Addiction is NOT a Brain Disease, It is a Choice

Click the photo for video of my TED Talk on addiction.

They’re screaming it from the rooftops: “addiction is a disease, and you can’t stop it without medical treatment”!  But why are they screaming it so loud, why are they browbeating us about it, why is it always mentioned with a qualifier?  You don’t hear people constantly referring to cancer as “the disease of cancer” – it’s just “cancer”, because it’s obvious that cancer is a disease, it’s been conclusively proven that the symptoms of cancer can’t be directly stopped with mere choices – therefore no qualifier is needed.  On the other hand, addiction to drugs and alcohol is not obviously a disease, and to call it such we must either overlook the major gaps in the disease argument, or we must completely redefine the term “disease.” Here we will analyze a few key points and show that what we call addiction doesn’t pass muster as a real disease.

Real Diseases versus The Disease Concept or Theory of Drug Addiction

In a true disease, some part of the body is in a state of abnormal physiological functioning, and this causes the undesirable symptoms.  In the case of cancer, it would be mutated cells which we point to as evidence of a physiological abnormality, in diabetes we can point to low insulin production or cells which fail to use insulin properly as the physiological abnormality which create the harmful symptoms.  If a person has either of these diseases, they cannot directly choose to stop their symptoms or directly choose to stop the abnormal physiological functioning which creates the symptoms.  They can only choose to stop the physiological abnormality indirectly, by the application of medical treatment, and in the case of diabetes, dietetic measures may also indirectly halt the symptoms as well (but such measures are not a cure so much as a lifestyle adjustment necessitated by permanent physiological malfunction).

Volkow NIDA Brain ScanIn addiction, there is no such physiological malfunction.  The best physical evidence put forward by the disease proponents falls totally flat on the measure of representing a physiological malfunction.  This evidence is the much touted brain scan[1].  The organization responsible for putting forth these brain scans, the National Institute on Drug Abuse and Addiction (NIDA), defines addiction in this way:

Addiction is defined as a chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.  It is considered a brain disease because drugs change the brain – they change it’s structure and how it works.  These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.

The NIDA is stating outright that the reason addiction is considered a disease is because of the brain changes evidenced by the brain scans they show us, and that these changes cause the behavior known as addiction, which they characterize as “compulsive drug seeking and use”.  There are three major ways in which this case for the disease model falls apart:

  • the changes in the brain which they show us are not abnormal at all
  • people change their behavior IN SPITE OF the fact that their brain has changed in response to repeated substance use jump to section
  • there is no evidence that the behavior of addicts is compulsive (compulsive meaning involuntary) (point two addresses this, as well as some other research that will be presented) jump to section

This all applies equally to “alcoholism” as well.  If you’re looking for information on alcoholism, the same theories and logic discussed here are applicable; wherever you see the term addiction used on this site, it includes alcoholism.

Brain Changes In Addicts Are Not Abnormal, and Do Not Prove The Brain Disease Theory

On the first count – the changes in the brain evidenced by brain scans of heavy substance users (“addicts”) do not represent a malfunctioning brain.  They are quite normal, as research into neuroplasticity has shown us.  Whenever we practice doing or thinking anything enough, the brain changes – different regions and neuronal pathways are grown or strengthened, and new connections are made; various areas of the brain become more or less active depending upon how much you use them, and this becomes the norm in your brain – but it changes again as you adjust how much you use those brain regions depending on what you choose to think and do.  This is a process which continues throughout life, there is nothing abnormal about it.  Here, Sharon Begley describes neuroplasticity: [2]

The term refers to the brain’s recently discovered ability to change its structure and function, in particular by expanding or strengthening circuits that are used and by shrinking or weakening those that are rarely engaged. In its short history, the science of neuroplasticity has mostly documented brain changes that reflect physical experience and input from the outside world.

So, when the NIDA’s Nora Volkow and others show us changes in the brain of a substance user as compared to a non-substance user, this difference is not as novel as they make it out to be.  They are showing us routine neuroplastic changes which every healthily functioning person’s brain goes through naturally.  The phenomenon of brain changes isn’t isolated to “addicts” or anyone else with a so-called brain disease – non-addicted and non-depressed and non-[insert brain disease of the week here] people experience neural adaptations too.  One poignant example was found in the brains of London taxi drivers, as Begley and Jeffrey Schwartz pointed out in The Mind and The Brain. [4]

Is Being A Good Taxi Driver A Disease?

A specific area of the brain’s hippocampus is associated with creating directional memories and a mental map of the environment. A team of researchers scanned the brains of London taxi drivers and compared their brains to non-taxi drivers. There was a very noticeable difference, not only between the drivers and non-drivers, but also between the more experienced and less experienced drivers:

There it was: the more years a man had been a taxi driver, the smaller the front of his hippocampus and the larger the posterior. “Length of time spent as a taxi driver correlated positively with volume in…the right posterior hippocampus,” found the scientists. Acquiring navigational skills causes a “redistribution of gray matter in the hippocampus” as a driver’s mental map of London grows larger and more detailed with experience. [4]

An abridged earlier version of this article appears in the 2014 edition of reference/textbook "Addiction: Opposing Viewpoints" from Cengage Learning/Greenhaven Press
An abridged earlier version of this article appears in the 2014 edition of reference/textbook “Addiction: Opposing Viewpoints” from Cengage Learning/Greenhaven Press

So, the longer you drive a cab in London (that is, the longer you exert the mental and physical effort to quickly find your way around one of the world’s toughest to navigate cities), the more your brain physically changes. And the longer you use drugs, the more your brain changes. And indeed, the longer and more intensely you apply yourself to any skill, thought, or activity – the more it will change your brain, and the more visible will be the differences between your brain and that of someone who hasn’t been focused on that particular skill.  So, if we follow the logic of the NIDA, then London’s taxi drivers have a disease, which we’ll call taxi-ism, that  forces them to drive taxis.  But the new diseases wouldn’t stop there.

Learning to play the piano well will change your brain – and if you were to compare brain scans of a piano player to a non-piano player, you would find significant differences.  Does this mean that piano playing is a disease called Pianoism?  Learning a new language changes your brain, are bilingual people diseased?  Athletes’ brains will change as a result of intensive practice – is playing tennis a disease?  Are soccer players unable to walk into a sporting goods store without kicking every ball in sight?  We could go on and on with examples, but the point is this – when you practice something, you get better at doing it, because your brain changes physiologically – and this is a normal process.  If someone dedicated a large portion of their life to seeking and using drugs, and their brain didn’t change – then that would be a true abnormality.  Something would be seriously wrong with their brain.

Its not just physical activity that changes our brains, thoughts alone can have a huge effect. What’s more, whether the brain changes or not, there is much research which shows that the brain is slave to the mind. As Begley points out elsewhere, thoughts alone can create the same brain activity that would come about by doing things[2]:

Using the brain scan called functional magnetic resonance imaging, the scientists pinpointed regions that were active during compassion meditation. In almost every case, the enhanced activity was greater in the monks’ brains than the novices’. Activity in the left prefrontal cortex (the seat of positive emotions such as happiness) swamped activity in the right prefrontal (site of negative emotions and anxiety), something never before seen from purely mental activity. A sprawling circuit that switches on at the sight of suffering also showed greater activity in the monks. So did regions responsible for planned movement, as if the monks’ brains were itching to go to the aid of those in distress.

So by simply practicing thinking about compassion, these monks made lasting changes in their brain activity. Purely mental activity can change the brain in physiologically significant ways.  And to back up this fact we look again to the work of Dr Jeffrey Schwartz[3], who has taught OCD patients techniques to think their way out of obsessive thoughts.  After exercising these thought practices, research showed that the brains of OCD patients looked no different than the brains of those who’d never had OCD.  If you change your thoughts, you change your brain physically – and this is voluntary.  This is outside the realm of disease, this shows a brain which changes as a matter of normality, and can change again, depending on what we practice choosing to think.  There is nothing abnormal about a changing brain, and the type of changes we’re discussing aren’t necessarily permanent, as they are characterized to be in the brain disease model of addiction.

These brain change don’t need to be brought on by exposure to chemicals. Thoughts alone, are enough to rewire the very circuits of the human brain responsible for reward and other positive emotions that substance use and other supposedly “addictive” behaviors (“process addictions” such as sex, gambling, and shopping, etc.) are connected with.

The Stolen Concept of Neuroplasticity in the Brain Disease Model of Addiction

Those who claim that addiction is a brain disease readily admit that the brain changes in evidence are arrived at through repeated choices to use substances and focus on using substances.  In this way, they are saying the disease is a product of routine neuroplastic processes.  Then they go on to claim that such brain changes either can’t be remedied, or can only be remedied by outside means (medical treatment).  When we break this down and look at it step by step, we see that the brain disease model rests on an argument similar to the “stolen concept”.  A stolen concept argument is one in which the argument denies a fact on which it simultaneously rests.  For example, the philosophical assertion that “reality is unknowable” rests on, or presumes that the speaker could know a fact of reality, it presumes that one could know that reality is unknowable – which of course one couldn’t, if reality truly was unknowable – so the statement “reality is unknowable” invalidates itself.  Likewise, the brain disease proponents are essentially saying “neuroplastic processes create a state called addiction which cannot be changed by thoughts and choices” – this however is to some degree self-invalidating, because it depends on neuroplasticity while seeking to invalidate it.  If neuroplasticity is involved, and is a valid explanation for how to become addicted, then we can’t act is if the same process doesn’t exist when it’s time to focus on getting un-addicted.  That is, if the brain can be changed into the addicted state by thoughts and choices, then it can be further changed or changed back by thoughts and choices.  Conditions which can be remedied by freely chosen thoughts and behaviors, don’t fit into the general understanding of disease.  Ultimately, if addiction is a disease, then it’s a disease so fundamentally different than any other that it should probably have a completely different name that doesn’t imply all the things contained in the term “disease” – such as the idea that the “will” of the afflicted is irrelevant to whether the condition continues.

People change their addictive behavior in spite of the fact that their brain is changed – and they do so without medication or surgery (added 4/18/14)

In the discussion above, we looked at some analogous cases of brain changes to see just how routine and normal (i.e. not a physiological malfunction) such changes are. Now we’re going to look directly at the most popular neuroscientific research which purports to prove that these brain changes actually cause “uncontrolled” substance use (“addiction”).

This supposedly explains why drug use becomes compulsive.
This supposedly explains why drug use becomes compulsive.

The most popular research is Nora Volkow’s brain scans of “meth addicts” presented by the NIDA. The logic is simple. We’re presented with the brain scan of a meth addict alongside the brain scan of a non-user, and we’re told that the decreased activity in the brain of the meth user (the lack of red in the “Drug Abuser” brain scan presented) is the cause of their “compulsive” methamphetamine use. Here’s how the National Institute on Drug Abuse (NIDA) explains the significance of these images in their booklet – Drugs, Brains, and Behavior: The Science of Addiction :

Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to try and bring their dopamine function back up to normal.

[emphasis added]

They go on that these same sorts of brain changes:

..may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.

[emphasis added]

That image is shown when NIDA is vaguely explaining how brain changes are responsible for “addiction.” But later on, when they try to make a case for treating addiction as a brain disease, they show the following image, which tells a far different story if you understand more of the context than they choose to mention:

brain scan prolonged abstinence

Again, this graphic is used to support the idea that we should treat addiction as a brain disease. However, the authors mistakenly let a big cat out of the bag with this one – because the brain wasn’t treated at all. Notice how the third image shows a brain in which the red level of activity has returned almost to normal after 14 months of abstinence. That’s wonderful – but it also means that the NIDA’s assertions that “Addiction means being unable to quit, even in the face of negative consequences”(LINK) and “It is considered a brain disease because drugs change the brain… These brain changes… can lead to the harmful behaviors seen in people who abuse drugs” are dead wrong.

When these studies were done, nobody was directly treating the brain of methamphetamine addicts. They were not giving them medication for it (there is no equivalent of methadone for speed users), and they weren’t sticking scalpels into the brains of these meth addicts, nor were they giving them shock treatment. So what did they do?

