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Ritual
Another important element of addiction is ritual. As simple, as eliminating the rituals that accompany the addiction can be enough to cause the addiction to lose appeal. Powerful aspects of the addiction are obtained from the ritual itself, such that without it, the behavior or substance no longer is accompanied by euphoria. Heroin is a good example. The ritual of injecting heroin and the lifestyle involved in the pursuit and use of the drug is a part of the addiction. Taking away these components, as is done in methadone clinics, often reforms addicts on these bases alone.
The essential role of ritual has been well studied in narcotic addicts by Light and Torrance (1929). They reported that narcotic addicts could have their withdrawal symptoms relieved by a single prick of a needle, or an injection of sterile water. They postulated that the greater the addiction, the more likely to obtain temporary relief from the ritual of injection without the chemical support. Since then similar studies have looked at smoking. Nicotine administered directly by ingestion or injection does not have nearly the same affect that inhaled nicotine does for smoking addicts. Along the same thread, smokers will continue to smoke long after the level of nicotine to achieve the desired affect is reached. Clearly the ritual of injection and inhalation in the case of narcotic addiction and smoking, respectively, play an important, even an essential, role in the addiction.
Developmental Variations
As people advance through life, their reactions, need for, and style of drug use change. The classic form of this phenomenon, originally hypothesized by Winick (1962), is termed maturing out. As they accept adult responsibilities and assume adult roles, the majority of young addicts will leave their chemical addictions behind. The more readily available the substance, however, the less chance that this will occur. Alcohol is much more readily available than heroin, and, although it also shows a tendency to mature out, it does so less dramatically. Those addictions, such as smoking, that are easily incorporated into one's lifestyle do not commonly have a tendency to mature out. In fact, as individuals with these addictions age, the habitual nature of the addiction makes it even more difficult to stop the addictive behavior.
Personality Differences
Before the 1920's, people were convinced that opiate use caused personality defects. At that time, investigators began to challenge this notion and concluded that these defective personality traits actually preceded the drug use. It was ascertained that to neurotic and psychopathic people opiates offered an escape from the realities of life that did not bother psychologically fit individuals. Thus, the drug use was an answer to their pathology, not a cause for it. A study done by Chein et al (1964) drove this point home. They noted that low self-esteem, learned incompetence, passivity, a negative outlook, and a history of dependent relationships characterized ghetto adolescent addicts: clearly individuals with an already burdened outlook on life.
There is no doubt that individuals are predisposed towards some types of addiction based on their personality. Some have tried to predict addictive behaviors based on personality traits. Efforts to unveil an overall addictive personality type have failed, but there are clearly some similarities. Addicted individuals often do not value achievement, they desire instant gratification and they complain of higher than normal levels of stress. The argument that an individual has an addictive personality is strengthened, though, when one considers that the same individuals become addicted to many things, whether simultaneously or sequentially. Furthermore, it is commonly seen that an individual addicted to one depressant is also addicted to another, or will subsequently become addicted. For example, individuals often leave behind a narcotic addiction in favor of an addiction to alcohol. Lastly, the notion that addiction is personality driven is solidified when one considers the habits of reformed addicts. Strong compulsions towards eating, prayer, and other non-drug involvements are classically seen among reformed heroin addicts.
Cognitive Bias
An individual's reaction to drugs is strongly influenced by many things. Expectations, beliefs, and behavior of surrounding people that affect the individual's mental set all contribute. These factors can be so imposing that they can overcome the pharmacological properties of the drugs. The efficacy of placebo demonstrates how cognitive bias can create expected drug effects. In some individuals, placebos can be as powerful as painkillers such as morphine. Cigarette smokers claim that smoking relaxes them, despite the fact that nicotine is a stimulant. In a study done by Zinberg (1974), subjects given nicotine infusions did not become addicted once released from the hospital because they did not believe themselves to be addicts.
