Political ideas and even medical categories are bound up with institutions that have histories. In On Liberty, Mill took little account of this fact, except for a few comments about savagery as a historical childhood and his warning against the tendency toward a tyranny of popular feeling in advanced democracies. But in other writings, even he paid more attention to history. Against the rationalistic radicalism of his first master, Bentham, who called tradition "the authority of inexperience," he eventually learned to balance the conservatism of Coleridge, who suggested that before denouncing an established institution or practice as irrational, we should ask, "What is the meaning of it?" The meaning of a practice, in the sense of its place in the life of a society, is inseparable from its development. Drug use may be one of those issues on which a page of history (or sociology) is worth more than a volume of logic.

Looked at as a series of incidents, the history of social and legal responses to drug use, especially in the last century and in the United States, sometimes seems melancholy and haphazard. It is easy Jo find inadequate pharmacology, inconsistent ad hoc responses based on poor information, indulgence of passions and prejudices, including racism, in response to drug scares, institutional self-aggrandizement by narcotics police, and a fair amount of hypocrisy and corruption. This has often been emphasized by people who are convinced that the drug control system is wrong and who want to find particular circumstances, institutions, or individuals to blame. But beneath the surface, there is a single trend and an established pattern not confined to the United States. The drug laws of all modern nations (except in the case of alcohol) are similar, despite some variations in severity. International treaties and supranational control institutions further guarantee unanimity and uniformity. In some corners, the system still contains fossil structures such as the classification of "narcotics" including three very different drugs (marihuana, opiates, and cocaine), but in general it has become more intellectually orderly.*

In its broad outlines, it is not a product of accident, error, fanaticism, or corruption.

Twentieth-century society has moved toward more and more profes-sionalization, rationalization, and formal regulation in the control of drugs. In these changes, two models we have discussed are at work, corresponding to the ambiguous character of drug use: consumer protection, including public health in the narrower sense associated with physiological medicine; and morality, public tranquility, or public health in the wider social sense. The first model has been more powerful because it covers the area of social life in which individual autonomy is now least valued. When Mill wrote On Liberty, absolute freedom of trade still seemed defensible; the disease concept of drug abuse was only an opinion, not an institution; and the medical profession and medical science were relatively feeble. We will never return to the social and intellectual conditions that made possible Mill's opposition to all drug laws. On the other hand, individual freedom of speech and sexual behavior is regarded more highly than in Mill's time. When drug laws are criticized, it is usually on the grounds that drug use has more in common with speech or sexual behavior (or dangerous sports) than with the situations in which medical or consumer regulations apply.

The morality or social health model has served to reinforce the medical—consumer model where necessary; otherwise, the different histories of pleasure drug regulation and ordinary medical drug regulation would be inexplicable. But as we noted in Chapter 1, legal restrictions based on fear of immorality or general social debilitation are notoriously subject to abuse. Common sense in these matters may be nothing more than shared prejudice. Our own common sense, for example, requires us to ,debate gravely whether possession of marihuana should be decriminalized, even though many obviously more dangerous commodities (alcohol is only one) are sold freely. Attitudes toward minorities, work, worldly success and failure, or sex and family life sometimes turn out to be the real issues in a controversy about drugs. Drugs are symbols charged with cultural tensions. An Asian government's commitment to eliminating opium use or a South American government's determination to stop coca chewing represents symbolically an aspiration to modernize and westernize. 'Conventional people in our own society may displace repressed anxieties to illicit drugs and their users as a form of scapegoating; rebels may define their difference by using exotic, often illegal drugs and scorning the commonplace ones. Users of disapproved drugs become dope fiends because they are possessed by demons the rest of us have cast out. Drugs become a source of fantasies and fears about excessive control (the chemical robot) and loss of control (the wandering intoxicated mind) Unfamiliar drugs in a given culture come to represent the threat of insidious, unlcnown evil. In preindustrial societies, fears of spiritual pollution, operating as systematic pressures to hold someone responsible for natural and social maladies, help to keep a group together by setting its members apart from another group (Wildavslcy and Douglas 1982). The same fears and pressures affect modern attitudes toward drugs.

The school of social interpretation called "sociology of deviance" pays systematic attention to these issues. In their view, the deviant or abnormal character of an action and the person who performs it constitutes a role created by those who define the rules of society. Certain persons who stray into a "primary deviation" are publicly labeled, and from then on their behavior is reinterpreted to fit a new role. People learn how to behave as mentally ill or alcoholic or addicted; they become secondary deviants. A classic example is Jean-Paul Sartre's account of Jean Genet's career. According to Sartre, the orphan child Genet, caught stealing and labeled a thief, decided to adopt the role and even glory in it. He became a thief by being called one. The deviant label is hard to shake off, especially if it is a "master status" that defines the social identity of its possessors and cuts them off from conventional society. Deviants who are being judged by rules they do not accept may form their own subcultures.

New deviant roles are created by "moral entrepreneurship," which busily extends the area of life subject to rule malcing and moral judgment, shaping vague values such as social order, liberty, equality, and family solidarity into specific rules of behavior. Ascription of a master staais or trait usually expresses an uncertain attitude toward the stigmatized person and behavior; the stereotypes created serve unconscious needs through projection and displacement, while dispelling ambiguity and doubt. In this interpretation, alcohol and drug prohibitions are successful exercises of moral enterprise; they are symbolic victories that impose a cultural hegemony, turning the defeated minority into labeled deviants and enhancing the self-esteem of those who have been able to impose their own definition of the straight path. Drug "abuse" often means involvement in a subordinate or marginal group's cultural ritual; examples can be drawn from the response to American Indian drug use. The purpose of drug laws is seen as symbolic and expressive rather than "instrumental," so that enforcement is not necessarily required (Becker 1963; Gusfield 1963).

The deadpan "value-free" style in which the labeling analysis is usually presented does not disguise its irony. It is implicitly libertarian and un-sympathetic to medical or criminal definitions of drug problems. By redefining "bad" behavior as neutral "deviance" and using the mildly derisive term "moral entrepreneurship," it also works as a critique of legal moralism. In fact, sociology of deviance is partly an oblique attack on the legal enforcement of standards that are "moral" in the senses discussed in Chapter 1; the arguments given there are recast in ostensibly objective terms. The sociology of deviance is a critical description of what Dworkin calls "sociological" as opposed to "discriminatory" morality. The difference is that for his professional purpose, the sociologist has no need of the notion of discriminatory morality; all morality is sociological. This is possible only in a world where moral discriminations are uncertain. The abstract notion of behavioral deviance, detached from all norms and standards, could exist only in a society with no moral majority or moral authority — a modern liberal society.

Labeling theory is hard to refute, since it treats every apparently objective fact of behavior as already contaminated in its definition by social responses and regards most deviance as produced by attempts to record it. The notion of a master status has doubtful empirical content; constant heavy drinking, for example, may dominate a person's life and therefore his or her social status, whether or not the status is master. There is some empirical evidence on alcoholism and addiction opposed to labeling theory. The label of alcoholic or addict is applied very reluctantly, usually at first not by an impersonal social order but by a member of the fatuity. The label is apparently not hard to shake off and does not determine behavior and social status (Clayton and Voss 1981); for example, a history of deviant behavior does not predict experimentation with heroin but does predict addiction (Robins 1975). A study of heroin addicts suggests that secondary deviance through labeling is a minor issue. Addicts often adopt the label themselves before courts of law and treatment agencies apply it to them; they do this partly so that they will be treated as sick rather than delinquent. Family and friends usually respond to the addict as an individual, not to a stereotype. Addicts rarely blame their relapse on the difficulty of reacceptance into straight society. Some keep using the drug but avoid secondary deviance — participation in the addict subculture, stealing, prostitution. Social pressures do not favor but discourage secondary deviance; addicts become known as untrustworthy, manipulative, and offensive, and everyone wants them to change (McAuliffe 1975). Nor does labeling oneself alcoholic, as AA recommends, seem to make the deviance greater. If anything, denial is a problem, and open self-identification may be the beginning of a solution.

