Starting Points

Points (n.) 1. marks of punctuation. 2. something that has position but not extension, as the intersection of two lines. 3. salient features of a story, epigram, joke, etc.:  he hit the high points. 4. (slang; U.S.) needles for intravenous drug use.

Dr. Robin Room receives the Drug Policy Alliance’s Alfred R. Lindesmith Award for Achievement in the Field of Scholarship

Editor’s Note: Today we bring you an announcement from the Drug Policy Alliance’s Office of Academic Engagement. Last week, from November 18-21, the DPA held its International Drug Policy Reform Conference in Washington, D.C. There they awarded Dr. Robin Room, the sociologist specializing in drug and alcohol research whose work is well-known by readers of Points, with the Alfred R. Lindesmith Award for Achievement in the Field of Scholarship. Points heartily congratulates Dr. Room!

Robin RoomThe Drug Policy Alliance is proud to announce Robin Room as the recipient of its biennial Alfred R. Lindesmith Award for Achievement in the Field of Scholarship, honoring scholars whose personal courage and quality of published research constitute a source of inspiration for all who aspire to break new ground in scholarship on drugs and drug policy. Dr. Room’s extraordinary and prolific work over the past fifty years, driven by both his profound curiosity and a commitment to dealing with drug use and problems in ways consistent with scientific evidence, compassion and human rights, have powerfully informed and bolstered the global movement for drug policy reform. We are delighted that this award coincides with the launch of DPA’s new Office of Academic Engagement to be directed by Julie Netherland. Please join us in congratulating Dr. Room.

Final note: Points will be enjoying Thanksgiving on Thursday. Check back next week for more alcohol and drug history, and happy holidays to all! 

The Points Interview: Elena Conis

Editor’s Note: Points is delighted Elena Conis, a historian of medicine and public health at Emory University. Below, Conis discusses her recent book Vaccine Nation: America’s Changing Relationship with Immunization (University of Chicago Press, 2014), which chronicles America’s changing relationship with vaccinations over the past 50 years.

Vaccine NationDescribe your book in terms your bartender could understand.

At the moment, my bartender is my husband, and at this point in our lives together, he’d probably rather hear me describe just about anything other than my book. But in a different life, I’d tell my hypothetical bartender this:

Vaccine Nation answers the question, how did we arrive at a moment in which vaccination is simultaneously widely accepted and intensely controversial? The answer takes about 250 pages to explain, but in short, it has to do with three key things that have happened since the 1960s. First, federal support for childhood immunization along with increased reliance on compulsory immunization helped secure the high rates of immunization we see today. At the same time, the social movements of the last half century—the feminist, environmental, and consumer rights movements in particular—gave the public the rhetoric and the reasons for questioning required immunizations. Lastly, the development of new vaccines transformed how we understood their target infections and the risks they posed to society. Sometimes this phenomenon bolstered vaccination acceptance, but at other times it worked against it; more on that below.

What do you think a bunch of alcohol and drug historians might find particularly interesting about your book?

Here’s one thing: Vaccines have often been thought of as a category apart from other drugs, as public health apparatus more than pharmaceutical. As such, they’ve often been exempt from certain kinds of scholarly scrutiny. They’re the “good” pharmaceuticals, the heroes of public health, responsible for some of the greatest accomplishments achieved in the history of medicine. But just like other pharmaceuticals, vaccines reframe the diseases they prevent. Once a vaccine comes on the market, we never see its target infection the same way again. The introduction of a new vaccine triggers a process of transformation: the vaccine shines a light on its target, and all of us—scientists and marketers and consumers alike—look more closely at the disease, focus more intently on its complications and sequelae (no matter how rare), and ultimately turn the infection into one known for those very complications and for the urgency of its prevention.

Now that the hard part is over, what is the thing YOU find most interesting about your book?

Elena ConisThere are a couple of ideas in my book that get a little lost in the larger history I tell, and I now think they deserve much more attention. In our contemporary cultural conversation about vaccination, we invoke again and again the character of the irresponsible, irrational, selfish, and villainous “anti-vaxxer.” I believe the trope of the “anti-vaxxer” has become so popular in media coverage of the vaccination issue in recent years for two reasons: because it resonates with cultural conversations about women, and because it distracts from uncomfortable conversations we aren’t having about class and privilege.

