Some Basic Problems in Drug Addiction and Suggestions for Research*

II. THE DEFINITION OF DRUG ADDICTION

An authoritative definition of drug addiction is that propounded by the World Health Organization: "Drug addiction is a state of periodic and chronic intoxication detrimental to the individual and to society, produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (1) An overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (2) A tendency to increase the dose; (3) A psychic (psychological) and sometimes a physical dependence on the effects of the drug." This definition of drug addiction includes many drugs which are not within the scope of our study, such as hypnotic and sedative drugs (barbiturates, etc.) alcohol, amphetamine, mescaline (peyote).9 We are interested primarily in the abuse of the opiate drugs and the synthetic-like opiates, such as heroin, morphine, opium, laudanum dilaudid, codeine, demerol, etc.

We are not engaged in anthropological investigation. Accordingly, we shall not study the abuse of mescaline or peyote, which is of little practical importance in this country and is used primarily by Indians in the Southwest for religious rites. We shall, however, pay some attention to cocaine and marihuana, which are included within the above definition, even though the effects of cocaine or marihuana differ from the opiate drugs. Cocaine is sometimes used alone. It is, however, frequently used as a concomitant of opiate addiction to obtain a special kind of thrill (speedball). The use of marihuana frequently precedes experimentation with the more powerful drugs, such as heroin. Neither cocaine nor marihuana, however, produces the characteristic withdrawal syndrome resulting from physical dependence on the opiates.

We shall not deal with the abuse of alcohol, even though there are many more alcoholics in the United States than opiate addicts. Nor shall we deal with the barbiturates or the amphetamine Problem, even though two Congressional Committees were concerned with their abuse. The legal, though regulated, distribution of alcohol, the barbiturates and amphetamine drugs presents a different set of problems from the complete prohibition of the non medical use and sale of the opiate drugs.* There are those who believe that the legal attitude of strict prohibition of the non medical use of opiate drugs is largely responsible for the character of the drug addiction problems in this country.

*We should note, however, that addiction to and intoxication with alcohol or the barbiturates may produce withdrawal symptoms or an abstinence syndrome which is the characteristic of opiate addiction. Addiction to barbiturates, moreover, may be even more dangerous and harmful than addiction to morphine or to an opium derivative. (See for example Nyswander, The Drug Addict As A Patient, Grune & Stratton, p. 126) The prime drug of addiction in this country is heroin. There is a great deal of use and experimentation with heroin, which does not quite fall within the above definition of the World Health Organization. There are many persons, particularly in the slum areas of our large cities, who have the drug habit--who use drugs more or less regularly, but who have not become addicted. While they may have become psychologically dependent upon heroin, they are not physically dependent upon it and deprivation of heroin may not, in these individuals, produce the characteristic withdrawal symptoms which appear whenever an addict to an opiate drug fails to obtain his usual "fix".

This is illustrated by the following comments of the N. Y. U. study, "Heroin Use and Street Gangs": "Heroin addiction is typified by regular use, increased tolerance and physical dependence. An addict uses at least one dose of heroin (or another drug) every day and his intake increases with time. Yet we find that not all of the 94 heroin users studied are seriously dependent upon the drug, even though most of them have been taking heroin for 2-3 years. For one thing, only 43% take one or more doses of heroin daily; only these can be presumed addicted. The rest take the drug two or three times a week or even less often and many of them remain on this non-addictive level, even though some of them inject directly into a vein. Furthermore, only about half of them (54%) Use the drug intravenously. Such casual or weekend use represents a type that is not usually encountered in the medical literature because such users do not show the typical characteristics of addiction, tolerance and physical dependence.

For this group, heroin use may be largely a social activity, the drug being taken as part of the leisure time patterns the boys have adopted." The terrific adulteration of the drugs sold may explain this phenomenon of use and experimentation with heroin without addiction. A Chicago police officer testified before the Senate Committee: "You see now there is something else. When we test the stuff in our crime laboratory, the quality is over 2%, what they are getting is all milk sugar. I remember years ago, back in 1928 and 1929 an addict would get a cap and it would last him 2 days because it was 50%, or 60% pure . . .

"Here is something else that is very important We have these addicts every day in our bureau and very seldom do we get an addict that is sick. They are all needle addicts. It is just a rare case of where we have an addict that is really sick and going through a withdrawal period"l0 A similar phenomenon was noted for Detroit: "I have tested 1,492 addicts.. . I would assume that there are at least half as many addicts unknown to us ... and when we refer to addicts . . . we are covering marihuana smokers, occasional and the regular type, people who are not really addicted. They are occasional users, what we call 'joy poppers’ - lightly addicted people. And the drugs in Michigan . . . are terrifically adulterated The average capsule of heroin on the street is almost 11/2 to 2%,. . . In other words, a lot of addicts are taking voluntary cures in this city." . . .11 Were it not for the aforementioned adulteration, our drug addict problem would be much more serious than it is at present. The greed of peddlers of narcotics has saved many from a full blown addiction. Nevertheless, there can be little doubt that much addiction results from the occasional or weekend use of drugs like heroin, even where the drugs are greatly adulterated.