The Myth of Drug-Induced Addiction (Heroin and cocaine)

The Myth of Drug-Induced Addiction

Bruce K. Alexander

Department of Psychology, Simon Fraser University

Burnaby, B.C., V5A 1S6

Most Canadians believe that certain drugs cause catastrophic addictions in people who use them. This conventional belief is reflected in such familiar phrases as "crack cocaine is instantly addictive" or "heroin is so good, don't even try it once". It is also implied in the professional literature which routinely describes certain drugs as "addictive", "dependency producing", or "habit forming". The belief that drugs can induce addiction has shaped drug policy for more than a century.

However, the only actual evidence for the belief in drug-induced addiction comes 1) from the testimonials of some addicted people who believe that exposure to a drug caused them to "lose control" and 2) from some highly technical research on laboratory animals. These bits of evidence have been embellished in the news media to the point where the belief in drug-induced addiction has acquired the status of an obvious truth that requires no further testing. But the widespread acceptance of this belief is a better demonstration of the power of repetition than of the influence of empirical research, because the great bulk of empirical evidence runs against it. Belief in drug-induced addiction may have deep cultural roots as well, since it is a pharmacological version of the belief in "demon possession" that has entranced western culture for centuries.

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Claim A: All or most people who use heroin or cocaine beyond a certain minimum amount become addicted.

Claim B: No matter what proportion of the users of heroin and cocaine become addicted, their addiction is caused by exposure to the drug.


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Claim A: Review of the Evidence

Heroin

Testing Claim A is logically straightforward; it predicts that when people are sufficiently exposed to drugs they will all become addicted. Of course, some people do become severely addicted after a few exposures to heroin and cocaine. However, controlled observations contradict both the strong and the cautious form of Claim A for heroin, morphine, or any opiate drugs. The large majority of people exposed to these drugs, even many times, do not become addicted.

Although the use of opiates in the U.S. and England during the 19th century was enormously greater than it is now, both through physician-prescribed injections and ubiquitous patent medicines which were used as tonics and for recreational purposes, the incidence of dependence and addiction never reached 1% of the population and was declining at the end of the century before the restrictive laws were passed (Brecher, 1972; Ledain, 1973; Courtwright, 1982)...

...A number of careful studies have described casual or regular non-addicted users of heroin who have not become addicted in spite of years of use (Blackwell, 1982; Zinberg, 1984)...

...The non-addicted users described by Zinberg, including those who used regularly, were no more likely to escalate their use than they were to reduce it. Zinberg studied a group of "controlled users" of opiates 12-24 months after an initial interview. He was able to re-interview 60% of the original group. Of these, 49% were using drugs in the same way as at the first interview, 27% "had reduced use to levels below those required for them to be considered controlled users", and 13% were using more opiates than at the first interview (Zinberg, 1984: 71). There is no doubt that some long-time users of heroin and other opiate drugs do escalate their use to true addiction, but the frequency of this is far less than claim A implies.

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Claim B: Review of the Logic and Evidence

Logic Used to Support Claim B. Whereas Claim A assumes that sufficient exposure to heroin or cocaine will cause addiction in virtually any person, Claim B allows for the possibility that only certain people are at risk. It asserts the existence of a subpopulation of "vulnerable" or "predisposed" people for whom exposure to heroin or cocaine causes addiction.

It is of course true that a small percentage of people who try heroin or cocaine do become addicted to it, but this in itself does not provide any evidence for Claim B, if the normal rules of logic are applied. Claim B asserts a cause—exposure to the drug—that transforms people into addicts against their own will. Claim B comprises a type of pharmacological determinism that is compatible with the overall assumptions of neurochemistry and psychopharmacology. Although a great deal of technically sophisticated research has been devoted to Claim B in these fields, the evidence is very far from a conclusive proof of it (Nadeau, in preparation). Some of this evidence will be examined below.

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In the U.K., heroin was widely used as a medication for cough, diarrhea, chronic pain from the beginning of the 20th century to the present. In the year 1972, for example, British physicians prescribed 29 kilograms of heroin—millions of doses—to medical patients. A major portion of this heroin is sold as an ingredient in cough syrups which are readily available. Careful examination of the British statistics on iatrogenic addiction ten years later revealed "there is a virtual absence of addicts created by this singular medical practice" (Trebach, 1982: p. 83). Heroin remains a staple drug in British medical practice along with morphine and other opiates. Fears of addiction amongst British physicians are minimal (White, Hoskin, Hanks, & Bliss, 1991).

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Rise and Fall of the Official View of Addiction

Official View of Addiction

1.Addiction is fundamentally a problem of drug or alcohol consumption.

2."Addictive drugs" have the power to take control of some or all of the people who use them into addicts, overcoming their normal will power.

3.A major portion of people's vulnerability to addiction comes from inherited genetic predispositions.

4.People who become addicted suffer from a chronic, relapsing brain disease, which is essential incurable.

5.Although people with the disease of addiction cannot be cured, they can be successfully managed through professional treatment or membership in self-help groups.

6.Addiction is an illness of deviant individuals within otherwise well-functioning societies.

Scientific Faith: Commitment to objective science guarantees that the foundational elements of the Official View are correct and certain.

Medical Promise: Medical research will soon find an effective treatment for addiction, which will probably be pharmacological.

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Please note that none of these six foundational elements of the Official View were discovered by high-tech neuroscience. All are old ideas that were part of the moral and medical way perspectives on addiction of the 19th century, particularly those of the American temperance movement.51 Most can be traced much further back in history, for example to the medieval idea of demon possession, to St. Augustine’s ideas of the loss of self-control in people involved in addictive types of sin,51.1 and to Aristotle’s conception of “akratic” persons, who habitually act for pleasure, although their reason tells them that the consequences will be dire.

