From: pez@manhattan.com (Gizmo) Subject: Re: Heroin: Lessons from Vietnam Date: 1996/10/01 newsgroups: alt.drugs.hard >Lessons from the Vietnam > Heroin Experience [...] > Perhaps our most remarkable finding was that only 5% of the men who became > addicted in Vietnam relapsed within 10 months after return, and only 12% > relapsed even briefly within three years. Treatment did not account for > this high recovery rate. Most Vietnam addicts were not even detoxified > (withdrawn from the drug under supervision) while in service, and only a > tiny percentage were treated after return. The few who did enter treatment > relapsed at the same rate as male civilians their age in the Federal > Narcotics Hospital at Lexington. Nor did recovery require abstention. > Nearly half of the men addicted in Vietnam tried opiates again after > returning, but few became readdicted. After correcting for drug problems > and antisocial behavior earlier in life, we found that the rate of heavy > heroin use among veterans in the second and third years after their return > was no higher than the rate among the civilians to whom we compared them. > There was no evidence that Vietnam service itself increased the risk of > long-term serious heroin use. [...] This was one of my points that I was making a few days ago about the "genetic" tendency's to addiction. What you sited above has been demonstrated a number of times in random testing. Take one thousand random folks from various walks of life, circumstance, men, woman etc. Give them a bunch of heroin for a while and then follow up the study to see who wants to do it again, and how many will become long term abusers of that drug, and I believe you get about the same results as this study showed. Now the reasons why that small percentage of users go on to long term abuse may not be genetic. But I do believe there is some biochemical link that causes some of us to love and abuse this drug. Maybe we have a natural opiate shortage in our brains and if that's the case, isn't that determined by our genes? Further, another question that I've raised here is how much different is our behavior from our phsyical charatoristics. You got no choice in how tall or short you are. In your hair color, or your skin color. The whole thing is mapped out when you are just a few cells in a womb. Psychology. Why is it that more and more we are finding out that for every psychological state, i.e. anger, joy, sadness, depression, hatred, love, etc., there are findings that these states are linked to, connected with and/or even caused by a corrosponding hormone or enzymne in the body? I guess you could make the old, "What came firs? The chicken or the egg," theory about this. But it seems to me that "states" are more tied to biochemistry than they are to psychology. Gizmo ==================================================================== From: (Peter McDermott) Subject: Re: Heroin: Lessons from Vietnam Date: 1996/10/03 newsgroups: alt.drugs.hard smisch wrote: >The problem with drugs is that they may step over a line dividing mere >behavior from something like brain surgery. Take enough smack, and it >ceases to matter whether you were born wired closer to or further from >"addicted", you will redesign yourself sooner or later. Yeah, this is my take on it precisely Ñ it doesn't matter whether or not someone has a genetic predisposition, if you do the drug for long enough and in large enough doses, the chances are you'll be digging in the dirt like the rest of us. But the thing that so many deterministic accounts of addiction often leave out is the fact that as humans, because we have the capacity to re-wire ourselves, we can wire ourselves clean as well. I think it's infinitely more difficult than wiring up the addiction pathways, but the existence of so many _ex_ users proves that it's possible. The key issue usually is, what is the cost, and for many people, the costs of getting clean are far higher than the costs of some sort of maintenance strategy. ==================================================================== From: (Peter McDermott) Subject: Re: withdrawal Date: 1995/10/01 Message-ID: #1/1 newsgroups: alt.drugs.hard In article <44l986$ih9@ixnews2.ix.netcom.com>, acie wrote: >It was indeed my choice to try drugs in the first place. Nobody >made me do it. I just happened to belive (like every junkie that >I've ever known) that "I won't get hooked. I'm stronger and smarter >than they (the junkies) are". I've got the strength/determination >and will power to prevent it". Personally I now chalk that old belief >up to ignorance. Because after all I was only thirteen years old at >the time. But, be-that-as-it-may you're right about one thing. Drug >addiction IS some sort of sickness. I don't know if it's a disease, >an affliction or just an oddity. But I do know it does exist. It's >not "stupidity". Nor is it a "learned response". I personally think >it's an uncommon disease that is contracted the first time you >introduce narcotics into your body AND it crosses your mind that you >like it. I'd just like to add my agreement to Ace's point here (and like him, I've got a good few years under my belt so I've seen a fair bit.) This thing _isn't_ about will power. I personally don't believe that addiction is a 'disease' as such -- I prefer to see it as some kind of disorder of the will -- albeit one that is chemically