Addiction: Choice or Disease?

The addiction debate has divided families for decades: Is it a disease requiring treatment or simply a choice demanding willpower? In this compassionate, straight-talking episode, interventionist Matt Brown cuts through this argument to focus on what actually helps people recover.

Drawing from personal experience and professional expertise, Matt explains why this distinction ultimately matters less than creating the conditions for healing. Using the powerful analogy of trying not to scratch chicken pox, he illustrates how addiction feels from the inside—an overwhelming internal "itch" that temporarily stops when substances are used, regardless of consequences.

The episode explores how addiction changes brain function, particularly affecting reward pathways and decision-making abilities. While the initial use may be voluntary, what follows involves complex neurological changes that compromise choice. Matt differentiates between situational substance use (which some people can stop through willpower alone) and clinical addiction (which requires comprehensive treatment).

Most powerfully, Matt identifies shame as the true killer in addiction—preventing both addicts and families from seeking help. He offers a practical framework for approaching loved ones that transcends the disease/choice debate: creating hope that sustainable change is possible while acknowledging consequences.

Whether you're struggling yourself or supporting someone through addiction, this episode provides clarity, compassion, and concrete next steps. Subscribe for more insights on navigating addiction with both boundaries and love, and join Matt's free nightly support calls at interventiononcall.com for personalized guidance.

Chapters

• 0:00 Introduction to Party Wreckers
• 1:49 The Choice vs Disease Debate
• 9:05 The Feeling of Addiction
• 15:13 Brain Function and Addiction
• 23:42 The Insanity of Addiction
• 28:15 Creating Hope for Sustainable Change
• 31:17 Finding Resources and Support

Transcript

Speaker 1: 0:00

Welcome to the Party Wreckers podcast, hosted by seasoned addiction interventionist, Matt Brown. This is a podcast for families or individuals with loved ones who are struggling with addiction or alcoholism. Perhaps they are reluctant to get the help that they need. We are here to educate and entertain you while removing the fear from the conversation. Stick with us and we will get you through it. Welcome the original party wrecker, Matt Brown. Original Party Wrecker, Matt Brown.

Speaker 2: 0:46

Welcome back to another episode of the Party Wreckers podcast. My name is Matt Brown. I'm your host. Thank you for being here. I'm glad you've joined me. If this is your first time, welcome.

Speaker 2: 0:57

The purpose of this podcast is to really help families have a different kind of conversation with their addicted loved ones. I want to equip families with some tools and some vocabulary and some knowledge and some education so that you can have a different kind of conversation with your loved one who's struggling with addiction, who may be reluctant to get some help for themselves, who may not see the problem for how it really is, or at least the way that you're able to see it, and so to really move this conversation in a direction that leads to healing and hope. If you're coming back and you've listened to episodes before and you're here again, thank you. I appreciate you enduring another episode of listening to me drone on, so thanks for being here Today.

Speaker 2: 1:49

I want to talk about kind of this age-old argument of whether or not addiction is a choice or a disease. Before I jump into that, I just want to remind everybody that Sunday through Thursday there are nightly Zoom calls for families who have loved one in active addiction, If you go to intervention on call. They're completely free. It's an hour each evening, Sunday through Thursday, where we answer questions and give families new strategy and new tools to be able to help their addicted loved ones. Very similar to what the purpose of this podcast is. We just move it into a venue where we can interact with one another on a Zoom call.

Speaker 2: 2:33

So register at interventiononcallcom if you want to be a part of that. So let me say first of all that whether or not you believe addiction is a disease or whether you believe it's a choice, that's okay. I'm not here to try to convince you one way or the other. I think this is an argument that could go round and round and round for as long as we want to debate it. My response typically to this and I'll say this from the outset is who cares whether it's a disease or whether it's a choice.

