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Drug Addictions





Much of what has been said with regard to alcoholism finds ready
application to the treatment of drug addictions. At the very beginning
it must be realized that there is no specific remedy that will enable
the patient to overcome his craving for a drag to which he has become
habituated. There is no method of treatment that will infallibly and
without serious and prolonged and determined effort on his part enable
him to overcome his craving. The first and most important thing in any
system of treatment is the patient's good will. If the patient is not
ready to give up the drug, then nothing that a physician can do for
him will make him do so, or will turn him against it; above all,
nothing will make the process of cure so easy that there will be no
trouble involved or only a passing period of struggle required to
accomplish it. There have been many claims made in this matter. We
have wanted such remedies and methods of treatment so much that it has
been rather easy to persuade us sometimes that they have been
discovered. It is like the question of specifics in medicine. For
centuries men devoted themselves to trying to find a specific remedy
for each disease. It was thought they must exist in nature. Now we
know that they probably do not exist, though those who claim to
discover them find an easy livelihood exploiting the credulity of
those who still cherish the belief in them. Scientific students of
medicine have practically given over the search for them in order to
devote themselves to strengthen the patient to resist the disease
rather than spend more time trying to find something to give him that
cures it.


Treating the Patient rather than the Habit--This principle holds with
special force with regard to drug addictions. We do not treat the
patient's habit, but we treat the patient. He must be braced up, must
be made to understand that if he wants to quit the habit, no matter
how slavishly he is addicted to it, he can do so. He must be told of
men who had habits like his, often of longer duration and to a greater
degree, yet gave them up when firmly resolved and properly stimulated.
It is not hard to find such examples, since medical and even ordinary
literature abound with them and every physician's experience furnishes
him with instances. The first and most absolutely necessary
preliminary of the treatment is to lift up the patient in his own eyes
and make him understand that, low as he has sunk, his case is not
hopeless, that his degradation is not at all uncommon nor so rare as
he might think, and that men and women have succeeded in lifting
themselves out of conditions worse than his. The psychotherapeutist
must, above all, not be of those who insist that human nature is
degenerating and that people are much weaker physically and morally
than they used to be, though of course he must be thoroughly aware
that drug habits are more frequent than they were and are quite
alarmingly on the increase. This is not due to any deterioration in
human nature, however, but mainly to the excitement of modern life and
its inevitable reaction, the strenuousness with which men now take
existence and the consequent craving for artificial relief from
over-activity, and then, above all, the facility with which the
habit-forming drugs can be obtained.


Prophylaxis.--This last point accounts for the frequency of drug
habits in our time more than anything else. Men have always been ready
to do something for the sake of novelty and excitement. Everyone is
curious to experience for himself the effects produced by drugs that
can make people such slaves to them. We hear too often of the intense
pleasure that the drug habitue gets from his use of drugs. The
curiosity thus aroused constitutes the suggestion that has led many to
try the effect, confident that he or she would be able to resist any
craving just before it became seriously tyrannous. Psychiatrists agree
that one of the worst elements in modern social conditions is the
impression generally maintained that there is such intense pleasure in
the taking of drugs. A clear statement of the reality of the case is
eminently desirable. It is not positive pleasure that the drug habitue
has, but mere negative pleasure, as a rule. His "dope" does not so
much add to his good feeling as take away the bad feelings that he has
because of depression or ennui at the beginning and later because of
the craving for the drug.

Physicians to whom many drug habitues have told their experience
frankly are not at all inclined to think that the usually accepted
opinion of pleasure in drug taking is true. It is not that it is
heaven to have the drug so much as it is hell to be without it. The
patient's system has learned to crave it so much because of the
surcease of painful consciousness of self it gives and this it is that
compels these unfortunates to go back to ever-increasing doses. The
pleasant side is a very dubious affair at all times, accompanies only
the earliest steps of the formation of the habit at most, and usually
whatever agreeable feelings there are are accompanied by such a
nightmare of solicitude and anxiety as a background that the pleasure
is more poignant than agreeable. As a prophylactic against the
formation of drug habits this aspect of the experience of drug
habitues deserves to be emphasized and knowledge of it widely
diffused. Of course, the morphin fiend brightens up after his dose of
morphin, his eye lightens, his expression becomes happy, and his
nerves get steadier, but that is only because the depression in which
he was sunk before has now been stimulated away, the struggle with his
worst feelings is over and the consequent reaction has developed. Of
course, the cocain-taker is pitiably helpless and downcast without his
"dope," but it is only by contrast with this previous state that his
succeeding condition can be said to be pleasant or agreeable, even to
himself.