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Why the Official View is Untenable

Although the current Official View receives unswerving support at the top of the power pyramid in the United States and in many other countries, it is untenable by normal rules of evidence and logic, once all the facts are taken into consideration. There is only space here to briefly review some of the missing evidence, counter-evidence, and logical contradictions that currently bedevil it. These are examined in greater detail in my book, The Globalization of Addiction and in more recent sources.72

1. Addiction is not primarily or essentially a problem of alcohol and drugs. In fact, alcohol and drug addiction is only a corner of the vast, doleful tapestry of human addictions. This fact contradicts the 1st foundational element.
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2. The large majority of people who use "addictive drugs" do not become addicted. This contradicts the strong form of the 2nd foundational element.
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3. There is no substantial evidence that the minority of drug users who do become addicted have lost their will power and gone “out of control”, and strong reasons to think that they have not. This contradicts the weak form of the 2nd foundational element of the Official View.
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4. Genetic research provides no substantial evidence of a genetic predisposition to addiction. This contradicts the 3rd foundational element of the Official View.
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5. Natural recovery is the most likely outcome of addiction. This contradicts part of the 4th foundational element of the Official View.
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6. Although their scientific merits are constantly proclaimed in the mainstream literature, neuroscientific explanations of addiction are not convincing, are constantly changing, and are rarely used in diagnosing addiction or in treating it even by their strong supporters.
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7. Despite countless interventions carried out under the rubric of the Official View, the prevalence of addiction has continued to rise throughout the 20th century and into the 21st. This shows the futility of the 5th foundational element and of the Official View as a whole.
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8. Addiction cannot be understood simply as an affliction of certain individuals with genetic or acquired predispositions to addiction in otherwise well-functioning societies. The most powerful risk factors for addiction are social and cultural rather than genetic or individual. This contradicts the 6th foundational element of the Official View.
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9. The Official View has drawn its principles more from old moralism than from new scientific discoveries. This contradicts the claim that the Official View is based on dispassionate science and seriously undermines part of the 4th foundational element.
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10. Contrary to the child abuse version of the Official View, childhood abuse is not a primary cause of addiction, although it is very important in some individual cases.
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11. Contrary to the claims of its advocates, the Official View is intrinsically moralistic and punitive, most obviously because it provides justification for some of the violent excesses of the "War on Drugs".
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'This is a book about the mythology of narcotics that has grown up in the past century, how and why it has grown, the particular purposes it has served, and not least of all, its relationship to the truth - the truth about the drugs themselves and the truth about the people who have used them...

...There has always been sufficient evidence to make the mythology of narcotics believable, if not verifiable, but in virtually no instance has the evidence been of both the necessary and sufficient kind...

...No deception on so great a scale, enduring for so long a time, can be satisfactorily reduced to a conscious conspiracy, even of such otherwise likely candidates as the American Medical Association and the old Federal Bureau of Narcotics, any more than the widespread consumption of the drugs can be laid to the ingenious plans of a singular public enemy or his mafiosi....

The principal myths are:

1.The consumption of narcotics was widely diffused throughout American society, at least until 1920. It is widely believed that not until the Harrison Act of 1914 and consequent Supreme Court rulings prohibited the unregulated use of the drugs did narcotics become concentrated in the working class...

...Social class is vital to the interpretation of this history, for the truth is, narcotics use in America has always, both before and after the Harrison Act, been predominantly a working-class phenomenon. This has been a specific cause, not a general consequence, of narcotics prohibition when it has been enacted.

2.Present public policy toward narcotics is an inheritance of the irrationality, ignorance, or confusion of the past and can now be superseded and reformed by rational and scientific solutions.

The truth is that, from the beginning there has always been reasoned scientific support for both prohibitionist and nonprohibitionist positions, as well as for policies with punitive and medical solutions...Not ignorance but selectivity has determined narcotics policy and will continue to determine it. Scientists are no more reformist than conservative and no less partisan than the rest.

3.Addiction is the inevitable outcome of prolonged narcotics use, and that addiction itself, a physiological condition chemically induced, deprives the addict of his capacity to control consumption, let alone stop it, which impels him to irrational extremes of behavior, including violent crime.

The truth is, from the very beginning, the consumer's control over the size of dosage and frequency of use has varied over a very wide range. Today, and virtually since 1920 - at any point in the range, at any dose with whatever frequency - use of the drug is called addiction. But intermittent, or occasional, use, regulated by social norms and self-willed without internal compulsion, physiological symptoms, or irrational behavior during withdrawal from the drug has been observed regularly throughout the twentieth century, among Indians as reported to the Royal Commission on Opium, among native Chinese by the Philippine Commission; among Chinese in America, as we see in Table 2.1, it was thought that occasional users outnumbered the regular or addicted ones by more than two to one. The Vietnam War has confirmed officially what has long been known, that heroin addiction, whatever it is, is reversible in a matter of days or weeks without coercive deterrents or medical treatment, with conscious volition instead and without noticeable aftereffects. With the return of the Vietnam addict, researchers have only just begun to find evidence of the occasional controlled use of heroin among conventional users - where it has been all along.

These, then are the foundations of the mythology of narcotics. No account of the drug problem in America today nor policy formula for dealing with it, whether in favor of prohibition or against, in favor of harsher criminal sanctions to deter narcotics use or gentler clinical therapy to overcome it, does not draw on these myths. They are the instruments of public deception, and deception is the mainspring of public policy. To interpret these myths at their source and analyze them in their social context is vital and urgent if the deception is to stop turning its predictable and destructive cycle.'