Take a close look (or even a cursory glance) at media coverage of the recent measles outbreak, or of the “anti-vaxx” phenomenon generally, and you’ll see that the “anti-vaxxer” is typically portrayed as female, white, well-educated, well-off, and often either a stay-at-home mother or a mother devoted to the extreme coddling of her own child. This doesn’t always square with statistics—there are many reasons children go unvaccinated or undervaccinated—but it does serve a function in the larger debate we’ve been having about women “having it all.” These vaccine-refusers are women who, often, have opted out of workplaces outside the home, either wholly or partly, and as such they are an affront to an economic system that is held up, in some part, by dual income households in which all children are vaccinated (and in school). They’re also, I believe, perceived as an affront to the assumed responsibility of the modern, well-educated woman to her gender, and to society, and thus find themselves demonized for their “selfish” choice to devote themselves so thoroughly to their children’s care that they choose to elevate vaccine risks to their individual children above risks to society as a whole.

In addition, our contemporary obsession with villainizing anti-vaxxers is treated with disproportional outrage compared with other ways in which the middle- and upper-middle class political left has opted out of many public goods—public school, public transportation, the military, and more. We live in a society increasingly segregated along class lines, and in such a society, the quality and consistency of public goods suffers. Opting out of vaccination requirements is, on some level, comparable to opting out of public schools in certain neighborhoods or public transportation systems—because the latter acts lead to disinvestment in certain communities that leave the children who remain at a severe disadvantage, even endangered. But we treat vaccination evasion as an act apart, as the only opt-out behavior that is ethically impermissible. It’s not. I believe, however, that we unconsciously draw attention to it as a way of drawing attention away from the greater crisis of liberalism in this country, which is that the ideal of quality public goods for all is increasingly a myth as our income gap widens and opportunities for social mobility diminish.

I’ve also come to see today’s anti-vaxxer as a straw man (or, more precisely, a straw woman), set up and knocked down in order for the left to distance itself from its own supposedly “anti-science” fringe – but this answer has already gone on too long, so maybe I’ll leave this point for another post.

Every research project leaves some stones unturned. What stone are you most curious to see turned over soon?

There are so many stones, so little time, and I’m excited for the next generation of historians to pick up the topic and turn some of those stones over. Here are just a few: There is not nearly enough historical scholarship on issues of race and vaccination in modern times, and there’s much to be written; for instance, about how civil rights discourse intersected with the expansion of vaccination as a public good in the 1950s and later, or about vaccination promotion across racial and ethnic groups. I know of some scholarship in progress on the subject of the rise of the cost-effectiveness justification of vaccination, and I’m eager to see that important work emerge. There are histories of specific childhood vaccines, the ones I think of as the “quiet” vaccines, like Hib and rotavirus, that deserve serious attention. I also hope someone tackles the topic of flu vaccine mandates in gendered work spaces—and the fascinating long history of flu vaccination generally. When I was at the end of my research, I learned that the papers of Merck vaccine developer Maurice Hilleman were at the American Philosophical Society, albeit not yet open to researchers. I believe those papers may hold important clues to the story of how our contemporary era of vaccination took shape. I don’t plan to dig into them myself, but if someone reading this decides to do so, let me know. I’m deeply curious about what’s in there.

BONUS QUESTION: In an audio version of this book, who should provide the narration?

Oh man. I’m not an auditory learner, so I don’t really get audio books. But maybe… Jenny McCarthy?

Where is drug policy? On Görlitzer Bahnhof and the levels of reading policy

Editor’s Note: Today we’re happy to bring you an article by Ferdinand Nyberg, a Finnish citizen currently getting his Ph.D. at the University of Tübingen in Germany, where he works at a collaborative research center which investigates ‘threatened orders.’ His focus is in American Studies and his research will specifically center on the intersections of nineteenth-century temperance efforts, abolitionism, race, and gender. He’ll be contributing several articles to Points and we look forward to reading his work!

Görlitzer Bahnhof
Görlitzer Bahnhof

Few visitors to Berlin aged around 16 to 30 will be unfamiliar with Görlitzer Bahnhof; or, rather, they’ll be familiar with the park frequently referred to by that name (often shortened as ‘Görlitzer’ or ‘Görli’). As the name suggests, it was once a Bahnhof, a railway station; and one, it happens, with a fascinating history.

