What are street heroin users really like? This question has perplexed policy makers for several years and is likely to do so in the near future as well. The public image holds that the addict is so physically dependent upon heroin that this drug must be injected several times per day and in large quantities or else the person will become severely sick. In order to obtain the heroin, the user must generally resort to crime to finance this habit; habit sizes of $100 per day or more are claimed by many heroin users and believed to be typical by the public.

 

This widely believed public image of the heroin addict has been hard to locate, however. National surveys of the adult and youth population show that low proportions have ever used heroin, and generally under half a percentage point have used it on a weekly or more regular basis (Miller and Cisin, 1980; Johnston et al, 1979; O'Donnell et al, 1976). Robins' (1973, 1974) study of Vietnam veterans showed that the vast majority of soldiers who reported physical dependence in Vietnam did not return to heroin use upon return to the U.S. The research of Zinberg and Harding (1979; Zinberg, 1979) demonstrate patterns of what they call "controlled heroin use" among subjects who report previous physical dependence.

 

McAuliffe and Gordon (1974, 1975, 1979, 1980) also raise questions about the importance of physical dependence as a necessary condition for `addiction.' According to McAuliffe and Gordon's (1980) theory of reinforcement and combination of effects:

there are important disadvantages associated with equating addiction with physical dependence as laymen do . . . (since this idea) encourages the seriously misleading impression . . . that a user is relatively safe as long as physical dependence is avoided (p 139). In the long term addict, euphoria, withdrawal symptoms, and other miscellaneous reinforcing effects combine in various proportions to yield a complex schedule of reinforcement that sustains continued use. The exact weighting of each effect . .. may vary from time to time within a given individual and from addict to addict.... Street addicts who are sick from withdrawal and have only maintenance doses on hand are obviously satisfied to respond to just one component. . . . With a larger supply, they typically respond . . . by reducing sickness and enjoying euphoric effects, too. . . . At any given time, most street addicts are distributed in intermediate positions, where they avoid withdrawal and receive intermittent positive rewards. It is the history of reinforcement gained from using drugs in all these ways that accounts for an individual's drug derived motivation for opiate use. (p 349).

 

This paper is narrowly focused upon describing the heroin consuming behavior of a few selected heroin users. No particular theoretical position is advanced or "tested," since the data were not originally collected to test theories of physical dependence and addiction, nor were subjects selected as representative of any population. Rather, the following brief portraits of loves of several subjects provides new insights about the stability (or lack thereof) in patterns of heroin consumption. These patterns, however,,raise questions relevant to theories of addiction which will be alluded to, but not resolved in this paper. Through careful description and analysis of behavior patterns, day-by-day, of several persons who exhibit continuing patterns of heroin consumption, a better understanding of how heroin is used, sought, purchased, and distributed will emerge. This will contribute to an improved model of the addiction process which must be developed in the future.

 

METHODOLOGY

 

The data come from two pilot-study years (1978-79) of a long-term effort to study the economic behavior of opiate users and street hustlers. The original design was to locate research subjects who exhibited differing criminal and drug use patterns; only those subjects who used heroin during a 30 day period are considered in this paper. Nonheroin users (all injected cocaine) and subjects enrolled in methadone treatment are not discussed in this paper. The intent was to maximize intersubject variation rather than select a representative sample. This means that the subjects should not be considered as a "sample" as that term is ordinarily used in statistics, nor representative of any larger population. The term "study group" will be applied to the subjects whose crime and heroin/drug use is analyzed here.

The research team established a field station in a well-known ghetto neighborhood in New York City. Subjects were recruited by professional ethnographic staff and trained ex-addict fieldworkers. They reported to the storefront field office where they were interviewed for 30 or more consecutive days. A daily interview instrument was administered and data was collected on the respondent's involvement and cash returns from several crimes, the type and dollar amount of drugs used, their income from all sources, and their expenditures for all purposes during the preceding day. Respondents were paid a modest sum for their time and information.

