The worst, most corrupting lies are problems badly stated. Georges Bernanos

Everything is a dangerous drug except reality, which is unendurable. Cyril Connolly

In a recent report commissioned by the National Academy of Sciences (Institute of Medicine 1980), the authors complain that research on alcohol abuse is seriously underfunded in comparison with research on cancer and heart disease, whether the standard is prevalence, mortality, or economic cost. For example, when mortality rates are adjusted, heart disease gets 10 to 20 times as much research money as alcoholism; adjusting for comparative prevalence, cancer gets 200 times as much; in relation to economic loss, cancer gets 75 times as much and heart disease 15 times as much. The report goes on: "Among many scientists, the field of alcohol studies has a reputation of extreme variability and questionable solidity . . . all of which gives the field a soiled cloak of respectability" (p. 23). The same could be said of other drug abuse research. This allegation of neglect is reminiscent of the complaint (see Chapter 2) that medical professionals are reluctant to confer the role of patient on drug and alcohol abusers. But there may be deep reasons why addicts and alcoholics are bad patients and drug and alcohol abuse are bad research topics. Medical researchers constantly warn us that advances in cancer treatment will come not from a "war on cancer" but from basic research in genetics and cell biology. But at least cancer is a relatively well-defined problem. Even less can be expected from a war on drugs or from a crash program of drug abuse research because we have so little idea of what enemy we are fighting or what needs to be studied.

When an adult beats a child, we do not talk about a "physical strength abuse problem," and we do not refer to the danger of drowning as the "deep water problem." The idea of a drug problem is not necessarily much more coherent. John Dewey said that an end in view is not an absolute ideal but only a guide to action. It is judged by the company it keeps among means. When the means seem distasteful or confused, it may be necessary to redefine the end. Suppose the drug problem is largely a misconception, a misleading way of dividing up reality for explanatory purposes. Sometimes we give signs that we suspect it is. An extraterrestrial creature who listened to our declarations about the terrible problems created by drugs, and then compared our approach to marihuana with our approach to alcohol and tobacco, would have conclude that we do not quite mean what we are saying.

It does seem perverse to deny that there is an alcohol problem, and in many senses there obviously is one. A report published in 1979 by the Royal College of Psychiatrists in England gives some idea of it (Royal College 1979, pp. 57-88). Half of all wife abusers in Great Britain are heavy drinkers; more than half of the prisoners have serious drinking problems; half of the homicides are committed by people who have been drinking; half of the people who die in car accidents have a blood alcohol level above the statutory limit. In one hospital studied, half of the head injuries were in some way connected with drinking. These figures could be matched in many other industrial countries. In the United States, alcoholic cirrhosis of the liver is as common a cause of death as diabetes and arteriosclerosis. Alcohol also causes stomach ulcers, cancer of the esophagus, birth defects (fetal alcohol syndrome), and severe brain damage (Korsakoff 's syndrome). The cost of alcohol abuse in lost productivity and medical and psychiatric services is reckoned in the tens of billions of dollars. The indirect and incalculable price of the havoc created in the lives of the alcoholics' families may be even more important. This is no phantom problem.

But it is not that simple. The great majority of drinkers do no serious harm to themselves or anyone else, or do more good than harm. As we noted in Chapter 1, being explicit about the benefits of alcohol or drug use (except strictly medical ones) is not popular. There is a kind of taboo on the subject, and in any case the benefits are hard to state. Heightened creativity and productivity are claimed for stimulant use and religious value for psychedelic drugs. Alcohol is praised for facilitating friendship and commerce, marihuana for enhancing sensitivity and sensuality. But the effects are so variable, so dependent on set and setting, so hard to distinguish from the activity to which the drug use is a background that when the benefits of drug and alcohol use are considered at all in serious discussions of the problem, it is usually in the misleading guise of an inquisition on motives and causes, as though drug use could be explained only by the users' unfortunate past or personal defects, and never by what it does for them in an ordinary way.

Even when the harm is obvious, the alcohol or drugs may not be obviously to blame. When the studies are looked at closely, it is hard to say just how much of the physical and social pathology and economic losses associated with alcohol use are actually caused by it (Gerstein 1981, pp. 205-7). Most studies on alcohol and crime, for example, do not distinguish alcoholism among criminals from criminality among alcoholics, or crimes caused by alcohol from crimes in which drinking is present. It might be that drunken offenders are more likely to be caught, for example. There is also the danger that alcoholism will be defined partly by the social and legal problems it seems to create, which may make hypotheses about the relationship of alcohol abuse to crime circular (Greenberg 1981).

