Addiction
is the word which is popularly in use to describe compulsive drug
taking. In scientific writing the word (and the underlying concept) has
to an extent been supplanted by the phrase drug dependence. Here though
the complexities of scientific nomenclature need not be gone into, and
it seems better to retain the older and slightly less cumbersome term.
The
opiates are drugs of addiction. There are variations in individual
susceptibility, but anyone who takes an opiate for a long enough period
and in sufficient dose will become addicted. What is the nature of this
condition which trails with it so many fears and stereotypes, and which
seems often to be thought of almost as possession rather than as
intelligible happening? This question is very relevant to an
understanding of the problems which society encountered over that long
period when opium was so readily available that it could provide the
conditions where addiction must have been common and endemic.
Opiates
are drugs to which the individual’s central nervous system will, on
repeated exposure, develop a high degree of tolerance – a much bigger
dose of the drug is then required to produce the same and desired
effect in the tolerant than in the naive subject. There is therefore in
the drug’s intrinsic properties a ready and in-built invitation to
escalate the dose. If the drug was taken for, say, a chronic neuralgia,
its effectiveness would at first be very evident and much valued, but
if it was to go on being of use to the person purchasing his laudanum
from the corner grocer’s shop, he would soon find that to produce the
original effects he was having to take the laudanum in larger
quantities. But every addict sooner or later finds his plateau dose,
and there is considerable variation in levels and patterns of use. Many
reach a fairly moderate dose level which suits them, and stick to it.
This is what nineteenth-century writers on addiction were referring to
when they cited cases of `moderate addicts‘ who showed no tendency to
continuing escalation.
Tolerance is then intimately linked to the
onset of withdrawal symptom experience and physical dependence. The
tolerant individual begins to find that some hours after his last dose
he feels restless, that he develops goose pimples and begins to yawn,
that his eyes are watering and his nose running, and that he is
generally uncomfortable. With increasing dependence more severe
withdrawal symptoms will be experienced, and if this person is then
deprived of his drug for twelve or more hours he risks an agonizing
withdrawal experience characterized particularly by great restlessness
and anxiety, severe abdominal cramps and profuse diarrhoea. Appalling
though the experience may then be, the condition is not
life-threatening unless there is some severe intercurrent illness or
infection. The patient recovers. Lesser degrees of addiction carry
risks only of lesser withdrawal symptoms, and like the drug effect
itself the withdrawal experience is much influenced by set and
expectation.
Addiction to opiates may best be pictured as both a
psychological- and biological condition, characterized by a desire to
continue taking the drug in high dosage, a salience of this
drug-seeking drive over other life considerations and a tendency to
relapse. It seems likely that repeated experience of the powerful
euphoriant effect of the drug contributes to the initiation of
addiction : in simple terms a habit is built up because it is intensely
pleasurable. But what also very importantly contributes to the
enhancement of this `learnt drive‘ is the repeated experience of
withdrawal and the concomitant experience of repeated and wonderfully
reassuring relief which is afforded by the next drug dose. The addict
is conditioned to crave that next dose. Such a view of addiction can,
however, be criticized for placing too great an emphasis on the drug
itself and its user’s experience in isolation from environmental
determinants which initiate and sustain drug use, and which give the
drug its symbolic meaning and the user his social role. The
pharmacological qualities cited here and the psychological experience
of the users are important, but it is difficult to see how, on their
own, they can provide a coherent idea of a condition called addiction
or dependence. Here can be seen very plainly what is meant by the need
to integrate different levels of explanation.
So much for the nature
of addiction. What about its significance, and in particular its
significance for nineteenth-century society? The threat which is posed
by addiction to oral preparations of opiates is much less than the
dangers of addiction to the drug in injected form, and it was of course
the latter type of addiction which characterized the British `heroin
epidemic‘ of the 1960s, and characterizes the large-scale contemporary
drug problem in the U.S.A. The special dangers of injected drug use
include the ease of accidental overdose and the risks of accidental
infection caused by a dirty needle. Today’s picture of injected heroin
use must therefore not be allowed too easily to colour any assumptions
as to what would have been the familiar picture, in the nineteenth
century, of addiction to opium or opium preparations taken by mouth.
There would have been risks of overdose, sometimes as a result of the
unreliable strength of many of the available commercial preparations,
but the risks would be nothing like so great as those encountered by
the twentieth-century heroin addict who injects the drug directly into
his veins. What proportion of overdose cases in the nineteenth century
were occurring among addicts and what proportion among casual users is
unknown, but certainly the contemporary concern with self-poisoning did
not simply equate overdosing with addiction. The problem of accidental
infection is then irrelevant to oral use. Another possible medical
implication of addiction which received nineteenth-century attention
was the general question of whether habitual opium use shortened life,
but here too the problem was conceived in terms of the fact of high
usage rather than the underlying fact of the addiction. On the
longevity issue the present judgement would probably be that opiates
themselves produce no directly damaging or life-shortening effect on
the body and that addiction itself is not a physically damaging
condition.
The problems which the nineteenth century encountered
with addiction were therefore presumably more in the social than the
medical sphere. Opium may have been cheap, but a heavily tolerant
individual might well build up to such a dose as to involve a weekly
cash outlay to embarrass the family’s finances in a working-class
household where every penny counted. The drive towards continued drug
use would mean that the family’s welfare easily became neglected. There
might also be other social complications -neglect in child care, for
instance, or impairment of working capacity. Such possible social
complications do not seem much to have caught the nineteenth-century
eye, although there were occasional references to matters of this sort.
Indeed, the fact that addiction itself was not sharply conceptualized
for the larger part of the century, in many of the relevant debates and
social movements, meant that the addict did not suffer the sort of
secondary social damage which comes from labelling and stigma, and
which has been so much part of the present-day reaction of the Western
world to drug-taking and the drug-taker.
Addiction to drugs other
than opiates has features specific to each drug group. Cocaine can
produce an intensely compulsive drive towards continued drug use,
despite the absence of withdrawal symptoms. Depressant substances such
as chloral can also induce addiction, with a well-marked withdrawal
picture. Psychomimetic substances in general do not give rise to
addiction, and if cannabis has any addictive potential this was
certainly not an issue with the sort of doses and preparations which
the nineteenth century encountered.
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.
Reference
A
very useful general source book on pharmacology is L. S. Goodman and A.
Gilman, Pharmacological Basis of Therapeutics, 5th edn (New York,
Macmillan, 1975).