How and Why Addiction is Not a Disease: A Neuroscientist Challenges Traditional Views

Rehab Helps Thousands of Addicts Quit. Who Answers?

“I truly believe no treatment will work on a person with an addiction if the patient hasn’t fully given themselves over to the fact that they have a disease that does not heal itself.”

Margaret F.’s words capture a core belief of the traditional type of treatment program she attended, one common in 12-step-based facilities. Leading professional organizations – including the American Medical Association, American Psychiatric Association, World Health Organization, and American Society of Addiction Medicine (ASAM) – subscribe to the notion that alcohol and other drug addictions are diseases.

However, a growing number of experts are challenging this view. One of them is neuroscientist Marc Lewis, Ph.D., who eloquently elucidates his reasoning in a new book, The Biology of Desire: Why Addiction is Not a Disease. Real-life stories of five different people who have struggled with addiction flesh out the framework he’s constructed from the latest neuropsychological findings.

From his home in the Netherlands, this Canadian expat and Pro Talk columnist (see his full bio here) gave me several hours of his time to answer the following questions:


Q: The ASAM defines addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry” and goes on to say that “dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations… reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.” What’s wrong with this?


A: It’s not that all these brain changes aren’t involved in addiction – they are, but they’re also involved in becoming a basketball fan, falling in love, in becoming a jihadist, in developing any new passion. So why would we call addiction a disease that requires medical treatment?

Saying addiction is a disease suggests that the brain can no longer change…that it’s an end state. But no, it’s not end state.-Marc Lewis

We know that treatment isn’t required by most to overcome addiction, so in that sense it’s not a disease. And the changes in the brain that occur because of addiction are not irreversible. We’ve been talking about neuroplasticity for decades. That is, the brain keeps on changing – due to changes in experience, self-motivated changes in behavior, as a result of practice, being in a different environment.

Saying addiction is a disease suggests that the brain can no longer change…that it’s an end state. But no, it’s not end state.


Q: If addiction isn’t a disease, what is it?


A: First, I’m not saying that addiction is not a serious problem – clearly it can be for many people. In terms of brain change, you could say that neuroplasticity has a dark side. But rather than a disease, I would say that addiction is a habit that grows and perpetuates itself relatively quickly when we repeatedly pursue the same highly attractive goal. This results in new pathways being built in the brain, which is always the case with learning: new pathways are formed and older pathways are pruned or eradicated.

…rather than a disease, I would say that addiction is a habit that grows and perpetuates itself relatively quickly when we repeatedly pursue the same highly attractive goal.-Marc Lewis

But with addiction, much of this rewiring is accelerated by the action of dopamine, a neurotransmitter released in response to highly compelling goals, creating an ever-tightening feedback loop of wanting, getting, and loss.

As the addiction grows, billions of new connections form in the brain. This network of connections supports a pattern of thinking and feeling, a strengthening belief, that taking this drug, ‘this thing,’ is going to make you feel better – despite plenty of evidence to the contrary.

It’s motivated repetition that gives rise to what I call “deep learning.” Addictive patterns grow more quickly and become more deeply entrenched than other, less rewarding habits. In general, brain changes naturally settle into brain habits – this is the case in all forms of learning. In addition, the habits are learned more deeply, locked in more tightly, and are bolstered by the weakening of other, incompatible habits, like playing with your pet or caring for your kids. [In the book, Lewis describes in detail how addiction changes the brain.]


Q: You note that the neurobiological mechanics of this process involve multiple brain regions, interlaced to form a web that holds the addiction in place and that gouges “deep ruts in the neural underpinnings of the self.”  Yet you go on to say that “brain change – even more extreme brain change – does not imply that something is wrong with the brain.” How can that be?


A: Such brain change may signify that by pursuing a single high-impact reward and letting other rewards fade, someone hasn’t been using his or her brain to its best advantage.

The notion that you never forget how to ride a bike reflects our recognition that normal habits can be deeply ingrained. Thus, deep ruts in the brain don’t make the brain damaged. And new ruts can be formed on top of or beside old ruts. For example, when you lose a relationship, the deep ruts are still there – they can cause pain and create barriers to a new relationship. But then you say, “Enough of that.” And with some effort, you meet a new person and the brain modifies itself, which it constantly does.

The notion that you never forget how to ride a bike reflects our recognition that normal habits can be deeply ingrained. Thus, deep ruts in the brain don’t make the brain damaged.-Marc Lewis

Psychiatrist Norman Doidge, author of The Brain that Changes Itself reminds us of a classic remark by Alvaro Pascual-Leone, a renowned Harvard neuropsychologist: The brain is plastic, not elastic. It doesn’t just spring back to its former shape. Rather, like Play-Doh [before it hardens], it can continue to be modified from whatever shape it’s currently in.


Q: Why does “The Biology of Desire” assume importance over your subtitle, “Addiction is Not a Disease”?


A: Basically, most of our attention is committed to achieving the goal, not to the goal in and of itself – it’s all about the drive to get to the pot of gold at the end, not the pot itself.

Basically, most of our attention is committed to achieving the goal, not to the goal in and of itself – it’s all about the drive to get to the pot of gold at the end, not the pot itself.-Marc Lewis

According to recent advances in addiction neuroscience, there is a “wanting” system (desire) that’s mostly independent of the “liking” system. “Wanting” is really what drives addictive behavior. In the book, I talk about eating pasta – before you eat it, your attention is converged on getting that food into your mouth. But once it’s there, your attention goes elsewhere; perhaps back to the people you’re dining with or the TV show you’re watching. How much attention you pay to the taste of that bite of food is a drop in the bucket compared with the amount you spent to get it to your mouth.