Alcoholism, as opposed to acute alcohol intoxication, may or may not be important as a cause of crime; definitions of alcoholism vary so much that it is hard to make use of the data. Sometimes other factors obviously matter much more than alcohol; for example, France, with its high rate of alcohol abuse, has a low rate of homicide. Scandinavian studies find that higher alcohol use is associated with more violent crime, but intervening variables have to be considered. Both alcohol consumption and violent crime increased in Finland from 1956 to 1974, but the proportion of violent crime associated with alcohol use did not increase, as would be expected if this parallel were regarded as proof that the rise in alcohol consumption alone produced more violence. Possibly something else causes both alcohol abuse and violence — low frustration tolerance, aggressive personality, stress, childhood neglect, organic brain damage. The real cause of violence might also be something usually associated with alcohol use, such as a high frequency of personal interactions or being in an all-male group. Different explanations might apply in different circumstances (Pemaen 1981). The problems are analogous to those that arise in trying to define the disease of alcoholism.

On an epidemiological scale, the connection between illicit drug use and the social ills attributed to it is even harder to prove. One of the best analyses of prospective studies of drug use concludes that "few unfavorable outcomes of drug use, especially marihuana use, have been identified" (Kandel 1978, p. 30). Most differences between drug users and nonusers apparently precede the drug use. For example, the causal connection between illicit drug use and juvenile delinquency seems to be spurious; that is, the statistical association is canceled out when conditions preceding both drug use and delinquency are factored in (Clayton 1981). Delinquents charged with violent offenses use the same amounts and kinds of drugs as nonviolent juvenile offenders (Tinklenberg et al. 1981). A study of crime and drug use among 9,945 Philadelphia men in their late twenties conducted in 1972 for the National Commission on Marihuana and Drug Abuse found that "available data did not permit a conclusion that drug use caused more crime or more serious crime" (Jacoby et al. 1973, p. 300). Other studies have found that moderate drug use had no effect on academic performance at a selective college (Mellinger et al. 1978) and that there were few differences between college undergraduates who used drugs and those who did not — even fewer differences in 1978 than in 1969 (Pope et al. 1981).

If there is one social consequence of drug use that almost everyone admits, it is the relationship between heroin addiction and crime. But even this turns out to be less solidly established than most of us think. Again, the complication is that addiction and criminal behavior have common roots. A study of 590 addicts in the federal hospital at Lexington, Kentucky, found the relationship between addiction and crime to be unclear (Voss and Stephens 1973). Addicts are usually criminals before they become addicts, and addicted criminals are much like nonaddicted criminals, who themselves often use heroin as well as other illicit drugs (Vaillant 1966). The addict's "need" for heroin is not necessarily more compulsive or irresistible than a nonaddicted criminal's "need" for gambling money, fancy cars, or expensive women, which "drives him to crime" as heroin drives the addict. Addicts are quite capable of adjusting the size of their habits to the price of heroin. A study in Washington, D.C., found that over a four-year period in the 1970s, higher heroin prices coincided with a lower rather than a higher rate of property crime (Goldman 1981). Another study of men who were both heroin and alcohol abusers revealed that their most common crimes were selling drugs (73.4 percent) and commercial vice (17.5 percent). About 17 percent had committed burglaries, 13 percent shoplifting, and 6 percent armed robbery. The criminal behavior almost always started before they were addicted (Chambers 1981). Addicts do commit fewer crimes during periods of voluntary abstention (Waldorf 1970; Ball et al., 1979). That might be simply because the reason they are abstaining is that they feel less capable of any active street hustling; or, in contrast, they may be disciplining themselves better in general. It may be wrong, but it is certainly not implausible, to say that a policy aimed mainly at getting the addict to stop using the drug "confounds a relatively minor symptom with the disease" (Chein et al. 1964, p. 14).

