The life cycle of the narcotic addict and of addiction

Abstract

One goal of a scientific investigation of any subject is to determine the underlying regularities that permit us to make generalizations about the subject. Generalizations that are confirmed may enable us not only to explain but to predict, and prediction is the hallmark of a mature science. A number of investigators have made contributions towards our understanding of the regularities that may underlie the phenomenon of narcotic addiction. For example, the statement by Him-melsbach and his associates of the near-schematic pattern of withdrawal behaviour suggests that a deep-rooted mechanism has manifested itself in withdrawal 8. The formulation by Wikler of a theory of narcotic use as a gratification of certain primary needs is another example of a broad-gauge generalization that seems to explain previously heterogeneous phenomena and that has predictive value 10. A number of other generalizations about addiction have also enabled us to observe mechanisms or response patterns that appear to have predictive value.

Details

Author: Charles WINICK
Pages: 1 to 11
Creation Date: 1964/01/01

The life cycle of the narcotic addict and of addiction

Ph.D Charles WINICK
Director, Narcotic Addiction Programme, American Social Health Association, New York

One goal of a scientific investigation of any subject is to determine the underlying regularities that permit us to make generalizations about the subject. Generalizations that are confirmed may enable us not only to explain but to predict, and prediction is the hallmark of a mature science. A number of investigators have made contributions towards our understanding of the regularities that may underlie the phenomenon of narcotic addiction. For example, the statement by Him-melsbach and his associates of the near-schematic pattern of withdrawal behaviour suggests that a deep-rooted mechanism has manifested itself in withdrawal [ 8] . The formulation by Wikler of a theory of narcotic use as a gratification of certain primary needs is another example of a broad-gauge generalization that seems to explain previously heterogeneous phenomena and that has predictive value [ 10] . A number of other generalizations about addiction have also enabled us to observe mechanisms or response patterns that appear to have predictive value.

Age is one of the very few continuous variables that it is possible for us to examine in the study of narcotic addiction. Interest in the phenomena of the length of addiction and age of the addict when he ceases to use narcotic drugs led to the analysis of data on former narcotic users obtained through the very generous and helpful co-operation of the Honorable H. J. Anslinger and the Honorable Henry L. Giordano, the former and incumbent Commissioner of Narcotics, respectively. The Federal Bureau of Narcotics made a tabulation of the age and number of years of addiction of those persons who had not used narcotics for five years, as of 31 December 1960 [ 11] . Of these 7,234 former drug users, there was a concentration of persons in their' thirties. The average age at which they became inactive was 35.1 and their average length of addiction was 8.6 years. By the age of 47, 87.3% of the total number of former narcotic users had become inactive.

These figures clearly suggest that there are fewer and fewer drug addicts who cease drug use in the later years of life and, contrariwise, that there is a considerable concentration of persons ceasing drug use in the years of prime adulthood. This phenomenon was identified as maturing out of narcotic addiction. It was speculated that, as the stresses of adolescence became less insistent and the drug user felt less threatened by the need to respond to such stresses, he tended to stop taking narcotics. The data, interpreted in the light of the maturing out concept, suggested that addiction might be a self limiting process for perhaps two-thirds of addicts.

The maturing-out phenomenon has received independent confirmation from other sources. A recent personal interview follow-up study in New York of 1,359 addicts released from the U.S. Public Health Service Hospital at Lexington found that patients over 30 had a significantly higher abstinence rate than younger patients [ 3] . Five years after release from the hospital, 61% of the group over 30 was abstinent. This is approximately the proportion of this age group which had become inactive in the author's earlier study ( [ 11] ).

Another kind of confirmation comes from psychopaths. The dropout curve for psychopaths is almost identical with that of the addicts who had ceased taking drugs after five years. Students of psychopathy have noted that psychopaths seem to "disappear" by their early thirties. There is reason to believe that they " disappear " because they have matured out of their psychopathy. Diethelm has summarized the experience of many psychiatrists with psychopaths: "During adult life, with the subsiding of instinctual desires... many psychopathic difficulties may disappear .... In a survey of patients.., it was possible to single out some patients of an age over 45 years whose lives represented that of a psychopath until about 30. These patients might be considered recovered psychopaths." [ 2]

The same phenomenon has been noted with juvenile delinquents, a large proportion of whom seem to begin functioning-within the "legitimate" society and "going straight" when they reach the age of about 30. Our most distinguished students of delinquency, the Gluecks, have observed a sharp drop in recidivism when offenders are about 30. They have also noted that even "repeaters" may shift from aggressive behaviour to "nuisance" offences after reaching their thirties. They have consistently found, in several different follow-up studies of delinquents, that there is a significant drop in the incidence of recidivism among young adult offenders. 1 The drop occurs in the late twenties and early and mid thirties.

