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Addiction and Opiates

Addiction and Opiates

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM file:///I|/drugtext/local/library/books/adopiates/chapter1.htm[24-8-2010 14:23:31] PART I The Nature of the Opiate Habit CHAPTER 1 METHOD AND PROBLEM The present study is directly concerned only with addiction to the opiate type drugs and their synthetic equivalents. A rational, general theoretical account of the nature of the experiences which generate the addict's characteristic craving for drugs is proposed and systematically elaborated. While this theoretical position has obvious implications for other addictions which resemble opiate addiction in that they also involve drugs which produce physical dependence and withdrawal distress, an extension of the theory to these other forms of addiction, such as alcoholism, is not attempted here. This is a matter which requires specific empirical investigation of a comparative nature. The central theoretical problem of this investigation is posed by the fact that some persons who experience the effects of opiate type drugs and use them for a period sufficient to establish physical dependence do not become addicts while others under what appear to be the same conditions do become addicted. The attempt to account for this differential reaction requires a specification of the circumstances under which physical dependence results in addiction and in the absence of which it does not. It also requires a careful consideration of the meaning of "addiction" spelled out in terms of behavior and attitudes characteristic of opiate addicts everywhere. The theory that is developed is a general one; its applicability is not limited to American addicts, to lower-class users, to twentieth-century addiction, to any restricted segment of the problem, or to any specific historical period. Consequently, the focus of theoretical attention must be on those aspects of addiction which may reasonably be regarded as basic or essential in the sense that they are invariably manifested by all types of addicts regardless of place, time, method of use, social class, and other similar variable circumstances. The second part of the study consists of a brief statement of a view of current public policy concerning addiction in the United States, with proposals for reform which, it is believed, would substantially reduce the evils now associated with addiction and the large illicit traffic in drugs. Since the original publication of this book in IL947 there has been a Widespread public realization that the American program of dealing with addicts is both cruel and ineffective and that it compares unfavorably in these respects with the programs of most European countries in which opiate addiction is handled primarily as a medical rather than as a police problem. It should be kept in mind that when I use such terms as "narcotics," "drugs," "drug addict," and "drug users," I will be referring to drugs that are commonly classified as opiates and their synthetic equivalents and to persons addicted to drugs in this class. Common and well-known examples are opium, heroin, morphine, methadone, and demerol. Marihuana and cocaine do not belong to this category, and only incidental reference will be made to them. While alcohol is addicting in approximately the same sense that heroin is, it will also be referred to only incidentally. The fact that marihuana, cocaine, and heroin and other opiate type drugs are covered in the same anti-narcotics legislation is a fertile source of confused thinking because it obscures the facts that the use of marihuana is totally unlike heroin or morphine addiction and that alcoholism, which is not covered by the legislation and is not popularly thought of as a form of narcotic addiction, actually has very much in common with opiate addiction. The theory that is proposed in this book, in its earliest stages, was derived from observing addicts and conversing with them. The later development of the theoretical framework of the study was also significantly influenced by data available in the extensive literature. Approximately fifty addicts were interviewed over a fairly extended period of time sufficient to establish an informal, friendly relationship of mutual trust. In the case of twelve others there was at least one interview but the relationship was brief or occurred under circumstances that made it impossible to place much confidence in what was said or to obtain a full and consistent account of the person's addiction history. Since my contacts were usually with addicts who were using drugs it was unavoidable that some of them disappeared before I could learn much from them. On the other hand, there were some with whom I established relationships that lasted for several years covering periods of use, of temporary voluntary abstention, and of incarceration. My principal assistance in becoming acquainted with new subjects came from "Broadway" Jones, officially known by the alias "Chic Conwell," which Sutherland gave to him in The Professional Thief.(1) Mr. Jones himself bad bad a

