The amount of time which should be devoted to the experiment must depend very greatly upon these considerations--the constitution of the patient, the length of time which has elapsed since the habit was formed, and the quantity habitually taken. When the habit is of recent date, and the daily dose has not been large--say not more than ten or twelve grains--if the patient has average health, his emancipation from the evil may be attained in a comparatively short period, though not without many sharp pangs and many wakeful nights which will call for the exercise of all his resolution.
The question will naturally suggest itself to others, as it has often done to myself, whether a less sudden relinquishment of opium would not be preferable as being attended with less present and less subsequent suffering. Numerous cases have come under my notice where a very gradual reduction was attempted, but which resulted in failure. Only two exceptions are known to me: in one of these the patient, himself a physician, effected his release by a graduated reduction extending through five months. The other is the case of Dr. S., a physician of eminence in Connecticut many years ago. This gentleman had made so free use of opium to counteract a tendency to consumption that the habit became established. After several years, and at the suggestion of his wife, he made a resolution to abandon it, engaging to take no opium except as it passed through her hands, but with the understanding that the process of relinquishment was to be slow and gradual. His allowance at this time was understood to be from twenty to thirty grains of crude opium daily. At the end of two years the habit was abandoned, with no very serious suffering during the time, and so far as his daughter was informed, with no subsequent inconvenience to himself. He lived many years after his disuse of opium, in the active discharge of the duties of his profession, and died at last in the ninetieth year of his age. The hazard of this course, however, consists in the possibility, not to say with some temperaments the probability, that somewhere in the course of so very gradual a descent the same influences which led originally to the use of opium may recur, with no counteracting influence derived from the excitement of the mind produced by the earnestness of the struggle. With some constitutions I have no doubt that a process even so slow as that of Dr. S.'s might be successful, but I suspect, with most men, that some mood of excited feeling, and some conscious sense of conflict, will be found necessary, in order to bring them up resolutely to the work of self-emancipation. On the other hand, I am satisfied that my own descent was too rapid. Had the experiment of between five and six weeks been protracted to twice that time, much of the immediate suffering, and probably more of that which soon followed, might have been prevented. As in the constitution of every person there is a limit beyond which further indulgence in any pernicious habit results in chronic derangement, so also there seems to be a limit in the discontinuance of accustomed indulgence, going beyond which is sure to result in some increased physical disorder. In the cure of _delirium tremens_, the first step of the physician is to stimulate. With more moderate drinkers abrupt cessation from the use of stimulants is the only sure remedy. In the first instance the nervous system is too violently agitated to dispense entirely with the accustomed habit; in the second, the nerves are presumed to be able to bear the temporary strain imposed upon them by the condition of the stomach and other organs. But with opium the case is otherwise. Insanity, I think, would be the general result of an attempt immediately to relinquish the habit by those who have long indulged it. The most the opium-eater can do is to diminish his allowance as rapidly as is safe. For the same reason that no sensible physician would direct the confinement of a patient and the absolute disuse of opium with the certainty that mania would result, so it would be equally ill advised to recommend a diminution so rapid as necessarily to call out the most serious disorder and derangement of all the bodily functions, especially if these could be made more endurable by being spread over a longer period. In one respect the opium-eater has greatly the advantage over those addicted to other bad habits. Those who have used distilled or fermented drinks, tobacco, and sometimes coffee and tea in excess, experience for a time a strong and definite craving for the wonted indulgence. This is never the case with the opium-eater; he has no specific desire whatever for the drug.
