5 years ago

Addiction and Opiates

Addiction and Opiates


CHAPTER 3 HABITUATION AND ADDICTION addicts, who use diluted drugs, generally do not know precisely bow much they are taking, and cannot be counted upon to report it correctly if they do know. The only plausible explanation of Table i, an explanation made by Pohlisch himself, is that a high percentage of the patients using very small amounts were not addicts, and that the percentage of those who were only habituated, but not addicted, decreases as the dosage increases. This conclusion is borne out if the physicians included in the Pobliscb study are listed separately, as follows: The marked concentration around the lower figures is absent in this distribution; only 22 per cent of the doctors used less than 3 grains per day. One would expect that the percentage of addicts among doctors who are regularly taking morphine would be larger than among non medical persons. Thus Table 2 corroborates the distinction made here between habituation and addiction. Further support of my thesis, that addiction and habituation are radically different, may be obtained by listing separately those cases mentioned by Pohliscb in which cocaine was used in connection with morphine, heroin, or another opiate. One could also expect most of this group to be addicts because of the relative infrequency with which cocaine is prescribed and because the use of cocaine and an opiate in combination represents a degree of sophistication ordinarily encountered only among addicts. The users of cocaine and an opiate (usually morphine) took the following amounts per day: file:///I|/drugtext/local/library/books/adopiates/chapter3.htm[24-8-2010 14:23:34]

CHAPTER 3 HABITUATION AND ADDICTION Only 16 per cent used less than 3 grains per day, as contrasted with 65 per cent of the total cases (including physicians and cocaine users). The distribution is again strikingly different from that of the ordinary run of cases and corresponds rather closely to general observation concerning the approximate size of the addict's dosage, as well as to the average Of 7.66 grains per day reported by Kolb for his medical cases. The impulse to increase the dosage is so powerful that most drug users with whom I discussed the matter regarded it as almost inevitable that an addict should use too much. They were skeptical of any addict who claimed to require only as little as 2 or 3 grains per day. It may be possible by resolute determination to stabilize drug consumption at a low level, but the trend toward a progressively larger dosage is probably a distinguishing characteristic of addict behavior. There is nothing in medical practice remotely corresponding to the insatiable appetite for large doses that characterizes most chronic users. It may safely be assumed that even those addicts who manage to stabilize their intake at a low level feel the desire to use more. Again in contrast to the addict, the habituated person not only uses a smaller amount on the average but does not feel the progressive need for more. Many German addicts studied by Dansauer and Rieth, for example, obtained their narcotics from two different doctors at the same time and tried similar deceptions, while nothing of the sort occurred among those who were using the drug without being addicted. I have known a number of cancer cases in which morphine was administered orally for more than a year without reaching a maximum Of 2 grains a day, the equivalent of perhaps one grain hypodermically. Such moderation is practically unheard of among addicts, unless it is involuntary. A final characteristic of addicts is that they know they are addicts and speak of themselves as such. American underworld addicts refer to themselves as "junkies" or "users," and are so regarded by others. Frequently, in a jocular sense, they use the more expressive term "dope fiend." Even the drug user in respectable society, who may lave few or no addicted associates, secretly labels himself a "drug addict" or "dope fiend." The most obvious way of defining addiction or of determining if a person is an addict is to ask him, provided, of course, that one has his confidence. Another simple procedure is to inquire among those of his associates who are in a position to know. While I was gathering the material for this study, I asked individuals who had once been "booked" if they were addicts, and they always replied unhesitatingly in the affirmative, even though they were free, of the drug or bad voluntarily abstained for several years. In contrast to the addict, the hospitalized patient who has been receiving opiates to deaden pain does not regard himself as an addict. If he does not recognize withdrawal distress, he obviously cannot infer that his experience has any connection with drugs. The most striking demonstration of this point is to be file:///I|/drugtext/local/library/books/adopiates/chapter3.htm[24-8-2010 14:23:34]

Opioid Addiction