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Addiction and Opiates

Addiction and Opiates


CHAPTER 3 HABITUATION AND ADDICTION found in Case 3, cited in Chapter 4. Further illustration is offered in the following case: While in his teens, Mr. D. fell from a telegraph pole and fractured his spinal column. He was taken to a hospital and, to relieve the pain, was given a number of white pills. His back was put into a cast, and the pills were discontinued, but the family doctor continued to give him a tonic. As he gradually recovered he continued to take this medicine, but derived absolutely no pleasure from it as far as he was able to recall, nor did he have the slightest notion that it contained an opiate. He had never seen a drug addict and had no conception of what addiction was. After ten months of this treatment, he suddenly decided to leave town and go to a distant city to seek work. He had noticed, in the meantime, that whenever he did not take his medicine he did not feel well, but attributed this to his accident. When he left home it did not occur to him to take any medicine along, so that when he became ill from withdrawal distress, he had no notion of what was wrong but assumed it was disease. He tried at first to treat himself, but, when he continued to feel worse and noticed that he was losing weight rapidly, he consulted a doctor, who diagnosed his condition correctly. It was then that he realized for the first time that he had been using an opiate. He then defined himself as a drug addict and began to read all the medical books on the subject that he could find. He also increased his dosage until he reached approximately 6o grains a day. This took place before the enactment of the Harrison Act, when narcotics were easily available and inexpensive. It is noteworthy that during the initial period of habituation in this case the behavior symptomatic of addiction was entirely absent. Then, when the true situation was brought home to Mr. D., a pronounced change occurred in his attitude toward the drug, as evidenced by his interest in reading about it. It should also be observed that when this turning point was reached the dosage was rapidly increased. Summary Addiction may be defined as that behavior which is distinguished primarily by an intense, conscious desire for the drug, and by a tendency to relapse, evidently caused by the persistence of attitudes established in the early stages of addiction. Other correlated aspects are the dependence upon the drug as a twenty four-hour-a-day necessity, the impulse to increase the dosage far beyond bodily need, and the definition of one's self as an addict. This complex of behavior will hereafter be referred to as 11 addiction," and the organism which exhibits it will be called an ,,addict." The term "habituation," on the other hand, will be used to refer to the prolonged use of opiates and to the appearance of tolerance and withdrawal distress, when it is not accompanied by the behavior described above as addiction behavior. It is evident from the above discussion that an animal cannot be called an "addict," regardless of how much opiate drug it is given. Johannes Biberfeld correctly expresses the relationship of animal experimentation to, and its bearing upon, the problem of drug addiction when he asserts that addiction involves two types of phenomena, tolerance for morphine and a craving for morphine, and that only the former has any connection with animal experimentation. The craving, he believes, is an exclusively human phenomenon and animal behavior cannot be compared with it.(21) While recent experimentation with lower animals has narrowed the gap between human and animal responses to opiates by inducing in lower animals some interesting parallels with the behavior of human addicts, the gap has by no means been closed and Biberfeld's conclusion is still essentially correct. The more cautious of the contemporary experimenters with lower animals recognize this and do not claim that their animal subjects exhibit the same behavior that a human subject does. This experimental work with lower animals will be considered in more detail in a later chapter. The physiological conditions produced by the drug when it is habitually assimilated by the body are essential to addiction, but other factors are also present, for the physiological conditions are not always followed by addiction. The problem of the present study, then, narrows down to that of isolating the factors which account for the transition from a biological condition, induced by regular drug administration for a period of time, to a psychological state of addiction or craving. Undoubtedly the physiological concomitants play a role in addiction, for certainly no one becomes an addict without first experiencing them. Any explanation of addiction must, therefore, consider these phases, but it must also take the psychic aspects into account. The theory proposed in this study must also account for the fact that some persons escape addiction while others, under essentially the same physiological condition, become incurable addicts. In other words, the physiological factors must be regarded as necessary concomitants of addiction file:///I|/drugtext/local/library/books/adopiates/chapter3.htm[24-8-2010 14:23:34]