Dr. Richard C. Cabot, in the preface to an early publication of the Gluecks, speculates that "Perhaps this type of crime is a symptom of a self limited disease of personality, which ordinarily runs its course during the years from sixteen to thirty-five or forty... [ 4] " Concluding a fifteen-year follow-up of 510 young adult offenders who had been convicted and served their sentences, the Gluecks reported ".. a rising trend toward improvement in all aspects of the activities of our men accompanying the passage of time (ageing) or maturation). This proceeds to approximately the age of 36 .... [ 5] " In the same study, they note that " A basic problem of this research was to determine which of the 63 factors studied were chiefly responsible for the reduction in criminality .... Such analysis revealed that only within the factor of ageing was a significant explanation to be found for the increasing trend away from criminal conduct .... "

A similar fifteen-year follow-up study on an entirely different sample of 1,000 juvenile delinquents came to essentially similar conclusions [ 6] . Their thinking on maturation as a contributor to de-recidivism has been confirmed by several different studies [ 7] . It is therefore within the realm of possibility that the same underlying forces that contribute to the settling down of delinquents or to their change from aggressive criminalism to petty offences of the nuisance type underlie both the phenomenon of de-recidivism and the analogous phenomenon of de-addiction. It is possible that de-addiction is simply one facet of de-recidivism. If this larger process of de-recidivism did not occur, our already large adult criminal population would be many times larger than it already is.

A similar phenomenon has been observed in delinquents who are incarcerated. Prison officials have noticed prisoners who commit infractions against the prison rules are usually under the age of 30. Even in the closed community of a prison, there appears to be a self selection of prisoners who flaunt established procedures and engage in behaviour that is frowned upon. The great majority of those who behave in this way are at roughly the same age as the addicts who stop taking drugs. That younger inmates in prison commit more infractions than older inmates is not unexpected; the younger people commit more infractions outside as well as inside a prison, and probably as a reflection of the same process of maturation. The infractions committed by young prisoners usually involve the expression of aggression - fighting, assaulting a guard, or overt stealing. It is difficulty with the expression of aggression that may turn some young persons to narcotics, and some violent "bopping" street gangs have turned to narcotics when they stopped "bopping ". The experience of prison officials is thus in line with what we know about what some young people do with feelings of aggression. Such young people may turn to narcotics, for so long as they experience difficulties in handling their aggression.

1 Grateful acknowledgement is made of some very suggestive and helpful comments about research data on juvenile delinquency that were made by Dr. Sheldon Glueek, Roscoe Pound Professor of Law at Harvard University. With his wife Eleanor T. Glueck, his pioneering applications of the scientific method to the study of delinquency have helped enormously to clarify this difficult area.

Parole officers working closely with addict parolees of all ages have observed that parolees in their thirties increasingly say " I'm too old for that stuff. I've had it. Who needs it ?" Such parolees may not like to stop taking drugs, but they dislike the consequences of return to drug use even more. What is curious is that the parolees' feeling that they have "had it" seems to become intensified by the time they reach their thirties. Many parolees in their thirties who are former addicts reject narcotics, even though they have improved their knowledge of techniques of evasion, like using a very fine needle, applying cocoa butter to facilitate the healing of needle scars, and using different drugs on different days in order to avoid dependence on any one drug. The parolees who turn their back on narcotics by their thirties tend to be those whose prison experiences are most radically different from their non-prison situation. 2

In all of these situations, persons who since adolescence have been violating the law or behaving in an anti-social manner, somewhere between their late twenties and mid-thirties, increasingly seem to be able to modify their behaviour patterns and to adapt to the larger society. This process is not automatic, and it does not happen to all the members of these groups, but it does happen to a significant proportion. To say that these persons have matured out of their earlier pattern of antisocial behaviour is to suggest the end product of a combination of forces: insight, possible regression to neurosis or perhaps psychosis, the effect of years of jail or harassment by authorities, difficulties in obtaining narcotics, the passage of time, reaching a point of satiation or saturation, and the decreasing pressure that the community applied on the drug user to make decisions.

2 Dr. Kurt Konietzko of the Philadelphia Parole Narcotic Project has helped greatly to clarify the psychology of the addict parolee.

The young man who turns to anti-social behaviour during his teens is likely to be responding to the many decisions - job, family, home - that he is called upon to make in our society during this period of his life. Basic human motivational systems are called into play in the late teens with a force that adds urgency to the decisions they require. The decision to use narcotics or to engage in other anti-social activity provides opportunities for gratifications that bypass the ordinary personal and social procedures for coping. In some cases, it may be a protection against a near-psychotic response. Drug use may represent a response to a physiological change. It may reflect a predisposing need which in turn reflects certain childhood experience, and especially certain kinds of parent-child relations. It may be a safeguard against feelings of inadequacy, or a means of lowering the organism's drive state. It may involve the counterphobic mechanism of repetitive exposure to narcotics' dangerous effect [ 9] .

The young person's separation from school during this period, whether by graduation or dropout, removes whatever blunting effect the school has had in absorbing the motives and drives that may manifest themselves in narcotics use. In our society, the place of a puberty rite is taken by the complex of decisions and actions that are the age-graded expectations that we have toward the adolescent moving into young adulthood. The implied threat posed by this complex may be faced by commencing narcotics use.

The commencement of narcotics use is likely to be reciprocally and complementarily related to the factor(s) that led to the maturing out of the use of drugs. For example, the young person who began using drugs as one way of coping with physiological changes seems to tend to mature out of narcotics use when these physiological changes lose their salience.

The data available in the earlier study did not make it possible to establish whether an addict's cessation of drug use is a function of either the age at which he begins using drugs or the life cycle of the disease of addiction itself, or some combination of both. It appeared important to attempt to clarify the relationship between the age at which drug use begins and the number of years that a person uses drugs. The data for such a study were made available through the very generous co-operation of Commissioners H. J. Anslinger and Henry L. Giordano of the Federal Bureau of Narcotics. 3 The Bureau prepared a cross-tabulation of the number of years of addiction of each age group in the population of 7,234 former drug users that had become inactive as of 1960. These records of the Federal Bureau of Narcotics are the only national figures on narcotic addiction. Great care has been taken to eliminate duplications from these records and to keep them up to date. Table 1 gives the age at cessation of drug use of the sample, in terms of the number of persons in each age category cross-tabulated against the length of their addiction. These are persons reported as drug users during 1955 and not subsequently reported as of the end of 1960. The criterion of five years of freedom from symptoms is the traditional medical criterion for recovery from a chronic disease.

3 Grateful acknowledgement is made of the extensive and helpful co-operation of Commissioners Anslinger and Giordano in providing this tabulation, and in making these data available completely unconditionally. All students of narcotics addiction are indebted to the Federal Bureau of Narcotics for its continuing efforts to keep its records as complete and reliable as possible. The author alone is, of course, responsible for the interpretations suggested for the Bureau data.

There is obviously a tremendous range in these data, from an eighteen-year-old with five years of drug use to a man of seventy-one with fifty-six years of drug use. The majority of the dropouts, however, clearly are clustered in the years of mid-adulthood and have an addiction history of less than a decade. It is possible to take these data and, by subtraction, to compute the number of persons beginning drug use at each age. 4 This is shown in table 2.

In the original report on maturing out, it had been speculated that there is a heavy concentration of commencement of drug use in the years of late adolescence and early adulthood, probably as one way of coping with the problems and decisions of these stressful years. Such a speculation appears to be confirmed by these data. Although the number of teenagers commencing drug use is most disturbing, even assuming a considerable period of time before these young users come to the attention of the authorities, the proportion of new teenage users to the total number of new users seems less than is sometimes assumed to be the case.

We are interested not only in how many persons commence drug use at each age, but also in how long they continue to use drugs. The median would probably be the best measure of central tendency for these data, but the limited number of cases in the very young and especially in the older age groups makes the median relatively impractical for this computation. The mean number of years of duration of addiction, at each age of onset, was therefore computed, and is shown in table 3.

The mean number of years that the persons in this sample used drugs suggests that the younger a person starts on narcotics, the longer is his period of drug use likely to last. The qualitative observations that can be made on each age group and each age decade doubtless have some value in making predictions about the life cycle of addiction. It was felt that the relationships between age at onset and length of addiction could be seen more clearly by smoothing the curve of these data, by dropping these cases that had been addicted for sixteen years or more. Table 4 gives the percentage of addicts at each age of onset who had used narcotics for sixteen or more years.

4 The statistical analysis of these data was directed by Professor David W.Miller of Columbia University. Professor Miller's imaginative and thoughtful analysis uncovered relationships that were not at all apparent.

 

Length of addiction in years

 

