The Meaning of Addiction - 1. The Concept of Addiction - The Concept of Addiction

Written by Stanton Peele

A finding with immense theoretical importance is that some former narcotics addicts become controlled users. The most comprehensive demonstration of this phenomenon was Robins et al.'s (1975) research on Vietnam veterans who had been addicted to narcotics in Asia. Of this group, only 14 percent became readdicted after their return home, although fully half used heroin—some regularly—in the United States. Not all these men used heroin in Vietnam (some used opium), and some relied on other drugs in the United States (most often alcohol). This finding of controlled use by former addicts may also be limited by the extreme alteration in the environments of the soldiers from Vietnam to the United States. Harding et al. (1980), however, reported on a group of addicts in the United States who had all used heroin more than once a day, some as often as ten times a day, who were now controlled heroin users. None of these subjects was currently alcoholic or addicted to barbiturates. Waldorf (1983) found that former addicts who quit on their own frequently—in a ceremonial proof of their escape from their habit—used the drug at a later point without becoming readdicted.

Although widely circulated, the data showing that the vast majority of soldiers using heroin in Vietnam readily gave up their habits (Jaffe and Harris 1973; Peele 1978) and that "contrary to conventional belief, the occasional use of narcotics without becoming addicted appears possible even for men who have previously been dependent on narcotics" (Robins et al. 1974: 236) have not been assimilated either into popular conceptions of heroin use or into theories of addiction. Indeed, the media and drug commentators in the United States seemingly feel obligated to conceal the existence of controlled heroin users, as in the case of the television film made of baseball player Ron LeFlore's life. Growing up in a Detroit ghetto, LeFlore acquired a heroin habit. He reported using the drug daily for nine months before abruptly withdrawing without experiencing any negative effects (LeFlore and Hawkins 1978). It proved impossible to depict this set of circumstances on American television, and the TV movie ignored LeFlore's personal experience with heroin, showing instead his brother being chained to a bed while undergoing agonizing heroin withdrawal. By portraying heroin use in the most dire light at all times, the media apparently hope to discourage heroin use and addiction. The fact that the United States has long been the most active propagandizer against recreational narcotic use—and drug use of all kinds—and yet has by far the largest heroin and other drug problems of any Western nation indicates the limitations of this strategy (see chapter 6).

The failure to take into account the varieties of narcotic use goes beyond media hype, however. Pharmacologists and other scientists simply cannot face the evidence in this area. Consider the tone of disbelief and resistance with which several expert discussants greeted a presentation by Zinberg and his colleagues on controlled heroin use (see Kissin et al. 1978: 23-24). Yet a similar reluctance to acknowledge the consequences of nonaddictive narcotics use is evident even in the writings of the very investigators who have demonstrated that such use occurs. Robins (1980) equated the use of illicit drugs with drug abuse, primarily because previous studies had done so, and maintained that among all drugs heroin creates the greatest dependency (Robins et al. 1980). At the same time, she noted that "heroin as used in the streets of the United States does not differ from other drugs in its liability to being used regularly or on a daily basis" (Robins 1980: 370) and that "heroin is 'worse' than amphetamines or barbiturates only because 'worse' people use it" (Robins et al. 1980: 229). In this way controlled use of narcotics—and of all illicit substances—and compulsive use of legal drugs are both disguised, obscuring the personality and social factors that actually distinguish styles of using any kind of drug (Zinberg and Harding 1982). Under these circumstances, it is perhaps not surprising that the major predictors of illicit use (irrespective of degree of harmfulness of such use) are nonconformity and independence (Jessor and Jessor 1977).

One final research and conceptual bias that has colored our ideas about heroin addiction has been that, more than with other drugs, our knowledge about heroin has come mainly from those users who cannot control their habits. These subjects make up the clinical populations on which prevailing notions of addiction have been based. Naturalistic studies reveal not only less harmful use but also more variation in the behavior of those who are addicted. It seems to be primarily those who report for treatment who have a lifetime of difficulty in overcoming their addictions (cf. Califano 1983). The same appears true for alcoholics: For example, an ability to shift to controlled drinking shows up regularly in field studies of alcoholics, although it is denied as a possibility by clinicians (Peele 1983a; Vaillant 1983).

Nonnarcotic Addiction

The prevailing twentieth-century concept of addiction considers addiction to be a byproduct of the chemical structure of a specific drug (or family of drugs). Consequently, pharmacologists and others have believed that an effective pain-reliever, or analgesic, could be synthesized that would not have addictive properties. The search for such a nonaddictive analgesic has been a dominant theme of twentieth-century pharmacology (cf. Clausen 1961; Cohen 1983; Eddy and May 1973; Peele 1977). Indeed, heroin was introduced in 1898 as offering pain relief without the disquieting side effects sometimes noted with morphine. Since that time, the early synthetic narcotics such as Demerol and the synthetic sedative family, the barbiturates, have been marketed with the same claims. Later, new groups of sedatives and narcotic-like substances, such as Valium and Darvon, were introduced as having more focused anti-anxiety and pain-relieving effects that would not be addictive. All such drugs have been found to lead to addiction in some, perhaps many, cases (cf. Hooper and Santo 1980; Smith and Wesson 1983; Solomon et al. 1979). Similarly, some have argued that analgesics based on the structures of endorphins—opiate peptides produced endogenously by the body—can be used without fear of addiction (Kosterlitz 1979). It is hardly believable that these substances will be different from every other narcotic with respect to addictive potential.

Alcohol is a nonnarcotic drug that, like the narcotics and sedatives, is a depressant. Since alcohol is legal and almost universally available, the possibility that it can be used in a controlled manner is generally accepted. At the same time, alcohol is also recognized to be an addicting substance. The divergent histories and differing contemporary visions of alcohol and narcotics in the United States have produced two different versions of the addiction concept (see chapter 2). Whereas narcotics have been considered to be universally addictive, the modern disease concept of alcoholism has emphasized a genetic susceptibility that predisposes only some individuals to become addicted to alcohol (Goodwin 1976; Schuckit 1984). In recent years, however, there has been some convergence in these conceptions. Goldstein (1976b) has accounted for the discovery that only a minority of narcotic users go on to be addicts by postulating constitutional biological differences between individuals. Coming from the opposite direction, some observers oppose the disease theory of alcoholism by maintaining that alcoholism is simply the inevitable result of a certain threshold level of consumption (cf. Beauchamp 1980; Kendell 1979).