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Addiction and Opiates

Addiction and Opiates


CHAPTER 5 PROCESSES IN ADDICTION 19. Robert Schasre, "Cessation Patterns among Neophyte Heroin Users," International Journal of the Addictions (June, 1966), 1 (2): 23-32. 20. Ibid., pp. 27-28. 21. Frederick B. Glaser, "Narcotic Addiction in the Pain-Prone Female Patient. 1. A Comparison with Addict Controls," The International journal of Addictions (June, 1966), 1 (2): 57. 22. Norman E. Zinberg and David C. Lewis, "Narcotic Usage: A Spectrum of a Difficult Medical Problem," New England journal of Medicine (May 7, 1964), 270: 989-93. 23. Terry and Pellens, op. cit., p. 66. 24. Ibid., chapter 2. 25. Virgil G. Eaton, "How the Opium Habit Is Acquired," Popular Science Monthly (1888), 33: 666. 26. Ibid., pp. 665-66, 27. Ibid., p. 665. 28. "The Opium Habit," Catholic World (September, 1881), 33: 829.-30. 29. The significance of the knowledge of the name of the drug administered is brought out by the British Medical Journal, June 4, 1932 (1: 1044), commenting editorially upon the 25th annual report of branches of the NorWood Sanitarium, Ltd., which handled 580 drug cases: "In some instances the patient had only learned the nature of the drug used by seeing the label on an empty tube left at the house by the doctor." 30. R. N. Chopra and K. S. Gremal, "The Opium Habit in India," Indian Journal of Medical Research (1927), 15: 61. 31. See the work of Chopra and his associates: Indian Journal of Medical Research, vols. 15, 16, and 20, and in the Indian Medical Gazette, vols. 66, 68, 69, and 70. 32. Ministry of Health of Great Britain, Report of the Departmental Committee on Morphine and Heroin Addiction (London: His Majesty's Stationery Office, 1926). 33. P. C. Remondino, "The Hypodermic Syringe and Our Morphine Habitues," Medical Sentinel (1896), 4: 5. 34. Paul Wolff, "Alcohol and Drug Addiction in Germany," British Journal of Inebriety (1933), 31: 164. 35. "Zur Pathogenese des chronischen Morphinismus," Monatschrift fur Psychiatrie und Neurologie (1920), 47: 90-97. The fact that the patient purchased the drug herself demonstrates that she was not ignorant of its name, and corroborates the view that although this knowledge is important, it is not the crux of the matter. 36. Dansauer and Rieth op. cit., case 115, p. 103. 37. John R. Nichols, "How Opiates Change Behavior," Scientific American (February, 1965), 212: 80-88. 38. Abraham Wilder, "Conditioning Factors in Opiate Addiction and Relapse," in Daniel M. Wilner and Gene G. Kassebaum (Eds.), Narcotics (New York: McGrawHill, 1965), pp. 85-100; James R. Weeks, "Experimental Narcotic Addiction," Scientific American (March, 1964), 210: 46-52; H. D. Beach, "Morphine Addiction in Rats," and "Some Effects of Morphine on Habit Function," Canadian Journal of Psychology (1957), 11: 104-112, 193--98 file:///I|/drugtext/local/library/books/adopiates/chapter5.htm[24-8-2010 14:23:36]

CHAPTER 6 CURE AND RELAPSE file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37] PART I The Nature of the Opiate Habit CHAPTER 6 CURE AND RELAPSE In the preceding chapters the theory has been proposed and elaborated that addiction is generated in a specific type of experience with withdrawal distress. From this experience the beginner acquires the behavior, attitudes, and impulses that make him an addict and compel him to recognize himself as such. The tendency to relapse is obviously an integral aspect of addiction, for if it did not exist addiction would not constitute a social problem and breaking the habit would be a simple matter readily accomplished in a few weeks. Implied in the suggested explanatory scheme is the idea that this pervasive and persistent impulse to relapse is a consequence of the persistence of impulses, cognitive patterns, and attitudes originally learned from experiences with the withdrawal distress. Since addicts are tempted to resume the use of drugs long after all withdrawal symptoms have vanished, it is not suggested that relapse occurs because of these symptoms in any direct sense. The argument is rather that the craving for drugs originally established in connection with these symptoms becomes functionally independent of them and of any and all chemical or physiological properties of the drug and its effects. As an independent cortical function the behavioral tendencies designated as a craving for drugs persist in a modified form in the abstaining addict and predispose him to resume his habit. The addict's impulse to relapse is qualitatively very different from his desire for the drug when he is physically dependent on it. In the latter situation the user's need is urgent, immediate, and continuous, since he knows that he is constantly threatened by withdrawal if he omits a regular injection. The impulse to relapse_ depends for its efficacy on more subtle long-range influences and is, not urgent and immediate. The addict who is taken off drugs sometimes resumes his habit at the first opportunity, but frequently he does not. Under certain circumstances and provided he has adequate motives, he may deliberately postpone his relapse for weeks, months, and sometimes for years. An addict who was on parole when I began my interviews with him in the fall told me repeatedly during the winter that he intended to start using drugs again in the spring before his parole expired. He was living at the time in a kind of halfway house which afforded little privacy, and he did not relish the idea of traveling during the winter months. He planned when he resumed his habit to go to the southwest part of the country. Late in March he did just what he had planned to do and tried very hard to get himself a shot before be left town. Another addict who served in the army in France during World War I said that he did not use morphine while he was there, even though it was readily procurable, because of the notorious lack of privacy of army life: "There were too many people around and not enough privacy. When he returned to the United States he at once resumed his habit. The statistics of relapse are further indications that the relapse impulse is not an overpowering compulsion requiring instant gratification. It is more in the nature of a persistent, intermittent, but unrelenting and subtle pressure. Cocteau exclaimed, "The patience of the poppy! He who has smoked will smoke again. Opium can afford to wait." Some idea of the nature of the relapse impulse may perhaps be obtained by considering the difficulties experienced by tobacco smokers in quittng a habit which is far less-powerful than opiate addiction. Like the urge to take another shot of morphine, the urge of the abstaining cigarette smoker to have a cigarette is usually not constant or overwhelming and can be resisted. Nevertheless, over a period of time, it tends to win the battle. The opiate addict's craving and his tendency to relapse, it should be emphasized, are not rational impulses any more than are those of the cigarette smoker. The cigarette smoker does not smoke and does not resume smoking after a period of abstinence for the purpose of exposing himself to the risks of lung cancer and emphysema, although he knows this is the effect of what he does. Neither can he be said to weigh the risks against the satisfactions and to conclude logically that the risks constitute a fair price to pay. The same reasoning applies to the drug habit, for the addict does not relapse because he enjoys the prospects of again undergoing the ordeal of withdrawal. What he does is to give way to an irrational impulse or desire, permitting it to seduce him by means of a variety of stratagems which have the effect of neutralizing the negative import of withdrawal as well as the many other burdensome and unpleasant features of addiction. An important feature of the mechanics of addiction is that the positive satisfactions involved in taking a shot are assured and immediate; in contrast, the negative effects of the habit are remote and indirect and can sometimes be