How to answer “Is addiction a choice?” in a medical school interview

A strong answer to "is addiction a choice" states what medicine currently understands about addiction, sets out both views fairly, and shows how each view changes the way a society treats people who have it. The prompt asks whether the view matters, so the answer has to trace each view to a consequence.

What the interviewer is assessing

• Critical thinking
• Empathy and compassion
• Ethical reasoning

Physicians treat patients with substance use disorders in every setting, and the attitude a student brings shapes the care those patients get. The interviewer listens for accuracy about what addiction is, for respect in how you speak about people who have it, and for the ability to connect a belief to a policy. The current medical understanding is that substance use disorder is a chronic, treatable medical condition with biological, psychological and social causes. Those causes include genetics, changes in the brain's reward circuits, trauma, poverty and a person's environment.

Many people hold the view that addiction is a choice and that recovery is a matter of will, and a strong answer takes that view seriously rather than dismissing it. In a panel interview, this question often follows a story about a patient or a family member. In a multiple mini interview (MMI), it can appear as a quote station that gives you both views and asks which a society should hold.

How to structure your answer

1. Define addiction by its clinical name, substance use disorder, and state the current medical understanding of its causes.
2. State the strongest form of each view, including that the first use of a substance is usually a choice and that the loss of control which follows is not experienced as one.
3. Name the stakeholders: the person with the disorder, their family, the clinicians who treat them, the public that funds treatment or prisons, and their community.
4. Trace each view to its consequences, such as whether a society funds treatment or punishment, whether it supports harm reduction, and whether a patient tells their physician the truth.
5. Take a position on whether the view matters, and say what evidence would change it.
6. Close with what the view means for a patient in front of you, such as whether they come back for a second appointment.

Harm reduction means measures that lower the harm of drug use without requiring abstinence first, such as naloxone kits, which reverse opioid overdoses, and needle exchange programs. Whether a region funds supervised consumption sites varies, so know what exists where you're interviewing.

Say "a person with a substance use disorder" rather than "an addict", because the words you choose are part of what the interviewer is assessing. If a family member has lived with addiction, you can draw on it, but keep the focus on the reasoning. With three minutes, spend one on the two views and two on their consequences and your position.

Common mistakes

• Dismissing the choice view as ignorance tells the panel you can't reason with the many patients and families who hold it.
• Calling addiction only a disease, with no room for the choices a person makes in recovery, leaves out the agency that treatment depends on.
• Using words like "addict" or "junkie" shows the panel the stigma they're screening for.
• Answering only whether addiction is a choice, and skipping whether the view matters, leaves the actual question unanswered.
• Treating the question as abstract, with no patient, family or policy in it, misses the reason it's asked.

Follow-up questions to prepare for

• If addiction is a medical condition, should drug possession be a crime?
• Should a patient who keeps drinking be offered a liver transplant?
• How would you respond to a colleague who said a patient "did this to themselves"?
• Does the same reasoning apply to gambling, or to smoking?
• Where does personal responsibility fit in your view?