These methamphetamine addicts were court ordered into a treatment program (whose methodology wasn’t disclosed in the research) which likely consisted of a general mixture of group and individual counseling with 12-step meeting attendance. I can’t stress the significance of this enough: their brains were not medically treated. They talked to counselors. They faced a choice between jail and abstinence. They CHOSE abstinence (for at least 14 months!) – even while their brains had been changed in a way that we’re told robs them of the ability to choose to quit “even in the face of negative consequences.” [5]

Even with changed brains, people are capable of choosing to change their substance use habits. They choose to stop using drugs, and as the brain scans above demonstrate – their brain activity follows this choice. If the brain changes caused the substance using behavior, i.e. if it was the other way around, then a true medical intervention should have been needed – the brain would’ve needed to have changed first via external force (medicine or surgery) before abstinence was initiated. They literally wouldn’t have been able to stop for 14 months without a real physical/biological medical intervention. But they did…

Substance Use Is Not Compulsive, It Is A Choice

In his classic book Addiction & Opiates, Alfred R Lindesmith PhD explained the requirements of reliable scientific theories explaining the causes of things such as heroin addiction:

…a genuine theory that proposes to explain a given phenomenon by relating it to another phenomenon must, in the first place, have clear empirical implications which, if not fulfilled, negate the theory.

If the theory is that neural adaptations alone cause uncontrolled behavior, then this proposition can easily be shown to be false. I demonstrated above that in the midst of having fully “changed” or “addicted” brains, people do indeed stop using substances, so essentially, it is case closed. But the depths to which the brain disease theory of addiction can be negated go even further, because the basic theory of addiction as representing uncontrolled substance use has never been explained. Explanation of the mechanism by which substance use happens without the individual’s consent is conspicuously missing – yet such explanation is a necessary part of such a theory, as Lindesmith writes (again in Addiction & Opiates):

…besides identifying the two types of phenomenon that are allegedly interrelated, there must be a description of the processes or events that link them. In other words, besides affirming that something causes something else, it is necessary to indicate how the cause operates to produce the alleged effect.

The brain disease model of addiction is a bogeyman. "Here Comes the Bogey-Man" by Goya, circa 1799
The brain disease model of addiction is a bogeyman.
“Here Comes the Bogey-Man” by Goya, circa 1799

There doesn’t seem to be any explanation or evidence that substance use is involuntary. In fact, the evidence, such as that presented above, shows the opposite. Nevertheless, when the case for the disease is presented, the idea that drug use is involuntary is taken for granted as true.  No evidence is ever actually presented to support this premise, so there isn’t much to be knocked down here, except to make the point I made above – is a piano player fundamentally incapable of resisting playing the piano?  They may love to play the piano, and want to do it often, they may even be obsessive about it, but it would be hard to say that at the sight of a piano they are involuntarily driven by their brain to push aside whatever else they need to do in order to play that piano.

There is another approach to the second claim though.  We can look at the people who have subjectively claimed that their substance use is involuntary, and see if the offer of incentives results in changed behavior. Gene Heyman covered this in his landmark book, Addiction: A Disorder of Choice[3].  He recounts studies in which cocaine abusers were given traditional addiction counseling, and also offered vouchers which they could trade in for modest rewards such as movie tickets or sports equipment – if they proved through urine tests that they were abstaining from drug use.  In the early stages of the study, 70% of those in the voucher program remained abstinent, while only 20% stayed abstinent in the control group which didn’t receive the incentive of the vouchers.  This demonstrates that substance use is not in fact compulsive or involuntary, but that it is a matter of choice, because these “addicts” when presented with a clear and immediately rewarding alternative to substance use and incentive not to use, chose it.  Furthermore, follow up studies showed that this led to long term changes.  A full year after the program, the voucher group had double the success rate of those who received only counseling (80% to 40%, respectively).  This ties back in to our first point that what you practice, you become good at.  The cocaine abusers in the voucher group practiced replacing substance use with other activities, such as using the sports equipment or movie passes they gained as a direct consequence of abstaining from drug use – thus they made it a habit to find other ways of amusing themselves, this probably led to brain changes, and the new habits became the norm.

Long story short, there is no evidence presented to prove that substance use is compulsive.  The only thing ever offered is subjective reports from drug users themselves that they “can’t stop”, and proclamations from treatment professionals that the behavior is compulsive due to brain changes.  But if the promise of a ticket to the movies is enough to double the success rate of conventional addiction counseling, then it’s hard to say that substance users can’t control themselves.  The reality is that they can control themselves, but they just happen to see substance use as the best option for happiness available to them at the times when they’re abusing substances.  When they can see other options for happiness as more attractive (i.e. as promising a greater reward than substance use), attainable to them, and as taking an amount of effort they’re willing to expend – then they will absolutely choose those options instead of substance use, and will not struggle to “stay sober”, prevent  relapse, practice self-control or self-regulation, or any other colloquialism for making a different choice. They will simply choose differently.

But wait… there’s more! (Added 4/21/14) Contrary to the claims that alcoholics and drug addicts literally lose control of their substance use, a great number of experiments have found that they are really in full control of themselves. Priming dose experiments have found that alcoholics are not triggered into uncontrollable craving after taking a drink. Here’s a link to the evidence and a deeper discussion of these findings: Do Addicts and Alcoholics Lose Control? Priming dose experiments of cocaine, crack, and methamphetamine users found that after being given a hit of their drug of choice (primed with a dose) they are capable of choosing a delayed reward rather than another hit of the drug.

Three Most Relevant Reasons Addiction Is Not A Disease

So to sum up, there are at least two significant reasons why the current brain disease theory of addiction is false.

  • A disease involves physiological malfunction, the “proof” of brain changes shows no malfunction of the brain.  These changes are indeed a normal part of how the brain works – not only in substance use, but in anything that we practice doing or thinking intensively.  Brain changes occur as a matter of everyday life; the brain can be changed by the choice to think or behave differently; and the type of changes we’re talking about are not permanent.
  • The very evidence used to demonstrate that addicts’ behavior is caused by brain changes also demonstrates that they change their behavior while their brain is changed, without a real medical intervention such as medication targeting the brain or surgical intervention in the brain – and that their brain changes back to normal AFTER they VOLITIONALLY change their behavior for a prolonged period of time
  • Drug use in “addicts” is not compulsive.  If it was truly compulsive, then offering a drug user tickets to the movies would not make a difference in whether they use or not – because this is an offer of a choice.  Research shows that the offer of this choice leads to cessation of substance abuse.  Furthermore, to clarify the point, if you offered a cancer patient movie tickets as a reward for ceasing to have a tumor – it would make no difference, it would not change his probability of recovery.

Addiction is NOT a disease, and it matters. This has huge implications for anyone struggling with a substance use habit.

References:

  • 1) NIDA, Drugs Brains and Behavior: The Science of Addiction, sciofaddiction.pdf
  • 2) Sharon Begley, Scans of Monks’ Brains Show Meditation Alters Structure, Functioning, Wall Street Journal, November 5, 2004; Page B1, http://psyphz.psych.wisc.edu/web/News/Meditation_Alters_Brain_WSJ_11-04.htm
  • 3) Gene Heyman, Addiction: A Disorder of Choice, Harvard University Press, 2009
  • 4) Sharon Begley and Jeffrey Schwartz, The Mind And The Brain, Harper Collins, 2002
  • 5) Links to the 2 methamphetamine abuser studies by Nora Volkow:
    http://www.jneurosci.org/cgi/content/full/21/23/9414
    http://ajp.psychiatryonline.org/cgi/reprint/158/3/377

Important Notes from the author to readers and especially commenters:

On “badness” or immorality:

Please do not attribute to me the idea that heavy substance users must be “bad” or “immoral” if they are in fact in control of and choosing their behavior. I do not think this. I think that at the time they’re using, it is what they prefer, given what life options they believe are available to them – and I don’t think it’s my job to decide what other people should prefer for themselves, and then declare them bad if they don’t live up to my vision of a “good” life. That’s what the disease recovery culture does, de facto, when they present the false dichotomy of ‘diseased or bad’. To say that addiction is chosen behavior is simply to make a statement about whether the behavior is within the control of the individual – it is not a judgment of the morality of the behavior or the individual choosing it.

On willpower:

Please do not attribute to me the suggestion to “use willpower.” I have not said that people should use willpower, nor do I think it’s a coherent or relevant concept in any way, nor do I think “addicts lack willpower” or that those who recover have more willpower, nor, and this is important, do I believe that a choice model of addiction necessarily implies willpower as the solution.

“Addicts” do not need extra willpower, strength, or support, to change their heavy substance use habits if that is what they want to do. They need to change their preference for heavy substance use, rather than trying to fight that preference with supposed “willpower.”

On compassion:

Please don’t accuse me of not having compassion for people who have substance use problems. You do not know that, and if you attack my motives in this way it just shows your own intellectual impotence and sleaze. I have a great deal of compassion for people with these problems – I was once one such person. I am trying to get at the truth of the nature of addiction, so that the most people can be helped in the most effective way possible. I don’t doubt the compassion of those who believe addiction is a disease, and I hope you’ll give me the same benefit of the doubt. I assure you I care and want the best for people – and I don’t need to see them as diseased to do so. When you see someone who’s gotten themselves into a mess, don’t you want to help, even if it’s of their own making? Why should we need to believe they have a disease to help them if the mess is substance use related? I don’t get that requirement.

Some Agreement I’ve Found From Addiction Researchers (added 6/10/14)

I began working out my understanding of the brain disease model back in 2005 as I started working on a book about addiction; published this article in 2010; and was happy to find in 2011 when I went back to work with Baldwin Research that they had arrived at a similar conclusion. The way they stated it amounted to “either everything is addiction, or nothing is” – referring to the fact that the brain changes presented as proof of addiction being a brain disease are so routine as to indicate that all behavior must be classified as addiction if we follow the logic.

I was also gratified to have found a neuroscientist who arrived at the same conclusions. I think Marc Lewis PhD and I may disagree on a few things, but it seems we may see eye to eye on the logic I presented above about such brain changes being routine, and thus not indicative of disease. Check what he wrote in 2012 for the PLOS Blog, Mind The Brain:

every experience that has potent emotional content changes the NAC and its uptake of dopamine. Yet we wouldn’t want to call the excitement you get from the love of your life, or your fifth visit to Paris, a disease. The NAC is highly plastic. It has to be, so that we can pursue different rewards as we develop, right through childhood to the rest of the lifespan. In fact, each highly rewarding experience builds its own network of synapses in and around the NAC, and that network sends a signal to the midbrain: I’m anticipating x, so send up some dopamine, right now! That’s the case with romantic love, Paris, and heroin. During and after each of these experiences, that network of synapses gets strengthened: so the “specialization” of dopamine uptake is further increased. London just doesn’t do it for you anymore. It’s got to be Paris. Pot, wine, music…they don’t turn your crank so much; but cocaine sure does. Physical changes in the brain are its only way to learn, to remember, and to develop. But we wouldn’t want to call learning a disease.

….

In my view, addiction (whether to drugs, food, gambling, or whatever) doesn’t fit a specific physiological category. Rather, I see addiction as an extreme form of normality, if one can say such a thing. Perhaps more precisely: an extreme form of learning. No doubt addiction is a frightening, often horrible, state to endure, whether in oneself or in one’s loved ones. But that doesn’t make it a disease.

I think that quote is very important, because it highlights neuronal changes that occur in the same region implicated in addiction (whereas the examples I presented earlier in the article represented some other regions).

In a brilliant paper titled “The naked empress: Modern neuro science and the concept of addiction”, Peter Cohen of The Centre for Drug Research at University of Amsterdam, states that:

The notions of addiction transformed into the language of neurology as performed by authors like Volkov, Berridge, Gessa or De Vries are completely tautological.

He essentially argues that Volkow et al take for granted that heavy drug and alcohol use is uncontrolled, identify neural correlates, and present them as evidence of uncontrollability. Yet they don’t do so with other behaviors, and he provides plenty of examples. He notes that they start with assumptions that certain patterns of behavior (e.g. heavy drug use) are uncontrolled, and others are controlled – based purely on cultural prejudices. He accurately identifies addiction as a learned behavior, or as routine bonding to a thing, and then expresses something very close to my thesis presented above (that all learned/intensely repeated behaviors result in “brain changes”).

