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Addiction and Opiates

Addiction and Opiates


CHAPTER 6 CURE AND RELAPSE put it, and said that he would never quit in the future unless forced to. Another addict confided that the longest time he had ever voluntarily abstained was thirteen months. The first several weeks and months involved a struggle because of the debility and other after-effects of the habit. Later his condition improved, and he felt that be had freed himself entirely. He began to feel jubilant and triumphant. During the thirteenth month be took a shot to celebrate and demonstrate his mastery of the drug and was soon readdicted. It is notorious that the drug user's statements of his intentions are very poor indicators of what he is likely to do. This is perhaps because of the conflict between what reason tells him he ought to do and what the irrational compulsion of the habit impels him to do. I once discussed relapse with Broadway Jones, the thief who helped Sutherland write The Professional Thief.(11) At the time of the conversation he had been off drugs for more than ten years. He denied that he felt tempted to use it again, even when he was with addicted friends who were using it in his presence. He was engaged in legitimate employment at the time and to the outside observer would surely have seemed to be a prize example of a permanently cured addict. I wrote of him at that time as follows in the original edition of this book: A casual observer might conclude that this was a case in which twenty-five years of addiction in connection with a "life of crime" had left few traces; in other words, one might ask if this man were not a cured addict. In reply, it may be pointed out that he refers to himself as an "ex-user," not a "square John," or non-addict, and looks upon himself as "one of the boys." Two other aspects of his behavior indicate that there is justification for this definition. One is his belief that morphine is a marvelous cure for most of the afflictions of mankind. Secondly, be frequently sees friends who are addicts and talks with them about narcotics and associated subjects. I do Dot maintain that this man must of necessity revert to the habit but only that certain conditions distinguish him from the non-addict and function as predisposing factors toward relapse. The factor of association per se cannot be regarded as the crucial condition in his case because be is and has constantly been in close association with drug users for more than ten years without relapsing. Some years later, after close to eighteen years of abstinence, he wrote to Professor Sutherland at Indiana University to ask for money. Surmising that he was readdicted, Sutherland, without sending any money, advised him to commit himself to Lexington for a cure. The next letter from Jones was mailed from the hospital for addicts in Lexington, Kentucky, where he was successfully withdrawn from the drug. He did not relapse again. Attitudes That Facilitate Relapse An individual suffering from a chronic illness notes chiefly, if not solely, the alleviation of pain which the drug brings, and therefore uses it for that purpose. On the other hand, the addict soon learns that, no matter what his difficulty, it is aggravated by his need for the drug and at the same time is relieved by its use. The contrast between the misery caused by the absence of the drug and the well-being which follows the injection gives the user an exaggerated notion of the effects of the shot. He begins by taking the drug for a limited purpose and finds that its usefulness constantly increases. Besides relieving withdrawal distress, the addict quickly learns that morphine also relieves almost all other kinds of distress. If he has a job, he says be cannot work well without it; if be feels anxious, ill, or uncomfortable, be feels that be needs more of it. When be has to appear in court be takes an extra quantity to bolster his morale. The significance of the drug is, in short, generalized as a symbol and guarantee of security, not only against withdrawal but against most of the disturbing and unpleasant aspects of life By the same token, the significance of withdrawal distress is also expanded so that the addict eventually responds to many or most of the troubles that beset him as if they were withdrawal distress to be remedied by another fix. The addict's exalted notion of the virtues of opiates is suggested by the fact that they sometimes refer to it as "G.O.M." or "God's Own Medicine." However, since I have also heard members of the medical profession use the same expression with regard to morphine, which is still evidently the best known analgesic, it may be argued that there is at least some truth in the addict's view of the efficacy of opiates. The addict may, of course, realize that his personal difficulties are not associated with withdrawal distress. Thus an file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