Built in 1866, it was to function as a major artery for trade and travel eastwards (notably to Görlitz). The impressive neo-renaissance station, commissioned by Prussian ‘railway king’ Bethel Strousberg, simultaneously advanced and symbolised Prussia’s rapid industrialisation and economic growth. But – as has so often happened in Berlin’s history – time and space had another say in the matter, and the station’s symbolic significance would take many turns.

In 1961, the Soviets erected the Berlin Wall (officially, the ‘Anti-Fascist Protection Rampart’) and Görlitzer Bahnhof, now located in closed-off West Berlin, lost its purpose. Within a year it was demolished, and its former location became nothing but empty space and rubble (in the 1990s, the area – already used for frolicking – was turned into the park we have today). Suddenly, Kreuzberg – the district in which Görlitzer Bahnhof stood, and one bordering the wall – had become a liminal and undesirable ‘Wild West’ in the already-liminal exclave that was West Berlin. Pretty quickly, locals moved out; either to West Germany proper or to newly-built government-subsidised housing projects (realising that the Berlin Wall might cause an exodus out of West Berlin, the government swiftly got to work, building spacious and affordable housing in the traditionally swanky parts of town). For a time, then, Kreuzberg was a destitute neighbourhood, myriad apartments standing empty. Some revitalisation would come through the German government inviting ‘guest workers’ from southern Europe and the Middle East to help instigate the Wirtschaftswunder. Thousands settled in Kreuzberg, which still forms the heart of Berlin’s Turkish and Arab community. Second, West Berlin became a sanctuary for ‘alternative types,’ defined broadly.[i] Students, artists, draft dodgers, and activists interested in ‘experimental living’ were attracted to Kreuzberg’s ‘different’ feel and eagerly took advantage of its low rents and ample squatting opportunities. Soon enough, liminal Kreuzberg had developed its own hybrid culture, a compound of left-leaning counterculture and ‘Middle Eastern’ elements. (A cultural admixture which, in retrospect, loudly forebodes the gentrification now taking place.) Görlitzer was, quite literally, central to these changes.

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This Is What’s Really Interesting About Ohio’s Vote Against Marijuana

Editor’s Note: This article was co-published with History News Network

Ohio_marijuana_legalization_issue_3When polling stations closed last week, the response to Ohio’s rejection of Issue 3 came fast and furious in local and national news. “Ohioans did the right thing on Tuesday by overwhelmingly rejecting a deeply flawed marijuana legalization ballot initiative,” Vikas Bajaj wrote in The New York Times. “The proposal would have amended the state’s constitution to grant a monopoly on commercial cultivation of cannabis to a small group of investors, which is a terrible idea.” The editorial board of agreed: “Issue 3 is the wrong way to legalize marijuana for recreational use,” they wrote, “if there is even a right way to do it.”

In the wake of the first major anti-legalization vote after three years of seemingly intractable progress, what Bajaj and many others decried was not the halted expansion of legal cannabis, but rather the specter of Big Marijuana: the threat that pot, if legalized, would become as fierce and monopolistic a vice as Big Tobacco, Big Alcohol or Big Gun. And Issue 3, which was originally proposed by a group calling itself ResponsibleOhio and backed by wealthy investors (including retired NBA player Oscar Robertson and former boy bander and Buckeye State native Nick Lachey), seemed to embody those fears by granting the sole right to cultivate legal weed to just ten farms, all of which were owned and operated by these same investors. As November 3 approached, the specter of a marijuana monopoly seemed increasingly real: even as legalization was being touted as a social justice issue (by reducing the number of arrests of non-white males), it couldn’t escape the fact that it also smacked of a system that was inherently unfair, a symbolic gesture toward social equality that, in truth, benefitted only the already-privileged few.

What’s particularly interesting for drug historians, however, is not that this was one of the first rejections of legal marijuana in the past three years, or that it could be a harbinger of marijuana’s difficulty making inroads in the Midwest, but rather that arguments against Big Marijuana are once again rearing their ugly heads. The specter of Big Marijuana invoked last week was only the most recent example in a debate that’s been going on for forty years. Newly-reinvigorated after Ohio’s rejection of Issue 3, whenever there are discussions of legalized or decriminalized marijuana, fears of corporate takeovers and monopolies are never far behind.

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“It was a Riot” – Berkeley, the FDA’s Bureau of Drug Abuse Control, and the Progressive Origins of Modern Drug Policing

Editor’s Note: This post is brought to you by contributing editor Matt June. Enjoy!

