Despite evidence that alcoholism and drug addiction share the symptomology of disease, as well as changes in social perspectives regarding them, there remains a persistent belief in many that all substance abuse is inherently due to individual inabilities to exercise self-control. This in turn enhances ideas that the addict or alcoholic has an essentially flawed moral character. When the realities of the issues are recognized, however, a different truth emerges, and both alcoholism and drug addiction are in fact simultaneously diseases and the results of lack of will.
To understand why substance addiction is both a disease and a voluntary behavior based on personal failures in choice, it is necessary to recognize that it is invariably a trajectory. With alcohol or drugs, addiction is a graduated process beginning with conscious decisions made by the individual. However, and after varying usages of the substance, a disease state is literally created because the individual’s brain is altered. The same is true of other diseases; genetic, environmental, and behavioral factors combine in cases of diabetes and heart disease as well. Personal choices made certainly encourage likelihoods of the disease, but it is also important to note that people cannot know beforehand that using drugs or alcohol will, in fact, lead to addiction, as it does not for some (NCASA, 2017). There is no rational discounting of the changes in brain chemistry as validating and/or prompting a disease state, so the assessment of addiction as solely the consequence of moral failure is innately incorrect.
At the same time, it is equally irresponsible to ignore the dimension of choice in substance abuse and addiction. Medical realities notwithstanding, it is reasonable to consider that identifying addiction as strictly a disease neglects the critical elements of the irrefutable issue of choice being exercised on some level. For many, the disease designation allows for an undue abnegation of any personal will: “The attribution of disease is the only way…that addiction can be apprehended as being caused rather than freely chosen” (Heather, 2017, p. 3). As turning to drugs or alcohol is an action which must be, to some extent, chosen by the individual, even brain chemistry alterations may not be seen as the only deciding factors. Added to the argument supporting weak moral character is the common reality that the addict fully knows the damage they are creating in the process. It then appears that the truly reasonable means of defining addiction cause is the perception that the disease state and character failures are inextricably connected. Research affirms that addicts who make efforts to revise their social networks, moving away from people and environments encouraging usage to those supportive of recovery, frequently generate new social identities necessary for recovery (Best et al, 2016, p. 117), just as abstinence promotes the greater physical health necessary for ongoing recovery.
When the forces behind alcoholism and drug addiction are assessed, it seems that no single answer clarifies the issue. On one level, addiction is a form of actual disease. On another, it is at least arguable that weakness of will and character encourage the disease because even significant changes in brain chemistry in addiction scenarios do not eliminate some power of choice. Consequently, rational response must incorporate an understanding of these dual elements. Adhering to moral weakness, moreover, does nothing to alleviate the problem, in either social or individual terms, nor does an insistence on disease alone generate the efforts necessary for the addict to engage in recovery. As is true of so many other human dilemmas, varying forces combine to create them, and it is ultimately essential to comprehend that both alcoholism and drug addiction are both simultaneously diseases and the results of moral weakness.
- Best, D., Beckwith, M., Haslam, C., Alexander Haslam, S., Jetten, J., Mawson, E., & Lubman, D. I. (2016). Overcoming alcohol and other drug addiction as a process of social identity transition: The Social Identity Model of Recovery (SIMOR). Addiction Research & Theory, 24(2), 111-123.
- Heather, N. (2017). Q: Is addiction a brain disease or a moral failing? A: Neither. Neuroethics, 1-
- National Center on Addiction and Substance Abuse (NCASA). (2017). The Disease Model of Addiction.