Gabor Maté

“Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects,” writes Lance Dodes, a psychiatrist at the Harvard Medical School Division on Addictions. It is true that some people will become hooked on substances after only a few times of using, with potentially tragic consequences, but to understand why, we have to know what about those individuals makes them vulnerable to addiction. Mere exposure to a stimulant or narcotic or to any other mood-altering chemical does not make a person susceptible. If she becomes an addict, it’s because she’s already at risk.

Heroin is considered to be a highly addictive drug — and it is, but only for a small minority of people, as the following example illustrates. It’s well known that many American soldiers serving in the Vietnam War in the late 1960s and early 1970s were regular users. Along with heroin, most of these soldier addicts also used barbiturates or amphetamines or both. According to a study published in the Archives of General Psychiatry in 1975, 20 per cent of the returning enlisted men met the criteria for the diagnosis of addiction while they were in Southeast Asia, whereas before they were shipped overseas fewer than 1 per cent had been opiate addicts. The researchers were astonished to find that “after Vietnam, use of particular drugs and combinations of drugs decreased to near or even below preservice levels.” The remission rate was 95 per cent, “unheard of among narcotics addicts treated in the U.S.”

“The high rates of narcotic use and addiction there were truly unlike anything prior in the American experience,” the researchers concluded. “Equally dramatic was the surprisingly high remission rate after return to the United States.” These results suggested that the addiction did not arise from the heroin itself but from the needs of the men who used the drug. Otherwise, most of them would have remained addicts. As with opiates so, too, with the other commonly abused drugs. Most people who try them, even repeatedly, will not become addicted.

According to a U.S. national survey, the highest rate of dependence after any use is for tobacco: 32 per cent of people who used nicotine even once went on to long-term habitual use. For alcohol, marijuana and cocaine the rate is about 15 per cent and for heroin the rate is 23 per cent. Taken together, American and Canadian population surveys indicate that merely having used cocaine a number of times is associated with an addiction risk of less than 10 per cent. This doesn’t prove, of course, that nicotine is “more” addictive than, say, cocaine. We cannot know, since tobacco — unlike cocaine — is legally available, commercially promoted and remains, more or less, a socially tolerated object of addiction. What such statistics do show is that whatever a drug’s physical effects and powers, they cannot be the sole cause of addiction.”


Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction
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In the Realm of Hungry Ghosts: Close Encounters with Addiction In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté
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