From Telegraph Avenue to the steps of Sproul Hall, it was quite a scene in Berkeley, California in the spring of 1966. “That was right in the middle of the free speech movement,” recalled former Food and Drug Administration (FDA) Inspector Frank Flaherty, “and the daily riots they had there, all the upset… real interesting time.” Another FDA man, Ed Wilkens remembered being immersed in “the hippie era.” He could still picture walking to lunch on “the main thoroughfare [and] there’d be, you know, ‘Legalize Abortion,’ ‘Legalize Marijuana.’” Joking, “it was Disney Land out there,” Wilkens concluded. “It was a riot.” Despite their own memories of this historic drama, Flaherty and Wilkens’ troupe of actors have often been forgotten or miscast. Nonetheless, their role in and around campus helped set the stage for the content and consequences of our contemporary drug policies.

Charter Day Protest against Vietnam War, Berkeley 1966 (copyright Ron Riesterer/Oakland Tribune)
Charter Day Protest against Vietnam War, Berkeley 1966 (copyright Ron Riesterer/Oakland Tribune)

In February 1966, the Food and Drug Administration prepared to launch its new Bureau of Drug Abuse Control (BDAC) – designed to combat the problem of drug abuse with the first strict federal controls over amphetamines, barbiturates and hallucinogens. Prepping their new agents to investigate the illegal manufacture and distribution of those “dangerous drugs,” officials chose the University of California’s School of Criminology as the location for their training programs. This was a natural choice, though not for the reasons one might first suspect.

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The Points Interview: Henry H. Work

Editor’s Note: Points is delighted to welcome Henry H. Work, an American cooper (that’s barrel-maker for those who don’t know) who now lives in beautiful New Zealand. Work’s new book is called Wood, Whisky and Wine: A History of Barrels (University of Chicago Press, 2015), and it tells the surprisingly important story of the humble barrel and its important, millenia-long effects on the production of intoxicating spirits. Wood was kind enough to answer a few questions for us about the role that barrels have played in the drinks you might enjoy today, as well as the long history of how barrels have shaped human history. 

Henry H. WorkDescribe your book in terms your bartender could understand.

The bourbon, scotch, or Cabernet Sauvignon served to bar patrons has been aged in barrels. Most likely the same for that Chardonnay, or at least it has an oak influence. Rums, whiskeys, cognacs, ports and sherries are also barrel aged. One has to appreciate the fact that so many of our traditional alcoholic drinks have been aged or processed in wooden barrels. That this simple container, developed at least 2,000 years ago, is still so much a part of the alcoholic beverage industry is pretty amazing. And its role is largely unmentioned, as it normally performs its functions quietly, behind the scenes.

To the bartender, understanding how barrels are made, and more importantly how they modify and enhance the liquids that are stored and aged in them, will improve the drink-lore narrative and customer’s appreciation.

What do you think a bunch of alcohol and drug historians might find particularly interesting about your book?

Today, the wooden barrel is primarily used only for the aging of alcoholic beverages. This, of course, is still a critical part of information for historians as they attempt to piece together how alcoholic beverages were used and evolved in the various cultures. However, it was but a few decades ago that the barrel was the container of choice for aging, shipping and storing a vast and mixed number of other commodities and supplies. And for Western society, this was true for at least the past thousand years, and they were possibly in common use in Roman times.

One of the obvious uses of barrels was to ship crude oil – for which we still use the term to measure the amount of bulk petroleum. Other products ranged from apples to vinegar and cement to whale oil. Certainly, this information is only peripheral within the scope of an alcohol historian’s research. But because the barrels were such a common container, especially starting about five hundred years ago, their understanding can aid the historian’s understanding of why and how certain beverages could develop and progress.

Now that the hard part is over, what is the thing YOU find most interesting about your book?

What I find fascinating is the public’s lack of knowledge about barrels. Unless one tours a winery or distillery, we normally see barrels only as tables in bars or cut up into planters; not as their intended use. Even the term for the craftsmen who built the barrels, the coopers, is not commonly known, nor is their art understood. And yet barrels were ubiquitous and extremely common up until just a century ago.

So I want the general public to be aware of this important tool which helped traders and seafarers spread our society and culture, for better or worse, around the world.

Every research project leaves some stones unturned. What stone are you most curious to see turned over soon?

