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The Addict and the Law By Alfred R. Lindesmith
The Introduction To The Addict And The Law
Washington Post, 1961
Introduction |
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Introduction
SINCE
1935, when I first became concerned with drug addiction, there has been an enormous shift in public attitudes toward the problem.
During the 1930's the police conception of addiction relatively rarely challenged and there was little research activity on matters that
pertained to policy. What research there was, was handled mainly by the Public Health Service. Few persons had at that time ever heard
that British and European programs were any different from ours, and the idea that addicts might be permitted to have access to legal drugs
was usually viewed as a startling, radical, or dangerous doctrine. There were, of course, always dissident voices,
usually from the medical, and much more rarely from the legal profession. The Federal Bureau
of Narcotics felt, at that time, that it had both the drug problem and critics of the Bureau's policies under reasonably effective control. The
number of addicts was said to be diminishing steadily, dope rings were being broken up with
satisfactory regularity, and there were few complaints about excessive leniency on the part of judges.
With the advent of World War II indices of narcotics activities
The postwar period has been one of bitter controversy as established
ways of viewing addiction and handling addicts have been
increasingly questioned and sharply challenged on the basis of
enlarged experience, increased knowledge, and new conceptions of the
problem. The usual spontaneous reaction of ordinary
people and of legislators to a deteriorating crime situation is to call for
increased punishment. This occurred -with respect to narcotics in the
United States, with the result that from about 1950 into the 1 960's
penalties for narcotics offenses at both federal and state levels were
increased to an extraordinary extent. These increases were ordinarily
asked for by the police and passed by huge majorities in most
legislatures. This was generally applauded by the press.
At the same time that penalties were being increased, a dissident
movement began to gather strength and to raise fundamental
questions challenging the basic conceptions of the program. In
increasing numbers, Americans, traveling to Great Britain and other
countries where addicts are handled as patients rather than criminals,
returned to write articles and books. Comparisons began to be made
between alcoholics and opiate addicts; leading magazines and
newspapers criticized the police conception of the addict; the image
of the addict in television programs and stage productions became
that of an unfortunate victim to be pitied and helped rather than
prosecuted and imprisoned.
With the calling of a White House Conference in 1961 and the
appointment of a new head of the Federal Bureau of Narcotics, the
reform movement reached a peak of hope and optimism. For the first
time it appeared that legislators might be willing to con
This book is designed to contribute to the discussion of issues which
are presently being debated, by presenting relevant materials of both
an historical and a current nature. Some of these materials are
discussed in other current writings but others are not. Limitations of
space and competence dictated that many matters be omitted, the
most conspicuous among these being international efforts to control
narcotics at the source by limiting production. In general, the topics
that are covered are those which bear most directly on the control of
narcotics within the nation.
It is taken for granted that the reader is in a general way acquainted
with the nature of addiction from his own previous reading and from
the mass
media. Nevertheless, it may be desirable to emphasize
2
number of points which will assist in understanding the basic
orientation of the present work.
We are concerned in this book primarily with addiction to opiate
drugs and their equivalents. These drugs are so completely different
from such substances as marihuana and cocaine that they cannot
intelligently be discussed together with them. A chapter on marihuana
is included to make this point and to indicate the consequences that
have followed from the fact that our lawmakers have failed to make
this elementary distinction. While the use of marihuana is illegal, the
use of alcohol is not, even though alcohol produces physical
dependence and is addicting in the same sense that heroin is, while
marihuana is not an addicting drug. The reader
might well ponder what the effects would be if alcohol were handled
as heroin is and if all alcoholics were subjected to the treatment
accorded opiate addicts. He should also consider how far he
would like to have his government authorized to interfere with the
obnoxious or undesirable personal habits of its citizens and where the
line ought to be drawn dividing matters of public concern from those
that are merely personal. How, for example, should cigarette smoking
be dealt with' ? Or barbiturate addiction' Or the excessive use of
tranquilizers and amphetamines?
In forming an opinion on matters like these, one should keep in mind
what the essential general features of the Opiate addict's behavior are.
After a period of initial use, when physical dependence is established,
the addict appears to use drugs primarily to avoid the unpleasant
reaction which occurs when he stops. When taking regular quantities
of drugs the ordinary addict seems to be relatively normal and reports
that he feels approximately so. Researchers who establish physical
dependence in lower animals such as rats and monkeys customarily
observe that these animals also seem normal under the effects of their
usual doses and become miserable and disturbed only when these
cease. It is not possible to determine reliably by casual observation
whether a given person is or is not under the influence of heroin.