Favorable Suggestion.--One of the most helpful sources of favorable
suggestion for these patients is to be found in the stories of cured
drug habitues. These may be used tactfully to bring confidence to
patients that they, too, can be broken of their habit if they are
willing to take the pains to do so. De Quincey, taking his thousand
drops of laudanum a day, represents one of the most encouraging
examples of this since he succeeded eventually in breaking away from
his habit. Coleridge succeeded, also, in breaking his habit more than
once, but unfortunately returned again and again, and illustrates the
danger of the almost inevitable tendency to relapse, if the patient
permits himself to think that now that he has once conquered the habit
he is too strong ever to let it get hold of him again. If he ventures
to think complacently of his self-control and that consequently he may
with impunity--always for some good reason--take a dose or two of his
favorite drug in order to tide him over some crisis of mental worry or
some spell of physical pain, relapse is certain. The tendency of
patients to fool themselves in this way is too well known to need
special emphasis, but it is as well to say that there is scarcely a
single cured case that does not relapse. The relapse is due not so
much to craving for the drug, as to the memory of its previous effects
in relieving discomfort and the unfortunate confidence that the
patient has developed that now, knowing the dangers, he will be able
to resist the formation of the habit before it gets a strong hold of
him.

It is curious how even highly intelligent patients will slip back into
their old habits, sometimes deeper than before, on this reasoning, in
spite of the lessons of experience, even their own as well as others.
Like the drunkard, they persuade themselves that just this once will
not count, and when it would have been comparatively easy for them to
say no they yield once or twice and make self-denial for the future
increasingly difficult. This is especially true if patients have the
drug near them, so that it is not difficult for them to have recourse
to it. Hence doctors and nurses are not hard to cure of such habits,
as a rule, provided they are away from their professional duties, but
they almost inevitably relapse when they go back to work. Every time
the relapse is due to the fact that tired feelings, because of
irregular hours or some physical pain, prompt them to seek relief and
they yield to the temptation of taking the old drug, sure that they
need it, only for the moment. They will all assert that they could
just as well resist as not, that, indeed, had not the drug been so
handy, they would not have taken it, and that if anyone had been near
to help them by a word in the matter even then they would not have
indulged in it.

If patients are to be kept from relapsing, all this must be set before
them frankly. After they have been told once or perhaps twice or
perhaps many times and yet relapse into their habits, they must simply
be told it again a little more emphatically, more encouragingly, up to
seventy times seven, if necessary. Patience is needed more than
anything else in taking care of these cases. Over and over again their
confidence in their power to overcome their habit, if they really wish
to do so, must be reawakened. Without this confidence in themselves
success is hopeless. It matters not how often they have relapsed, they
can still break off the habit, and if they will not fool themselves
into over-confidence in their power to keep away, they need never be
slaves to the habit again. There will be quite as many disappointments
in treating drug addiction as in the treatment of alcoholism.
Those who have most experience insist that there are even more, but
there are some wonderfully encouraging examples of men and women who
have broken from their habit, even after a number of bad relapses, and
have for many years lived absolutely without any of their drug and,
though still not over-confident in their power to resist if once they
should yield (such confidence, it cannot be repeated too often, is
always fatal), do actually keep away from the drug without any other
bother than the necessity of living a regular hygienic life and
exercising a little self-control.

