Did you know that when someone is diagnosed with a substance abuse disorder or addiction, they receive a medical diagnosis code? The code is typically taken from the DSM-5 — that stands for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.
Codes from the DSM-5 are used to indicate in medical charts the diagnosis a person is being treated for. They’re also used to bill insurance companies for those services; the treatments being billed for have to align with the diagnosis code in question for the insurance company to consider making payment.
It all sounds very official, right? That’s because it is.
Addiction to drugs or alcohol is recognized by mental health professionals, insurance companies, hospitals and even agencies of the United States government, such as the Substance Abuse and Mental Health Services Administration, as a disease. If you’ve ever wondered if addiction is a choice, find out more about the reality behind addiction and what might cause it below.
Is Addiction a Choice?
The short answer is: No, addiction is not a choice.
Does someone make the choice to abuse a substance for the first time? They may. Do they make the choice to abuse it for the 100th time? Typically, yes.
But no matter their behavior, they don’t actively make the choice to become addicted to drugs or alcohol.
What Is Addiction, Then?
You already know that in medical settings, it’s considered a diagnosable disease or condition. That’s actually good news, because it’s a disease that can be treated. But what, exactly, do people mean when they say addiction is a chronic disease?
1. Addiction Is Not a Bad Habit
Many people buy into this myth about substance abuse disorders. If someone is struggling with alcohol or drug use, people might consider them to have a bad habit.
Someone who has a habit of drinking to excess each time they go to a certain restaurant because they just love the way the mixed drinks taste — and who doesn’t otherwise drink a lot or care about drinking — has a bad habit. Someone who can’t escape alcohol because they’re constantly thinking about it, can’t physically go without drinking on a regular basis or require liquor to help them deal with psychological issues doesn’t have a bad habit. They have an addiction.
2. Addiction Is a Mental or Physical Health Disorder
According to the National Institutes of Health, people with an addiction don’t always have control over their actions or how their bodies react to certain stimuli. Some substances can create a physical change in your brain and body, causing your system to react in ways that become a new normal if you keep using the drugs. At the same time, this “new normal” causes you to crave or need the drugs just to function.
In some cases, addiction can also be psychological in nature. Due to previous traumas or simply the way someone is wired, they may develop a psychological need for a certain substance or the effect it has on them.
3. Addiction Doesn’t Have a Cure and Won’t Go Away
Addiction is called a chronic disorder because it doesn’t have a cure. Someone with a substance abuse disorder can go through rehab and long-term recovery, finding a way to live a sober lifestyle. But they still have an addiction and must remain aware of that condition and continue to treat it.
It might sound like a grim statement, but many people live long, healthy and happy lives with chronic disorders. Someone who is diabetic or has heart disease, for example, must pay attention to their diet and overall wellness, potentially take medication and see their health care provider regularly for help managing their condition. Addiction works the same way: You pay attention to wellness factors, manage your triggers and responses and check in with your support system periodically for help managing your addiction.
Understanding Causes of Addiction
Many people simplify the causes of addiction, pointing to the first time someone abuses drugs or alcohol. That, they say, is the cause of their addiction. But this isn’t true — and is another reason why addiction is not a choice.
First, there are plenty of people who can have a beer or who have experimented with drugs before and don’t become addicted. That’s because some people are more predisposed to addiction than others.
Second, in many cases, there are mitigating factors that led to that initial drug or alcohol abuse. While medical science still doesn’t have all the answers when it comes to the causes of addiction, here are some common theories supported by research and mental health professionals.
Genetics Plays a Role in Addiction
One reason people in the past believed incorrectly that addiction was a choice is that not everyone gets addicted. Two people can experiment with the same substance in almost exactly the same way and one gets addicted while the other person doesn’t. One of the reasons for that is because there are genetic factors at play.
This isn’t surprising to modern science. Many diseases, including some forms of cancer, have genetic factors. If you carry a certain gene, for example, you can be more at risk for breast cancer. To date, medical science has not been able to isolate a specific gene that makes someone more likely to suffer from addiction, though. It’s a bit more complex than that, and research indicates there is actually a combination of genetic factors that make someone potentially more likely to develop an addiction.
Family History Can Increase the Likelihood of Addiction
A history of addiction in your immediate or close family can also increase the chances you might suffer from addiction in the future. Part of this is likely tied to genetics. You share a lot of genes with the people you’re related to, and if genes put one person in a family at risk, it stands to reason that others might be more at risk too.
