The “Lee Robins Study” and Its Legacy, Part One

It has been forty years since Dr. Lee Robins, a Washington University sociologist and pioneer of psychiatric epidemiology, conducted her now-famous study of opiate use among U.S. servicemen returning from Vietnam.  Forty years ago exactly–January, 1972–Robins was already working on the project, having been recruited by Dr. Jerome Jaffe (head of the White House’s Special Action Office on Drug Abuse Prevention [SAODAP]) the previous year.  The actual collection of interviews with study participants was still some months away; study staff conducted the interviews between May and September 1972, after some delays over project funding.

Photograph of Dr. Lee Robins
Dr. Lee Robins, 1922-2009

They asked a lot of questions–Robins’ tendency as a researcher was to pack as much as she could into survey instruments, and the original 1972 and 1974 surveys were very long.  In the end, however, the main initial thrust of Robins’ study was toward two central research questions.  First, what was the prevalence of opiate use and opiate addiction among servicemen in Vietnam and, second, how many users/addicts continued their use and/or addiction once they returned to the United States?

Remarkably, given the scope of the project, Robins and her colleagues managed to get the final study results into print in 1973, in a SAODAP monograph.  These results suggested, to most observers, that the answer to the Vietnam prevalence question was “quite high, indeed” while the answer to the post-Vietnam prevalence question was “shockingly low, considering levels of wartime use.”  It isn’t surprising that the first public presentation of Robins’ research findings generated an immediate and intense reaction, given the charged politics of Vietnam, veterans’ affairs, and the Nixon White House.  Perhaps the strongest response came from within the addiction research field, where older medical paradigms stressing the intractable nature of opiate addiction were rapidly coming under fire from newer generations of researchers.  The locus of addiction research itself was shifting, as an older research network, dominated by the Addiction Research Center at the Lexington Narcotics Hospital, was giving way to a newer, more heterogeneous (for the moment) and de-centralized (for the moment) research field.  As Robins recalled, no group was more resistant to her findings than the established “research community,” which “resisted giving up the beliefs that heroin was a uniquely dangerous drug, to which a user became addicted very quickly, and [sic] addiction to which was virtually incurable.”

Objects of Interest, Then and Now

So the 1973-era response is not surprising.  What is, perhaps, more striking is the extent to which the Robins study remains widely cited and capable of rousing interest.  Robins herself took an early measure of this legacy in “Vietnam Veterans’ Rapid Recovery From Heroin Addiction: A Fluke or Normal Expectation?” Addiction (1993) 88: 1041-1054.  Robins’ study frames the entire chapter on Vietnam in Griffith Edwards’ Matters of Substance–and Why Everyone’s a User (Macmillan 2006).  Edwards, by the way, calls the Robins study “research driven by national anxiety” (p. 125), and her research takes a prominent role in various recent projects that focus on that anxious moment.  These include Michael Massing’s The Fix (Simon & Schuster 1998), and particularly Jeremy Kuzmarov’s The Myth of the Addicted Army: Vietnam and the Modern War on Drugs (University of Massachusetts Press 2009).  It remains a touchstone for critics of the addiction paradigm, from Norman Zinberg’s classic Drug, Set & Setting: The Basis for Controlled Intoxicant Use (Yale 1986), to more recent works such as Richard J. DeGrandpre’s The Cult of Pharmacology (Duke 2006; pp. 116-117) and Gene Heyman’s Addiction: A Disorder of Choice (Harvard 2009; pp. 74-80).

As we reflect on the forty-year legacy of the Robins-Vietnam study, it seems worthwhile to get some additional perspectives.  Our first in what we hope will be a continuing discussion comes from Dessa Bergen-Cico, assistant professor in the Department of Public Health Food Studies and Nutrition, Syracuse University. Dr. Bergen-Cico is the lead faculty of the Addiction Studies Program at Syracuse University and the author of “War and Drugs: The Role of Military Conflict in the Development of Substance Abuse” from Paradigm Publishers.  Part One of her reflections starts here:

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