Desire and expectancy make up most of the experience. The “wanting” part of the brain, called the striatum, underlies different variations of desire (impulsivity, drive, compulsivity, craving) – and the striatum is very large, while pleasure itself (the endpoint) occupies a relatively small part of the brain. Addiction relies on the “wanting” system, so it’s got a lot of brain matter at its disposal.
Part two of Anne Fletcher’s compelling interview with author and neuroscientist Marc Lewis, Ph.D will be published next week.

Image courtesy of iStock

What Are Your Thoughts on this Topic?

  • AddictionMyth

    I like this interview. I would just point out that saying compulsive drug use is a form of ‘deep learning’ caused by drug use is circular. After all, most addicts had a strong compulsion to take the drug in the first place, such as stealing it, or joining the ‘wrong crowd’, which they freely admit. So if there is a ‘learning disorder’ it likely existed before the first drug use in most cases. (The notion that addiction can happen to the average opiate prescription recipient has been debunked – sorry Keith.)

  • Silver Damsen

    Fletcher’s insights are fascinating in and of themselves for what they say about the human experience. I think they also could help to revolutionize the clearly ineffective model that is now place, and seems if anything to encourage drug abuse and death rather than “heal” it. The current model is, of course, the 12 Steps associated with Alcoholics Anonymous. AA is a very inexpensive model for treatment centers to employ, and the fact that AA ideology blames those that don’t “recover” with its program, helps to make it even more lucrative because it means repeat customers. The problem is that the AA model is killing people and destroying lives.

    • GTFO

      LOL who told you this? What 12 step program have you gone to that shuns people for relapsing?? Anonymous programs do much more for addicts than any big buck treatment center and the benefit of them is that anyone can walk in and recover if they want to and all they have to do is show up and participate….

      • dank

        NEGATIVE. Showing up doesn’t mean anything. To recover, you have to commit.

  • Gaylord Perry

    A better question is how does not calling it a disease help? Answer: It doesn’t.

    • Dean Blackburn

      By calling it a disease, you create an entire industry of individuals who live up to it. It becomes their identity even after they are no longer using; what’s worse is people in recovery who still consider themselves addicts….they would have to choose to go out and use…at the moment they chose to be abstinent. I don’t know to many diseases you can choose to have and not have. Addiction is part of the human condition; most suffer from addiction to self (ego). Again, choice.

      • Paul Stromberg

        Trust me it’s not a choice. If you have aren’t a addict don’t comment

        • Chad Gautier

          I have been addicted. It is a choice! You chose to go get help? And if you do and relapse. You had a choice to go get help or go get high. What was your choice? But addiction and disease are two different things. But they put them together like they aren1. You have to take responsibility and control of your life. I mean can you walk into a children’s ward and say I am as sick as you? I decided to shoot,smoke or drink my disease. Do you shoot ,smoke or drink your cancer? Sometime you just have to say your became a slave. I did but every day I CHOOSE not to go back.

          • Diane Cerulli

            Agree all the way.

          • Joel Perez

            Good on you man, we are behind you 100%

        • Frank A

          Naah, it’s a choice, but we’ve been brainwashed to think otherwise (btw, ex-addict here)

          • Diane Cerulli

            Me too. agree.

    • Charlie Payne

      Because more modify their behavior without it than with! That is actually a fact! You know how it helps? It can’t be used as a way to control people! Your being controlled by the disease right now even, if you don’t have it! You’ll find out! at the most physically painful time of your life! It’s gonna hurt! But wait, you have it right! It does help to call it a disease so a guideline from the CDC enforced by the DEA, already decided how much pain you live in, not your doctor! OH YOU DIDN’T KNOW!!!

    • Mary

      Most people look at a disease as something that malfunctioned in their body due to no fault of their own. If we are taught to look at an addiction as a disease we then believe that it is no fault of ours but something that malfunctioned within our body. If a person never put the substance into their body they would have never had the so-called disease that brings pleasure and torture to their selves. Our society today does not want to take responsibility for one’s actions if viewed as an action or choice that cause this addiction there would be shame, regret, and embarrassment but if labeled as a disease I can say it wasn’t my fault. Being honest with yourself on how you arrived at this addiction hopefully one day will help you in Breaking Free from it and stay Free. I don’t know how each person came to their addiction but this I’m sure your hurting and you’ve heard a lot of people. Own up to your addiction ,whatever help you need get it! Make a new life for you and your loved ones.

    • Joel Perez

      It helps by identifying the underlying cause and targeting efforts there. The reason many addicts can’t break, is because they like it. When they say they do not, they are lying to you. And what’s worse, you believe them. Their want/reward drive is so strong, they will do anything, even lie steal and cheat, to get to a place where they can carry on their addiction.

      But if you stop pandering by calling it a disease, and then train figurative weapons on the actual cause of the addiction you will have better success rates.

    • Krayal

      It gives addicts back their agency and empowers them to address underlying causes.

  • MicoB

    “And with some effort, you meet a new person and the brain modifies itself, which it constantly does.”

    All it takes is effort, eh? As in many diseases, it is brought on by typical human activity, like smoking, or over eating. I see the quote about as self-contradicting as it does admit a change takes place in the brain –something far more extreme than simply meeting a new person, or finding a new hobby.

    It seems as though many who make the claim that addiction isn’t a disease seem to underestimate the power that cravings can have over an addict, and these cravings are cause by changes in the brain, which is an impairment of its normal functioning.

