The Epidemiology of Opiate Addiction in the United States
The Chinese Opiate Addict in the United States
JOHN C. BALL AND M. P. LAU
Note: Reprinted from Social Forces, 45:68-72, 1966.
It is now established that there are a number of diverse types of narcotic drug addicts in the United States. Included among the major types are white metropolitan addicts, metropolitan Negroes, Puerto Ricans, Mexicans, southern whites, doctors, nurses, female prostitutes, and Chinese addicts. In the present paper the social characteristics of the Chinese drug addicts in the United States are delineated and the implications of narcotic use among this minority group considered.
From 1935 through 1964 more than eight hundred Chinese male narcotic addicts were admitted to the hospital in Lexington, Kentucky. Although this number was but a small proportion ( less than 3% ) of the 32,209 male addicts treated at the hospital during this thirty-year period,' the Chinese are markedly overrepresented inasmuch as they constitute less than two-tenths of one percent of the United States male population? Furthermore, it seems efficacious-in our continuing efforts to explain the phenomenon of narcotic addiction-to study various apparently distinct groups of addicts in order to effect comparisons and thereby broaden our knowledge.
The sample selected for study consisted of all addict patientsof Chinese ancestry who were discharged from the Lexington hospital during a five-year period from July 1957 through June 1962. There were 137 Chinese male patients and one female discharged during this period. The present report refers only to the 137 Chinese males. Data on each patient was obtained from the medical records of the Lexington hospital.
The Chinese Sojourner Life Pattern
The Chinese narcotic addicts hospitalized at Lexington exemplify the sojourner way of life described by Rose Hum Lee.$ Of Chinese birth and ancestry, these young men migrate to America to seek their fortune with the intent of returning to their homeland and becoming landowners or businessmen. The sojourner is, then, a migrant whose goal is a return with wealth to his native land. He is not interested in acculturation to the host culture; he learns what is necessary for his practical occupational accommodation but otherwise lives a segregated and alien way of life. The Chinese narcotic addicts of the present study were unsuccessful sojourners.
Of the 137 Chinese male addicts, 99 ( 72% ) were born in China; all but one of the remaining subjects were born in the United States. This latter circumstance reflects the fact that some of these addicts were the children of sojourner parents.
With respect to parentage, in 94 percent of the cases one or both parents were born in China. Since the sojourner is male and commonly returns to China for marriage, more of the mothers than fathers were born in China ( l I0 versus 58 ) .'
At the time of their admission to the Lexington hospital, the 137 Chinese addict patients were exclusively metropolitan residents and predominantly from New York City; 102 of the patients were from New York City, 19 from Chicago, and the remaining 16 from other U.S. cities.
The two common occupations followed by the Chinese addictswere laundry and restaurant work ( Table 14-I ) . The absence of unemployment or full-time illegal occupations among these addicts is notable when contrasted with other lower-class addict populations.
The Chinese addicts were an older group at the time of their last Lexington hospitalization ( Table14-II ) . Their mean age of fifty-three years is more than twenty years older than that of the hospital population."
The Chinese addicts were more alienated from their families than their current marital status indicates. Of the 137 males, 31 percent were single, 55 percent married, 12 percent widowed, and 2 percent separated. A tabulation of their present household composition, however, revealed that 88 percent of the males were not living with family members, only 10 percent were living with their wives, and 2 percent were single but living with their parents.
At the time of their last Lexington hospitalization, the principal opiate used by the Chinese addicts was heroin, and it was commonly used intravenously. Of the 137 patients, 124 used heroin,7 morphine,4 opium, and 2 Dolophine®.
Most of the Chinese patients had a long history of opiate addiction. The onset of opiate use usually occurred before age thirty ( Table14-III ) ; this was some twenty years before their current hospitalization. With respect to opiates ever used, 44 percent of the addicts had only used heroin, while 53 percent had at some time used opium; 3 percent had used morphine exclusively. Use of barbiturates was not common ( use denied by74% of the patients), and no use of marihuana was recorded.
A Composite Case History
A composite case history of the Chinese male addict of this study affords a means of synthesizing the tabular data and depicting the addict sojourner's way of life. This modal case history is based on data from the patients' medical records.
The typical Chinese addict in this sample was fifty-three years old, born in the Sze Yap district of South China, of Chinese parents. Brought up in China by his mother and having completed Chinese grammar school there, he came to the United States at age twenty to join his father and the community of sojourners. He carried on the tradition of resisting acculturation and assimilation, dedicated himself to the accumulation of wealth so that he could return to China as soon as possible. He spoke poor English; he was obedient, modest, fearful of authority, and suspicious of the whites.
