Rethinking Addiction: Is It Really a Disease, or Just a Choice?
If you ask the average adult, or even a health care provider, “Do you believe addiction is a disease?” most will answer, “Yes.” With a bit of prompting, they might even mention the “drug of choice” that’s devastating a loved one or patient’s life. But do they truly believe addiction is a disease?
Have you ever heard a primary care physician refer to a raspy cough and sore throat as an “infection of choice,” or an oncologist discuss a “cancer of choice?” The answer is, hopefully, no. Yet the term “drug of choice” is commonly used in medical circles to specify substances associated with addiction.
In his recently published book, “Beyond Shame: Healing the Pain Beneath the Surface of Addiction,” Jeff Georgi approaches addiction as a disease, much like an infection or cancer, rather than some voluntary moral failing. Over four decades of working with people struggling with substance use disorders (SUDs), Jeff has never encountered anyone who claimed, “I woke up one morning and decided alcohol addiction seemed like a good way to spend my adult years.” People living with addiction deserve just as much compassion, treatment, and love as those facing any other illness.
In “Beyond Shame,” Jeff defines the disease of addiction as dysfunction within five key domains of life: Biological, Psychological, Social, Spiritual, and Experiential.
Biological Domain
On a biological level, individuals have varied responses to substances. While some people experience nausea or even allergic reactions when consuming alcohol, others find that it acts as an effective anesthetic, dulling life’s challenges. For certain individuals, the sense of relief that alcohol provides can be so profound that it leads to unhealthy patterns of use and increases their vulnerability to developing an alcohol use disorder. Recognizing these biological differences is essential for understanding and effectively treating addiction.
Psychological Domain
Psychological struggles are often deeply intertwined with patterns of substance abuse. Emotional wounds can foster feelings of shame, fueling behaviors that contribute to the development of addictive disorders. Addressing and healing these areas of pain and shame can be a transformative part of the recovery journey, strengthening one’s path toward lasting well-being.
Social Domain
The quality of social connectedness plays an integral role in addiction. As humans, social rejection and isolation are among the most painful experiences we can have, and some use substances to cope with loneliness and disconnection. Addiction is isolating in and of itself, which can exacerbate shame and trap people in negative cycles of loneliness, pain, and substance misuse. Social connection can serve as a powerful healing force navigating the path to recovery.
Spiritual Domain
SUDs can interrupt one’s spiritual connection and their ability to make healthy choices, take growth producing risks and participate in awe and wonder. Addiction robs people of the capacity to be fully present in their lives. Mindfulness and other spiritual practices can support recovery through revitalizing one’s innate sense of connectedness to themselves and others.
Experiential Domain
Life experiences, especially hurtful or traumatic ones, can have a profound impact on a person’s sense of well-being. Events such as childhood losses or deeply distressing situations may erode self-worth and make daily life feel overwhelming. In response to this emotional pain, individuals often seek relief, sometimes turning to substances to cope with or escape discomfort and distress.
Ultimately, when considering addiction through the lens of the Biological, Psychological, Social, Spiritual, and Experiential Model (BPSSEM), recovery from a substance use disorder goes beyond mere abstinence. It involves strengthening resilience across all five domains and transforming our relationship with substances that undermine our overall well-being.
