Sociopaths and opiate addiction

Heroin and oxycontin belong to a class of drugs called opiates. Lovefraud recently received a letter from a reader that raised the issue of heroin addiction in sociopaths:

For nearly two years after my relationship with him ended, I was on the web researching heroin addiction because I assumed this was where all of his abusive behavior came from, but I stumbled upon information on sociopaths, and realized that he fits every trait”¦I know substance abuse behavior can mimic sociopathic behavior, but it is clear that the man I was in a relationship with is a sociopath, and was able to use his addiction as an explanation and excuse to further manipulate the many people who offered help to him”¦ The man I dated definitely went beyond the regular lying and stealing that takes place and went far into the realm of sadism- taking great joy in manipulation and emotional devastation of others. He was breaking into cars and taking great risks to his physical safety as a child/young man, well before his drug use started. It makes sense to me that people who are sociopaths and do not have a conscience would be more likely to become heroin addicts, as seeing others being hurt by their behavior would not be a deterrent. Whereas someone with a conscience would feel just as good when they take the heroin, they would be more likely to think about its effects on others, and stop the behavior.

I trained in three public urban hospitals where the prevalence of opiate addiction was so high that I treated countless numbers of these patients and encountered them on a daily basis. That nearly all were sociopaths was an inescapable reality. It did not seem possible that all these people were sociopaths prior to becoming addicted, so I have long believed that heroin especially makes people into sociopaths.

My beliefs have been confirmed by a number of scientific studies. One particularly thorough study was published in the Journal of Abnormal Psychology in 1998 (Vol. 107.p 412-422) entitled, A Typology of Antisociality in Methadone Patients by Dr. Arthur I. Alterman and colleagues of the University of Pennsylvania School of Medicine.

These researchers studied 252 men in methadone maintenance programs. Their average age was 40. The researchers looked extensively into the backgrounds and histories of the subjects and had them complete a number of personality tests. They also interviewed them using Robert Hare’s PCL-R.

The study identified 6 groups of subjects, each with a unique psychological profile. 72 percent of the sample were sociopaths. That means that only 28 percent were not significantly antisocial. The researchers believed that in perhaps 17 percent of the sample the sociopathy was due to the addiction. The take home message though was that 55 percent were highly psychopathic as measured by the PCL-R. About a quarter of the total sample were married and we can assume the rest had relationships of some sort.

Government statistics indicate there may be as many as 2 million opiate addicts in the US. There are only 650 methadone maintenance programs in the US with an estimated 120,000 clients. These clients are likely similar to those of the reported study, but it is reasonable to believe that non-sociopaths are over represented in treatment programs, so the 28 percent figure may be an over-estimate with regard to the total addict population.

One of the most interesting findings of the above study was that Machiavellianism was high in the 55 percent of methadone clients who were sociopaths. Machiavellianism was measured by the 20-item MACH-IV which measures egocentricity, a lack of concern with conventional morality, and interpersonal manipulativeness. These symptoms would predict a great deal of distress in the spouses and romantic partners of the subjects- not to mention the children born to these parents.

The results of the study raise other important points I have made on this blog. First, among the very antisocial and manipulative opiate addicts there were a range of PCL-R scores. This means that you should not be concerned with trying to decide if the person who is hurting and manipulating you meets some magical cut-off score. Instead look at the list of traits Donna has posted and see if the description more or less fits.

Also, childhood and teen problems cannot always be identified in people who are very psychopathic. Things happen in late adolescence and early adulthood that change people. Furthermore, just because we can’t prove a given person had antisocial tendencies early in life, doesn’t mean they weren’t there. The other implication of this is that at-risk young people require careful, loving, hands-on parenting even if they seem OK. Addiction may be an event that tips at-risk individuals into the realm of psychopathy.

The brain opiate systems are central to love and attachment in humans. This fact may account for the propensity for sociopaths to use heroin. It may also be that opiate drugs specifically poison a person’s ability to love, making him/her egocentric, grandiose and manipulative.