There is an ongoing debate on whether addiction is a disease or not. Most medical associations will define it as such – including the American Medical Association. Others, however, consider it a consequence of poor choices and that addiction can be broken with willpower alone.

There is much evidence of both biological, behavioural and environmental issues that may lead someone to a life of addiction. We will now explore the causes of addiction further and consider whether these causes are due to poor choices or something out of the user’s hands.

Correlation Between Mental Illness and Addiction:

There is a strong correlation between mental illness and addiction. According to the Orlando Recovery Center, about half of all addicts have been diagnosed with at least one mental illness. It can be argued that those with mental illness are unable to make rational decisions about drug use and may use drugs for self-medication.

addiction and mental ill

Youth Addiction:

Most illicit drug use starts in teenage years. In the British Drugs Survey (2014) 64% of participants stated they were under 18 when they first began taking drugs. Those under 18 are not fully developed enough to be able to make rational decisions and fully understand the consequences for their future.

Biology of Addiction:

After the first time, someone takes drugs their body takes over and keeps them coming back for more. Addictive drugs release a lot of pleasure chemicals in the brain. Over time these chemicals change the way the brain’s pleasure and reward system works. It will take more of a drug for the individual to feel happy. Going without the drug will cause the individual to experience withdrawal symptoms. This hijack can take any choice a user may have had away from them. They may desperately wish to stop but the withdrawal symptoms are too severe to comfortably stop drug use.

In conclusion:

Although there are users that may have made poor decisions in their lives that resulted in addiction, many drug users are victims of mental health or were introduced to drugs at too young of an age to truly understand the consequences of drug use. Regardless of whether or not addiction is a choice, it is a problem that severly affects thousands of people worldwide and the focus of conversation should be on prevention and recovery. The choice aregument is ultimately irrelevant.

40 thoughts on “Is Drug Addiction a Choice?

  1. So there’s probably a fine line between substance abuser and addict. I’m not really sure which I was… but for years I wouldn’t stop drinking (couldn’t? not sure that’s true). I’m talking about alcohol now: Clearly there is a choice factor. If there wasn’t, people couldn’t quit. But so much of the choice has to do with external factors such as support network, positive role models, reasons to stay sober. And then there are all the internal factors like self esteem, satisfaction with your life, etc. And then there are physiological factors that go hand in hand with self-medication. So I guess I’m going with “neither a disease nor a choice” but a complex set of circumstances that make substance abuse seem preferable to sobriety. My two cents anyway.

    Liked by 4 people

  2. Say what you will about choice and addiction. I know what I went through and am going through.
    Addiction isn’t a choice.
    Using the first time is a choice.
    Let me give you an example.
    You visit a friend in the hospital. They’ve been run over by a car. They chose to cross the street in front of the car.
    Sad? Yeah.
    The next week, they’re back in the hospital. Run over again.
    Over the next several months, they’re hospitalized several more times, sometimes the same day they were released.
    Is it a choice? Is there a mental disorder? Is it a disease? Do they want to die?
    Personally, I think it’s related to split personality. If that’s a disease, so is addiction.
    My two cents…

    Liked by 2 people

  3. I agree wholeheartedly with Jeff. Sometimes the question is, “Which came first?” mental illness or addiction? Regardless, we need to understand that people who abuse substances in an effort to self-medicate, or those whose perception of life and relationships have been thwarted and distorted by early drug experimentation, are first and foremost people – not drug addicts or drunkards. They are human beings who unfortunately have a dependence on alcohol or drugs or because they haven’t used or perhaps who have never been taught other coping skills. They are people who never learned to deal with rejection, separation or loss; people who haven’t learned empathy, who have been damaged by traumatic events, or who never learned how to be an adult. These individuals are hurting and need understanding, good role models and people to listen to them and gently guide their perceptions of the world back to normal. I know the general public believes in ‘tough love’ or medication, but in order to eradicate a problem we must get to the cause, not just patch it up with quick or easy solutions. Meds do have their place, as does discipline and boundaries, but to employ them to the exclusion of compassion is a mistake.

    Often, mental illness co-occurs along with drug dependence or is a result of it. The first order of operation should be to correct any nutritional or chemical imbalances which probably arise from lack of self-care. Minerals and vitamins can even help with ‘dope sickness.’ Everyone knows how something as easily treatable as Candida (or UTI) can run wild in a nursing home resident and can make them act like a crazy person. If you say that food has no power, tell that to a grade school teacher after a Halloween party. Administering strong antipsychotic drugs should be discouraged as it often only leads to bigger problems and more distrust of the very people who are trying to help.

