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Drug Addiction and its Treatment.
DRUG
ADDICTION AND ITS TREATMENT.
not for want of
137 that
trying
some
persons
arc
only
alcoholic. To explain the alcoholiphil, action of drugs we must take cognisance of the soil in which they seek to germinate, prepared as it may be by neuropathic inheritance or diathesis. A tendency to suicide may assume a familial form, and so, undoubtedly, may alcoholism ; and were sufficient evidence forthcoming, the association of any form of LOJVDON: SATURDAY, JULY 15, 1922. drug-taking, from tea to methylated spirit, with congenital or acquired neural instability might be demonstrated-as a fact, the student of the subject is Addiction and its Treatment. aware that data supporting this opinion can be WITHIN the last year or two a number of cases of adduced in abundance. We regard, therefore, with some concern the drug addiction, some of which have achieved considerable notoriety, have focused public attention apparently tacit acceptance of the situation now of medicine never, unfortunately, arising, which can only lead to further conflicts an aspect on There between opposing points of view. That evils, included much cultivated by the profession itself. are by-paths of medical lore along which the student in which may be reckoned antisocial behaviour, are will never proceed or, at least, is not likely to proceed, prone to follow drug addiction in certain cases, has if he is not given a lead by his teachers, and it is in long been a commonplace to the physician. As the these lanes that the irregular practitioner flourishes. law now stands, confirmed drug maniacs can scarcely Instances of the truth of this general statement will hope to avoid coming in contact with it, while if its at once occur to the mind, but we are concerned for purview is extended, as seems a possible future the moment with the treatment of drug intoxications, development, then a still larger group of cases, the forced into the limelight of publicity largely through legitimate concern of the practitioner, will have forced the passing of the Dangerous Drugs Act of 1920. on them a legal aspect to which no doctor can remain From the obiter dicta of anonymous magistrates indifferent. We had begun to think that horror of published in the daily press it might be supposed by the supposed stigma conferred on the mentally the uninitiated that drug addiction is an offence or afflicted by sojourn in an asylum was being reduced a misdemeanour and not a disease, though a descripby dissemination of the knowledge that mental tion of symptoms and of treatment will be found disease is nervous disease and by a wider use of the in every adequate text-book of medicine; even if expression " mental hospital "v recent public disrecognition of this, the medical aspect of the question, cussions, however, appear rather to nullify our hope. has sometimes been admitted by those in authority, But what of the stigma attached to imprisonment’? we have, on one occasion at least, been assured that Are cases of nervous disease, for that is what drug are in essence, to be sent to prison for their imprisonment is salutary because of the inability of cases " the victim to obtain his particular "poison," and the cure " ?‘? The profession is surely not so impotent, incarceration has been hailed as a peculiarly effective or indifferent, as to countenance further spread of this form of "treatment." Such an attitude of mind is particular practice. Before drug habitues are likely not far removed from that of the eighteenth-century to transgress the law of the land, it is the urgent who declared the miserable wretch before him duty of medical men to familiarise themselves with judge " would be nane the waur o’ a hanging," and is greatly approved methods of treatment and with their applicato be deprecated. The practising physician knows tion. Morphinism is, qua morphinism, definitely that any simple and reputedly harmless drug, such curable; and the same may be said of many varieties as aspirin, phenacetin, sulphonal, can be taken in of drug habit; and a nursing home or a hospital quantity till the limits of its compatibility with should be able to accomplish what a prison regime is are nervous health overstepped; the individual now credited with. The nefarious traffic in a certain becomes a drug-taker, and his morbid state a disease. class of drug it is hoped can and will be checkmated Any anodyne or sedative may constitute the " poison," by police regulations, and all efforts to combat this and produce a train of symptoms calling for skilful evil are welcomed by the healthy-minded citizen, who treatment. From the medical viewpoint, there is believes that prevention is better than cure. But the no difference whatsoever between addiction to aspirin question whether disease can be prevented or cured by and addiction to morphia, between alcoholism and Act of Parliament requires much deeper study than it cocainism ; but because it has been thought fit to commonly receives ; no study is complete which does regard opium-eaters as partakers of a dangerous drug, not take into consideration the medical factors. The legally, their affliction automatically becomes an publicity given by recent facts to this subject will offence if they are found in possession of the " poison." serve a useful purpose if it directs attention to a In chronic morphinism the loss of will-power, the part of medical practice hitherto cultivated by comdulling of the moral sense, the ethical deterioration, paratively few doctors, though it is one which has are symptoms of the condition no more and no less great possibilities of development. than are delirium and hallucinations those of a toxic psychosis. It is highly important to bear in mind, medically speaking, that in this respect no differentiaFood A Maintion can be made between one drug and another, tenance Ration. except in so far as the effects on the individual are more serious in one than in another, and this, in turn, DURING the two generations that preceded the war depends, at least, as much on the patient concerned Britain was slowly becoming throughout a wellas on the drug to which he has succumbed. Other- nourished nation, and from 1915-1917 the process wise expressed, we are to recognise fundamental was greatly accelerated, for a large proportion of the differences in individual make-up." By no means young male population was being fed abroad at all, who would, can possibly become drug-takers. A national expense, while at home the family budget dose of morphia, experimentally taken, may sicken was raised to a high level by unusual wage-earning. one individual and fascinate another ; it is assuredly The school-children of this period bear the marks of but
THE
never
LANCET.
