Stanton Peele
Morristown, New Jersey

Abstract

Our current conception of addiction is a historical anomaly, one that has arisen independent of laboratory or epidemiological data about drug use. This concept has never reflected actual patterns of heroin use, and it currently does no better at describing cocaine use. Neither this vision of heroin addiction nor an equally popular, complimentary model of alcoholism accurately reflects data on the cause, epidemiology, life history or consistency of addictive behavior. Nonetheless, versions of addictions based on these images of narcotic addiction and alcoholism have become increasingly popular in the second half of the twentieth century and have been generalized to whole new areas of behavior, where they succeed no better at explaining the data. These concepts, moreover, have considerable potential for doing harm.

Introduction

In 1929, two Philadelphia physicians--Arthur Light and Edward Torrance--attempted to identify physiological correlates of the withdrawal experienced by hospitalized addicts suddenly withdrawn from morphine.¹ The range and care of their measures, including detailed analysis of the blood, blood pressure, respiratory data, cardiovascular recovery rates, and urinalysis, has hardly been matched since. The research turned up no reliable biological index for withdrawal: The variability among the addicts on all the measures was too great.

Beyond these measures, the researchers reported the connection between actual administration of the drug and craving as described by the addicts was highly unreliable and subjective. The most recalcitrant subject refused to continue the experiment at 36 hours after withdrawal unless he was given more morphine, at which time the experimenters injected him with sterile water. This addict "promptly went to sleep for a period of eight hours" and "never became aware of the fact that he was given nothing but sterile water " (p. 12). Noting their own failure to "find any marked changes" in circulation, metabolism, respiration, or blood composition, the researchers anticipated other investigators might criticize the research regimen in the experiment. They cautioned any such critics, who might have observed addict behavior during withdrawal, that "the incessant begging and annoying behavior of the addict during the withdrawal period becomes at times almost unbearable," thereby "warping" the judgment of observers and leading them "to conclusions that would not have been reached except for the behavior of the addict" (p. 14).

Light and Torrance did observe a withdrawal syndrome composed of restlessness, vomiting, diarrhea, perspiration, and enervation. However, they considered these reactions that supposedly defined narcotic withdrawal not to be particularly singular or noteworthy; for example, they reported observing a similar syndrome among "a university football team just prior to the playing of a so-called 'important game'...yet, when the whistle starting the game is blown, all fatigue quickly disappears" (pp. 14-15). Observations such as these led subsequent observers to accuse Light and Torrance of naiveté about the biological reality of withdrawal, and of mistaking withdrawal for a form of malingering.

Light and Torrance's addicts were maintained on high levels of morphine, and yet their withdrawal could be overcome by admonition, forced labor, or H20 injection. Unlike the high dosage levels these 1920s addicts were accustomed to, addicts on the streets of major North American cities today often report to clinics with pronounced addictive symptoms but are not found to have any narcotics in their systems. This phenomenon has prompted the coining of phrases like "pseudo-junkie" and "pseudo-heroinism" and speculation about "psychologic vs. pharmacologic heroin dependence."^2/3/4 In other words, a substantial number of patients who report potent addictive symptoms have taken little or no heroin, while regularly maintained narcotics users often express feeble or inconsistent withdrawal. Our reaction to these phenomena does not conform to the supposedly empirical basis of science: We deny the former is "real" and ignore the latter in order to maintain our existing preconceptions of addiction.

Since the 1929 Light and Torrance research, we have observed a hardening of ideas about the reality of addiction and its invariant relationship to narcotics use. Yet we are less able actually to account for observations either about clinical addicts, or about the millions of people who take considerable amounts of narcotics (in the hospital, for example) without becoming addicted. The formalization of the addiction concept and of notions of addictive symptoms does not represent a scientific advance, and instead is better understood as a cultural phenomenon that fulfills functional and symbolic needs. If we actually wished to create a scientifically well-defined concept of addiction, we would need to wean ourselves from our preoccupation with narcotics and several other illicit drugs and to think about why people form overwhelming attachments of all kinds.⁵

A History of the Addiction Concept

Light and Torrance's research took place in a historical epoch when the addiction syndrome was newly formalized as a specific entity traceable to habitual narcotics use and cessation of use. Ten to 20 years earlier, Light and Torrance would not have been able to find hospitalized, long-term narcotics addicts who would manifest such ready indications of the addiction and withdrawal syndromes as their subjects presented. In other words, even the somewhat pale list of symptoms these addicts manifested--considered as a specific, chemically induced syndrome--was of recent historical origin. The narcotic addiction syndrome had not been widely identified in the public mind or by physicians in the nineteenth century or in any other previous era, although narcotics had been known and used since antiquity.

The German physician Levinstein was the first to describe narcotic addiction in detail, in 1877. Even so, at this early date Levinstein "still saw addiction as a human passion 'such as smoking, gambling, greediness for profit, sexual excesses, etc.'" (Berridge & Edwards,⁶ pp.142-143). Further, "from 1870 to 19OO, most physicians regarded addiction as a morbid appetite, a habit, or a vice" (Isbell,⁷ p. 115). At the same time, "acetanilide, bromide, and caffeine attracted almost comparable concern to that drawn by opium," and "the analogy so easily drawn with tobacco and particularly alcohol habituation" confused notions of narcotic addiction and tangled efforts at control" (Sonnedecker,⁸ p. 21). Earlier, although some theorists described narcotic addiction, "this does not mean [they]...held any concept distinguishing addiction to opium from addiction to, say, sugar plums. . . . In this period between the late 16th and the early 19th centuries. . .'to addict' commonly meant 'to devote, give up, or apply habitually to a practice' such as to a vice . . . . [those using the term] meant: It's a bad habit" (Sonnedecker, p. 18).

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