“When you can stop, you don’t want to. And when you want to stop, you can’t. That’s addiction.”

–Anonymous

Drug Use & Drug Uses

Addiction. Substance Use Disorder. Drugs. Sex. Gambling. Pornography.

While most drugs are inevitably harmful– especially if chronically used, misused, or abused–they serve a purpose, which is why addiction and substance use disorder develop in the first place.

For the sake of argument, the terms “addiction” and “substance use disorder (SUD)” will be used interchangeably, both referring to compulsive and repetitive engagement in both substances (drugs) and behaviours (gambling, pornography, etc).

In line with Duncan (2020), drugs that affect brain function, performance, perception, and subjective experience are sought after and perceived as desirable and beneficial. Some reasons for psychoactive drug use include:

1. desire to alter states of consciousness,
2. utilitarian purposes (to achieve a goal),
3. medicinal purposes (to treat an illness), &
4. to experience pleasure.

Priests have used drugs for religious ceremonies and rituals, spiritual healers for medicinal purposes and introspection, and in the modern era, the general population for social purposes (Crocq, 2007). Griesinger (1817-1868), a German psychiatrist, one of the founders of modern psychiatry, recommended the use of opium in the treatment of melancholia, otherwise known as depression.

With the discovery of the first intoxicating substances, our ancestors have continuously sought out ways to produce more potent forms with alternative routes of administration.

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The Moral Model

The moral model is a model, or more so widely held belief system that views addictive behaviour as a moral failing. It sees repetitive compulsive engagement in addictive behaviours and substances as a result of lack of judgement, antisocial personality, and an inability to take personal responsibility for one’s behaviours (Opus Health, 2025).

Some emotional and mental consequences of this perception are created in the minds of those who battle with addiction, such as social shame for their behaviours, guilt and regret for their behaviours, and as a result, further decline by prolonging their isolation away from society in favour of more solitary drug use.

This model and social perception often fail to take into account medical, biological, genetic, and environmental considerations such as genetic predispositions, traumatic experiences, neural correlates, and social factors, all of which increase the risk and likelihood of beginning and maintaining an SUD.

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Modern Perspectives of Addiction

Brain-Disease Theory of SUD

In the last decade, scientists have proposed a medical model of SUD. This model approaches and accepts addiction as a physical disease of the brain that is treated like other physical diseases: through medicine and treatment.

In this view, it is treated no differently than diseases like amyloidosis, rabies, or pneumonia with regard to the brain instead of the body.

Does this model have merit? Yes and No.

If we go by a traditional definition of disease, such as “an abnormal condition that affects the structure or function of part or all of the body and is usually associated with specific signs and symptoms” (National Cancer Institute, 2011), then yes, SUD may very well be considered a disease.

However, before we jump to conclusions, let’s examine the five characteristics of the disease concept and form our own judgment.

Essential Features of Addiction as a Disease (Duncan, 2020)

1. Addiction is a primary disorder and not a reaction to some other medical or emotional disorder.
2. Addiction is chronic and progressive in that it continues and becomes more severe if left untreated.
3. Addiction distorts the reality of the mind of the individual user.
4. Addiction significantly impairs control of behaviour and results in repetitive, compulsive substance use.
5. Addiction is developed through a multitude of biopsychosocial factors.

Let’s analyse the premise of feature #1: Addiction is a primary disorder and not a reaction.

Addiction is a convoluted condition. Both psychiatric and neurologic in nature. It alters the functionality of the brain and consequently the thought processes of the mind.

However, often, if not most of the time, addiction is never something that just develops out of the blue.

According to Duncan (2020), the secondary substance use model proposes that compulsive use of a substance results from adverse past experiences

It is usually accompanied by a history of trauma, abuse, or difficulty, whether just experienced or experienced in childhood. Most people who try drugs do not get addicted to the substance they are engaging in. This is because many genetic and environmental factors play a role in developing an addiction.

Drugs provide such a potent and fulfilling stimulus that they become associated with feelings of pleasure and emotional relief. In this model, substance use develops as a method of treatment for physical and psychological trauma experienced in the past. Even though the treatment method is more pathological in nature, it still provides the necessary relief one hopes to get if provided traditional treatment.

Feature #1 rendered moot.

Moving on to feature #2: Addiction is chronic and progressive.

