Bringing Them Home

After 16 years of failure to achieve military victory, President Nixon ordered his national security advisor, Henry Kissinger, to begin secret peace negotiations with Le Duc-Tho, Kissinger’s North Vietnamese counterpart. These talks eventually led to the Nobel Prize for Duc-Tho and Kissinger, as well as a complete US withdrawal from Vietnam. Even more secretively, Nixon was anxious about a different kind of withdrawal.

Heroin use among the US soldiers in Vietnam had spread like an epidemic. Cheap and readily available, heroin supplanted marijuana as the drug-of-choice among the fighting men in the jungle. By one estimate, 20% of American servicemen were using the drug on a daily basis. The President worried what would happen to these men upon their return stateside and he needed a plan, now. Nixon convinced research psychiatrist, Jerome Jaffe, to be the first “Drug Czar.” Jaffe’s mission: figure out what to do with the 1,400 heroin-addicted veterans coming home every month.

A fortuitous confluence of events

Dr. Jaffe was both smart and lucky. His good luck was that a new machine prototype, one that could detect heroin in a urine sample in under two minutes, had just been tested. Smart because he hired Dr. Lee Robins, an extraordinary researcher. She had a spooky knack for collecting survey data, a challenging task in the drug-dependent population. Her success remains a benchmark with 97% accuracy and 94% sustained follow-up of the GIs.

Beginning in 1970, she tracked US servicemen for three years after their return stateside. Though one in five was hooked on heroin while in Vietnam, only one in fifty was still a daily user three years later. Her findings were published in 1973. Most of us in the addiction field still haven’t fully absorbed them.

Even more astonishing: these results were achieved with no treatment whatsoever. No methadone, no buprenorphine, nada. Cold-turkey.

How is it that a half-million traumatized young men recovered from heroin addiction without rehab? Could it be that we are, much more than we realize, products of our environment?

A new way of thinking about addiction

When I was addicted to fentanyl in the 90s, my life was, no surprise, unbalanced. I was working over 100 hours a week at a Level One trauma center. My tasks ranged from the mind-numbing tedium of checking lab results, to the literal bloodbath of liver transplant surgery. I had no time for friends or exercise. I didn’t pray or meditate. My nutrition go-to was a glazed donut and a cup of Constant Comment tea, wolfed as I ran back upstairs to the operating room.

After it all came crashing down, I was out of the hospital, away from my supply of narcotics, and surrounded by supportive people who wanted me to get well. I won’t lie; detox was the single worst physical experience of my life. But I made it out of that hell and never went back to drugs.

At the time, the prevailing wisdom was that I would never return to the O.R. as an anesthesiologist. Some suggested I should reconsider medicine as a career. None of that was true, however. With the help of a community of people who’d gone before me, the best wife ever, and a hospital Chairman who gave me a second chance, I went back to the O.R. — as an anesthesiologist. You know what? I was better than before my big splat. In the interim I developed deep gratitude. Though surrounded by drugs, back in the tile crucible, I was safe and protected. Realizing the best thing I could do with the gift of courage, the best thing for me to do was help others break their lethal habits if I could.

A survival mechanism, not a disease state

How can addiction be a disease? Some say addiction is caused by trauma: my history didn’t change. If it is a brain disease, then how come I haven’t had a drink or a drug in nineteen years? Same old brain. If it is caused by powerful opiates, why have I left them behind for all this time? Addiction isn’t a disease, plain and simple. Addiction is a self-preservation mechanism that we are all born with. All human beings are susceptible to developing the habitual act of using chemicals to modulate their feelings and perceptions. We seek relief of pain. All creatures do.

Sometimes the habit of using these chemicals (or behaviors) can take on a life of its own, but the process of habit formation isn’t a disease. It’s why we are the most successful animal on the planet.

This mechanism is most likely to be activated in people who find themselves in stressful situations (war, poverty, inhumane working conditions) and without a strong social support system. Our childhood home life may not have been so terrific. Our parents and family aren’t automatically the best, safest people for us to be around.

But regardless of the circumstances of our birth, or what life has done to us along the way, the solution is the same for anyone wanting to stop the self-destructive habit. Make a decision, and spend as much time as possible with people who support your choice. In other words, do what the soldiers did when they “magically” quit heroin en masse: come home.

Further reading:

NPR: What Vietnam Taught Us About Breaking Bad Habits
Vietnam veterans three years after Vietnam: how our study changed our view of heroin
Vietnam veterans’ rapid recovery from heroin addiction: a fluke or normal expectation?

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