But this cause isn’t completely based on genetics. Addiction isn’t just a physical disease — it’s also a behavioral disorder, and behaviors can be learned. Growing up in a home with someone with an addiction, for example, can prime some of your psychological responses to be at risk for those same behaviors. If you see a parent turning to alcohol as a coping mechanism as you grow up, you might be more likely to engage in that behavior too.
General Lifestyle and Environment Might Drive Addiction
Overall environment — whether or not you choose it — can also be a factor in developing a substance abuse disorder. For example, if you hang out with people who engage in drug abuse regularly, you are more likely to do so yourself than if you surround yourself with people who don’t use drugs. And while these may be choices, whether or not you get addicted to the drug in question isn’t a choice.
Even people who don’t live or socialize in an environment that involves drugs or alcohol could be at risk for addiction if they’re under a great deal of stress. Someone who’s facing extreme pressure at work might turn to a glass or two of wine in the evening to relax and be able to sleep. If that experience is repeated consistently, it might form the beginnings of an addiction — especially if the person is genetically or otherwise predisposed to developing a chemical dependency.
Use of Prescription Medications with a Potential for Dependency
Sometimes, a drug addiction begins with a tool meant to create a positive effect in your body or life. Perhaps you had surgery and were prescribed opioids to help with post-op pain, or you’re taking sedatives to help you deal with anxiety issues. These types of medicines can create a physical dependency in your body, which means even after you don’t have a medical need for them, your body might continue to crave them. You might deal with uncomfortable withdrawal symptoms that force you back to them or cause you to seek other types of drugs — even illegal drugs.
Again, not everyone has this experience with prescription medications. But it’s a common enough problem that many programs offer treatments specifically for this type of addiction.
Mental Health Disorders Can Make Addiction More Likely
Another factor that can increase risks for developing an addiction is a mental health disorder. From depression and anxiety to mood disorders or schizophrenia, these conditions can reduce someone’s ability to make rational, safe decisions or cause them to seek out drugs or alcohol to self-medicate. Dealing with mental health symptoms by abusing substances can lead to physical dependence on drugs or alcohol.
It’s perhaps worth noting that the opposite is true. Abusing drugs or alcohol and becoming addicted can lead to mental health issues such as depression. That’s due in part to feelings of shame or guilt related to the addiction and the potential failure to stop using no matter how hard you try. It can also be related to the way the substances interact with your mind and body, altering your brain chemistry, mood and ability to react appropriately to certain life situations.
If Quitting an Addiction Isn’t About Self-Control, How Does Treatment Work?
Treatment for substance abuse disorders isn’t about suddenly deciding you’re going to make the choice to quit your addiction and muscling through everything that comes after. Self-control is a great virtue, but it’s not everything you need to treat this type of condition.
Addiction treatment actually looks different for each person because the factors, situations and steps that led to the substance abuse disorder are different. But here are some common things professional rehab brings to the equation that individual will can’t:
- A caring environment and support system. Safety, security and people who won’t judge you as you work through your addiction and all the triggers and factors involved in it — these are critical to rehab and long-term recovery. And while many people do have supportive families or other communities to turn to, an organized, structured approach is often best for kicking off your breakout from addiction.
- Proven techniques. Treatment centers typically offer a variety of methods for treating addiction, including individual and group therapy. You may take part in cognitive behavioral therapy to help identify negative thought and behavior patterns and how you can change them, as well as recreational therapy and wellness education to boost your confidence and ensure you better understand how to care for your body.
- Professionals to guide you. Counselors walk with you throughout your rehab journey, providing guidance as you learn to use these new tools and practice healthier coping skills. They also help you understand the truth about your addiction, what triggers and issues in your past might have contributed to it and what you can do to resolve some of these matters.
- Comprehensive treatment for the entire person. Depending on your personal preferences and needs, you might engage in faith-based therapy to support you spiritually, for example, or exercise to build up your physical body.
- A long-term plan. A good rehab treatment program plans ahead, working with you to understand how you will be supported in the future as you manage your addiction long term.
Addiction may not be a choice. But if you’re caught in this cycle of substance abuse, you can make some choices. One of them is to reach out, right now, to the staff at Holdfast Recovery. Call us or contact us online to find out what choices you can start to make to get help for your addiction and seek a brighter future.