Speaker 2: 3:10

The fact of the matter is we have somebody in your family who's struggling with an addiction, and whether or not it's a choice or whether or not it's a disease doesn't really move the conversation in a different direction. Now what I will say is that having some context for this can actually be something that can unite a family that otherwise may be divided. It can provide a little bit more compassion for people who are struggling with addiction in the way that this conversation happens. But I don't want to get stuck in the argument, if that makes sense. So I don't want the outcome of this episode to be hey, we got to put everybody in the same camp. That is not what I'm trying to do. I personally believe it's a disease. You don't have to agree with me. I'm going to talk about arguments from each side of the topic here for just a minute. I want to start by, you know, making the argument that addiction is a choice, and there's several factors that you know in my private practice as an interventionist, as I work with families on intervention on call, sometimes the thing that divides families more than anything is you get some family members that are looking at this from the standpoint of this is a disease. It needs to be treated. It needs to have some medical components to it, it needs to have some behavioral components, some therapeutic components. And then you have some other family members that are saying why can't he just stop? This is a choice. He just needs to choose to stop. He doesn't need treatment. He, this is a choice. He just needs to choose to stop. He doesn't need treatment, he doesn't need meetings, he just needs to stop. And so I think, when it comes to the debate on whether it's a choice or whether it's a disease, this is where I see that it becomes the most important, where it becomes the division in a support system that prevents somebody from moving forward and actually getting their loved one the help that they need. And so I think that's the important thing that I really want to get to today is let's find a way to make this issue not as relevant or not as important in the conversation, so that more families are able to move forward in a united way and get their loved ones some help. So let's talk about addiction being a choice first.

Speaker 2: 5:37

Obviously, the first argument that most people will make is they chose to start using drugs in the first place. You know what? I'll give you that point. I think that, from the standpoint of, do I have freedom of choice to make the decision on whether or not I'm going to start using drugs or alcohol? Absolutely.

Speaker 2: 5:58

When I had my first drink in high school, I had a choice as to whether or not I was going to do that Now. When I did it and I felt the relief that came from taking that drink, it was immediately apparent to me that this was more than just catching a buzz. This was relief that I hadn't found in any other solution up to that point. But I did have a choice. Did I make the choice to drink the first time? Did I make the choice to smoke pot the first time? Or do cocaine or methamphetamines or all the other substances that I did along the way, absolutely so.

Speaker 2: 6:47

So there's that part of it that I think a lot of people focus on and say well, they're making the choice. If they made the choice the first time, they're making the choice every single other time that they're choosing to do this. We won't argue that right now, we'll just kind of let that sit there. We'll just kind of let that sit there. There's this idea that, well, if they can go to work, if they can show up and be responsible in other areas of their life, why is this one area that they have can't choose whether or not they're going to use or drink? Going forward, they're able to go to work, they're able to earn a paycheck, they're able to show up and be responsible in other areas of their life why not this one? To the outside person, who really doesn't understand what addiction feels like and I want to really talk about how it feels.

Speaker 2: 7:42

And some of you guys may have heard me use this analogy before, but for those of us that are old enough to have had chicken pox when we're kids, I remember my mom sent us down the street. One of the neighbor kids had chicken pox. Me and my five brothers and sisters got sent down the street and we had a little chicken pox party and we all came back and within the next couple of days we were all coming down with the chicken pox and she just wanted us to go and knock it out have to deal with, even though there were six of us. It's like let's just get it all over and done with and then, and then we don't have to worry about it anymore. But I remember, and if your mom was like my mom, you heard over and over and over again stop scratching. You're going to get scars, it's going to get infected, you're going to have consequences that you don't want to have later on if you keep scratching. And as an 11-year-old 12-year-old, however old I was when I got the chickenpox, at the time I didn't care about the consequences. I just knew that I had a tremendous need to scratch an itch. That itch was going to get scratched, and so I struggled because I didn't care about who cares if I get scars, who cares if I get an infection. I know that's probably not going to happen right this minute, and right this minute I need to scratch this itch. And so at first she started putting socks on my hands. Well, I just pulled them off and kept scratching. Well, then it was the oven mitts that got taped on my hands. I just chew through the oven mitts and keep scratching.

