is Addiction a Conscious choice? Nurse's point of view

I took care of a patient a while ago. Younger than me and admitted for a bleed caused by ruptured esophageal varices. Esophageal varices are caused by severe liver disease - significant amount of cases are related to alcohol abuse. Blood cannot pass through the liver due to blockage or presence of scar tissue and so it backs up causing bulging blood vessels in the esophagus which can rupture at any point causing life-threatening bleeds.
I will never forget the face of this patient - full of fear and terror yet appearing withdrawn at the same time. I've seen this look before and I've seen it in patients who sensed that they're at the end of their journey. The sheer terror in one's eyes is not something you easily forget.

The bleed was so severe that the blood pressure was dropping fast from volume loss and heart rate skyrocketed since it now has to work harder to distribute the remaining blood to all of the tissues. I noticed several emesis bags in the sink full of bright red blood and knew immediately this is going to be a tough case. We rushed to prepare the room and intubation equipment and got extra nurses and tech support just in case. Once the scope went in I was shocked to realize how hard this case was going to be - the bleed was so severe you could not see anything on the camera. I'll spare you the details because describing what I saw and sounds I heard - is horrifying to those who do not work in healthcare. It took over an hour to band those vessels to stop the bleed - during that time we had to transfuse a lot of blood but the patient made it through the procedure. We arranged for the immediate transfer to intensive care so the vital signs can be stabilized from a massive blood loss. Success I thought, this person was granted another chance in life. However, when I went back to work a few days later I received the tragic news that this patient could not be stabilized and ended up passing.
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Why is this case significant? Because as a society we often look at people who struggle with addiction and conclude that they had made their conscious choices. But is this the entire truth? Were the choices really conscious? I remember one of the anesthesia providers telling me about the time he worked in the rural hospital in a community that was severely socioeconomically disadvantaged. He described children being born to mothers under the influence of street drugs, mothers who overdosed on drugs and even completely passed out from alcohol use. What future does a child have when born into a home like that? Do we think this child will grow up in a home full of love and support? Will they be carefully nurtured, hugged, tucked in at bedtime and told that they are loved? Will they be told about the importance of self-love and respect for their own bodies so that they don't reach out for substances that can severely impact their health for life? Will they be taught right from wrong or will the "wrong" we perceive as society become their every day life since that's what they grew up seeing on a daily basis?

How easily we pass judgement onto others without walking a day in their shoes. Does the infant licking clay off of the floor from hunger or spending days in the same soiled diaper will have a fair chance at life? Is the same chance in life be guaranteed to those children who are physically, verbally or sexually abused on a daily basis? Will the society understand the effects of the psychological trauma, lack of proper nutrition or substance abuse early in life on their brain development? I can tell you that growing up in constant fear and terror will have severe negative psychological effects which will later emerge as depression, anxiety, aggressive behaviors or addictions.

Understanding my own trauma allowed me to view people in a completely different light. People often ask how can we provide compassionate care to violent prisoners, drug addicts or alcoholics who end up in Hospital due to their "own" choices. Well, I guess now you know how.
When I first saw that patient and the look of the pure terror in their eyes - I did not see an alcoholic whose "conscious actions" led to their death. Instead I saw a suffering human being who most likely lived through devastating events or situations which ultimately led their life in this direction. And then, I felt sadness in my heart for the tragic loss of life, life lost too soon, life lost unnecessarily.
I felt it was necessary for me to share this with you because our society is breaking apart and maybe what we really need is less judgement toward one another and more love and compassion for each other. I might be naive here but I feel like love, mutual understanding and respect for one another - are probably the only way out of this mess.

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