November 5th , 2012 The Phoenix House interviewed April, an ex-drug addict. She shared her journey which included her history with using multiple substances, the factors that instituted her drug use, and how she overcame addiction.  April's testimony was structured like any other testimony. April began by giving a brief summary of her childhood , explaining that addiction served as a reocurring issue that had been handed-down from her mother, older siblings, and now to her. She then tells that her addiction started when she was 12 , when her parents divorced. April said that she drank heavily and smoked a lot of marijuana .April emphasized that the birth of her first child at the age of 19 motivated her to get her life together and triggered her upward mobility. Shel held down a job, had a nice apartment for her and her daughter, and started taking classes at a local community college. She explained it is when she let her drug addicted mother move in with her that she started to pick up her old drug habits. April’s drug use exacerbated the second time. She began using methadone, cocaine, marijuana, and an assortment of prescription pills.  April even started dating a full-blown addict which caused her addiction to worsen due to her partner's easy access to substances. As a result, April lost her job, the custody of her children, and was arrested multiple times for petty thefts. April explained that her life had hit rock bottom and she tried to seek help with a therapist. I started to think critically about addiction when April's therapist said, " There is little I can do for you while you are on all these drugs" (The Phoenix House, 3).  Why couldn’t this trained health professional simply guide April to recovery?

April's therapist statement made me think critically and questioned the complexity of her addiction , and why it was not an easy fix. I wanted to break down April's drug addiction into simpler parts and apply my own morals and intuitions. Also I wanted to research addiction from a scientific view to strengthen my argument.  I knew already that addiction has a negative stigma attached to it and is a very controversial issue. Drug abuse is a rampant problem in the Unites States. Drugs will become abused whether they are recreational, narcotics, or alcohol. When the misuses of substances are discussed society usually talk about how they are used for the wrong reason rather than being used unconsciously. I battle with categorizing drug addiction as a disease or a choice. Many researcher have reported drug dependency as a choice, while others have deemed it as a disease. I believe that drug addiction is ultimate choice and not a disease  by definition, the effects of the drugs on the brain, behaviors of the addict, and the stage which the addict is in.

To gain a better understanding of addiction and for a certain behavior to be considered an addition , it must be properly defined. Within the article Addictions : definitions and Implications  the author discusses how the integration of the definition of addiction, disease, and choice/free-will is necessary to  determine factors of addictions and properly categorized them (Goodman  2). I agree with this method because I feel that if addiction has one consistent definition, then proper treatment can be issued and controversy will be decreased. Also I think that if society rids the theoretical conception about addiction and defines addiction in a more practical way, then more addicts, families of addicts.and drug treatment specialist can better understand the individual's specific addiction. 

The definition of drug addiction is a behavior that  is characterized by an individual that is drug seeking and usually experiences use that is compulsive (NIDA, 2). From this definition, we simply know that a substance is involved, the addict has an uncontrollable urge to use the substance, and the substance gives off a rewarding stimuli.  Also factors that attribute to this definitions is re-occurrent feelings of powerlessness and continuation of using the substance despite negative consequences. This definition of disease can be implicated in April’s. This is shown through April’s experimentation with drugs at an early age. Her frequent use of many drugs strengthen her addiction and caused her drug use to be compulsive. April’s also illustrates characteristics of powerlessness to the substances when she lost her home and the custody of her children, but continued to abuse the substances that were stemmed to her mishaps. Once addiction has a set definition, then rationales can be made on the cause of addiction ( Wiley, 1). 

To have a better understanding of the debate weather or not drug addiction is a disease or choice, the definitions of disease and choice must be specified and synthesized. Goodman gives the central definition of disease when he defines it as “ an abnormal condition of a structure or function that gives off symptoms” (Goodman, 3). Goodman explains that the continuous use of a  substance affects the normal function of the body and its system. I do not think drug addiction is a disease because although drugs alters the body’s normal function, overtime the the drug becomes apart of the body’s homeostasis meaning the body returns to a new normal. April’s new normal is describe when she she says “ I would use cocaine to ease the withdrawal symptoms” (Phoenix House, 2). Her statement shows that she had to continue using drugs for  her body to operate at her new normal. Jones jeffrey uses a poll that results that more 76% of families who are dealing with drug addiction believe it is a disease. I believe that since more than three-fourths of people categorize drug addiction as a disease it creates a bandwagon effect that distorts other opinions without knowing any information. Many people also believe that addiction is something that runs in their family so it is inevitable.    Also certain factors like probable cause and medical treatment contribute to the definition to disease (Satel, 3). In April’s case the drugs she was ingesting did not affect her body physically, but it did alter her judgments and decisions making. I can tell this when April explains in her story that she lost her job and the custody of her children. This statement told me that her drug use causes her to make decisions that were not beneficial to her life. April’s also did not experience a medical treatment. She went to a rehabilitation center where she was weaned off the multiple drugs she was taking , and taught how to keep herself occupied and focus on positive activities so she will not have to turn back to using drugs (Phoenix house, 1) . April’s drug addiction is not a disease based from the characteristics of her case. 

