Responsibility and choice in addiction

The treatment of patients with substance use disorders requires that providers be aware of their own views on the relative roles of personal responsibility and of forces outside personal control in the onset and progression of and recovery from these disorders. The authors review the role of responsibility for addiction from several viewpoints: biological, psychological, sociocultural, self-help, religious, and forensic. Factors that affect personal responsibility in addictive diseases include awareness of the problem, knowledge of a genetic predisposition, understanding of addictive processes, comorbid psychiatric or medical conditions, adequacy of the support network, nature of the early environment, degree of tolerance of substance abuse in the sociocultural context, and the availability of competent psychiatric, medical, and chemical dependency treatment. Factors that affect societal responsibility include degree of access to illicit drugs, society's level of tolerance of drug use, the courts' approach to deterring substance abuse (punishment versus treatment), individuals' refusal to obtain substance abuse treatment, presence of clear behavioral norms, availability of early assessment and prevention, presence of community education, and degree of access to outpatient and community treatment.