WHAT IS ADDICTION
WHAT KIND OF ADDICTIONS
DO WE KNOW?
Paper presented at the AEGEE- congress "Addiction and its place in society", Eindhoven University of Technology, 20-10-1994.
To answer the question "what is addiction?" we have first to look at the apparition of the notion of addiction in the past. This will show that addiction is a fairly recent connotation, although the use of especially alcohol and opium have a long history in the world. After studying the past notions regarding the use of alcohol and opium, we will consider the present notion from the viewpoints of pharmacologists and sociologists. From the sociologist's realm we will enter the lawyer's empire. Finally I will present my own views, based on the data presented.
In addition I have to explain my use of the word "drugs". While in english the word "drug" is used to denote substances that are being used as medicines, we use this word in dutch virtually only in the sense of illegal luxuries, varying from heroin to Cannabis, although the insight is increasing that alcohol and nicotine as well as coffee are drugs as well, if only legal. as they are used as luxuries instead of medicines. This results in remarkable semantics: morphine prescribed by a doctor is 'medicijn', (dutch for medicine), while the same substance obtained from a dealer is a drug. The moment I see a drugstore in an anglo-saxon country, I experience a subtle kind of cognitive dissociation, which can only be compared with the ones anglo-saxons will experience when seeing a dutch "coffee-shop". You will observe that in the following I use the word drug as often in the anglo-saxon sense as in the dutch sense.
Fermented beverages are as old as humankind and the discovery of them is probably older than the discovery of agriculture. Probably fermented honey, mead, has been the first source of drinkable ethanol, and later on fermentation of grapes and dates was developed. The Bible tells us how Noah, after becoming a farmer cultivating a vineyard, ostensibly unfamiliar with the intoxicating properties of wine, drank to much and fell asleep naked in his tent1. It is remarkable that not his drunkenness but his nakedness was scandalous. In historic times the Pillar of Hammurabi dating from 1700 BC holds rules regarding the sale of wine2. Wine is an ever returning symbol of fortune and peace in the Bible, although mention is made of excessive use of alcohol3.
The Ancient Greeks drank mead, but learned to make wine from Dionysus, the god of the wine, son of Zeus and a Theban princes. He himself had learned the procedure in Egypt, where he fled to escape the wrath of a jealous Hera. This knowledge laid the basis for the Dionysian fertility rituals, according to tradition orgies characterized by excessive use of wine. However, the more appolinically inclined Plato describes in 'Symposion' excessive use of alcohol without any critical note.
The Romans too consumed alcohol in a fair measure. Cato the Elder recommended wine, be it in moderate amounts, moreover considered it of medicinal value against snakebite, both constipation and diarrhea, gout and a number of other, minor, complaints. Later on Petronius describes in his Cena Trimalchionis an orgy, not to be surpassed by the Bacchantic orgies.
Manifold as the references to alcohol may be, the number of references to the consequences of alcohol use are remarkably few. Galenus and Cassius Felix describe delirium tremens under the name "frenesis" as the result of wine-intoxication4. It was only in the eleventh century that for the first time a relation was observed between excessive use of alcohol and "inflammation of the liver". The notion "addiction" is completely absent!
The Germanic peoples drank mead and beer. Drinking bouts were proof of virility. The use of wine spread to the northern part of Europe with Christianity. Early Christians considered beer drinking as pagan, contrarily drinking wine was a sign of conversion. Is there any relation with the use of wine during Mass? Anyhow we observe wine having now the same meaning as with the ancient Greeks: a symbol of happiness, fortune, warmth and virility, being notions clearly older than christianity, based on humankind's need to escape from the daily treadmill of life5.
We have however to realise that in the Middle Ages and before the drinking of alcohol was a matter of course, an obvious part of nutricion. The notion of alcoholism and the resulting behaviour we have did not exist. Only when food is plentiful and varied, a new situation is created. Than, people go to the tavern, to drink for pleasure, while before alcohol was only used at home with the wife and children, as food. Now wife and children are not anymore to be included: "Tom Tipsay is joyful in remembrance of the bountie of his god Bacchus, but sorrowfull alas at his returne when first hee came within the viewe of his wife" writes Philip Foulface in 15936. In this way the notion of recreative use develops, opposing the use as nutricion. Recreative use is "use aiming to promote pleasure, happiness or euphoria in the user"7. It is only in this perspective of recreative use of alcohol that notions as "alcohol-abuse" can develop. As I already told you, alcoholism is a very recent notion.
We can as well make another distinction. We observed already Cato the Elder ascribing a medicinal value to alcohol. Apart form use as nutricion or luxury, we may distinguish "medical use". This can better be elucidated by considering the use of another centuries old drug: opium.
Excavation of the remnants of the neolithic Cortaillod-cultuur (3200-2600 BC), in Switserland have shown that at that time Papaver was already cultured, probably because of the nutricious value of the poppy-seeds that contain 45% oil. Without any doubt the light narcotic properties of this plant had been discovered8. The strong narcotic action of the milky juice that can be obtained by incising the ovary, that results in opium when dried, will have been discovered not much later. The writings of Theophrastus (3e century BC) are the first written account of the use of opium in the West. Arab physicians were well acquainted with the usefulness of the effects of opium and arab merchants introduced its use in the East. In Europe it was reintroduced by Paracelsus (1493-1541) and thus the english doctor Sydenham could write in 1680:
"Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium."
