We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
As we've said in the past, it depends on how one wishers to define "disease." The term is highly fluid, constantly expanding to include normal variations and things one might term "conditions" (mainly for insurance purposes), and lacks any natural definition.
My view is that substance abuse derives from one simple effect: Some people like it a lot and it makes them feel better than they otherwise feel. Any physiological dependence part is secondary to that. Also, I am not too keen on the criminalization of drugs. The "War on Drugs" has accomplished little good and has many unintended and unfortunate consequences.
There is something about drugs that is related to mental health or personality. Just as some people are risk takers and some are not. I know people who are or have been addicted and the common string between them is that they are not right in the head. I would guess that most of them are bipolar. Just as there are people who want to bungee jump or embrace dangerous actions or get tattoos all over their body there are those people who want to try drugs. In my experience these are all related. It is likely that the people you see with excessive tattoos and piercings are also chemically addicted.
As for genetics, I have connections with Indians in multiple places and sadly alcohol addiction and drug addiction is common for them. It doesn't seem to be cultural but rather a simple addiction that once triggered they cannot break.
So easy to blame it all on "poor willpower" and "immorality".
Makes it natural to blame the victim and lock them up rather than seek what's causing them to become addicted.
Sure, some people are stupid and try things with a very high chance to get addicted, thinking themselves "strong enough to resist", mainly because just that thinking that it's all a choice to become addicted.
There ARE physiological factors involved, and simply ignoring them is idiotic and very dangerous.
Some people just are more prone to become addicted to certain things than others. And some people DO get addicted to opiates through medication, then seek other opiates when their doctors stop the supply rather than carefully guiding them through programs to get rid of the addiction (which is indeed possible, but takes time and money).
This also revolves around the much vexed question of nature vs nurture.
There are unquestionably some potent genetics at work and some rather elegant investigations to show this. There are commonly "polymorphisms" with respect to the genes that code for the proteins responsible in neural signal transduction. Some of these genes render some individuals either more or less responsive to external and indeed internal sources of opioids and other drugs (alcohol being arguably prime).
When it is all said and done however my own problem with the "disease" model is that it then isn't too far way from saying that a victim of addiction no longer has agency.
I'm sorry I ran over that child you honour but I can't help it, I have a disease so don't send me to jail".
That could even be a viable defense. If you got a stroke or heart attack that caused you to lose control over the car you should get medical treatment, not jail time...
As to addictions, both my parents have at times been treated with high doses of morphine. Hardly a decision to choose getting an addictive substance into your system, it's a great test (though not one I'd want performed on people as a test).
My mother routinely got addicted to the stuff every single time it was applied, my father never got addicted to it at all.
Both were at least some of the times it happened in a coma so not even aware what was being pumped into their veins.
Can't fake the physical withdrawal symptoms when you're bed ridden with monitoring equipment all over your body.
So the claim that people choose to get addicted to things is nonsense based on that small sample size alone.
Maybe some do, but far from all.
I have myself been somewhat addicted to certain medication, to the point it was no longer functioning for me. The withdrawal wasn't nice.
I didn't want that, I didn't choose that, it happened and with some help from my doctor and pharmacist (gradual reduction in dose until I could get by without) I got rid of it.
Probably inherited the ability to easily get addicted to things from my mother...
i suspect there are multiple reasons for addiction; different addicts can have different reasons for their problems. Some are probably impacted physiologically differently from non addicts that experiment with that substance. Others are risk takers that think they can control it and don't realize what is happening to themselves. Others have mental issues like depression or despair. And yes, some are just mentally/morally weak.
Its such a tragedy, I know too many young people that have become addicted.