In drug addictions as in alcoholisms, the question of sanitarium
treatment comes up in every case. Much more rarely than in the case of
the alcohol habit is it necessary to send a drug habitue to a
sanitarium. Here once more, however, the patient's circumstances and
the possibility of diversion of mind with reasonable freedom from
temptations to take the drug and from ready access to it, are the most
important considerations. If a patient really wants to break off the
use of a drug, it can be done gently and without much bother in the
course of three or four weeks. I have seen cocain fiends who have
tried many remedies and many physicians completely cured in five or
six weeks without serious trouble. The important thing is perseverance
in the effort and in the treatment and the definite persuasion of the
patient that it is not only perfectly possible to get rid of the
habit, but that it is even easy with good will on his part. If certain
other milder stimulants are supplied for a time so that all the
symptoms due to the physiological effects of the excessive use of the
drug are minimized, the physical trial need not be severe. The
patient's mind, however, must be occupied. Time must not be allowed to
hang heavy on his hands and all physical symptoms must be treated
promptly. Drug addictions are indeed more curable than alcoholism and
the danger of relapse is not quite so imminent. The social temptations
do not exist for drug habitues as they do for alcoholics. As I have
said, however, in the cases of nurses and physicians almost a
corresponding state of affairs obtains and in them the danger of
relapse is great.


Early Treatment.--It is quite as important for drug victims as it is
for alcoholics that the case should be taken under treatment early.
Every physician knows how curiously easy it is for some people, indeed
for most people, to acquire a drug habit. I have seen one of the
solidest men I ever knew, with plenty of character that had been tried
by many a crisis in life, recommended cocain for a toothache when he
was past fifty years of age and in the course of ten days acquire a
thorough beginning of the cocain habit, so that he was taking several
grains a day. He had no idea that he was unconsciously slipping into a
drug habit. When the druggist refused any longer to supply the cocain
solution without a prescription he was quite indignant. It was not
until he had forty-eight hours of nervous symptoms and craving that he
realized that he had created a need for stimulation of his nervous
system by the mere taking of cocain by application on his gums. This
habit was broken up at once and there has never been any tendency to
its recurrence. He had his warning, fortunately, without evil effects.

If the cocain habit can be formed as unconsciously as this, there
should be little difficulty in treating it. It is not a profound
change in the organism, but only a habit. It is not the habit itself
that is hard to break, but the effects upon the nervous system
of the patient are such as to create a series of symptoms that can
only be soothed by the drug. It is these symptoms of depression,
irritation, sleeplessness, lack of appetite, constipation and the rest
that it is the physician's duty to treat in order to help the patient.
The patient breaks the habit by his will-power when properly persuaded
and when it is made clear to him that it is neither so difficult as he
thought, nor is he so likely to fail in the matter as he has imagined,
and as has perhaps been suggested to him even by physicians. The
mental treatment consists in making him realize that he can do it and
that if he wants to get rid of his habit he must do it for himself.
With this must come the assurance that every annoying symptom will be
met, that he need not recur to his favorite drug for this purpose,
that his appetite will be gradually restored and that, though perhaps
for a week he will have considerable inconvenience to bear, after that
it will be plain sailing. Usually three days can be set as the term at
which his craving ceases to be so disturbing as to make the
possibility of his relapsing into the habit a positive danger. As in
alcoholic and sex habits, the patient to be helped in breaking the
habit should be seen once a day at least, usually oftener. If he can
be made to understand that whenever the old tendency seems about to
get the upper hand is the time to see his physician, and if something
physical as well as moral is done for him, the breaking of the habit
is comparatively simple.

This method of treatment looks too simple to be quite credible to
those who have so often tried and failed in the cure of drug habits.
It is not the doctor, however, who fails, but the patient. We cannot
put new wills into a patient, but we can so brace up even an old and
tottering will as to make it possible for the worst victims of drug
habits to reform. The doctor, too, easily becomes discouraged. He has
not confidence enough in his own methods to make assurance doubly sure
for the patient as to his cure. This is what many of the pretended
specific purveyors of drug habit cures have as their principal stock
in trade. They assure patients with absolute confidence, while the
physician only too often says the same thing, but half-heartedly. A
half-hearted physician makes a hesitant patient, and success is then
very dubious from the beginning. Every patient can be cured. They may
relapse, but then they can be cured again. This is the essence of the
psychotherapy of drug habits, but it is also the only successful
element in any treatment of the drug habit that is really effective.
Specifics come and go. Sure cures cease to have their effect. The only
really effective element in any cure is the absolute trust of the
patient.

