There is a memorable scene in the film Trainspotting in which one of the protagonists goes cold turkey. He locks himself in a room for a few days and undergoes the torments of hell as he withdraws from heroin. He sweats, he hallucinates, he rolls in agony, he starts out of his bed as if he has seen a ghost. The message is that no one could reasonably be expected to subject himself to such an ordeal or be criticised for failing to do so. And if to avoid it an addict has to snatch old ladies’ handbags in the street or burgle their houses, who can really blame him? It isn’t the addict who does these terrible things, it’s merely the drugs acting through him.
Many junkies must have been delighted by the film. It provided them with an implicit justification for their continuance of the habit: precisely what most of them desire, in any case. But the depiction of withdrawal from opiates in the film was nevertheless a gross exaggeration. The great majority of addicts have very few symptoms at all on ceasing to take the drug, symptoms that are rarely worse than a bout of flu. They are never so great that the desire to avoid them could justify committing a crime, or even the continuance of the habit.
Addicts themselves are apt to exaggerate the horrors of withdrawal. The naive among them are genuinely frightened because of the scare stories they have heard, and their fear of withdrawal is worse than withdrawal itself.
By contrast, more experienced addicts are only trying to persuade a doctor against his better judgement to prescribe something for them. (“I’m clucking, doctor,” they say to describe their condition, though gobbling is the term they should use if avian metaphors are not to be mixed. And somehow going cold chicken doesn’t have the same ring as going cold turkey.) It has been established experimentally that the way addicts talk to doctors and others whose professional sympathies they wish to engage is very different from how they talk to other addicts.
To the former they emphasise their unbearable symptoms and their irresistible craving for the drug; among the latter they talk of the pleasures of taking it, where the best quality is to be found and who are the doctors most easily fooled.
Occasionally addicts’ exaggerations have fatal consequences. A prison doctor was recently struck off the medical register because he was foolish enough to believe two prisoners who told him when they entered prison that they took a certain daily dose of methadone (the synthetic opiate developed in Germany for Goering’s benefit). Anxious that they should not suffer the pains of withdrawal, the kindly but gullible doctor prescribed them what they asked for, and in the morning both prisoners were dead – from methadone overdose.
Addiction is a real physiological phenomenon, of course, and there are addictions to drugs from which withdrawal can actually be dangerous: alcohol is the one that springs to mind. Withdrawal from barbiturates (addiction to which is now rare) is also dangerous; the despair that follows the cessation of the regular consumption of amphetamines can lead to suicide; and even withdrawal from the tranquilliser diazepam is sometimes far worse than anything suffered by an opiate addict.
But there is no drug from which withdrawal, albeit under medical supervision, and subsequent abstention are impossible: the flesh is willing but the spirit is weak.
Real as addiction is, then, it is not quite the enslavement that it is often portrayed as. No substance known to man is capable of binding the mind with such hoops of psychic steel that cannot be burst asunder by an effort of will. There is no addictive drug from which abstention has not been achieved by many of those once addicted to it.
Contrary to what is often claimed (in the name of compassion), addiction is more a moral, cultural or spiritual problem than it is a physiological or medical one. This is strenuously denied because of a characteristic modern form of sentimentality, according to which troubled people who need help must be immaculate victims of circumstance who contribute nothing to their own downfall. This doctrine ought to have the unfortunate corollary that anyone who is the author, even in part, of his own misfortunes is deemed unworthy of assistance. But a doctor who refused to help those who had contributed something to their own misfortunes would soon have precious little to do. The unpleasant corollary is avoided by simply regarding everyone as a victim of circumstance – except those in authority. No one is such a determinist that he fails to blame his parents.
The sub-Freudian buried-treasure conception of psychology, according to which if one digs about in one’s past for long enough the source of all one’s woes will eventually come to light, is popular among addicts for several obvious reasons. They assume that until they know the answer to the question “Why do I drink?” or “Why do I take drugs?” they cannot give up. Since the question asked is inherently unanswerable, at least beyond reasonable doubt, the responsibility for their drinking or drug-taking is effortlessly transferred to the therapist or doctor treating them, since he or she has been unable to find the buried treasure.
Furthermore, it is assumed that if only this buried treasure could be found, the problem would dissolve in the warm solvent of psychological self-knowledge. This happy result means that no further effort on the part of the addict himself would be required. Knowing why he drank or took drugs in the first place would constitute an impregnable defence against taking them again.
There are subsidiary arguments to disguise the addict’s responsibility for his own fate. There seems, for example, to be a genetic predisposition to alcoholism: not only does alcoholism run in families, but the children of alcoholics, even when separated from them at birth, are more likely than others to become alcoholics themselves.
Even those with the strongest possible genetic loading, however, can escape their “fate”: a patient of mine, whose parents and brothers were alcoholics, has been abstinent for years. Those who are born to the bottle are not fated to live by the bottle.
Then there is the Mount Everest argument: I take heroin (or whatever) because it is there. But not everyone for whom it is there takes it. Alcohol is more or less equally available to everyone in this country, and it is certainly true that if the price goes down (as it has, relative to other commodities) consumption goes up, so that the number of alcoholics rises as the price falls. But this is not a purely mechanical or hydraulic effect: it is the result of millions of conscious human decisions.
If it suits addicts to regard their condition as an illness just like any other, it also suits those who would look after them and try to help them. The caring professions, as they are known to themselves and to those who are fortunate enough to have nothing whatever to do with them, need a constant supply of hapless victims to justify their existence. A bona fide illness fits the bill admirably because it requires a special body of technical knowledge, not available to all and sundry, to understand it.
The conception of addiction as helpless bondage to a pathological process has been extended well beyond the abuse of chemical substances. It is now applied to a wide range of undesirable traits, from gambling to the point of bankruptcy and fraud, to Bill Clinton’s apparent inability to leave unravished any female who comes within his reach. No one applies the term to laudable traits, except metaphorically: no one of whom it could be said that he is addicted to saving the lives of others or producing valuable works of science or art is deemed in need of treatment.
Not long ago, I bought a book with the title Addicted to Crime? (if there is a second edition, the question mark will no doubt be removed, as it was from the second edition of the Webbs’ Soviet Communism: a new civilisation?). It was the contention of the academic authors that repeated crimes, such as twocking – which is to say, taking without owner’s consent, or TWOC – are the result of an addiction conceived as an illness.
A compulsive stealer of cars feels a craving to steal another. The more he steals, the more he wants to steal. He thus has tolerance to the effect of stealing. If for some reason he is temporarily unable to do so, he feels agitated, restless and miserable: in short, he is withdrawing, and the symptoms can only be abolished by another theft. Poor chap, he is now addicted. What can he do, except continue? It didn’t take long for the etiolated ideas of the academy to filter down into the criminal class. As a burglar who had broken into a hundred houses once said to me when I asked him whether he was going to stop: “What can I do, doctor? I’m a burglar. Burglary is what I do.” He could delude himself that when he burgled a house it was someone else’s fault – certainly not his own.
There is untold collusion with the idea that addiction is physiological slavery. The idea serves the interests of middle-class carers who have established an institutional empire of compassion. But it nevertheless adds its mite to the sum of human misery.
The author is a GP in Birmingham
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