    • Charlie Payne

      I don’t think people on this Earth have any illusion about the “power of cravings”! It explains the reason that their are around seven billion of us! It does take the mind a lot of convincing that it gives you the feeling like you will die or go nuts if you don’t have it! That you “need” it! To answer your question, No, I wouldn’t say that it has to be something more extreme than meeting a new person, in that context! Otherwise you are telling them that they have to live with a broken heart and their is no chance to love as much again! That is why the disease model is 3-5% effective and always will be! Besides, to tell patients that it is a fact that it is a “disease” is unethical and a flat out lie. Damn, we knew that in the 70’s when they first allowed adolescents into treatment! The treatment was the ways that it is the treatment that they had the most success with. Yet, did all the other treatments like grief counseling… ! Also, they gave options on believing anything or none of it. No thought control, just truths, like was expected from them!!! You were giving them options they admittedly, only had and or were trying in hopes something would work! Let’s see now! An impairment of “normal” functioning! I wonder how many of us have looked at a friend who has fallen for someone you can see threw their BS when your friend couldn’t and thought the same thing? Have you thought of it this way? Those with eating addictions survive for the rest of their lives on their addiction, longer with moderation, while people that get a drug habit have a solution of complete abstinence and a brain disease? I hate to tell you this, but I think you’ve been led down the garden path, just like most of American and other, but not all societies. So it’s political too! :) So much more to this than a label that’s useful!

    • Diane Cerulli

      But your statement doesn’t say that when you remove the substance, the brain goes back to normal. Neuroplasticity. The addiction goes away, If it were a real disease like cancer, the odds of it going away by doing nothing are slim.

      • MicoB

        There is a misconception that dealing with addiction is by “not doing something”. The treatment for addiction is not comparable to that of cancer, but yes, neuroplasticity is what gives people hope of recovery, but the Doctor is wrong when he says no treatment is required to deal with addiction.

    • Joel Perez

      Yes, all it takes is effort. See the post above by 3 former addicts who said so.

      Yes typical human activity will bring about disease, for example overeating, will lead to diseases associated with being overweight. But being overweight itself is not really a disease, but how the body is designed to work when you feed it more food than it needs. Smoking is another activity. Smoking itself is not a disease, although some might argue it is, but it can lead to real diseases, such as cancer, emphysema, etc. Overworking is an addiction. And it can lead to stress which then leads to gastric problems, high blood pressure, joint inflammation etc. Having unprotected sex is not a disease, but can lead to many of them.

      But no disease can be cured by changing the plasticity of the brain. That’s why depression is a disease, but addiction is not. You cannot unlearn depression, because it is usually cause by chemical imbalances caused by things outside your control. Using drugs merely abuses the brain’s want/reward system into creating deep learned behavior. So in depression the brain is actually broken, and in addiction you are merely abusing a natural mechanism to your own detriment. That however, is not to say drug use does not cause brain damage or other physical damage. Extended drug use can damage the kidneys, heart, arteries, lungs, nose, throat, etc. This is a consequence of the addiction, not the addiction itself. It is important that you learn to separate the two. Because many smokers do not develop cancer and they stop smoking. Many stop smoking and develop cancer.

  • JayStoneMiddleMan

    Why can’t addiction just be an addiction. What’s the point of calling it a disease? I was addicted to snuff… I didn’t have a disease. I didn’t catch it… I made a choice to chew not knowing the consequences. I still have cravings from time to time because I’m still addicted 8 years later. I chose not to relapse. I believe some addictions are stronger than others… heroin for example. If cancer was an addiction my father would be alive today.

    • Tamara Cate

      Calling it a “disease” just placates the alcoholic and makes them feel better about problem. Calling it a disease is counter productive and enables them to keep on their destructive path because in calling it a “disease” they don’t have to take PERSONAL RESPONSIBILITY .
      My mom was a closet alcoholic that basically ruined my childhood. I married a man who has become an alcoholic (despite watching what my mom’s problem did to me).
      My prayers are to the victims of alcohlics. I have zero sympathy of compassion for addicts. I tried in vain to help my Mom ( she is now dead ). I attempted to get help for my husband, but he continues to lie and not take responsiblity for his action. I’m done with it. No help from me. He can chose to die or he can chose to get help. I really don’t care. Not my problem.

      • Andrea Mullins

        This is more or less what I’m dealing with, only it’s my uncle. We are both caretakers for my grandma (his mother), and he’s her Power of Attorney. No one in our family knew that he’s had drinking problems for more than 30 years, because he and his wife covered it up and lied about it to everyone to “keep up appearances.” Last month, in May, he had a meltdown and I had him put under a 10-day involuntary commitment order. The very day that he got out and came back here, he went right back to drinking. Five weeks later, and he drinks all hours of the day and night — usually at least a good 20-24 cans of beer within a 16-hour period of time — and he’s stumbling around the house and unable to stay on his feet. Grandma is 94 years old and has dementia, and keeps trying to “help him get up” when he falls, which I’m afraid is going to make HER fall and break something. Yet when other members of the family call, he sounds completely normal and assures them that everything is “just fine.” They refuse to even attempt to do anything to help.

        Adult Protective Services won’t help. They called the house, talked to him, and fell for his “everything is just fine and there are no problems” line. The cops won’t help. I can’t just go, because I cannot leave my grandmother alone with him. No one will do anything to help get my grandmother and me out of this nightmare. They all feel “so sowwy” for him because “oh, he has a disease!” Bullsh*t. He CHOSE to go right back to drinking. He’s CHOSEN to keep drinking for more than 30 years. I have no sympathy for him, no compassion, and to be perfectly honest, I keep hoping that every time he goes down the stairs for yet another beer out of the fridge, he’ll fall and break his neck. If it happens, I’ll spit on his corpse. And that’s more than what the filthy drunk deserves.

