NYC Therapist Talks: Addiction: Disease or Choice

NYC Therapist Talks" The Fallacy of the ‘Hijacked Brain’- is addiction a disease, a choice or both?


Of all the philosophical discussions that surface in contemporary life, the question of free will — mainly, the debate over whether or not we have it — is certainly one of the most persistent.

A popular analogy clouds our understanding of addiction. 

That might seem odd, as the average person rarely seems to pause to reflect on whether their choices on, say, where they live, whom they marry, or what they eat for dinner, are their own or the inevitable outcome of a deterministic universe. Still, as James Atlas pointed out last month, the spate of “can’t help yourself” books would indicate that people are in fact deeply concerned with how much of their lives they can control. Perhaps that’s because, upon further reflection, we find that our understanding of free will lurks beneath many essential aspects of our existence.

One particularly interesting variation on this question appears in scientific, academic and therapeutic discussions about addiction. Many times, the question is framed as follows: “Is addiction a disease or a choice?”

The argument runs along these lines: If addiction is a disease, then in some ways it is out of our control and forecloses choices. A disease is a medical condition that develops outside of our control; it is, then, not a matter of choice. In the absence of choice, the addicted person is essentially relieved of responsibility. The addict has been overpowered by her addiction.

The counterargument describes addictive behavior as a choice. People whose use of drugs and alcohol leads to obvious problems but who continue to use them anyway are making choices to do so. Since those choices lead to addiction, blame and responsibility clearly rest on the addict’s shoulders. It then becomes more a matter of free will. (Read article)



Choice or disease, it's important to know how to get help for substance abuse.  Unfortunately the 12-Step movement (religious groups like Alcoholics Anonymous, Scientology-based Narconon, etc)  tend to be what people think of when they think of drug and alcohol treatment (and increasingly help with gambling, sexuality, eating, shopping, playing World of Warcraft, and more).  12 Step Programs and their offshoots (Al-Anon, etc) are so ubiquitous in the American psyche that these sorts of groups are often even court-mandated.  These groups are religious in nature, and have little scientific basis to their methods.

An effective (and evidence-based) alternative to the 12-step model is called SMART Recovery (Self Management and Recovery Training). Using techniques derived from cognitive behavioral therapy, SMART Recovery aims to challenge the underlying irrational beliefs that lead people to continue their self-defeating habit.  Regardless of whether addiction is viewed as a disease or a choice, using cognitive-behavioral methods is a secular, effective, non-confrontational way to achieve and maintain sobriety.

For a list of free SMART Recovery groups, handouts and other resources, visit


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