The theory of addiction as a disease is taking a solid establishment in the medical field (Szott, 2015). The perception of drug addiction as a disease has been created during the late 1930s (Walters, 1992). Addiction has always been divided into two categories. On one side is the medical model which perceives addiction as a disease categorised by degenerating and obsessive drug use which the individual has no power on and a moral model where addiction is understood to be an individual’s volunteer choice (Henden, Melberg, & Roseberg, 2013). Addiction can be characterised as a physical need, cognitive choice, emotional instability, psychological failure, neuroadaptation or a disease. Drug addiction, for instance, involves opiate substances (Boshears, Boeri, & Harbry, 2011). Since the 21st century, in Western industrialised societies, addiction is said to be a disease by most of the people in the medical industry as well as people who are in a recovery phase of addiction (Reinarman, 2005), however, numerous researches were conducted to identify whether addiction was really a disease or can be influenced by many factors and be part of an individual’s choice.
Nowadays, drug addiction is considered a brain disease (Vrecko, 2010). Research on this field has been operated to claim that addiction is a long-lasting brain disease which deteriorates with time (Meurk, Carter, Patridge, Lucke, & Hall, 2014). Vrecko (2010) proposed that addiction interacts with the structures of the brain which relate to rewarding behaviours. As such, the brain is unable to make a difference between neurotransmitters’ chemistry which naturally happen and drugs as drugs substances can copy endogenous neurotransmitters and take control of the brain’s reward system producing over-production of pleasure.
Three other studies provide support for this argument (Snoek, 2010; Meurk, Carter, Patridge, Lucke, & Hall, 2014). Snoek (2010) described that when people start consuming drugs, it can have positive aspects in their lives by allowing them to de-stress. At this point, the prefrontal cortex accepts the substance due to its sudden problem-solving factors. Consequently, the brain develops a learning process and forms a habit out of the individual’s craving for substances (Snoek, 2010). Dingel, Karkazis, Koenig (2011) explored the view of addiction as a brain disease among stakeholders of nicotine research and found that addiction was mainly viewed as a medical occurrence. It was found that the rapidity which addiction occurs is a biological process (Dingel, 2011).
Meurk et al (2014) investigated whether drug addiction was perceived as a brain disease among the general public and found that most of the participants believed that addiction was a brain disease especially the ones who were addicted to heroin. Moreover, brain changes are said to be linked with frequent drug use which ceases an individual’s capacity to make decisions (Meurk, Carter, Patridge, Lucke, & Hall, 2014). Limitation such as self-report of participants on their own or other’s behaviour did not measure the participants’ seriousness.
On the other hand, other research indicated that drug addiction is a choice, not a disease. Lewis (2011) stated that addiction is a choice through which instant rewards surpass long-term advantages because drug addicts decide voluntarily to take substances as well as recover and disease does not involve choices (Lewis, 2011). People at times chose less distressing decisions without thinking about the outcomes (Lewis, 2011). Accordingly, before rewards actions, the brain is overflowed with dopamine. It is focused on the ventral striatum where attention and action are determined by rewards and orbitofrontal cortex where events are estimated as rewarding or not (Lewis, 2011). Moreover, the fact that addiction generates neurological dysfunction is not enough to consider it as a disease (Pickard, Ahmed, & Foddy, 2015). While drugs can change the brain, they do not discourage individuals from renouncing as the chances of quitting neither increased nor decreased overtime in heroin addicts (Heyman, 2013). In his self-report research, Lewis (2011) found that drug addicts cravings and orbitofrontal activity increased just before the moment of the drug consumption and decreased quickly after.
Although drug addiction has been linked to a disease or an individual’s choice, researches suggest that the environment of the individual, as well as his childhood and other factors, may determine his or her choice in consuming drugs (Garami, Valikhani, Parkes, Haber, Maniberg, Misiak, Frydecka, & Moustafa, 2019; Milivojevic, Milovanovic, Javanovic, Svranovic, Svratic, Cloninger, 2012). Factors such as stress have been related to drug addiction. Garami et al (2019) found that trauma especially childhood trauma is strongly connected with adults’ drug abuse and addiction. Moreover, being exposed to stress during childhood may weaken the development of the brain structures which are accountable for the prefrontal cortex, emotional and behavioural stress responses including decision-making ability (Garami et al, 2019). Besides, stress can predict drug addiction as it is mainly moderated by stress hormones which strengthen the amygdala and weaken the hippocampus prefrontal cortex. This, therefore, leads to a negative emotional state, less self-control and increase the risk of relapse (Ruisoto, 2019). Risotto's study (2019), argues that early life stress increases damages in the inhibitory control involved in drug addiction.
Two studies provide evidence to support this argument (Milivojevic et al., 2012; Garami et al., 2019). Garami et al (2019) used self-report questionnaires to measure the history of childhood trauma of participants. They found that people who struggled with drug addiction reported greater childhood trauma and high-stress level. Furthermore, childhood trauma was more potentially linked with drug addiction compared to stress. It was concluded that the greater the number of life trauma predicted a higher level of addiction and this can have an important effect on opioid addiction. While these researches provide strong evidence that increasing the existing literature concerning trauma in opioid-dependent individual, further studies using a greater sample size are warranted to gain more support for these findings (Garami et al, 2019).
Nevertheless, Milivojevic et al (2012) suggest that personality traits can determine if an individual will take drugs or not. They found in their research that novelty seeking project the most vulnerability to drug addiction. They argued that individuals from the novelty-seeking group were found to be antisocial and manifested impulsive behaviours with no empathy for others. It was found that younger individuals with antisocial traits tend to fall in the opioid drug addiction category and anxious individuals tend to fall into alcohol addiction. Additionally, novelty Seeking was found to be a high-risk factor for drug addiction and personality disorders amplify the risk of drugs consumption (Milivojevic et al., 2012).
Although changes in the brain common sense function occur due to the use of drugs, other activities which do not involve drugs produce the same changes in the brain such as gambling (Reinarman, 2004). Reinarman (2004) argue that people will do anything to activate dopamine neurons. Besides, Walters (1992) suggest that drug addiction is a disorder. Besides, Snoek (2017) claimed that individuals can determine choices to make to overcome addiction. He supported this view by highlighting how quickly people recover from heroin addiction. Moreover, people tend to view addiction as a disease due to the difficulty of recovery (Snoek., 2017). Vrecko (2010) argued that drug addiction is diagnosed as a social functioning impairment such as personal incapabilities, undesirable feelings and personal problems. However, Meurk et al (2014) suggested that the acceptance of drug addiction as a brain disease will reduce the stigma of moral weakness and will increase treatment seeking among drug addicts.
In conclusion, the review of findings has revealed that drug has some effects on some parts of the brain, for example, the orbitofrontal cortex which is responsible for distinguishing rewards. This can lead to some changes in the way the brain functions which can lead an individual to look for drugs constantly (Vrecko, 2010). While other studies indicate that drug addiction is nothing but a choice which an individual makes voluntarily (Lewis, 2011; Garami et al., 2019; Heyman, 2013). Nonetheless, other studies like Reinarman (2004) and Walters (1992) point out different factors such as stress and personality traits which lead to drug addiction and act as both a disease and a choice. However, further research is warranted to clarify if specific environmental factors predict other influences on the choice of drugs (Milivojevic et al., 2012).