Hooked? The Reality of Opiate Addiction
“Man is a being of volitional consciousness. Reason does not work automatically; thinking is not a mechanical process; the connections of logic are not made by instinct. The function of your stomach, lungs or heart is automatic; the function of your mind is not.” - Ayn Rand
"Drugs are everywhere; I couldn’t help myself; I did it once, and now I’m hooked." "Hooked" as in a fish with metal pushed through its mouth by an external force, and "hooked" as in lacking any responsibility for what is occurring. Beginning in the early 1800s with De Quincey’s Confessions of an English Opium-Eater, opiate addiction was described in such a way that it could be categorized as a disease. As time has moved on, individual addicts have continued to convince society that they have a real medical problem. It is common to hear that withdrawal from opiates is a horrible pain that can be deadly and requires extensive supervision. These are also the people who promote pharmacology to solve the problem of opiate addiction. These positions have stood tall on a social level because of the reinforcements offered by famous institutions such as the A.M.A. and C.D.C., which label opiate addiction a disease and, further, an epidemic. This article will challenge the mainstream understanding of opiate addiction. Although many of the ideas discussed will apply to other forms of addiction, certain evidence will be specific to opiates.
The question that will first be analyzed is "How does addiction begin?" not to be confused with "Why does addiction begin?" According to the Encyclopedia of Drugs and Alcohol, addiction is the constant craving for a substance to the point that it takes prominence over all other thoughts in the mind. Addiction is commonly believed to occur when an individual "becomes physiologically dependent upon a drug," otherwise understood as addicts suffering withdrawal when they stop using. The issue with this definition is that a person can build a tolerance to a drug and suffer withdrawal symptoms without being addicted. Tolerance and withdrawal can occur soon after frequent use. A surgical patient using opiates may need to increase their doses, as this is merely the physiological aspect of drug use, while the addiction is psychological. Due to this definition, many people hold that addiction can occur almost immediately after using a drug or beginning to use it frequently and that its occurrence is entirely up to chance, hence the phrase "hooked." The Encyclopedia of Drugs and Alcohol notes, "Susceptible persons rarely become compulsive daily users immediately after first use … From first use to daily use it usually takes about one year.” Using the definition offered initially, addiction can truly be seen as a choice. As psychiatrist Theodore Dalrymple argues in his book Romancing Opiates, addiction requires a certain level of determination as users consciously decide to use the drug more and more until it becomes the basis of their life. Addicts have various reasons why they begin and continue to take drugs; there is no evidence of a chemical that turns a user into a robot programmed to act a certain way. As Dalrymple notes, people are not being “hooked” by drugs. Instead, they are doing the hooking.
The supposed horrors of withdrawal are one of the main reasons why opiate addiction is commonly touted as a "use disorder" or "brain disease." The mainstream belief is that opiate withdrawal is tortuous, long-lasting, and deadly. Not only that, but it also requires medical supervision, or so they say. The truth is, opiate withdrawal typically only lasts 2-3 days. It also doesn’t induce fever, seizures, hallucinations, or delirium, and it is not life-threatening. Actual symptoms are described as uncomfortable, and it is noted that patient perception is vastly different from that of observed symptoms. Dalrymple worked as a psychiatrist in prison, where he watched thousands of inmates going through withdrawal. He notes in his book that his patients would label their suffering as "indescribably painful," and they would threaten suicide unless they received their drug of choice. He also says that when he would call their bluff or when they realized that he would not give in, their "symptoms" would suddenly dissipate. Withdrawal not being the fundamental reason for continued drug use is displayed in Stewart & Wise 1992, in which they concluded that their "observations support the view that the proponent primes opioid-seeking behavior or opioid-like actions of opioids and not by the opponent or drug-opposite effects associated with opioid withdrawal." The withdrawal-based addiction rhetoric has been built out of a complete myth; it has only been perpetuated by addicts as it allows them to gain more sympathy from society and furthers their addiction's rationalization. In his book Junkie, William Burroughs, a heroin addict, discusses how men who get prescriptions have "put down a story worn smooth by years of use." He also describes the doctors who wrote the prescriptions as "writing fools." This again reinforces our understanding that addicts are more than willing to be untruthful to get their fix. This concept is not necessarily a heavily challenged one. However, it seems to be ignored in the context of the discussion around withdrawal.
