The lessons of Vietnam War heroin addiction for policy interventions

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A fascinating piece on heroin addiction in US troops in Vietnam, and the strength of evidence that our environment affects our behavior. The article reports on the incredibly low relapse rate among US soldiers who reported being addicted to heroin while in Vietnam – just 5% relapse in the first year among soldiers returning home compared to the standard relapse rate of 90% following drug treatment. The suggestion is that the radical change in environment explains the low relapse rate:

But one big theory about why the rates of heroin relapse were so low on return to the U.S. has to do with the fact that the soldiers, after being treated for their physical addiction in Vietnam, returned to a place radically different from the environment where their addiction took hold of them.

“I think that most people accept that the change in the environment, and the fact that the addiction occurred in this exotic environment, you know, makes it plausible that the addiction rate would be that much lower,” Jaffe said.

We think of ourselves as controlling our behavior, willing our actions into being, but it’s not that simple.

It’s as if over time, we leave parts of ourselves all around us, which in turn, come to shape who we are.

The following quotations within the article from David Neal go some way towards explaining this phenomenon:

“Once a behavior had been repeated a lot, especially if the person does it in the same setting, you can successfully change what people want to do. But if they’ve done it enough, their behavior doesn’t follow their intentions,”

…”People, when they perform a behavior a lot — especially in the same environment, same sort of physical setting — outsource the control of the behavior to the environment,”

…”For a smoker, the view of the entrance to their office building — which is a place that they go to smoke all the time — becomes a powerful mental cue to go and perform that behavior,”

The article argues for a focus on the environment, rather than on conscious intentions, if we want to change behavior :

To battle bad behaviors then, one answer is to disrupt the environment in some way. Even small changes can help — like eating the ice cream with your nondominant hand. What this does is disrupt the learned body sequence that’s driving the behavior, which allows your conscious mind to come back online and reassert control.

Eating ice cream with a nondominant hand is a nice trick. But this kind of thinking should also inform all kinds of policy interventions. The war on drugs is an obvious place to start – there must be less brutal ways than incarceration to change people’s environments. But the lessons go beyond addiction. If our environment is so powerful that a new location can overcome heroin addiction, then surely our first thought whenever we want to reduce or change any behavior should be to look to the environment rather than the choices or dispositions of individual actors.

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