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opioid-abstinence syndrome, and probably the two phenomena are mediated, in part, by the same central nervous system pathways. Hence, the occurrence of anxiety for whatever reason long after detoxification may result in relapse.

ROLE THEORY (p. 225)

The reasons for relapse, in terms of this theory, would reflect the person's inability to sustain the role of the nonuser. Each period of abstinence may represent a trying out of the nonuser's role, for varying periods of time. lt is likely that the most common pattern of cessation of drug dependence involves experimentation with the nonuser's role until it is consonant with other aspects of the person's life.

An earlier formulation of the theory argued that drug-dependent persons "matured out" when there was a lessening of the role pressures which had led to the beginning of regular drug use (Winick 1962a). The process of "maturing out" was slow and typically involved a stopstart pattern of drug use until the person felt comfortable with the role of the nonuser.

ln the original study which led to the formulation of the "maturing out" theory, based on a national sample, the mean age of "maturing out" was 35 (Winick 1962a). The narrow clustering of age at "maturing out" in different samples at different times suggests that there are underlying regularities in the process. Ethnicity, sex, residence, access to and salience of drugs, attitudes toward drugs in an area, and the extent to which nondrug-related roles are plausible and reinforced, contribute to cessation of drug use, as does the extent to which the user experiences less role strain and/or deprivation.


Since the underlying conflicts usually are not resolved, and the propensity to affect regression and ensuing defense by denial remains, any new, usually inevitably recurring disturbance of the narcissistic equilibrium gets the specific circular process of drug use once more into motion. Quite often one can find a displacement from the drugwithdrawal-related discomfort onto all distress. The process is this: When l was anxious (etc.), drugs relieved the otherwise unmanageable feelings. When the drugs ceased their effectiveness (e.g., in acute withdrawal), all the suppressed feelings came back, usually with increased vehemence, and coupled with all the added unpleasantness of withdrawal. Now, whenever l feel intense affective distress l also feel the typical withdrawal symptoms. Such microconversion symptoms based on displacement (from anxiety, shame, etc., onto physical symptoms once accompanying their resurgence) in form of chills, diarrhea, the "yen," etc., weeks or years after detoxification from physical addiction, can be observed in many compulsive drug users. The drug

is seen as a specific relief for both: affective distress and the conversion symptoms in the form of pseudowithdrawal.


Abelson, H.; Cohen, R.; and Schrayer, D. A nationwide study of beliefs, information and experience. ln: National Commission on Marihuana and Drug Abuse. Marihuana: A Signal of Misunderstanding . Appendix, Vol. ll. Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office, 1972.

Abelson, H.; Cohen, R.; Schrayer, D.; and Rappeport, M. Drug

experience, attitudes and related behavior among adolescents and
adults. ln: National Commission on Marihuana and Drug Abuse.
Drug Use in America: Problem in Perspective. Appendix, Vol. l.
Washington, U.L.: Superintendent ot Documents, U.S. Government
Printing Office, 1973.

Abelson, H., and Atkinson, R. Public Experience with Psychoactive
Substances: A Nationwide Study Among Adults and Youth.
Princeton, N.J.: Response Analysis Corporation, 1975.

Abelson, H., and Fishburne, P.M. Nonmedical Use of Psychoactive
Substances. Princeton, N.J.: Response Analysis Corporation,

Abelson, H.l.; Fishburne, P.M.; and Cisin, l. National Survey on Drug Abuse: 1977. A Nationwide Study—Youth, Young Adults, and Older People. Vol. 1. Main Findings. Rockville, Md.: National lnstitute on Drug Abuse, 1977.

Aberle, D.F. The Peyote Religion Among the Navaho. Chicago, lll.: Aldine, 1966.

Abramson, L.Y.; Seligman, M.E.P.; and Teasdale, J.D. Learned

helplessness in humans: Critique and reformulation. Journal of
Abnormal Psychology, 87(1):49-74, 1978.

Ackerman, N.W. The Psychodynamics of Family Life: Diagnosis and

Treatment of Family Relationships. New York: Basic Books, 1958.

Ade, G. The Old Time Saloon: Not Wet—Not Dry, Just History.
Detroit: Gale Research Corporation, 1931.

Adler, A. Ueber den nervosen Charakter. Munich: Bergmann, 1912; 4th. ed., 1928.

Adler, A. /On the origin of the striving for superiority and of social

interest/(Ger). lnternationale Zeitschrift Fuer lndividualpsychologie, 1 1:257-263, 1933. Reprinted in Ansbacher, H.L., and Ansbacher7 R.R., eds. Superiority and Social lnterest: A Collection of Later Writings. Evanston, lll.: Northwestern University Press, 1964.

Agar, M. Ripping and Running: A Formal Ethnography of Urban Heroin
Addicts. New York: Seminar Press, 1973.