Besides, drugs are not just symbols; they are substances with distinct chemical properties and physical and psychological effects. At times it is hard to separate objective from symbolic threats or instrumental from expressive purposes of drug laws, just as it may be hard to distinguish public health in the physiological sense from public health in a broader social sense. If we want to lcnow why cocaine has been classified as a narcotic and the otherwise very similar amphetamines have not, we must look at history. But to explain why, in so many preindustrial cultures, alcohol and opium are considered a social problem but marihuana, stim-ulants, and hallucinogens are not (Blum and Associates 1969), we must think about the psychopharmacological properties of the drugs themselves.

In any case, labels and cultural symbolism cannot be studied apart from history. Drug use includes magic, religion, medicine, recreation, disease, vice, and crime. In contemporary society we want to keep these categories separate, so classification becomes a problem. In assigning meanings to the experiences produced by drugs, we are confronted by many possibilities and need to make many distinctions. We have separate formal and informal institutions regulating recreation, illness, religion, and so on; much controversy about psychoactive drugs involves conflicting claims by representatives of these institutions, officially sanctioned or outlaw, to be the rightful judges of what drug use means.

The loss of moral authority by many established institutions in industrially advanced countries, together with an efflorescence of drug technology, has made the potential ambiguity greater and the insistence of conflicting claims to transform it into socially acceptable meanings more intense: on one side, authorities proclaiming drug use to be disease and crime; on the other side, rebels declaring it to be fun or even a religious act. Drug use is stigmatized as an irresponsible addiction to kicks and thrills, or praised as delightful and liberating highs, or trips, or consciousness qx-pansion, which lies on the border between religion and fun.

Different drugs have found their way into different cultural categories. Officially, use of morphine, for example, is medicine in certain contexts; otherwise, it is disease or crime, and there is something wrong with anyone who regards it as recreation. Amphetamines prescribed by a doctor for depression might be medicine; amphetamines used by a layman to feel better are disease and crime. Alcohol, self-prescribed, is fun unless you use too much, and then it is disease — alcoholism; it is never medicine, as it was in the nineteenth century. Certain drugs belong in a utilitarian category on the border between medicine and pleasure that is therapeutic in a loose sense: They start users going in the morning, or keep them going during the day, or put them to sleep at night.

Much drug use is vice, the unacceptable kind of fun that offends public morality. Only a few marginal social groups — Mormons, Black Muslims, some fundamentalists — regard all drug use as vice all the time, but a much larger number think that some use of some drugs or any use of other drugs is vice. Once there were two varieties of drug vice: the exotic, fascinating, tempting, and debasing kind associated with illicit drugs, and the homey, domesticated kind connected with a legal drug like alcohol. These differences have become less important as more ordinary people have begun to use illicit drugs. But even within the class of mild or domesticated vice, there are some odd distinctions. Coffee is permissible for children in Latin America but not in the United States, where, however, Coca-Cola, which contains the same drug, is a favorite children's drink. When tobacco was acceptable for men but not for women, spurious health reasons were often given for the discrimination.

Our social categories for psychoactive dnig use and our dilernmas about how to distribute drugs among them are not universal features of the human mind or of certain chemicals but products of a specific historical situation. In earlier cultures, the conceptual partitions so carefully erected by our society did not exist. In particular, the distinctions between magic, religion, and medicine have not always been so clear. The words "health" and "holiness" have a common root meaning "whole." Medical diagnosis and prognosis have always partaken of the occult, as a form of divination, and disease has been considered an instrument of gods or evil spirits, sometimes independent and sometimes called forth by the victims' enemies or their own moral delinquency or ritual transgression — as in the plagues of Egypt and Thebes. Shaman, witch doctor, sorcerer, and medicine man arevelated social roles. The religious—medical or magical—medical ceremony restores the harmony of soul and spirit world, repairing the broken whole and reintegrating the victim into the cultural community.

But today this is an underground theme. Medicine in the West began to separate itself from religion thousands of years ago, and by the early nineteenth century, in Europe and the United States, healers no longer attributed illness to spirits or consciously thought of drugs as magical substances. The scientific revolution and the enormous prestige of Newtonian physics had convinced doctors that most illness had physical and chemical causes. But a medical science created in the image of physics remained only a hope. Even a century after Voltaire's death, his description of doctors as men who poured drugs of which they knew little into patients of whom they knew less remained largely accurate. This uncertain situation, together with the growth of manufacturing, capitalist enterprise, and liberal individualism, made the nineteenth century a great age of self-medication and competing medical authorities. The proprietary drug industry that in some ways expresses the state of medical science and the conditions of medical practice at this stage of history had a great flowering in the late-nineteenth-century United States.

The story of patent medicines is intimately bound up with the history of alcohol, opium, and cocaine. It is more than a comedy-melodrama in which ridiculous or villainous quacks are routed at the end by the forces of honesty, truth, organized medicine, progress, and the criminal law. Even the best histories of the patent medicine era, such as James Harvey Young's The Toadstool Millionaires (1961), tend to rely on a framework of amusing or horrifying anecdotes alternating with praise for the triumph of modern medical and legal regulation. But in light of the present conflict over social definition and control of drug use, the moral of the story seems less obvious and less simple.

At the time, doctors tried to discourage the public's interest in entre-preneurial medicine by asldng potential customers whether they would trust the repair of a watch to a blacksmith. Unfortunately, this analogy embarrassingly emphasized the inadequacy of physicians as repairmen of the body. The public knew that even the best doctor did not, for practical purposes, understand much more about the human body than a blacksmith understood about watches; no one did. In a time when doctors offered bleeding, emetics, and purges as therapy for many illnesses, it is hardly surprising that people often turned to unlicensed healers and dubious drugs instead. Some of the best physicians, such as Oliver Wendell Holmes, Sr. (who called the patent medicine men "toadstool millionaires") adopted the doctrine of therapeutic nihilism, which declared most current medical practices and materials useless or worse. Holmes may have been right, but a suffering public often preferred the placebo response evoked by the strong personalities or advertising campaigns of the proprietary drug makers.

The relationship between proprietary drug use and orthodox meditpine was complicated. Many preparations described in standard pharmacopeias also appeared, often unlabeled or mislabeled, in patent medicines. Both sides searched the same sources in botany and folk medicine, and there was borrowing in both directions. Most doctors in the United States prescribed some proprietary remedies. Pharmacists also concocted pro-prietary drugs; one of them was Coca-Cola, which originally contained cocaine. In spite of great advances in some fields by the late nineteenth century, neither the state of medical science nor the organization of the profession was yet capable of producing great confidence in the value of reputable as opposed to disreputable or legitimate as opposed to illegitimate medicine.

Psychoactive drugs were in a peculiar position. They were not specific cures for anything but provided relief from suffering of many kinds. Opium, alcohol, or cocaine, lilce faith in some chemically inactive nostrum, could control the pain while the patient got better. These drugs were important to both orthodox and proprietary medicine. Even Holmes's therapeutic nihilism allowed an exception for opium (and anesthetics).

A list of the drugs most widely used in 1885 shows opiates (for pain) fourth and alcohol (as a sedative and anticonvulsant) sixth (first was iron chloride for anemia; second, quinine for malaria; third, ether for anesthesia; and fifth, sodium bicarbonate for indigestion). By 1910 the list had hardly changed; morphine was fourth and alcohol fifth (Smith and Knapp 1972, p. 161). Hospital pharmacies stocked large amounts of wine as an appetite stimulant, diuretic, sedative, and treatment for psychosomatic illness. Conditions had not changed greatly since the Roman physician Galen recommended laudanum (wine of opium) as a universal remedy.

It had always been known that psychoactive drugs could also be strong poisons. But consciousness of their dangers and demands for restriction began to increase in the late nineteenth century. The new wariness developed because the powers of these drugs began to seem too indeterminate and uncontrollable for medicine — more reliable than the power of quack nostrums, but no less mysterious and potentially monstrous. The first significant federal legislation on drugs, the Pure Food and Drug Act, was a compromise between nineteenth-century liberal attitudes (represented in an extreme form by Mill) and the new reaction against drug misuse. One of the inspirations for this law was a series of articles by Samuel HoPkins Adams entitled "The Great American Fraud," published in Collier' s magazine in 1905. After considering some of the odder nostrums and the products containing mostly alcohol, Adams devoted an article to the "subtle poisons" that he believed to be "the most dangerous of all quack medicines" because, in a sense, they worked — so well that they would lead âstray highly intelligent people. He meant opium and cocaine. The Pure Food and Drug Act forbade interstate shipment of food and soda water containing opium or cocaine, and required that these and certain other drugs in patent medicines be indicated on the label. It was mainly a truth-in-packaging law; the aim was not to eliminate free self-medication but to make it safer by preventing fraud and guaranteeing that the customer would be informed. It was still possible to believe in people's capacity to decide how and when to drug themselves. But soon afterward, far more drastic methods for organized repression of psychoactive drugs came to seem necessary.