The problem of course is that probably all learning produces temporary or lasting ‘change in neural systems’. Also, continuation of learned behavior may be functional in the eyes and experience of the person but less so in the eyes of the outsider. Who is right? We know of people remaining married in spite of-in the eyes of a beholder- a very bad marriage. Who speaks of lasting ‘neural change’ as the basis of the continued marriage? But, even when a person herself sees some behavior as counter functional, it is not necessarily seen as addiction. It may be seen as impotence, ingrained habit or unhappy adaptation. It all depends on which behavior we discuss, not on the brain.

The great points contained in this article would be done an injustice if I tried to sum them up here, so check it out for yourself at The Center for Drug Research University of Amsterdam. As with Marc Lewis, I suspect that Peter Cohen and I might have some substantial disagreements about the full nature of addiction and human behavior in general, but I think we at least agree that the changes in the brain of an “addict” do not necessarily represent disease, and more likely represent a routine process.

Writing in 2013 for the journal Frontiers In Psychiatry, esteemed behavioral and addiction researcher Gene Heyman pointed out something so painfully obvious that we don’t even take notice – no causal link has ever been found between the neural adaptations caused by excessive substance use and continued heavy use. That is, correlation is not causation:

With the exception of alcohol, addictive drugs produce their biological and psychological changes by binding to specific receptor sites throughout the body. As self-administered drug doses greatly exceed the circulating levels of their natural analogs, persistent heavy drug use leads to structural and functional changes in the nervous system. It is widely – if not universally – assumed that these neural adaptations play a causal role in addiction. In support of this interpretation brain imaging studies often reveal differences between the brains of addicts and comparison groups (e.g., Volkow et al., 1997; Martin-Soelch et al., 2001) However, these studies are cross-sectional and the results are correlations. There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.

Did you get that? Let me repeat the words of this experienced researcher, PhD, and lecturer/professor from Boston College and Harvard who, in addition to publishing scores of papers in peer reviewed medical journals has also had an entire book debunking the disease model of addiction by Harvard University press (I say all of this about his credentials so that I can hopefully STOP getting commenters who say “but you’re not a doctor, and what are your credentials wah, wah, wah,……” here’s a “credentialed” expert who essentially agrees with most of what I’ve written in this article – so please, for the love of god, save your fallacious ad hominems and appeals to authority for another day!)- he (Gene Heyman PhD) said this, as of 2013:

There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.

And this was in a recently published paper in a section headed “But Drugs Change the Brain”, in which he continued to debunk the “brain changes cause addiction” argument by saying:

There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. For example, in a frequently referred to animal study, Robinson et al. (2001) found dendritic changes in the striatum and the prefrontal cortex of rats who had self-administered cocaine. They concluded that this was a “recipe for addiction.” However, they did not evaluate whether their findings with rodents applied to humans, nor did they even test if the dendritic modifications had anything to do with changes in preference for cocaine in their rats. In principle then it is possible that the drug-induced neural changes play little or no role in the persistence of drug use. This is a testable hypothesis.

First, most addicts quit. Thus, drug-induced neural plasticity does not prevent quitting. Second, in follow-up studies, which tested Robinson et al.’s claims, there were no increases in preference for cocaine. For instance in a preference test that provided both cocaine and saccharin, rats preferred saccharin (Lenoir et al., 2007) even after they had consumed about three to four times more cocaine than the rats in the Robinson et al study, and even though the cocaine had induced motoric changes which have been interpreted as signs of the neural underpinnings of addiction (e.g., Robinson and Berridge, 2003). Third [an analysis of epidemiological studies] shows that the likelihood of remission was constant over time since the onset of dependence. Although this is a surprising result, it is not without precedent. In a longitudinal study of heroin addicts, Vaillant (1973) reports that the likelihood of going off drugs neither increased nor decreased over time (1973), and in a study with rats, Serge Ahmed and his colleagues (Cantin et al., 2010) report that the probability of switching from cocaine to saccharin (which was about 0.85) was independent of past cocaine consumption. Since drugs change the brain, these results suggest that the changes do not prevent quitting, and the slope of [an analysis of epidemiological studies] implies that drug-induced neural changes do not even decrease the likelihood of quitting drugs once dependence is in place.

Read the full paper here – it’s an amazingly concise summary of the truths about addiction that contradict many of the accepted opinions pushed by the recovery culture –  Heyman, G. M. (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry, 4. doi:10.3389/fpsyt.2013.00031

Why Does It Matter Whether or Not Addiction Is A Brain Disease?

When we accept the unproven view that addiction and alcoholism are brain diseases, then it will lead us down a long, painful, costly, and pointless road of cycling in and out of ineffective treatment programs and 12 step meetings.  You will waste a lot of time without finding a permanent solution.  When we examine the evidence, throw out the false disease concepts, and think rationally about the problem we can see that addiction is really just a matter of choice.  Knowing this, we can bypass the rehabs, and find the true solution within ourselves.  You can choose to end your addiction.  You can choose to improv your life.  You can choose to stop the endless cycle of “recovery” and start living.  You don’t need to be a victim of the self-fulfilling prophecy that is the brain disease model of addiction.  There are alternative views and methods of change which I hope you’ll take the time to learn about on The Clean Slate Addiction Site.

There are many different ways to argue against the brain disease model of addiction. I have only presented 3 basic arguments here. But beyond just addiction, many modern claims of “brain disease” are fatally flawed, in that they are founded on the logically impossible philosophical stance of psychological determinism. From this standpoint, any evidence of any brain activity is immediately interpreted as a “cause” of a particular mind state or behavior – with no regard for free will/the ability to choose one’s thoughts and thus behaviors. If you understand the impossibility of psychological determinism (or “epiphenomenalism”) then you’ll take all such claims with a grain of salt. For a detailed examination of this issue, see the following article: The Philosophical Problem with the Brain Disease Model of Addiction: Epiphenomenalism

How To End Addiction, Substance Dependence, Substance Abuse, Alcoholism, and General Drug and Alcohol Problems (updated 11/4/2015)

Due to the fact that most conventional rehab and addiction treatment programs follow the false belief that addiction is a disease, they are generally not effective at dealing with these problems – so I really can’t ethically recommend any “treatment” programs other than a run of the mill detoxification procedure if you feel you may be experiencing physical withdrawal symptoms – you can find that through your local hospital or emergency room; by asking your primary care doctor; or by calling 911 if you feel your life is in danger due to withdrawal (beware that withdrawal from alcohol and some prescription drugs such as the class known as benzodiazepines can lead to fatal seizures).  But what comes after detoxification is simply personal choices, and treatment programs actually discourage productive personal choices by attempting to control people and feeding them nonsense such as the disease theory and idea of powerlessness.

If you want to end or alter your own substance use habits you need to make the choice to do so. Many readers will object to this answer as flippant, cruel, out of touch, et cetera. I realize this, but I chose to change, and in reality everyone who moves beyond problematic substance use chooses to change as well.

There is too much to unpack within what people believe is contained in the statement “choose to change.” I have tried to address some of that here in the past, but I realize this article is not the place to do that. This article’s scope needs to remain limited to the question of whether or not addiction is a disease.

My conclusion is that addiction is freely chosen behavior, and that the person who continues heavy substance use despite mounting costs still sees heavy substance use as their best viable option at the time they’re doing it – even though they recognize many costs and downsides. Choosing to change then, really means that they rethink whether heavy substance use is their best viable option. The only way I know to come to new conclusions is to re-examine the issues methodically, and this may often mean gathering new information and perspectives. Thus, the help that can be given to troubled heavy substance users is information. Helpers can provide accurate information that troubled people can use to change their perspective and come to believe they have better viable options than continued heavy problematic substance use.

I endeavor to give accurate information here that will help people to understand that change is possible, and that they are not doomed to a lifetime of addiction. Hopefully, this helps them on their way to believing in better viable options.

About this article:

I originally published this article on September 25, 2010. I have since added some significant supporting work I was able to find over the years, and those additions are noted. Some other minor edits from the original article are not noted.

Author

Hi, I’m, Steven Slate, the author of this post and of all content on this website. Yes, I was what you would call an “addict.” If you want to know more about me, go to the About page. If you want quotes from PhDs and such (as if I haven’t given enough here already) go to my Quotes From Experts About Addiction page. Please be civil in your comments, and many of your angry comments may already be answered on my FAQs page, so maybe check that out before you scream at me.

1,525 comments

    1. I am very gay, but I’m not a social justice warrior, as I understand the term. But let’s assume I am an SJW. Here’s the good news: you can believe BOTH a FSJW and doctors with college degrees! If you read this article with a 7th grade level of comprehension, you will see that I quoted many doctors with college degrees (PhD’s) who agree with me, the FSJW!

      Years ago, when I found agreement from PhD’s, I added their quotes to this article. Specifically, I added quotes from Gene Heyman PhD (a doctor with a college degree who even teaches at colleges such as Boston College and Harvard), Peter Cohen PhD (a doctor with a college degree who was the Director of the Centre for Drug Research (CEDRO) at the University of Amsterdam – A COLLEGE!), and Marc Lewis PhD (a doctor and neuroscientist with a college degree who even debated Nora Volkow [also a doctor with a college degree with the opposing opinion who is head of NIDA] with the exact same arguments I have made here!).

      LOTS OF DOCTORS WITH DEGREES!!! YOU CAN BELIEVE BOTH THEM AND FSJWs LIKE ME! YOU DON’T HAVE TO CHOOSE! HUZZAH!!!!

      Sincerely,

      Steven Slate FSJW, author of this article

      1. Are you saying that people with Mental Health illness should get better just because they chose to feel better. Mental health disorders including addiction have distinct physiological basis and just because we have not elucidated the exact abnormality does not mean one does not exist.
        Just as smoking induces translational changes in a cells DNA which leads to abnormal cell growth and cancer; drugs and alcohol have similiar effects on the cells within certain structures in the brain. The changes in neural networks cause changes in behavior(symptoms). People with cancer that is caused by chemicals(CARCINOGENS) made a choice to smoke but did not make a choice to have cancer. They need medical treatment just as many people with addiction need medical treatment. Some people with addiction can get better without formal medical treatment and some people can have a spontaneous remission(albiet rare) from cancer. the bottom line is that most patients with drug and alcohol disorders need help to recover just like patients with diabetes, cancer and hundreds of other medical disorders.

        1. Addiction does not have a distinct physiological basis. The neuroadaptation seen in “addiction” is basically the same as that seen in any other habitualized skill or behavior. That is the point of this article. And thank god I no longer have to defend this point on my own – I can now point you to fully detailed breakdowns of the neuroscience written by neuroscientist Marc Lewis:

          Lewis, M. (2018). Brain Change in Addiction as Learning, Not Disease. New England Journal of Medicine, 379(16), 1551–1560. https://doi.org/10.1056/NEJMra1602872

          Lewis, M. (2017). Addiction and the Brain: Development, Not Disease. Neuroethics, 10(1), 7–18. https://doi.org/10.1007/s12152-016-9293-4

          I don’t expect people to snap their fingers and cease to feel addicted/attracted to substances. It is a psychological process that can be complicated, like choosing to get a divorce or make a career change, or make any other big change in life. We recognize that plenty of big complicated changes are within the realm of volition, i.e. choice while also being able to understand that the choice isn’t so simplistic as choosing between a Coke or a Sprite. We are able to sympathize with the fact that people can feel stuck in place with these involvements and have a hard time getting to the decision point where they move on. I see addictions in exactly the same way.

          About your cancer example: so what? I haven’t said that people make the choices that cause the disease of addiction. I have said there is no disease of addiction. I am fully aware of the fact that there are many choices that lead to diseases. But there is no disease of addiction. I am not looking to blame anyone for acquiring it because it doesn’t exist to acquire. I am only looking to explain the nature of a relentless desire for substance use. If we can understand it we can begin to solve it. If we choose explanations only because they are socially expedient, we probably won’t help anyone to escape their relentless desire – but we will make ourselves feel better when we cut the ribbons at openings of new treatment centers, because we are displaying that we care and want to help. Lot of good that has done.