Drug
Family
"
Budgets:
ADDICTION AND ITS TREATMENT.
not for want of
137 that
trying
some
persons
arc
only
alcoholic. To explain the alcoholiphil, action of drugs we must take cognisance of the soil in which they seek to germinate, prepared as it may be by neuropathic inheritance or diathesis. A tendency to suicide may assume a familial form, and so, undoubtedly, may alcoholism ; and were sufficient evidence forthcoming, the association of any form of LOJVDON: SATURDAY, JULY 15, 1922. drug-taking, from tea to methylated spirit, with congenital or acquired neural instability might be demonstrated-as a fact, the student of the subject is Addiction and its Treatment. aware that data supporting this opinion can be WITHIN the last year or two a number of cases of adduced in abundance. We regard, therefore, with some concern the drug addiction, some of which have achieved considerable notoriety, have focused public attention apparently tacit acceptance of the situation now of medicine never, unfortunately, arising, which can only lead to further conflicts an aspect on There between opposing points of view. That evils, included much cultivated by the profession itself. are by-paths of medical lore along which the student in which may be reckoned antisocial behaviour, are will never proceed or, at least, is not likely to proceed, prone to follow drug addiction in certain cases, has if he is not given a lead by his teachers, and it is in long been a commonplace to the physician. As the these lanes that the irregular practitioner flourishes. law now stands, confirmed drug maniacs can scarcely Instances of the truth of this general statement will hope to avoid coming in contact with it, while if its at once occur to the mind, but we are concerned for purview is extended, as seems a possible future the moment with the treatment of drug intoxications, development, then a still larger group of cases, the forced into the limelight of publicity largely through legitimate concern of the practitioner, will have forced the passing of the Dangerous Drugs Act of 1920. on them a legal aspect to which no doctor can remain From the obiter dicta of anonymous magistrates indifferent. We had begun to think that horror of published in the daily press it might be supposed by the supposed stigma conferred on the mentally the uninitiated that drug addiction is an offence or afflicted by sojourn in an asylum was being reduced a misdemeanour and not a disease, though a descripby dissemination of the knowledge that mental tion of symptoms and of treatment will be found disease is nervous disease and by a wider use of the in every adequate text-book of medicine; even if expression " mental hospital "v recent public disrecognition of this, the medical aspect of the question, cussions, however, appear rather to nullify our hope. has sometimes been admitted by those in authority, But what of the stigma attached to imprisonment’? we have, on one occasion at least, been assured that Are cases of nervous disease, for that is what drug are in essence, to be sent to prison for their imprisonment is salutary because of the inability of cases " the victim to obtain his particular "poison," and the cure " ?‘? The profession is surely not so impotent, incarceration has been hailed as a peculiarly effective or indifferent, as to countenance further spread of this form of "treatment." Such an attitude of mind is particular practice. Before drug habitues are likely not far removed from that of the eighteenth-century to transgress the law of the land, it is the urgent who declared the miserable wretch before him duty of medical men to familiarise themselves with judge " would be nane the waur o’ a hanging," and is greatly approved methods of treatment and with their applicato be deprecated. The practising physician knows tion. Morphinism is, qua morphinism, definitely that any simple and reputedly harmless drug, such curable; and the same may be said of many varieties as aspirin, phenacetin, sulphonal, can be taken in of drug habit; and a nursing home or a hospital quantity till the limits of its compatibility with should be able to accomplish what a prison regime is are nervous health overstepped; the individual now credited with. The nefarious traffic in a certain becomes a drug-taker, and his morbid state a disease. class of drug it is hoped can and will be checkmated Any anodyne or sedative may constitute the " poison," by police regulations, and all efforts to combat this and produce a train of symptoms calling for skilful evil are welcomed by the healthy-minded citizen, who treatment. From the medical viewpoint, there is believes that prevention is better than cure. But the no difference whatsoever between addiction to aspirin question whether disease can be prevented or cured by and addiction to morphia, between alcoholism and Act of Parliament requires much deeper study than it cocainism ; but because it has been thought fit to commonly receives ; no study is complete which does regard opium-eaters as partakers of a dangerous drug, not take into consideration the medical factors. The legally, their affliction automatically becomes an publicity given by recent facts to this subject will offence if they are found in possession of the " poison." serve a useful purpose if it directs attention to a In chronic morphinism the loss of will-power, the part of medical practice hitherto cultivated by comdulling of the moral sense, the ethical deterioration, paratively few doctors, though it is one which has are symptoms of the condition no more and no less great possibilities of development. than are delirium and hallucinations those of a toxic psychosis. It is highly important to bear in mind, medically speaking, that in this respect no differentiaFood A Maintion can be made between one drug and another, tenance Ration. except in so far as the effects on the individual are more serious in one than in another, and this, in turn, DURING the two generations that preceded the war depends, at least, as much on the patient concerned Britain was slowly becoming throughout a wellas on the drug to which he has succumbed. Other- nourished nation, and from 1915-1917 the process wise expressed, we are to recognise fundamental was greatly accelerated, for a large proportion of the differences in individual make-up." By no means young male population was being fed abroad at all, who would, can possibly become drug-takers. A national expense, while at home the family budget dose of morphia, experimentally taken, may sicken was raised to a high level by unusual wage-earning. one individual and fascinate another ; it is assuredly The school-children of this period bear the marks of but
THE
never
LANCET.
Drug
Family
"
Budgets: