artical based on studys show chippers far out-number addicts

[drug-bot]

H

The surprising truth about heroin and addiction.



In 1992 The New York Times carried a front-page story about a successful businessman who happened to be a regular heroin user. It began: "He is an executive in a company in New York, lives in a condo on the Upper East Side of Manhattan, drives an expensive car, plays tennis in the Hamptons and vacations with his wife in Europe and the Caribbean. But unknown to office colleagues, friends, and most of his family, the man is also a longtime heroin user. He says he finds heroin relaxing and pleasurable and has seen no reason to stop using it until the woman he recently married insisted that he do so. 'The drug is an enhancement of my life,' he said. 'I see it as similar to a guy coming home and having a drink of alcohol. Only alcohol has never done it for me.'"
The Times noted that "nearly everything about the 44-year-old executive...seems to fly in the face of widely held perceptions about heroin users." The reporter who wrote the story and his editors seemed uncomfortable with contradicting official anti-drug propaganda, which depicts heroin use as incompatible with a satisfying, productive life. The headline read, "Executive's Secret Struggle With Heroin's Powerful Grip," which sounds more like a cautionary tale than a success story. And the Times hastened to add that heroin users "are flirting with disaster." It
conceded that "heroin does not damage the organs as, for instance, heavy alcohol use does." But it cited the risk of arrest, overdose, AIDS, and hepatitis -- without noting that all of these risks are created or exacerbated by prohibition.
The general thrust of the piece was: Here is a privileged man who is tempting fate by messing around with a very dangerous drug. He may have escaped disaster so far, but unless he quits he will probably end up dead or in prison.
That is not the way the businessman saw his situation. He said he had decided to give up heroin only because his wife did not approve of the habit. "In my heart," he said, "I really don't feel there's anything wrong with using heroin. But there doesn't seem to be any way in the world I can persuade my wife to grant me this space in our relationship. I don't want to lose her, so I'm making this effort."
Judging from the "widely held perceptions about heroin users" mentioned by the Times, that effort was bound to fail. The conventional view of heroin, which powerfully shapes the popular understanding of addiction, is nicely summed up in the journalist Martin Booth's 1996 history of opium. "Addiction is the compulsive taking of drugs which have such a hold over the addict he or she cannot stop using them without suffering severe symptoms and even death," he writes. "Opiate dependence...is as fundamental to an addict's existence as food and water, a physio-chemical fact: an addict's body is chemically reliant upon its drug for opiates actually alter the body's chemistry so it cannot function properly without being periodically primed. A hunger for the drug forms when the quantity in the bloodstream falls below a certain level....Fail to feed the body and it deteriorates and may die from drug starvation." Booth also declares that "everyone...is a potential addict"; that "addiction can start with the very first dose"; and that "with continued use addiction is a certainty."
Booth's description is wrong or grossly misleading in every particular. To understand why is to recognize the fallacies underlying a reductionist, drug-centered view of addiction in which chemicals force themselves on people -- a view that skeptics such as the maverick psychiatrist Thomas Szasz and the psychologist Stanton Peele have long questioned. The idea that a drug can compel the person who consumes it to continue consuming it is one of the most important beliefs underlying the war on drugs, because this power makes possible all the other evils to which drug use supposedly leads.
When Martin Booth tells us that anyone can be addicted to heroin, that it may take just one dose, and that it will certainly happen to you if you're foolish enough to repeat the experiment, he is drawing on a long tradition of anti-drug propaganda. As the sociologist Harry G. Levine has shown, the original model for such warnings was not heroin or opium but alcohol. "The idea that drugs are inherently addicting," Levine wrote in 1978, "was first systematically worked out for alcohol and then extended to other substances. Long before opium was popularly accepted as addicting, alcohol was so regarded." The dry crusaders of the 19th and early 20th centuries taught that every tippler was a potential drunkard, that a glass of beer was the first step on the road to ruin, and that repeated use of distilled spirits made addiction virtually inevitable. Today, when a kitchen wrecked by a skinny model wielding a frying pan is supposed to symbolize the havoc caused by a snort of heroin, similar assumptions about opiates are even more widely held, and they likewise are based more on faith than facts.
 

• 1Withdrawal Penalty
• 2Simply Irresistible?
• 3The Needle and the Damage Done
• 4Heroin in Moderation
• 5Better Homes & Gardens

[top]Withdrawal Penalty

Beginning early in the 20th century, Stanton Peele notes, heroin "came to be seen in American society as the nonpareil drug of addiction -- as leading inescapably from even the most casual contact to an intractable dependence, withdrawal from which was traumatic and unthinkable for the addict." According to this view, reflected in Booth's gloss and other popular portrayals, the potentially fatal agony of withdrawal is the gun that heroin holds to the addict's head. These accounts greatly exaggerate both the severity and the importance of withdrawal symptoms.
Heroin addicts who abruptly stop using the drug commonly report flu-like symptoms, which may include chills, sweating, runny nose and eyes, muscular aches, stomach cramps, nausea, diarrhea, or headaches. While certainly unpleasant, the experience is not life threatening. Indeed, addicts who have developed tolerance (needing higher doses to achieve the same effect) often voluntarily undergo withdrawal so they can begin using heroin again at a lower dose, thereby reducing the cost of their habit. Another sign that fear of withdrawal symptoms is not the essence of addiction is the fact that heroin users commonly drift in and out of their habits, going through periods of abstinence and returning to the drug long after any physical discomfort has faded away. Indeed, the observation that detoxification is not tantamount to overcoming an addiction, that addicts typically will try repeatedly before successfully kicking the habit, is a commonplace of drug treatment.
More evidence that withdrawal has been overemphasized as a motivation for using opiates comes from patients who take narcotic painkillers over extended periods of time. Like heroin addicts, they develop "physical dependence" and experience withdrawal symptoms when they stop taking the drugs. But studies conducted during the last two decades have consistently found that patients in pain who receive opioids (opiates or synthetics with similar effects) rarely become addicted.
Pain experts emphasize that physical dependence should not be confused with addiction, which requires a psychological component: a persistent desire to use the substance for its mood-altering effects. Critics have long complained that unreasonable fears about narcotic addiction discourage adequate pain treatment. In 1989 Charles Schuster, then director of the National Institute on Drug Abuse, confessed, "We have been so effective in warning the medical establishment and the public in general about the inappropriate use of opiates that we have endowed these drugs with a mysterious power to enslave that is overrated."
Although popular perceptions lag behind, the point made by pain specialists -- that "physical dependence" is not the same as addiction -- is now widely accepted by professionals who deal with drug problems. But under the heroin-based model that prevailed until the 1970s, tolerance and withdrawal symptoms were considered the hallmarks of addiction. By this standard, drugs such as nicotine and cocaine were not truly addictive; they were merely "habituating." That distinction proved untenable, given the difficulty that people often had in giving up substances that were not considered addictive.
Having hijacked the term addiction, which in its original sense referred to any strong habit, psychiatrists ultimately abandoned it in favor of substance dependence. "The essential feature of Substance Dependence," according to the American Psychiatric Association, "is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems....Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence." Instead, the condition is defined as "a maladaptive pattern of substance use" involving at least three of seven features. In addition to tolerance and withdrawal, these include using more of the drug than intended; trying unsuccessfully to cut back; spending a lot of time getting the drug, using it, or recovering from its effects; giving up or reducing important social, occupational, or recreational activities because of drug use; and continuing use even while recognizing drug-related psychological or physical problems.
One can quibble with these criteria, especially since they are meant to be applied not by the drug user himself but by a government-licensed expert with whose judgment he may disagree. The possibility of such a conflict is all the more troubling because the evaluation may be involuntary (the result of an arrest, for example) and may have implications for the drug user's freedom. More fundamentally, classifying substance dependence as a "mental disorder" to be treated by medical doctors suggests that drug abuse is a disease, something that happens to people rather than something that people do. Yet it is clear from the description that we are talking about a pattern of behavior. Addiction is not simply a matter of introducing a chemical into someone's body, even if it is done often enough to create tolerance and withdrawal symptoms. Conversely, someone who takes a steady dose of a drug and who can stop using it without physical distress may still be addicted to it.

