1. The Meaning of Drug

For the purposes of this book, a drug is any chemical substance that alters mood, perception or consciousness and is misused, to the apparent detriment of society. We exclude alcohol as a drug because our society is itself dependent on it, and as Prohibition seems to have shown, its enforced absence is more damaging than its legal presence.

In many people's minds, the most important and dangerous quality of A drug is its addictiveness. To begin with semantics: there has been, and still is, a woolly debate about the proper words to apply to drug abuse. 'Addict' and its compounds are now out of fashion; but since the word still popularly encapsulates the menace, we will have to use it, but with reservations. In this work 'addict', 'addictive', 'aildiction ' and so on will only be applied to drugs that cause physical changes in the body, perpetuating their use. That is, 'tolerance' is established in the 'addict', and he needs more of the drug to hold off withdrawal symptoms or to reach the same intensity of effect.

It might be thought that here we have the problem n Addictive drugs physically enslave; non-addictive drugs d6 no. Find an antidote or a harmless substitute and your drug problem is solved. Unfortunately it is all morejcomplicated. The common addictive drugs are: alcohol, morphine, heroin and barbiturate& There are many examples of people who use them without becoming either physically or psychically dependent on them. There are also examples of people who become extremely dependent on drugs that cause no long-term chabges in the body at all, like cannabis. But the distinction between physically addictive and non-addictive drugs is still worth making, if only for a negative reason: it doesn't very much matter.

The World Health Organization recommend saying 'drug dependence':

Individuals may become dependent on a wide variety of chemical substances covering the whole range of pharmacodynamic effects from stimulation to depression. All these drugs have this in common: they are capable of creating a state of mind in some individuals which is termed psychic dependence. This is a psychic drive which requires periodic or chronic administration of the substance for pleasure or to avoid discomfort. Indeed it is the most powerful factor involved in chronic intoxication with psychotropic drugs. With certain types of drugs it may be the only factor involved, even in the most intense types of craving and compulsive abuse.'

One might add that people become dependent not only on drugs but on the experiences drugs give, and indeed on experiences which are obtained quite independently of drugs. There are many in our society who need the satisfaction of fast driving as badly as many addicts need their drugs, and their 'fix' causes a good deal more social damage. We can see, when we think about him, that the delinquent driver is the product of opportunity, inadequate personality and bad training; but we like to look on the drug addict as the tragic victim of an irresistible delight.

The debate over 'addiction', `habituation' and the fruitless inquiry whether this or that drug falls into one class or another was perhaps misconceived. It was supposed that a pharmacological peculiarity of some drugs made them either grip or not grip the system of their user. But how to explain the fact that many people can use heroin and give it up? (See p. 154.)

The experiments of Pavlov showed that any experience can be involuntarily and unconsciously associated in the mind with any other, providing one happens soon after the other. If conditions are right, the link can be extremely strong and durable, and each time it is repeated the bonds are strengthened. Thus when we come across someone who is said to be `addicted' to a drug like marihuana which produces no physical habituation at all, in the sense that they demand it, say they can't live without it, are depressed when deprived of it, and so on (see p.95 for an example) we have a situation which is a function of the pleasurable effects of the drug, the bleak inner life of the addict, the sympathetic social conditions under which he has used the drug. He has become conditioned in a Pavlovian way to the drug as a sole source of pleasure, and every time he proves himself right, his dependence is strengthened. At the same time, by being the sort of person he is, by leading the life he does, he makes the chances of learning new sources of gratification — from working well, having a stable relationship with a wife — more and more remote. This idea was proposed to explain the otherwise mysterious relapses of , heroin addicts who, often decades after their cure, start using the drug again, when one would expect them to have every reason not to. The theory is that during their addiction they became conditioned to heroin as a reliever of anxiety. Whenever any thing threatened them then they would give themselves a shot; years later when anxiety is strong enough it breaks through the later training against use.2

All that is necessary for conditioning and dependence is some effect from the drug. Since, by definition, any drug produces a mental effect, any drug can form dependence if experienced in the right way by the right person. But one need not confine the argument to chemicals taken internally. Clothes are artificial Metabolic aids that satisfy many of the criteria for dependence-producing drugs. We all — all men that is — rely heavily on our trousers; if they are taken away, we can suffer disabling physical and mental stress. Shoes are another example. We even have a name for people who become unusually dependent on them: fetishists.

