I will do you one better on that. I mean, yeah, it does make sense to think of addicts as people trying to escape intolerable pain. But that is not even the half of it.
Our drug problem is actually a toxic childhood stress problem, and a shitty life circumstances problem. This is true for all drugs, and alcohol, but for this ask I’ll limit myself to opioids.
Let’s look at it this way: In the 1960s and 70s, hundreds of thousands of American troops were stationed in Vietnam during a war that was incredibly difficult and stressful for them. They also had easy access to a great many drugs which were illegal back home. In Vietnam, about 40% of service members tried heroin at least once. About 20% were heroin addicts in Vietnam.
When they got back to the US, 5% of the people addicted to heroin continued to be addicted to it and sought out illicit heroin to use. Use of heroin among Vietnam veterans in the USA was equivalent to the overall rate of heroin use in the USA. 95% of the heroin addicts suddenly stopped being addicted to heroin when they got home. This abrupt cessation occurred in pretty equal rates between people who went into detox and rehab, and people who quit cold turkey and didn’t get any treatment.
(For perspective, about 6% of the USA’s population today has some sort of substance abuse disorder; about 1% of Americans are addicted to heroin or prescription opioids.)
Drug use after Vietnam was not a fluke. For a large number of people, the amount of stress in your life (including being in pain all the time) is the major determining factor in whether you’ll be addicted. It’s why it was relatively safe to prescribe opioids up until the opioid itself became a source of stress. The vast majority of people will go, “Gee! Thanks for the highly pleasurable and addictive substance! Still, though, my surgery site has stopped hurting, and I’d like my brain back now, so I’m gonna stop taking it.”
Who stays addicted? Who keeps injecting opioids until the amount of pain the drugs cause (abscesses, blocked veins, social ostracization, violence…) far exceeds the physical pain they take away?
Are children who had toxically stressful childhoods. There are several different responses to growing up neglected, abused, or surrounded by poverty and dysfunction, but escaping unscathed is a lot less common. Lack of proper nurturing, and exposure to violence, are major triggers for addiction. Because basically, that kind of trauma wires your brain to deal with trauma and stress; you can grow up with your brain literally set to feel like a soldier in Vietnam every day of your life. So a lot of chronic addicts are in constant, unremitting psychological pain all the time, and their substances are what make that feel temporarily better.
This is why the most effective treatments for opioid addiction are largely replacing street drugs with safe, legal opioid alternatives like methadone or buprenorphine, or just giving them the fucking heroin. Kind of like how if oxycontin users had been given one extra pill a fucking day, there wouldn’t have been THAT boom in addiction. (ノಠ益ಠ)ノ彡┻━┻
So yeah! I forget what my concluding thought would have been, because now I just want to burn the entire War on Drugs to the ground and piss on Richard Nixon’s grave. But! If you want to learn more, I recommend Gabor Maté’s book In the Realm of Hungry Ghosts.
I also strongly recommend the writing of Maia Szalavitz on the topic–she has a lot to say about the way that many addiction treatments, most of them not evidence-based, are really counterproductive when it comes to actually helping addicts deal with the source of the problems that make the addiction grab them all the time. Her book, Unbroken Brain, is particularly good in that it tackles some of the things that often go totally unremarked when it comes to toxic stress–for example, stressors like undiagnosed neurodiversity issues and isolation. And she’s got some very interesting points about the onset of addictive behaviors.
Fuck the War on Drugs, basically.
High Price by Carl Hart is another good read on the psychology of addiction. He specifically focuses on the importance of a social safety net and accessible social services to reduce trauma and poverty at the root of the problem.
Loki is the Philosopher King 