Addiction

Addiction in my game describes the compulsion that characters possess for hard drink or for stimulants and hallucinogens (such as tobacco, opium or qat), the dependency upon which can require a character to daily partake, at some expense, or to become stressed and less effective when these substances are not available.

Most often, a character will acquire an addiction through the character background generator, due to a negative roll against a middle to low wisdom. Addictions are reckoned as a measurement of material that must be drunk, eaten or smoked within the space of a day or a week. When addicted characters fail to obtain their dose, they can temporarily lose ability points or combat ability until such time as they can acquire a 'fix.'

Kicking an Addiction

To get rid of an addiction, a character must make a wisdom check each day to abstain from use of the substance. Success at this roll will not, in the short term, suspend the negative consequences of failing to partake, it is the only path that will, in the long run, end the dependency. The character must, initially, succeed at a wisdom check for seven days running. All wisdom checks are presumed to have been made at sunrise of a particular day. For each successful string of seven days, a character will receive a +1 bonus to all further wisdom checks with regards to their addiction, provided they do not fail to make a wisdom check and attempt to relapse. In relapsing, the character will immediately take steps to acquire the substance they need and use it. If this occurs, the character has lost all ground gained and must begin their resistance anew.

It should be obvious that this makes it almost impossible for a character to become free from an addiction on their own. It is so easy to relapse that, if the substance they need is available, they will certainly fail again and again to kick their addiction. There are, therefore, only two real paths to kicking their addiction:

• The first is for others to take steps, often combative steps, to ensure that the character cannot relapse even if the character attempts to do so. If it happens that the character, failing to make a wisdom check, is kept from relapsing until sunrise the following day, they will be entitled to another wisdom check. If this succeeds, the character will not attempt to relapse that day, the crisis will be past and the character's forward accumulation of days is not compromised.
• Secondly, the character can put themselves under the care of a physician able to aid in detoxification. This will give a +3 bonus to all wisdom checks made under the physician's care, in addition to bonuses gained by repeated weeks of success.

Thus, the path of success will mean that the character, with the help of friends and a physician, will steadily improve their bonuses week by week until it is impossible for them to fail a wisdom check.

Further Issues

Note, however, that friends must be vigilant in keeping a watch on an addicted character, as the character will give no sign of intending to relapse. As well, the player, having spent multiple sessions with a character of lowered strength, dexterity or other ability statistic will likely want to quit their treatment, returning to their use of whatever substance. These negative consequences, difficult as they are, do not go away until characters have truly freed themselves of the dependency.

Finally, a character can be compelled to fight other characters (though I do not support player-vs-player, this is a special case) from a sort of madness, if physical restraint is applied against a character's will. In cases where a character is in a town, where these substances are easily available, this may be necessary.

To determine a character's success at obtaining a substance in a town or city (where anyone might possess the substance), the character should make an intelligence check; success would indicate that the character has somehow met an individual willing to pass the substance quietly into the character's possession (addicted persons help each other). One other random character in the party, keeping watch on the addicted character, should make a wisdom check to see if this exchange is observed. If it is not, consider this:

The character may obtain this substance on a day when they have not failed their wisdom check - just in case they may want it later. Therefore, the character may already be ready to use the substance with a wisdom check is failed . . . potentially within minutes of sunrise. Thus, a failed wisdom check by the party will mean the relapse has occurred, even in the wilderness. Occasionally subjecting the addicted character to a search could prevent this, but any such searches that occur when the character is actually in possession (make the intelligence check to know) should result in a player-vs.-player conflict. Suffice to say that choice of weapons is left up to the characters.

Last, it must be noted that each time a character wants to relapse and fails to do so, the character should make a system shock survival roll (see Player's Handbook). Failure to succeed at this roll will mean the character will fall to a random disease of random nature and degree.

Bring Enough for Everyone, Did We?

Of course, the first thing that most role-players think when finding rules for practicing medicine without the use of magic is, "why bother?"  After all, magical spells are much faster and less problematic, yes?  What party doesn't have a regeneration scroll just kicking around?

Well, my parties, for one. Regeneration is a 7th level spell and requires a 16th level cleric to cast.  16th level clerics are ridiculously rare and invariably very busy.  Think of it this way: the pope can easily lay his hand on your shoulder and bless you . . . but given that there are a billion other people who want the same thing, the simple act of receiving a personal blessing is probably not going to happen for you.

