In any case, combat troops avoided heroin use in the field: being stoned, especially on a drug as soporific as heroin, was more likely to get them killed. But they made up for it when they returned to base. One soldier came back from a long patrol of 13 days; his first action was to tip a vial of heroin into a shot of vodka and knock it back.14
Panicky headlines about the ‘GI epidemic’ started appearing in American newspapers. The Nixon administration was terrified of a crime wave caused by the return of thousands of desperate junkies to American cities. But it never materialised. Instead, the addicted soldiers cleaned up their act – fast.
We know this because the US government, anticipating disaster, commissioned a medical study that recruited more than 400 returning soldiers who snorted, smoked or injected heroin and described themselves as addicted (making it possibly the largest ever study of heroin users). To researchers’ surprise, back in the United States only 12 per cent of these addicts carried on using heroin at a level that met the study’s criteria for addiction.15
This is really powerful evidence that changes in social environment can dramatically affect people’s drug-taking habits. As Professor Michael Gossop, a leading researcher at the National Addiction Centre, King’s College, London, explains: ‘The young men who served in Vietnam were removed from their normal social environment and from many of its usual social and moral constraints. For many of them it was a confusing, chaotic and often extremely frightening experience and the chances of physical escape were remote except through the hazardous possibilities of self-inflicted injury.’16 Gossop uses the phrase ‘inward desertion’ to describe what heroin offered the soldiers: a cheap trip to another world.
The scared, disorientated soldiers in Vietnam were being offered a chemical fix to relieve their fear. The social and psychological pressure to do something they would never dream of doing in America – take heroin – was intense: one in five slid all the way into addiction. But, once home again, they weren’t scared any more. They weren’t mixing with other users. The drug was expensive, hard to find, low-grade and highly illegal. The pressure went into reverse. In other words, the same combination of social and psychological factors that turned these men into addicts explains why they were able to stop.
True, these were remarkable circumstances. So we might expect other addicts, whose initiation into drug use was less dramatic and more gradual, to recover at a slower rate. And that’s precisely what those four big epidemiological studies show: they paint a picture of users slowly changing their behaviour when their circumstances changed. They don’t support the progressive disease model. The Vietnam statistics, meanwhile, directly undermine it. The US government went to a lot of trouble to make sure that the soldiers it was testing were addicts. Are we supposed to believe that the 88 per cent who later kicked the habit were misdiagnosed? Or that being drafted to fight in heroin-saturated Vietnam ‘doesn’t count’ because it was such an unusual situation?
The Vietnam survey identifies a key factor in addiction: availability. To quote Michael Gossop: ‘Availability is such an obvious determinant of drug taking that it is often overlooked. In its simplest form the availability hypothesis states that the greater the availability of a drug in a society, the more people are likely to use it and the more they are likely to run into problems with it [my italics].’17
This hypothesis might seem like a statement of the obvious. Actually, as Gossop says, the question of availability is often treated as a secondary factor, less important than any predisposition to a so-called ‘disease’.
Gossop identifies different dimensions of availability. There’s physical availability, obviously, but also psychological availability (whether someone’s personality, background and beliefs increases their interest in using particular drugs), economic availability (whether the drugs are affordable) and social availability (whether the social context encourages use of the drugs). In the case of Vietnam, he points out, many soldiers found that all the boxes were ticked. Troops in Thailand, by contrast, could easily get hold of heroin – but their lives were not in danger, they were free to move among a friendly population and their peers were not using it. Less than one per cent of military personnel took the drug.18
Availability doesn’t offer a comprehensive explanation for addiction, but it reminds us that we cannot hope to understand why people engage in addictive activities – be it shooting up heroin in the jungle or gorging on muffins in Starbucks – unless we take account of what that activity means in its social setting.
No one who has watched The Wire, the magnificent television epic of life in drug-saturated districts of Baltimore, can seriously propose that it depicts a black population afflicted by chronic disease. The characters in the show who smoke heroin do so, basically, because they live in districts where everyone does. If I lived there, I’d be a smack addict. Since I’m an addict, perhaps that goes without saying. But I have a sneaking feeling that even my local vicar would be hooked on the stuff.
Gossop, who has advised the British government on drug policy, is unusual among addiction experts for the bluntness with which he dismisses the disease theory. He describes addiction as a ‘habit’. That may sound less scary than an irreversible disease, but it isn’t. In a society overflowing with abundance, the implications of a habit of addiction driven by availability are every bit as alarming as those of a disease that strikes only individuals with malfunctioning brains.
This isn’t to deny that some people are naturally more vulnerable to addiction than others. And we can’t ignore recent discoveries in neuroscience, which show how the brain’s natural reward systems are being hijacked by newly available substances and gadgets. In the next chapter, we’ll look at what the brain does and doesn’t tell us about addiction.
But I want to end this chapter by stressing, yet again, the inadequacies of the disease model. If the word ‘disease’ is at all useful in this context, it’s as a metaphor for addiction, not as a diagnosis. And I can think of another vivid metaphor that works just as well. Modern consumers are like soldiers drafted to Vietnam – disorientated, fearful and relentlessly tempted by fixes that promise to make reality more bearable. You don’t have to be ill to give in; just human.
WHAT THE BRAIN TELLS US (AND WHAT IT DOESN’T)
Imagine the embarrassment. You are a retired civil servant with Parkinson’s disease. You are industrious and introverted, like many sufferers from the condition. (We don’t know for sure why it often strikes people with this type of personality, but the correlation was noted as long ago as the 19th century.1) You’re a regular at your local pub, where you’re known as a modest, affable chap who orders half-pints rather than pints. Occasionally you while away 20 minutes by pushing a few coins into the slot machine, accepting your losses with a philosophical shrug.
Then something odd happens. Without warning, you develop an obsession with playing the machine. You stand in front of it from opening time until last orders, much to the bemusement of the other regulars. You know that the pub’s fruit machine is programmed to return only 80 per cent of the money you put into it, but one day you hit multiple jackpots that earn you £50. The thrill of this experience – and