What Vietnam Taught Us

A Marine at Vietnam Memorial on 4th July 2002

A Marine at Vietnam Memorial on 4th July 2002 (Photo credit: Wikipedia)

I’ve noticed an uptick in book, news and blog references to heroin addiction among returning Vietnam vets. (A Google news search suggests that this perception is accurate. I suspect it’s because it offers a narrative that’s consistent with the current monoculture.) It’s claimed that this offers important lessons about addiction and behavior change.

In May of 1971 two congressmen, Robert Steele from Connecticut and Morgan Murphy of Illinois, went to Vietnam for an official visit and returned with some extremely disturbing news: 15 percent of U.S. servicemen in Vietnam, they said, were actively addicted to heroin.

Soon a comprehensive system was set up so that every enlisted man was tested for heroin addiction before he was allowed to return home. And in this population, Robinsdid find high rates of addiction: Around 20 percent of the soldiers self-identified as addicts.

Those who were addicted were kept in Vietnam until they dried out. When these soldiers finally did return to their lives back in the U.S., Robins tracked them, collecting data at regular intervals. And this is where the story takes a curious turn: According to her research, the number of soldiers who continued their heroin addiction once they returned to the U.S. was shockingly low.

“I believe the number of people who actually relapsed to heroin use in the first year was about 5 percent,” Jaffe said recently from his suburban Maryland home. In other words, 95 percent of the people who were addicted in Vietnam did not become re-addicted when they returned to the United States.

This flew in the face of everything everyone knew both about heroin and drug addiction generally. When addicts were treated in the U.S. and returned to their homes, relapse rates hovered around 90 percent. It didn’t make sense.

Studies of this cohort do offer some important lessons, in particular, that exposure to opiates does not create addicts on a large scale. But the lesson is not this:

It’s important not to overstate this, because a variety of factors are probably at play. But one big theory about why the rates of heroin relapse were so low on return to the U.S. has to do with the fact that the soldiers, after being treated for their physical addiction in Vietnam, returned to a place radically different from the environment where their addiction took hold of them.

These stories often ignore the fact that:

there was that other cohort, that 5 to 12 per cent of the servicemen in the study, for whom it did not go that way at all. This group of former users could not seem to shake it, except with great difficulty.

Hmmmm. That range….5 to 12 percent…why, that’s similar to estimates of the portion of the population that experiences addiction to alcohol or other drugs.

To me, the other important lesson is that opiate dependence and opiate addiction are not the same thing. Hospitals and doctors treating patients for pain recreate this experiment on a daily basis. They prescribe opiates to patients, often producing opiate dependence. However, all but a small minority will never develop drug seeking behavior once their pain is resolved and they are detoxed.

My problem with all the references to these vets and addiction, is that I suspect most of them were dependent and not addicted.

So…it certainly has something to offer us about how addictions develops (Or, more specifically, how it does not develop.), but not how it’s resolved.

Why is it so frequently cited and presented without any attempt to distinguish between dependence and addiction? Probably because it fits the preferred narrative of the writer.

It’s worth noting that this can cut in both directions. There’s a tendency to respond to problem users (people who drink too much, but are not alcoholics.) and dependent non-addicts (most pain patients or these returning vets) as though they are addicts. This results in bad treatment for those people, bad research and it manufactures resentment toward treatment, mutual aid groups and recovery advocates.

7 Comments

Filed under Policy, Research, Treatment

7 responses to “What Vietnam Taught Us

  1. Excellent post, Jason. In my experience dependence and addiction are often mixed up in our culture and I agree it can prevent people from getting the appropriate treatment. I attribute this partially to ignorance of the disease model.

    • Thanks for the comment. This might cloud discussion of drug and alcohol problems more than anything else. Worse, it’s not just among lay people. I often look at journal articles and find them to be meaningless because the author conflates abuse, dependence and addiction.

  2. It’s always frustrating when writers draw exactly the wrong conclusions from the Robins work on Vietnam vets.

  3. “So…it certainly has something to offer us about how addictions develops (Or, more specifically, how it does not develop.), but not how it’s resolved.”

    Precisely. Nice article, Jason.

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  5. Thom Reistad

    This is a very interesting perspective. I experienced a realatively easty transition out of heroin use upon returning home from Vietnam Nam. No heroin use in the US, used every day in VN. Stars and Strips did some interesting interviews with people “in country” using heroin. I recall numerous comments from vets at the time explaining the drug use as temporary during the war with no intentions of using afterwards which was my case. This supports the dependency concept rather than addiction. I have considered overcoming heroin use, dependency or addiction, as a major achievement in my life. Heroin is a very powerful drug. Allows your world to come apart or blow apart around you with little to no anxiety over such matters.
    Crazy way to have lived for a year. God bless the 53,000+ who did not.