Addiction Is a Disease of Free Will

When I was five or six years old, my grandfather — my mother’s father — died of what I was always told were complications of heart disease. It was not until much later, after I had completed my medical training in psychiatry, and had already been working for a long time using neuroimaging to study the addicted brain, that I learned the real reason for his death. My mother called me one day, near the end of her life, and said, “Nora, I need to tell you something I have never spoken to you about.” She revealed to me that my grandfather had been an alcoholic, and that he had killed himself in his distress at not being able to control his strong urges to drink.

This came as a shock. My mother had kept the real reason for my grandfather’s death a secret from me, even though she knew that my whole professional life was devoted to trying to understand what drugs do to the brain. She had heard me speak of addiction as a disease of the brain. So I wondered how I had miscommunicated — how I had not made her realize that it was okay to speak about addiction, that there should be no shame in it.

I’ve thought about this many times, and I realize that describing addiction as a “chronic brain disease” is a very theoretical and abstract concept. If you were a parent with a very sick child, and you went to the hospital and the doctor said, “Your child is in a coma because he has diabetes,” and the doctor went on to explain that diabetes is a chronic disease of the pancreas, would it help you understand why your child was so severely ill? No it wouldn’t. What explains —> Read More