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Andronas said:

I took oxy after a surgery. Funny thing is that I couldn't wait to stop taking it. I wasn't really in that much pain, and the side effects were extremely annoying to say the least. I couldn't and still can't understand why anyone would want to take that medication for pleasure.

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Hard said:

The only time I was ever given an opiate was fentanyl when I had a kidney stone a few years ago. My first thought was "oooooh. Ooh now I understand why people like opiates and shit. This is niiiiice ". Needless to say I will be avoiding opiates as much as possible if I ever need pain meds.

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Andronas said:

I don't understand why doctors are prescribing such strong pain medications for simple things like that. Fentanyl had the original intended use of palliative care. Oxys were only given to terminal cancer patients. These drugs are way over prescribed for simple crap. That said, it sounds like you enjoyed yourself.

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Hard said:

oh that is a very valid situation. Kidney stones are regarded as more painful that childbirth. They fucking HURT.

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Above all it demonstrates that the concepts, the reactions, the structures of control which are now taken for granted are not fixed and immutable. The division between 'medical' and 'non-medical' use, the categorization of what is 'legitimate' or 'illegitimate' drug use, addiction as a sickness, or even as an exclusive condition, are not timeless concepts, but historically specific and laden with implicit assumptions. Contemporary attitudes towards narcotics are not simply an arbitrary figment of man's unreason for which history proveds some whiggishly relevant insights. They are the product of a social structure and the social tensions of that time. Michael Ignatieff has commented in a recent study of the establishment of the prison in the early nineteenth century that no proper discussion of reform or change can take place as long as the participants still use concepts and perceptions which arise out of a past which they ostensibly deny. Discussions of the historical relevance of opium and its contemporary implications have suffered from much the same deficiency. But through an awareness of the dynamics of the 'problem' of opium use, of the social roots of medical ideas, of the developing links between medicine and the state, can come a questioning of our present-day assumptions and contemporary pretensions to control.

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Speculations on the nature and pattern of opium smoking
John C. Kramer, M.D., Associate Professor in the Department of Psychiatry and the Department of Pharmacology at the University of California, Irvine.

'...most evidence suggests that moderation in the consumption of smoking opium was the rule both in China and elsewhere...This is not an argument favoring moderate use of opium. It is rather an indication that social and perhaps psychophysiological forces work toward limiting the liabilities of drug use within society.'

'...We have assumed, evidently erroneously, that opiates including smoking opium are so seductive and tolerance to it is so profound that moderation is impossible.'

'...While testimony varied widely, it appears likely that most opium smokers were not disabled by their practice. This appears to be the case today, too, among those people in southeast Asia who have continued to smoke opium. There appear to be social and perhaps psychophysiological forces which work toward limiting the liabilities of drug use.'

'...estimates of average consumption are available. Kane (1992:64) reported one survey of the daily consumption of 1000 smokers:

646 smokers used between 1 and 8.5 Gm.
250 smokers used between 11 and 21 Gm.
104 smokers used between 32 and 107 Gm.

Thus, about two thirds of the smokers surveyed used substantially less than 12 Gm. daily and probably few of the heaviest smokers approached the maximum consumption listed.'

'...One survey about 1880 of 1000 opium smokers suggests that the heaviest using 10 percent of the group consumed 50 percent of the opium....'

'...Geddes (1976:221-2) reviewed the Thai government's 1965-6 survey on addiction: The Miao were reported to have a 9.55 percent addiction rate, the Lahu 11.17 percent and the Yao, 15.9 percent. The overall rate for the tribes studied was 3.6 to 6.1 percent among males and 1.2 percent among females. He says that though addiction is recognized as a social problem among the Miao, it is not severe in most Mao communities. In one village he noted "a number" of occasional and moderate smokers, one of whom had retired as headman, and was still vigorous for his age. Four to 5 percent of the village were "seriously" addicted.'

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.. the opiates, barbiturates, and amphetamines incude tolerance, so that increasingly large doses are needed, and barbiturate users, especially, suffer severe withdrawal symptoms when the drug is stopped. But even with these drugs the personality of the user and the situation in which use occurs - set and setting - have to be taken into account. It is a myth that one shot of heroin makes an addict. Addiction occurs much later, often after a long period of "chipping" or a weekend habit. It has been demonstrated that a number of doctors who were taking as many as four shots of morphine a day were able to stop without discomfort when they were on vacation. It appears that even the problem of severe withdrawal symptoms has been exaggerated...

... medical authorities now widely agree that even heroin and the opiates cause no physiological damage. An addict may suffer from chronic constipation and reduced sexual potency, but assured of a drug supply he will live to a ripe old age. It is true that addicts risk collapsed or abscessed veins, and even death, but these result from unregulated doses and unsterile equipment. The addict who is a "walking death" has been brought to that condition by the present state of the law...'

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...Laudanum and the other preparations were to be found not just in high-street pharmacies but on show in back-street shops crowded with food, clothing, materials and other drugs.... those selling drugs in Preston included a basket maker, shoe maker, smallware dealer, factory operative, tailor, rubbing stone maker and baker, and a rent collector, who, as he pointedly noted, was `connected with a burying club'... Many of the people engaged in selling drugs and chemicals would sell opium with complete freedom, and their number was estimated in the 1850s to be between 16,000 and 26,000, although even this number probably
did not include small `general' stores dealing in all manner of goods as well as opiates.

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In essence, the nineteenth century evolved the treatment of addiction as a method of dealing with the individual who in some way offended society's idea of what was decent and orderly. It was not as if anyone could put forward evidence that the condition was particularly life-threatening or damaging to the health of the individual himself, nor was there much evidence that the social demand for treatment was generated in any large measure by the belief that the addict caused great trouble to family and friends, or to other members of society. In the late nineteenth century the leading image of the addict was of the middle-class patient (often a woman) indulging in a self-regarding act which was mildly damaging to health and perhaps a little bit of a nuisance. The historical evidence given in Chapter 12 suggests that this image of the class and sex characteristics of the addict was badly out of focus, while even at the height of concern about morphine addiction, remarkably few addicts were actually being admitted to hospitals or nursing homes. The extent of learned debates on therapeutic methods which were conducted in the medical journals was out of balance with the actual treatment demands...

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n so far as treatment had a manifest clinical purpose it was therefore to save the individual from his own behaviour, although the latent social purpose of correcting unacceptable deviance must have been of equal or greater importance. If opiates had produced compulsive drug-seeking without physical withdrawal symptoms, the medical profession might not have had such a ready opening for promulgation of disease theories, while if alcoholism treatment had not provided a contemporary parallel and a base for medicalization, treatment of opiate addiction might not have become such a socially accepted idea. Without alcoholism, there would certainly have been no Society for the Study of Inebriety.

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The hint is though that incapacity from use of opium was not seen as a problem of such frequency and severity as to be a leading cause for social anxiety. The prime image of the opium user was dissimilar to that of the wastrel and disruptive drunkard. Opium users were not lying about in the streets, or filling the workhouses, or beating their wives. It seems fair to conclude that at the saturation level which the plateau represented, opium was not a vastly malign or problematic drug in terms of its impact on social functioning. But the conclusion must at the same time also be accepted that opium when freely available was, indeed, a drug which could at the population level give rise to certain definite health risks. The impact on infant mortality cannot be quantified, and as has already been argued in Chapter 9 opium would often have interacted with disease and malnutrition to produce an unhappy result, when no single factor could be held solely to blame..

So much then for a tentative set of conclusions. In a particular historical period and in the social context of a particular country, and with opium as a drug available only in oral form, we can begin to see the outline nature of the equilibrium reached between the society and the drug - a plateau at a high general level of usage and with regional variation, no persuasive evidence of large-scale social incapacity, but with associated mortality levels which, though not too disastrous when matched against certain modem drug experiences, were nonetheless cause for concern..

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The second conclusion relates to the actual level of the plateau. Three pounds avoirdupois amount approximately to 1.36 kg. The average consumption per person at alb. per 1,000 population would therefore have been 1,360 mg. of opium annually. A recommended single-dose level for opium is today 6o mg. (containing about 6 mg. of morphine). This would imply that between 1830 and 1860 the average user - man, woman and child - was consuming in terms of today's judgements roughly 127 therapeutic doses of opium each year. It is fair to conclude therefore that the plateau represented a very high level of population experience with this drug.
There has recently, as regards population alcohol consumption, been much interest among epidemiologists in how use levels are distributed within the population, with the prediction that the distribution curve will usually be skewed and with a long low upper tail, rather than being represented by the familiar inverted U of the normal distribution curve.32 The data are not available to reconstruct how opium consumption would have been distributed, but obviously the average alone does not tell us all we want to know - many people would have been consuming less than the average, and equally certainly a proportion would here have been consuming much more, and some people very much more.

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..the contention that heroin irreversibly enslaves the user has not been confirmed by any large-scale study of drug use. In Vietnam, for example, the U.S. Army found by testing urine specimens that more than 250,000 American soldiers had used heroin, and that of these, some 80,000 could be classified as addicts (in that they used it every day for long periods and suffered withdrawal symptoms). Yet, more than 90 percent of these users and addicts were able voluntarily to withdraw from the use of heroin without any medical assistance or without any permanent aftereffects. Follow-up studies showed that less than 1 percent of the total number - and less than 6 percent of the addicts - used heroin again in a two-year period after they were discharged from the Army. Doctors and scientists studying this massive data were compelled to conclude that heroin use did not necessarily lead to addiction, and that addiction was not necessarily irreversible...

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...The authors sum up the question of opium's impact on social functioning by saying that there are `two extremes with many in-between'. As ever, there is need to underline the point that different contexts will mean different consequences. ...

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The work incentives of opiate users, as reported by hostile parties, have changed radically with the politics of their times. According to a contemporary authority, an addict "characteristically becomes lethargic, slovenly, undependable, and devoid of ambition." By contrast, at the turn of the century opium became illegal in the United States, in large part due to the efforts of Samuel Gompers. He claimed that its use by Chinese immigrants so increased their productivity that whites were at a disadvantage in the labor market. Additionally, it increased their risk-taking proclivity, as virtually all Chinese were alleged to be heavy gamblers. In reality, the period between the Civil War and World War I was the period of America's greatest sustained proportional economic growth. It was characterized by low unemployment rates, legal opium, and a large population of habitual users. The same was true of Victorian England.

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...We believe that this Dutch example demonstrates that less repression of heroin use most likely results in less risky modes of heroin use and that fiercer repression leads to riskier methods. At the same time less repression has not resulted in higher numbers of consumers. On the contrary, heroin consumption has mostly become an issue in geriatric care in the Dutch context.

Now, although we by no means support moral judgements over heroin self-administration by injection or injecting as such, for example calling it a form of auto- mutilation, we do believe chasing heroin to be a generally safer method of heroin use than injecting. We believe the Dutch epidemiological data[24] as well as the general condition of the average Dutch heroin user, support this argument but are obviously open to debate.

