Is Substance Use Disorder an Illness? Is Abuse a Crime? Part II

December 22, 2025

Lisa Yates, Author 

Belinda Morey, Subject Matter Expert 

This article is Part II of a 2-Part Series reflecting Lisa's family's journey through addiction. Last week, you read Part I: Skeletons in the Closet: A Family's Journey Through Addiction. 

The American Society of Addiction Medicine (ASAM) is a professional medical society representing more than 7,000 physicians, clinicians, and allied professionals in addiction medicine. ASAM states that: "Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences." 

This clearly states that addiction is treatable and a chronic medical disease, not a moral failing. Something is going on in the brains of those with addiction that is different from those without it. Science now shows actual differences in the brain structure and function in people dealing with substance use disorders. This rewiring makes quitting vastly more difficult than simply 'deciding' to stop. 

Some people view addiction as something dirty. I've had breast cancer. Do you see me as dirty? Do you think of me as having a moral failing? If my cancer comes back, do you blame me or the cancer? 

Just as cancer was my illness, addiction is an illness too. Rape, murder, and burglary are crimes, and they involve abuse. We have to be clear in our language: substance use disorder is a health problem that requires medical treatment, understanding, and support. Abuse—especially when it causes harm to others—is a crime. The distinction separates those who need help from those who inflict harm.

Like diabetes, cancer, and heart disease, addiction is caused by a combination of factors, including behavioral, psychological, environmental, and biological influences. The genes passed down from parents can also play a key role, accounting for about half of a person's risk of developing a substance use disorder. 

Family history, trauma, and untreated mental health conditions are enormous risk factors for substance use. Environment and genetics are intertwined—neither is destiny, but together they shape outcomes.

When left untreated, addiction can often lead to other physical and mental health issues. Over time, it can become more severe, disabling, and life-threatening. Just like with any illness, if my cancer had gone untreated, the tumor would have grown, putting my health and life at risk. Let's examine some of the questions that have surrounded past controversies. 

Is Substance Use a Choice? 

Early decisions to use substances are based in large part on a person's own choice, though this is often affected by their culture and environment. However, some people are more at risk of developing a substance use disorder (SUD) than others. This is caused by certain factors, such as: 

● A family history of addiction 

● Trauma 

● Untreated mental health disorders, such as depression and anxiety 

● Family conflict 

Addictions develop through repeated exposure and reinforcement. While 'choice' may be a factor for the first drink or pill, nobody chooses to become addicted. 

The transition from voluntary use to compulsive, life-disrupting use—the core of addiction—crosses a line where choice is severely impaired. When substance use progresses to the point of addiction, a person no longer chooses to use; they are now dependent on substances. 

A key sign of addiction is a loss of control over substance use. Nobody wants to lose their job, family, and health. This loss of power is a fundamental aspect of addiction that needs to be understood and empathized with. 

*Read Part 1 of Lisa's series here

Is Addiction a Chronic Disease? 

A chronic disease is a long-term condition that can be managed but not cured. This concept also applies to substance use disorder (SUD). Sobriety is a form of managing addiction, but it's not a cure. How many times have we heard of someone sober for many years, only to relapse and find themselves back in the grips of addiction? This is a clear demonstration that addiction is a chronic disease, not a moral failing, and it's essential to accept and understand this reality. 

My breast cancer is controllable and treatable, but not curable. Depending on the choices I make, it could come back. 

Why Do Some People Say Addiction Is Not a Disease? 

Some people think addiction cannot be a disease because it is caused by the individual's choice to use substances. While the first use (or early use) may be by choice, once the brain has been changed by addiction, most experts believe that the person loses control of their behavior. This is a crucial distinction. Addiction works by essentially hijacking the brain's reward system, making sobriety difficult—sometimes impossible—without structured help and long-term support. 

At about the age of 8, I began to see my first glimpse into a life with alcohol. As my father attempted to establish himself in the upper echelons of the business world, numerous business parties were held at our house. I was always banished to my bedroom during these parties. I would often sneak out of my room and peek around the corner.

Unconsciously, the pattern I was seeing began to take hold within me. They unknowingly made alcohol look like something I needed. The image portrayed elegance and refined sophistication. It was a sign of prestige. Who the heck wouldn't want that? 

It was a couple of years before my mom passed from her battle with breast cancer that I had my first beer. I was about 15 and attending a Christian High School. As interesting as that may sound, there is often a reason parents send their kids to a private school. I was a good kid, so my reason for being there was only for education, not because of my behavior. 