Speaker 2: 9:30

With somebody who's struggling with an addiction, the itch is on the inside. It's a mental itch, it's an emotional itch, and when I learned that I could scratch that itch with a substance and the itching stopped, I didn't care what the consequences were. I just knew that I had found the solution to my problem, or at least I thought I had, because it brought me some relief. And so when you see somebody that is showing up in different areas of their life, it doesn't mean that they're not experiencing a tremendous amount of internal itch. They may not scratch it until five or six o'clock in the evening. They may know, hey, if I do this during the day, I might lose my job, and so it may have not gotten to that point where they're willing to compromise on every aspect of their life. Yet what I have learned is that, given enough time and a long enough timeline that those compromises will happen, because the itch does not diminish over time, it gets worse.

Speaker 2: 10:39

Now there's this argument to be made for personal responsibility. There's this argument to be made for personal responsibility and I think that this is big both in the disease model camp and in the choice model camp. I think personal responsibility, the argument is there for both schools of thought, and that is if you can take accountability and pull yourself up by your bootstraps and recognize, hey, I'm doing something here that I shouldn't be doing, and I just I want to exercise some willpower here and really take responsibility for how my life is going, that you're going to find your way out of it. Now here's what I'll say. Some people can do that. Some people can make the decision to stop and they never look back.

Speaker 2: 11:27

Most of us cannot, and what I would compare this to is kind of the idea around situational depression and clinical depression. Because of a situation, the consequences begin to pile up and, given enough consequences and the proper motivation from external sources, that person could say you know what, I don't want to do this anymore, I'm going to quit. And because of the fact that it's a situational type of you know whether it's a divorce or a loss of a job or you know whatever caused that momentary relief-seeking in substances, the consequences become so severe that I don't want to do this anymore and they'll make the decision I'm going to stop. And they don't look back. By and large, most of us that get into this situation it's kind of like clinical depression.

Speaker 2: 12:36

No matter how much willpower I try to exercise into being positive and coming out of my depression, I need medical treatment to deal with my depression on a daily basis. Those of us with clinical depression or clinical anything anxiety, bipolar disorder, whatever it is. It's not a matter of, hey, I'm going to will myself to be happy, or I'm going to will myself to be less anxious, or I'm going to will myself to not have bipolar disorder or borderline personality disorder. It's not a matter of willpower. There needs to be some treatment involved. Sometimes that treatment involves therapy, sometimes it involves psychiatry and medications. Sometimes it's all of the above, the response to incentives like the negative consequences. It's when the consequences get significant enough I'm going to change my behavior.

Speaker 2: 13:37

With somebody who has, let's call it clinical alcoholism or clinical addiction, the consequences will begin to mount and my behavior doesn't change because willpower alone is not going to be enough to pull me out of that. I may recognize that that's not what I want anymore, but that internal itch, that mental and emotional itch, is still there and has not been treated. And so this idea that I can exercise willpower, or that I can just exercise, you know, a tremendous amount of self-control. And stop doing this. Occasionally you'll see somebody who can stop drinking or stop using drugs, but the next thing you know they're getting into gambling or they're having an issue with food. Like you know, when I got sober I gained a tremendous amount of weight. I knew I didn't want to drink anymore, but I hadn't treated that internal condition yet, and food became my new drug of choice. And so we'll see cross addictions beginning to happen. Sometimes it's pornography or sex, or gambling, or exercise, or work, or you know whatever it is, or work, or you know whatever it is. But it just becomes a game of whack-a-mole where we may curtail one behavior only to see a new one pop up, or one that you know used to be there become more prominent. And it's not necessarily that I'm dealing with an addiction, I'm just switching from one to another.

