Addiction Isn’t a Choice — It’s a Medical Condition

For too long, researchers of substance use disorders worked against deep-rooted views about what drives a person to take drugs. Much of that research was viewed through the lens of addiction stemming from a moral flaw or a lack of willpower.

Yet now we are developing a clearer understanding. Leading research implores us to view addiction as the medical condition it is, helping rehab and treatment providers connect with the 40 million people around the world struggling with a substance use disorder.

What is an addiction, medically speaking?

A person can become addicted to almost any substance or activity. For centuries, humans have battled to maintain their control over their daily actions and avoid repeating harmful behaviours, in the hope of becoming stronger, healthier, and, broadly speaking, free from Earthly temptations.

Now in today’s technological age, digital detox proponents warn us of growing addicted to social media, online gambling, videogames and doomscrolling. We may have had less exposure to the dangers of these more modern vices, compared to substance addictions, which have dominated addictive behavioural research for over a century.

Addiction is classified as a chronic, relapsing disorder. This means it tends to develop over time, can be managed but not necessarily “cured,” and often requires long-term care and support. Crucially, suffering from an addiction is not an indicator of being weak, but instead relates to being unwell.

No matter the form of addiction, certain shared processes happen in the mind over time, which are starting to show that addictions are not necessarily a matter of choice. They may stem from a constellation of factors outside a person’s control, and understanding these medical underpinnings may broadly benefit society at large.

Defining substance addiction

Substance addiction, also known as substance use disorder, is a diagnosable condition in the DSM-5, the leading manual for psychiatric diagnoses. To meet clinical criteria, a person will typically show some of the following:

• Loss of control over how often or how much they use
• A growing tolerance to the substance’s effects
• Withdrawal symptoms occur when they stop or reduce use
• Strong cravings and urges
• Continued use despite serious consequences

There are a large number of impairments found in the relationship between addiction and the brain, including in areas responsible for how we perceive reward, motivation, risk and stress. What may start as voluntary use eventually becomes a compulsion, driven by a host of neurological changes.

Why do many people see addiction as a choice?

We live in a time where deaths related to drug poisoning in the country are the highest since records began. We seem to be approaching unprecedented drug use across the country. As the number continues to grow, thankfully so too does the body of research into the causes of substance use disorder (SUDs). Many people still carry the belief that addiction is a moral failing or simply a series of bad choices.

Our views on what addiction is and where it stems from may lead us to overly simple outcomes or passing a brash judgement on a person who is suffering. It is easy to judge someone else’s struggle from the outside. In the realm of healthcare and rehab treatment, it has never benefited us to be devoid of sympathy.

A person struggling with addiction is living with a condition that has rewired how their reward and survival mechanisms function. Understanding addiction as a medical condition may, over time, help us develop stronger treatment and save the lives of millions of people suffering today.

Isn’t the first use still a choice?

This is one of the most common counterarguments, and yes, technically, the first use of a substance is almost always voluntary. Aside from a smaller number of unfortunate people who are physically forced into drug use, most people indulge in experiments with drugs out of curiosity during adolescence, or their early 20s.

What starts as an innocuous trial of a drug can slip out of a person’s control quicker than they realise. Many people try a drink, a cigarette or an illegal substance in their teens and don’t develop an addiction. However, for some, the first use marks the beginning of a treacherous journey, often stemming from quiet underlying factors.

While the first step may be voluntary, addiction itself can become as real as prison walls, given enough time. Returning to using a drug undermines the person’s ability to choose differently. Understanding this premise will help us remove focus on the first time a person uses drugs, instead replacing blame with what the person needs: care and compassion.

What role do genetics and environment play?

Countless factors are at play that can drive someone into drug use, and, sadly, keep them there. This includes both the hand a person is dealt (genetics) and the events in the world they grow up in (environment).

How can we reframe the conversation on addiction?

Brashly labelling someone’s addiction as “their choice” might not seem like the most painful choice of words, but it has consequences reaching further than you may think. Misunderstanding the nature of alcohol and drug addiction can actively shape how people view themselves and whether they’re able to reach the help they need.

Here are some ways we can start reframing our conversations more constructively:

• Use science-based language: Talk about the impairments in the relationship between addiction and the brain, rather than a behavioural flaw or lack of willpower. This helps ground the issue in facts, not judgement.
• Replace blame with curiosity and compassion: Instead of asking “What’s wrong with them?”, try “What happened to them?” A compassionate lens promotes a clearer view and lays the groundwork for healing.
• Emphasise recovery over punishment: We all find ourselves in situations where being punished does not help us make amends. Focus on the possibility of change and long-term recovery, rather than what is needed as a punitive response or consequence. This opens the door to support, not shame.
• Promote access to evidence-based treatment: Encourage pathways that are rooted in proven science and evidence-based therapy. We all have access to credible scientific studies into addiction and substance abuse. Be diligent about the people who influence and shape your views on addiction. It may help you give support to a person who needs it.

Where can I find medical help for addiction?

If you’re struggling with addiction, or supporting someone who is, it’s important to remember this: addiction isn’t a moral failure. It’s a medical condition that deserves expert insight and care.

At UKAT, we provide professional treatment that addresses every aspect of addiction, from safe detox and withdrawal support to long-term therapy and relapse prevention. Our expert team understands the complex roots of substance use and works with you to build a recovery plan tailored to your needs.

You’ll be treated with dignity and understanding in a safe, supportive space. We’re ready to lay the foundations that give you the best chances of sustained and complete recovery.

Your journey can begin today. Reach out to UKAT to take the first step of healing and develop a brighter, sober tomorrow.