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Addiction and Opiates

Addiction and Opiates


CHAPTER 6 CURE AND RELAPSE had the experiences and the non-addict has not. The addict's "knowledge" is sometimes merely an erroneous belief or a rationalization, but if it appears as knowledge to him it tends to function as if it were. Such knowledge contributes to relapse, and since people can not be cured of the knowledge they have, this intellectual or cognitive element' is probably close to the heart of whatever there is in addiction that is permanent and incurable. A nineteenth-century addict, S. T. Morton, who had not used opiates for two years wrote the following: There is one thing which the habitue wishing to be cured would perhaps anticipate with dread: that is an insatiable craving for the old stimulant, and a consequent prolonged and weary resistance of temptation I can only say that, greatly to my surprise, I have felt no craving for it at any time since the beginning of the treatment. This may seem a strange statement to any one under the sorcery of the drug, and conscious of its fearful grip. There is of course the knowledge from experience of the marvelous potency of opium in annulling all discomfort and distress of body or mind, but this is all. The sense of profound satisfaction, ever present at the release from its slavery, as well as a lively appreciation of the great danger of again tampering with it, is sufficient to leave the tempt at ion-whatever it may befrom such knowledge, powerless.(13) This remarkable statement brings out clearly One of the common experiences of addicts prior to relapse. They seem to have no desire whatever for the drug. Yet the impulse to relapse in the above case was present, but in a different form, as revealed in the words, "knowledge from experience of the marvelous potency of opium in annulling all discomfort and distress of body or mind." The anonymous author underestimates the significance of this factor, for, when the "sense of profound satisfaction" at having quit has worn off, this knowledge is still present, subtly attracting the user to his favorite drug. Given a certain situation, certain misfortunes, or a certain mood, and the ex-user may decide to throw caution to the winds and have "just one pop." For those who are disposed to regard the praise bestowed on opiates by this anonymous addict as sheer exaggeration, a reminder of the traditional view of medicine may be pertinent. Alonzo Calkins has this to say: Opium has been denominated, and in no extravagance of hyperbole, the grand catholicon for human ills. Laudation here has scarcely been exhausted, even in the excess. In the "Opiologia" of Wedelius, opium is the "medicatamentum coelitus demissum,"-the heaven-born gift. Tillingius styles it the "anchora salutis sacra,"the bower-anchor of health. Sydenham says that "medicine without it would go at a limping gait"; and John Hunter, in an exuberance of enthusiasm, exclaims, "Thank God for opium!" Van Swieten in his estimate does not fall behind: "Opium le plus efficace de tous les medicaments et sans quoi ]'art de guerir cesserait d'exister, est le remede de quoi le Tout-Puissant a fait present pour le bonheur et la consolation de l'humanite souffrante. (14) Boredom and Disgust in the Cured Addict One addict whom I interviewed a number of times was imprisoned for a few weeks in the Chicago Bridewell Prison on a charge of theft. When he came out, he returned to precisely the same locality in which he had been living. I expected him to relapse at once and was amazed that he did not do so. A number of weeks passed. He denied that he felt any great temptation or craving but admitted that he did not intend to practice abstinence permanently. His state of mind when off the drug appeared markedly worse than during addiction. He was inordinately bored and extremely inert, spending most of his time sleeping. He was no longer interested in reading magazines, and his conversation was unanimated and dull in comparison to the sparkle which bad characterized it before. Later he obtained a temporary job distributing hand bills and, becoming fatigued by the walking he had to do, felt the need of a shot after work. Sometime later, when he had developed minor, though irritating, complaints, he took nembutal hypodermically. Seeing the fresh drops of blood on his bed, I had assumed that be was re-addicted. It was a week or so before be admitted having had a few little shots, and still another week before be announced that he was "hooked" again. He now resumed his alert, active attitude; his indifference, apathy, and dullness were gone, He had found. a, motive for living and was himself again, conniving and stealing as before. It cannot be assumed in- the case of this addict, who- abstained for only a few weeks, that be bad recovered from the withdrawal of the drug. Erich David, for example, remarks concerning the time element in the treatment of addiction: file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

