Opioids Heroin addiction is just context and willpower?

[Jabberwocky]

I’ve lately read a number of articles arguing that heroin relapses are predominently the result of context and weak willpower.

All of these articles use the case of addicted american GI’s in the vietnam war as evidence. Apparently while 15 % of US soldiers were heroin addicted when they left vietnam, only 5 % of these soldiers relapsed and maintained a habit when they returned home (because new non-drug context + willpower).

Does anyone know if this story is true and, if so, why addicts today need lifelong substitution therapy when those in the 1970s did not.

 

[JTemperance]

I’ve lately read a number of articles arguing that heroin relapses are predominently the result of context and weak willpower.

All of these articles use the case of addicted american GI’s in the vietnam war as evidence. Apparently while 15 % of US soldiers were heroin addicted when they left vietnam, only 5 % of these soldiers relapsed and maintained a habit when they returned home (because new non-drug context + willpower).

Does anyone know if this story is true and, if so, why addicts today need lifelong substitution therapy when those in the 1970s did not.

My post from the other thread has more bearing on this one. I'm quoting it below:

Yes. And unsurprisingly, the GIs likeliest to resume heroin use in the US were those from neighborhoods with high unemployment, limited social mobility, and a saturated drug market (i.e. "the ghetto" in the early 70s). The relative inaccessability of the drugs combined with a return to mainstream American norms and the stabilizing influence of family/community/career meant that most veterans returning to Middle America could leave behind a behavior (or "addiction") that made perfect sense in the context of the war, once the withdrawal was completed.

We might question how many parts of the US (or other countries) have the same confluence of factors that Middle America circa 1971 did... there aren't quite as many places where drugs are unavailable or even uncommon, or where well-paying jobs with long-term futures are readily available to high-school graduates, or where community cohesion is tight and a stable family structure is the norm.

I'd suggest that social context, not just immediate personal context, plays a big role in determining the outcomes. Soldiers in Vietnam were drawn from a mostly working-class cross-section of the country at a time when working-class social mobility (real wage gains, homeownership, unionization, etc.) was pretty much at its historical peak, communities were more closely knit, and most children grew up in two-parent families.

Heroin use at the time was concentrated near-exclusively in a handful of slum neighborhoods in a handful of major cities, where the majority of addicts were black and Puerto Rican (or Mexican in Texas/LA) with a smattering of ethnic whites and a sprinkling of hippies joining them by the end of the 60s. Outside of college campuses (marijuana/LSD) and truck stops (amphetamines), drug use in any form was virtually unknown across wide swathes of the country, and drugs themselves were virtually impossible to acquire. Even in the few drug markets that existed, hard drugs were very expensive (in real dollars per pure gram) compared to today's prices,

Today, every socioeconomic indicator for the working-class is down from what is was 50 years ago, and the stabilizing forces have largely evaporated. At the same time, drugs are now accessible not only in every city of any size, but throughout rural and small-town America. You can extrapolate from the American situation to other countries, though few countries match the USA for the hope-destroying effect of felony convictions given out on a large scale.

A despondent outlook for future success and limited objective opportunities for social advancement combined with easy access to cheap and potent drugs constitutes a social context that predisposes larger numbers to chronic addiction, regardless of willpower. Willpower is something individual but it is reinforced and built up by the social interactions that the individual has. The more promising the circumstances, the easier it is to exercise the willpower.

 

[JessFR]

It might well be technically true. But there's a big difference between addiction and dependence. People confuse them all the time and given the context, assuming it's true, it's almost up to 15% dependent, not 15% addicted.

Some people take heroin several times, stop, then never touch it again. Some people even take it enough to get a mild dependence, stop, and don't go back.

Other people try any opioid, once, and are sucked in for life. Still wanting it years after getting off it. It all depends on your nature, if you as an individual are predisposed to addiction, and opioid addiction in particular.

I don't think anyone really knows what proportion of people are predisposed. So it's very hard to say how many people will react one way vs another. But it is quite possible that a majority is not predisposed, and so have an easier time staying away.