Studies show that everyday judgment in certain situations tends to be systematically distorted in several ways (Tversky and Kahneman 1974; Kahneman et al. 1982). It is easy to see how these biases affect views on drug abuse. One finding is that certain kinds of dangers are particularly vivid and memorable, and therefore appear to be much more common than they really are. People tend to overestimate the number of deaths from accidents and violence and underestimate the number caused by chronic illness. Damage from drug abuse, especially acute intoxication, is highly visible to the public even when relatively rare, and it is made even more interesting by lurid publicity involving celebrities. Many people hardly ever hear about illicit drugs except when there has been a disaster or an arrest. Ordinary drug use is usually inconspicuous, a background to other activities. Most people have no clear image of social drug use, except for alcohol, but vivid scenarios of drug abuse are common and easily called to mind.

Another finding is that some things are regarded as explaining others, even when there is no good reason to suppose that they do. For example, people judge that a person described as tall is likely to be heavy rather than light, but they do not judge that a person described as heavy is more likely to be tall than short, even though logically the inference should go both ways. Height seems somehow to account for weight, but not the reverse; the representative or stereotypical heavy person is visualized as fat rather than tall. More generally, people tend to ignore diagnostic inferences and favor causal ones. Given the hypothetical assumption that more solar energy is being used in the 1980s, most people judge that fuel prices will be lower in the 1990s (use of solar energy as the cause), even though increased use of solar energy might more plausibly indicate (diagnostically) a growing fuel shortage and therefore higher future prices.

Revising any accepted explanatory model is a form of diagnostic inference; it involves figuring out what features of the model might be giving rise to error, which implies ceasing to regard them as capses. Experimental subjects were told that a certain person took a projective test in high school that showed him to be cold and self-centered; now he was teaching handicapped children. The subjects developed ingenious ways to explain how this person had changed or why he was compensating for his personal deficiencies, but they rarely suggested that the test might have been wrong. In the same way, some people might try to understand why a student does well in school despite marihuana smoking, without ever challenging the idea that marihuana smoking makes for poor schoolwork. Drug use is to crime, social disaster, and personal troubles as height is to weight; it is easier to make inferences in which drugs explain things than inferences in which drug use is what needs to be explained. The diagnostic view is more difficult. There are too many causes, and they are too uncertain; no vivid picture emerges. We are not inclined to see the relationship between, say, heroin addiction and crime as incidental or indicational (both having a common cause, like height and body weight) rather than causal. The stereotypical addict is a criminal, but the stereotypical criminal is not an addict, so we are likely to make the inference in only one direction.

People also tend to judge conjunctive probabilities badly. In one experiment, the subjects were given a fictional description of a woman who had had artistic and radical political interests in college; then they were presented with a list of occupations and activities, and asked which of them she was most likely to be pursuing ten years later. "Feminist," understandably, was chosen often and "bank teller" seldom. "Feminist bank teller" was chosen less often than "feminist" but more often than "bank teller"; subjects noticed the logical contradiction only when it was pointed out to them. The added detail in "feminist bank teller" made it more vivid and plausible than the description "bank teller," more representative in a psychological sense, even though it was by definition less probable. The imaginary stereotypical college radical is less likely to become a bank teller than to become a bank teller who is also a feminist.
We have a vivid image of the pale, ragged addict injecting heroin into his vein with a dirty needle in an abandoned house or going through withdrawal agonies in a jail cell. In a sense, this figure is more real to us than the generic heroin addict and much more real than the average heroin user, who is not addicted — just as the college radical who becomes a feminist bank teller is more vivid and plausible as an image, though less likely as a reality, than one who becomes a bank teller.

Everyday judgment also fails in assessing covariation. When people consider,evidence for the statement that redheads are hot-tempered, they may try to remember the proportion of redheads they have known who are hot-tempered. But this means very little unless compared with the proportion of nonredheads who are hot-tempered — a fact people tend not to consider. Even worse, someone who is biased toward the opinion that redheads are hot-tempered may unconsciously stretch the definitions of the vague terms "redhead" and "hot-tempered" so as to validate the correlation. This is an enormous problem in making judgments about drug abuse. Persons inclined to think that, say, habitual marihuana use causes poor performance at work or in school — a very common belief not established by evidence — will remember the habitual marihuana users they have known who work badly or do poorly in school. But they will forget the marihuana users who work or study well, and they will never try to compare the proportions of marihuana users and nonusers who do poorly. Even more important, they are likely to adjust their definition of habitual marihuana use and their understanding of poor work or schoolwork, so that anyone they do not regard as a poor student or worker will not seem to be a habitual marihuana user.

