Diseasing of America - 6. What Is Addiction, and How Do People Get It? - Diseasing of America - What Is Addiction

Written by Stanton Peele

But this isn't the end of this amazing saga. Half of these men who were addicted in Vietnam used heroin when they returned to the United States—yet only one in eight (or 12 percent) became readdicted here. Here is how Lee Robins, Richard Helzer, and their colleagues who studied this phenomenon described all this:

It is commonly believed that after recovery from addiction, one must avoid any further contact with heroin. It is thought that trying heroin even once will rapidly lead to readdiction. Perhaps an even more surprising finding than the high proportion of men who recovered from addiction after Vietnam was the number who went back to heroin without becoming readdicted. Half of the men who had been addicted in Vietnam used heroin on their return, but only one-eighth became readdicted to heroin. Even when heroin was used frequently, that is, more than once a week for a considerable period of time, only one-half of those who used it frequently became readdicted.[33]

How to explain this remarkable finding? The answer is not a lack of availability of the drug in the United States, since the men who sought it found heroin to be readily available on their return home. Something about the environment in Vietnam made addiction the norm there. Thus, the Vietnam experience stands out as an almost laboratorylike demonstration of the kinds of situational, or life-stage, elements that create addiction. The characteristics of the Vietnam setting that made it a breeding ground for addiction were the discomfort and fear; the absence of positive work, family, and other social involvements; the peer group acceptance of drugs and the disinhibition of norms against addiction; and the soldiers' inability to control their destinies—including whether they would live or die.

These elements combined to cause men to welcome the lulling, analgesic—or painkilling—effects of narcotics. The same men who were addicted in Vietnam, given a more positive environment, did not find narcosis to be addictively alluring even if they sometimes took the drug at home. If we can only disregard what we "know" about addiction and its biological properties, we can see how completely logical addictive drug use is. If someone who knew nothing about addiction were asked to predict how people would react to the availability of a powerful analgesic drug when they were stuck in Vietnam, and then whether they would regularly seek out such a debilitating substance when they had the chance to do better things in the United States, average, nonexpert people could have predicted the Vietnam addiction scenario. Yet the leading addiction specialists in America have been perplexed by all this and still cannot come to grips with these data.

Cultural Beliefs and the Addiction Splurge

It's truly remarkable how differently people in previous eras reacted to the situations we deal with as diseases as a matter of course today. When Ulysses S. Grant's periodic drinking binges were described to Abraham Lincoln, Lincoln is reputed to have asked which brand of liquor Grant drank, so that he could send it to his other generals. Lincoln was apparently untroubled by Grant's drinking, since Grant was successful as a general. He even toasted Grant when they met and watched Grant drink. What would happen to a general who had drinking binges today? (Grant, incidentally, drank excessively only when he was separated from his wife.) We would hospitalize him. Let's not imagine the results of the Civil War if Grant had been removed from service. Of course, Lincoln himself would be disqualified from the presidency on the grounds of what today would be called his manic-depressive disorder.

But now we know that alcoholism is a disease, just as—more recently—we have learned that sexual compulsions and child abuse are diseases that require therapy. Strangely, these realizations have come at times when we seem to be discovering more and more of each of these—and other—diseases. This brings up another remarkable aspect of alcoholism—the groups with the highest rates of alcoholism, such as the Irish and Native Americans, readily acknowledge that drinking easily becomes uncontrollable. These groups had the most diseaselike image of alcoholism before the modern disease era commenced. Other groups with abnormally low rates of alcoholism, such as the Jews and Chinese, literally cannot fathom the disease notion of alcoholism and hold all drinkers to high standards of self-control and mutual policing of drinking behavior.

Craig MacAndrew and sociologist Robert Edgerton surveyed the drinking practices of societies around the world.[34] They found that people's behavior when they are drunk is socially determined. Rather than invariably becoming disinhibited, or aggressive, or sexually promiscuous, or sociable when drunk, people behave according to the customs for drunken behavior in their particular cultural group. Even tribal sexual orgies follow clear-cut prescriptive rules—for example, tribe members observe incest taboos during orgies, even when the family connection among the people who will not have intercourse is incomprehensible to Western observers. On the other hand, those behaviors that are permitted during these drunken "time outs" from ordinary social restrictions are almost uniformly present during the orgies. In other words, societies define which kinds of behaviors are the result of getting drunk, and these behaviors become typical of drunkenness.

Consider, then, the impact of labeling an activity a disease and convincing people that they cannot control these experiences. Cultural and historical data indicate that believing alcohol has the power to addict a person goes hand in hand with more alcoholism. For this belief convinces susceptible people that alcohol is stronger than are they, and that—no matter what they do—they cannot escape its grasp. What people believe about their drinking actually affects bow they react to alcohol. In the words of Peter Nathan, director of the Rutgers Center for Alcohol Studies, "it has become increasingly clear that, in many instances, what alcoholics think the effects of alcohol are on their behavior influences that behavior as much as or more than the pharmacologic effects of the drug."[35] Alan Marlatt's classic study—in which alcoholics drank more when they believed they were drinking alcohol than when they actually drank alcohol in a disguised form—shows that beliefs are so powerful that they actually can cause the loss of control that defines alcoholism.[36]