Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy by Theodore Dalrymple (New York: Encounter Books, 2006); 146 pages; $21.95.
This is a hugely important book. If it gets sufficient attention, it could be a major landmark in the ongoing campaign to introduce truth into the honesty-challenged issue of recreational drugs. Although written very much from a conservative point of view, the content of the book is important to libertarians for the way it shakes two key foundations of conservative and socialist support for drug prohibition.
The first of these is the idea that drug addiction is a threat to ordinary people a force so powerful that mere experimental or occasional exposure would turn even healthy and well-balanced people into helpless victims of a raging compulsion that is beyond their power to resist.
The second is the generally misplaced trust conservatives (especially) tend to have in the medical and drug-treatment establishments pronouncements on the subject.
The book deals with these issues in the particular context of heroin and other opiates, but the principles probably have wider application to most recreational drugs.
If you are generally conservative in outlook, you must read this book, because it is written with unimpeachable authority by one of your own, and because you will learn some important facts about the reality of heroin use, as opposed to the myths. If you are of a generally libertarian outlook, you should read this book for the same reason. Although you may be less inclined to accept the authority of the author, and will undoubtedly find many of his strongly conservative assumptions and assertions irritating, you will find it especially useful as ammunition in debates with conservatives.
Theodore Dalrymple is a pen name used by a British medical doctor (a psychiatrist). In the book under review, he states,
During the past fourteen years, I have worked as a doctor in a large general hospital in a British slum, and in the even larger prison next door.
His long experience of working in and around medical and corrective institutions has clearly given him a profound insight both into the British underclass and its mentality and also into the consequences of drug abuse. This experience, however, should be kept in mind, when assessing his conclusions, as I shall discuss in due course.
Addiction or choice?
Dalrymples case is that there is an almost universally held, conventional view about heroin addiction that is wrong in almost every particular but nevertheless is maintained in the face of countervailing evidence for various self-serving reasons.
His heretical position is as follows: It is not actually particularly easy to become an addict by using heroin it takes some effort over a period of time. Being an addict is not primarily a medical issue, but rather a spiritual or psychological one, because withdrawal is actually not a particularly hard, drawn-out, or hazardous, process. (It is equivalent in terms of physical discomfort to a mild case of flu, at most, and holds no physical dangers.)
Those who want to stop taking heroin simply do so (and many do), and if they continue to want not to take heroin they have no difficulty in abstaining from its use. Those who relapse are simply the ones who seek its recreational (or escapist) benefits. The received opinion that heroin withdrawal is a nightmarish process, impossible for most without assistance, is simply a lie, perpetrated by addicts themselves, who seek justification for their own lack of willpower and dramatization of their condition, or to inveigle people in authority into supplying them with the drugs they want.
The lie is willfully maintained by those whose employment and status depend on the fiction that addiction is a medical condition and by those who dont wish to appear unempathetic to people society designates as victims. The false view of heroin addiction rests on a long and highly influential Western literary tradition, stretching from Thomas De Quincey and Samuel Taylor Coleridge down to Irvine Welsh and Melvin Burgess today. In addition to the false view of addiction, this tradition carries the equally false and equally self-serving romantic nonsense that drug use leads to artistic inspiration or insight. Heroin addiction does not cause crime. Rather, the kind of people who are addicts (at any rate, the ones Dalrymple has encountered) are predisposed to criminality anyway.
In this short book, Dalrymple effectively deploys the authority of his personal experience together with analysis of the literature and some medical references, to make his case for the above. In doing so, he manages to place responsibility for the consequences of heroin use squarely where it properly belongs on the shoulders of the user himself without losing his underlying human sympathy for the person concerned. Referring to an addict who hospitalized himself after overdosing following his release from prison, despite having been warned by Dalrymple that his tolerance would be reduced, Dalrymple writes, All of us know what it is like to give in to temptation, and to that extent the man was deserving of our compassion. He also quotes one Dr. Chambard approvingly, suggesting that he sympathizes with the predicament of people who poison their intelligence, without thereby absolving them from their responsibility for doing so, and without accepting uncritically their views of themselves.
I suspect that Dalrymple probably somewhat understates the unpleasantness of withdrawal from heroin addiction because of his concentration on the limited physical effects and his general lack of concern for the psychological effects. The comments of addicts themselves suggest that it is likely there is a very large depressive element to the unpleasantness of the experience. This does not, of course, particularly detract from Dalrymples main point. For the vast majority of people possessed of a minimum of willpower and a real reason to quit withdrawal would not be an insurmountable problem, as Dalrymple soundly demonstrates.
