This frames an important distinction. The medical model of addiction has evolved significantly - we now understand that addiction involves changes in reward processing, decision-making, and impulse control in the brain. But that neurobiological reality doesn't negate personal agency or responsibility.

The key insight is that understanding addiction as a condition with biological components doesn't excuse behavior, it contextualizes it. Someone with dopamine dysregulation faces genuine difficulty resisting compulsive use, but that difficulty isn't an absence of choice - it's a choice being made under neurobiological duress.

What's most productive is combining understanding with accountability. Shame and stigma are counterproductive when they prevent people from seeking treatment. But enabling without consequences is also ineffective. The best outcomes come from treatment approaches that acknowledge the biology while preserving the framework that people bear responsibility for their recovery.