It is believed that the Celtic tribes living in France and Germany, before being invaded and overrun by the Romans, were the first to develop the wooden barrels of the style we still see today. But exactly where or when? Because the Celts had no written language, it is extremely difficult to trace the barrel’s origins. Additionally, this research is complicated by the fact that the barrels, being made of wood, decompose quickly, leaving nary a trace. To pinpoint the barrel’s origins is my next quest.

Through vastly improved archaeological technology in recent years, much more is known about the Celtic culture. There are now a number of museums and on-going digs at some of the European Celtic oppidum (hilltop forts) which are continuing to provide insight. Actually visiting these places to research the details of the Celtic culture may provide further clues to the barrels true origins. A tour of these sites is something I hope to do in the near future.

BONUS QUESTION: In an audio version of this book, who should provide the narration?

I would choose someone with a deep baritone voice, and preferably someone with an English accent as that seems most appropriate to this historic container.

The Forgotten Drug War: One Million Drug Addicts, Part II

In the first part of this post, I described the manner in which the Treasury Department and its Special Narcotic Committee produced the “mythical number” of one million opiate addicts residing in the United States in 1919. The methods (if that word can be applied here) to arrive at the one million figure involved a laughable mixture of bad statistics and lazy guesswork. Moreover, historian David Courtwright has subsequently marshaled enough empirical evidence to show that the estimate was at least three times larger than the actual figure. As I mentioned in part one, the one million addicts are a classic example of what Max Singer had called in 1971 the “vitality of mythical numbers,” an observation reiterated by economist Peter Reuter in 1987 in his own discussion of the “continued” vitality of mythical numbers. The Treasury Department arrived at a figure that served their organizational interest in maximizing the need for drug control efforts, and they and their political allies worked to disseminate that figure. But that wasn’t the point of my post. Today, in part two, I’d like to consider what happened to the “one million addict” figure, after it was first promoted by the federal government.Read More »

“Addictions Old and New” Conference: An Overview

Editor’s Note: In this post, Points Assistant Managing Editor Kyle Bridge offers a textual overview of the “Addictions Old and New” conference, convened October 22-23 at the University of Richmond. In the near future, conference organizer David Courtwright will post a link to a professionally-edited video of the proceedings. Stay tuned!

Increased specialization in scientific research has yielded nuance but added little coherence to how we conceptualize addiction. More broadly across disciplines, the study of addictions is fraught with disagreements over methodologies, treatment and policy implications, and even defining what “addiction” actually is. So it was no surprise that last week’s conference, “Addictions Old and New,” which featured a variety of presenters with current and historical perspectives on the phenomenon, was an enlightening and provocative experience.

Psychiatrist Charles O’Brien’s keynote address, “What is Addiction and What do Addictions Have in Common?”, set the tone for the event. Taking the long view of history—meaning from-the-dawn-of-man long—he argued that addiction is a “coincidence of evolution.” Anything that can activate the neurological reward system has addictive potential, though more data is needed before we label new, discrete addictions. As for etiology, it turns out that addiction and memories are formed the same way and one is as hard to “forget” as the other. Though, O’Brien did differentiate “addiction,” characterized by drug seeking despite adverse consequences, from “dependence,” what he called a natural physical adaptation. Furthermore, he claimed, all addictions are influenced in some way by genes. He also addressed what constitutes sound treatment, which may include medicine, talk therapy, and even potentially electrical stimulation of particular parts of the brain.

The keynote covered far more than can be addressed here, but two main points were raised in the subsequent Q&A. The first took issue with the criteria for recognizing iterations of addictions. Fortunately for anyone curious, two of the next day’s presentations made the case for adding some new acts in addiction’s big tent: food and sex. In “Food as a Drug: How Good is the Analogy?”, historian David Courtwright found that the comparison holds because, at a basic level, food addicts look like drug addicts, exhibiting similar patterns of use and co-morbidity with other disorders. They also recover like drug addicts; for example, promising therapeutic medications like naltrexone suggest biological commonalities between addictions. In fact, food addict behavior often fits neatly within the National Institute on Drug Abuse’s disease model of addiction. Thus, it may only be a matter of time before public health reformers and capitalist interests clash over the availability of hyperpalatable foods, for, almost inevitably, “economic rationality begets social irrationality.”

