Others say looking at addiction like a disease misrepresents what's actually going on. Personal responsibility needs to be the center of any conversation about recovery. Addiction is not an inescapable black hole, it's the accumulation of personal choices compounded by a person's environment. Framing it as a disease makes escaping addiction something that's out of a person's control. That sends the wrong message.
Psychologist and former addict Marc Lewis argues the changes brought by addiction are not as extreme as people think:
All significant and repeated experiences change the brain; adaptability and habit are the brain’s secret weapons. The changes wrought by addiction are not, however, permanent, and while they are dangerous, they’re not abnormal. Through a combination of a difficult emotional history, bad luck and the ordinary operations of the brain itself, an addict is someone whose brain has been transformed, but also someone who can be pushed further along the road toward healthy development.
The takeaway here is that there is a choice to be made. Even deep into an addiction, a person's brain can still change. Arguing that addiction is a choice doesn't trivialize it at all. Rather, it frames it so people know and understand addiction is something that's under their control. It's not something that's just happening to them—like a disease—but it's something they're actively participating in.
“The severe consequences of addiction,” writes Lewis, “don’t make it a disease, any more than the severe consequences of violence make violence a disease, or the severe consequences of racism make racism a disease, or the folly of loving thy neighbor’s wife makes infidelity a disease. What they make it is a very bad habit.”
Some medical experts say it's better to treat addiction like a disease because drug addiction is tied to biological changes to the brain and body. Treating addiction as a matter of criminal justice and personal responsibility puts people struggling with addiction at a disadvantage. It doesn't help people get their lives in order.
Drugs like heroin work on the pleasure centers of the brain, flooding them with dopamine that creates the intense feeling of pleasure and euphoria. Dopamine doesn't stop there. It then interacts with other systems in the brain that regulate learning and memory. Over time, a person's like for a drug becomes a want, then a need as the brain learns to associate it with extreme pleasure. As a person falls further into addiction, their tolerance grows and creates a vicious cycle where people grow their addiction the longer they use drugs.
By treating addiction like a chronic disease, medical professionals can help addicts get clean and stay off drugs through medicine. Things like rehab, Narcotics Anonymous and criminal penalties all have their place, but the key is to get people the medical attention they need to put their lives back together. Drugs like buprenorphine are able to mitigate or halt the urge to use heroin entirely.
Treating people struggling with addiction with medicine helps them through the worst parts of getting clean. Instead of a nasty withdrawal period, people can be eased off of their addictions. Other drugs can remove the high from opioids entirely.
Treating addiction as a disease is more effective and humane. People may make the choice to try drugs but no one chooses to stay addicted.