Clearly opium was used as medicine, however in an era where a regulated medical and/or pharmaceutical order did not exist at all. Opium could be produced, traded and consumed by everybody. Oral use of opium, either as tablets, but mostly as drink laudanum (tincture of opium) or paregoric (camphorated tinctura opii) was widespread, without being considered remarkable. In a time that effective medicines hardly existed opium was one of the very few medicines that worked, if not curative than at least palliative. It is not surprising that this "medical" use often was continued even if the direct cause for the use had disappeared. Opiuym relieved the worries of the daily life, not only of the lower class but of all classes. However it was the use among the lower classes that started to draw attention halfway the last century. Upper class people even started to talk about the stimulant use of opium, suggesting use for other aims than as a painkiller.
It was especially the arising medical order that in the framework of its professionalisation advocated the restriction of the availability of opium. "Medical use" had to implicate the physicians monopoly to prescibe and deliver opium. To reach the necessary change of attitude of the upper and middle classes in favour of their own position physicians introduced the notion of addiction, both with regard to alcohol and opium and its derivatives morphine and heroin. Addiction was defined as a disease and as such a condition under the unique competence of the medical order9,10,11. The fact that normally the incapability of doctors to cure a disease is considered a failure of the medical science, but in the case of the disease "addiction" this failure is ascribed to the failure of the morality and/or willpower of the patient, shows how illogical this view is.
The opposition of the opium sellers, basically all grocers, to such a monopoly was broken by the rising order of pharmacists, when they started to realise that the restriction of opiumsales to them was an excellent issue to serve their professionalisation. They threw in their lot with the doctors and that decided the issue: opium and its derivatives became substances that could only be used in a strictly medical framework to be decided by doctors, although the that time medical indications differed significantly from the present ones. I have only to remind you the use of heroin and cocain to "cure" morphine-addiction to show this. For an extensive documentation of this process of medicalisation for the cause of the medical and pharmaceutical orders, I refer you to the monumental study of Virginia Berridge en Griffith Edwards: Opium and the people12.
Thus we have observed how within the framework of our Western culture the notions of recreative versus medical use have developed. It is important to stress that this way the right to selfdetermination of the individual was violated: the physician would decide what was good for us. Later on I will return to this issue.
I must emphasize that this development has followed a "scientific" path. The doctors voicing these views were respectable, and moreover sincere practitioners of their profession. Isn't science an instrument by eminence to exert influence in power-struggles? I do not have to refer to extreme examples as the "science" of eugenics as the basis of the N�rnberger racist laws to make this clear. Stephen Jay Gould, the Harvard paleontologist, offers us in his many essays13 a wealth of simple examples of how, in this case especially biological, conceptions, at their time considered "scientific", were used, unconsciously, by their students, to influence decisions regarding power issues in their society. Let us thus now consider the notion of addiction in the light of the sciences. The word 'addiction' as it is commonly used leads there to confusion. The word is obviously too poorly defined to offer clarity. There are two approaches that seem to be able to bridge these differences in interpretation. The relevant keywords are: dependence and deviance belonging to the realms of psychopharmacology and sociology respectively.
Addiction in the light of psychopharmacology.
When we speak of addiction to drugs, we mean addiction to substances which have an effect on the human brain. When these substances are administered, they reach the brain by way of the blood, and influence there the stimulus transfer between nerve cells. Some psychopharmaca, e.g. the opiates, directly stimulate the nerve cell receptors as artificial neurotransmitters. Nerve cells are directly stimulated by the drug.
Much larger amounts of artificial neurotransmitters are used for artificial stimulation of the receptors than when a true neurotransmitter is released under influence of an action potential. With artificial stimulation the receptors are flooded. If this occurs only a few times or very occasionally, it is not a problem. However, if it happens often, the cells react by making more receptors, in order to be able to process this regularly returning flood. This, in turn, lowers the effect of the dose administered. This phenomenon is called tolerance: the user needs more and more of the substance to achieve the same effect.
In addition, when administration of the substance is stopped, the number of natural neurotransmitters is too small for the sharp rise in the number of receptors. The nerve cells have become used to the administration of large amounts of artificial neurotransmitters, the body has become used to the presence of the substance and can no longer function without it. It needs the substance. This is called physical dependence. Discontinuing administration, then, also brings on symptoms of illness, withdrawal symptoms, together called the abstinence syndrome. The abstinence syndrome has three characteristics:
- commencement within a definite time span of which the length is dependent on the duration of action of the relevant substance;
- the development of new symptoms during the abstinence syndrome; and
- the symptoms must disappear again after peaking.
