Heroin Addiction is Not an Illness

A couple of weeks ago I heard a piece on NPR:  “What Vietnam Taught Us About Breaking Bad Habits.” 

It’s an interesting story.  It tells how in 1971, researchers found that about 20% of the American soldiers in Vietnam were addicted to heroin.  This was shocking news to the Pentagon and to President Nixon, who promptly created a new government department – the Special Action Office of Drug Abuse Prevention.  This was the beginning of the so-called War on Drugs.

The story, however, takes an interesting turn.  Those servicemen who were addicted to heroin were “dried out” in Vietnam, and then returned to the States.  Then a year later they were examined again, and it was found that only 5% of them had resumed heroin use.  Only 5%!

The conventional wisdom then (and now) was (and is) that heroin addiction is a disease, with very high rates of relapse (typically 90%).  So how could the soldiers returning from Vietnam have such a low relapse rate?  This result is simply inexplicable from a disease model of addiction, but is very readily explained from a behaviorist perspective.

To a behaviorist, context is a critical component in the formulation and shaping of behavior.  For these soldiers, the Vietnam context had become so associated with heroin use that their use became addictive.  Back in the States – in their homes – at their workplaces or classrooms – recreating in the company of their friends, etc. – the context no longer provided cues and opportunities for heroin use.

Heroin addiction is not a disease.  It is a habit.  And like all habits, it is best broken by avoiding people, places, and things that are associated with the habit, and by reinforcing behaviors that are incompatible with the habit.

  • MollyMay

    I don’t know where you got this idea that heroin addiction is a “habit”,Vietnam was, of course a highly stressful environment. Individuals were much more likely to use heroin while there, watching their friends die and getting shot at, than if they were home. Heroin was mostly smoked with tobacco or marijuana among the soldiers, making it much easier and more “user friendly” to try and continue using than if one were exposed to the more common route in the U.S., the hypodermic needle. The numbers are obviously flawed due to various circumstances, as others in the field have previously noted. You do have one thing right; environment and behavior do play a role in the treatment of addiction, but that fact certainly does not qualify heroin addiction as a habit. Drug and alcohol dependence is a disease and requires continued treatment in order to achieve full remission.

  • Phil_Hickey

    MollyMay,

    Thanks for coming in. Let’s begin by defining our terms. I would define the word habit largely by reference to the frequency with which the act in question is emitted. For instance, I don’t gamble, I don’t bet on horse races or other sporting events or indeed on anything. Suppose, however, I were to start going to the track and placing bets, and became very attached to this activity to the point where I was placing multiple bets on a frequent basis. I think most people would say that I had now acquired the habit of gambling. Similarly with heroin use. A person who uses heroin frequently is said to have a habit of using heroin. To deny this is simply to fly in the face of normal word usage.

    Now you begin by saying that you don’t know where I got this idea that heroin addiction is a habit. My only possible response is to ask where in the world did you get the idea that it is not. Now I am aware that in traditional AA/NA treatment circles the word habit is almost taboo, because it is seen as undermining the central tenet that substance addictions are diseases.

    The fact is that the guys in Vietnam were using heroin very frequently, but when they came home, many (most) of them just stopped. The response of the traditionalists to this fact is that they can’t have been “real” addicts, because “real” addiction is a disease which needs a lifetime commitment to recovery. One hears the same argument in the context of heavy drinkers who just stop – “well they weren’t real alcoholics in the first place.” The invalidity of this kind of post-hoc diagnosing is obvious and is simply a way of propping up the traditional position at all costs.

    The real issue, of course, is what do you mean by a disease/illness? I define a disease or illness as something wrong with the organism – some identifiable pathology. Now if a person has been using heroin
    frequently for an appreciable length of time, I would certainly agree that there is something wrong with his body (e.g. heroin intoxication; heroin withdrawal; heroin-induced delirium, etc.). But that’s not what is meant in traditional circles by the statement “heroin addiction is a disease.”

    What is meant in traditional circles is that if a person who has been abstinent from heroin for months (even years) starts using again, this
    resumption of using was caused by his “disease.”

    So let’s examine the logic. Imagine the following conversation between a parent and an addiction counselor.

    Parent: Why does my son always go back to the heroin?Counselor: Because he has a disease called heroin addiction.Parent: How do you know that he has this disease? Counselor: Because he always goes back to the heroin.

    In other words, the only evidence for the disease is the very behavior it purports to explain. The so-called disease theory has no explanatory value. It is simply a form of words – a mantra, if you like – that has become an article of faith within traditional circles. Nor is it a neutral matter. Traditional treatment does not have a good track record. In my view this is because it places such heavy reliance on dogma, and relatively little on science, logic, and healthy self-criticism. The fact is that lots of addicted people just quit – without treatment; without “surrendering” to their disease; and without a lifetime commitment to “treatment.”