CHAPTER 3 HABITUATION AND ADDICTION but they are not causal in the sense that they "produce" such behavior. In subsequent chapters, the conditions which lead to the transformation of mere drug use or habituation into addiction will be specified and described. The theory that will be developed assigns an essential but not a determining role to the biological aspects of addiction. Some students of addiction from the biological sciences insist that addiction ought to be defined in biological or biochemical terms and sometimes equate it with physical dependence. Such a definition is clearly unacceptable for one who studies the behavior of the addict since it would require that infants born of addicted mothers be called addicts while drug users locked up in jail could not be. As has been shown in this chapter, physical dependence may exist without addiction and addiction without physical dependence. If one is interested solely in the bodily effects of opiates it is certainly legitimate and necessary to study the phenomena of physical dependence and tolerance, but if one is concerned with the social psychology of addiction, that is, with behavior, the definition of addiction must be in behavioral terms. If it is argued that the regular use of opiates produces permanent organic or biological changes which form the basis of the craving and of the relapse impulse, then it is necessary to assume that the same effects must be produced in countless hospital patients who unknowingly receive morphine and exhibit no craving whatever. To call such patients addicts is to do violence to the plain meaning of terms. The definition of addiction that has been proposed here is one that focuses on what are believed to be essential, common, or universal aspects of the behavior of addicts. There are many other aspects of addiction behavior which occur in some addicts and not in others, and there are special forms of behavior associated with different ways of using the drug. All of these must be excluded from consideration because, being nonessential differences between the instances, they cannot form the basis of a sound definition and they are not of central theoretical relevance. A general theory of addiction must obviously be concerned with explaining the central core of common behavior, not the peripheral and idiosyncratic variations which sometimes occur and sometimes do not. Neither can a sound definition of addiction include any element of moral judgment such as an assertion that it involves the illegal use of drugs or that it is harmful to the individual or the society. Persons dying of cancer who are provided with liberal quantities of morphine by their physicians may be addicted in the same essential sense that any other person may be. The definition proposed is one that is designed to apply to addicts anywhere, whether they use the drug intravenously, by inhalation, by smoking, by drinking it, or any other way. It distinguishes especially between those who are merely physically dependent on the drug and those who are psychologically dependent on it in the special sense implied by the word "addiction." One hypothetical qualification might perhaps be made. If one could imagine a society in which addiction carried absolutely no stigma and in which opiates were freely available to users, it is reasonable to suppose that the addict's preoccupation with maintaining his supply would not be as strong or as continuous as it has been described here. Much of the American user's anxiety and preoccupation stems from the scarcity of the supply and the difficulties in obtaining it and might be compared with attitudes toward food during a famine. In a hypothetical society made up entirely of addicts in which drugs were abundant and food scarce, no doubt the central preoccupation would be with food rather than with drugs. 1. See Albrecht Erlenmeyer, Die Morphiumsucht (3d ed.; Munich; Heuser, 1887); Edouard Levinstein, Die Morphiumsucht (Berlin; Hirschwald, 188o); F. McKelvey Bell, "Morphinism and Morphinomania," New York Medical journal (j-911) 93: 69092; and Daniel jouet, Etude sur le morphinisme chronique (thesis, University of Paris, 1883). 2. Friedrich Dansauer and Adolph Rieth, "Ueber Morphinismus bei Kriegsbeshadigten, Arbeit und Gesundheit: Schriftenreihe zum Reichsarbeitsblatt (1931), 38: 23. Cf. also Kurt Pohlisch "Die Verbreitung des chronischen Opiatsmissbrauchs in Deutschland," Monatschrift fur Psychiatric und Neurologie (1931), 79 (1): 1-32. C. E. Terry in Report to the Committee on Drug Addictions on the Legal Use of Narcotics in Detroit, Michigan, and Environs for the Period July 1, 1925, to June 30, 1926 (New York: Bureau of Social Hygiene, 1927), P. 18, notes that "patients suffering from chronic painful maladies and taking large doses of morphine or other opium equivalents were said by their physicians not to be addicted." 3. Isidor Chein, Donald L. Gerard, Robert S. Lee, and Eva Rosenfeld, The Road to H: Narcotics, Delinquency and Social Policy (New York: Basic Books, 1964), PP. 5-6. 4. John A. O'Donnell, "A Follow-up of Narcotic Addicts: Mortality, Relapse and Abstinence," American Journal of Orthopsychiatry (October, 1964), 34: 948-54. file:///I|/drugtext/local/library/books/adopiates/chapter3.htm[24-8-2010 14:23:34]

Opioid Addiction