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Addiction and Opiates

Addiction and Opiates


CHAPTER 8 CONCLUSIONS, IMPLICATIONS, PROBLEMS In the course of our studies in child psychology we had expected to fix upon 7-8 as the age before which no genuinely physical explanation could be given of natural phenomena. Our present inquiry entirely confirms this expectation. After 7-8 the more positive forms of causality gradually supplant the others, and we can say that at the age of about 1 1 12 the evolution is completed. There is therefore, in the domain peculiar to causality, a process of evolution exactly similar to that to which we drew attention in speaking of reality: confusion of the self and the universe, then progressive separation with objectification of the causal sequences.... It is only after having assimilated the activity of external bodies to his own muscular activity that the child turns the new-made instrument upon himself and, thanks to it, becomes conscious of his internal experience.(5) In view of Piaget's description of a child's developing conceptions of causality, the immunity of children to addiction, the apparently permanent cure of a 12-year-old who bad been given drugs from birth, and the complete absence of addiction in young persons below the age of ten years or thereabouts, are not accidental circumstances but exactly what one would expect. It is of considerable interest and significance that, during the last fifteen or so years, there has been considerable experimental work with rats and monkeys that has seemed to a number of investigators to confirm the idea that the book in opiates is derived from the experience of relief of withdrawal distress, that is, from negative reinforcement. This convergence of views is notable in that it includes persons of very different professional and ideological commitments, such as sociologists, psychologists, and pharmacologists. The experimental findings with lower animals may be summarized with respect to the theoretical position outlined here by saying that they seem to indicate, insofar as animals are capable of responding to opiates as human subjects do, that the similarity is produced by the same basic mechanisms but in a simpler form. In other words, in so far as rats and monkeys can be hooked on drugs, the processes of their becoming so follow the same patterns as in human subjects. A point of controversy is the question of how far lower animals can go in duplicating human responses. This question is part of the broader question of man's special place in the animal kingdom, his extraordinary intellectual capacities, and his possession of language. Complex human responses, it is argued, are mediated by language symbols, by ideas or concepts. The significance of a stimulus or situation is not inherent and fixed, but is determined by the way in which it is perceived or conceived. Applied to addiction, these ideas suggest that the effects of drugs on behavior would be expected to depend on how they were understood and interpreted. Man's possession of language and conceptual thought also enables him to organize and integrate his responses on a more complex level than is the case with lower animals. Human addiction, unlike the reactions of lower animals, is a cultural or societal phenomenon. It becomes that when the person understands or grasps conceptually what is happening to him and identifies himself as an addict. When the raw biological and pharmacological events are conceptually elaborated they enter into relationships with other conceptual processes, such as conceptions of self and those connected with laws, rules, morality, punishment, and guilt. The complexities of addiction behavior which arise from the 'Cultural nature of man and the fact that he is the only language-manipulating animal are naturally not found in rats and monkeys. Addicting and Non-addicting Drugs The drugs designated as addicting, such as barbiturates, opiates, and alcohol, share the characteristic feature that all produce physical dependence and withdrawal distress. Non-addicting drugs, such as LSD, marihuana, cocaine, and others, do not involve these features. Confusion arises from the fact that there are persons who use non-addicting drugs regularly just as there are persons who use addicting drugs irregularly. What is implied by the preceding analysis is that the attachments to these two types of substances are qualitatively different and are established in two very different ways. In the case of addicting drugs, we have argued that it is the push of withdrawal distress that fixes the habit; in the case of the non-addicting subtances it is the pull of positive pleasure that motivates use. While the opiate addict says be takes the drug to feel normal, the users of LSD and marihuana obviously take these substances to feel other than normal. While opiate addicts under certain circumstances can be deceived about whether they are under the drug's influence, it is inconceivable that an experienced LSD user file:///I|/drugtext/local/library/books/adopiates/chapter8.htm[24-8-2010 14:23:39]