Age at drop out

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

 
18 1                                                   18
19 5                                                   19
20 3 3   1                                             20
21 12 6 4   1                                           21
22 23 17 4 2 1                                           22
23 53 37 18 3 3 3 1                                       23
24 86 43 26 17 1 4 1                                       24
25 102 63 39 21 15 3 2   2                                   25
26 131 81 62 29 27 18 9 3 4 1                                 26
27 134 96 58 38 30 25 21 7 3                                   27
28 175 84 56 39 39 38 21 9 4 4                                 28
29 146 72 57 44 42 31 13 18 19 1 4                               29
30 161 96 66 54 42 32 24 19 13 4 3                               30
31 161 66 46 47 18 36 23 16 10 8 3   1 1                         31
32 144 69 53 43 34 42 23 23 12 7 10       1 1                     32
33 127 57 56 28 24 41 26 18 14 4 9 4 1 3     1                   33
34 129 40 38 28 32 24 11 10 8 7 7 6 3   2 1             1       34
35 89 39 35 29 21 25 9 14 8 5 3 4 3 4 2 2 1                   35
36 81 43 22 16 20 27 13 12 7 4 5 3 1 1   1 1 2 1               36
37 80 28 29 12 23 20 12 5 2 3 3 3 3 3 1 3 1                   37
38 51 17 15 6 11 10 10 10 9 1 5 1   1 3 1   1 1   1           38
39 34 23 12 10 14 13 5 3 7 2 7         3       2             39
40 46 21 13 10 4 7 5 6 3   7   1 1 1       1               40
41 35 20 9 7 3 9 3 3 6 1 8   3 1 2 3 1 1   1 1           41
42 35 13 13 7 5 5 9 2 5 1 2 1     2 2 2 1     1 1       1 42
43 25 17 8 7 7 5 2 1 1 1 9   3   1 5 1 1 1 1 3     1   1 43
44 27 13 3 6 3 3 2 1 5   4       1 2 1   2 1   2 1       44
45 25 11 9 5 3 5 2 2 3 2 3     4 1 1 2   1   3       1   45
46 27 5 3 6 4 1 2   1 1 4 1   1 2 9       1 4 1     1 2 46
47 20 6 2 3   5 5 1 2 1 7   2 1   4   1 1   3 1   1     47
48 22 6 2 3   5 1 3 3   1   1   1 3 2 1 1   6 1         48
49 14 3 5 4 2 4 2 2 2   4   2     5   1     4 1   2     49
50 23 2 1 3 1 1 1   1 2 8 1       2 1   1   3 1     1 2 50
51 14 3 5 1 1 1 3 4 3   2   3     1 1 1 1   5   1 1   4 51
52 11 3 4 4   2 2 1   1 3 1 2     1 1   1   2 3 1 1 2 2 52
53 27 4 1 3 1 3 1 2 2   5   1 2 1 4 1 1 1   4   2     2 53
54 12 1 5 1   2 1   2 1 3         4       1 10     1   1 54
55 13 4 1 3 2 5 2 3   1 1   3     2 1   1   4   1 2   3 55
56 10   4   1 1 1 1 1   2 1       2         6     2   1 56
57 12 2 4 2 1 2   1   1 1 1       1   2     3       1 1 57
58 26 3 3 3 1 1   2 1   1     1   3   1     1 1         58
59 16   3 2   1   2 3   1   1     1     1   2         2 59
60 20 2 1 1   2       1 7         3           71     1 1 60
61 10 1   1   1         3     1         2   2         1 61
62 16 1 2       1       1       1           1       1 2 62
63
13 1 1   1 1               1   2     1   1   1     1
63
64 8 3                 1       1 1 1   1   1         1 64
65 10   1     1 1             1             3         2 65
66 13   3     2                                       1 66
67 8 3 1                                         1 1 2 67
68 6 1 1               1         1   1             1   68
69                                           1         69
70                                                     70
71                             1                       71
72                               2                     72
73                                         1           73
74                                                     74
75                                                 1   75
76 1                                                   76
TOTAL
2473 1128 807 547 438 463 270 204 166 65 148 29 34 27 24 76 18 16 19 7 82 13 8 12 11 35  
 

Length of addiction in years

 

Age at drop out

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

Total

 
18                                                     1 18
19                                                     5 19
20                                                     7 20
21                                                     23 21
22                                                     47 22
23                                                     118 23
24                                                     178 24
25                                                     247 25
26                                                     365 26
27                                                     412 27
28                                                     469 28
29                                                     447 29
30                                                     514 30
31                                                     436 31
32                                                     462 32
33                                                     413 33
34                                                     347 34
35                                                     293 35
36                                                     260 36
37                                                     231 37
38                                                     154 38
39                                                     135 39
40                                                     126 40
41 1                                                   118 41
42                                                     108 42
43   1                                                 101 43
44 1                                                   78 44
45                                                     83 45
46                                                     76 46
47   1 1                                               64 47
48       1 1                                           63 48
49                                                     57 49
50 1     1 1                                           58 50
51 1   2                                               58 51
52     1   2         1                                 52 52
53 2       2           1                               73 53
54 2 1   1 1   1                                       54 54
55 1   1   2   2                                       58 55
56         5     1             1                       40 56
57         1         1                                 37 57
58         3   1     2                                 54 58
59 1       3             1                             39 59
60         1           1         1                     51 60
61 1       2       1 2   1 1                           32 61
62 1   1     1     1 2   1                             32 62
63         1     1       1     2                       29 63
64                 1 3 1                               23 64
65         2           1 1     2   1                   26 65
66                       2     1                       23 66
67         1                   1                       19 67
68         3       1               1                   16 68
69                             1                   1   3 69
70         1   1       1         1           1     1   6 70
71                             1         1         1 1 5 71
72                             1                       3 72
73                                                     1 73
74     1                                               1 74
75             1                                       2 75
76                                                     1 76
TOTAL
12 3 7 3 32 1 6 2 4 11 4 7 1   11 1 3     1 1     1 2 1 7 234  

