Preface

This book is meant for the reader interested in opium and its uses,
benefits, and consequences among the people in Laos. It is based primar-
ily on my experiences as a physician, public health worker, and researcher
there between 1965 and 1975. Research work of others conducted in Asia
and my own work elsewhere in Asia and in the United States supplement
these firsthand observations from Laos.
Several different research methodologies were employed to examine
opium, its uses, and its effects. T o begin with, I focused on ecological,
sociocultural, and agroeconomic issues. Later my efforts focused on
lengthy interviews with addicts and their families. Several epidemiologi-
cal surveys were undertaken in different communities, utilizing several
methods of case finding. Addicts and their families were studied in
general medical settings, as well as in special treatment facilities for
addicts. Folk treatment methods for addiction were described, along
with the milieu, inhabitants, and functions of opium dens. Treatment
outcome for addicts was evaluated, with a comparison of a Buddhist
monastery program and a multimodality medical program. In recent
years I have had the opportunity of studying former addicts from Laos
who are now in the United States as refugees.
The diversity of these experiences and observations presents certain
inherent advantages and disadvantages for the reader. O n the bene-
ficial side, numerous facets of opium and its uses are presented, as
opposed to a single social, medical, or economic focus. It is hoped that
this will allow the reader to see the complexity of the issue, the desirable
as well as undesirable aspects of this widely praised and widely con-
demned substance. But there is a disadvantage as well. If I have done

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 PREFACE

my task as I set out to do it, this book will be read by people from a
diversity of backgrounds who have a common interest in this topic.
It is expected that readers will include physicians, social and behavioral
scientists, epidemiologists, a few pharmacologists, a historian or two,
and perhaps even a legislator or government official. Therein has lain a
special obstacle for me, since each of these various groups employs
terms or jargon that are not mutually intelligible to the others. Even
worse, a term that has quite precise, denotative meaning to those in one
field (e.g., "addiction" for physicians and pharmacologists) may have
highly subjective, connotative meaning to those in other fields (e.g.,
"addiction" for most social scientists and legislators). There is the addi-
tional difficulty that those in different fields do not always know how
those other than themselves go about their work. For example, anthro-
pologists and epidemiologists tend to know little or nothing of one
another's research techniques, even though both often undertake research
in communities (as opposed to laboratories or hospitals).
I have tried to handle this problem in several ways. First, there is
a glossary that includes many terms that may not be clear to all readers.
Reference to the glossary is made in the first few chapters so that the
reader can become familiar with it. Second, the sampling methods,
research techniques, and data collection instruments are presented in
somewhat greater detail than usual, rather than using the usual short-
hand descriptions that most of us use when writing for people from
similar backgrounds. (Some of this is located in the footnotes.) And
third, I have elaborated some of the common philosophical and episte-
mological issues in certain fields as they touch on these data. All of
these three means of handling the basic communication problem will
undoubtedly assist the reader at some points, while causing some frustra-
tion with overly elementary descriptions or explanations at other points.
I ask the readers' indulgence when this occurs and suggest reading
rapidly through such paragraphs until the material becomes engaging
again.

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