Courtwright (whose earlier book, Dark Paradise, detailed commonplace narcotics use in the nineteenth-century America) has written a sprightly and often fascinating account of how substances are brought into the mainstream, banned, and soldlicitly and illicitlyas commodities. Unfortunately, as with his previous work, he can't get free of the idea that some drugs are really dangerous and are driving markets, even though his own history shows how remarkably fluid and malleable drug images and commerce have been throughout history. Thus, while he toys with harm reduction concepts, he is thrown back on drug menace paranoia and recommending more effective means of eradicating the drug scourgewhatever drug that may be. This review serves as an introduction to a popular readership of the futility of efforts to ban drugs through the ages and of the concept of harm reduction.
Psychology Today, July/August, 2001, p. 72
The World As Addict
Review of Forces of Habit: Drugs and the Making of the Modern World, by David E. Courtwright
Ask the next person you meet to name the most serious problem facing America, and chances are he or she will say, "drugs." Good answer. The annual cost of drug-related law enforcement, lost productivity and illness (IV drug use is a major cause of AIDS transmission) runs into the billions. The cost in human suffering is incalculable. What should we do about this monstrous problem?
History might suggest an answer. Understanding how drugs spread through nations and across continents, and how governments have dealt with drugs and with what results, might help us learn how to deal with the issue today. For that reason, Forces of Habit: Drugs and the Making of the Modern World is a welcome volume. Written by David Courtwright, Ph.D., a social historian and professor of history at the University of North Florida, his book is "the story of psychoactive commerce."
Courtwright's theme is that psychoactive drugslegal and illegalare commodities, like sugar or soap. They are manufactured, packaged, distributed, marketed and used much like any other commodity. Drugs go in and out of favor (tobacco is increasingly unfashionable in the U.S.), prices obey the principle of supply and demand, and new and improved products are constantly being introduced. The drug businessboth legal and illegalis highly competitive, and those in it are always trying to reduce costs and maximize profits. One result is that throughout much of the world today, opium "costs less than alcoholic beverages or other recreational diversions."
Throughout history, governments have generally treated drugs like other commodities. In the latter part of the 19th century, for example, opiates were legally available in the U.S. and Britain in the form of patent medicines and were commonly and casualty used. About 100 years ago, however, many countries, including our own, adopted a restrictive policy. Certain drugs (the big three being alcohol, tobacco and caffeine) remained legally available; others were outlawed.
Although illegal drugs such as marijuana, opium and cocaine now inspire fear and loathing, the legal status of a drug has little to do with its intrinsic properties. Some people abuse alcohol, a legal drug, with devastating results; many others use cocaine, an illegal drug, in moderation and function very well. The adverse effects of a drug have less to do with the drug than with the person using it. The hypocrisies of legalization are due in part to the drug preferences of powerful people and to a drug's popularity among the masses.
Of course, making a drug illegal does not cause it to disappear from the landscape. The effort to control the use of illegal drugs has focused almost exclusively on limiting supply. The logic here is simple and direct: If a drug is not available, it cannot be abused.
The trouble, as Courtwright's analysis clearly shows, is that we cannot effectively control supply. And, no, this isn't because we have been soft on drug crime. Our prisons are filled with people found guilty of possessing a few grams of cocaine or an ounce of marijuana. Nor is it likely that escalating punishment further will help: The Chinese shoot heroin traffickers in the back of the head, then send the family a bill for the bullet, but the heroin trade goes on. Executing drug peddlers merely creates job openings for others eager to risk life and limb for a share of the profits.
Yet despite the evident failure of attempts to control availability, Courtwright supports the continuation of supply-side strategies. He insists that drugs will be abused wherever they are available, and that efforts must therefore focus on reducing supply. "The task now," he writes, "is to adjust the system."
But this optimism seems perfunctory. Throughout his book, Courtwright paints a gloomy view of the drug problem and convinces the reader that no tweaking of the system will cut off the supply of drugs.
Fortunately, there is another approach. Instead of trying to eliminate illegal drugs, we can focus on limiting the damage that some people do to themselves and others as a result of abusing drugs. This "harm reduction" approach includes policies such as needle exchange (which has been shown to reduce the spread of HIV infection), methadone and other maintenance programs that allow addicts to explore positive lifestyles and decriminalization of marijuana, a drug many youthful users quit on their own as they mature. Harm reduction concentrates on achievable goals, instead of the impossible goal of creating a world without drugs.
Courtwright knows about the harm reduction approach that I and others advocate, but he rejects it out of hand. He insists that our only recourse is to control supply, even though this approach has failed miserably and is likely to continue to fail. History has evidently convinced Courtwright that the world is doomed to addiction.
But that is not what history teaches me. Rather, it tells me that what we've been doing for the past century hasn't worked, and it's time to try something else.
David Courtwright's response:
Forces of Habit does suggest that broad-gauge legalization schemes are an unwise response to global drug commerce, and I'm willing to take my lumps for maintaining that position. But I dispute the claim in the Psychology Today review that I reject harm-approaches "out of hand." I do mention that people like Robert DuPont have criticized harm-reduction measures, but this is simply stating a historical fact, not equating my position with theirs. For the record, I favor more reasonable and flexible sentencing, expanded methadone maintenance, and needle exchange, which I have endorsed in print and supported with public testimony. My views on the excesses of recent U.S. drug policy are summarized in "The Drug War's Hidden Costs," Issues in Science and Technology 13 (Winter 1996-1997): 71-77.
SPAWS readers may also be interested in knowing that Dark Paradise has been released in an expanded paperback edition with a new subtitle, A History of Opiate Addiction in America. Two new chapters deal with the post-World War II heroin epidemic and drug policy from the Nixon through the Clinton administrations. More information about Dark Paradise, as well as Forces of Habit, is available at: