Points Bookshelf: “The Age of Addiction” by David Courtwright

Editor’s Note: It’s David Courtwright week on Points! Today we feature a review by contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University, of Courtwright’s most recent book, The Age of Addiction (Harvard University Press, 2019). We’ll follow Hudson’s review with an interview with Courtwright on Thursday. Enjoy!

Screenshot 2019-07-16 08.40.48In Age of Addiction, the acclaimed historian David Courtwright dips his toes into familiar waters, analyzing the history of the brain reward mechanism through its component parts: pleasure, vice, and addiction. The book expands on earlier attempts, such as John Burnham’s Bad Habits, which investigated America’s evolving attitudes on everything from alcohol and drugs to gambling, swearing, and sex. Building off and updating Burnham, Courtwright injects fresh blood into the discussion, mapping the newest additions to our pleasure palettes. Courtwright catalogs sugary sweets formulated by Nestlé and Kraft, delineates digital subcultures such as the frenzied World of Warcraft, and documents young men’s sexual fetishes—with Pornhub substituting as both sex education and a how-to manual—while still leaving room for gambling, an ever-changing issue as states embrace sports betting following last year’s Murphy v. NCAA decision. Courtwright draws our attentions to the vast “pleasure meccas” erected of late, updating parts of his previous book Dark Paradise (Harvard University Press, 1982) as opioids have returned to the headlines too.   

Let me invite the skeptical reader to ask the obvious question: hasn’t this always been the case? Courtwright would agree, but with a caveat. To conclude “more of the same” ignores three critical distinctions. First, the rate “hedonic change” has accelerated, Courtwright likening it to the rapid pace of technological change, following its own “Moore’s Law of brain reward” (164). (Moore’s law, first delineated in 1965, predicted that the speed and capability of computers would double every two years due to advancements in the number of components per integrated circuit; in the past half-century, this has proven to be untrue: computer speed now doubles much more rapidly.)

Second, pleasure and vice are more diverse and ubiquitous, appealing to specific subsets of the population. Third, and most significantly, pleasure and vices are meticulously engineered by companies with billion-dollar marketing and advertising budgets. In effect, this means that Big Pharma, Silicon Valley and the food industry have grown much more efficient at weaponizing our weaknesses against us, and reaping the profitable rewards. This asymmetry means companies are able cater and concoct an ever-widening array of products and pleasures, while conveniently sidestepping externalities and effects on global health. Whereas earlier eras met vice with reluctance, if not with outright resistance, today the tendency is on an opposite trajectory: vice is both normalized and accepted. 

 

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David Courtwright

The Age of Addiction hones in on the brain reward system’s “big bang” moment, tracing it back to the agricultural revolution. What characterized pleasure, vice and addiction then was limited. People dabbled with local food-drugs but had little else at their disposal. Pleasure was in its infancy. Gambling, for instance, consisted of improvised devices: “sticks, shells, fruit pits,” and the occasional animal bone. Questions of accessibility or affordability were not yet part of the vocabulary. From the agricultural revolution on, the story follows a familiar trajectory: the invention of new technology, innovative forms of transportation, and specialized knowledge that built up networks for global trade, transforming rickety ship with a few luxury goods into colossal container ships packed with the inexpensive goodies we all enjoy today. 

The second half of the book deals with changes over the last hundred years or so. In the late nineteenth and early twentieth centuries pleasure, vice and addiction seeped into urban areas, leaving few places or people untouched by their influence. In response, anti-vice reformers rallied and challenged vice’s legitimacy and sought to ban or suppress commodities like narcotics and alcohol and activities like prostitution and gambling. Reformers, as Courtwright sees it, have been unfairly maligned and should be given a second hearing, or at least some credit for enacting regulatory measures that curbed use and resulted in improvements to public health. He argues that we should not separate some reform measures and label them “progressive” (among them, sewage and water infrastructure and vaccination efforts) from their other attempts to eliminate vice. In practice the desires that propelled one propelled the other activities as well, all with the aim of improving public health and safety. Yet the gains made by anti-vice reformers were partial. They failed, as Courtwright documents, for multiple reasons: from internal divisions, corporate resistance and government ambivalence on the one hand, and from their desire to raise revenue on the other. 

Neoliberalism was in its ascendancy by the late twentieth century. It brought with it a new figure, the “vice entrepreneur” who pushed and profited from packaged delights. Courtwright coins the term “limbic capitalism,” described as “a technologically advanced but socially regressive business system in which global industries, often with the help of complicit governments and criminal organizations, encourage excessive consumption and addiction.” Limbic capitalism refined the art of exploiting brain reward and weaponizing it against consumers, perhaps best captured by the Pringles slogan: “Once you pop, the fun don’t stop.” This corporate slogan distills the limbic capitalisms formula: hook customers, encourage them to indulge, rinse and repeat—or, in short, reap the rewards and ignore responsibility for subsequent externalities. Limbic capitalism continues as a force to be reckoned with. It has aided overeating, led to distracted driving, compulsive porn consumption, and other ills. And all of it was intentionally constructed to be this way, causing some of the biggest public health problems globally, according to Courtwright. 

