Views
5 years ago

Addiction and Opiates

Addiction and Opiates

CHAPTER 6 CURE AND

CHAPTER 6 CURE AND RELAPSE seems to have any effect. At length the time came when I must go to work, though in no fit condition for it. Shorthand reporting is a pursuit requiring in those who practice it the best condition of physical and mental capacity. The mental faculties which it calls into action are put to the utmost stretch, and the physical health must be such as to give them adequate support. However, the attempt must be made, and I made it. I very soon found that without assistance from some quarter I could not succeed. What was to be done now? I ventured to take a grain of morphine. The effect was marvelous. I could report, now, verbatim, never losing a word. And I could do any amount of labor at transcribing, the drudgery of the stenographer. I now liked to work, the harder and the more of it the better. The morphine had such a bracing tonic effect! . . . I found myself necessitated to take it every second day in order to be able to work, and I was determined not to take it oftener, for I knew that in this way alone could I preserve my freedom. I thought that in the meanwhile, perhaps in two or three weeks, .1 my system might rally, and so become able to work itself out of its relaxed condition when the morphine could be dispensed with. Here, and here only do I acknowledge guilt in my dealings with morphine: that is, in taking it merely to remove languor of the system, and brace it up sufficiently to enable me to attend to business, at a time when I was not suffering actual pain. Had I bad my time fully at my own command I would doubtless have acted differently. But I was the victim of circumstances. Work I must, and in my then condition I could not work. Say, ye caviliers, what in like circumstances would you have done? It seemed as though I bad now lost that wholesome fear of morphine which I had once entertained.... So I played with morphine as a child plays with fire. Instead of any improvement taking place in my physical condition, such as I had hoped for, matters only grew worse, and to add to my other difficulties, neuralgic troubles began again to make their appearance about this time. It was not long, under this new condition of affairs, before I found m self compelled to take morphine every day, then twice a day, and also to increase the dose.(19) A later relapse is described as follows: I bore my suffering as well as I could until the end of the fourth day, and then I had to yield. . . . And in all subsequent trials that I made, I could never hold out against these gastric symptoms beyond the fourth day.(20) Summary In the initial conditioning experience, repeated hundreds of times as the drug is used to relieve or avoid withdrawal, the patterns of addiction behavior are fixed. These include the user's realization that be is trapped and has become an addict-a new and traumatic self-conception that stimulates rebellion and struggle against the grip of a powerful compulsion. The craving for drugs, generated initially by the threat and the experience of withdrawal, may be conceived as a basically irrational and subliminal impulse or tendency that is left as a deposit or residuum from thousands of shots. When the user is taken off drugs, this basic craving, which has become symbolically elaborated in the user's psychological make-up, persists as a cortical or conceptual complex independent of the various chemical and physiological conditions that are indispensable in its origins. As such, it predisposes the person who has been hooked and is abstaining to resume use of the drug. Because the craving is an irrational impulse it impels the person to do things that reason tells him be should not do and causes him to be dissatisfied both with being an addict and with being an abstainer and to switch from one status to the other and back again in a recurring cycle. This chapter has been concerned with identifying and describing bow the basic drive toward the drug works, behind the scenes one may say, to push or seduce the abstaining addict back to his habit Among the most important of these influences are: the changed perceptions of the addict which lead him to respond to virtually all distress as though it were withdrawal distress to be banished by a fix; the neutralization of memories of the miseries of addiction which are relatively remote consequences of taking a shot compared to the invariable satisfactory immediate ones;, the rationalizations of the abstainer that life without the drug is dull, that he is better off using it than not, and that he might as well use it because he is stigmatized anyway; the knowledge or beliefs acquired from direct personal experience of the marvelous potency and versatility of the drug; and, finally, the attraction exercised by associations file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

CHAPTER 6 CURE AND RELAPSE within the drug using subculture, which, with a few exceptions, provides the only social setting in which full and free communication on all matters associated with the habit is possible without risk to the ego. 1. H. H. Kane, Opium Smoking in America and China (New York: G. P. Putnam, 1882), P. 59. 2. C. Edouard Sandoz, "Report on Morpbinism to the Municipal Court of Boston," Journal of Criminal Law and Criminology (1922) 53: 38. 3. "Report of Committee on Drug Addiction to Commissioner of Correction, New York City," American Journal of Psychiatry (1930-31), 10: 471. 4. H. H. Kane, Op. cit., pp- 73-74. 5. Dr. Wilder D. Bancroft, for example, declares, "Nothing will keep a man from taking morphine again if he wishes to.... I doubt whether much can be done in the way of permanent cure for the criminal addict. I am interested in the man who really wants to be cured" (unpublished paper, "The Chemical Treatment of Drug Addicts," presented at the fifth annual conference of the committees of the World Narcotics Defense Association and the International Narcotic Education Association, in New York, 1932). See also the writings of Lawrence Kolb. This invidious distinction between socalled criminal and noncriminal addicts simply discriminates against the impoverished addict. In this country, be is ipso facto a criminal. 6. "Report of the Committee on Drug Addiction to Commissioner of Correction, New York City," op. cit., PP. 532-33. 7. T. D. Crothers states: "Not infrequently the question comes up as to the advisability of treating elderly morphinists and opium users who seem not to be greatly injured by the use of the drug. Often such persons who have long been addicted . . . become very anxious to break away from its influence. The prognosis is usually unfavorable and the treatment unsatisfactory" (Morphinism and Narcomanias from Other Drugs [Philadelphia: W. B. Saunders, 19021, P. 149). 8. It is significant that Dansauer and Rieth cite this desire to quit as evidence that in a number of their cases of habituation the subject bad begun to develop a "craving" for the drug, that is, was becoming an addict ("Ueber Morphinismus bei Kriegsbeshadigten," Arbeit und Gesundheit: Schriftenreihe zum Reichsarbeitsblatt ( 1931) 18: 92-- 93, case 28; P. 95, case 459; and pp. 96-97, case 616). 9. Jean Cocteau, Opium: the Diary of an Addict, translated 1)), Ernest Boyd (New York: Longmans, Green, 1932), pp. 55-56. 10. This is a fairly frequent cause of relapse. After he has been drunk for a while, the addict usually decides that "it's better to be a junkie than a drunkard," or be decides to have a shot to "get straightened out." 11. Chicago: University of Chicago Press, 1937. 12. Charles Schultz in "Report of Committee on Drug Addiction to Commissioner of Correction, New York City," American Journal of Psychiatry (1930-31), 10: 519. 13. "An Experience with Opium," Popular Science Monthly (1885), 27: 339 14. Alonzo Calkins, Opium and the Opium Appetite (Philadelphia: J. B. Lippincott, 1871), pp. 135-36. 15. Quoted by Charles E. Terry and Mildred Pellens, The Opium Problem (New York: Committee on Drug Addictions and Bureau of Social Hygiene, 1928), P. 594. David's conclusion concerning the length of time necessary for all traces of withdrawal distress to disappear are substantially the same as those reached by researchers at the Public Health Service Hospital in Lexington, Kentucky. 16. Marsh B. Ray, "The Cycle of Abstinence and Relapse among Heroin Addicts," in Howard Becker (Ed.), The Other file:///I|/drugtext/local/library/books/adopiates/chapter6.htm[24-8-2010 14:23:37]

PRESCRIPTION ADDICTION
Opioid Addiction