Heroin addiction isn't an illness...and we should stop spending millions 'treating' it
By DR THEODORE DALRYMPLE
Last updated at 20:35 18 August 2007
• It's very hard work to become an addict
• Going cold turkey is quite easy
• People choose to get hooked...
For the past 14 years, I have worked as a doctor in a large general hospital in a deprived area of Britain, and in the even larger prison next door.
In that time, I have seen heroin addiction rise from an infrequently encountered problem to a mass phenomenon.
It has now become so widespread that the city council has politely asked residents not to put used needles and syringes in the weekly rubbish collections.
No stairwell in any housing estate is complete without the discarded paraphernalia of drug abuse.
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Drug-addiction services have also grown massively. In our society, every problem calls forth its equal and supposedly opposite bureaucracy, the ostensible purpose of which is to solve the problem.
But the bureaucracy quickly develops a survival instinct, and so no more wishes the problem to disappear altogether than the lion wishes to kill all the gazelle in the bush and leave itself without food.
In short, the bureaucracy of drug addiction needs drug addicts far more than drug addicts need the bureaucracy of drug addiction.
The propaganda, assiduously spread for many years now, is that heroin addiction is an "illness". This view serves the interests both of the addicts who wish to continue their habit while placing the blame for their behaviour elsewhere, and the bureaucracy that wishes to continue in employment, preferably for ever and at higher rates of pay.
Viewing addiction as an illness automatically implies there is a medical solution to it. So, when all the proposed "cures" fail to work, addicts blame not themselves but those who have offered them ineffectual solutions.
And for bureaucracies, nothing succeeds like failure. The Government spends more than a quarter of a billion pounds a year on drug treatment in the UK, despite there being little evidence of any reduction in the number of addicts.
Since the bureaucratic solution to waste is to waste even more, you don't have to be Nostradamus to predict that funding in Britain will continue to rise.
Before the expansion of heroin addiction in my city, I knew little about it. I'd known a few addicts in the higher echelons of society, but they had been peculiar even before their addiction.
I had briefly run a drug-addiction clinic in a famous university town, at a time when I accepted what I now know to be myths about heroin addiction.
But as more addicts came to my attention ? I see up to 20 new cases a day in prison ? I began to think about it more. The medical perspective, that these people were ill and in need of treatment, seemed less and less convincing.
I discovered that most addicted prisoners stopped taking heroin in jail, even when it was available. They came into the prison starving and miserable, and went out relatively healthy.
But within a few months, many were back in their former condition, and when brought once more before the courts, some would beg to be imprisoned.
When, soon after their return, I asked them whether they intended to give up taking heroin, some would reply: "I'll have to, I've got no choice."
Asked why, they would offer replies such as: "Because my girlfriend's just had a baby and she won't let me see it unless I do."
This answer was a strange one if these addicts truly thought of themselves as ill and in need of treatment. #
Instead, they clearly believed a purpose in life was enough to enable them to abstain. This is not how pneumonia, for instance, is cured.
No one would say: "I must stop having pleuritic pain each time I breathe deeply because I have just had a baby." Yet the medical services allow addicts to focus exclusively on the physiological aspects of addiction, which in practice means the prescription of a drug such as methadone.
There is a strenuous, almost outraged, rejection of the idea that addiction is, at bottom, a moral problem, or even that it raises any moral questions at all.
Of course, addiction to heroin and other opiates has serious medical consequences. I often saw addicts with deep vein thromboses or multiple abscesses; they would have TB; they would be malnourished and infected with Hepatitis B or C, or both, and HIV.
It would be difficult to obtain blood from the veins in their arms or legs because they had injected so often.
But medical consequences do not make a disease. Many mountaineers get frostbite, but mountaineering is not a disease.
To conceive of heroin addiction as such seems to me to miss the fundamental point: it is a moral or spiritual condition that will never yield to medical treatment.
Having started with a vague supposition that the medical approach to addiction must be right, I came to a different conclusion: that such an approach, having started no doubt as an honest attempt to help addicts, now represented a combination of moral cowardice, displacement activity and employment opportunity.
The therapeutic juggernaut rolls on. It is easier, after all, to give people a dose of medicine than a reason for living. That is something the patient must minister to himself.
In coming to these conclusions, I felt I was living in a world in which the plainest of truths could neither be said out loud nor acknowledged.
Every day I saw addicts selling their prescription drugs or continuing to take heroin and any other drug they could get; addicts who, despite their "treatment", continued to commit crimes; addicts openly contemptuous of attempts to help them, who lied to and manipulated their helpers shamelessly; and addicts who had, without any assistance, given up heroin completely.
Above all, I observed the true triviality of heroin withdrawal symptoms.
Yet my observations did not seem to matter. It was almost impolite, and increasingly impolitic, to mention them to colleagues who dealt with addicts, though they must have observed the same things.