    As someone who has often been in the midst of dysfunction (but ok myself) for over six decades, I can say with conviction that the best skill I ever learned to help the sufferer – and the situations one finds surrounding mental illness/addiction – was Dialectic Behavior Therapy. I always thought I was powerless to prevent the merry-go-round of pain and suffering of another, but through DBT I have learned otherwise.

    Liked by 3 people

    1. Hillary, I like a lot of your commentary. I’m going to look into Dialectic Behavior Therapy. Through all my years of therapy, I’ve never heard of it. I’ve heard of Cognitive Behavioral Therapy, however, I stopped my pursuit of becoming a counselor because I couldn’t decide on a theory or application of theory. I mainly stopped, however, because I had the realization that I didn’t want to actually harm someone else by saying the wrong thing during therapy, But given my insight and personal experience with therapy, I am rethinking this field of work. The program I was in was making me anxious and it was just after I recovered from a major illness myself. I often cannot think of a more fulfilling thing to do than to help those suffering.

      Liked by 2 people

      1. Dear janamariaart,
        I truly believe that only those who have suffered or have directly witnessed the suffering of others can truly help those who are in pain! I know my son was reluctant to be in counseling with an ‘academic,’ to take medications that left him zoned-out, and was not keen on 12-step programs. No wonder there are so many people who go round and round with their recovery efforts! There MUST be a better way.
        I first heard of DBT when I took a (free) 12-week course entitled, Family-to-Family by NAMI (National Alliance on Mental Illness). Although I went head-to-head with the instructors because NAMI’s focus is on antipsychotics, etc., I did learn about the various types of mental illness and determined that my son did NOT have bi-polar (which takes about 10 years to figure out) as the doctors diagnosed, but that he was acting more like a man with Borderline Personality Disorder. BPD is not covered by insurance because it does not respond to medication and is difficult to cure. But the literature did say that CBT, and DBT especially, were used with some success. I took a $12 course online at and learned skills that anyone can use anywhere. I think it should be taught in primary and secondary school!
        It has been about a year since I began to employ this way of conversing with my son and I can definitively say that I am enjoying his company and his personality as I have not done since he was in junior high! Another thing that I found out just recently: it takes about 14 months for dopamine receptors to regrow – BUT THEY DO. It had been thought that parts of the brain were destroyed and that’s that. Little by little, I see joy in his face: he plays the guitar, works on his car, laughs, helps with the cooking and is a capable handyman around the house.
        If you are inclined to be a counselor, I believe you could truly make a difference if you included DBT in your toolkit. Not everyone practices it, but I know if I were in your shoes, I would explore the possibility. I’ve studied psychology over the decades, but nothing (except behaviorism long ago) ever intrigued me as this does. I hope more and more people come to realize its value. 😉

        Liked by 1 person

  4. Through volunteering at a recovery home I have been able to see people who are both addicted physically and those who self-medicate by choice. As Hilary mentioned, we are quick to label people as addicts, when they are people first, addicts second. Removing that label has helped me have compassion for people who are addicted to drugs. I have seen enough people suffer from addiction to understand it as a disease. On the choice side of it, there are people like me, who when I was younger drank alcohol heavily. It was not a physical addiction. Once I understood that I was drinking to fit in and not making healthy choices, I made a conscious choice to stop. It was easy and I still don’t crave alcohol.
    Drug use is also influenced by our cultural beliefs. We discourage youth from using drugs while at the same time portray it as glamorous. We criminalize drugs, unless they are from a reputable manufacturer. We put people on addicting drugs when they are in serious medical pain and then expect them to stop and not become addicted. These mixed messages are clearly a contributing factor to the high numbers of drug use.

    Liked by 4 people

  5. First off, I don’t think I heard mention of (or it wasn’t emphasized enough) the frequency that an addiction was passed on from parental decisions. Children far younger than 10 often are exposed to substance abuse through their parents directly. Deep addicts do not withhold from their children. Where did Johnny get that bag? Probably from a kid whose parents don’t keep it from them!
    Secondly, the doctor’s office is a significant source of drug problems. One way of doing so is inadvertent addiction to things such as opiates. The other way is by offering such inattentive care as to make an addict or user more comfortable with their own medicating. Think prescribing something that ends up having horrible effects just to try the next drug and even more drugs to treat the side effects. The pharmaceutical rollercoaster can be worse than the condition it’s all meant to treat.
    I’ve shoved enough things in my face to tell you that the pills from the doctor’s office have always been the worst. This country needs to stop letting big pharma push pills. The solution is genuinely in -listening- to their plight and helping them find the light for themselves. It’s incredibly pretentious to assume nobody’s life is so bad that getting high would be the only comfort available.
    Lastly, I have to say that it’s quite natural to crave a fix or high. To say that giving in to the urge is the problem is like saying the problem with wildfires is that trees are flammable.

