Substance Abuse and Addiction: Choice or Disease

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Substance abuse and addiction will always be a hot topic, especially in the world we live. Drugs and alcohol are everywhere no matter where you live. There are those who are the occasional users and those who use all the time. Within the last year we have seen neighbors stick themselves with a needle and get high as well as receive Narcan in order to revive them. Scary to think it can be so close to home. You will find various opinions and research on the topic of substance abuse.

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Substance abuse can often be associated with abusing drugs, alcohol and miss using them. Addiction is just that being addicted to a substance. Within this paper I will be summarizing articles that discuss substance abuse and addiction as a choice or as a disease. Furthermore, I will share my personal thoughts and feelings as to where I stand on this matter.


According to WebMD, “”Substance abuse is when you take drugs that are not legal. It’s also when you use alcohol, prescription medicine and other legal substances too much or in a wrong way (“”What Is Substance Abuse”” 2018). WebMD continues to further state that, “”Substance abuse differs from addiction. Those who may struggle with substance abuse problems are able to quit or change their unhealthy behavior. Addiction is a disease, which means they can’t stop using even when it causes harm (“”What Is Substance Abuse”” 2018).

Article 1 Addiction Is a Choice

The first article that I looked at was called “”Addiction Is a Choice by Jefferey Schaler, PH. D. This was an interesting article where this gentleman argues that addiction is a choice and not a disease. “”Foolish, self-destructive activity is not necessarily a disease. (Schaler, 2002) “”Scientifically, the contention that addiction is a disease is empirically unsupported. Addiction is a behavior and thus clearly intended by the individual person. (Schaler, 2002, paragraph 3) He further discusses that “”there is no dispute that various substances cause physiological changes in the bodies of people who ingest them. (Schaler, 2002, paragraph 10 ) He argues that when a patient meets with a therapist in order to help them with their addiction that “”most of the conversation that occurs in therapy based on the disease model is potentially harmful and they mislead the patient into believing something that is not true-addiction is a disease and that addicts cannot control their behavior. (Schaler, 2002, Paragraph 16)

Article 2 Addiction Is a Disease

The second article that was looked at was “”Why Addiction Should Be Considered a Disease by Anna Lembke. This article had a much different read and of course this author believed that addiction should be considered a disease. “”Addiction affects 16 percent of the U.S. population, about 40 million people, which far exceeds other serious illnesses or diseases. (Lembke, 2018 pg. 4) Opioids is one of the biggest drugs that is causing these issues and unfortunately this cause can be directed at the doctors that are “”overprescribing (Lembke, 2018 pg. 4) it for pain meds. “”In 2016, 50,000 Americans died from drug overdoses, while at least four million Americans are addicted to opioids while a smaller amount are using them recreationally. (Lembke, 2018 pg. 4) She believes that we must “”embrace addiction as a disease and treat it as such within mainstream medical care even if we don’t believe it is one. (Lembke, 2018 pg. 4) Lembke continues her argument as she utilizes the “”disease model of addiction. (Lembke, 2018 pg. 5-6) (See figure 1 below) For those who become addicted it can be related to “”genetics. (Lembke, 2018 pg. 5) This disease can cause “”relapsing, and behavioral components (Lembke, 2018 pg. 5) Those who are addicted to drugs it unfortunately “”changes their brain function. (Lembke, 2018 pg. 5) While the down side to the disease model some might argue is that “”brain changes are not sufficient to categorize addiction as a disease. (Lembke, 2018 pg. 6)

Figure 1: Disease Model (Besse, 2005-2006)

“”The disease model of addiction describes an addiction as a disease with biological, neurological, genetic, and environmental sources of origin. The traditional medical model of disease requires only that an abnormal condition be present that causes discomfort, dysfunction, or distress to the individual afflicted. (“”Disease Model of Addiction”” 2013, para. 1)

My Argument

When I first thought about this paper, I was completely against substance abuse and addiction being a disease. I have always felt that people who would drink or do drugs made that choice and felt that if they make the choice to stick themselves with a needle, over dose on pills or drink themselves to oblivion then they have no problem risking their life with the chance of death. I don’t know what it’s like to have an addiction. On some level I understand why some pain medications can be addictive as they take away all the pain and you feel so good. What truly changed my thoughts were some of the readings. Individuals that are addicted to drugs and alcohol have a serious problem and I stand on the side that it should be considered a disease. “”Addiction, is a disease, which means they can’t stop using even when it causes harm. (“”What Is Substance Abuse”” 2018). Children that have parents or grandparents “”with substance disorder has a two to four times increased chance of developing addiction when compared to the general population. (Lembke, 2018 pg. 5) One major issue with trying to convince others that addiction is a disease is health care. “”Disease burden due to addiction exceeds half a trillion dollars annually. Yet only 1 percent of the total health care budget goes to treating addiction, and fewer than 1 in 10 persons with addiction receives treatment. (Lembke, 2018 pg. 4) I continue to support my argument with the support of the ethical theory, the ethics of care. This ethical theory supports health care being involved and helping those who are ill and in need of help. “”Disclosures, discussions and decision making in health care typically become a family affair, with support from a health care team. The ethics of care maintains that many human relationships in health care and research involve persons who are vulnerable, dependent, ill and frail and that the desirable moral response is attached attentiveness to needs. (Beauchamp, Walters, Kahn and Mastroianni, 2014, pg. 20) The ethical principle beneficence further supports my argument with, “”The welfare of patients is the goal of health care. This welfare objective is medicine’s context and justification: Clinical therapies are aimed at the promotion of health by cure or prevention of disease. (Beauchamp, Walters, Kahn and Mastroianni, 2014, pg. 24)


So where do we go from here? It will take a lot for the health care system and the many others to begin to accept addiction as a disease. This would require a lot to change in health benefits and some people might not be ready for those changes. If we can continue to support mental health places and what they are able to offer for support and services is better than nothing. Unfortunately, not all those who use drugs and alcohol want the help and those individuals can only help themselves when they are ready.


Beauchamp, T. L., Walters, L., & Kahn, J. P., Mastroianni, C. A., (2014). Contemporary Issues in Bioethics. Boston: Cengage Learning.

Besse, Jenny. “”Drug Addiction and Disease. Prized Writing (2005-2006), edited by Gregory Miller

Lembke, A. (2018). Why Addiction Should Be Considered a Disease [article]. Judges’ Journal, (Issue 1), 4. Retrieved from

Schaler, A. A. (2002) Is Addiction a Disease, or is it a Choice?. Psychiatric Times, Volume XIX, (Issue 10). Retrieved from

Wikipedia contributors. (2018, October 13). Disease model of addiction. In Wikipedia, The Free Encyclopedia. Retrieved 00:24, December 13, 2018, from

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Substance Abuse and Addiction: Choice or Disease. (2019, Mar 18). Retrieved from