          1. Just to briefly mention one idea in your arguement that it is similar to a learned skill, does that mean your saying that anyone that tries to learn how can just learn how to be a brain surgeon? Can an addict decide they not only want to quit but they want to become a brain surgeon and if they don’t it’s a matter of them not trying hard enough? I think you would find a large number of brain surgeons that would tell you not everyone is capable of doing it. I’m not saying everyone is not capable of quitting, but I’m simply noting that the problem of addiction is not one that can be solved with a one dimensional approach and viewpoint like this as it’s a multi dimensional problem. It’s also a good indicator (although this is part is just an opinion) that the basis for such an idea being so simple was an original desire to be able to label it in a given way and fit it in a box possibly in order to be able to justify judgements made about the character of addicts or that they’re all the same and one that is made by someone who hasn’t had to experience it first hand. I also agree it’s not a disease by the traditional definition, that’s also a one dimensional idea with the desire being to label it and fit it in a nice box. It falls in the same category as other mental illnesses which unfortunately are not completely understood at this point and are far more complicated than many people thought they were.

    2. How about a 30 year long wife of an addict who has told me many times he does drugs because he is bored. Just because it’s not the answer you want, doesn’t make it wrong. In fact, my life experience says the writer is absolutely right. And I know many addicts and try to talk to them personally about what they are doing. The ones repeating the “disease” model just use it as a reason they CAN’T help themselves. And it is complete BS. My husband died of an apparent overdose three weeks ago. Told me upon his release from the hospital three weeks earlier that he thought this was his last chance. It was. But he absolutely DID choose to do it, knowing it would kill him. You say the dire consequences proves compulsion or disease. I say it proves a complete and utter inability to accept reality for what it is and accept responsibility for oneself. That’s what it is – plain and simple.

    3. I just saw a medical doctor this morning and mentioned this website and philosophy to him. He totally agrees and says I am not a candidate for inpatient. I allowed recovery culture to pull the wool over my eyes and I’m thankful I’ve discovered this site. That’s two more points for the “faggot social justice warrior” – including one from an MD.
      Steven – thank you for saving me $3,000 and 45 days of wasted time.
      -Melissa, proud lesbian and someone who struggles with alcohol use.

  1. I want to say, that this is one of the most comprehensive articles I’ve read on the subject of addiction as a choice instead of a disease. Having been an addict myself and recently losing one of my best friends to a heroin addiction, I never believed that it was a disease. It started out as my choice and then quickly turned pathological.

    1. It never occurred to you that saturating your brain with narcotics took away what was once a freely made choice? Note that alcohol is a narcotic, a mood altering substance, but in the addiction world a different definition is used, an illicit mood altering substance; NA is not for alcoholics. See NA Bulletin # 13.

      Is there a really difference between an involuntary act or lacking the will power to just say no?

      Has it ever occurred to you that narcotic addiction causes the brain to malfunction, thus constituting a “disease?”

      1. Surely it has since everyone is claiming it to be so. I say the substance alters the brain by its interaction with the brain. It does not malfunction, it adapts the best it can under the circumstances. However, if you don’t have any respect for yourself or your body, you will not understand the responsibility you have to yourself and you certainly will not accept that responsibility as yours to own. The fact that introducing a chemical into your body alters your nervous system does not make it a disease. A condition?? Maybe. But not a disease.

  2. Your theory that substance addiction is not a disease is not supported by the definition of disease: “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” Meriam Webster’s online dictionary.

    Further, you your theory that the there is no disease because there is no bodily malfunction is fatally flawed, the brain was never intended be constantly or near constantly be subjected to narcotics, mood altering substances that include alcohol. Strangely nicotine and caffeine have some mood altering effects, but they are not classified as narcotics. The fact that one gets high or drunk is a brain malfunction or at least changes the brain’s normal functioning. While there are changes in the brain’s functioning while under the influence, whether there are lasting physiological effects on the brain or not, there are behavioral changes that occur over time.

    Your words: “Its [sic] not just physical activity that changes our brains, thoughts alone can have a huge effect. What’s more, whether the brain changes or not, there is much research which shows that the brain is slave to the mind.”

    As far as powerlessness goes, you’re right, the brain doesn’t involuntarily make me mechanically grasp a beer bottle, raise it to my lips, and force me to swallow; the same applies to the introduction of any narcotic into the body. Can we feel so compelled to use or drink that it mimics or approaches true powerlessness? Yes. Arguably true powerlessness is a metaphor here or understand that psychological powerlessness is physiologically different from physical powerlessness but no less powerful and having the same end effect.

    Your words: “The only thing ever offered is subjective reports from drug users themselves that they “can’t stop.” How about the compulsion is so strong, the habit so ingrained, that they “feel” or “believe” they can’t stop?

    “When a man or a woman has a spiritual awakening, the most important meaning of it is that he has now become able to do, feel, and believe that which he could not do before on his unaided strength and resources alone.” 12&12, pgs. 106-107.

    Don’t 12-step programs rely on one’s ability to voluntarily stop? Of course they do! Otherwise 12-step programs wouldn’t work. Through various tools and emotional support from fellow sufferers one finds the strength or willpower to voluntarily quit. “There was, they said, no such thing as the personal conquest of this compulsion by the unaided will.” 12&12, pg. 22. “His lone courage and unaided will cannot do it. Surely he must now depend upon Somebody or Something else.” 12&12, pg. 39.

    Your words: “These brain change [sic] don’t need to be brought on by exposure to chemicals. Thoughts alone, are enough to rewire the very circuits of the human brain responsible for reward and other positive emotions that substance use and other supposedly “addictive” behaviors (“process addictions” such as sex, gambling, and shopping, etc.) are connected with.”

    It is quite true that it takes one to know one here. Those who are afflicted understand the concept of powerlessness whether it meets medical science’s strict definition or not.

    Returning to knowing one, that is why 12-step groups work, the newcomer no longer feels alone or ashamed or that they are unique. Somebody understands me.

    “He cannot picture life without alcohol. Some day he will be unable to imagine life either with alcohol or without it. Then he will know loneliness such as few do. He will be at the jumping-off place. He will wish for the end.” Alcoholics Anonymous, pg. 152.

    Walk a mile in an addict or alcoholic’s shoes: “The admonition to walk a mile in someone else’s shoes means before judging someone, you must understand his experiences, challenges, thought processes, etc.” It takes one to know one…..

    It seems that you take a naïve or overly simplistic position here.

    1. Your words “That is why 12 step groups work.”

      That’s actually not true. Unless you consider the fact that it helps a single digit percentile of those who are exposed to it as “working”. I would send a link detailing this but just Google ’12 step programs spontaneous remission’ but don’t do it in front of a sponsee or anyone in the program because it is likely to be viewed as non-12step therefore irrelevant nonsense not worth reading, even if the sponsee has relapsed all year long. And that reminds me that insanity is doing the same thing over and over again, expecting a different result; always remember that logic can be applied to ‘the program’ itself.

      Lots of talk on this page about whether or not “addiction is a disease”. I really like all the information. I was thinking about things, and at the root of everyone’s comments I believe lies a primary motive – to try and get the best possible solution out there for people struggling with addiction because we’ve been through it and wouldn’t wish it on our worst enemy(a little blob about me – 17 year long consistent, street scoring crack addict, followed by a several year long fascination with IV Meth, internet porn, and alcohol, all three simultaneously, daily was preferred. I’ve been about as “addicted” as a human being can possibly get). We really want to spread solutions to the problem. With that said, just for a moment, let’s pretend that they are both scientific facts:

      That addiction is a disease

      That addiction is not a disease

      Of course they cant both be true, but for this exercise, let’s pretend they are both true.

      Well, upon first examination I realize that even if they are both true, you still can only choose one because powerlessness and self empowerment are not compatible. So you either got the power to kick the habit or Joe Smith with 67 years in the AA basement will be your doorway to it, after you confess your sins to him of course.

      But if we all put all the science and our own personal methods of recovery aside and we were going to help one person dying at the hands of the bottle and the needle and it was his very first exposure to any kind of ‘help’ for his ‘addiction’.

      Which belief would increase his chances of success the most?

      Is it best that we convince him that he is going to need help for the rest of his life and that his brain is all fucked up from drinking and using so much that he may never be able to stop but if he gives his life over to God and reaches out to strangers in a support group, confesses his sins, and does that same thing every single day for the rest of his life then he *might* be able to stop but even if, then it will only be a daily reprieve? Is that an empowering, success type mindset that he can draw hope and courage from? Or is that pretty much the worst news you could give to another guy?

      Or should we convince him that its no big deal, people stop all the time, he absolutely has the power to do so and any voice in his head that has historically told him otherwise was actually the voice of the drugs themselves and to ignore that moving forward and to get really excited about the fact that quitting daily drinking and drugging is an awesome lifestyle change with many, many benefits in comparison and that it doesnt matter if he started using crack at age 2 and is stopping at age 69, it will still be absolutely achievable? Is that an empowering, encouraging mindset to bestow upon him?

      The human belief system is incredibly powerful. If I truly, in my heart of hearts and down to my very core believed that playing with 19 rubber duckeys in a brown closet for 48.5 minutes on cinco de mayo would immediately and permanently resolve my tendency to do way too many really hard drugs, then it would resolve that problem.

      And in truth, all the brain disease jargon aside, when I first felt I needed to reach out for ‘help’ with my ‘addiction’, I wish someone would have convinced me of the rubber duckeys, would have been more efficient, less time consuming by far.

      But seriously, if it was your dying fucking dad and you could only convince him that it is a disease or it isnt, which one will increase the likelihood of him being successful? Which one will result in more self esteem? Which one is less time consuming?

      And of course after considering those questions there is no question at all:

      Let’s get a 12 step phamplet into his hand and send him off to a meeting with a book from 1935 and put a cross around his neck, and if he has any kind of thought that aligns with the idea that he may just be strong enough to quit the drug use all together, on his own, without the groups, then we should immediately inform him that he cant tell, because he should never trust his own thinking, but we can tell that he is in serious denial of his disease and that now hes gonna need to double up his meetings until that nonsensical type thinking he is doing ceases, right? (I wish I was just joking around, but it really is like this in “the program”.)

      Of course I’m just making fun, but I think we all know in our hearts which one we would prescribe, if our goal was to arm him in a way that would give him the best possible mindset to maintain sobriety.

      And things are changing in this world, nowadays if you come at somebody’s life threatening problem with ‘its hopeless, give it to God’…well go see for yourself, offer that solution to someone’s life threatening problem and they will pretty much never even consider putting your name in the same paragraph with the word logic and their life threatening problem will likely persist and potentially worsen in the event that .

      I got too long winded. All I wanted to do was break it down to the root and ask the question “Which will make you stronger in your desire for permanent abstinence believing it is a disease or believing it isnt? Because ultimately, in my opinion, you always want to choose the one that will make you stronger in your desire for permanent abstinence, and anything that is going to weaken that or make you second guess your abilities should, in my opinion, be discarded, and if most of the people on the planet are doing it that means nothing people in large groups can become idiots, look at the holocaust.

      1. One more thing, for anyone that didnt find it clear, when I talk of all the groups and refer to the cross around the neck and the book from 1935 and confessing your sins to Uncle Joe from your local downtown ‘four horseman’ 12 step group, I am actually describing the ‘brain disease’ model’s only method of recovery; wherever ‘Brain Disease’ thinking exists, it will inevitably and unfortunately be piggybacked with the ‘brain disease’ model of recovery which is confessing sins, reliance on things other than yourself, and a shared understanding that it is unwise to think independently and all thinking should be based around the section of the Big Book that you are currently ‘studying’ and that’s all it should ever be. And that any thinking beyond whats outlined in the ‘big book’ is likely to be ‘diseased’ and should be ran by another person in the program just in case that thinking consists of self reliance or self empowerment, because those two traits are concrete evidence that your not working a strong program and even though they seem like healthy thoughts, they are actually evidence of your disease. Amd not wanting to be sitting in a meeting every day, that is evidence as well.