He was an industrious worker and a thrifty spender; his outlook on life vas narrow, and he tended to withdraw and insulate himself within the Chinese community. He claimed U.S. citizenship but no military service.e He had been a worker in laundries or restaurants for decades, and these were the only trades he knew. His jobs were unstable, and he worked irregularly when he was heavily addicted. He earned thirty-six to fifty dollars per week when he was regularly employed.
He lived alone or with co-workers in shabby rooms near his working place-in New York City's or Chicago's Chinatown. His address often changed. He had little recreation, social life, or spiritual life.
He had returned to China to get married, but his wife and children were left in China, partially dependent on him. Formerly, he visited them as frequently as possible. He was now without resources to effect a reunion, in either China ° or in the United States.
At the time of his last admission to the Lexington hospital in the 1960's he was a heroin addict using this drug by injection. He spent ten dollars per day on heroin which he secured from drug peddlers. In so doing he needed somewhat more than his regular wages to make ends meet. He might borrow from his acquaintances, or, become more or less involved in drug traffic and underworld associations. He admitted having run afoul of the law because of possession or transportation of narcotics, but denied criminal history before addiction." No violent crime or other comparable antisocial behavior was on record.
The typical Chinese addict in the sample came to the hospital as a voluntary patient, seeking treatment because of financial distress, shortness of drug supply, or deteriorating health. He had an uneventful withdrawal from physical dependence while hospitalized and left the institution against medical advice within four weeks' time, giving various excuses.
If he stayed longer, it would be to obtain medical or surgical treatment for some somatic illness.' He was domiciled with the other Chinese patients and with them formed an isolated community of their own. He was a good worker in the Dietetic or Clothing Services and aimed to please those in authority. He had few complaints and did not understand how the nonphysical treatment facilities in the hospital could help him. After discharge from the Lexington hospital the Chinese addict returned to work at his old job.
The Chinese narcotic addict of the present study has a number of characteristics which differentiate him clearly from other addict groups in the United States. He is foreign born and markedly alienated from American culture. In his employment, family life, religion, recreation, and social existence he has kept to himself or to a few Chinese associates."' His attitudes and personality reflect this alienation: American goals and values are not a part of his way of life. Now in his later years the addict sojourner finds that his life's goal is beyond attainment, he has neither the financial resources nor the political possibility of returning to his homeland. And yet, one cannot but note the initial motivation required to cross the Pacific in search of success nor forget the fact that the sojourner has been an assiduous worker despite the restricted opportunities which were available to him in the NewWorld.
The high incidence of hospitalization of Chinese-American addicts at Lexington during the past thirty years provides substantiation for the reports in the criminological literature of high rates of opiate use by the Chinese in the United States. Terry and Pellens'1 held that opium smoking was introduced to the United States by Chinese laborers brought to California after 1850. In 1914 Lichtenstein reported that opiate addiction in New York City was most prevalent among Orientals." The U. S. National Commission of Law Observance and Enforcement"' reported in 1931 that the Chinese had a low crime rate in Stockton, California, but of those arrested a high proportion were for narcotic violations. Lemertl' reported similar findings for Los Angeles County in 1938; of the felonies reported for Chinese, 44 percent were for narcotic violations. And Bingham Dailb found that the Chinese were overrepresented among Chicago addicts.
The question arises as to why there has been a high incidence of opiate addiction among Chinese-American males. While no definitive answer can be advanced, several comments are relevant. To begin with, opiate use among Chinese populations outside of the United States is not an insignificant fact. Thus, opiate use bas been a part of contemporary Chinese culture, and this deviation has been transmitted from generation to generation. The present widespread use of opiates in Hong Kong is an outgrowthof varied cultural forces, but it has persisted.l8 In the United States the segregated, ghetto way of fife of the Chinese-Americans has restricted the available types of deviation, as life in America for the Chinese has similarly restricted their employment opportunities to menial or noncompetitive occupations. It seems likely, then, that the use of opiates among Chinese-Americans was associated both with an existing cultural pattern and restricted access to alternative modes of behavior. In this regard, it is pertinent to note that a high incidence of drug addiction has not been observed among Japanese-Americans.
Even more provocative is the question of why narcotic drug abuse among the Chinese in the United States has markedly decreased during the past decade and particularly since 1960. This decrease has been reported by the Federal Bureau of Narcotics and noted from Lexington admissions. From 1955 to 1964 the annual number of new Oriental addicts reported to the Federal Bureau has decreased from 275 to 34-a tenfold decline from 3.0 percent of new addicts to 0.3 percent. During the same period, Chinese addict male first admissions to Lexington have decreased from fifteen to two."
