addiction and the science of history

Addiction and the science of historyadd_3723 486..492

David T. CourtwrightDepartment of History, University of North Florida, Jacksonville, FL, USA

ABSTRACT

Aims To discuss the contributions historians have made to the addiction field, broadly construed to include licit andillicit drug use, drug policy, drug treatment and epidemiological and neuroscientific research. Methods Review ofliterature, highlighting specific contributions and controversies from recent research on the United States, the UnitedKingdom, China and world history. Findings and conclusions At the bar of addiction knowledge, historians make forexcellent companions—until they turn quarrelsome. Historians’ companionability arises from their ability to tell aparticularly rich kind of story, one that blends structure, agency and contingency in a contextualizing narrative.Historians’ occasional quarrelsomeness arises from their skepticism about the ascendant brain-disease paradigm, themedical and pharmaceutical establishments and the drug war, especially in its US incarnation. These enterprises haveput some historians in a polemical frame of mind, raising doubts about the objectivity of their work and questionsabout the political orientation of historical scholarship (and, more generally, of social science research) in the field.

Keywords Addiction, drug policy, drug treatment, epidemiology, history, neuroscience.

Correspondence to: David T. Courtwright, Department of History, University of North Florida, 3 UNF Drive, Jacksonville, FL 32224-2645, USA.E-mail: [email protected] 23 August 2011; initial review completed 17 October 2011; final version accepted 10 November 2011

INTRODUCTION

Historians do not usually think of themselves as scien-tists, let alone scientists allied to addiction researchers.Even so, history provides data, contextual knowledgeand narrative syntheses for those who study addictionin more conventionally scientific disciplines. In someresearch areas, such as retrospective epidemiology orpolicy analysis, history is indispensible. Things are theway they are because they got that way, as any evolution-ary biologist will attest. Understanding the present stateof things requires understanding past events.

WHAT HISTORIANS DO

Although historians gain knowledge about the past inmany ways, their signature method is the location, closereading and interpretation of primary sources. Why, forexample, did the US Supreme Court uphold the federalgovernment’s position that the ambiguously worded1914 Harrison Narcotic Act forbade maintenance, thelong-term supply of addicts with prescribed narcotics?Part of the answer can be found by unearthing the briefsgovernment attorneys prepared for two crucial 1919

cases. Both briefs exaggerated the prevalence of addictionand the threat it posed to the nation. Given that the Har-rison Act’s extension of federal police power was contro-versial and constitutionally convoluted; that the Courthad previously ruled against government attempts toblock maintenance; and that the vote was five-to-four,it seems likely that the misinformation contributed to theoutcome [1].

‘It seems likely’ and ‘contributed to’ are modest andtentative formulations. This is necessarily so, becausehistorians deal in retrodiction rather than prediction.They cannot test their findings experimentally. No timemachine permits us to dial up 1919, substitute amendedbriefs, and then observe whether the justices’ voteschange. No statistical program can run a regressionequation through their minds, calculating causal weightsfor the many variables in their decision processes.

What historians can do, however, is amass enoughinformation to give themselves and their readers anunderstanding of how historical actors saw evolving situ-ations, with all their peculiarities and ambiguities, andwhy they acted as they did. The evidence behind suchempathic explanations is cumulative and, in an impor-tant sense, verifiable. How do we know that the justices

ADDICTION AND ITS SCIENCES doi:10.1111/j.1360-0443.2011.03723.x

© 2012 The Author, Addiction © 2012 Society for the Study of Addiction Addiction, 107, 486–492

confronted ‘exaggerated’ claims? What evidence justifiesthat adjective? The answer is that several contemporane-ous reports, as well as correspondence between cha-grined researchers, showed the government estimatesof 750 000–1 500 000 addicts to be impossibly high.Prevalence had been declining, rather than increasing,and had been doing so for years [1]. Historical claims maynot be experimentally verifiable, but they are objective inthe sense that they emerge from corroborative evidencethat can be confirmed by others. Historians look forpatterns.

They also look for litigation. Intellectual propertylawsuits over amphetamine gave Nicolas Rasmussenthe opportunity to show, in rare detail, how medicalresearchers and pharmaceutical companies developedand marketed the drug, turning quotidian problemsinto ‘amphetamine-treatable medical conditions’ [2].The tobacco litigation discovery process, and convenientinternet access, gave Alan Brandt much of the materialfor The Cigarette Century (2007) [3], his monumentalstudy of how tobacco companies addicted tens of millionsof people world-wide—and went on doing so after theemergence of damning health evidence. ‘Rather thanstaring up at the Camel Man’, Brandt wrote, ‘I canexamine his personal papers—the very contracts, plans,and letters that made him a reality’.