[top]Simply Irresistible?

Even if addiction is not a physical compulsion, perhaps some drug experiences are so alluring that people find it impossible to resist them. Certainly that is heroin's reputation, encapsulated in the title of a 1972 book: It's So Good, Don't Even Try It Once.
The fact that heroin use is so rare -- involving, according to the government's data, something like 0.2 percent of the U.S. population in 2001 -- suggests that its appeal is much more limited than we've been led to believe. If heroin really is "so good," why does it have such a tiny share of the illegal drug market? Marijuana is more than 45 times as popular. The National Household Survey on Drug Abuse indicates that about 3 million Americans have used heroin in their lifetimes; of them, 15 percent had used it in the last year, 4 percent in the last month. These numbers suggest that the vast majority of heroin users either never become addicted or, if they do, manage to give the drug up. A survey of high school seniors found that 1 percent had used heroin in the previous year, while 0.1 percent had used it on 20 or more days in the previous month. Assuming that daily use is a reasonable proxy for opiate addiction, one in 10 of the students who had taken heroin in the last year might have qualified as addicts. These are not the sort of numbers you'd expect for a drug that's irresistible.
True, these surveys exclude certain groups in which heroin use is more common and in which a larger percentage of users probably could be described as addicts. The household survey misses people living on the street, in prisons, and in residential drug treatment programs, while the high school survey leaves out truants and dropouts. But even for the entire population of heroin users, the estimated addiction rates do not come close to matching heroin's reputation. A 1976 study by the drug researchers Leon G. Hunt and Carl D. Chambers estimated there were 3 or 4 million heroin users in the United States, perhaps 10 percent of them addicts. "Of all active heroin users," Hunt and Chambers wrote, "a large majority are not addicts: they are not physically or socially dysfunctional; they are not daily users and they do not seem to require treatment." A 1994 study based on data from the National Comorbidity Survey estimated that 23 percent of heroin users ever experience substance dependence.
The comparable rate for alcohol in that study was 15 percent, which seems to support the idea that heroin is more addictive: A larger percentage of the people who try it become heavy users, even though it's harder to get. At the same time, the fact that using heroin is illegal, expensive, risky, inconvenient, and almost universally condemned means that the people who nevertheless choose to do it repeatedly will tend to differ from people who choose to drink. They will be especially attracted to heroin's effects, the associated lifestyle, or both. In other words, heroin users are a self-selected group, less representative of the general population than alcohol users are, and they may be more inclined from the outset to form strong attachments to the drug.
The same study found that 32 percent of tobacco users had experienced substance dependence. Figures like that one are the basis for the claim that nicotine is "more addictive than heroin." After all, cigarette smokers typically go through a pack or so a day, so they're under the influence of nicotine every waking moment. Heroin users typically do not use their drug even once a day. Smokers offended by this comparison are quick to point out that they function fine, meeting their responsibilities at work and home, despite their habit. This, they assume, is impossible for heroin users. Examples like the businessman described by The New York Times indicate otherwise.
Still, it's true that nicotine's psychoactive effects are easier to reconcile with the requirements of everyday life than heroin's are. Indeed, nicotine can enhance concentration and improve performance on certain tasks. So one important reason why most cigarette smokers consume their drug throughout the day is that they can do so without running into trouble. And because they're used to smoking in so many different settings, they may find nicotine harder to give up than a drug they use only with certain people in secret. In one survey, 57 percent of drug users entering a Canadian treatment program said giving up their problem substance (not necessarily heroin) would be easier than giving up cigarettes. In another survey, 36 heroin users entering treatment were asked to compare their strongest cigarette urge to their strongest heroin urge. Most said the heroin urge was stronger, but two said the cigarette urge was, and 11 rated the two urges about the same.
In a sense, nicotine's compatibility with a wide range of tasks makes it more addictive than alcohol or heroin. But this is not the sort of thing people usually have in mind when they worry about addiction. Indeed, if it weren't for the health effects of smoking (and the complaints of bystanders exposed to the smoke), nicotine addiction probably would be seen as no big deal, just as caffeine addiction is. As alternative sources of nicotine that do not involve smoking (gum, patches, inhalers, beverages, lozenges, oral snuff) become popular not just as aids in quitting but as long-term replacements, it will be interesting to see whether they will be socially accepted. Once the health risks are dramatically reduced or eliminated, will daily consumption of nicotine still be viewed as shameful and déclassé, as a disease to be treated or a problem to be overcome? Perhaps so, if addiction per se is the issue. But not if it's the medical, social, and psychological consequences of addiction that really matter.

[top]The Needle and the Damage Done

To a large extent, regular heroin use also can be separated from the terrible consequences that have come to be associated with it. Because of prohibition, users face the risk of arrest and imprisonment, the handicap of a criminal record, and the violence associated with the black market. The artificially high price of heroin, perhaps 40 or 50 times what it would otherwise cost, may lead to heavy debts, housing problems, poor nutrition, and theft. The inflated cost also encourages users to inject the drug, a more efficient but riskier mode of administration. The legal treatment of injection equipment, including restrictions on distribution and penalties for possession, encourages needle sharing, which spreads diseases such as AIDS and hepatitis. The unreliable quality and unpredictable purity associated with the black market can lead to poisoning and accidental overdoses.
Without prohibition, then, a daily heroin habit would be far less burdensome and hazardous. Heroin itself is much less likely to kill a user than the reckless combination of heroin with other depressants, such as alcohol or barbiturates. The federal government's Drug Abuse Warning Network counted 4,820 mentions of heroin or morphine (which are indistinguishable in the blood) by medical examiners in 1999. Only 438 of these deaths (9 percent) were listed as directly caused by an overdose of the opiate. Three-quarters of the deaths were caused by heroin/morphine in combination with other drugs. Provided the user avoids such mixtures, has access to a supply of reliable purity, and follows sanitary injection procedures, the health risks of long-term opiate consumption are minimal.
The comparison between heroin and nicotine is also instructive when it comes to the role of drug treatment. Although many smokers have a hard time quitting, those who succeed generally do so on their own. Surprisingly, the same may be true of heroin addicts. In the early 1960s, based on records kept by the Federal Bureau of Narcotics, sociologist Charles Winick concluded that narcotic addicts tend to "mature out" of the habit in their 30s. He suggested that "addiction may be a self limiting process for perhaps two-thirds of addicts." Subsequent researchers have questioned Winick's assumptions, and other studies have come up with lower estimates. But it's clear that "natural recovery" is much more common than the public has been led
to believe.
In a 1974 study of Vietnam veterans, only 12 percent of those who were addicted to heroin in Vietnam took up the habit again during the three years after their return to the United States. (This was not because they couldn't find heroin; half of them used it at least once after their return,
generally without becoming addicted again.) Those who had undergone treatment (half of the group) were just as likely to be re-addicted as those who had not. Since those with stronger addictions were more likely to receive treatment, this does not necessarily mean that treatment was useless, but it clearly was not a prerequisite for giving up heroin.
Despite its reputation, then, heroin is neither irresistible nor inescapable. Only a very small share of the population ever uses it, and a large majority of those who do never become addicted. Even within the minority who develop a daily habit, most manage to stop using heroin, often without professional intervention. Yet heroin is still perceived as the paradigmatic voodoo drug, ineluctably turning its users into zombies who must obey its commands.

