Love and Addiction - 2. What Addiction Is, and What It Has to Do with Drugs - Addiction and Love

Written by Stanton Peele

Such recent instances of fear and irrationality with regard to psychoactive drugs show that addiction is still very much with us as a society: addiction, in the sense of an unsureness of our own strength and power, coupled with a need to find scapegoats for our uncertainties. And while we are distracted with questions of what drugs can do to us, our misunderstanding of the nature and causes of addiction makes it possible for addictions to slip in where we least expect to find them—in safe, respectable places like our love relationships.

A New Concept of Addiction

At present, the general confusion about drugs and their effects is a reflection of a similar confusion felt by scientists. Experts throw up their hands when confronted with the wide range of reactions people can have to the same drugs, and the wide range of substances which can produce addiction in some people. This confusion is expressed in Scientific Basis of Drug Dependence, a report on a British colloquium of the world's leading authorities on drugs. Predictably, the participants gave up trying to talk about addiction altogether, and addressed themselves instead to the broader phenomenon of "drug dependence." After the discussions the chairman, Professor W. D. M. Paton of the Department of Pharmacology at Oxford, summarized the major conclusions which had been reached. First, drug dependence is no longer equated with the "classical withdrawal syndrome." In its place, "the central issue of drug dependence has shifted elsewhere and seems to lie in the nature of the primary 'reward' which the drug provides." That is, the scientists have begun to think of drug dependence in terms of the benefits which habitual users get from a drug—its making them feel good, or helping them forget their problems and pain. Along with this change in emphasis has come a less exclusive concentration on the opiates as addicting drugs, and also a greater recognition of the importance of cultural factors in drug dependence.

These are all constructive steps toward a more flexible, people-centered definition of addiction. But they also reveal that in abandoning the old idea of narcotic addiction, the scientists have been left with a mass of unorganized facts about different drugs and different ways of using drugs. In a misguided effort to catalogue these facts in something resembling the old familiar way, pharmacologists have simply replaced the term "physical dependence" with "psychic dependence" in their classifications of drugs. With the discovery or popularization of many new drugs in recent years, a new concept was needed to explain this diversity. The notion of psychic dependence could be applied to more drugs than could addiction, since it was even less precisely defined than addiction. If we go by a table of drugs prepared by Dale Cameron under the aegis of the World Health Organization, there is not one commonly used psychoactive drug that does not produce psychic dependence.

Such an assertion is the reductio ad absurdum of drug classification. For a scientific concept to have any value, it has to distinguish between some things and others. With the shift to the category of psychic dependence, pharmacologists have lost whatever meaning the earlier concept of physical dependence might have had, since, looked at on their own, drugs could only bring about a dependence of chemical origin. And if dependence does not stem from any specific properties of the drugs themselves, then why single out drugs as dependency-producing objects at all? As Erich Goode puts it, to say that a drug like marijuana creates psychic dependence is to say merely that some people have reason regularly to do something of which you disapprove. Where the experts have gone wrong, of course, is in conceiving of the creation of dependence as an attribute of drugs, whereas in reality it is an attribute of people. There is such a thing as addiction; we just haven't known where to look for it.

We need a new concept of addiction to make understandable the observed facts that have been left in a theoretical limbo by the breakdown of the old concept. In their recognition that drug use has many causes and takes many forms, drug experts have reached that critical point in the history of a science where an old idea has been discredited, but where there is not yet a new idea to take its place. Unlike these experts, however—unlike even Goode and Zinberg, the most informed investigators in the field—I believe we do not have to stop short by acknowledging that drug effects can vary almost without limit. Rather, we can understand that some types of drug use are dependencies, and that there are equivalent dependencies of many other sorts. To do this, we need a concept of addiction that emphasizes the way people interpret and organize their experience. As Paton says, we have to start with people's needs, and then ask how drugs fit into those needs. What psychological benefits does a habitual user seek from a drug? (See Appendix F.) What does the fact that he needs this type of gratification say about him, and what are the consequences for him of obtaining it? Finally, what does this tell us about the possibilities for addiction to things other than drugs?

First, drugs do have real effects. Although these effects can be mimicked or masked by placebos, drug-using rituals, and other means of manipulating people's expectations, ultimately there are specific actions which drugs have and which differ from one drug to another. There will be times when nothing but the effects of a particular drug will do. For example, in demonstrating that cigarette-smoking is a genuine drug addiction (rather than an addiction to the activity of smoking), Edward Brecher cites studies where people were observed to puff harder on cigarettes which contained a lower concentration of nicotine. Similarly, given that the mere name of heroin is enough to trigger strong reactions in individuals who are exposed only to a placebo or the injection ritual, there must be something about heroin that inspires the addictive reactions of varying severity that large numbers of people have to it. Clearly, the real effects of heroin—or nicotine—produce a state of being that a person desires. At the same time, the drug also symbolizes this state of being even when, as Chein found among New York addicts, there is little or no direct effect from the drug. In this state of being, whatever it is, lies the key to understanding addiction.

Narcotics, barbiturates, and alcohol suppress the user's consciousness of things he wants to forget. In terms of their chemical action, all three drugs are depressants. For example, they inhibit reflexes and sensitivity to outside stimulation. Heroin in particular detaches a person from feelings of pain, lessening the awareness of physical and emotional discomfort. The heroin user experiences what is called "total drive satiation"; his appetite and sex drive are suppressed, and his motivation to achieve—or his guilt at not achieving—likewise disappear. Thus, opiates remove memories and worries about unresolved issues and reduce life to a single striving. The heroin or morphine high is not one which in itself produces ecstasy for most people. Rather, opiates are desired because they bring welcome relief from other sensations and feelings which the addict finds unpleasant.