Love and Addiction - Appendix

In: Peele, S., with Brodsky, A. (1975), Love and Addiction. New York: Taplinger.

© 1975 Stanton Peele and Archie Brodsky.
Reprinted with permission from Taplinger Publishing Co., Inc.

A. Responses to Morphine and a Placebo

In the Lasagna experiment, patients were given injections of an allegedly pain-killing drug which was sometimes morphine and sometimes a placebo. The drugs were administered under double-blind conditions; that is, neither the patients nor the technicians who administered the drugs knew which was which. Depending on the sequence of administration of the two drugs, which was varied in several ways, between 30 and 40 percent of the patients found the placebo as adequate as the morphine. Those who believed in the efficacy of the placebo also were somewhat more likely to obtain relief from the morphine itself. The average percentage of times relief was obtained from morphine by those who never responded to the placebo was 61 percent, while for those who did accept the placebo at least once, it was 78 percent.

B. Shared Action of Chemically Distinct Substances

In grouping barbiturates, alcohol, and opiates into one category, we depart, of course, from a strictly pharmacological approach to drugs. Since these three kinds of drugs have different chemical structures, a pharmacological model cannot explain the fundamental similarities in people's reactions to them. Consequently, many biologically oriented researchers have attempted to discount such similarities. Foremost among these scientists is Abraham Wikler (see Appendix F), whose position may have ideological overtones. It is consistent, for instance, with the importance he gives physiological habituation in his reinforcement model of addiction, and with the conservative public position he has maintained on such issues as marijuana. However, nowhere have pharmacologists been able to demonstrate a link between the particular chemical structures of the major depressants and the unique addictive properties that Wikler believes each of them has. In any case, there are other biochemical researchers who claim, as do Virginia Davis and Michael Walsh, that "Because of the resemblance of symptoms occurring on withdrawal of either alcohol or the opiates, it seems possible that the addictions may be similar and that the real distinctions between the two drugs could be only the length of time and dosage required for development of dependence."

Generalizing from Davis and Walsh's argument, differences in the effects of many drugs are perhaps more quantitative than qualitative. Marijuana, for instance, would have small potential for addiction simply because it is too mild a sedative to engage fully a person's consciousness in the manner of heroin or alcohol. Even these quantitative distinctions may not always be intrinsic to the drugs in question, but may be strongly influenced by the dosage strengths and methods of administration that are characteristically employed with these drugs in a given culture. The Bushmen and Hottentots may have reacted violently to smoking tobacco because they swallowed the smoke rather than exhaling it. Coffee and tea may be prepared in milder concentrations in present-day America than in nineteenth-century England. Smoking a cigarette may provide a small and gradual infusion of nicotine, compared to the amount of heroin one gets from injecting a strong dose directly into the bloodstream. These circumstantial differences are not inconsiderable, and should not be mistaken for categorical differences between substances which in important respects operate similarly.

C. Effects of Expectations and Setting on Reactions to a Drug

Subjects in the Schachter and Singer study received an injection of the stimulant epinephrine (adrenalin), which was presented to them as an "experimental vitamin." Half of the subjects were told what to expect from the injection (i.e., generalized arousal); the other half were kept in the dark about these "side effects" of the supposed vitamin. Then each subject was left in a room with another person—a stooge paid by the experimenter to act in a specified way. Half the subjects in each of the original two groups were exposed, individually, to a stooge who acted as though he were euphoric, joking and throwing paper around, and half were put in with a stooge who took offense at the experiment and stalked out in anger. The result was that uninformed subjects—those who had not been told what their physiological reaction to the injection was going to be—picked up the mood set by the stooge, while informed subjects did not. That is, if the subject experienced an effect from the drug, but didn't know why he was feeling that way, he became very suggestible. Seeing the stooge react to the experiment in a certain way served to explain for the subject why he himself was physiologically aroused—i.e., that he was angry, or that he was euphoric. On the other hand, if the subject could link his physiological state with the injection, then he had no need to look around him for an emotional explanation for his arousal. Another group of subjects, who were grossly misinformed about what the injection would do to them, were even more suggestible than were uninformed subjects.

To investigate what happens generally when people mislabel the drug they take, or anticipate effects that actually are characteristic of a different kind of drug, Cedric Wilson and Pamela Huby gave subjects three classes of drugs: stimulants, depressants, and tranquilizers. "When the subjects guessed correctly which drug they had received," reported Wilson and Huby, "they responded to it vigorously. When they guessed incorrectly, the effects of the drug were partially or completely inhibited."

