In: Peele, S., with Brodsky, A. (1975), Love and Addiction. New York: Taplinger.
© 1975 Stanton Peele and Archie Brodsky.
Reprinted with permission from Taplinger Publishing Co., Inc.
I hate its weakness more than I like its pleasant futility. I hate it and myself in it all the time I'm dwelling on it. I hate it as I'd hate a little drug habit fastened on my nerves. Its influence is the same but more insidious than a drug would be, more demoralizing. As feeling fear makes one afraid, feeling more fear makes one more afraid.
—MARY MacLANE, I, Mary MacLane: A Diary of Human Days
With our new model of addiction in mind, we need no longer think of addiction exclusively in terms of drugs. We are concerned with the larger question of why some people seek to close off their experience through a comforting, but artificial and self-consuming relationship with something external to themselves. In itself, the choice of object is irrelevant to this universal process of becoming dependent. Anything that people use to release their consciousness can be addictively misused.
As a starting point for our analysis, however, addictive drug use serves as a convenient illustration of the psychological whys and hows of addiction. Since people usually think of drug dependencies in terms of addiction, who becomes addicted and why is best understood in that area, and psychologists have come up with some fairly good answers to these questions. But once we take account of their work and its implications for a general theory of addiction, we must move beyond drugs. It is necessary to transcend the culture-bound, class-bound definition that has enabled us to dismiss addiction as somebody else's problem. With a new definition, we can look directly at our own addictions.
Personality Characteristics of Addicts
The first researcher to take a serious interest in the personalities of addicts was Lawrence Kolb, whose studies of opiate addicts at the U.S. Public Health Service in the 1920s are collected in a volume entitled Drug Addiction: A Medical Problem. Discovering that the psychological problems of addicts existed prior to addiction, Kolb concluded, "The neurotic and the psychopath receive from narcotics a pleasurable sense of relief from the realities of life that normal persons do not receive because life is no special burden to them." At the time, Kolb's work offered a note of reason amidst the hysteria about the personal deterioration that the opiates in themselves supposedly caused. Since then, however, Kolb's approach has been criticized as being too negative toward drug users and ignoring the range of motivations that contribute to drug use. If drug users per se are what we are concerned with, then the criticism of Kolb is well-taken, for we know now that there are many varieties of drug users besides those with "addictive personalities." But in its having pinpointed a personality orientation that often reveals itself in self-destructive drug use, as well a-s in many other unhealthy things that people do, Kolb's insight remains sound.
Later personality studies of drug users have expanded upon Kolb's discoveries. In their study of reactions to a morphine placebo among hospital patients, Lasagna and his colleagues found that patients who accepted the placebo as a pain-killer, as compared with those who did not, were also more likely to be satisfied with the effects of morphine itself. It seems that certain people, as well as being more suggestible about an innocuous injection, are more vulnerable to the actual effects of a potent analgesic like morphine. What characteristics distinguish this group of people? From interviews and Rorschach tests, some generalizations emerged about the placebo reactors. They all considered hospital care "wonderful," were more cooperative with the staff, were more active churchgoers, and used conventional household drugs more than the nonreactors. They were more anxious and more emotionally volatile, had less control over the expression of their instinctual needs, and were more dependent on outside stimulation than on their own mental processes, which were not as mature as those of nonreactors.
These traits yield a distinct picture of the people who respond most strongly to narcotics (or placebos) in hospitals as being pliable, trusting, unsure of themselves, and ready to believe that a drug given them by a doctor must be beneficial. Can we draw a parallel between these people and street addicts? Charles Winick gives the following explanation for the fact that many addicts become addicted in adolescence, only to "mature out" when they become older and more stable:
. . . they [the addicts] began taking heroin in their late teens or early twenties as their method of coping with the challenges and problems of early adulthood.... The use of narcotics may make it possible for the user to evade, mask, or postpone the expression of these needs and these decisions [i.e., sex, aggression, vocation, financial independence and support of others].... On a less conscious level, he may be anticipating becoming dependent on jails and other community resources. . . . Becoming a narcotics addict in early adulthood thus enables the addict to avoid many decisions....
Here again, we see that lack of self-assurance and related dependency needs determine the pattern of addiction. When the addict arrives at some resolution of his problems (whether by permanently accepting some other dependent social role or by finally gathering the emotional resources to attain maturity), his addiction to heroin ceases. It no longer serves a function in his life. Stressing the importance of fatalistic beliefs in the addiction process, Winick concludes that addicts who fail to mature out are those "who decide that they are 'hooked,' make no effort to abandon addiction, and give in to what they regard as inevitable."
