EDITOR’S NOTE: Today’s post is written by Points contributing editor Michelle McClellan.
Like many others, I read the story in Rolling Stone magazine about a gang rape at the University of Virginia with a sense of mounting horror. Then, when I began to hear hints and then assertions that the victim’s story might not hold up, I felt angry and confused—for a lot of reasons. The fallout from this story and its aftermath has been extensive, and will likely change again before you read these words. The cover page of the December 5, 2014 Chronicle of Higher Education includes the headline “UVa Rocked by Account of Rape” but that is overshadowed on the page by a photo of recycling bins heaped high with Bud Light cans to illustrate a special report called “Alcohol’s Hold on Campus.” How, if at all, do these stories go together?
Editor’s Note: Guest blogger and medical anthropologist Kim Sue returned from a recent conference entitled “From Punishment to Wellness: A Public Health Approach to Women and the War on Drugs” with some questions about the coherence of the public health paradigm.
To celebrate the release of a joint report published by the New York Academy of Medicine (NYAM) and the Drug Policy Alliance (DPA) entitled a Blueprint for a Public Health and Safety Approach to Drug Policy, WORTH (Women on The Rise Telling Herstory) organized a conference focusing on women and the War on Drugs. The conference brought together formerly incarcerated women, direct service providers, researchers, policy analysts, and advocates and activists to discuss how to move from a criminalization model of drug use to a public health model. “The war on drugs is more than a failure,” the organizers announced. “It has swollen the prison system, left millions of people with criminal records and damaged communities.” The one-day event was aimed at exploring “practical examples of public health alternatives,” through discussions around four main themes: prevention, treatment, harm reduction, and safety.
What was interesting to me during the panel sessions and the break-out groups was the relative absence of public health professionals and clinicians in these discussions (one notable exception was Professor Lynn Roberts of Hunter College’s Department of Community Health). While “public health” was one of the buzzwords of the day, it seemed to stand in for other things that the conference attendees were actually more interested in talking about: structural violence, poverty, racism, patriarchy—often referred to as the “structural determinants of health.” One possibility is that “public health” was being used rhetorically as a means to talk publicly and politically about race, class, gender and various axes of social inequality under “public health’s” cloak of respectability.
There was some discussion of specific legislation and public-health oriented programming by several of the speakers—for example, Good Samaritan Acts, needle exchange programs, the decriminalization of sex work, and bills against the criminalization of HIV status—but the conference neglected how the massive apparatus of the War on Drugs endeavor will be “public health-ified” on a large scale. What will be the unintended consequences of doing so?
New York mayor Michael Bloomberg’s attempted ban on the sale of sodas larger than 16 ounces suffered a defeat in court a few weeks ago. But criticism of the industry that has been termed “Big Sugar” or “Big Food” shows no signs of abating. Those critical names are spinoffs from a down-market brand we all remember: Big Tobacco. Public health advocates from the populist food writer Michael Pollan to the lauded obesity researcher Kelly Brownell draw a direct comparison between the tactics of today’s convenience-food conglomerates and the tobacco industry of the twentieth century. Michael Moss’s recent bestseller Salt, Sugar, Fat reads like a journalistic sequel to historian Allan Brandt’s Cigarette Century.
Moss’s book begins with a series of comparisons between cigarette manufacturers and Big Food companies like Kraft and General Mills (both, he notes, now owned by Philip Morris). Moss draws from a series of executive testimonials and previously secret industry documents that detail the familiar tactics the companies used: scientific breakthroughs that exploit our basic biological impulses for consumption, collusion with government regulators, marketing targeted at children—all of which, he concludes, resulted in a growing chronic disease burden. With this common history established, the analogy seems straightforward: cigarette manufacturers are to cancer as food companies are to obesity-related illnesses. But it has a subtext that should interest alcohol and drugs historians as well as regulators: the suggestion that sugary substances aren’t just physiologically harmful—they’re addictive.
Critics like Moss are already alleging that the “Food Giants Hooked Us.” While I’m not sure I buy the argument, I can see how the threat of “addictive potential” might be politically useful for activists seeking to establish new regulations to curb the consumption of processed food and drinks.
Wine, chocolate, cigarettes: psychoactive substances have long been trappings of romance. As far back as high school English, I was instructed that the definition of romanticism owes a debt to the Shelleys and their opiates. For lovers who make substance use a routine rather than a romantic ritual, the days of wine and roses turn tragic. Psychologists have other words for this dynamic: codependency, misplaced loyalty, marital dysfunction.*
Some anthropologists take issue with the way substance-using couples are depicted in mainstream public health scholarship: “While other people have lovers and spouses,” wrote Nina Glick Schiller, “drug users have only ‘sex partners.’” People who use drugs—whether in couples or subcultural social networks—are seen as a special population at greater risk for contracting and transmitting infectious diseases such as AIDS or hepatitis. Neutral scientific terms like “sex partners” are designed, at least in part, to de-stigmatize at-risk populations by objectively describing pathways of disease transmission that might necessitate public health interventions.
