Is Addiction a Disease or a Lack of Willpower? What Modern Medicine Says

Why Addiction Is Considered a Disease

Dependence syndrome is described in the World Health Organization’s International Classification of Diseases and in the American diagnostic manual DSM-5. It has clear diagnostic criteria, known mechanisms of development, a predictable course, and treatment methods with proven effectiveness. It is precisely by these features that medicine classifies a condition as a disease rather than a trait of character.

According to ICD-10, dependence is diagnosed if at least three of six signs have been present during the past year: a strong desire or compulsion to use; impaired control over starting, stopping, or the amount used; withdrawal symptoms on stopping; increased tolerance; neglect of other interests; and continued use despite clear harm. In ICD-11, the criteria are grouped into three key features: impaired control, increasing priority given to use, and physiological features.

What Happens to the Brain in Addiction

Alcohol, nicotine, drugs, and some medications cause a powerful release of dopamine in the brain’s reward system — far stronger than natural sources of pleasure. With repetition, the brain adapts: receptor sensitivity decreases, the response to ordinary pleasures weakens, and more of the substance is needed for the same effect. Without it, the person feels emptiness, anxiety, and irritability.

At the same time, the prefrontal cortex — the part of the brain responsible for self-control, planning, and weighing consequences — begins to work differently. Its ability to restrain impulses declines. The stress response system becomes overactive, and any tension triggers a craving. Strong conditioned links form between the substance and particular situations. That is exactly why a person can sincerely want to stop and still keep going back to using.

The reward system

The substance hijacks a mechanism designed to motivate vital behaviors and becomes the brain’s top priority.

Self-control

The prefrontal cortex becomes less able to inhibit impulses. The person understands the harm, but in the moment of craving that understanding loses its force.

Stress

A chronically overstrained stress system makes sobriety feel hard and increases the risk of relapse under any kind of pressure.

Why Some People Become Addicted and Others Don’t

Not everyone who tries alcohol or other substances becomes addicted. The risk is determined by a combination of factors — just as with type 2 diabetes or high blood pressure. Heredity plays a significant role: people whose close relatives have had an addiction are at higher risk. This is not a life sentence, but a reason to be more careful.

Other important factors include the age at which use began — the earlier, the higher the risk — childhood trauma and experience of violence, chronic stress, and the presence of depression, anxiety disorders, ADHD, or PTSD. The availability of the substance and cultural norms around use in a person’s surroundings also play a part. None of these factors depends on willpower.

• Heredity: addiction in parents or close relatives
• Starting to use early, in adolescence
• Childhood trauma, violence, family dysfunction
• Mental health disorders: depression, anxiety, ADHD, PTSD
• Chronic stress and social isolation
• Availability of the substance and use among the people around you

If It’s a Disease, Where Does Responsibility Come In?

A common objection is: if addiction is a disease, then the person is not to blame for anything and doesn’t have to do anything. That is not true. The disease model answers the question of causes, but it does not remove responsibility for what the person does next. Someone with diabetes did not choose to get ill, but they are responsible for watching their diet and taking their treatment. It is the same with addiction: the disease is not your fault, but treatment is your responsibility.

Understanding addiction as a disease has practical significance. Shame and stigma are among the main reasons people go years without seeking help and hide the problem. When a person and their loved ones understand that they are dealing with an illness, a conversation about treatment becomes possible. The family stops spending its energy on blame and starts looking for specialists.

Why Willpower Isn’t Enough

Many people with addiction have repeatedly promised themselves and their loved ones that they would quit, and they really have tried — sometimes successfully for a while. Then came a relapse, which was put down to weakness of character. In reality, changes in the brain make self-control especially vulnerable precisely in situations of stress, fatigue, and exposure to triggers. Willpower is a limited resource, and relying on it alone is like trying to heal a broken bone by sheer effort.

This does not mean that willpower isn’t needed. Deciding to get treatment, attending sessions regularly, and using coping techniques are all expressions of will. But it works best in combination with professional help: medical support, psychotherapy, and changes to one’s environment and social circle, which take some of the load off willpower.

How Addiction Is Treated as a Disease

Addiction treatment follows the same principles as the treatment of other chronic diseases: diagnosis, relief of acute symptoms, long-term therapy, and prevention of flare-ups. The first stage is detox and stabilization, as an inpatient if necessary. Next comes psychotherapy with proven effectiveness: cognitive behavioral therapy, motivational interviewing, relapse prevention, and family therapy. For some types of addiction, medications that reduce cravings are used, prescribed by a doctor.

At the Narcology 24 clinic, addiction is treated jointly by an addiction doctor (narcologist), a psychiatrist, and a psychotherapist. We treat the patient as a person with an illness, not as someone to blame, and build a pathway from the first consultation through to remission support. Care is anonymous and voluntary, and the family receives separate support.

1. Diagnosis: examination by an addiction doctor, assessment of physical health and mental state
2. Detox and relief of withdrawal
3. Treatment of co-occurring mental health disorders
4. Addiction psychotherapy and relapse prevention
5. Where indicated, medication support prescribed by a doctor
6. Work with the family and long-term follow-up

When to see a doctor

• You have tried several times to stop drinking or using but went back to it
• Use continues despite problems with health, work, or family
• You need more and more alcohol or the substance to get the same effect
• When you stop, you get tremors, sweating, anxiety, and insomnia
• Use is combined with depression, anxiety, or other mental health problems
• Someone close to you is using and you want to understand how to help them

Questions and answers

Medically reviewed by

Olga Smirnova, MDAddiction psychiatrist · experience 27 years

Alcohol dependence, alcoholism in women, dual diagnosis, coding after assessment and family consultations.