The brain disease model of addiction is widely endorsed by agencies concerned with treating behavioral disorders and combatting the stigma often associated with addiction. However, both its accuracy and its effectiveness in reducing stigma have been challenged. A proposed alternative, the “choice” model, recognizes the residual rational behavior control capacities of addicted individuals and their ability to make choices, some of which may cause harm. Since harmful choices are ordinarily perceived as blameworthy, the choice model may inadvertently help justify stigma. This paper seeks to fully naturalize the choice model by highlighting the determinants of voluntary action and thus increase its potential for destigmatizing addiction. In light of a deterministic understanding of behavior, it is unreasonable to suppose that addicted individuals could have made different choices in becoming addicted and in subsequent situations. To the extent that stigma is motivated by the supposition that addicted individuals could have chosen otherwise in actual situations, a deterministic understanding of addictive behavior promises to mitigate blame and stigma.

成瘾的大脑疾病模型得到了有关治疗行为障碍和打击通常与成瘾相关的耻辱感的机构的广泛认可。然而，它在减少污名方面的准确性和有效性都受到了挑战。一个提议的替代方案，即“选择”模型，认识到成瘾者剩余的理性行为控制能力及其做出选择的能力，其中一些可能会造成伤害。由于有害的选择通常被认为是应受谴责的，因此选择模型可能会无意中帮助证明耻辱感。本文旨在通过强调自愿行动的决定因素来使选择模型完全自然化，从而增加其消除成瘾的潜力。根据对行为的确定性理解，假设上瘾的人在上瘾和随后的情况下可以做出不同的选择是不合理的。在某种程度上，成瘾者在实际情况下可能会做出其他选择的假设激发了耻辱感，因此对成瘾行为的确定性理解有望减轻责备和耻辱感。