Uncertainty about cause and effect was one of the main reasons for mistrusting legal moralism in general. Many of the sexual practices that have been regulated by law are actually at most symptoms, and rarely causes, of the social problems the regulation is supposed to solve. That , objection seems less applicable to drug laws because the ill effects of drug use are sometimes immediate and obvious. But on closer study of the social conditions in which drug abuse occurs, it often becomes much less clear what is cause and what is symptom. The imagery of simple poisoning seems less apt, and laws or other control techniques directed at the drugs themselves seem less useful. Even among serious drug abusers, the problems related to drug abuse are not necessarily worst for those with the biggest habits, and abstinence often does not even help much (McLellan et al. 1981). Thomas Szasz has gone so far as to say that the chapter on drug abuse in standard reference works on pharmacology is no more appropriately placed than a chapter on prostitution would be in a textbook on gynecology (Szasz 1974, p. 10). That is, drugs cause drug abuse only in the sense that female sexual organs cause prostitution. By vivid exaggeration, this statement indicates what the issue is. To the extent that drug abuse is a social problem rather than a physiological one, we may be missing the point by concentrating our attention on the drugs themselves.

Even the idea of a social problem is not as obvious as it stems. Sociologists studying the alcoholism movement that began in the 1930s have emphasized what they call the "construction" of social problems (Gusfield 1981; Wiener 1981; Beauchamp 1980). Even seemingly raw facts do not exist until they are shaped for public presentation; a social fact is a symbolic thing, a human creation. It takes on reality when it is collectively defined and legitimated by groups that appropriate it and make it their own. The way a problem is defined depends on what society is willing to recognize and take seriously. Before Prohibition, alcohol itself was a legitimate social problem, "owned" largely by the temperance crusaders and the churches. During Prohibition it was also the government's business. After 1933, reconstruction and a transfer of property were necessary; now the problem was the alcoholic and alcoholism, including "hidden alcoholism," and it was owned by the health professions and groups like AA. Since the establishment of the National Institute on Alcoholism and Alcohol Abuse, the problem has become government property again in a different way.

This view of how social problems are defined is an aspect of the sociology of deviance. The moral entrepreneurs who create deviant labels are like the groups that appropriate social problems; often they are the same people. And like the neutral notion of deviance labeling, the idea that social problems are constructed rather than given is implicitly a critique. It implies that what seems obvious and straightforward is not so. The choice of what to regard as a problem often depends on interests and feelings hidden even from those who make the choice.

Recent studies have illustrated fluctuations in the definition of social problems by using the example of drunk driving (Gusfield 1981). For many years, this problem was largely disregarded. People knew that there were drunk drivers, but no one concentrated on them as a social cause. There were alcoholics, there were auto accidents, and there were sad stories about people who had one too many and died or killed on the road. It was no more regarded as a distinct social problem than falling off a ladder in the home; it belonged to the residual category of miscellaneous accidents. The laws against drunk driving were rarely enforced in a serious way for the reasons discussed in Chapter 4: Few drunk drivers were caught; prosecutors, judges, and juries felt more sympathy than contempt for those who were. (France had no laws against drunk driving until 1962, and even afterward police at the scene of accidents did not routinely record whether there had been drinking.)

In the last five or ten years, at least in the United States, attitudes have changed. Drunk driving has become a center of attention, and the killer drunk has become a mass media villain. Legislatures are passing harsher laws against driving under the influence, and politicians are promising that they will be enforced more strictly. Whether this will make much difference in the long run is doubtful, given the problems of detection and the persistent reluctance to follow through. What is certain is that the problem is being dramatized in a particular way — blame is placed primarily on the driver and secondarily on alcohol abuse. Liquor companies are allowed to disown it (unlike heroin dealers, who are held socially responsible for addict crime). Automobile manufacturers also disown it. There is not much talk about reducing alcohol consumption, nor is the subject changed to improving automobile safety, highway design, the siting of bars, or emergency medical services (Gusfield 1981). In the midst of a public campaign against criminally negligent drivers, we tend to forget that the present proprietorship of the problem and the present way of construing it are not the only possible ones, or even necessarily the best.