In their portrait of the day-to-day existence of the street heroin user in The Road to H. Chein and his colleagues emphasize the addict's need to compensate for his lack of more substantial outlets. As Chein puts it in a later article:
From almost his earliest days, the addict has been systematically educated and trained into incompetence. Unlike others, therefore, he could not find a vocation, a career, a meaningful, sustained activity around which he could, so to say, wrap his life. The addiction, however, offers an answer to even this problem of emptiness. The life of an addict constitutes a vocation—hustling, raising funds, assuring a connection and the maintenance of supply, outmaneuvering the police, performing the rituals of preparing and of taking the drug—a vocation around which the addict can build a reasonably full life.
Although Chein doesn't say so in quite these terms, the substitute way of life is what the street user is addicted to.
Exploring why the addict needs such a substitute life, the authors of The Road to H. describe the addict's constricted outlook and his defensive stance toward the world. Addicts are pessimistic about life and preoccupied with its negative and dangerous aspects. In the ghetto setting studied by Chein, they are emotionally detached from people, and are capable of seeing others only as objects to be exploited. They lack confidence in themselves and are not motivated toward positive activities except when pushed by someone in a position of authority. They are passive even as they are manipulative, and the need they feel most strongly is a need for predictable gratification. Chein's findings are consistent with Lasagna's and Winick's. Together, they show that the person predisposed to drug addiction has not resolved childhood conflicts about autonomy and dependence so as to develop a mature personality.
To understand what makes a person an addict, consider the controlled users, the people who do not become addicts even though they take the same powerful drugs. The doctors Winick studied are aided in keeping their use of narcotics under control by the relative ease with which they can obtain the drugs. A more important factor, however, is the purposefulness of their lives—the activities and goals to which drug use is subordinated. What enables most physicians who use narcotics to withstand dominance by a drug is simply the fact that they must regulate their drug-taking in line with its effect on the performance of their duties.
Even among people who do not have the social standing of doctors, the principle behind controlled use is the same. Norman Zinberg and Richard Jacobson unearthed many controlled users of heroin and other drugs among young people in a variety of settings. Zinberg and Jacobson suggest that the extent and diversity of a person's social relationships are crucial in determining whether the person will become a controlled or compulsive drug user. If a person is acquainted with others who do not use the drug in question, he is not likely to become totally immersed in that drug. These investigators also report that controlled use depends on whether the user has a specific routine which dictates when he will take the drug, so that there are only some situations where he will consider it appropriate and others—such as work or school—where he will rule it out. Again, the controlled user is distinguished from the addict by the way drugs fit into the overall context of his life.
Considering the research on controlled users in conjunction with that on addicts, we can infer that addiction is a pattern of drug use that occurs in people who have little to anchor them to life. Lacking an underlying direction, finding few things that can entertain or motivate them, they have nothing to compete with the effects of a narcotic for possession of their lives. But for other people the impact of a drug, while it may be considerable, is not overwhelming. They have involvements and satisfactions which forestall total submission to something whose action is to limit and deaden. The occasional user may have need for relief or may only use a drug for specific positive effects. But he values his activities, his friendships, his possibilities too much to sacrifice them to the exclusion and repetition which is addiction.
The absence of drug dependencies in people who have been exposed to narcotics under special conditions, such as hospital patients and the G.I.'s in Vietnam, has already been noted. These people use an opiate for solace or relief from some sort of temporary misery. In normal circumstances, they do not find life sufficiently unpleasant to want to obliterate their consciousness. As people with a normal range of motivations, they have other options—once they have been removed from the painful situation—which are more attractive than unconsciousness. Almost never do they experience the full symptoms of withdrawal or a craving for drugs.
In Addiction and Opiates, Alfred Lindesmith has noted that even when medical patients do experience some degree of withdrawal pain from morphine, they are able to protect themselves against prolonged craving by thinking of themselves as normal people with a temporary problem, rather than as addicts. Just as a culture can be influenced by a widespread belief in the existence of addiction, an individual who thinks of himself as an addict will more readily feel the addictive effects of a drug. Unlike the street addict, whose lifestyle they probably despise, medical patients and G.I.'s naturally assume that they are stronger than the drug. This belief enables them, in fact, to resist addiction. Reverse this, and we have the orientation of someone who is susceptible to addiction: he believes the drug is stronger than he is. In both cases, people's estimate of a drug's power over them reflects their estimate of their own essential strengths and weaknesses. Thus an addict believes that he can be overwhelmed by an experience at the same time he is driven to seek It out.
