Below the wholesale level, selling cocaine or heroin is an easy-entry business, requiring only a source and funds. Any variety of groups can come together to deal heroin, such as street gangs in many urban areas. A variety of black criminal groups exist throughout the United States. Some are homegrown, such as Chicago’s Gangster Disciples; others, such as Jamaican posses, are imported.

There are important black criminal organizations in the heroin business, particularly in New York, Detroit, Chicago, Philadelphia, and Washington, D.C. Whereas African Americans have traditionally been locked out of many activities associated with organized crime (e.g., labor racketeering and loan-sharking) by prejudice, dope is an equal opportunity employer. African-American criminal groups made important strides in the heroin business when the Vietnam War exposed many black soldiers to the heroin markets of the Golden Triangle; previously, black drug-trafficking groups had depended on the American Mafia for their heroin.
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Like those in the past, contemporary treatment programs typically begin with detoxification a term left over from an obsolete theory that addicts suffer from an accumulation of toxins with or without the assistance of drugs. Antagonists are sometimes used as an aid in heroin detoxification. Because of its potency, withdrawal from licit maintenance doses of methadone is generally accomplished by decreasing dosages.

The antihypertension drug clonidine has been used to relieve many of the symptoms of opioid withdrawal, particularly those involving autonomic nervous system hyperactivity. Some physicians have recommended clonidine for the detoxification of methadone patients who are being maintained on relatively low dosages. Whereas methadone can be found in the patient’s system more than a week after the last dose, clonidine has a shorter life. Thus, a clonidine patient can be placed on naltrexone immediately on detoxification, whereas a methadone patient would experience unpleasant withdrawal symptoms under similar treatment.
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Like the quest for an explanation of drug abuse, the search for a cure, particularly a “magic bullet” in the form of a chemical cure, has a history that cautions us to be skeptical. Opiates were once presented as a cure for alcohol dependence; morphine was offered as a cure for opiate addiction; cocaine was offered as a cure for morphine addiction (though patients became dependent on cocaine while remaining addicted to morphine); heroin was proposed as a cure for morphine addiction; and methadone was presented as a cure for heroin addiction. In fact, the “cure industry” has a long and often less than honorable history.

The medical profession often shared the distaste for drug users that permeated the society. Furthermore, the problem of addiction was only peripheral to the practice of most doctors, who typically sought to avoid association with the failure that was so common to treating drug dependence.
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Freud posited that unconscious feelings and thoughts relate to stages of psychosexual development from infancy to adulthood. Psychoanalytic theory “conceives of the human being as a dynamic energy system consisting of basic drives and instincts which in interaction with the environment serve to organize and develop the personality through a series of developmental stages. Individuals from birth are pushed by these largely unconscious and irrational drives toward satisfaction of desires which are largely unconscious and irrational”.

Although we lack conscious memory of these stages, in later life they serve as a source of anxiety and guilt, psychoneurosis, and psychosis. The stages overlap, and transition from one to the other is gradual, the time spans noted below being approximate and dependent on individual and cultural differences.
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