to continue to choose a life of chaos – we’re just not built that way. We’ve evolved to be self-preserving. So if addiction is not a choice, then stopping the use is not easy. However, addicts can make an important choice in helping themselves to recover. They can realize that it is difficult to deal with this problem on their own, and they can choose to reach out for help.