Choice is the act of selecting when faced with two or more possibilities. When pertaining to drug abuse the two possibilities of repeating the use of the substance or refraining from use of the substance.  April’s drug abuse story was full of choices. Although April’s parents divorce was a factor in the start of her drug use, her decision is still considered a choice. Choices are based on our beliefs and our estimation of where the choice will lead us, which always may not be the proper analysis (Lewis 1-2).  Regarding to April’s situation,  her early drug use was most likely was based off her thinking the drugs would relieve her stress from her home life. Also April was young so peer-pressure and the need to fit in gave her early drug use stability. It is also important to note choice is an ambiguous term where the individual has many options and the word decision connotes to a more final selection. Although the terms choice and decision are interchangeable, choice is where you know all the options and decision is where act upon these choices.  Therefore April’s initial use of drugs was choice and every actions after that was a decision.

There is a sharp distinction that separates a choice from a disease. The disease model of addiction focuses of the changes in the brain that occur with chemical dependency (Jones, 2). Choice is labeled as a behavior. Since drugs are something the individuals does, therefore it is a choice. The effect of drug on the brain and behaviors go hand-in-hand. “To be alive is to behave” (Jones ,3). Jones argues that since these changes occur in the brain that choice is no longer an option for the addict . Firsty, the drugs targets the brain's rewards system by flooding it with dopamine; a neurotransmitter that regulates movement, emotion, motivation and feelings of pleasure. When the system is overstimulated with drugs it produces a feeling of euphoria, which strongly reinforces the the behavior to use. The addict is not addicted to the actual substance, but addicted to the feeling brought about from the drug. Just as humans get adjusted to environmental changes like sounds or temperature, the brain adjusted to the overwhelming amounts of dopamine ( Satel, 3).  Drugs also taps into the communication system, interfering with the way neurons normally send, receive, and process information (Beyer, 1). This may account for why April believe that her behaviors like missing work, missing school, and neglected her children were ok because her judgments were distorted. Continues drug abuse may lead to tolerance or higher drug doses to produce an effect. April’s body began to form a tolerance to one drug, this is why she had the need to experiment with more than one drug. There are many many behavioral issues related to drug abuse. Drugs abuse and unemployment is bidirectional (Alavi 1). Those who are having a hard time finding employment are are stressed, depressed, and socially isolated which leads to the start or increase of substance abuse.The opposite relationship involves those who already addicted experience behavioral changes that make them irritable and difficult to maintain a set schedule. This results in the addict not coming to work consistently and getting laid off or fired. Drug abuse also leads to problems in a close and personal relationships and violent outbursts.This is evident when April explained, “I got into relationships with abusive guys who hit her and introduced her to shooting up crack” (Phoenix House , 2). Drug addiction can directly or indirectly affect your family.  Drug abuse is also associated with the addict engaging in risky behavior. These risky behaviors include using dirty paraphernalia , driving under the influence and participating in unprotected sex. Although all these behaviors are negative, the strongest behavioral issue is the constant powerful craving that the addict has for the drug. The drug craving i so strong that the addict sometimes will go great lengths to obtain the drug. When the person first begins to use the drug the brains pleasures system is highly activated(Beyer 1). After that the brain tells the body that it needs more of the drug to achieve that “high” feeling. Over time, the body and the brain depend on the drug to feel normal. 

One might object to my argument that drug addiction is a choice based off the idea that an individual loses all control of their actions and decisions when the drug alters the functioning of brain neurons. It is true that if the drug is used over a substantial period of time the body will get to the point where the drug is required to uphold normality. In many cases addicts who experience a decrease in the intake of the drug go through a process called withdrawal. Drug withdrawal symptoms causes the patient to have feelings of anxiety, sweating, vomiting, and diarrhea which strengthens the substance use to avoid these symptoms (Wiley 3).  This behavior is said to be brought about by a chronic brain disease. Nevertheless, the key factor that makes drug addiction a choice is relapse. An addict may experience brain disease characteristics, go through a withdrawal period and recovery, but the moment the addict decides to reuse that substance it makes it a choice. Not all patients relapse, but relapse is an important stage of recovery. Many people believe it to be both a disease and a choice since the addict goes through both the choice phase and the disease phase. I feel as though since relapse is one of the final stages of addiction then drug addiction should be categorized by as a choice. The moment the addict decides the to reuse drugs again solidifies that drug addiction is a choice.Also the addict spends more time in the choice phase than any other. 

So what do we do now ? Is categorizing drug addiction really that serious?  Yes! If categorizing drug addiction was not necessary, the debate of whether or not it is a disease or a choice  would not extend back to the early 1900’s. While the debate continues , drug abuse is becoming a growing epidemic, and many families are losing a family member to addiction.  Drug addiction needs to recognize so that proper treatment can be put into act , laws can be modify to favor those who going through addiction, and decrease the death and incarceration rates. Most states in America does not have modern legislature to deal with the increasing problem of drug abuse.  I believe that as societal problems evolve our laws should evolve too. If drug addiction is recognized as a choice then the addict can be held more accountable for their actions without uses the excuse that drug addiction is a disease. Treatment of drug addiction is more than getting medical help like you would if you would have a disease. To overcome drug addiction more cognitive treatment need to be utilize since the initial start of drug addiction is a behavioral thing. The addict needs to taught more adaptive ways of thinking that intervenes between old emotions and events. I also believe to reduce the chances of relapse will be decreased if the detox time is increased among rehabilitation facilities and the rate of drug addiction with the cohesiveness of the law enforcement , judicial system,  and legislation. 

I believe that addicts are a group of people lives worth saving . I do think that at a point of addiction the addict where the addict has no control of their actions, but I also see that having limitations. Limitations that demonstrates that body becomes accustom to the drugs and creates a new normal. Therefore the addicts chooses to amplify their drug use. I apologize that i fail to mention the power of gender roles that differ in choice-making. 