Who, then, is the addict? We can say that he or she is someone who lacks the desire—or confidence in his or her capacity—to come to grips with life independently. His view of life is not a positive one which anticipates chances for pleasure and fulfillment, but a negative one which fears the world and people as threats to himself. When this person is confronted with demands or problems, he seeks support from an external source which, since he feels it is stronger than he is, he believes can protect him. The addict is not a genuinely rebellious person. Rather, he is a fearful one. He is eager to rely on drugs (or medicines), on people, on institutions (like prisons and hospitals). In giving himself up to these larger forces, he is a perpetual invalid. Richard Blum has found that drug users have been trained at home, as children, to accept and exploit the sick role. This readiness for submission is the keynote of addiction. Disbelieving his own adequacy, recoiling from challenge, the addict welcomes control from outside himself as the ideal state of affairs.
A Social-Psychological Approach to Addiction
Working from this emphasis on subjective, personal experience, we can now attempt to define addiction. The definition we have been moving toward is a social-psychological one in that it focuses on a person's emotional states and his relationship to his surroundings. These must in turn be understood in terms of the impact which social institutions have had on the person's outlook. Instead of working with biological or even psychological absolutes, a social-psychological approach tries to make sense out of people's experience by asking what people are like, what in their thinking and feeling underlies their behavior, how they come to be as they are, and what pressures from their environment they currently face.
In these terms, then, an addiction exists when a person's attachment to a sensation, an object, or another person is such as to lessen his appreciation of and ability to deal with other things in his environment, or in himself, so that he has become increasingly dependent on that experience as his only source of gratification. A person will be predisposed to addiction to the extent that he cannot establish a meaningful relationship to his environment as a whole, and thus cannot develop a fully elaborated life. In this case, he will be susceptible to a mindless absorption in something external to himself, his susceptibility growing with each new exposure to the addictive object.
Our analysis of addiction starts with the addict's low opinion of himself and his lack of genuine involvement in life, and examines how this malaise progresses into the deepening spiral which is at the center of the psychology of addiction. The person who becomes an addict has not learned to accomplish things he can regard as worthwhile, or even simply to enjoy life. Feeling incapable of engaging himself in an activity that he finds meaningful, he naturally turns away from any opportunities to do so. His lack of self-respect causes this pessimism. A result, too, of the addict's low self-esteem is his belief that he cannot stand alone, that he must have outside support to survive. Thus his life assumes the shape of a series of dependencies, whether approved (such as family, school, or work) or disapproved (such as drugs, prisons, or mental institutions).
His is not a pleasant state of affairs. He is anxious in the face of a world he fears, and his feelings about himself are likewise unhappy. Yearning to escape from a distasteful consciousness of his life, and having no abiding purpose to check his desire for unconsciousness, the addict welcomes oblivion. He finds it in any experience that can temporarily erase his painful awareness of himself and his situation. The opiates and other strong depressant drugs accomplish this function directly by inducing an all-encompassing soothing sensation. Their pain-killing effect, the feeling they create that the user need do nothing more to set his life straight, makes the opiates prominent as objects of addiction. Chein quotes the addict who, after his first shot of heroin, became a regular user: "I got real sleepy. I went in to lay on the bed.... I thought, this is for me! And I never missed a day since, until now." Any experience in which a person can lose himself—if that is what he desires—can serve the same addictive function.
There is a paradoxical cost extracted, however, as fee for this relief from consciousness. In turning away from his world to the addictive object, which he values increasingly for its safe, predictable effects, the addict ceases to cope with that world. As he becomes more involved with the drug or other addictive experience, he becomes progressively less able to deal with the anxieties and uncertainties that drove him to it in the first place. He realizes this, and his having resorted to escape and intoxication only exacerbates his self-doubt. When a person does something in response to his anxiety that he doesn't respect (like getting drunk or overeating), his disgust with himself causes his anxiety to increase. As a result, and now also faced by a bleaker objective situation, he is even more needful of the reassurance the addictive experience offers him. This is the cycle of addiction. Eventually, the addict depends totally on the addiction for his gratifications in life, and nothing else can interest him. He has given up hope of managing his existence; forgetfulness is the one aim he is capable of pursuing wholeheartedly.