But even before the AIDS crisis reinvigorated the perception of substance-using sex partners as vectors of disease, self-help and social science literature depicted the relationships as degrading. Read More »
Last month, I attended the American Public Health Association conference in San Francisco. While there were many interest groups and high-profile lectures that appealed to my interest in the history of addiction, I wound up spending most of my time at the Public Health Expo. In a stadium-like open space, my research team’s posters competed for attention with potential employers, university recruiters, and lots of public health swag.
As I was making the rounds, I stopped by the SAMDHA table. SAMDHA —short for the Substance Abuse and Mental Health Data Archive—is a fabulous database of survey results collected by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The University of Michigan’s Inter-University Consortium for Political and Social Research (ICPSR) maintains the archive, from which researchers or quant-savvy members of the public can download datasets and run analyses using a range of different statistical software programs. They can also use the online analysis tool provided on the SAMDHA website.
Finding this tool even cooler than swag, I asked the representative to help me run some basic descriptive statistics about Georgia’s alcoholism treatment admissions, drawn from the Treatment Episode Data Set (or TEDS) survey. We clicked through the site to the analysis tool, and clicked again. No data. We tried another year—no luck. Toggling through the site, we discovered that Georgia had not reported its treatment data to SAMHSA since 2006—and that it was the only state to fail to do so.
Since 2006, there have been big changes in Georgia’s substance abuse policies. Governor Nathan Deal (a former Democrat who switched parties in 1995) was elected in 2010 and immediately began an overhaul of the substance abuse policies that had driven Georgia’s rate of incarceration, which was among the highest in the nation. While pursuing other austerity measures for the cash-strapped state, Deal recommended over $5 million for the creation of residential substance abuse treatment centers and $10 million to support the creation of new drug courts that would divert offenders from jail and prison. The Obama administration and other mediaoutlets hailed Deal’s enlightened drug policy. But without accessible TEDS data from previous years, it will be more difficult for the public to evaluate the impact of policies designed to increase access to residential addiction treatment or encourage treatment rather than incarceration.
The rapid expansion of addiction treatment and drug courts was accompanied, ironically, with a populist challenge to Georgia’s long-standing Blue Laws. A coalition of libertarians, fiscal conservatives, and unchurched beer enthusiasts passed ballot initiatives allowing Georgia counties to overturn the state-wide ban on Sunday alcohol sales. Of the 128 cities that placed Sunday sales on the November 2011 ballot, 105 approved the referendum. While several extra hours of access might not lead to an increase in individuals seeking alcoholism treatment, the circumstance is exactly the kind of natural experiment that has occupied alcohol policy researchers—and historians—for decades. That is, when they can get the statistics.
Scholars will face a challenge in determining whether the new Georgia policies moved population-level treatment data. According to my later correspondence with a SAMDHA representative, the state reportedly “had issues with their data system contractors” which “caused them to have no data in the TEDS database since 2006.” The problem has apparently been solved, and figures will be reported again beginning with 2011. The five years of data from 2006-2010 is probably lost.
I admit, I was disappointed— until it occurred me that the missing survey data makes early twenty-first century Georgia a lot like the vast expanse of alcohol and drugs history. Most of the blockbuster surveys that fall under SAMHSA’s purview today—including studies like the Drug Abuse Warning Network (DAWN) and the National Survey on Drug Use and Health (NSDUH) — didn’t get underway until the 1970s, when federal officials began viewing addiction as a large-scale social problem and promoting the expansion of drug treatment.
The surveys like TEDS and DAWN work a lot like the epidemiological approach to monitoring diseases: hospitals or treatment centers report cases of drug overdose or drug treatment admission up the chain of command. When states report the cases to the federal government, officials are able to analyze particular areas of interest, identify national trends, and coordinate appropriate responses. The research process is far from perfect—there are some lively debates in early National Institute on Drug Abuse publications— but I still view the longevity of surveys like TEDS as evidence of a moment in which government officials sought to align new drug policies like the promotion of treatment with an ambitious national research agenda. The studies continue to be a wonderful resource for historians as well as policymakers.
In the absence of representative national survey data, we synthesize secondary data, estimate, and speculate. Those three useful tools have inspired provocative arguments about the validity of addiction statistics from the Anslinger era, or the hypothesis that national alcohol Prohibition was a short-lived public health success. But the systematic, national, population-based research of the last 40 years helps us say with some confidence that, for example, marijuana is making a comeback among youth or the main source for non-medical prescription drug use is doctors, not dealers. While all surveys have limitations, the insights they provide offer a useful starting point for research questions and plenty of fodder for historical interpretation.
One scholar summed up the importance of Census data to historians thusly:
“Imagine a history of the Revolutionary era written with Census returns. Imagine a history of the Civil War era written without them.” As an alcohol and drugs historian, you could say that the addiction treatment revival of the 1960s and 1970s is my Civil War, and surveys like TEDS are my Census.