We may also conclude from this example that peer, fashion and culture driven processes are far stronger than any policy, legislation or prevention program. There is nothing any policy or prevention program has done initially to drive heroin users from the needle to chasing the dragon. We had no clue and a lot of Dutch luck. Which by no means implies we can do nothing. On the contrary, we believe that, proper, non-stigmatized information and low threshold care services combined with decriminalization of use are vital for a healthier drug policy reducing substance use related risks.

Promoting chasing as a harm reduction campaign in our view is potentially a useful strategy but strongly depends on the availability of chaseable heroin, relatively low prices and low repression. Furthermore changing drug administration rituals by means of drug service programs is a substantial challenge not to be underestimated.[25]

A design for a functional regulation of heroin is not in the scope of this article but we may conclude that also in the relation of heroin and criminal law, it is difficult to distinguish between remedy and disease. In our view, administrative/medicinal legislation/regulation is by nature better suited for public health issues such as substance use and the Dutch policy is but an example of damage control under self inflicted hazardous conditions.

Finally as heroin is now generally seen as unfashionable, uncool and a even a loser’s drug in Dutch youth culture and we almost haven’t seen any new, young heroin users for many years now, what does this mean for the future? Very little or nothing. If heroin would suddenly become hip, fashionable and sexy again tomorrow, we believe there is not much that any policy can do about it.

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Occasional and controlled heroin use: Not a problem?

Hamish Warburton, Paul J. Turnbull and Mike Houg

JRF Drugs and alcohol research programme
This series of publications examines the social dimensions of drug and alcohol use. It focuses on sensitive issues which are difficult for government-funded research to address, and on the implications for policy and practice

...The report deconstructs some of the myths surrounding heroin use and heroin dependence. It is relevant to policy-makers, those working in the drug treatment field, academics and drug researchers.

...Some people will argue that it is irresponsible to draw attention to groups of heroin users who manage to control their heroin use. The argument is that downplaying the risks will inevitably result in more widespread use and greater suffering. We would argue that in drugs prevention honesty is always the best policy. Those who are the target of drugs education are highly sensitive to exaggerated messages, and will discount these. We also think that sustaining a popular belief in the inherent uncontrollability of heroin dependence could itself have perverse consequences. Drug dependence is to some extent socially constructed - in the sense that public beliefs about drugs such as heroin determine how people actually experience them. It is possible - but not provable - that the way that public stereotypes of heroin use are deployed may help create the highly destructive role of 'junkie' that many heroin users occupy. In a world in which heroin is increasingly available, policy should do all that it can to undermine this stereotype.

...Heroin careers can be fluid, varied and hard to define. Patterns of heroin use described to us are at odds with popular beliefs about heroin use...These findings show that some people can use heroin for prolonged periods of time without becoming dependent. They show that some people can use heroin dependently, but in a stable and controlled way that causes few of the problems typically associated with the drug. Some interviewees had also switched from problematic patterns of use to stable, controlled or non-dependent patterns of heroin use. Contrary to popular assumptions about heroin use, the findings suggest that heroin use does not lead inexorably to dependence and that chaotic use is not an inevitable outcome of dependence. Importantly, it also shows that some people can bring their heroin use back under control after periods of uncontrolled or highly problematic use. Interviewees were careful about where they used heroin and whom they used with. This allowed them to use heroin in a safe, comfortable and relaxing environment.

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Far from the physical attributes of the drugs in question being a side-issue or something quite separate from the main business, an understanding of the extraordinary subtlety and potency of the actions of these substances on the human mind and body helps not only to make intelligible the social processes which were the game evolved around them, but re-inforces one's sense also of the astonishing subtlety and potency of accidental and informal, or formal and purposive social processes, which allow society at different phases in history to live on terms with these strange mindacting chemicals.

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Drug users may be grouped into three categories. The first consists of dependency-prone persons who, because of psychological and personality problems, have become heavily immersed in drug use and drug subcultures. The heroin and barbiturate addict, the speed freak, and some chronic marijuana users are in this group...

The second group, although continually identified by the public with the first, differs markedly in number, motivation, and drug choice...This group uses marijuana, and many of its members have tried LSD, amphetamines, and, to a lesser extent, heroin and cocaine. Though officially labeled drug abusers, they are strictly speaking drug experimenters...

The third group of drug users consists of people who at first seem to blend with the drug-experimenting group. They are disturbed youngsters who express their difficulties in drug use and find the support they need in the drug subculture. They can be pushed into the first, dependency-prone group by exaggerated public reaction to their dabbling in drugs or may be helped back into ordinary life by rational support. This group is significant not because of its size - it is very small - but because it highlights the social factors that may push it over the boundary line.

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Here we discuss the common attitudes toward illegal drug use, showing how they are based to a large extent on inadequate information, poor arguments, and extraordinary examples...We go on to explain the social and psychological functions of these attitudes and show that they maintain themselves in the face of a mass of contradictory evidence.

The public response to nonmedical drug use is overwhelmingly one of moral disgust, condemnation, and fear at the threat of social and personal chaos that drug use seems to portend... Public attitudes both reflect and inspire the treatment of drug use by the mass media... In fact, the drug problem is exaggerated by the newspapers and we suggest that it is worsened by this overreaction.

...We would like to describe a typical example of this group. We shall call him "Mr. Fry." He is not a closed-minded bigot... He describes himself as a political liberal, and he keeps himself well informed...He is in favor of civil rights... Mr Fry describes himself as "damned worried." Not given to apocalyptic visions, he nevertheless dreads and conceives possible the breakdown of his own world... The flurry of conflicting reports on drug use confuse him, and he is in some doubt as to what attitudes he should adopt to help maintain the social institutions he values...He is also guiltily aware of a parallel between smoking and marijuana use; however, he pushes back incipient doubts and accepts the position: drugs are a threat, and nonmedical users are bad; they must be controlled and shown the error of their ways, for his sake and theirs...