The Cigarette Century exemplifies three of narrativehistory’s cardinal virtues: efficiency, readability andrange. ‘Efficiency’ seems an odd compliment to bestowon a 600-page book, but Brandt distills thousands ofscattered sources, from laboratory reports to marketingstudies, into a single, gracefully written narrative thatcombines technology, culture, science and law with thedecisions of key corporate, medical and political actors.His book serves double duty as the chronicle of a con-flicted, modernizing society and a history of drug use—afeat duplicated in Alan Baumler’s study of opium in theChinese Republic and Robert Stephens’s account of theHamburg counterculture, Germans on Drugs [4,5]. Ingood history, everything is connected to everything else.

What makes interwoven accounts possible is hind-sight, the one advantage that historians enjoy overdeadline-pressed journalists and prediction-orientedscientists. From Thucydides onwards, historians havegrasped that the accumulation of evidence from differentsources after the fact will reveal processes beyond thecontrol, or even the knowledge, of the historical actors.To those who say that ‘hindsight is always 20/20’, thehistorian responds that there is nothing wrong withexcellent vision.

Consider again the question of maintenance. In 1880most US addicts were middle-class women whosenarcotic use was medical in origin. By 1920 most werelower- or working-class men whose use was non-medical

in origin. Because the change occurred gradually andarose from multiple independent causes, contemporarieswere not always aware of it; yet it affected policy, in so faras legislators and judges had previously shown no inter-est in criminalizing drug use by elderly morphine addicts.‘Junkies’ were another matter. We can now see that thedemographic transformation of the addict populationwas a necessary, but not a sufficient, condition for theanti-maintenance policy, which also arose from deci-sions, ill-informed or otherwise, of elite historical actorssuch as the Supreme Court justices [1].

PROGRESS AND RECOGNITION

Historical knowledge is thus cumulative. The perspectivethat comes with time, the opening of new archives andthe growth of secondary literature adds continuously tothe store of insight, making possible ambitious bookssuch as Brandt’s or the international drug history andpolicy studies by Rudi Matthee, Kathryn Meyer and TerryParssinen, William McAllister, Richard Davenport-Hinesand Griffith Edwards [6–10]. The emergence of Englishas a common academic language has facilitated accessto the secondary literature, as has the translation ofsuch important works as Wolfgang Schivelbusch’s DasParadies, der Geschmack und die Vernunft [Tastes of Paradise:A Social History of Spices, Stimulants, and Intoxicants]and Pierre-Arnaud Chouvy’s Les Territoires de l’Opium[Opium: Uncovering the Politics of the Poppy] [11,12]. Itis now possible for an English-fluent graduate studentin any discipline, anywhere in the world, to gain, in asemester’s reading, knowledge of the history of addictivesubstances beyond all but the most sophisticated scholarsof a generation ago.

The same graduate student would also learn some-thing about addiction science. Although historians donot usually test theories in a formal way, their researchoften applies, and sometimes corroborates, findings ofsocial and natural scientists. Why, for example, did addic-tion become much more widespread during the 19thcentury, to the point that political elites began imposingmarket restrictions? The answer is complex, but wouldminimally include the expanded production and exportof cheap spirits; the isolation and non-medical use ofpsychoactive alkaloids (morphine, cocaine); new meansof consuming drugs (injecting narcotics, smoking ciga-rettes); and global migrations, such as those of inden-tured Indian and Chinese laborers, who introducedcannabis and smoking opium to new lands. What isstriking about this list is how well it corresponds to thefindings of epidemiologists, economists and clinicians,namely, that exposure, price and mode of administrationare crucial variables in the addiction process [13].

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Historians—I include all serious researchers whoapply the methods and insights of the discipline, not onlyhistory PhDs—have also turned their attention to addic-tion research and treatment. They have given us classicaccounts of the origins of the concept of alcoholism[14,15]. They have described the development of alcoholand drug treatment [16,17]. They have profiled suchseminal figures as Marie Nyswander and Jerry Jaffe[18,19]. They have described the rise of addiction as amedical and scientific field [20,21]. They have recorded,transcribed and provided internet access to interviewswith many of the field’s leading figures [22]. Attentionfrom historians is, like imitation, a sincere form of flattery.The College on Problems of Drug Dependence (CPDD) hasreturned the flattery in the form of media awards forNancy Campbell, Brandt and other academic historians.CPDD has also honored journalist Michael Massing andeconomist Peter Reuter, both of whose works are deeplyinformed by history.

All this prize-giving is of little moment to bench scien-tists working in wet laboratories and imaging centers.Like research into consciousness, pain or mental illness(broadly considered), the great intellectual divide in theaddiction field is between the reductivists and the non-reductivists. Those who are concerned only with nomo-thetic brain research, such as receptor pharmacology inexperimental animals, will have little or no immediate usefor the idiographic history that sociologists, ethnogra-phers, economists and other social scientists find valu-able; yet the trend towards preserving and articulatingthe history of addiction science and treatment shows thatthere are at least some areas of common interest andpotential collaboration between those in white coats andthose in tweed.

TENSIONS

Whatever common ground historians and addictionscientists have found, there are still some significant ten-sions. One involves an unspoken double standard, whichhistorian Joseph Gabriel described with unusual candor:

Scientists often feel free to make historicalclaims—and in fact they often feel somewhatcompelled to—but, at least in my experience, theyreally don’t like it when historians try to makescientific ones. Historians, for our part, generallydon’t feel comfortable making scientific claims at all,and when we do we generally do so with a lot ofapologies—disqualifiers of the ‘now, I’m not aneuroscientist . . .’ type. But when was the lasttime you heard a scientist apologize for not beinga historian? When was the last time you saw a

scientist exhibit any awareness at all that thehistorical claims they were making were, at best,simplistic? [23]

Or, at worst, erroneous. At some point the number andcasualness of historical misstatements in a purportedlyscientific book, such as Solomon Snyder’s Brainstorming,crosses the line from irritation to unconscious disci-plinary insult [24].

The problem has a time-honored solution: hard workand accuracy. To avoid appearing foolish, scientists needto understand that history is the fruit of disciplinedresearch, not something cobbled together from memory,oral tradition and prefaces from old journal articles. His-torians, for their part, will gain credibility and insight byadding the new language of addiction neuroscience tothe familiar languages of paradigms past. Historians,who are interested in the diachronic development ofmultiple scientific approaches, are multi-lingual in theclassical languages of addiction; laboratory researchers,who are interested mainly in the synchronic elaborationof the current paradigm, are monolingual in theirmodern language—and blissfully unaware that it, too,will pass into the classics under the pressure of revision.Even so, historians should do their best to understand thelatest dispensation. Veteran researchers such as MichaelKuhar have simplified the task by providing, in interdisci-plinary conferences and journals, lucid surveys of basicscience in the field [25]. Such surveys are especiallyuseful in addiction, where developments are occurringrapidly and issues of etiology and treatment remaintangled and complex.

The words ‘etiology’ and ‘treatment’ connote disease,which raises another fundamental difference betweenhistorians and scientists: addiction as a pathologicalframe. Like most social scientists, historians study alcoholand other drugs in contexts other than those of addictionor disease. Tellingly, the name of their international asso-ciation makes no mention of addiction. Founded in 1979as the Alcohol and Temperance History Group (ATHG),the organization grew from a renaissance of historicalstudies of alcohol, which was itself part of a larger waveof new social history in the late 1960s and 1970s. Therewas a smaller but near-simultaneous revival of the his-torical study of narcotics and street drugs such as can-nabis and cocaine. The informal alliance between the twogroups of researchers became formal in 2004, when theATHG renamed itself the Alcohol and Drugs HistorySociety (ADHS). Specialists in licit psychoactive drugs,such as historian David Herzberg [26], have since becomeactive in ADHS, whose 2011 conference was expansivelyentitled ‘The Pub, the Street, and the Medicine Cabinet’.

ADHS members are concerned with addiction, in thataddicts have long accounted for a disproportionate share

488 David T. Courtwright


of alcohol and drug consumption, profits, taxes andsocial costs. Without addiction’s pathos and urgency,alcohol and drug history probably would not have coa-lesced into a specialty with its own organization andjournal. However, in absolute terms, compulsive usersnever made up more than a minority of all users. Alcoholand other drugs played multiple, often positive socialroles—as markers of identity, occasions of conviviality,talismans of faith—that had little to do with addiction.ADHS members, whose meetings are conspicuouslycatholic affairs, assume neither a common interest inaddiction nor, for that matter, common training. Theylack the equivalent of a fellowship in addiction medicine.