TABLE 2

Number of persons beginning drug use at various ages

Age

Number of persons

Age

Number of persons

7 1 37 76
10 1 38 81
11 3 39 57
12 10 40 58
13 16 41 52
14 46 42 40
15 59 43 43
16 167 44 33
17 253 45 50
18 320 46 33
19 405 47 30
20 449 48 33
21 499 49 25
22 462 50 22
23 505 51 19
24 438 52 22
25 416 53 30
26 430 54 20
27 347 55 24
28 293 56 14
29 268 57 17
30 214 58 17
31 151 59 11
32 153 60 11
33 122 61 17
34 103 62 9
35 126 63 6
36 90 71 1

It will be noted that the proportion of those using narcotics for over fifteen years is relatively high in those starting on narcotics in their early teens and mid thirties. From age 34 to 43, the proportions are very erratic. For ages over 48, there are practically no cases of more than fifteen years of use, probably because of the decreased life span possible. There are 525 cases of narcotics use for more than fifteen years, or 7.26% of the total. When we subtract those cases from the mean number of years of drug use at each age of onset, the mean number of years of drug use appears to follow a clear cut pattern, as can be seen in table 5.

If we look at the mean number of years of addiction at the ages of onset up to 30, we see that a correlation ( r) of - 0.95 obtains between age at onset and length of addiction. This extraordinarily high correlation documents how, in this age group, the length of addiction declines progressively and consistently as the age at onset increases. We do not know whether this relationship is the result of a decrease in need, an increase in resistance, external factors, or a combination of these and other factors.

TABLE 3

Mean number of years of duration of addiction at each age of onset

Age

Average duration

Age

Average duration

7 27 37 7.7
10 31 38 9.8
11 36.3 39 7.9
12 19.9 40 9.2
13 16.1 41 8.0
14 13.8 42 6.7
15 13.7 43 8.9
16 10.9 44 7.5
17 10.4 45 8.3
18 10.2 46 9.2
19 8.7 47 7.5
20 8.7 48 6.4
21 8.9 49 6.5
22 8.2 50 6.2
23 8.2 51 6.3
24 8.3 52 7.6
25 7.7 53 5.7
26 8.2 54 5.6
27 7.6 55 5.4
28 7.8 56 5.9
29 8.1 57 5.1
30 7.9 58 5.3
31 8.1 59 5.6
32 8.0 60 5.2
33 8.4 61 5.3
34 8.8 62 5.1
35 9.3 63 5.0
36 8.8 71 5.0

TABLE 4

Proportion of former drug users at each age level who have been addicted for more than fifteen years

Age

Proportion (Per cent)

Age

Proportion (Per cent)

14 19.6 32 7.8
15 25.4 33 9.0
16 8.4 34 13.6
17 9.5 35 14.3
18 9.4 36 11.1
19 5.7 37 5.3
20 5.4 38 14.8
21 7.2 39 5.3
22 4.8 40 15.5
23 5.9 41 5.8
24 6.4 42 2.5
25 3.6 43 13.9
26 7.2 44 3.0
27 5.8 45 4.0
28 5.1 46 6.1
29 9.0 47 3.3
30 8.0 48 6.1
31 7.2    

TABLE 5

Average length of addiction for those addicted fifteen years or less, in years

Age

Length of addiction

Age

Length of addiction

14 9.9 38 7.4
15 9.9 39 6.9
16 9.3 40 7.0
17 9.0 41 7.1
18 8.3 42 6.4
19 7.8 43 7.1
20 7.7 44 7.1
21 7.4 45 7.8
22 7.3 46 8.2
23 7.1 47 7.1
24 6.9 48 5.4
25 7.0 49 6.5
26 6.9 50 6.2
27 6.6 51 6.3
28 6.6 52 5.6
29 6.5 53 5.7
30 6.4 54 5.6
31 6.8 55 5.4
32 6.6 56 5.7
33 6.5 57 5.1
34 6.9 58 5.3
35 7.1 59 5.6
36 7.1 60 5.2
37 6.6    

The correlation ( r) between length of addiction and age at onset between ages 38 and 60 is - 0.80, which is also extremely high. The reason for the correlation being lower in the older than in the younger age group is probably a function of the diminishing life expectancy and much smaller number of cases on each cell in the older group. The ages 31 to 37 present a less clear picture. It is possible to present these relationships graphically, in figure 1. The length of addiction is the dependent variable, and is plotted against age at onset.

Figure 1 makes it clear that there are essentially three different groups in this population of former drug users: the group starting drug use at ages up to 30, the group starting from 38 to 60, and an intermediate group starting between 30 and 38.

