Addiction and Opiates

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION
now, and addiction was distributed fairly evenly in the social classes and may even have been concentrated to a slight
extent in the middle and upper strata. Obviously the selective processes at work must have been very different from
what they now are, and there is obviously much more involved than personality types.
A study which, like those that have been cited, stresses personality predisposition, but also allows for the other
influences of the type noted, is that of Chein and his associates, (26) whose conclusions were based on their wellknown
investigations of adolescent addiction in New York City slums. Gerard, who co-authored the final published
report, presented in it the same classification of addict personality types that be and Kornetsky had previously
published.
Chein evidently accepted the general purport of these findings, for be remarks elsewhere that when addicts come to
psychiatric attention "they seem to be, without exception, suffering from one or another of a variety of mental
disturbances, apart from their addiction .(27) Unlike Gerard and Kornetsky, Chein emphasizes.. the idea that the spread
of, drug use is associated with human misery generated by the nature of life in the slums and, especially- by the nature
of family life. Two moods favorable to the spread of the habit are identified: one of pessimism, unhappiness, and
futility; the other of mistrust, negativism, and defiance. At the same time
he observes that only a small percentage of the boys in the areas studied (never more than 10 per cent) become addicted.
He thus conceives of the personality disorders which are said invariably to precede and facilitate the addiction as
natural consequences of slum life and experiences within the family.
The study by Chein and his associates, it should be recalled, was focused on adolescents in a twentieth-century urban
slum. As such, it deals with a specific pattern of recruitment into the ranks of addiction that is prominent in the United
States at present, but which does not encompass all existing paths to addiction and which scarcely existed throughout
most of the nineteenth century. There are, for example, many European and other metropolitan slums scattered
throughout the world which can at least match those of New York and in which addiction rates are probably lower
than are those, for example, among physicians. From the very nature of the Chein studies, addiction among physicians,
in foreign countries, among hospital patients, in non-slum, non-urban environments, in the upper classes, and in past
periods of time, were not taken into account.
The Chein studies, thus, were not, and did not really purport to be, of addicts in general. The conclusions which they
generated do not constitute a universally applicable theory of the mechanisms of the addiction process, but are rather
descriptions of selective processes, operating within a particular social environment in contemporary American society
and applicable to some addicts but not to all and possibly not even to most of them.
A Psychoanalytic Perspective
While the views of Sandor Rado on addiction have commonly been spoken of as a "theory" of the etiology of drug
addiction, it appears that Rado himself regarded them as something other than that. In a 1963 article Rado observed:
"though the etiology of narcotic bondage is still unknown, its clinical feature is obviously the victim's craving: if we
could stop his craving he would no longer be in bondage " (28) What Rado evidently seeks to do is to indicate, in
psychoanalytic terms, how the craving for drugs is integrated in the motivational structures of the addicted person.
Since Rado is not concerned with the origin of the craving, which is the central concern of this study, his views are not
directly competitive and are only occasionally of theoretical relevance here.
In an earlier article, Rado suggested that all types of drug craving be regarded as varieties of a single disease which he
proposed to call "pharmacothymia." Noting the addict's typical fluctuations in mood between a state of elation or
euphoria and one of depression, he characterized the "megalomania of pharmacothymic elation" as a manifestation of
narcissistic regression. For many years, Rado says, he could not understand why the addict did not simply quit his
habit when continued use of the drug bad demonstrated to him that the initial elation disappears and that his hopes
concerning it bad been delusional: "A patient himself gave me the explanation. He said, 'I know all the things that
people say when they upbraid me. But mark my words, doctor, nothing can happen to me.' . The elation bad
reactivated his narcissistic belief in his invulnerability."
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