Withdrawal symptoms occur because a person cannot be deprived of his sole source of reassurance in the world—a world from which he has grown increasingly alienated—without considerable trauma. The problems he originally encountered are now magnified, and he has gotten used to the constant lulling of his awareness. At this point, dreading reexposure to the world above all else, he will do whatever he can to maintain his protected state. Here is the completion of the addiction process. Once again the addict's low self-esteem has come into play. It has made him feel helpless not only against the rest of the world, but against the addictive object as well, so that he now believes he can neither live without it nor free himself from its grasp. It is a natural end for a person who has been trained to be helpless all his life.
Interestingly, an argument which is used against psychological explanations for addiction can actually help us understand the psychology of addiction. It is often contended that because animals get addicted to morphine in laboratories, and because infants are born drug-dependent when their mothers have taken heroin regularly during pregnancy, there is no possibility that psychological factors can play a part in the process. But it is the very fact that infants and animals do not have the subtlety of interests or the full life that an adult human being ideally possesses which makes them so uniformly susceptible to addiction. When we think of the conditions under which animals and infants become addicted, we can better appreciate the situation of the addict. Aside from their relatively simple motivations, monkeys kept in a small cage with an injection apparatus strapped to their backs are deprived of the variety of stimulation their natural environment provides. All they can do is push the lever. Obviously, an infant is also not capable of sampling life's full complexity. Yet these physically or biologically limiting factors are not unlike the psychological constraints the addict lives with. Then, too, the "addicted" infant is separated at birth both from the womb and from a sensation—that of heroin in its bloodstream—which it associates with the womb and which in itself simulates womb-like comfort. The normal trauma of birth is made worse, and the infant recoils from its harsh exposure to the world. This infantile feeling of being deprived of some necessary sense of security is again something which has startling parallels in the adult addict.
Criteria for Addiction and Nonaddiction
Just as a person can be a compulsive or a controlled drug user, so there are addictive and nonaddictive ways of doing anything. When a person is strongly predisposed to be addicted, whatever he does can fit the psychological pattern of addiction. Unless he deals with his weaknesses, his major emotional involvements will be addictive, and his life will consist of a series of addictions. A passage from Lawrence Kubie's Neurotic Distortion of the Creative Process dramatically focuses on the way personality determines the quality of any kind of feeling or activity:
There is not a single thing which a human being can do or feel, or think, whether it is eating or sleeping or drinking or fighting or killing or hating or loving or grieving or exulting or working or playing or painting or inventing, which cannot be either sick or well.... The measure of health is flexibility, the freedom to learn through experience, the freedom to change with changing internal and external circumstances . . . the freedom to respond appropriately to the stimulus of reward and punishment, and especially the freedom to cease when sated.
If a person cannot cease after being sated, if he cannot be sated, he is addicted. Fear, and feelings of inadequacy, cause an addict to seek constancy of stimulation and setting rather than to chance the dangers of novel or unpredictable experience. Psychological security is what he wants above all. He searches for it outside himself, until he finds that the experience of addiction is completely predictable. At this point, satiation is impossible—because it is the sameness of sensation that he craves. As the addiction proceeds, novelty and change become things he is even less able to tolerate.
What are the key psychological dimensions of addiction, and of the freedom and growth which are the antitheses of addiction? A major theory in psychology is that of achievement motivation, as summarized by John Atkinson in An Introduction to Motivation. The motive to achieve refers to a person's positive desire to pursue a task, and to the satisfaction he gets from successfully completing it. Opposed to achievement motivation is what is called "fear of failure," an outlook which causes a person to react to challenges with anxiety rather than positive anticipation. This happens because the person does not see a new situation as an opportunity for exploration, satisfaction, or accomplishment. For him, it only holds out the threat of disgrace through the failure he believes is likely. A person with a high fear of failure avoids new things, is conservative, and seeks to reduce life to safe routines and rituals.
The fundamental distinction involved here—and in addiction—is the distinction between a desire to grow and experience and a desire to stagnate and remain untouched. Jozef Cohen quotes the addict who says, "The best high . . . is death." Where life is seen as a burden, full of unpleasant and useless struggles, addiction is a way to surrender. The difference between not being addicted and being addicted is the difference between seeing the world as your arena and seeing the world as your prison. These contrasting orientations suggest a standard for assessing whether a substance or activity is addictive for a particular person. If what a person is engaged in enhances his ability to live—if it enables him to work more effectively, to love more beautifully, to appreciate the things around him more, and finally, if it allows him to grow, to change, and expand—then it is not addictive. If, on the other hand, it diminishes him—if it makes him less attractive, less capable, less sensitive, and if it limits him, stifles him, harms him—then it is addictive.
