Frequently, though, many people in my life who are familiar with my horrid drug and alcohol odyssey still offer me a drink. I understand that it’s not their responsibility to worry about my addiction, but it still strikes me as odd. I’m often asked why I can’t have just a glass of wine or why I still consider myself an addict when I’ve been clean for so long. They’re surprised that my cravings never went away, and perplexed why it is still difficult for me to be near liquor.

For 15 years I was a heavy drug and alcohol user. After trying to quit repeatedly—and failing miserably—I finally asked for help in 1988. My recovery began with spending 31 days in a rehab, then decades of therapy, plus 28 years of surrounding myself with sober addicts who “get it.” Am I cured? No. But I’m grateful for the daily reprieve.

It seems that no matter how many articles are written and read, and documentaries made and seen, those who do not suffer from addiction have an inability to relate to my illness. I decided to post a query on Facebook: What is the hardest thing to understand about those that suffer with addiction? 

Within two days I had 100 responses. Here are the most commonly asked questions and my answers for The Fix. (Note: These are my answers and represent my experiences and feelings and those of the many addicts and alcoholics I have met in nearly three decades of being in recovery communities. Please note that not everyone who struggles with addiction or who identifies as an addict will have these same answers.)

Questions and Answers

Why do addicts have a skeptical view that others can use substances casually?

In many cases, it’s because we can’t. For me it is a combination of jealousy and disbelief. I minimized and denied my problem for so long, I can make the mistake of projecting my experience onto others and thinking they are in denial.

Heroin withdrawal symptoms sound like a flu. I’ve had really bad flus but I know it’ll end. What keeps heroin addicts from not just powering through it?

Addiction is a physical and mental disorder. Underneath many addictions is an underlying inability to tolerate negative feelings. Addicts believe in a substance in the way many describe believing in god. The substance is soothing, our best friend, our protector, the one thing that will take away our pain. It is mentally-ill thinking because whatever euphoria and pleasure we found at the beginning of our substance use is no longer attainable by the time we are deep into our addiction. But just like Pavlov’s dogs, we practically drool for our substance of choice. Without it, we fear the return of often paralyzing pain and depression.  Also, with heroin, the physical malady of quitting is horrific and we know that the one thing to stop it immediately is more heroin. If everyone who had the flu knew of one substance that would immediately take away the nearly unbearable symptoms, wouldn’t they be compelled to take it?

I can almost hear the non-addict saying, “But if I knew it was bad for me, I wouldn’t take it.” Yes, and that right there is the difference between a non-addict and an addict. An addict craves the very thing they are “allergic” to. The compulsion to use is so strong, it often wins out.

When an addict craves a substance, their logical mind is not working. They’re not thinking, “This is bad for me.” They’re thinking, “I need this right now. I must have it. I cannot go on another second without it.”

We don’t think about anything else in that moment. We are not able to care about our loved ones, or our health, or job, or beloved pets. The craving is the loudest thing in our head and forces every other thought out—including the thought that there will be horrible consequences if we use again.

What are the reasons people get addicted in the first place? How do the drugs make them feel?

When I was on a drug, it quieted down the noise of anxiety and depression in my head. The closest comparison I can think of is wrapping myself in a down coat when I was freezing cold. The substance seemed necessary. I found drugs and alcohol as a young teenager and they lit my head up like a pinball machine. At the same time my frontal lobe—the brain region that makes decisions like “Okay, you’ve had enough, go home and get some sleep”—might as well have been in a coma. It did not function when I was under the influence. The pleasure center always took over. When that happened, I basked in the euphoria and the absence of anxiety, self-consciousness, and despair.

Every addict I have ever spoken to in the past 28 years has understood that “noise in my head.” It was a constant gnawing of negative thoughts that I didn’t have the power to shut off. Along came substances that made all the negative chatter shut up. It was new and wonderful and a tremendous relief. It made me feel “normal,” i.e., like everybody else seemed to be.

How do genetics play a role? Why do some people in the same family become addicts while others don’t?