 

The characteristics of the 31 respondents were compared with clients attending public methadone clinics in East Harlem. A majority of both the study group and MMTP clients were over age 30, but the study group had a substantially lower proportion of females than the clinics. The ethnic distributions are relatively similar except that blacks are proportionately larger in the study group. The group exhibited extensive patterns of drug use and crime. Over 90 percent had been arrested, and 80 percent had been incarcarated. Their educational level was low, only a third had graduated from high school and only 6 percent were employed at the point of the daily interviews. The subjects exhibited long term patterns of heroin use, routine cocaine consumption, and extensive criminal careers as measured by arrests and incarcerations. All were chronic users of heroin or cocaine, which they generally consumed by injection.

 

Before presenting the data from the heroin-using subjects, several caveats may be noted. These data were obtained in 1978 and 1979 in a small neighborhood in one of the New York City's highest addiction communities. Existing evidence (Frank, 1979, 1980) suggests that the quality of street heroin and the severity of the heroin problem was at about its lowest point in the 1970 decade during these two years. Thus, even persons who used heroin several times daily may have been consuming so little heroin or opiate equivalent that they were not physically dependent in the classical definition of this phenomena. This research effort was never intented, nor is it currently attempting, to measure directly various socio-psychophysiological states of these respondents such as degree of withdrawal sickness, desire for euphoria, perceptions of tolerance or craving, etc; so the number of days of nonheroin/nonopiate use and dollar amounts used below provides imprecise and faulty indicators of such concepts. The portraits of several types of heroin users will give a better "feel" about the diversity in heroin consumption patterns and raise important questions without proving or disproving particular hypotheses about addiction.

 

EMPIRICAL PATTERNS OF HEROIN CONSUMPTION

 

The data show considerable variation in heroin use patterns. One of the striking findings is that many chronic heroin users exhibit several days of nonheroin use during the 30 day period. Even among the subjects who used heroin most regularly (see next paragraph), all except one respondent exhibited days of nonheroin use.

 

In an attempt to develop a simple distinction between "addicts" and "nonaddicts," several typologies of respondents were studied. The most empirically useful classification was the proportion of 30 consecutive days that the subject used heroin. Thus, respondents were classified according to a Regularity of Heroin Use Typology: (1) "Near daily" users (n=9) consumed heroin 75 percent or more of the days; these subjects used heroin on an average of 27 (90 percent of 30) days. (2) "Regular" users (n=16) consumed heroin on 40-74 percent of their 30 days; they used heroin on an average of 18 (60 percent of 30) days. (3) "Irregular" heroin users (n=6) had up to 40 percent of days with use; but actually used it on only about two (7 percent of 30) days. Thus, the image of the daily heroin user, which is widely accepted in the professional literature and assumed by the press and lay public, was not evidenced by most of the study's subjects.

 

Moreover, among all heroin users, extensive variation in heroin consumption occurs. Important differences in heroin consumption occurs as the regularity of heroin use increases. The irregular heroin users use heroin on less than 10 percent of all days. Even on days of heroin use, they consume more than $20 on less than a quarter of these days. In short, they seldom use heroin, and in small amounts if they do. The regular heroin users consume over $20 on about two fifths of the days with a mean* consumption of $23. The near daily heroin users, however, consume heroin on an average of 90 percent of the days; they use over $20 on almost three quarters of their use days. Their mean consumption on days of heroin use in $43. In short, the near daily heroin users appear to have characteristics (many days of use, with large amounts consumed per day of use) associated with physical dependence.

 

Thus, to the extent that the regularity and amount of heroin consumed is indicative of physical dependence, the near daily heroin users most closely approximate this condition. The regular heroin users provide much less compelling evidence of possible physical dependence to heroin while the irregular heroin users appear not to be dependent regardless of how far this concept is stretched. Several days of nonheroin consumption are partially accounted for by consumption of methadone, both licit and illicit; but many subjects still exhibit several days without any opiate use as the following case histories show.

