Kelly Carr

Is Addiction a Disease or a Decision?

Kelly Carr
Is Addiction a Disease or a Decision?

by Amanda Porter

He’s hunched over in the chair across from my desk, elbows on knees. His eyes are on the hands in his lap, his fingers are curled into tight knots of shame. It’s painstaking, his account of his addiction to pornography—how it’s wrecked his marriage, his career, his finances, and his relationship with his adult children. He speaks of his isolation, his guilt, and where to go from here.

He would never say it aloud, but I know he’s wanting me to say these words: It’s not your fault. You have an illness. Words like these could absolve him. Perhaps he would be welcomed back into his family and his church.

I wish I could gift him these words with some confidence.

Which Is More Forgivable?

It’s an eternal question in mental health treatment, and it’s a question that extends to church life.

Is addiction a disease or a decision?

And which addictions are more forgivable? Are some addictions worse than others? And should we let these people in our doors? What do we do with them once they’re here? Exactly how many second chances should we give them? What do they deserve?

Addiction could not refer to the rest of us . . .

In church, addictions are right up there with affairs and homosexuality in terms of exclusion and shunning. Labeled the worst of the worst. And let’s be clear, addiction clearly refers to the guy at the end of the pew, the one with the glassy eyes, tattoo sleeves, and three-day stubble. The one who’s on Medicaid and SNAP. Addiction could not refer to the rest of us, swallowing one too many Starbucks or jonesing for another Facebook like.

We could talk about brain scans and heredity. We could talk about childhood influences and coping skills. Personally, I haven’t seen any sound science to definitively support either side, disease versus decision.

Who Is Deserving?

Yet I have to believe that addiction is a disease. Because the alternative is to believe it’s a decision, and this has too many ramifications for me to wrap my head around.

I do know this much about myself: Being a human, I’m not above feeling a jaded weariness when treating substance abusers. Such feelings would only skyrocket if it were somehow proven that my patients bring this upon themselves.

I’m not above feeling a jaded weariness.

So I choose to believe that substance abuse is a disease, not a decision. Whatever my personal feelings are. However I might feel when they walk into my office. Whatever they might look like on the outside. However they may behave or deceive.

The bottom line is—it’s not my assignment to determine who is deserving of compassion and care.

I am simply called to care.

posted on May 26, 2018


Meet the Author:

Amanda Porter is a board-certified psychiatric nurse practitioner, practicing at the nationally renowned Lindner Center of HOPE in Mason, Ohio. She's also an introvert and writer who likes to talk about faith, hope, and recovery. She is currently working toward a PhD in Integrative Mental Health. She teaches workshops on Mental Health and Anxiety at her home church, WhiteWater Crossing. She lives in Cincinnati with her husband and two kids.

Other Rivulet Collective articles by Amanda Porter:
Parenting Teenagers


Photo by Lurm on Unsplash