Addiction Is Not a Weakness but a Chronic Health Condition

First, a change of perspective

For a long time, addiction was seen as a moral failing, even a crime, and the response was punishment instead of treatment. The current approach treats it as a public health matter: substance use disorder is a chronic condition, like diabetes or high blood pressure, that needs diagnosis and specialist care and tends to relapse (start again). The definition reflects this: compulsive, repeated use of a substance despite harmful physical and mental consequences.

The starting years matter too: the most common age of onset is 18–25, when the front part of the brain (the frontal lobe) is still developing. According to World Health Organization data from 2000, alcohol, tobacco and drugs are linked to 12.4% of deaths worldwide. Tobacco use in Türkiye is higher than in the US and rising; among people aged 15 and over, 30.1% smoke every day (Turkish Statistical Institute, 2025). Because patients often conceal their use, asking without judgment and listening is the first step.

Tobacco: quitting pays off at any age

Tobacco is the leading preventable cause of death. Smoke contains more than 7,000 chemicals and harms almost every organ: the heart and blood vessels, the lungs, many types of cancer, gum health, and pregnancy and childhood. In the US, 480,000 deaths a year are tobacco-related, 41,000 of them from passive smoking (exposure to others' smoke).

The good news is that quitting helps at any age. After one year, the risk of heart attack drops markedly. Within 2–5 years, stroke risk falls to the level of people who have never smoked. At 5 years, the risk of mouth, throat, esophagus (food pipe) and bladder cancer is halved; at 10 years, the risk of death from lung cancer is halved too.

Of smokers, 68% want to quit and 55% try within a year, yet only 7.4% manage to stay quit for more than 6 months. Among those who try, just 29% use medication and 6.8% use counseling. Medication, prescribed by a physician, works better alongside behavioral support than either one alone. Referral to a quitline also roughly doubles the quit rate.

Alcohol, opioids and cannabis: a shared logic

Science explains addiction through the brain’s reward circuitry. Use starts out impulsive and over time becomes compulsive (hard to resist); alcohol comes to be drunk not for pleasure but to relieve negative feelings. The same criteria are used to diagnose alcohol, opioid and cannabis use disorders: at least 2 of 11 criteria within 12 months. They cover loss of control, disruption of social and daily life, risky use, tolerance (needing more for the same effect) and withdrawal. Severity is graded as mild (2–3), moderate (4–5) or severe (6 or more).

Some common misconceptions need correcting. Alcohol harms almost every organ, including the liver, heart and brain, and there is no safe amount of alcohol in pregnancy. That cannabis is “natural” does not make it harmless; its withdrawal is real, peaks in the first week and can last up to a month. Withdrawal can also mimic depression and anxiety: the feeling that “it relaxes me” may often be relief from withdrawal.

Withdrawal can be serious. With alcohol, symptoms can begin within hours of the last drink and can lead to dangerous conditions such as seizures, so stopping should be planned with a physician’s assessment. In opioid use disorder, replacement treatment is not swapping one addiction for another; it is an evidence-based treatment that reduces deaths.

Talking without judgment, taking small steps

For someone ready to quit, health professionals follow five steps: ask, offer tailored advice, assess readiness, assist and arrange follow-up (the 5 A’s). Brief advice works even when it lasts under 3 minutes. For someone not ready, the approach is to ask rather than tell: what does smoking or drinking mean to you, what would you gain by stopping, what makes it hard? Because motivation changes from week to week, the conversation is reopened at every visit; asking each time does not lower patient satisfaction and can raise it.

There is no single right path. Counseling, cognitive behavioral therapy, family and couples therapy, self-help groups such as Alcoholics Anonymous, and peer support are among the options; someone unhappy with one group can try another. Medication and psychosocial support together usually work better. Relapse is not a failure; it is most likely around the 3rd month and the 1st year, and treatment simply continues. In Türkiye, points of contact include the ALO 171 Smoking Cessation Helpline, smoking cessation clinics, alcohol and substance addiction treatment centers (AMATEM), child and adolescent substance addiction treatment centers (ÇEMATEM), the Yeşilay Counseling Center (YEDAM) and ALO 191.