Is Addiction a Disease?

There is a common model that says that addiction is a disease. It is a genetic malfunction. Well, I am no neuroscientists but I do believe that we have all been affected by the fall.[1] I do not mean the season fall, of course. I mean the fall that took place in the Garden of Eden. Man disobeyed God and we have been living with the ramifications ever since. We all have a sin nature.

So, for instance, one way my sinful nature shows itself is anger. When I get mad I like to punch people in the face; and I have done that in the past on a few occasions. But just because my natural disposition is anger and a tendency to violence does not make it right.[2] And it also does not make it a disease. I do not have a virus. I did not catch this sickness from someone else. It is my nature. That being said I do realize that many addictions have very difficult physical “side-affects.” However, those side-affects came as a result of choosing to do the addictive thing in the first place. I do believe it is clear that different people have tendencies. So, there are different factors involved; nature[3] and nurture. But when it all comes down to it, we, ourselves, are culpable. We choose to do whatever it is we choose to do.

That being said, it does have a lot of similarities to disease which is why that model has been so accepted. Scripture even uses sickness as an analogy:

“Oh, what a sinful nation they are—
loaded down with a burden of guilt.
They are evil people,
corrupt children who have rejected the LORD.
They have despised the Holy One of Israel
and turned their backs on him.
5Why do you continue to invite punishment?
Must you rebel forever?
Your head is injured,
and your heart is sick.
6You are battered from head to foot—
covered with bruises, welts, and infected wounds—
without any soothing ointments or bandages” (Is. 1:4-6).

But it uses it as an analogy. And says that the heart is sick. By “heart” is meant the “inner man,” “mind,” or “will.” It is similar to saying you have a fallen nature. All of you is affected and truly infected. It plays itself out like a rancid disease. Our sin is a parasitic cancer that eats away at our life and soul.

So, no, addiction is not a disease. Not biblically. And I would say not medically; though some make it sound like it is.[4]

Then what is it? Addiction is sin. Yet, it is a complex sin. It is idolatry. It is a complex habit.[5] It is a complex habit because through use the addicted has tricked their brain and body to say that they desperately need the substance (which is why professional help should be sought when detoxing).  Truly, as Aristotle said, “habit is hard to change because it is like nature.”

Have you ever been off road mudding? When you go mudding it creates groves in the road, sometime huge groves, that are difficult not to drive in. Once you slip into one of those groves it takes you down that path until you can get out of it. But it is hard to get out of because it has been driven down so much. That is kinda what addiction is like. It is like a path that has been driven down a lot. It has created ruts.  There are no  barriers, no trees or even weeds, in the way. The neural pathways have been blazed. It is an easy path to go down now.

That is why I plan to blog about “action steps.” It is necessary to recalibrate your mind. You need to fill in those old destructive ditches and make new paths that lead to life. This reminds me of Romans 6:20-23. This passage tells us that in our natural state we are a “slave of sin.” That is, we do what our sin tells us to do and apparently it uses neural pathways to tell us what to do. However, these pathways, as Scripture tells us, leads to death. Instead, we need to be sanctified, progressively made into the image of Jesus, and this takes place, at least in part, by creating new healthy and God-honoring neural pathways (we see passages like Deut. 17:18, Rom. 12:2, Eph. 4:22-24, Col. 3:10, 1 Tim. 4:7-8, and Heb. 5:14  are important here) So we see neuroscience does not contradict Scripture. Actually, I think Scripture and neuroscience complement each other (I would like to explore this more in a future post).


[1] “Addiction looks like a disease, but it is a sin nature problem in the heart rather than a disease coming from the outside to the inside” (Mark Shaw, The Heart of Addiction, 20). One writer has said, “It’s a disease in the sense that it attacks a person and is degenerative. However, it’s not a disease in the sense that it takes over a person without that person making choices that allow it to happen” (Substance Abuse, 92). One of the problems is that “he ‘disease’ concept can be used to allow a person to escape moral responsibility” (Ibid.).

[2] “High levels of testosterone are related to higher levels of aggression…; yet malevolent violence is an expression of sin and is blameworthy.” People with “a biological predisposition toward aggressive behavior…” are “still ethically and spiritually responsible to deal with their aggressive predispositions in socially and divinely sanctioned ways” (Eric L. Johnson, Foundations of Soul Care477). However, he goes on to point out, “a comprehensive human understanding of such problems–one that corresponds in some measure to God’s understanding–cannot be gained by ignoring the lower-level influences and focusing only on their ethicospiritual blameworthiness. The lower-level dynamics constitute extenuating circumstances–without their being exculpating influences” (Ibid., 478-79).

[3] Note what Edward T. Welch who  earned his Ph.D. in counseling (neuropsychology) from the University of Utah says, “There is a categorical difference between being influenced by genetics and being determined by it” (Addictions: A banquet in the grave, 27). He also says that “the scientific data… cannot support the disease approach. For example, it doesn’t account for identical twins (with the same genetic makeup) when one twin is a heavy drinker and the other is not” (Ibid.). Also see his book Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience; especially 183-202.

[4] So, for instance, Kent Dunnington has pointed out that “neither neural adaptions brought on by substance abuse nor a genetic presdispostion for addiction provides sufficient evidence that addiction is a disease… The disease concept of addiction maintains, first, that addiction is a chronic physiological disorder, and second, that it therefore can be most adequately treated through medical intervention. As it turns out, however, neither of these claims is supported by the evidence. In fact, contrary to the prevailing view of addiction, most substance abusers do stop practicing their additions and go on to lead lives free of addiction, without relapse. Furthermore, the great majority of these addicted persons recover in a nonmedicalized context” (Addiction and Virtue24). Also see endnote 2.

[5] Mark Shaw defines addiction as the persistent habitual use of a substance known by the user to be harmful (The Heart of Addiction, 28). “Addiction is a ‘sin nature’ problem and the body responds to the substances in natural ways. Then, in time, the actions associated with addiction become habitual and extremely difficult to overcome” (Ibid., 15 see also Edward Welch,Addictions: A banquet in the grave, 38-39). He also says that this definition “brings more hope to the suffering Christian addict. Because ungodly, destructive habits can be replaced by godly, productive habits” (Ibid., 29). The most profound book on addiction I have ever read is  Addiction and Virtue and it is very helpful here; see esp. 138-40.

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About Paul O'Brien

I am a lot of things; saint and sinner. I struggle and I strive. I am a husband and father of three. I have been in pastoral ministry for 10 years. I went to school at the Southern Baptist Theological Seminary but most of my schooling has been at the School of Hard Knocks. I have worked various jobs, including pheasant farmer, toilet maker, construction worker, and I served in the military. My wife and I enjoy reading at coffee shops, taking walks, hanging out with friends and family, and watching our three kid's antics. :)

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