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Addiction and Opiates

Addiction and Opiates


CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION It is at once evident from Adams' statement that it does not qualify as a scientific general theory of addiction because it claims only that most addicts who become addicted by voluntarily taking drugs are abnormal in some way and implies that this abnormality occurs more often among addicts than among non addicts. His statement suggests that the above conclusions may be reversed in the case of those persons who become addicted in medical practice without using the drug voluntarily. While he asserts the existence of a psychopathic basis for most voluntary addiction, Adams does not stop to consider whether even this weak conclusion is generally or universally valid. For example, in Eastern countries where folk beliefs bold that opium is an effective remedy for widespread tropical diseases, for sexual impotence, and other complaints and ailments, would voluntary use of opium under such circumstances have the same psychopathic basis? Does such a psychopathic basis exist when the use of the drug is a status symbol, as it has been among upperclass Chinese? Would this idea apply to communities in China and other Eastern countries where it has been reported that it was the custom of virtually all adult males to use opium? The view expressed by Adams is still widely accepted among students of addiction despite its obvious deficiencies and the wide range of disagreement as to bow the alleged psychopathic predisposition or addiction-prone personality is to be described. Some writers in Adams' time and earlier sought to extend the conclusion to all addicts just as contemporary students occasionally do. This position is, in my opinion, mainly a reflection of a popular conception which long antedates it, that persons with bad compulsive habits are afflicted with "weak wills." A narcotic agent whom I asked why addicts used drugs replied that it was because 11 they are weaklings'' The prevalence of the popular view and the scientific view with which it is in essential agreement is based primarily on frequency of repetition rather than on evidence. Even if it were to be unequivocally confirmed that most addicts are in fact not psychologically normal, little would be gained, since the problem of explaining the mechanisms of addiction would still remain and it would still be necessary to account for the minority, however small, of addicts to whom the description did not apply. Two of the older studies may be taken as prototypes of this approach. Both were published by competent investigators of excellent standing in their professions, Dr. Lawrence Kolb and Dr. Charles Schultz. As is characteristic of studies in this tradition, both present a classification of addicts as the main grounds for their conclusions. In a study by Kolb, 225 addicts were classified in the following categories: "Normals who are accidentally or necessarily addicted in medical practice ( 14 per cent). Care free individuals, devoted to pleasure, seeking new sensations (38 per cent). Definite neuroses ( 13.5 per cent). Habitual criminalsalways psychopathic ( 13 per cent). Inebriates (21.5 per cent) . (4) Kolb states that all these addicts became addicted "because of the pleasurable mental satisfaction that the first few doses of the narcotic gave them. The degree of inflation varies in direct proportion to the degree of pathology. It occurred only slightly or not at all in those considered nervously normal, but was very striking in some of the extreme psychopaths." (5) Concerning the habitual criminal, Kolb asserts: "Habitual criminals are psychopaths, and psychopaths are abnormal individuals who, because of their abnormality, are especially liable to become addicts."(6) He concludes: The instability of the various abnormal cases expressed itself in some form of social or Psychical reaction that marked them off as different from the average stable individual. They were not necessarily invalids or vicious; some of them were useful citizens and remained so; others were so abnormal as to have been social problems before their addiction, or the use of narcotics with its attendant social and physical difficulties, had seriously reduced their efficiency. Frank cases of hysteria and psychasthenia were less common than cases that showed biased personality of one kind or another. Psychopathic characters, periodic inebriates, extremely temperamental individuals, and persons who had been problem children were more common than cases with phobias, fits, or pathological fears. A common type among these cases is a psychopath who, with his special deviation of personality, is, in the language of the street, an individual who knows it all and does not care.... The psychopath, the inebriate, the psychoneurotic, and the temperamental individuals who fall easy victims to narcotics have this in common: they are struggling with a sense of inadequacy, imagined or real, or with unconscious pathological strivings that narcotics temporarily remove; and the open make-up that so many of them show is not a normal expression of men at ease with the world, but a mechanism of inferiors who are striving to appear like normal men. (7) file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION In another study of 119 persons who became addicted in medical practice, Kolb rated only 67 per cent as psychopathic, (8) while in a third study he found that go per cent Of 210 cases were psychopathic prior to addiction. (9) He summarizes his viewpoint as follows: It has long been recognized by students of the subject that the addict is generally abnormal from the nervous standpoint before he acquires the habit while some, like Block, assert that normal persons never become habitues. It is probable that Block does not class as habitues persons who, because of certain painful conditions, are necessarily addicted in the treatment of them. If this assertion allows for this exception and is limited in application to countries which like the United States have laws that protect people from the consequences of their own ignorance, its accuracy is supported by my own findings. Ninety-one per cent of this group and eighty-six per cent of a group reported elsewhere by me deviated from the normal in their personalities before they became addicted.... The unstable individuals who constitute the vast majority of addicts in the United States may be divided into two general classes: Those having an inebriate type of personality, and those afflicted with other forms of nervous instability. The various types find relief in narcotics. The mechanism by which this is brought about differs in some respects in the different types but the motive that prompts them to take narcotics is in all cases essentially the same. The neurotic and the psychopath receive from narcotics a pleasurable sense of relief from the realities of life that normal persons do not receive because life is no special burden to them. The first few doses, especially if larger than the average medicinal doses, may cause nausea and other symptoms of discomfort, but in the unstable there is also produced a feeling of peace and calm to which they are not accustomed and which, because of its contrast with their usual restless and dissatisfied state of mind, is interpreted as pleasure.(10) Schultz classified 318 cases of addiction in the following manner: Unclassified, 42 patients (13.2 per cent); i.e., in 13.2 per cent of the patients treated, little or no evidence could be elicited of psychopathic personality other than the drug addiction per se. These cases gave the impression of having possessed and still retaining normal personalities. Inadequate personalities,' 96 patients (30 per cent). While the majority in this group were probably psychopathic types who had been the shiftless black sheep and ne'er-do-wells of their families before using drugs and whose failings may have been accentuated as a result of the addiction, there were some who appeared to have been fairly normal individuals before using drugs, but who went to seed afterwards, from what information was available. Emotional instability, 65 patients (20 per cent). Here there is a question, in some cases, as to whether the instability was present before or came as the result of the addiction. Undoubtedly, the majority were unstable before using drugs.... There are some types who from their previous histories appear to have been more stable before using narcotics, and in whom the instability was secondary to the use of drugs. (In all observations carried out on these drug addicts, the emotional instability was the most striking feature.) ... The following groups appear to have been basically psychopathic. Criminalism, 41 patients (13 per cent). The dominant feature here is seen to be profound egotism combined with complete indifference in regard to ethical issues. The exclusive aim of such an individual is his own pleasure or his own interest. He has neither sentiment of honor nor respect for the truth. His unique pre-occupation is to escape conviction and punishment. . . . Paranoid personality, 29 patients (9 per cent). In this type we find conceit and suspicion, and a stubborn adherence to a fixed idea; contempt for the opinions of others, argumentativeness, and a tendency to develop persecutory trends. Nomadism, 26 patients (8 per cent). The nomadic or wandering tendency is present in most of us to some degree and, as all know, is in certain races so pronounced as to govern their mode of existence and social organization. . . . Sexual psychopathy, 18 patients (6 per cent), homosexuality. These patients all showed the stigmata and reactions which were characteristic. In addition, many patients showed tendencies to be masochistic; e.g., pricking themselves with pins and needles during treatment or asking for "sterile hypos" after they were off treatment to get a "kick" out of it. This they termed "needlemania" [The followers of Watson and Pavlov might call this a conditioned reflex.] file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

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