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Addiction and Opiates

Addiction and Opiates


CHAPTER 6 CURE AND RELAPSE avoided or postponed. It is a commonplace to observe that even a small immediate and certain gratification may counterbalance the effect of a dire but remote and contingent threat.. There are two separate and somewhat different theoretical problems involved in dealing with relapse. The first is to determine the source of the tendency the second and more difficult problem is to try to describe the mechanisms which lead to relapse. The first of these theoretical problems has already been dealt with in preceding chapters; the second is the concern of this one. It may be observed in passing that the linkage between withdrawal distress and the craving for drugs which prompts resumption of the habit is strongly suggested by a curious phenomenon that has been noted frequently in the literature. This is that addicts who have been off drugs for long periods of time frequently experience what may be called pseudowithdrawal symptoms on occasions when they are strongly tempted to resume use. At a conference on drugs in California, for example, an addict in the audience approached me and said that in the course of the afternoon I s programs he had been gripped by a powerful "yen" to have a shot of the drug that was being talked about so much. I asked him what he felt. He reported that he broke into a cold sweat and felt a peculiar sensation in the pit of his stomach. As he himself pointed out, these are also among the initial symptoms of withdrawal. This phenomenon seems to fit neatly with the idea that the relapse tendency is a residual aspect of the craving that is established in a conditioning process in which the withdrawal symptoms play an indispensable role. Having become functionally linked with each other in the initial conditioning process, each subsequently tends to elicit the other; withdrawal elicits desire, and desire withdrawal, . The Desire To Be Cured Certain paradoxical features of the opiate habit should be indicated here, and the reader's attention should be focused again upon the ambivalence of the user who Dot only bends all his efforts toward maintaining his supply but also hopes to be extricated from the trap into which he has fallen. The original effectiveness of the drug diminishes and eventually disappears with continued use, and at the same time its consumption must be constantly increased. Before long the user consumes large quantities merely to keep himself normal, and when this point is reached, as it usually is within a few months, the addict is trapped. As H. H. Kane said of opium smokers, "Then the good spirit of the pipe disappears, giving place to a demon who binds his victims hand and foot. Smoking no longer gives the pleasure of the first few months, and the victim of the habit continues not for the pleasure obtained from it, but is driven to it by the terrible suffering that surely comes if the pipe is not smoked at the accustomed time.(1) The drug user then sees the folly of the habit and, realizing the transitory character of its pleasures, he desires to escape. Sandoz said of drug users that 11 most of them realize their bondage and its consequences. If their lives were not all they should have been before their addiction, they know now how much worse they have become since.(2) This desire to be cured is best demonstrated by the large number of cures attempted by the chronic user. Charles Schultz (3) found that the average number of cures taken by each of the 318 addicts who came under his care was four. If one were to include those attempts to quit which were given up after a day or so, or after several hours, there is no question that this average number would have been much larger. I once asked an addict if drug users often tried to go off the drug and his reply was, "Every time they take a good jolt." The same idea was expressed by another user: "A junkie always quits on a full ounce. He never quits when he is out." Kane has described this tendency as follows: A very odd conceit obtains among many smokers. When you ask them, "Can you stop this?" they will answer with the instant assurance, especially if they have been smoking opium for an hour or two and are well primed with opium, "Stop it? Certainly. For instance, this will be my last smoke for a month," Nevertheless you will find him there smoking as usual the next day, and for many days thereafter. Some men will bid their companions good-night and good-bye night after night, sometimes for months, about as follows: "Well, boys, good-bye. I've bad my last smoke with you. It has given me a world of pleasure and served to while away many a tedious hour, and I forgive it whatever it has done to me. I wish you joy. Goodbye." The next night he will be found smoking again as bard as ever, and at the finish go through the same performance.(4) I have never met a chronic user addicted for several years or more who bad not tried to free himself Of tbe-babit. file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

CHAPTER 6 CURE AND RELAPSE Moreover, contrary to the frequently expressed notion that so-called criminal addicts do not desire to be cured, (5) I have encountered professional thieves who voluntarily abstained from opiates for as long as five to eight years in grim determination to throw off the habit. Recognition of the evil effects of addiction, however, bears little relationship to the probability of permanent cure. Otherwise there would be few addicts, for they are keenly aware of, and often bitterly resentful of, the stigma and misfortune attached to being a "dope fiend." Addicts relapse again and again after the drug has been removed at their earnest request. lt is sometimes said, therefore, that the user's desire to be cured cannot be sincere and that he is motivated by ulterior purposes, such as reducing the size of his dosage, recreating the initial pleasure, obtaining admission to an institution during the cold winter months, avoiding the law, or complying with the demands of relatives. This skeptical view is discussed by Schultz: They do not think their habit is a vice, or that it degrades or injures them. To them it is a pleasure, which they see no reason for giving up, and as a result they are often amused at others' attempts to "reform" them. If a patient of this type openly declares he is going to revert to drugs (and many do) and boasts about it, enlarging upon the pleasures of his first shot upon discharge, others are apt to do likewise. This attitude is detrimental to the exercise of self-control and will power on the part of the more sincere patients, as sometimes they will ridicule such a patient's statements that he is going to try to stay off drugs; e.g., one patient declared on discharge that be was "through with drugs." Another patient then told him, "For God's sake, be a man. Get shot up!" (6) While this account is correct, as far as it goes, it does not imply that the hardened addict has no desire to be rid of his habit. The addict who is least motivated to quit is probably the young user with a recently acquired habit. As the habit is continued there is increasing disenchantment. The long-term addict often more or less gives up the struggle after a series of attempts to quit have failed. Some of them reach a point of disillusionment and despair which leads them to consider or attempt suicide. Users who comment cynically on the impurity of the motives of others who take cures usually insist that their own efforts are sincere. What often happens is that the user begins to quit with sincere but inadequate motives and promptly changes his mind and postpones the attempt. In this respect, opiate addiction is not very different from a great many other bad habits. While there may be some addicts who never fight the habit but simply accept it and allow themselves to be swept along by it, 1 have never met such a person. An apparent attitude of unconcern is frequently a pose, an adaptation to a hopeless situation. In group association with each other, addicts commonly assume an attitude of bravado and defiance, and they ridicule users who want to quit. Such association often creates shared misconceptions in the mind of each addict about the others. Each privately admits that he wishes he could quit and that be has tried to do so, but each assumes that the others accept their addiction and have no real desire to break it. The group attitude gives the individual user relief from the frustration, guilt and sense of helplessness that come from fighting a long, losing battle and provides supporting rationalizations for continuing the habit. The hope of cure is not easily extinguished, even in the confirmed and experienced addict; be wants to die as a "square," not as a dope fiend, and he may permit himself to be deceived into believing that his next attempt will succeed. He tries once more and adds to his own disillusionment. If the addict's desire to be cured were not genuine and persistent, it would not have been commercially exploited for so many decades of the nineteenth century. The addict steadfastly maintains that he wants to quit and that he would if he could only feel right off the drug.(7) The following case from my notes lists the major attempts of one addict to break his habit: Case 14. Mr. T. became addicted to morphine in 1909 after using the drug occasionally for several years. He was a periodic drunkard and first took morphine to recover from inebriety. An only child, his parents, reasonably well-to-do, left him an adequate income. The following list of cures shows how often he attempted to get rid of his habit. 1. 191o: took a home cure without any real determination to quit. He spent $40 and reduced the dosage without getting off the drug. 2. 1912: took a cure lasting five weeks which cost him $175. The drug was completely removed for a time. He file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

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