Shut Up About ‘Choices’: Why Substance Use Disorder Isn’t What You Think It Is
Shut Up About ‘Choices’: Why Substance Use Disorder (SUD) Isn’t What You Think It Is
Every time someone dies from SUD, the same tired, cruel line gets dragged out: “They made their choices.”
It’s always someone who hasn’t lived a day in that kind of pain, someone who’s never watched a loved one fight a losing battle against something bigger than themselves. It’s always someone who hasn’t faced SUD and thinks it’s as simple as just choosing to stop.
Here’s the thing: SUD isn’t about choices. It never was.
Let’s Talk About Those So-Called ‘Choices’
You think they chose this? Let me spell it out for you:
Nobody wakes up one day and says, “You know what? I’d love to ruin my life today.”
Nobody plans to lose everything they care about, from their health to their relationships to their sense of self-worth.
Nobody wants to need something so badly it burns their life to the ground.
SUD is messy, complicated, and rooted in things most people don’t want to talk about—trauma, mental illness, genetics, pain.
Yes, the first use might have been a choice. But here’s the kicker: Addiction isn’t about that first choice. It’s about what happens after. It’s about a brain that gets rewired by a substance to the point where it’s no longer a choice at all.
The Science You Keep Ignoring
SUD isn’t just “bad decisions.” It’s a chronic disease. The same way diabetes affects the pancreas or asthma affects the lungs, substance use affects the brain—specifically the parts that control judgment, self-control, and decision-making.
Once SUD takes hold, it’s not about willpower. It’s about biology.
Drugs flood the brain with dopamine, hijacking the reward system and making normal life feel unbearable without the substance.
Over time, the brain stops producing dopamine naturally, meaning people aren’t just chasing a high—they’re trying to feel normal.
You wouldn’t tell someone with cancer to just “choose” to stop having tumors, would you? So why the hell do we think it’s okay to say that to someone struggling with substance use?
Trauma, Pain, and the World That Failed Them
SUD doesn’t happen in a vacuum. Look closer, and you’ll almost always find a story of pain:
Childhood trauma they never had the tools to heal from.
A mental illness that went untreated because therapy and medication are luxuries, not accessible resources.
Chronic pain that doctors dismissed until the only relief came from a pill or a needle.
And let’s not pretend society isn’t part of the problem. We judge people for struggling but don’t give them the tools to succeed. We tell them to “get help” but don’t fund treatment centers or make recovery affordable.
We shame them for their SUD but ignore the systems that pushed them into it.
Substance Use Disorder Is a Disease. Stigma Is a Choice.
Here’s the truth: People with SUD don’t need your judgment. They need your compassion. They need access to treatment, not punishment. They need you to shut up about “choices” and start showing up for them as human beings.
SUD is not a moral failing. But treating someone like their life doesn’t matter because of their struggles? That is.
Stop Kicking People When They’re Down
Every time you dismiss someone’s struggle as “their choice,” you’re doing more harm than good. Stigma doesn’t help people recover—it drives them deeper into shame, isolation, and silence.
You’re not helping. You’re not better than them. And if you think you are, you’re part of the problem.
What You Can Do Instead
Educate yourself about SUD as a disease, not a character flaw.
Advocate for better access to treatment, because recovery shouldn’t be a privilege.
Show up for the people in your life who are struggling, without judgment or shame.
Because here’s the reality: No one is immune to SUD. Not you. Not your family. Not your friends. And when it’s someone you love, you’ll realize just how cruel and hollow those words about “choices” really are.
At Adams Legacy Project, we see the people behind the substance use. We see their struggles, their humanity, and their worth. And we’re here to fight for a world where compassion wins over stigma.