The layman's right to make choices about these drugs was repudiated out of a conviction that any use of them outside of a few contexts dominated by medical professionals must be ignorant. These drugs had intrinsic powers of deception, and even the best informed person could be possessed by them, so correct labeling was not enough. Taking opiates to relax or cocaine to feel alert would no longer be legitimated as medical treatment. Soda fountains in drugstores were no longer thought of as medicinal in any way. Coca-Cola, originally sold as a quasimedicinal stimulant, was purged of cocaine and became just a soft drink (with added caffeine). Nineteenth-century ambiguity between health and pleasure began to seem dangerous, just as the conflation of health and holiness in primitive cultures had long seemed absurd. Doctors today may still dispense amphetamines and tranquilizers for the same reasons they once prescribed cocaine, opiates, and alcohol, but laymen cannot prescribe these drugs for themselves, and the medical ritual prevents any confusion between their intended effects and fun.

This control system became established at a particular stage in the development of the medical profession and of (capitalist) industrial society. The process can be observed clearly in the United States, where the first two decades of the twentieth century are generally known as the Progressive era in politics. Some revisionist historians call it a conservative period in which big business consolidated its power against labor and populist threats by means of rationalizing reforms and greater integration with government. In any case, the main political achievement was to bring some order into the chaos of late-nineteenth-century capitalism, and possibly to prevent mass misery that might have led to revolution. The greatest legislative monument of the age was the Federal Reserve Act', which reorganized the banking system; the Pure Food and Drug Act, the Harrison Act, and the Vo!stead Act were also characteristic Progressive legislation.

The attack on proprietary nostrums and the indiscriminate use of psy-choactive drugs not only put a stop to certain dangerous and fraudulent practices but also served to consolidate the strength of organized metlicine and pharmacy and the larger drug companies, in cooperation with the federal government. Muckraking journalists, medical professionals, and government officials all agreed that the sale of proprietaries had to be curbed. Narcotics laws aided the institutional growth of the modern health professions by helping to define their areas of competence and exclude unlicensed practitioners. (State licensing for medical practice was first upheld by the Supreme Court in 1888.) The impulse to clean things up and reduce disorder worked against both free self-medication and the small-scale entrepreneurial competition it encouraged.

But advances in the art and science of medicine were just as important as the trend toward consolidation and formal regulation in business and the professions. With the rise of synthetic chemistry, experimental phys-iology, and above all, bacteriology, the promise of a materialist medicine in the Newtonian image, based on the recognition of specific disease agents for specific diseases, finally seemed about to be fulfilled. The work of Pasteur, Koch, and their colleagues and successors became a model.

It is no accident that this was the era when drug abuse began to be conceived as epidemic disease. A new self-respect and esprit de corps came with the growing social power and professional organization of physicians. In these circumstances, the old psychoactive drugs naturally became more suspect. It required little special training or diagnostic ability to dose patients with alcohol, opium, or cocaine for their complaints and produce satisfied customers who might come back for more indefinitely. This was a challenge to the professional standing of doctors as well as a danger to the patient; intellectual hygiene required clear and enforceable classification of psychoactive drugs.

The law helped to fix the image of drugs that were being used indis-• criminately as medicine and for pleasure at a time when changes in social stnicture and medical knowledge decreed that medicine and pleasure were to be divorced and much of what had been regarded as medicine or pleasure was now to be treated as disease, vice, or crime. Synthetic psychoactive drugs, most of them developed later by a much more highly disciplined, organized, and respected medical profession and drug industry, were at first not treated so harshly, but as their potential for use as pleasure drugs became clear, they were placed under similar controls.

Both doctors and police are part of this arrangement, which serves a protective and conservative function. Disputes about when drug use is illness Arid when it is crime are often in effect jurisdictional disputes between the medical and police professions; Siegler and Osmond acknowledge this when they emphasize that they favor a medical model rather than a disease concept of drug dependence. Organized medicine has always adjusted its views to those of the government by mutual accommodation (with some open conflict, of course, as in the court decisions forbidding doctors to treat addicts with opiates). Most people regard this as a natural partnership that expresses the nature of public health medicine; even police are happy to turn addicts over to the medical system. Only extreme libertarians such as Szasz, the most faithful intellectual descendants of Mill, think that doctors have sullied their professional purity by turning themselves into police officers and penologists. What matters is that the system of concepts and the institutional structure provide mutual support.

In twentieth-century societies, more and more occupations come to claim the title of profession. A form of work establishes itself as a profession largely through self-consciousness with regard to its technique. Law and medicine are among the oldest professions, with the most highly developed consciousness of technique. The medical and allied professions today, as they expand, divide, and put out new branches, tend to incorporate more and more social functions (Szasz denounces this as "medical im-perialism"). In the words of Harold Rosenberg, "A profession becomes really top-rank when it can offer its system of technical redefinition as the key to the human situation, that is, as philosophy" (Rosenberg 1959, pp. 61-3). Medicine may have come closer than any other profession to achieving this status, as more and more kinds of things are defined as illness. For example, the American Psychiatric Association has recently classified habitual cigarette smoking (tobacco dependence) as an illness in certain circumstances.

But medicine has had to make its way by alliance as much as by conquest. Pharmacology and psychiatry, the divisions assigned to psy-choactive drugs, operate in relation to the bordering armies of the criminal law by a delicate alternation of skirmishes and treaty conferences. The license of medical professionals to define illness as a social role remains limited, and their right (as well as the law's) to interpret the meaning of psychoactive drug use is persistently contested by people who go on thinking of it as recreation. This challenge has had little effect on formal regulations but a strong effect on informal attitudes, especially -since it came into the open in the 1960s. The change came about partly because of a general loss of respect for established institutions and partly as a penalty for professional and government overreaching, especially where marihuana was concerned.

The movement to prohibit alcohol illustrates well how the medical or consumerist side and the moralistic side of drug regulation have been separated and joined at different times and for different purposes. We have always had fewer effective fixed prejudices about alcohol than about other psychoactive drugs and more socially acceptable ways of looking at alcohol problems; alcohol has always been a respectable pleasure as well as a vice and a medical problem, so policy debates have been unusually open and free.

The distinction between drug laws as health and social reform measures and drug laws as symbolic cultural domination is reflected in the way the history of the prohibition movement has been written. Historians during the Prohibition era itself emphasized the progressive and reformist character of the new law. Charles and Mary Beard, writing in 1927, denied that Prohibition was puritan tyranny; Samuel Eliot Morrison and Henry Steele Commager, in a very popular history textbook published in 1930, called it "the most notable of all reforms" of the Progressive generation (Paulson 1973, p. 2). Soon after repeal a reaction set in, and it became standard to regard advocates of prohibition as moralistic fanatics bent on spoiling other people's innocent pleasures. Terms such as "pseudoreform," "status politics," "rural-evangelical virus" (Hofstadter 1955), and "symbolic crusade" (Gusfield 1963) became popular. Prohibitionists were pictured as wanting to impose their provincial, nativistic conception of propriety and self-discipline on the urban, foreign-born, and working-class popu-lations. They were said to be seeking a symbolic victory to compensate for a loss of real power and prestige — a reaffirmation of a way of life that was doomed. The purpose of Prohibition was not instrumental but expressive; that is, its effectiveness was less important than its symbolic and emotional valence. The movement was reactionary and tinged with hysteria and sadism. Alcohol itself was largely a token, an object for displacement of inchoate anxieties. Prohibitionists were projecting what they feared in themselves onto outsiders and repressing it (Sinclair 1962).

This folklore of Prohibition first developed among the more articulate drinIcing classes during the 1920s. Its most eloquent proponent was H. L. Mencken, politically conservative and derisive about democracy. He surnmed it up: "A prohibitionist is the sort of man one wouldn't care to drink with — even if he drank." The journalist Franklin P. Adams observed, in a famous verse response to the report of President Hoover's commission on alcohol prohibition:

It's left a trail of filth and slime;

It's filled the land with vice and crime;

It don't prohibit worth a dime.

