Is Addiction a Habit or a Choice?

This is a popular debate among treatment professionals. Some say those who engage in substance abuse are in complete control of their actions. That’s the “choice and personal responsibility” theory.

Others disagree. They feel the substance abuser has no control over this kind of harmful behavior. They believe the biology of addicts compels them to seek drugs.  They follow the “neuroscience and disease” model.

Which one is right?

Well, they both are. Habit formation and substance use are often intertwined.

With my clients, I typically like using the act of crossing the street as an example. In the United States, people look to the left before they cross the street. Why? Because our parents taught us to do so. Over time, this pattern of looking left, right, and left again, becomes an automatic response. In neuroscience we call this a “pre-potent response (link is external).”

But looking to the left is the wrong response in a country where people drive on the opposite side of the street (like England). If you moved to such a country, you’d have to change your habit, which isn’t easy. It would require deliberate action (the decision to change) and ongoing practice (diligence). Only then could the brain rewire itself and create a new automatic response—and even that would take time. In the meantime, you’d be stuck with a habit that is dangerous to your survival but difficult to override.

How does this apply to the argument about substance abuse?

Substance use often begins as a simple rewarded experience, which through repetition and the rewiring of the brain’s learning and reward circuits can become habitual. If that habit escalates into problematic substance use, we can end up with something that our society has called “addiction.” Changing that automatic response would require a similar approach to the one it took to adjust our ritual of crossing the street: deliberate action (the decision to break the habit) and ongoing training (diligent adherence to a treatment program). Eventually, the brain would rewire itself and create a new, healthier automatic response.

You may have noticed something missing from that discussion, namely judgment (link is external). I don’t wonder why my clients behave the way they do any more than I wonder why they cross the street while looking to the left. In the end it comes down to training, and if we want to end up with a different set of behaviors, we have to understand the mechanisms and processes that got us there and make a change.

As I said, changing an automatic response isn’t easy. But it can be done. The brain is highly adaptable. If you work with it rather than against it, the brain will respond favorably.

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2 comments on “Is Addiction a Habit or a Choice?
  1. Matheus says:

    Well first and foremost I would never have been able to quit cold-turkey. Kudos to those it works for. I smkeod 1 1/2-2 packs a day for 24 years and have now been smoke free for 5+ years. I don’t constantly think about it or crave it one bit despite that some ex-smokers say they do. And I’ll never pick the habit up again. Here’s what worked for me: The most important thing was that I sincerely wanted to quit. I didn’t do it because I should or a doctor told me to. I was so determined that I was going to find a way and failure was not an option. That’s how bad I wanted it. And what encouraged me in the first place was that I sold my house and decided to only smoke outside while it was on the market. I was shocked to realize that that alone cut my habit down to about 1/2 a pack a day without experiencing any nicotine cravings. In other words most of my smoking was just because. I used the nicotine patch and zyban the most effective method at the time was to combine the two. And it worked very well ALMOST. I didn’t crave the nicotine the patch pill took care of that. What I missed was the physical sensation of inhaling the smoke. Since you can’t smoke and continue to wear the patch I took off the patch, bought a pack and continued to smoke for another month while searching for answers. I found a tobacco shop that sold non-nicotine herbal cigarettes and bought them. Now in all honesty they tasted rather nasty, but they satisfied that urge to inhale. At the same time I de-sensitized myself to my triggers, you know get in the car light up a cigarette. Fire up the puter light up a cigarette. Finish dinner smoke for dessert. Every time I thought about lighting up I just told myself I don’t do that any more and gradually the triggers became meaningless to me. I’m convinced that the addiction is at least as much mental as it is physical. And gradually I got away from those stinky herbal ciggies too. There are a couple of ways to use the patch and one of them is to just change it every 24 hours. I went through the first box of them and then stepped down to the lower level of nicotine with the next box. One day I was at work and it occured to me that I had forgotten to change my patch. For a split second I felt trapped, but then I thought about it. If I was only just now thinking about it (8 or 9 hours after the fact) then I obviously didn’t need them anymore and I never used one again. Looking back I guess that was the defining moment when I realized I had done it! Anyway I hope you find perhaps some useful info in this answer. I love being a non-smoker! Good luck to you.

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