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Addiction and Opiates

Addiction and Opiates


CHAPTER 8 CONCLUSIONS, IMPLICATIONS, PROBLEMS file:///I|/drugtext/local/library/books/adopiates/chapter8.htm[24-8-2010 14:23:39] PART I The Nature of the Opiate Habit CHAPTER 8 CONCLUSIONS, IMPLICATIONS, PROBLEMS It has been argued that the power of the opiate habit is derived basically from effects which follow when the drug is removed rather than upon any positive effects which its presence in the body produces. Addiction occurs only when opiates are used to alleviate withdrawal distress, after this distress has been properly understood or interpreted, that is to say, after it has been represented to the individual in terms of the linguistic symbols and cultural patterns which have grown up around the opiate habit. If the individual fails to conceive of his distress as withdrawal distress brought about by the absence of opiates, be does not become addicted, but, if be does, addiction is quickly and permanently established through further use of the drug. Evidence from a wide variety of sources seems uniformly to confirm this conclusion. Data concerning the habit which from other points of view appear paradoxical or contradictory fall into place as logically necessary consequences of the position. The theory furnishes a relatively simple account of the experience in which the craving for drugs is generated. When this experience is more closely considered, the essential, universal, or common features of addiction can be traced from it in a readily intelligible way. The theory seems to flow from the data and at the same time to make sense of it, even of that part of the data which is constituted by what addicts say. There is, for instance, no need to attribute euphoric effects to the user which the latter denies experiencing, and there is no need for the hackneyed excuse that addicts are unreliable witnesses. In fact, the point of view explicitly developed here can be shown to be implicit in the addict's own special language. The individual's interpretation of withdrawal distress is a belief or attitude that exists as a cultural and psychological phenomenon. It tends to be imposed upon the addict by his social environment. The crucial fact about it is not is validity, but that the individual, once having accepted it, is subject to influences and social pressures of which he was previously unaware. The attitudes he assumes toward himself are altered. He realizes for the first time that be may be a "dope fiend," and in the privacy of his own thoughts he begins to entertain tentatively that idea of himself and to explore its implications. Further experience with the drug quickly impresses him with the truth of his notion, and be is soon compelled to accept it, though be usually struggles for some time and makes fruitless efforts to free himself. During this time the person is transformed from a non-addict to an addict with all that that implies. The essential process involved in this transformation and basic to it is a linguistic and conceptual one. It is through the use of the social symbols of language in conversation with himself and with others that the personality changes involved in becoming an addict are initiated and developed. The individual, when be uses the symbols which society provides him, also assumes the attitudes appropriate to those symbols when be applies them to himself. He calls himself a "dope fiend" and gradually hardens himself to the fact that he has become an outcast and a pariah to respectable people. He of necessity seeks the company of other addicts, both because they can help to solve the problems arising out of addiction and because he feels more at home with them. He attempts to quit because be accepts the general public disapproval of addiction and wishes to remove himself from the pariah category. It is this whole process which George Herbert Mead has described as "taking the role of the generalized other" or assuming toward oneself the attitudes of the group or society in which one lives.(1) The development of addiction presupposes in the individual a complex conception of causality. He must be able to understand and believe that the way he feels at a given moment is due to the presence in his body of a minute quantity of drugs taken many hours earlier. The effects of morphine are subtle and often difficult to detect. A person who is not aware that he is under the influence of the drug often thinks that he is perfectly normal. The association between the effects of the drug and the drug itself is therefore a perception which has to be learned. It involves the association of events which occur separately with a considerable time interval between them. The understanding of withdrawal symptoms is even more complex, since it involves grasping the connection between the interruption of a series of injections and the distress that follows several hours later. It also involves reasoning which is contrary to the ordinary. When a person suddenly becomes ill he usually assumes that a foreign substance has been introduced into his body, not that one has been removed.

