May 25, 2006
By THEODORE DALRYMPLE
In 1822, Thomas De Quincey published a short book, "The Confessions of an English Opium Eater." The nature of addiction to opiates has been misunderstood ever since.
De Quincey took opiates in the form of laudanum, which was tincture of opium in alcohol. He claimed that special philosophical insights and emotional states were available to opium-eaters, as they were then called, that were not available to abstainers; but he also claimed that the effort to stop taking opium involved a titanic struggle of almost superhuman misery. Thus, those who wanted to know the heights had also to plumb the depths.
This romantic nonsense has been accepted wholesale by doctors and litterateurs for nearly two centuries. It has given rise to an orthodoxy about opiate addiction, including heroin addiction, that the general public likewise takes for granted: To wit, a person takes a little of a drug, and is hooked; the drug renders him incapable of work, but since withdrawal from the drug is such a terrible experience, and since the drug is expensive, the addict is virtually forced into criminal activity to fund his habit. He cannot abandon the habit except under medical supervision, often by means of a substitute drug.
In each and every particular, this picture is not only mistaken, but obviously mistaken. It actually takes some considerable effort to addict oneself to opiates: The average heroin addict has been taking it for a year before he develops an addiction. Like many people who are able to take opiates intermittently, De Quincey took opium every week for several years before becoming habituated to it. William Burroughs, who lied about many things, admitted truthfully that you may take heroin many times, and for quite a long period, before becoming addicted.
Heroin doesn't hook people; rather, people hook heroin. It is quite untrue that withdrawal from heroin or other opiates is a serious business, so serious that it would justify or at least mitigate the commission of crimes such as mugging. Withdrawal effects from opiates are trivial, medically speaking (unlike those from alcohol, barbiturates or even, on occasion, benzodiazepines such as valium), and experiment demonstrates that they are largely, though not entirely, psychological in origin. Lurid descriptions in books and depictions in films exaggerate them à la De Quincey (and also Coleridge, who was a chronic self-dramatizer).
I have witnessed thousands of addicts withdraw; and, notwithstanding the histrionic displays of suffering, provoked by the presence of someone in a position to prescribe substitute opiates, and which cease when that person is no longer present, I have never had any reason to fear for their safety from the effects of withdrawal. It is well known that addicts present themselves differently according to whether they are speaking to doctors or fellow addicts. In front of doctors, they will emphasize their suffering; but among themselves, they will talk about where to get the best and cheapest heroin.
When, unbeknown to them, I have observed addicts before they entered my office, they were cheerful; in my office, they doubled up in pain and claimed never to have experienced suffering like it, threatening suicide unless I gave them what they wanted. When refused, they often turned abusive, but a few laughed and confessed that it had been worth a try. Somehow, doctors—most of whom have had similar experiences— never draw the appropriate conclusion from all of this. Insofar as there is a causative relation between criminality and opiate addiction, it is more likely that a criminal tendency causes addiction than that addiction causes criminality.
Furthermore, I discovered in the prison in which I worked that 67% of heroin addicts had been imprisoned before they ever took heroin. Since only one in 20 crimes in Britain leads to a conviction, and since most first-time prisoners have been convicted 10 times before they are ever imprisoned, it is safe to assume that most heroin addicts were confirmed and habitual criminals before they ever took heroin. In other words, whatever caused them to commit crimes in all probability caused them also to take heroin: perhaps an adversarial stance to the world caused by the emotional, spiritual, cultural and intellectual vacuity of their lives.
It is not true either that addicts cannot give up without the help of an apparatus of medical and paramedical care. Thousands of American servicemen returning from Vietnam, where they had addicted themselves to heroin, gave up on their return home without any assistance whatsoever. And in China, millions of Chinese addicts gave up with only minimal help: Mao Tse-Tung's credible offer to shoot them if they did not. There is thus no question that Mao was the greatest drug-addiction therapist in history.
Substitution of one drug for another is at best equivocal as a means of treating drug addicts. No doubt if you gave every burglar $10 million, each would burgle far less in the future; but this treatment of the disease of burglary would scarcely discourage burglary as a social, or rather antisocial, phenomenon. And the fact that there would be a dose-response relationship between the amount of money given to burglars and the number of burglaries they subsequently committed does not establish burglary as a real disease or money as a real treatment for it.
Why has the orthodox view swept all before it? First, the literary tradition sustains it: Works that deal with the subject continue to disregard pharmacological reality, from De Quincey and Coleridge through Baudelaire, Aleister Crowley, Bulgakov, Cocteau, Nelson Algren, Burroughs and others. Second, addicts and therapists have a vested interest in the orthodox view. Addicts want to place the responsibility for their plight elsewhere, and the orthodox view is the very raison d'être of the therapists. Finally, as a society, we are always on the lookout for a category of victims upon whom to expend our virtuous, which is to say conspicuous, compassion. Contrary to the orthodoxy, drug addiction is a matter of morals, which is why threats such as Mao's, and experiences such as religious conversion, are so often effective in "curing" addicts.
Mr. Dalrymple is the author of "Romancing Opiates" (Encounter, 2006).
©2006 The Wall Street Journal