determined. I think that there is far too little emphasis placed these days on the role of the chemical. After all, as someone keeps pointing out on another thread, our bodies are made of chemicals, and if we introduce a new one it _will_ change the chemical balance, and thus who we are, in some sense. That doesn't make it impossible to function without opiates eventually -- but it does make it much harder, by several orders of magnitude. And I don't think it's necessarily about ignorance either. The equation is simple. If you do the drugs often enough -- and you are prone -- you will end up with a habit. What opiates actually seem to do is _change_ the will. Change the nature of your desire, so that at first, life without them no longer seems desirable, and then it no longer seems possible. And I've seen people who were very smart and fully aware of what the consequences could be who said, 'It can't happen to me. I'm too smart. I'll just do it occasionally and I'll be able to control it." And they could at first, but as time passes, getting high becomes more important than controlling it. And you're aware of what is happening, but somehow powerless to change the nature of your desire which is gradually being reshaped your the use of the drug. One last point. We've been subject to bullshit from prohibitionists and abstentionists in their statements about drugs and addiction for years and years. Now that the time is turning, I think that we'd better learn from their mistakes and make sure that _our_ statements are backed up by reality and experience -- rather than the type of wishful thinking that says just because something is possible, it's generalizable in all cases. Some small proportion of people _are_ capable of controlled opiate use -- but the longer they've been using, the more likely it is that they will fuck up. And a much higher proportion start on that road to addiction on day one. And there isn't any way of telling which group _you_ fall into until you find yourself in that prison cell, sweating and crying and praying for a fix. ==================================================================== From: Raymond Prick Subject: Re: Addiction: "Nature Or Nurture?" Date: 1996/10/14 newsgroups: alt.drugs.hard Re: Addiction: "Nature Or Nurture?" [...] Reading messages and articles of the a.d.h. newsgroup for over a week or so now, it is more or less what I'd expected to find: a/o AA, AN & the miraculous 12 steps (they never worked for me!), rebellious pieces (Dole on Dope!), scandals (CIA on Coke!), HELP!, "war stories" ("Thank you, Gizmo, for your amazing adventures which I enjoy reading" ), informative articles, debate & dispute... ...but I also get the feeling I've missed some points-never mind, I'll catch up with you guys-for example the dispute, in which Peter McDermott and Smisch say there's just no sound scientific evidence that addiction is a disease caused by the genes, whereas Gizmo will go for genetics, given the choice-see, e.g., the articles "Re: Drugs: The Universal Growth Inhibitor" (Articles #: 3073, 3077) and "Re: Heroin: Lessons From Vietnam" (Articles #: 3212, 3215, 3219). Biologists tend to put it thus: "Nature or Nurture?" Is a certain trait, or disease for that matter, caused by the genetic constitution of the individual ("Nature"), or is it caused by environmental factors, and thus acquired later in life ("Nurture")? It's an essential question in many fields of biology, clearly in genetics, evolution, ecology, etc., and also in developing clinical methods for treatment and ultimately in justice. Peter McDermott sure sounds like an expert and his remarks confused me somewhat, because my recollection of the literature is that addiction is a disease, caused in part by genetic elements. Thus I reread a special on DRUGSVERSLAVING (Drugs addiction), the 16 December 1995-issue of the Dutch Medical Journal (Nederlands Tijdschrift voor Geneeskunde). VARIOUS MODELS OF ADDICTION Prof. dr. W. van den Brink (1995) reviews the "Etiologie en pathogenese van verslaving" ("Etiology and pathogeneses of addiction")-Etiology is the study of the causes of a disease-and firstly describes the various models of addiction: (1) moral model Until far in 19th century the 'moral model', dominates and addiction is considered sinful and immoral behavior based on conscious and voluntary made free choices of the individual. (2) pharmacological (addiction) model At the end of the 19th century, this model changes into the 'pharmacological (addiction) model'. By the end of the 19th century the line of thinking about the cause of the addiction changes and the emphasis now lies on the dangerous, and necessarily addictive substance itself. This model leads in the 1920s to the prohibition in the USA. But even nowadays, many still use this model when it involves substances like alcohol, cannabis, heroin, or cocaine and leads to the well-known 'war against drugs'campaigns! It is, "unjustly", believed that these drugs exert such a strong addictive and destructive action that problems can only be avoided or dissolved by total abstinence. (3) disease model (traditional view). In the 1930s the 'disease model' is developed: there are fundamental biological and psychic differences between addicts and non-addicts. The diagnosis of addiction is 'loss of control' (use more, or more often than initially planned). It's main implication is that