Addiction and Opiates

CHAPTER 3 HABITUATION AND ADDICTION
among non-addicts. It is particularly necessary that a definition of addiction take into account the similarities and
differences between habituation and addiction and sharply differentiate between them.
As already indicated, the most obvious characteristic of, the addict's behavior is his intense desire and striving for the
drug. This desire is not casual or vague but is a powerful conscious motive driving him to seek satisfaction in the face
of almost insuperable obstacles and at the cost of unbelievable sacrifices. A universal aspect of the behavior of addicts
is that they permit little or nothing to stand between them and the drug. It would be ridiculous to speak of an addict
who wanted drugs but was un aware of the need around which virtually all of his behavior was organized.
Another characteristic of the addict, and one that is as universal as the first, is his tendency toward relapse. Once
addiction is confirmed, the craving acquires an -independent status; the desire persists even after the original
physiological conditions have disappeared. In other words, when the addict's supply is cut off and he has been treated
for withdrawal symptoms, he may be restored to apparent health, but he still tends to relapse. Were it not for this,
addiction would obviously be no great social problem. It would only be necessary to separate the addict from his
source of supply and then release him. Yet, in the vast majority of cases, the cured addict apparently returns to his old
habit.
There is a belief prevalent among addicts that it is a misnomer to speak of a cure for addiction. They remark, "Once a
junkie always a junkie." They admit that now and then an addict may refrain absolutely from using the drug for years,
even though it is available, and that others do not use it for long periods of time simply because, either as a result of
incarceration or for other reasons, they cannot get it. These cases are not regarded as cures, however, for the habitue
knows only too well from bitter personal experience that the so-called cured case is merely one in which the regular
use of the drug has been temporarily discontinued. The number of cases accessible for study in which an individual has
voluntarily abstained from the narcotic for a period of years is small.
Most of the addicts whom I interviewed said that they either knew of no users who bad voluntarily refrained from
using drugs for more than five years or that they knew of one, two, or a few who bad. All believed that the impulse to
relapse was permanent and ineradicable. Some argued that even those few addicts who manage to abstain for long
periods could probably be induced to relapse by skillful propaganda over a day or two. Relapses have been known to
occur after more than ten years of abstinence.
These expressions of opinion by drug users must be discounted to some extent to allow for the addict's rationalizations.
The self help organization known as Synanon is made up of former users, and many of them have abstained from
drugs for considerable periods. There is also some indication that with advancing age the user's periods of abstention
become longer and that some may quit permanently. In a study of former residents of Kentucky who had been at the
Lexington Hospital for addicts it was found that more than half were not using drugs when they were interviewed. This
fact was determined by analysis of a urine specimen from each of them. Many of these abstainers succeeded in staying
off by moving to small localities where there was no illicit traffic and where they knew of no other users .(4) Such
abstainers obviously would not be known to active urban addicts All the evidence suggests that the relapse rates for
those addicts who go from institutions to the metropolitan centers where addiction is concentrated are much higher
than those reported in the Kentucky study.
While there are undoubtedly some drug addicts who voluntarily and permanently renounce their habits, the matter of
eradicating the impulse to relapse poses another and different issue. The same one arises with respect to alcoholics, of
whom it is said that they cannot become casual or social drinkers no matter how long they abstain. Similarly, once an
individual has been booked on opiates his attitudes toward the drug are permanently changed and resumption of the
habit after long periods of abstinence is easy.
The temporarily abstaining addict is a familiar figure to other addicts, who have themselves usually tried
unsuccessfully to break their habits. The users are all too well aware of the boredom of non-use, and they know the
rationalizations that the unhappy cured addict uses to seduce himself into a resumption of his habit. Such abstainers are
not viewed as "squares" or non addicts, but simply as addicts who happen at the moment to be off drugs. The abstainer
himself, like the reformed alcoholic who joins Alcoholics Anonymous, thinks of himself, not as a "non addict" but as
an "ex-addict." Having joined the fraternity of those who have been booked, be feels a continuing bond that unites him
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