If addiction is a disease, does that mean choice disappears completely? A look at consequences, responsibility, and family boundaries.
I find myself increasingly thinking about addiction from an unusual angle. My position may be open to debate, and I do not claim to have the final truth. But there is an important question for me: if addiction is a disease, does that mean a person is completely deprived of choice?
The word “privileges” is deliberately provocative here. I do not mean that life is easier for a person with an addiction, or that the disease gives them advantages. I am referring to a paradox: with addiction, a person still has the possibility of directly influencing the next episode of the disease through their next action.
If the Cost of the Action Were Immediate
Imagine a person with cancer. They are physically unwell, and the disease threatens their life. Now let us introduce an impossible condition: if they continue gambling, every bet immediately brings them closer to death; if they completely stop gambling, the disease recedes and they recover. The person knows this rule with certainty and is absolutely sure of the outcome.
I am convinced that they would not go near gambling. I am leaving extreme states outside this thought experiment — severe intoxication, psychosis, or pronounced cognitive impairment, in which a person is barely able to assess consequences. I am talking about a person with an addiction who understands the condition, recognizes the danger, and is capable of acting consciously.
This is not a medical comparison between cancer and addiction, but a thought experiment. I use it to test the literal meaning of the phrase “an addicted person cannot stop.” If, under a different and completely clear cost, a person is capable of refusing the action, then there is no absolute inability to choose. What has changed is the cost of the choice and the inevitability of the consequences.
A person with cancer does not have a decision that is guaranteed to stop the tumor. They can undergo treatment, but they cannot end the disease through a single choice. With gambling addiction or substance addiction, however, the next episode does not occur without an action by the person themselves: placing a bet, buying alcohol, or using a substance. Refusing that action does not instantly solve psychological, family, or financial problems, nor does it mean automatic recovery. But without that action, the next episode does not occur.
Why Real-Life Choice Works Differently
In real life, the cost is not so clear-cut. Pleasure, excitement, hope of winning, or relief are available now. The consequences come later. They are familiar, but they are perceived as possible rather than inevitable: “This time I will stop,” “Now I have the situation under control,” “I can win the money back.”
Addiction genuinely changes the conditions of choice. It strengthens craving, self-deception, and the drive for immediate relief. But influencing choice is not the same as eliminating choice altogether.
Sometimes this is accompanied by a sense of being an exception. Not in everyone and not all the time, but I do encounter a way of thinking in which a person knows how gambling ends for others and still believes that the rules will somehow be different for them. They have already seen the consequences in their own life, yet they think: now I understand the system, now I will stop in time.
Sometimes this overconfidence may conceal shame, fear, or a sense of personal inadequacy. But what matters more to me is something else: as long as the danger remains something that happens “to other people” or “sometime later,” the immediate desire can easily take priority.
The Second “Privilege” Is Created by the Family
There is another paradox. Sometimes loved ones unintentionally make the consequences less immediate and less personal. Parents pay off debts, a spouse provides money, explains things to relatives, hides the problem, or resolves the difficulties that arose after gambling or substance use.
I understand why this happens. The family is trying to save the person while also protecting itself from another crisis. But the result can be the opposite: the person receives the pleasure or relief personally and immediately, while part of the cost of their decision is later paid by someone else.
For me, this is one of the key problems of codependency: it breaks the connection between an action and its consequence. Family boundaries restore that connection.
This is not punishment, nor is it about artificially creating “rock bottom.” It is about stopping the protection of an adult from the natural consequences of their own decisions. When debts are no longer automatically paid off, lies are no longer covered up, and problems created by the person are no longer solved by others, the consequences become more concrete and more closely connected to the action itself.
A Disease in Which Choice Remains
For me, therefore, the main distinction lies precisely in the presence of choice. A person with cancer may undergo treatment, follow every medical recommendation, and desperately want to live, but they do not have a single decision that is guaranteed to stop the growth of the tumor. A person with an addiction did not choose their disease either, but before the next episode they still have a choice: to perform the action that continues the addiction, or to refrain from it.
The thought experiment makes this especially clear: if the next bet immediately and inevitably brought death closer, the person would choose not to gamble. This means that the capacity to choose remains, however difficult addiction may make that choice.
It is in this sense that I call addiction a disease with a “privilege”: a person cannot cure themselves through a single decision, but they can choose not to take the next step that continues the disease.
Unfortunately, people with many other illnesses do not have that possibility.
About the author
Author: Hrachya Badalyan
Hrachya Badalyan is a psychologist specializing in addictions. I work with gambling addiction, codependency, and anxiety-related conditions. I help people struggling with addiction and their loved ones build a more stable life, restore personal responsibility, and break out of familiar destructive patterns.
Specialist’s page: Hrachya Badalyan
