Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy
By Theodore Dalrymple
(Encounter Books, 165 pages, $21.95)
Theodore Dalrymple has a knack for draining all of the fun and romance out of drug addiction. This is not a particularly easy task, considering that some of our finest writers, filmmakers and Harvard professors have been romanticizing smack, jack, coke and junk for nearly two centuries. Dalyrmple, pen name of Anthony Daniels, MD, worked for years as a doctor and psychiatrist in some of the most underdeveloped parts of Africa, only to return to Britain to take up practice in a British slum hospital and prison. His many years of experience with substance abusers has led him to conclude that drug use is a willful self-indulgence and a conscious choice that individuals make -- like whether to drive drunk or rape the neighbor's daughter -- and not an illness that like HIV or the bubonic plague can be treated.
Trouble is most of us have been taught that addiction is a disease that can be cured (usually by recourse to other opiates) rather than a moral failing. Dalrymple devotes much of his book to debunking this notion of addiction as illness, noting that it takes a lot of energy and effort to become an addict. Nor is it as hard to kick the habit as presumed: most addicts tire of the criminal lifestyle and prison as they age. Mao Tse-tung managed to get 20 million Chinese off opium by executing dealers and threatening to shoot those who continued using. Chairman Mao -- "the greatest drug-addiction therapist in history" -- understood that opium use was a lifestyle choice -- not an epidemic like the plague -- and while one may disagree with his methods, one cannot quibble over the results. If all that is required to cure the disease of addiction is a threat then we cannot be looking at a very serious "disease."
Scott Fitzgerald once noted that the rich are not like you and me, to which Hemingway responded, "Yes, they have more money." In the same way society assumes the addict is not like you and me. But rather than having a surplus of hard currency, he maintains a deficit of moral character. As a consequence he is unable to imagine the results of his actions, therefore society must treat him like a sick child, and not even like misbehaving sick child. Just a sick child. Indeed an entire addiction bureaucracy has been created based on the idea that the addict is a helpless victim. The "view of heroin addiction that is almost universally accepted by the general public," Dalrymple writes..."serves the interests both of the addicts who wish to continue their habit while placing the blame elsewhere, and the [addiction] bureaucracy that wishes to continue in employment, preferably forever and at higher rates of pay."
According to the author, our coddling of addicts only worsens the problem for the addict and society. "Harm reduction as a policy is inherently infantilizing of the population: it assumes that the authorities are, and ought to be, responsible for the ill-consequences of what people insist upon doing," he writes. The government in effect tells the addict that antisocial behavior has few if any consequences. Then provides him with free methadone.
IN HIS review of Romancing Opiates Lee Harris suggests that Dalrymple is too unsympathetic toward the addict, as if a physician who has dedicated his entire career to administering to the poor, the crapulous and the insane were some kind of pitiless cad. What is needed is not tough medicine, says Harris, but more compassion and sympathy. "There will inevitably be large groups of human beings who will be unable to control their own lives," writes Harris.
Unable or unwilling? Most heroine addicts, Dalrymple notes, "were confirmed and habitual criminals before they ever took heroine...[possessed] with an adversarial stance to the world caused by the emotional, spiritual, cultural and intellectual vacuity of their lives." Indeed criminality causes addiction far more often than addiction causes criminality. And what is more, the addict had to work damn hard at becoming addicted. Even the adding machine heiress and beatnik novelist William S. Burroughs said so: "You don't wake up one morning and decide to be a drug addict. It takes at least three months shooting twice a day to get any habit at all." Dalrymple writes that it can take up to 12 months to hook the user.
Which is it then? Are addicts self-indulgent criminals or morally weak slaves? Dalrymple agrees with Harris that the potential addict is likely a person of weak character and moral failings. But he is not so ready to shift blame from the addict's misbehavior and choices to the drug, or to some dubious gene, or to society's failure to educate its citizenry about personal responsibility. He makes a convincing case that many addicts do in fact shake their habits, if they truly desire to do so. Nor is kicking the habit as onerous as it is often portrayed (particularly by Hollywood), Dalrymple writes, likening the symptoms of heroine withdrawal to the flu.
The problem is the addict's lack of incentive to kick the habit. Why should he? The addiction bureaucracy will take care of him. The drunkard may be viewed negatively, but the opium addict has been romanticized for centuries. The original romancer was Thomas De Quincey, who, in his Confessions of an English Opium-Eater, suggested a connection between opiates and creativity, that drugs could indeed unlock the mysteries of the universe, and offer rare philosophical insights. De Quincey was followed by other romantics the likes of Coleridge and Baudelaire ("first class self-dramatizers"), and in our own day Burroughs, Ken Kesey, and Dr. Timothy Leary who preached "Drop Out, turn on, leech off society," or some similarly vacuous mantra. Finally the addict suffers little in the way of stigmatization or shame. In fact, he is pitied. "Addicts should therefore be stigmatized far more than they are," Dalrymple writes, a policy that Harris finds "utopian," and unsympathetic, and suggests that submitting the opium eater to Darwinian evolution would be as bad for our collective soul as letting the AIDs patient die without treatment.
Dalrymple's favorite quotation comes from Edmund Burke:
Men are qualified for civil liberties in exact proportion to their disposition to put moral chains upon their appetites: in proportion as their love of justice is above their rapacity...Society cannot exist, unless a controlling power upon will and appetite be placed somewhere; and the less of it there is within, the more there must be without. It is ordained in the eternal constitution of things, that men of intemperate minds cannot be free. Their passions forge their fetters.Today, rather than encouraging temperance, we embrace the notion of addict as victim. Ultimately the question becomes what society should do with the addict? Dalrymple concludes that he should receive rehabilitation -- not treatment. He should be told that his free ride is over, and that it is his duty to put moral chains on his appetites. Hard work putting chains on one's appetites, but it is also hard work getting up at 5 a.m. every weekday and going to work in an office building in order to support your family. And there is not a thing romantic about it.