Since the "Hooked" stories began, I've had several emails about the issue of choice in addiction. Some people say addicts are weak and self-centered, that addiction is a personality flaw. On the other side of the spectrum people write to say that addiction is a disease that people cannot control.
I thought it might be useful to look a little deeper into the mechanics of addiction to help think about this question.
Heroin addiction is a combination of psychological and physical dependency. Heroin produces a sense of emotional calm, soothing and well-being. Withdrawal symptoms are just the opposite. Psychologically, an addict craves the high and fears withdrawal.
Heroin also has serious physical effects, according to scientists who have studied its effects in the brain. Heroin and other other opiates stimulate the same receptors in the brain as endorphins, the feel-good, pain-numbing chemicals human bodies naturally produce after exercise or during child birth or because of stress.
Long-term heroin use increases the number of receptors for opiates in the brain. This creates a tolerance, so more drugs are necessary to get high. When the addict withdraws from heroin, the body can't produce enough natural feel-good chemicals to stimulate all those receptors. This leads to withdrawal symptoms and strong cravings. In a way the brain gets rewired for addictive behavior. For a while it's hard to feel good without drugs.
Eventually, doctor's say, the body can come back into balance. But the risk of relapse lasts a lifetime.
Certainly there is an element of choice in seeking out drugs, but can it become something someone cannot control? Someone told me that the best case scenario with heroin addiction is that someone can learn to manage it, just like they might manage diabetes. They learn how to avoid using, just like someone with diabetes learns to avoid sugar. But they never out live the possibility of relapsing. Like a disease, addiction is permanent.
What part does choice play in addiction? Are there things that addicts can't control?