D. Comparison of Health Hazards of Commonly Used Drugs with Those of Heroin

The major health hazards of tobacco are in the areas of lung cancer, emphysema, chronic bronchitis, and heart disease. Coffee, according to Marjorie Baldwin's article "Caffeine on Trial," is being implicated in heart disease, diabetes, hypoglycemia, and stomach acidity. In addition, recent research has concentrated on the increased incidence of birth defects and increased risks in pregnancy with both of these drugs, as well as with aspirin. The U.S. Public Health Service has reported that smoking on the part of mothers is an important contributor to the high rate of fetal mortality in this country. Lissy Jarvik and her colleagues, investigating chromosomal damage from LSD (see Appendix E), find that long-time aspirin users and "coffee or Coca-Cola addicts" run similar risks of genetic damage and congenital abnormality in their offspring, and women who take aspirin daily are now being observed to show a higher than normal rate of irregularities in pregnancy and childbirth.

While American society has been slow in recognizing the deleterious consequences of these familiar drugs, it has from the outset exaggerated those of heroin. Along with the myths of addiction after one shot (for which only a psychological explanation is possible) and unlimited tolerance, heroin is thought to lead to physical degeneration and death. But the experience of lifetime users in favorable social climates has shown that heroin is as viable a habit to maintain as any other, and medical research has not isolated any ill effects on health from heroin use alone. The main cause of illness and death among street addicts is contamination from unhealthy conditions of administration, such as dirty hypodermic needles. The addict's lifestyle also contributes in many ways to his high mortality rate. Charles Winick has concluded, "Opiates usually are harmless, but they are taken under unsatisfactory conditions. Malnutrition caused by loss of appetite probably is the most serious complication of opiate addiction."

The physical danger that heroin is most widely believed to present for its users is that of death by overdose. Constituting perhaps the most persistent misapprehension about the drug, "heroin overdoses" have vastly increased in recent years while the average heroin content in doses available on the street has been shrinking. Citing an investigation by Dr. Milton Helpern, New York City's Chief Medical Examiner, Edward Brecher shows that so-called deaths by OD could not possibly result from that cause. The best current guess is that deaths attributed to overdosing are actually due to the use of heroin in combination with another depressant, such as alcohol or a barbiturate.

The information presented here is not intended as an argument favoring the use of heroin. In fact, it is true that heroin offers the most sure and complete chance for eradicating one's consciousness, which is the basic element in an addiction. The premise of this book is that addiction as a way of life is psychologically unhealthy both in its causes and consequences, and the values which the book is meant to encourage run directly counter to those of a drugged or otherwise artificially supported existence. The exculpatory data on heroin, together with the evidence of ill effects from cigarettes and coffee, are offered in support of the proposition that a culture's—our culture's—estimate of the physical as well as psychological hazards of different drugs is an expression of its overall attitude toward those drugs. What must be dealt with is our society's need to condemn heroin from every possible angle, regardless of the facts, even while that society is so strongly susceptible to heroin and other forms of addiction.

E. LSD Research

Sidney Cohen's study was based on a survey of 44 LSD researchers who, among them, had collected data on 5000 individuals who had been given LSD or mescaline on a total of 25,000 occasions. These subjects, broken down into "normal" experimental volunteers and patients undergoing psychotherapy, showed the following rates of complications associated with hallucinogenic trips: attempted suicides—0 per 1000 for normal subjects, 1.2 per 1000 for psychiatric patients; psychotic reactions lasting longer than 48 hours (roughly the duration of a trip)—less than 1 per 1000 for normal subjects, less than 2 per 1000 for psychiatric patients.

The refutation of the Maimon Cohen study on chromosomal breakage caused by LSD focused on the fact that the study employed human leukocytes (white blood cells) cultured artificially in a test tube (in vitro), rather than in the living organism (in vivo). Under these conditions, where the cells cannot easily rid themselves of toxins, many chemicals cause increased chromosomal breakage. These include aspirin, benzene, caffeine, antibiotics, and even more innocuous substances, such as water that has not been twice distilled. Subsequent in vivo studies of users of pure and illicit LSD, along with further in vitro studies with proper controls, showed that there is no special danger with LSD. Reporting that caffeine doubles breakage rates just as LSD does, Jarvik and her colleagues note that any substance introduced into the body in sufficient quantity during gestation can cause congenital abnormality.

F. Conditioning Models of Addiction

A major line of thought in addiction research—the conditioned learning approach of Abraham Wikler and the animal experimenters at the University of Michigan (see Appendix B)—is explicitly concerned with the psychological rewards and punishments associated with drug use. The chief limitation of this theorizing and research, however, is that it takes withdrawal distress for granted and assumes that the relief of withdrawal pain is invariably the addict's primary reinforcement for taking an opiate past the period of initial involvement with the drug. Other rewards (such as those provided by environmental stimuli) are considered, but only as secondary reinforcements that are linked to the relief of withdrawal.

The mechanistic character of conditioning theories is associated with their origins in the observation of laboratory animals. Human consciousness entails a greater complexity of response to drugs, and withdrawal, than animals are capable of. Only animals respond to drugs in a predictable way, and only animals (especially encaged animals) respond uniformly to the onset of withdrawal by renewing their dosage of a drug. For a conditioning theory to explain the behavior of human addicts, as well as nonaddicted drug users, it must take into account the various social and personal reinforcements— ego-gratification, social approval, security, self-consistency, sensory stimulation, etc.—that motivate human beings in their drug-taking as in other activities.