This opinion of the effects (probably incorrect) made it easier to criticize the prohibitionists' motives as mean, naive, or self-deluded. Later so-ciological and historical studies elaborated the view more decorously and less polemically — in a more deadpan way.

We all know that alcohol abuse produces disease, accidents, crime, family conflict, and social chaos — effects that would be considered bad under any cultural definition and whatever the symbolic resonances of drinking. And yet for a long time, historians would hardly admit that the prohibitionists' intentions might have borne any rational relationship to these evils. It was as though they were concerned with something quite different from what draws the attention of serious people to alcohol problems today. But a revisionist trend began in the 1960s, and now some historians emphasize the serious concern for health and family life, moral universalism, faith in science and democracy, and utopian social hopes that influenced the Prohibition movement (Paulson 1973; Blocker 1976; Clark 1976).

In fact, provincial moralism and a more universalistic reform impulse were interwoven, often inextricably, in the Prohibition movement, as in all campaigns for the suppression of pleasure drugs. But in other antidrug campaigns, we tend to underestimate the influence of provincial moralism; in antialcohol campaigns, we are more inclined to ignore or explain away the serious effort at social reform. Maybe this is a situation in which too much of the history has been written by the victors; it would do no harm to examine the losing side more sympathetically.

The public campaign against alcohol abuse affected all northern European and Anglo-Saxon countries in the nineteenth and early twentieth centuries. It was a large and complicated movement that started with a crusade for voluntary temperance, then abstinence, and sometimes developed into a drive for government restrictions on alcohol production and sales: passboolcs, licensing, nationalization, and finally selective or total prohibition. The Gothenburg system for regulation of spirits (city control of bars, restricted hours, no profits on alcohol) was introduced in Sweden in 1865 and made obligatory in 1905. The Bratt system of individual passbooks for liquor consumption was established in 1919, and liquor stores were nationalized in 1922. Finland imposed national prohibition between 1919 and 1932. Canadians voted for prohibition province by province up to 1919, but then reverted to local option on alcohol sales. England had a 's'erious temperance movement that turned toward prohibition in the 1870s. All of these movements were similar in their social roots, ideologies, and historical development. The U.S. prohibition drive was not unique or uniquely pathological. The campaign against alcohol was a reform move-ment, often a radical one, associated with other radical causes: s'ocial justice, industrial reform, women's suffrage, and, in both Great Britain and the United States, antislavery. It also had much in common with other antidrug movements, especially the crusade against the opium trade, although it faced a much bigger problem and much greater social obstacles.

In medieval England, drunkenness was a matter for the ecclesiastical courts; like other moral issues, it was left to the church. By the fourteenth century there were penalities against the clergy for drunkenness, and laws covering breach of the peace were sometimes used against public intox-ication. Taxes, tariffs, licensing laws, and statutes fixing the price and quality of alcoholic drinks were also in effect. There were no secular laws against laymen's drunkenness until an Act of Parliament passed in 1606 allowed local common law courts to punish it. The colonies adopted the English common law system and introduced their own variations. There were the usual licensing, tax, and other regulations, and laws against public and even private drunkenness. Some colonies enacted special laws, usually ineffective, against the sale of alcohol to Indians (to prevent disturbances) or to apprentices and sailors (to preserve property rights in their services). Old records show the same alcohol problems and even more or less the same range of proposed answers that we find today; here not much has changed.

Americans developed a reputation for alcoholic intemperance in the first fifty years after the founding of the Republic; those generations drank more than any before or since. The best estimate is that per capita alcohol , consumption in 1830 was two and a half times what it is today, even though drinking is now at a high for this century. Men (and boys) did most of the early-nineteenth-century drinlcing, and most of it was spirits, especially whiskey. Between 1772 and 1802, consumption of spirits rose from 2.5 to 5 gallons per person per year. The United States before the Civil War was notorious for drinking binges and horrendous drunken degradation of the lcind represented by Huck Finn's father in Mark Twain's novel. The alcohol industry was economically important; much of the country's grain production went into the distilleries. Alcohol taxes were intensely resented on the frontier as class legislation. The Whiskey Rebellion of 1794, which forced George Washington to order troops to western Pennsylvania, was an uprising by frontier farmers against a federal excise tax on whiskey. The tax was repealed in 1802, after the Federalist party of Washington and Hamilton fell from power (Rorabaugh 1979).

Licentious drinking habits evoked a public response in the temperance movement that began in the late eighteenth century and became more powerful and more radical after 1830. One of the earliest prominent temperance reformers was the Quaker radical, pacifist, and abolitionist An,thony Benezet, who was especially concerned about the damage liquor did to Negroes and Indians. It was also at this time that the physicians Benjamin Rush and Thomas Trotter began to write seriously about al-' coholism; Trotter's study of 1804 is sometimes said to be the first publication treating alcohol abuse as a disease. Although religion in one form or another was the most powerful impulse for temperance reform, it was not an evangelical reaction against Catholics, an Anglo-Saxon reaction against immigrants, or a rural response to urbanism. The nativist Know-Nothing party of the 1850s, for example, gave no consistent support to prohibition.

The movement preceded any significant industrialization and was joined " by members of all social classes. It began in the Northeast and was mainly a middle-class and urban or at least small-town phenomenon, rather than a rural one, right up to the twentieth century. It attracted skilled workers, small manufacturers, professionals, and modernizing farmers (Tyre11 1979). For a time, beer and wine were thought to be better than spirits (temperance advocates soon became disillusioned with this notion). Drunlcenness was regarded at first mainly as a personal moral problem, to be solved by education, self-discipline, or religious self-purification rather than laws — a position that Mill still held in 1859, when many reformers had abandoned it. The temperance reformers were promoting security, ratio-nality, orderly work habits, and family stability (Rorabaugh 1979).

Disillusionment with voluntary change soon set in. Americans began to drink less whiskey and more beer after 1830, but that seemed to make little difference. Interest turned from temperance to abstinence and then to legal restraints. Prohibition laws of varying severity were passed in several states in the 1840s and 1850s and then repealed: the so-called first wave of prohibition. Mill used them as bad examples in On Liberty. Instead of pledge taking and appeals to self-respect, the movement was now calling for state action; the change implied a new view of the citizen's relation to society.

In some of its supporters' dreams, prohibitionism took on a messianic quality: A revolution in human habits would transform society and produce a new birth of liberty and justice. Many abolitionists favored prohibition, including the most famous of them, William Lloyd Garrison. Abolitionists drew an analogy between the two causes; after emancipation one ofthem, Gerrit Smith, spoke of drinkers as "millions of our voluntary slaves who still cling to their chains" (Sinclair 1962, p. 82). The men who founded the Prohibition party in 1869 regarded it as the true heir to abolitionism.

Temperance reform was even more closely allied with the movement for women's rights and suffrage. Some preliterate societies exercisedittle control over male drinking because the women, who suffer most from it, have low status and little power (Lemert 1967). Women's rights leaders like Susan B. Anthony and Frances Willard of the Women's Christian Temperance Union (WCTU) pointed out that in Europe and the United States too, women often had to bear the burden of male drunkenness and suffer the hegemony of that quintessentially male supremacist institution, the saloon. The sisterhood of the WCTU was meant to serve partly as a counterweight to the fellowship of the saloon bar. Willard said that she was working to liberate white slaves (women), wage slaves, and whiskey slaves. The alliance between women's rights and the campaign against alcohol was international; the Universal Suffrage Association, founded in Sweden in 1890, united women's rights, socialist, and temperance groups.

Many temperance reformers and prohibitionists thought restraints on the use of alcohol to be necessary for democracy itself. Before the Civil War, elections were sometimes bought with whiskey. After it, brewers and distillers formed alliances with other reactionary groups to work against women's suffrage and other reforms. By the late nineteenth century, most saloons were tied houses, controlled (through mortgages) by mo-nopolistic liquor distributors. The liquor industry strongly influenced the corrupt politics of the Gilded Age, especially by supplying graft to party machines. In 1884 almost two-thirds of the one thousand Republican and Democratic party political conventions were held in saloons.

