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Addiction and Opiates

Addiction and Opiates


CHAPTER 5 PROCESSES IN ADDICTION Anyone who has ever been "hooked" is regarded by other addicts as one of the "in-group." Whether or not he is using opiates at the moment, he is considered "one of the boys," a "junkie," a " user," or as an "ex-junkie" never a "square, " or non-addict. The addict who is temporarily not using drugs is familiar to other addicts and is regarded with tolerance and often encouraged in his effort to stay "off the drug." He is never viewed as an outsider. Since other addicts remember only too well their own helpless efforts to quit, they fully appreciate the position of the former user. Consequently, they wish the abstainer good luck by such remarks as "I hope you make it; I can't." Between the addict who is using drugs and the one who is not there is never the social barrier that separates the addict from the non addict. In the present study, drug users were asked in their own vernacular whether they had ever known or heard of anyone who had experienced and understood withdrawal and used the drug to avoid these symptoms without becoming addicted. This involved asking the self-contradictory questions, "Have you ever heard of a person who got hooked without becoming an addict?" or "Did you ever hear of an addict who was never hooked?" Both questions were meaningless to addicts, and I was compelled to explain myself. To the drug user, to be "hooked" is to be addicted and to be addicted is to be "hooked." Another term, "yen," is used popularly as a synonym for "desire"; for example, "I have a yen for a piece of pie." In the addicts' argot, this word signifies the desire for narcotics incidental to abstinence distress. In this sense, the drug user who is full 'of narcotics cannot feel a "yen," nor can he feel it after he has been in prison a few months and the withdrawal symptoms subsequent to the removal of the drug have vanished. The desire for narcotics that persists after abstinence symptoms have vanished is not called a "yen" by addicts. (3) On the other hand, the term is actually applied to the withdrawal symptoms as such, whether they are understood or not by the individual experiencing them. Thus, it will be recalled that in Case 10 (Chapter 4) Mr. 0., who was yawning and feeling bad, was asked if he had a "yen." This question was evidently asked, not because Mr. 0. bad verbally expressed any desire for narcotics, but because be yawned constantly and showed other physical symptoms of opiate withdrawal. The identification of withdrawal symptoms with the desire for narcotics is evident in the warning frequently given to those who experiment with the drug: "You'll put too many shots too close together sometime and wake up some morning with a yen." In other words, the "yen" or "desire," which is basic to addiction, is so inextricably bound up with withdrawal distress that the two are designated by the same term. I once jokingly remarked that I was talking so much about drug addiction, withdrawal, etc., that I was beginning to wonder about the possibilities of developing a yen." The addict's reply was, "It can't be done by proxy." As further evidence it may be mentioned that when a drug user declares that he "feels his habit," he means that the distress of withdrawal is being felt. On the other hand, the addict who has all the drug he wants does not "feel his habit." Another significant usage distinguishes between the "pleasure user," or "Joy popper," and the addict. A "joy popper" is simply an individual who uses the drug intermittently and who has never been "hooked." It is probably true that most of the so-called pleasure users eventually become addicted, but as long as they space their shots so as to avoid withdrawal symptoms, they are sharply distinguished from those who have been "hooked" and they do not regard themselves as addicts. Those who use drugs irregularly, for example, once a week, are called "pleasure users," or they may be said to have "week-end" or "ice cream" habits. The distinction between the joy popper and the junkie is almost exactly paralleled by that between the "social drinker" and the alcoholic. just as the alcoholic cannot again become a social drinker', the junkie cannot revert to the status of a joy popper. The addict's standard remark, "Once a junkie, always a junkie," possibly refers to this fact. An addict elaborated on this idea by remarking, "Any man who has ever been hooked who says he doesn't want to use morphine again is either a damn fool or a liar." Immunity to Morphine Effects The wide range of differences commonly observed with respect to withdrawal effects suggests that certain individuals may use the drug with impunity, or at least without suffering much distress. It is well known that in certain rare cases the drug may have other than the usual pleasant effects during the initial period of use. In such cases, continued injection does not produce tolerance but simply results in progressively aggravated distress. Such persons obviously cannot become addicted. Are there, on the other hand, persons who obtain the usual pleasurable effects from opiates without experiencing the customary withdrawal symptoms? In this connection, I was very interested in the report of an unusually reliable addict concerning a user who was ostensibly immune to the withdrawal symptoms. Since no other file:///I|/drugtext/local/library/books/adopiates/chapter5.htm[24-8-2010 14:23:36]

