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Background/Objectives There continues to be a debate on whether Substance Addiction (SA) is best understood as a brain disease or a moral condition. We aim to review the current evidence about substance use disorder and to answer two questions: “should Substance Addiction be conceptualized as a medical disorder, a morality flaw or an intermediate construct?” and “can individuals with substance use disorders be held responsible for their behaviour and, if so, to what extent?”.
Methods Systematic review of scientific literature (search of scientific articles in PubMed/MEDLINE database and use of a psychiatry textbook) related with SA and its relationship to free will.
Results Besides the psychiatry textbook, 38 studies met the inclusion criteria. Much of the scientific knowledge related with SA is in its early stages. Several risk factors were found to influence SA's development. SA's neurobiology includes several brain circuits and neurotransmitters. Drug consumption involves a series of voluntary acts; howbeit, its development is associated with enduring changes in brain function related to automatized behaviour. SA can be a major cause of morbidity and mortality.
Conclusions Significant scientific evidence has been found not to consider SA as a simple morality flaw. Exclusively defining it as a medical diagnosis may be too short for its complexity, as a search for a broader multi-faceted perspective may be warranted. These individual's willpower and self-determination is not entirely preserved nor totally disrupted, and their accountability is a complex and not clear matter. Additional research is needed to further characterize SA and its mechanisms.