That is the $60-million-dollar question. Science cannot provide a definitive equation to explain how much genetics play a role in addiction and how much is determined by life experiences, but there are many educated opinions. Neuroscientist Dr. Nora Volkow of the National Institute on Drug Abuse (NIDA), believes that addiction can be explained by dopamine in the brain. Another addiction expert, Canadian physician Dr. Gabor Maté, believes “emotions are deeply implicated in both the development of illness, addictions and disorders, and in their healing.”

The National Council on Alcoholism and Drug Dependence (NCADD) states that genetics make up only 50% of the risk for alcohol and drug dependence.

For example, if one sibling underwent a trauma and the other did not, that might explain why only one becomes an addict. Another factor may be personality and it’s not clear how much a personality is formed by nature vs. nurture. There are a multitude of studies on this topic, but as we all know, studies need to be studied in order to determine their accuracy. Most studies can present facts in a way that support the author’s hypothesis.

Does sobriety become easier over time or is there always a temptation to use?

That depends on the particular person. I know many sober peeps who gave up drugs and alcohol and no longer wrestle with cravings. That hasn’t been the case for me. When I smell alcohol, I crave it. I’ve made sure to avoid any situation where someone might have cocaine and ask me if I’d like to snort a line. I don’t know how I’d react in that situation and I don’t want to gamble.

There are sober alcoholics who can bartend and people who were addicted to drugs who can deal drugs. That would never be possible for me. My desire to use remains strong. I stay sober by using the tools that I’ve learned and by staying away from temptations.

Why have a child or children when you are more interested in your addiction?

This question made me tear up. It was asked by a woman who is open about having been raised in an abusive alcoholic home. The phrasing relays pain and resentment. Sadly, it is an unanswerable question. Everyone’s situation is different and none of us believe that our addictions will take over our lives and hurt the ones we love. Most parents have the best of intentions for bringing a child into the world. If they are aware of their addiction, they probably don’t feel that it will affect their ability to parent. Perhaps the pregnancy was accidental and abortion or adoption did not feel like options.

I have chosen to live child-free for myriad reasons. One of the strongest was the fear that I might pass along addiction, depression and anxiety. For me, it was the right decision. My guess is that most parents do not have children with the intention of treating them horribly and causing them enormous pain, but sadly humans aren’t always equipped to take care of themselves, let alone their children.

Why do addicts drag their families halfway into the grave with them?

They don’t. Anyone who loves someone with an addiction needs to get professional help to learn how to protect themselves and their children. People in active addiction can be out of control and may hurt and manipulate the people closest to them.

Why does someone start?

The reasons are different for each person. For me it was a combination of curiosity and rebellion. I wanted to do what I wasn’t supposed to do, like some kind of rite of passage towards adulthood. I romanticized dead rock stars who’d lived fast and died young. I wanted to die because life felt too hard.

Can an addict see how sick they are when they look in the mirror?

Sometimes, but denial is a large part of any addiction. Many addicts lie to themselves. Most minimize, justify, and rationalize what they’re doing to themselves and others.

How is it so easy to lie about everything?

That is part of the mental illness. I believed my own lies. I also felt dissociated. I didn’t have a compass for right and wrong anymore. I ran on the fumes of need. One therapist described me as sociopathic. That may or may not have been true. I was traumatized by a gang rape at 13 by classmates. I became cut off from my feelings and reality. I was enraged and incapable of empathizing with others in a normal way.

Why do addicts blame other people?

When an addict blames other people, it could be that their sense of reality is so altered that they actually believe their problems were caused by other people. Or they might be attempting to gain sympathy and attention. Or maybe they are trying to manipulate others in order to get what they believe they need.

What is it about life that is so hard that an addict can’t handle it without drugs or alcohol?

I can only answer for myself. I had obsessive and horrible thoughts. I hated myself and I wanted to die. I obsessed about ways to kill myself. When I tried drugs and alcohol, all of that was lifted when I was high. It was like magic. When that magic stopped working I kept believing that I could get it back. I’m sure you’ve heard the expression, “Insanity is doing the same thing and expecting different results.” Every addict I have ever known had that form of insanity.

Is there a way to prevent it?

I’ve thought about that for decades. I still don’t know the answer. I think if there were a reliable means of prevention, we would have heard about it.