        So when I talk about that stuff, I’m actually describing ‘Brain Disease’ recovery in detail. Believe me, I know that seems far fetched and you may be wondering how that can be treatment for a ‘brain disease’? Or any kind of problem that is destroying your life and can only be solved by you. Problems with that kind of description necessitate self empowering belief in ones own ability to achieve such a thing, I was never able to generate that kind of belief when I was going to meetings regularly. And I was going to meetings regularly so that I could continue to condition the mindset that I would have to continue going to meetings on days that end with y till I die if I want to *maybe* die sober and the only way I would *maybe* have that chance is by my shutting my mouth, turning off my brain, unfolding my metal chair, only talking about what’s in the book, and going to meetings regularly, every day meeting attendance is a trait of AA champion breed. And I was young when I was exposed to that method of recovery so I believed it to be true – that I would never be able to have any real power over my cravings for hard drugs unless I poured my whole life into daily 12 step meeting attendance. That kind of mentality resulted in my becoming weaker in my belief that I could maintain abstinence, and the people in the groups…they are high risk for me to be around because I always know who’s relapsing and I have their phone number in case I feel like doing a really hard drug without driving around waving cash out the window at strangers who have all the signs of a decade or two in the dope show. And having those kinds of connections are anti-recovery. Ideally, all of a persons Drug Contacts need to be deleted right away and if you know someone is a drug user, no matter how cool they are, it’s best to end the relationship entirely and permanently whenever possible. I had never even shot up until I met people in ‘recovery’.

        Please dont get upset if you’re really into 12 step, I’m not trying to bash you and I dont really care what you’re doing as long as your happy with the result. The reason I say this kind of stuff is because I hope it triggers someone to get out of that atmosphere if they’ve been ‘working it’ but have found that ‘it isnt working’. That usually means they think independently, question things, have leadership qualities and will respond to anything other than Uncle Joe and the downtown AA four horsemen group. And that’s actually great news because it really sucks spending an hour each day in a metal chair with Joe and the horseman, if it were that everyday for life or just die at the hands of the needle and bottle….I’m actually not sure, I’d have to think on that. I mean I’ve actually had fun here and there drinking and using. I’ve never been excited or sincerely had a great time at a support group, maybe I did in year one of NA, maybe. But for the most part regular or daily meeting attendance is a nightmare, and if you start looking like you’re hating the meetings, everyone will approach you and explain that the only reason you’re hating them is because you need to be going to more of them. Its like being on a never ending episode of the twilight zone. And I thought it over – I would do bottle and needle to the young death vs. an extra 40 years of life with Uncle Joe and the horses. And trust me, no matter where you are in the world, Uncle Joe and the horse group are sitting in folded metal chairs near you and they cant wait for you to decide that you have a ‘Brain Disease’, they will instantly unfold an additional metal chair for you, Joe will probably even take you to Dennys too and the cook part is that whenever you spend time with Joe, even if your just talking about the hot girls in the group, even though it doesnt seem like it, youre actually treating your brain disease, according to Joe.

  3. I share any articals I can find that show addictions as habits because that is what they are. They are choices. Very bad ones. We can choose to keep making these bad choices and destroy our lives or start making good choices.

  4. Thank you sir for a great insightful article. I’ve never yet walked down the aisle of a store and had Jack (Daniels) jump off the shelf, gently land in my basket, wheel his way to the checkout, pay for himself, sack himself, walk himself to my car, jump from the car into the house, unscrew his lid, pour himself in a glass and make me drink him. The AVRT (Addictive Voice Recognition Technique) was my 1st glance at seeing this and understanding that it’s my choice. And in the throes of “addiction,” I finally decided enough is enough and went through a lot of discomfort letting my body recover to some degree of normality. I’ve sensed discovered that waves of “clean and sober” bliss are far more rewarding than whatever high I might have had with Jack and Mary.

  5. I have to agree with the gay guy. Ever since I heard addiction being referred to as disease, I thought bullshit! I started questioning the possible motives for such an opinion. I believe it to be just one of many areas in society that people who are considered “Experts” in a field are writing their own meal tickets. These “Experts know that the average man (or woman) depend on their advise. Unlike a mechanic or building contractor taking advantage of unwitting individual; groups like attorneys, politicians, and psychologists are just short of conspiring when they set their professional standards to benefit them before the client. Complicated laws have required attorneys to specialize to the point that you need one for anything you do or plan to do. The US Congress mandate laws and restrictions on states and individuals that don’t apply to themselves. Rehab has become big business in the last 30 years and has expanded the field of psychology. They have created their own niche. Who can argue with them? They are the experts.

  6. THANK YOU!!!! I for one thought that I was the only person that disagreed with the “addiction is a disease” model, but apparently, I’m not! I personally find this slogan to be offensive to myself and others who actually suffer from LEGITIMATE diseases.

    My argument is this: a disease is something that you are either born with (like sickle cell), can contract (like AIDS), or develop (like cancer) and needs to be MEDICALLY discovered and attended to. It unfortunately is NOT something that can be wished or willed away. If every disease out there could be cured by a twice a week, 1 hour group session in a church basement, we wouldn’t need doctors OR hospitals. (This is almost the equivalent of “pray away the gay”, but that’s another story.) A disease is something that can be pinpointed under a microscope and studied.

    I truly hate it, hate, hate, HATE IT, when some drug user is wailing louder than an ambulance to their guy or gal “I can’t help it! / I’m sick! / It’s not my fault! / It’s a disease!” (Cry me a river.) No one is born an addict. When first presented with the drug, it is the persons CHOICE to either say no or say yes and use it. If they like it, they do it again. And again. And again. This can be said for ANYTHING that we like. If we like a show, we watch all episodes. If we like roller coasters, we ride each one. if we like Chinese food, we order it for dinner every Friday night. If we LIKE something, WE REPEAT THE BEHAVIOR. If you like how cocaine makes you feel, chances are you’ll use it again if given the chance. When using that drug is all you can think about and is all you do, then of course you’ll be branded as an addict, or as some put it, “recreational user”. This also confirms what you said about repeated practiced behavior becoming the new norm. So after CHOOSING to continue ‘using’ and they run out of cash, they CHOOSE to find a way to attain their drug. They CHOOSE to steal from others. They CHOOSE to exchange those goods for cash and CHOOSE to use that cash to buy their drugs. Then CHOOSE to ‘use’ again. They also CHOOSE to exchange sexual favors for their drugs.

    Since they claim that it is a compulsory thing that “can’t be helped”, then I believe stress eating should also be labeled as a disease. If someone is super upset and turns to food to ‘eat their feelings’ (which I’m sure at least 90% of us do), this could be likened to drug use. When they get that ‘urge to use’ (ie. become depressed), they turn to their drug of choice, FOOD (ie. “the needle”). (This is also the beginning of my argument of how “obesity is NOT a disease”, but a RESULT of bad CHOICES.)

    I could go on forever with more examples and arguments. Please respond or email me as I would love to continue this argument with you! Possibly we could write a game changing book!

  7. It’s hard convincing some people of this simple truth. I have always felt the use of drugs/alcohol to be a choice, like everything else in life. You choose to pick up the drink, the needle or pills. But you don’t choose diseases like cancer, arthritis, sickle cell etc. It’s not like you can run to the corner for the disease of your “choice”. Everything in life is a choice.

    1. People do in fact make a myriad of choices in their life that put them at greater risk of any number of diseases: diabetes, cardiovascular disease, COPD, and indeed many types of cancer.

  8. Addition is not solely a choice nor a disease. For some, it might be a choice if they knew they where taking a dangerous drug and proceeded to take it, then it is mostly a choice. If however, the drug was given to them without them knowing the consquence of taking such a drug like certian opioides, then it was not a choice. They became physically depend before they were aware of it’s harmful consequences. Also, we cannot pretend as though genetics don’t play a key role. Lets say Mary and Mara are both hard partiers and take drugs on a regular bases. One becomes addicted while the other does not.

    1. Sorry in advance, I’m about to rip apart your entire argument.

      1. I believe you meant to say ‘addiction’ not ‘addition’.

      2. It is a CHOICE. If someone spikes your drink, or you’re in the hospital and a nurse comes in and puts something in your IV, or if a relative gives their kid a ‘vitamin’ or a ‘special drink’ THEN you can say that person didn’t KNOW what they were taking or given.

      3. If a teen is with their friends and someone passes them a pill and the kid doesn’t know what the pill is, what it does or what it will do, and they CHOOSE TO TAKE IT, they have CHOSEN to take that pill, regardless of whether they knew what the pill was or what consequences they might face from taking it. The point is that they CHOSE to take it. If afterwards that kid wanted to experience that ‘high’ again, they CHOOSE to continue taking that pill and get hooked. (Ever heard of “Chasing the Dragon”? It means they’re constantly looking for that ultimate high they first experienced.)

      4. If both Mary and Mara are ‘hard partiers’ and both take drugs, one has the ability to say ‘I LOVE how that drug makes me feel. I’m not partying right now, BUT I will not get high right now because I’m making soup.’ While the other says ‘I LOVE how that drug makes me feel. I’m not partying right now, BUT I’m going to take the drug ANYWAY because I WANT TO.’
      If they both continue to take drugs, they’re both considered ‘drug users’. They’ll become an ‘addict’ when they become DEPENDENT on the drug in order to function.

      1. Wow! Such anger and contempt!

        “Before you judge a man, walk a mile in his shoes.” This so true and so forgotten! It’s the keystone of every 12-step program, an addict of the same kind can best understand another, that is why there isn’t just one 12-step program.

        If addictive behavior is a choice, then there must be a psychological aspect to it because no sane person, no person in their right mind, would engage in the self-destructive behavior that addiction brings. I don’t agree with it, but some believe that addiction is genetic or a disease.

        Regarding your earlier post, it was AA that put forth the disease theory of addiction. Consistent with the definition of disease, the brain does in fact malfunction in the presence of mood altering substances. Alcohol can damage the brain or cause brain, heart, liver, and kidney disease. Certain narcotics when taken before the brain fully matures in the early twenties causes permanent changes in the brain or brain disease from which the addict never fully recovers.

        Rip away, but you only show your ignorance!

        1. I’m displaying common-sense and education. You’re confusing it for anger and ignorance because you do not understand the conversation being spoken.
          No thanks, I would rather not walk in the shoes of an addict. We’re all addicted to something, like cookies, certain cakes, driving, smoking (any form), TV, etc. We ALL have an addiction to something. Some people just choose to use drugs.
          The argument here is about ADDICTION and CHOICES, not AA or those in recovery.
          EVERYTHING is psychological. Would you put your hand on a hot stove? Probably not since psychologically you know the consequence of doing it. Would you inject yourself with a needle filled with drugs? If asked, people will tell you no, but some do.
          Your argument is that sane people don’t do drugs. “What sane person would do THAT?” could be said for ANYTHING. What sane person would order a pizza cold with no toppings? What sane person would purposefully hike Mount Everest? What sane person would take a shower with absolutely no hot water? Anything someone does that seems baffling to others brings up the question ‘What sane person would do THAT?’
          Addiction is NOT a disease, but can be the cause of some diseases. Addiction to alcohol = all of your organs will be damaged over time. Addiction to drugs = brain functions differently because the chemicals of the drug substance is altering your body’s chemistry. Addiction to smoking = throat cancer as well as other cancers, bad breath, yellow teeth, etc.
          Once again, the kids that take the drugs are choosing to take it and choose to continue to take it. The constant presence of the substance in the body will of course continue to ravage the body in the side effect that it causes. That’s why people go through withdrawals and have to detox when away from the drug for a certain amount of time. It means the body is trying to rid itself of the toxins (ie. the drug) and the effects of detoxing (night sweats, vomiting, sweating, etc.) are what addicts are trying to prevent and take more of the drug so they won’t be “sick”.

          If you’d like to keep going, I can continue this forever.

          1. Two constructive observations:

            It is better to understand than be understood; and your anger addiction will consume you if you don’t get help.