Inasmuch as narcotic addiction in the United States is currently entwined with minority group status, it is particularly meaningful to consider why such an association may be terminated. Is it that the Chinese-Americans have been acculturated in the second generation? Or was the high incidence of opiate addiction a part of the sojourner way of life that has now ended? Or has the present generation of Chinese-Americans turned to other types of deviant behavior? Has the availability of drugs ( or lack of drugs) been a contributing factor? This last factor seems unlikely to account for the decreased incidence of addiction among the Chinese, as they primarily reside in cities with sizable addict populations.
We are inclined to view the virtual termination of opiate addiction among Chinese-Americans as a reflection of an ongoingprocess of modernization of the Chinatown communities and the gradual dissolution of the old type of addict subculture hitherto fostered by these communities. This process has been furthered by the severance of cultural ties with the homeland after the Communists' take-over of mainland China in 1949. Some thirty years ago a young Chinese voiced a common but prophetic opinion about narcotics use: "The traffic in narcotics by Chinese in the United States will blow over like a broken branch in the next generation."18
In this study of Chinese narcotic patients hospitalized at Lexington, it has been found that these addicts were unsuccessful sojourners. Migrants to America in search of wealth, these Chinese males were alienated from the main currents of American life. They lived in metropolitan Chinatowns, worked in laundries or restaurants, and were separated from their families. At the time PART IV of their present hospitalization for opiate addiction (1957-1962 ) these patients were an older group ( 53 years) with a long history of drug use. Evidence of the high incidence of opiate addiction among Chinese-Americans during the first half of the twentieth century was discussed. By the 1960's opiate use within this minority group had almost terminated. Probable reasons for this outcome were considered.
1. Ball, John C., and Cottrell, Emily S.: Admissions of narcotic drug addicts to Public Health Service hospitals,1935-63. Public Health Reports, 80, Table 2, June1965.
2. In1980 there were135,549 males of Chinese ancestry living in the United States; U. S. Bureau of the Census:U. S. Censor of Population: 1960, General Population Characteristics, United States Summary. Final Report PC( i )-1B, Table 44.
3. Lee, Rose Hum:The Chinese in the United States of America. Hong Kong, Cathay Press,1980, Ch.5.
4. All of the fathers of these patients were Chinese; all of the mothers were Chinese except for two white mothers and one Negro mother.
5. in 1963 the mean age of the 1,923 male addicts admitted to Lexington was 32.5 years
6. Of the 137 patients, 128 claimed U.S. citizenship, and 22 had U.S. military service.
7. . In recent years this was Hong Kong.
8 . Only 20 of the 137 patients deniedinvolvement with the law; 39 had one or more prisoner admissions to the Lexington hospital.
9. . Many of the illnesses that the patients had were of a painful respiratory or geriatric nature. Thirty-three patients received surgery during hospitalization; among the common illnesses treated were peptic ulcer, prolapsed hemorrhoids, and chronic lung diseases.
10. or a description of this way of life, see Siu, Paul C. P.: The Isolation of the Chinese Laundryman. In Burgess, Ernest W., and Bogue, Donald J. ( Eds. )
11. Terry, Charles E., and Pellens, Mildred:The Opium Problem. New York, Bureau of Social Hygiene, 1928, p.73. A leading Indian authority on opiate addiction has expressed the same opinion concerning the introduction of opium smoking in the U.S.-Chopra, RN., and Chopra, G.S.: The opium smoking habit in India,The Indian Medical Gazette, 73:82, 1938.
12. These Oriental addicts were Chinese addicts, and Lichtenstein was referring to the proportion among the various races. Lichtenstein, Perry M.: Narcotic addiction.New York Medical journal, 100:964 1914.
13. Report on Crime and the Foreign Born. Washington, D.C., U.S. Government Printing Office, June 10, 1931, p.383.
14. Lemert, Edwin AZ.: SocialPathology. New York, McGraw-Hill Book Co., Inc., 1951, p.291.
15. Dai, Bingham:Opium Addiction in Chicago. Shanghai, China, The Commercial Press, 1937, p.48. Dai noted that "other races" had about seven times the incidence of addiction as their proportion in the general population and that these addicts were mostly Chinese.
16. Hess, Albert G.:Chasing the Dragon. New York, The Free Press, 1985.
17. A similar decrease of opiate addiction among the Chinese in Canada has been reported; see Stevenson, George H.: Drug Addiction in British Columbia. Unpublished research report, The University of British Columbia, Vancouver, June 1956, Chaps. 23, 24.
18. Report on Crime and the Foreign Born, op. cit., p.383.