Addiction and Opiates

CHAPTER 3 HABITUATION AND ADDICTION
file:///I|/drugtext/local/library/books/adopiates/chapter3.htm[24-8-2010 14:23:34]
PART I The Nature of the Opiate Habit
CHAPTER 3 HABITUATION AND ADDICTION
Not all persons receiving opiates regularly for long periods of time become addicted. Edouard Levinstein, a prominent
nineteenth century German authority, designated persons who were not addicted, but who were receiving the drug, as
"morphinists," and applied the term "Morphiumsuchtiger" (morphine addict) to those who were addicted. French
students made the same distinction. In this country, also, there have been attempts to introduce separate terms for the
two conditions.(1) Patients who receive therapeutic doses of opiates for a period of time without becoming addicted do
not, however, constitute a homogeneous group requiring separate conceptual consideration. There is no generally
accepted term to differentiate the two conditions, and yet they need to be examined separately. One condition involves
pharmacological tolerance and withdrawal distress upon removal of the drug, without the usual manifestations of
intense desire that occur in addiction, the other concerns, in addition to these two symptoms, intense and persistent
desire.
That morphine or some other opiate may be given to a patient over a long period of time without creating an
independent craving is confirmed by many scientific reports. In a study of morphine use among ex-soldiers, Friedrich
Dansauer and Adolf Rieth found many had been using the drug regularly for years, sometimes more than five, but
were, nevertheless, not addicted. These users are designated as the "symptomatic type," and are not classified with true
addicts, who are called "the idiopathic type." Classifying 240 of their cases in the former category, the authors give
representative summaries of about 20. (2)
In the more recent literature, the distinction with which we are here concerned has been made by differentiating
between drug users and drug addicts. Chein and his associates, for example, remark:
It was not until this book was well under way that it dawned on us that even a person with a history of drug use and
physiological dependence on the drug might conceivably not be an addict. Such a person might be lacking in what we
now regard as an indispensable characteristic of a true addict-craving, that is, a powerful 1 desire for the drug
independent of the-degree to which the drug has insinuated itself into the physiological workings of his body.(3)
In the discussion that follows, the term "habituation" will be used to refer to the state of the person who is physically
dependent on the drug but not addicted to it. The term "addiction" will be reserved for those individuals who have the
characteristic craving, whether it be in the form in which it is manifested during regular use or as it exists in the
abstaining addict impelling him to resume use. An unconscious patient or one who is given morphine regularly by
attendant nurses without his knowing it could thus be described as habituated but obviously not as addicted.
Terminological confusion has been increased in the current literature by the introduction of a variety of new terms and
redefinitions of old ones. "Habituation" is, for example, sometimes taken to refer to the regular use of a drug like
marihuana which does not produce physical dependence as the opiates do. It has been suggested that, because there is
ambiguity in the meaning of the terms "addict" and "addiction," the awkward and even more ambiguous terms, "drug
abuse" and "drug abuser" be substituted for them. Some writers refer to "opiate-directed behavior" or to "sustained
opiate-directed behavior," rather than to "drug use" and "drug addiction." A standardized terminology would be highly
desirable, of course, but is not likely to be adopted. Confusion can be avoided only by paying attention to the
substantive distinctions rather than to the terminology in which they are expressed.
Characteristics of Addiction Behavior
In any inquiry the subject matter to be investigated must be defined and described as exactly as possible. This
description is usually found at or near the beginning of the study even though the definition itself is to a large extent
the result of the research. The distinction between habituation and addiction must be made by describing and
enumerating those characteristics of the behavior of addicts which are unique and common and which do not occur