Points Interview: David Courtwright

Editor’s note: Points author interviews begin with a set question: Describe your book in terms your bartender could understand. David Courtwright said he preferred conversations with bartenders. He talked to his about The Age of Addiction: How Bad Habits Became Big Business (Belknap Press, 2019). 

Screenshot 2019-07-16 08.40.48Bartender: I hear you have a new book.

Courtwright: Just came out in May. I’ll have the draft IPA.

What’s the book about?

How addictions multiplied throughout human history. Even before civilization people discovered pleasurable drugs and pastimes like alcohol and gambling. They went on finding new ones. They traded, refined, manufactured, and digitized them to the point that we live in an age of addiction. Think about it. When you heard the word “addiction” forty years ago, what came to mind? 

Drugs. Heroin. Junkies. Juicers, only back then we called them alcoholics. 

Google the word now and you’ll find addiction to sugar, video poker, computer games, social media, internet porn, shopping, tanning, you name it.

Could be hype.

Some of it is. And some of it is science. Nora Volkow, the director of the National Institute on Drug Abuse, promotes food-addiction studies.  

What’s food got to do with drugs?  

Our brains—well, some brains—react to food packed with sugar, salt, and fat like it was booze. People can lose control over eating the way they lose control over drinking. They join groups like Food Addicts in Recovery Anonymous

They’re like AA? 

Right down to the lingo. And it goes beyond eating.  When I told friends I was writing a history of addictions, they all said, “You’ve got to include kids glued to their phones.” So I did. Behavioral addictions have become social facts.

What’s history got to do with social facts?

Historians explain their origins and how they changed over time. In The Age of Addiction, it’s a long time.

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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. 

 

Points Bookshelf: “Never Enough” by Judith Grisel

Editor’s Note: Welcome to the first installment of the Points Bookshelf, in which we review books about drugs, alcohol, history–and maybe even a combination of all three. We open with a review of Judith Grisel’s new book “Never Enough: The Neuroscience and Experience of Addiction,” which was released last month. 

If you’re interested in reviewing a book for Points, get in touch! You can reach editor Emily Dufton at emily.dufton (a) gmail.com

Screenshot 2019-03-07 at 9.02.18 AMSometimes it’s nice to consult an expert.

I first heard Judith Grisel on Fresh Air. Her interview with Terry Gross was fascinating. She has a PhD in behavioral neuroscience and psychology from the University of Colorado, Boulder, and she spent a good part of her early life addicted to numerous substances, including alcohol, marijuana, cocaine, heroin, and more. Now drug-free for over thirty years, she is a professor of psychology at Bucknell University, in Lewisburg, Pennsylvania.

Her approach to the difficult subject of addiction is thus colored by all of her experiences. Because of her years as someone who had an unhealthy romance with numerous intoxicants (the title comes from a statement a friend made to her in a seedy hotel room in Miami as they snorted up as much cocaine as they physically could; there would “never be enough cocaine” for Grisel, her friend said, and when she realized the truth in this statement, it was a turning point in her life and career), she’s aware of the havoc addiction can wreak in individuals’, families’ and communities’ lives. As a neuroscientist and psychologist who has spent decades studying how the brain reacts to, and adapts to, intoxicant use, she’s also adept at explaining the biological and neurological underpinnings of this issue.

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Bad History, Bad Policy: Maybe Historians Should Be Ostracized from Society

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

Screenshot 2018-10-07 at 8.19.07 PM

Historians aren’t the first people national publications go for hot-takes. That may be a good thing. But I’ve always been in the camp that says historians should be more active outside of academia. So, I’ve been encouraged by publications like The New York Times and Washington Post reaching out to historians, asking them to analyze the opioid epidemic in its historical context. On the other hand, it’s been frustrating to see those opportunities squandered. An example that caught my eye was Clinton Lawson’s op-ed for the Times, published in May. It’s well-written and pleasant enough to read, but his interpretation of effective policies, then and now, resembles a DEA spokesperson more than a member of the public. Overall, his argument is aesthetic, encouraging us to avoid bad things, like racism or overhyping stories in the news, while at the same time offering the conventional wisdom: penalties and prison.

