As we saw, many heroin abusers take their drug of choice on less than a daily basis and are not literally physically dependent on it. However, most street opiate abusers would become addicted if given the opportunity. They simply cannot sustain the daily grind of raising the cash, locating the seller, dealing with the consequences, or running the risk of arrest that severaltimes-a-day use would entail.

At the same time, a high proportion of opiate users take their drug or drugs on a controlled basis. Until recently, it was not realized that controlled opiate use is possible; again, one was considered either an addict or an abstainer.

However, it is entirely possible that the occasional yet regular controlled user of narcotic drugs is more common than the addict. The term that is used in the world of narcotic drug use to describe this limited use is "chippying." "Chippying" means to fool around or play around with heroin, to use it once in a while or somewhat more often without getting hooked.

How common is opiate "chippying"?.

We all recognize that the controlled use of alcohol is not only possible;— it is in fact the majority pattern. Most drinkers are moderate in their consumption and do not become alcoholics. Yes, one might object, but narcotics are, well, addicting; they produce a physical dependence. Fair enough, but so does alcohol.

As we saw in Chapter 5, during much of the history of the United States, alcohol was consumed at levels far greater than it is now, and in terms of quantity consumed, there were proportionally many more alcoholics than there are today. The simple fact is, patterns and styles of drug use are not a simple function of the properties of the drugs themselves.

To think that they are is to fall victim to what I called the chemicalistic fallacy, discussed in Chapter 1, or what Himmelstein calls "the fetishism of drugs" (1979). It is people who take drugs, not drugs that control people; what they take, how they take them, how often, and under what circumstances, are under the control of the actor, the individual deciding to take (or not to take) a given drug or set of drugs.

All drug use is surrounded by values and rules of conduct; these values and rules spell out sanctions—penalties for misuse and rewards for proper use—and these values, rules, and sanctions have an impact on how drugs are actually used..

These rules (sociologists call them norms) may be widely accepted and operate on the society-wide level, as with alcohol, or they may be characteristic only of small groups or subcultures, whose attitudes and values differ from those of society at large. But when the important people in one's life believe in a rule and act on it, one's own behavior will be influenced by that fact.

Of course, some will follow their society's or subculture's rules on drug use and some will not. Norms set limits or establish guidelines that form the framework within which use takes place; they influence people's behavior. but they do not dictate it..

Values, rules, and sanctions promoting controlled or moderate use "function in four basic and overlapping ways." First of all, they "define moderate use and condemn complusive use." For instance, controlled opiate users "have sanctions limiting frequency of use to levels far below that required for addiction." Second, such sanctions "limit use to physical and social settings that are conducive to a positive or 'safe' drug experience." Third, sanctions "identify potentially untoward drug effects." Precautions must be taken before and during use; for instance, opiate users may "minimize the risk of overdose by using only a portion of the drug and waiting to gauge its effect before using more." And fourth, sanctions and rituals "operate to compartmentalize drug use and support the users' non-drugrelated obligations and relationships." For instance, users may budget the amount of money they spend on drugs and limit use to evenings or weekends to avoid interfering with work and other obligations ..

Is it really possible to use heroin or the other opiates on a moderate or controlled basis? One study (Zinberg, 1984) located a number of controlled opiate users and examined their patterns of use—what made them distinctive, how they accomplished this seemingly impossible feat. They had been using opiate drugs for an average of more than seven years; for four and a half years, they had been using them on a controlled basis. (Some controlled users had used opiates compulsively, and some on a marginal basis, for part of the time they had been using opiates overall.) For the year preceding the study, about a quarter (23 percent) used opiates sporadically, or less than once a month; a third (36 percent) used one to three times a month; and four in ten (41 percent) used twice a week.

None used daily or more. Their pattern of use, and the length of time that they sustained this pattern. showed "without question that controlled use can be stable" ..

Some observers have objected that opiate users who are not yet addicted have simply not reached the stage in their drug "careers" when use inevitably becomes uncontrolled or complusive (Robins, 1979). But in fact, the length of time of opiate use in this sample was not only substantial (more than seven years), but it was not significantly different from that of compulsive users in the sample.

Moreover, most compulsive users had never had a period of controlled use. And the length of time controlled users had been taking opiates on a moderate basis, four and a half, years, was ample time for them to have become compulsive users . Clearly, controlled use is a stable pattern for a significant proportion of narcotic users; moderate use does not necessarily or inevitably turn into compulsive use or addiction.

It is a phenomenon that must be understood in its own right..

This same study compared and contrasted the patterns of use that characterized controlled users with those of the compulsive users and found interesting differences. They did not differ in type of opiate used—say, sticking with some of the "soft" narcotics, such as Darvon or codeine, versus using heroin.

They did not differ in route of administration—snorting versus IV injection. They did not differ in personal acquaintance with other users who suffered extremely negative consequences as a result of opiate use—for instance, death from an overdose..

However, the controlled users did differ from the compulsive users in a number of crucial ways. In contrast to compulsive users, controlled users:

Rarely used more than once a day.

Often kept opiates on hand for a period of time without immediately using them.

Tended to avoid using opiates in the company of known addicts.

Tended not to use opiates to alleviate depression.

Rarely or never used opiates on a "binge" or a "spree" basis.

Usually knew their opiate source or dealer personally.

Usually used opiates for recreation or for relaxation.

Tended not to use opiates to "escape" from the difficulties of everyday life.

Home : Controlled opiate use