Corrections XX – posted 20th February 2019

I was emailed with a series of thoughtful and intelligent questions by Stephen who runs the YouTube channel Coffee Break, and in a series of email exchanges with him, a few areas came up that I thought it might be useful to clarify here for readers and to add as an additional footnote in the book.

Stephen emailed me about the material covered in pages 173 to 175, which is about heroin use by American soldiers in Vietnam during the war there.

In the text, I reference a study that was published in the Archives of General Psychiatry. Stephen pointed out that I should have also have put a full citation in the footnotes giving the full name of the study and where readers can find it, and he’s totally right, so I’ll be adding a footnote to the full study: it’s called ‘Narcotic Use in Southeast Asia and Afterwards: An interview study of 898 returnees’. The full reference is Arch Gen Psychiatry. 1975;32(8):955-961. doi:10.1001/archpsyc.1975.01760260019001

You can also read some of Professor Robin’s interesting later reflections on the study here.

Stephen read the study and wondered if I had misunderstood some of Professor Robin’s conclusions.

Professor Robin showed that most troops who used heroin in Vietnam came home and stopped rapidly and did not continue their use in the US itself. I interpret these findings primarily as one more piece of evidence contributing to the growing insight that there is a huge environmental component to addiction – that where the environment makes people distressed and disconnected, addiction will generally go up; and where the environment makes people feel secure and connected, addiction will generally go down.

It’s not the only factor, of course. There are significant biological and psychological components that exist alongside (and interact with) the environment. Chemical hooks, for example, are a real component in addiction, as is childhood trauma – along with other aspects I discuss more in my more recent book ‘Lost Connections.’

Stephen asked me several questions that I had considered when I was reading Robin’s study for the book years ago, but didn’t include in the book itself. His questions made me realise it would be a good idea to expand on this in the footnotes (and here, on this site) because they are, I think, interesting and instructive.

He pointed out that Professor Robin interpreted her own data differently to my reading of it in Chasing The Scream. It’s normal for a scientist like Robin to gather data that are solid and undisputed, and then for others (like myself and Professor Bruce Alexander and Dr Gabor Mate) to interpret that data differently – but Stephen is right to suggest I should have made it clear in the text why I was doing this.

He points out the following areas of disagreement between Robin and me about what her findings mean – I’d like to go through one by one and explain why I read her findings differently:


Robin did not think that avoiding distress was the key driver of this heroin use in Vietnam. As Stephen explained in his email, “it was asked why these people used heroin while at war, and the vast majority of them responded “to get high” rather than to “relieve depression” or “relieve boredom”. This seems to fly in the face of the dislocation hypothesis, where you’d expect depression, boredom and fear to be the main drivers.”

40% said the goal of their heroin use was to “get high”, while 9% said to “relieve depression”, 9 percent said “to relieve boredom”, and 8 percent said “to relieve fear.”


(a) As I explain in Chasing The Scream, today most drug use isn’t addictive use (even with ‘harder’ drugs) – in fact, even according to the UNODC (the main drug war body in the world), 90 percent of all currently banned drug use is ‘non-problematic’ use. So it’s natural that even in the extreme circumstances of Vietnam, there would be plenty of recreational use, and some people would describe themselves that way accurately because they were in fact recreational users and not addicted.

(b) Perhaps most importantly, I don’t think the options Professor Robin presented them with cancel each other out. Almost everyone I know who has an addiction would tell you they used their heroin or crack or drug of choice to “get high” (or get drunk etc) – using a drug to get high doesn’t preclude you having an addiction. “Getting high” is what takes away the pain for people with addiction problems. If you’re reading from those figures that everyone who gave “getting high” as the goal of their drug use as a statement that they weren’t addicted, that would rule out the vast majority of people who you and I would describe as addicted today.

(c) Even if you thought naming “getting high” as the primary reason for your use precluded you being addicted (and I think it’s very hard to make such a case), it would be important to bear in mind: Addictive use is deeply stigmatised now. It was far, far more stigmatised when Professor Robins was writing – the fact that the vast majority of soldiers, given a tick-list of options, would say “getting high” as their goal rather than “avoiding pain” will be skewed by that stigma.

If you go now and ask the first homeless drug users you meet why they are using (as I have done many times), even with people who clearly have really problematic addictions, most of them will give you a similar answer. Addiction is a really painful condition that it’s hard to talk about, especially in a context of deep stigma. Under-reporting of addiction is very common.


She wrote: “The argument that addiction in Vietnam was a response to war stress, and therefore remitted on exit from the Vietnam war theatre, is still frequently cited as though it were self-evident, because it sounds so plausible. Yet accepting this argument is difficult in the face of the facts. Heroin was so readily available in Vietnam that more than 80% were offered it, and usually within the week following arrival. Those who became addicted had typically begun use early in their Vietnam tour, before they were exposed to combat.”


Every soldier sent to Vietnam knew that it was a terrible and terrifying war where they could be killed and where they may have to kill – so I find it a bit strange that she implies that “war stress” only begins in the active combat-zone itself. If I was told that next month I was going to have to fight in Vietnam, and started taking heroin to calm myself today, I think it would be a peculiar interpretation to say “it is hard to say Johann used heroin to deal with the war stress. He started using before he was exposed to combat.”

The soldiers used the heroin knowing they were on their way into a combat-zone that would be horrific and where they could die and where they could be made to commit horrible crimes against civilians. Most were conscripts who didn’t want to be there at all. They were under intolerable pressure.

That’s why I think it’s reasonable to interpret this heroin use when they arrived in Vietnam in their first week of deployment as, in many (not all) instances, a response to war stress. (I stress not all, because some of it will simply have been recreational use.)


She thought the main reasons people stopped using after they came home from Vietnam were because their family and friends disapproved, and because it was harder to get hold of the drug.


I think we need to understand Robin’s data in terms of what we’ve learned since about the interaction between the environment and addiction.

We now have a lot of evidence demonstrating that there’s a very significant environmental component to human addiction. Ann Case and Angus Deaton’s studies, to name a great (and heart-breaking) recent example, have shown that the areas with the highest opiod addictions & deaths are the areas with the highest disconnection, interpreted broadly (which is not to say that it’s the only factor: it’s not, as they stress).

The most powerful human example is the transformation in the drug policies of Portugal and Switzerland in the past twenty years. They made drugs more easily accessible, yet at the same time, they dealt with many of the underlying disconnections that were driving the addiction epidemics in their countries – and they saw a significant and well-documented fall in problematic drug use and overdoses.

If Robin was right and it was both availability of the drug and disapproval from relatives and friends that were the main reasons why people broke opioid addictions, it would be really hard to account for the huge fall in addiction in Portugal and Switzerland since they (respectively) decriminalised or legalised. They made the drug more easily available; and there was a reduction in social stigma from friends and family, not an increase; yet addiction fell – largely because they dealt with the deeper dislocations. (I go through how in the book, in chapters sixteen and seventeen.) The vast majority of people who have studied the Swiss and Portuguese successes (and the people working in it on the ground, who I spent loads of time with) think problematic drug use has fallen because they dealt much more successfully with the environmental factors that cause addiction.

I’m grateful to Stephen for raising these questions and I’ll be adding the full details of the study and a link to these reflections to the footnotes of the book.

Comments are closed.