The same outline can be applied to all other psychoactive substances whether they are legal such as alcohol and tobacco, semi-legal such as the tranquilizers and sleep-inducing drugs or illegal such as the substances we Dutch then suddenly classify as drugs. All these substances cause effects by interfering in one way or the other with the stimulus transfer mechanism between nerve cells. The different effects are due to the differences between the activity of the neurotransmitters involved and their different properties.
Both physical dependence and tolerance are characteristics that depend not so much on the individual in question, but lie in the nature of the substance.
Genetic factors can, however, influence the effect of the substance. A well known example of this is that women are less able to break down alcohol because the alcohol-inactivating enzyme alcohol dehydrogenase is less active in women. But even if we take these kinds of genetically determined differences into account, we can still say that physical dependence and tolerance occur in anyone who over a period of time and more or less regularly takes artificial neurotransmitters, as happens when opiates are used as pain-killers after serious operations or in cases of illnesses with severe pain as one of the symptoms. Nevertheless, our hospitals are certainly not junkie factories. It is true that doctors never break off the administration of opiates suddenly: the dosage is reduced over a period of days to zero (called weaning off), but, in contrast to junkies after a similar procedure (a reduction course in addiction terminology), these patients do not run straight to a dealer. In short, physical dependence is not determinant for the addiction, something else must be present. This other aspect is psychological dependence. Psychological dependence, in contrast to physical dependence, depends less on the substance than on the user. Psychological dependence has to do with 'pleasurable`. Something can be so pleasurable that you can almost not do without it. But whether or not you find something pleasurable depends on you, not on it. One person likes sweets, another savories. So, although you cannot say that a substance causes psychological dependence, you can observe the fact that many more people like sweets than like savories. The chance then that someone who has never tried anything sweet will like it after tasting it is great. To be able to examine the basis of this phenomenon we will take a closer look at the effects of that psychopharmaca classified as addictive on the brain.
We then immediately have to pay attention to the nucleus accumbens, a group of cells functions as a kind of punishment/reward center in the brain. Experiments in animals give us an indication of the extent to which a substance is "addictive". The animals are provided with a permanently implanted infusion, administration of which they can control by pressing a button. If the substance has 'addictive' qualities, the animals administer it to an increasing degree. This is called self-injection behavior.
The behavior of animals (generally rats or monkeys) here may not be regarded as identical to that of humans, although this is often the case in 'addiction'-studies. Firstly because these experimental animals are always in isolation: there is no social interaction, thus no other rewarding stimuli can be received. There is little other than administering a 'chemical' reward. Think here also about the use of drugs by people in prison. When the environment also offers other rewarding stimuli, the chemical reward becomes less important and the self-administration may extinguish altogether, as has been shown in the so-called rat-park studies14,15,16,17.
The second difference is that humans have a much more complicated repertoire of behavior patterns, in other words the human cortex allows many more possibilities of modifying behavior. Psychologically dependent behavior in humans is present only when neither the internal environment (e.g. in psychiatric disorders), nor the external environment (social and family situations) offer sufficient rewarding stimuli. Only then do we see the occurrence of psychological dependence. Psychological dependence in humans does not necessarily come only from substances that stimulate the reward system. Humans can also become psychologically dependent on other rewarding activities. The best example of this is gambling. The excitement that gambling evokes is for some just as rewarding, and brings on 'gambling fever'. In a similar way, people talk of bulemia, or its antithesis, anorexia. But running marathons is rewarding as well, on the pharmacological level based on increased production of endorphins.
This, of course does not disregard the fact that some substances stimulate the human reward center more than others, thereby evoking dependent behavior quicker.
Although this falls somewhat outside pharmacology, the question can also be asked whether 'addiction' uses and understands language symbols. According to Lindesmith18 it does, and chimpanzees e.g. cannot become addicted. He regards chimpanzees that demonstrate cravings no different from patients who, not knowing they are getting morphine, demonstrate cravings, but then directed towards pain-killing or even more directly towards getting an injection. He says they are 'not addictions', in contrast to Spraggs19 who considers both to be examples of addiction. Many psychopharmaco-logists20,21,22 consider the drive to intoxication a biological property of both animals and humans, to be compared with the drive for sex and food.
By using the word 'addiction', thusfar get a highly variable cocktail of the concepts of physical dependence and psychological dependence. So variable that we can safely reject the notion of addiction as a sound medical diagnosis. Especially as we realise that invariably a large measure of the perception of 'trouble', the degree in which the ultimate resulting behavior deviates from our standard, is stirred in that coctail. With this we leave the concept dependence and go over to the earlier mentioned other concept 'deviance'.
Addiction in the light of sociology.
No human society exists where no psychoactive drug or drugs are taken. Whether Fijians drinking kava, mongolian shamans using the fly agaric, khat chewing Yemenis or westerners drinking alcohol, members of all human cultures have found ways to alter their minds by the use of psycho-active substances. No culture exists that denies the right on intoxication altogether.
