Psychiatrist Dr Neha Bhave Salankar on whether addiction is an illness orchoice?

Dr Neha Bhave Salankar | Nov 18, 2019 12:33

Addiction is defined as the ongoing use of mood-altering substances or activity, such as alcohol and drugs, despite adverse consequences.
Dr Neha Bhave Salankar

Dr Neha Bhave Salankar is an MD in Psychiatry, who works as a Consultant Psychiatrist in Nagpur. Read what Neha has to say about addiction – whether it’s an illness or it happens by choice?

Addiction is defined as the ongoing use of mood-altering substances or activity, such as alcohol and drugs, despite adverse consequences. The inherent tendency in most of us is to negatively judge a person who is suffering from any addiction. Our judgement implies, we believe there is an element of voluntariness in the condition.

So what causes addiction?

A percentage of the population has a biological predisposition to addictive behaviours; factors like genes, early-life experiences, such as isolation or abuse, certain personality problems, such as impulsivity and poor coping skills can contribute to a predisposition to addiction. However, a predisposition alone is generally not enough to cause the disease. Often, a person is influenced by social factors, such as peers, societal and familial norms and associated psychiatric problems (e.g. presence of anxiety, depression).

Addiction is ‘disease-like’ in the sense that it persists even though its costs outweigh the benefits. Studies have repeatedly demonstrated a genetic predisposition for addiction. The idea is that if genes influence an activity, then it can’t be voluntary. Drug-induced brain changes are also an evidence in this direction. The fundamental assumption is that individuals make choices that are in their best interests. Since addiction is self-destructive, the logical implication is that addicts cannot be voluntarily choosing to use drugs. Since the symptoms of diseases are involuntary, then addiction must be a disease.

However, there is another school of thought, which believes that addiction is voluntary. Society commonly believes that we all possess free will, and that human behaviours arise out of it. But do we really possess free will? Looking at things from a scientific perspective, our behaviours arise out of a complex interplay between our genes, our early childhood environment and our present environment.

The former two are clearly beyond our control, and the last one, arguably, too is beyond us, as it is largely determined by the earlier two. So, if the predisposing factors of our behaviour are beyond us, clearly, the resultant behaviour too has to be beyond control. In fact, this very concept forms the bedrock of the ‘medical model’ of addictions, i.e. addictions are ‘illnesses,’ and that an addict needs empathetic handling, not unlike a person with a physical disease.

I am reminded of a learned patient of mine, who, albeit in an inebriated state, had said to me, “Doctor, I am not a bad man. I am a weak man.” I couldn’t agree more.

The ideas and information expressed are solely by the columnist and not by Nation Next.

Also read: Psychiatrist Dr Neha Bhave Salankar on domestic abuse, effect on mental health and more