[top]Heroin in Moderation

The idea that drugs cause addiction was rejected in the case of alcohol because it was so clearly at odds with everyday experience, which showed that the typical drinker was not an alcoholic. But what the psychologist Bruce Alexander calls "the myth of drug-induced addiction" is still widely accepted in the case of heroin -- and, by extension, the drugs compared to it (see sidebar) -- because moderate opiate users are hard to find. That does not mean they don't exist; indeed, judging from the government's survey results, they are a lot more common than addicts. It's just that people who use opiates in a controlled way are inconspicuous by definition, and keen to remain so.
In the early 1960s, however, researchers began to tentatively identify users of heroin and other opiates who were not addicts. "Surprisingly enough," a Northwestern University psychiatrist wrote in 1961, "in some cases at
least, narcotic use may be confined to weekends or parties and the users may be able to continue in gainful employment for some time. Although this pattern often deteriorates and the rate of use increases, several cases have been observed in which relatively gainful and steady employment has been maintained for two to three years while the user was on what might be called a regulated or controlled habit."
A few years later, Harvard psychiatrist Norman Zinberg and David C. Lewis, then a medical resident, described five categories of narcotic users, including "people who use narcotics regularly but who develop little or no tolerance for them and do not suffer withdrawal symptoms." They explained that "such people are usually able to work regularly and productively. They value the relaxation and the 'kick' obtained from the drug, but their fear of needing more and more of the drug to get the same kick causes them to impose rigorous controls on themselves."
The example offered by Zinberg and Lewis was a 47-year-old physician with a successful practice who had been injecting morphine four times a day, except weekends, for 12 years. He experienced modest discomfort on Saturdays and Sundays, when he abstained, but he stuck to his schedule and did not raise his dose except on occasions when he was especially busy or tense. Zinberg and Lewis' account suggests that morphine's main function for him was stress relief: "Somewhat facetiously, when describing his intolerance of people making emotional demands on him, he said that he took 1 shot for his patients, 1 for his mistress, 1 for his family and 1 to sleep. He expressed no guilt about his drug taking, and made it clear that he had no intention of stopping."
Zinberg eventually interviewed 61 controlled opiate users. His criteria excluded both dabblers (the largest group of people who have used heroin) and daily users. One subject was a 41-year-old carpenter who had used heroin on weekends for a decade. Married 16 years, he lived with his wife and three children in a middle-class suburb. Another was a 27-year-old college student studying special education. He had used heroin two or three times a month for three years, then once a week for a year. The controlled users said they liked "the 'rush' (glow or warmth), the sense of distance from their problems, and the tranquilizing powers of the drug." Opiate use was generally seen as a social activity, and it was often combined with other forms of recreation. Summing up the lessons he learned from his research, Zinberg emphasized the importance of self-imposed rules dictating when, where, and with whom the drug would be used. More broadly, he concluded that "set and setting" -- expectations and environment -- play crucial roles in shaping a drug user's experience.
Other researchers have reported similar findings. After interviewing 12 occasional heroin users in the early 1970s, a Harvard researcher concluded that "it seems possible for young people from a number of different backgrounds, family patterns, and educational abilities to use heroin occasionally without becoming addicted." The subjects typically took heroin with one or more friends, and the most frequently reported benefit was relaxation. One subject, a 23-year-old graduate student, said it was "like taking a vacation from yourself....When things get to you, it's a way of getting away without getting away." These occasional users were unanimous in rejecting addiction as inconsistent with their self-images. A 1983 British study of 51 opiate users likewise found that distaste for the junkie lifestyle was an important deterrent to excessive use.
While these studies show that controlled opiate use is possible, the 1974 Vietnam veterans study gives us some idea of how common it is. "Only one-quarter of those who used heroin in the last two years used it daily at all," the researchers reported. Likewise, only a quarter said they had felt dependent, and only a quarter said heroin use had interfered with their lives. Regular heroin use (more than once a week for more than a month) was associated with a significant increase in "social adjustment problems," but occasional use was not.
Many of these occasional users had been addicted in Vietnam, so they knew what it was like. Paradoxically, a drug's attractiveness, whether experienced directly or observed secondhand, can reinforce the user's determination to remain in control. (Presumably, that is the theory behind all the propaganda warning how wonderful certain drug experiences are, except that the aim of those messages is to stop people from experimenting at all.) A neuro-scientist in his late 20s who smoked heroin a couple of times in college told me it was "nothing dramatic, just the feeling that everything was OK for about six hours, and I wasn't really motivated to do anything." Having observed several friends who were addicted to heroin at one time or another, he understood that the experience could be seductive, but "that kind of seduction...kind of repulsed me. That was exactly the kind of thing that I was trying to avoid in my life."
Similarly, a horticulturist in his 40s who first snorted heroin in the mid-1980s said, "It was too nice." As he described it, "you're sort of not awake and you're not asleep, and you feel sort of like a baby in the cradle, with no worries, just floating in a comfortable cocoon. That's an interesting place to be if you don't have anything else to do. That's Sunday-afternoon-on-the-couch material." He did have other things to do, and after that first experience he used heroin only "once in a blue moon." But he managed to incorporate the regular use of another opiate, morphine pills, into a busy, productive life. For years he had been taking them once a week, as a way of unwinding and relieving the aches and pains from the hard manual labor required by his landscaping business. "We use it as a reward system," he said. "On a Friday, if we've been working really hard and we're sore and it's available, it's a reward. It's like, 'We've worked hard today. We've earned our money, we paid our bills, but we're sore, so let's do this. It's medicine.'"