Let us look at alcohol addiction. It should be evident that a Frenchman's concept of 'an alcoholic' is different of of a Swede's concept of it. It is only when drug addiction is meant that there seems to be wide consensus as to the interpretation of the concept addiction, at least within our culture. But even here we cannot deny that a Dutch person thinks differently about the use of hashish than does a German, let alone a Pakistani farmer. For a Norwegian judge, possession of khat means something quite different than it does for his Yemenite colleague. As you see, the word addiction also has different interpretations when talking about addiction to drugs. By the way, attention lately is focusing more and more on the 'new' addictions such as bulimia, anorexia, gambling (not to mention sex and work addictions). It is the patterns of behavior which are becoming more and more a part of the 'addiction problem' as perceived by society and which are often being treated according to the AA model. These 'addictions' lead to two mutually exclusive questions: we must ask ourselves whether these behavior patterns really are addictions, or we must ask ourselves whether it is worthwhile to extend the concept of addiction so far beyond addiction to alcohol, tobacco or drugs. We should however first research whether the concept of addiction serves at all.
The virtually universally acknowledged right on intoxication does however not mean that this right can be exercised under all circumstances: the use of local psycho-active substance or substances is always surrounded by a number of written and unwritten rules that regulate it's use. The kind of drug being locally used is dependent on what Nature, albeit occasionally with a little help, has to offer and has scarcely to do with it's pharmacological properties, psychoactivity provided. The inhabitants of some regions of the world like South America are provided by nature with large numbers of plants containing psycho-active drugs, while others like Europeans have pitifully few and so have had to resort to the fermentation of grapes or barley (the Mongolians even to the fermenting of mare's milk) to obtain alcohol or the use of poppy's until it was prohibited. So every culture has developed its own ways to handle their drugs, ways that are products of a co-evolution of the society and the naturally available drugs, as much as orchids and their pollinators are products of co-evolution. Thus, drug use being normal human behaviour and approved within the culture it belongs to, is surrounded by rules regulating its use. Some authors, and I agree with them, describe these rules as "ritual"23,24. To cite Harding en Zinberg25:
"Taken as a whole the rituals and social sanctions towards controlled (..) drug use have several major features:
- 1. They define and approve controlled use and condemn compulsive use.
- 2. They limit use to physical and social settings conducive to a positive drug experience.
- 3. They incorporate the principle that use should be kept infrequent enough to avoid dependence/addiction and to maximize the desired drug effect.
- 4. They identify potential untoward drug effects and prescribe relevant precautions to be taken before and during use.
- 5. They assist the user in interpreting and controlling his drug high."
This regards the approved use of drugs. The notion of how to use these substances properly tend to differ within a culture: different subcultures have different notions. As we already mentioned: the notions regarding the use of alcohol differ significantly between the French and the Swedish for example. And they differ even more between cultures, dependent of the properties of the actual substance among other factors. Members of one culture tend to regard the use of other drugs in other cultures as a sign of primitivity. The muslim rejection of alcohol does not differ from our rejection of their former Cannabis use. The chewing of khat within the Yemeni culture can be compared with our alcohol use, however we try to impose prohibition on their use of khat!
So the next notion is unapproved use of drugs: defined as abuse. The above examples already show that what is considered abuse occurs in two varieties: improper use of approved drugs as well as use of unapproved drugs. Both have to do with deviance.
This aspect, the aspect of standards and surpassing these standards is clear: the more behavior deviates from the local norm, the sooner we tend to reject it. In human behavior we see quite often a distribution according to Gauss' bel-curve. In the middle we have the prevailing standard. It does not matter which that is. On each side we have deviations. The first deviation from the standard has no meaning. The second is already 'oh, that's just the way he/she is'. Deviant, but not seriously so. It is only after we pass the second deviation of the standard that it becomes difficult. We have different methods of dealing with such deviant behaviours. However, all of these methods must satisfy one requirement: they must be stripped of their threatening character. After all, society is not just a lot of separate individuals, no, society is defined as a collection of people who more or less agree with each other on a number of things. And what we more or less agree about are our values and the rules of behavior, our standards which are based on those values. Extreme deviation from these standards is fundamentally threatening for the society. So, we must avert the threat. Both medicalisation and criminalisation are instruments by excellence for this. The use of medicalisation has been discussed above and has led to the defining of perceived deviant substance use as "addiction". We pathologized this behavior: we created the addiction-disease.
The other approach, criminalising, has been introduced as well although later than the medicalisation. Here we enter the empire of the lawyers, although the word "addiction" does not appear in any lawbook, as far as I know.
Addiction in the light of the law.
When the United States at the end of the nineteenth century began to campaign for control of the trade in opium, partly based on it's strong abolitionist tendency, partly for economic reasons26, the international drug treaties that were concluded as a result did initially not limit the rights of citizens to use these drugs, as they were in principle legally available either by the state monopolies as in the Dutch East Indies for opium, or as we have seen as over the counter "medicines". The treaties served to limit trafficking, not by themselves limiting legal availability for users, as governments like the Dutch and the English held trade monopolies. This kind of regulation had nothing to do with the general public in Europe and the U.S.A., as it only regarded colonies. As far as drug use occurred in the western countries, it was not a public, but a medical concern. The increasing regulation of the medical and pharmaceutical profession did not regard drugs in another sense than as medicines. To execute the 1914 International Opium Treaty national laws were enacted to prohibit the production and trade of raw opium and processed opium except with government approval, for medical reasons and they left the distribution to the pharmacists and physicians competence. These national laws did not prohibit possession for personal use: the user was not criminalised.