As a chart to the chapters ahead, a table follows, setting out the principal effects of the problem drugs, with a couple of other substances for the purposes of comparison.

x means that major effects are often found, not that they always occur. Amphetamines are stimulants — methedrine, benzedrine, purple hearts, etc. 'Craving' means an immediate physical hunger. The 0 for LSD tolerance means that this drug is anti-addictive; after a few days' continuous use the effects vanish and cannot be re-established even by massive doses. It is worth noticing that only heroin, caffeine, nicotine and trousers produce no major psychic effects when they are taken. Trousers are included as another example of the similarity between drug-oriented behaviour and other relationships that we consider perfectly normal. We depend quite intensely on this substance, both mentally and physically, its withdrawal causes discomfort, mental distress, and is a well-known weapon in brain-washing.3

The whole problem of drug effects and dependence is complicated by the effect of the social surroundings in which they are taken, and the expectations of those that use them. It is almost meaningless, particularly when one is talking about the illicit WO of drugs, round which whole umbras and penumbras of sub-societies revolve, to ask what are the specific effects of this or that drug. Drugs are used quite differently in different social situations; very often the situation and the expectations of the user have far more effect than the chemical. Beer drunk in a rugger club is an excuse for taking trousers off; whisky in a pub in the Gorbals excuses bitting your friends with bottles; Bloody Marys at a Chelsea party facilitate sexual advances towards other people's wives. Each society uses alcohol as a key to unlock different forms of behaviour — activities one would never guess at from the controlled administration of the drug in a laboratory.

Judged impartially alcohol is probably more harmful than heroin, because its prolonged use in itself causes physical and nervous deterioration, which heroin does not. If alcohol, instead of being a beneficent gift from the gods in the remote past, were invented today by a research chemist, there is little doubt it would immediately be stringently controlled by law. But because our society has lived with it so long, we can control it, and tolerate those e,fi'ects we can't control. For example, it is estimated that there are about 100,000 acute alcoholics in England and Wales, and the upkeep of those that are in prison or who cannot work, with their families, costs the nation about £6 million a year. Less acute alcoholics are probably forty times as numerous, and their absenteeism and poor work costs, at a moderate estimate, anotheri £35 million a year.4 Seven to eight per cent of alcoholics eventually commit suicide.9 Alcohol probably causes some 1,200 deaths on the roads and 50,000 injuries a year.5 In Scotland al- • coholism it the cause of admission to mental hospital of One patient in five. In Glasgow 15,000 crimes a year are committed under the influence of this drug, and in the three worst wards of the city six per cent of all males are arrested every year for being drunk and incapable..6 These things happen around us and we are not worried. Our society spends £20 million a year advertising alcohol on TV and in the press,7 and 340,000 pebple work at the manufacture and distribution of alcohol — half as many again as work in all gas, electricity and water supply industries.5

An alarming feature of the affluent society, even under economic pressure, is the increase in juvenile drunkenness. Between 1966 and 1973 there was a 36 per cent increase in prosecutions in England and Wales for under-age drinking. There was a tlireefold increase in admissions to mental hospitals for alcoholism in patients wider 25. The teenage violent-alcoholic emerged as a challenge to discipline in schools - an educational problem hitherto unknown.10 This pattern is not peculiar to the United Kingdom, but has been noted with justifiable alarm in many countries of the West, particularly America, Canada, Germany and Scandinavia. In terms of numbers affected, it probably far outweighs any other drug, but because government revenues everywhere depend on substantial income from taxation on the sale of alcohol, little is likely to be done about it.

Alcohol for us is a useful and necessary part of life. In other contexts it has been socially catastrophic, decimating populations and destroying cultures. Its impact on unsophisticated people who had not developed our complex of social controls was a powerful weapon in the last century's spread of European civilization in America, Australia, Africa. In the same way, the culture that goes with a drug is as important as the pharmacology of the stuff. Cannabis was, and is, used in the Far East to assist meditation and religious out-of-self-ness ; the assassins or Haschischiens-took it to make them ferocious; in Cairo in the thirties it was the centre fa nationalist, anti-British movement; American jazz musicians use it socially, and feel it improves their musical sensitivity; students here take it as an emblem of rebellion. In each situation the drug induces different effects. So we must also look at the people who use these problem drugs, and the circumstances in which their use meets with approval from others.
Since heroin and the opiates are the archetypal drugs of addiction - that is, if it were not for them, we would hardly be so conscious of drug problems - the next three chapters are devoted to them. In the next chapter we examine what is known of the drugs' pharmacology and the clinical behaviour of users; Chapter 3 deals with the addict's psychology, and Chapter 4 with the myths that he and society weave around drugs.