Is Addiction a Choice?

By Carol Cannon, M.A., C.C.D.C.

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Is addiction a sin? Or is it a disease? Is it a choice, or is it an accident? If we define addiction as a disease, does that mean alcoholics and addicts aren’t responsible for their actions? If we consider it a sin, does that mean addicts and alcoholics aren’t worthy of respect? And, finally, is the “disease concept of addiction” an excuse for inappropriate behavior?

As a certified addictions counselor who has spent eight hours a day, five days a week, for the last thirty years in the company of alcoholics and addicts, I would say that the disease concept of alcoholism/addiction generates more internal conflict and interpersonal controversy among both conservatives and liberals, churchgoers and non-believers, and addicts and their families than many other subjects. Discussing this topic is nearly as risky as discussing religion and politics, probably because our views on the nature of addiction have implications in both areas.

While listening to a politically-oriented talk show recently, I heard someone make an uncom-plimentary remark about people who rationalize bad behavior by calling it an addiction. The caller’s statement raised several questions in my mind: (1) Is the so-called disease concept of addiction a ploy for excusing inappropriate behavior? (2) Is it valid to assume that identifying a behavior as addictive gives addicts “license” or permission to act illegally or immorally? And (3) if inappropriate behavior is prompted by a diseased condition of body or mind, what is the best way for concerned persons to respond?

Before we proceed, let me give a clinical description of addiction: addiction is a bio/psycho, social/spiritual disease that is—by nature—primary, chronic, progressive, and potentially fatal. It is characterized by tolerance and loss of control. People can addict themselves to almost anything they make highest priority in their lives while ignoring other important priorities. In so doing, they avoid relationships, reality, and responsibility. If their indulgences are detrimental to them or the people closest to them and they persist in doing them in the face of adverse consequences, they are considered addicts.

Coming to terms with reality

When we define a given behavior as addictive or compulsive, are we implying that it’s okay? Is it acceptable for addicts and alcoholics to drink, drug, or gamble while their families go hungry? Is it okay for them to abuse and neglect their spouses and children? Not at all. Saying that someone is an addict doesn’t make him/her any less responsible for correcting his/her behavior than saying “I am a sinner” releases me to trespass indiscriminately or indefinitely! Nor does it suggest that addicts are not accountable for the damage done while they are under the in-fluence. Behavior has consequences. Drug addicts and alcoholics are accountable for their misdeeds, as are workaholics, relationship junkies, and food addicts. Let’s use a common physical illness like diabetes as an example: When a physician informs a patient that he has diabetes, is she implying that it’s okay for the patient to use his symptoms as a reason to avoid making lifestyle changes? Hardly! The diagnosis simply suggests a course of action that could prolong or improve the patient’s quality of life! A diagnosis of addiction serves exactly the same purpose. It helps the addict create an effective treatment plan.

Lisa, a young nurse who was addicted to prescription drugs, was on the brink of losing her family and career. Here’s her perspective on the matter: “As long as I considered myself a bad person who needed to get good, I felt hopeless. When a counselor told me I wasn’t a bad person who needed to get good, but rather a sick person who needed to get well, I breathed a sigh of relief. As a medical professional, I knew what to do about illness.” With the help of a counselor, Lisa created a viable treatment plan to arrest her chemical dependence. She took responsibility for her recovery and, by God’s grace, has been sober for fifteen years.

Admittedly, there are addicts who use the disease concept to excuse bad behavior—particularly those who don’t want to quit. If they didn’t have that excuse, they would find another. But this doesn’t mean that all addicts use the disease concept to justify their drug-taking. Five church-goers deal honestly and fairly in business. One does not. The dishonesty of the one is not a reflection on the other five. The fact that some addicts use the disease concept of addiction to avoid recovering is not a reflection on those who don’t.

The disease concept does not preclude moral responsibility. I have met very few alcoholics or addicts in the treatment setting who are looking for excuses. Their substance abuse has driven them into the ground. They are looking a practical ways to recover. They accept responsibility for change and growth and, in the process, make themselves fully accountable for past actions. Making amends is a major part of twelve-step programs, which are an intrinsic component of most treatment plans.

Parenthetically, some people who are uncomfortable with the disease concept of addiction are also uneasy with the idea of personal powerlessness upon which twelve-step programs are based. They see powerlessness as a kind of defeatism or blind resignation. Please note that powerlessness does not equate with mindless resignation. There is a vast difference between (1) succumbing to one’s weakness and (2) surrendering to one’s need of help. An addict’s admission of powerlessness simply indicates that he knows his problems are bigger than he is and that he needs help.

Would you and I be powerless if we stepped into a boxing ring with the heavyweight champion of the world? No doubt. When addicts and alcoholics acknowledge their powerlessness, they are consciously admitting that they are “beyond human aid” and that all attempts to “win through in single-handed combat” have failed.* No matter how seriously they may want to change their lives, they recognize the fact that they will lose the battle if they persist in fighting it alone. They have discovered by unhappy experience that there is “no such thing as the personal conquest of this compulsion with the unaided will.” Thus, when addicts admit that they are powerless, they’re simply facing the fact that they need good orderly direction from a source of wisdom and strength outside themselves. That’s not a bad place to start!

On your journey today, if you meet an addict or alcoholic along the way, let him/her know that s/he has a disease from which he or she can recover. The medical model provides a solid framework for treating unhealthy dependencies. Professional care (either inpatient or out-patient) and twelve-step aftercare programs have been proven by research to be the most effective means for gaining and maintaining sobriety. There is no better support system for recovering addicts than the people and principles of twelve-step groups. They offer a simple spiritual program for remaining abstinent and, ultimately, for developing character. Treatment and twelve-step meetings, used in combination, are a God-given means of recovery.

*Phrases quoted in this article come from Alcoholics Anonymous material.