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Addiction and Opiates

Addiction and Opiates


CHAPTER 8 CONCLUSIONS, IMPLICATIONS, PROBLEMS the period of the illness."(9) Dr. Emil Bratz, director of the Berlin Sanitarium, replying to Dr. Wolff's questionnaire, made the following observation on this question, recommending morphine for use in case of depression and for endogenous psychoses: ... but also only in endogenous, that is in simple or periodic melancholia arising from a constitutional basis, and even then it should be administered only by an experienced neurologist. Warning must be issued against the administratiorr of opiate preparations in cases of reactive depression in psychopaths-that is, depression in response to the vicissitudes of life. In these cases, it leads with especial ease to the development of addiction.(10) Professor Karl Bonhoeffer stated: Opium is indispensable in many cases of endogenous depressions. . The prescription of opiates for states of depression is unobjectionable also because we know from experience that the depressed persons feel no need for narcotics when the depression has passed away, and practically never become addicts."(11) These medical opinions clearly suggest that - the individual who is isolated from society by certain kinds of mental disease is immune to addiction. It is especially significant that some of the authorities insisted upon the distinction between "endogenous" depressions and those brought about, as Bratz said, by "the vicissitudes of life." The latter, it is indicated, are associated with susceptibility to addiction, the former with immunity. Marginal Patterns Reference has already been made to patterns of drug dependence among patients in medical practice in which the individual does not identify himself as an addict even though he is not altogether ignorant of his actual situation. Between the patient who has no idea what drug he is receiving and knows nothing of withdrawal and physical dependence and one who becomes addicted in the ordinary and usual sense, there is evidently a range of. variation which has been inadequately investigated. In the case of the drug-dependent person who defines himself as a medical patient and considers morphine as a "medicine" which be must have to control or alleviate disease symptoms or pain, it appears that there must be something in the objective situation to validate and support this self-conception. Such objective elements may be the actual presence of organic pathology and the very fact that the drug is prescribed by the physician and administered in a medical setting. When such a patient takes the step of administering drugs to himself it seems probable that this tends to undermine and soon destroy his conception of himself as a medical patient. Since the person ordinarily has strong motivations for preferring to be a patient rather than a dope addict, it would be expected that self-deceiving rationalizations would be employed to maintain the former identity whenever possible. By the same token, the person who, in his own mind, has, made the switch and knows he is simply an addict would be expected to conceal this fact and prevent others from realizing it. The settings in which drugs are taken or in which withdrawal distress occurs are, known to have profound effects upon the human subject's evaluation of these experiences. Thus, initial euphoric effects are often not noticed when the drug is first taken in a medical setting for medical reasons. An experienced addict, invited to give himself an injection in the police station with several narcotic agents as an audience, is not likely to enjoy the experience. Withdrawal distress appears markedly more severe when the addict kicks his habit in a cell in a jail than when he kicks it in Synanon attended and surrounded by friends who are also addicts. Related phenomena which contribute to the same point are that some of the unpleasant effects associated with the first few trials of the drug, such as dizziness and nausea, come to be highly prized and desired by the addict and that some of the withdrawal symptoms may be evoked in the abstaining addict by suggestions communicated to him. Considerations of this kind indicate that pleasure and pain are elusive, subjective phenomena and that the perception of pain and pleasure may sometimes be considerably modified, neutralized, or even reversed by influences of a conceptual nature derived from the social environment. It should thus not be surprising that persons who become addicted in medical practice sometimes report that they have never experienced euphoria from the drug. Drug-dependent patients and others who receive opiates for shorter periods no doubt exhibit a wide range of cognitive responses to their situations. A more systematic exploration of this area, with close attention given to the patient's ideas, would be of the greatest interest and importance to the social file:///I|/drugtext/local/library/books/adopiates/chapter8.htm[24-8-2010 14:23:39]

CHAPTER 8 CONCLUSIONS, IMPLICATIONS, PROBLEMS psychologist concerned with the study of drug effects. The same may be said of experiments with opiates in which placebos are employed. A fuller exploitation of data from these sources would undoubtedly contribute greatly to a more discriminating analysis of addiction than is presently possible. Extremely interesting and challenging theoretical notions are implicit in the Dole-Nyswander project in New York City in which heroin addicts taken from street of the city are provided with maintenance doses of methadone, a synthetic equivalent of heroin. The methadone is provided the addict gratis once or twice a day in orange juice in sufficient quantity to maintain body equilibrium and prevent withdrawal distress from appearing. Dole and Nyswander describe what they do in medical terms: they provide "patients" with a "medicine" which "blocks the craving for heroin." The manifestations of heroin addiction are controlled, they argue, much as those of diabetes are controlled by insulin. The program is entirely voluntary and contains no punishment and no threats. The subjects are encouraged to get jobs or to go on to school, and most do. Under this program the behavior of the subjects changes in a remarkable manner. For example, they begin to speak of their addiction in the past tense, they spontaneously stop talking much about dope and report that they think about it very much less. It appears, in short, that their identity conceptions are changed; they are no longer junkies, but medical patients, and there are corresponding behavioral changes implied by the redefinition. It has been reported repeatedly that there has been no problem in stabilizing the daily dosage of the subjects and that the addict's usual impulse to increase it is either greatly diminished or absent. The subjects seem to act and think like medical patients. Some of the reported effects are no doubt connected with the reduction in anxiety that is associated with having an assured supply of pure drugs made available without any of the usual risks and with much less stigma .(12) Cures of Addiction If the craving for opiates which characterizes addiction is indeed dependent upon withdrawal distress in the manner that has been suggested, the longstanding idea that the problem of narcotics addiction might be solved by the discovery of a non-habit forming substitute for morphine or heroin is illusory. In a sense, addicts desire the drug because it is habit forming, that is, because it produces physical dependence and withdrawal distress. A drug which did not have such effects could not conceivably be the psychological equivalent of morphine; such an equivalent drug would necessarily have to be another habit-forming drug. One may argue that there are many non-habit-forming substitutes for opiates available at present, if one means by this drugs which produce pleasant sensations but no physical dependence or withdrawal reaction. Marihuana is such a drug, and cocaine is another and a much more powerful one. Neither functions as a substitute for heroin or morphine. The idea of a non-habit forming substitute for habit-forming drugs, conceived as a solution of the narcotics problem, is comparable to the idea of a non nutritious substitute for food or a non-liquid substitute for water. When cures of addiction are discussed, the reference is usually to the process of separating the addict from his drug or to voluntary abstention from use. Little attention is given to the relapse impulse itself, which apparently persists for very long periods of time and probably permanently, in the abstinent addict. This feature of drug addiction is not peculiar to it but is also apparent in other habits. As has been suggested, the cognitive changes that addiction produces as the individual learns from direct experience about the drug and its effects on him may well constitute the most ineradicable feature of the relapse impulse. It is inappropriate to speak of a cure for knowledge. Curing a person of addiction might, in this sense, be compared with curing a person of a college education. 1. George H. Mead, "A Behavioristic Account of the Significant Symbol," Journal of Philosophy (1922), 19 16o. 2. Charles E. Terry and Mildred Pellens, The Opium Problem (New York: Committee on Drug Addiction and Bureau of Social Hygiene, 1928), pp. 426-27. 3. R. N. Chopra and G. S. Chopra, "The Administration of Opium to Infants in India," Indian Medical Gazette (1934), 69: 489--94. file:///I|/drugtext/local/library/books/adopiates/chapter8.htm[24-8-2010 14:23:39]

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