“Limbic capitalism” differs from capitalism through its route of administration: brain reward and its repetition. But is limbic capitalism more predatory or detrimental to public health than the routine behavior of say, Big Pharma or the climate catastrophe wrought by the fossil fuel industry? And does that matter? These are some questions that lingered. One feature that works in limbic capitalism’s favor it is that it is easy to understand, meaning there is less asymmetry of information—risk, for instance—when buying cigarettes or alcohol than in other transactions, like purchasing health insurance, signing financial contracts, or whatever it is we are agreeing to when we hit the “agree” button after every iPhone update. The book’s last line recommends that “we should be against excess,” which, in general, is sensible. But as a concrete matter, policy implications and what limiting excesses means in practice—preference for punitive or health-oriented approaches—also matters but gets less attention. Courtwright offers solutions: government regulation, restrictions on advertising, targeted taxation, and education campaigns. All of these could be good, depending on a lot of other things. 

Like any book, Age of Addiction has shortcomings, many of which might be exposed by the authors and thinkers he cites. Critics of the brain disease model will be disappointed there is not a full airing of arguments made against it, such as Marc Lewis’s The Biology of Desire. Stanton Peele, mentioned twice, will likely continue to have his reservations about this book over exposure and accessibility. This same could be said for Bruce Alexander, whose book The Globalization of Addiction disagrees with Courtwright when Courtwright argues that exposure is a driving force for addiction — Alexander’s other writings suggest that exposure is a secondary or tertiary concern.

Courtwright also perhaps missed an opportunity in his exploration of vice, a very elastic category, limiting it only to individuals and excluding corporate persons. Vice is defined as “bad for the individual, bad for other people, bad for the social order, or some combination of the three” (emphasis mine). Vice looked at through the lens of greed would have been an edifying avenue for him to pursue: patients rationing insulin, some dying; the “public health” consequence of things like the EpiPen, a drug that sells for several hundred of dollars while its active ingredients cost pennies. This could have played to Courtwright’s advantage, given that he uses the idea of “nudges.” Everyone can get behind Courtwright’s goal, which ultimately is about improving public health, but if public health continues to be mostly privatized, preventing people from accessing essential services—mental health services, medication, and the rest—many of the issues discussed will unfortunately remain unresolved. 

 

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Points Bookshelf: “Ten Drugs” by Thomas Hager

Editor’s Note:  Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University. As part of our Points Bookshelf series, he reviews Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine (Abrams Press, 2019), and breaks his findings down into a few major takeaways.

 

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Drug policy historians, academics and the press more generally often present drug use as though it were a marginal activity. We can fault a lot of this confusion on the arbitrary distinctions that are commonly made, starting with categories like legal and illegal use, which are then further subdivided and sliced into even more granular classifications.

Thomas Hager’s Ten Drugs whose focus is on prescription “medications,” opens the book by highlighting drugs’ ubiquity in American life: “More than half of all Americans take at least one prescription drug on a regular basis, and most of those who fall into that group take more than one (somewhere between four and twelve prescriptions per person per year, depending on which study you look at). One expert estimates that Americans takes an average of ten pills per person per day. Add in nonprescription drugs—over-the-counter vitamins, cold and flu remedies, aspirin, and other supplements—and run the numbers: Let’s say a low-ball estimate of two pills per day per American over an average of seventy-eight plus years of life. The total outcome comes to somewhere more than 50,000 pills, on average, in the average American’s lifetime. And there’s a good chance it’s a lot more. Americans constitute less than 5 percent of the world’s population but spend more than 50 percent of the money that flows into the world’s drug companies. And that’s not even counting illegal drugs.”

Once you throw in recreational and illegal drugs, this leaves no segment of society untouched. These figures could be interpreted as troubling, as our society grows ever reliant on psychological crutches to get through the day. Of course, while that’s partially true, there are also serious issues that have been left unresolved, to say nothing of the precarious state millions wake up to. Setting that aside, the larger point is our discourse is divorced from this underlying reality.  

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Nuance-Trolls and Bad-Faith Policy Debates

Editor’s Note:  Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

How do you make someone reluctant about supporting a policy? One strategy is to suggest people with clear answers do not appreciate just how complicated, complex, multifaceted—and my favorite — “nuanced” the situation really is. No one wants to view themselves as unsophisticated or unrefined and this plays on that insecurity. Unfortunately, major news outlets embraced this strategy, for some reason, and one can only speculate about motive.

What am I talking about? These constant nuance arguments. You’ve probably read them: the ones that muddy the waters but don’t seem to say anything. There’s even a term for it. It’s nuance-trolling; not the best term, but it works. Nuance-trolling is constructing a debate by evading and relying on rhetorical filibustering; it turns complexity into a virtue, a fetish for its own sake. Sociologist Kieran Healy of Duke University summed it up in his article “Fuck Nuance,” arguing that nuance, or rather what he called “actually existing nuance,” a pillar of academia and mainstream discourse, “is what one does when faced with a question for which one does not yet have a compelling or interesting answer. Thinking up compelling or interesting ideas is difficult, so it is often easier to embrace complexity than to cut through it.” In his essay, he writes about “nuance traps.” One is “the nuance of the fine-grain [ed],” an “empirical description… masquerading as increased accuracy.”

