The myth of addicts’ power over actions

By Marshall Allen

Thursday, Nov. 6, 2008 | 2 a.m.

We don’t consider it a moral failure if a diabetic can’t control her blood sugar level.

And no one finds it shameful when someone with diarrhea can’t control his bowels.

So why do people blame addicts for taking their substance of choice?

The answer highlights one of the greatest myths and misunderstandings about addiction, according to medical experts.

People who think addicts are making willful decisions to ingest their substance of choice don’t know the science behind the disease of addiction, said Dr. Mel Pohl, a Las Vegas addiction expert and author of the book “A Day Without Pain.”

“It’s a medical disease,” Pohl said of addiction. “There isn’t any medical organization that doesn’t understand that. It really is a lack of information that commits people to believing that it’s a choice that’s related to self-will.”

And yet, the myth is propagated incessantly, evident by readers’ reactions to an ongoing investigation by the Las Vegas Sun that has identified a prescription narcotics crisis in Las Vegas. A Sun analysis of Drug Enforcement Administration data showed that Nevada ranks No. 1 among states for per capita consumption of hydrocodone, the drug in Lortab and Vicodin, and No. 4 for per capital consumption of methadone, morphine and oxycodone, the active ingredient in OxyContin.

Readers are quick to blame prescription drug users for their addictions.

One reader, claiming to be a pharmacy technician, wrote on the Sun’s Web site of one addict: “No one forced her to take so many meds that she OD’d. Addiction is a CHOICE. No one and nothing forces ANYONE to pop a pill, shoot a balloon of heroin, snort a line of coke, take a drink, etc. Regardless of ANY doctor’s actions, the ultimate responsibility lies with the patient.”

Pohl said he can understand why people hold such opinions, but they are wrong. Many people abuse substances without becoming addicted, but an estimated 15 percent of users — no one knows exactly how many — become addicted. Addicts have a genetic predisposition to a short circuit in their brain that allows their rewards system to be hijacked by certain substances.

The reward system of an addict’s brain drives the person to consume the drugs at the expense of anything else, even eating or sleeping, he said.

Dr. Jim Marx, a Las Vegas addiction and pain management specialist, said scientists have done addiction experiments in which animals will give themselves doses of medicine — and ignore the food by their side — until they starve to death.

“That’s the issue with addiction,” Marx said. “It will overpower any other urges you have. At that point, does the person have a choice? I guess they do have a choice to a certain extent, but the chemistry will override that.”

Pohl, who has worked with thousands of addicts, said it’s common for family members and friends to blame the drug addict because the behavior has had such a negative effect on so many people. Drug addiction destroys relationships, he said, because the addict will do anything — lie, steal, break laws — to get the drugs.

Addiction is a chronic disease that can’t be cured, Pohl said, because an addict still craves the drug when it’s absent.

When addicts overdose on prescription drugs the doctors who wrote the prescriptions don’t directly cause the death, but they are complicit in it, Pohl said. That’s why doctors must screen for addiction and survey patients to ensure they’re taking them in a manner that won’t cause harm, Pohl said. When prescribing potentially addictive and deadly drugs such as narcotics, he said, doctors should have a plan to ween the patient of the drugs.

“I don’t think most doctors do that,” Pohl said.