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Addiction and Opiates

Addiction and Opiates

CHAPTER 7 A CRITIQUE OF

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION Thus if we exclude all those in the unclassified and inadequate personality groups, we still have about 56 per cent who appear to have been constitutionally psychopathic. However, most of those grouped as inadequate personality were probably also basically psychopathic, so that we have between 56 per cent and 87 per cent of the patients who may well have been psychopathic before acquiring the state of drug addiction.(11) Since the attributes which are said to characterize the various types of addicts in these studies also exist among nonaddicts, before one could say with assurance that they were more frequent among drug users it would be necessary to compare addicts with non-addicts from the same social strata, residential and family backgrounds, income level, ethnic background, and so on. However, no control groups were utilized in these two studies. A more recent investigation by Gerard and Kornetsky, (12) in which a controlled comparison is made, is often cited to support the current versions of the position under discussion. Gerard and Kornetsky used a randomly selected group Of 32 adolescent addicts who were federal probationers or volunteer patients admitted consecutively to the Lexington Public Health Service Hospital. The controls consisted Of 23 non-addicts who were acquaintances or friends of known addicts, who were of the same age, ethnic and educational background, who lived in high drug-use census tracts in New York City, and who bad "no probationary or institutional record." The search for control subjects began with 91 prospects, of whom all but 23 had to be eliminated for a variety of reasons. The findings of the study were based mainly upon results obtained from administering the Rorschach and Human Figure Drawings tests, and from a psychiatric interview with each of the subjects in both groups. Evidently because some addict subjects were lost before the study was completed, the authors summarized their psychiatric diagnoses with respect to 30 addicts and the 23 controls as follows.(13) These results are sharply at variance with those reported by Kolb and Schultz and many other writers in a number of interesting respects. Schizophrenia, for example, which Gerard and Kornetsky report in overt or incipient form in almost half of their addicts, is not mentioned at all by Kolb and Schultz. The latter writers, on the other band, mention definite neuroses or neurotictype ailments which Gerard and Kornetsky find only in the controls. All of these studies are alike in at least one respect, namely, that the categories containing the largest number of cases are invariably especially nebulous and poorly defined. In Kolb's studies about 60 per cent of the addicts are characterized as carefree individuals devoted to pleasure or as inebriates; Schultz describes 50 per cent of his cases as inadequate personalities or emotionally unstable; Gerard and Kornetsky find that most of their addicts who did not fit under the schizophrenia labels bad delinquencydominated character disorders while no controls did. Since the controls in the latter study were selected on the basis of having no probationary or institutional record, this particular difference was guaranteed in advance by the design of the study and is of no significance. The manner in which the controls were selected suggests that the comparison, besides being one of addicts with non-addicts, was also to a considerable extent a comparison of delinquents and non-delinquents in high delinquency areas. file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION Gerard and Kornetsky themselves indicate that the size of their sample was inadequate for secure conclusions to be drawn from it. Another serious problem is involved in their interpretations of the Rorschach results, which -they found differentiated significantly between addicts and controls and buttressed their conclusions. In a footnote, the authors note that a clinical psychologist who made a blind rating of the Rorschach protocols found no statistically significant differences whatever between the addicts and the controls. (14) This makes one wonder what would have happened if the psychiatric interviews bad also been blind, that is, without the interviewer's knowing which subjects were addicted and which not. As Clausen has suggested, it is virtually impossible to interview an addict without tending to attribute to him the personality traits which ones entire training and ideological commitments indicate must be there. (15) Another 'classification of addicts has been developed by Ausube], who regards his scheme as superior to "the widely used Kolb classification."(16); According to Ausubel, there are three basic categories of opiate addiction: (1) "primary addiction in which opiates have specific adjustive value for particular personality defects"; (2) symptomatic addiction in which the use of the drug is "only an incidental symptom of behavior disorder and has no adjustive value"; and (3) reactive addiction "in which drug use is a transitory developmental phenomenon in essentially normal individuals influenced by distorted peer groups.(17) The first category of primary addiction includes two subtypes: the inadequate personality and drug use in connection with anxiety and reactive depression states. Symptomatic addiction occurs' mainly in "aggressive antisocial psychopaths," or criminals, for whom the drug has no particular adjustive value but is merely incidental in a criminal career. Reactive addiction, according to Ausubel, is essentially an adolescent phenomenon involving mainly "essentially normal boys and girls" for whom the use of drugs "is largely a non-specific aggressive response to the prolonged status deprivation to which adolescents are subjected in our society."(18) This kind of addiction, he says, is usually transitory and self-limiting, with no serious or lasting consequences. The above description of adolescent addiction is in sharp conflict with that of Gerard and Kornetsky, and the assertion that youthful addiction is a relatively trivial matter, easily overcome and with few serious long-range consequences is, simply not true. Speaking of Kolb's inclusion of persons who are accidentally addicted in medical practice, Ausubel dismisses them with the assertion that they are "rare and are not true addicts since their addiction is based chiefly on physical dependence and has little adjustive value in a psychological sense."(19) In support of his classificatory scheme he advances the astonishing argument that parents and teachers who think that anyone can become addicted will be relieved to learn that only those with "very special kinds of personality defects can become truly addicted to drugs.(20) It is evident that the promulgation of classificatory schemes such as those that have been described has not contributed significantly to the development of theory. While almost all of them recognize the existence of addicts without psychiatric problems and personality defects apart from addiction itself, none offers a rational way of accounting for this. If addiction is contracted because of personality defects one may ask why normal persons also become addicted. If the answer is like that of Ausubel, that is, such persons are addicted largely because of the withdrawal symptoms, why should not the same symptoms be sufficient to addict abnormal persons? Almost all of the writers who, like Ausubel, Kolb, Schultz, and Gerard and Kornetsky, have adopted classificatory schemes in support of the view that addiction is produced by psychiatric or personality problems, have concerned themselves exclusively with American addicts, and have contented themselves by applying their conclusions to "most," "the great majority," or the "bulk" of twentieth century American heroin addicts. Kolb, however, intimated that his conclusions might not be applicable in other countries where laws do not protect individuals against the consequences of their own ignorance as they are presumed to do in the United States. As a matter of fact, of course, which kinds of persons become addicted is a matter that is influenced by patterns of availability, by control policies by social custom, and by many other factors. The pattern of recruitment in the United States of the twentieth century is vastly different from that of the nineteenth, and both differ drastically from some of those found in European and especially in Asiatic countries. In their superb survey of the literature of addiction up to 1928, Terry and Pellens evaluated the classificatory schemes that bad been proposed, in words that are as relevant today as when they were written: In the foregoing, one is struck with the contradictions apparent in the widely varying views expressed as to the types file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

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