In his "Drugs and the Drug Habit" (Methuen, London) Dr. Harrington
Sainsbury, Senior Physician to the Royal Free Hospital of London, has
emphasized all these points that can only be touched on very briefly
here. He has called particular attention to the fact that the victim
of one drug habit is rather prone to acquire another if by any chance
he should once begin to take another habit-forming drug. The original
drug habit has broken down the will. It is not so much the craving for
a particular drug as the lack of will power that proves unfortunate
for the patient. He suggests "incidentally, if this explanation hold
good, it proves the solidarity of the will that it works as a whole
and not by compartments." He has dwelt on recoveries from the most
discouraging depths and insists "we must teach that no one is
ever so enslaved by a habit as to be incapable of relief--this alone
is right teaching, justifiable moreover by records well
substantiated of recoveries from desperate plights."


Heredity and Unfavorable Suggestion.--As to the suggestion, sometimes
encountered, of the influence of heredity and its all-powerful effect
in making it practically impossible for the son of a man who has taken
drugs to keep from doing the same thing, we must recall very
emphatically here the principles discussed elsewhere. So far as
concerns heredity, opium and the other drugs are exactly in the same
position as alcohol in their effect upon the human race. Instead of
being justified in saying that by heredity individuals of succeeding
generations are rendered more susceptible to them, just the opposite
is true and, if anything, an immunity is produced. This is not only
racial and general but is personal and actual. In recent years we have
come to realize that individuals born of tuberculous parents who care
for themselves properly are much better able to resist the invasion of
the tubercle bacilli than those who come from stocks that were never
affected by the disease. They are the patients who, in spite of the
fact that their disease reaches an advanced stage, sometimes live on
for years with proper care. Just this is true for drug addictions so
far as we know anything about it. The whole subject is as yet obscure,
but heredity rather favors than hurts the patient in these cases.


Hereditary Resistance.--Instead of being discouraged by the fact that
his father took a drug to excess and that therefore he is weaker
against this than other people, a man should rather be encouraged by
the thought that a certain amount of resistance to the craving has
probably been acquired by the particular line of cells through which
his personality is manifested. Dr. Archdall Reid has said that "the
facts concerning opium are very similar" (to those that concern
alcohol). Then he continues:

That narcotic has been used extensively in India for several
centuries. It was introduced by the English into China about two
centuries ago. Quite recently the Chinese have taken it to Burma, to
various Polynesian Islands, and to Australia. There is no evidence
that the use of opium has caused any race to deteriorate. Indeed it
happens that the finest races in India are most addicted to its use.
According to the evidence given before the late Royal Commission on
Opium, the natives of India never or very rarely take it to excess.
When first introduced into China it was the cause of a large
mortality; but to-day most Chinamen, especially in the littoral
provinces, take it in great moderation. On the other hand. Burmans,
Polynesians and Australian natives take opium in such excess and
perish of it in such numbers that their European governors are
obliged to forbid the drug to them, though the use of it is
permitted to foreign immigrants to their countries. In exactly the
same way alcohol is forbidden to Australians and Red Indians in
places where It is permitted to white men.


After-Cures.--I have said so much about the after-cure of alcoholism
that applies directly to drug addictions also, that it does not seem
necessary to repeat it here. Patients must be warned that if they
become overtired, if they lose sleep, if they are subject to much
excitement, if they put themselves in conditions of anxiety and worry,
if any form of recurrent pain develops--headache, toothache,
stomach-ache--they are likely to be tempted to take up their old
habit. If they are in a position where they can easily get the drug it
is almost inevitable that something will happen to make them feel that
they are justified in taking one or two doses and from this to
the reestablishment of the habit is only a small step. Often these
patients need a change of occupation. Some of them are over-occupied,
some of them have not enough to do. In either case it is the doctor's
duty to know enough about his patient to be able to give directions.
We do not treat a drug addiction with the hope of curing it, but we
treat a patient suffering from a particular drug habit and we try so
to modify that patient's life that after we have succeeded in getting
him away from his habit, which is never difficult, he will not relapse
into it. The after-cure is the more important of the two.





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Previous: Alcoholism



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