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Fraud in Addiction Treatment Centers

Editor’s Note: Today’s post comes from guest blogger Nicole Allen. Nicole is a freelance writer and educator based in the Michigan and believes that her writing is an extension of her career as a tutor since they both encourage learning and discussing new things. When she isn’t writing, you might find Nicole running, hiking, or swimming. She’s participated in several 10K races and hopes to compete in a marathon one day.

It seems to be these days that whenever there’s money involved, there’s always a sure case of fraud. Although fraud is not new in business transactions, it can be surprising that some people are finding devious ways to trick insurance companies into paying for the rehabilitation process. Much like watching crime and investigation documentaries about insurance fraud, individuals can also “fake” their way into claiming a benefit from a company, without using it for the actual cause.

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As seen in a Roman epigram: A case of fraud?

Surprisingly, insurance fraud is not a new thing–in fact, it may even be as old as the stone statues built by the previous civilization. As seen in an epigram by the Roman poet Martial, there is a clear evidence that insurance fraud dates back to the old ages of the Roman Empire:

“Tongilianus, you paid two hundred for your house;

An accident too common in this city destroyed it.

You collected ten times more. Doesn’t it seem, I pray,

That you set fire to your own house, Tongilianus?”

Source: Book III, No. 52, Martial

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Language: Abandoning “Addiction”

Editor’s Note: Today’s post comes from Brooks Hudson, a PhD student in history at Southern Illinois University. Brooks is joining Points as a contributing editor for the 2018-2019 year, so look for more posts from him to come. Enjoy!

Historians change their language for all sorts of reasons, specifically when it dehumanizes other people. The humanities have abandoned pejorative and race-based terms, whether it’s “negro,” “colored,” or “oriental.” We understand these terms are powerful and demean others. Similarly, individuals with disabilities no longer face the indignity of having their medical condition be synonymous with who they are as people. Within the last century, we discarded “mentally retarded,” “lunatic,” “imbecile” and “feeble-minded.” Now, we use first-person language, for example, “a person with a mental or physical disability.” Within my lifetime, it’s gone from acceptable to unacceptable to use homophobic language to paint the LGBTQ community as “deviant” or prone to “unnatural desires.” Only in the last five years have mental health professionals acknowledged this mistake and declared that transgender individuals do not suffer from mental illness (“gender identity disorder”). This revision is from the updated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Progress has stalled when it comes to another health issue, however: “drug addiction.” Interestingly, another revision in the DSM-5 was taking out “addiction”—partially because of its “uncertain definition”—and replacing it with substance use disorder. Adoption of this change is underway, but not too many historians are breaking down barricades to enter the debate.

There are a thousand reason to reject “addiction.” It is imprecise. It is laden with value judgements. It is embedded in a history of religious rhetoric. It cannot be separated from largely fact-free government propaganda campaigns, not to mention the newspapers archives that are filled with word, usually within graphic and hysterical accounts that have little basis in reality.

Few have adequately addressed this issue. Fewer have proposed ways to resolve it. Arguably, the closest attempt might be Bruce Alexander’s Globalization of Addiction. In it, he dedicates an entire chapter to disentangling the various meanings of the word, marking distinct usage by subscript—admittedly, a distracting strategy, though one that reduces misinterpretation.

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Ibogaine Treatment: A Psychedelic Approach to Addiction

aaaibogaineToday’s post was contributed by Aeden Smith-Ahearn, who once was a heroin addict for almost 7 years. After trying many different traditional methods to get off drugs, he decided to take a chance on Ibogaine treatment for his addiction. Now, 5 years later, Aeden is the treatment coordinator for a major Ibogaine clinic and he has helped hundreds of individuals find a new life through Ibogaine treatment.

When a highly recognized US medical doctor—the one prescribing opiates to patients on a daily basis—walks through the door of an Ibogaine clinic in Mexico to get treatment for his prescription pill addiction, the massive nature of America’s opioid dependence becomes clear—it affects everyone.

It’s not just doctors but lawyers, teachers, students, parents, CEOs, and the list goes on. Everyone, no matter what walk of life, is a target for opiate addiction. It is physically binding, psychologically confining, and, in almost every instance, impossible to break on your own. Continue reading →