CHAPTER 8 CONCLUSIONS, IMPLICATIONS, PROBLEMS A person to whom the drug is given without his knowledge does not feel the buoyant sensations because the opiate's effects in small doses are not unusual enough to produce such a response. But it is evident that the buoyancy can be so interpreted to an ignorant user, and, by virtue of this explanation, he can learn to feel buoyed up with a shot. In order that the explanation may acquire meaning, however, the individual must appreciate the causal sequence that associates his sensations at a given moment with a series of preceding injections. it may be concluded, then, that only those to whom the drug's effects can be explained develop addiction. It has been shown that in many cases the beginning of addiction was marked by an addict's or physician's explanation of the significance of the withdrawal distress. On the other band, patients experiencing withdrawal distress without understanding its connection with opiates, because the connection was not pointed out, escaped addiction. It may, therefore, be concluded that the immunity of the insane, idiots, and young children who may have taken morphine is based upon a feature common to all, namely, that the meaning of withdrawal symptoms cannot be explained to them. The inexperienced non-addict fails to recognize the long-range effects of the first injection or to associate them with the immediate effect; hence be neglects, at first, to connect the withdrawal distress with prior use of the drug. Each aspect of opiate usage first appears as an isolated occurrence and is responded to in that way. When the withdrawal distress, the injection, and the drug's effects have been united into a single conceptual scheme, the individual no longer reacts to them separately but sees them as an integrated whole, one reaction implying or symbolizing the others. Withdrawal symptoms signify the need of an injection and are identified with the desire for it. The conceptualization of these events not only puts the various parts into relationship with each other but also relates them to the individual's self and to the culture of the group. It is evident that the drug addict assumes the group's viewpoint with respect to his experience of withdrawal distress by virtue of the fact that, prior to addiction, be has been a non addict and a participating member of society. In view of the very use of language symbols, in terms of which the processes of reevaluation which constitute addiction proceed, the addict necessarily shares the traditional heritage which includes knowledge of, and attitudes toward, the drug habit. Prior to addiction addicts acquire the attitudes of non-addicts, and when they become addicted they must adjust themselves to these attitudes. In other words, as my theory emphasizes, addiction presupposes life in its organized society. Children and animals cannot become addicts because they lack the ability to use and respond to the complex linguistic structures which have grown up in human society. It is interesting to ask at what point a child can become an addict. Infants of 1 or 9 certainly do not become addicted, but a youth of 15 can. At what age does immunity end and why? Only one case which appears to have some bearing on this question was found in the literature of the subject. This involved an infant to whom opiates bad been given from birth. Withdrawal symptoms had occurred during the first few days of extra uterine life, the mother having been addicted during pregnancy. The drug was withdrawn gradually when the child was 12 years old, and, as far as is known, he did not exhibit the usual tendency to relapse. (2) It is impossible to form an exact conception of the special factors involved in this case because of the meagerness of the data. The work of R. N. Chopra, who demonstrated that the feeding of opium to infants for the first three years of their lives was unrelated to addiction during adulthood, shows that 3-year-olds cannot be regarded as addicts. (3) The question may be raised whether the cases in which the drug was continually used from birth do not constitute an exception to the assertion that the addict must belong to a social group before becoming addicted. It is evident, since the 3-year-old cannot be called an addict in our sense of the term, that the child who receives the drug continuously from birth would become an addict only with increasing participation in the culture of his group. The developing concepts of self and of causality and the growing appreciation of and the ability to use language are all involved in the normal development of a child; they are also implicated, as already shown, in the process of addiction. Jean Piaget, describing some aspects of the mental development of children, writes: "Originally the child puts the whole content of consciousness in the world and draws no distinction between the 'I' and the external world. Above all we mean that the constitution of the idea of reality presupposes a progressive splitting up of this protoplasmic consciousness into two complementary universes-the objective universe and the subjective. "(4) Piaget discusses the influence of the progressive differentiation of the subjective and objective upon the child's ideas of physical causality and concludes: file:///I|/drugtext/local/library/books/adopiates/chapter8.htm[24-8-2010 14:23:39]