Addiction and Opiates

Alfred R. Lindesmith

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351534000
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Sociologie

This classic study is concerned with addiction to opiate-type drugs and their synthetic equivalents. Lindesmith proposes and systematically elaborates a rational, general theoretical account of the nature of the experiences which generate the addict's characteristic craving for drugs. While this theoretical position has obvious implications for addictions that resemble opiate addiction in that they also involve drugs which produce physical dependence and withdrawal distress, the author does not extend the theory to these other forms of addiction, such as alcoholism.The central theoretical problem is posed by the fact that some persons who experience the effects of opiate-type drugs and use them for a period sufficient to establish physical dependence do not become addicts, while others under what appear to be the same conditions do become addicted. The focus of theoretical attention is on those aspects of addiction which may reasonably he regarded as basic or essential in the sense that they are invariably manifested by all types of addicts regardless of place, time, method of use, social class, and other similar variable circumstances. Lindesmith then makes a brief statement of a view of current public policy concerning addiction in the United States reform which, it is believed, would substantially reduce the evils now associated with addiction and the large illicit traffic in drugs. He interviews approximately fifty addicts over a fairly extended period of time sufficient to establish an informal, friendly relationship of mutual trust.The attempt to account for the differential reactions among drug users requires specification of the circumstances under which physical dependence results in addiction and in the absence of which it does not. It also requires careful consideration of the meaning of "addiction, " spelled out in terms of behavior and attitudes characteristic of opiate addicts everywhere. This book strives to understand these aspects of addiction with t

Part I
The Nature of the Opiate Habit

Chapter
1
Method and Problem

The present study is directly concerned only with addiction to the opiate-type drugs and their synthetic equivalents. A rational, general theoretical account of the nature of the experiences which generate the addict’s characteristic craving for drugs is proposed and systematically elaborated. While this theoretical position has obvious implications for other addictions which resemble opiate addiction in that they also involve drugs which produce physical dependence and withdrawal distress, an extension of the theory to these other forms of addiction, such as alcoholism, is not attempted here. This is a matter which requires specific empirical investigation of a comparative nature.

The central theoretical problem of this investigation is posed by the fact that some persons who experience the effects of opiate-type drugs and use them for a period sufficient to establish physical dependence do not become addicts while others under what appear to be the same conditions do become addicted. The attempt to account for this differential reaction requires a specification of the circumstances under which physical dependence results in addiction and in the absence of which it does not. It also requires a careful consideration of the meaning of ‘addiction” spelled out in terms of behavior and attitudes characteristic of opiate addicts everywhere. The theory that is developed is a general one; its applicability is not limited to American addicts, to lower-class users, to twentieth-century addiction, to any restricted segment of the problem, or to any specific historical period. Consequently, the focus of theoretical attention must be on those aspects of addiction which may reasonably be regarded as basic or essential in the sense that they are invariably manifested by all types of addicts regardless of place, time, method of use, social class, and other similar variable circumstances.

The second part of the study consists of a brief statement of a view of current public policy concerning addiction in the United States, with proposals for reform which, it is believed, would substantially reduce the evils now associated with addiction and the large illicit traffic in drugs. Since the original publication of this book in 1947 there has been a widespread public realization that the American program of dealing with addicts is both cruel and ineffective and that it compares unfavorably in these respects with the programs of most European countries in which opiate addiction is handled primarily as a medical rather than as a police problem.

It should be kept in mind that when I use such terms as “narcotics,” “drugs,” “drug addict,” and “drug users,” I will be referring to drugs that are commonly classified as opiates and their synthetic equivalents and to persons addicted to drugs in this class. Common and well-known examples are opium, heroin, morphine, methadone, and demerol. Marihuana and cocaine do not belong to this category, and only incidental reference will be made to them. While alcohol is addicting in approximately the same sense that heroin is, it will also be referred to only incidentally. The fact that marihuana, cocaine, and heroin and other opiate-type drugs are covered in the same anti-narcotics legislation is a fertile source of confused thinking because it obscures the facts that the use of marihuana is totally unlike heroin or morphine addiction and that alcoholism, which is not covered by the legislation and is not popularly thought of as a form of narcotic addiction, actually has very much in common with opiate addiction.

The theory that is proposed in this book, in its earliest stages, was derived from observing addicts and conversing with them. The later development of the theoretical framework of the study was also significantly influenced by data available in the extensive literature. Approximately fifty addicts were interviewed over a fairly extended period of time sufficient to establish an informal, friendly relationship of mutual trust. In the case of twelve others there was at least one interview but the relationship was brief or occurred under circumstances that made it impossible to place much confidence in what was said or to obtain a full and consistent account of the person’s addiction history. Since my contacts were usually with addicts who were using drugs it was unavoidable that some of them disappeared before I could learn much from them. On the other hand, there were some with whom I established relationships that lasted for several years covering periods of use, of temporary voluntary abstention, and of incarceration.