These criteria do not mean that an involvement is necessarily addictive because it is intensely absorbing. When someone can truly engage himself in something, as opposed to seeking out its most general, superficial features, he is not addicted. Addiction is marked by an intensity of need, which only motivates a person to expose himself repeatedly to the grossest aspects of a sensation, primarily its intoxicating effects. Heroin addicts are most attached to the ritualistic elements in their use of the drug, such as the act of injecting heroin and the stereotyped relationships and hustling that go along with getting it, not to mention the deadening predictability of the action that narcotics have.
When someone enjoys or is energized by an experience, he wishes to pursue it further, master it more, understand it better. The addict, on the other hand, wishes only to stay with a clearly defined routine. This obviously does not have to be true for heroin addicts alone. When a man or woman works purely for the reassurance of knowing that he or she is working, rather than positively desiring to do something, then that person's involvement with work is compulsive, the so-called "workaholic" syndrome. Such a person is not concerned that the products of his labors, that all other concomitants and results of what he does, may be meaningless, or worse, harmful. In the same way, the heroin addict's life does include the discipline and challenge entailed in obtaining the drug. But he cannot maintain respect for these efforts in the face of society's judgment that they are nonconstructive and, worse, vicious. It is difficult for the addict to feel that he has done something of lasting value when he works feverishly to get high four times a day.
From this perspective, while we might be tempted to refer to the dedicated artist or scientist as being addicted to his or her work, the description doesn't fit. There may be elements of addiction in a person's throwing himself into solitary creative work when it is done out of an incapacity to have normal relationships with people, but great achievements often require a narrowing of focus. What distinguishes such concentration from addiction is that the artist or scientist is not escaping from novelty and uncertainty into a predictable, comforting state of affairs. He receives the pleasure of creation and discovery from his activity, a pleasure that is sometimes long deferred. He moves on to new problems, sharpens his skills, takes risks, meets resistance and frustration, and always challenges himself. To do otherwise means the end of his productive career. Whatever his personal incompleteness, his involvement in his work does not diminish his integrity and his capacity to live, and thus does not cause him to want to escape from himself. He is in touch with a difficult and demanding reality, and his accomplishments are open to the judgment of those who are similarly engaged, those who will decide his place in the history of his discipline. Finally, his work can be evaluated by the benefits or pleasures it brings to humanity as a whole.
Working, socializing, eating, drinking, praying—any regular part of a person's life can be evaluated in terms of how it contributes to, or detracts from, the quality of his experience. Or, looked at from the other direction, the nature of a person's general feelings about living will determine the character of any of his habitual involvements. As Marx noted, it is the attempt to separate a single involvement from the rest of one's life which allows for addiction:
It is nonsense to believe . . . one could satisfy one passion separated from all others without satisfying oneself, the whole living individual. If this passion assumes an abstract, separate character, if it confronts him as an alien power . . . the result is that this individual achieves only a one-sided, crippled development.
(quoted in Erich Fromm, "Marx's Contribution to the Knowledge of Man")
Yardsticks like this can be applied to any thing or any act; that is why many involvements besides those with drugs meet the criteria for addiction. Drugs, on the other hand, are not addictive when they serve to fulfill a larger purpose in life, even if the purpose is to increase self-awareness, to expand consciousness, or simply to enjoy oneself.
The ability to derive a positive pleasure from something, to do something because it brings joy to oneself, is, in fact, a principal criterion of nonaddiction. It might seem a foregone conclusion that people take drugs for enjoyment, yet this is not true of addicts. An addict does not find heroin pleasurable in itself. Rather, he uses it to obliterate other aspects of his environment which he dreads. A cigarette addict or an alcoholic may once have enjoyed a smoke or a drink, but by the time he has become addicted, he is driven to use the substance merely to maintain himself at a bearable level of existence. This is the tolerance process, through which the addict comes to rely on the addictive object as something necessary to his psychological survival. What might have been a positive motivation turns out to be a negative one. It is a matter of need rather than of desire.