CHAPTER 8 CONCLUSIONS, IMPLICATIONS, PROBLEMS could take a trip without knowing it or be sent on a trip with a placebo. In the language of reinforcement theory, one may suggest, therefore, that the powerful habits connected with addicting drugs are established by the mechanisms of negative reinforcement, while the weaker habits connected with non-addicting drugs are based on those of positive reinforcement. From considerations of this kind it is reasonable to suppose that other addictions, such as those involving barbiturates and alcohol, follow the same pattern and involve essentially the same mechanisms as opiate addiction. This point has been made explicitly by Bales with respect to alcoholism.(6) Hebb has argued that there is addiction. to -food and that the mechanisms that establish this necessary form of addiction may be the same as those of opiate addiction. Withdrawal distress in this case is called hunger. As with opiates, the child is taught to recognize the symptoms and what to do about them. As the individual increases in sophistication, hunger ceases to be the almost purely biological matter that it is at birth and becomes a conceptually and socially controlled process that is linked in intricate ways with other higher cortical functions. As in the case of opium, deprivation or prolonged suffering from hunger and undernourishment intensify the craving and lead to overindulgence when the opportunity offers itself. just as the symptoms of opiate withdrawal and the desire for opiates are identified with each other by the drug user, so also is the word "hunger" used to refer both to a bodily condition and to a desire for food, which is sometimes linked with the bodily condition and sometimes not.(7) There are substances like' The vitamins, which produce withdrawal symptoms when they are withdrawn, but which do not generate a craving and do not produce an immediately identifiable impact or kick when they are injected. One may speculate that, if the symptoms of severe vitamin deficiency were relieved immediately and dramatically by taking the vitamin, a psychological dependence or craving for such substances might be developed. Conversely, if the symptoms of opiate withdrawal vanished only very gradually over a considerable time period after a shot, it may be supposed that no craving would be produced. Speculations of this kind raise questions as to what the timing must be in the relief of distress of this sort for the subject to experience it as euphoria. Psychoses and Addiction The contention that addiction requires a relatively normal cognitive ability sufficient to understand withdrawal symptoms or to grasp a proffered explanation of them implies that full-fledged psychotics with seriously disturbed cognitive processes should be immune to addiction. Pertinent observations by physicians concerning this point may be cited. Sceleth and Kuh, for example, remarked: Several hundred patients suffering from the depressed stage of manic depressive insanity were given large doses of opium orally in many instances for periods of from six months to one year. Not one of these patients ever knew what drug he was taking or ever showed any untoward results when it was withdrawn, or in any other way gave evidence of a desire to continue its use. Nor do we recall a single instance recorded in the medical literature of the period during which this form of treatment was administered quite commonly, in which either withdrawal symptoms or a craving for narcotics was reported. This is significant in view of the idea that manic depressive insanity is based on an inherited unstable nervous system.(8) Dr. Paul Wolff, formerly of Germany, reported the answers to the following question, which was asked of many leading German medical men: "When is the prescription of opium justified?" Three of those who replied referred incidentally to the absence of addiction among psychotics. Dr. Wolff concluded: Opium is indispensable in dealing with the fear states of the melancholic individual. But here we make the surprising discovery that the continued administration of opium, in the form of opium tincture, during the melancholic mental disturbances, even when continued over a long period of time does not produce drug addiction. That is, it does not, provided the dosage is adapted to the diseased mental state of the patient and provided that the doctor is careful to withdraw the drug at the correct time, as soon as he notes a decrease in the fear tension or excitement of the psychotic patient. In the last three and one-half decades I have seen a number of cases of morphine addiction develop as a consequence of the over-hasty application of morphine in physical distress or disease, but do not recall one single instance in which the administration of scopolaminemorphine during a psychosis led to a craving which lasted beyond file:///I|/drugtext/local/library/books/adopiates/chapter8.htm[24-8-2010 14:23:39]

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