The campaign against alcohol, like other antidrug campaigns, was also a movement for public health reform. Often parallels were drawn between drunkenness and cholera, the most terrifying epidemic disease of the nineteenth century; like cholera, alcohol abuse was regarded as a symptom of social disorder as well as a disease — something that required indirect solutions. The teaching of physiology and hygiene in public schools was promoted mainly by temperance reformers and prohibitionists; much more space in school textbooks was devoted to the dangers of alcohol in the 1880s than in the 1930s. (Sometimes lurid misinformation was introduced into this educational material — for example, the assertion that alcohol could burn the throat or cause spontaneous combustion in a drunkard. Parallels with more recent antidrug campaigns are evident.)

The temperance movement in Scandinavia, the British Empire, and the United States eventually worked out a critique of free trade and the night-watchman state. In England, early temperance reformers actually thought that a free market — what was known as "free licensing" — would be better than the existing system of government favoritism, which they associat$ with the corrupt old regime of aristocratic privilege, poor work habits, and lax morality (Harrison 1971). Their belief that this change would reduce alcohol abuse was soon dispelled, and the political philosophy that came to dominate the British temperance movement was best articulated by Mill's great opponent, T. H. Green, who had a strong personal interest in the problem because his brother was an alcoholic. Green's "Lecture on Liberal Legislation and Freedom of Contract," first delivered in 1880, became an important text for the campaign. He reconunended prohibition (by local option) on the same grounds as factory acts, health regulations, and laws to protect tenant farmers. Absolute freedom of contract had to be abridged to maintain the conditions for the free exercise of human powers. We must take men as we find them, Green said, rather than treat them as though existing conditions allowed them to live according to an ideal of autonomy. The degradation of drunlcenness, lilce factory abuses and tenancy arrangements detrimental to agriculture, would be perpetuated if the solution were left to casual benevolence, education, and persuasion (Green 1900). It is the familiar argument for enforcing positive liberty.

But with it, all of the old questions about positive liberty arise. It can be asked what interests are really served by laws that deny people the right to make a choice about alcohol, supposedly for their own good or society's. Anthony Benezet's motives for wanting to protect Indians and blacks from liquor may have been irreproachable, but that cannot be said of masters who wanted to get more work out of their slaves or local governments that wanted less trouble from nearby Indians. Like cocaine, whiskey was sometimes regarded as a "Negro" problem by late-nine-teenth-century prohibitionists who were also racist. To appeal to manu-facturers and landowners, prohibition propaganda mentioned industrial discipline and the danger of pauperism; that was one reason Mill was suspicious of it. The saloon was sometimes vicious and sordid, but it also served the workingman as a union hall, labor exchange, and center of social life.

So the temperance movement sometimes had an undemocratic undertone, with members of the middle class deciding that the poor could not both drink and work. Would prohibition be good for workers and the poor, or would it take away one of their few pleasures? This has always been an issue in drug control. James I put a 4,000 percent customs duty on tobacco in 1604; he hoped to keep the poor from smoking the weed and becoming "riotous." Periodic bans on the sale of gin in eighteenth-century England had the same purpose. The first state prohibition law, forbidding the retail sale of spirits, was passed in Massachusetts in 1838; it was repealéd in 1840 after a campaign in which the opposition insisted that it favored the rich, who could afford to buy in bulk. Prohibitionists were naturally sarcastic about the liquor interests' concern for the poor, but it remains true that most forms of drug and alcohol control weigh more heavily on people with less money, and often are designed to do so. This ambigtiity in the prohibitionists' notion of liberation allowed a group of brewers and distillers to set up an organization called the Personal Liberty League in 1880.

Especially after 1890, the most powerful prohibition organizations began to adopt (in the words of Joseph R. Gusfield) a "coercive" rather than an "assimilative" attitude toward drinkers (Gusfield 1963). The change was marked by the passage of leadership from the Prohibition party (founded 1869) and the WCTU (founded 1874) to the Anti-Saloon League (founded 1895). The Prohibition party was not leading a one-issue crusade; it was probably the most important reform political or-ganization in the country during the Gilded Age. Although not radical, it favored many changes that were a threat to vested economic interests. . Just as abolitionists denounced churches that compromised on slavery, prohibitionists denounced church compromise with the liquor interests. In the 1890s, the Prohibition party lost its more radical constituency to the Populists and its more conservative constituency to the Anti-Saloon League, which made no broad reform demands but concentrated on alcohol alone. The Anti-Saloon League was led mostly by upper-middle-class people in middle-sized towns and cities. It operated as a centralized, politically manipulative pressure group, appealed to conservative churches, avoided direct attacks on the liquor industry, and sometimes introduced a touch of anti-immigrant prejudice (Blocker 1976, 1979).

It is hard to tell why national prohibition succeeded in Finland and the United States but nowhere else in northern Europe or the British Empire. Finland's parliament passed the prohibition law shortly after the country achieved independence from Russia and became a republic; the law was associated with a new beginning in politics. In the United States, a puritan social messianism, a dream of human perfection, may have been more powerful than it was elsewhere. The drive for national prohibition began in earnest in 1913 after limited success in state referenda. Between 1900 and 1918 there were forty-nine state referendum votes. Before 1912, five of fourteen favored prohibition; after 1912, twenty-five of thirty-five. These were mostly in the less populous states and proposed only a limited form of prohibition. Still, by 1917, half of the states had some form of prohibition, usually a ban on spirits only. Despite the lobbying of the Anti-Saloon League, in the end Prohibition was not imposed merely by a militant minority seeking cultural dominance; it was probably a more popular cause than women's suffrage, which was enacted into law at about the same time.

The limited reach of Prohibition (for example, fruit juice could be legally fexmented at home, and the sale of distilling equipment was never outlawed) and its spotty enforcement are sometimes cited as evidence that prohibitionists sought mainly a symbolic victory rather than a real decline in the use of alcohol. But that is probably a misunderstanding of their intentions and the magnitude of their utopian hopes. Prohibitionists did not place their faith in the law alone; they thought that destruction of the saloon system (which Prohibition did achieve), along with other advances in civilization, would lead to a gradual fading of the appetite for alcohol. President Hoover has often been ridiculed for calling Prohibition "an experiment noble in intent," but there was nothing intrinsically foolish about that statement. His mistake was not to admit that the experiment had failed in the simple sense that the public had turned against it. A legend has developed on the assumption that if it failed in this way, it must have been wrong in every possible way. Many histories tell us that drinlcing and its dangers became worse and that organized crime gained extraordinary wealth and power. Prohibition was "the skeleton at the feast, a grim reminder of the moral frenzy that so many wished to forget, a ludicrous caricature of the Yankee-Protestant notion that it is both possible and desirable to moralize private life through public action" (Hofstadter 1955, pp. 289-90).

But this description itself is a caricature. Although Prohibition was laxly enforced, especially in the areas where it was most unpopular, the law was not ignored; for example, in 1930, 4,000 out of 12,000 inmates of federal prisons were there for liquor trafficking. The law apparently did make it inconvenient to get alcohol and therefore reduced the amount of drinldng. Cirrhosis of the liver became much less conunon. Yearly per capita consumption of alcohol in gallons has been estimated as 2.6 in 1906-10, 1.69 in 1911-14, 0.97 in 1918-19, at the start of Prohibition, 0.73 in 1921-22, 1.14 in 1927-30, and 0.97 in 1934, just as Prohibition ended; by 1940 it was up to 1.56, and today it is 2.6 (Clark 1976).

Admittedly, estimates are uncertain for the Prohibition era; the decline began even before national Prohibition was imposed; and alcohol use also fell off during those years in other countries without Prohibition. It may also be significant that alcohol consumption was lowest in the early years of Prohibition, rather than later on, when the enforcement Machinery was putting more people in prison. Still, for whatever reason, the 1920s were apparently the low point rather than the high point of alcohol abuse in U.S. history. Most people never saw a speakeasy, and the publicity given to the conspicuous drinlcing habits of a few young people of the middle and upper classes created a misleading impression. Thé poor especially dranlc much less, apparently because alcohol became relatively expensive. The Wickersham Commission, appointed by President Hoover to investigate the enforcement problem, concluded that Prohibition had probably been good for the health of the poor. There is not even any substantial evidence that Prohibition produced a new wave of lawlessness, apart from the newly created illegality of alcohol trafficldng. Organized vice and crime had always been associated with the legal saloon system; the chief business of organized crime was then and still is gambling. Al Capone, the prototypical 1920s gangster, did run a business smuggling beer from Canada, but most of his income and power came from gambling and loan sharking. It is not at all clear whether the history of organized crime would have been much different or its growth much slower if there had been no Volstead Act (Burnham 1968-9).

Prohibition was repealed not because of its scandals, inefficiencies, and nasty side effects (these were never considered good reasons to repeal other drug laws) but because tastes were changing as the middle class became less puritan. People decided that they wanted legal alcohol and found ways to justify the desire. Before the Civil War, William Lloyd Garrison could make an analogy between the liberation of slaves and the liberation of drunlcards. By 1930 Nicholas Murray Butler, the president of Columbia University, was comparing the repeal movement to abolitionism (Sinclair 1962, p. 361). But repeal was not brought about mainly by new ideas of personal liberty. The lobby for repeal was supported by hotel i and real estate interests and led by a group called the Association Against 4 die Prohibition Amendment (AAPA), which included a DuPont and John D. Rockefeller, Jr. on its board of directors. The campaign emphasized 1 benefits that seemed attractive in a country suffering from economic depression: taxes, jobs, and the elimination of enforcement costs.

When the AAPA reconstituted itself after repeal as the Liberty League 't to oppose the Roosevelt government 's social programs, it became the f president's favorite target of attack and soon collapsed; support for repeal I did not mean general opposition to state interference in the economy or , a nineteenth-century ideological liberalism. It is no accident that new theories of alcoholism as a disease, developed by AA and the Yale School of Akohol Studies in the 1930s, emphasized the susceptibility of particular persolas rather than the plague germ of alcohol itself. The rhetorical assault 41n other drugs might continue, but alcohol would no longer be regarded as a menace to society as a whole.

The process that began around 1900 and was completed by the Prohibition ,experiment eliminated most of the symbolic resonances of the alcohol 'problem. Today a culturally reactionary movement such as the Moral ' Majority talces no special interest in alcohol as a moral issue. But pro-hibitionism also lost its association with other progressive reform move-, ments in Europe and the United States. India offers an interesting contrast; ' there the Congress party under Gandhi struggled for women's rights and Moslem—Hindu friendship, and opposed British rule, the caste system, alcohol, and opium. The goals of temperance, equality, social cohesion, and democracy were united as they had been in the European and American prohibition movements of the nineteenth century (Paulson 1973, pp. 175— 84).

The war against alcohol was produced by the same social changes that provoked the war against opium and other drugs. It involved the same mixture of social and health reform, class interests, and symbolic cultural conflict; the campaign against alcohol was neither more nor less driven by "moral frenzy" than other antidrug movements. Similar medical re-definitions were required; doctors began to think of alcoholism as a disease at about the same time, and in the same at first hesitant way, that they began to define other drug abuse problems as disease. But unlilce opium and cocaine, alcohol was not an exotic substance with powers that were frightening because mysterious. It was too familiar to be branded with the narcotic stigma and too closely associated with innocent fun in too many respectable people's minds to be purely a drug menace. Penalties for purchase and possession of alcohol were never imposed, much less enforced. Alcohol use was never reduced to the categories of medicine and vice. The Wickersham Corrunission concluded that true enforcement of alcohol prohibition was impossible without either religious sanctions or methods intolerable in a liberal democracy, and it admitted that in this respect the only difference between alcohol and other drugs ("narcotics") was public opinion. Here the dream of enforcing positive liberty by law had to be abandoned.

As the Liberty League found out, Prohibition was not rejected because of any theory of state control and liberalism, but because lawmakers finally made a muddled adjustment to persistent public sentiment. Other drugs have always been regarded differently by the public, so government control over them has steadily increased. The temperance movement had difficulty choosing between voluntary self-help and public control as a solution to the alcohol problem — thus its hesitations, backward turnings, and abortive experimentation. By now the Western countries have come down firmly against serious legal restraints. On the control of ()the/ drugs, there was little wavering; from the late nineteenth century on, it was not remotely likely that freedom to use them would be included among the rights of classical liberalism.

The international opium trade and most legal opiate use succumbed in the early twentieth century to a long campaign that paralleled the Prohibition movement and was allied with it. The antiopium crusade opposed customary vices, established economic interests and free-market doctrine in the name of public health, morality, and social reform. Lilce the temperance campaign, it raised questions about liberty and legal moralism. The outcome differed partly because, as a federal judge observed in 1886 while invalidating a Portland, Oregon, city ordinance on opium smoking, "Opium is not our vice" (Bonnie and Whitebread 1974, p. 14); that was one reason we were more likely to go to extremes in our desire to suppress it or to harass those who practiced it.

Well into the nineteenth century, many respectable people considered opium no worse than alcohol. In Europe and the United States, it was freely available and no more expensive than aspirin is today. Moderate habitual use of opium in the form of laudanum was not necessarily considered addiction, and many people regarded addiction itself as less dangerous to individual and social health than alcoholism. In any case, it was rare in the West until the late nineteenth century. Opium smoking, which was common only in China, became a moral and political issue much earlier.

The history of the opium trade conducted by the British government between India and China illustrates the conflicts that arose in an era when the principles of drug control that seem natural today were still struggling for social dominance. Opium had been used in the Far East for thousands of years, but the habit of smoking it apparently began to spread only after tobacco smoking was introduced from Spanish America in the sev-enteenth century. The import trade was organized first by Arabs and then by Europeans. Imperial China seems to have been the first nation to define opium use as a serious social problem; the emperor issued edicts against it in 1729 and 1799, but enforced them halfheartedly.

In the eighteenth century, England became the dominant power in India, ruling largely through the East India Company, a joint stock trading company that had been operating in Asia since it was chartered by Elizabeth I. The government of Bengal, which was under direct British control, licensed the cultivation of opium, bought it at a monopoly price, refined it, and sold it at auction in Calcutta, taking the profit. Opium transported to Bombay from the western areas of India under indirect British rule was subject to a transit tax. The government of India in the mid-nineteenth century drew a sixth of its revenues from this crop. Private buyers transported the arug to China, where they anchored their ships offshore at Canton and transferred it to Chinese smuggling boats. Chinese officials took bribes from merchants and connived at the contraband traffic.

In the 1820s and 1830s, as opium imports increased, the Chinese government responded more seriously. The demoralizing physical and mentaf effects of the drug were exacerbated by the debilitating financial effects of the trade. The British wanted China's tea and silk, but had little to offer in exchange. Since the Chinese were not interested in British manufactures, only the sale of opium kept the British treasUry from being drained of gold and silver to pay for Chinese products; even so, the balance of trade was unfavorable to Great Britain throughout the first half of the nineteenth century. But the Chinese did not like to lose any precious metals at all in exchange for opium. Some factions in the imperial gov-ernment therefore recommended legalizing the drug to collect taxes on it, but in 1838 the emperor instead decided to send an honest commissioner to Canton to suppress the commerce. Opium belonging to British merchants was destroyed, and a conflict followed that is now lcnown as the Opium War. The British attacked several Chinese coastal cities, and the Chinese l'quickly capitulated. By the Treaty of Nanking in 1842, Hong Kong was ceded to Great Britain and five Chinese ports were opened to British trade and residence. Other Western powers soon received similar privileges. Opium smuggling was allowed to continue as before. China did not comply fully with the provisions of the treaty it had been forced to sign, and the seizure of a British merchant ship in 1856 precipitated another war, which ended in 1860 after British and French troops occupied PeIcing. China now promised to open more ports to European trade, allow foreign legations in Peking, permit Christian missionary activity, and legalize the importation of opium.

These events are sometimes described by saying that the British forced opium on the Chinese. But from the point of view of European govenunents, the aim of the Opium War and the conflict of 1856-60 was to make China accept the same rules of commerce and diplomacy that Europeans ' followed among themselves, and treat the representatives of European nations respectfully, as equals rather than barbarian interlopers. The former - president of the United States, John Quincy Adams, said that opium figured in the Opium War in the same way that tea figured in the Boston Tea Party; some of the British, oddly, thought of themselves as defénding a principle.

