Drug Addiction: Choice vs Disease
by
Lucas Fowls
Adam Korman
English 102
April 4, 2020
Research Paper - Drug Addiction: Choice vs Disease
The crisis of drug and alcohol addiction in today's society is reaching epidemic proportions. According to statistics, there are over twenty-three million people in the United States alone addicted to some form of drugs or alcohol (Yerby, 2019). From 1990 to 2017, more than 700 thousand Americans died from a drug overdose (Yerby, 2019). An event that starts out as a party in high school on a Friday night concludes with someone landing in the intensive care unite of a local hospital on a ventilator. For some people, this is the beginning of a long and arduous path that leads to addiction. For others, it is a wake up call: they realize that they need to be aware of the potential danger that is associated with drug and alcohol use. What is the lurking causality behind drug and alcohol addiction? Why do some people become addicted and other people do not? The causation of addiction is multi-factorial and includes such factors as heredity, psychology, economic status, and sociability. It has been referred to as a disease by some organizations such as alcoholics anonymous and narcotics anonymous. Although there is a school of thought that identifies drug addiction as a disease, it is important to stop this designation because, unlike true disease, addiction is a choice.
An understanding of the distinction between addiction and disease is helpful. According to the National Institute on Drug Abuse, addiction "...is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences" ("What is Drug Addiction?" par.1). The American Psychiatric Association describes addiction as, "...a complex condition...that is manifested by compulsive substance use despite harmful consequence," ("What is Addiction?", psychiatry.org, 2020). Further, it explains that people will continue to use a drug or alcohol even when they know it has harmful effects to their body. However, disease is defined as "...any harmful deviation from the normal structural or functional state of an organism, generally associated with certain signs and symptoms and differing in nature from physical injury." (Scarpelli and Burrows, britannica.com). The key words here are, "...differing in nature from physical injury." When a person initiates drug use or drinks excessively, they are causing physical injury to their body. "Chronic disease" is a condition that requires continuous medical attention. Examples of chronic disease are arthritis, cancer, asthma, diabetes, cystic fibrosis, Alzheimers, and dementia (cdc.gov, "About Chronic Diseases"). None of these conditions are brought on by the person suffering from them by extrinsic activity; they are inherent. They are part of their genetic maps they inherited from previous generations. However, taking a drug is a choice. Drug and alcohol addiction IS brought on by extrinsic activity, causing harm to the body. Therefore, this makes it difficult to justify that addiction is a disease. A person makes a choice when he or she uses chemical substances leading to chemical dependencies.
This choice to use the substance can cause an array of outcomes, one being alterations in brain chemistry and the ability of the brain to regulate the choices they make and to anticipate associated consequences ("What is Drug Addiction?" par.1). The brain adapts to the substance neurologically and it makes it difficult for the person to disengage from cyclical pattern of behavior. I know from observing other people close to me that using drugs impaired their ability to think clearly and to anticipate consequences associated with situations in which they found themselves. When they made an attempt to stop the drug use, they were unable to do so, because their brain chemistry had been altered to the point that the substance had become a necessary component in order to function. Thus, addiction occurs when the body adapts to substances that have been introduced through extrinsic methods and the body requires the substance in order to function adequately.
A person's genetic map has a lot to do with what happens to them when an addictive substance is introduced into their system. A genetic map is what each of us inherits from previous generations and is scientifically known as the human genome. It can represent how a person's biology is going to react to substance use. For example, there is a liver enzyme called alcohol dehydrogenase, which breaks down alcohol in the systemic organs of the body. Some people with a genetic variation of this enzyme, the variation being a missing isozyme, are less likely to manifest alcohol dependency. However, people who do not have this neurologically protective variation in their body are more susceptible to addiction when alcohol is introduced (Skewes and Gonzales 63).
Another example of the significance of the genetic map or genome, is found in genetic predispositions in children of alcohol-dependent parents. When these children become adults, a third of them will develop a dependency on alcohol if they have had at least one alcohol-dependent parent because of the heritable aspect of addiction. Male parentage produces a higher percentage of alcohol-dependent offspring than female parentage alcohol dependent offspring, which suggests the male-sibling genome is more heritable than the female genome (Skewes and Gonzales 63).