In a similar vein, sex addiction therapist Robert Weiss lamented that the American Psychological Association does not officially recognize the disorder in its Diagnostic and Statistical Manual. His presentation, “Hyperstimulation and Digital Media,” laid out what sex addiction is not, including an excuse for infidelity, a high sex drive, or criminal sexual offenses. Though his presentation was cut short for time, Weiss made a compelling case that sex addiction is not really about the act of sex at all. Instead, it is the thrill of anticipation and underlying intimacy issues which compel sexually addictive behavior. Hopefully historian Virginia Berridge’s talk, “Whatever Happened to Alcoholism?”, which focused on the twentieth-century British concept of alcoholism, gave Courtwright and Weiss some historical optimism. Alcoholism’s time came, passed, and then came again, bolstering the perennial truth that popular ideas about addiction are subject to change.

Later, in “Addiction by Design,” communications scholar Natasha Schull presented on technological gambling addiction, or, more accurately, the efforts of gaming companies from Las Vegas to Silicon Valley to maximize user “time on device” through innovative ergonomics, deceptive wagering patterns, and sensory gratification. Gambling addiction’s long history relative to food or sex certainly makes it a less contentious notion, but Schull’s research introduced a counterintuitive idea about the practice: that chronic gamers are not actually in it to win it. Really, they play to get in what she calls “the zone” and numb themselves to reality. After her thoroughly fascinating discussion of the increasing sophistication of game design, she considered some policies that would mandate occasionally rousing gamblers from “the zone” while allowing them to still use machines and remain profitable for casino companies. But, she concluded, the latter’s interests may stifle or simply work around any legislative interventions.

A user in “the zone”

Market capitalism’s addictive potential was the subject of many talks. Like Schull, public policy professor Mark Kleiman was skeptical of allowing commercial interests free reign over a vice, in his case cannabis consumption. He argued in his presentation, “Science and Policy in the Legalization Debate,” that removing criminal penalties for marijuana sales and sanctioning mass production would likely reduce price with the undesirable side effect of increased availability and use. Comparing a potential legal cannabis market to the extant alcohol trade is reasonable, Kleiman allowed, but the modal drinking occasion consists of one or two drinks while the modal smoking session only concludes when participants get stoned. The public health costs of increased smoking will fall on the disadvantaged minority who currently bear the brunt of harms from other legalized commercial vices. Still, he made clear, this is no reason to continue incarcerating millions for marijuana possession.

Circling back, the second major flashpoint following O’Brien’s keynote was the boundary between “addiction” and “dependence.” Clinician-researcher Andrew Kolodny addressed this most directly in his presentation, “The Prescription Opioid Epidemic and the Heroin Revival.” The “bright line” separating the two concepts was in large part contrived by pharmaceutical interests looking to change the culture of opioid prescribing. He dated the current opioid addiction epidemic to 1996, when Purdue Pharma introduced Oxycontin and rolled out an extensive marketing campaign to convince doctors that long-term use of addictive drugs was safe under medical supervision. They reinforced their message through sponsoring mandated continuing education classes for physicians and propping up “grassroots” (or “astroturf”) patient advocacy groups that called for considering pain the “fifth vital sign.” The takeaway was that the current crisis is almost entirely rooted in medical practice. Overdose deaths are highest among older folks with easy access to prescriptions. And the media narrative of a mass migration to heroin following police crackdowns on “pill mills” is wrong on two counts: first, the “migration” has actually been a gradual, consistent process over the last two decades among young, healthy people with sporadic access to legitimate prescriptions or expensive black market versions; and second, there is no evidence of a substantial “crackdown” at all.

Kolodny concluded that to address the epidemic we must prevent new cases of opioid addiction with more cautious prescribing and expand access to treatment for people who are already addicted. And at one point, during another Q&A, even a self-described “drug warrior” conceded that the hardline drug war is lost. Most attendees and presenters seemed sympathetic to or enthusiastic about the goals of harm reduction, or mitigating the negative outcomes of drug use as opposed to simply imposing abstinence. Though this principle is usually applied to illegal drugs, given that their consequences are generally exacerbated by prohibition, in an innovative presentation titled, “Old Drug in a New Container?”, pharmacologist Robert Balster applied it to tobacco and e-cigarettes. Abstinence campaigns have been hugely successful in reducing the prevalence and incidence of smoking, but they may suffer diminishing returns and implicitly accept the harms accrued by the minority that continues to light up. Alternatively, a harm reduction approach of encouraging e-cigarette or other electronic nicotine delivery system (ENDS) use, might maintain or even increase nicotine consumption but at a much lower public health cost. No matter the ethos going forward, he urged for more research into ENDS, which are severely under-regulated by state authorities.

