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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:

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.

The One in Ten

Look around your office. Your family gathering. Look around the room at your next cocktail party or bingo night. We’re told that one out of every ten people you see has fallen into a destructive pattern of addiction.


Let’s try a little experiment. Go ahead and think of the people in your social circle. Write down their names. How many do you think may have a problem?

Just one in ten?

Addiction takes many forms; the most common picture that comes to mind, is the friend, or loved one, who has dropped out of school, lost their job, or their family, due to excessive drinking or drug use. But addictions may be entrenched in lives and families in ways that are not immediately obvious. Many people with alcohol and drug addictions are still gainfully employed, may have high profiles in their communities, and may generally appear to have their life in order. But what could be going on under the surface… increasing absenteeism and decreasing productivity at work, neglect of family and responsibilities, cover-ups about the consequences of their addiction. And what about that friend who is up all night gambling or surfing porn on-line? What about the kid down the street who spends every waking hour computer gaming and throws a tantrum when his parents try and reign in his Internet use? Are they addicted? It’s very possible.

So what is “addiction”? It’s a tough word with a lot of negative stereotypes. Any behaviour characterized by an uncontrolled dependence, that continues in spite of causing physical, social or spiritual harm can be defined as an addiction.

Believe me, nobody wants to think of themselves as an addict, it carries a lot of shame.

But why should it? Firstly, addiction is a disease, not a choice. No one plans to become addicted, just as no one plans to get cancer, heart disease or any other illness. For some people there is a genetic component, for others, these behaviours have become a coping mechanism for abuse or trauma.

And although addiction is an equal opportunity disease (men and women, rich and poor from any culture can become addicts) we don’t talk about addiction as openly and honestly as we discuss other diseases.

Which makes getting healthy so much more difficult.

We always treat people with diabetes or heart disease or lung cancer with compassion. Yet just like addiction, all of those diseases have a genetic precursor that is exacerbated by unhealthy lifestyle choices. People with these conditions can organize fundraisers to help them get well, yet when was the last time you were asked to help Suzie go to rehab?

It’s true. We are still very smug and judgmental of people who struggle with addictions.

Now… back to that list!

In my social circle I can count eight people as being in need of treatment. Some are routine binge drinkers, some are daily heavy drinkers, some routinely drink and drive, some use drugs to the point where there is a negative impact on their lives, and at least one person I can think of will probably die from alcoholism.

What does your list look like? Still believe it’s just 10%?

In spite of the general knowledge that I am a recovering addict myself and an addiction counsellor, only one person has come to me and asked for help. I guess that person is the one in ten everybody talks about.

Whether your list includes one, two or three people in ten, the important truth is that an addiction is a disease caused by a complex set of circumstances. Becoming an addict isn’t a choice. But seeking recovery is. And their responsibility. They’ll need all your support and compassion in the journey.

Brian E. Johnson