We also interviewed city employees, steelworkers, secretaries, housewives, carpenters, machinists, insurance salesmen, clerks, and police officers, and found not just unanimity of opinion that nonmedical drug use was wrong, but also a hyperemotional conviction that somehow someone should do something about it, i.e., stamp it out. Each fresh exposé in the mass media was seized on as an illustration of the extent of the evil, and served to still any remaining doubts. These interviewees saw the nonmedical drug user as one important representative of the uncontrolled social forces that were destroying all that they had worked toward.'

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Drugs seem to hold out the promise of undreamed-of pleasure, and yet at the same time are considered wrong. Now especially, when drug use has increased so vastly and is constantly in the news, many people find it more than ever necessary to take a strong stand against users. Mr. Fry always disliked drug use, but until recently the users were strange and undesirable characters somewhere "out there": now they are constantly thrust under his nose, and he is forced to reaffirm his decision to forgo that sort of pleasure. To strengthen his rejection he must not only decide objectively that he prefers other forms of relaxation; he needs to feel disgust at drug-taking because he fears being overwhelmed by ancient passive longings never completely laid to rest. And, of course, being a rational man, he marshals whatever reasons he can to justify his distaste. In this crisis situation the psychic mechanisms which select what he perceives and inhibit conflicting material, striving to remove offending stimuli, automatically take over and interfere with reason and objectivity.


...The new drug users are not divided socially from the public that abhors them. The public, therefore, must maintain a wide psychological distance, and how better than by disgust, self-rightousness and moral revulsion?

...In this chapter we have discussed some characteristic attitudes held by members of the public, and some of the arguments they offer in support of their attitudes. And we have indicated the underlying concerns that make it important for the public to maintain these attitudes even after they have been shown to be irrational. It has been our intention to show that this repetitious and shifting dialogue has itself become central to the drug "problem" in this country, rather than to refute the arguments point by point. Drug use lends itself to confusion because drug response is so susceptible to personality and atmosphere. Hence, a process by which many people invest emotion into attitudes and discussion, and are not open to changes in opinion, must be faced as an integral part of the issue...

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The real drug problem arises out of the almost hysterical public reaction to common news items...Drug use is a complex matter, and when faced with complex problems society frequently opts for a simple, if possibly familiar, solution, rather than dealing with doubts and ambiguities. Recent reactions to the nonmedical use of psychoactive drugs illustrate this tendency. The label "drug user" or "drug sympathizer" evokes for most people an entire system of behavior and mores of which they disapprove. Thus they conveniently package a number of contradictory and confusing facts and include types of people and kinds of behavior that they would otherwise have to tackle individually and laboriously. So much ambiguity is disposed of in this neat package that it is no surprise to find these same members of the public reacting with powerful and irrational condemnation...

...The unquestioning alacrity with which people have continued to accept the old categories...is a dramatic example of the difficulty most people have in tolerating ambiguity - the discomfort of mixed feelings on an emotive subject. This tendency has led individuals, groups, and institutions to attempt facile blanket solutions to the problem of drug use and abuse, and these solutions may in fact have exacerbated the situation...

...Finally, there is the ambiguity of the drugs themselves. On the one hand, the general public believes that drugs are destructive; on the other, drug users believe that they may be the source of great benefits. Like beauty, the qualities of drugs are usually in the eye of the beholder. The psychic changes that drugs produce vary widely, as does the interpretation of those changes, so that each side can adduce evidence for its point of view.

In our examination of the drug controversy and the public response to it, we intend no apologia for drug use, though we do deflate some of the traditional notions about the harmfulness of drugs and suggest some new ways of viewing their use. Our aim is to unravel the more emotional responses to nonmedical drug use, see why they have heated up the drug issue, and find a way to put drugs back into a social framework where their harm can be minimized and their benefits enjoyed.'

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THE MARKET FOR HEROIN BEFORE AND AFTER LEGALIZATION

Robert J. Michaels, Ph.D., Associate Professor of Economics

INTRODUCTION

If Mark Twain were alive today, he could probably be found studying either drug abuse or economics. Anyone wishing to predict the consequences of legalized opiates must first invest in some facts. The historical, biological, and statistical sources, however, yield little in the way of verifiable facts or properly constructed data. The conclusions typically drawn after a reading of this literature vary about as widely as the alleged facts and are frequently derived without the aid of elementary logic. In this paper I deal with the inferences about legalization that can reasonably be made on the basis of what is known about the market today. My mode of reasoning will be that of an economist.'

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Time patterns of population use and adjustment patterns of individual use give little support to a simple notion of addiction. There is general agreement that heroin use in the United States is predominantly a habit of the young, and that users "mature out" of their habits, in most cases without medical aid.45 Use of opiates in nineteenth century American was a middle-class phenomenon, with the majority of users being housewives who had acquired a tolerance for patent remedies that contained them. There is little record of withdrawal problems among them (and no record of criminal problems) following the passage of the Harrison Act, although their number may have been in the millions.46 Estimates of the percentage of American servicemen who used opiates while in Vietnam center around 30 to 40 percent's' Yet one study found that those defined by its author as addicted on or after their return constituted less than 3 percent of those sampled." Equally interestingly, they apparently functioned well while on active duty. As will be seen below, such evidence makes an estimation of postlegalization addiction rates either impossible or meaningless.