A final example of a genetic predisposition to substance addiction involves the heritable characteristics between monozygotic and dizygotic twins. Monozygotic means that a single egg is fertilized by a single sperm and have one-hundred percent of their genes in common. They are commonly referred to as identical twins. Dizygotic means that two eggs are fertilized by two separate sperm and they share approximately a fifty percent genetic similarity (osaka university twin research, 2015-2020, med.osaka-u.ac.jp/twin/en/twin_research/twins). In monozygotic twins, because they share a one-hundred percent genetic similarity, if one is alcohol dependent than there is a high probability that the other twin will manifest a similar dependency. The only event that would change this outcome is if the environmental and social factors vary between the two twins. In dizygotic twins, the correlation in alcohol dependence is not as strong because they only share fifty percent of their genetics (alcoholrehab.com 2008/2019 "Twins in Research on Addiction").
Even though all of these examples point to the significance of the human genome in addiction, it is worth noting that a person still has the choice to initiate the use of the substance that leads to addiction. For example, I have a friend whose mother was a drug addict, eventually passing away from the addiction. As a teenager, this friend of mine experimented with chemical substances. As he has matured, the drug use has terminated and he has shown no symptoms of addiction. On the other hand, I know someone who became a heroin addict, reaching the terminal stages of addiction resulting in death. His parents did not use chemical substances. Even with genetic predispositions, there are many people who do not end up taking drugs because they do not choose to.
Another way addiction manifests itself is through a process that occurs in the brain when the chemical substance is introduced. as a functionality of time and neurological adaptation. There is a chemical in the brain known as "dopamine". Dopamine is produced naturally in the brain and, therefore, is associated with sensations of pleasure and satisfaction. When a drug is introduced to the susceptible candidate's genome, it interferes with the body's natural ability to produce dopamine because when the the drug is present it is producing the chemical for the body. The hypothalamus region of the brain neurologically adjusts to the dopaminergic surplus that is created by the drug. Therefore, when the cyclical pattern of behavior reaches its terminal stages, it becomes difficult for the person abusing the chemical substance to restore the scarcity of dopamine that is present when the drug is absent after an extended period of drug use has passed. This causative process leads to a disequilibrium of dopamine when the drug use is initiated, leading to a scarcity when the drug is absent from the person's genome. This absence of dopamine within the neurotransmitter that is caused by the drug results in depression, anxiety, lack of sleep, symptomatic behaviors and paranoia. This occurrence in the brain transpires because the brain has adjusted to the excess dopamine the substance was creating for it. As a result, the neurotransmitter has been halted from reaching its potential equilibrium of dopamine or previous state of functionality prior to the initiation of the drug use. The problem is there are other activities that can positively impact dopamine biochemistry. Examples include exercise, sufficient sleep, and listening to music. Even before one chooses to initiate the drug use, one can engage in these activities. They do not have to resort to drug use. They have a choice.
There are other signs that genetic variabilities may be indicative of addictive behavior. Comparative animal studies have confirmed that selective breeding among rats has promoted certain characteristics associated with substance use that could be analogous to humans. One such study has shown that rats who were selectively bred to prefer alcohol over water developed a dependency on the alcohol. This study strongly suggests the susceptibility of genetic inheritance to new generations of offspring where addictive behaviors are concerned. The problem with studies like these is that they involve animals and not humans. Even though this information has been discovered and introduced into the scientific community, rats and animals do not have a choice like humans.
There are still other indicators of choice in addiction that need to be accounted for and addressed.
In relation to a person's socioeconomic status, it is widely thought that poverty lends itself to drug and alcohol addiction. However, this is an erroneous generalization because there are just as many wealthy people who engage in addictive behaviors as poor people. Addiction does not discriminate against socioeconomic status. As stated in unityrehab.com, "...addiction is an equal opportunity affliction" (unity behavioral health, "Can Wealth Shield you from Addiction" 2018). In terms of alcohol abuse, according to a 2015 Gallup Poll, 80 percent of upper-income, college-educated American citizens use alcohol as opposed to 50 percent of lower-income, high-school educated citizens. As well, 78 percent of people with an income of 75,000 dollars or more annually, reported drinking alcohol as opposed to 45 percent of people who earned less than 30,000 dollars annually. One observation that is notable is the cost of drugs and alcohol. Higher income individuals and families have the money to spend on drugs and alcohol whereas lower income individuals families do not ("Wealth comes with risks as well", unityrehab.com, 2018).
In contrast, the idea that drug use is more wide-spread in poverty-stricken neighborhoods is false. A study by the National Institute of Health, observed that people with the highest incomes were the most susceptible to drug use as opposed to people from lower income populations ("Poverty Myth: Drug Use is Higher in Poor Communities", 4thworldmovement.org, 2018). Another statistic supporting the misperception that drug use and poverty are correlated is the drug testing policy implementation of welfare recipients. In Arizona one-hundred and eight-thousand people on welfare were drug tested. In the study only two of the test results were positive. Sixteen thousand drug test results in Tennessee showed only thirty-seven positive tests within the welfare recipient population (4thworldmovement.org, 2018). This is a clear indication that income has nothing to do with drug use.