        • Louise Cann

          Ever tried videotaping him? Try to get evidence ,clear and unarguable evidence. What you are describing is nonsense-it doesn’t make sense. If they thought, like you say”they feel so sowwy for him becuz he has a diease”, then adult protection services would immediately step in as would the lawyers that wrote the ‘power of attorney’ for him( if he can no longer be of sound mind due to drinking ,how can he LEGALLY represent your grandmother? You need to challenge his authority. There are many ways to handle this problem that you are not either mentioning or pursuing. His behavior must be checked at once. Good luck to you and your grandmother and I pray ,if he is as drunk as you say,you will get him on your phone video. He will never notice.

      • Louise Cann

        Let’s see: you hate your mother for being an alcoholic so you took that knowledge and grew up and married one. So now you declared to the world that you’ve hardened your heart and don’t care if those struggling with this DISEASE live or die. Wow. You must be quite the coquette!

      • Renee Connolly

        I beg to have Alanon codependent written all over you. No way would i take on an alcoholic. ..but one zeroed right in on you. This way. ..i bet you don’t get to take responsibility for any of your loud and clear attitude problems…you are just the victim. ..your whole life.

    • Joel Perez

      $$$$ for doctors

  • Frank A

    Totally agree, I spent 6 years as a 24-7 crack head in and out of various treatment and 12 step programs, multiple trips to prison, ended up homeless living in an abandoned building, etc.. I was the lowest of the low. And then one day 3 years ago I woke up in a filthy crack-hotel and decided to quit. That was it, just like that. No more crack. Where’d my “disease” go?
    Since then, on several occasions, I’ve been in the presence of old using buddies while they smoked crack and I didn’t use. Where’s my disease?
    I’ve even pushed the limits and consumed alcohol several times but didn’t relapse on crack because of it (nor did I abuse the alcohol).
    And I’ve met several others like me, some of them way worse than I was as an addict, and they’ve quit too without help.

    • Kornelija Milosevic Conda

      Wonderful. Thank you

    • Diane Cerulli

      Totally agree. Went thru alcohol addiction and finall just stopped. I attempted that many times, it was hard but the right day came along and I did it. Congrats to you

  • Chad Gautier

    Calling this a disease it then lays down the foundation for excuses. It’s called irresponsible. A man that was/is an addict will always be an addict. But if he is clean for 10 years. Then one day decides to go get high and dies. Does that make it a disease or does it make it a guy who made a bad choice? When using a disease I believe it is for the medical so you are coversed for treatment. But when you use that word disease . You are then giving yourself a good excuse to relapse and have everyone be like oh they couldn’t help it. Basically giving the person a free pass. I don’t buy it at all. I think you make choices in life. A lot will be good some will be great. But a large amount will be very bad. But to push blame off for your bad choices will never make you grow. You did it accept change,make it better or whatever. But don’t sandbag yourself. And if the problem is a disease why in the steps do you have to make amends? If it wasn’t you doing it why would you have to apoligize?

    • Eileen MacDougall

      Good for you Frank. I’m in a support group for parents and I see and know the devastation hard core drug users cause to people who love the. Plus how coddling them only lets them continue such a destructive lifestyle. Truly I liked your take on this, thank you!

      • Louise Cann

        Liking his “take” on this doesn’t mean he’s right. Your family member STILL has a disease. If you want to help him ,you won’t be a continued co-dependent but you must not withhold love,affection and support,ever.

  • John Wilson

    Addiction is a disease, by definition. The definition of disease is a disorder of structure or function in a human, plant or animal, that is not caused by physical accident. There is nothing in the definition for disease about choice, nor does it mention voluntary methods to eliminate said disease.
    Whether you are born with an actual disease like sickle cell anemia, or acquire one through lifestyle like Type 2 diabetes, or choose actions where the consequences can be the disease of addiction, like Heroin abuse, the result is still a disease…by definition.
    To deal with a disease, you must choose to ensure it and any causes of it, or treat the disease and eliminate any potential causes.

    • JustConsiderThis

      I don’t think an etymological argument works – – – not the dictionary “definition” of a word. Webster didn’t know anything about “disease.”

      • cteas

        I think the etymological argument works. Webster does not define addiction as a disease. Below is Websters definition. The others are similar. I can’t even find the source for John’s definition.

        Definition of addiction

        1 : the quality or state of being addicted i.e. addiction to reading

        2 : compulsive need for and use of a habit-forming substance (such as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful


        First Known Use: circa 1532

        Maybe I should give my definition of suicide.
        suicide – the action of a white man going to the south side of Chicago and yelling racial slurs at 12:30 in the morning. See, I can make up definitions too.

        • Jennifer

          Millions of people wish they could “behave” their way out of cancer…which IS a disease. Physical and/or psychological dependence is not a disease. It is the result of a series of choices to ingest mind-altering substances. It is more akin to brain damage—also not a disease—reversible brain damage at that.

          More simply put, it is a habit or learned behavior. It does result in changes to the brain that make quitting harder, but so do countless other things that by no definition are diseases. Classifying addiction as a disease is not only incorrect, it is counterproductive. It gives people yet another excuse to continue abusing their drug of choice due to removing the element of responsibility.

          • Kate

            You say cancer is a disease but what if that cancer was caused by someone’s addiction to smoking? Would it then not be considered a disease? There are many actions which lead to diseases but they are still diseases, how does that make sense? Telling these people they have a disease is not removing their responsibility it’s giving them a way out, a way to not feel ashamed to get help. Remove the stigma everyone has about addicts and more will be likely to get help. This has been proven with other diseases.

