With all of the people in Guernsey County who have fallen afoul of the law because of illegal drug use, the temptation looms to simply dismiss them as scofflaws or, even, as criminals. By continuing to use drugs, they have made a choice. Or have they?
Do they exercise free will, or are they compelled to use drugs? In other words, is addiction a choice or is it a disease?
"Our position is that it is a disease," Misty Cromwell said. Cromwell is associate director of the Muskingum Area Board of Mental Health & Recovery Services.
"Drugs have been proven to change the brain chemistry," she said.
She and her associates are not the only ones who believe addiction is an illness.
"I call it a brain disease," said Karen Wiggins, executive director of Alcohol and Drug Services of Guernsey County.
"I call it a disease because the brain is rewired," she said. "Everything we do is dictated by our brains. They've done research after research after research. Once you become an addict, you will always be an addict."
That doesn't necessarily mean, however, that one's fate is sealed, she said. (More on that later.)
In many cases, what makes addiction so pernicious is that, too often, people become addicts at a young age, Cromwell said. Sometimes, youth as young as 11 or 12 years old become addicted.
"A teenager's brain is not fully developed," Cromwell said. "And drug use interrupts that development."
With the changes in brain chemistry, how the addict functions and makes decisions becomes ever more flawed.
"Their brain development has been arrested and they have no control over desires and impulses," she said.
"Their drug use began as a choice, but as they grow older, they have less control. That's why we're trying to ramp up prevention as early as we can."
But many people also become addicts as adults, Wiggins said. And, sometimes, their addictions result not from a choice, but as a side effect of another situation. For example, people who have been injured because of an accident or who are in pain because of a surgery become addicted to pain pills.
Then, after they have recovered from their injury, they are unable to obtain the pain medicine by prescription. Because the opiates in that pain medication can cause a physical addiction, the newly addicted become extremely sick from the withdrawal symptoms.
"So, when somebody is so addicted and they're so afraid of that physical sickness, they are forced to turn to heroin because they are so sick," Wiggins said. "They're not taking it to get high. They're taking it to stay well, so they can function."
Wiggins elaborated on the changes to the brain functioning.
"When people become addicted, a different part of the brain is in charge," she said. "It's more the limbic system which is in charge of such bodily functions as breathing and heart beat. It's the part that kicks in for survival.
"The simplest way to explain it is that, when that is in charge, it trumps your frontal lobe. The whole brain is triggered differently."
The brain never fully reverts to normal functioning, she said. Even addicts who have been in recovery for 10 years or more remain susceptible. When those recovering addicts undergo magnetic resonance imaging tests and are shown pictures of drugs, the images of their brains light up in the limbic area.
"The recovering addicts' brains actually start to secrete dopamine with the memory of that," Wiggins said.
"I know people who are recovering addicts and they are the strongest people I have ever met in my life. They're literally working against their own brains. Once you become an addict, you will always be an addict."
So are their fates sealed? Is there no hope? Are they doomed?
Not necessarily, Cromwell and Wiggins agreed.
"We try to get them in rehab long enough that they can begin to reverse that understanding that they are going to be in recovery the rest of their lives," Cromwell said. "They are no longer able to make rational decisions without long-term support systems."
A recovering addict is not fated to relapse into drug use, Wiggins said. In rehabilitation, they slowly learn the skills to combat their drug predilections.
"They get better and stronger as time goes along," she said. "We have some wonderful people. They've done bad things with their addiction, but they're good people. We just have to help them become who they were supposed to be before addiction robbed them."