In short, even if the party in an everyday munchkinish game has enough of every kind of healing spell available to ensure never having to worry about getting their hands dirty with ~ shudder ~ surgery, most of the other people filling all the towns and rural countryside of the world probably have little choice about it.

But why should that matter?  Why concern ourselves with what the simple people do ~ we're busy adventuring here!  We can't worry about what limbs or diseases the common folk care to die from ~ right?

This thinking expresses a kind of bubble that most campaigns simply ignore, one where the setting is built wholly upon the party's specific needs.  If a member of the party catches a disease, no problem: we have a spell for that.  If a member loses a limb, boom, here's another.  If a member slips and falls among a patch of razor cactus, we have a handy rod of resurrection right here.  The important thing is that we survive, we keep going, we get the adventure done.  Other people don't matter.

Suppose the party, having just come from killing off an otyugh in some slime filled trough five miles into the forest, returns to the nearest village, all safe and sound.  Quite by surprise, by the middle of the first night, half the inn's residents are mysteriously down with some sort of malady.  The party is awoken by the tramping of twenty pairs of feet going up and down the stairs and with doors opening and shutting, because all of these poor souls have the trots.

The next day, finishing their breakfast, the party notices the bartender and the barmaid are clearly pale and in poor shape.  As they collect their horses from the stables, they see signs of a spreading ailment everywhere: there are slop buckets full of vomit and rumours that half the village has been infected.  As the party is saddling their horses, the chief magistrate approaches them, saying, "Within a single night, there are more than a hundred people who have some sort of disease!  You must have brought it with you, you're the only outsiders here!  What are you going to do about it?"

Well?  What are they going to do?  There isn't enough disease-curing and resurrection to go around for everyone, is there?  And since the party are clearly carriers, as they are unaffected themselves, are they really going to go to another place and spread whatever they've got there, too?  If they leave this horror behind, someone is going to have to deal with it.  Sooner or later, someone is going to have to deal with the party, too, before their selfishness kills half the kingdom - just how hard do they think it will be to identify them and follow the trail of disease and death they leave behind them.

But this sort of thing never happens in most campaigns, because DMs don't think of it.  Evil is something that happens to the party, not to the innocents . . . and the party is never at fault, never put in a position where their clumsy indifference to the world where they live eventually turns up some consequence they can't wave away with a single cleric.

I'm steadily coming to the conclusion that "simple rules" work for most campaigns because the adventures ~ and the problems ~ are kept as two-dimensional as possible.  Simplistic adventures don't demand many rules.  On the other hand, complicated situations and catastrophes can't help but challenge the magic parachute most parties depend upon, because usually they involve more than a population of just three to five persons.

Yes, I do know about the ridiculous healing rules that have been included in the Pathfinder system.  They have been explained to me.  Even those, however, falter when dealing with thousands of people suffering from large scale disasters and holocausts.  No party, ever, has enough resources for everyone.

It's a question of how hard do we want to bring this home for them.  It's hard to feel like a hero when we're lambing it out of town to avoid admitting that we'd rather just let people die rather than risk contracting the disease ourselves ~ even as we make excuses for our behaviour.  Excuses, however, are a lot easier than performing ordinary, mundane, non-magical surgery for 42 hours at a stretch because we are able . . . long after the spells have run out.

Just for a little perspective:

Amputation

A procedure in which a part of the body is removed, possibly resulting in death. Amputation is sometimes used to control the spread of disease or necrosis moving outward from an affected limb, such as malignancy or gangrene. It may also be necessary to separate a creature from a limb if the creature is trapped and cannot otherwise be freed.

When performed by any person without sufficient medical knowledge, the chances of a creature surviving the loss of a limb is extremely low. To determine if a creature survives an amputation, the creature will need to roll on the amputation shock survival chart (see below). If survival occurs, the creature will also suffer a severe injury.