    Human existence is a good deal more complicated than traditional chemical dependency dogma.

    So that’s where I’m coming from. Clearly we don’t agree. But I hope you’ll come back. Give me your definition of a disease. Explain the reasoning behind the contention that addiction is essentially an illness.

    Best wishes.

  • Peter Spiteri

    i take it you never used heroin in your life you sad act, first off the usage of heroin is typically a addiction YES !!!., but the continuation is not, the idea that habit keeps a heroin addict on the drug is laughable at best, this is because it is not a psychological addiction it is a physical addiction. the Human Body convulses with out the drug in the body in approx 18 – 24 the symptoms start then at about 24 – 40 hours the body goes into a serious RELAPSE State that causes the symptoms of Convulsion and Serious Flu like symptoms, inc severe Diarrhea, puking, severe aches and pains, watery eyes runny nose, . basically EVERY Hole in the human Body becomes a free for all / anytime EXIT of body fluids.

    The only side of this that is a habit is the psychological that you refer to is the needle fixation or chasing the dragon fixation, or the need to harm to feel normal. and with that being said after the first period of time using the drug, the drug becomes i tool to feel normal not to get high anymore. i have done a lot of research on the drug and i am a current user of about 8 years. so if you think you know what you are talking about because you seen a documentary on this and have your own theory think again !!!

  • Jorge_Videla

    the same is true for alcohol, but unlike heroin withdrawal can kill. the same goes for barbiturates and benzodiazepines. the addict no longer takes the substance to escape or get high, but to not go through unpleasant withdrawal.

    but how does that make it a disease?

    one can stop drinking too much or stop heroin in a very short period of time, if he has the right environment and is careful about it.

  • Jorge_Videla

    except molly that the “treatment” is totally ineffective.

    people do drugs or drink for reasons in addition to any physical addiction. and often those are good reasons.

    my uncle used heroin in vietnam. he’s never used it since as far as i know.

    context can even affect the severity of withdrawal. exposure to cues for the drug can kill addicted animals. or so i’ve read.

  • Anonymous

    Pete, you’re a fan of heroin and you could stop if you wanted to. Personally I don’t mind if you’re a fan of whatever substance, I think the prohibition on drugs should be ended.

    http://www.spectator.co.uk/features/3212846/withdrawal-from-heroin-is-a-trivial-matter/

  • cate

    I thikn that you should edit the title of this post. IMO, heroin addiction certainly is an illness, although perhaps not a disease.

  • Anonymous

    It’s neither. It’s a frowned upon habit, undertaken by fans of the way the drug makes them feel. You tell Phil to edit the title, as if you haven’t even read the article. Sure he could “edit the title”, but what about the meat of the article, where he explains why he doesn’t believe in medicalizing the heroin habit. The only question the heroin fan has to ask himself is, is this habit creating interpersonal problems or damaging his health, and is it time to stop, the risk/reward tradeoff of all substance use. The problem with heroin prohibition is that because the supply is forced into the black market, due to the hordes of statists that are baying for the blood of dealers and itching to (have armed government goons) cage people for a victimless crime of drug consumption, you never know the purity level you’re gonna get, and like the late actor Philip Seymour Hoffman, one night you might get some very strong shit and it’s lights out. Whereas because liquor is standardized, regulated and liquor prohibition was ended decades ago, you always know what you’re going to get when you open a bottle of Jim Beam. You always know the strength is going to be the same. Like nuclear weapons, heroin is always going to have its fans, and always be with us, it’s the thought controllers and prohibitionists, the statists, that seek to extend the grip of government to personal habits, and pie in the sky nuclear weapon elimination. Once some substance or technology exists, there’s no erasing it from the face of the Earth. The giant drug hauls police proudly show off, have they ever stopped the flow of drugs even for one day? Was there ever a day when the sun rose on this planet that the heroin fan couldn’t find some heroin if he wanted some? No. Same with the blueprints to make a nuke, nations will always find a way.

    For the heroin fan that thinks it may be time to take it easy on the heroin and use it in moderation or quit altogether, he will be hampered by a giant load of mythology sent his way, mythology around him having no free will, no power to change, and that mythology gets pumped into their minds and all of society, by the dishonest, spurious, quackery based, psychiatry/addiction “treatment” industry. If you want to know how deeply ingrained the mythology is, just listen to your first instinctual reaction when I suggested “moderation in heroin use”, I bet you didn’t know such thing was even possible, well, it is, there are plenty of casual users of opiates and every substance, you just don’t hear about them in a world where the focus is on selling the notion of the “helpless brain diseased genetic addict”.