 

CASE HISTORIES OF HEROIN CONSUMPTION FOR SELECTED RESPONDENTS: HOW STABLE ARE PATTERNS OF HEROIN USE DAY-BY-DAY?

 

The following case history material offer additional insight about respondents exhibiting different patterns of heroin consumption during the study period. The emergent finding is that each respondent consumes relatively differing amounts of heroin on consecutive days. The cases represent different patterns of heroin use.

 

Theo W, Sonny C, and Stephen H were three of the nine near-daily heroin users. Theo W was a very successful burglar who used large amounts of heroin. Sonny C was a street drug dealer, specializing in heroin sales. Stephen H was the one subject who used (and continues) to use heroin every single day; he also happens to be a versatile and successful criminal. Frenchy S was one of the most frequent heroin users among respondents classified as "regular" users; his heroin consumption on days of use is somewhat higher than the mean among those in the regular heroin use category. He also used illicit methadone several times during the daily interviews and joined a MMTP prograM during later interviews. Bobby H used heroin on as many days as Frenchy S but has an average consumption that was very low. Vance D was among the least frequent "regular" heroin users; he seldom exhibits successive days of use. Ulric Q is a former methadone patient who is an "irregular" heroin user, more regular cocaine user, and a severe alcoholic.

 

A brief biographical portrait of each is provided. Information about each subject's pattern of economic support as well as his day-by-day heroin consumption and methadone use is provided from life history interviews and the daily interview forms.

 

In the graphs presented for each subject, the vertical axis contains the dollar amount of heroin used on a given day. The horizontal axis is the number of the day after the first interview; no specific calendar days are given to protect the respondent's anonymity. The "X" on some charts indicates use of illicit methadone, the height of the X indicates the dollar amount paid for such illicit methadone (the amount in mgs could not be obtained). On Sonny C's graph (2), the small circles "o" indicate that he consumed methadone given at a detoxification program; the height of the circle indicates the amount of heroin he also consumed on that same day.

Theo W

 

Theo W is a black male about 50 years old. He is one of two professional burglars in the study group who uses a large amount of heroin and cocaine when he has a high income. Although he has worked at odd jobs in the recent past, he has been a lifelong criminal.

He has spent almost half his life in prison. He was first arrested for robbery at age 14 and sent to the State Training School on two different occasions. On an adult robbery charge, he was sentenced to 25-30 years, but served eleven in state prison, mainly in the 1960s. Although arrested subsequently, he has managed to avoid long prison sentences.

 

He first started using heroin in 1948-49, and has been mainlining heroin most of the time he was not in prison. He was asked: "How much are you spending now?"

 

"It's difficult to put a value on it now. Because you can get like a ten dollar bag, or a half of a quarter or a $50 quarter." When asked whether addicted or not: "I'd say I've got a chippy, but the way narcotics are today, it's nothing worse than the flu really" (but admitted to being addicted now when asked directly).

 

He was one of the few subjects with several days where he used $100 of heroin (but never more) even though he had more cash from successful burglaries on several of those days. His heroin use profile (Fig. 1) is very ragged, indicating many days of nonheroin use preceded and followed by days of use up to $100. On six of these nonuse days, however, he purchased street methadone which he felt held him over to the next day. On two days (26 and 34), he used no opiate; on both of the previous days, he had either used methadone or a low amount ($20) of heroin.

 

Although not shown on the graph, Theo W used an sizable amount of cocaine on days when he also used heroin, generally when he had a large income from a successful burglary. He also drinks heavily. "I was in the hospital about three times for drinking. . . . Twice it was for what they called acute pancreatitis, and then one time I went for detox. . . . I used to run up a bill at the liquor store of over $100 in a two week period." Despite his irregular use of street methadone, he has never been on a methadone program although he was once in a detoxification program.

 

Sonny C

 

Sonny C is a black male who basically supports himself by being a street heroin dealer. He began using heroin in the late 1950s and was quite active in the following years, although there were some years with irregular use.

