Why do people continue with behaviours or substances, such as alcohol or drugs, even when they openly wish to stop? This question cuts to the heart of understanding addiction. The disparity between intention and action reveals contradictions central to addiction behaviour, often oversimplified by two prevalent views.

For decades, addiction has been described through the lens of brain disease models, focusing on how substance use alters brain function to make drug use compulsive. While these models uncover meaningful insights, they are just one part of the story. On the other hand, some reduce addiction to an issue of morality or simple bad decisions, claiming people use substances solely out of selfish indulgence. Both these views highlight partial truths but fail to complete the picture.

Instead, a deeper understanding must combine these perspectives, recognising both the complex brain changes involved and the environmental and social factors that shape behaviour.

The Brain Disease Model and Its Challenges

The brain disease model, which gained prominence in addiction science, explains how repeated substance use reshapes the brain. It suggests these neuroadaptations bypass conscious decision-making, making drug use automatic and compulsive. These findings are significant, shining light on the biological basis of addiction.

However, while this perspective sought to reduce stigma by framing addiction as a medical condition, it has fallen short in key areas. Despite billion-pound neuroscience investments, few groundbreaking medications have been developed to address addiction directly. Furthermore, psychosocial interventions such as talking therapies and harm-reduction strategies remain the most effective treatments, as they target the behavioural and emotional underpinnings of addiction.

There is another ironic twist to the brain disease framework. By overly focusing on neurophysiology, the approach may inadvertently increase stigma, portraying recovery as almost impossible without medical intervention or framing individuals as irreparably damaged.

The Flaws of the “Just Say No” Mindset

Equally flawed is the notion that addiction is driven purely by pleasure-seeking. This view suggests that individuals knowingly make bad choices in pursuit of hedonistic highs. Critics argue this overly simplistic interpretation unfairly blames those struggling with addiction, ignoring the broader context of their decisions.

Research provides a more nuanced picture. Addiction is not entirely beyond voluntary control. While cravings and neuroadaptations play a significant role, people can reduce or even stop substance use in response to life changes or the consequences of their actions. Events like marriage, a new job, or becoming a parent can shift the perceived value of substance use, highlighting that even those deeply affected by addiction retain some agency.

Decision-Making in Addiction: Understanding addiction requires examining how people make decisions under challenging circumstances. Neuroeconomics, the study of value-based decision-making, sheds light on how these choices unfold. For instance, research shows that when people are hungry, they prioritise taste over health, leading to unhealthy decisions. Similarly, alcohol users experiencing cravings and negative emotions are more likely to value alcohol over non-drug alternatives, influencing their choices.

This reveals a broader pattern seen in addiction. When the environment fails to offer healthier or more appealing alternatives, the relative value of drugs increases. Take treatment settings as an example. There, individuals may genuinely want to stop using substances because the focus shifts to recovery and future goals. However, returning to environments where drugs are easily accessible and attractive options are limited often increases the likelihood of relapse.

Social and Environmental Drivers of Addiction: Poverty illustrates how environments shape decision-making. Areas with high deprivation often present limited opportunities for meaningful work, stable housing, or education. Meanwhile, gambling outlets, alcohol vendors, and drug availability may dominate these settings, making addiction more likely.

Addiction in these circumstances is less about losing the ability to choose and more about how structural barriers reduce the value of healthier choices. By reshaping environments and addressing inequalities, we can start to tackle these deep-rooted issues.

Paths to Recovery: Understanding addiction through the lens of decision-making opens new pathways for support. Instead of framing individuals as broken or helpless, this perspective views people in the context of their environment.

Encouragingly, it shows recovery is possible by increasing the availability, visibility, and value of non-drug alternatives. This may include offering accessible education, creating stable job opportunities, or fostering supportive communities. By making these changes, we shift focus away from stigma and towards empowering individuals to make better-informed choices.

While the psychology of addiction is undeniably complex, treating those impacted with empathy and focusing on promoting meaningful alternatives is the way forward. The path to recovery is not simple, but it’s one that can be supported through understanding human behaviour and its environmental influences. Source: WRD News

(Also a must read Research Report on this; Drug Use, Stigma & Proactive Contagions to Reduce Both – also containing Dealing with Addiction. Models, Modes, Mantras & Mandates – A Review of Literature Investigating Models of Addiction Management)