Editor’s note: As has become apparent in this symposium, how individuals read The American Disease depends on when and where they first encountered the book. In today’s post, Caroline Jean Acker, author of Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control (2002) reflects on how The American Disease played in the social world of street-level drug education and ethnography in the late 1970s.
On February 1, 1979, I walked into the office of Up Front Drug Information in Miami’s Coconut Grove, my first day on the job as Coordinator of the agency. Smaller and less well known than the Do It Now Foundation or the Student Association for the Study of Hallucinogens (STASH), Up Front shared these groups’ conviction that scare tactics did little to deter drug use once people found even one of their claims false.
Founded in 1973 by Tracy Brown, Up Front assumed that if people were going to use psychoactive drugs, they would be less likely to experience undesirable effects if they had accurate information about them. Lacking clear understanding of drug effects, they risked overdose and other untoward outcomes. The organization maintained a small library (books ranged from Goodman and Gilman to Peter Stafford’s Psychedelics Encyclopedia; periodicals, from The New England Journal of Medicine to High Times), fielded questioners’ phone calls, developed and distributed pamphlets on drug effects and risks, managed a DEA-licensed anonymous street drug testing laboratory, and produced a small monthly magazine called Street Pharmacologist.
My first published writing appeared in this venue where, as editor, I accepted my own submissions. When I was hired, I knew little about psychoactive drugs, and Tracy set about educating me before he went off to law school.
The first book he put into my hands was David Musto’s The American Disease. Read this, he told me, and you’ll see where American drug policy came from. I devoured the book. The American Disease set my first context for thinking about Americans’ social and legal responses to psychoactive drugs. I read other books, such as Ed Brecher’s Licit and Illicit Drugs and Andrew Weil’s The Natural Mind. And I also found that Musto’s form of history had limits in its ability to help me understand the experience of drug users. But Up Front’s staff included, half time, an anthropologist, Patricia Cleckner (later, Patricia Morningstar), who had written a fieldwork-based dissertation for Cornell based on her experience of living in a therapeutic community in New York City. Her ethnographic work with different groups of drug users in Miami enabled deep insights that informed both the academic and activist aspects of my professional life.
Some years and jobs later, I decided I must return to graduate school (I had left Stanford’s graduate program in history with a master’s in 1970). The question motivating my graduate school research emerged from my experience at Up Front. I had worked there from 1979 to 1982. During that time, I witnessed a debate over how best to define “addiction.” An older definition held that a drug was addictive if it produced both tolerance and a physiologically overt withdrawal syndrome. But a new definition was emerging during the years I worked at Up Front: one focused on drug users and one that included stimulants as well as depressants. This new definition (which I quickly came to call the Three C’s) held that Compulsive drug use which was out of Control and continued in spite of adverse Consequences constituted addiction.
My dissertation research was driven by the question, where had that earlier definition come from? What emerged was a story of disciplinary silos. As reform-minded psychiatrists in the early 20th century established community clinics, insinuated themselves into the court system, and otherwise sought to influence broad areas of American life, so also they sought to explain addiction on the basis of character and behavior. Pharmacologists, in turn, put to the task of developing a nonaddicting analgesic to replace morphine, focused solely on measurable drug effects. Happily for their purpose, the physiologically overt withdrawal syndrome produced by opioid dependence proved quantifiable and a reliable test of addictiveness resulted. Less happily, one candidate drug after another which showed good analgesic strength also displayed problematic liability for addiction. From these two disciplines, psychiatry and pharmacology, arose a definition of addiction that included physiological aspects (tolerance; withdrawal) and characterological ones (heroin addicts, the focus of concern through the middle of the twentieth century, were liable to addiction because of fundamental defects of character). Finally, sociologists sought to understand addicts’ behavior as experienced by addicts themselves. Each of these disciplines turned its own eye on the phenomenon of addiction.
Drugs were also placed in silos as scientists and clinicians debated whether certain drugs were addicting or not, or perhaps psychologically, but not physiologically, addicting. By contrast, the definition of the late 1970s, emerging largely from the Free Clinic movement, was a unified perspective that included all drugs associated with a particular pattern of compulsive behavior. In the same period, growing cohorts of NIDA-funded ethnographers, inspired by an earlier generation of sociologists (mainly, Alfred Lindesmith and Howard Becker) brought an anthropological sensibility to the study of drug users and the contexts and meanings of drug use. (And both the Free Clinic movement and the work of the ethnographers helped shape the ethos at Up Front.)
As I worked on my dissertation, I would get to a place where, say, I wanted to characterize physicians’ ideas about addiction in the 1910s. Or, what about the maintenance clinics of the immediate post-Harrison years? Oh, no, how much time and research would this take? Not to worry: David Musto had done the work before me. This happened over and over again. I came to see that the first thing to do when I had such a question was to pull The American Disease off the shelf.
David came into my life in a third critically important way when he organized two drug history conferences at Yale in the mid-1990s. At one time, American drug history had consisted almost entirely of the Two Davids: Musto and Courtwright. This phase lasted from 1982, when David Courtwright’s Dark Paradise appeared, into the 1990s. Then, about the time that I began my own historical research on drug use, so did others, including Sarah Tracy, Joe Spillane, and Nancy Campbell. Many of us first met each other at a conference organized by David Musto in 1996. I vividly remember the reception on the second evening, when I kept walking around to different groups of my new friends, saying, “Remember when drug history was just two guys named David?” And the Younger David leaned against a wall, surveying the room, grinning broadly, and saying over and over, “I’m so happy! I’m so happy!”
The Elder David convened a second conference in 1998 to observe the 100th anniversary of Bayer’s introduction of heroin onto the market. (He approached Bayer for possible funding; unaccountably, Bayer declined!) This time, he included key scientists and policy makers from the Nixon years, including Jerome Jaffe, Egil Krogh, and Herbert Kleber, who gave a keynote speech at dinner. In organizing these conferences, the Elder David drew on his stellar reputation to secure the requisite funds from NIDA. Not only as a scholar, but also as a generous mentor and networker, David Musto left a profound and indelible mark on the still growing and ever more vibrant field of the history of drugs in America and the world.
–Caroline Jean Acker