A further, and related, sign of addiction is that an exclusive craving for something is accompanied by a loss of discrimination toward the object which satisfies the craving. In the early stages of an addict's relationship to a substance, he may desire a specific quality in the experience it gives him. He hopes for a certain reaction and, if it is not forthcoming, he is dissatisfied. But after a certain point, the addict cannot distinguish between a good or a bad version of that experience. All he cares about is that he wants it and that he gets it. The alcoholic is not interested in the taste of the liquor that is available; likewise, the compulsive eater is not particular about what he eats when there is food around. The difference between the heroin addict and the controlled user is the ability to discriminate among conditions for taking the drug. Zinberg and Jacobson found that the controlled drug user weighs a number of pragmatic considerations—how much the drug costs, how good the supply is, whether the assembled company is appealing, what else he might do with his time—before indulging on any given occasion. Such choices are not open to an addict.
Since it is only the repetition of the basic experience for which the addict yearns, he is unaware of variations in his environment—even in the addictive sensation itself—as long as certain key stimuli are always present. This phenomenon is observable in those who use heroin, LSD, marijuana, speed, or cocaine. While light, irregular, or novice users are very dependent on situational cues to set the mood for the enjoyment of their trips, the heavy user or the addict disregards these variables almost entirely. This, and all our criteria, are applicable to addicts in other areas of life, including love addicts.
Groups and the Private World
Addiction, since it avoids reality, amounts to the substitution of a private standard of meaning and value for publicly accepted standards. It is natural to bolster this alienated worldview by sharing it with others; in fact, it is often learned from others in the first place. Understanding the process by which groups coalesce around obsessive, exclusive activities and systems of belief is an important step in exploring how groups, including couples, can themselves comprise an addiction. By looking at the ways in which groups of addicts construct their own worlds, we gain essential insights into the social aspects of addiction, and—what directly follows from this—social addictions.
Howard Becker observed groups of marijuana users in the fifties showing new members how to smoke marijuana and how to interpret its effect. What they were also showing them was how to be part of the group. The initiates were teaching the experience which made the group distinctive—the marijuana high—and why this distinctive experience was pleasurable, and therefore good. The group was engaged in the process of defining itself, and of creating an internal set of values separate from those of the world at large. In this way, miniature societies are formed by people who share a set of values relating to something which they have in common, but which people generally do not accept. That something can be the use of a particular drug, a fanatical religious or political belief, or the pursuit of esoteric knowledge. The same thing happens when a discipline becomes so abstract that its human relevance is lost in the interchange of secrets among experts. There is no desire to influence the course of events outside of the group setting, except to draw new devotees into its boundaries. This happens regularly with such self-contained mental systems as chess, bridge, and horse-race handicapping. Activities like bridge are addictions for so many people because in them the elements of group ritual and private language, the bases of group addictions, are so strong.
To understand these separate worlds, consider a group organized around its members' involvement with a drug, such as heroin, or marijuana when it was a disapproved and deviant activity. The members agree that it is right to use the drug, both because of the way it makes one feel and because of the difficulty or unattractiveness of being a total participant in the regular world, i.e., of being a "straight." In the "hip" subculture of the drug user, this attitude constitutes a conscious ideology of superiority to the straight world. Such groups, like the hipsters Norman Mailer wrote about in "The White Negro," or the delinquent addicts that Chein studied, feel both disdain and fear toward the mainstream of society. When someone becomes a part of that group, accepting its distinct values and associating exclusively with the people in it, he becomes "in"—a part of that subculture—and cuts himself off from those outside it.
Addicts need to evolve their own societies because, having devoted themselves entirely to their shared addictions, they must turn to each other to gain approval for behavior that the larger society despises. Always fearful of and alienated by broader standards, these individuals can now be accepted in terms of internal group standards that they find easier to meet. At the same time, their alienation increases, so that they become more insecure in the face of the outside world's values. When they are exposed to these attitudes, they reject them as irrelevant, and return to their circumscribed existence with a strengthened allegiance. Thus, with the group as well as with the drug, the addict goes through a spiral of growing dependency.
The behavior of people who are under the influence of a drug is explicable only to those who are likewise intoxicated. Even in their own eyes, their behavior only makes sense when they are in that condition. After a person has been drunk, he may say, "I can't believe I did all that." In order to be able to accept his behavior, or to forget that he had appeared so foolish, he feels that he has to reenter the intoxicated state. This discontinuity between ordinary reality and the addicts' reality makes each the negation of the other. To participate in one is to reject the other. Thus, when someone quits a private world, the break is likely to be a sharp one, as when an alcoholic swears off drinking or seeing his old drinking friends ever again, or when political or religious extremists turn into violent opponents of the ideologies they once held.
