The Democracy of Addicts, if not of Addiction

Recently I read a brief article by George E. Vaillant called “The Natural History of Narcotic Drug Addiction” in the 1970 volume of Seminars in Psychiatry. It was based on follow-up studies of patients admitted to the federal narcotic hospital in Lexington, Kentucky, between 1936 and 1952. I was curious about how or whether it anticipated Vaillant’s conclusions in his influential 1983 book, The Natural History of Alcoholism, which was based on longitudinal data about Harvard students, working-class men, and detox patients starting just before World War II. Before getting far, though, I was struck by the second paragraph:

A Nation of In-Patients

There seem to be many different kinds of narcotics addicts and in each decade patterns of addiction change. At first glance this makes delineation of the natural history impossible. There are adolescent and middle-aged addicts; there are “criminal” and “medical” addicts; there are heroin and Demerol addicts; there are white Anglo-Saxon Protestant addicts from small towns and black immigrant addicts from urban ghettos; there are male addicts and female addicts; there are high school dropout addicts with inadequate personalities and an allergy to employment and physician addicts who self-prescribe and remain employed throughout their addiction. However, one of the conclusions of this review will be that both the addiction pattern and underlying personalities of these disparate groups are more similar than dissimilar.

Vaillant’s reference to an “underlying personality” among opiate addicts jumps out, because it is a phenomenon he concludes is absent among alcoholics in his later book. But leaving that observation aside, what captured my attention was the rhetorical shape of the long third sentence. It reminded me of a passage written a generation earlier, by Richard R. Peabody in his 1931 book The Common Sense of Drinking:

It takes all types

When we investigate any particular group, we find the most strikingly contrasted persons succumbing to excessive drinking. The rich and the poor, the highly intellectual and the ignorant, the frail and the robust, the shy and the apparently bold, the worried and the seemingly carefree, all furnish their quota of inebriates. We find that this unhappy group includes people of accomplishment as well as those who achieve nothing, the religious and the unbeliever, those with an interest in life and those without one, those who love and are loved, and those who are alone in the world.

Both of these prominent figures in the history of addiction studies drew a series of opposites to illustrate the breadth of social locations that users and boozers hail from. These soup-to-nuts sketches of the social order have been a consistent feature of addiction and recovery discourse over the years. For me, they are signs of the way that the addiction concept has remained bound at a deep level with efforts to define and reform social relations. They are moments when the effort to describe addiction invokes not just a society but a demos, the populace of a democracy.

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