 

He has not escaped the arms of the law. He recalls about 14 arrests, mainly for possession of heroin or sale of methadone. He has served about 5 years in prison, the longest was a three year stint for a robbery.

 

While he has committed many different offenses (burglary, robbery, purse snatching, mugging, shoplifting), he was mainly involved in dealing heroin. A house connection gives him 25 "dime" ($10) bags and he must return back $175. Thus, he has the potential of a $75 profit; but he must frequently "sell short" (sell several bags for less than a multiple of 10).

 

Sonny was in two methadone programs during 1973-1979. He returned to heroin addiction immediately afterwords and was a near daily heroin user when interviewed in the fall of 1979. Heroin and legal methadone were the only drugs to which he reported addiction. He uses cocaine on an irregular basis. His graph (Fig. 2) shows one of the more stable patterns of heroin use exhibited by respondents.

 

The three days with nonheroin use occurred while he was attending a 14-day detoxification program (small circles represent methadone consumed at this program), but so did four days with $50 of heroin use between these. On all of the nonheroin use days, he was on the street selling his usual amount of heroin. Although his supplier frequently supplied him with "heroin" tips, Sonny reported, "The heroin I sell is garbage. I sell what he gives me and go uptown and cop (better stuff)."

 

Steven H

 

Steven H is a Puerto Rican male. He uses heroin several times pej day and generally supports his heroin use through a variety of crimes (burglary, robbery, shoplifting, and other thefts).

 

Steven moved to New York City in 1959 and shortly thereafter began sniffing heroin. "I didn't know what a habit was. I knew it (heroin) was habit forming. I didn't want to believe it myself. I didn't know what to do. I kept buying bags. Then I started skinpopping and then mainlining. My wife found out that I was using drugs. I tried to OD (overdose) by taking three bags. Nothing happened, except (I got) very, very high."

 

He moved back to Puerto Rico, detoxified on his own, and then moved back to New York City. In the early 1960s, he obtained a job as a bartendar at a major hotel where he made up to $500 per week. In 1968, he started using heroin again, and quit his job prior to being fired for nonattendance. He had two short term jobs in 1969 and 1970, but has not been employed since then.

 

During the 1970s, he supported himself by shoplifting, robbery, burglary, and theft from cars, but has never been involved in pimping, con games, dealing, or gambling. "I am a loner. Do you see me with someone? I like to be by myself."

 

In 1970 Steven reported, ". . . There wasn't any (methadone) programs like now anywhere. I went to this doctor on West Street. (The doctor gave me) pills; they used to give me seven biscuits (dolophine tablets) a week for $20. It was only for two months, because they closed the place; they was doing something out of order. They gave me a letter to another program if I wanted to. I didn't go." Other than this treatment episode, he has never been enrolled in another program nor has he used illicit methadone purchased from the street.

 

In 1972 Steven was arrested, "They charged me with possession of a hypodermic needle, and two bags of heroin. I was in (jail) 18 days. They dismissed the case, I have no record. The police never showed up or nothing." He was also arrested for jumping a subway turnstile in 1978 (with $200 and two tokens). Otherwise, "I don't have a record and want to keep it that way as long as possible. The most important thing is to stay out of jail."

 

Project staff have now maintained contact with Steven H for over three years. His pattern of daily heroin consumption exhibited during the first 46 days has continued all year. His average consumption is about $50 and while quite variable, shows less daily variation (Fig. 3) than several other subjects. "My usual amount of heroin is one "quarter" (about $50 on the illicit market). I can get by with less than half a quarter ($25). But I seldom get sick very often. I take care of myself." He is one of the few heroin users among those contacted who does not consume all that he buys. "If I make enough, I buy heroin for two or three days, it's less expensive that way. Before, k used to take the total amount, but now I can control this. I don't like to be very high. I just want my usual."

 

The maximum amount of heroin that he used on any day was $100, but this amount was used on only 2 days. The low point of Steven's heroin use was one day on which he used only $10. His modal amount ($50 per day) was achieved on 16 days (or about a third of the days).

