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

Written by Stanton Peele

Going to college, reading books, and striving to get ahead make it less likely that people will become heavy or addicted drug users or alcoholics. Having a good-paying job and a good social position makes it more likely that people can quit drugs or drinking or cut back when these produce bad effects. No data dispute these facts, even among those claiming that alcoholism and addiction are medical diseases that occur independent of people's social status. George Vaillant, for example, found his inner-city sample of white ethnic groups were three to four times more likely to become alcoholic than were the college students his research tracked over forty years.

The truth of the commonsense notion that people who are better off are less likely to become addicted, even after using a powerful psychoactive substance, is amply demonstrated by the fate of the cocaine "epidemic." In 1987, epidemiological data indicated, "The nation's cocaine epidemic appears to have peaked. Yet within the broad trend runs a worrisome countertrend." Although American cocaine use has stabilized or diminished, small groups within the larger group seem to have intensified their use. What is more, "cocaine use is moving down the social ladder." David Musto, a Yale psychiatrist, analyzed the situation:

We are dealing with two different worlds here. The question we must be asking now is not why people take drugs, but why do people stop. In the inner city, the factors that counterbalance drug use—family, employment, status within the community—often are not there.[28]

Overall, systematic research finds cocaine to be about as addictive as alcohol and less addictive than cigarettes. About ten to twenty percent of middle-class repeated cocaine users experience control problems, and perhaps five percent develop a full-scale addiction which they cannot arrest or reverse on their own. As for the newest crisis drug, crack, a front-page New York Times story (August 24, 1989) carried the subtitle "Importance of users' environment is stressed over the drug's attributes." Jack Henningfield of the National Institute on Drug Abuse indicated in the article that one in six crack users becomes addicted, while several studies have shown that addicts find it easier to quit cocaine—"either injected, sniffed or smoked"—than to stop smoking or drinking. Those who become addicted to cocaine have generally abused other drugs and alcohol and are usually socially and economically disadvantaged. Certainly some middle-class users become addicts, even some with good jobs, but the percentage is relatively small and nearly all have important psychological, job, and family problems that precede addiction.

WHAT DO WE LEARN FROM JOHN BELUSHI'S DEATH?

Probably the single most shocking drug death in recent memory was John Belushi's in 1982. Since Belushi was a superstar (although after he left Saturday Night Live, only one of his films—his first, Animal House—succeeded), his death from overdose seemed to say that anyone could be destroyed by cocaine. Alternatively, people saw in it the message that heroin, which Belushi had only started injecting (along with cocaine) in the preceding few days, was the ultimate killer drug. However, we still must consider that almost the entire Hollywood and entertainment community Belushi knew took drugs (Belushi had snorted cocaine with Robert De Niro and Robin Williams the night before he died), and they didn't kill themselves. What is more, while Belushi had only just started taking heroin, his accomplice—Cathy Smith, who was injecting him with drugs—had been taking heroin since 1978. Was Belushi a worse addict than Smith?

Belushi's death was more a statement of the gargantuan nature of his binges, along with his overall self-destructiveness and bad health. Belushi died in the midst of his first serious binge in half a year. When he died, his body was filled with drugs. Over the previous week, he had been continuously injecting heroin and cocaine, had been drinking heavily, popping Quaaludes, and had smoked marijuana and taken amphetamines. Moreover, Belushi was grossly overweight (he carried over 220 pounds on his squat frame) and had a serious respiratory problem, compounded by his heavy cigarette smoking. Like most drug overdose cases, Belushi died in his sleep of asphyxiation or pulmonary edema (fluid on the lungs), having failed in his deep unconsciousness to clear the mucus from his asthmatic lungs.

Why did Belushi act this way? Belushi was deeply troubled by the state of his career and his relationships, yet he seemingly could not get a handle on either through constructive action. He considered himself unattractive and seemed to have few if any sexual relationships; he was rarely with his wife, whom he had dated since high school, but whom he frequently deserted, often in the middle of an evening. Belushi was living off the success of the film Animal House, while his last five films had failed. He was anxiously vacillating between two film projects when he died—one a script he had written (his first) in a feverish, drugged haze with another comedian, the other a project that had been offered to Belushi after floating around Hollywood—and interesting no one—for years. In contrast, Dan Aykroyd, Belushi's partner with whom he often took drugs, was in the midst of writing Ghostbusters, Spies Like Us, and another script. For Belushi, it is clear, risk factors that fed his massive drug use and that led to his death were bad work habits and insensitivity to his wife.[29]