            1. 1. I have always been proud to say that I’ve never touched any drug. Not even pot. Not once, nor will I ever. If I have an addiction to something, (which we ALL do) I will seek help when ready. My “addiction” is nowhere near the mind altering substances we’re talking about today.
              2. I agree that it is better to understand. That is why I choose to talk about what I know, and not guess at meanings. I like to learn and ensure that I have all the tools in my arsenal before getting into a debate.
              3. I still don’t know why you’re insistent that I’m angry. I am not. I am quite calm. I don’t like to get upset.

              1. If it walks like a duck and talks like a duck it is probably a duck. . .

                I know from experience that when a person accumulates enough anger that it permeates everything we do whether we “feel” angry or not at the time.

                One thing that makes your behavior angry is that you are so “passionate,” even willing to do battle, about a condition you have never experience with and don’t understand and should have no feelings about.

                To be frank, it is quite obvious that you know nothing substance abuse or addiction.

                Again, your anger is going is probably already consuming you.

              2. Keisha.

                You’re right, of course. Addiction is NOT a disease. Like the article shows, it does not have the characteristics common to a disease. At worst, it is a disorder.

                As a person who has and still does smoke pot, has consumed alcohol, cigarettes, cocaine, and crack, I have let various habits form and broken them all, completely on my own. I have seen close family members become addicts and recover, with help, and I have been there with them along the way. So I DO have experience with addiction. WILLPOWER and positive life changes will overcome it.

                “Disease” has become a very convenient and inaccurate excuse for bad behavior. We’re adults, not babies, and part of being adults is taking personal responsibility for one’s own action and exercising self-control, no matter how hard that is to do.

        2. SoberinMI I wholeheartedly agree with you. I watched two of my sons suffer through the disease of addiction. My family and my husband’s family have a long history of alcoholism. There has to be some genetic link.
          I lost my youngest son in May of 2015 and my oldest son in November of 2015. My youngest was 25 and my oldest was 31. I watched as this drug altered their brains and personalities. Grown men crying that they wanted out of this. And guess what?! Neither of them ever said when I grow up I want to be an addict. Which might indicate a “choice”.
          I blame pharmaceutical companies who push them on doctors for profit and doctors who push them on patients for profit. And then throw in the growing pain management clinics , whose sole job is to keep you on drugs or to offer an alternative, suboxone or methadone, both equally addictive.
          All drug pushers don’t lurk on dark street corners.
          Please Dr. Slate explain how meth has no effect in the brain. My boys did not use this drug but I am seeing an alarming rise in the use of it. I have a nephew who uses it. I’ve read it can irreparable damage to the brain. BRAIN not mind.

          1. LostMom,

            I am not a doctor.

            I will not “explain how meth has no effect in the brain” because it is not something that I believe, nor is it a claim that I have ever made anywhere. What I have done, regarding the effects of methamphetamine on the brain, is refute the idea that it “hijacks the brain” and causes “addiction”/involuntary substance use.

            -Steven Slate

  9. Ok I’m ending this.
    Yes I do know what addiction is like because there is something that I’m legitimately addicted to. And you know what? I choose to continue to do it because it has yet to harm me in any way, and I like it. Should I stop the behavior? Everyone else wants me to. But the reality is that I’ll quit when I’m ready.

    As for substance abuse, I’m on pain killers that EVERY DOCTOR warned me was highly addictive. Guess what? I didn’t get addicted to it! Haha! But every now and then I’ll take one.
    So don’t assume I don’t know what I’m talking about. Like I said before, I only talk about the things I have knowledge about. The argument here was that “Addiction is NOT a Disease.” I happen to agree with this statement as I have much to say about it.
    Good day to you sir, and stay sober.

    1. If you truly understood addiction you would act like it and you show no evidence that you do. I am being analytical here and not judgemental.

      You went off on a tangent, I merely offered you some compassion and understanding.

      While you and others want to believe otherwise, and many want to oversimplify the situation by pretending it is nothing more than a choice, but substance addiction does in fact meet the definition of being a disease, logically and reasonably a brain constantly exposed to high levels of chemicals, a “toxicity,” will begin to malfunction for longer and longer periods during and after exposure:

      “a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment.”

      If, for instance alcoholism wasn’t a disease, why is it that we suffer through delirium tremens upon alcohol withdrawal, with a long list of symptoms including grand mal seizures and potentially death? Other substances all suffer serious withdrawal symptoms upon sudden abstinence.

      I wish you the best and hope you get help with your anger problem, I’ve been there!

  10. I couldn’t get past the first paragraph of this sorry excuse for an article. It is uninformed and the author’s concept of a disease is disgustingly rigid and blatantly ignorant. As someone formally educated and currently employed in addiction treatment, I strongly suggest that any readers who find themselves in this bias corner of the internet move on to more refutable websites. Yes, people who have substance abuse problems made a choice once, but for many individuals that was the last time it was a choice for them. Just because someone made the choice not to wear sunscreen does not mean that their subsequent skin cancer is not a disease…

    1. Dear Ashley,

      Your comment fits the definition of ignorance – you didn’t read the article, and now you proceed to knock down an argument that I did not make and do not subscribe to.

      My position IS NOT that people make choices that result in addiction (as one makes the choice to smoke, resulting in emphysema or cancer). My position IS that people are never truly addicted at any point. That is, they retain full power of choice at any stage of their substance-using career. I’ve shown that substance use is voluntary in many ways in my writings. In this particular article, I showed that the brain changes involved in addiction are normal – they are what happens when any activity is habitualized. That being the case, control over one’s behavior is not truly lost.

      Steven Slate

      1. Further, if you contend that other “normal” habits are not under our control – or if you contend that there is no such thing as free will at all – then at best this still means that so-called addictions are absolutely normal human functioning, and not in the realm of disease. Of course, I wouldn’t agree with those contentions, but just putting this up in case that’s where you or some other commenter is tempted to go.

      2. You’re a bit caustic there! If you believed in your position you wouldn’t upset so easily.

        Following your argument that there is no such thing as “addiction,” that the “addict” is a always a mere substance abuser and always has a choice, that no substance on this Earth is able to make a person act contrary to their own “free will” means that those who ultimately die from their substance abuse have chosen freely and informed to die, their will to live has not been compromised by their substance abuse, that their cognitive functions have never been impaired which means there is no such thing as a narcotic, the medical community you really on so much has been lying to us.

        So, why do rehabs and 12-step groups exist since they can do NOTHING to stop these suicides rather than having the courts refer substance offenders to suicide counselors?

        Where is the evidence that brain changes made by substance abuse are “normal”? I think you mean that those brain changes are predictable.

        Are you suggesting that reports from substance abusers of their compulsion to use and their consequent actions evidencing this “compulsion” doesn’t actually happen?

        Ever hear the saying that you must walk a mile in other man’s shoes before you can judge them? Until you have experienced “addiction,” you’re in no position to judge whether addiction and compulsion really exist.

        1. SoberinMI,

          Not caustic, not angry – just accurate. She’s literally ignorant of what is written on this page. And she is arguing against a position I do not hold, did not write on this page, and have spoken out against in the comments several times, and in other articles on this site, and which I addressed in great detail on my FAQs page. Here is the position she argued against, in her words, which I do not make on this page:

          Yes, people who have substance abuse problems made a choice once, but for many individuals that was the last time it was a choice for them. Just because someone made the choice not to wear sunscreen does not mean that their subsequent skin cancer is not a disease…

          On my FAQs page I make a big point against this argument, it starts out like this with me paraphrasing people who express that position sincerely thinking they are in agreement with me:

          “I agree with you Steven, people choose to get addicted. It’s their fault because they chose to do drugs in the first place, and then got addicted.”

          I realize this isn’t a question, but it’s a frequent comment that I need to address. Now, please take note of my response to this sentiment, and let me be totally clear:

          WE ARE NOT IN AGREEMENT BECAUSE THAT IS NOT HOW I SEE THIS.

          I explore the issues related to this, and then further down in the same section I speak directly to the cancer example Ashley raises:

          If you try to make some comparison to cancer or diabetes, then you look like a total idiotic fool, and I hate to be associated with you. I hate it. Your argument is so silly on it’s face. People say nonsense such as:

          “You don’t choose to get cancer but you choose to get addicted. You didn’t have to take drugs but you did, and now you got yourself addicted, and it’s your fault – so addiction isn’t a disease, it’s a choice.”

          God, I really can’t get across how much I HATE being associated with such views. I completely disagree.

          Here’s a simple hole in that statement: you absolutely can make choices that bring cancer upon yourself. Lung cancer from smoking is the perfect example. And now your whole argument has fallen apart. So if your contention is that any condition acquired by choices is not a disease, then you are wrong. PLENTY of disease are acquired by our freely chosen behavior. The fact is that you can make the choices that develop cancer, but then the cancer has a life of it’s own, and you can’t choose to not have it in an instant. It requires medicine or a fluke of a miracle to reverse/stop the progression.

          Also, in such an argument, YOU ARE AGREEING WITH THE MAIN FEATURE OF THE DISEASE MODEL OF ADDICTION. You are saying that they’ve gotten into an addicted state in which they can’t stop. You may say you don’t believe addiction is a disease, but YOU BELIEVE IN EXACTLY THE SAME THING.

          The debate here, for people who are seriously interested in addiction is whether or not people who use substances are compelled or currently in control. It’s not about their past choices – it’s about their present ability/or inability. I believe they have the ability to choose now, and I believe my conclusion is a solid scientific conclusion based on all the evidence I have been able to gather and analyze.

          I can’t say this enough times: people choose every single instance of substance use. They aren’t “addicted” they are freely acting at all times. IF YOU THINK PEOPLE “GET ADDICTED” THEN YOU AND I DISAGREE.

          I’m not angry at Ashley at this point because I’ve encountered her rhetoric thousands of times. It’s just plain comical for someone to come here telling me I’m wrong by arguing against a position I’ve explicitly demonstrated my disagreement with. I’d say she’s exhibiting the reading and comprehension level of a first grader, except for the fact that she admitted she didn’t even read what’s here before she decided to argue against what she imagines is here.

          I’ll get to your nonsense in my next comment.

          1. Now, SoberinMI – let me attempt to respond to your astonishing run-on sentence:

            Following your argument that there is no such thing as “addiction,” that the “addict” is a always a mere substance abuser and always has a choice, that no substance on this Earth is able to make a person act contrary to their own “free will” means that those who ultimately die from their substance abuse have chosen freely and informed to die, their will to live has not been compromised by their substance abuse, that their cognitive functions have never been impaired which means there is no such thing as a narcotic, the medical community you really on so much has been lying to us.

            All of those things don’t follow from my position that substance use is voluntary. The effects of a drug are a separate issue from the choice to take the drug.

            I am not saying that, for example, opioids don’t depress respiration. They do depress respiration. When people die of opioid overdoses they’re usually technically suffocating to death because the drug has slowed their breathing to a halt. I haven’t denied this.

            Nor does it logically follow from my position that drug-taking is voluntary. Driving a car is voluntary. It comes with risks. If I decide to get in a car and drive to the store to pick up some bread and eggs, another car may crash into me on the way, ending my life. Does this mean that I chose to die on this trip? No. It means only that I chose to drive to the store for some food.

            Does my death indicate that I was suicidal? No. I was trying to get food – not to die.

            Does my death mean that logically I didn’t choose to drive to the store? That seems to be the argument people make when they say “John Doe couldn’t have made this choice to use drugs – it killed him!” A negative result doesn’t obliterate the goal and free choice that led to it. If you invest in the stock market, you hope to make money. You don’t all of a sudden become a person who was compelled to hand over your money when the company you invested in goes belly up. You wanted to make money. You freely chose a means to make that happen. It didn’t work out. So it is the same with drugs. We try to get high with them, to relieve emotional pain, to be social, etc. – and sometimes the results are bad, tragically bad, or even fatal.

            Where is the evidence that brain changes made by substance abuse are “normal”? I think you mean that those brain changes are predictable.

            I’ve given citations in this article. Check them out. Here’s another recent reference that covers all the big neuroscience claims better than any I’ve seen before: Brain Change in Addiction as Learning, Not DiseaseMarc Lewis, Ph.D.