My principal assistance in becoming acquainted with new subjects came from “Broadway” Jones, officially known by the alias “Chic Conwell,” which Sutherland gave to him in The Professional Thief.¹ Mr. Jones himself had had a long history of addiction that began in his late teens. He was an invaluable source of information. He also read and criticized my manuscript. Indeed, he initially suggested that I study drug addiction and offered his cooperation in the project. I remained in communication with him until his death, some years after that of Dr. Sutherland. Mr. Jones was not using drugs during most of the approximately twenty years that I knew him but did relapse some years before his death. On the advice of Sutherland he voluntarily committed himself to Lexington for withdrawal.

When I first began to talk to addicts with the idea of making a systematic analysis of the habit, I became fascinated by the theoretical problems it posed. I dreamed of basing my analysis on interviews with hundreds of addicts, perhaps even as many as a thousand. For this purpose, through the good offices of Professor Sutherland I obtained permission from the Federal Bureau of Prisons to interview addicts at the Lexington Public Health Service Hospital and the annex of the Federal Penitentiary at Leavenworth, which at that time specialized in handling drug offenders. However, the Public Health Service, which also exercised authority in these two establishments, refused to give me this permission on the grounds that what I proposed to do was already being done by their personnel. I was consequently compelled to rely on the costly, slow, and arduous techniques involved in picking up subjects from the Chicago streets, financing my research almost entirely from my own pocket.

Many but not all of my subjects were introduced to me by Broadway Jones, who briefed both them and me in advance. Most of them were experienced in criminal activity such as drug peddling, some form of theft, or the confidence game. Mr. Jones sometimes warned me that my new subject could not be trusted and that I should keep one hand on my billfold and the other on my watch when I was with him. In other instances the subject was characterized as an “honest thief” who could be trusted implicitly to steal only from strangers and whom I could safely take into my home. A substantial number of my subjects did in fact visit with me, my wife, and our daughter in our apartment. None of these ever pilfered anything; on the contrary, a number of them offered to provide us with stolen goods.

I ordinarily told each new subject that I was interested in studying the “psychology” of the habit and trying to understand it. This invariably satisfied them, and they asked no probing questions, perhaps because they felt that they knew a great deal more about the psychology of addiction than I ever would. It was thus unnecessary to explain the theoretical development of the study to them, and, indeed, they were not interested in it.

To encourage addicts to remain in contact with me I usually rewarded them by buying them a meal in a cheap restaurant or bar or by giving them fifty cents or a dollar after an interview. My conversations with them were held in bars and restaurants as a rule. Most of my subjects were very cooperative, in part perhaps because addicts talk and think about their addiction a great deal in any case, and also, in many instances, because they felt that an objective, non-moralistic study of addiction was needed and might benefit them by leading to a more rational public policy. There is a widespread feeling among addicts that addiction is not understood, that it is misrepresented in the mass media, and that it is dealt with in an inhumane and needlessly severe manner. Non-addicts who have dealings with known addicts generally deal with them in a condescending or authoritarian manner and often moralize with them. I consciously avoided all of this, even at times when I was repelled or shocked. I felt no condescension because I knew that my subjects had information which might be useful to me and that I was thus dependent on them. Finally, I was in no position to be authoritarian because my subjects were free to break off the relationship whenever they wished to.

The literature of drug addiction was at first not consulted for fear that the opinions expressed would introduce an initial and perhaps decisive bias into the investigation. The first temporary hypothesis was formulated exclusively on the basis of observation of and conversations with addicts, and it was only after the study had crystallized around a few central problems and theories that the literature was intensively examined. It was examined particularly with the view of uncovering negative evidence which would force revision of the theory and also of exploring as exhaustively as possible all relevant aspects of the subject and all implications of the theory.

The first tentative and obviously inadequate hypothesis formulated was that individuals who do not know what drug they are receiving do not become addicted and, on the positive side, that they become addicted when they know what they are getting and have taken it long enough to experience withdrawal distress when they stop. This hypothesis was destroyed almost at once by negative evidence. One of the first addicts to be interviewed, a doctor, had once received morphine for several weeks; he was fully aware of the fact, but he did not become addicted at that time. The difficulty presented by this case remained unresolved until my attention was attracted to a rather casual and incidental comment made by Dr. Albrecht Erlenmeyer in an article concerned mainly with the physiological effects of morphine. Speaking of withdrawal distress, Erlenmeyer said, “In such moments the craving for morphine is born and rapidly becomes insatiable, because the patient has learned during the period of habituation, when abstinence symptoms always set in after the effect of the last morphine dose has passed off, that those terrible symptoms are banished as if by magic by a sufficiently large dose of morphine”² In the light of this statement, the second hypothesis of the investigation was that persons become addicts when they recognize or perceive the significance of withdrawal distress which they are experiencing, and that if they do not recognize withdrawal distress they do not become addicts regardless of other considerations.

