Forces of habit - introduction

 THE PSYCHOACTIVE REVOLUTION

ON JULY 13 , 1926 , Anthony Colombo, a man of many habits, all of them bad, checked into the Philadelphia General Hospital. The staff assigned him to the drug ward—a good choice, considering that each day of his life he smoked a quarter-ounce of opium, puffed 80 cigarettes, drank two cups of coffee or tea, and downed a quart of whiskey. He got drunk nearly every day, he explained to an intern. He had begun smoking the opium to sober up.

But he didn’t use the hard stuff. No cocaine. No barbiturates. “No narcotics other than opium”—a lie betrayed by his upper arms and thighs, pitted with the scars of hypodermic abscesses. Or perhaps it was a white lie. Opium smokers looked down on needle users in those days. Colombo had his pride to consider.

He was, after all, a working man. Addiction to opium had affected neither his will power, he boasted, nor his ability to work. He was in the liquor business, he said—a striking admission from the citizen of a country that did not, in 1926, officially have a liquor business.

The opium habit did not affect his appetite, the intern noted. Just 33 years of age, Colombo tipped the scales at 275 pounds. “The chest is immense,” he wrote; “the abdomen is large and pendulous.” Considering Colombo’s weight, his “three to five meals daily,” his opium, his four score cigarettes, his coffee, his tea, and his whiskey, some form of gratification must have been passing through his mouth practically every waking moment. Indeed, Colombo led a life—probably not a long life—of such continuous and varied stimulation and psychoactive pleasure that no emperor, no despot, no potentate of the ancient world, however wealthy, determined, or decadent, could have matched it.1Yet Anthony Colombo was a lowly man, a petty bootlegger of modest means. It was his luck, or misfortune, to live in the twentieth century, in an industrial city in an industrial nation that had, in its brief history, managed to refine and mass-market an impressive array of psychoactive pleasures. By the time Colombo checked into the hospital, millions of ordinary people throughout the world could lead, in neurochemical terms, a life-style unimaginable for even the wealthiest five hundred years earlier.

I call this development the psychoactive revolution. People everywhere have acquired progressively more, and more potent, means of altering their ordinary waking consciousness. One of the signal events of world history, this development had its roots in the transoceanic commerce and empire building of the early modern period—that is, the years from about 1500 to 1789. Forces of Habit describes how early modern merchants, planters, and other imperial elites succeeded in bringing about the confluence of the world’s psychoactive resources and then explores why, despite enormous profits and tax revenues, their successors changed their minds and restricted or prohibited many—but not all—drugs.

The term “drugs” is an extremely problematic one, connoting such things as abuse and addiction. For all its baggage, the word has one great virtue. It is short. Indeed, one of the reasons its use persisted, over the objections of offended pharmacists, was that headline writers needed something pithier than “narcotic drugs.” In this book I use “drugs” as a convenient and neutral term of reference for a long list of psychoactive substances, licit or illicit, mild or potent, deployed for medical and nonmedical purposes. Alcoholic and caffeinated beverages, cannabis, coca, cocaine, opium, morphine, and tobacco are all drugs in this sense, as are heroin, methamphetamine, and many other semisynthetic and synthetic substances. None is inherently evil. All can be abused. All are sources of profit. All have become, or at least have the potential to become, global commodities. 2This might not be apparent from a casual inspection of drug histories. Most scholarship deals with particular drugs or types of drugs in a particular setting: tea in Japan, vodka in Russia, narcotics in America, and so on. I have tried to connect these scholarly dots, linking the many separate histories in a big-picture narrative of the discovery, interchange, and exploitation of the planet’s psychoactive resources. I aim to do for drugs what William McNeill did for diseases in Plagues and Peoples (1976), a world-historical study of the exchange of microorganisms and its impact on civilizations. Disease and drug exchanges have many close parallels. That imported alcohol, for example, acted as a deadly pathogen for indigenous peoples is more than a metaphor. But there are also important differences. McNeill’s story was largely one of tragic happenstance. Invisible germs spread by human contact had lethal but usually unintended consequences. The spread of drug cultivation and manufacturing, however, was anything but accidental. It depended on conscious human enterprise, and only secondarily on unconscious biological processes.

The book’s first section describes the confluence of the world’s principal psychoactive resources, concentrating on alcoholic and caffeinated beverages, tobacco, opiates, cannabis, coca, cocaine, and sugar—the last a key ingredient in many drug products. These substances, once geographically confined, all entered the stream of global commerce, though at different times and from different places. Coffee, for example, spread from Ethiopia, where the bush was indigenous, to Arabia, and then throughout the Islamic lands and Christian Europe. Europeans took the taste and the beans to the Americas, which produced 70 percent of the world’s coffee crop by the late nineteenth century. 3 European farmers and planters, employing indentured and slave labor, enjoyed great success cultivating drug crops in both hemispheres. Their collective efforts expanded world supply, drove down prices, and drew millions of less affluent purchasers into the market, democratizing drug consumption.

But not for all drugs. Embedded in the story of psychoactive commerce is a mystery, one that is often overlooked. A number of regionally popular plant drugs—kava, betel, qat, peyote—failed to become commodities in both hemispheres in the way that wine or opium did. Global drug commerce, propelled by European overseas expansion, was highly selective. For reasons that ranged from limited shelf life to cultural biases against their effects, Europeans chose to ignore or suppress many novel psychoactive plants. The ones they found useful and acceptable they traded and cultivated throughout the world, with social and environmental consequences that are still very much in evidence.

The second section, on drugs and commerce, deals with psychoactive substances as medical and recreational products. Drugs typically began their careers as expensive and rarefied medicines, touted for a variety of human and animal ailments. Once their pleasurable and consciousness-altering properties became known, they escaped the therapeutic realm and entered that of popular consumption. As they did so, their political status changed. Widespread nonmedical use of spirits, tobacco, amphetamines, and other psychoactive substances occasioned controversy, alarm, and official intervention. All large-scale societies differentiated in some way between the medical use and the nonmedical abuse of drugs, and eventually they made this distinction the moral and legal foundation for the international drug control system.

Such a system was necessary because drugs were at once dangerous and lucrative products. The opposite of “durable goods,” they were quickly consumed and had to be just as quickly replaced by those dependent on them. Regular users needed larger doses to experience the original effect, which meant that the volume of sales was likely to increase. Inventions such as improved stills, hypodermic syringes, and blended cigarettes made for more efficient, speedier, and more profitable ways to get refined chemicals into consumers’ brains. Competition sparked further innovation and widespread advertising, as manufacturers sought to cut their costs, increase market share, and enhance the appeal of their products. As drugs became cheaper and more seductive, they attracted millions of new users, generating profitable opportunities in enterprises ranging from addiction treatment to Zippo lighters. Drug commerce and its externalities were manifestations of mature capitalism’s limbic turn, its increasing focus on pleasure and emotional gratification, as opposed to consumers’ material needs. Drug commerce, to paraphrase the anthropologist Robert Ardrey, flourished in a world in which the hungry psyche was replacing the hungry belly. 4The third section, which concerns drugs and power, shows how psychoactive trade benefited mercantile and imperial elites in ways that went beyond ordinary commercial profits. These elites quickly discovered that they could use drugs to control manual laborers and exploit indigenes. Opium, for instance, kept Chinese laborers in a state of debt and dependency. Alcohol induced native peoples to trade their furs, sell their captives into slavery, and negotiate away their lands. Early modern political elites found drugs to be dependable sources of revenue. Though rulers were often initially hostile to novel drugs (tobacco struck them as an especially nasty foreign vice, provoking sanctions from royal denunciations to ritual executions), they bowed to the inevitable and imposed taxes or their equivalents, monopolies, on the expanding commerce. They prospered beyond their dreams. By 1885 taxes on alcohol, tobacco, and tea accounted for close to half of the British government’s gross income. Drug taxation was the fiscal cornerstone of the modern state, and the chief financial prop of European colonial empires. 5Political elites do not ordinarily kill the geese that lay their golden eggs. Yet, during the last hundred years, they have selectively abandoned a policy of taxed, legal commerce for one of greater restriction and prohibition, achieved by domestic legislation and international treaties. The final chapters explore the modernizing pressures, medical developments, and political maneuvers that prompted so many governments to reverse course, and why they did so for some drugs rather than others. The psychoactive counterrevolution was strikingly erratic. Its legacy is a world in which (for now) tobacco and liquor are easily and legally available, while drugs like cannabis or heroin are generally not.

Writing world history is like peering through a microscope with a low-powered lens. The observer can see a good deal of the specimen, but only by sacrificing detail. One way to avoid this problem, and the narrative monotony it entails, is to periodically zoom in on a particular episode or personality, and then back out to the larger picture. That, at any rate, is my narrative strategy. Generalizations culled from the historical, social scientific, and scientific literature are fleshed out with specific examples and—dialing up the power further—several case studies. Among these are the democratization of amphetamines, James Duke and the cigarette industry, alcohol taxation in India, and the failure of prohibition in the Soviet Union. Each of these cases serves as a kind of parable, illustrating principles important to drug history.

The subject and my approach to it require selectivity. I have concentrated on identifying and illustrating the most significant trends of the past 500 years, and have made no attempt to provide comprehensive histories of all psychoactive drugs. That task, rendered impossible by the weight of numbers, has been beyond the capability of any one person since Louis Lewin, the pioneering German psychopharmacologist, died in 1929. I should add that I have cited only a fraction of the voluminous literature on drugs. The reader will discover, however, that my documentation is not ungenerous, and will find in it many leads to the outstanding specialized scholarship on the role and impact of drugs in the modern world. 

(...)

A TRAP BAITED WITH PLEASURE

THE IDEA THAT MOST DRUGS are dangerous substances best used in limited amounts under medical supervision has become the official attitude about their appropriate social role. But it is not the only attitude. Merchants, capitalists, and the political elites who tax them have long appreciated that drugs are seductive products and lucrative sources of revenue. The clash between opportunities for profit and concerns about health forms the central moral and political conflict running through the history of psychoactive commerce. Monetary motives and concerns are as historically significant as medical ones, and for some drugs doubtless more so. The first question to consider, however, is what is it about drugs that generates so much demand? And why do some people, as Simon Paulli observed more than three centuries ago, sacrifice everything they possess to acquire them?

 

 The Evolutionary Paradox 

Drugs are poisons. Psychoactive plant alkaloids evolved as a defense mechanism against herbivores. Insects and animals who eat them become dizzy and disoriented, or experience hallucinations. Yet some persist in eating intoxicating plants and fermented fruit, even though they disrupt their repertoire of survival skills. In evolutionary terms, accidental intoxication may be valuable: it warns an organism not to go near the plant again. Seeking intoxication, let alone profiting from it, is paradoxical. It seemingly defies the logic of natural selection.

One possible explanation is that the consumption of intoxicants satisfies a basic need. All people, argues Andrew Weil, possess an innate drive to alter their normal consciousness. Children at play will whirl themselves into a vertiginous stupor; holy men and women lose themselves in meditation. The desire to vacate ego-centered consciousness is deep-seated. However, some means of achieving this end are more dangerous than others. Drugs are powerful chemical shortcuts to altered states of mind. They do not alone determine the final state, which is a product of their interaction with the user’s expectations (“set”) and physical and social environment (“setting”). But they are key ingredients. Anyone who uses them to satisfy the drive is trading off toxic effects for potency and rapidity of action. 1Although Weil’s postulated drive may be inborn, social circumstances have much to do with its strength. Bored, miserable creatures are more likely to seek altered consciousness than engaged, contented ones. Animals in captivity, for example, are much more likely to use intoxicants than those in the wild. And one could say that civilization itself represents a state of captivity. Humans evolved as hunter-gatherers in itinerant bands. After the Neolithic Revolution, most of them lived as peasants in crowded, oppressive, and disease-ridden societies. The misery and grinding poverty that were the lot of 90 percent of humanity in the early modern world go far toward explaining why tobacco and other novel drugs became objects of mass consumption. They were unexpected weapons against the human condition, newfound tools of escape from the mean prison of everyday existence. “There is no more profound way of understanding the course of history,” Nathan Kline wrote, “than in terms of this effort to escape from one’s own ‘sweating self ’ and to experience even temporary states of euphoria or relief of discomfort regardless of the cost.” 2Euphoria and relief are products of a molecular accident. Only a few toxic alkaloids have molecules that, if they succeed in entering the circulatory system and passing the blood-brain barrier, mimic or influence neurotransmitters in the brain’s reward and pain-control centers. Nature is parsimonious with pleasure. Euphoria-inducing neurotransmitters are ordinarily meted out frugally and for some accomplishment that enhances survival or reproduction. Drugs fool the system, temporarily increasing the level of these pleasure-inducing neurotransmitters.

Though scientific knowledge has accumulated rapidly in the last three decades, researchers still do not know all of the ways the brain responds to different psychoactive drugs. Some, particularly alcohol, are “messy” in that they affect several neural systems. But they do appear to have at least one common denominator. They affect—directly or indirectly, strongly or weakly—the mesolimbic dopamine system, a primitive neural substrate that serves as a key pathway for pleasure and means of providing motivation for the choices we make. Drugs stimulate this system, and perhaps others not yet identified, signaling “good choice” by way of good feelings. Even a relatively nonintoxicating drug like coffee markedly elevates mood. A carefully controlled study of coffee drinking among nurses showed that those who drank two to three cups daily committed suicide only about a third as often as abstainers. It is a fascinating finding, entirely consistent with the notion of drugs as a coping tool. 3Before refilling your mug, however, bear in mind that the repeated use of caffeine and other drugs also alters the brain’s natural chemistry in ways that are not healthful. Awash with external chemicals, the brain adjusts production of their internal equivalents or the number of receptors, becoming dependent on an outside supply. If that supply ceases, unpleasant consequences follow. Opiate withdrawal in particular triggers a cascade of symptoms: restlessness, sweating, extreme anxiety, depression, irritability, dysphoria, insomnia, fever, chills, retching and vomiting, explosive diarrhea, flu-like aches and pains. The cumulative misery has tempted many patients to suicide, as may be seen in the 1925 case history of Hermann Göring:

Cause of illness: abuse of Morphine and Eukodal; severe withdrawal symptoms . . . The patient holds a prominent place in the “Hitler party” in Germany, took part in the Hitler putsch, during which he was injured and hospitalized; says he escaped from there to Austria, was given morphine by the doctors at the hospital, after which he became addicted to morphine. Admitted to Aspuddens [Nursing Home], the patient manifested violent withdrawal symptoms (in spite of the nurse allowing him more morphine), during which he became threatening and so violent that he could no longer be kept there. Threatened to take his own life, wanted to “die like a man,” threatened to commit hara-kiri, and so on.

That Göring, winner of the Pour le Mérite (the “Blue Max”), should sink to such a state, or that he should continue to use opiates intermittently for the next twenty years, nodding off in Luftwaffe staff meetings, is a testament to the extraordinary hold this class of drugs can exert on the human system. “When the druggist sells me my daily box of Eukodol [sic] ampules he smirks like I had picked up the bait to a trap,” William S. Burroughs wrote Allen Ginsberg from Tangier in 1954. “Allen, I never had a habit like this before. Shooting every two hours. Maybe it is the Eukodol, which is semisynthetic. Trust the Germans to concoct some really evil shit.” 4Physical and psychological withdrawal symptoms can follow the regular use of any of the principal psychoactive commodities, including the less potent ones like caffeinated beverages. In 1989 doctors at London’s Hammersmith Hospital discovered that the headaches commonly experienced by postoperative patients had nothing to do with anesthesia. They were a consequence of abstaining from caffeinated beverages before and during surgery. Depression, fatigue, and lethargy are other common symptoms. Though withdrawal is not synonymous with addiction, researchers have nevertheless found unequivocal evidence of a “caffeine dependence syndrome.” This refers to patients who go to extremes to obtain caffeinated drinks, use them in dangerous or inappropriate situations, and continue drinking them despite adverse health consequences and warnings by their physicians. Honoré de Balzac, whose stubborn devotion to coffee hastened his death from heart disease, is the historical prototype. 5The notion of reversal of effects helps to explain the paradox of why people persist in manifestly unhealthful behavior. They have, as Burroughs put it, walked into a trap baited with pleasure. Having begun using the drug to feel good, they dare not stop for fear of feeling bad. If addiction is the hijacking of the body’s natural reinforcement mechanisms, withdrawal is the gun held to the head. Even addicts who detoxify completely—a process that can extend over many months for a drug like cocaine—are not the same afterwards. The brain remembers the chemical shortcuts to pleasure. Environmental cues such as a familiar tavern sign can trigger powerful cravings. Addiction is a chronic, relapsing brain disease.

 

 Why Exposure Matters 

The last sentence takes us into fiercely contested terrain. Before exploring the economic implications of addiction and the related phenomenon of tolerance, it is necessary to take a closer look at compulsive use. Is it fundamentally a problem of repeatedly exposing brain cells to drugs? Or is it a problem of individuals who happen to have the wrong genetic, psychological, social, cultural, and/or moral characteristics? This issue has enormous implications for both understanding the history of drugs and implementing policies for their intelligent control.

At one extreme of the debate is a figure like Nils Bejerot who views drugs as germ-like pathogens that can artificially induce destructive drives in anyone: “No disturbed personality and no underlying social problems are required for an individual to develop a drug dependence.” Exposure is the crucial variable. It explains why physicians in Germany, the United States, and other countries have historically had narcotic addiction rates up to 100 times that of the general population. “We almost never find a lawyer who plays around with the stuff,” Harry Anslinger once remarked, “and nobody can tell me that lawyers are more moral or less inclined to get into trouble than doctors or nurses. You can’t get away from it—if people lay their hands on the stuff, there are always a few who will try.” Salvation lay in supply control. 6At the other extreme is a figure like Stanton Peele who views addiction as a people problem, not a drug problem. Addiction has nothing to do with a drug or its chemical properties. Indeed, people can become addicted to activities like gambling or drug treatment itself. In this view, addicts are essentially inadequate or misguided personalities who return again and again to drugs (or their behavioral equivalents) for a “reassuring absorption into a consuming sensation which takes away all consciousness of life’s problems.” Personal values determine whether people use, persist in using, become addicted to, and quit using drugs. Cultural values in turn shape personal ones. Cultures that tolerate drunkenness and invest alcohol with the power to control behavior suffer worse alcohol problems than those that frown on drunkenness and hold the individual accountable. Hence alcoholism is more widespread in Ireland than in Italy, despite high levels of per capita consumption in both countries. Supply matters less than the personal and cultural values that modulate demand and comportment. 7My own view of the matter (and that of most drug producers, distributors, and advertisers) is that both of these seemingly contradictory positions are true, though exposure is the critical precondition. Addiction following the use of any drug is the exception, not the rule. Only about a third of the young people who experiment with cigarettes, one of the most powerful addictive products known, become dependent users. Many individuals have inborn characteristics that confer immunity. The philosopher Karl Popper became so allergic to cigarette smoke that he turned into a virtual recluse. The real reason Bill Clinton didn’t inhale marijuana is that he couldn’t tolerate smoke in his lungs, despite repeated efforts by his friends to instruct him in this essential Oxonian art. Anyone with a persistent, violent reaction to a drug is essentially addiction-proof. Those with strong superegos and religious scruples are similarly less prone to experiment. Their opposite numbers, thrill-seeking sociopaths, are far more likely to light up. Peele has a point: individual values matter. So do collective ones. A strong taboo against consuming (as opposed to exporting) opium helped the Turks avoid a major addiction problem. LSD never became popular in Chinese cultures that equated hallucination with mental illness. The indulgent Japanese attitude toward alcohol abuse, by contrast, diminished the protective effect of the flushing genes carried by half its population. 8Yet history furnishes equally dramatic lessons about the importance of exposure. Iranian opium production expanded rapidly in the second half of the nineteenth century. The silk industry went into decline, and opium seemed an attractive export crop for which there was rising world demand. But with time the exports fell, and large numbers of Iranians took to obliterating their miseries with home-grown opium. An estimated 2.8 million of them were addicts when Reza Shah Pahlavi’s government attempted to eliminate production in the mid-1950s. The predictable result was fewer addicts, somewhere between a quarter and a half million in 1968, but more users of smuggled heroin. Heroin smuggled from neighboring countries also proved to be the bane of the Shah’s puritanical successors. Though they launched a crusade against narcotics, hanging dealers by the score, they could not stanch the flow of heroin from Afghanistan and Pakistan. Nor could they ease the severe unemployment that tempted Iranians to engage in drug use and trafficking. 9That Cubans once smoked 30 percent of all cigars made in Cuba, that Asian communities which grow and sell opium have consistently higher addiction rates than those which do not, that African transshipment points like Ghana or Nigeria have developed serious heroin and cocaine problems, that Kentuckians suffer exceptionally high rates of lung cancer—all of this strongly suggests that proximity, and hence familiarity and availability, matters. But how much? In 1973 Philip Baridon published the results of a unique global study in which he compiled officially reported addiction rates for 33 countries. He then compared these rates to twelve independent social, economic, and geographic variables (for example, urbanization, per capita income, proximity to opium- and coca-producing areas) in a multiple-regression analysis (a statistical technique for estimating relative causal weights). Proximity alone explained 45 percent of the variance, far more than any other variable. “The most fundamental fact about drug abuse is frequently overlooked in the welter of complicated psycho-social explanations,” Baridon concluded. “If the drug is not available, there will be no abuse of it.” 10This is why drug history is replete with giveaway promotions: bottles of Vin Mariani, cigarettes during rush week, smokeless tobacco at drag races, and surplus Brazilian coffee shipped gratis to Japan. The providers of the celebrated “free lunch” that accompanied the not-so-free beer in American workingmen’s saloons a century ago played a clever variation on this theme. One Chicago salesman confided to a fellow worker that “he had had to swear off the free lunch when he realized he was beginning to go to saloons more for the beer than for the food.” The idea behind all such schemes is to expose potential lifelong customers, particularly young ones whose consumption habits are still plastic. Young, single, undersocialized urban males who lack genetic or cultural protections and who are already using other drugs are on the A-list of susceptibility. They are most likely to experiment with and eventually become addicted to novel drugs, although, as Bejerot insisted, they are not the only types of people who become compulsive users. Given enough time and exposure, millions of others may join them. In 1915 American cigarette smokers were mostly confined to pool halls and street corners. In 1955 two-thirds of all American men between 25 and 64 smoked regularly, the vast majority of them cigarettes. 11 

Davit T. Courtwright