Most academic papers I've read on alcoholism and drug addiction favour the view that they are more akin to an illness than a life choice. The principal reason for this seems to be that such activity alters brain states in ways that are beyond the control of the users. This seems to me to be a flawed argument. Just because an activity brings about physiological ramifications doesn’t mean that it should be seen as an illness. Excessive sun-bathing alters the state of my skin beyond my control, and excessive junk food alters the state of my body weight beyond my control - but we'd be on dodgy ground if we tried to claim that sun-bathing and bad eating are illnesses rather than choices we undertake of our own volition. If we are always cautious in exposing our skin to the sun, and always sensible in our choice of health foods, we can avoid the ill-effects that occur as a result of excessive sun-bathing and junk food. Similarly, if we always drink sensibly and avoid drug taking we can avoid the ill-effects that occur as a result of indulging in excessive alcohol and drugs.
Given the foregoing, then, my feeling is that alcoholism and drug addiction constitute life choices, not illness or disease. That said, I'm fully seized of the ways in which alcoholism and drugs upset the natural cognitive protocols, and disturb people's desires and needs. To that end there appears to be some kind of correlation between drug dependence and addiction, which may then be considered in accordance with psychological underpinnings (such as depression, absence of ambition, low self-esteem, myopia, and lack of confidence) of which these addictions are by-products. I will even concur that addictive behaviour is a lot do to with genetic predisposition - as studies exhibit higher rates of addiction among monozygotic (identical) twins rather than dizygotic (fraternal) twins, which clearly suggests genetic factors.
But the underlying truth seems to be that there is a lot of dogma circulated around the idea of alcoholism and drugs constituting illness or disease - and I don't think this is helpful because it leads many people astray by having them think that willingness to recover is powerless in the teeth of illness. Hence, my position is that tough love is a very powerful tool of renewal so long as it is employed with kindness, love and grace.
Individuals plagued by alcohol and drugs are often able to overcome their plight with sheer determination, persistence, and help and encouragment from others - I've seen it happen. The key for them was that it was not seen as an illness for which they needed treatment, but as a life situation brought about by the willingness to participate in something physiologically, psychologically and socially destructive, and that the impact of this participation was sufficiently degenerative to elicit in the sufferer a diligent and galvanised approach to recovery. Not everyone can manage this, but that doesn't mean what they have is an illness - it just means that the power of the will is hard to summon up. I'm not that surprised; I think there is a lot of tragedy and pathos attached to being human - and we all struggle in so many ways. Drugs and alcohol taken in excess are two ways to anaesthetise people against the thrall of human pressure, hardship and tumult - and one can get so lost in them (as one can in religion or extreme politics or cupidity) as they can provide a numbing effect that partially negates the many psychological and emotional problems we face. Realising these things amount to life choices helps us see that our destiny lies in our control – and this can only be a good thing in encouraging addicts to set themselves free and make a clean break, and in pre-empting potential addicts from ever going down such a destructive route in the first place.
* Picture courtesy of care2.com