This was logical in the nineteenth century many europese and american patent medicines contained not only opium, but there were as well cocaine or cannabis, mostly as an alcoholic extract: I mentioned already the opium-derived potions as laudanum and paregoric, but as well the cocain containing Vin Mariani and the original Coca Cola and a number of different cannabis-tinctures. Although their use was labelled as medical, these potions were freely available: no legal controls existed. Pharmacists in the western world produced many potions containing psycho-active drugs as painkillers, stimulants, spasmolytics, etc. The "medical" use of Vin Mariani and Pemberton's Coca Cola as "tonics" are relevant examples. Even at the end of the nineteen-twenties only 20% of all medically prescribed cocain, would presently be considered medically proper, under consideration that cocaine at that time was the only available local anaesthetic.
But the use of this kind of potions diminished slowly as stricter controls were imposed on medicines, not primarily to reduce their use, but as protection for the medical and pharmaceutical professions, as we have seen. This made the use of these types of drugs not as much as disappear, but brought their use more and more under medical control, without becoming a matter of public concern.
After the first World War, nobody in war-torn and -tired Europe objected against the United States pressure to extend the prohibition of the use of opium, coca and cannabis, so nobody objected against article 295 of the Versailles Treaty that ended W.W.I., obliging all Parties to the Treaty to obey to the the Hague Convention and to enact the necessary legislation within twelve month. Again, this did not criminalise the use of drugs. It is important to note that the Narcotic Laws which in this way were introduced in Europe are not the result of an european perception of an european domestic problem, but the result of clear pressure of the U.S.A., "the barbarians of the West" with their "extraordinary savage idea of stamping out all people who happen to disagree .... with their social theories" against narcotics, alcohol27.
In the twenties the pressure from the U.S.A. increased to extend the existing international treaties that until that moment only regarded the drug crops: opium-poppies and coca-leaves, to their chemical derivatives: morfine, heroin and cocain and to limit their production. At first both the Germans and the Dutch objected, refined opiates and pure cocaine being important income generating drugs for their respective pharmaceutical industries. In the twenties the Netherlands were the world's biggest producer of pure cocaine, as we succeeded to grow a Erythroxylon variety in the Dutch East Indies. However both dutch and germans complied in the end, which resulted in the ratification of the 1925 Geneva Treaty. This Treaty started the criminalisation of drug use, bringing all then known "drugs", now including hemp, and their derivatives under the penal code, exept when used in the realm of the medical/scientific profession and disregarded what decades later became known as recreational druguse. The stated standard of behaviour with regard to all psychopharmacological luxuries except ethanol, nicotine and caffein in the Western world became: no use. In modern war on drugs phraseology: "just say no", or even worse: "zero tolerance", and the especially american cultural imperialism tries to impose this standard, not unsucsesfully, on the whole of the world. You might have noticed that even the use of nicotine as a drug is being made deviant in the U.S.A. and even caffeine has recently been denoted as an addictive "drug".
We already observed how within the framework of our Western culture the notion medical use has developed, and how this way the right to selfdetermination of the individual was violated. By the installation of the medical order insidiously an infraction was made in our basic human right of self-determination. So, the crux of this matter is whether limiting the legal availability to use to firm medical and pharmaceutical control and criminalising recreational use outside the medical situation, is a serious infraction on the civil rights as defined in the french constitution, the basis of modern western world law, with exeption of the remnants of the British empire that still use common law? Let us consider the root principles of this law.
In 1762 Jean-Jacques Rousseau28 confronted his contemporaries with the question:
"Trouver une forme d'association qui defende et protege de toute la force commune la personne et les biens de chaque associe, et par laquelle chacun s'unissant a tous n'obeisse pourtant qu'a lui-meme et reste aussi libre qu'auparavant.1"
He answered this question by describing the "social contract" between citizens and sovereign, a contract based on the right of freedom for the individual:
"aucun homme n'a une autorite naturelle sur son sembable"29.
His ideas were put into practice when on july 4, 1776 Thomas Jefferson read the Declaration of Independence in which the United States justified their rejection of the British rule based on the perception of some self evident truths:
"that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness."
This perception was again formulated, when on 26 augustus 1789 in Paris the Constituante met to decide upon the "D‚claration des droits de l'homme et du citoyen", which was written under the redaction of the Marquis de Lafayette (known from the U.S. liberation war). In the preamble "les droits naturels, inali‚nables et sacr‚s" were defined: in its article IV was stated:
"La libert‚ consiste … pouvoir tout ce qui nuit pas … autrui. Ainsi l'exercise des droits naturels de chaque homme n'a de bornes que celles qui assurent aux autres membres de la societ‚ la jouissance de ces mˆmes droits; ces bornes ne peuvent ˆtre d‚termin‚es que par la loi."2
This still is one of the most basic principles of the civil (and as such human) rights in our society. A corollary of this basic right is that the state does not have the right to limit the exercise of the liberty of the citizen, unless the exercise of this liberty harms other people.
