Addiction is a disease. Science says this is undebatable.

Two months ago the Falconer published an editorial with the headline, “Addiction should be treated as a choice.” Reading it, I decided I had to respond; it felt wrong to let that opinion go without a rebuttal, specifically, the unquestionable, concrete fact that addiction is a disease, not a choice, and it is imperative that it be treated as such.

I could launch into flourishing rhetoric and vivid description, flashbacks and horror stories, recitations of conversations from a psychotherapist’s couch to prove this point, but I will not. I could shame my readers into agreeing with me, but I will not. Almost everyone in the orbit of an addict, regardless of the drug of choice, has an emotional stake in whether addiction is a disease or not. Experiencing addiction either in oneself, in a family member or in a friend drags behind it the difficult balance of coping with the boundary between choice and compunction. I intend to map out the exact reasons why addiction is a disease. That is how important of a distinction this is.

To strip addiction down to its bones, substance use causes biochemical changes in a user’s neural pathways, hijacking the brain’s production of dopamine. The structures of some drugs bear a resemblance to other chemical messengers, according to the University of Michigan’s medical center, Michigan Medicine, allowing the drug to bind to brain cells and produce dopamine. This is why drugs produce euphoric feelings, the intensity of that euphoria increasing with the amount of dopamine released. Continued use of a substance causes the brain to produce less and less dopamine naturally, making the person physically reliant on the drug.

Scientists and addiction specialists do recognize that the initial act of using a substance is, in most cases, a choice. Sure, a teenager who picks up a vape for their first-ever hit or a college student who indulges in some light-hearted illegal drinking does make the choice to try the substance. But the choice ends the moment the act is done for a person genetically predisposed to addiction. In family studies, the American Psychological Association found that at least half of a person’s risk of becoming addicted to drugs depends on their genetic makeup.

It is dangerously easy, trust me, to categorize addicts as people who are not trying hard enough, who do not have the resilience nor the love in their hearts to just put down the bottle, the pipe, the syringe. Though it may seem counterintuitive, for anyone who has known or loved an addict,

thinking they simply “do not want to get better” is less scary than thinking “they have a physical disease that makes it very difficult to get better.” Through the former lens, relapse is a weakness of will, and continued use is selfish, undisciplined and immature. Acknowledging the genetic predisposition and seriousness of the disease forces one to confront the very real possibility that things may never get better, and may likely get worse.

Compare the disease of substance abuse to heart disease. Yes, someone with heart disease can one day decide, ‘I’m going to eat better and exercise more’ and their condition will improve. But, they will still always have that systemic weakness. Addiction is much the same. An addict absolutely can wake up one day and decide they are “sick and tired of being sick and tired,” as civil rights leader Fannie Lou Hamer once said, and stop using. However, as with other diseases, the physical components remain.

In 1956 the American Medical Association designated addiction to alcohol and other drugs a disease. Some say a medical diagnosis of addiction removes the incentive to get sober because it offers a clear excuse for continuing to use. However, for an addict, and anyone in that user’s circle, knowing addictive behavior is part of a syndrome that has been tracked across a wide spectrum of people and cultures removes the stigma of addiction and the judgment that comes with it, even from those closest to the user.

This is significant because the National Institutes of Health says “family involvement in treatment can … improve treatment entry, treatment completion and treatment outcomes for the individual coping with addiction.” Viewing a substance use disorder as a disease helps users see themselves as people suffering from a disease that does not define them, rather than people who time and again, seemingly against their will, “choose” to suffer.

Two months ago we did publish a tried and true fact: that nobody, nobody deliberately chooses to struggle. A college student who leans on methamphetamines to get through the week does not choose this reliance. A single mother who needs a drink to keep from collapsing in on herself does not choose to sacrifice Saturday mornings with her kids.

It is dangerous to overgeneralize, from a limited perspective, the repercussions of calling addiction a choice. It places the blame for an uncontrollable genetic makeup, socially imposed substance-use norms and a decrepit addiction aid system in our country on the tired shoulders of an addict. This shame, the side-eyes, the “tough love,” does nothing but isolate the user. The mental health implications of this speak for themselves. One in four addicts commits suicide, accounting for over half of all suicides in the U.S.

It cannot be expressed enough that treating substance use as a disease, not a choice, is so important. It is not hyperbole to say that this distinction, the simple difference between two words, can be a matter of life or death.