After the actor Phillip Seymour Hoffman was treated for drug problems in his early twenties, he apparently remained drug-free for over 20 years until he developed a problem with prescription drugs, began using heroin, and entered a detox facility in 2013. He died of a heroin overdose in 2014. The National Institute on Drug Abuse reported on its website: “Drugs change the brain — as we at NIDA tirelessly repeat — and even decades of abstinence from drugs may not entirely erase their imprint from the brain of a person in recovery.” Elsewhere, the Institute wrote, “Once addiction is established, the sufferer from this disease cannot will themselves to be healthy and avoid drugs any more than a person with heart disease can will their heart back to perfect functioning, or a person with diabetes can will their body’s insulin response to return to normal.”
The experience of American soldiers in Vietnam, however, suggests that many people can drop a heroin habit. According to Institute reports, about 23 percent of people who use heroin become addicted. In 1971, when researchers interviewed nearly a 1,000 soldiers in the U.S Army leaving Vietnam, 20 percent said that they had become addicted to heroin while on duty. But usage and addiction dropped to around 1 percent once the soldiers had returned to the United States. Coming home was the cure.
What happens today when a large population of people encounter heroin for the first time? It seems to depend upon their social circumstances. In hospitals, people may receive diamorphine, a cleaner form of heroin, for pain relief, sometimes for months. About a quarter should become addicted; however, very few continue to need the drug after they recover. As Johann Hari, author of “Chasing The Scream: The First and Last Days of the War on Drugs,” writes, “The same drug, used for the same length of time, turns street-users into desperate addicts and leaves medical patients unaffected.”
Some argue that this makes the most sense if you see drug use as a choice — rather than a compulsion. We all like pleasure, they say, but will forgo it for the sake of other values such as doing a job well, or caring for children. Clearly, some people experience more powerful urges than others and the same person may be more or less vulnerable depending upon circumstances. The medical patients didn’t seek out the drugs, and are more likely to have family and work that they value. The street addicts who sought out the drugs are more likely to be at loose ends.
Why is the lovely city of Vancouver packed with addicts? Because it is a place that people leave home to move to, says Vancouver psychologist Bruce Alexander, who sees addictive behavior as a response to “dislocation.” Alexander argues that throughout history, people have turned to addiction when they felt a lack of meaningful ties. Addiction isn’t really a medical problem, but a social one. When people feel at loose ends, they focus too much on one activity — gambling, say, or sexual adventures — or a sensation produced by a drug, and gradually become even more disconnected from other areas of life.
Alexander illustrated the point in a controversial study with rats. He showed that isolated rats in bare cages were much more likely to drink water laced with morphine, a form of heroin, than rats in a colony in a pleasant cage with toys and cedar shavings. This comic by Stuart McMillen explains the study further. The “Rat Park” results aren’t widely cited in the scientific literature, and attempts to replicate the results have been mixed.
The number of prescriptions for painkillers has soared and many people seem to have trouble limiting their use, especially if they have anxiety or depression and are under the age of 55. The best way to help addicts may be to provide services that knit them into a community, such as secure housing, jobs, and business loans, Hari argues. When Portugal decriminalized all illegal drugs in 2001, and concentrated on providing services instead, illegal drug use and related crime both fell. Around 25 countries have removed criminal penalties for the personal possession of some or all drugs in the past 10 years or so.
June 10, 2015
Christopher Nystuen, MD, MBA