    Liked by 1 person

  6. Thanks for all the info. I like that you concluded that it is an irrelevant argument, we can waste a lot of time and energy arguing and judging, or we can help with prevention and we can help with recovery. I also liked the comment from Immpower You who seems to be doing exactly that. They seemed to have a person centred perspective and really it’s the people not the science we have to help in the long run. Great blog, keep writing.

    Liked by 3 people

  7. I agree with Lauren Macdonald, this is a great blog post and an important topic This is the first time in my five years of blogging that I’ve returned to a post to follow the comments. I think people have made excellent points here and it has helped me learn about (my own) substance abuse.

    Liked by 3 people

  8. Well written. I love this discussion…I watched a very close family member kick a 3-year pain pill addiction pretty much cold turkey. There were lots of underlying issues, including mental illness, and self-esteem issues…ask her now, she will tell you she chose it, but I know that is not true. Her grit and determination now says she could get out of that situation, but she was in a hole impossible to escape alone.

    Liked by 1 person

    1. Sometimes the issue is not just kicking the habit, but finding joy again so that they stay off the drugs. Their Dopamine has been so depleted that the world looks so gray to these unfortunates.

      Liked by 3 people

  9. Addictive substances will always be there, much like things that cause stressors, hurt or disappointment, some people thrive under stressful environment and seem energised, others crumble. You hear stories of people that have through untold evil and have come out stronger on the other end.

    Getting people clean while in rehab is the easy part, the hard part is building resilience in them to say “NO” to drugs in the face of the same temptations or circumstances that caused them to take drugs in the first place. Be it stress, anxiety, hurt or depression.

    This is what is interesting about addiction, why some can say no and others can’t even when they are put in the same situations.

    Liked by 3 people

    1. We have to ask why people take resorted to taking drugs in the first place, we have to ask why everyone else is not on drugs. I think any treatment has to deal with the underlying reasons for the addiction otherwise it will not work.

      For example, if it is the depression that caused addiction, don’t you think it is essential to treat the depression as well as the addiction?

      Some people become addicts because of lack of purpose, so treating the addiction here becomes just as important as helping them find meaning in there lives.

      Liked by 2 people

  10. The choice is more about getting into recovery. But first the person has to know about and understand a little about recovery. After working for 30 years as an addictions counselor, what I want people to know is that recovery is possible, but for most people it’s a lot of work. The general public has no idea about the slippery slope from substance abuse, about the power of addiction and how much work it takes to recovery from or to become stable and stay sober. For most addicts, it’s a life long process. People in recovery need support and encouragement.

    Liked by 3 people

  11. Environment, I believe, is key. As someone who has played both the light and dark sides, I’m very aware of influences. I don’t think we ever want to lose control. But sometimes to really live life is a scary proposition


  12. I used to think it was all a choice, that there was NO way it had anything to do with mental health… My older sister had been addict for more years than I can count. She was married to a doctor had two beautiful children, pretty much the perfect life. She went to Hazelden twice, each time, we believed she would beat this. After getting a divorce, giving up the rights of her children, she spent the last 15 years of her life in and out of treatment, jail, and at one point was homeless. She sadly, took her life last June. We both grew up the same, received the same care, love, and opportunities, yes, mental health is a BIG problem, it is over looked and looked down upon. I believe there are still many judgements made against people who have mental health problems, it is a very sad thing and something that needs to be addressed and more education starting at a very young age, before kids even get to junior high. Thanks for writing this post, the word needs to get out, genetics, is not about drug use, it is about the genetics of mental health.


  13. Hey I enjoyed your post, I was wondering if you would follow me as well because i have ablog site on addiction and parenting and have found there’s not much information out there or many parents out there willingly to talk about theor addiction because of shame, guilt or being afraid of ridicule or even legal involvement with their kids so they stay silent and most people who become addicted are depressed and
    I want to help reach those who need help. Thanks so much i hope to have you as a follower

    Liked by 1 person

  14. Hello! I just started my blog about addiction and recovery. I am telling my story in hopes of helping anyone who may want it. I am new to this so I was just wondering if maybe you could take a look at my posts and recommend it to anyone? Thank you so much!!!

    Liked by 2 people

  15. Navjeevan Rehabilitation center Patiala is home for people who wish to change their lives. Our therapeutic treatments are best suited to treat drug addicts and alcoholics. Allow us to be your ‘guiding light’ and find a way out of substance addiction.

    We have successfully tailored many alternatives to help people who have fallen prey in the world of drugs. Our services are organized to treat the mind as well as the body. We give behavioral counseling to our patients, understand their inner turmoil and help them overcome their fear of being carried away by drugs.


    Liked by 1 person

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