moderate use of addictive drugs is possible for non-addicts, where-as for addicts the only alternative is total abstinence. (4) disease model (psycho-social dynamic). Modification of the 'disease model'. Differences between addicts and non-addicts are not strict but relative: there exist smooth transitions between (moderate) use, excessive use, abuse and dependence. (Even spontaneous recovery of heroin addiction occurs!) Addiction is seen as the continuous interaction between the genetically determined (biological) vulnerability of an individual and his (her) psycho-social circumstances. GENETIC VULNERABILITY Furthermore...contrary to what Peter McDermott says, I found evidence that genetics is involved in the development of a drugs addiction This is shown by: (1) family history studies: Under the paragraph-heading "Genetic Vulnerability," Prof. Dr. W. van den Brink writes: "Addiction is a familial disease. (...) It is, therefore, not surprising addiction occurs more often in children of addicted parents than in children of non-addicted parents. Family history studies show that children having 1 alcohol addicted parent have a circa 4 times greater risk of becoming addicted themselves, i.e. 20-25% of the sons and 5% of the daughters. For children having 2 addicted parents these percentages may rise as high as 40% for sons and 10-15% for daughters. Furthermore," and this is very important ! , "research on twins and adopted children, have made it plausible that at least a part of the familial burden can be attributed to genetic influences. (...) There is much less emperic research into the causes of drugs addiction, (...) [but] the available research points in the same direction as the alcohol research."[1] (2) genetic research/molecular biology: "...back in 1990," Van den Brink continues, "it looked like the gene for alcohol addiction was found." But, of course, it was too good to be true; "we know now the situation is a lot more complex." Researchers identified the DRD2-gene (the dopamine D2-receptor) on chromosome nr. #11, which among others seems to be implicated in, let's say, the "depth" (seriousness) of an alcohol addiction and drugs addiction; [see note 1] (3) pharmacological research: (this surely is Gizmo's line of thought: "biochemistry, enzymes,...") it was shown, writes Prof. Dr. J.P. van Ree in his review article, that test animals (apes, rats) learned to become addicted and to self-administer (iv, orally) substances which are addictive in humans (heroin, cocaine, alcohol, etc.); substances which are not addictive in humans, the test animals normally didn't self-administer.[2] (4) pharmacological research: another line of research, Van Ree goes on, demonstrated that in normal physiology addictive substances (endogeneous endorphins) are present in the brains of humans and animals...More-over, the brain of humans and animals appears to have a "neuro-chemical substrate for addiction!"-The question thus is: "Why does not everyone become addicted?" Apparantly inhibiting factors exist, Van Ree concludes, and knowledge of these factors may be useful to lower the incidence of drugs addictions...[etc.]."[2] So, is drugs addiction "Nature or Nurture?" The answer is already given: it's both! There's mounting scientific different people have a different, genetically determined vulnerability to develop a drugs addiction. Whether someone actually develops an addiction, is most probably a combination of his/her genetic vulnerability and his/her psycho-social circumstances. Furthermore, genetics appear to be implicated in how serious someone gets addicted. Indeed, I know of people who'd sell their mother, so to speak, to get their daily dose of heroin. But I also know people, like myself, who keep within certain limits and hold on to their ethics. I'll never use the needle, e.g., and prefer to kick the habit over stealing, cheating and lying. I agree with Peter McDermott there's a risk a model is chosen just because it has an apparent pragmatic advantage, e.g. in the juridical system, politics, etc. A model should firstly describe an accurate view of our present biological and medical knowledge of the phenomena and the underlying causes. Its outcome, then, can be used for treatment, policy positions, law enforcement strategies, and so on. Also, when it is shown that addiction runs in the family, this does not implicitly mean, an individual can not be held responsible for his or her actions. On the other hand, the knowledge genetic elements are involved (in the development of an addiction) may lead to mitigating circumstances. But that's up to the judges and the society as a whole. All I plead for is an accurate model of addiction based on the biological and medical findings. Last, but not least: Can somebody please explain to be what the hell "Lessons From Vietnam" have to do with the Nurture Or Nature-question. What Lessons? What did you learn from Vietnam (apart from the fact that War is totally senseless)? C.U., Raymond, Ray's Penthouse, Maastricht, the Netherlands 14-10-96 3:29 / 5:32 (CET, Central European Time) Notes [1] W. van den Brink, 1995. "Etiologie en pathologie van verslaving." Nederlands Tijdschrift voor Geneeskunde, 139/50 (16 December 1995): 2606-2610 [in Dutch] [2] J.M. van Ree, 1995. "De farmacologie van verslaving." Nederlands Tijdschrift voor Geneeskunde, 139/50 (16 December 1995):2606-2610 [in Dutch]