CHAPTER 5 PROCESSES IN ADDICTION pertinent information is available on this case, it is reported with a frank acknowledgment of its hearsay source. Case 12. Mr. Y. was a rather heavy drinker who sometimes used morphine in association with friends of his who were drug addicts. According to the informant, who was a professional thief, Mr. Y. used morphine regularly for at least two weeks and probably longer. At the end of this time he stopped it abruptly, gave away whatever morphine he had left, and went about his affairs. The addicts with whom he had associated were dumfounded at his casual attitude toward the drug and his ability to withstand addiction. He himself was astonished and discussed the situation with his friends. With the exception of a pain in his back lasting only a few hours, he noted nothing unusual after be stopped and bad neither an inclination to use the drug steadily nor a craving for it. In fact, he considered the behavior of addicts with as great surprise as they did his. Their constant conniving and sacrifices to keep themselves supplied with the drug were absolutely unintelligible to him, and be told them so. In his entire association with these men he never succeeded in acquiring an understanding of them nor did he become addicted. One occasion particularly impressed the informant. Setting out to attend the funeral of a mutual friend who bad died from an overdose of morphine, the group stopped their automobile in front of the public library to administer shots of morphine in the library washrooms. Mr. Y. was amazed and remarked upon the utter absurdity of a group of apparently sane individuals attending the funeral of a user who died from the effects of morphine and finding it necessary to consume the same poison before going to the funeral! Since there was no way for me to communicate with Mr. Y. I questioned the informant closely. No motive for exaggeration or distortion of the facts was found. The First Shot At first glance it may seem that those cases of addiction in which the results of the first injection were tremendously impressive and led at once to continuous use are apparent exceptions to the theory in that addiction may have preceded the experience of withdrawal symptoms. A very intelligent addict, asked to explain the drug habit, cited his own case to support his contention that the very first injection was decisive.(4) Case 13. Mr. F. was wounded in World War I and, during his convalescence in an English hospital, was employed by the hospital authorities. He bad hoped the work would be easy, because of his condition, but found instead that he had to spend fifteen to sixteen hours a day at it. Consequently, he became exhausted and, in an effort to overcome his chronic fatigue, drank whiskey in small quantities in company with other members of the staff. As he said, "For months I wasn't either entirely sober or entirely drunk." The drug supplies of the hospital were under his care, and one day he determined to try a little heroin to see if it would help overcome his chronic fatigue. He sniffed a little and found the effects marvelous. It not only enabled him to work long hours, but gave him energy for recreation and entertainment. He used the drug a little each day for two months. At this point in his story be stopped, feeling that be bad sufficiently explained the crucial importance of his first experience. Encouraged to go on, he continued his story. After two months of using the drug regularly, he went on a short vacation without taking a supply, for it did not occur to him that there was any need for it. Gradually he became more and more affected by withdrawal distress. At first be was unable to diagnose his trouble, but eventually be realized what it was. The symptoms became so severe that he was forced to take the train back to the city where he worked in order to replenish his supply. It was then be realized, though in an incomplete way, that he was "hooked." After about six months be returned to Canada, using the voyage as an opportunity to quit his habit. He threw his supplies overboard. Persons on board attributed his withdrawal symptoms to seasickness. After surviving the abstinence distress, he was certain that he could stay off the drug, but he relapsed after about six months, stating that he was then convinced that this thing was stronger than I was." In spite of Mr. F's own theory, it should be noted that in his case, as in others, the drug was continued for reasons intimately associated with the very use of the drug itself and not because of the original drive. The fact that Mr. F. abandoned his source of supply without providing for-future needs demonstrates that his attitude toward the drug did not at that time qualify him as an addict. What really impressed addiction upon him was his experience with the acute withdrawal distress during the sea voyage. Evidently during the first four months of use the withdrawal symptoms file:///I|/drugtext/local/library/books/adopiates/chapter5.htm[24-8-2010 14:23:36]

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