Although the introduction of said principle marked the end of absolute monarchy and replaced the monarch's government by the people's government, the course of events during the French Revolution and its aftermath showed that the people's sovereignty could involve a tyranny by the people's so-called "majority" that eventually might pale the tyranny of an absolute monarch.
"Like other tyrannies, the tyranny of the majority was at first, and is still vulgarly, held in dread, chiefly as operating through the acts of the public authorities. But reflecting persons perceived that when society is itself the tyrant - society collectively over the separate individuals who compose it - its means of tyrannizing are not restricted to the acts which it may do by the hands of its political functionaries. Society can and does execute its own mandates; and if it issues wrong mandates instead of right, or any mandates at all in things with which it ought not to meddle, it practises a social tyranny more formidable than many kinds of political oppression, since, though not usually upheld by such extreme penalties, it leaves fewer means of escape, penetrating much more deeply into the details of life, and enslaving the soul itself. Protection therefore, against the tyranny of the magistrate is not enough; there needs protection also against the tyranny of the prevailing opinion and feeling, against the tendency of society to impose, by other means than civil penalties, its own ideas and practices as rules of conduct on those who dissent from them; to fetter the development and, if possible, prevent the formation of any individuality not in harmony with its ways, and compel all characters to fashion themselves upon the model of its own. There is a limit to the legitimate interference of collective opinion with individual independence; and to find that limit, and maintain it against encroachment, is as indispensable to a good condition of human affairs as protection against political despotism.30" wrote John Stuart Mill less than a century later.
This is not to say that society has to morally justify all individual behaviour of its members, it means only that the state does not have the right to prohibit those behaviours unless they directly harm other citizens.
"The acts of an individual may be hurtful to others or wanting in due consideration for their welfare, without going to the length of violating any of their constituted rights. The offender may then be justly punished by opinion, though not by law."31
These principles found their final application in the Universal Declaration of Human Rights of 1948: Article 3 states:
"Everyone has the right to life, liberty and the security of person"
and art. 29.2 states:
"In the exercise of is rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society."
How do these principles relate to the present "War on Drugs"? As "everyone has the right to life, liberty and the security of person" the prohibition is without question an infraction on the freedom of the individual. Whether this is however an illegal infraction remains to be seen. The State has the right to limit the exercise of an individuals rights and freedoms. But the individual shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.
Does drug use threaten recognition and respect for rights and freedoms of others? No! Or would you request me to recognise moral opinions as "Just say no" that are imposed on me without recognising my opinions. Does "Thou shalt not use drugs" by the way respect my rights and freedoms?
Sure, some drug users do infringe on the rights and freedoms of others!. Some drug users do threaten morality, public order and general welfare!
The question is whether this is the necessary consequence of their drug use? And, moreover, whether prohibition is a necessary condition to limit their freedom, which can be legally done to protect other citizens?
It will be clear that the answer to these questions is no. Alcohol has not to be prohibited to prosecute the drunken driver! Tobacco use has not to be outlawed to protect non-smokers against smokers' toxic fumes!
Sure, "there is a degree of folly, and a degree of what may be called (though the phrase is not unobjectionable) lowness or depravation of taste, which, though it cannot justify doing harm to the person who manifests it, renders him necessarily and properly subject of distaste, or, in extreme cases even of contempt.32" Again: "The acts of an individual may (even) be hurtful to others or wanting in due cosideration of their welfare, without going to the length of violating any of their constituted rights"32.
Let us apply all the foregoing to the present situation. We have seen that we apply the notion of 'addiction' in two situations: the behaviour of so-called abusers of legal drugs and users of illegal drugs, whatever their behaviour.
Regarding the first category, alcoholics are not criminalised by their use but by the way their behaviour infracts on other people's liberties. We do not need the conception op addiction to deal with them, exept in a pseudo-medical sense. If they want to be "treated" they can get medical treatment, although all these treatments, with the exception of administering refusal, is not medical but moral in nature, all being derived of the Alcoholics Anonymous' Twelve seps program. This should however not be confused with the real medical treatment of the ailments that are somatic consequences of a continuous high alcohol intake, due to alcohol's innate toxic properties. We may conclude that the notion "addiction" serves here only to indicate a level of alcohol intake with behavioural consequences that we consider deviant.
We have however to note that when societies are suddenly confronted with a new drug, they have no previously developed sociocultural rules, rituals, to regulate it's use. The result is often unchecked use, which can have a highly destructive effect on at least a large number of the members of that society. Examples may not be in particular the introduction of alcohol among Indian tribes in the U.S.A. or among Esquimaux in Canada and Greenland, as the role of alcohol-pushing arms peddlers may obscure the right picture, but the sudden availability of large amounts of alcohol in concentrated form due to the industrial application of the distillation process in western Europe and the availability of heroin in South East Asia are. Although heroin only appeared in these countries after opium became repressed33, we observe that societal regulations that governed the use of opium in these societies did not function with regard to heroin, like the rules applying for beer and wine, did (at least for a time) not function for spirits.