 

Steven usually works alone, cops drugs alone, and uses his drugs alone. He lives with his mother (who believes he is on a program and doing well) on a good block just outside the ghetto neighborhood where he cops drugs. "I leave my apartment at the same time and come back at the same time; people think I have a job." While he has old track marks on his arms, Steven now injects into leg veins so that his mother will not know about his current addiction. After committing a crime, he will immediately go to the same dealer who gives him drugs for the stolen merchandise. But he used heroin on every day, at about $50 daily. Overall, his appearance is so neat that he has had trouble buying drugs because dealers suspect him of being an undercover policeman. He never loiters with other heroin users on street corners and seldom visits with heroin-using friends.

 

In many ways, Steven controls his daily heroin consumption, presents himself as a respectable working person, avoids contact with other addicts, and successfully conceals his current heroin use from his mother and neighbors. Thus, he is seldom labeled as an addict by others, although he presents considerable evidence of being currently physically dependent.

 

Frenchy S

 

Frenchy S is a 33-year-old Puerto Rican male who began heroin use in 1963; he has been on and off heroin since that time. In the initial interview, he claimed to be taking heroin on a daily basis since 1976 and reported current daily heroin expenditures of "about $60 at least." He makes some of his money from off-the-book jobs (porter, messenger, floral delivery man, doorman, houseman), plus shoplifting, helping someone else deal drugs or "whatever I could just to get over." For example, in the spring of 1979 Frenchy was earning drugs by performing various services for a drug dealer. Every evening he would get food for this dealer and clean up the dealer's apartment, for which Frenchy received a $10 bag of cocaine and a $10 bag of heroin. Once a week he would "taste" this dealer's heroin and cocaine in order to see how many times it could be cut. Frenchy received $30 worth of heroin and $30 worth of cocaine for this service. Additionally, he would receive a $10 bag of cocaine and a $10 bag of heroin for every five buyers that he "steered" to this dealer. Frenchy claimed that he averaged about $30 worth of cocaine and $30 worth of heroin per day from his steering activity. He entered a detoxification program in 1978, but otherwise had no treatment prior to his contact with the project. He has two arrests and convictions for grand larceny for which he served 90 days each; plus he has four other minor arrests.

 

His claim of expending about $60 per day for heroin was not supported in the days that he was interviewed. On only three days did he use $60 or more. His actual average consumption was about $25 and this includes 12 days without any use. His heroin use profile is very ragged (Fig. 4); consider the eight day period beginning on day 4 of the daily interviews. Frenchy successively used (in dollars): 15, 70, 35, 15, 40, 9 (methadone), 0, and 50. The remainder of the days also show wide variation in heroin use.

He preferred to take some weekends off, so he bought about $10 of methadone, and then used no opiates on Saturday or Sunday.

 

Interestingly, when Frenchy was interviewed about his daily behavior over a weekly basis in the spring of 1979 (data not presented), he reported two periods of enrollment in a methadone maintenance treatment program. During the first treatment episode Frenchy continued his heroin use and, in fact, had his single day of greatest consumption ($90). During the second treatment episode Frenchy remained completely drug free for the first week but returned to his usual pattern of heroin use in the second week, while receiving licit methadone.

 

Bobby H

 

Bobby H is a high school graduate of Puerto Rican extraction. His father is a police officer. He was employed full-time for one year in the early 1960s as a corrections officer but never received a permanent appointment, probably because of a previous minor delinquency arrest. He began using heroin in 1965, shortly after losing his job. He has been using heroin quite regularly since that time and has no injectable veins left in his arm, so he injects in his leg. He has been arrested 12-14 times (mainly for possession), and has served about 6 years in jail. He has jumped bail a couple of times and currently has two arrest warrants outstanding. He was on a private methadone program for 3 months in 1972 and has subsequently been detoxified three times, most recently in 1977, for both alcohol and heroin dependence. He also uses small amounts of methadone on both heroin use and nonuse days (Fig. 5).