This is why some people seem to get addicted after trying it once, even though you simply can't become dependant that fast. They're not dependant yet. But already they just can't seem to help themselves from taking more, even if they had just recently planned not to.

So I suspect that accounts for some of the difference. I also wonder just how accessible substitution therapy really was for them at the time. If it wasn't as simple for them to take that option, that would play a part too.

Now, none of this is to say that willpower has no role to play at all. But I'd say it's a pretty minor one all things considered. Even if it is though, will power, just like predisposition to addiction, is part of who you are. It's not equal for everyone.

EDIT: The post above mine makes a good point too. It's gonna be easier to get off it if it's harder for you to get. That's why people move to a completely different place when they quit sometimes, and throw away their dealers numbers and shit. Even if drugs are around, just delaying access to them for a little bit can make it easier to maintain sobriety. Not to mention that if people are using all around you, staying off it is gonna be so much harder.

It's probably no one thing, it all adds up.

 

[WellTram]

Addiction, withdrawal, cravings.. Its all psychological but it stems from chemical changes in addict's brain. So in my opinion, willpower is individual and some of us have more of it and can use it to stop the habit. Relapses are all psychologically triggered but the main reason is missing or imbalanced chemicals in your body, the brain asks for endorphins and dopamine it used to get in past. But these chemical changes are time-reversible and recovery time is higly individual and depends on your attitute, life-style (exercise, eating right...) and support from your friends/family/maybe doctor.

 

[Iceman1216]

My post from the other thread has more bearing on this one. I'm quoting it below:


I'd suggest that social context, not just immediate personal context, plays a big role in determining the outcomes. Soldiers in Vietnam were drawn from a mostly working-class cross-section of the country at a time when working-class social mobility (real wage gains, homeownership, unionization, etc.) was pretty much at its historical peak, communities were more closely knit, and most children grew up in two-parent families.

Heroin use at the time was concentrated near-exclusively in a handful of slum neighborhoods in a handful of major cities, where the majority of addicts were black and Puerto Rican (or Mexican in Texas/LA) with a smattering of ethnic whites and a sprinkling of hippies joining them by the end of the 60s. Outside of college campuses (marijuana/LSD) and truck stops (amphetamines), drug use in any form was virtually unknown across wide swathes of the country, and drugs themselves were virtually impossible to acquire. Even in the few drug markets that existed, hard drugs were very expensive (in real dollars per pure gram) compared to today's prices,

Today, every socioeconomic indicator for the working-class is down from what is was 50 years ago, and the stabilizing forces have largely evaporated. At the same time, drugs are now accessible not only in every city of any size, but throughout rural and small-town America. You can extrapolate from the American situation to other countries, though few countries match the USA for the hope-destroying effect of felony convictions given out on a large scale.

A despondent outlook for future success and limited objective opportunities for social advancement combined with easy access to cheap and potent drugs constitutes a social context that predisposes larger numbers to chronic addiction, regardless of willpower. Willpower is something individual but it is reinforced and built up by the social interactions that the individual has. The more promising the circumstances, the easier it is to exercise the willpower.

Thank you this is so well written that I have cut and pasted it to my recovery work book, for my next run in with some one in denial!!!

 

[Jabberwocky]

My post from the other thread has more bearing on this one. I'm quoting it below:

I'd suggest that social context, not just immediate personal context, plays a big role in determining the outcomes. Soldiers in Vietnam were drawn from a mostly working-class cross-section of the country at a time when working-class social mobility (real wage gains, homeownership, unionization, etc.) was pretty much at its historical peak, communities were more closely knit, and most children grew up in two-parent families.

Heroin use at the time was concentrated near-exclusively in a handful of slum neighborhoods in a handful of major cities, where the majority of addicts were black and Puerto Rican (or Mexican in Texas/LA) with a smattering of ethnic whites and a sprinkling of hippies joining them by the end of the 60s. .

A lot of people argue that the solution to 'the drug problem' is to de-criminalise drugs and treat them like a health problem, which is fine as far as it goes. However, if your description is true (which I think it is) then the State should look to socio-economic policies rather than either the criminal law or the health system to reduce the 'ravages of drugs' and high levels of dependence.