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Treatment, as it exists, is treatment for the few

Editor’s Note:  Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

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If you look at recent coverage of opioid epidemic, media outlets admit that in the past they added gasoline to the fire during the “crack epidemic” and want to apologize for those mistakes. The New York Times editorial board gave a belated “whoopsie-daisy” for feeding the American people a steady diet of bad science and race-baiting incitement several decades ago. In their mea culpa they wrote:

“Today, with some notable exceptions, the nation is reacting to the opioid epidemic by humanizing people with addictions — depicting them not as hopeless junkies, but as people battling substance use disorders — while describing the crisis as a public health emergency. That depth of sympathy for a group of people who are overwhelmingly white was nowhere to be seen during the 1980s and 90s, when a cheap, smokable form of cocaine known as crack was ravaging black communities across the country.”

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Points Roundtable, Part 3: Brooks Hudson on Alex Berenson’s “Tell Your Children”

Editor’s Note: Today we bring you the third installment of our roundtable on Alex Berenson’s new book Tell Your Children: The Truth About Marijuana, Mental Illness, and ViolenceThis post comes from Brooks Hudson, contributing editor and a PhD candidate in history at Southern Illinois University. 

screenshot 2019-01-21 14.01.00Alex Berenson’s Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence is refreshing in one sense: I know what I’m getting. I know where Berenson stands. Occasionally you find a crop of contrarian pieces in places like The Atlantic, Annie Lowry’s “Invisible Addicts” being one recent example, that hide behind a detached third-person voice, making it impossible to gauge what the writer believes, whether they are engaging in an empty intellectual exercise, adding a manipulative headline to drive traffic, or whether it is sincere. With Berenson, despite the shoddy research, which any number of researchers have already denounced, this doesn’t happen because his hostility to cannabis is reinforced for more than two hundred pages.

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Visible Problems with “Invisible Pot Addicts”

Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD candidate in history at Southern Illinois University. 

The Atlantic, as one critic remarked, “perfectly captures…the puzzled dining club member’s approach to civic and political organizing, and the all-around obtuseness of elite discourse”; it is an “ideological compromised organ of beltway consensus.” Matt Christman, of Chapo Trap House fame, quipped in one episode that The Atlantic is “neoliberal Dabiq,” a death-cult of discredited ideas concealed in a glossy facade. Jeffrey Goldberg, the Atlantic‘s editor-in-chief, was an early and enthusiastic promoter of the Iraq War, injecting into the bloodstream such fantasies as the collaboration between Saddam Hussein and Al Qaeda. His journalistic style, as one watchdog organization put it, was “complete with cherry-picked evidence, dubious inferences, rejection of contradictory evidence and ideological blinders.”

Don’t get me wrong, The Atlantic isn’t total garbage, but, like a kitchen after Thanksgiving, garbage is involved.

By that I mean that the Atlantic has a tendency to generate two kinds of content: the inane and the disingenuous. An example of the former: attributing “bigotry on the right,” to the left. Another example: solving New York’s subway system à la hoverboards.

But Annie Lowrey’s recent article, “America’s Invisible Pot Addicts,” isn’t inane, just disingenuous.

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The Pharmacological Era

Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a history PhD student at Southern Illinois University.

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Stanton Peele

Psychologist Stanton Peele refers to the time we’re living in as a “pharmacological era,” one where “drug use, both approved and unapproved, is widespread, almost universal.” Currently, it’s dealt with through regulation and prohibition. Dr. Peele argues: “Instead, we need to accept drug use as socially and psychologically regulatable behavior to be incorporated into modern life.”

In some ways, we’re already there. It’s near universal, just two-tiered. A Vice News headline summed it up perfectly: “America’s Rich and Powerful have permission slips to get high.” We don’t have to look far to see these inequities in action. Recently, Elon Musk—of Tesla fame—smoked a blunt on the Joe Rogan Experience. Had it been a Tesla employee, they would’ve been fired. Ivy League students swallow smart pills to study just like their future selves, the businessmen burning the midnight oil. And a white woman popping a Xanax found in the seabed of her Hermès bag, totally normal too. But a black man smoking a joint—whoa, wait a minute, that’s unacceptable. So, yeah, like I said universal but two-tiered—same dynamic in Washington. Recall Dr. Ronnie Jackson, Trump’s (failed) nominee for Veteran Affairs Secretary. Apart from his stunning lack of qualifications and experience, we learned during his time as Physician to the President he regularly doled out Schedule II drugs for recreational purposes. As Politico reported:

Nearly a dozen current and former officials — including some who were treated by Jackson while working in the Obama White House — say Jackson is being unfairly labeled as a “candy man” and that casual use of some prescription drugs is an established fact of life at the highest echelons of government. “Not everyone wants it. But anyone who does gets it,” said a former Trump administration official who traveled extensively with Jackson and the president.

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