We can establish a regression equation for each of the two major age groups. The equation for the 19-30 group is y = 10.09 - 0.126 x, with y the average length of addiction and x the age at onset. This equation enables us to predict the length of drug use of the average person starting drug use at any age in this range. The results of this equation provide the best estimate on how long a person starting at any given age will use narcotics. It will be noticed that the younger a person in this age range begins drug use, the longer he is likely to continue using drugs. A person, however, who has held off using drugs until a later age will use them for a shorter period. If we now look at the older age group from 38-60, the regression equation y = 11.58 - 0.107 x enables us to predict how long a person commencing drug use within this age group will continue to use narcotics. These two age groups are distinct and separate, but roughly the same equation helps to clarify the duration of their drug use. The two regression lines drawn on figure 1 are almost exactly parallel and have essentially the same slope, suggesting the operation of some profound underlying principle.

The reason for considering the 32-36 group separately is that it appears to offer data that seem to depart from either of the two regression formulae. Inspection of the length of addiction at each of the years in this group suggest that some unusual factors are operating. The regression line that was developed for this age group is shown in figure 1. Perhaps the simplest way of interpreting these data is to assume that each age group from 32 to 36 contains different proportions of the two age groups that appear to be present at each step in the series. We can assume, if there are two distinct groups in this population of former addicts, that the intermediate group is a mixture of the trend lines of the two groups. The components of the mixture are shown in table 6. The first column gives the age and the second column gives the mean length of the addiction period. The third column gives the mean length of addiction at each age if the younger group's regression equation ( y = 10.09 - 0.126 x) were to be applied to the addicts commencing drug at each age. The fourth column gives the mean length of addiction at each age of onset each age if the older group's regression equation ( y = 11.58 - 0.107 x) were to be applied to the addicts commencing drug use at each age.

TABLE 6

TABLE 6

Proportions of two age groups in former drug users commencing drug use between 32 and 38

Age

Actual mean length of addiction

Mean length of addiction if younger group

Mean length of addiction if older group

Proportion of younger group at this age (Per cent)

32 6.6 6.1 8.15 76
34 6.9 5.85 7.95 50
36 7.18 5.60 7.70 25

FIGURE 1 Mean length of addiction

Full size image: 30 kB, FIGURE 1 Mean length of addiction

It will be noticed that there is an extraordinary symmetry in the progression. The 32-year-old group bas 76% of the under-30 proportions, the 34-year-old group has 50% and the 36-year-old group has 25% of the younger group. Although the group from 32 to 36 did not seem to cease drug use with the predictable regularity of the other ages, it appears to be similar to them if we assume a symmetrically varying proportion of each of the two established age groups at each step in the continuum. The relative importance of the two age groups changes as the addict between 32 and 36 grows older, which is not surprising. As his age increases, the salience and importance of the older group increases, and vice versa. Even the intermediate group thus appears to be understandable in the light of the existence of the two separate but analogous age groups in this population of addicts who ceased taking drugs.

The length of a narcotic user's addiction will be between one-eighth and one-ninth of a year less, for each year that the onset of his addiction is delayed. This relationship, and its implications of maturing out, appear to apply to almost two-thirds of addicts. This straight line regression relationship does not apply, of course, to the relatively small number of addicts who continue narcotics use for over fifteen years. Why is there such a precise consistent decline in the average length of addiction, as the age at onset increases ? These average lengths might have remained constant, or might have increased. The decrease in the number of years, and its remarkable consistency, suggest the possibility of a pervasive relationship that involves some causal force that counters the development of the addiction.

Why does the curve representing the older group, even though this group is smaller in number, so closely parallel that of the younger group ? There is no reason why it should. It may be that both groups are responding to the same kind of life pressures, but that accessibility of narcotics and contact with peers may lead the younger group to start drug use earlier. The older users may have been able to cope with their symptoms without using drugs up to a certain point in their lives. An addiction that begins at age 19 is likely to serve different purposes for the addict than an addiction that begins at age 38. The 19-year-old is likely to be responding to the decisions that he is asked to make. The older man's decision to use narcotics, on the other hand, may be a response to the realization that decisions such as those about jobs, family and home will be less and less possible. The realization that decisions of significance to the life situation are decreasingly likely may lead some persons in their late thirties and early forties to begin to use narcotic drugs on whatever level such a decision may be made.

It is a reasonable assumption that the persons who begin drug use at different ages do so for different reasons, because the urgency of the drives that may have led to the beginning of drug use varies with a person's place on the life cycle. Another way of saying this is that the coefficient which expresses a person's predilection for addiction is a function of age. This coefficient takes a track through time. The earlier addiction starts, the longer it lasts. This suggests that a person who has yielded relatively early in life to addiction has less resistance than someone who starts later. The user who begins with drugs relatively later in life has withstood yielding to drug use for a long enough period of time to manifest the kind of resilience that shows itself in a shorter period of drug use. Resistiveness to drug use in the earlier age groups is all the more impressive a sign of the ability to defer gratifications because drugs are more available to young people, who are more likely to be in contact with drug-using peers. Their turning away from the anchorage provided by narcotics is a clue to their possession of resources for coping with their life space.

