This article, published in an offshoot that wished to be a more sophisticated Psychology Today, announced the experiential analysis of addiction, and was the first to draw critical attention to the need to redefine the meaning of addiction in light of the Vietnam heroin experience. Nick Cummings, director of the Kaiser Permanente HMO clinical psychology service, called attention to the article in delivering his inaugural address

Palm eBook

Published in Human Nature, September 1978, pp. 61-67.
© 1978 Stanton Peele. All rights reserved.

Social setting and cultural expectation are better predictors of addiction than body chemistry.

Caffeine, nicotine, and even food can be as addictive as heroin.

Stanton Peele
Morristown, New Jersey

The concept of addiction, once thought to be clearly delineated in both its meaning and its causes, has become cloudy and confused. The World Health Organization has dropped the term "addiction" in favor of drug "dependence," dividing illicit drugs into those that produce physical dependence and those that produce psychic dependence. A group of distinguished scientists connected with WHO has called the mental state of psychic dependence "the most powerful of all the factors involved in chronic intoxication with psychotropic drugs."

The distinction between physical and psychic dependence, however, does not fit the facts of addiction; it is scientifically misleading and probably in error. The definitive characteristic of every sort of addiction is that the addict regularly takes something that relieves pain of whatever kind. This "analgesic experience" goes far toward explaining the realities of addiction to a number of very different substances. The who, when, where, why, and how of addiction to the analgesic experience will be fathomed only when we understand addiction's social and psychological dimensions.

Pharmacological research has begun to show how some of the most notorious addictive substances affect the body. Most recently, for example, Avram Goldstein, Solomon Snyder, and other pharmacologists have discovered opiate receptors, sites in the body where narcotics combine with nerve cells. In addition, morphine-like peptides that are produced naturally by the body have been found in the brain and pituitary gland. Called endorphins, these substances act through the opiate receptors to alleviate pain. Goldstein postulates that when a narcotic is regularly introduced into the body, the external substance shuts off the production of endorphins, making the person dependent on the narcotic for relief of pain. Since only some people who take narcotics become addicted to them, Goldstein suggests that those most susceptible to addiction are deficient in the ability of their bodies to produce endorphins.

This line of research has given us a major clue to how narcotics produce their analgesic effects. But it seems impossible that biochemistry alone can provide a simple physiological explanation of addiction, as some of its more enthusiastic proponents expect. For one thing, there now appear to be many addictive substances in addition to the narcotics, including other depressants like alcohol and barbiturates. There are also several stimulants, such as caffeine and nicotine, that produce genuine withdrawal, as Avram Goldstein (with coffee) and Stanley Schachter (with cigarettes) have verified experimentally. Perhaps these substances inhibit the production of endogenous painkillers in some people, although how this would come about is unclear, since only precisely constructed molecules can enter the opiate-receptor sites.

There are other problems with a too-exclusively biochemical approach. Among them:

• Different societies have different rates of addiction to the same drug, even when there is comparably widespread use of the drug in the societies.
• The number of people addicted to a given substance in a group or a society increases and decreases with the passage of time and the occurrence of social change. For example, in the United States alcoholism is increasing among adolescents.
• Genetically related groups in different societies vary in their addiction rates, and the susceptibility of the same individual changes over time.
• Although the phenomenon of withdrawal has always been the crucial physiological test for distinguishing addictive from nonaddictive drugs, it has become increasingly evident that many regular heroin users do not experience withdrawal symptoms. What is more, when symptoms of withdrawal do appear, they are subject to a variety of social influences.

Another area of research has further clouded the concept of withdrawal. Although many babies born to heroin-addicted mothers exhibit physical problems, a withdrawal syndrome attributable to the drug itself is less clear-cut than most people have suspected. Studies by Carl Zelson and by Murdina Desmond and Geraldine Wilson have shown that in 10 to 25 percent of the infants born to addicted mothers, withdrawal failed to appear even in a mild form. Enrique Ostrea and his colleagues indicate that the convulsions typically described as part of infant withdrawal are in fact extremely rare; they also found, as did Zelson, that the degree of infant withdrawal—or whether it appears at all—is not related to the amount of heroin the mother has been taking or to the amount of heroin in her or her baby's system.

According to Wilson, the symptoms found in babies born to addicts may be partly the result of the mothers' malnutrition or of venereal infection, both of which are common among street addicts, or they may be due to some physical damage caused by the heroin itself. What is clear is that the symptoms of addiction and withdrawal are not the results of straightforward physiological mechanisms.