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 »
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. Follow the link above to see the professionally-recorded presentations in their entirety.
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.
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.
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 (see the videos linked above). I can only hope that this conference serves as a model for more interdisciplinary gatherings in the future.
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 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.”
(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.
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.
Editor’s Note: Two upcoming opportunities for ADHS scholars to gather together and discuss ideas. Submit papers for conferences in Ohio (April 2016) and Illinois (July 2016). Contact information for both, below.
Alcohol and Drugs History Society
Ohio Academy of History
April 1-2, 2016
Kent State University – Stark Campus
Call for Papers
The Alcohol and Drugs History Society (ADHS) is organizing several sessions at the 2016 Spring Conference of the Ohio Academy of History, a professional society that brings together teachers, scholars, public historians, and students of history.
If you are interested in presenting research to Ohio historians related to the history of alcohol use, temperance, drug use (legal or illicit), prohibition, tobacco, drug enforcement, or related topics, please submit the title of your research paper and a 100-word abstract by October 15, 2015 to email@example.com.
Stephen Siff David Fahey
CALL FOR PAPERS
“I’ve Been to Dwight”
Transnational Perspectives on Addiction, Temperance and Treatment in the Nineteenth and
Dwight, Illinois; 14-17 July, 2016
“I’ve Been to Dwight,” is an off-year conference of the Alcohol and Drugs History Society, commemorating the fiftieth anniversary of the Leslie E. Keeley Company’s closure. It will gather historians and social scientists at the site of the company’s former headquarters in Dwight, Illinois to present and discuss new research on the history of addiction, temperance and treatment in the nineteenth and twentieth centuries. The conference offers an opportunity to discuss these broad topics in a transnational, comparative, historical framework and will not limit participation to any particular psychoactive substance, habitual practice or region of study.
We wish to encourage applications from scholars at all ranks, including graduate students, junior and senior faculty, archivists, collectors and historically minded treatment professionals.
Applications for individual papers, full panels and/or table and poster displays are welcome.
SUBMISSION DEADLINE, 15 DECEMBER 2015
For full details, including submission, see:
Editor’s Note: In this, our last installment of the Points roundtable on Howard Becker’s Becoming a Marihuana User, we are thrilled to welcome the author himself. Here, Becker responds to our previous contributors and offers some insights of his own.
We’d also like to take this opportunity to once again thank Nancy Campbell, Mary Jane Gibson, Amanda Reiman, Cookie Woolner and Carl Hart for their intriguing, thought-provoking and entertaining contributions. We are honored to count you as members of the Points family.
I have never been a “marijuana expert,” certainly never claimed to be such a thing. But I was, for quite a while, the only sociologist who had ever actually published anything about it. So, when it did become a legitimate topic of study and big shots and politicians convoked meetings to decide on scientific matters related to the subject, the attendees mostly consisted of physiologists and pharmacologists and psychologists. But, just to avoid troubles, the organizers of these events always thought they should have a social scientist and for quite a while I was the only one who had the slightest claim to be there. Eventually, of course, plenty of others joined me, including people like the anthropologist Mike Agar. Nancy Campbell talked with me about that phase of the thing and she did an excellent of getting me to tell about the politics of that period, which was pretty funny.
As a result of that phase of my “being an expert,” I became more expert than I had been by learning a lot from hanging around between meeting sessions with people like Mike and Andy Weil, who were doing research on the drug. A whole apparatus had been built up out of people who had met at such events and thus come to understand the politics involved at the level of science and research (also covered in my interview with Nancy Campbell). In addition, I was part of the informal information exchange created by Allen Ginsberg, who traveled constantly and kept his eye on who was doing research about what. He would call me when he came through Chicago to ask if I knew about so-and-so who had some interesting findings on this or that and wanting to know if I had anything new to tell him.
Well, I didn’t, not really, because my interests had moved on to other areas of activity, like art. But the basic ideas that I got out of making sense of the marijuana experience stayed with me because they traveled well and turned out to be useful in quite different areas. Most recently I devoted a chapter in What About Mozart? What About Murder?, to a sort of updating and generalizing of what I learned from the work I did fifty years ago, pointing out how it helps make sense out of a lot of other things, not just more recently invented substances but even what happens to people climbing Mt. Everest (where there isn’t a whole lot of oxygen in the air) and other situations where the ordinary inputs to our physical experiences take new values and produce novel feelings.
At the intersection of race, space, class and hoops Jalen Anthony Rose entered the national imagination in the twilight of the Crack Era. Depending on where you stood in the culture wars, Rose and his teammates—dubbed the Fab Five—were cultural icons or yet another sign of a culture in decline. Broadcasting personality Dick Vitale bemoaned the team’s aesthetic, blaming their “ugly black socks,” baggy shorts and shaved heads. From Vitale’s perspective people didn’t look at the young black boys as “that clean cut, that All-American sort of guys.” Basketball legend Bill Walton once known for his anti-establishment politics and counterculture leanings rankled that the team “epitomized what is wrong with a lot of basketball players.” Something was clearly different about this young team. Beat writer Brian Burwell assessed the situation best: “It was all generational and cultural. If you were young and black, you were like, ‘those are my boys.’ If you were old and white, you were going, ‘oh my god the criminals are taking over our sports and influencing our children. Get away from the TV.’”
Ice Cube, a cultural icon in his own right, referenced the teams “style, swagger and attitude.” In a “cultural sense” Ice Cube argued, “they represented the homeboys and the homegirls.” Of the five, no member of the team represented the brash defiance of the streets more than Jalen Rose. A proud graduate of Detroit’s Southwestern High School, Rose grew up poor, raised by a single mother. Rose and his father—NBA star Jimmy Walker—would never meet. Despite growing up around dope houses and shooting galleries, Rose stuck to the basketball courts at the recreation center of St. Cecilia’s. Regardless of his personal merit, Rose was still a kid from the hood. As such he nearly became prey in the broader War on Drugs.
October 4, 1992 was just another day in Southwest Detroit. Jalen and three friends, Lamont Wheeler, Garland Royall and Daman Holmes gathered on a Sunday morning at the house of their high school friend, Frederick Hogan. A conspiracy to play video games. With John Madden in the Sega Genesis, the boys were ready to relax. Unfortunately, October 4, 1992 was indeed just another day in Southwest Detroit. Police piled through the unlocked door yelling, “Police! Search Warrant!” This was a drug raid but this was not a crackhouse. Nonetheless, the house and their persons were searched. Rose, per usual, had no drugs or paraphernalia on him. Ditto for three of the other boys, including Frederick Hogan, the owner of the house he inherited from his recently deceased mother. The police were about to come up empty.Read More »