On occasion, Dalrymple can be oversimplistic in his treatment of an example that suits his case and perhaps his underlying philosophy. He raises the much-cited example of Maos treatment of the problem of opiate addiction by shooting drug addicts and dealers and suggests that within three years from 1949 Mao produced more cures than all the drug clinics in the world before or since. One wonders whether Dalrymple is in the habit of treating communist claims of superlative production achievements in other areas with such credulity. However, given that heroin addiction is largely a moral and spiritual matter, it should not be a surprise to anyone that it would decline dramatically following the reestablishment of civil authority after a long period of catastrophic war, foreign occupation, and civil war.
Dalrymples book also highlights a classic example of what every libertarian and paleoconservative knows is the inevitable consequence of state involvement in social problems the self-justifying, ever-expanding but generally utterly ineffective bureaucracy. The mechanisms of self-deception and mass delusion by which this is maintained in the case of drug treatment would certainly bear generalizing to other areas of government, and perhaps a few readers of Dalrymples book will be inspired to do just that.
Drawbacks of the book
There is one obvious weakness in an argument resting so strongly (though by no means exclusively) on the authors personal experience. That is the possibility that his perception has been skewed by the self-selecting nature of the sample he has observed. In this case, it is obvious that Dalrymples experience of heroin addicts has been heavily biased towards the underclass (concerning which, see Dalrymples excellent book Life at the Bottom) and those who have failed to successfully manage their use of heroin. By definition, those in prison will be largely of the underclass. Similarly by definition, those who end up in a hospital will be largely those who have overdosed on heroin or suffered other medical complications resulting, mainly, from failure to take adequate precautions.
There is no apparent reason why this should be fatal to the main thrust of Dalrymples case. While members of the underclass may well be much less reluctant to lie than the broader population, there is no reason to suppose nonunderclass addicts might suffer genuinely agonizing withdrawal symptoms when under-class addicts do not. It is, however, likely to color his broader conclusions, and I suspect it does. Dalrymple almost completely ignores the existence of a huge class of people who use heroin in a controlled manner for recreation while maintaining apparently normal lives, perhaps because he has presumably never, or very rarely, encountered them in prison or in the hospital. Because heroin use and possession are illegal, the people concerned will obviously not have engaged him in dinner party discussion on the subject.
For this reason, I would recommend that readers of this book also read carefully another indispensable book on heroin: Heroin Century by Tom Carnwath and Ian Smith (Routledge, 2002). If, in the light of Dalrymples observations, the authors, who are just as qualified by experience to talk about heroin use and effects as Dalrymple, are maybe a little too ready to sympathize with claims of the agonies of withdrawal or the inspirational possibilities of heroin use, they are certainly not taken in completely.
Sad to say, Dalrymples concluding section concerning the wider implications of his argument is disappointingly superficial. It is perhaps unsurprising that he comes down against the (in my opinion) incontestably correct solution of relegalization of drugs, but it is a pity that his arguments for doing so are so unconsidered.
On the immediate policy consequences of his views, he is admirably direct and forceful:
As a first step … I would suggest the closure of all clinics claiming to treat drug addicts, the modern bureaucratic institutionalisation of Romantic ideas…. Henceforth, instead, doctors should treat addicts only for the serious physical complications of drug addiction: abscesses, viral infections and the like.
It is when he comes to the inevitable issue of whether to maintain prohibition or relegalize these drugs that he falls, in my view.
All Dalrymples arguments in favor of continued prohibition of heroin are unsophisticated and easily rebutted. But this is not a book written about prohibition versus relegalization. The benefit of Dalrymples continued advocacy of prohibition is that his credibility with the authoritarians will be undiminished, and the weak conclusion of this book does not significantly undermine the power and significance of the basic case that he makes.
Dalrymple is a highly accomplished writer, who can get his point across very effectively. I find his witty, competent, and blunt prose very readable. He has the knack for producing pithy phrases and sentences that uncompromisingly encapsulate his position in ways that will certainly delight those who share his outlook, although inevitably sometimes this can stray towards the crassness of the American conservative shock jock style.
The evident decision not to use notes means that, where the writer occasionally quotes from published texts, he is forced to include the full reference in parentheses within the text, and this can somewhat break the flow. In one section, he quotes from no fewer than nine such texts over the course of four pages. This also means that there are occasions when he quotes from studies without proper attribution, which means the reader has no way of checking whether his interpretation of the results is correct.
Unfortunately, this particular edition appears to have been poorly proofed, with an uncomfortably large number of minor typographical errors, particularly later in the text.
These are minor irritants in what is otherwise a smooth read.
Buy Romancing Opiates, read it, and use Dalrymples authority and arguments in discussions on this hugely important issue.
January 13, 2007
Randal Cousins lives in Yorkshire, England, and is the father of four children. His educational background is in mathematics, but he devotes his intellectual energies largely to trying to reconcile conservative instincts with libertarian reason.