[top]Better Homes & Gardens

Evelyn Schwartz learned to use heroin in a similar way: as a complement to rest and relaxation rather than a means of suppressing unpleasant emotions. A social worker in her 50s, she injected heroin every day for years but was using it intermittently when I interviewed her a few years ago. Schwartz (a pseudonym) originally became addicted after leaving home at 14 because of conflict with her mother. "As I felt more and more alienated from my family, more and more alone, more and more depressed," she said, "I started to use [heroin] not in a recreational fashion but as a coping mechanism, to get rid of feelings, to feel OK....I was very unhappy...and just hopeless about life, and I was just trying to survive day by day for many years."
But after Schwartz found work that she loved and started feeling good about her life, she was able to use heroin in a different way. "I try not to use as a coping mechanism," she said. "I try very hard not to use when I'm miserable, because that's what gets me into trouble. It's set and setting. It's not the drug, because I can use this drug in a very controlled way, and I can also go out of control." To stay in control, "I try to use when I'm feeling good," such as on vacation with friends, listening to music, or before a walk on a beautiful spring day. "If I need to clean the house, I do a little heroin, and I can clean the house, and it just makes me feel so good."
Many people are shocked by the idea of using heroin so casually, which helps explain the controversy surrounding a 2001 BBC documentary that explored why people use drugs. "Heroin is my drug of choice over alcohol or cocaine," said one user interviewed for the program. "I take it at weekends in small doses, and do the gardening." It may be unconventional, but using heroin to enliven housework or gardening is surely wiser than using it to alleviate grief, dissatisfaction, or loneliness. It's when drugs are used for emotional management that a destructive habit is apt to develop.
Even daily opiate use is not necessarily inconsistent with a productive life. One famous example is the pioneering surgeon William Halsted, who led a brilliant career while secretly addicted to morphine. On a more modest level, Schwartz said that even during her years as a self-described junkie she always held a job, always paid the rent, and was able to conceal her drug use from people who would have been alarmed by it. "I was always one of the best secretaries at work, and no one ever knew, because I learned how to titrate my doses," she said. She would generally take three or four doses a day: when she got up in the morning, at lunchtime, when she came home from work, and perhaps before going to sleep. The doses she took during the day were small enough so that she could get her work done. "Aside from the fact that I was a junkie," she said, "I was raised to be a really good girl and do what I'm supposed to do, and I did."
Schwartz, a warm, smart, hard-working woman, is quite different from the heroin users portrayed by government propaganda. Even when she was taking heroin every day, her worst crime was shoplifting a raincoat for a job interview. "I never robbed," she said. "I never did anything like that. I never hurt a human being. I could never do that....I'm not going to hit anybody over the head....I went sick a lot as a consequence. When other junkies would commit crimes, get money, and tighten up, I would be sick. Everyone used to say: 'You're terrible at being a junkie.'"

http://www.reason.com/news/show/28809.html

Reputation Comments on this post:

very interesting story

[Alfa]

I like the article it is thought provoking and raises good points.

Like heroin not being harmful for organs. Though absence of pain and hunger is not very good for physical health.

Though I very much disagree with several arguments. At the very least this is not what I have seen. I have seen the addicts outweigh the chippers by far.
I have seen many occasional users slip into full blown addiction and from there into becoming a junky.

Off course it is possible to lead a normal life or even a very successful life, while using heroin. But I do not think that the grasp of heroin should be underestimated.

It is not without reason that quite a large amount of heroin addicts become prostitutes to sustain the habit. IMHO this says something about that grasp. About the change in perspective. Someone's word can become quite small.

A very dear friend of FUBAR once described the feeling of his first heroin use. He knew one thing for sure: heroin felt so good that he would do this again. That for him was the seed, that later grew into addiction and then turned him into a junky. Well actually he did it all himself. But still.

I have spoken to many people, who are now addicted to opiates, because of the morphine addiction stemming from medical treatment. I must disagree on that point as well.

[drug-bot]

this artical is actually part of the book- Saying Yes: in defense of drug by Jacob Sullum. unfortunately it doesnt include the foot notes, so swim will try and find some.
swim is a heroin addict(and doesnt wish to discount the grasp of heroin either,just present unbiased facts) but also knows many chippers, he thinks the reason this isnt well excepted is because chippers tend to wish to remain annonomous, saying every heroin user is the typical junky on the street is like saying the typical alcohol drinker is the homeless wineo begging for spare change.

heres some interesting footnotes to the above artical-

Dr. Norman Zinberg ((1922 in Harrisburg, Pennsylvania - 1989 in Cambridge, Massachusetts) was a psychoanalyst and psychiatrist whose research into addiction is seen as a great influence on current clinical models and greatly influenced the work of addiction treatment specialists like Stanton Peele.
His allegiance to the scientific method allowed him to delineate why some people controlled their drug use while others did not. And why people's relation to drug use could change according to type of drug (an its method of ingestion), their (mind)set, and setting. His book, "Drug, Set, and Setting: The Basis for Controlled Intoxicant Use" explains with data and case histories why someone can drink for 20 years in a controlled fashion and then become out of control. And then over time return to being a controlled user.
His scientific work flies directly in the face of any idea that some people have "addictive personalities" while other don't. One classic example was a study citing the large number of overseas soldiers who became addicted to heroin during the Vietnam war who came back and led normal lives; once back in the U.S., the number of dysfunctional addicts went down and comported with the average number of heroin addicts in the general population (Drug, Set, and Setting: The Basis for Controlled Intoxicant Use", 1984, Page X). The book is made up all kinds of examples that fly in the face of addiction as a "disease" or that some have "addictive personalities" while others don't. Zinberg followed recreational heroin users over a ten year period, dispelling any myths that all heroin users because addicted. The full text of "Drug, Set, and Setting" can be found at various sites on the internet or bought used on amazon.com
In his obituary the New York Times (April 4, 1989) wrote, "He had a remarkable impact on our understanding that drug effects are not simply a consequence of biochemistry, said Dr. Howard Shaffer, a colleague at Harvard and at Cambridge Hospital. He showed that an individual's expectations, his psychological set and his social milieu interact to produce the effects on behavior that we observe. Equally important, Norman Zinberg helped us explain why an addictive drug affects a person differently at different times and how it affects various people in different ways.
If drug treatment programs become less faith based and less dogmatic, Zinberg's science based work will hopefully come into fashion and make drug treatment much more personalized and effective. But at the time of this writing, AA and related ideologies dominate the field despite their high drop out rate, impracticability for most and failure to deal with the underlying problems that compel people to abuse drugs.

http://en.wikipedia.org/wiki/Norman_Zinberg

Shiffman's work follows in the footsteps of research on heroin chippers directed by the late Norman E. Zinberg, a psychiatrist at Harvard Medical School in Boston. Zinberg held that three major forces mold a person's use of and experience with heroin or any other substance: the pharmacology of the drug, the personality of the user and the physical and social setting in which use takes place.