Sometimes these effects can be mitigated: when the new drug in question is introduced as part of a complete new (and dominant) culture, the rules of this new culture can be taken over as well. When, on the other hand, it is just the drug which is introduced no existing rules apply and the drug can have very negative effects on society, independent of it's pharmacological properties.
This perception is highly applicable with regard to the use of the presently illegal drugs. Here hardly any distinction is being made between use, abuse and addiction. Here without any doubt the French bear the palm. Their term "toxicomanie" is being applied with equal ease for those that smoke an occasional joint of Cannabis as for those that we denote as hard core junkies. The fact that over 95 % of users of Cannabis as well as cocaine34,35,36,37 are decent citizens, employed, paying taxes and not infringing the law more than by misdemeanors as parking their car wrongly, with exception of the narcotic law eludes them, as much as this eludes most governments.
They, as much as most of the population, base their opinions on the 5 % that are troublesome, the junkies. This is not surprising as these people are visible and physicians go on taking these people as representative for all users of illegal drugs38.
Thus we can again safely state that the notion of addiction is not applicable on use of illegal drugs. Illegal drug use does not equal the notion of addiction in the pseudo-medical sense as in alcoholism, although it is presently deviant behaviour, the more as the use is being prohibited by the authorities. But, again this deviance has nothing to do with the medical notion of addiction.
So what is left is abuse of illegal drugs. Can we apply the notion of addiction here fruitfully? The behaviour of junkies is, rightly, condemned. But does this have to do with 'drugs' or with a special situation of dependence, in a situation in which the object of the dependence is 'scarce'?
As we saw above, the behavior we call addictive is the behavior that results if a substance causes physical dependence, thus is necessary; lowers stress, thus is pleasurable and is also forbidden, thus scarce, this behavior takes on the pattern of junkie behavior, characterized by stealing, manipulating, considering other people as no more than utensils to be thrown away when unnecessary, etc.
When we observe that many inmates of the Nazi extermination camps have shown the same quote "irresponsible" unquote behaviour, by torturing their fellow inmates, stealing food of others as hungry as themselves, it dawns to us that this behaviour is dictated by the necessity to survive. So junkies with all their rejectable behaviour are just trying to survive. This behaviour is not to be considered pathological, but as a behavioural subroutine present in all of us, but only activated in rather rare circumstances, those were something is perceived as an necessary condition to survive, a condition without its fulfillment survival is perceived impossible. Under such conditions one either resigns and dies or has only one objective: to obtain its fulfillment at any price.
When people are exposed to a reality that is unbearable and are unable to change these circumstances they have two options. Suicide is one of them. The other is surviving by changing their perception of reality. The use of mind-altering drugs is one of them. This situation is not exceptional, the stress relieving effect of the use of legal drugs as coffee, alcohol and tobacco are used in this way, but only limited in time and place. The daily stress of waking up to work is relieved by the use of a cup of coffee, the stress of talking is relieved by many (and count me among them) by a cigarette, the stress of work is relieved by an alcoholic drink after work.
It is only those that are under the permanent stress of an unbearable reality, caused by either often incurable psychic problems, or family situations or unchangable societal factors as poverty and unemployment that need to change their perceptions on a continuous basis to survive. In my opinion it is criminal to condemn this people and to prohibit their drugs of choice and to deliver them to the mafia. To my opinion it is criminal to medicalize them by applying the label addiction-disease. Addiction is a construct that only serves the powerful and serves neither a medical, nor a social aim. I hope you will understand that there are no addictions, because the concept of addiction is nonsense!
- 1 "To find a form of association that defends and protects with all its might the person and the possessions of all its members, and by which anybody who associates himself with the others only obeys himself and remains free as before".
- 2 "Liberty consists of the power to do whatever is not injurious to others; thus the enjoyment of the natural rights of every man has for its limits only those that assure other members of society the enjoyment of the same rights; such limits may be determined only by law.
- 1. Genesis 9:20-25
- 2. EDWARDS,C.: The world's earliest laws. Watts, London,1934.
- 3. 1 Samuel 1:13-15;
- 4. LEIBOWITZ,J.O.: Studies in the history of alcoholism-II.Acute alcoholism in Ancient Greek and Roman medicine. Br.J.Addictions, 1967;62:83-86
- 5. SOURNIA,J.-Ch.: A history of alcoholism. Basil Blackwell, Oxford, 1990.
- 6. FOULFACE, Ph.: Bacchus bountie, Describing the Debonaire Dietie of his Bountifull Godhead. London, Henry Krykham, 1593. Geciteerd door WARNER,J.: Before there was "alcoholism": lessons from the medieval experience with alcohol. Contemporary Drug Problems, herfst 1992,pp.409-429.
- 7. HUSAK,D.: Drugs and rights. Cambridge University Press, 1992
- 8. MERLIN, M.D.: On the trail of the ancient opium poppy. Associated University Presses, Cranbury, 1984.