Speaker 2: 15:11

Let's talk a little bit about healthy brain function, because I think this is really important. When you look at how a healthy brain functions, there are certain reward mechanisms in the brain. When we do healthy things, a normal healthy brain will reward us with feeling good. When I exercise, when I eat healthy, when I spend time with people that are loving and kind, and I get something out of those relationships when I achieve a goal, you know those kinds of things Like my brain knows to reward those behaviors. A healthy brain knows to reward those behaviors. There's also a mechanism in a healthy brain that's there to warn us hey, this is risky, this is dangerous, you should not do this. If you do this, this is likely to happen and fear will tell me don't do that. And then there's these gray areas where it's like, well, there is risk, but there's reward. And so I need to rationally kind of think through does the risk outweigh the reward or does the reward outweigh the risk? And that's where the prefrontal cortex comes in and really kind of helps us to make a lot of those executive decisions in terms of is this something I should do or not? And we're able to really, in a much more logical way, usually think through how our choices and our actions are going to impact us down the line.

Speaker 2: 16:50

When you deal with somebody who's in active addiction, those mechanisms get really, really messed up. What ordinarily the pleasure centers of the brain or the reward centers of the brain. They're not rewarding the healthy behaviors anymore. Sometimes it's an environmental factor. Sometimes the person struggling with an addiction doesn't have experiences in healthy behaviors. They weren't taught healthy behaviors because they grew up in a very dysfunctional system. There was abuse, there was neglect, there was abandonment, there was all kinds of dysfunction going on, and the wiring that happens in our early youth never really happened for that person and so it never took hold in the first place.

Speaker 2: 17:39

And a lot of these coping strategies were developed at a very early age and addiction becomes just kind of a natural progression of that. Becomes just kind of a natural progression of that. And you know, I talked a little bit about this in the last episode when it came to screen addiction and technology addiction, where young people are getting a hold of devices at a much earlier age and even, you know, I say earlier than my generation. The internet didn't even exist until I was in college, and so emails, those kinds of things, that was cutting edge technology when I was in college. Now my kids get access to these dopamine hits on a regular basis when they're on their phones, whether it's social media, whether it's games, whether it's, you know, 60 second videos on YouTube. All of this is designed to hit those dopamine centers and those reward centers of the brain, to keep that person engaged. And we see that as the development happens down the line and they get exposed to opportunities to use drugs and to use alcohols, and those alcohol and those dopamine hits become more pronounced than what they'd even experienced before. It's just kind of that natural progression of. I'm going to continue to go after this instant gratification.

Speaker 2: 19:03

Now, sometimes the environmental factors are overwhelmingly contributory to what's going on. Sometimes it's a genetic component. Sometimes it's generational trauma that becomes not only genetic but also environmental. There's so many different factors that we have to attribute to this. It's not as cut and dry as this person's going to become addicted because they're genetically predisposed to this and we can identify that there's genes that they have that are active, that maybe in somebody else are dormant. It's not as simple as that. There is no gene that people can identify to say, okay, this is the gene for addiction. Gabor Mate really talks about this in one of his more recent books, about how it's not that somebody is genetically predisposed to addiction. It's that they're wired to be, to be more sensitive than than other people on an emotional level. And then the environmental factors that that that hit that sensitivity will largely determine whether that becomes an asset or a liability. You know, am I going to look to use this sensitivity as a way to inform my empathy and compassion towards other people, or will I want to run away from these feelings in a way that causes me to seek out chemical substitutes to avoid those feelings. So there's no genetic marker for addiction. There's no gene that says, hey, this person's going to become addicted, but there is a genetic component to it. That's indisputable. The bigger factors, of course, are the environmental ones.

Speaker 2: 20:49

How know, how informed is this person from a young age about the risks associated with drug and alcohol use? How informed are they in terms of how their choices affect consequences? Education is a big part of this and this is why I spend so much time educating families, because we're so behind the curve. There's such a stigma out there that is so strong when it comes to addiction and alcoholism. Our society really looks at this. Even though many of us will look at this and say, oh, addiction is a disease, there's this moral stigma that gets attached to it. We can't completely separate the fact that this is a medical disease and not a moral issue. Even though somebody can say, oh, that person has the disease of addiction, there's still this pall of stigma that hangs over a lot of the people that struggle with this.