 

Bobby H supports his heroin use mainly by "copping." Towards the end of August 1978, he had a typical day. He bought for a friend six $5 bags of heroin for $28 plus a $10 bag of cocaine for $9. This friend put three of the heroin bags and a cocaine bag in the "cooker"; Bobby H and the friend shared this "speedball" mixture equally. Thus, Bobby H consumed about $12 of drugs for which he did not pay a penny. He also met another friend who shared a half a joint of marijuana with him. Then he visited his girlfriend, who receives welfare, where he had two meals, used her pack of cigarettes, and received a free room for the night. The only cash he received on this day was $5 for a daily interview, of which he gave his girlfriend $4 and spent $1 on rum that he shared with another friend.

 

Bobby's life has undergone several changes during the year that he has been interviewed. He has no permanent living arrangement but has always lived with someone else. His housing is intimately linked to his drug use and/or employment, with heroin use a critical factor. About two months before the first interview, Bobby lived with his brother's family and worked at a small "sweat shop" garment factory that his brother owned. His brother's wife had Bobby move out and had him fired when she found out that he was using heroin too heavily. But according to Bobby the wife said, "as long as you get yourself together, of course, you can come back anytime, but I just don't want you shooting that garbage." In part, the wife fears that her husband, who is a former addict, might relapse with Bobby around.

 

During his daily interviews in summer of 1978, Bobby lived with different persons, mainly girlfriends. The graph shows Bobby's heroin use was consistently low. Of the 71 days for which data were collected, he used $50 worth of heroin once, $40 twice, and $30 or less the remainder of the time. On 14 of the 71 days (20%) he used no heroin at all, although he used illicit methadone. He claimed a $25 per day habit but during the summer of 1978 (daily interviews), averaged only about $9. Most of this heroin was received as drug payments for steering and copping; his actual cash expenditures for drugs were much less than his use (Johnson, Goldstein, and Preble, 1979).

 

In the spring of 1979 Bobby H was again interviewed but on a weekly basis. At the first interview, he provided the following story: "I was doing beautiful for about three months. I was living with my girlfriend, really doing good, working as a stone grinder—$3.10 per hour with overtime, cleared $190 per week. I started fooling around three weeks ago dibbing and dabbing. The girl kicked me out two weeks ago. She said she has two growing daughters and she can't put up with this shit. I lost my job a week ago." During the time, he used heroin every day for four weeks with a mean amount of $22 per day, having a minimum of $12 and a high of $50 of heroin. He was also drinking over a quart of wine per day. In the late summer of 1979, Bobby's heroin use had declined and became irregular. He was back living with his brother and sister-in-law and working at the brother's clothing factory.

 

Vance D

 

Vance D is a 30-year-old black who lives with a common law wife and three children. He has had a full-time job since 1969 in a florist shop. He earns about $250 (take home) per week and gives $225 to his wife for household expenses. In addition to the remaining $25 of his salary, he earns $40-50 in tips, shoplifts about twice per week, and engages in a burglary when the occasion presents minimal risk of arrest. Almost all of this money is spent for alcohol and drugs, mainly heroin. He has been arrested 12-14 times on various charges (burglary, robbery, possession of stolen property, but mainly loitering and disorderly conduct); he served about 21/2 years in jail or prison on two of these charges. He was enrolled in a methadone program for about a year ending in 1977 and was admitted to the prison detox unit at Riker's Island in 1976.

 

Vance had very irregular and low levels of heroin use (Fig. 6). During 35 consecutive days in winter 1979, he had 19 days without heroin use, 8 days using $10 or less, 6 days with $20, and only 2 days with more. He used no illicit methadone, but did use cocaine and marijuana on occasion. During the spring of 1979, Vance used heroin on only 5 of the 28 days for which he was interviewed. He consumed $50 worth of heroin on one occasion, $25 on two occasions, $10 once and $15 once.

