Addiction is thought to be due to a proclivity to become addicted that the individual brings to the situation, and which remains in that person even if they manage to control its expression, which is always "one day at a time."Yes, that's the view of AA, NA and associated groups.
The addictive personality can develop an addiction to any number of activities, not just drug abuse. There are people addicted to tanning and others addicted to cell phone use.
When their addiction is to substances in which dependence may result, the addict develops dependent on the drug, which amps up the addictive behavior, as withdrawal sets off drug seeking behavior - gotta get a fix.
I was taught that about 6% of the population had this proclivity. They were the most difficult pain patients, because we really have no better drugs for chronic severe pain than narcotic analgesics.
And where you and I could use these drugs even for months at doses sufficient to cause drug dependence - say after being severely burned - once the need to use them resolved, we would go through withdrawal, but not crave or seek the drugs thereafter. In fact, we would not be enjoying the drugs, just the pain relief. Most such people hate the other effects of the drug, including the mind-altering effects.
Let me share some of the problem from the prescribing physician's perspective.
When the addiction prone person has the same need and they commonly do, as the addictive personality leads to getting hurt, maybe on a motorcycle when intoxicated, or in street fights, or falling off the roof of a pharmacy while trying to break into it while high and Tylenol and ibuprofen just dont cut it, we have to use narcotics. This was always a horrible predicament for everybody, including the treating physician, who has an ethical obligation to treat the pain adequately. You can probably imagine how law enforcement feels about us prescribing narcotics to such people.
The people who hold the jailhouse keys, who are not trained in pain medicine or addiction medicine, are happy to nab a doctor if they feel that he is contributing to the problem. We were reassured that the authorities were only interested in physicians who were not practicing medicine, but were doing something else. But guess who gets to judge that? Ultimately, other physicians are involved, but its police who will call in regulatory agencies such as the DEA and state medical board on whim. Furthermore, such agencies only advise the police. They do not have authority over them.
The combination of the fear of harming the addict with such prescriptions, and of regulatory sanctions keeps a lot of people in pain from getting adequate analgesia.
From Chronic Pain and Narcotics - A Dilemma for Primary Care at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1...
A national survey of nearly 7,000 physicians in multiple specialties indicated that the negative effects of opioids and concerns over regulatory consequences inhibit many from prescribing narcotics for patients with nonmalignant chronic pain.
And once the addict has been accepted as a patient, he is educated in gaming the system. Then the real fun begins. Hell be back even when he doesnt hurt as much, with the same story. He knows that cant read minds and have no objective test for pain - yet. PET scans may solve that dilemma soon.
One more wrinkle: pseudoaddiction. Nonaddictive types like you (I presume) and I may have trouble being believed and in getting adequate treatment for severe pain because of the addicts. This leads to you guessed it drug seeking behavior, albeit legitimately. Such people are often forced to go to the street for drugs for relief. Then they get arrested. Its a horrible little part of modern life for everybody involved. If only we had good analgesics that didn't create euphoria and dependence.