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Addiction and Opiates

Addiction and Opiates

CHAPTER 7 A CRITIQUE OF

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION of individuals predominating among chronic opium users. Unless we bear in mind, along with other coexisting factors which will be discussed below, the fact that for the most part each writer was influenced by impressions received from observations on selected cases, we may become confused by the picture presented. For example, terms such as "constitutionally inferior," "degenerate," "vicious," "highly intellectual," "akin to genius," "of the upper social strata," "of the most depraved type, 11 "potential criminals," etc., etc., commonly have been used to indicate type characteristics. All too often the proponent for one type or another loses sight of the fact that his experience has been limited because of certain influencing factors to a selected group. It is obvious, therefore, that generalizations from such selected and hence quite atypical groups are valueless and prejudicial to a true conception of the real nature of the problem as a whole.... In addition to the foregoing possible misinterpretations oil the part of the writers quoted, is it not possible that where individual writers have accorded to certain types a tendency to the use of this drug, effect has been mistaken for cause? Have not these patients, possibly as a result of the situation in which they find themselves-the toxic effect of the drug, disturbed metabolism, fear of discovery and realization that unaided they cannot regain their health presented temporarily characteristics that were not constitutional with them? In spite of frequently repeated statements that the use of opium and its derivatives causes mental and ethical deterioration in all cases, we are inclined to believe that this alleged effect has not been established. The evidence submitted in support of such statements, in practically every instance coming under our notice, has been secured after the development of the addiction and was not based on a knowledge of the individual's condition prior to his addiction. In other words, the pre-addict has not been studied, and traits of character, ethical standards, and intellectual capacities based on post hoc findings may or may not have a propter hoc significance and effects attributable to the influence of the drug quite possibly may be evidence-as also may the taking of the drug-of pre-existing constitutional tendencies. It may be said with equal truth in considering the claims of those who state that certain types of individuals comprise the bulk of chronic opium users, that for one reason or another in the writings of many, 11 types" as generally understood are not considered as such until extraneous circumstances, possibly even the use of the drug itself, have altered the individual or group in question. In other words, what might be called the original type has come to be something else or attributes or factors not inherent in type delineation have been introduced as type-descriptive. Wherever the truth may lie the evidence submitted in support of the statements appearing in this chapter dealing with type predisposition and with the effect of opium use on mental and ethical characteristics is, in our opinion, insufficient to warrant the opinions expressed. . . . Unfortunately, in an attempt to present a comprehensive picture of the sociologic, constitutional, and other types of individuals involved in chronic opium intoxication, we are handicapped by the fact that there are available few valuable data, but rather in their place we find categoric statements without any presentation of the evidence upon which they are based. For the most part, we have found as data brief series of cases which by reason of the factors determining their selection may not be considered typical of the opium-using population as a whole. In general, however, it would appear from the data submitted that this condition is not restricted to any social, economic, mental or other group; that there is no type which may be called the habitual user of opium, but that all types are actually or potentially users.(21) It is difficult to discover in what exact sense the term "normal" is defined by Kolb and others, who take the position that addiction can be explained by the preexisting abnormality of the person who becomes an addict. It is clear, however, that the term is not used in the sense of "average." Kolb, Ausubel, and Schultz admit that normal persons, as they define them, do become addicts, but the implication of their theory is that they should not that they should show immunity. Apparently some practicing physicians have been more consistent in this matter. Ernst Meyer, a writer who held to the psychopathic theory, tells of cases known to him in which physicians. ordered morphine for repeated use with the explanation that there was no danger because of the absence of psychopathic predisposition. Meyer solemnly warns against this practice: "Care in the use of narcotics should still be maintained in spite of the theory that a psychopathic constitution is a necessary basis for the development of a chronic abuse of the drug. " (22) Since all of the so-called character and personality defects which are said to lead to addiction also exist in the general population and are often found in the addict only after he has become addicted, the view being considered appears as an ex post facto explanation without practical or predictive value for the physician. Indeed, as Meyer indicated, it is a dangerous doctrine for physicians or anyone else to accept, if its logical implication, that there are some types of persons who are immune to addiction because of normal personality makeup, is accepted and acted upon. file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION Joel and Frankel have sharply criticized this view of addiction as a consequence of psychopathy in terms which are directly applicable to current positions like those of Ausubel, Gerard, and Kornetsky: This conception is wrong in all its details and has dubious consequences. Even disregarding the fact that the concept of psychopathy is so extended today that one can find some psychopathic traits in anyone, the addiction itself is often taken as evidence of degeneracy when psychopathy cannot be otherwise proved. This is, of course, to reason in a circle. Also when it has been demonstrated that these persons have tainted heredities, therapeutically and for prognosis very little has been gained.(23) If one substitutes "tainted personality" for "tainted heredity" in the above statement, it can be applied without any other change to current theories of the kind under examination. An American addict, William S. Burroughs, has expressed his views of the idea that there is an addiction-prone personality, in the following blunt language: Addiction is an illness by exposure. By and large those who have access to junk become addicts.... But there is no preaddict personality any more than there is a pre-malarial personality, all the hogwash of psychiatry to the contrary.... Knock on any door, Whatever answers, give it four half-grain shots of God's Own Medicine every day for six months and the so-called "addict personality" is there! (24) In support of Burroughs' conclusions, it is generally impossible to find any adherent of the addiction-prone personality school who is willing to test his theory on himself-by the six months' test suggested by Burroughs, for example. Clearly if one does not have the special personality attributes necessary for addiction one should be immune. Nevertheless, even with the stimulus of a substantial wager, these investigators refuse to risk the experiment on themselves. This indicates one of three things: ( 1) they suspect that they may have addiction prone personalities; (2) they do not know what the type is and do not believe their own theory; or (3) those who have made the test have become addicted and changed their occupations. In the older literature of addiction a significant aspect of the attempt to show that addicts constituted a different breed of human beings from non-addicts included the investigation of their genealogical histories. Since such studies are no longer given much attention in the behavioral sciences, I shall content myself by indicating that, when the necessity of controlled comparisons was recognized and - applied, virtually all of the claims which had been made concerning the unusual prevalence of hereditary defects in addicts dissolved. The more sophisticated studies that were made seemed to indicate that the hereditary backgrounds of addicts were not significantly different from those of normals, with the possible exception that psychotic conditions of some kinds seemed to be less frequently found in the addict's background. (25) Selective Factors in Addiction The purport of the preceding discussion is not that personality factors do not play any role in the process of becoming addicted. On the contrary, it seems certain that they do and that if there were personality types that could be identified objectively and reliably they would be distributed differently among addicts and non-addicts. However, the same statement would probably be true of the persons who contract venereal disease. One does not speak of a predisposing personality type as a cause of venereal disease, but it would certainly be relevant in a consideration of exposure to the disease. Personality influences may well operate in a similar selective manner in the case of exposure In addiction. However, all the types that exist in the general population also sometimes turn tip as addicts and the influence of given personality attributes varies widely in different social settings. Besides the personality factors there are a great many other kinds of influences that operate selectively with respect to who uses drugs and who does not. Availability of the drug is such an influence. In the United States high availability exists primarily in two broad areas; one of these is the medical profession, the other, the underworld and the metropolitan slums. Addiction rates are comparatively high in both. Other more indirect influences are those of age, skin color, place of residence, income level, occupation, special events such as going to war or acquiring certain types of diseases, one's associates, and no doubt many others. During the nineteenth century, for example, there were more female than male addicts, the average age of users was much higher than now, Negroes were not over-represented as file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

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