    The way I look at it, if you’re feeding your family, working, living up to your responsibilities and you want to do some heroin once in a while on a weekend, why not, if you’re a fan of the feeling it gives you, go for it, none of anyone’s business provided you’re using responsibly. And you have my sympathy if you’re killed by an unexpectedly strong hit, I certainly didn’t vote for you to be forced to get your supply on an unpredictable black market, if I made drug policy, you’d have a clean, factory quality controlled supply, as is your basic right as a paying customer for a product provided to consenting adults. If some cats got killed by poison moonshine during prohibition, that wasn’t completely their fault, it was the fault of the supporters of prohibition. If Philip Seymour Hoffman’s kids are orphans, that’s partly his fault, and partly the fault of the idiots that support the failed, anti-human and deadly war on drugs. There is good news for the heroin fan that wants to take control of his own supply however, poppies can be grown in your own home garden and the internet is filled with literature on how to educate oneself to produce your own supply away from the prying eyes of the freedom haters, and the unpredictable supply of dealers. I’m not a heroin fan myself, but I don’t hold it against anybody who is.

  • Francesca Allan

    Could you explain the distinction you are making between the two terms?

  • cate

    I appreciate your libertarian perspective in some sense, but I think that labeling people with heroin addictions as “heroin fans” is quite cruel. Heroin is a far cry from marijuana use, and no, I don’t think it should be legalized. And yes, I suggested to change the title, because words mean something, and many people are responding to an incorrect word here.

  • cate

    This is a quote I found that I agree with.

    What is illness?

    An illness refers to the human response to disease. Let’s say a patient has diabetes. What is the human response to having diabetes? Mentally, a newly diagnosed diabetes patient may experience denial. This denial can include refusing to monitor glucose levels or change dietary habits. Physically, a diabetes patient may experience abnormal blood glucose levels resulting in hyper/hypoglycemia. In 1972, Dr Anthony Suchman defined what we know today as the four stages illness:

    -Experiencing signs and symptoms

    -Assuming the sick role, or validating the sickness

    -Seeking medical care

    -Assuming dependent role while recovering

    What is Disease?

    A disease is an alteration of the mental and/or physical structure of the human body or mind. Diseases can have numerous causes: biological (like viruses), chemical (like drugs or heavy metals), genetics, physical agents (like temperature extremes), and alterations in immunity or metabolism (like allergies or hormonal disturbances.) With disease comes specific signs and symptoms that manifest themselves, allowing physicians/medical experts to diagnose their patients.

  • Anonymous

    Good for you, you “don’t think it should be legalized”. Be sure to book a seat in the police cruiser while heroin users are transported to be caged for the “crime” of using this substance, shot dead for trying to run away upon being caught, etc. My “cruelty” in choosing to call fans of heroin, heroin fans, pales in comparison to the cruelty of overdoses, drug cartel murder, torture, imprisonment, ripped apart families, caused by those who blithely say “I don’t think it should be legalized”. For what could be “crueler”, me “labeling” someone a fan, or you joining the fray at the ballot box to enable extreme violence against drug users/choosers? Harmless words from me, or democratically enabled chickenhawk violence from you? There are no incorrect words in the title. I don’t accept the premise of your assertion of “heroin addictions”. Addiction is a loaded with pseudoscience concept, and invalid. Habit, is a far better way of conceptualizing these issues.

    See John Booth Davies’ book, the “Myth of Addiction”
    See Jeff Schaler’s book “Addiction is a Choice”
    See Herbert Fingerette’s book “Heavy Drinking: The Myth of Alcoholism as a Disease”… for the reasons myriad why you shouldn’t be blithely claiming there exists such things as “heroin addictions”.

    And see every critical analysis of the drug war since 30 years ago.

    I’m not cruel, I’m further from any cruelty a heroin user has experienced than you are, simply because of my political position versus your political position, which is, prohibition, enabled by government force, and all the death and violence and misery that comes with enforcing that old “I don’t think it should legalized” mantra. If that’s a “Libertarian” position it was the position of the US government until the early 20th century, after existing as a government for over a century beforehand.

  • cate

    Oh, whatever. Again, you misinterpret what I’m saying by assuming because I disagree with you that I agree with the opposite extreme. I’ve had more than enough experience dealing with heroin addiction, and I don’t appreciate your extreme judgements. “Joining the fray at the ballot box…” Please. How drole.

  • Phil_Hickey

    cate,

    Thanks for coming in. Prolonged and excessive use of heroin does indeed make people very sick. But in traditional psychiatric/mental health/chemical dependency circles, even if a person has been clean for years, he still has this “illness.” In my view, that is simply false. I’m not sure what your intention is in distinguishing between disease and illness. I would say that the words are essentially synonymous.

    The distinction that you draw between illness and disease, in your response below to Francesca, strikes me as simply arbitrary. You are free, of course to use words to mean whatever you like, but in ordinary speech, disease and illness mean essentially the same thing: something going wrong in the function or structure of the organism.

