The Merriam Webster dictionary defines alcoholism as “continued excessive and usually uncontrollable use of alcoholic drinks.” The definition is quite valid if uncontrollable refers to uncontrollable by others. The record is clear, however, that alcoholics can and do control their drinking when they want to.
Even AA based treatment centers usually expect alcoholics and addicts to voluntarily stop drinking and using. Publicly funded treatment centers often demand that an alcoholic or addict stop using before being allowed to enter treatment. The discrepancy between how alcoholism has been defined and the real life patterns of alcohol abuse has led one leading alcoholism researcher to say that alcoholism exists “in our language and in our minds, but not in the objective world around us.”94
Of course, the phenomenon of long term drinking of alcohol to excess does indeed exist. The problem with the dictionary definition and others is that they are loaded with implied or explicit reasons for, or characteristics of, the behavior.
To keep things in the broadest of perspectives, addiction will be defined here as the continual repetition of a normally non problematical behavior to self destructive excess. This definition leaves room for a broad range of behaviors including but not limited to: alcohol and drug addictions, “love” addiction, sex addiction, religious addiction, work addiction, compulsive exercise, television addiction, overeating, bulimia and compulsive gambling. This definition also assumes no origin, lifetime course, or resolution for these behaviors. Although no physical cause is implied, there is room for one or, for that matter, any other presumed cause. It is also free of the circular trap inherent in definitions such as “the flu is an always fatal disease.“ This definition is an empty frame on which to build.
The listed addictions seem so varied.*1 At first glance, they seem to have little in common except that it defies logic that some people would engage in them to such excess as to cause themselves, and possibly those about them, great harm. With some addictions, the use of a chemical is at the center of the behavior. An inordinate amount of pleasure due to alcohol or a drug seems to be the cause of these addictions.
It is often assumed that people derive euphoria, or an inordinate amount of pleasure, from their addictions. In fact, all activities to which people become addicted are rewarding to almost everyone at one time or another. Many people enjoy the euphoria attached to a drink or two. People enjoy sex. People are thankful for the pain killing associated with being “high” on narcotics in surgical wards. People find great rewards in prayer or reading religious literature. Many people enjoy exercise, a brisk walk, jogging or working out. A lot of people enjoy occasionally playing cards or slot machines. All of these behaviors are engaged in to some degree by almost everyone. Most of them are considered good for people. This is one strange twist in addiction. Behavior, which in and of itself is harmless, and perhaps even essential to life, is carried to excessive proportions.
Another strange twist is that people in the throes of their addictions are not happy people. They do not enjoy their addictions. We are all familiar with the images of the woman turned prostitute to support her heroin habit, the alcoholic who loses his job and family, the gambler losing his paycheck, and love addict who could be happy if only…
It has been a mystery why people are so compelled. For centuries, labeling these people immoral or weak was thought to explain it. Today, with impetus from the groupers, many people have come to see these behaviors as diseases, but this explanation requires “faith,” since every bit of independent evidence contradicts it.
Many modern day beliefs about addictions are derived from beliefs about the opiates, drugs like heroin and morphine. It has been inferred from laboratory studies with animals and the behavior of many addicts that these drugs cause certain bodily changes. It was thought that those changes set up a particular reaction. If a user were to stop, he would soon be in a temporary, but excruciatingly horrible, physical and emotional state. This state, thought to be entirely derived from the chemical, is called withdrawal. Under the duress, or fear, of withdrawal, addicts were thought to be driven to seek out more of the drug. We have held this view for decades.
Without doubt, some people go through severe withdrawal. Some people will do anything for a “fix.” Research results, while not contradicting the details, paint quite a different overall picture. One study which contradicts the inevitable addictive power of morphine was done in 1982.95 Fifty patients who had just completed surgery were allowed to self administer morphine for their pain around the clock. Even though they used higher doses than street addicts use, some for as long as six days, they didn’t become addicted. They didn’t suffer withdrawal. In every case they decreased use of the morphine as their pain from surgery decreased.
U.S. soldiers, Vietnam, and heroin addiction
During the Vietnam War, many U.S. soldiers became addicted to heroin. The problem was so widespread many government officials feared what would happen when the troops returned home. There were visions of drug addicts running wild in the streets committing crimes to feed their habits. That didn’t happen. After returning home, only about 10 percent had further experience with opiates. After returning home, only about one-eigth became re-addicted.96 It was also found that, of those who didn’t quit upon return, 63 percent had already been using narcotics before going to Vietnam.
