Sunday, 10 August 2008

The Vietnam War Experience

Most people assume that the effects of psychoactive drugs are fixed and predictable, being dependent on their physiological actions in the brain. In fact, the psychological effects of a drug are also dependent on a variety of characteristics of the individual, as well as the influence of the social context in which the drug is taken. In the field, this is known as 'drug, set and setting'.

If we are to better understand the impact of drugs and alcohol on the lives of individuals, and help them find their path to recovery from addiction, then we need to appreciate the importance of 'drug, set and setting'. Sadly, this is not a widely appreciated fact in the field.
Many people assume that once you have tried heroin you become addicted to the drug. It is also commonly assumed that it is extremely difficult to give up using heroin. Whilst this may be the case for many people, it is not for many others. The most dramatic illustration of this point, and of the role of 'setting' in addiction and recovery, is provided by research conducted with US soldiers returning from the Vietnam War.   
Please read about this fascinating research study in the attached short document.


Dirk Hanson said...

Thanks for posting on the importance of the Robins study. The sad truth is, we've had good evidence for 35 years about the truth of heroin addiction--and the basic facts are still being disputed to this day.

Anonymous said...

An interesting piece of research, which if accurate, is highly revealing.

It is undeniable that heroin is probably the most addictive drug of all, but it does not necessarily follow that all users become addicted within the clinical criteria of DSM-1V, which refers to that condition as 'dependency'

Insofar as the the difficulties in quitting are concerned, that must surely, to no small degree, also depend on the severity of the addiction and the severity of individual withdrawel symptoms.

I would not necessarily accept the views of two politicians "that many servicemen had become addicted", without knowing their qualifications for reaching that diagnostic conclusion. together with how they reached that conclusion.

In the absence of any reference to the contrary in the study, it also appears that the presence of addiction was 'diagnosed' from the ancedotal evidence provided by the users, rather than any clincal assessment.

tim1leg said...

It is essential to look beyond the drug alone when considering both addiction and recovery from addiction. I would say then that we have to consider that alcohol and drug addiction are possibly the consequences of decades of free market policies that promote poverty, inequality, poor job opportunities, etc especially in working class communities. So the Robins study highlights treating the causes not the symptoms ie the causes in the study being access to the drug the stress of the war etc, the causes in Scotland today being treated nwould mean a huge programme of public works to meet the needs of us all in housing, recreation, health, arts, etc; god forbid even an £8 per hour min wage, decent student grants and higher pensions and disability benefits for those who cannot undertake paid employment. Sorry ranting now but not so easy to fix the causes when its not just a simple geographical/social change and i wonder how many of those men coming home from Vietnam commited suicide, went on to have alcohol problems or mental ill health... hmmmmm.

David Clark said...

The diagnosis was not made by the politicians- there information triggered the desire to set up a study, which was conducted by serious researchers. The diagnoses were made by people who were much more capable of determining whether people were dependent - as far as I remember, dependence was determined on whether individuals reported showing withdrawal symptoms. There is no reason to believe that the research team were any less able to make accurate assessments as are many practitioners today.
Experts in the field accept this as a high quality piece of research which rightly challenges commonly held assumptions. Of course, the system (including the US government) still challenges these findings because they do not fit what some people want others to believe.

Anonymous said...

The inverse of this of course is addicts "detoxed" in prison returning to their old haunts and relapsing (often ODing as a result).

If promoting recovery is a serious intention, I would suggest it's not going to work for many unless the person can be removed from his or her old lifestyle, easier said than done for most people.

A serious attack on poverty would be a start though, and may prove more effective than all the drug re-hab courses.

David Clark said...

Yes, moving people out of their old lifestyle. Trying to move them on from the culture of addiction - to the culture of recovery. These are real challenges, but first we must understand what needs to be done.
Yes, a serious attack on poverty is needed, but then there is the question as to whether politicians will take on this challenge.
My best,

Anonymous said...


Thank you for your comments and for putting the record straight.

I accept that my comments regarding the congress men was poorly worded. I acknowledge that I was wrong to use the tem diagnostic and I apologise. I should have made it clear that I was seeking clarification on how they reached their conclusion

My views were not intended to be read as questioning the credentials of the researchers, simply to point out that no evidence, other than self reporting, was offered as to how their conclusion was reached. Whether or not that is relevant is a matter of opinion.

David Clark said...


Absolutely no need to apologise. These blogs are for commenting upon, challenging, questioning, etc. This research causes controversy all these years later.


Anonymous said...

I found it very interesting reading,identification,testing,an early intervention with the goal of reducing harm to the individual and significant others when returning home.Tim1leg mentioned in his comment dual-disorders and its of great relevance to looking beyond the drug,we need to as clincians I feel take a personal responsibilty to endebt ourselves with knowledge of pharmacokinetics (how drugs work and affect the brain)with brain images available we can now become more than rather than less than who we are,the internet and global socialisation is here now.Education on dual-disorders will refresh us all on the holistic approach to substance and mental disorders as it includes every aspect.Then we need to keep an eye on identification of drug trends and global shifts of substances and treat accordingly.Whats missing at the minute is a clear assessment tool for dual-diagnosis,I agree history informs practice with a clients personal history being of paramount importance so we can learn whats missing that can promote the gain of healthier living.I totally agree with Derek Williams on how minimising poverty will improve individuals quality of life the again if somones on their own the safety of a detox in a safe enviroment may make the desired change accur.Thanks for showing me a good example of how the enviroment and social change affect drug use.