The NY Times recently had a Room for Debate feature on addiction. They published opinions from 6 different people on addiction with one being a clear advocate for the disease model. This is a little like publishing a debate feature on climate change and having 1 of 6 experts believe that global climate change is occurring.
Two of the writers, Carl Hart (previous posts on Hart) and Gene Heyman (previous posts on Heyman), emphasized pleasure.
It’s well established that addiction is a disorder of the pleasure pathways. When other parts of the brain (related to, say, vision or movement) or other organs experience disorders, we don’t devote NY Times features to whether they really are a disease or whether choice is a factor in the illness. However, when pleasure enters the picture, we have a very difficult time surrendering the notion that we are, or should be, in full control of our behavior.
Kevin McCauley addresses the role of pleasure in advocacy for the choice argument:
Addiction is a disorder of the brain’s ability to properly perceive pleasure. I think it’s this moral loading of pleasure that makes it harder to accept that this is a disease process. It’s easier to just write addicts off as bad people who just want to feel good. In fact, that’s a corollary of the choice argument. It says exactly that, “Addicts don’t shoot gasoline into their veins, they shoot drugs into their veins! And, why? Because it feels good. Addicts do it because it feels good!”
In fact, there’s a sentence in the AA big book that says basically the same thing, “Men and women drink essentially because they like the effect produced by alcohol.” And that’s exactly right. What addiction is, is a defect in the brain’s like mechanism. Pleasure is the capacity of the brain, and being a natural organ, the brain can break. And, addiction is, at it’s heart, a broken pleasure sense.
recoveryreview.blog 
The resistance to the disease model seems to me to come from a resistance to admitting that something that feels good can unexpectedly and irreversibly turn into a disease — a source of unease, a sickness, a big mistake. If a pleasure that feels innocent – and getting high feels innocent even though it doesn’t look that way from the outside — is really a trap, then how shall “normal” people view their own tastes? What if they, too, face the possibility of ending up sick and permanently impaired by their own pastimes of choice? But if they can all it a “rational choice” they can believe that it won’t happen to them, for their own “choice” would be different.
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There are some good points debated and some good comments afterwards with the usual level of disagreement. I am not a fan of the term disease to describe addiction, as the only way to get well is after making the choice to stop the addiction, unlike cancer when you do not have that option. I prefer to term it an illness, and that helped me with self empowerment to get well. I have just finished the book by Mark Lewis and think he provides a good description of what happens to your brain, when you make the bad descision to use drugs.
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