Better than the alternative, but worth the risk?

In “Uppers and Downers,” an historical evaluation of under-regulated pharmaceuticals, historian David Herzberg offered that the mid-twentieth-century’s narrow definition of addiction “shielded sedatives and stimulants from regulation.” Laws passed in the decades after the 1914 Harrison Act targeted “dangerous,” not “addictive” drugs. They imposed few if any manufacturing limits, little required record-keeping, and mild penalties for offending pharmacists. Even as barbiturate overdoses mounted by the 1950s—perhaps as high as over 7 per 100,000 in 1953—public concern did not translate to punitive laws. Harms from prescription drugs were widely viewed as accidental poisonings. It took the 1960s culmination of the civil rights movement and experimental white hippies to overturn mainstream American ideas about who actually used drugs. Meanwhile, a series of public scandals within the pharmaceutical industry made it an easier legislative target. Of course, New York’s Rockefeller drug laws and the crack epidemic reoriented public discourse toward illegal drugs once again, allowing for new pharmaceuticals like Valium and, ultimately, Oxycontin to establish relative legitimacy.

In real, tangible ways, we continue to grapple with the historical and more contemporary issues broached by the presenters, and this report did not even address every issue discussed (again, stay tuned for the video). I can only hope that this conference serves as a model for more interdisciplinary gatherings in the future.

“Trading One Addiction For Another”: Alcoholism and Nutrition from the 1950s to Today

There are about a half-dozen Little Free Libraries in my Washington, D.C., neighborhood, where the “take a book, leave a book” ethos lives in elaborate little houses that people post in their front lawns. I love them, and examine each one closely as I pass by on the dog’s daily walks. It’s always interesting to see what shows up, which books languish for days or weeks, and which books call out to me, begging to be brought home.

A few weeks ago, while Bruno investigated some nearby grass, I came across a tattered paperback in the Little Free Library near an elementary school. Its cover was folded and its spine repeatedly creased, to the point where it was almost difficult to read the title. It was obviously, at one point at least, a well-loved book. But it was the title that stopped me and forced me to slip the book into my pocket: Eating Right to Live Sober, by Katherine Ketcham and L. Ann Mueller, M.D.

eating right to live soberEating Right to live Sober was published in 1983, during a moment that James R. Milam, Ph.D., author of Under the Influence (co-written with Ketcham) and cofounder of Milam Recovery Center, called a “turning point in the history of alcoholism.” It was in the early 1980s that Milam saw alcoholism shedding its skin as a purely psychiatric disease, when it was beginning to be understood as a mental and physical condition. This meant that new treatments, ones that were more holistically attuned, were necessary to treat its expanding definition. “Everyone who understands alcoholism as a disease also needs to know what to do about it,” Milam explained in his introduction. Ketcham and Mueller’s book was “valid core material to build on.”

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Oscar Hopefuls Contending with Drug War History

(Editor’s Note: Today’s post is brought to you by our contributing editor Matthew June.)

For your consideration… Oscar contenders are hitting theaters, awards season is coming, and more films than you might realize have ties to the history of U.S. drug policy. Although the film barely shows any trafficking and rarely even mentions drugs, the context of Sicario will be obvious to most viewers. Hyper-realistic, violent, and morally ambiguous, the film plumbs the depths of our failed drug war and its devastating consequences for the U.S.-Mexico border region. Without much hope for a viable solution, the film also offers no explanation for why the U.S. finds itself in this position.

Sicario Poster (Lionsgate Motion Pictures) & Bridge of Spies Poster (DreamWorks Pictures)
Sicario Poster (Lionsgate Motion Pictures) & Bridge of Spies Poster (DreamWorks Pictures)

Next on the docket for Academy voters, Steven Spielberg’s Bridge of Spies arrives in theaters this weekend. At first glance, the latest starring vehicle for Tom Hanks might seem like the antithesis of Sicario. It is a period-piece drama with a moral protagonist helping Cold War America retrieve one of its heroes. Bridge of Spies is based on the life of former Nuremburg attorney, James B. Donovan (Hanks), who successfully negotiated the release of Captain Francis Gary Powers when the Soviet Union shot down his U-2 spy plane. After this mission – and the focus of Spielberg’s film – ended, however, Donovan took on another assignment that gave him an important supporting role in the development of federal drug policy. Exploring that overlooked history, in turn, offers another vantage for surveying the blighted backdrop of Sicario.

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