This formulation proved to be much more significant and useful than the first, but like the first it did not stand the test of evidence and had to be revised when cases were found in which individuals who had experienced and understood withdrawal distress, though not in its severest form, did not use the drug to alleviate the distress and never became addicts. The final revision of the hypothesis involved a shift in emphasis from the individual’s recognition of withdrawal distress to his use of the drug to alleviate the distress after this insight has occurred. This hypothesis was found to be superior to the others. It had the advantage of attributing the origin of addiction, not to a single event, but to a series of events, thus implying that addiction is established in a learning process extending over a period of time.

If one thinks of the central problem of addiction as being that of isolating and describing the nature of the experience from which the fatal craving or “hook” is derived, the hypothesis stated above suggests that the critical experience in the fixation process is not the positive euphoria produced by the drug but rather the relief of the pain that invariably appears when a physically dependent person stops using the drug. This experience becomes critical, however, only when an additional indispensable element in the situation is taken into account, namely, a cognitive one. The individual not only must experience relief of withdrawal distress but must understand or conceptualize this experience in a particular way. He must realize that his distress is produced by the interruption of prior regular use of the drug.

It is evident that when a person becomes addicted to heroin or morphine the entire pattern of his social behavior is commonly altered to a pervasive degree and that his orientation toward the drug is radically altered. These drastic changes in behavior and attitude are not of the kind that could reasonably be expected to occur in an instant. They are learned, according to the theory, in a gradual but rather rapid way as the withdrawal distress recurs and must repeatedly be banished by further use of the drug. Even though the beginner may like the effects of morphine or heroin, the prospects of becoming an addict are traumatic if they are actually fully understood. In this sense, the addict does not ordinarily become such voluntarily but is rather trapped “against his will” by the hook of withdrawal.

If one disregards the cognitive aspect, one can say of this hypothesis that it is a theory emphasizing negative rather than positive reinforcement as the basis of addiction. In psychological writings the term “negative reinforcement” is used to refer to a situation in which a given action is rewarded by the elimination of something unpleasant—an adverse stimulus. Thus, if a child is locked in his room until he masters his school assignment, his reward for doing it will be that he will be freed from confinement. This is negative reinforcement. If, on the other hand, the child is promised a much desired trip to the zoo when he completes his homework, this is called positive reinforcement.

It will be pointed out in a later chapter that psychologists have explored the theory advanced here, minus the cognitive feature, in ingenious experimental investigations of the effects of opiates on lower animals. Some of this work strongly suggests that insofar as lower animals are capable of matching the behavior of human subjects in becoming attached to drugs, their attachment also depends upon the negative reinforcement obtained from the relief of withdrawal rather than on positive reinforcement stemming from pleasurable effects of the drugs. Investigations of this type which necessarily ignore the differences between human beings and animals occasioned by the former’s immense cognitive superiority leave open the question of the extent to which the responses of lower animals to opiates can be made to parallel those of human subjects. In a subsequent chapter attention will be given to the matter of determining whether it is justifiable or meaningful to assert, as some investigators do, that addiction can be induced in rats, monkeys, and other animals.

The hypothesis of this study was tested under the following assumptions: (1) the verification of a theory consists not in piling up selected instances which confirm it but in looking for evidence which contradicts clear logical implications which may be deduced from it; (2) a valid theory of addiction must account for the basic or essential aspects of addiction by indicating that they form a system or pattern which is logically implied or predicted by the theory. All of the evidence obtained from the literature and from conversations with all subjects was considered from this point of view. None of it seems to me to contradict the theory. On the contrary, the theory seems to make sense of a number of aspects of addiction which have usually been regarded as paradoxical or puzzling from other points of view. It also suggests a simple unitary explanation of a central theoretical problem, that of accounting for the fact that physical dependence on opiates is sometimes followed by addiction and sometimes is not.

The fact that the hypothesis of the study was revised a number of times in the course of the investigation suggests that further evidence or the extension of the theory to other forms of addiction may necessitate further reformulations. This is a probability rather than a mere possibility and seems to me to constitute an advantage rather than a weakness. It is characteristic of all genuine scientific systems that they evolve as they are confronted with new evidence that does not fit the old theories. The prime virtue of a general theory is that it stimulates the search...

Table of contents

• Cover Page
• Addiction & Opiates
• Copyright Page
• PREFACE
• Contents
• PART I The Nature of the Opiate Habit
• PART II Opiate Addiction as a Social Problem
• APPENDIX Kinds of Drugs and Methods of Use
• GLOSSARY OF ADDICT ARGOT
• SELECTED BIBLIOGRAPHY
• INDEX