The Spring and Summer months of my early teenage years were spent cruising through the San Juan Islands in Washington State. There were stops at the fanciest ports with the biggest yachts and the so-called finest of the finest in the boating community. 

In the evenings, while listening to Neil Diamond, Mom and Dad would sit out on the upper boat deck, relaxing with their preferred drinks: Mom enjoyed wine, while Dad preferred whiskey or bourbon. There were happy hours on the deck of the boat with other boating friends and nice restaurants overlooking the Puget Sound. As a young girl, how could I not be influenced by this lifestyle?!! 

During one of our excursions, a storm struck, and the wave swells were enormous. Mom was in hysterics, fearing that we were going to capsize and perish. It was a genuine threat. In a photo from that moment, Mom can be seen clutching a bottle of wine tightly while gripping the counter. I thought that was funny. Again, a picture of alcohol and fun. At that time, alcohol was not something I really understood. 

During Mom's last year of life, the discovery of the liquor cabinet became a factor. A friend and I would sneak into the liquor cabinet and taste-test most of its contents. The gin — Tanqueray Gin, in particular — stood out. Drinking it straight from the bottle. It was gross, but it gave me that warm feeling that seemed to take all my worries away, and the thoughts of losing my mom. With her eventual death, the liquor cabinet visits became more frequent. I began to realize, with these numerous visits, that alcohol could numb all the emotions that I had inside. I did not have to deal with the feelings and emotions I was experiencing. Drinking became a way for me to numb the pain that had invaded my soul, especially when everyone else was grieving, and nobody was talking about it. 

I believe that losing my mother manifested itself in me as trauma-related alcohol abuse. In the beginning, I would say alcohol 'use', but as I've grown older, I will say alcohol 'abuse' from the aforementioned 'use'. 

Until recently, I never thought of losing my mom as childhood trauma because I was 17 and not really a child. However, the whole process started when I was 13. That is still a child, particularly with respect to brain maturation. 

I am now 60 and on day 95 of my 100-day goal. I've spent months learning what alcohol does to the body and how, scientifically, addiction does happen. Never did I realize that what I was doing was hurting me. Never did I think that alcohol was addictive. It was something we did frequently with our friends. Everything centered around alcohol.

In college, that's what we did. Within my marriage, the big drinking didn't really start until our income increased and our kids were old enough to be left alone for a couple of hours. We were in our upper 30s at this time. It was a time when we should have been slowing down, but instead, our drinking was ramping up. 

It's been 40-plus years since that first beer. These years have not been continuous periods of drinking. I did not drink while I was pregnant, and there were times when our kids were small that there were long breaks in healthy living. 

Alcohol creeps up, and before you know it, a habit has taken over the reason you started drinking in the first place. This is what I believe happened to me. Habits are hard to break, but they can be broken.

Neuroscience tells us that habits, especially those around substances, form deeply ingrained patterns that cannot be "willed" away overnight. Treatment and support groups work, in part, by helping to establish new, healthier routines and reward systems. 

Choice Does Not Determine Whether Something is a Disease 

Heart disease, diabetes, and some forms of cancer involve personal choices like diet, exercise, and sun exposure. A disease is what happens in the body as a result of those choices. I may have made choices, some of which I am unaware of, that led me to have breast cancer. We know the link between breast cancer and alcohol. Nonetheless, I still had a disease, and the cancer was not my choice. 

Others argue that addiction is not a disease because some people with addiction get better without treatment. This is undoubtedly true, as I am one of those people. Individuals with mild substance use disorder may recover with little or no treatment. 

In contrast, those with the most serious form of substance use disorder usually need intensive treatment followed by lifelong management of the disease. Some achieve recovery by attending AA meetings or online groups.

Recovery is personal. Some people find success independently, while others require medical and community support, and most benefit from a combination of resources, compassion, and accountability. There is no single path. 

Whether it's addiction or cancer, neither should be stigmatized or blamed on the person going through it. Both are health conditions that require care, compassion, and support. 

There is no blame to be placed on you. 

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Lisa Yates lives in Marysville, Washington, and is a paraeducator for preschoolers with developmental delays. She also writes about her experiences as a motherless daughter, grief and loss, and sobriety. 

If you want to read more articles authored by Lisa Yates, please visit https://medium.com/@lisaryates. 

If you, or someone you know, is struggling with substance use, help is available. You can contact the SAMHSA Helpline at 1-800-662-HELP or explore family support options, such as Al-Anon or local recovery communities. Compassion saves lives. 

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