    • Krayal

      Real disease responds to medication whether the sufferer wants it to or not. Not 100% but regularly enough. Cancer and diabetes aren’t treated by meetings in church basements, because they are real diseases that respond to treatment.

  • David Behrens

    Calling alcohol or drug addiction a disease is simply covering the lack of clear thinking and will power in the individual who chooses to become addicted with a euphemism.
    So many taxpayer resources are wasted on these weak willed individuals. Simply make ALL DRUGS available, just as alcohol is available. Do not waste taxpayer money on subsidizing treatment for those who have premeditatively chosen to abuse drugs or alcohol; simply let them die of their bad choices.

    • cteas

      Wow, that is cold. I would say legalize it, but apply harm reduction as much as possible. It is much cheaper than imprisoning people.

    • Kate Jayr

      Wow, you’re all heart. Addiction is both physical and psychological. But anybody who ignores the fact that people build up a tolerance is living in cloud cuckoo land. If somebody just stopped taking certain meds cold turkey it would be very dangerous which is why most drugs need tapered and supervised withdrawal.
      I’m sure you would have a little more humanity if you thought someone had become a drug addict because of childhood sex abuse. I worked in the field and this was the reality. But funny how people have sympathy for the poor kids who were abused but suddenly become hard-faced fascists when those some kids grow up to be drug addicts. Hmmm

  • Mark Allen

    I rejected everything Mr. Lewis has to say when he begins by making the argument that addiction doesn’t always require treatment to be overcome, ergo not a disease.

    This seems logical to anyone? At all? Chicken pox and measles don’t require treatment to be overcome. There are many diseases for which there is no known treatment, yet regularly are beaten.

    The necessity of treatment has absolutely no impact on classifying any condition as a disease. None whatsoever. I don’t accept the illogical argument of an agenda-driven position.

    • Joel Perez

      Chicken pox and measles, orthe common cold, or the Flu don’t require treatment, because your own body provides the treatment. But left unchecked, they can, and have killed people. Plus you are forgetting the basic fact that those diseases are caused by a virus, and intruder, an undesired agent, causing damage. Drugs and booze are not undesired, they are not intruders. People take them voluntarilly.

      • Lexi Feight

        You can take drugs and not become an addict. You can smoke cigarettes and not contract cancer. You can develop depression when your life is just fine. It’s the genetic predisposition that weakens your body to potential illness. Is addiction/depression the same as cancer? No. Will it kill a patient that doesn’t receive treatment? Yes. Saving their life matters more than a label, and these people need help. I feel you’d be hard pressed to find an addict who wants to be addicted, it’s not a choice any more than any other disease. It’s not someone’s “fault” any more than cancer/depression is mine.

        • cteas

          No, but it does require self-destructive behavior on the part of the consumer to exist. The diseases are either a side effect of destructive behavior (like smoking and cancer) or just bad luck (got the flu virus). Addiction is the only “disease” that requires action on the users part to have. If a cancer patient quits smoking, then he doesn’t get cured of cancer. If an alcoholic gives up alcohol for life then he is effectively cured. I do agree that what is important is the life of the individual, and if calling it a “disease” saves people, then go right ahead. If calling it a “disease” does more harm than good, it is not right.

          • Louise Cann

            The giving up alcohol may stop the drink but the disease process is still there.

            • Kris Roth

              The brain changes constantly; new neural pathways are formed and others are left abandoned or amended. You honestly think our brains don’t normalize again chemically over time? Well, I do. I’ve gone on to healing and living a healthy, happy life. I no longer call myself an alcoholic, nor think of myself as one. I’ve done therapy, found passions, and learned to take care of myself instead of the self-sabotage I used to love. I have a glass of wine occasionally. And in case you’re going to say something like, “Oh, then you weren’t a true alcoholic”, just don’t. You’re stuck in the AA loop.

        • Jack Elmore

          Bullsh*t… it is a choice, one they make everytime they get high!!

          “Addiction does not meet the criteria specified for a core disease entity, namely the presence of a primary measurable deviation from physiologic or anatomical norm.2 Addiction is self-acquired and is not transmissible, contagious, autoimmune, hereditary, degenerative or traumatic. Treatment consists of little more than stopping a given behaviour. True diseases worsen if left untreated. A patient with cancer is not cured if locked in a cell, whereas an alcoholic is automatically cured. ”

          “At best, addiction is a maladaptive response to an underlying condition, such as depression or a nonspecific inability to cope with the world.”

          “Medicalizing addiction has not led to any management advances at the individual level. The need for helping or treating people with addictions is not in doubt, but a social problem requires social interventions.”

          link to

          • Louise Cann

            When in jail the act of drinking is cured,not the alcoholism.

        • Krayal

          Depression is a physical and mental disease. It’s proven and real, and medication works on depression, whether the sufferer wants it to or not. It isn’t a case of thinking happy thoughts and praying as is the standard prescribed ‘treatment’ for addiction.

      • Louise Cann

        Drugs and alcohol,left unchecked,could and do kill people. The chemical reaction in the liver and brain which causes the compulsion to keep using is intruder that’s undesired,”causing damage”

    • Dean Hart

      I didn’t require treatment to quit smokeless tobacco. I just decided to quit. It was hard, I was sick as a dog for a week, but I didn’t need any doctors or prescriptions. Is that enough logic for you?

  • Andrea Mullins

    Drinking is NOT a disease. People drink because they CHOOSE to. It’s nothing to do with having a “disease.” I’m sick of seeing drunks coddled and babied and felt sorry for, when they bring their problems on themselves by the choices they make. Saying that it’s a “disease” just gives them an excuse to keep whining and expecting everybody to put up with their crap. No one should.