I felt like a heretic who had better keep his beliefs to himself. Had I not been lucky enough to work with three eminent physicians who had observed precisely what I had, and drawn the same conclusions, I might have broken down.
The orthodox view of addiction is that a person is somehow exposed to heroin more or less by chance. It has a pleasurable effect, and he or she keeps taking it.
Before long, the person is addicted and, to avoid the terrible suffering of withdrawal, must take more.
Of course, to pay for this, addicts usually resort to crime, for their addiction precludes normal paid work but requires a large income.
All powers of self-control are destroyed by heroin, and unless they take a substitute drug, such as methadone, or enter a lengthy rehabilitation programme, addicts cannot give up.
They are hooked for life and need help ? from the drug-addiction bureaucracy.
There is only a tiny grain of truth in all this. That physiological addiction exists is indisputable. But in practically all other respects the standard view is wrong, a masterpiece of rhetorical tricks.
It is to heroin addicts what Marxism was to the Politburo of the former Soviet Union: a systematic pseudo-scientific justification for everything they do.
The orthodox view is self-serving for addicts because it implies no possibility of self-control and so no blame.
What, perhaps, is more surprising is that many doctors, therapists and social workers swallow such nonsense. The truth is people who are genuinely exposed to strong opiates by chance, such as after an operation, rarely become addicted to them.
It might once have been the case, before awareness of the addictive properties of heroin was so general, that unsuspecting people were introduced to the habit by others and were thus "hooked".
Whatever may have been the case in the past, this is not a plausible explanation now.
Children may no longer know the date of the Battle of Hastings, but they know heroin is addictive. Many addicts say they did not know what they were getting themselves into when first they took heroin, but this is not credible; they could not have failed to know.
Again, the standard view is that the process of becoming addicted to heroin is swift. The future addict has to take the drug only a couple of times and then ? hey presto ? his willpower is gone.
He is hooked forever. But actually, you have to work quite hard to become a heroin addict. It is not something that creeps up on you unnoticed. In fact, addicts are people intent on rebelling against received norms.
They enjoy the feeling of swimmy calm that heroin produces and make a free choice to become an addict.
Nor are the withdrawal symptoms from heroin anywhere as terrible as normally painted. In the popular conception, going "cold turkey" is dreadful beyond all description, involving cramps, insomnia, vomiting, shaking and sweating.
But not a single addict has ever caused me as a doctor to feel anxiety for his safety on account of his withdrawal.
And all the genuine symptoms, which are never severe, such as muscular aching, diarrhoea, crying, sneezing and insomnia, have been relieved by simple, non-opiate medication.
Certainly, most withdrawing addicts have portrayed themselves to me as being in the grip of dreadful suffering.
They writhe in agony, claiming they have experienced nothing as bad in their lives, and they make all kinds of threats if I do not prescribe "something" ? they mean an opiate ? to alleviate their suffering.
The threats range from damaging their cells to killing themselves, others or even me. (Withdrawing alcoholics never make such threats.)
In fact, heroin addicts rarely carry out their threats. Those who say they are suicidal quickly admit they were merely trying to get methadone when I suggest they be put in a cell so bare that there is nowhere from which to suspend a noose.
My counter-threat produces in most cases the most miraculous improvement in their mood.
Not all the addicts I see exaggerate in this fashion. Some admit with a laugh that anyone who says cold turkey is terrible is lying and more than likely trying to bluff his way to getting methadone.
As long ago as the Thirties, experiments showed that salt solution could be substituted for morphine without the addicts' knowledge, and they could be deceived out of their withdrawal symptoms.
Yet the established fact that withdrawal from opiates is not a serious medical condition is a truth universally ignored by doctors.
The great glory of withdrawal agony, from a career point of view, is that where suffering exists, it is necessary to employ more and more doctors, nurses, psychologists, social workers and counsellors to relieve it.
Yet consider what happened in China after Mao took power in 1949. At the time, China had more opiate addicts than the rest of the world put together ? about 20million.
But Mao gave them a strong motive to give up: he shot the dealers and any addicts who did not give up their habit.
Within three years, Mao produced more cures than all the drug clinics in the world before or since, or indeed to come. He was, indeed, the greatest drug worker in history.
The point of this story is not to advocate a repetition of Mao's methods. It is to demonstrate that, when a motive is sufficiently strong, many millions of addicted people can abandon their addiction without the paraphernalia of help considered necessary today.
It demonstrates that people take heroin out of choice, ultimately, and so can stop out of choice. Addicts are not blameless victims of some terrible illness they have no control over. Junk Medicine: Doctors, Lies And The Addiction Bureaucracy, by Theodore Dalrymple, is published by Harriman House Publishing on August 27, 2007, priced £14.99. To order your copy with free p&p, call The Review Bookstore on 0845 606 4213.