The Government wants general practitioners to involve themselves more in the treatment of drug addicts, principally by means of the prescription of methadone, the heroin substitute. But the Government’s policy is a surrender to untruth and plays into addicts’ hands.

The GPs, who are being bribed with £1,500 a year, are reluctant to prescribe the treatment, largely because addicts are so difficult to deal with: by turns ingratiating, wheedling, pleading, demanding, threatening and even violent. In these circumstances, doctors prescribe more from fear of their patients than from desire to do them good: a prescription for what they want will get them out of the room as expeditiously as possible.

One GP told me yesterday that when she had to deal with some of her drug addicts, she shook for ten minutes afterwards, and had to postpone seeing her next patient until she had recovered her composure.

The whole subject of drug addiction — particularly to opiates such as heroin — is steeped in mythology. Among the strongest and most persistent myths is that of the terrors of withdrawal, known as cold turkey.

It has long been established in scientific literature that withdrawal from opiates is medically trivial, and that the symptoms are much less unpleasant than flu, and easily alleviated. This is in marked contrast to, say, withdrawal from alcohol among those who drink greatly to excess. Withdrawing alcoholics may suddenly collapse and die; they may have epileptic fits; and their terrifying hallucinations may prompt them to behave in bizarre and dangerous ways, for example by throwing themselves from high windows to escape the pursuing monsters. Even withdrawal from long-term use of diazepam (Valium) may sometimes produce this picture: but withdrawal from heroin never.

Yet in the popular imagination, and even in that of many doctors, withdrawal from heroin is so terrible an experience that no person could be expected to undergo it without a vast panoply of assistance, preceded by months of reflection, counselling and so forth. Most people’s idea of heroin withdrawal is probably now derived from the film Trainspotting, in which a withdrawing addict is locked in a room to prevent his attempts at escape, and there undergoes a phantasmagoric range of horrors. This is plain, straightforward untruth.

Of course, this is not the view of heroin addicts. One addict recently told me that withdrawal for him was “the evillest thing in the world”. But this is self-serving. Addicts tell themselves that the withdrawals are terrible in order to justify continuation of their habit. They want to continue and seek a reason why they should do so.

They are encouraged in this by the vast apparatus of medical and other assistance that either exists or they believe should exist (“I would stop, doctor, only I can’t get the help I need”). Obviously, such an apparatus must exist only if withdrawal from heroin is a serious condition, because otherwise money wouldn’t be wasted on it; and since the apparatus does exist, or is believed to be necessary, withdrawal from heroin must be a serious condition. It is all nonsense.

Addicts live in a strange cognitive world, in which lies are vehemently asserted and truths just as vehemently denied: a little akin to my state as a child when I was accused of some misdeed I had committed. I would loudly and even angrily protest my innocence; but a still small voice at the back of my head (that was where it really seemed to be located) told me that I was lying.

On the one hand addicts have a clear-sighted Machiavellian view of the world, in order to be able to manipulate it. On the other, they come half or three quarters to believe the lies that they know they tell in the course of their manipulations. What maintains them in this curiously ambivalent and counter-productive frame of mind is the willingness of the world to be manipulated. It takes two to live a lie: he who tells the lie, and he who believes it.

Addicts tell each other a completely different story from the one they tell those who might “help” them — by which they mean, of course, those who give them what they want, as and when they want it. Unbeknown to them, I observe addicts before they enter my room as well as after. With me, they present themselves as suffering horribly from withdrawals in the hope that I will prescribe them something; outside, among each other, they talk normally and even laugh and joke. Not surprisingly, they feel contempt for those who “help” them by giving them what they want.

When we admit addicts for withdrawal in a general hospital, under strict conditions such as that they should receive no visitors, that they do not leave the immediate vicinity of their bed, and that they will be given medication only when the doctors consider it necessary, they very rarely require any treatment for the alleviation of symptoms. Even the heaviest abusers of drugs are surprised by the mildness of their experience: it comes as something of a revelation to them. And yet at the same time they know they had all along been lying to themselves and others.

The real difficulty is maintaining abstinence. The problem of abstinence is not a technical one and the medical profession will never have a solution to drug addiction.

Soldiers who in Vietnam became addicted to opiates gave up their habit en masse on their return to the United States. The reason why they were able to do this is obvious: they now felt they had something to live for.

The problem for so many addicts in this country is that they feel that there is nothing better for them than the oblivion and idiot euphoria that heroin offers them: and, given the bleakness of the world we have created, I can well understand how they come to this dispiriting and ultimately mistaken conclusion.

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