Given this tension between the private world and what lies outside, the task which the group performs for its members is to bring about self-acceptance through the maintenance of a distorted but shared outlook. The other people who also participate in the group's peculiar vision, or in the intoxication it favors, can understand the addict's perspective where outsiders cannot. Someone else who is drunk is not critical of a drunk's behavior. Someone who begs or steals money to obtain heroin is not likely to criticize someone similarly occupied. Such groupings of addicts are not predicated on genuine human feelings and appreciation; the other group members in themselves are not the object of the addict's concern. Rather, his own addiction is his concern, and those other people who can tolerate it and even help him pursue it are simply adjuncts to his one preoccupation in life.
The same expediency in forming connections is there with the person addicted to a lover. It is there in the use of another person to shore up a beleaguered sense of self and to obtain acceptance when the rest of the world seems frightening and forbidding. The lovers gladly lose track of how insular their behavior becomes in the creation of their separate world, until such time as they may be forced to return to reality. But there is one respect in which the isolation of addicted lovers from the world is even more stark than that of other alienated groups of addicts. While drug users and ideologues support each other in maintaining some belief or behavior, the relationship is the sole value around which the private society of the interpersonal addict is organized. While drugs are the theme for groups of heroin addicts, the relationship is the theme for the lovers' group; the group itself is the object of the members' addiction. And thus the addicted love relationship is the tightest group of all. You are "in" with only one person at a time—or one person forever.
References
Atkinson, John W. An Introduction to Motivation. Princeton, NJ: Van Nostrand, 1962.
Becker, Howard. Outsiders. London: Free Press of Glencoe, 1963.
Blum, Richard H., & Associates. Drugs I: Society and Drugs. San Francisco: Jossey-Bass, 1969.
Chein, Isidor. "Psychological Functions of Drug Use." In Scientific Basis of Drug Dependence, edited by Hannah Steinberg, pp. 13-30. London: Churchill Ltd., 1969.
_______; Gerard, Donald L.; Lee, Robert S.; and Rosenfeld, Eva. The Road to H. New York: Basic Books, 1964.
Cohen, Jozef. Secondary Motivation. Vol. I. Chicago: Rand McNally, 1970.
Fromm, Erich. "Marx's Contribution to the Knowledge of Man." In The Crisis in Psychoanalysis, pp. 61-75. Greenwich, CT: Fawcett, 1970.
Kolb, Lawrence. Drug Addiction: A Medical Problem. Springfield, IL: Charles C Thomas, 1962.
Kubie, Lawrence. Neurotic Distortion of the Creative Process. Lawrence, KS: University of Kansas Press, 1958.
Lasagna, Louis; Mosteller, Frederick; von Felsinger, John M.; and Beecher, Henry K. "A Study of the Placebo Response." American Journal of Medicine 16(1954): 770-779.
Lindesmith, Alfred R. Addiction and Opiates. Chicago: Aldine, 1968.
Mailer, Norman. "The White Negro" (1957). In Advertisements for Myself, pp. 313-333. New York: Putnam, 1966.
Winick, Charles. "Physician Narcotic Addicts." Social Problems 9(1961): 174-186.
_________. "Maturing Out of Narcotic Addiction." Bulletin on Narcotics 14(1962): 1-7.
Zinberg, Norman E., and Jacobson, Richard. The Social Controls of Non- medical Drug Use. Washington, D.C.: Interim Report to the Drug Abuse Council, 1974.
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In the briefest possible terms, here are the warning signs, or symptoms, of depression. If you, or someone you know, exhibits 5 or more of these signs, for more than 2 weeks, then you, or he or she, needs to get help.
In addition to stopping drug use, the goal of treatment is to return the individual to productive functioning in the family, workplace, and community. Measures of effectiveness typically include levels of criminal behavior, family functioning, employability, and medical condition. Overall, treatment of drug addiction is as successful as treatment of other chronic diseases, such as diabetes, hypertension, and asthma.
Is a client-centered counseling approach for initiating behavior change by helping clients to resolve ambivalence about engaging in drug addiction treatment and stopping drug use. This approach employs strategies to evoke rapid and internally motivated change in the client, rather than guiding the client stepwise through the recovery process.