The relative normality of the heroin or morphine addict contrasts sh
arply with the state of the alcoholic, the barbiturate addict, or
persons under the influence of marihuana. While the opiate addict
suffers more than his share of physical disease and minor troubles
such as constipation, lack Of sexual desire, and tooth decay, there is
no known major tissue pathology associated with heroin and
morphine addiction as there is with the abuse of alcohol. Some
addicts manage to escape many or all of the above difficulties, and
some live to an advanced age. For example, the grandfather of an
Indian graduate student in Indiana University has been using opiates
since he was about twenty and is now more than ninety
years old. There are many examples of drug addicts who have
continued to engage in productive work and who have even had
positions of eminence while they were using drugs.
Opiate-type drugs do not directly incite to crime or to irresponsible
behavior as alcohol does, for example. They have 2 sedative,
tranquilizing effect and if all other things were held equal would
probably inhibit rather than encourage crime. The crimes of drug
users are overwhelmingly crimes against property committed to
secure the means of obtaining drugs. Some addicts are criminals first
and drug addicts second, and others are criminals primarily because
they are addicts. Both types must, in the United States, almost
necessarily raise money by illegal means when they use drugs.
When reference is made to opiates and opiate-type drugs, the main
substances that are called to mind are opium and the "manufactured
drugs" morphine and heroin. The species of poppy known as
Papaver somniferum produces raw opium from which the "prepared
opium" used by smokers is made in a boiling down process. In the
first decade of the nineteenth century a German chemist, William A.
Serturner discovered morphine, the first of the opiate alkaloids, in
opium. Shortly thereafter other alkaloids were found and in 1898
another German scientist named H. Dreser produced, by chemical
treatment of morphine, a substance technically known as
diacetylmorphine and popularly as heroin. During World War 11,
wholly synthetic opiate-equivalents which are addicting and may be
substituted for heroin or morphine were discovered. The most widely
known of these are demerol (pethidine or meperidine) and methadone (dolophine or
amidone). There are so many opiate alkaloids,
synthetic equivalents and derivatives that it is a formidable task
merely to list them. Most are unknown to addicts and can be ignored
here. A few of the more familiar ones are codeine, eucodal, Dilaudids, dicodide, and
percodan.
Controversies concerning the nature and causes Of addiction are less
violent than those connected with policy but they are more
confusing and more varied. There is a strong general tendency for each discipline that is involved in the varied
aspects of addiction
to promote its own views and interests at the expense of those of
other disciplines. Pharmacologists tend to have pharmacological
theories of addiction, psychoanalysts promote Freudian theories,
Sociologists advance sociological views, and so on, with the persons
in each field unconvinced by evidence from the others. It is neither
possible nor appropriate to enter into a discussion of the varied and
complex theoretical issues which drug addiction raises other than to
indicate that the cliches in the popular literature which purport to
explain addiction are generally worthless, although frequently
repeated with assurances that they are the products of impeccable
research and agreed upon by all experts, or at least by all that count.
Serious shortcomings of the current literature on addiction are that it
tends to be time-bound and culture-bound. The contemporary young,
urban, male heroin addict tends to be taken as the prototype of
addicts in general, and attention is too exclusively focused on the
pattern of addiction which is now found in our metropolitan slums. It
should be remembered that opium has a very long history that
extends back beyond the first written records, and that it has been
used in a bewildering variety of social contexts for multitudinous
motives by persons of many diff erent types from all social strata.
The intravenous use of heroin dates from near the beginning of the
twentieth century, hypodermic use of morphine began in the middle
of the preceding century, and opium smoking was taken up during the
sixteenth century. For several thousand years before that, opium was
consumed in liquid form or eaten. For about two thousand years it
was the prime therapeutic agent in Western medical practice and was
employed by physicians to treat or cure almost all the ills of the flesh
and of the mind. When morphine was discovered, it was used to treat
and cure opium addiction, just as heroin was subsequently
recommended as a cure for morphine addiction, and as morphine was
used to cure alcoholism.
I have not attempted the impossible task of concealing from the
reader my own feelings, preferences, and biases. Instead, I have stated
them as frankly and fully
as
possible under the circumstances, so that
readers might be warned and make allowances for them. At the same
time I have tried to present available evidence and lines of reasoning in
such a way that the interested reader can judge them for himself and, if he wishes, go to the sources that are
indicated to check the evidence for himself or to consult opposing
opinions and interpretations.
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