I would like to take a moment to share with you all a common response to the fact that addiction is a chronic illness. The response is “I do not think addiction is a disease. People don’t choose to have a disease. People with addictions make the choice to start using. They should take responsibility that they started their addiction.” I have heard this many times throughout my career in the field of addiction treatment, and it comes from patients, family of patients, employees, the community, our own families as we discuss what we do for a living, and so on. I appreciate the honest response, and addiction is not without responsibility, but we must educate when we hear this from people. It is not okay to perpetuate the myth that addiction is not an illness. While it can be a complicated discussion with many follow up questions, we must continue to address this head on until popular culture catches up with science.
Addiction as compared to Type I and Type II diabetes adds some layers of understanding when considering what constitutes a chronic disease. The function of the addicted brain has both hereditary and environmental components (i.e. nature and nurture) that can lead to a diagnosis of a substance use disorder. An individual with Type I diabetes is born with genetic predisposition to the disease. With Type II diabetes, lifestyle factors appear to play a role. Let’s frame ‘lifestyle factors’ as the choices individuals make in diet, exercise, etc. that can lead to diabetes. Compared to addiction, individuals do have a choice as to whether or not they use substances. But, as we compare the chronic illnesses of addiction and Type II diabetes, the disease can develop further due to choices that are made during life. Individuals with addiction do have a choice in the matter, but they may also feel like they are swimming upstream as they are challenged by their own biology. For more information about addiction as a chronic disease, please review the 2016 Surgeon General’s Report: Facing Addiction in America.