Addiction as a Disease
To tie this back to the fundamental issue of the mainstream stance, addiction is not a disease. The topic of withdrawal was already discussed, which illustrated the existing misconceptions and how they cannot be used to ground the mainstream position. However, there are much more crucial reasons why the mainstream position fails. As understood in pathology, a disease requires some identifiable alteration in phenotypes, which is not found in addiction. One must remember that the classification of addiction as a disease means the actual use of a drug is the disease itself, not the consequences of said drug use. When one considers a disease such as tuberculosis, one would never associate it with addiction because they are so dissimilar. A tuberculosis patient cannot simply stop bacteria from attacking their lungs, as a drug addict can stop using drugs. The label "disease" is a misnomer, which has only lessened the accountability addicts have had to take over time. Although some may say they’ve never claimed addiction to be similar to tuberculosis or other physical diseases, they place them under the same general category, which implies they are identical, at least fundamentally, which they are not.
Beyond the mere definition, many faulty premises have yet to be addressed. A comment made earlier was that addicts have reasons behind their drug use. Two primary motivators behind using drugs are an escape from distress and a chase for excitement. Understandably, people would enjoy a high that numbs their pain and seemingly allows them to escape from the world. A study conducted of veterans returning from the Vietnam War found that only 14% of those who used heroin in Vietnam continued their use when returning home. As psychologist Jeffery Schaler puts it, "Robin’s findings support the theory that drug use is a function of environmental stress, which in this example ceased when the veterans left Vietnam." It can also be understood that individuals may want to see where drugs take them; they want to experience the new heights they’ve been told they will reach. As psychologist William James said in his book, The Varieties of Religious Experience, "Sobriety diminishes, discriminates, and says no; drunkenness expands, unites, and says yes." If one can agree with the fundamental premise that addicts have reasons behind their use, one must realize how it contradicts the disease model. Because addicts have reasons for beginning and continuing to use drugs, it is not that they cannot stop using; instead, they do not want to stop using. Many believe otherwise because addicts will tell them they want to stop but cannot. In reality, they do not want to stop, but they also know the only way to keep these people in their lives is by lying to them. Dalrymple notes that in his time as a prison psychiatrist, it was common for addicts to give in to ultimatums. For example, when a woman told an addict they had to get clean or they wouldn’t be able to see their child, the addict was more likely to comply. This does not mean the addict will always get clean when faced with an ultimatum, not because they cannot, but because they value their drug use more. This is also why relapses occur. By the disease model, an addict who is "cured" should no longer have a compulsion for the drug, but by understanding the rationalization for drug use, we can see why addicts may resort to drugs.
The disease-based approach to addiction has led to the use of pharmacology to stop addiction. The pharmacological process is called substitution therapy, in which addicts are given doses of other synthetic opiates, such as methadone. This substitution therapy can get heroin addicts to quit heroin slowly, but they are still maintaining an opiate addiction, just to a different opiate. Proponents of methadone treatment do not dispute this; the WHO states that the main benefits of the therapy are the reduced risk of H.I.V. transmission and the reduced need to engage in criminal activity. Many argue that addicts will slowly be weaned off the drug until they are no longer addicted; however, it is likely for them to return to heroin after methadone is no longer available. And while certain heroin users are "taken off the market," their dealers will look for other users to market to. On top of this, according to the National Epidemiologic Survey on Alcohol and Related Conditions in 2001-2002, the percentage of alcoholics who remain addicted with and without treatment is close. Slightly fewer remain addicted without treatment. More importantly, without treatment, over 75% of alcoholics were able to end their addiction.
This evidence is not specific to opiates, but it shows that, generally, addicts are more than capable of recovering on their behalf, and pharmacology is not necessary or even beneficial.
Attempts to cure addiction have stemmed from misunderstanding the nature of the issue. The only way to face addiction is to see it as an issue of value judgments. Individuals who center their lives around a substance do not know what life can store for them; they’d instead get high than pursue their own lives. Ultimately, life is a choice, and those who choose opiates are choosing against life. No substitution therapy can end an addiction because it does not address the root of the issue, which is an individual’s conscious recognition of a drug as something they need.
Opiate addiction is most certainly a problem in modern society. Society’s response has primarily been to take the blame off of addicts and put it on the substances they abuse. "The heroine did it" is reminiscent of a small child blaming their stuffed animal for breaking a vase. Addicts have a problem, and it is their fault. This is not meant to diminish the struggles many addicts have gone through that led them to their current state; it acknowledges their active role in the problem. I find it more offensive to treat addicts like animals without control over their state of affairs. The only way society can fight this problem is by holding addicts accountable for their actions and seeing it for what it is: a moral issue. Addicts need to see a greater purpose in their lives, a reason to give up drugs—not sterile needles and medically supervised drug use.