arms when they’re actually trying not to, then any goal-directed behaviour could be a symptom of disease.8
The behaviour of addicts looks voluntary because it is. However intense the temptations offered by substances and experiences, there will always be people who, having given in to them, change their mind and pull themselves out of addiction.
As we’ve seen, AA brushes aside this phenomenon with unbreakable circular logic: if you cure yourself, you were never an addict. Medically qualified addiction specialists basically agree, though they usually espouse a more nuanced version of the disease theory. They don’t deny that some addicts appear to cure themselves – but they treat such cases as outliers or questionable diagnoses. The official line remains that, to quote the Sourcebook on Substance Abuse, ‘the majority of individuals who receive treatment for substance abuse relapse’.9 Clinical reports that between 50 and 60 per cent of patients relapse within six months of ending treatment are accepted as evidence of the power of the disease.
There’s something wrong with this methodology, however, as Gene M. Heyman, a hospital research psychologist and lecturer at Harvard University, points out.
‘Most research is based on addicts who come to clinics,’ he says. ‘But these are a distinct minority, and they are much more likely to keep using drugs past the age of 30 – probably because they have many more health problems than non-clinic addicts. They are about twice as likely to suffer from depression, and are many times more likely to have HIV/AIDS. These problems interfere with activities that can successfully compete with drug use. Thus, experts have based their view of addiction on an unrepresentative sample of addicts.’10
Heyman went looking for large-scale studies of addiction in the US based on more representative samples of addicts in the general population, not just in clinics. He found four of them, carried out by leading researchers and funded by national health institutes.11 Yet, mysteriously, the clinical texts and journal articles spreading the message of a ‘primary, chronic, relapsing disease’ fail to mention these epidemiological studies. Why?
Could it have been because none of the surveys found that most addicts eventually relapse? What they suggested, inconveniently, was that between 60 and 80 per cent of individuals who met the criteria for lifetime addiction stopped using drugs in their late twenties or early thirties. In short, high remission rates would seem to be a stable feature of addiction.12
In 1970 there was a shockingly sudden burst of heroin addiction among GIs in Vietnam. As Alfred McCoy describes in his book The Politics of Heroin, until 1969 the ‘Golden Triangle’ of south-east Asia was harvesting nearly a thousand tons of raw opium annually – but there were no laboratories capable of turning it into high-grade heroin. That changed when Chinese master chemists from Hong Kong arrived in the region. Suddenly South Vietnam was full of fine-grained No. 4 heroin instead of the impure, chunky No. 3 grade.
‘Heroin addiction spread like the plague,’ writes McCoy. ‘Fourteen-year-old girls were selling heroin at roadside stands on the main highway from Saigon to the US army base at Long Binh; Saigon street peddlers stuffed plastic vials of 95 percent pure heroin into the pockets of GIs as they strolled through downtown Saigon; and “mama-sans”, or Vietnamese barracks’ maids, started carrying a few vials to work for sale to on-duty GIs.’13
By the summer of 1970, virtually every enlisted man in Vietnam was being offered high-quality heroin. Almost half of them took it at least once; between 15 and 20 per cent of GIs in the Mekong delta were snorting heroin or smoking cigarettes laced with it. Ironically, heroin use soared after the Army cracked down on the much more easily detectable habit of smoking pungent marijuana. But the key factor, argues McCoy, is that drug manufacturers could make $88 million a year from selling heroin to soldiers; no wonder that ‘base after base was overrun by these ant-armies of heroin pushers with their identical plastic vials’. Rumours spread that the North Vietnamese were behind this intense marketing campaign – what better way to immobilise the enemy? But the truth was that South Vietnamese government officials were protecting the pushers.
In any case, combat troops avoided heroin use in the field: being stoned, especially on a drug as soporific as heroin, was more likely to get them killed. But they made up for it when they returned to base. One soldier came back from a long patrol of 13 days; his first action was to tip a vial of heroin into a shot of vodka and knock it back.14
Panicky headlines about the ‘GI epidemic’ started appearing in American newspapers. The Nixon administration was terrified of a crime wave caused by the return of thousands of desperate junkies to American cities. But it never materialised. Instead, the addicted soldiers cleaned up their act – fast.
We know this because the US government, anticipating disaster, commissioned a medical study that recruited more than 400 returning soldiers who snorted, smoked or injected heroin and described themselves as addicted (making it possibly the largest ever study of heroin users). To researchers’ surprise, back in the United States only 12 per cent of these addicts carried on using heroin at a level that met the study’s criteria for addiction.15
This is really powerful evidence that changes in social environment can dramatically affect people’s drug-taking habits. As Professor Michael Gossop, a leading researcher at the National Addiction Centre, King’s College, London, explains: ‘The young men who served in Vietnam were removed from their normal social environment and from many of its usual social and moral constraints. For many of them it was a confusing, chaotic and often extremely frightening experience and the chances of physical escape were remote except through the hazardous possibilities of self-inflicted injury.’16 Gossop uses the phrase ‘inward desertion’ to describe what heroin offered the soldiers: a cheap trip to another world.
The scared, disorientated soldiers in Vietnam were being offered a chemical fix to relieve their fear. The social and psychological pressure to do something they would never dream of doing in America – take heroin – was intense: one in five slid all the way into addiction. But, once home again, they weren’t scared any more. They weren’t mixing with other users. The drug was expensive, hard to find, low-grade and highly illegal. The pressure went into reverse. In other words, the same combination of social and psychological factors that turned these men into addicts explains why they were able to stop.
True, these were remarkable circumstances. So we might expect other addicts, whose initiation into drug use was less dramatic and more gradual, to recover at a slower rate. And that’s precisely what those four big epidemiological studies show: they paint a picture of users slowly changing their behaviour when their circumstances changed. They don’t support the progressive disease model. The Vietnam statistics, meanwhile, directly undermine it. The US government went to a lot of trouble to make sure that the soldiers it was testing were addicts. Are we supposed to believe that the 88 per cent who later kicked the habit were misdiagnosed? Or that being drafted to fight in heroin-saturated Vietnam ‘doesn’t count’ because it was such an unusual situation?
The Vietnam survey identifies a key factor in addiction: availability. To quote Michael Gossop: ‘Availability is such an obvious determinant of drug taking that it is often overlooked. In its simplest form the availability hypothesis states that the greater the availability of a drug in a society, the more people are likely to use it and the more they are likely to run into problems with it [my italics].’17