Speaker 2: 21:45

I experienced this in my own life. I remember, after I had gotten sober, I had told my parents that I I'd been going to AA, and I remember the reaction from my dad was you're an alcoholic. And even though he knew that I was, I had a very severe drinking problem and I had a very severe drug problem. The idea that I would use the word alcoholic to define what I was struggling with was almost inconceivable for him. There was this association with somebody who's an alcoholic is a bad person. It really took a lot for me to get out from under that early on, because I didn't want to have to call myself an alcoholic, I didn't want to have to identify as an addict because I had grown up in an environment where those words were, those were awful things to be associated with. And I think that that happens in many, many homes. And so we can say, oh, addiction is a disease. But until we can really look at it objectively and say, okay, this person is struggling with a disease, let's treat it versus good or bad or morally, there's some sort of an assignment given to the quality of somebody and their character, based on whether or not they're alcoholic or an addict. We have to find a way through that, because I think the shame that gets associated with that, the shame that gets projected onto the alcoholic and the addict, and the shame that I absorb or put on myself because of some of the choices that I made during my addiction. I think that's really the thing that kills people. We can look at it and say, oh, it's drunk driving, accidents, it's DUIs, it's overdoses. But if the shame wasn't there, would those people have gotten help before it ever got to that point? And I think the answer is yes. I think that we've got to find a way to have a different conversation. Now back to the point.

Speaker 2: 23:56

The American Society of Addiction Medicine defines addiction as a primary chronic disease of brain, reward, motivation, memory and related circuitry. It is characterized by compulsive drug seeking and use despite negative consequences. So, even though the consequences are starting to mount and we talked a little bit about this when we were kind of making the argument for addiction being a choice as the consequences start to mount, it's like from the outside, looking in, people are looking at this, going. Why can't he just stop? This is crazy. He's going to jail, he's losing his family. There's so many things that this person is losing, including his health, his self-esteem. Why can't he just stop?

Speaker 2: 24:50

And what I'll say is no one wakes up with a life of addiction and says yes, this is exactly what I wanted when I was a little boy and somebody asked me what I wanted to be. When I grew up, this is what I had in mind. I wanted to be homeless. I wanted to be penniless. I wanted to be without friends or family around me. I wanted to hurt the feelings of anyone that ever cared about me. I wanted to take advantage and manipulate and deceive everyone in my life.

Speaker 2: 25:16

Nobody wakes up and says that, but what happens is, as this disease takes hold of us, all of those things begin to happen. And it's not because we're choosing that. It's because the disease takes hold and we're no longer in control of what happens next. I'm no longer in control of my ability to say no anymore. I'm no longer in control of my ability to say no anymore. The craziest thing we do when we're in active addiction, we do in a completely sober state of mind, and that, given the abundance of consequences. That said that I should not go out and do this again. I will, because I will somehow convince myself that this time it's going to be different. And here's how I'm going to do it differently, and here's how I'm going to avoid some of the consequences that I've been having lately, and I'm going to outthink this thing.

Speaker 2: 26:10

I've got a guy that I recently did an intervention on, who's in treatment right now, who is trying to convince his family. Hey, you know what? I think it's just the substance that I was using, because he was using a substance and alcohol. I think the substance was the problem. I think I could probably drink like a normal person, as long as I don't go back to using that substance.

Speaker 2: 26:30

And that's the insanity of addiction is that I'm willing to risk everything that is in front of me, all the potential, all the relationships, all of those things that are in front of me right now. I'm willing to risk that because I think I can have a healthy relationship with alcohol, or I think I can have a healthy relationship with a substance. It's absolutely insane, but yet we will convince ourselves that it's possible. And that is where the disease of addiction lives. It's in the brain, it's in these delusional thoughts that somehow I can do this in a different way. Somehow I can do this in a responsible way, that I can drink like people who are not alcoholic or addicted, because Because we remember when it felt good, we remember when the relief was there. We have such an ability to forget the consequences. We have such an ability to forget the negative things that happen Almost as immediately as they're over, we will somehow convince ourselves that it's going to go back to being good again, and that's the insanity of this problem, that's the insanity of this. And so whether or not you believe addiction is a disease or whether or not you believe it's a choice, honestly it doesn't matter. What I do know is that medicine has not been able to produce a medication. Medicine has not been able to produce a medication. Therapists have not been able to produce a specific type of therapy that eliminates this problem.