    • Louise Cann

      Ive always seen the point of view you are expressing as very popular with well meaning fools who have not the capacity for any other self aware thinking and intelligent thought abstract that strays from their own view of their perfect world and self

    • Kate Jayr

      You’re all heart too, Andrea. So you must be completely oblivious to the aetiology of alcoholism and drug addiction. How simple life must be for you: so black and white. The alcoholics vs the non-alcoholic and no shades of grey in between. No continuums.

  • JustConsiderThis

    One more time: I watched a loved one die (a horrible death) of ALS. She had a DISEASE. If all she had to do to cure her ALS was to stop drinking the “ALS juice,” she would have…. instantly.

    I watched a loved one die of kidney cancer. He had a disease. If all he had to do to cure his kidney cancer was to stop taking “the kidney cancer pills,” he would have … instantly.

    “DISEASE” is NOT decided science. Google “why it’s wrong to call addiction a disease.” There, you can read some very insightful and scholarly views regarding this topic.

    (Oh, and labeling addiction as a disease makes it simpler for doctors, therapists, treatment centers, and insurance companies to get more and more of our money.)

    • Renee Connolly

      Absolutely! !!

    • Louise Cann

      If one smokes,gets lung cancer (a disease) should they be treated as a selfish horrible and not worthy of care or treatment becuz they chose to smoke?No,they shouldn’t. Neither should addicts and alcoholics

      • William W Wernecke

        Disease is an excuse to keep using bottom line!

  • Jacob Nagy

    What does homosexuality have to do with any of this.

    • Louise Cann

      It’s a choice ,is it not, of course it isn’t.

    • Kate Jayr

      I was wondering the same, Jacob. Why on earth is someone talking of ‘curing’ homosexuality? Did I just enter a timeslip back to the 1950s?

  • Susan

    I’m glad somebody recognizes the fact that addictions are not diseases but a person’s choice that can get help I have been a drug addict and alcoholic and in back in 1992 I started my war against it until I became sober again and a normal person not doing the things I used to do that were not me… like a matter of choice to get help with personality disorders and addictions I chose to go get help and I kept fighting and finding all the help I needed till I was out of there my ex-husband is a serious alcoholic with Grandma seizures and refuses to do anything about his drinking he’s basically given up and it is killing him he can no longer hold his urine or his bowel movements and his behavior is just horrible he’s mean and nasty and violent and I divorced him because I wasn’t going to put up with that and that too was my choice addictions are not diseases they are choices that a person has to continue on or to get help thank you for all of those who recognize this I’m so sick of people calling it a disease and the Healthcare Systems fighting their medical care because they think it’s a disease I had wrote in to Gail Manning of Ohio a government representative about this when they wanted to let the heroin-addicted people and trouble making people out of jail

  • Susan

    Using the term disease for addictions is only an excuse to keep doing it

    • Renee Connolly

      Once you are addicted. ..with the guilt, the shame (ie Guilt= l MADE a mistake /did something wrong. Shame=l AM a mistake /l am something wrong) ; the self loathing, the lack of self/others care; the self absorption /centered thinking; – you no longer need an excuse to go on using. You will drink and/or use long after you have been longing and desperate to stop. As he says…the cost so far outweighs the “reward”… ie putting alcohol before your child knowingly- the self hatred is indescribable.

  • Krayal

    How dare you put homosexuality in the same category as drug abuse. You disgust me. Homosexuality is not a disorder or a disease, or a bad thing in any way. There is something very, very wrong with you.

  • Bethany Wheeler

    I would gladly trade you one of my actual diseases for your addiction, because you CAN choose to quit. People need mental health drugs sometimes, but a disorder is nothing like an actual disease attacking your body.

    • Chester

      Can someone post the definition of disease?

  • Bron Ramey Flowers

    Folks, people who are so enarmoured with alcohol they destroy themselves and others, need assistance and support. The argumentative below sound pretty bloody angry and so am I! However, I live in a country where people are more than not, treated as human beans. Alcoholism isn’t a disease but it’s a pretty dreadful choice in the long run. Be kind. Science is there; so can you.

  • Renee Connolly

    You have summed it up as well as one though.

  • Menon Dtes

    The origin of the word disease is, Middle English (in the sense ‘lack of ease; inconvenience’): from Old French desaise ‘lack of ease,’ from des- (expressing reversal) + aise ‘ease.’ Or without comfort.
    Being clean for 22 years I personally know that there is NO comfort in drug addiction! There was a lack of ‘ease’ for sure. If you’ve been there, you’d know.
    Founder/Men On Down Town East Society

  • Jeremy K Music

    ok so how do you explain the 10% that get very addicted, very easily and the other 90% that do not? I’ll tell you: they have an impaired frontal cortex due to their genes. Their brains do not produce enough dopamine and they are on a constant search for it. (This has been proven in a UK study. Watch the Russell Brand documentary where he talks to Professor David Nutt.) These are the high risk addicts and yes they DO require treatment. Many have undiagnosed adhd as well.

    • Erik Swanson

      there are a lot of factors that go into this before assuming that its a disease. A genetic polymorphism such as overmethylation or undermethylation could be the cause of that 10 percent. Methylation status is a huge factor when brain chemistry is involved. This does not mean one has a disease. A polymorphism isnt a disease, its a unique genetic trait about ones self. Nutrition could also be a factor because of the micro nutrients and amino acids your unique body requires to operate correctly, which could be lacking in precursors to brain chemicals such as dopamine. Environment and stress could be involved. The word disease should not be being used with addiction because, like said above, that puts a end result on it when you are not permanently addicted.

