Is Addiction an Illness?

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“Addict” carries baggage when you use it to describe a person. But so does “diseased.” There’s an ongoing debate about whether addiction is a moral choice or a physical disease, and the debate impacts addiction recovery. Here’s what you need to understand.

What Causes Addiction?

First, let’s define addiction with the help of the National Institute on Drug Abuse: “chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.”

But where there’s one meaning, there isn’t one clear cause of addiction. The experts and scientists who study addiction point to many risk factors. They’re called “risk factors” because having them doesn’t mean you will become addicted, just that you’re more at risk. Here are three:

1. What You’re Born With

Scientists link addiction to genetics, though they’re still researching how strongly the link works in the brain and body. Having addicted relatives might mean you’re more prone to it. Also, they consider personality traits (impulsivity or thrill-seeking) as inherent risk factors, along with mental illness.

The mental illness factors are called co-occurring disorders. You might risk addiction more if you experience depression, anxiety, or other mental illnesses.

2. Who You’re Around

Like the internal (genetics, personality, and mental illness), the external features someone’s life might increase their risk of addiction. 

These include who you spend time with, whether they often abuse substances, how stable your home is, and if you’ve faced previous trauma, among others.

3. How Much You’ve Developed

Because addictive substances can chemically alter your brain, how much you’ve already developed matters. If you first use drugs at a younger age, your risk of addiction increases. After all, your brain doesn’t fully develop until your twenties. Drug use as a teenager catches you at a fragile stage and is more likely to cause addiction.

These factors have many parts, but none have a clear relationship to addiction. And so, people who want to treat addiction develop their own models of explanation.

The Two Models

The addiction debate mostly involves two models: the Moral Model and the Disease Model. Let’s get into what they are and what they do.

The Moral Model

The moral model of addiction explains an addiction in moral terms: someone becomes addicted because they have a personal flaw. The first time you use drugs or alcohol, it’s viewed as the first poor choice of a larger problem. Because this idea connects addiction and morality, it often involves a higher power. Addiction, because it’s immoral, disconnects the addict from the higher power.

But the moral model has a rehab plan for redemption: willpower and reconnection to a moral center, often with the twelve-step program we’ve all heard about. Alcoholic recovery tends to rely on this moral approach to sobriety.

What’s the Issue?

This moral idea of addiction informed the Temperance Movement in the mid-19th and early 20th century, when its reformers called alcohol evil and said it led drinkers into sin. Today the moral model might explain why drug users more often receive jail time than rehab. If addiction is immoral, it deserves punishment.

This extension of the moral model leads its critics to say that it’s unsympathetic to addicts, that it generates stigma, and that it ignores the complicated nature of addiction. Most medical experts have rejected the moral model as harmful — if you feel shame for addiction, you might not admit that you need help. 

The Disease Model

The disease model rejects the moral explanation and says that addiction is a chronic brain sickness, like a mental illness. “Disease” here means disease in the medical sense: a physical abnormality that causes discomfort and possibly death if not treated. Addiction is tied to physical factors, alters the brain’s chemicals, and harms the body, just like an illness. Addiction can’t be cured but can be treated, just like an illness.

And the disease model says that recovery comes through treatment, again just like an illness. Doctors should treat how addiction alters the mind and body, rather than expect patients to buck up and will themselves through it. Like other diseases, addiction needs a treatment developed especially for the patient. And medical attention will need to last a long time to do any good, like the long-term MATs for opioid recovery.

What’s the Issue?

Critics claim that calling addiction an illness makes addicts into victims and maybe denies their own responsibility. This might hamper recovery: if you’re not in control of your addiction, how can you be in control of your recovery? One critic in particular, neuroscientist Marc Lewis, wrote a book that notes the harm of calling addiction a disease. He argues instead that addiction is a habit that begins in the brain like a disease, but one that the brain can adapt to overcome.

What Does All This Mean to Me?

This debate might seem like a terminology debate with no stakes, but it matters because how we define addiction decides how we treat it. The moral model says that recovery improves character; the disease model says recovery improves health. If you’re addicted to opioids, you need to know what to do. If someone you know is addicted to opioids, they need to know what to do. We act based on our understandings.

It matters that most medical professionals embrace the disease model. If they see addiction as a health issue, all their health resources and expertise will support recovery. But on the other hand, if you seek treatment but also think that recovery will better your moral standing, the moral model could assist you as well. Ultimately, your recovery or the recovery of a loved one will come from your understanding of addiction. The key is that you don’t feel ashamed of that first choice to use drugs, and that you feel secure in asking for help.