Speaker 2: 28:12

It requires what we call in recovery, a complete psychic change. We have to change the way we see ourselves. We have to change the way we see how we fit into the world, and that is not an easy process, but it's also not a difficult process it requires. The hard part about it is that it requires a tremendous amount of humility, and it requires a tremendous amount of willingness to say okay is it possible that I've been wrong? Willingness to say okay, is it possible that I've been wrong? Is it possible that I haven't looked at this with honest eyes? And, when it comes right down to it, regardless of whether you see this as a disease or whether you see this as a choice.

Speaker 2: 28:55

Moving from addiction into recovery involves two factors. People will only change when they've begun to experience some negative consequences as a result of their drinking and drug use. That has to be present. If I'm not experiencing negative consequences, regardless of what everybody else sees in my life, if I can't identify that there's some negative consequences going on, I'm probably not going to be motivated to change. But here's the other thing and this is the most important thing is that there has to be hope and some optimism that change is possible and it's sustainable. Because when I just get pointed out hey, you need help, you need to do this, you're experiencing some consequences, it's happening all over again, can't you see? That is not enough to create lasting change. And that's the most important part of the intervention process when I'm working with families is the consequences are pretty easy to identify, even to the person that we're intervening on. The consequences are pretty easy to identify, even to the person that we're intervening on. But unless we can create some hope that change is possible and sustainable and that life can get better as a result of moving into recovery. That person is not going to do it, and so, as you guys are thinking about having new conversations with your loved ones, if you're thinking about, hey, how do I approach this differently, it's not about you need to do this or you need to go to treatment or you need to get help. They know that. They know that things need to change. What we have to do is create hope.

Speaker 2: 31:08

No-transcript is shame. Shame on the part of the individual who's addicted, because I don't want to have to confront the fact that I've hurt people and I've made a mess of my life and there's a lot of cleanup that I've got to do. And shame on the part of the family because they don't see this as they can't remove the judgment from the equation. I don't want to have to confront the fact that I have an addict in my home equation. I don't want to have to confront the fact that I have an addict in my home. I don't want to have to confront the fact that I have been contributory to that in my enabling of the addiction. My motives have been loving, my motives have been pure, but I've enabled that and I don't want to have to confront that, and so we have to get the stigma removed out of this. We have to be able to see this in a different way and I challenge each and every one of you to start looking into some resources. You don't have to be a part of what I'm a part of.

Speaker 2: 32:09

This isn't me trying to necessarily promote myself or my services or even the free services offered at Intervention on Call. Go to an Al-Anon meeting, go to an R-Anon meeting, go to an alan on meeting, go to an arnon meeting, go to an an aca meeting. Um, there, get into therapy. Like. There's so many different resources that are out there.

Speaker 2: 32:28

One of the sponsors of this podcast that I don't really talk about very often is better help if you need to get into therapy and you haven't been able to find a therapist.

Speaker 2: 32:37

If you go to betterhelpcom party records, you get a discount on your first month of online therapy. You can switch therapists as often as you go to betterhelpcom slash partywreckers you get a discount on your first month of online therapy. You can switch therapists as often as you need to. There are so many resources out there that families can use to begin moving this conversation in a different way, and I just implore you to not let fear paralyze you to the point where it compromises your loved one, to a point where they're not going to be able to get help down the line. I'm here to help. I would love to hear from you guys. If you have questions, email me at matt at partyrecordscom. I really appreciate you making it all the way to the end of this episode. If there's anything I can do to help you guys, let me know, and until then I hope your loved one will get sober and stay sober. Thank you.

Speaker 1: 33:27

Thanks again for listening to the Party Wreckers. If you liked what you heard, please leave us a rating and a review. This helps us get the word out to more people, to learn more or to ask us a question we can answer in a future episode. Please visit us at PartyWreckerscom and remember don't enable addiction ever.