PORTSMOUTH – With much in the news lately about the opioid epidemic, medical experts often find themselves at odds with the stigma of addiction and with convincing the public that addiction is a disease and not a character flaw or weakness.

Whether it is heroin or alcohol, there is a segment of the population that believes substance abuse addiction could never happen to a “good” person, and that the addict should be capable of simply stopping. Nothing could be further from the truth.

Addiction is a disease and can affect anyone, in any segment of the population. While there may have been an element of choice — choosing to drink or choosing to try drugs, that choice can be quickly taken away and the addicted person will lose control of the ability to make a choice about his or her addiction.

Dr. Will Torrey, professor and vice chairman of clinical services for the department of psychiatry at Dartmouth-Hitchcock, said that while it is fairly common for people to consider addiction a result of willful misconduct, he said it follows the typical pathway of a disease.

Torrey said addiction follows a predictable course and has a real genetic component. He said many people drink alcohol and have no problem, but if they are closely related to someone who has an alcohol problem, they may be predisposed to have a drinking problem, up to 50 percent more likely than a person with no genetic component in their family history.

“When you think of the human body, we know the brain has pathways that recognize pain and that keeps us away from bad things,” Torrey said. “The brain also has pleasure receptors, which helps us to recognize things we want to do more. It is designed for normal human activities and is part of how we are built. When we use substances like drugs or alcohol, it can also trigger these receptors and we can get a positive response. It makes people want to do more.”

Torrey said substances like opioids hit the brain’s pleasure receptors hard and it is then that people get into trouble.

“The substances themselves make change to the body,” Torrey said. “They have an impact on, and change the brain. People smoke cigarettes and some get lung cancer. No one would argue the connection there.”

Justin Looser, director of Behavioral Health Services at Portsmouth Regional Hospital, said substance abuse moves out of the realm of individual control when it begins to take over the person’s decision-making capabilities.

Looser said studies of the brain show that certain areas of the brain are highlighted in addicts who are using that are not highlighted in people without a substance abuse problem. He said the changes indicate that in order to treat addiction, it must be recognized as a disease.

“We know it is a disease,” Looser said. “Insurance companies know it is a disease and most cover addiction services as a valid diagnosis. End stage addiction is never pretty. People do not come in feeling great. They would stop and regain their lives if they could. Without medical intervention, they can’t. They may have started as a choice and there is some truth to that. But when we see them, that choice is long gone.”

Addiction leads to behavior changes.

“The addict spends a great deal of time craving the substance they are addicted to,” Torrey said. “It overwhelms them and eventually overwhelms all aspects of their life, their work, their home life and their relationships. They will start using in ways that are physically risky.”

Once that happens, Torrey said, it requires a great deal of commitment and help to change the behavior.

“No one wants to be an addict,” Torrey said. “No one sets out to become one. It’s not fun at all. The person feels terrible and out of control. It really is not a state that anyone is seeking.”

There is an Alcoholics Anonymous adage that Looser quotes. It says, for an addict, one is too many and 1,000 is not enough. There is no clear stopping point for an addict.

Torrey said addicts are drawn into predictable behavior patterns. Getting better has a lot to do with how far along they are in the addiction process.

“Some people can be advised that they are getting into a bad situation and they can stop,” Torrey said. “But for those who are heavily into their addiction, intervention is needed. The staff at health care settings see the people who are having a real hard time quitting, who are extremely addicted.”

While alcoholism is tough to treat, Torrey said opioids have a more negative impact on the brain much more quickly. He said they become addicted faster and are in greater danger of dying from an overdose.

“A lot of people do expose themselves to substances they probably shouldn’t,” Torrey said. “The difference comes when something grabs on to them and they lose control of their own decision-making. We are not responsible for any health condition that strikes us. We are responsible for taking the action we need to try and address them, and (that) includes addiction. For many, that means understanding, by them and by their family, that they are now in the midst of a disease. The addict is not only hurting himself. He or she is hurting the people around them who love them. It’s not their aim, but it is what happens.”

When a patient comes into PRH for detox services, Looser said they understand there is a network of family involved. He said, at first, that cannot be the focus.

“Relationships are put on hold,” Looser said. “We focus on the patient. We will detox and treat them. Then we work in groups for peer recovery and finally a good maintenance program is needed.”