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Written by Virginia Berridge Thursday, 28 January 2010 00:00 - Last Updated Tuesday, 24 May 2011 14:58
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very importantly contributes to the enhancement of this `learnt drive' is the repeated experience of withdrawal and the concomitant experience of repeated and wonderfully reassuring relief which is afforded by the next drug dose. The addict is conditioned to crave that next dose. Such a view of addiction can, however, be criticized for placing too great an emphasis on the drug itself and its user's experience in isolation from environmental determinants which initiate and sustain drug use, and which give the drug its symbolic meaning and the user his social role. The pharmacological qualities cited here and the psychological experience of the users are important, but it is difficult to see how, on their own, they can provide a coherent idea of a condition called addiction or dependence. Here can be seen very plainly what is meant by the need to integrate different levels of explanation. So much for the nature of addiction. What about its significance, and in particular its significance for nineteenth-century society? The threat which is posed by addiction to oral preparations of opiates is much less than the dangers of addiction to the drug in injected form, and it was of course the latter type of addiction which characterized the British `heroin epidemic' of the 1960s, and characterizes the large-scale contemporary drug problem in the U.S.A. The special dangers of injected drug use include the ease of accidental overdose and the risks of accidental infection caused by a dirty needle. Today's picture of injected heroin use must therefore not be allowed too easily to colour any assumptions as to what would have been the familiar picture, in the nineteenth century, of addiction to opium or opium preparations taken by mouth. There would have been risks of overdose, sometimes as a result of the unreliable strength of many of the available commercial preparations, but the risks would be nothing like so great as those encountered by the twentieth-century heroin addict who injects the drug directly into his veins. What proportion of overdose cases in the nineteenth century were occurring among addicts and what proportion among casual users is unknown, but certainly the contemporary concern with self-poisoning did not simply equate overdosing with addiction. The problem of accidental infection is then irrelevant to oral use. Another possible medical implication of addiction which received nineteenth-century attention was the general question of whether habitual opium use shortened life, but here too the problem was conceived in terms of the fact of high usage rather than the underlying fact of the addiction. On the longevity issue the present judgement would probably be that opiates themselves produce no directly damaging or life-shortening effect on the body and that addiction itself is not a physically damaging condition. The problems which the nineteenth century encountered with addiction were therefore presumably more in the social than the medical sphere. Opium may have been cheap, but a heavily tolerant individual might well build up to such a dose as to involve a weekly cash outlay to embarrass the family's finances in a working-class household where every penny counted. The drive towards continued drug use would mean that the family's welfare easily became neglected. There might also be other social complications -neglect in child care, for instance, or impairment of working capacity. Such possible social complications do not seem much to have caught the nineteenth-century eye, although there were occasional references to matters of this sort. Indeed, the fact that addiction itself was not sharply conceptualized for the larger part of the century, in many of the relevant debates and social movements, meant that the addict did not suffer the sort of secondary social damage which comes from labelling and stigma, and which has been so much part of the present-day reaction of the Western world to drug-taking and the drug-taker. Addiction to drugs other than opiates has features specific to each drug group. Cocaine can produce an intensely compulsive drive towards continued drug use, despite the absence of
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withdrawal symptoms. Depressant substances such as chloral can also induce addiction, with a well-marked withdrawal picture. Psychomimetic substances in general do not give rise to addiction, and if cannabis has any addictive potential this was certainly not an issue with the sort of doses and preparations which the nineteenth century encountered. Far from the physical attributes of the drugs in question being a side-issue or something quite separate from the main business, an understanding of the extraordinary subtlety and potency of the actions of these substances on the human mind and body helps not only to make intelligible the social processes which were the game evolved around them, but re-inforces one's sense also of the astonishing subtlety and potency of accidental and informal, or formal and purposive social processes, which allow society at different phases in history to live on terms with these strange mindacting chemicals. Reference A very useful general source book on pharmacology is L. S. Goodman and A. Gilman, Pharmacological Basis of Therapeutics, 5th edn (New York, Macmillan, 1975).
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