    • William W Wernecke

      The same processes that occur in the brain with addiction also occur in the brain with people who learn how to play the piano or any other hobby or skill

  • Louise Cann

    Whooo! So right you are!(you are one tho,huh? Lol)

  • Louise Cann

    Did you know that only recently it had been declared a disease. Then if that’s so,how can you state”….when people stop listening to doctors and therapists & realize that,the better”? Did it seem better to you before that started to catogoritize it like a disease? I hope you don’t find yourself eating those ‘very fat opinions’ of yours in the future.

  • Erik Swanson

    “You are permanently addicted. Your body will go into remission with non use but may become yet again active with or without use.” Yea its called learn how to live life without your crutch. You have to learn to live life without the substance again. “Would you call schizophrenia a disease? Doesn’t that include brain chemistry?what is th3 difference?” I actually do not believe schizophrenia, as well as the other mental health issues are disease. This is actually a theory and pharmaceutical companies as well as everyone who profits off of these “mental diseases,” still say they dont know what causes it. The claim that mental health issues are diseases are highly refuted by different scientists, like the one who wrote this book that is referenced in this article. Overmethylators have a high chance of getting schizophrenia. This is caused by polymorphisms that affect the methylation status as well as brain chemistry. People who have schizophrenia usually have high dopamine if they are actually tested. Usually no tests are done besides one on one questions with a psychiatrist.

    • Kristeen Izzio

      It really is not that simple. I would not label it a “crutch” because their is something missing in an addicts brain chemistry that the drug compensates for. Otherwise, one would not get addicted. A good example of what im saying is a person who takes painkillers for pain. They never intended to “get high”. They took the drug for a legitimate purpose. They didn’t even realize something was missing from their lives. Until they take that pill. Then it’s really when a person realizes somethings missing/somethings wrong with me. The drug makes up for that. Which is why it’s so hard to stop taking it. Your making an active decision to go back to feeling “inadequate”…literally. you’re choosing to live in a constant state of depression, anxiety, and overall inner conflict. That is why it is so hard to stop. Addicts don’t ever feel normal without the drug.and they know that once they stop, they’ll never quite feel normal again. This is the biggest hurdle addicts face. Actively choosing to go back to feeling lesser. To stop vs wanting to stop. Addicts want to want to stop…. if that makes sense. And many many don’t want to. They eventually do stop, but they never wanted too per se….

      • Kate Jayr

        I agree it is much more complex. People do get addicted to prescription painkillers because of physical addiction. Addiction is both physical and psychological. But anybody who ignores the fact that people build up a tolerance is living in cloud cuckoo land. If somebody just stopped taking certain meds cold turkey it would be very dangerous which is why most drugs need tapered and supervised withdrawal

      • Hannah

        Anyone can get addicted it comes back to this..who CHOSE to take those pills?
        prescribed or not? DO YOU KNOW anything about the pharmaceutical industry in America? If so, you’d be aware that all man made drugs are truly poison and come with side affects and yes some are addictive. Addiction comes with withdraw. SO What?!? When the addict decides “this is not what I want anymore” they can just stop Or they can seek counseling which will help them develop coping mechanisms, but seeking out that help is a choice. Quitting is a choice. UNLIKE lung cancer which is a REAL DISEASE where a person is UNABLE to just decide to get mental treatment for their problem to stop. Be wary of pills. ANyone can become addicted to anything; just keep CHOOSING to put it in your body and you’ll soon see what I mean.

  • Terry

    OMG, thank you, I just learned you cant fix stupid. You have all fixed Canada’s National crisis. Too fat, stop eating. too short grow. Too dumb, get smart. Too poor, get rich. Too hungry, start eating. Syrians, start fighting. Africans, grow a garden or stay indoors. China, stop procreating. According to you all its that easy. It’s right up there with our prime minister saying “the budget will balance itself”. It’s not as simple as making a choice!

  • brandon

    addiction is not a disease it is developed from choice making, and the cure is also obtained by choice making. I also understand that an alcoholic will always be one but that does not mean they will always be affected by the consumption of alcohol I.E being sober. where as someone with leukemia will always be affected by leukemia, there is no choice making involved, its permanent until a cure is found If a persons choices are the cure to all of your addictions, than it can never be labeled a disease.

    When the day comes that someone can choose to not be diseased than addiction will fall in this category. YOU CAN BEAT YOUR ADDICTION WITH YOUR OWN WILL POWER. i say bull to anyone who says you can’t beat your addiction with your own brain power.

  • Inge

    Idiotic 12-step nonsense.

  • Leah Robinson

    Oh wow, loved this article. Makes sense. Ive been to rehab 6 times, many AA meetings, several psychiatrists and psychologists and addictions specialists and just regular counsellors. While, I am sure all of them had good intentions, they all supported the disease model. When I voiced my concerns about how I didn’t think my addiction and alcoholism was a legitimate disease, or how it didn’t make sense to me.. they just told me I had to go back to AA or that I was in denial. I just stopped arguing and eventually stopping going to counseling and AA. Although, I do love the group concept of AA. If you find sober people you can clique with- that’s awesome. But, yah.. the 12 steps and the disease model does not work for me. But yah, the hardcore believers in the program are scary to confront in person with differing views. Been there. Done that. They just do not want to hear anything else.

    • Kris Roth

      If you’re on facebook, take a look at Whatever it Takes Recovery. We’re a pretty open group that’s largely made up of people who have done aa but rejected it for whatever reason, and many of us don’t believe in the addiction model. There are people who are into harm reduction, many who are totally abstinent and some that believe we can heal from addiction and not be saddled with it for the rest of our lives.