Recognizing the limitations of animal-based hypotheses, Alfred Lindesmith has proposed a variation of conditioning theory which adds to it an important cognitive dimension. In Addiction and Opiates, Lindesmith argues that addiction occurs only when the addict understands that physiological habituation to morphine or heroin has taken place, and that only another dose of the drug will protect him from withdrawal. Despite Lindesmith's insistence that addiction is a conscious, human phenomenon, his theory is just as narrowly based on physical dependence and withdrawal as all-purpose reinforcers as are other conditioning models. It posits only one kind of cognition (i.e., the awareness of an association between withdrawal and taking an opiate) as influencing the psychological process of conditioning, rather than allowing for the range of cognitions of which human beings are capable. Lindesmith notes marginally that hospital patients who know that they have received morphine, and who are knowingly withdrawn from the drug, still do not usually become addicted. This is because they think of themselves as patients, not addicts. Lindesmith fails to draw what seems a reasonable inference from this observation: that self-image is always a factor to be considered in the addiction process.

G. Physiological and Psychological Mechanisms of Addiction

The publication in Science of a study by Louise Lowney and her colleagues on the binding of opiate molecules in the brains of mice, which is part of an ongoing line of research in that area, has convinced many people that a breakthrough has been achieved in understanding addiction physiologically. But for every study of this sort that reaches the public eye, there is also one like Psychology Today's report on Richard Drawbaugh and Harbans Lal's work with morphine-addicted rats who had been conditioned to accept the ringing of a bell (together with a placebo injection) in place of morphine. Lal and Drawbaugh found that the morphine antagonist naloxone, which is presumed to counteract the effects of morphine chemically, inhibited the effects of the conditioned stimulus (the bell) as well as those of morphine itself. Clearly, the antagonist was working at something besides a chemical level.

Chemical reactions in the brain can, of course, be observed whenever a psychoactive drug is introduced. The existence of such reactions, and the fact that all psychological processes ultimately take the form of neural and chemical processes, should not be used to beg the questions raised by the impressive array of research, observations, and subjective reports that testify to the variability of human reactions to drugs.

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References

Baldwin, Marjorie V. "Caffeine on Trial." Life and Health (October 1973): 10-13.

Brecher, Edward M. Licit and Illicit Drugs. Mount Vernon, N.Y.: Consumers Union, 1972.

Cohen, Maimon M.; Marinello, Michelle J.; and Back, Nathan. "Chromosomal Damage in Human Leukocytes Induced by Lysergic Acid Diethylamide." Science 155 (1967): 1417-1419.

Cohen, Sidney. "Lysergic Acid Diethylamide: Side Effects and Complications." Journal of Nervous and Mental Disease 130 (1960): 30-40.

Davis, Virginia E., and Walsh, Michael J. "Alcohol, Amines, and Alkaloids: A Possible Biochemical Basis for Alcohol Addiction." Science 167 (1970): 1005-1007.

Dishotsky, Norman I.; Loughman, William D.; Mogar, Robert E.; and Lipscomb, Wendell R. "LSD and Genetic Damage." Science 172 (1971): 431-440.

Drawbaugh, Richard, and Lal, Harbans. "Reversal by Narcotic Antagonist of a Narcotic Action Elicited by a Conditioned Stimulus." Nature 247 (1974): 65-67.

Jarvik, Lissy F.; Kato, Takashi; Saunders, Barbara; and Moralishvili, Emelia. "LSD and Human Chromosomes." In Psychopharmacology: A Review of Progress 1957-1967 edited by Daniel H. Efron, pp. 1247-1252. Washington, D.C.: Public Health Service Document No. 1836; HEW, 1968.

Lasagna, Louis; Mosteller, Frederick; von Felsinger, John M.; and Beecher, Henry K. "A Study of the Placebo Response." American Journal of Medicine 16 (1954): 770-779.

Lindesmith, Alfred R. Addiction and Opiates. Chicago: Aldine, 1968.

Lowney, Louise I.; Schulz, Karin; Lowery, Patricia J.; and Goldstein, Avram. "Partial Purification of an Opiate Receptor from Mouse Brain." Science 183 (1974): 749-753.

Schachter, Stanley, and Singer, Jerome E. "Cognitive, Social, and Physiological Determinants of Emotional State." Psychological Review 69 (1962): 379-399.

Wikler, Abraham. "Some Implications of Conditioning Theory for Problems of Drug Abuse." In Drug Abuse: Data and Debate, edited by Paul L. Blachly, pp. 104-113. Springfield, Ill.: Charles C Thomas, 1970.

Wilson, Cedric W. M., and Huby, Pamela, M. "An Assessment of the Responses to Drugs Acting on the Central Nervous System." Clinical Pharmacology and Therapeutics 2 (1961): 174-186.