In simple terms, an addiction happens when someone loses control of his or her consumption. On these webpages, I will try my best to demystify addiction.
Addiction is related to but not the same thing as Tolerance, Physical Dependence or Withdrawal. Many patients on long-term pain medications develop tolerance to the medication, requiring higher and higher doses to obtain the same degree of pain relief. They also become physically dependent on their opioids - if they cannot get their medications, they will go into withdrawal, which is very similar to what heroin addicts go through when they cannot get their heroin. However, in order to be considered addicted, the patient needs to meet the Three "C"s.
Addiction is related to but not the same thing as Tolerance, Physical Dependence or Withdrawal. Many patients on long-term pain medications develop tolerance to the medication, requiring higher and higher doses to obtain the same degree of pain relief. They also become physically dependent on their opioids - if they cannot get their medications, they will go into withdrawal, which is very similar to what heroin addicts go through when they cannot get their heroin. However, in order to be considered addicted, the patient needs to meet the Three "C"s.
Compulsion or Cravings
The addict is obsessed with getting their drug/medication. The drug/medication is almost constantly on their mind, or at the back of their mind. Addicts spend a lot of their time and energy around getting and using their drug/medication. They often plan their activities around their addiction, planning how, when and where to get their drug.
Control
Loss of control is another key feature of addiction. The addict has lost control of his/her consumption. A social drinker is able to control his/her drinking and stop after one or two drinks, or choose not to drink on any given day. By contrast, an alcoholic is unable to control his/her intake of alcohol or cannot stop drinking. Similarly, someone addicted to opioids loses control of their drug consumption. Addicts need their drug and no longer can do without it.
Consequences
The addict continues to use even in the face of terrible consequences. Smokers often continue to smoke even though they have already had a heart attack, emphysema or even cancer caused by smoking. Similarly, people addicted to opioids will continue to use despite severe financial hardships caused by their addiction, facing the possibility of arrest or incarceration, and risk even fatal overdose. Even financial ruin, the loss of their kids to DCS, risks of Hepatitis or HIV, etc. is often not enough to stop the addict from using.
The addict is obsessed with getting their drug/medication. The drug/medication is almost constantly on their mind, or at the back of their mind. Addicts spend a lot of their time and energy around getting and using their drug/medication. They often plan their activities around their addiction, planning how, when and where to get their drug.
Control
Loss of control is another key feature of addiction. The addict has lost control of his/her consumption. A social drinker is able to control his/her drinking and stop after one or two drinks, or choose not to drink on any given day. By contrast, an alcoholic is unable to control his/her intake of alcohol or cannot stop drinking. Similarly, someone addicted to opioids loses control of their drug consumption. Addicts need their drug and no longer can do without it.
Consequences
The addict continues to use even in the face of terrible consequences. Smokers often continue to smoke even though they have already had a heart attack, emphysema or even cancer caused by smoking. Similarly, people addicted to opioids will continue to use despite severe financial hardships caused by their addiction, facing the possibility of arrest or incarceration, and risk even fatal overdose. Even financial ruin, the loss of their kids to DCS, risks of Hepatitis or HIV, etc. is often not enough to stop the addict from using.
Addiction is a Mental Disease
Many people think of addiction as a moral failing, thinking of drug addicts as dirty criminals, untrustworthy and despicable. The truth is that drug addicts come in all varieties from physicians and lawyers to the person next door; from criminals serving long prison sentences to the policemen who arrested them. They can be teenagers or elderly people in their seventies. They can be respected professionals or homeless people on skid row.
Addiction = Bad Choices?
Many people view addicts as criminals who keep making bad choices, seeking just to get high. This probably does describe some, but certainly not all addicts. Addictions are NOT simply a matter of bad choices. I have heard some of my colleagues say things such as "Nobody puts a gun to their head to use drugs." But, addiction is not merely bad intentions and no motivation for change. Many addicts desperately want to get clean.
To make a comparison, I have personally known three physicians who couldn't quit smoking - they included a cardiologist, a lung specialist and a cancer doctor. These were not stupid people who did not understand the dangers of smoking or were not motivated to quit. They were very ashamed of their addiction and desperately wanted to quit.
Wanting badly to quit is not enough. How many overweight and obese people join gyms and Weight Watchers every January 1, determined to lose weight and willing to commit significant amount of money to do it, yet fail only a few weeks later? Did someone put a gun to their head to eat a doughnut? Similarly, heroin addicts do not deserve our scorn or contempt but our compassion and our help.
Furthermore, in the section on Tolerance and Withdrawal, I outlined some of the many paths to addiction that sometimes never involved the "bad decision" to get high but simply developed out of a tolerance to lawfully prescribed pain medications. Even those who did become drug addicts because they wanted to get high do not deserve our scorn, especially when they truly do want to become clean again. Addicts in treatment deserve our admiration for making the courageous decision to try to get clean rather than our contempt. Escaping addiction is not an easy task and they might falter. Even then, these patients should be treated with dignity.
WWJD?
For those readers who identify themselves as Christians, I would suggest that heroin addicts of the 21st Century are directly analogous to the lepers of Jesus' day. Just like heroin addicts today, lepers at the time of Jesus were feared and shunned by society, cast aside, considered dirty and even criminal. Yet, Jesus treated them with dignity and compassion. Should we not treat heroin addicts similarly?
Don't ask WWJD (What would Jesus do?) - This is WJWD (What Jesus Would Do).