Addiction and Opiates

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM
made by Dr. Albrecht Erlenmeyer in an article concerned mainly with the physiological effects of morphine. Speaking
of withdrawal distress, Erlenmeyer said, "In such moments the craving for morphine is born and rapidly becomes insatiable,
because the patient has learned during the period of habituation, when abstinence symptoms always set in after the
effect of the last morphine dose has passed off, that those terrible symptoms are banished as if by magic by a
sufficiently large dose of morphine ."(2) In the light of this statement, the second hypothesis of the investigation was
that persons become addicts when they recognize or perceive the significance of withdrawal distress which they are
experiencing, and that if they do not recognize withdrawal distress they do not become addicts regardless of other
considerations.
This formulation proved to be much more significant and useful than the first, but like the first it did not stand the test
of evidence and had to be revised when cases were found in which individuals who bad experienced and understood
withdrawal distress, though not in its severest form, did not use the drug to alleviate the distress and never became
addicts. The final revision of the hypothesis involved a shift in emphasis from the individual's recognition of
withdrawal distress to his use of the drug to alleviate the distress after this insight has occurred. This hypothesis was
found to be superior to the others. It had the advantage of attributing the origin of addiction, not to a single event, but
to a series of events, thus implying that addiction is established in a learning process extending over a period of time.
If one thinks of the central problem of addiction as being that of isolating and describing the nature of the experience
from which the fatal craving or "book" is derived, the hypothesis stated above suggests that the critical experience in
the fixation process is not the positive euphoria produced by the drug but rather the relief of the pain that invariably
appears when a physically dependent person stops using the drug. This experience becomes critical, however, only
when an additional indispensable element in the situation is taken into account, namely, a cognitive one. The
individual not only must experience relief of withdrawal distress but must understand or conceptualize this experience
in a particular way. He must realize that his distress is produced by the interruption of prior regular use of the drug.
It is evident that when a person becomes addicted to heroin or morphine the entire pattern of his social behavior is
commonly altered to a pervasive degree and that his orientation toward the drug is radically altered. These drastic
changes in behavior and attitude are not of the kind that could reasonably be expected to occur in an instant. They are
learned, according to the theory, in a gradual but rather rapid way as the withdrawal distress recurs and must
repeatedly be banished by further use of the drug. Even though the beginner may like the effects of morphine or
heroin, the prospects of becoming an addict are traumatic if they are actually fully understood. In this sense, the addict
does not ordinarily become such voluntarily but is rather trapped "against his will" by the book of withdrawal.
If one disregards the cognitive aspect, one can say of this hypothesis that it is a theory emphasizing negative rather
than positive reinforcement as the basis of addiction. In psychological writings the term 11 negative reinforcement" is
used to refer to a situation in which a given action is rewarded by the elimination of something unpleasant-an adverse
stimulus. Thus, if a child is locked in his room until be masters his school assignment, his reward for doing it will be
that he will be freed from confinement. This is negative reinforcement. If, on the other band, the child is promised a
much desired trip to the zoo when be completes his homework, this is called positive reinforcement.
It will be pointed out in a later chapter that psychologists have explored the theory advanced here, minus the cognitive
feature, in ingenious experimental investigations of the effects of opiates on lower animals. Some of this work strongly
suggests that insofar as lower animals are capable of matching the behavior of human subjects in becoming attached to
drugs, their attachment also depends upon the negative reinforcement obtained from the relief of withdrawal rather
than on positive reinforcement stemming from pleasurable effects of the drugs. Investigations of this type which
necessarily ignore the differences between human beings and animals occasioned by the former's immense cognitive
superiority leave open the question of the extent to which the responses of lower animals to opiates can be made to
parallel those of human subjects. In a subsequent chapter attention will be given to the matter of determining whether
it is justifiable or meaningful to assert, as some investigators do, that addiction can be induced in rats, monkeys, and
other animals.
The hypothesis of this study was tested under the following assumptions: ( 1) the verification of a theory consists not
in piling up selected instances which confirm it but in looking for evidence which contradicts clear logical implications
which may be deduced from it; (2) a valid theory of addiction must account for the basic or essential aspects of
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