CHAPTER 6 CURE AND RELAPSE addict, earning $90 a month on a WPA project, bought an ounce of heroin and remarked to me that it would last him about a month. He actually consumed it in half the time. Part of his explanation was that he bad a foot complaint and simply bad to use more. Other users to whom I mentioned the incident accepted this as a perfectly legitimate and satisfactory explanation. The point is even more directly illustrated by the user who made hypodermic injections into a painful knee in order to alleviate the discomfort. Virtually every addict I interviewed had high regard for opiates as a curative or ameliorative agent. The more intelligent insisted that the potency of opiates was a fact and not a figment of the imagination. On one occasion in conversation with an intelligent addict, I ridiculed the unfounded belief that morphine is good for anything. The addict joined in the laughter, agreeing that the drug was so regarded, then added seriously, "But, you know, morphine is good ' for anything." When the addict is' taken off drugs, he does not lose his belief in their efficacy, nor does he cease to respond to discomfort and distress as though it were withdrawal distress calling for a shot. Untoward or unpleasant experiences of almost any sort therefore constantly remind the abstainer of the potency of the drug and subtly impel him to take it again. The addicts tendency to interpret all discomfort as withdrawal distress is strengthened by the fact that the initial manifestations of withdrawal, such as nervousness, irritability, depression, and lethargy, cannot be distinguished out of context from the same feelings when they are not connected with the drug or when they occur in a non-addict. Not only does the addict use drugs to alleviate withdrawal and virtually all other ordinary forms of distress but be- may also use them to alleviate discomforts which the habit itself produces, such as those connected with chronic constipation or with excessive dosage. From considerations of this sort it is easy to understand that the abstaining addict often appears to be a hypochondriac, complaining of a variety of illnesses, pains , and discomforts which he argues did not bother him when be was on the drug because be could banish them at once with a shot. Having reached this point, the abstaining addict may rationalize his relapse by saying that be really does not crave the drug but that he hates to go on sufferingunnecessarily from, a host of complaints. He may contend that his condition is so bad that lie is unable to work unless be resumes use of the drug. This, frame of mind is illustrated by an addicted woman who wished to send an expensive Christmas present to her child, who was being cared for by others. Her dilemma was that she would be unable to work unless she were' on drugs, but that if she were on drugs she would be unable to, save any money. Much relapse is, of course, directly produced by the withdrawal symptoms themselves. When an active addict is locked up in jail for a day or two or even for a couple of weeks and then released, he is still often in a weakened condition or still undergoing withdrawal. Severe and abrupt withdrawal is sometimes advocated on the grounds that it will serve as a deterrent to relapse but the actual effect may well be the opposite. A prolonged, gradual withdrawal, on the other hand, although it is more humane and less dangerous than the cold turkey method, prolongs suspense and anxiety and probably enhances the addict's feeling that be needs the drug. Schultz has commented on this point: There is no feeling of sudden relief from intense suffering as in the abrupt withdrawal treatment; on the contrary they feel that an injustice is being done them when they are taken "off shots" as opposed to the feeling or relief and gratitude when taken off with the abrupt treatment. They resent being taken off treatment and psychologically this suspicious, resentful frame of mind and the suggestion which is impressed upon them by each injection that the narcotics are essential to relieve their symptoms, is not one conducive to the patient's abstaining from narcotics when discharged.(12) "Cured" addicts often relapse when they are in the best of health, much better than they were when using the drug. I have been told by addicts discharged from Leavenworth that poverty stricken addicts enter prison in an extremely emaciated and starved condition, as a result of the bitter financial struggle to maintain their habits. In fact, some are so bony that they find it difficult to make injections into their shrunken veins. Under the regular prison routine, they put on weight and gradually achieve sound, normal health. Often one of these ex-addicts will rub the veins of his wellrounded arm and exclaim with satisfaction, "Boy, will I be able to hit that when I get out!" Another influence that lures the-cured addict back to his drug may be called a cognitive factor. It consists of the knowledge the addict acquires about the effects of opiates from his personal experienced When he is on drugs he knows that he can regulate how he feels at will. From direct experience he knows what the drug can do. It is useless for the non-addict to argue with the user about such matters of direct experience, since the addict has file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

Opioid Addiction