Rather than looking at heroin addiction as merely a pharmacological effect of using heroin, it is more productive to look at the many other factors that come into play. For instance, what is the effect of the environment?
By comparing the Vietnam Vets with troops stationed in other areas, it becomes clear that being in the war zone, and presumably the associated stress, had a lot to do with whether or not a soldier would become addicted. Soldiers stationed in other areas, like Thailand and Korea, where heroin was available but away from the war zone, had a much lower rate of addiction. It is also noteworthy that even after addiction, a change of environment, specifically going home, usually ”cured“ the soldiers stationed in Vietnam.
Another interesting fact about heroin addiction is that an injection of saline solution will stop the withdrawal.97 This, of course, only works if the addict receiving the injection doesn’t know it is just saline. Also, the severity of withdrawal symptoms depends on the environment. Someone who withdraws in jail may have dramatic symptoms similar to those portrayed in television dramas. However, in other situations, such as certain treatment communities for heroin addicts or in hospital surgical wards, withdrawal is either mild or doesn’t exist at all.98
Even in non chemical addictions, like gambling, withdrawal symptoms often appear.99 Gambling behavior spans a range of intensity from the tourists who lose a few nickels in a slot machine to the most compulsive gamblers who lose their homes, families and even their lives rather than not gamble. Of course, with non chemical addictions, it is difficult to attribute the extremes in behavior to a physical cause such as chemical action or bad genes.
The supposed physical nature of alcohol and drug addiction is belied by the techniques used to determine its existence. There is no test for it. No one can test a blood sample and tell whether a person has a physiological characteristic that defines him or her as addicted. There is no genetic test, or even proven cause and effect connection between any addiction and a physiological difference in anyone. The way addiction is determined is by asking about behavior and asking about the results of that behavior.
An almost endless series of animal experiments was thought to have proven addiction was caused solely by the consumption of alcohol or drugs. Typically in animal research, great effort is needed to get animals to consume drugs or alcohol. One way this is done is to add alcohol or another drug to the available water. The animals must drink the laced water or die of thirst. Once they become habituated, they continue to drink the laced water even when plain water is added to the cage. This was thought to prove the addictive properties of the drug itself. However, not all the variables were considered.
The severe deprivation needed to induce addiction, and the unnatural conditions needed to maintain it, are not taken into account. For example, for addicted rats housed in groups, which is natural for rats, the consumption of drugs decreased when they had a choice. Those alone in a cage, in solitary confinement, continued to increase their intake even if they had a choice to cut down.100 Rather than the rats being “slaves to” the chemical, their chemical consumption was directly related to their environment.
In one of the cruelest experiments, a monkey is ”wired up“ so that it can press a lever and inject itself with a drug. The monkey, isolated from others of its kind and restricted from normal monkey behavior, sometimes even strapped to the wall of a cage, will inject itself until death. These studies have been used to demonstrate the addictive nature of the drug itself.
A more sophisticated method of getting animals to drink or drug themselves heavily is called intermittent reinforcement.101 In this method, a rat is fed just enough to keep it always hungry. The hungry rat is placed in a cage where it can get only a tiny pellet of food about every minute. Under these conditions, if alcohol is available, the rat will quickly begin to “drink alcoholically.” If an opiate solution should be available instead, it will become a “drug addict.” In either case the rat is subject to be aggressive and to behave bizarrely in other ways, such as eating its litter.*2
This appears to be an excellent demonstration of the power of the drugs. Any substance considered addictive can be used and the results will be similar. The only weakness in this model of addiction (which is also its strength) is that the conditions create excessive behavior. The behavior isn’t caused by the particular chemical available.
Water can be substituted for the alcohol or drug. Rats will consume as much as one half of their body weight in water in just three hours. They will become aggressive and behave bizarrely. They become just as “addicted to water” as they do to alcohol and opiates. Of course, the roots of the excessive behavior in rats is not in the alcohol, the opiate or in the water. It is in the environment and in the rats.
Rats aren’t the only animals that respond this way under intermittent reinforcement. Excessive behavior has been brought about in a long list of animals including squirrels, pigeons, monkeys and even humans. Nor is food the only item which can be manipulated to bring on excessive behavior. Anything needed by any mammal, including humans, can be used. Water, sex, space or status all can be used to bring about the same effect.
