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Addiction and Opiates

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." file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION Rado' describes the attainment of pleasure from the drug as "an artificial sexual organization which is autocratic and modeled on infantile masturbation. . . . The ingestion of drugs, it is well known, in infantile archaic thinking represents an oral insemination; planning to die from poisoning is a cover for the wish to become pregnant in this fashion. We see, therefore, that after the pharmacothymia has paralyzed the ego's virility, the hurt pride in genitality, forced into passivity because of masochism, desires as a substitute the satisfaction of child bearing."(29) In the 1963 article, Rado refers to the psychoanalytic doctrine that in the initial experiences of manipulating his own limbs the child comes to believe in his omnipotence and that this is his first self-image or primordial self. The addict's experience of gratification or narcotic grandeur from a fix is said to reactivate the feeling of omnipotence of the primordial self, making the satisfied addict feel like the "omnipotent giant" he bad always fundamentally thought he was .(30) Rado concludes that the response of narcotic grandeur is elicited only in a small minority of persons who retain a more powerful primordial, omnipotent self than is the case with the vast majority. He notes, however, that some persons who become addicts evidently do not possess this predisposing trait and do not develop narcotic intoxication or experience narcotic grandeur. From the perspective of the theory concerning the nature and origin of the craving for drugs that has been outlined in previous chapters, it might be expected that this irrational and powerful impulse would be symbolically elaborated by the person subject to its influence and that it would become a pervasive aspect of his personality structure as the latter is viewed by psychiatrists. Rado's interpretation would not be accepted by psychiatrists committed to other ideological positions, and it is bard to see bow it could be subjected to any sort of empirical verification. This, however, need not concern us here. The important point to be kept in mind concerning Rado's work is that it is concerned essentially with the consequences of addiction, not with its antecedents. This is the clear import of his own remark that the etiology of addiction is unknown. The Pleasure Theory It is a common belief that opiate addiction is based upon the pleasure or happiness which the drug is supposed to produce. In a sense, this view is incontestable, for obviously the user of drugs obtains satisfactions of some sort or he would not be addicted. The satisfaction of the addict's craving for drugs may itself be called a pleasure. The relief from withdrawal distress which an injection gives may also be so designated. So considered, the assertion that an addict uses drugs because be obtains pleasure or satisfaction from them is merely a tautology. If one views this theory as a serious attempt at causal explanation it has grave faults. Virtually all addicts maintain, for example, that they feel only "normal" under the influence of the drug after the initial interval when addiction is being established. This contention can scarcely be denied, for, after all, the addict is the final authority on this question of how he feels. Nevertheless, Ausubel ventures to disagree with the addict about how he feels. Noting that addicts as a group maintain that the kick disappears and that the drug is used, when dependence is fully established, merely to feel "normal," he suggests that they are untruthful. Faced with data that do not conform to his theory, Ausubel alters the data rather than his views by inventing "a lesser residual euphoria, possibly devoid of the original voluptuosity" that always remains. The addict's claim, he argues, "sounds very unlikely when one considers the tremendous cost in money and social prestige, as well as the risk of imprisonment and disgrace involved-all of which could be avoided by simply undergoing the moderate and self-limited physical suffering of withdrawal ."(31) Because addicts have a bad reputation for veracity and because they rarely read or write articles in learned journals, there is little hazard attached to attributing wholely imaginary subjective effects to the drug. Indeed, this is more or less required in the mass media catering to popular tastes, since the general public commonly assumes that the mysterious power of the habit must be based upon an equally mysterious and uncanny pleasure. The writer who in one paragraph describes addicts as living in a state of ecstasy may in the next elaborate on the disaster, disgrace, and misery that addiction entails. Anyone with minimal knowledge of the conditions under which American addicts live could not possibly characterize them as anything but miserable. If they use the drug for pleasure in the usual sense it is certainly not evident in their lives. Obviously, if they were suddenly to begin to act so as to maximize their pleasures and file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

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