Alfred R. Lindesmith

Alfred R. Lindesmith was an Indiana University professor of sociology. He was also among the early scholars providing a rigorous and thoughtful account of the nature of addiction. He lived from 1905 to 1991.

Lindesmith's interest in drugs began at the University of Chicago, where he was trained in social psychology, earning his doctorate in 1937. His education there was a mixture of the analytical and theoretical, a balance that would later appear in his drug studies. The work at Chicago involved research with interactionist theory, including the research of Chicago's Herbert Blumer, emphasizing the idea of self-concept in human interaction.

Theory of addiction

Lindesmith's work on drugs began with his questioning of the nature of addiction in a 1938 essay entitled "A sociological theory of drug addiction". This paper appeared in the "American Journal of Sociology" and involved in-depth interviews with 50 so-called addicts.

As this work progressed, it developed into a full theoretical and empirical account of the nature of opiate addiction, culminating in his book "Opiate Addictions" in 1947 (republished as "Addiction and Opiates" in 1968).

What Lindesmith developed was an account of opiate addiction that (1) distinguished between the physical reactions of narcotic withdrawal and its psychological (phenomenological) experience, and (2) described the relationship between these two phenomena and addiction. Addressing the question of why regular users of opiates do not necessary become dependent or addicted, he found that, while continuous opiate use does cause many to experience physical withdrawal, the impact of withdrawal on the likelihood of dependence and addiction is not certain. Lindesmith's "addicts" revealed this, in part, as did general reports from individuals who, despite regular use of opiates, failed to become habitual users, stressing "the advantage of attributing the origin of addiction, not to a single event, but to a series of events, thus implying that addiction is established in a learning process extending over a period of time."

This learning process has two parts. First, opiate users must connect their drug withdrawal to their use of the drug, which something that individuals exposed to opiates in hospital settings are more likely to do. When withdrawal is interpreted as a form of addiction, the perceived (and felt) need for more drugs grows. More recent research has shown that, because hospital patients often associate opiate analgesia with an illness and/or hospital care, and because the drugs cause sedation and other mind-altering effects, patients rarely experience any withdrawal.

Here is the second part of the equation: if and when an opiate user identifies opiate withdrawal as such, he or she must initiate a ritual activity that is a physiological, cognitive, and behavioral mixture. As Richard DeGrandpre writes in "The Cult of Pharmacology" [R. DeGrandpre, The Cult of Pharmacology: How America Became the World's Most Troubled Drug Culture. Durham: Duke University Press (2006).] , "the opiate user must first experience withdrawal (a physical phenomenon), he or she must develop a concern over the withdrawal experience as such (a cognitive phenomenon), and then he or she must engage in drug use, taking opiates repeatedly to eliminate or avoid opiate withdrawal (a behavioral phenomenon). A breakdown in any part of this bio-psycho-social circuit can keep a pattern of dependent opiate use from emerging."

In Robert Scharse's study of Mexican-American users, for example, some interpreted withdrawal as a sign of emerging drug dependence, and subsequently reduced or quit their drug use. For others, the withdrawal experience caused an obsession over the prospect of withdrawal, encouraging them to repeatedly use in order to avoid it. This then completed a circuit, with Lindesmith's learning process being reinforced and strengthened.

As his career ended, Lindesmith held on to his belief that opiate addiction is not the simple product of one's exposure to opiates. Rather it is the result of a dramatic shift in a person's mental and motivational state. Once the individual concludes that he or she is hooked, it rarely occurs to them that they are engaging in a self-fulfilling prophecy, trapped within a belief that makes the experience exactly what it is feared to be.

War on drugs

The fact that Lindesmith's work threatened the emerging demonization of heroin, etc., is clear from how the Federal Bureau of Narcotics (FBN)—predecessor of the DEA—worked to discredit him. This is outlined in a paper by Galliher, Keys, and Elsner, "Lindesmith v. Anslinger: An Early Government Victory in the Failed War on Drugs". [John F. Galliher, David P. Keys, Michael Elsner, Lindesmith v. Anslinger: An Early Government Victory in the Failed War on Drugs. The Journal of Criminal Law and Criminology, Vol. 88, No. 2 (Winter, 1998), pp. 661-682] As early as 1939, FBN director Harry Anslinger had the Chicago District Supervisor of the Bureau notify Indiana University that one of their professors was a drug addict. An internal FBN memo also suggests that, some years later, a wiretap may have been placed on Lindesmith's phone by the Bureau. Incidentally, there is no evidence that Lindesmith ever used illegal drugs. As Galliher et al. point out, "the targeting of Lindesmith was possible because Lindesmith acted virtually alone in standing up against federal drug control policies."

In his book "The Addict and the Law" [A.R. Lindesmith, The Addict and the Law. Bloomington: Indiana University Press (1965).] , he presents a detailed account of U.S. laws, regulations, police practices and court procedures, often in painful detail. He was describing what we now know as the beginning of the "war on drugs", although that term was not coined until 1971. It was published just 3 years after Anslinger retired. In his book, Lindesmith expressed hope that the relatively liberal drug policies of the Kennedy and Johnson Administrations would continue, but that was not to be.

Criticism

Professor Nils Bejerot, the founder of the Swedish anti drug strategy, argued that professor Lindesmiths books had contributed to the drug problems in the US. by making wrong conclusions from a comparison between England and the US., for ex. what caused the low abuse of opium in the late 1940s in England. [http://www.nilsbejerot.se/om.htm Nils Bejerot: Narkotika och Narkomani, 1975] ] . Lindesmith preferred the British System. Bejerot claimed that Lindesmith wrote his earlier books from close personal interviews with a very limited number of addicts, about 50, almost all of them victims of "therapeutic use" of drugs when they were in health care for other reasons. Bejerot argued that this small group was a very lower and different risk than the more frequent addicts introduced in the habits by close personal contacts with other users of the drug. The "therapeutic addicts" could be treated as a personal health problem. The other type of users, the "epidemic users", was also a risk for other citizens by introducing new users, particularly in the beginning of their drug career when the downside of the drug use was not so visible. Bejerot argued that Lindesmiths suggestions was adopted to the first group, the "therapeutic addicts".

Lindesmith had noticed that England in the 1940s had very liberal narcotics laws (Rollestone Act from 1926) and draws the conclusion that this contributed to a low abuse of opium. Bejerot draw the opposite conclusion, the low abuse of opium in England in the late 1940s was the cause for the liberal opium laws in England; the low abuse of opium in England had other causes. An experiment in the late 1940s in England with free opium distributed by doctors to opium addicts had ended with a multiplied number of opium addicts. When the number of addicts of heroin in England doubled every sixteenth month 1959-1968 the British government was forced to implement a more restrictive law. [ [http://www.drugtext.org/library/articles/92333.html Rachel Lart BRITISH MEDICAL PERCEPTION FROM ROLLESTON TO BRAIN, CHANGING IMAGES OF THE ADDICT AND ADDICTION] ] [ [http://www.nilsbejerot.se/atgarder.pdf Nils Bejerot & Jonas Hartelius Missbruk och motåtgärder, 1984] ]

Bejerot argued that a policy with liberal drug laws, like neglecting smaller amounts of illegal drugs for personal use, will open the doors for a much larger "epidemic" [ [http://www.rns.se/swedish-addiction.asp Nils Bejerot: The Swedish addiction epidemic in Global perspective, 1988] ] outbreak of recreational drugs to a level not acceptable for the government. Then the society will rebound with much more restrictive laws (compare with the War on drugs). “A country can afford liberal narcotics laws as long as it has no widespread "epidemic" use of narcotics”.

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