Forces of Habit: Drugs and the Making of the Modern World

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 drugs--legal and illegal--are 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 business--both legal and illegal--is 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 casually 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.

(Harvard University Press, 2001)

Edited By Paul Chance, Ph.D.

Reviewed by Stanton Peele, Ph.D., J.D.

Stanton Peele is an expert on drug use and the author of The Diseasing of America: Addiction Treatment Out of Control (Lexington Books, 1989).