To what extent does your notion of addiction square with the assessment that addiction is an illness of exposure?
Dear Mr. Peele:
By way of introduction, I am a history teacher at Council Rock South Highs School in Newtown, Pennsylvania. I recently completed reading David T. Courtwright's Dark Paradise: A History of Opiate Addiction in America. The introduction to the book contains this observation by William S. Burroughs, "Addiction is an illness of exposure. By and large those who have access to junk become addicts . . . There is no pre-addict personality any more than there is a pre-malarial personality, all the hogwash of psychiatry to the contrary."
To what extent does your notion of addiction square with this assessment by Burroughs?
Very truly yours,
Dear Mr. Hentz:
I strongly disagree with Courtwright’s statement, as I have told him (although the issue is not one of personality so much as of culture). The evidence he provides in his book, Dark Paradise, is that in a period in American history when opiates were broadly available throughout the population, there were remarkably low levels of narcotic addiction. Somehow, the widespread availability of and exposure to narcotics did not lead most Americans to become drug addicts. This point was made much more directly in another book on the subject, Virginia Berridge’s Opium and the People. I discussed the first edition of Opium and the People in The Meaning of Addiction (Peele, 1985, 1998):
Berridge and Edwards (1981) found that use of standard opium preparations was massive and indiscriminate in England throughout much of the nineteenth century as was use of hypodermic morphine at the end of the century. Yet these investigators found little evidence of serious narcotic addiction problems at the time. Instead, they noted that later in the century, "The quite small number of morphine addicts who happened to be obvious to the [medical] profession assumed the dimensions of a pressing problem—at a time when, as general consumption and mortality data indicate, usage and addiction to opium in general was tending to decline, not increase" (p.149).
In discussing Courtwright’s contrary conclusions, I noted:
Courtwright (1982) and others typically cloud the significance of the massive nonaddicted use of opiates in the nineteenth century by claiming local observers were unaware of the genuine nature of addiction and thus missed the large numbers who manifested withdrawal and other addictive symptomatology. He struggles to explain how the commonplace administration of opiates to babies "was unlikely to develop into a full-blown addiction, for the infant would not have comprehended the nature of its withdrawal distress, not could it have done anything about it" (p. 58).
How can people be widely exposed to a substance and not become addicted to it? Researchers in the large European Comparative Alcohol Study (Norstöm, 2002). found the same thing – that not only alcohol problems, but actually alcohol-related mortality – was less in Southern European nations where more alcohol was consumed. Moreover, the same southern European countries show less binge drinking and drunkenness by adolescents than in the rest of Europe, according to ESPAD (Hibell et al. 2000), despite the fact that the legal drinking age is 16 in Mediterranean countries (Engels & Knibbe, 2000).
In places and times when a substance is largely used and integrated into the social fabric of a culture, it simply does not have the same runaway addictive impact it does elsewhere. This cultural truism is very difficult to comprehend (since we are all locked into our own cultural perspectives). Yet it expresses something so fundamental about addiction that we can never escape it.
Perhaps the most significant aspect of the evidence on consumption patterns cited in the ECAS study is the influence of culture on the pattern of alcohol consumption. The same level of consumption can have very different social and economic effects depending on the cultural context within which the drinking takes place. In the Southern European countries, alcohol leads to less social harm than in Northern Europe, with drunk driving the exception, because the act of drinking is seen as normal. . . In the southern societies, education about drinking starts early and in the home. (Hope & Byrne, 2002, pp. 212-212).
Berridge, V., and Edwards, G. (1981). Opium and the people: Opiate use in nineteenth-century England. New York: St. Martin's. (See Berridge, V., 1999, Opium and the people: Opiate use and drug control policy in nineteenth and early twentieth century England, London: Free Association Books.)
Courtwright, D.T. (1982). Dark paradise: Opiate addiction in America before 1940. Cambridge, MA: Harvard University Press.
Engles, R.C.M.E. & Knibbe, R.A. (2000). Young people’s alcohol consumption from a European perspective: risks and benefits. European Journal of Clinical Nutrition, 54 (Supp. 1): S52-S55.
Hibell, B., Andersson, B., Ahlstrom, S., Balikireva, O., Bjarnasson, T., Kokkevi, A., & Morgan, M. (2000). The 1999 ESPAD Study. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs.
Hope, A. and Byrne, S. (2002). ECAS findings: Policy implications from an EU perspective. In Norstöm, T. (Ed.), Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries. Stockholm: SW: National Institute of Public Health, pp. 206-212.
Norstöm, T. (Ed.). (2002). Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries. Stockholm: SW: National Institute of Public Health.
Peele, S. (1985; 1998). The meaning of Addiction: Compulsive experience and its interpretation. Lexington, MA: Lexington Books. (Republished by Jossey-Bass in 1998 as The meaning of addiction: An unconventional view.)