Although many people in Europe were slightly ashamed of the traffic and regarded opium smoking as a vice, it had not yet become a powerful moral issue except for a few progressive reformers and missionaries. Defenders of the trade could plausibly say that opium was no worsethan gin or whiskey; only a minority of opium smokers were demoralized and degraded addicts, just as only a minority of drinlcers were drunkards. Evidence from modern opium-smoking areas suggests that this was true., (Kramer 1982). It was also plausible to say that the opium trade would have continued even without the Opium War, given local demand and the weakness and corruption of the imperial government. The Chinese rulers were often told that it was their problem; if the Chinese people did, not want the drug, there would be no market for it. The government' should either suppress the buying and selling of opium within China or. educate the people out of the habit, as temperance reformers were educating Europeans out of the alcohol habit. Imperial China could be seen as an autocratic and corrupt government making sporadic and insincere efforts to enforce a law that its people would not accept. In fact, by the 1850s, China had given up on prohibition; the government willingly accepted legalization and the tax revenues that went with it.

John Stuart Mill was involved in the opium controversy by virtue o his position as a clerk in the London office of the East India Company, where he worked from 1823 to 1858. In 1856 he became chief of the examiner's office, a job his father had also held. It was his duty to write pcecutive orders to the government in India on political subjects; he fulfilled many of the functions of a secretary of state. In 1857 Indian soldiers of the army in Bengal mutinied, and a general uprising followed. After it was put down, the Crown assumed direct rule, despite Mill's loquent defense of the East India Company's administration (Packe 1954).

The East India Company was removed from power in 1858, the same year that China signed the first treaty legalizing the opium trade. On Liberty was completed in 1857 and published in 1859. When Mill defended i.:ternalistic despotism for backward peoples, he was probably thinking if India. When he defended the opium trade in the name of the opium smoker's liberty, he presumably meant either that the Chinese were not backward in this sense, or else that the Chinese government should have 'talcen paternal responsibility for suppressing opium without making de-parids on the British. It is easy to see how Mill's service in the government of India might have influenced his views on freedom of choice for the Chinese. He was not a hypocrite, and he was never formally inconsistent on this subject, but he was forced by his own and his nation's history mto the curious position of defending the freedom of the Chinese to indulge a dubious taste against the opposition of their own autocratic rulers, while himself serving another despotic government that derived profit from supplying that taste.

The campaign to prohibit cultivation of opium in India for export gained ltrength after the China trade was legalized. The Chinese government ;still formally expressed disapproval of the imports, but China began to vow its own opium. Cultivation was legalized in the 1860s, and by 1885 two-thirds of the opium consumed in China was produced there (Owen 1934, p. 266). Revenue from the India trade began to lose its importance for Great Britain after 1880. Opium prohibitionists forced the appointment of a Royal Commission that studied the Indian cultivation and manufac-turing system from 1893 to 1895. Its report contained 2,500 pages of testimony in which evidence for varying opinions could be found. The commission concluded that the system was a fairly good one that derived maximum revenue from minimum consumption. It said that in any case, the dangers of opium had been exaggerated (this was true; even the most sensible antidrug campaigns always seem to feature lurid exaggeration). Reformers rejected the conclusions as biased by the commission's complicity with the government of India.

Ten years later, heightened public conscience and lowered public revenue made opium prohibition an idea whose time had come. In 1906 the Chinese began to reduce the area of cultivation, close opium dens, and establish a maintenance system for addicts. The British agreed to cut down imports. The republic established in China after the revolution of 1911 extended the antiopium measures taken by its predecessor. The last Indian opium reached China in 1913, and the last imported opium in stock was bumed in 1919.

The India trade had ended for good, but despite the government's efforts, cultivation of opium in China went on through the years of internal chaos, civil war, and foreign invasion that followed. Opium smoking was not eliminated until the Communists took control in 1949 and established the first strong central government China had had in many years. Even without imports from India, Chinese addicts (and other opium smokers) found ways to provide themselves with the drug until they were educated or coerced into abandoning the habit by a resolute reforming despotism within China itself. History tends to confirm the opinion of those who said in the nineteenth century that international drug traffic was not the cause of the opium problem in China but a result of it.

Western nations became less tolerant of the opium habit as it began to spread in Europe and especially in the United States. While the opium traffic between India and China declined and the Prohibition mpvement became stronger in northern Europe and North America, the United States began an attempt to impose strict international controls on narcotics. A series of international conferences at The Hague from 1911 to 1914 drew up a convention that provided for restrictions on the manufacture and distribution of opiates but left the details mostly to domestic legiNjation; soon afterward the United States passed the Harrison Narcotics Act. The Hague Convention was made part of the Treaty of Versailles in 1919; international control had been fully accepted, at least in theory. Since then, the League of Nations and the United Nations have made a series of arrangements culminating in the United Nations Single Convention on Narcotic Drugs of 1961. This treaty came into force in 1964, setting detailed requirements for the control of opiate manufacture and distribution by the ratifying governments, most of which already had their own highly restrictive laws.

In the United States, concern about narcotics began to mount when vagrants and criminals on the West Coast took up the opium habit from Chinese indentured laborers. San Francisco passed a law against opium dens in 1878; in 1909 the importation of smoking opium was prohibited. The opiate preparations most commonly used in the United States were at first treated more leniently, because most users were middle-class whites (the majority were women). But gradually all opiates came to seem dangerous, and restrictions were introduced, first at the local and state levels and then at the national level. The Harrison Act of 1914 placed all trade in opiates under the jurisdiction of the Bureau of Internal Revenue in the Treasury Department. Every dealer in narcotics and every doctor who prescribed them had to register, record all transactions, and pay a nominal tax (so that the right of Congress to raise revenue could be used as a constitutional justification for the law). A doctor could prescribe opiates only in the pursuit of his professional practice. In form the act was very mild; the police powers granted to the federal government were only implied. But the Treasury Department was able to get the Supreme Court to rule, in the Doremus and Webb cases (1919) and the Behrman case (1923), that addict maintenance was not properly part of professional practice and therefore violated the Harrison Act. After a brief experiment with clinics dispensing opiates in 1920-1 (in Shreveport, Louisiana, until 1923), addicts no longer had a legitimate source of the drug. The problem was defined as a criminal one in 1920 when narcotics enforcement was turned over to Prohibition agents by the establishment of the Narcotic Division of the Treasury Department's Prohibition Unit; this definition faced little opposition until the 1950s. In the 1930s most states made opiate possession a criminal offense by passing the Uniform Narcotic Drugs Act, and many made addiction itself a crime.

A. change in medical attitudes followed the change in government policy. When the Harrison Act was passed, many doctors thought that addiction could be cured by supervised withdrawal. The Treasury Department's policy of treating maintenance as an illegitimate professional practice was based on that assumption. When it became clear that there was nef easy cure for addiction, the whole medical approach came under suspicion. Even the abstinence syndrome was sometimes said to be psy-chological in origin. A new kind of criminal addict had become highly visible, and it was now plausible to regard addiction as a vice rather than a disease. This retreat of the medical model and the medical profession had important effects. In the Linder case (1925) and the Boyd case (1926), the Supreme Court modified its rulings against maintenance, allowing prescription of opiates if the doctor acted in good faith "for relief of a condition incident to addiction" — that is, abstinence symptoms. But by that time doctors were wary of prescribing for addicts anyway, not only because of the law but also because they were such demanding, dishonest, and troublesome patients.

The character of addicts had begun to change in the 1890s as doctors became more conscious of the dangers of opium and introduced new painlcillers. The Harrison Act would not have been possible without this decline in medical use and may have had only a minor independent effect.

There were probably fewer opiate addicts in 1920 than in 1895, but the social problems they created, both real and fancied, were greater (Court-wright 1982). Except for the federal narcotics hospitals established at Lexington and Fort Worth, the disease concept of addiction was not, reflected again in government policy until the 1950s and 1960s.

The United States has a more serious narcotics problem than other industrial countries, but the principles of control in the twentieth century have been similar everywhere. England, for example, began to pass restrictive narcotics laws before the United States. The British system of addict maintenance by individual doctors, which lasted from 1926 to 1967, has often been cited as an alternative to the U.S. system. But the British preserved this arrangment only as long as addiction was a minor problem, affecting only a few hundred people. Even under the old system, no one had a right to receive opiates; the choice of whether to treat was the doctor's alone. In the 1950s and 1960s addiction began to rise, a black market in narcotics developed, and a new lcind of addict appeared — younger, more manipulative, and criminal; in 1967 clinics were established in place of the individual prescription system. Great Britain now has about 1,000 opiate addicts; it has been estimated that a clinic system of the same quality as the one introduced in Great Britain in 196,7 would require 1,500 clinics, 2,300 psychiatrists, and 4,000 nurses for New York City alone (Judson 1975, p. 95). Anyway, most of the British clinics have now shifted from intravenous heroin maintenance to oral methadone, the synthetic opiate that prevents a withdrawal reaction without producing a heroinlike intoxication. The present British system resembles American methadone maintenance programs.

