Contents

Foreword

Preface

Acknowledgments

I Introduction
Background 4
The Research Hypotheses 6
Methods 7
The Writing 12

II The Country and Its People

Geography and Climate 14
History and Government 16
The Lao 18
The Hmong (Meo) and Iu Mien (Yao)
The Lao Theung 31
Expatriate Asians 32
The Caucasians 34
Comment 35

III Agroeconomics of Poppy and Opium

Agricultural Technology 37
Economics of Opium 42
Opium Commerce 48
Comment 53

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IV Using Opium
Techniques for Using 55
Reasons for Using 60
Demographic Characteristics of Opium Users 71
Patterns of Use 73
Comment 77

V Natural Courses of Addiction

Researching Addiction 79
Preaddictive Use 86
Addictive Use 88
Consequences 91
Addicts' Attempts at Stopping Addiction 97
Comment 100

VI Epidemiology of Addiction
Special Problems of Addiction Epidemiology 101
Methods Used in Laos 106
Community Surveys 108
Case Registry 113
Comparison of Hmong Surveys 117
Demographic Characteristics of Addicts 120
Comment 123

VII Subgroups Among Addicts

Why Study Subgroups? 124
Gender 125
Age 128
Ethnicity 130
Socioeconomic Status 131
Geographic Correlates 132
Comment 133

VIII Opium Dens: Evil or Asset?

Gaining an Entree 137
Community Size 138
Den Clientele 139
Den Attendance Among Addict-Patients 141
Social Functions 144
Comment 146

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IX Appearance of Heroin Use

Pharmacology of Heroin 148
An Antiopium Campaign 149
A Heroin "Epidemic" 156
Comparison of Opium and Heroin Addicts 159
A Matched-Pair Study 161
Comment 163

X Caucasian Addicts
Sampling and Data Collections 165
Introduction to Using Opiates 169
Demographic Characteristics 172
Patterns of Usage 176
Clinical Observations 182
Comparison With American "At-Home" Addicts
Comment 187

XI Treatment Modalities
Folk Treatments 189
Treatment at a Buddhist Monastery 199
The National Narcotic Detoxification Center 203
Supplemental and Follow-Up Programs 210
A Vocational Rehabilitation Program 213
Comment 217

XII Evaluating Treatment

Treatment Acceptability 220
Mortality 225
Treatment Outcome 227
Abstinent and Unimproved 243
Cost Effectiveness 245
Ethical Considerations 247
Unsuccessful Pilot Projects 248
Comment 249

XIII Other Drugs

Alcohol 252
Tobacco 260
Betel 263
Cannabis 265
Pharmaceuticals: Folk and Modern 268
Comment 270
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XIV Social Considerations and Addiction 272

Effects of An Antiopium Law 272
Repercussions of War 275
Religious Concomitants 278
Political Relationships 279
Opium as Symbol 280
Comment 281

X V Opium Reconsidered 283

Clinical Versus Public Health Approaches 292
Factors Affecting Treatment Outcome 295
Public Health Intervention or Laissez-faire? 298

Appendix 301

Glossary 305

References 313

Index 327