Editor’s Note: Today’s twenty-sixth installment of our author interview feature offers some compelling reporting from the trenches of the drug war, by Michael Reznicek. Here, he discusses his recently published book, Blowing Smoke: Rethinking the War on Drugs Without Prohibition and Rehab (Rowman & Littlefield, 2012). Though Blowing Smoke obviously focuses attention on contemporary policy regimes and alternatives, Reznicek takes the historical roots of these regimes seriously–the first four chapters are dedicated to a broad history of prohibitionist and disease models in American history.
Describe your book in terms your mother (or the average mother-in-the-street) could understand.
This is a report from the trenches in the war on drugs where things are not going well. Blowing Smoke is a criticism of the disease model of substance abuse, which I believe lies at the heart of all drug war efforts. Drug warriors are not moral scolds; they are concerned about public health. Punitive sanctions more often than not are used to force people into rehab, and prohibition laws are an important extension of the disease model: if drug abuse is a brain disease, then drugs are pathogens that need to be banned. Prohibition laws didn’t start out that way, but I think that is how they are popularly understood today.
I’m a clinical psychiatrist who has worked with substance abusers for over 27 years. I currently work in a state prison system where about ninety percent of inmates have had extensive drug problems. Blowing Smoke reviews the history and science behind the disease model and argues that the model misjudges the problem of addiction and that it leads to important unintended consequences. Essentially, I believe the disease model enables the problem. I offer a competing model—the habit model—that I believe more accurately captures addictive behavior. The habit model also leads to dramatically different responses.
My criticism of the disease model is not limited to the “NIDA paradigm” but to all models that view substance abusers as passive agents who are merely responding to forces within or around them. That is not how substance abusers view themselves while they’re using drugs, and not how they recount their experiences years later.
What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?
When I first encountered the disease model in medical school I wondered how a model that was so over-the-top reductionistic could gain traction within an intelligent neuroscientific community. I started to understand why after reading the exceptional scholarship of alcohol and drug historians such as Ron Roizen, William L. White, Sarah Tracy and many others. Knowing the history of the disease model allowed me to appreciate it as a Kuhnian paradigm.
Paradigms always have stakeholders, and when paradigms acquire political clout—as the disease model has—its stakeholders resort to a wide range of tactics to protect their turf. I think that there exists a rich trove of historical evidence—emails, committee reports, journal articles, censorship and more—that tells how the disease model’s thought-leaders have fortified their defenses and how they’ve even gone on the attack. I don’t think this story has been adequately explored, and it can be told regardless of one’s affinity for the model. One tactic I write about is how charges of stigmatization are often hurled at those who criticize the model. It works; critics often retreat.
Now that the hard part is over, what is the thing YOU find most interesting about your book?
I have always been fascinated by human nature, both its beauty and its sordidness. I’ve tried to capture this in Blowing Smoke. People are opportunistic and this creates problems for most models of human behavior. In college I remember thinking that many psychological theories bore an uncanny resemblance to another popular theory of the time: Marxism. They shared overly reductionistic explanations of human behavior and grand prescriptions that seemed to help the theorists more than they helped the stated beneficiaries.
Human opportunism is the elephant-in-the-room with the disease model, and by extension, with the war on drugs. Addicts, law enforcement officials, neuroscientists and politicians all benefit in important ways, but not in ways that help maintain a civil society. People will behave responsibly when the right kinds of incentives exist, and will behave irresponsibly when the opposite incentives exist. I think we can incentivize responsible drug use without recourse to destructive prohibition laws. Let’s turn back the clock—to 1913.
Every research project leaves some stones unturned. What stone are you most curious to see turned over soon?
In parts of the world where drugs have been decriminalized, such as Portugal, there has not been an increase in drug use and social problems related to drug use have been greatly reduced. I’m waiting for the day when we can study countries that have legalized drugs, taxed and regulated them, and that have also incentivized responsible use.
BONUS QUESTION: In an audio version of this book, who should provide the narration?
Hands-down it would be Morgan Freeman. He’s got the most authoritative, calm, reassuring voice—just what’s needed for the “scary” ideas contained in Blowing Smoke.