All of these surveys indicate that socioeconomic status is not associated with chemical dependency. For example, I had a friend who came from a lower-income neighborhood. He has never developed a drug addiction even though he still lives in a poverty-stricken neighborhood. Conversely, I knew someone who lived in a high income neighborhood that died from a heroin overdose at twenty-eight years old. This all supports that addiction does not discriminate based on socioeconomic status and every person within their status has a choice to initiate the drug or alcohol use.
The role that psychological and emotional trauma plays in drug and alcohol use is another component of addiction worth noting. According to Cascade Behavioral Health, "Psychological, or emotional trauma, is damage or injury to the psyche after living through an extremely frightening or distressing event and may result in challenges in functioning or coping normally after the event," (cascadebh.com, 2020, "Symptoms, Signs and Effects of Psychological Trauma"). Some examples of this type of emotional trauma are divorce, rape, abuse during childhood, and death of a loved one. Many times people do not recognize the extent of the damage associated with a traumatic event and attempt to use coping mechanisms that are unhealthy and even more damaging. Chemical substances and alcohol only exacerbate the trauma, but are not uncommon in this population of people. There are many avenues to treat this type of trauma. Everything from a national help line through SAMSHA.gov to church counseling to psychotherapy to support groups are available to help people deal with their traumatic experience. One of the underlying reasons people may not choose to seek treatment in a more supportive environment such as the aforementioned has to do with denial. They are in a state of denial of the traumatizing event. This is not an uncommon response; however, it inevitably leads to depression, anxiety, anger, social isolation, and guilt. As a result, it causes them to be vulnerable to substance abuse. It is important to recognize that sometimes these traumatic events are such a burden for people to carry that they become dysfunctional. This causes them to make poor choices and they pay the consequences for their choices, being substance abuse leading to addiction.
A final variability of substance use is mental illness. According to the National Institute of Mental Health, mental illness is defined as, "...a mental, behavioral, or emotional disorder...can vary in impact ranging from no impairment to mild, moderate, and severe impairment," (NIMH.gov, Mental Illness 2018). In 2017, 18.9 percent of adults, or 46.6 million people, in the United States had some form of mental illness. Various forms of mental illness include Bipolar Disorder, Schizophrenia, Anxiety, Post traumatic stress disorder, obsessive compulsive disorder, eating disorders, and Depression. Within this population, 42.6 percent chose to seek help through mental health services that include inpatient treatment or outpatient treatment, counseling, or prescription medications to address their problems (NIMH.NIH.gov, Mental Illness 2018). There are organizations such as the The National Alliance for the Mentally Ill that provide resources and support for this population of people as well as their families. In recent years, insurance companies have even started to initiate coverage for mental illness in their plans. Even with all of this, there is a subset of this population that refuses to seek help and, unfortunately, if the volatility of these illnesses is left untreated, it can lead to drug use, homelessness, and even suicide.
A disease is inherent because it suggests that people are victimized due to birth conditions; therefore, they are limited in their choices and their outcomes of the situation are set. It is necessary to recognize what role choice plays in addiction and to stop this designation that addiction is a disease. These choices are not easy. There are a variety of biological, chemical, psychological, socioeconomic, and other variabilities that contribute to continued drug use. Denial, fear of the unknown, and self-loathing all contribute to the choices that people make. Once the choice is made to use and the chemical substance invades the inherited susceptible genome, people are going to be at risk for addiction. The issue with the designation that addiction is a disease is that people do not account for or take responsibility for their previous actions to initiate the drug use. When a person truly takes responsibility for their actions and own them, they have the power to change the result or the outcome.
It is important to recognize the role that choice plays in addiction. These choices are not easy. There are a variety of emotional and psychological factors that contribute to why people continue to use. Denial, fear of the unknown and self-loathing all contribute to the choices that people make. Once the choice is made to use and the chemical substance invades the genome, people with susceptible, heritable characteristics are going to be at risk for addiction. The issue with the idea that addiction is a disease is that people do not account for or own their actions. When you truly take responsibility for an action, then you have the power to change your behavior. On the other hand, a disease is inherent. It suggests that people are victims of their birth conditions, and therefore limited to what they can do to change their situation. Therefore, you do not have to own your actions. When you truly take responsibility for an action, then you have the power to change your behavior
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