Although there are a lot of people on BL proud of the fact that they maintain a job and an addiction (good for them) there's a lot to be said for a loving home (as both child and adult) and a meaningful and properly remunerated purpose in life as pillars of sobriety and general welfare.

However, my understanding of American politics and culture is that as far as governmenbt involvement goes, anything that looks like social engineering or community building never flys in the land of individual rights and freedoms.

 

[JessFR]

A lot of people argue that the solution to 'the drug problem' is to de-criminalise drugs and treat them like a health problem, which is fine as far as it goes. However, if your description is true (which I think it is) then the State should look to socio-economic policies rather than either the criminal law or the health system to reduce the 'ravages of drugs' and high levels of dependence.

Although there are a lot of people on BL proud of the fact that they maintain a job and an addiction (good for them) there's a lot to be said for a loving home (as both child and adult) and a meaningful and properly remunerated purpose in life as pillars of sobriety and general welfare.

However, my understanding of American politics and culture is that as far as governmenbt involvement goes, anything that looks like social engineering or community building never flys in the land of individual rights and freedoms.

Socialism is a dirty word in America unfortunately. Also there's a lot of money invested in the status quo.

Way I see it, it should be both, it's a health problem and should be treated as such, but there are also socioeconomic factors to it and they should be improved as well.

Unfortunately you're right and it's a major effort to try and make these kinds of changes. But I'm hopeful that it'll happen sooner or later. It always seems impossible right up until it happens. Then people realize it was inevitable.

 

[sekio]

It's also interesting to note that the first use of methadone as replacement therapy (Dole and Nyswander) was 1965. The prevailing attitude at the time was that opioid dependency was a moral failing & despite the evidence that maintenance therapy both reduced drug use and related mortality and gave addicts a chance to get their life together, widespread acceptance of the technique took a while and many doctors did not want to deal with such a "dirty" business, and/or needed specific licensing to do so, outside of typical controlled-substance licensing.

It's before my time but I expect there were many doctors who would "treat" your street narcotic habit by cold-turkey detoxing, maybe attendance at Narcotics Anaonymous, and that methadone therapy was seen as little more than government funded narcotics to abuse. Now, it's established that opioid replacement therapy is basically a first-line treatment and is way more effective. I believe that part of why is that the OxyContin overprescription epidemic lead a bunch of middle age, white Protestants into addiction, which meant suddenly the problem was no longer just for filthy street junkies, the African-Americans, and white punk kids, and therefore $$$ was put into treatment options.

 

[inzn]

It's a Combination of everything... It's not a simple answer. Some people like myself, when they find opiates they think they found the panacea. The best thing everything, Gods own medicine. Far from the truth, it makes you lose everything slowly as you go deeper into addiction. But it is not a lack of willpower to get clean what is wrong, your brain is hijacked by the opiates and its a long rocky road to get back to normal again. Some ppl can handle the sickness, others don't. I don't think ppl should be treated with suboxone of methadone tho. The most humane answer would be to give them pure dope to dope addicts. Just enough for them to get well and not get high. That would be ideal and lots of money would be saved(lower crime rate, less ods, less homeless ppl, more ppl paying taxes). Its a long way till that option will be available to everyone since there is so much prejudice towards addicts in society. OH Well let's just wait, in the mean time I'll just stay clean. Xp

 

[JessFR]

I don't think ppl should be treated with suboxone of methadone tho. The most humane answer would be to give them pure dope to dope addicts. Just enough for them to get well and not get high. That would be ideal and lots of money would be saved(lower crime rate, less ods, less homeless ppl, more ppl paying taxes). Its a long way till that option will be available to everyone since there is so much prejudice towards addicts in society. OH Well let's just wait, in the mean time I'll just stay clean. Xp

I would allow all 3 personally. The advantage of methadone and subuxone is that they're longer lasting. While with heroin you go from feeling fine to really sick crazy fast. The other issue with heroin is IV use. Even in the best of cases it has its own series of health problems.

I still agree with you that it should be allowed too, and I think it's increasingly being seen as a legitimate option. But I don't think it should be the only option.