Government control over therapeutic drugs regarded as nonnarcotic de-veloped more slowly and in a somewhat different way. Here the symbolic, cultural, and moral concerns were slight compared to the medical and consumer interest. But the trend has taken more or less the same direction as opiate laws; the assumption has been that authoritative lcnowledge about the efficacy and safety of drugs makes free individual choice illusory and pointless. The story has been described as a passage from "customary" to "conunand" regulation, with little space for "instrumental" regulation by consumer choice in a more or less free market (Temin 1980). In this interpretation, only the Pure Food and Drug Act, of all the federal drug laws in the United States, was designed to encourage instrumental behavior because it was the only law aimed at simple fraud — false statements about the contents of a drug preparation. The Bureau of Chemistry in the Department of Agriculture, set up to enforce this law, eventually became the Food and Drug Administration (FDA), which interpreted the Food, ) g and Cosmetics Act of 1938 so as to establish a class of drugs ' vailable only on prescription (just as the Bureau of Internal Revenue had administratively interpreted the Harrison Act to deny doctors the right 'tto maintain addicts). An amendment passed in 1951 codified the distinc-'tion between prescription and nonprescription drugs into law and gave the FDA sole power to decide which drugs could be sold only on prescription.

This step only transferred power from consumers to doctors, who acted according to "customary" norms, the established practices of the profession. ''With many new prescription drugs coming onto the market, that seemed 'insufficient protection for consumers, so the government moved to decide 'which drugs would be made available to doctors. Amendments passed in 1962 gave the FDA considerably greater powers, and specifically allowed it to withdraw approval of a drug if there was no substantial evidence for its effectiveness. The evidence was to be judged by adequate and well-controlled investigations conducted by experts. Effectiveness was no longer a matter of opinion, including the ordinary doctor's opinion; even the medical market was unreliable.

"Well-controlled," "experts," and "effectiveness" were not yet carefully . defined, so more restrictions were inevitable. In 1961-9 the FDA arranged foethe National Academy of Science to conduct a Drug Efficacy Study. The scientific panel rejected as ineffective a certain fixed combination of antibiotics marketed by the Upjohn Company, and the FDA moved to ban it. Upjohn sued, but a federal court ruled that the company could not even get a hearing without presenting reasonable grounds. Commercial success — the general approval of doctors — did not constitute reasonable grounds because it did not constitute an adequate and well-controlled study. In 1970 the FDA issued regulations defining "adequate and well-controlled"; the most demanding form of experiment, with placebo control , and double-blinding, was not required, but mere clinical experience without some quantitative comparisons was excluded (Temin 1980).

Safety was no longer the issue now. Doctors and patients alike were assumed to need protection from the dangers of wasting their money on prescription drugs. Even if fully informed, they would not be allowed to choose harmless drugs of unproven usefulness. Such extraordinarily strict rules are applied only in medicine; in other kinds of commerce, usefulness or efficaciousness is left mostly to individual judgment, and consumer regulations are supposed to protect us mainly against products that are unsafe.

There were many reasons to control "narcotics" strictly, but only one reason for strict controls on drugs defined as purely medicinal. Much depended on what was regarded as a narcotic. This problem gave rise to some anomalies at first, since the social classification of a drug did not depend entirely on its pharmacological effects or even on its attractiveness as a pleasure drug. Certain synthetic psychoactive drugs that had been developed and introduced under medical control in the twentieth century did not have the same disreputable aura as the natural drugs used for centuries by ordinary people. Barbiturates, amphetamines, and tranquilizers could be used for pleasure in a way that might create serious health and social problems, but for a long time they were handled legally in the same way as other prescription drugs. One odd result was that we had severe penalties for possession of marihuana and none for illicit possession of amphetamines and barbiturates, which are much more dangerous. (In the same way, opium smoking had been made illegal before the quasimedical opium use of the middle class.) The situation began to change in the 1960s, and the Comprehensive Drug Abuse Prevention and Control Act of 1970 finally subjected the synthetic psychoactive drugs, old and new, to the same regulations as the older natural drugs. It took a long time, because the law is often a conservative institution that preserves obsolete social distinctions. The major international drug conventions still formally distinguish between "narcotics" (opiates, cocaine, and marihuana) and "psychotropic drugs."

Technical progress is one reason for the new restrictions. In the second half of the nineteenth century, pure chemicals were isolated from many natural drugs, the hypodermic syringe made intravenous injection pcissible, and the manipulation of molecules to create synthetic drugs began. Since then, thousands of new drugs have been introduced, and mass production has supplied vast quantities of them for medical use. Mill's advocacy of free individual choice was more plausible in a time when few drugs were in use and so little was known about them that the average consumer might have as good a claim as anyone to judge their safety and usefulness. Things are much more complicated now, and social control of biological technology in general is more acceptable.

But the campaign against recreational drugs began (with alcohol and opium) before any important technological change; here a free market or control by custom seemed dangerous for reasons other than consumer ignorance of technical complexities. More important than any purely scientific development is the fact that in twentieth-century society, experience and behavior that are hard to classify make us anxious. Except for alcohol control, the present system of drug control has developed almost entirely in this century. Institutions have been created to impose certain legal and social categories that are different for different drugs. These rules may represent some collective historical wisdom, but we do not have an undivided good conscience about them. Political scientists doubt the validity of enforcing morality; sociologists talk of moral entrepreneurship, symbolic status wars, the creation of deviance by labeling, and the stigmatizing of tmpopular groups. Many ordinary people simply refuse to take the laws very seriously.

Our society both needs and mistrusts the kind of rule that prevents people from acting in ways that have undesirable consequences for the quality of their own lives. Whether we think of these regulations as paternalistic or not, there is always some doubt whether education and protection are not just excuses for the domination of a majority's (or even a minority's) psychological needs or material interests. The complexity
d diversity of modem societies make the basis of legal authority uncertain. Since there is no common morality or accepted idea of natural human ends, anything presented by one group as necessary for morals or social order can be rejected by others as prejudice and mystification. Cultural ideals may be poorly understood without prescriptions that establish models of conduct, and prescriptions must often be codified into laws. But once they are fixed in this way, it may become harder to reinterpret ideals for chatted social circumstances. And where consensus has become weak, enforcement is likely to seem arbitrary.

As we noted in Chapter 1, a kind of solution is provided by the social and political institutions concerned with health, which have grown so much in scope and power in this century. Anyone living before 1800 would" probably have found it hard to comprehend the notion of an in-ternational body called the World Health Organization assigned to such oddly assorted tasks as eradicating malaria and discouraging marihuana use. As long as anything involving drugs is a health issue, the political institutions dealing with drugs will not have to take much account of variations in habits and values. They will inevitably prefer authority to liberty, even when the authority of doctors over patients has to be transferred to a government that has learned that doctors themselves are unreliable.

Serious government and medical control over alcohol is so thoroughly discredited that we are hardly prepared to acknowledge even in historical retrospect that the temperance and prohibition movements were concerned with the same issues of health and safety as other drug control movements; we remember mainly the moralism and cultural conflict. In the case of ordinary medical drugs, there is no cultural conflict, so that effective 'controls are easily imposed. In the case of illicit pleasure drugs, controls came earlier and are still stricter, partly because symbolic and moral concerns as well as health and safety interests are involved. But in twentieth- century industrial democracies, it has become hard to impose rules of moral comportment even when they are also health and safety regulations, so these drug laws are hard to enforce and often shamelessly, guiltlessly flouted. In some cases (especially marihuana), the health and safety jus-tifications for prohibition may appear to be largely a pretext, and this typical twentieth-century confusion about drug control takes on the ap-pearance of pure hypocrisy.

* The American Psychiatric Association's new diagnostic classification of drug abuse problems is an example of this lcind of conceptual clarification; another (though still inadequate) is the Com-prehensive Drug Abuse Prevention and Control Act, the major federal drug law passed in 1970.