5 years ago

Addiction and Opiates

Addiction and Opiates


CHAPTER 5 PROCESSES IN ADDICTION were an unconscious and unrecognized factor which favored the continuance of the drug, although Mr. F. himself thought that he used it solely to avoid fatigue and to increase efficiency. After his experience with withdrawal, however, these symptoms became conscious factors in his conduct. Mr. F.'s account is representative of those instances in which the initial effects of the drug are so pleasurable and impressive to the beginner, that, provided he has no strong inhibitions against it, regular use is likely to be continued. In such instances one may say that there is a desire for the drug and even a habit of using it prior to addiction. This habit and desire, however, were obviously very different qualitatively from the subsequent addiction and the craving that it entailed. The fact that Mr. F. went on a vacation in England without thinking of taking a supply with him is sufficient evidence of this. Clearly also, while Mr. F. thought that he used heroin for the first two months because of its positive effects in reducing fatigue and stimulating him, it was not for such reasons that be resumed its use after he had tried to quit. It should also be remembered that, however marvelous the initial effects of morphine or heroin may seem during the beginning or honeymoon period of use, they are considerably less than marvelous when addiction is fully established. The determined effort made by Mr. F. to break his habit on his return to Canada suggests that he bad discovered this. In a discussion of cases of this sort in which the authors speak of a primary or pre-existing desire for euphoric drugs in what might be called addiction-prone personalities, Ernest Joel and Fritz Frankel remark: The unusual and complicating aspect of this second phenomenon is that the continued use of morphine with the gradual development of tolerance and the appearance of withdrawal distress upon the removal of the drug, leads to a morphine-hunger which has not the slightest connection with the original desire for euphoric drugs. ... It is possible to make a drug addict out of anyone, regardless of his constitutional make-up. (5) In the same connection, Kolb comments: "The original impulse [toward narcotics] may have subsided long ago, but this new craving grows stronger and is more difficult to throw off the longer the drug is used. Normal people, who never had an intoxication or narcotic impulse, are as much subject to it as the inebriate.(6) In another article, the same author asserts: "It thus happens that the drug taken in the beginning because of its power to raise an inferior individual above his normal level, must be taken in the end to keep him from sinking slowly below it and to relieve conditions that the drug itself has produced.(7) Self-Experimentation A consideration of cases of self -experimentation by technical workers with advance theoretical knowledge of the habit presents interesting problems. If one assumes, for example, that a thorough-going acquaintance with the phenomenon of addiction confers upon the investigator the ability to control his reaction, it follows that opiates could be systematically used for relatively long periods without inducing addiction. Louis Faucher, as noted above, may be placed in such a category. He used the drug only once a day for six days and affirmed that knowing what to expect enabled him to take precautions to discontinue its use after that time. What would have happened had he extended the experiment for six weeks? Faucher declares that further use of the drug even a short time would have made him an addict. How may one account for the difference between this case and that of the patient mentioned by Dansauer and Rieth who received opiates steadily for six years without showing any desire for the drug? (8) The implications of the theory advanced here with respect to such cases is quite clear. The deliberate selfexperimenter, who knows what to expect, will note and understand the withdrawal distress sooner and more certainly than an ignorant layman, and he is, therefore, more susceptible to addiction under these conditions. Morphine addiction seems to be a case in which foreknowledge is a dangerous thing, in the sense, that, if the drug is administered regularly, this very knowledge aggravates susceptibility to addiction rather than providing immunity. In the light of this interpretation, it should, therefore, be expected that cases of habituation which did not lead to addiction would be relatively more numerous among non-medically trained individuals than among members of the medical profession. This is precisely the situation found among German medical men; here addiction, defined by Pohliscb as the use of file:///I|/drugtext/local/library/books/adopiates/chapter5.htm[24-8-2010 14:23:36]

CHAPTER 5 PROCESSES IN ADDICTION more than 1-5 grains of Morphine or its equivalent per day for at least six months, was over 100 times more prevalent in the medical profession than in the general population.(9) The percentage of drug using doctors estimated to be not addicted was only 6.6 per cent, in comparison with 48.9 per cent of the non-doctors.(10) Pohlisch's distinction between addiction and habituation, based solely on the size of the dosage, is, of course, arbitrary and subject to error, as has already been indicated. The literature on the subject records numerous instances of personal excursions into addiction by curious individuals who have been lured into smoking opium once or twice or trying a few injections of morphine. During part of the nineteenth century and earlier, when the drug habit was little understood and its dangers inadequately realized, such experiments were more common than they are today. Nevertheless, so far as I have been able to ascertain, not a single instance has come to light of a self experiment, carried out beyond the several weeks' trial admittedly necessary to establish full-fledged withdrawal symptoms, which did Dot end in the addiction of the experimenter. This is all the more significant in view of the frequent accounts of supposedly "cured" addicts, and the interest in "cures." One would suppose that a user, demonstrating his immunity to the habit-forming tendencies of the drug would be widely advertised and pointed out as proof that persons with "strong will power" or a certain type of character might escape addiction despite steady and prolonged use. Apparently, such experiments have always ended in grief, for while it is easy to find accounts of addicts who began out of "curiosity" or a desire to experiment, accounts of individuals who have knowingly experimented with severe withdrawal symptoms and escaped addiction are entirely absent. William Willcox describes a patient who believed that regular use of heroin or morphine would not be dangerous: This patient, who is a man of very strong will and brilliant attainments took morphine some years ago in order to relieve the pain of sciatic neuralgia. He said, I have a strong will, and there is no risk in my taking morphine, though others should Dot do so." He has been an addict for fifteen years.(11) In another article, Willcox declares: It has been said with truth, I think, that the administration of morphine or heroin hypodermically daily for a month is likely to give rise to addiction in a person of normal temperament. We know people who say: "I am a man, and one having a strong will. Morphine or heroin will not affect me; I can take it as long as I like without becoming an addict." I have known people-sometimes medical men-who have made that boast, and without exception they have come to grief.(12) Dr. J. B. Mattison records instances resulting from too frequent selfexperimentation; commenting on the causes of the frequent addiction among medical men, he states: "Still another genetic 'factor, and in my opinion the one which outranks all others relative to the frequency of this disease in medical men, is their ignorance or unbelief as to the subtle, seductive, snaref ul power of morphia. (13) He adds that physicians do not usually use the drug for pleasure: "Rather, they are impelled thereto by force of physical conditions that, with the largely prevailing failure to realize the risk incident to incautious morphia using, are practically beyond control.... The subtly ensnaring power of morphia is simply incredible to one who has not had personal observation or experience.... I make bold to say that the man does not live who, under certain conditions, can bear up against it.... Let him not be blinded by an underestimate of the poppy's power to ensnare. Let him not be deluded by an over-confidence in his own strength to resist, for along this line history has repeated itself with sorrowful frequency and, as my experience will well attest, on these two treacherous rocks hundreds of promising lives have gone awreck.(14) Thus, though the theory advanced in this study makes the reaction to withdrawal symptoms the decisive factor in the establishment of addiction, and although this theory could be destroyed by the selfexperimentation of a single person, if he demonstrated his immunity, no such negative evidence has appeared in the literature of the last century. Those who have been bold or foolhardy enough knowingly to risk the prolonged experimental use of morphine on themselves apparently either have stopped before it was too late, as did Faucher, or have fallen into the ranks of the addicted. New recruits are being enlisted in this manner today. I have often been told by non-addicts with perfect assurance that they would never become addicts, even though they might take morphine or heroin regularly for a long time. Most addicts file:///I|/drugtext/local/library/books/adopiates/chapter5.htm[24-8-2010 14:23:36]

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