While many people who experience addiction have gone down progressive and worsening trajectories, it is not appropriate to say this is typical of all addictions. Many can have an SUD and not progress toward a more deteriorating path.

Although if the use of a substance does not progressively worsen, does it still warrant the diagnosis of addiction? Or could it just be considered a vice, just like other guilty pleasures one engages in? When is something considered an addiction?

As I will cover in a separate post, addiction to a substance or behaviour is usually diagnosed using three basic criteria, best understood as the 3 C’s of Substance Use Disorder (SUD):

1. Compulsive Use– feeling a strong urge, pull, or craving to engage in a substance.
2. Lack of Control— having reduced ability to engage in substance and regulate behaviour.
3. Consequences— continued use of the substance even after experiencing negative outcomes in life.

In addition, SUD doesn’t always last a lifetime. While the circuits and neuronal pathways in the brain responsible for addictive behaviour do not completely disappear, they can weaken over time. This weakening in addictive circuits transpires with a strengthening of regulatory circuits, preventing SUD from becoming chronic and progressive.

Feature #2 rendered moot.

Furthermore, features #3 and 4 are characterised by distortions in reality and a lack of control, leading to compulsive, repetitive use.

These two features fall on a slippery slope. Why? Because they aren’t precise on their definitions about what distortions of reality are or their boundaries for what could be considered compulsive use? I’ll explain.

What exactly does distortion in reality mean? Does it mean a person is in denial about how their drug or behaviour is affecting their life?

Distortions of reality can be characteristic of any substance, behaviour, disorder, or disease that affects the brain. Because when you affect the brain, you ultimately affect the mind and behaviour. Distortions, delusions, denial, etc., are all psychological afflictions of the mind. Knowing this, do we consider depression, social anxiety, fear of giving a speech, and diseases?

To a certain degree, some may warrant a diagnosis of a disorder in that these are characteristic of mental disorders. Which begs another question: Is disorder the same as disease?

While disease points to a specific, measurable, and identifiable illness, disorder pertains to a generalised disruption of a particular bodily process.

If addiction & substance use are a disease, then depression and anxiety could be considered as well, calling into question, “Does that mean these conditions require management through medication, and to what extent?”

In addition, feature #4 is often a characteristic of addictive behaviour. This is one of the 3 C’s and is a hallmark in any behaviour and/or substance addiction. However, initial drug use is not characterised by this feature. Compulsivity is typically not characteristic until later stages of addiction development.

Compulsivity is also not completely out of one’s control, merely a reduced ability to control, mostly due to reduced inhibition by the prefrontal cortex.

This is where proponents of the moral model may argue it is caused by the individual’s lack of will, weak moral character, and poor personal judgment, as these traits “would be needed” to begin and continue use.

Finally, feature #5 is a near incontestable characteristic of addiction. Many psychological and neurological conditions arise from a multitude of biopsychosocial factors.

Biopsychosocial factors include:

1. genetic and familial history of substance use,
2. adverse childhood experiences (ACE),
3. proclivity toward negative emotion,
4. inability to self-regulate emotions and behaviour,
5. psychopathology,
6. peer groups and social pressure,
7. drug curiosity, etc.

Addiction is not just a straightforward pathological condition that develops from one negatively experienced event. It is the result of a series of factors that inch an individual closer to developing an addiction in the first place.

A Learning Disorder

With an even more modern approach, Maia Szalavitz (2016) has proposed or better yet, reintroduced the idea that addiction is more on par with learning and neurodevelopment disorders like Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder.

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References

Crocq M. A. (2007). Historical and cultural aspects of man’s relationship with addictive drugs. Dialogues in clinical neuroscience, 9(4), 355–361. https://doi.org/10.31887/DCNS.2007.9.4/macrocq

• (Crocq, 2007)

Duncan, P. M. (2020). Substance Use Disorders: A Biopsychosocial Perspective. Cambridge: Cambridge University Press.

• (Duncan, 2020)

National Cancer Institute. (2011). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/disease. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/disease

• (National Cancer Institute, 2011)

Opus Health. (2025, January 18). Opus Treatment. https://opustreatment.com/the-moral-model-of-addiction/

• (Opus Health, 2025)

Szalavitz, M. (2016). Unbroken brain: A revolutionary new way of understanding addiction. St. Martin’s Press.

• (Szalavitz, 2016)