Using a drug for the first time may be a choice, but the resulting addiction is a disease. It is a common misconception that drug addiction is a choice, but the state of addiction is an actual disease of the brain.

The definition of addiction varies by organization in addition to society’s general view of drug use and addictive behavior.

However, the National Institute of Health and other public health institutions tend to describe addiction as a long-term disease where an individual acts on impulses to seek and use drugs despite adverse consequences.

According to the Substance Abuse and Mental Health Services Administration’s 2018 National Survey on Drug Use and Health, 14.8 million Americans ages 12 and older had alcohol use disorder in comparison to 2 million who had an opioid use disorder. Methamphetamine use has risen in the United States as well, with 1.1 million Americans having a disorder related to methamphetamine use.

If people who use drugs continually seek them out despite the consequences, is it really a choice or a sickness that makes them do so?

What Addiction Does To a Person’s Brain

Medical professionals have studied addiction for decades and find that it alters a person’s brain in numerous ways. It is not simply a bad habit caused by choice until it gets out of hand. Addiction is a disease.

Most drugs enhance dopamine levels—a “feel good” neurotransmitter that tells the body it’s experiencing pleasure— which is what causes addicts to keep seeking and doing drugs even though it causes harm.

When someone gets addicted to drugs, it erodes brain circuitry that enables the brain to produce dopamine naturally. Pleasure is no longer derived from activities once organically enjoyed, and can cause the addict to become withdrawn, focused solely on acquiring more drugs.

Brain circuitry can also become overactive as a result of addiction. These circuits control how we respond to stressful situations. But an addict’s brain may cause them to feel stressed even in the absence of drugs.

Compulsive behavior goes hand in hand with addiction because the prefrontal cortex that handles decision-making processes can be altered by drug addiction.

Risk Factors for Addiction

  • Family and home life. Strained family relationships and stressful home life can cause people to seek refuge in substance abuse, particularly if household members exposed them to drugs.
  • Childhood trauma. There is a profound correlation between childhood trauma, abuse, and developing compulsive and/or addictive behaviors as a coping strategy.
  • How old you were when you began using drugs. While addiction can develop at any age, usually the younger a person is when they start, the more likely they are to develop addiction.
  • Genetics.
  • Peer pressure. School, friends, and professional environments can create pressure to try drugs.

Genetic Predisposition for Addiction

As for whether drug addiction is a choice, medical professionals believe that addiction is due in part to genetic predisposition and poor coping skills in stressful situations.

Studies have shown that the children of parents who struggled with alcohol or drug addiction were eight times more likely to develop an addiction compared to children whose parents did not have substance abuse issues.

Even if you aren’t genetically predisposed to addictive behaviors, you can still end up suffering from drug addiction. Repeatedly using drugs and/or alcohol can rewire your brain. Trauma and stressful situations that arise may also cause you to keep seeking and using substances to the point of addiction.

Why Don’t Addicts Just Go To Rehab?

Drug and alcohol addiction are extremely common problems. Things like cost, availability of rehabilitative care and recovery in one’s location, and lack of social and familial support can bar someone from receiving help with an addiction.

Since drug addiction can be seen as a choice rather than the result of a disease, the stigmatization of addiction can also cause one to not seek treatment.

This can cause a snowball effect. Additional health, financial, and legal consequences are created as a result of refusing to seek treatment. And the addict doesn’t seek treatment mainly because they don’t want other people to know that they are suffering with an addiction. The fear stemming from the worry that it could cost them their job, relationship, or any other thing that they hold dear.


  1. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health
  2. Addiction is a Disease
  3. The Genetics of Drug and Alcohol Addiction
  4. Understanding Stigma of Mental and Substance Use Disorders

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