Shock

The amount of shock a creature suffers from an amputation depends upon the limb that is severed. For the purpose of this system, amputations have been broken down into five categories, from the least invasive to the most extreme, from the least likely to result in death to the most likely:

• Incidental: fingers and toes, ears, nose and teeth. 
• Minor: partial hand or foot, tongue or eyes. 
• Major: wrist or ankle, through the forearm, at the elbow, below the knee, at the knee. 
• Radical: above the elbow, at the shoulder, above the knee, at the hip, removing the genitals or the breasts. 
• Drastic: cutting through the torso or decapitation (remembering that many creatures have more than one head). 

It must be noted that the success or failure of the procedure is not always one that can be determined in a matter of minutes. For that reason, there are two stages in determining the survival of the patient. The first is where the chance of surviving the initial surgery is checked on the amputation shock table below:

This indicates the patient's chance to survive the procedure. Note that these numbers are unchanged even if the amputation is performed by an ordinary person - so long as every possible measure (with or without the use of magic) is made to reduce the bleeding and care for the patient's welfare. If the roll is made under the percentile shown, the patient has not died on the table and is very likely to survive (see post-surgery infection, below).

If the patient has failed the amputation shock roll, however, and the operation was performed by an unskilled surgeon, then the patient will be dead in just a few minutes. Note that nothing can be done to save the patient short of a heal spell. Because the amputation was bungled by a physician with less than an authority medical knowledge, the patient will bleed out or die from shock no matter what other cure spells or procedures are employed.

However, if the amputation was performed by a character with a medical knowledge of at least 30 points (amputation is a medical sage ability for authorities), then there is still a chance of saving the patient. If this is the case, the patient is assumed not to die immediately, unless the amount of knowledge needed is greater than the medical skill of the physician. To determine this, the DM rolls a d100 in secret. If this number is greater than the number of knowledge points possessed by the physician, the patient will still die - but they will linger for a time before death occurs.

For example, a character with a 15 constitution, Bertrand, has a hand removed at the wrist by a physician with 46 points of medical knowledge. With a 71% chance of surviving outright, Bertrand rolls a 74. The DM then rolls a d100, with the result of 37 - meaning that Bertrand will survive, as long as he continues to receive care from a physician with at least 37 points of knowledge. At this point, we consult the Survival Time table to see how long Bertrand's life remains in jeopardy:

Bertrand's amputation was major, so he will need 2-5 weeks of recovery. If it proves that no physician of sufficient knowledge can look after him, he will die at the end of the period rolled - it is simply a matter of course that his body fails in some manner to adjust to the damage done. On the other hand, if he gets sufficient care, he will absolutely survive once the time period has passed.

Note that if the original roll of d100 resulted in a number that an amateur (or even less than an amateur) had enough knowledge points to look after Bertrand, he would not actually need an authority physician to ensure his good health.

Infections

Regardless of who performs the amputation, all patients must make a constitution check against acquiring a disease of some kind. This is a random roll, determining the area of infection, nature and degree of the ailment; the amount of time necessary to survive this disease is then added to total recovery time for both disease and amputation survival. If a disease is contracted and the patient failed their initial amputation shock roll, they will need the care of a physician, with the necessary knowledge, for the combined recovery time. And, of course, there is always a chance that the disease might end in death.

Injury

Naturally, the amputation is in itself an injury, meaning that hit points are lost and the amount of time to heal is greatly increase (see Injury rules). For the amount of damage suffered, consult this table:

Returning to Bertrand, imagine that he has a maximum total of 36 hit points at the time of the amputation (always use the character's full health as the guideline when determining the amount of damage). We'll remember that Bertrand had his hand removed at the wrist. Because the amputation was major, he suffers a total of 32 damage from the removal of his hand. Of this, 18 of this damage will be injury damage, meaning that he will need to regain a total of 196 hit points before he is at full (180 from the injury and the additional 16 ordinary damage he suffered. This damage can be healed by any form of spell, magic item, healing practice or rest to which the character has access.

Note that where 105% of total hit points is indicated, this will mean that the character is reduced to negative hit points (Bertrand would take his full 36 hit points plus 1.8 more - rounded down to 1 additional hit point, putting him at -1 total).

If the number of hit points caused by the amputation is sufficient to kill the patient, then no amount of medical care can help the patient survive the procedure. Somehow, the patient's hit points must be raised sufficiently to allow the patient to survive the amputation.

See Medicine