The National Commission on Marihuana and Drug Abuse suggested that drug use be divided into five classes. Experimental use means trying a drug once or twice to find out what it is like. Recreational-social use is the pattern of the ordinary social drinker or marihuana user, and even that of many heroin users who are not addicted. Situational use is use for special (nonmedical) purposes — stimulants for work or study, tranquilizers for public speaking, psychedelic drugs for religious or personal insight. Most people are quite capable of using most drugs only in these ways, which produce relatively little harm. The last two categories, intensive use and compulsive use, cause most of the trouble. But here, unusual personalities and social circumstances often matter more than the drug. The same compulsive drug user will shift from LSD to amphetamines, from amphetamines or cocaine to alcohol or heroin, from alcohol to heroin, from heroin to barbiturates or back to alcohol. The ways of redefining drug problems parallel the ways of accounting for addiction and dependence, which are alternative descriptions of intensive and compulsive use. Instead of concentrating on the drug, we can think about the person, the situation, the society, or even the human condition. A direct assault on drug problems, in this view, is aimed at the wrong target. Even if it succeeded, other symptoms would replace drug abuse. That is why modern societies look for indirect solutions (even as they police drug use itself more closely).

We have already discussed many of these solutions, but others are worth mentioning. In nineteenth-century England, the temperance movement tried to encourage "counterattractions" that would keep people away from taverns. Supply the poor with clean water, milk, decent housing, parks, sports, and adult education, and they will want less alcohol (Harrison 1971). The problem is redefined as a question of what liquids to drink or how to spend leisure time. An analogous idea that has been popular recently in the United States is "natural highs." This term itself shows that the drug culture has made some inroads on our vocabulary, but the principle is the same: Take the emphasis off the dangers of drugs and put it on better ways to get what drugs provide. Students of alcohol abuse have also called the technique "diversion." As a variant of the sociocultural or integration model, it is subject to the same criticism: It is a good idea that is almost impossible to turn into an effective policy. Diversion may work best in special situations in which men are isolated in a group and drink simply because there is nowhere to go and nothing else to do — a logging camp or a battleship (Lemert 1962).

Another indirect approach to drug problems is through social psychology. Preliterate societies have been studied to determine what cultural characteristics encourage moderate drinking habits. Attitudes toward dependency, aggression, and impulse control are considered important. It has been suggested that serious drinking problems are more likely in a culture that curbs impulses heavily but imperfectly, or one in which dependency needs are frustrated and there is anxiety about achievement and power (Bacon 1976; Boyatzis 1976). In a study of 247 hunter-gatherer cultures, it was found that a low level of alcohol and tobacco use was associated with a harsh environment and difficulty for the men in finding wives. Males drank a great deal in societies in which games of chance were popular, feats of war were admired, and self-reliance was demanded (Blum and Associates 1969). Another study found aggressive drunkenness to be associated with low social complexity, fear of ghosts, and weak families (Schaefer 1976). Still another study found that a low level of drunkenness in communal drinking festivals was unrelated to the level of anxiety in a culture but was associated with collective property, patrilocal residence after marriage, bride price, village life as opposed to nomadism, and severe restraints on aggression in children (Field 1962).

If we knew what childrearing practices or what modal personality in a culture produced moderation in drug use, and if we knew how to influence childrearing or personality development, we would have a way to prevent drug and alcohol problems. But we understand too little about what cliltural features cause drug abuse and have little idea what to do about it in any case. This approach too is subject to the same objections as the integration model of drug control.

One limitation of these studies is that they are still, however indirectly, aimed at resolving something that is conceived primarily as a drug problem. The anarogy of epidemic disease is inadequate for many purposes but interesting in this context. Classically, epidemiologists divide their field of study into disease agent, host, and environment. It is often better to work on the host or the environment rather than try to eliminate the agent. Smallpox has been wiped out by vaccination, a direct assault on the virus that produces the disease. But the decline in tuberculosis over the past century in advanced industrial countries has more complicated and obscure causes. It began long before antibiotics were available, and many people today carry tuberculosis bacilli in their bodies all their lives with no symptoms of illness. Better nutrition, greater public cleanliness — the main deliberate changes have been in the host and the environment, and most of them were not aimed directly at the tuberculosis problem. Apart from any conscious efforts, we may also have seen a biological reconciliation between the bacillus and its human host, a process of mutual adaptation with its own rhythm (Dubos 1965).