      • Nicole Lowery

        Hi Kris. I can not find the Facebook page you mentioned. Could there be a typo? I am really interested in the page.

  • Alexander Ivlev

    As a certified hypnotist I help people with alcohol drinking problem get sober. Often people come to me after been going to a rehab center or attending group psychotherapy sessions without any success.

    I think that if alcoholism is an illness then why the medical doctors are not able to heal people with alcohol drinking problem?

    Here is the truth: your desire to drink alcohol can be easily eliminated by hypnotic suggestion in one or several hypnosis sessions! Of course, hypnosis is not magic. But it works magically for those people with drinking problem, who REALLY want to get sober.

  • Wesley Michael

    Learn to control yourself.. your drug addiction is no different than a woman eating bon bons at 3am cause shes obsessed with the flavor…

  • Kate Jayr

    Wow, you’re all heart, Stewart. So I assume you’ve never had to take any prescription painkillers over a long period of time and if you did your body is somehow different than the rest of humanity who, would become physically addicted over a period of time because addiction is also physical in the form of body tolerance. But you’re so strong you must be an exception to the rule and must ignore the dangers of just stopping a prescription drug without medical supervision or tapered withdrawal!

  • Beth

    I love this article. As I have many examples of why addiction isn’t a disease. My favorite one to use because it has to do with brain chemicals, missing information, the satisfaction, or the want factor, and how they are never the same. Is look serial killers, physio path. They all have a chemical imbalance. When they do satisfie the want factor they have a change, are proud, are happy, a different person. As normal people we think never could I do something that wrong. Some don’t go as far as others. Look at that as the % who don’t need medical treatment. As many people we may have a thought from time to time but never act upon it. Then there are those who can’t control the want factor. That need that satisfaction. Now we don’t say those people have a disease do we? For some even if they can be cured they are still confined to a mental hospital for life. Or Do we say they have a mental disorder, or a chemical imbalance of the brain, or even a genetic disorder? Yes, we do. That is what addiction is too. All those same chemical imbalances, missing information, never developed fully, wanting of satisfaction, all that stuff happens just in a different form.

    • hannah

      Tell yourself that if it comforts you, but as a former addict myself, I choose to take responsibility for my choices. The whole addiction was my choice just as it is everyone’s personal choice. When I started, it was my choice. When I thought “hey this shit is killing me in many ways, but I still want it,” That was My choice and when I finally decided and said NO MORE to myself and hit rock bottom and DECIDED NEVER AGAIN to use. Well…THAT was A CHOICE I made. Having a real disease such as diabetes can not be overcome by Willpower. An addiction is powerful, but it can be overcome with the right mindset, coping skills and your own desire to change. Change is intentional. It’s your choice. I wish the world would learn to accept responsibility for their choices. Unless your mother used while you were in the womb and you came out already addicted to a drug…then it was and is and always will be YOUR CHOICE. Prayers for all addicts but the first step in recovery is to stop living in denial and take responsibility!

  • Jeff Hyatt

    The person being interviewed, Marc Lewis, Ph.D., is a former heroin addict.

  • John Harper

    regardless of what people think of Alcoholism/or drug abuse being a disease, consider this! If a drunk driver kills a van full of children and the soccer mom driving, our society does not view the perpetrator as having a disease. Far from it. Now if a diabetic does the same exact thing, and perhaps isn’t even managing his health problems, he will not get anywhere near the shame and societal penalty that the drunk driver will get the rest of his life. Alcoholism is NOT a disease. It is something worse!

    • Chris Marshall

      One is a choice and the other is a medical problem . Diabetic patients sugar going out of whack can happen at random even when eating. You going out and getting lit and then hoping into your car is a choice that why they tell You to have designated driver. This comparison is far from the same at.

      • John Harper

        that was my point. A huge segment of our society, doctors, treatment centers, insurance co’s, court systems, are saying it is a HEALTH problem! I don’t agree with that. I agree with you that it is a choice. What did you think I was trying to say??

  • John Harper

    this late night moronic commercial of the young doctor with the stethoscope needs to be shut down immeadiately. The recovery and treatment industry have no scientific record or data to prove their efficacy and they lie about their anecdotal results. They have no pedagogy, theory, coherent scientific plan. They are totally charlatans, and it is all done for money. And if there wasn’t insurance available for poor or low income workers, you would not even see these commercial pitches. They absolutely do not care about the individual but money. And their science is non existent!

  • John Harper

    most people with serious drug and alcohol problems eventually right themselves and their course. The skid row alkie and the problem drinker really don’t have that much in common though (the Sellers of the Disease Model) they would have you believe they are one and the same. They are not! Manufacturing false lies and mythologies for money is a disease! Greed is a disease! Life is a disease! Smoking is a disease! Insurance is a disease. Longitudinal studies are a disease!

  • Lori Levoy

    Addiction is a moral problem. No one would even know they were in That 10% if they weren’t dabbling in illegal drugs in the first place. “Genetics” is also nonsense. Kids display the same bad morals and bad decisions their parents do. They also learn how to manipulate. They see their parents coddled and enabled, using the word “disease” as an excuse for their disgusting behavior.

  • Latina Mitchell

    I’m not a scholar and I do not consider myself a know it all. I come from a long line of alcholics, judgmental torrents, and

  • William W Wernecke

    I have had plenty of contact with addiction dozens of friends have died one parent and I totally agree it’s not a disease

  • William W Wernecke

    Sounds like Jeremy a know it all bub cause he said undiagnosed ADHD how do you know if it’s undiagnosed?

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