It is important to remember that the addicts in this sample began their drug use at different times, although the majority probably began as contributors to the localized "epidemics" which began in 1946. The year or decade or era in which a person begins narcotics use may be a major contributor to his having done so, because it contributes to the kind of socialization process that occurs. Such dimensions doubtless contribute to the age at which narcotics use begins. The addicts commencing drug use in the 1930s, for example, were perhaps ten years older on the average than those beginning drug use in the 1950s.

Strong evidence for the operation of some kind of inherent mechanism in the life cycle of addiction is provided by the extraordinary similarity between the two regression lines, and their having essentially the game slope. It is almost as if a constant is added to the regression line for the younger group to make the regression line for the older group.

While we recognize that opiates may serve varying functions for their users, and that it is difficult to generalize about a phenomenon as complex as narcotic addiction, it should not be surprising that there is a certain larger regularity in the pattern of commencement and cessation of drug use. A number of authorities have suggested that opiate addiction meets certain underlying needs and follows a unique cycle of its own, almost independent of the personalities of its users. It would seem possible that one parameter like length of addiction adequately explains much drug addiction. This one parameter may be the end product of an interaction or combination of biological forces, personality, propinquity to drugs, environmental pressures, subcultures, social conditions, differential socialization within a delinquent subculture, the alertness of enforcement agencies, comparative life expectancy and morbidity, and similar factors.

The data that are the basis for this study are not perfect, although they represent the best information available. The five-year criterion of nonuse of drugs, an addict becoming a medical addict, or death may contribute to possible imperfections in the data. The criterion of five years of drug inactivity before assuming that a person may be deemed not to be a user is, of course, relatively conservative. Since these former users had no official record of narcotics use after 1955, many doubtless ceased drug use long before 1960. The actual age at which these former users cease drug use may thus be less than the age at which they are officially credited with doing so. An appreciable number of addicts disappear from the active list by acquiring some pathology which requires narcotic medication, so that they are classified as medically addicted persons. Some may die from " hot shots ", overdoses, or conditions related to addiction. Others may cease drug use as a result of their regression to another or deeper level of symptomatology.

Another possible imperfection in our data is that cessation of drug use is, for statistical purposes, treated as a phenomenon. One possible implication of such an approach is that addicts are assumed to stop using drugs as of a specific date. The likelihood is, of course, that many addicts refrain from drug use for a brief period of time, return to drug use, refrain for a longer period of time, return to drugs, refrain for yet a longer period of time, and so forth. It may be a relatively long-term process, which proceeds by an accretion of insight and experience. There are some addicts who vow not to use narcotics on a birthday or anniversary or other occasion that has special symbolic meaning for them, and can sustain such a decision. They would seem, however, to be in a minority. It is therefore often difficult to determine precisely when a given narcotics user ceased using drugs.

We have previously noted that approximately two-thirds of addicts seem to mature out, and that this study is based on a sample of all of the addicts who had ceased using drugs as of one year. Even in this sample, however, there is a small group that has been using narcotics for over fifteen years that seems to be different from the others. The average addict who matures out, we may speculate, seems to have contact with narcotics for a range of time the upper limit of which is fifteen years. This suggests that people who use narcotic drugs for a very long time differ from those who use them for an intermediate period, and that the latter differ from short-term users. We refer to each of these three groups as "addicts ", although the likelihood is that there ought to be different designations for each group, and for the different degrees of craving for and dependence on narcotics that exist.

The Law of Mass Action

Although narcotic addiction is often discussed as if it were a condition that is entirely unique, there is reason to believe that the phenomenon of cessation of drug use may be clarified in terms of larger regularities and generalizations in nature. The data in this study appear to lend themselves to interpretation in terms of the well-known chemistry principle of the law of mass action, formulated in 1799 by Berthollet and substantiated by Wilhelmy in 1850. 5 This principle, originally used to explain chemical reactions in vitro, explains the rate of development of an aspect of an organism when the development is proceeding at a rate proportional to the growth already achieved, and then procedes at a rate proportional to the growth it might have achieved. A typical example of mass action is provided by what happens when acidophus bacilli get into milk. They grow geometrically, but as a result of their own excretory processes toxicity, they create an environment that is hostile to themselves. The classic mathematical statement of the law of mass action is a straight line relationship with a negative slope, which is the relationship that emerges from the current study.

It is possible, in the approximately two-thirds of the addict population to whom the maturing out concept seems to apply, that the body's defence mechanisms are responding to some of the cumultative effects of the addiction process. Such mechanisms, judging from our data, seem to have a predictable relationship to age at onset. Another possibility is that the environment only permits a certain amount of development of addiction in these cases. Yet another possibility is that internal or external resistances manifest themselves as a countervailing force that leads to maturing out.

