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Addiction and Opiates

Addiction and Opiates

CHAPTER 7 A CRITIQUE OF

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION conditions, choosing a syringe-containing box (whereupon injection is given) in preference to a food-containing boxe. (39) The choice of food or drugs was offered these chimpanzees under four conditions: (1) when they were hungry and also in need of a dose; (2) hungry, but bad recently been given an injection of morphine; (3) recently fed, but in need of a dose; and (4) recently fed and recently injected. Spragg anticipated that the chimpanzees would choose food under conditions (2) and (4) and drugs under conditions (1) and (3). His expectations were fulfilled in the course of the experiment, leading him to the conclusion that the desire for morphine bad been unequivocally established and that the animals' behavior was essentially like that of human addicts. There are a number of serious objections to Spragg's conclusions which make it necessary to reject them. In the first place, the assertion that the chimpanzees desired morphine injections involves the fallacy of projecting human attributes onto the animal subjects. On the basis of experimental evidence alone, Spragg might have concluded that the chimpanzees exhibited a desire to be pricked with a hypodermic needle. A second objection to Spragg's conclusions is that hospital patients to whom drugs have been given regularly for a short time frequently demand that the injections be continued and object strenuously if they are not. Such patients by no means necessarily become addicted, yet their behavior is essentially like that of Spragg's animals. Hospital patients, under the conditions mentioned above, do not become addicts if they are kept in ignorance. It is also possible to satisfy them by giving them other drugs than opiates. Spragg's assumption that the choices made by the chimpanzees are those which an addict would make under the same conditions is incorrect. American drug addicts, if given the choice of food or drugs when (1) hungry or suffering withdrawal distress, (2) hungry but not suffering withdrawal, (3) not hungry but suffering withdrawal symptoms, and (4) neither hungry nor suffering withdrawal distress, would unquestionably choose drugs Under all four conditions provided that the other conditions of the experiment were identical with those imposed upon the chimpanzees. Spragg's results therefore demonstrate an essential difference between the animals and human beings, not a similarity, as Spragg assumes. Spragg mentions that the chimpanzees did not conform to one of the criteria of addiction as we have defined it, namely, the tendency to relapse. As a matter of fact, however, none of the criteria of our definition were applicable to his chimpanzees.(40) Subsequent to Spragg's study, there has been a great deal of highly interesting experimental work done on the responses of lower animals to the regular administration of opiates, especially morphine. Allusion has already been made to some of this work in which the gap between human and animal responses to morphine has been further narrowed by the fact that relapse behavior has been induced in lower animals. Some of the investigators in this area speak of their animals as "addicts" and insist or imply that their behavior is essentially identical with that of human addicts. Such a claim is comparable to a similar claim that is made with respect to so-called homosexuality in lower animals. These conclusions should be regarded as hypotheses to be tested by detailed empirical comparison of the behavior of human and animal subjects, and not asserted simply on the basis of systematic information obtained from animal experiments related to a few selected aspects of human addiction. If a rat that behaves as did some of those that Nichols (41) trained is to be called an addict, there should be no sense of anomaly or absurdity in the idea of arresting rats as violators of the narcotic laws. The definition of addiction that was developed in an earlier chapter, and which is much like those proposed by others, included five items which were thought to be characteristic and common features of addiction behavior. Before lower animals can be said to exhibit behavior that is identical with that of human subjects it is reasonable to require that a behavioral comparison be made on all of these five points. The claim, however, is based on only one of them, namely, relapse, and even in this case the evidence presented by Nichols is equivocal. For example, after the training period had ended and drug intake had been stopped, the rats did voluntarily choose to drink much more of the morphine, but the amount diminished rather rapidly from the fourteenth day after withdrawal to the forty-ninth. While Nichols assumed that the withdrawal symptoms had disappeared, it is well known that they do not disappear in all human subjects in 49 days but may last as long as four or five months or even longer. This suggests that the tendency of the file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION experimental rats to drink the morphine solution may have been linked with residual withdrawal symptoms and may subside as they diminish and disappear. The tendency of human users to relapse because of lingering withdrawal symptoms presents a close parallel, but the human subjects also relapse after many years of forced or voluntary abstinence. If one supposes a hypothetical experiment with human subjects like that performed by Nichols, and supposes that the subjects knew just as little about the drug and what was happening to them as the rats did, it is certain that no one acquainted with the behavior of the average American addict would be willing to say that such subjects were addicts in the same sense. Indeed, it is well known that morphine-dependent hospital patients who are kept in total ignorance of the drug and of withdrawal distress sometimes demand injections or "medicine" to relieve withdrawal symptoms when they are unaware of the nature of the medicine and of the discomfort they experience. The insistence of the demand tends to be proportional to the severity of the symptoms and to decline as they subside. If, after a period of time, such a patient were allowed to have his way, he might well resume the medication or "relapse" into regular use of the drug. Relapse of this sort does not constitute addiction in human subjects, since such patients can still be successfully withdrawn without being any the worse or the wiser for their experience. Such resumption of drug use is qualitatively far removed from the superficially comparable behavior of addicts, and it leads to few or no important long-range behavioral consequences. Such patients also do not think of themselves as addicts or even suspect that they may be. This matter of self conception, which is an integral aspect of human addiction with vast social and behavioral consequences, does not, of course, arise in experiments with lower animals, but clearly it has to be considered before human and animal responses can be declared to be identical or equivalent. It is difficult and hazardous to extrapolate to human subjects findings obtained from observing lower animals in highly contrived experimental situations in which human beings are never placed. Most investigators, in fact, avoid doing this. The difficulties involved in such extrapolation, and in determining what experimental findings mean, is well illustrated by the differences between Spragg's and Nichols' findings with regard to relapse. If rats relapsed for Nichols, why did the chimps not relapse for Spragg? Another example is provided by the extensive work with monkeys trained in the self-administration of drugs. (42) In some of these experiments the caged animals had an apparatus fastened on their backs that was arranged to permit them to move about freely and to obtain an injection any time they wished by pressing a lever. In this situation monkeys routinely take morphine injections regularly to the point of physical dependence and continue the injections over considerable time periods. If they are withdrawn and after a time are put back in the same situation they promptly resume the injections. In general, monkeys show a liking for the same drugs that humans use for kicks and reject the others. The equivocal significance of these experiments with respect to human subjects is suggested by the fact that monkeys go on giving themselves injections of cocaine and other nonaddicting drugs in much the same way as they do with morphine, thus obscuring the difference between drugs that produce physical dependence and those that do not. It is hard to imagine a similar experiment with human subjects that would justify a valid comparative judgment. Conditioning Theory As would be anticipated, those investigators who attempt to generalize about both human and lower animal responses to opiates from data secured primarily from observing lower animals usually interpret their findings in terms of the standard concepts of conditioning or reinforcement theory. Since the latter is itself mainly derived from experimental work with lower animals, it is formulated in terms of concepts that are equally applicable to man and animal and characteristically makes no or few allowances for the effect of any of the special attributes or capabilities of human beings which distinguish them from lower animals. Of particular importance to the analysis of opiate addiction is the conditioning theorist's lack of attention to cognitive behavior. If it is conceded that nearly all human beings are more intelligent than any animal, it may be proposed that it is not unreasonable to expect this to make a difference in the way in which conditioning or reinforcement operates. From what is known about complex human conduct, it is abundantly clear that stimuli and situations affect it primarily as they are understood or interpreted by the subject. The argument that I have developed with respect to the role of withdrawal distress in addiction is simply another instance of this point. So also is the argument that the addicting effect which the relief of these symptoms has depends upon how it is interpreted. file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

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