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The work incentives of opiate users, as reported by hostile parties, have changed radically with the politics of their times. According to a contemporary authority, an addict "characteristically becomes lethargic, slovenly, undependable, and devoid of ambition."34 By contrast, at the turn of the century opium became illegal in the United States, in large part due to the efforts of Samuel Gompers. He claimed that its use by Chinese immigrants so increased their productivity that whites were at a disadvantage in the labor market. Additionally, it increased their risk-taking proclivity, as virtually all Chinese were alleged to be heavy gamblers.'" In reality, the period between the Civil War and World War I was the period of America's greatest sustained proportional economic growth. It was characterized by low unemployment rates, legal opium, and a large population of habitual users. The same was true of Victorian England.

People's choices of work and leisure, or of occupations or employers, are fundamentally dependent on the alternatives available. An individual who works legally gives up the possibility of some illegally obtained income. One who can support a $30/day habit and $10/day in living expenses'36 from illegal activity is earning an income of $14,600 per year, which puts him considerably above any reasonably defined poverty level. An obsession with the concept of addiction leads us to forget that in all but the shortest of runs the money is voluntarily spent on this bundle of goods. Relative to legitimate alternatives, the street may offer a superior financial incentive and work environment, if this is one's preferred consumption bundle. Given the uncertainty associated with the supply and quality of drugs, a more public life-style is probably a method of reducing one's search costs for drugs and becoming more cognizant of earning opportunities.

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Even today, those with appropriate skills can support their habits by working, although regular employment probably increases the time-cost of a heroin purchase. The relatively high frequency of use in the health professions'4° may reflect their members' lower full cost of obtaining drugs. For users in less renumerative positions, crime supplements work income. Additionally, size of habit appears to be positively correlated with work income.'4' Although the above gives some reason to be hopeful, we cannot even qualitatively predict the effects of legalization on work time and effort. Cheapening heroin implies that an individual will be more disposed to consume it, an activity that requires both heroin and time. Lowering the value of heroin search time relative to the value of work time, taken by itself, will lead to an increase in work. Which of the two effects will dominate cannot be determined a priori. The actual consumption pattern of Chinese opium smokers was typically one of moderate use after the day's work was finished.'42 Their world, however, was characterized by minimal uncertainty about quality or availability.

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...If the specious figures on oil reserves announced at the start of the "energy crisis" were correct, America would have by now been immobilized and frozen. The "crisis," of course, was no more than an attempt to politicize and bureaucratize the allocation of a good for which market conditions had changed. As an issue loses political saliency, the crisis fades away. We thus move from one statistical crisis to another—from vanishing farmland to environmental cancer to heroin epidemics to illegal aliens. Some of these matters may actually be problems on which accurate statistics could shed considerable light. The policy-making process, however, is unlikely to produce either good statistics or good policy.

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There is some evidence that delinquency often precedes heroin use, frequently by several years.'24 What drug use actually does, accord-ing to Chein et al.,'26 is to alter the objectives of one who is already predisposed to and possibly involved in criminal behavior. The mix of crimes committed will change to favor those which facilitate the acquisition of heroin. Finestone'26 found higher rates of larceny and robbery for addict offenders, and higher rates of sex crimes, auto theft, and assault for nonaddict offenders, consistent with this the-ory. According to Coate and Goldman's survey-based simultaneous equation mode1,127 criminal earnings, if one can obtain them, pre-cede drug use.

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The National Commission on Marihuana and Drug Abuse suggested that drug use be divided into five classes. Experimental use means trying a drug once or twice to find out what it is like. Recreational-social use is the pattern of the ordinary social drinker or marihuana user, and even that of many heroin users who are not addicted. Situational use is use for special (nonmedical) purposes — stimulants for work or study, tranquilizers for public speaking, psychedelic drugs for religious or personal insight. Most people are quite capable of using most drugs only in these ways, which produce relatively little harm. The last two categories, intensive use and compulsive use, cause most of the trouble. But here, unusual personalities and social circumstances often matter more than the drug. The same compulsive drug user will shift from LSD to amphetamines, from amphetamines or cocaine to alcohol or heroin, from alcohol to heroin, from heroin to barbiturates or back to alcohol. The ways of redefining drug problems parallel the ways of accounting for addiction and dependence, which are alternative descriptions of intensive and compulsive use. Instead of concentrating on the drug, we can think about the person, the situation, the society, or even the human condition. A direct assault on drug problems, in this view, is aimed at the wrong target. Even if it succeeded, other symptoms would replace drug abuse. That is why modern societies look for indirect solutions (even as they police drug use itself more closely).

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Legend of the Living Dead

Captain Hobson was at the turn of the century a hero in search of a grand cause... Captain Hobson's crusade against alcohol...attempted to mobilize public opinion into an apocalyptic battle between the forces of good and evil, the outcome of which would determine the fate of Western civilization...When alcohol reached the "top of the brain" of "negroes," according to Hobson's theory, "they degenerate ... to the level of the cannibal." Similarly, "peacable redmen" became "the savage" when they drank....Proposing in Congress tha alcohol be totally prohibited, he forged a dramatic nexus between alcohol and crime. Innocent men were converted to violent criminals in almost all cases, he argued, because alcohol had degenerated the "gray matter" in their brains. Not only did alcohol destroy self-control in 95 percent of criminal cases, but it created an economic need for those afflicted with the disease of alcoholism to steal in order to pay for their chronic habit... By 1912 Captain Hobson had become the highest-paid speaker on the lecture circuit in America. He helped organize (with financial support from John D. Rockefeller, Jr.) the Women's Christian Temperance Union (WCTU), which helped galvanize national support for Prohibition. Congress ordered his speech to the House of Representatives in 1912, entitled "The Great Destroyer", to be republished in 50 million copies by the Government Printing Office...

