There are several ways of understanding how people can become addicted to drugs. It has been described as a brain disease, as a developmental learning disorder, or simply as a bad habit. When construed as a habit, addiction is always understood to be a condition from which addicts could free themselves by an always possible, if seldom made, sustained effort of will.
Addiction as a brain disease is the view most widely shared by healthcare professionals today. What makes drugs addictive, says Dr. Nora Volkow, director of the National Institute on Drug Abuse, is that they “increase dopamine in brain reward regions.” They hijack the reward-motivation conditioning in the brain, according to recent studies. With many diseases, we don’t put the responsibility for illness on the sufferer, and we should not for drug addiction either, Volkow argues.
At the opposite end of the spectrum are psychologists who believe addicts can and do make rational decisions, and can choose to stop taking drugs. One is Gene Heyman of Boston College, who has written that most addicts “quit using illegal drugs by about age 30” and do so “without professional help.” Dr. Heyman listed “the correlates of quitting” as “legal concerns, economic pressures, and the desire for respect, particularly from family members,” among other factors.
A major proponent of the view that drug addiction is a developmental-learning disorder—which falls somewhere between the aforementioned stances—is a former cocaine addict, the neuroscientist and professor of developmental psychology, Marc Lewis, who emphasizes what he calls “neuroplasticity,” and “the brain’s capacity to change.” This last matches the approach taken by journalist Maia Szalavitz in her new book Unbroken Brain: A Revolutionary New Way of Understanding Addiction.