Zinberg saw the social setting as an especially powerful influence on heroin use. In 1972, he observed two types of heroin addicts in England, where these users obtained the opiate legally through public clinics. The first type used heroin in a controlled fashion and functioned adequately or even quite successfully, while the second took heroin constantly and lived desperate, self-destructive lives. But the latter group was not a cause of societal unrest, crime or public hysteria, Zinberg writes in Drug, Set, and Setting (1984, Yale University Press), because British social and legal sanctions allowed them to live as addicts.
Zinberg then studied small groups of heroin chippers and addicts in the United States. He found that occasional users did not experience the distressing withdrawal symptoms of hard-core addicts and tended to use heroin at specific times when it would not disrupt their jobs or other responsibilities.
The Vietnam War also provided a natural laboratory for studying controlled heroin use. Southeast Asian heroin was cheap, plentiful and delivered in an easy-to-use smokable form. About one out of three U.S. soldiers tried heroin while in Vietnam and half of them became addicted, according to surveys conducted in the early 1970s by psychologist Lee N. Robins of Washington University in St. Louis and her colleagues.
Yet when these veterans came home and left the bleak social setting of the war behind, their craving for heroin largely diminished. In one study, Robins and her co-workers interviewed 617 enlisted men before their return from Vietnam in 1971 and again three years later. Half the veterans addicted in Vietnam had used heroin since their return home, but only 12 percent of those became readdicted.
As early as 1947, heroin chippers were recognized as "joy poppers" who used the drug occasionally without signs of addiction, Siegel points out.
"Even if most heroin addicts had once been chippers," he asks, "why didn't all chippers become addicts? Is there a secret to controlled intoxicant use?"
No one offers a simple answer to this question, but in Siegel's opinion, the drug dose taken by an individual and its frequency are critical.

http://findarticles.com/p/articles/mi_m1200/is_n25_v136/ai_8207099/pg_2?tag=artBody;col1

NATURAL RECOVERY FROM HEROIN ADDICTION:

A REVIEW OF THE INCIDENCE LITERATURE
Dan Waldorf & Patrick Biernacki

Dan Waldorf, M.A., has worked in the field of addiction for over ten years. His initial work was with a study of addict careers in New York City at Columbia University which culminated in the book, Careers in Dope. Since that time he has been involved with numerous evaluations of drug treatment programs, a historical study of the Shreveport, Louisiana morphine maintenance clinic. and an ethnographic study of a group of cocaine users in San Francisco. Most recently, he has been working as a consultant to a P.C.P. ethnographic study and is Co-Principal Investigator of the Recovery Project, an exploratory study of natural recovery of heroin addicts.
Patrick Biernacki, Ph.D. co-author of the Natural Recovery article, teaches Sociology at San Francisco State University. He has conducted a research study that analyzed the life careers of 1400 addicts who had been civily committed to the California Rehabilitation Center. He has also directed research projects in the areas of alternative education, criminal justice and consumer affairs. At the present time he and Dan Waldorf are conducting a study of the processes involved in the "natural" termination of heroin addiction careers.

This paper reviews the literature in an area which has received little attention of drug researchers spontaneous remission. The paper reviews all the research studies that have looked at the phenomena of the "natural" recovery from heroin addiction natural in the sense that some addicts manage to stop using heroin and not become re-addicted without the help of treatment intervention. Some areas for future research are also suggested.

Introduction

Conventional wisdom among clinicians and researchers in the field of drug abuse and addiction is that heroin addicts seldom, if ever, overcome addiction without treatment. Occasionally researchers have speculated that there may be something akin to spontaneous remission among addicts, but until recently it was thought that the numbers and percentages of such recoveries were very small (5-15%) and insignificant. New evidence suggests that the rate of natural recovery may be much higher than expected. Furthermore, new studies suggest that addicts who do not go to treatment recover at approximately the same rates as those who do go to treatment.

The Incidence Literature

The first evidence to suggest natural recovery came from Charles Winick's famous "maturing out" study published in 1962. Winick traced the official records of addicts in files of the Federal Bureau of Narcotics and found that age was associated with such traces. As addicts approached ages 35-40 years they tended to drop out of the files which suggested to Winick that some life cycle processes were involved. He postulated that addicts gave up their addiction just as some adolescents matured out of juvenile delinquency.
There are, however, problems with Winick's study; he did not know exactly what happened to persons who were no longer in the file and assumed that they had given up their addiction. A 1973 report of George Vaillant's longitudinal study of 100 New York addicts (originally admitted to Lexington Hospital and followed for 20 years) questions Winick's assumption of recovery. Vaillant found that " . . . more than half of the actively addicted men of [his] study [were] able to go for five years or more without being reported to the Federal Bureau of Narcotics and Dangerous Drugs," and that "Over 25% of active addicts went for five years without being reported to the New York Narcotics Register." (Vaillant, 1973) These data suggest that Winick's assumption of recovery may not be completely justified.
The next study to suggest natural recovery was conducted in 1964 and 1965 and published in 1966. Robert Scharse working in the East Los Angeles Halfway House asked known addicts in the program to identify and locate friends who had used heroin with them but had since given it up. Scharse identified 71 ex-users by this means and interviewed 40 of them in a dual interview situation (both the addict and the ex-user). He found that at least 9 of the 40 interviewed reported that they had experienced physical dependence from heroin and had recovered without going to treatment. (Scharse, 1966)
Social survey data amplified the exploratory studies of Scharse and Winick in 1967. Lee Robins working out of Washington University in St. Louis published the results of a social survey of a sample of black males born during 1930-1934 in St. Louis and who attended schools in that city. This was the first study of drug use of a non-treatment sample (called "normal" by Robins) and she found that 10% (22) of the 235 men interviewed had been addicted to heroin while 4% (9) had been to Lexington and Ft. Worth Hospitals for drug treatment (at that time there were few other treatments available). Of the 22 persons reporting heroin addiction only 16% (4) reported heroin ule during the previous year (1964-1965); 2 of the 4 had been to treatments (or 22% of the 13) and the remaining (15% of the 13) had not been treated. Put another way, 78% of the treated and 85% of the untreated addicts reported no heroin use for the previous year. (Robins, 1967) These findings were so unusual and so much at odds with the accepted knowledge of addiction at the time that many persons were cautiously skeptical.
This skepticism subsided somewhat in 1973 when Robins published her milestone study of returned Vietnam veterans. Startled by reports of widespread heroin use in Vietnam during the war, the federal agencies (more specifically the Special Action Office for Drug Abuse Prevention) commissioned a study of returned veterans in 1972 to learn more about their drug use in Vietnam and also since returning. A sample of 898 men who had returned from Vietnam during September 1971 were interviewed in 1972 from 8-12 months after their return. Of the 898 it was found that nearly one in two had used narcotics in Vietnam (45%) and one in five (20%) had been addicted to heroin. After returning only 10% reported using narcotics between the time of their return and the interview and only 1% had been re-addicted. At the time of the interview only 2% (8% of those addicted in Vietnam) reported to have been currently using narcotics and 1% were detected to have used opiates through urine analyses.
Research findings concerning the differences between treated and untreated addicts were not as expected. Veterans who did not get treatment for their addiction did just as well upon return as those treated. More specifically the study found that:
37% of the treated and 49% of the untreated veterans who were dependent and detected (DEROS urine samples) narcotics users (186) were drug positive at the interview.