            Are you suggesting that reports from substance abusers of their compulsion to use and their consequent actions evidencing this “compulsion” doesn’t actually happen?

            They often feel compelled – but in the same way that we feel angry sometimes when no wrong has been genuinely done to us, we can feel compelled when we actually do retain the ability to choose. IMO most of the feelings of being compelled come from everyone berating us and telling us we’re monsters who can’t control ourselves, and that drugs control us. I am not denying the desperate actions, such as when I kept boosting baby formula to sell at bodegas to make money for heroin. But desperate measures are only proof of desperation. They aren’t logically evidence of “compulsion” in and of themselves.

            Ever hear the saying that you must walk a mile in other man’s shoes before you can judge them? Until you have experienced “addiction,” you’re in no position to judge whether addiction and compulsion really exist.

            Yes. I’ve heard it from every knee-jerk reacting dummy who comments on my site, messages, or emails me without even bothering to glean from the many places where I”ve said it outright that I had a massive drug problem and underwent a lot of treatment. Again, screaming at me about things like this when you could easily find out that I’ve walked in the shoes of an addict just makes your ignorant retorts that much more laughable.

            Best,

            Steven Slate

            1. You are entitled to your opinion and you are entitle to be wrong:

              I don’t have to look at your citations, I have lived it. Nobody is going to tell me I didn’t experience what I did in fact experience except you.

              I suppose the fact you are attacking me doesn’t mean you’re angry with me.

              “Does my death indicate that I was suicidal? No. I was trying to get food – not to die.” If you freely and knowingly chose to engage in the behavior that ultimately killed you over and over again until you died that is suicide and the definition of insanity according to Albert Einstein. Cigarette packs have had the Surgeon General’s warning for decades, but people still die and suffer other substantial ailments from their smoking.

              “All of those things don’t follow from my position that substance use is voluntary. The effects of a drug are a separate issue from the choice to take the drug.” Unto itself, these are inseparably intertwined and undeniable…

              Otherwise, you just contradicted yourself: “My position IS NOT that people make choices that result in addiction (as one makes the choice to smoke, resulting in emphysema or cancer). My position IS that people are never truly addicted at any point.” So why do they continue to smoke when the Emphysema first appears? A-D-D-I-C-T-I-O-N!

              “Nor does it logically follow from my position that drug-taking is voluntary.” If “drug-taking is not “voluntary,” you have just admitted that addiction does in fact exist.

              Some addict or alcoholic must have crossed you at some time to make you attack other substance abusers. As constructive criticism, you may want to seek emotional help.

              1. I believe this person is bitter and cynical. They felt that I was “attacking” them and others as well. They’re seeking attention and are trying to illicit a response. Is this what an ‘internet troll’ is? If so, thanks for helping me know what that definition really means SoberInMi!

                1. It is true that one cannot see the for forest for the trees. I still see anger and vitriol in your posts, not unlike Mr. Slate’s.

                  If you don’t see it, then some help may be warranted, but there is no anger, vitriol, or personal attacks here.

                2. It is true that one cannot see the forest for the trees. I still see anger and vitriol in your posts, not unlike Mr. Slate’s.

                  If you don’t see it, then some help may be warranted, but there is no anger, vitriol, or personal attacks here.

          2. You have to be the most arrogant and ignorant man I’ve ever not had the misfortune of meeting. You stand by your argument as if you are the sole authority on substance abuse, ie the disease of addiction. Forgive me , you did on a planet of billions of people , find 3 supporters of your opinion.
            I pray you never meet this disease face to face through the painful eyes of a loved one. And I also pray you do not preach to them to “just quit”. If it was as easy as that we’d have no addiction problems. I assure it’s not as easy as that. I’ve lived it.

            1. Dear LostMom,

              Regarding this and your other comment: I sympathize with you for having lost your sons. I count myself as lucky that when I was using heroin in the mid-late 90s to the early 2000s, the street opiate/opioid supply was not tainted as it is now. Had I been using when your sons were, I might have met the same fate.

              I wanted out of my heroin use problem as well, but I was extremely confused and disillusioned by the disease-centered treatment I received. My spirit was crushed, and I was under the false impression that my life was permanently ruined, and that more heroin would be the only thing that could make me feel better. This ended for me when I rejected the disease views. So you see, this is a personal issue for me too. I have dealt with it firsthand. Under the confusion, I couldn’t choose. It took changing a whole bunch of beliefs to be able to choose to quit.

              I wouldn’t shame your sons for their fate. That’s never my intention. Life is hard, and complicated, and I think many of our helpers make it even harder and complicated.

              I am not alone in having bad experiences with addiction treatment and rejecting it’s views. Many others share this experience and view. Nor do I have only 3 professionals who agree – here is a list of 94 signatories to a statement rejecting the brain disease model of addiction, published in the Journal Nature – Addiction: not just brain malfunction. They say, among other things, that:

              we disagree with your one-dimensional view that addiction is a disease, and with your claim that this view is not particularly controversial among scientists (Nature 506, 5; 2014). Neuroscience has been widely documented as just one of many important influences in drug addiction.

              If you’ve run into my website, I can only assume you’re still looking for information about addiction, and maybe that you are even engaging in some activism to help change things. If so, I applaud your efforts. You may want to seriously consider other viewpoints. I have compassion for all people with substance use problems. It is not necessary to see them as diseased in order to have compassion and want to help.

              Again, sorry for your loss.

              Best,

              Steven Slate

  11. Steven:
    I am sorry, it just wasn’t worth reading all of that drivel. Or was it to see that you admit to being an addict, but there is no such thing as “addiction”: “Again, screaming (no screaming S.I.M.) at me about things like this when you could easily find out that I’ve walked in the shoes of an addict just makes your ignorant retorts that much more laughable.”

    Note that I have not attacked you personally, but I have found unwarranted personal attacks come from someone who has run out of arguments, often small minded people, the ones Randy Newman sung about (“Short People”) so long ago. You are forgiven.

    Have a blessed day!

  12. I love this. I think it gets to the root of addiction when you acknowledge it as being a choice, rather than a ‘brain disease’. People have good reasons for using drugs, regardless of whether they are positive (eg. fun, curiosity) or negative (eg. attempts to avoid or treat pathology). Simply plastering addiction with a label of ‘disease’ way oversimplifies the matter.

    I think you are right when you characterise the brain disease model as a failed attempt to avoid shame. I think avoiding shaming addicts is the right way to go, so the people who support the ‘brain disease’ model are very well meaning here. Since the substance use is a free choice the individual has made, they will have to make their own decision to change for themselves, rather than being shamed into changing. I know what it’s like to have somebody attempt to shame you into making positive changes in your life, and I found it incredibly confusing and unhelpful.

  13. Regarding: is being a taxi driver a disease? No, because t does not have negative consequences for our bodies.

    Are the millions of bacteria in our guts a disease? no, because they are good for us.

    You see, disease is defined as a disorder, which is sensible, otherwise everything would be a disease! Disorders are only in ‘things’ in context – if out gut bacteria spread to our bloodstream, then, yes, they would be a disease.

    If the taxi driver became obsessed with learning and following route to the detriment of his health (eg: OCD) then that would be different: context is needed.

  14. Yes, addiction is certainly a problem, but I think it is different from a disease. Those who suffer debilitating diseases would do anything — or cease any activity — if that would make their diseases go away. They do nothing to perpetuate the disease.

    Addiction is a choice. The addicted know what the cure is: abstinence. Yet they choose to perpetuate their addiction through continued abuse. They remain diseased because they refuse the cure!

    To categorize addiction as a disease is an insult to those with muscular dystrophy, cystic fibrosis, cancer, diabetes and thousands of other diseases, for which there is no known cure.

    That does not mean we should ignore addiction as a social ill. It just means that the addiction problem requires different approaches and methods than that of true diseases.

    1. I think you could in fact find many a diabetic patient who has not “ceased any activity” to halt the progression of their disease or keep at bay the many complications that are more likely to result from poorly controlled diabetes, and any number of patients with COPD who do perpetuate their disease due to continued smoking. To be clear I pass no judgment on these individuals in saying this. Your statement was just incorrect.

  15. The American Board of Preventative Medicine has now recognized Addiction Medicine as its own nationally recognized medical specialty. My husband (a doctor with two college degrees and 18 years of practice), is doubled boarded in emergency medicine and addiction medicine. Addiction medicine is now seen as a medical specialty, just like gynecology, oncology, family medicine, etc.
    My husband has been treating addicts for many years. It’s a disease process. Period.

    1. None of what you said makes any sort of case for the disease model of addiction. There’s a long list of dubious diseases that have been endorsed by doctors’ professional organizations/trade guilds throughout history. That doctors declare something a disease doesn’t make it true. One well known example: homosexuality was considered a mental illness by the American Psychiatric Association until 1974.

      If you’re going to make an argument, try to make it on the facts, not on appeals to authority alone.

    2. As a person who has been clean from meth for almost 9 years with zero relapses, I have to disagree with you saying it’s a disease process. I made a choice to stop point-blank, and then I did. People CAN make the choice because it is always a choice to give in to the urges.

  16. What is your take on eating disorders? Is it all a choice because it is an addiction. If you even suggest that eating disorders are a choice, I can’t believe you work at slate. As someone in recovery from anorexia and hospitalized 8X, your addiction comments are invalidating and I would be careful with what you say because you have an online public blog attached to a genuinely respected company ( slate ) and so your words can cause someone to truly beat themselves up over an addiction ( and disease). Be careful in any way you may play a role in someone who is already sensitive emotionally and may be feeling suicidal. Then they watch your TedTalk. Watch yourself before you find your words becoming a trigger and/or last straw in a string of things that can cause one to decide to end their life. Words matter. Invalidation in addiction awareness , saying it is all a choice ( thus shaming the addict). And , you’ll never know if your words were the last thing someone read. Think about that possibility. Am I guilt shaming you? Yes. The same way you shame addicts, except my statement may be true.

    Also cancer is not called cancer the disease because it is assumed that everyone knows that cancer IS a disease. So, there’s that answer.

    However, I will say : recovery is a choice.

    And it’s not just an easy choice.

    If you’ve read up on NIH reports on addictions. You’d find out that anorexia is the leading cause of death for all mental health DISEASES. You would find out that anorexia is harder to treat than other addictions. You would find many studies that show that the reward neuron pathway is often running backwards. You’d find that many of the reward section of the brains of addicts light up at different times and is different than a non user. I would cite you know, one article to seem legitimate but you could google how addiction can affect the brain- make sure it’s on the google scholar part though and that you’re only reading studies that have been vetted enough by multiple professionals to be published in an academic journal.

    Please educate yourself more properly before using your public platform to shame those already hurting.

    Thanks

    1. First, who I work for (BRI) and what this blog is attached to (nothing but me) is clearly stated on the About page, accessible from the menu bar which appears on every single page of this site. The brazen arrogance of angry commenters like yourself is betrayed by the fact that you spout a bunch of strange claims, insults, and charges that would easily be dispelled if you simply clicked on that About link or the FAQs link. I love when folks like you chastise me about the facts when you can’t even do 1 second of research about me before blasting out a bunch of nonsense about me. Slate is my last name.

      Second – there are plenty of peer reviewed journal articles cited and linked in this very page on which you are angrily commenting and telling me I should look at some peer reviewed research. Don’t tell me to “educate yourself more” when you obviously can’t even be bothered to read the blog you are railing against.

      Third – I am not shaming anyone except for some (read: not all) of the people who spread the “disease of addiction myth.” And most of them needn’t even be ashamed, because they simply don’t know any better. I understand their hearts are in the right place, even if they get the facts wrong.

      Based on this sentence fragment “Invalidation in addiction awareness , saying it is all a choice ( thus shaming the addict).” your logic seems to be that to point out that a behavior/preference is not a disease is to shame people who engage in that behavior/hold that preference. I find your logic to be faulty. To be ashamed of drug/alcohol use, you first have to believe that drug/alcohol use is inherently bad. Not everyone believes that. I don’t believe that. I am not ashamed of my past heavy substance use, and I know that even when I was inject heroin and cocaine dozens of times a day, I was in full control, not diseased, doing exactly what I believed I needed to do at the time. I believe it is my right to use whatever drugs I want to use; that drug use is a victimless behavior; and that acting by your own judgment is the ultimate virtue even if your own judgment sometimes leads to bad consequences. I do have regrets about some of my past drug use and some choices related to it – but I do not have any shame over it.

