Saturday, March 25, 2017

Heroin in Vietnam: The True Story of the Robins Study


Editor's note: The famous Robins study 
on heroin use among Vietnam veterans
 has been so often—and so recently—misinterpreted 
that I felt motivated to reprint an older post on the subject.

[Originally posted 7/24/10]

In 1971, under the direction of Dr. Jerome Jaffe of the Special Action Office on Drug Abuse Prevention, Dr. Lee Robins of Washington University in St. Louis undertook an investigation of heroin use among young American servicemen in Vietnam. Nothing about addiction research would ever be quite the same after the Robins study. The results of the Robins investigation turned the official story of heroin completely upside down.

The dirty secret that Robins laid bare was that a staggering number of Vietnam veterans were returning to the U.S. addicted to heroin and morphine. Sources were already reporting a huge trade in opium throughout the U.S. military in Southeast Asia, but it was all mostly rumor until Dr. Robins surveyed a representative sample of enlisted Army men who had left Vietnam in September of 1971—the date at which the U.S. Army began a policy of urine screening. The Robins team interviewed veterans within a year after their return, and again two years later.

After she had worked up the interviews, Dr. Robins, who died in 2009, found that almost half—45 per cent—had used either opium or heroin at least once during their tour of duty. 11 per cent had tested positive for opiates on the way out of Vietnam. Overall, about 20 per cent reported that they had been addicted to heroin at some point during their term of service overseas.

To put it in the kindest possible light, military brass had vastly underestimated the problem. One out of every five soldiers in Vietnam had logged some time as a junky. As it turned out, soldiers under the age of 21 found it easier to score heroin than to hassle through the military’s alcohol restrictions. The “gateway drug hypothesis” didn’t seem to function overseas. In the United States, the typical progression was assumed to be from “soft” drugs (alcohol, cigarettes, and marijuana) to the “hard” category of cocaine, amphetamine, and heroin. In Vietnam, soldiers who drank heavily almost never used heroin, and the people who used heroin only rarely drank. The mystery of the gateway drug was revealed to be mostly a matter of choice and availability. One way or another, addicts found their way to the gate, and pushed on through.

“Perhaps our most remarkable finding,” Robins later noted, “was that only 5% of the men who became addicted in Vietnam relapsed within 10 months after return, and only 12% relapsed even briefly within three years.” What accounted for this surprisingly high recovery rate from heroin, thought to be the most addictive drug of all? As is turned out, treatment and/or institutional rehabilitation didn’t make the difference: Heroin addiction treatment was close to nonexistent in the 1970s, anyway. “Most Vietnam addicts were not even detoxified while in service, and only a tiny percentage were treated after return,” Robins reported. It wasn’t solely a matter of easier access, either, since roughly half of those addicted in Vietnam had tried smack at least once after returning home. But very few of them stayed permanently readdicted.

Any way you looked at it, too many soldiers had become addicted, many more than the military brass had predicted. But somehow, the bulk of addicted soldiers toughed their way through it, without formal intervention, after they got home. Most of them kicked the habit. Even the good news, then, took some getting used to. The Robins Study painted a picture of a majority of soldiers kicking it on their own, without formal intervention. For some of them, kicking wasn’t even an issue. They could “chip” the drug at will—they could take it or leave it. And when they came home, they decided to leave it.

However, 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. And when they did, they had a very strong tendency to relapse. Frequently, they could not shake it at all, and rarely could they shake it for good and forever. Readers old enough to remember Vietnam may have seen them at one time or another over the years, on the streets of American cities large and small. Until quite recently, only very seriously addicted people who happened to conflict with the law ended up in non-voluntary treatment programs.

The Robins Study sparked an aggressive public relations debate in the military. Almost half of America’s fighting men in Vietnam had evidently tried opium or heroin at least once, but if the Robins numbers were representative of the population at large, then relatively few people who tried opium or heroin faced any serious risk of long-term addiction. A relative small number of users were not so fortunate, as Robins noted. What was the difference? Was it a change in setting and circumstances that allowed most heroin users to quit? Or was it that the minority of soldiers who stubbornly became readdicted did so because, like Dr. Li’s rats, they were biochemically different from their friends who stayed clean?


Quotes from: Robins, Lee N. (1994). “Lessons from the Vietnam Heroin Experience.” Harvard Mental Health Letter. December.

4 comments:

Istvan Ujvary said...

Am I right that the soldiers inhaled pure heroin (heroin free base or 'China White') available to them in Vietnam? Due to different pharmacoknetics the effects - and thus addictive liability - depends on the route of administration: injected heroin kicks immeditely which makes it more addictive. See for example:
https://www.ncbi.nlm.nih.gov/pubmed/16433897
https://www.ncbi.nlm.nih.gov/pubmed/11418285

Also, one should not ignore that heroin-using soldiers had to undergo a treatment before allowed to return home.
It might be noted, that upon Jaffe's proposal, which included drug testing and rehabilitation while still in VietnamPresident Nixon sent a letter to the Secretary of Defense that included:
"(1) Drug use per se shall not be a crime under the
military code of justice.
(2) Initiate a program to detect drug use.
(3) Treat all drug users—prior to discharge"
More details:
- https://www.ncbi.nlm.nih.gov/pubmed/3475098
- Michael Massing: The Fix (1998)

Mark said...

What this tells me is that no treatment works better than treatment. That is how I kicked, with no help. Although my problem was alcohol.

I think it is just very hard for the rehab industry to let go of 20+ billion dollars a year. But sooner or later they will have to admit, their way doesn't work.

God only knows how many people they will hurt in the process. How much money they will fraudulently take from insurers.

Its like the mafia run operation now. Screw everyone else, but we always get paid.

Thom Deem said...

The first answer that comes to mind for me is, while a vast majority of people drink alcohol (at least in the US), only 8-14% become addicted. Those are roughly the same numbers that Robbins found in the Heroin study. A reasonable conclusion would be that 8-14% of people have a predisposition, genetic or otherwise, to addiction.

What I find amazing is the lack of will on the part of the medical community to get to the bottom of addiction. Alcohol alone has an associated cost of 223 BILLION a year, about half of which is footed by the taxpayer, and yet we spend less than 500 MILLION a year to study the problem. While so many systems reap the financial rewards of addiction (Liquor companies, Medical, bars and restaurants, morgues) it will be difficult to find the financial or political will to confront the problem head-on.

Thom Deem, Clean and Social

Dirk Hanson said...

Thanks for your comment. Unfortunately, a lot of people didn't read the conclusions as succinctly as you did. I can't improve on your first paragraph. In fact, I wrote a book about that premise.

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