Is addiction a choice or a disease? There are proponents on both sides with research to back their claims. Is it possible that addiction is neither? Kent Dunnington argues for another model in his book, Addiction and Virtue: Beyond the Models of Disease and Choice.
Dunnington begins by stating, “If addictions are diseases, then they are not the sorts of thing that humans do but rather the sorts of thing that humans suffer. And, if this is so, then it would be simply misguided to ask – as I propose to ask – how we should understand and describe addiction as a type of human action.” (15)
Alcoholism is commonly defined as a “chronic, relapsing, brain disease” characterized by “compulsive use of drugs.” (17) Being a philosopher, Dunnington takes their definition to task. There are several arguments made by proponents of the disease model supporting their claim that addiction is in fact a disease.
Argument 1 – Tolerance and Withdrawal
“Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain”, and those changes are accompanied by what is known as tolerance and withdrawal. Therefore, addiction must be accompanied by tolerance and withdrawal and all cases of tolerance and withdrawal must be considered addiction. However, tolerance and withdrawal really are not necessary and sufficient conditions for addiction. People without addiction can experience tolerance and withdrawal and plenty of people with addictions have communicated that upon stopping they did not experience the negative side effects of tolerance and withdrawal.
Argument 2 – Brain Changes Result in Involuntary Behavior
It is often noted that drug abuse leads to changes in the structure and function of the brain. It is assumed that these changes then result in involuntary behavior, therefore making addiction more like a disease than a type of human action. Dunnington argues that the first premise is correct, but not the second premise. He writes, “if it [the second premise] were true, it would turn out that all sorts of activities that we consider voluntary are in fact involuntary. For instance, studies show that the brain structure and function of skilled musicians are transformed by years of practice.” (20)
Argument 3 – Addiction is Genetic
This argument holds that if an activity is influenced by genetics it is therefore involuntary. The problem with this position is that we now know that our genes shape everything we do. Research has shown that cheerfulness, religiosity and the like are genetically influenced, yet we do not consider these to be diseases. “Why, then, should we conclude that addiction is a disease simply because addiction has genetic underpinnings? Unless we are content to reduce all human behavior to pathology, we must reject the assumption that genetic influence entails biological determinism.” (24)
Argument 4 – Medical Treatment is the Best Option
Dunnignton agrees that if medical intervention is the best option for treatment then it may be appropriate to speak of addiction as disease. “The disease concept of addiction maintains, first, that addiction is a chronic physiological disorder, and second, that it therefore can be most adequately treated through medical intervention.” (24) The problem with this is that most addicts do stop without medical intervention. While studies of addiction relapse indicate a 10-40% remission rate in those treated they do not take into account that those who have willingly entered into treatment most likely “exhibit comorbidity”, possibly influencing their recovery rate. However, recent studies of the general public indicate up to an 82% remission rate of addiction without medical treatment. Addiction, by these results, is neither chronic nor best treated medically.