Though he grew up in a close-knit family, Joe has felt lonely and isolated all his life. As a child, he was excluded by his peers and didn't get the affection and acceptance he needed from his father. At age eight, Joe learned "the choking game," in which a person uses his hands to cut off the oxygen supply to his brain to get high. Joe loved the sensation, and secretly choked himself regularly throughout childhood as a way of dealing with his pain. In high school, Joe discovered drugs and alcohol; he began using heroin at 18 and has been addicted for the past six years. Now, living in a motel, he often steals to support his addiction, and he has been arrested and jailed several times for drug possession and theft. He has gone through treatment programs before but has always relapsed soon afterward.