    Best wishes.

  • cate

    I disagree with you that the words illness and disease are synonmous. The medical profession as a whole certainly disagrees as well, as they clearly and intentionally differentiate the two words when training nurses and doctors. And I think that the definition: illness is the body’s response to disease is a good one. However, I have noticed that my “argument” is flawed nevertheless, because even if they are two different things, and even if the definition I laid out is correct, the question in this case would be “What disease is the illness of heroin responding to?” And for that I do not have an answer. Also since, my background is in linguistics (and economics) I would also disagree with the positive freedom of “using words however I like”. That would eradicate communicate in my opinion – and debate.

  • cate

    As far as “still having an illness” once you have “come clean” goes, I don’t know how I feel about this for certain, but I would tend to agree with you that the verbiage “illness” is incorrect in this case.

  • Phil_Hickey

    cate,

    We can agree to differ. What I meant when I said you can use words any way you like is simply that I can’t legislate for the meaning of words. I – like most linguists – simply abide by
    common usage. And in my experience in common usage, illness and disease are essentially synonymous. But, as I said, we can agree to differ.

    Best wishes.

  • Francesca Allan

    Thanks for clarifying, Cate. As I understand it, you consider disease to be the actual pathological entity and illness to be the reaction to same. I have always considered disease and illness to be interchangeable terms so your perspective gives me a new twist to think over.

    With respect to disease, though, I cannot see how the term can be reasonably applied to alteration of mental structure because the mind is not an organ. Brains certainly can become diseased but that’s within the realm of neurology, not psychiatry.

  • cate

    I think you are making a choice here. You are choosing to “use” the verbiage that “traditional psychiatric/mental health/chemical dependency circles” uses – instead of what medical professionals use. “Common usage” ? Of the word: “illness” – well in that case, what about all the posters? They don’t agree that this “common usage” definition is correct. There is a hole here. You may mean to say that the EFFECTS of illness and disease are synonomous, but even there I would disagree, based on the fact that if someone no longer believes that he/ she has an “illness” (or exhibits the symptoms) in the 12 step program or whatever, then we also should no longer stake them to the definition. Wouldn’t you agree?

  • cate

    Francesca, thank you for your clear point. My question then is, what is the mind if not an organ? And are you sure that the mind cannot become diseased?

  • cate

    Peter. Kudos to you, and don’t listen to anonymous. He is a fan of heroin, and you clearly are not. Heroin addiction is certainly an illness, as the body responds to it. In fact, the body’s response to certain external things like drugs cannot be cured or even diagnosed in a blanket way – and that is a problem. But it’s not the point. Once something external – heroin is in fact the extreme example – is introduced to the body, then the body reacts by establishing a reaction, and the reaction is an illness. Congratulations to you for getting past this.

  • Phil_Hickey

    cate,Random House Webster’s College Dictionary, 1992:disease: a disordered or abnormal condition of an organ or other part of an organism resulting from the effect of genetic or developmental errors, infection, nutritional deficiency, toxicity, or unfavorable environmental factors; illness; sickness.illness: unhealthy condition; poor health; indisposition; sicknessAs I’ve said before, if you want to use these words in some other sense, then that’s your business – but, as you yourself correctly pointed out, that will impair the quality of communication.The issue is important, because when psychiatry’s claim that all significant problems of thinking, feeling, and/or behaving are illnesses, is exposed as spurious, they routinely resort to a different definition of illness – one that does not involve biological pathology.

  • Cledwyn Enemy of the People

    Nothing wrong with drug addiction; anything is preferable to “success”. The man who seeks to climb up the dunghill from which he has sprung, in order so that he may command the respect of others, is but a slave to the mob; herein consists the failure of the “successful”.

    “To have grazed every form of failure, including success.”

    Emil Cioran

    The mob maps out the path a man must follow if he is to win its favor and be awarded the designation, “successful”. The real gravamen of the charge against the drug addict consists in the fact that he chooses his own path, and thereby offends against the vanity of the mob, a crime more unpardonable than the worst enormities and punishable under pain of sundry punitive measures, for the mob is so accustomed to deference, to the validation of its own ways and beliefs amongst its own members and from its rulers, and so swollen with a sense of entitlement and arrogance, that deviation from its ways, and the refusal to value the mob at its own grandiosely delusional estimate – never goes unpunished.

    Hence the hatred of the drug addict, the “madman”, the misfit, the cultural snob, and so forth.

    Such is the fanatical faith of the mob in its laws, it attacks the drug addict on the grounds that what he is doing is illegal.

    To which I would say that justice and the law are two different things, and rarely do the twain meet.

  • Rob

    People aren’t addicted to drugs. They’re addicted to escaping reality.