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

Written by Stanton Peele

Doctors are the best-known single group of controlled drug users. Historically, we can cite Sir Arthur Conan Doyle's cocaine habit and the distinguished surgeon William Halsted's daily use of morphine. Today, estimates of the number of physicians taking opiates run to about one in every hundred. The very circumstance that prompts many doctors to use narcotics—their ready access to such drugs as morphine or the synthetic narcotic Demerol—makes such users difficult to uncover, especially when they remain in control of their habit and of themselves. Charles Winick, a New York physician and public health official who has investigated many aspects of opiate use, studied physician users who had been publicly exposed, but who were not obviously incapacitated, either in their own eyes or in the eyes of others. Only two out of the ninety-eight doctors Winick questioned turned themselves in because they found they needed increasing dosages of the narcotic. On the whole, the doctors Winick studied were more successful than average. "Most were useful and effective members of their community," Winick notes, and continued to be while they were involved with drugs.

It is not only middle-class and professional people who can use narcotics without meeting the fate which supposedly awaits addicts. Both Donald Louria (in Newark) and Irving Lukoff and his colleagues (in Brooklyn) have found evidence of controlled heroin use in the lower class. Their studies show that heroin users in these ghetto communities are more numerous, better off financially, and better educated than was previously supposed. In many cases, in fact, heroin users are doing better economically than the average ghetto resident.

3. Ritualistic drug use. In The Road to H. Isidor Chein and his coworkers investigated the variety of heroin usage patterns in the ghettos of New York. Along with regular, controlled users, they found some adolescents who were taking the drug irregularly and without withdrawal, and others who were drug-dependent even when they were getting the drug in doses too weak to have any physical effect. Addicts in the latter circumstances have even been observed to go through withdrawal. Chein believes that people like these are dependent not on the drug itself, but on the ritual of obtaining and administering it. Thus a large majority of the addicts interviewed by John Ball and his colleagues rejected the idea of legalized heroin, because that would eliminate the secretive and illicit rituals of their drug use.

4. Maturing out of addiction. By going over the Federal Bureau of Narcotics' lists of addicts, and comparing the names which appeared on the lists at five-year intervals, Charles Winick discovered that street addicts commonly grow out of their dependency on heroin. In his study, entitled "Maturing Out of Narcotic Addiction," Winick demonstrated that one-fourth of all known addicts become inactive by the age of 26, and three-fourths by 36. He concluded from these findings that heroin addiction is largely an adolescent habit, one which most people get over at some point in their adulthood.

5. Reactions to a morphine placebo. A placebo is a neutral substance (like sugared water) which is given to a patient in the guise of an active medication. Since people can show moderate or practically nonexistent reactions to morphine, it is not surprising that they also may experience the effects of morphine when they simply imagine that they are receiving the drug. In a classic study of the placebo effect, Louis Lasagna and his co-workers found that 30 to 40 percent of a group of postoperative patients couldn't tell the difference between morphine and a placebo that they were told was morphine. For them, the placebo relieved pain as well as the morphine did. The morphine itself worked only 60 to 80 percent of the time, so that although it was somewhat more effective than the placebo as a painkiller, it too was not infallible (see Appendix A).

6. Addictions transferred from one drug to another. If the action of a powerful drug can be simulated by an injection of sugared water, then we should certainly expect people to be able to substitute one drug for another when the effects of the drugs are similar. For example, pharmacologists consider barbiturates and alcohol to be cross-dependent. That is, a person who is addicted to either of them can suppress the withdrawal symptoms that result from not getting the one drug by taking the other. Both of these drugs also serve as substitutes for the opiates. The historical evidence, presented by Lawrence Kolb and Harris Isbell in the anthology Narcotic Drug Addiction Problems, shows that the fact that all three substances are depressants makes them roughly interchangeable for the purposes of addiction (see Appendix B). When there is a shortage of available heroin, addicts typically resort to barbiturates, as they did in World War II when the normal channels for importation of heroin were cut off. And many of the Americans who became opiate users in the nineteenth century had been heavy drinkers before the arrival of opium in this country. Among heroin addicts whom John O'Donnell surveyed in Kentucky, those who were no longer able to obtain the drug tended heavily to become alcoholics. This shift to alcoholism by narcotic users has been commonly observed in many other settings

7. Addiction to everyday drugs. Addiction occurs not only with strong depressant drugs like heroin, alcohol, and barbiturates, but with mild sedatives and pain-relievers like tranquilizers and aspirin. It also appears with commonly used stimulants like cigarettes (nicotine) and coffee, tea, and cola (caffeine). Imagine someone who begins smoking a few cigarettes a day and works up to a stable daily habit of one or two or three packs; or a habitual coffee drinker who eventually needs five cups in the morning to get started and several more during the day to feel normal. Think how uncomfortable such a person gets when there are no cigarettes or coffee in the house, and to what lengths he or she will go to obtain some. If an inveterate smoker can't get a cigarette, or tries to give up smoking, he may show the full symptoms of withdrawal—shaking nervously, becoming uncomfortable, agitated, uncontrollably restless, and so on.

In the Consumers Union report, Licit and Illicit Drugs, Edward Brecher states that no essential difference exists between the heroin and nicotine habits. He cites cigarette-deprived, post-World War II Germany, where proper citizens begged, stole, prostituted themselves, and traded off precious commodities—all in order to obtain tobacco. Closer to home, Joseph Alsop devoted a series of newspaper columns to the problem many ex-smokers have in concentrating on their work after giving up their habit—a difficulty heroin treatment programs traditionally have had to deal with in addicts. Alsop wrote that the first of these articles "brought in scores of readers' letters saying in effect, 'Thank God you wrote about not being able to work. We've told the doctors again and again, and they won't believe it.' "