...The dramatic mythology that Hobson had popularized, if not created, which put alcohol at the root of society's evils, was undermined ironically by the passage of National Prohibition legislation in 1921. Neither crime rate nor death rate was diminished by the banning of alcohol; indeed, each rose during Prohibition. Human nature did not markedly change for the better. Hobson no longer had a demon on which to unleash his virtually unlimited moral indignation. In the 1920s, thus, Captain Hobson was again in quest of a great cause... For almost a year Captain Hobson retired from public life - or at least from public speaking engagements - and sought an issue around which another moral campaign could be organized. He soon found a new "greatest evil," which not only could be held accountable for all crime and vice but had the added advantage of being a foreign import, thus coinciding with the xenophobia of the times. This new devil was a drug called heroin.

...According to the "scientific" explanation that Hobson popularized, the degeneracy of the "upper cerebral regions" turned the addict into a "beast" or "monster", spreading his disease like a medieval vampire. Hobson explained thus: "The addict has an insane desire to make addicts of others." As evidence of this vampire phenomenon of the "living dead", Hobson gave examples of how a mother-addict had injected her eight-year-old son with heroin; how teenage addicts infected other teenagers by secreting heroin in ice-cream cones; and how lovers seduced their partners with heroin. He suggested the calculus (which President Nixon adopted a half-century later) that one addict will recruit seven others in his lifetime. He also fully played up the xenophobic appeal of heroin's coming from foreign lands, stating, "Like the invasions and plagues of history, the scourge of narcotic drug addiction came out of Asia..." Also, like the irreversible bite of the mythical vampire, Hobson asserted, "So hopeless is the victim, and so pitiless the master," that the heroin addicts are termed "the living dead."

After having established the dreaded imagery of the vampire-addict, Hobson went on to organize his crusade. In a short time, he had mobilized such groups as the Women's Christian Temperance Union, the Moose, the Kiwanis, the Knights of Columbus, the Masonic orders, and various other lodges in his battle against heroin (The cause of temperance having been mitigated by the Prohibition law, the heroin crusade provided a new sense of purpose for many of these organizations.) He created the World Narcotic Association and the Narcotic Defense Foundation, whose goal was to raise $10 million in ten years for "the defense of society from the peril and menace of narcotic addiction". He also published his own journal of "narcotic education". By 1927 Hobson claimed to have recruited "21,000 majob clubs and organization" into his various "narcotic education programs."...

...the contention that heroin irreversibly enslaves the user has not been confirmed by any large-scale study of drug use. In Vietnam, for example, the U.S. Army found by testing urine specimens that more than 250,000 American soldiers had used heroin, and that of these, some 80,000 could be classified as addicts (in that they used it every day for long periods and suffered withdrawal symptoms). Yet, more than 90 percent of these users and addicts were able voluntarily to withdraw from the use of heroin without any medical assistance or without any permanent aftereffects. Follow-up studies showed that less than 1 percent of the total number - and less than 6 percent of the addicts - used heroin again in a two-year period after they were discharged from the Army. Doctors and scientists studying this massive data were compelled to conclude that heroin use did not necessarily lead to addiction, and that addiction was not necessarily irreversible...

...Hobson's definition of narcotics addiction as a threat to the very existence of civilization subsequently became the official justification for the federal government's mounting a massive law-enforcement program against drug smugglers, dealers and even addicts...

...For a host of reasons, then, Hobson's vampirelike visions of addiction were kept alive by politicians, police officials, doctors, and enterprising bureaucrats. The drama of the "living dead" subverting our civilization was reported with great enthusiasm by the press rather than questioned. The themes were not woven together into a coherent pattern until the early 1960s, when the governor of New York, Nelson Rockefeller, ingeniously transformed Hobson's vampire-addict notion into a political design.'

The Manipulation of the Media

... the artful use of the media to propagate a simple but terrifying set of stereotypes about drug addiction: the addict-dealer would be depicted as a modern-day version of the medieval vampire, ineluctably driven to commit crimes and infect others by his insatiable and incurable need for heroin. The victims would be shown as innocent youth, totally vulnerable to the vampire-addict... The most obvious medium available for projecting these stereotypes on the popular imagination was television...

...The plan to mobilize the media developed in March, 1970. President Nixon had instructed his chief domestic advisor, John Ehrlichman, to "further utilize television as a tool in the fight against drug abuse."...

...Magruder...explained, "The individuals being invited think in dramatic terms. We have therefore tailored the program to appeal to their dramatic instincts. Yout personal presentation will be virtually the only 'straight' speech. The remainder of the program will consist of audio-visual and unusual presentations."...

John Ehrlichman got a slightly different explanation for the purpose of this "White House Theater." Jeffrey Donfeld stated in an April 3 memorandum, "The government has a difficult time changing the attitudes of people.... Television, however, is a subliminal stimulus."...

'The Crime Nexus

...In computing the costs of addiction to the rest of society, the administration's sharp departure from reality proceeded from the myth of the vampire-addict that had been developed almost a half century before by Captain Hobson. So long as it was assumed that all heroin users were ultimately transformed into fiends who were driven by their insatiable appetite for the drug to commit any crime or take any risk to obtain enough money to satisfy their habit, it followed that the total cost of their crimes could be computed simply by multiplying the cost of their drug consumption by the number of addicts. Although such a model of addict behavior became an integral part of television dramas depicting themes of drugs and crime (partly owing to the efforts of the Nixon administration), such dramatic stereotypes grossly oversimplified the behavior of most heroin users...

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