48% of the treated and 24% of the untreated veterans who were dependent but not detected narcotic users (76) were drug positive and;
13% of the treated and 16% of the untreated persons who claimed never to have been dependent in Vietnam (12) were drug positive. These findings were even more startling than those of the first Robins study. The idea that addiction was nearly always a long lasting phenomena and the old myth 11 once an addict, always an addict" had to be abandoned in the face of these findings. Very clearly, the natural history of addiction had to be re-thought to account for these new data. Discussing the findings in 1975 she and her co-authors said:
... it does seem clear that the opiates are not so addictive that use is necessarily followed by addiction nor that once addicted, an individual is necessarily addicted permanently. At least in certain circumstances, individuals can use narcotics and even become addicted to them but yet be able to avoid use in other social circumstances. (Robins, Helzer and Davis, 1975)*
Still another large scale survey also lends support to the findings of the two Robins' studies. In 1976 John O'Donnell and researchers from the Universities of Kentucky and California (at Berkeley) published preliminary results from a survey of 2,510 males taken in 1974 and 1975. (O'Donnell, Voss, Clayton, Slatin and Room, 1976). From a sample of all the males in the United States born between 1944-1954 and known to draft boards, O'Donnell and his associates found that 6% of the sample had used heroin and 2% were considered heavy users (using 100 times or more). Only 20 of the heroin users reported going to treatment; this number constituted 13% of all the heroin users. Half the heavy heroin users had been to treatment. Comparing those who had been to treatment with those who had not the authors found major differences in current heroin use (use during 1974 and 1975):
... 65 percent of the men who had been treated for heroin use were currently using it, in contrast with 27 percent of the men who had never been treated for use of heroin. These data suggest that users who enter treatment comprise those least likely to succeed in terminating the use of heroin. (O'Donnell, Voss, Clayton, Slatin and Room, 1976)
Unfortunately, O'Donnell did not organize his data on the current use of treated and untreated users into addicts or non-addicts, heavy or light users; as a result, we can not tell from his presentation the extent of the prior heroin use of the non-treated sub-sample. It could be that the majority of the non-treated users were light or experimental users rather than heavy users or addicts. We expect that the authors will clarify this confusion in future analyses.
Still other sources of data that suggest natural recovery are two large scale treatment evaluation studies that employed control groups. These studies are the Macro Systems, Inc., evaluation of the New York City Addiction Services Agency (A.S.A.) programs and the Burt Associates study of the effectiveness of the National Treatment Association (N.T.A.) of Washington, D.C. Prior to these two studies, evaluations of drug treatment did not to the best of our knowledge incorporate control groups against which the treatment groups could be compared. Consequently, there has been no base to compare the relative outcomes of treatment groups and little information about the remission of drug users who do not partake in long-term treatment programs.
The first evaluation conducted by Macro Systems, Inc., a profit research firm, followed up a sample of 462 persons who had been to a variety of A.S.A. treatment programs (during the last 6 months of 1971). One-third of the sample (156) were persons who had stayed in treatment less than 10 days (and had not undergone any subsequent treatment); this group was designated as the control group. (Macro System, 1975) Three years after entry in treatment the evaluation findings showed that narcotics use by the control group was no greater than it was for those who had been to treatment. Using an index of narcotics use as a basis of comparison they found that the controls had a score of 0.29 while those in treatment from 10-90 days had 0.21 and those persons who had been in longer than 90 days had a score of 0.20. The differences between the three scores were not statistically significant. The authors summarized:
These findings have an iconoclastic tenor insofar as they challenge widely held orthodoxies and substantive implications upon the future course and direction of drug treatment efforts. The findings, however, are not consistent with theories related to the natural history of addiction, the healing effect of time, and the inner psychological motivation of drug users. (Macro Systems, Inc., 1975)

These assertions must be tempered, however, in light of some methodological problems with the study. Macro Systems had a low interview completion rate-they initially claimed to have had completed interviews with 74% of the sample but a subsequent report indicated a much lower completion rate of only 61%. (Burt Associates, 1977) Ile researchers had considerable difficulty in locating and interviewing Puerto Ricans in the sample, particularly those living in the South Bronx, and as a result Puerto Ricans were underrepresented in the interviewed group and this may have biased the findings.
Burt Associates in their evaluation of the National Treatment Association programs used a similar design in that they also employed a control group. They successfully located and interviewed 81% of an initial sample of 360 persons who had previously been to treatment one to three years earlier. One-third of those interviewed were persons who had stayed in treatment five days or less and were used as the comparison or control group. One in five (29%) of the total sample were considered "fully recovered" at the follow-up interview, while 37% were considered 'partially recovered". Full recovery was defined by the study as persons who two months before the follow-up interview:
1. used no illicit drugs (except marijuana),
2. had not been arrested or incarcerated and
3. who were employed, in school, or job training or a housewife.

Partial recovery was more complexly defined but usually included one negative response to the arrest and employment criteria or some daily illicit drug use.
When the treatment sample was compared with the comparison sample, no significant differences were found between the two. The comparison sample defined as the non-treatment group did just as well in terms of the definitions of recovery as did the treated group. Furthermore, time in treatment had no particular association with outcome; people who stayed in treatment one day did just as well as those who stayed a year, two years, or five years. (Burt Associates, 1977)
The next evidence to suggest natural recovery comes from an imaginative study of a heroin epidemic that occurred in two high schools in a San Francisco Bay Area suburb. Using known heroin users as informants the authors of the study, David and Kathleen Graeven, asked them to identify persons they had used heroin with from high school yearbooks. The study identified 294 heroin users and interviewed 120 of them. Of those interviewed 51% (76) were found to have been addicted (used heroin daily and experienced dependence) and of those addicted 53 (71%) had been to some drug treatment. (Graeven and Graeven, n.d.) Comparing the treated with the untreated addicts the authors found that:
By 1975 the percent of untreated addicts not using heroin (52%) was quite similar to those who had only one or two treatment experiences (50%), however, those with more treatment experiences were more likely to use heroin. [ 28% of those with three or more treatment experiences were not using heroin at the interview in 1975.] Furthermore, the authors concluded that:

... the untreated addict is more likely to stop using heroin and less likely to have high use of heroin than the treated addict. This in part can be explained by the smaller habits of untreated addicts, but it also is due in part to the fact that untreated addicts had better family lives, more self-esteem and less involvement [with the criminal justice system]. Given the size of the sample, the conclusions of the authors are, perhaps, premature, but the data does suggest that there are similar frequencies of recovery for both untreated and treated groups.
The most recent study to suggest natural recovery comes from a longitudinal health study conducted in Central Harlem (in New York City) by Ann Brunswick at Columbia University School of Public Health. In 1975-1976, during a second wave of interviews, 535 of the original sample of 668 black youth (18-23 years of age) were interviewed; this was 80% of the original sample. The follow-up interviews revealed that 16% of the sample had used heroin at least once and 13% had used it daily or a "few times a week" at some time in their life (usually during the five year interval between the first and second interview).
When respondents were asked about their most recent use of heroin, only 25% of the 69 persons (who used heroin more than twice) reported using heroin in the last year. Organizing the data into those who had received treatment and those who had not it was discovered that 25% of the treated group reported to have used heroin in the previous year while only 16% of the untreated had. (Brunswick, 1978)
For purposes of this review, the best incidence data to support natural recovery is the second Robins study, of returned Vietnam veterans. It is best because it utilized urine samples rather than merely relying on self reports, which is the principal source of data used in all the other studies reviewed here except Winick's which used arrest reports. Robins second study is also special in another way, the users in the sample were predominantly smokers of heroin and opium and were subject to dramatic environmental changes (returned from wartime Vietnam). The study population may be so unique that it would be unwarranted to generalize findings from it to typical addicts in the United States who most commonly use heroin through intravenous injection.
All of the studies reviewed suggest natural recovery but do not by any means settle the issue with detailed and conclusive data. Only three of the studies explored the length of heroin abstinence (the Brunswick study set a one-year criteria, O'Donnell et al had a nine month to one year period, and the Burt Associates study used two months) while most reported heroin use only at the time of the interview. It is possible that a good number of the persons in the other studies were experiencing some short-term or periodic hiatus from heroin use and might be merely in temporary remission. It is well known that addicts use heroin cyclically (Waldorf, 1970; O'Donnell, 1965); seldom is heroin used uninterruptedly. Occasionally individuals initiate an abstinence from use themselves only to eventually drift back to regular use.
Other important concerns with the study of natural recovery are the processes related to the recovery and the characteristics of those who do overcome their heroin addiction. Only two of the above studies dealt with process because most were not designed to explore it. In most instances the researchers did not anticipate findings of this type and thus were not prepared to explore the why and wherefore of the abstinence. Moreover, in many instances the size of the sub-samples of treated and untreated groups were too small to allow even simple statistical correlations to be done to say nothing of more complex kinds of analyses.
Only two studies suggested reasons for natural recovery and both had very small numbers of untreated addicts. The Columbia University study which included 36 treated and 32 untreated heroin users found that the treated used heroin for longer periods and the untreated had greater education attainment. The second study conducted by the Graevens had similar small numbers of treated (53) and untreated (23). Their data suggest that the untreated heroin addict had higher self-esteem and better family relations than the treated addicts. Both suggest that personal and family resources contribute to natural recovery.

Conclusion and Recommendations For Future Research

The review of the studies presented here documents the fact that significant numbers of heroin addicts naturally recover from their addiction without treatment intervention. Some of the evidence even suggests that the untreated addict may have as good or possibly even a better chance at breaking the bond of addiction than the treated heroin user. However, there is a virtual absence of substantive information concerning the dynamics and processes-social, psychological and environmental-that may be at work to bring about recovery.
Reasons for the sparcity of knowledge in this area are without doubt numerous and complex but certainly a major one is the widely-held belief of both the lay and professional communities of "once an addict, always an addict". Such a rigid, unyielding and deterministic viewpoint toward heroin addiction precludes serious consideration of the possibility that some addicts might "naturally" find their own path to recovery. As a result, most research efforts at this time have concentrated on documenting the incidence and spread of addiction, on developing methods to control heroin use and its distribution and on creating prevention and treatment programs.
In short, society has over the past decade responded to heroin addiction in much the same way it did to alcohol use and alcoholism. It has implicitly accepted the phenomena as a intrangent social problem that should be eradicated or at least controlled. The perspective that shaped the current social policy and programatic responses to the heroin problem inadvertently turned research efforts away from developing a more complete substantive understanding of the natural course of the career of heroin addiction and its possible natural discontinuance.
In order to gain a more definitive understanding of the career of heroin addiction and its various possible outcomes, we recommend future research be undertaken to:
1. establish the length of recovery so as to be sure that the non-addictive state is not short term or temporary;
2. explore the possibility of controlled use after addiction-it may be that ex-addicts can resort to a more controlled pattern of drug use rather than strict abstinence as recent findings on recovered addicts (Harding et al., 1978) and recovered alcoholics has shown (Tuckfeld, 1976; Armour et al., 1976);
3. discover the extent that individuals substitute other drugs for heroin-most particularly alcohol and barbiturates as they are much more dangerous than opiates;
4. determine the characteristics and resources of persons who recover naturally and compare them with their treated counterparts and the larger populations, and lastly
5. learn what are the actual processes of recovery for both treated and untreated addicts-what initiated the attempt to recover, how the individuals cope and what kind of interpersonal, familiaI and community support are utilized.

Researchers interested in the area should be sure to consult the literature on alcoholism recovery as there has been much more work done in that field than in the field of illicit drugs. In recent years there has been a growing concern in the field of alcoholism about the incidence of recovery without the help of formal treatment. Data from social surveys of the general population and control groups of treatment evaluations has suggested natural recovery rates of 4170-63%. (Knupfer, 1972; Armour et. al., 1976; Rutledge, 1973; Smart, 1975) Much of this variation may be accounted for in the different ways researchers have defined recovery. Recovery for some has meant total abstention while for others there can be "normal" drinking. In an effort to apply the various criteria and definitions for recovery to data from a San Francisco survey it was found that recovery without treatment could vary from a low of 11% to a high of 71% depending upon how recovery was defined. (Roizen, Cahalan and Shank, 1976)
These findings and those of a recent RAND evaluation of NIAA sponsored treatment centers (Armour et. al., 1976) kindled interest and debate around the issue and NIAA contracted with a research firm to conduct an in-depth study of the processes of untreated alcoholic remission. (Tuckfeld, 1976) This study which is available from the National Technical Information Service, is, at present, the only study that deals with the dynamics of natural recovery. There are, however, several studies of the processes of treated recovery for opiates (Bess, et. al., 1972; Brill, 1972; Bull, 1972; Waldorf, 1973) of which Brill's book is the most detailed.

NOTES

*While this paper was at the printers we received from Dr. Robins a copy of her report of a three year follow-up of 617 Vietnam veterans. That report confirms her earlier data as only 12% of all men addicted in Vietnam became readdicted. Of those treated 47% were re-addicted in the second period and of those not treated. 17%.
1. The research for this paper was supported by a National Institute on Drug Abuse grant #H81 DA01 988-01.
2. The authors of this paper are currently in the process of exploring the areas suggested here in a study supported by a two year NIDA research grant. The study's goal is to explore and analyze the experiences of two groups of ex-addicts--one that has received some form of treatment and a second that has never undergone any treatment for their addiction. The criteria for inclusion in the study are in general physical addiction for a total of at least one year and following that to not have been re-addicted for at least two years. The research goal is to interview 100 persons in each group.

REFERENCES

Armour, David J. et. al 1976 Alcoholism and Treatment Santa Monica: Rand Corporation, Report #1739-NIAA

Bess, Barbara, et. al. 1972 Factors in successful narcotics renunciation. American Journal of Psychiatry. 28 (7).
Brill, Leon 1972 The De-Addiction Process. Springfield, Ill.: Charles Thomas. Brunswick, Ann F. 1978 Black Youth and Drug Use Behavior. Mimeographed. New York: Columbia University School of Public Health.
Bull, James 1972 Coming Alive: The Dynamics of Personal Recovery. Mimeographed. Ph.D. Dissertation. Santa Barbara, Ca.: University of California.