 

In the spring of 1979 Vance had lost about 50 pounds, apparently due to increased alcohol consumption (now over a quart of wine per day). He also used heroin ($35) on two separate occasions during a typical week. His heroin use has remained sporadic, but his alcohol dependence has grown and is negatively affecting his health.

 

Ulric Q

 

Ulric Q is a 24-year-old white male who lives with his father. While he had jobs as a delivery man with a softdrink distributor and as a doorman, he was fired from both jobs after short periods.

 

He began heroin use in 1971 at age 14, but his patterns have generally been irregular and not daily (as in the heroin use chart, Fig. 7). His consumption of cocaine is more regular but typically involves small dollar amounts. Nevertheless, he was using enough heroin to qualify for a methadone maintenance program. His enrollment qualified him for welfare benefits which he converted to cash for drugs. His welfare lodging check needed to be cosigned by the landlord; Ulrich signed the check, the landlord gave him $25 to $30 and Ulrich stayed with a girlfriend or his father. The landlord could rent out his room and collect the $96 payment from welfare.

 

He was on the methadone program in 1975-76 but was discharged for heavy drinking. In fact, his drinking has been the major problem. He began drinking alcohol on a daily basis at age 12 and has been a heavy daily drinker ever since. He has been to alcohol detoxification about six times, has stayed at a temporary alcoholic rehabilitation center many times, and has illegally bought alcohol in jail (supplied by a jail employee). During the course of this research, he was constantly in such an alcoholic stupor that he was hard to interview. The ethnographer took him to the hospital for alcohol detoxification and other medical problems during the study period.

 

Although he reports about 16 arrests, including a homicide and assault charge, both were dismissed. He has several small heroin and cocaine possession charges. Most of these charges were handled without a jail or prison sentence, although he did eight months in Riker's Island jail in early 1978 for a parole violation charge.

 

He is a low-level hustler, doing almost anything except major crime to gain a dollar. Most of his hustles are very low level. Steering, touting, and copping drugs are very common. The following transaction is typical. A friend may say, "I got ten pills to sell for $6." Later Ulric meets a person who wants to buy the pills. Ulric charges $8 for the 10 pills making two dollars, "plus the guy I bought it for will give me $1-$2 and the juy I sold it for, he'll give me $1 or $2." Thus, he may make $4-$6 off the transaction. He also sells loose joints (marijuana) and does odd jobs. His daily income is low and so is his drug use.

 

DISCUSSION

 

These case histories only touch upon the fascinating patterns of heroin use which influence the lives of these subjects. Several major findings emerge.

 

All of the subjects show relatively ragged prifiles of heroin use during consecutive days. Days of heroin use and nonheroin use (excepting Steven) are typically intermixed without a major discernable pattern. Among the three heaviest users (Steven, Theo, and Sonny), the amounts of heroin consumed varied considerably from day to day. Both Steven and Sonny had no days without opiate use (Sonny received treatment at a detoxification program during his nonheroin use days). Theo, who clearly had the greatest number of days with $100 of heroin consumption, however, had two days without any heroin or illicit methadone consumption, although these days followed days when low amounts of heroin or methadone were consumed. All three of the subjects considered themselves as "addicted", although they reported having a small habit size. All of these subjects used cocaine on several days when they also used heroin.

 

The other subjects had many days of nonheroin and nonmethadone use. Their heroin use profiles are quite ragged. On days of use, the dollar amounts are quite modest, generally $20 or under. The evidence for their being physically dependent appears slim because they have days of nonheroin use and appear to consume such small amounts that it would be hard to demonstrate true physical dependence, although several subjects such as Frenchy and Bobby claim to be addicted and have a habit.

 

This evidence suggests that physical dependence, while possibly present among a few of these subjects, seems not to be a necessary condition for current "addiction" as is usually believed by the lay public. Among these heroin users, the difference between Frenchy and Sonny are one of degree. In the eyes of the public, police, treatment personnel, and other opiate users, both subjects exhibit many characteristics associated with beliefs about addiction. Yet the number of days of heroin use differ considerably, as Frenchy has many nonuse days, half of which involved illicit methadone use and half which did not.

