Before making any decisions, ultimately and always, any discussion or consideration involving addiction and recovery must begin, continue, and conclude with medical advice. Addiction is a complex and serious circumstance. One point to consider is that the first step toward the road of recovery is the cognitive action of acknowledgment and acceptance (Chen, 2022; Lewis, 2018; Purje, 2014).
If acknowledgment and acceptance are not present, denial may become the determining thought, which then may continue with the ongoing addictive behavior. Without the insight of acknowledgment and acceptance of addiction, the process of recovery may not necessarily continue or even begin (Prochaska et al.; Purje, 2014).
Former self-acknowledged addict Marc Lewis (a professor emeritus of developmental psychology and neuroscientist) argues that addiction is a desire, that it is learned and not a disease. According to Lewis, a behavior is often repeated when feelings of excitement, delight, or pleasure occur (Lewis, 2018).
Further to this, neuroscience informs that the neural pathways associated with repeated thoughts and behaviors become stronger and more efficient. This is the same mechanism that allows us to learn skills, form habits, or develop preferences. According to Lewis, addiction initially begins as a pattern of choices that changes the brain and leads to learned behaviors. According to Lewis, and also supported by Purje (2014), this behavior of addiction will continue until the individual makes the choice to change their thinking and behavior.
According to Lewis, this is how he eventually changed his thinking and behavior, and removed addiction from his life (which clinicians might refer to as sustained remission). Lewis’ account of addiction continues to prompt discussion, and a range of perspectives remain active in the field (Powell et al., 2026).
Disease Model vs Choice Model in Understanding Addiction
The literature informs that there are those who maintain a disease‑based interpretation of addiction, while others, including Lewis, emphasize that addiction is a choice and a developmental and learning process. These approaches reflect ongoing debates about how addiction and recovery may be thought about, understood, and explained (Lewis, 2018; Pies, 2009; Powell et al., 2026; Purje, 2014).
Cognitive behavior therapy (CBT) proposes that thoughts influence behaviors, and that learned patterns of thinking can reinforce addictive cycles. Repeated thoughts and behaviors strengthen neural pathways, and repeated thoughts reinforce cognitive potential. CBT treats addiction as a pattern of thoughts and behaviors that can be examined, challenged, and replaced. It is when this self-reflective and self-determined conscious choice and action takes place that the potential for recovery is possible (Brand et al., 2025).
Rational emotive behavior therapy (REBT) of Albert Ellis supports the requirement of self‑reflective thinking by emphasizing that individuals need to engage (in deliberate and disciplined focussed thinking), to intentionally identify and challenge their irrational beliefs that have led to their addictive behaviors. Without this intentional self-reflective cognitive engagement taking place, their irrational beliefs will remain unchallenged, and their addictive behavior will have the belief-based potential to continue. For behavior to change, beliefs must change (David et al., 2018).
William Glasser’s reality therapy emphasizes personal choice and present‑focused responsibility. The past cannot be changed. The reality of the present is the only place where changes to thinking, life, and behavior can take place (Glasser, 1965/1975). To which we add the quote from Viktor Frankl (1946/2006), who lived in unimaginable circumstances: “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” As such, and immutably, choices only occur in the present, and that present is now.
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Another perspective worth considering is that of Stephen Yoder (2002), who argues that health and well-being are the responsibility of the individual. Yoder’s emphasis on deliberate self-reflective decision-making and agency – in the present – aligns with the cognitive and behavioral approaches (Yoder, 2002).
Further to this, Schumann and Dweck (2014) examined why some individuals accept responsibility for their actions while others do not. Their research shows that individuals who constructively and positively view themselves as capable of learning and adapting are more willing to take responsibility for their actions. This aligns with the concept that these individuals are therefore operating from an internal locus of control perspective.
Although not a clinical therapy, Responsibility Theory offers a philosophical and educational framework for understanding personal responsibility, agency and choice. The individual begins to regain the capacity to take control of their decisions, behaviours, actions and their life, which begins with the following question: “What am I responsible for, and what power do I have?” With that question posed, the answer is: “I am responsible for, and I have the power over what I think, do, say, learn and choose.” As such, a choice can change at any time and place, and with this, the intention should always be one where only positive and beneficial choices are made (Purje, 2014).
Ongoing Considerations
Taken together, these considerations and discussion points aim to offer insights for self-reflection and recovery. They are offered for analysis rather than prescription, the purpose of which is to allow the reader to form their own opinions and conclusions.
These frameworks present psychological models, philosophical theories, and educational perspectives, allowing individuals to consider how they choose to understand addiction and recovery and which presentation—if any—offers insight or potential. As such, and as noted, before making any decisions, ultimately, and always, any conversations or deliberations involving addiction and recovery must begin with, and continue with, medical advice.