It’s a shame that our culture can’t separate choice and agency from blame and accountability. These terms have become laden with implications that make it really difficult to discuss something on its own terms. For instance, much of the disagreement over describing addiction as a disease comes from debate over the therapeutic value of conveying to clients that they have choice in the form of treatment and management over a disorder they didn’t choose to have. The social stigma and poor education around addiction is intense enough that it’s worth discussing the merits of choosing terms to improve communication rather than technical accuracy. This certainly isn’t a new idea: from The Big Book of Alcoholics Anonymous, Dr. Silkworth framed alcoholism as both a physical allergy and a mental obsession. Researchers and clinicians have generally moved on from that description to arguing about the disease model, but that’s only partially reflected among those with substance abuse disorders. To this day, many people conceptualize their relationship with substances as an allergy that they can only manage by either abstinence or, if ingested, immediate treatment for a life-threatening crisis.