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Addiction and Opiates

Addiction and Opiates

CHAPTER 7 A CRITIQUE OF

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION minimize their pains and sorrows, they would all quit their habits. The idea that the power of the opiate habit rests upon the pleasant state of mind that it engenders shatters upon the fact that there are substantial numbers of addicts who state that they have never experienced euphoria from the drug and the fact that the initial euphoria vanishes either entirely or almost entirely in confirmed addiction. Reports of the absence of any euphoric experiences are particularly common from persons who first begin to use an opiate to relieve severe organic pain, who use it by other than the intravenous route, and who are not members of the addict subculture. Thus, a prominent member of the New York Bar, cited by Bishop in 1921, stated flatly," I have never experienced the slightest pleasurable or sensually enjoyable sensations (32) from the administration of morphine.... A noted investigator in the field, Abraham Wikler, over a period of many years of research, has come to a conclusion much like mine concerning the inadequacy of the pleasure theory. When the first edition of this book was published in 1.947, however, Wikler had a different opinion and dismissed my contention that it was the relief of withdrawal that created the hook in addiction. Subsequently, perhaps in large part because of an experiment that he performed at Lexington in which he permitted an addict inmate to administer to himself the drug of his choice, his views changed. He found that while the addict accepted the opportunity to use drugs with alacrity and anticipatory pleasure, after a few days of use he became morose and unhappy-a fact which showed up not only as direct statements in the interviews but also in the subject's dreams. (33) The development of Wikler's thinking on this matter is interestingly brought out if one compares his earlier publications with his later ones. (34) A German physician and ex-addict protested as follows against the notion that an addict uses drugs to produce in himself a pleasant state of mind: How false it is to say of a drug addict that he takes his injections to produce a "pleasurable state of mind." Good heavens! If people only knew how much misery it causes the addict each time he has to take the drug, they would not say this, True, that the first few injections cause some users to feel stimulated, alert, and so on. However, as soon as tolerance is completely established the euphoria vanishes. When this point is reached, the addict takes his morphine in the same spirit that the prisoner carries his chains. One would then have to use the term "euphoria" to refer to the fact that the distress of abstinence disappears after the injection, but by the same logic any person with a headache could be said to experience euphoria when it disappeared. According to such a standard every normal man spends his whole life in a state of euphoria. . . . And it is entirely false to believe as people do, that addicts use drugs to produce pleasurable sensations. Every addict who hears- people talk in these terms, sighs and holds his peace. (35) Some persons become addicts without ever becoming aware of the euphoric effects of the drug which are alleged to be the cause or basis of addiction. This is often the case when drug users have first used the drug in connection with serious and painful disease or when they were semiconscious or unconscious when they received their first injections. As a German physician correctly observed: A fundamental fact that must be added here is that the experience of euphoria is by no means a necessary precondition for the development of a craving. In addition to the fact that some people develop a desire for sedatives which never produce euphoria, I am acquainted with morphine users who have never, throughout the long period of their addiction, experienced any euphoria from the drug. In the case of most addicts, whatever pleasurable effects may be experienced are of short duration. Morphine addicts have become addicts after reacting to first injection with dizziness, painful vomiting, and headache, rather than with pleasure. (36) As in the case of alcoholism, the persons who experience the pleasurable effects of morphine alone are never addicts. The casual or social drinker who drinks a few cocktails is exhilarated and stimulated by them and suffers few if any bad effects. The chronic alcohol addict, on the other band, suffers severe aftereffects in the form of physical symptoms, and the social effects may be serious as well. Similarly, it is the non-addict who experiences the beneficent effects of morphine with few or none of the evil effects which are so prominent in the case of the addict. The benign effects of morphine are well recognized in medical practice. Whatever unpleasant effects may follow from the medical use of a few injections of opiates are slight, and are in any case usually not recognized by the patient. On the other hand, the file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

CHAPTER 7 A CRITIQUE OF CURRENT VIEWS OF ADDICTION opiate addict himself describes the vast evil social and physical consequences that his habit brings upon him. From the standpoint that emphasizes the pleasures produced by drugs as the key to understanding addiction, a drug such as marihuana should be intensely addictive, since the pleasurable sensations it produces are comparatively pure and uncomplicated by adverse physical consequences, and there is no withdrawal distress. Yet, it is well known that the addictive powers of marihuana and other drugs like it are negligible by comparison. Indeed, these drugs are described as nonaddicting. It is sometimes said that only pathological persons experience pleasure from opiate drugs. This contention is manifestly incorrect, as anyone can find out for himself by talking with acquaintances who have bad morphine injections or by talking to a few experienced nurses. Almost all persons who had had morphine injections with whom I discussed the matter described the effects as pleasant, and some found them intensely so. It is usually reported that, if allowances are made for some unpleasant effects with the very first injections, the vast majority of patients experience the initial effects as pleasurable. Retrospective reports of addicts indicate that the initial experiences of addicts cover the entire range of possibilities from those that are intensely pleasurable to those that are decidedly unpleasant. In some cases no effect is noticed. Addiction as an Escape The assertion, which is commonly made, that drug addiction is an "escape mechanism" is evidently based upon the assumption that the drug user's assertion that he feels "normal" is false. It implies that by means of drugs a person can escape from the problems that harass him when he is not using drugs, into a realm of fantasy or pleasurable physical sensations which allow him to forget his inadequacies and his problems. As already indicated, there is no evidence that such a mental state is produced in morphine addicts. There is a great deal of evidence to indicate that it is not. Moreover, the drug user is fully aware of the disastrous effects of his habit, particularly upon his social life. It is therefore difficult to see how the drug habit can be regarded as an escape mechanism, since it does not produce forgetfulness as alcohol does, and since the habit itself constitutes a burden and a problem which is usually more serious than those for which it is alleged to provide an escape. It is true that there may be a parallel between the use of alcohol and the initial use of opiates, and that opiates may be used as an escape device before addiction is established. Morphine as used in hospitals is a potent escape device, enabling patients to escape from intolerable pain, from worry, insomnia and so on. When addiction is established, however, this effect is no longer present. Lower Animals as Addicts Dr. S. D. S. Spragg described the effects upon chimpanzees of repeated doses of morphine .(37) He claimed that be found unequivocal evidence in the behavior of chimpanzees of a "desire for morphine" and therefore insisted on calling them addicts. He concluded: A discussion of the nature of morphine addiction in chimpanzee and man was undertaken, and the thesis was defended that morphine addiction is fundamentally a physiogenic phenomenon, developed according to principles of association. That the "societal" factor (which is usually present in human addiction) is not essential in the development of addiction has been demonstrated by the present results.(38) Spragg taught his chimpanzee subjects to associate withdrawal distress with the hypodermic injection of morphine. He contended that they exhibited genuine addiction behavior in the following ways: (1) By showing eagerness to be taken from the living cage by the experimenter, at the regular dose times or when doses are needed, in clear contrast to behavior exhibited when taken from the cage at other times; (2) by struggling, under such conditions, to get to the room in which injections are regularly given; tugging at the leash and leading the experimenter toward and into that room; and exhibiting frustration when led away from the injection room and back to the living cage without having been given an injection; (3) by showing eagerness and excitement when allowed to get up on the box on which the injections were regularly made, and more or less definite solicitation of the injection by eager cooperation in the injection procedure or even by initiation of the procedure itself; and (4) under controlled test file:///I|/drugtext/local/library/books/adopiates/chapter7.htm[24-8-2010 14:23:37]

Opioid Addiction
PRESCRIPTION ADDICTION