Addiction and Opiates

CHAPTER 3 HABITUATION AND ADDICTION
with others who have had the experience and a communication barrier between him and those who have not bad it. It
is in this sense that addiction may be called incurable.
In contrast to the voluntary abstainer, the user whose habit is interrupted by a prison sentence is obviously in a very
different category and is usually simply called an addict and regards himself as such. The imprisoned addict
commonly connives and schemes to smuggle drugs into the prison and makes his keepers acutely aware that he is
different from the other inmates. To a warden of a penitentiary it would seem absurd to argue that an addict ceases to
be that whenever he is off drugs. Hence, in this discussion I shall simply use the term "addict" to refer to anyone who
has been booked.
Relapse Rates
There are few reliable general statistics on relapse among American drug addicts, and estimates can be made only by
indirect means. A careful study of about 8oo German addicts led to the following findings: 81.6 per cent of the cures
were followed by relapse within a year, 93.9 per cent within three years, and 96.7 per cent within five years. It seems
probable that the relapse rate among American addicts may be even higher because of the predisposing circumstances
in which "cured" American addicts usually find themselves. Moreover, relapse can take place after more than five
years of abstention, so that even the remaining 3.3 per cent noted above could scarcely be regarded as cured, in the
sense that the impulse to replapse bad been permanently eradicated. On the other hand, it should be observed that some
of the addicts who relapsed soon after being withdrawn may well have quit again before the end of the five years. Had
the authors determined how many of the 8oo were not using drugs at the end of the five-year interval the percentage
would have been substantially higher than 3.3 per cent and the picture would have seemed more hopeful.(5) Because of
the addict's propensity to resume his habit it is argued that progress in breaking the habit should be measured in terms
of man-hours or days off drugs, rather than simply by whether relapse does or does not occur. The apparently higher
rate of abstention among older addicts may mean that older users abstain more often or for longer periods than do the
younger ones.
In a review of eleven studies of relapse among American addicts O'Donnell notes that the reported relapse rates varied
from a low of 8 per cent over a five-year interval to a high of about go per cent over an interval of from one to 4.5
years. He notes that most of the studies focus on whether relapse occurred and do not provide information concerning
the actual percentages of the time interval during which the addicts were not using drugs. When the problem is posed
in this way, O'Donnell observes that the prospects appear more hopeful and that there appears to be a tendency for
older addicts to abstain more on the average than is the case with younger ones. Relapse rates also are related to the
addict's status during the period of study. For example, if he is on parole and threatened with reincarceration if he
relapses, relapse is likely to be inhibited. The lowest relapse rate of only 8 per cent over a five-year period was secured
with physicians who were assured of losing their licenses to practice medicine if they relapsed. Virtually all of the 8
per cent who did relapse under these circumstances committed suicide.(6)
Whatever the relapse rates may be for various categories of addicts, it is agreed by all who have studied them in any
part of the world that relapse rates are high and that the impulse to relapse is probably permanent and ineradicable.
Periodically in the past, special techniques of curing addicts have been announced with claims of an extraordinarily
high percentage of cures. In no known instance have such cures turned out to be of any special significance. In some
instances they were simply frauds; in others the apparent success hinged upon the brevity of the follow-up period or
upon careless methods of determining whether the cured patient was actually off drugs. Clearly the word "cure" may
be used in a variety of senses. It is sometimes used merely to indicate that the addict has been taken off drugs. It may
also be used to indicate voluntary abstention for periods of time varying from a few weeks or months to five or more
years, and it may be used to refer to the elimination of the desire or temptation to relapse. If any addict who abstains
voluntarily for a period of several weeks is said to be cured, then one can say of most long term users that they have
been cured many times. If, on the other hand, one reserves the term for those in whom the desire for drugs has been
permanently eradicated, it is doubtful if there are any cured addicts.
The practical problem of controlling addiction, of course, is to promote abstention whenever this is possible.
Theoretical interest is more focused on the nature and origin of the craving for drugs than on attempting to understand
file:///I|/drugtext/local/library/books/adopiates/chapter3.htm[24-8-2010 14:23:34]