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM long history of addiction that began in his late teens. He was an invaluable -source of information. He also read and criticized my manuscript. Indeed, he initially suggested that I study drug addiction and offered his cooperation in the project. I remained in communication with him until his death, some years after that of Dr. Sutherland. Mr. Jones was not using drugs during most of the approximately twenty years that I knew him but did relapse some years before his death. On the advice of Sutherland he voluntarily committed himself to Lexington for withdrawal. When I first began to talk to addicts with the idea of making a systematic analysis of the habit I became fascinated by the theoretical problems it posed. I dreamed of basing my analysis on interviews with hundreds of addicts, perhaps even as many as a thousand. For this purpose, through the good offices of Professor Sutherland I obtained permission from the Federal Bureau of Prisons to interview addicts at the Lexington Public Health Service Hospital and the annex of the Federal Penitentiary at Leavenworth, which at that time specialized in handling drug offenders. However, the Public Health Service, which also exercised authority in these two establishments, refused to give me this permission on the grounds that what I proposed to do was already being done by their personnel. I was consequently compelled to rely on the costly, slow, and arduous techniques involved in picking up subjects from the Chicago streets, financing my research almost entirely from my own pocket. Many but not all of my subjects were introduced to me by Broadway Jones, who briefed both them and me in advance. Most of them were experienced in criminal activity such as drug peddling, some form of theft, or the confidence game. Mr. Jones sometimes warned me that my new subject could not be trusted and that I should keep one hand on my billfold and the other on my watch when I was with him. In other instances the subject was characterized as an "honest thief" who could be trusted implicitly to steal only from strangers and whom I could safely take into my home. A substantial number of my subjects did in fact visit with me, my wife, and our daughter in our apartment. None of these ever pilfered anything; on the contrary, a number of them offered to provide us with stolen goods. I ordinarily told each new subject that I was interested in studying the "psychology" of the habit and trying to understand it. This invariably satisfied them, and they asked no probing questions, perhaps because they felt that they knew a great deal more about the psychology of addiction than I ever would. It was thus unnecessary to explain the theoretical development of the study to them, and, indeed, they were not interested in it. To encourage addicts to remain in contact with me I usually rewarded them by buying them a meal in a cheap restaurant or bar or by giving them fifty cents or a dollar after an interview. My conversations with them were held in bars and restaurants as a rule. Most of my subjects were very cooperative, in part perhaps because addicts talk and think about their addiction a great deal in any case, and also, in many instances, because they felt that an objective, non-moralistic study of addiction was needed and might benefit them by leading to a more rational public policy. There is a widespread feeling among addicts that addiction is not understood, that it is misrepresented in the mass media, and that it is dealt with in an inhumane and needlessly severe manner. Non addicts who have dealings with known addicts generally deal with them in a condescending or authoritarian manner and often moralize with them. I consciously avoided all of this, even at times when I was repelled or shocked. I felt no condescension because I knew that my subjects had information which might be useful to me and that I was thus dependent on them. Finally, I was in no position to be authoritarian because my subjects were free to break off the relationship whenever they wished to. The literature of drug addiction was at first not consulted for fear that the opinions expressed would introduce an initial and perhaps decisive bias into the investigation. The first temporary hypothesis was formulated exclusively on the basis of observation of and conversations with addicts, and it was only after the study had crystallized around a few central problems and theories that the literature was intensively examined. It was examined particularly with the view of uncovering negative evidence which would force revision of the theory and also of exploring as exhaustively as possible all relevant aspects of the subject and all implications of the theory. The first tentative and obviously inadequate hypothesis formulated was that individuals who do not know what drug they are receiving do not become addicted and, on the positive side, that they become addicted when they know what they are getting and have taken it long enough to experience withdrawal distress when they stop. This hypothesis was destroyed almost at once by negative evidence. One of the first addicts to be interviewed, a doctor, had once received morphine for several weeks; be was fully aware of the fact, but be did not become addicted at that time. The difficulty presented by this case remained unresolved until my attention was attracted to a rather casual and incidental comment file:///I|/drugtext/local/library/books/adopiates/chapter1.htm[24-8-2010 14:23:31]

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