      I am a homosexual man. I don’t take any strong position on where my homosexuality comes from. I only know that it is what I like, and like drug use, I do not think that it is inherently bad/immoral, nor that it has any victims. If someone were to come up with indisputable evidence that homosexuality is a choice, I would not feel ashamed, nor would I choose to stop being homosexual. It wouldn’t affect me emotionally in any way. I know that many people disapprove of homosexuality, but I do not care. Shame doesn’t just hinge on control over a behavior; it requires the belief that an act is bad – this holds for drug use, sexual behavior, or any other thing.

      I should also add that shame shouldn’t Trump the truth. If you react with negative emotions to some truth, but that truth helps you to improve your life and ultimately feel much better in the long run, then the temporary negative emotions were worth suffering. But again, I don’t personally think substance use is shame-worthy.

      Per your warning that my words will harm – I have received countless personal communications from people who say that the information on my website, in my book, and in my ted talk helped them to improve their lives/get over their substance use problems. Many have literally said that I “saved their life.” I can’t take credit for that, because they saved their own lives, through their own power of choice – but I can say it flies in the face of all the people over the years who have told me my ideas are dangerous.

      1. Beautifully stated. Unfortunately ignorant commenters basically COMPLETELY failed to comprehend the article and the studies done on addiction as a choice.

        EVERYONES brain changes with habits and mere repetitive thoughts!
        Choose a really bad habit your brain will alter for the worse. CHOOSE to quit (yes much harder with horrible habits) and your brain will REVERT to near normal. You think there won’t be consequences for incredibly bad dare I say stupid choices?

        Unfortunately, there are many in this world try suffer and then want to blame the world and hold it responsible for their failure to choose a non-destructive path.

        Don’t eat crap you’re unfamiliar with. Basic common sense. All the information on every life destroying drug is out there. It doesn’t jump down your throat. It’s a choice.

    2. I am someone who used Meth every day for more than 7 years, I have been clean for almost 9 years now. With all due respect for your opinion and empathy (not sympathy) for your personal lived experience, all I hear when I am reading your post is a victim mentality mindset. We have to do better about allowing people to feel they have the right to feel sorry for themselves for choices that they make. It’s not about shaming people, it’s about building confidence and teaching accountability for making choices. I know from my personal experience that the brain sends the urges to continue the habit, but in the end, it is the choice to give in to that inner voice trying to convince you to do it again. Getting involved and connected to healthy things and activities that help the brain to build new pathways is the right answer. Please stop the victim mentality thinking and instead teach strength and growth through accountability, someone can only feel shame if they allow themselves to feel that way. The reality is that it is uncomfortable when we realize the mistakes that we have made and have to be held accountable, and growth can only occur when we face that accountability and get uncomfortable.

  17. I think this argument is oversimplistic. It seems to do what it crtiticizes, placing the ‘blame’ on one factor, it just chooses a different one. Instead of drug abuse being all and only a ‘disease’, it is all and only a ‘choice’. In truth, it is both of these things and more, all intertwined in a complex and frustrating cycle.
    One may choose to begin using drugs for many reasons, such as injury or illness, recreation, escape, a coping mechanism, peer pressure, etc. They may choose to keep using until they cause
    dis-ease in their brain and body, the same way someone can cause diabetes from poor diet choices. It’s normal for one to accumulate excessive amounts of fat (among other things) from eating more calories than they burn, but that doesn’t make it healthy. Then, that extra weight and all the problems that come with it make it exponentially harder for a person to make the healthy choices necessary to cure the dis-ease that they have created by their choices. I don’t see how altering your brain structure through the use of harmful drugs is any different.
    Personally, I can attest to the overwhelming ‘compulsion’ that these brain changes can cause. Everyone is different. We do not experience all things the same way or even at all. One person may have strong compulsions, or shame, or something else, and another may not. Some depressed people are so overwhelmingly affected by their own brain dis-ease that they kill themselves, even when it looks to everyone around them like they ‘have it all’.
    Disease can be spontaneous, congenital, or caused by the person’s life choices. Some of those associated with the brain that deal with intangibles, such as thoughts and feelings, are naturally more difficult to objectively study and quantify, for now. That doesn’t mean they don’t exist or overpoweringly affect our behaviors sometimes.
    Chemical and structural changes in our brains, normal or natural and chosen or not, strongly affect our perceptions, behaviors, cognitive abilities, and decision making processes. To imply that drug abuse is simply choice is not telling the whole story, and not as helpful to as many people as a more complete understanding would be.

    1. “I don’t see how altering your brain structure through the use of harmful drugs is any different.”

      Then please read the post. The whole point of this post is that the brain is altered with any repetitious activity/learned skill/habit – which includes countless activities in which no drug or substance enters the body. So, it’s very different than putting on weight from eating.

      Also, if you want to use the old english sense of the word disease (as evidenced by your constant use of “dis-ease”), go ahead. But then don’t argue that it’s a medical disease. You’re conflating.

      “To imply that drug abuse is simply choice is not telling the whole story, and not as helpful to as many people as a more complete understanding would be.”

      I wrote a 450 page book fully explaining addiction and quitting in depth. Do you actually expect me to reprint that in a blog post? This post is about a single issue: the fact that there is no condition of the brain that robs people of the ability to not choose to use drugs/alcohol.

      1. While I think you have done a great job arguing your belief/opinion, backed up with a lot of great studies and facts, I choose to agree with Christina McCall. Your argument is just a little over simplified. Your arguments have validity, but there are so many factors that are in play here. And… While this post might have started out as a single issue, it has taken many different directions. For you to dismiss her comments in such a flippant way shows, to me, that maybe you didn’t fully read or understand her comments. Maybe the real issue here is to ask why do some people continue to choose behavior with such negative consequences…does that result from something that can be a “brain disease”? It is all a worthy subject for sure, and it would be spectacular to find a solution! For now though, I believe it is great to have discussions like these, so people can have different avenues to find success in overcoming addictions. One size does not yet fit all.

  18. You obviously have twisted medical facts to fit your model. Look up how a disease is qualified medically! I’ll scream this from the rooftop YOU ARE FUCKING STUPID!!! It is only a choice once you have been medically detoxed. Then you are made aware how your disease works. Then you have a choice to pick up.

    1. I strongly believe it all start as a simple choice or urge, but eventually, once it triggers your body organs to begin to react differently causing your brain to control the rest of your body, then it has turn out to be a medical problem regardless how anybody see it.

  19. It all starts with the fact that free will is not as strong as you think it is.
    We are our experiences and our DNA, nothing more, nothing less. Read the book: free will from Sam Harris and it will open up your eyes. You really miss a lot of points and don’t look at it wide enough. Just call yourself lucky that you grew up in an environment that gave you the opportunity to be strong willed enough to not touch drugs. And if it’s not that, thank your DNA for the fact that you don’t have the natural urge to explore that kinds of behaviour. A person never chooses which thoughts occur in his mind. The choices we make are highly influenced by everything around us.

    1. I read Sam Harris’s book several years ago. He doesn’t just say that free will is “not as strong as you think,” he says that free will is an illusion.

      Sam Harris is wrong. But assuming for the sake of argument that he is correct, then I am not choosing to write this blog, I am forced to have my beliefs, opinions, and interpretations of the available data – and to write them in this blog. And you are forced to disagree and to arrogantly tell me to read things I’ve already read. You are also forced to not read the whole blog, including the part that says:

      I was what you would call an “addict. If you want to know more about me, go to the About page.

      Furthermore, free will being an illusion, you also don’t have the ability to choose to click on the “about” page link to learn a little more about my background, or to to watch my video where I describe my experience as a “heroin addict,” or to look any further to where you would’ve had words forced into your brain that force you to know that I have ‘touched drugs.’ Well maybe that’s inaccurate. Many times I didn’t touch the drugs at all. I unfolded the wax bags the heroin came in, dumped the powder into a spoon, and mixed them up with water then injected them, without ever technically touching them. I can’t hold you responsible for what seems like a hastily fired off morally righteous set of comments because, again, free will is an illusion. Nevertheless, I must tell you (because deterministic forces make me do so), that I have read Sam Harris’s Free Will, and I have touched drugs (I’m sure some got onto my hands somewhere along the line of thousands of instances of injecting them.

      To say that our choices are “influenced by everything around us” is accurate in my opinion, but to say that we don’t have choices and that free will is an illusion is a totally different sort of proposition, and one with which I disagree. To be influenced is different than to be determined/caused to think/behave in a particular way.

      Ultimately, Sam Harris’s case against free will rests on what many have realized is a misinterpetation of Benjamin Libet’s experiments. Furthermore, later experiments have put that earlier data into much clearer focus – for example, this one by Schurger et al: An accumulator model for spontaneous neural activity prior to self-initiated movement.

      If you haven’t read it, I recommend Edwin Locke’s book The Illusion of Determinism: Why Free Will Is Real and Causal. It provides a good counterpoint to Harris and many other deniers of free will.

      I should also recommend my own article on one particular anti-free-will view: Philosophical Problem with the Brain Disease Model of Addiction: Epiphenomenalism.

      Finally, I have to say I do not think that strength of will has anything to do with the choice to use or not use substances. I don’t believe in will power. Once you really know you don’t like drugs/alcohol to the same degree that you used to, then reducing or quitting your use of them doesn’t take “strength.” I also do not think that merely touching drugs – using them – is the problem. The problem is believing their effects to be extremely meaningful. Drugs aren’t “addictive” – we attach ourselves to them because of what we see in them. This perspective can change, and when it does, people happily alter their substance use habits.

      1. Addiction certainly fits many of the descriptions of a disease. My sponsor once said, however, that while the disease model is a good way to understand addiction, it is not a good way to explain it. I think recovery is a matter of taking responsibility. As soon as I begin to talk about “my disease,” I am placing the locus of control outside of myself. You might say that “I can’t control my first thought,” but I MUST be in control of my second one. DNA can be changed, it has been shown, and the life experience that led me to believe that drugs and alcohol gave my life meaning can be changed, too. I have always said that the only way to stop doing something that you enjoy doing is to find something that you enjoy doing more. Addiction is a practice and I was good at it. My life in recovery is a practice as well and, though I am new at it (10 years), it is rewarding beyond anything I could have imagined. I don’t worry about a disease, but I am diligent in my choices.

  20. Just a quick question…do you consider type 2 diabetes to be a disease? I mean, everyone likes to bring up diabetes as an example…type 2 diabetes is generally a result of someone choosing to overindulge in sugar for a really long time. Eventually the body starts becoming resistant to insulin to the point that the body cannot produce enough to function adequately.

    Next question… Has anyone bothered to stop and consider the idea that the choice model and the disease model are both correct? They aren’t mutually exclusive ideas, folks. You can absolutely choose to have a disease. Your choices can result in a disease (for example, see every STD on earth). Why don’t you start working *with* the disease model folks to develop a better model that helps instead of wasting time and resources in a pointless debate about who’s right and who’s wrong?

    Points of logic…
    1. 70% of people getting away from substance use through incentive introduction doesn’t invalidate the disease model. 30% failed to get away from substance use.

    2. How do you know the difference between an addict and a heavy abuser? Sounds like your only qualification is “sought help with a substance abuse problem.” that’s a pretty low bar. Are you arguing that there’s no difference between abuse and addiction?

    There were more problems that I saw with this article, but I can’t remember them now, and I’m wasting my time posting as is, so I’ll leave it at that.

  21. My friend and I started partying together at the same time. While she walked away after a week, I could not stop due to the cravings and the constant thoughts that made everything else in life less important than feeling good (with that drug). Why? Why could she walk away and not have a craving or another thought about it and I be so obsessed as to destroy my life (job, health, family, criminal record, etc.) over it? see https://www.scientificamerican.com/article/the-new-genetics-of-mental-illness/

Leave a comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.