Burt Associates. 1977 Drug Treatment in New York City and Washington, D.C.: Follow-up Studies. N.I.D.A. Monograph.
Graeven, David B. and Kathleen A. Graeven Treated and untreated addicts: factors associated with participation in treatment and cessation of heroin use. Mimeographed, n.d.
Harding, Wayne M., Zinberg, Norman E., Stelmack, Shirely M., and Barry, Michael 1979 "Formerly Addicted-Now-Controlled Opiate Users" Mimeographed, 1978 to be published in The International Journal of the Addictions 14(7), 1979.
Knupfer, Genevieve 1972 Ex-problem drinkers. In Life History Research in Psychopathology. Edited by Merrill Kopp, Lee N. Robins and Max Pollack. Minneapolis: University of Minneapolis Press.
Macro Systems, Inc. 1975 Three year follow-up study of clients enrolled in treatment programs in New York City. Phase III Final Report.
O'Donnell, John A. 1968 The relapse rate in narcotic addiction: a critique of follow-up studies. In N.A.C.C. Reprints 2 (1). Originally published in 1965. O'Donnell, John A., Voss, Harwin L., Clayton, Richard R., Slatin, Gerald T., and Room, Robin G. W. 1976 Young Men and Drugs-A Nationwide Survey. NIDA Research Monograph 5.
Robins, Lee N. and Murphy, George T. 1967 Drug use in a normal population of young negro men. American Journal of Public Health. 57 (9), 1967.

Robins, Lee N. 1973 The Vietnam Drug User Returns. Washington D.C.: U.S. Government Printing Office.
Robins, Lee N., Helzer, John E. and Davis, Darlene H. 1975 Narcotic use in Southeast Asia and afterward. Archives of General Psychiatry. 23.
Rutledge, Carolyn, et. al. 1973 A socio-epiderniological study of alcoholism in East Baton Rouge parish. Baton Rouge, Louisiana: Alcohol and Drug Abuse Section, Division of Health.
Scharse, Robert 1966 Cessation patterns among neophyte heroin users. The International Journal of the Addictions. 1
Smart, Reginald 1975- Spontaneous recovery in alcoholics: a review and analysis of available 1976 research. Drug and Alcohol Dependence. 1 (4) Tuckfeld, Barry S., Simuel, Judy B., Schmitt, Mary L., Ries, Janet L., Kay, Debra L. and Waterhouse, Gloria J. 1976 Changes in patterns of alcohol use without the aid of formal treatment: an exploratory study of former drinkers. Research Triangle Park, North Carolina: Research Triangle Institute. Contract #ADM 281-75-0023.
Vaillant, George E. 1973 A 20-year follow-up of New York narcotic addicts. Archives of General Psychiatry. 29

Waldorf, Dan 1970 Life without heroin: some social adjustments during long-term periods of voluntary abstention. Social Problems 18 (Fall).

Waldorf, Dan 1973 Rock bottom. Chapter 9 in Careers in Dope by Dan Waldorf. Englewood Cliffs: Prentice-Hall, Inc. Winick, Charles 1962 Maturing out of narcotic addiction. U.S. Bulletin on Narcotics. 14.

http://www.drugtext.org/library/articles/narehead.htm

How bad is Heroin Withdrawal?

An excerpt from:

Heroin, Myths and Reality
by: Jara A. Krivanek pub. 1988, Allen & Unwin
and a general discussion, with references of the dangers of heroin.

"The development of physical dependence depends as much on regularity of use as on the amount actually used. In practice, the vast majority of addicts of not use heroin consistently on an ongoing basis. Less than half of the addicts who have been on the streets for more than a year will have used daily for that period (Johnson, 1978). They may voluntarily withdraw to reduce their tolerance, or the scene may be temporarily too much of a hassle, or they may have an important engagement such as a trial, at which an appearance of addiction would be undesirable. Or they may simply need a rest. During such times, physical dependence may virtually disappear, yet they will still think of themselves and describe themselves as addicts. In other cases, the users may never use enough drug to develop significant physical dependence. Senay (1986) estimates that between 25 per cent and 40 per cent of street addicts are not physically dependent. Nevertheless, such 'chippers' may wish to see themselves as addicts for reasons of their own, and will so describe themselves.

http://www.druglibrary.org/schaffer/heroin/herowith.htm

the following excert shows how \societys views on heroin can effect the user-

The next year (1968-69) I was invited to lecture in social psychology at the London School of Economics, and at the same time I received a Guggenheim award to study the British system of heroin maintenance (Zinberg & Robertson 1972). I was fortunate enough_ to arrive in England in July 1968, just as the British were beginning to send heroin addicts to designated clinics instead of permitting private physicians to prescribe heroin for them, a change that greatly facilitated my study. I found that in Britain there were two types of addicts, both of which differed from American addicts: the first functioned adequately, even successfully, while the second was even more debilitated than the Ameri can junkie. But although the second type of junkie behaved in an uncontrolled way and did great harm to himself, he, like the American alcoholic, was not cause of social unrest, crime, or public hysteria.

Gradually I came to understand that the differences between British an American addicts were attributable to their different social settings-that is, to the differing social and legal attitudes toward heroin in the two countries. In England, where heroin use was not illicit and addicts' needs could be legally supplied, they were free from legal restraints and were not necessarily considered deviants. British addicts had a free choice: either they could accept drug use as a facet of life and carry on their usual activities, or they could view themselves as defective and adopt a destructive junkie life-style. Thus my year in England revealed the same phenomenon I had observed at the Beth Israel Hospital several years earlier: the power of the social setting, of cultural and social attitudes, to influence drug use and its effects. It was becoming obvious that in order to understand the drug experience, I would have to take into account not just the pharmacology of the drug and the personality of the use (the set) but also the physical and social setting in which use occurred.

http://www.drugtext.org/library/books/zinberg2/preface.htm

[newgrower]

There's a lot of good information here - thanks!

The one thing that I wonder about and haven't seen yet is what amount of those who try heroin eventually become addicted. The one figure that I've seen is the 25% figure from the vietman veterans study. But I thinks they got that figure from asking do you use heroin and do you use heroin daily at one time point. Just because only 25% of users are addicted at a given time doesn't mean at only 25% of users get addicted. Also, I don't know that looking at veterans that used in an country during wartime translates well to the general population.

It looks like some of the best information comes from "Drug, Set and Setting". The author did prove that controlled use is possible but don't know if he completely answered how many get addicted. The followups were only 12-24 months and the folllowup rate was pretty low - 61% for controlled users. He did find in the 1-2 year period that 13% (of controlled users) upped their usage. There could be the assumption that the 39% (of controlled users) that weren't reachable for followup that a good amount were unreachable because of issues to do with drug usage.

It does look like he showed that out of the 62% (of study popluation) that were controlled users to start with that the 38% (of study popluation) that completed followup , 33% (of the study population) could be proven to still be controlled users at followup.

Does anyone know of good information on how many people who use heroin get addicted at some point?