CHAPTER 6 CURE AND RELAPSE As we have seen, after six weeks the patient is generally physically well, but he still feels the lack of stimulation furnished him thus far by morphine. The days seem endless, but be has not yet the energy to busy himself with work. He has not yet regained completely the capacity and desire for work, and just because of that, be will inevitably be seduced to a relapse by the recollection of his former greater capacity and the oppression of his complete lack of energy. That be is not yet mentally fully recovered, we can easily prove by giving him some easy scientific book to read and asking him to give a report on it after a few days. The patient will not yet be capable of doing that. If it is at all possible for him to read the book through intelligently, it will take him weeks and weeks to finish his task. This lack of stimulation, however, passes after several months, and I am willing to say that after four or five months every withdrawn individual has completely recovered capacity and desire for work. If then assigned the task just mentioned, he will perform it very quickly with utmost satisfaction. This test seems to me the most infallible indication as to whether the time for discharging him has arrived. To retain him any longer in ,in institution, just because it is true that physical alterations with reference to morphine still exist, would be absolutely senseless, since we have seen that the same phenomena are present even after a year. The prognosis is unfortunately very inauspicious. (15) An addict who read this manuscript expressed the opinion that it was the boredom of abstinence that was hardest to endure. He told of going to baseball games, in which he was normally very interested, and leaving after a few innings. He walked out of movies before they were finished. He could not enjoy life without the drug, so he eventually resumed using it. Another user, who had once abstained for more than ten years, confessed that he had never felt altogether right throughout the period. He used alcohol as a poor substitute for opiates and finally returned to the drug in disgust. The word "disgust" is one that recurs in the addict's explanations both of why he decides to quit and of why he relapses. When he is on drugs he becomes disgusted with himself, the habit, other users, informers, the police, the public, and so on; when he is voluntarily off drugs he discovers that people are slow to accept him in his new role as an abstainer. This tends to disgust him, as do a great many other aspects of his tentative new identity as a cured addict. These include boredom, lack of motivation, the suspicions attitudes of others, job discrimination, the effects of whiskey and other inferior substitutes for the drug, and lack of communication with former friends. In a study of relapse and abstinence, Marsh B. Ray quotes an addict's description of how he resumed use: When I got home I stayed off for two months but my mother was hollering at me all the time and there was this one family in the neighborhood that was always "chopping me up." I wanted to tell this woman off because she talked all right to my face but behind my back she said things like she was afraid I would turn her son on because I was banging around with him. She would tell these things to my mother. I never turned anybody on! She didn't know that but I wanted to tell her. Finally, I just got disgusted because nobody wanted to believe me and I went back on.(16) [Another user commented pungently]: My relatives were always saying things to me like 'Have you really quit using that drug now?' and things like that. And I knew that they were doing a lot of talking behind my back because when I came around they would stop talking but I overheard them. It used to burn my ass.(17) The boredom and disgust of the-abstainer may be said to spring from the inability of the ex-user to resume his preaddiction social identity and role. His experiences as an addict have spoiled his other identity and set up communication blocks between him and those from whom he hopes for support and confirmation of his new role. He recalls, perhaps with some nostalgia, the feverish whirl of activity and excitement that engulfed him when he was on drugs, and be recalls the intimate associations with other addicts and the frank, unfettered talk, especially about everything connected with drugs. By contrast, his life off drugs seems empty and dull, and his personal associations seem unsatisfactory, inhibited, and hypocritical. There is no good easy resolution of this dilemma. The addict is not happy with either of his two possible identities and tends to move from one to the other and back again. The Influence of Availability and Associations, Because the addict is generally stigmatized and is often a criminal, be finds it difficult to secure and bold a legitimate job whether he is using drugs or not. If, as in the United States, the user leaves respectable society to join the addict subculture, his associations tend to be heavily or exclusively concentrated within it. It is within this subculture-which file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

Opioid Addiction