Vietnam and Bad Habits

NPR's Alix Spiegel offers up a fascinating feature on the contemporary social science of behavior change that sheds light on a forgotten corner of the war on drugs with lots of implications for present conundrums of criminal justice reform (read, What Vietnam Taught us about Bad Habits). When President Nixon described illegal drugs as "public enemy number 1" in his now famous June 1971 speech announcing the formation of a presidential "Special Action Office of Drug Abuse" he was responding specifically to a spike of public concern and media attention based on reports from two Congressmen who had toured Vietnam in May, that 15% of servicemen in Vietnam were addicted to heroin. As Spiegel notes "at that point heroin was the bete noir of American drugs" considered almost impossible to recover from. Those who had already sacrificed by doing combat service seemed poised for a life of drug addiction and despair.

Spiegel introduces us to Jerome Jaffe (remarkably still alive), the psychiatrist and drug addiction expert that President Nixon appointed to head up his new executive initiative, one aimed at developing effective practices to treat heroine addiction generally and in this Vietnam cohort in particular. Under this remarkable and little discussed project perhaps the most comprehensive effort in history to identify, treat, and follow up the treatment of heroine addiction was undertaken under the direction of one of the leading social scientists of her time, Dr. Lee Robins of Washington University (read her Wikipedia entry here).

Soon a comprehensive system was set up so that every enlisted man was tested for heroin addiction before he was allowed to return home. And in this population, Robins did find high rates of addiction: Around 20 percent of the soldiers self-identified as addicts.

Those who were addicted were kept in Vietnam until they dried out. When these soldiers finally did return to their lives back in the U.S., Robins tracked them, collecting data at regular intervals. And this is where the story takes a curious turn: According to her research, the number of soldiers who continued their heroin addiction once they returned to the U.S. was shockingly low.

"I believe the number of people who actually relapsed to heroin use in the first year was about 5 percent," Jaffe said recently from his suburban Maryland home. In other words, 95 percent of the people who were addicted in Vietnam did not become re-addicted when they returned to the United States.

This dramatic experiment is actually just the lead-in to Spiegel's real story, which is on what this incident teaches us about how bad habits are shaped and how we can change them. I want to return to her lead in a moment, but a few notes on this fascinating episode of politics, social science, policy, and power.

The Vietnam connection is a fascinating and little discussed aspect of the war on drugs. The specter of a drug addicted army surely played a crucial role in formulating the political culture around crime that we are still trying to recover from. Vietnam in 1971 was already considered a lost war and one that Nixon had promised to end. The heroin story surely helped lift some of the blame for the war from the politicians who had chosen it, and onto the backs of the very soldiers who had been largely conscripted to fight it.

Not only were they not going to receive a hero's welcome home, they were now stigmatized as drug addicts. As Spiegel notes, this seemed tragic but it also must have been alarming. At a time when Americans were already deeply fearful of violent crime often linked in the media with robberies committed to sustain a heroin habit, they were being told that a large minority of Vietnam vets were likely to be heroin addicts for the rest of their lives (without of course, knowing who, and therefore suspecting all). Whatever stigma the anti-war movement may or may not have caused Vietnam veterans through talk about war crimes in Vietnam, we can agree that it must pale behind this. Needless to say the impact must have been particularly profound for Black and Latino veterans whose expectation that military service would accelerate their economic and political progress in American society was at least in part undone.

The Robins study is fascinating on a number of different dimensions:

It highlights the fact that Nixon was perhaps our most social science oriented president (even though modern day conservatives have treated any social science other than economics and electoral political science as something akin to treason).

It also reminds us that a war on drugs, for Nixon was still much about treatment and rehabilitation rather than punishment. This was an era that still believed science based policies could address rising crime. It was fall to later politicians, both right and center left, to embrace a nothing works but prison attitude.

The self report finding of 20 percent is staggering (how many were reluctant to self identify?). Apparently what WWI was to cigarettes, Vietnam was to heroin, the launching of a consumer culture of addiction with lethal consequences. Surely this shadow of war has proved far more deadly (at least in the case of the expansion of cigarette use) than the actual fighting by a multiple.

The fact that those who did admit to being addicted to heroin were then subject to something a kin to involuntary detention in Vietnam for purposes of drug treatment makes this an extraordinary (if justified) chapter in the history of civil commitment.

Why did the good news that heroin addiction in veterans could be beaten (with fewer than five percent returning to heroine use) get so little cultural uptake (Spiegel suggests it was controversial but does that mean it was widely publicized?) May be the truth was just too far out of line with the cultural narrative about heroin to be convincing (which suggests just how unrealistic most "evidence based policy" aspirations may be). The result was disastrous. What might have been a just in time reminder that rehabilitation may be a realistic was to prevent crime, was lost on the eve of a shift in our penality toward exclusionary punishments.

Going back, briefly, to Spiegel's story about behavior change, recent research seems to provide a satisfying explanation for why Robin's 1970s study found such low recidivism rates. Vietnam soldiers were most people who were exposed to and got addicted to heroin in Vietnam. After being treated they returned to their communities in the US. While much our post Vietnam narrative is committed to describing that return as troubled, it appears to for the vast majority it was a world in which they no longer felt compelled to use heroin.

According to the behavioral psychologists interviewed by Spiegel, Wendy Wood of USC and David Neal, a great deal of our behavioral control is implemented through our spatial environment which routines are response so that we do not need to (or get to) think about much of what we do. For addicts this means that the routine spatial associations for use are a trigger that can and usually does overwhelm will based efforts to not use. The example given is smoking at the entry of an office building. For an addicted smoker, the approach to the building is a powerful signal to light up.

In the language of behavioral psychology we "outsource" behavioral control to the environment (something sociologists and anthropology also recognizes in Pierre Bourdieu's concept of "habitus") this suggest that self conscious efforts to change behavior, even if reinforced by a coercive state effort through police, courts, and corrections, face an up-hill battle unless they coincide with radical efforts to reshape the environment that a person is habitually acting in. This is likely not only to be true of classic addictive behaviors like drug use, but also other criminally relevant behaviors like aggression and theft.

Two quick notes on this behavioral lead of Spiegel's story (which is reflecting on the low odds that many of us will fulfill our behavioral new years resolutions).

Vietnam was not just another place, it was a place where soldiers were killed and being killed. Heroin use was not just another behavior, it was a behavior with a particular relevance to relieving the pain of inhuman conditions created by war. This suggests that the Robin's study may be less relevant to behaviors less determined by such extreme conditions (that is people whose addiction is associated with great pain may be easier to treat if the pain goes away). At the same time it may have particular relevance for behaviors associated with crime, which may be rooted in experiences of inhumanity, whether child abuse, grinding poverty, or degradation at the hands of the youth control complex (see Victor Rios, Punished).

This research seems particularly relevant to the problems of trying to reduce dependence on prisons in California. Prison first of all, is a particular environment, to the degree that we move large numbers of Californians out of regular contact with prisons we may actually have an opportunity to promote better behavior among the people we have been routinely sending to that highly criminogenic environment (change is not, of course, guaranteed by a change in environment, just facilitated). But second, to the degree that measure the success of alternatives to imprisonment in terms of behaviors like drug use and gang associations, we will face a difficult struggle so long as most people leaving prison are returning to environments that got them into trouble with drugs or gangs to begin with. We need to make sure our assessments acknowledge this "legacy effect" so that we do not prematurely dismiss innovative efforts to change behavior.