They also lack allegiance to ‘the NIDA paradigm’,shorthand for the scientific model of addiction as achronic, relapsing brain disease with a social and geneticcomponent, significant comorbidity with other mentaland physical disorders, long-term changes in brain struc-ture and function visible in imaging studies, and a defin-ing loss of control over drug craving, seeking and usedespite adverse consequences. Emanating from research-ers at the National Institute on Drug Abuse (NIDA), thisparadigm currently dominates, and may one day unify,scientific work in the addiction field. Researchers, andjournalists who popularize their findings, now routinelydescribe compulsive behaviors involving gambling, sex,shopping and eating as ‘addictions’. These claims aremore than metaphorical. Imaging studies have shownthat drug and behavioral addictions activate the sameneural pathways. Epidemiological and genetic studieshave found that compulsive gamblers are more prone toalcohol and drug abuse. Clinical studies have revealedthat narcotic antagonists can reduce compulsive gam-bling and viewing of pornography, evidently by limitingthese activities’ capacity to augment dopamine release.In the NIDA paradigm all addiction is, in the words ofpsychiatrists Michael Bostwick and Jeffrey Bucci, anacquired ‘malfunctioning of the brain’s reward center’[27,28].

Historians have found much evidence that vices, asthey were once called, were linked spatially and concep-tually. Gamblers flocked to bars. Prostitutes and theircustomers drank liquor and snorted cocaine. Chinatownrevelers found opium dens, brothels and gambling parlorsin the same teeming quarter, a stone’s throw from thepawnbrokers. Victorian reformers regarded vices as a‘constellation’ of ruinous behaviors, all of which theysought to discourage or suppress [29].

However, historians are loath to concede the neuraland genetic commonalities of these same behaviors.The brain-disease paradigm appears to be an old-fashioned monistic pathology wearing the fashionablegarb of neuroscience [30]. It strikes them (and manyother social scientists) as crudely reductive because it

ignores that which cannot be illumined with positronsor studied in neurons. It seems irrelevant because itsheds no light on culturally specific phenomena. It seemsthreatening because it gains all the funding and mediaattention. It seems intellectually reactionary because itevokes biological essentialism and naive positivism. Itmay even be politically reactionary because it lends, inad-vertently and despite the medicalizing intentions of itsproponents, the prestige of science to supply-side drugwarriors bent on keeping everyone’s fragile brains outof the sizzling drug grease [27].

In The Cult of Pharmacology, Richard DeGrandpremarshals these grievances and more in his retelling of thestory of ‘how America became the world’s most troubleddrug culture’. Drawing selectively on history, as wellas on such critics as psychologist Bruce Alexanderand physician-ethnobotanist Andrew Weil, DeGrandpreindicts the brain-disease model as a prop of ‘pharmaco-logicalism’. This is his term for the largely arbitrary,socially clueless and highly profitable division of thepharmacopeia into ‘angel’ drugs on which we spend bil-lions for prescriptions and ‘devil’ drugs on which wespend billions for futile suppression. Among former NIDAdirectors, DeGrandpre has some angels and devils of hisown. The late Bob Schuster has wings. Alan Leschner hashorns [31].

OPPOSITIONAL SCHOLARSHIP

The Cult of Pharmacology exemplifies what historiogra-phers call ‘oppositional’ histories, works that are highlycritical of the status quo and that favor radical change.They occupy the left end of an ideological spectrum thatruns from oppositional to ‘accommodationist’ (i.e. mildlyreformist) to ‘dominant’ (i.e. conservative) views [32]. Ina discipline in which left-liberal views are commonplace,virtually any political or social subject can prompt anoppositional response; but they arise most often whenthe subject involves morally charged policy questions orclaims about the biological determinants of behavior.

America’s punitive drug policy and high-profile addic-tion research programs have made for especially tempt-ing targets. For much of the mid-20th century, authorssuch as Alfred Lindesmith, Rufus King and EdwardBrecher treated history as a sort of munitions dumpwhere they might find the means of exploding prejudicialideas and unjust policies [33–35]. Then, beginning in the1970s, historians such as David Musto, Wayne Morgan,Jill Jonnes, Joseph Spillane, Timothy Hickman and EricSchneider published new, conspicuously professionalhistories [36–41]. Although these works were accommo-dationist to a lesser or greater degree, they providedempathic narratives based on primary sources. Theirauthors, all of whom had graduate training in history,



ground no axes, or none so conspicuous that readersmight doubt their selection and handling of evidence.(Social psychologist Robert MacCoun and economistPeter Reuter displayed similar circumspection in DrugWar Heresies: Learning from Other Vices, Times, and Places,a widely read hybrid of comparative policy analysis andhistory that used past experience of vice regulation toguardedly support such ‘heresies’ as cannabis depenal-ization [42].) The new accommodationist scholarshipmerely counterbalanced the older polemical tradition. Itdid not replace it, as books such as those of DeGrandpre[31] or Arthur Benavie [43] continued to roll off thepresses.

