Drug addiction- the eternal riches to rags story.

I am looking at a patient who was a pharmacist, and after starting his heroin use around 10 years back(for which there are hundreds of reasons- curiosity, cheated in cigarettes, sex..) he is living in the streets as a beggar for years. His family has forsaken him. He is so weak that he cannot even work as a manual laborer but somehow he manages 100-200 Rs per day for heroin. Pick pocketting, mugging who knows..

I differ with you when you say that if he is suffering its his fault-10 years- there was lot of time to change or to take control of his life.
He may have done one thing wrong in his life- that he first tried heroin. But I don’t think he would have tried it if he was able to see 10 years into the future.

What makes him do what he does?

There is a part of our brain called 'reward and reinforcement system'. When you take nicotine, alcohol, heroin etc dopamine is secreted into this pathway and you get the feeling of fulfillment.
After taking the substance for the first time its memory is imprinted in your amygdala and you run like the donkey after the carrot forever after it. Along with it, due to chronic use, you get conditioned like the pavlovian dog to expect the substance in situations where you have earlier used it. Like the feeling that you should smoke after the food.
I have seen a patient who vomits every time he sees a medical store where he used to buy fortwin injections earlier.(vomiting is a sign of opioid
withdrawal)
You become like a zombie who has only on e aim in life- to satisfy his hunger for drugs- you will be so desperate that you will lie, cheat, steal and murder for it.
All the callousness that you see in a drug addict was not there in the first place. They attain it over time. They subconsciously learn what behaviour earns them money- brings them drugs.

If there is a hell on earth it is this, it is this...