- 9. ENFIELD,A.: Alcoholism. A disease. JAMA, 1892;18:287-289 reprinted JAMA 1992;267(10).
- 10. YVOREL,J.-J.: Les mots pour le dire. Naissance du concept de toxicomanie. Psychotropes, 1992;7(2):13-19
- 11. MUSTO,D.: The American disease. Yale University Press, New Haven, 1973.
- 12. BERRIDGE,V.& EDWARDS,G.: Opium and the people. Allan Lane, London, 1981
- 13. GOULD,S.J.: Ever since Darwin. Burnett Books Ltd. 1978.
- The panda's thumb. W.W.Norton & Company, New York, 1982.
- The flamingo's smile. W.W.Norton & Company, New York, 1987.
- The mismeasure of man, W.W.Norton & Company, New York, 1981
- 14. ALEXANDER,B.K., COAMBS,R.B. & HADAWAY,P.F.: The effect of housing and gender on morphine selfadministration in rats. Psychopharmacology, 1978; 58:175-179
- 15. HADAWAY,P.F., ALEXANDER,B.K., COAMBS,R.B. & BEYERSTEIN,B.L.: The effect of housing and gender on preference for morphine-sucrose solutions in rats. Psychopharmacology. 1979; 66:87-91
- 16. ALEXANDER,B.K., BEYERSTEIN,B.L., HADAWAY,P.F. & COAMBS,R.B.: The effect of early and later colony housing on oral ingestion of morphine in rats. Pharmacology, Biochemistry, and Behaviour. 1981; 15:571-576.
- 17. ALEXANDER,B.K., HADAWAY,P.F. & COAMBS,R.B.: Rat park chronicle. In: J.S.Blackwell & P.G.Erickson, eds. Illicit drugs in Canada: risky business. Nelson. Scarborough, Ontario. 1988.
- 18. LINDESMITH,A.: Can chimpansees become addicts? J..Compar.Psychol. 39; 1946
- 19. SPRAGG,S.D.S.: Morphine addiction in Chimpansees. Comparative Psychology Monograph 15, no 7, 1940
- 20. SCHUSTER,C.R., RENAULT,P.F. & BLAINE,J.: An analysis of the relationship of psychopathology to non-medical drug use. In: R.W.Pickens & L.L.Heston (ed.): Psychiatric factors in drug abuse. New York, Grune and Stratton, 1979
- 21. JAFFE,J.H.: Drug addiction and drug abuse. In: Goodman and Gilman: The pharmacological basis of therapeutics. 7th edition. MacMillan, New York, 1985
- 22. SIEGEL,R.K.: Intoxication, life in pursuit of artificial paradise. E.P.Dutton, New York, 1989
- 23. SZASZ,T.: Ceremonial chemistry. The ritual persecution of drugs, addicts and pushers. Routledge & Kegan Paul, London, 1975.
- 24. GRUND,J.-P.,C.: Drug use as a social ritual. Rotterdam, Erasmus Universiteit, IVO-reeks no. 4, 1993.
- 25. HARDING,W.M. & ZINBERG,N.: The effectiveness of the subculture in developing rituals and social sanctions for controlled drug use. In: Du Toit,B.M.: Drugs, rituals and altered states of consciousness. Balkema, Rotterdam, 1977.
- 26. TAYLOR,A.H.: American Diplomacy and the narcotics traffic, 1900-1939. Duke University Press, Durham, N.C., 1969
- 27. Captain W.Elliott, M.P., cited in: H.F.Judson: Heroin addiction in Britain. Harcourt Brace Jovanovich, New York & London, 1973, page 17.
- 28. ROUSSEAU,J.-J.: Du contrat social. Book I, chapter VI.
- 29. ibidem: book I, chapter IV.
- 30. MILL,J.S.: On liberty. Chapter I: Introductory. 1859
- 31. ibidem: Chapter IV.
- 32. ibidem: Chapter IV
- 33. WESTERMEYER,J.: The pro-heroin effects of anti-opium laws. Arch.Gen.Psychiatry 33:1135-1139, 1976
- 34. WALDORF,D., MURPHY,S., REINARMAN,C. & JOYCE,B. Doing coke: an ethnography of cocaine users and sellers. 1977. Washington, D.C., Drug Abuse Council.
- 35. MURPHY,S., REINERMAN,C. & WALDORF,D.: An 11 year follow-up of a network of cocaine users. British Journal of Addictions, 1989; 84:427-436
- 36. ERICKSON,P.: A longitudinal study of cocaine users: the natural history of cocaine use and its consequences among Canadian adults. Toronto, Addiction Research Foundation. Final report NHRDP #6606-3929-DA, 1992.
- 37. COHEN,P.& SAS,A.: Ten years of cocaine. Department of Human Geography, University of Amsterdam, 1993
- 38. FROMBERG,E.: Waarom kijken dokters zo scheef. In: Dokters en dope. NIAD, Utrecht, 1994.
©html 1995 drugtext web-lab