5 John Beeston, M.D., and M. Norman Orgel, M.D., members of the Board of the American Social Health Association, identified the possibility of the relevance of the law of mass action to the phenomenon of maturing out.

In order to apply tile law of mass action, it would be desirable to have more than the single measurement of length of addiction. It is possible to assume the existence of some kind of counterpressure of the kind that characterizes the mass action phenomenon. Why, otherwise, should the addiction of a typical 19-year-old last longer than that of a typical 27-year-old ? These data, of course, are based on group averages and can adequately explain only modal or typical cases.

Why are there two age groups in this population of former drug users, and does the existence of the two groups vitiate our ability to understand maturing out as a mass-action phenomenon ? Where mass action is operating, we would expect that there would logically be two groups, one that is self-accelerating and the other of which is self-inhibiting. The classic discussion of mass action by Brody notes that "no equation has been found to represent the whole of the growth cycle of animal... the actual growth curve shows breaks.... for this reason, we prefer to break up the age curve, as far as possible, into its significant constituent segments and employ separate equations with rational, clearly defined constants to represent each segment. [ 1] " The phenomenon of successive decrement of length of addiction as age at onset increases is thus in line with other manifestations of the mass-action phenomenon in nature.

The regularity of the mass-action phenomenon and the apparent illustration of the maturing out hypothesis demonstrated by the data are all the more remarkable in view of the possible imperfections in the data. Whatever imperfections there may be, there is no reason to believe that they are concentrated in any one age group. The underlying biological or other regularities seem to manifest themselves via underlying causal mechanisms in spite of social changes like recessions, war, and other extraordinary external events, as well as regional and subcultural differences.

Another concept that helps us in relating these data to larger principles of behaviour is the Weber-Fechner law, or the principle of diminishing increments as the physical intensity of a stimulus is increased at a constant ratio. We see that as the age of the user increases, the extent of the addiction decreases at a constant ratio. This law, deriving from physiological psychology, provides an additional method of interpreting the data. The law of mass action and the Weber-Fechner law do not completely explain the phenomenon of successive decrement of length of addiction as age at onset increases, but they provide additional dimensions of understanding that help to clarify it.

The phenomena that we have explored suggest that there is an "average" or modal addict, who is representative of perhaps three-fifths to two-thirds of the total number of persons who begin to use narcotic drugs on any kind of regular basis. Analysis of variance suggests that those persons who start using narcotics at a very early age, or when over 60, or who use narcotics for over fifteen years, are not likely to be typical of the majority of addicts. One of the hazards of averaging, of course, is that an average does not enable us to predict the outcome of any one case. The very concept of the average means that some addicts will stop using drugs earlier and other will stop using drugs later than the average.

We also have no information on the amount and frequency of ingestion of narcotics on the part of our sample. It is likely that the amount of drugs used and the intensity of use, as well as the length of intermediate periods of abstinence, contribute substantially to the age at cessation of drug use. Such dimensions would have to be considered against the context of the somatotype and weight of the body of the drug user. The increase in dosage is also a factor, so that we might hypothesize, for example, that users who reach the peak of sensation more rapidly might also tend to cease drug use more rapidly.

Another kind of possible hypothesis has to do with the relationship between age at onset and severity of withdrawal symptoms. Some addicts who began narcotics use at a relatively early age and who have had a protracted period of heavy narcotics use appear to have extremely severe withdrawal symptoms, even if the " habit " from which they are withdrawing most recently is a mild one. They appear to have deep-seated withdrawal symptoms that are almost independent of the strength of their current " habit ". This may possibly reflect their commencing narcotics use at an age when the organism was perhaps not " ready " to absorb such quantities of drugs, or it may reflect psychological factors.

One possible implication of the fairly predictable relationship between age at onset and length of addiction is that it suggests the possibility of a specific age range within which an addict is most likely to be able to stop drug use, and to be most responsive to therapeutic intervention. Rehabilitation of addicts may be most successful if it is introduced when the addict is at the point in his cycle of addiction at which the modal addicts who started drug use when he did are likely to be ceasing drug use.

The programmes for probation or parole under civil commitment that are becoming more widespread provide an opportunity for intensive study of special populations with respect to the life cycle of their addiction. The close relationships between parole officers and their parolees ought to permit the pinpointing of nodal experiences and life situations that are related to cessation of drug use.

Physiological studies should be able to determine whether this peculiarly regular relationship of attentuation of drug use with age is a function of motivation, intensity of need, or strength of resistance. In any scientific field, the smaller the number of parameters, the better an explanation is likely to be. The parameter of age and length of addiction appears to be suggestive and heuristic enough to warrant further study. It suggests some of the regularities that underlie narcotic addiction and enables us to make predictions. Further exploration based on this concept may help us to understand more of the regularities that are related to addiction [ 12] .

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