Recent drug-history literature in the United Kingdomfollows a similar pattern. Virginia Berridge’s Opium andthe People [44] and Alex Mold’s Heroin [45] are straight-forward narratives, measured in tone. Griffith Edwards’sMatters of Substance [10], a medical and historical tourd’horizon with a coda of policy suggestions, is more expli-citly accommodationist. Davenport-Hines’s The Pursuitof Oblivion [9], Gargi Bhattacharyya’s Traffick [46] andToby Seddon’s Foucauldian A History of Drugs [47] are allfrankly oppositional works.

The same spectrum runs throughout Chinese drughistory. Here the stakes are particularly high, as all histo-rians agree that the Chinese opium situation motivatedinternational efforts to curtail the drug traffic in the late19th and early 20th centuries. Historians do not,however, agree on how serious the Chinese problem wasor whether it warranted strong prohibitory medicine.Carl Trocki [48], who uses words such as ‘plague’ or‘bane’ to describe the drug’s impact in China and otherAsian lands, argues that opium enabled Europeans tocreate a vast empire and to exploit Asian consumers andlaborers. Although he concedes that Qing China hadmany underlying problems, his ‘damage narrative’ isconsistent with that of the nationalists, missionaries,physicians and diplomats who sought to suppress thetraffic. The same could not be said of Frank Dikötter,Lars Laamann and Zhou Xun, who deny that Chinawas ‘Patient Zero’ in a global drug plague [49,50]. Theycondemn as counterproductive (and sometimes murder-ous) the 20th-century drug wars inflicted within andwithout China. Opium was, if not quite harmless, then apopular, multi-purpose drug used in social contexts otherthan compulsion and degradation—an interpretationconsistent with work by Richard Newman [51] andZheng Yangwen [52]. Broadly speaking, the more a his-torian doubts or qualifies the extent of past addiction andother drug-related harms, the more likely he or she is tocriticize ‘prohibitionist’ regimes.

The same is true of social scientists, save that opposi-tional scholars in disciplines such as sociology or crimi-nology argue typically that current drug problems are

exaggerated and/or by-products of suppression. ThusTom Decorte writes that ‘captive samples’ in prisons andtreatment programs blind authorities to the extent ofcontrolled drug use, which is made more difficult by theirimposition of prohibition regimes [53]. AnthropologistPhillipe Bourgois describes vividly the self-destructivebehavior of homeless street addicts, but presents them asvictims of social neglect and structural change whoselives are worsened, not improved, by law enforcement[54]. Unsurprisingly, when oppositional social scientistsevoke history, they most often cite the works of opposi-tional historians with whom they are simpatico. As inMiddle Eastern politics, the enemy of my enemy is myfriend.

If it is natural for controversial subjects such as drugpolicy to produce oppositional scholarship, it is alsonatural for such scholarship to breed a measure of dis-trust and confusion. While a single polemic can bebracing, a dozen can color the perception of an entirefield: guilt by association. The value of history to policyanalysts and addiction scientists—or even the likelihoodthat they will bother to read it—diminishes in proportionto their perception that it is politicized or dismissiveof cutting-edge research. The danger is that the addic-tion field will become a grotesque caricature of C. P.Snow’s ‘two cultures’ [55]. Neuroscientists willdismiss historians—in fact, all non-quantitative socialscientists—as naive leftists and neurochemical Luddites.The compliment will be returned in renewed charges ofscientific arrogance and indifference to the addictions’real-world contexts.

While we have not yet reached such an impasse, Iworry that mutual distrust and incomprehension willend the tenuous cross-fertilization between scientists andhistorians concerned with addiction. That would be anirony as well as a shame, for—this is the nub of myessay—both of their enterprises have flourished in thelast four decades. We know more than ever about addic-tive processes that occur inside the brain. We know morethan ever about addictive processes, past and present,that occur outside the brain. The chance to put thatknowledge together represents, perhaps more for his-torians and social scientists than for bench-boundresearchers, an ungrasped intellectual opportunity.

Declaration of interests

None.

Acknowledgements

The author thanks Nancy Campbell, Claire Clark,Andrew Courtwright, Shelby Miller, Joseph Spillane andNicolas Rasmussen for commenting on a preliminarydraft.



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