Very little is needed to bring about the excessive behavior characteristic of addiction. All that is needed is for the animal or person to be in a frustrated state. Something must be needed which is not available in sufficient quantity but available enough so continued effort will partly fill the need. Giving up must appear to be the worst option. For instance, if rats are given the same amount of food at once instead of a little at a time, they will eat it and give up on finding more. Their behavior doesn’t become excessive. It is only in the frustrating gap between enough reward to keep trying and not enough to fill the need that excessive behavior occurs. It can be stated that chronic frustration causes excessive behavior. While over simplifying things, it can be stated that chronic frustration causes addiction.
It might seem difficult to translate laboratory experience into the human experience of addiction outside the laboratory. Humans are different from animals in that, relatively speaking, we live by reason rather than instinct. We learn much faster. Our behavior is much more complex. With our greater abilities, we have an almost unlimited range of possible responses in any given situation. Nor are we so obviously restricted in choice as laboratory subjects. But there are parallels.
For all of our greater skills at reasoning out any situation, we have a matching greater set of needs to fill. A rat may be relatively content with some food, water, companionship from fellow rats and an exercise wheel. People, however, need much more.
outside of the laboratory
Outside of the laboratory, addiction strikes hardest at those who are chronically frustrated in attempts to fill their needs due to an environment which limits choice. Alcoholism, heroin addiction, smoking and overeating are all much more frequent among the poor. The recent crack epidemic is almost entirely an urban poor phenomenon. Poverty is a powerful restricter of choice and a powerful source of chronic frustration. By the same token, the high rate of addiction among U.S. soldiers in Vietnam occurred under an environment of intermittent reinforcement.
The most important thing for any organism is survival. Feeling safe, that survival was not threatened, must have been nearly impossible most of the time in Vietnam. In a war, particularly in a guerrilla war where the whole country is a war zone, there are few, if any, safe choices. The few that were available may have been ruled out because they conflicted with loyalty, patriotism or duty. Many troops must have been chronically in a state where no choice was a safe choice but where things weren’t so hopelessly threatening as to give up. They were, in terms of producing addiction, much like the rats in an experimenters cage. Instead of food being in short supply, safety was. Like the rats, there was no good choice. The rats had no good choice because there literally wasn’t enough food made available and what was available was under intermittent reinforcement conditions. The humans most needed safety. It was at best only sporadically available.
Of course, for the servicemen, safety was just one factor. Physical hardship, being isolated from their loved ones and being at the whim of forces beyond their control all contributed. These factors are breeding grounds for excessive behavior. Once the environment changed, once they were removed from these no good choice situations, their addictions faded away.
The hospital patients were in an entirely different situation. They were removed from everyday sources of frustration. They were in a temporary situation. Anything of importance outside the hospital simply had to wait. Their biggest need was to deal with the post surgical pain. The solution to the pain problem was self administered morphine. Although “the drug” is highly addictive, no one became addicted. There were no powerful forces of intermittent reinforcement at work. There was no high level of frustration. Self administering the drug was an ideal choice for the overriding problem of pain. As the pain diminished the morphine lost its purpose. It might be interesting to speculate what might have happened if the patients had been suffering severe chronic pain. Given a choice, would they have maintained the level of self administration as needed for the pain? Would they have had a severe reaction to removal of the drug if they had still perceived it as needed? Would they have “craved” it?
Environmental conditions alone fall far short of explaining addiction in humans. Poor people are more likely to suffer from addictions but not every poor person becomes an addict, alcoholic, smoker or overeater. Only some American soldiers became addicted in Vietnam. Also, sometimes those with the most opportunity and choice, the rich, become addicted.
The environment is important, but the person is more important. Rats in a cage have little or no choice in how to fill their needs. Either the experimenter provides for their needs, ignores them or purposely frustrates them. For human beings even the most deprived environments provide opportunities to fill needs and avoid chronic frustration. Another difference between humans and caged rats is that, except for the people in prison, there are no bars holding anyone in an impoverished environment. A person has no external physical restraints preventing him from picking up and moving, getting an education, changing social circles, switching jobs or whatever else may seem desirable.
Human beings, however, often have formidable internal restraints which are just as restrictive, if not more so, than prison bars…