 

The patterns of heroin consumption or methadone substitution that Steven, Sonny, and Theo exhibit appear relatively consistent with the concept of physical dependence in that they use large amounts of heroin on typical days, have few days of nonheroin use, and tend to consume methadone on nonheroin days. Yet if they are physically dependent, questions arise about the minimum amount they must consume to avoid withdrawal and how much they need to achieve euphoria. In addition, they state that they have small habits, if any, due to the poor quality of street heroin. Their heroin consumption may also be due to a belief that they are physically dependent, rather than exhibiting a true physiological state of withdrawal if they do not use the drug.

 

For the other subjects, especially Frenchy and Bobby, their patterns of heroin consumption appear quite regular although not daily, but the amounts are smaller, methadone substitution somewhat more common, and the means of support appear different. The regular heroin users (including Frenchy, Bobby, and Vance) use heroin on about 60 percent of the days, but typically consume half as much as the near daily heroin users (including Steven, Sonny, and Theo). For the former subjects, the existence of physical dependence is either very low or nonexistent. For the irregular heroin users (including Ulric), no evidence of physical dependence to heroin is evident; sporadic use is common.

 

The formulation by McAuliffe and Gordon (1980), quoted at length earlier, appears to describe many of these subjects well. While physical dependence may or may not be present, many other factors also seem to be present and confound any explanation of their status of "addict" however this illusive term is defined. That is, several subjects may seem by some arbitrary definition to be physically dependent but this may not be a necessary condition for them considering themselves as "addicts," being so considered by others as "addicts," or living a lifestyle as an "addict" evident in each respondent's story.

 

Clearly, Bobby and Frenchy believe themselves to be physically dependent and act upon this belief to some extent, yet their actual consumption raises questions about whether they are (since they have so many days of nonuse preceded or followed by use days) as well as their degree of physical dependence. Even Vance, whose irregular patterns of heroin consumption and many days of nonheroin&nonopiate use, suggesting a controlled heroin use pattern a la Zinberg and Harding (1979), does not appear vastly different than Bobby's. Vance's commitment to his family and job appears to be the major obstacle to developing a heroin pattern similar to Bobby or Vance. As McAuliffe and Gordon (1980, 139) note, "there are important disadvantages with equating addiction with physical dependence . . . (since this idea) encourages the seriously misleading impression .. . that the user is relatively safe as long as physical dependence is avoided." While all subjects are not clearly physically dependent, they are heavily involved in an addict lifestyle.

 

This paper has presented patterns of heroin consumption among seven heroin users. Similar patterns of irregular heroin use could be provided for many other subjects in the study. The empirical patterns exhibited here do not fit comfortable with existing models of "addiction." These data suggest that careful analyses of daily behavior may provide new insights from which a clearer model of opiate addiction may eventually emerge, but this model appears quite distant at present.

 

ACKNOWLEDGMENTS

 

This research was supported by the New York State Division of Substance Abuse Services, by a Public Health Services Award from the National Institute on Drug Abuse (ROI-DA-01926-01-03), and by an Interagency Agreement between the National Institute on Drug Abuse (R01-DA002355) and the Law Enforcement Assistance Administration (LEAA-J-IAA-005-8), U.S. Department of Justice under the Omnibus Crime Control and Safe Streets Act of 1968, as amended.

Additional support was provided by the Interdisciplinary Research Center funded by the National Institute of Justice (80-IJ-CX-0049) and by Narcotic and Drug Research, Inc.

Points of view or opinions in this document do not necessarily represent the official position or policies of the U.S. Government or the New York State Division of Substance Abuse Services.

 

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*The arithmetic mean on days of use is used here. The median is somewhat less. Standards deviations are large relative to the mean—as expected given the selection process.