In keeping with our recent paying-gig focus on addiction science, we’d like to turn your attention toward the remarkable work of Lee N. Robins, who recently passed away. In the early 1970s, after hearing rumors that tens of thousands of Vietnam War veterans had come stumbling home as hopeless heroin addicts, Robins vowed to determine whether that was really the case. She found that although drug abuse had been alarmingly common on the battlefield, with a third of Army enlistees trying heroin and 20 percent suffering through the symptoms of addiction, everything changed once the soldiers came home. Remarkably, only a small percentage continued their drug use on the homefront, and those vets were a predictable lot—namely, men who had abused drugs prior to the war (see above).
After publishing her findings in 1973, Robins spent the rest of her career defending her contrarian conclusion regarding the real power of opiates. She always did so with unusually keen intelligence, as evidenced by this snippet from this 1993 lecture:
Beliefs about heroin based entirely on results in treated populations have created a self-fulfilling prophecy. Heroin is thought of, by law enforcement personnel and users alike, as the “worst” drug, virtually instantly and permanently addictive and creating craving so extreme that it overcomes all normal ability to resist temptations to theft and robber to acquire it. Users who share that view show by their use that they are ready to commit themselves to their concept of an addictive lifestyle. The public’s ranking of drugs with respect to “hardness’ probably has more to do with the drug’s legal status, the government’s commitment to discouraging its use, and its price than any intrinsic addictive liability. This is best demonstrated by tobacco, a highly addictive drug ranked as “soft.”
Robins was obviously trying to be provocative with that last statement, and she surely wouldn’t want heroin to be as easily accessible as cigarettes. But her point is valid, as far as treatment goes—could we more effectively wean users off heroin by treating them as no less “sick” than smokers who need the patch? Should the treatment of heroin addiction be normalized, so that those who’ve deigned to use the drug aren’t immediately shunted into a severe program that doesn’t address their underlying psychological issues?