Ainsworth, M.D.S. Attachment and dependency: A comparison. ln:
Gewirtz, J.L., ed. Attachment and Dependency. Washington,
D.C.: Winston, 1972. pp. 97-138.

Akers, R.L. Deviant Behavior: A Social Learning Approach. Belmont,
Calif.: Wadsworth, 1977.

Akers, R.L.; Krohn, M.D.; Lanza-Kuduce, L.; and Radosevich, N.

Social learning and deviant behavior. American Sociological Review, 44(4):635-655, 1979.

Akil, H.; Mayer, D.J.; and Liebeskind, J.C. Antagonism of stimulationproduced analgesia by naloxone, a narcotic antagonist. Science, 191:961-962, 1976.

Alarcon, R. de. The spread of heroin abuse in a community. Bulletin on Narcotics, 21 (3): 17-22, 1969.

Alexander, B.K., and Dibb, G.S. Opiate addicts and their parents.
Family Process, 14:499-514, 1975.

Alexander, l., and Adlerstein, A. Death and religion. ln: Feifel,
H., ed. The Meaning of Death. New York: McGraw-Hill, 1959.

Alexander, P., and Barton, D.H.R. Biochemical Journal, 37:463,

Alksne, H.; Trussell, R.E.; Elinson, J.; and Patrick, P. A Follow-Up Study of Treated Adolescent Narcotics Users. New York: Columbia University School of Public Health and Administrative Medicine, 1955.

Allen, A.A. Auk, 51:180, 1934.

Allen, T.R., and West, L.J. Flight from violence: Hippies and the green rebellion. American Journal of Psychiatry, 124:364-370, 1968.

Allgulander, C. Dependence on sedative and hypnotic drugs, a comparative clinical and social study. Acta Psychiatrica Scandinavica, Supplement 270, 1978.

American Psychiatric Association, Committee on Nomenclature and

Statistics. Diagnostic and Statistical Manual. Vol. ll. Washington,
D.C.: the Association, 1968.

Andrews, K.H., and Kandel, D.B. Attitude and behavior: A specification of the contingent consistency hypothesis. American Sociological Review, 44:298-310, 1979.

Angrist, B., and Gershon, S. Amphetamine abuse in N.Y.C., 19661968. Seminar in Psychiatry. 1:195-207, 1969.

Annis, H.M. Patterns of intra-familial drug use. British Journal of Addiction, 69:361-369, 1974.

Ansbacher, H.L., and Ansbacher, R.R. The lndividual Psychology of Alfred Adler. New York: Harper Torchbooks, 1956.

Arnold, D.O. A process model of subcultures. ln: Arnold, D.O., ed. Subcultures. Berkeley, Calif.: Glendessary, 1970.

Atweh, S.F., and Kuhar, M.J. Autoradiographic localization of opiate receptors in rat brain. l. Spinal cord and lower medulla. Brain Research, 124:53-67, 1977a.

Atweh, S.F., and Kuhar, M.J. Autoradiographic localization of opiate receptors in rat brain. ll. The Brainstem. Brain Research. 129:1-12, 1977b.

Atweh, S.F., and Kuhar, M.J. Autoradiographic localization of opiate receptors in rat brain. lll. The telencephalon. Brain Research, 134:393-406, 1977c.

Ausubel, D.P. "Personality Predispositions in Drug Addiction: A

Psychometric Study of 80 Matched Addicts and Controls." Unpublished paper. Lexington, Ky.: U.S. Public Health Service Hospital, 1947.

Ausubel, D.P. The psychopathology and treatment of drug addiction

in relation to the mental hygiene movement. Psychiatric Quarterly,
22(Supp., Part ll): 219-250, 1948.

Ausubel, D.P. An evaluation of recent adolescent drug addiction.
Mental Hygiene, 36:373-382, 1952a.

Ausubel, D.P. Ego Development and the Personality Disorders. New
York: Grune 6 Stratton, 1952b.

Ausubel, D.P. Controversial issues in the management of drug addiction: Legalization, ambulatory treatment, and the British system. Mental Hygiene, 44:535-544, 1958a.

Ausubel, D.P. Drug Addiction: Physiological, Psychological, and Sociological Aspects. New York: Random House, 1958b.

Ausubel, D.P. Causes and types of drug addiction: A psychosocial view. Psychiatric Quarterly, 35:523-531, 1961.

Ausubel, D.P. The case for compulsory closed ward treatment of narcotic addicts. ln: Medical Views of the Narcotics Problem. Annual Judicial Conference of the Second Judicial Circuit of the United States. Federal Rules Decisions, 1962. pp. 53-59.

Ausubel, D.P. The Dole-Nyswander treatment of heroin addiction. Journal of the American Medical Association, 195:949-950, March 14, 1966.

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