Last updated : May 12, 2025
The National Institutes of Health, taking into account decades of cellular, molecular, and biochemical research, understands addiction as a disease of the brain. And yet, family members and co-workers impacted by an addicted person may believe drug use is the user’s choice. The drug user may think so too. Let’s carefully consider both positions.
The impact of drugs on your brain
First, consider how drugs work on the brain. Chemicals in the brain give us that sense of pleasure when we meet our body’s basic needs. A chemical “high” mimics that response.
Frequent highs can modify the brain’s reward and motivation centers, to the point where a person feels normal only when under the influence. In severe cases the person will seek out the addictive substance continually, despite the self-harm and painful consequences for others. The impact on others is alarming. For example, drugs are now statistically ahead of alcohol in connection with fatal car crashes.
Initial use can be a choice or a conscious decision. Yet the changes in the brain we’ve just discussed will steadily remove that power of choice. These biochemical changes can affect the brain for years, even after recovery.
Drug addiction: What it has in common with diseases
The American Medical Association classifies addiction as a disease. Addiction has a way of ravaging the body over time, just as heart disease and cancer do. As with diabetes, heart conditions, or other diseases, the causes of addiction are often mixed: they’re environmental, genetic, and behavioral.
Addiction is also a chronic condition for as many as half of its sufferers. It is a long-term health challenge, for which treatment must be intensive.
While there is no cure, there is the potential for recovery. Monitoring and care, as well as social support, will be necessary over the long haul. A person with access to this care and support can manage the condition and recover from addiction.
Why some people consider drug addiction a choice
The first few times, use of any addictive substance can indeed be a choice. Even so, it can also be a disease. To understand this, consider that diabetes, hypertension and other chronic health problems can involve choice too: food and fitness habits and so forth.
And yet, people who must cope with the addicted person’s actions may, understandably, have a hard time viewing the problem as a disease. They may have family members suffering from dementia, diabetes, cancer, Crohn’s or Parkinson’s or some other diseases. And they see these family members cooperating with medical treatment plans.
They see the addicted person behaving in a completely different way. Not only is the addicted person refusing to take advice, but this person might manipulate family, friends, or strangers to feed the addiction.
When you are suffering because of someone else’s actions, it makes sense to assign blame to that person for the problems those actions cause, in some cases for years or decades.
Here’s the complicated part.
If taking an addictive substance is a choice…
Why can some people manage the substance, taking it in moderation or only for pain, for example? Why do others quickly acquire a craving?
Most everyone tries alcohol or drugs at some point. But a person who is genetically predisposed to addiction will be experiencing brain chemistry changes. The changes happen during the very first experience with the drink or drug.
And that, according to most addiction professionals, means a loss of control, even while other people stay in charge, “taking or leaving” the drink or the drug.
For an addicted person, taking or leaving may not be a choice. And the person is not blameworthy for this chemical difference. But here’s the key point.
Recovery is a choice
People with addiction, while not blameworthy for their brain chemistry, are responsible for getting treatment and nurturing their own recovery.
That’s no easy feat. Most people in treatment get there only after finding themselves completely out of options, or after their family intervenes.
The more serious the addiction, the more intensive the treatment the person will need. Then, accepting responsibility for lifelong management of the condition is the most important choice the person will ever make.
