(The bulk of this material is covered in Chapters 4 and 16 of the book.)

Yes, many drugs elevate mood. That’s why people talk about using drugs to get “high.” That’s why many people think of drug addicts as crazed, selfish, irresponsible monsters who would sell their own souls for pleasure, at the expense of their children, society, and their own health. 

But it’s not true! Yes, drugs can elevate mood, but drug addiction is fueled not by chasing pleasure but by seeking relief. 

Most people use drugs not to raise their mood from normal to some crazed state of happiness but to raise their mood from terrible toward normal. They use drugs to ESCAPE bad feelings. “High” is not a state of bliss but a state of numbness. The more unbearable their lives, the more they feel they need to use drugs. 

Look, I’m not saying people don’t enjoy the feeling they get from drugs. Addicts will admit they like to feel high. But let’s look at the example of alcohol. People obviously like how alcohol makes them feel. Otherwise, why would there be so many bars in America? But people don’t become alcoholics just because they like that feeling. The descent into alcoholism begins when people start using alcohol to deal with their problems, to stop feeling bad, to feel numb. (See Chapter 16 of the book.)

Opioids are even stronger than alcohol. Opioids are the most potent painkillers on Earth, and they are just as effective at numbing psychological pain as physical pain.

But here’s the problem: I ask my patients, “When was the last time using drugs solved any problems for you?” The only answer I ever get is, “Never.”  Once a person becomes addicted, the bad feelings they are trying to escape from keep getting worse. 

Someone I know once told me that she found sobriety after she realized she had to stop running away from problems and start running toward solutions. That’s so true! But it is also very difficult to stop running away from pain.

When you understand that people use drugs to escape bad feelings rather than to pursue selfish pleasure, maybe it becomes a little easier to see them as suffering human beings. I am a physician. The word “patient” comes from the Latin word “patiens” which means “one who suffers.” The addicts I treat are patients in the full sense of the word. They need help and caring, not scorn.

To the haters out there, you have no right to judge addicts if you have never been raped or abused, if you did not grow up in the ghetto, or in a highly dysfunctional family. Lucky people have no right to look down on the unlucky.