There are parallels in the case of drugs. The integration or sociocultural model of drug control is an attempt to regulate the environment rather than the agent or host. It is unsuccessful as a policy directed from above by public institutions and aimed directly at the drug problem. But mutual adaptation does arise, often quite rapidly. When psychedelic or hallucinogenic drugs first appeared on the illicit market, there were many casualties. But after a few years people learned how to use them, and adverse reactions became much less common. This knowledge was transmitted informally and not by official institutions. In many cultures, controlled, integrated drug use has evolved historically with little conscious attention devoted to a drug problem, just as the tuberculosis bacillus and the human body have become mutually tolerant. A society in which everyone drinks a little but no one becomes an alcoholic is analogous to one in which many people carry the tuberculosis bacillus but few are made ill by it. Another analogy is our symbiotic relationship with the intestinal bacteria that help us digest food: "What grape, to keep its place in the sun, taught our ancestors to make wine?" (Connolly 1983, p. 39).

It is interesting to press this comparison between drugs and microorganisms. Both derive their power from a microscopic structure that is intimately attuned to the structure of our bodies and therefore allows them to infiltrate our defenses. Migrations and conquests always lead to general exchange of both drugs and microorganisms. In the last great exchange, which took place in the sixteenth and seventeenth centuries, the Western Hemisphere was introduced to cannabis, opium, and distilled alcohol, as well as smallpox and measles; the Eastern Hemisphere received tobacco and possibly syphilis; coffee and tea spread from Asia to Europe and America. Adaptation to either drugs or microorganisms takes time and often remains imperfect; some of the cultures to which Europeans introduced alcohol five hundred years ago have not become adapted to it yet.

One kind of redefinition that avoids taking the drug problem seriously on its own terms is the socialist revolutionary analysis. When Karl Marx called religion the opium of the people, he meant that it was a consolation for the oppressed in a class society that would become unnecessary and lose its hold after the revolution. A direct attack on this spiritual drug problem was pointless; it would solve itself when social conditions changed. The same was true of the material drug problem. Engels wrote of the English working class in the 1840s that the only pleasures left to it were drink and sex. A revolutionary could say that when there are no more poor and no more rich, no pauper will need to drink to feel like a millionaire, and there will be no more millionaires to become alcoholics out of idleness and dissipation. Being an alcoholic or addict is, so to speak, one of the roles provided by a class society, like being a household servant or a stockbroker. As the socialist economist J. H. Hobson put it, "There is no separate Drink Problem" (Harrison 1971, p. 405).

But the attitudes of radicals and revolutionaries on this issue have varied. In general, they have been suspicious of psychological explanations, and they have regarded antidrug crusades as a distraction from the real task at hand. Karl Marx scorned the people he called "temperance fanatics," as he scorned feminists and other bourgeois reformers. When the British Parliament was debating a liquor licensing law in 1909, a socialist member said, "There are thousands of people dying in the streets while you are trifling with this Bill" (Harrison 1971, p. 425). On the other hand, the Bolsheviks made an abortive attempt to ban vodka after they took power, and the socialist and communist movements in Scandinavia often supported prohibition in the early twentieth century.

When Marx said that the people were drugged by religion, he did not mean to imply that the ruling class did this deliberately to pacify them; it was only the inevitable outcome of their oppression, "the heart of a heartless world." But the matter can also be viewed more simply: The ruling class uses religion (or drugs) to keep the masses quiet. Some blacks think that about heroin. The accusation is hard to prove or disapprove, but if it implies that the people who are now addicts might otherwise have become political radicals, there is reason to doubt it. It is equally hard to believe that even reactionary racists would not be delighted to see heroin disappear from the ghettos.

A more interesting kind of radical analysis concentrates on the recreational drug market and its functions in the political economy of drug use and abuse. We have already mentioned the direct and indirect economic interests in the commercial drug trade that are threatened by serious drug law enforcement. The world market created by European imperial expansion in the seventeenth century has made the exchange of drugs and drug technologies much more effective. The rum trade was a mainstay of the New England economy, and tobacco cultivation was almost the sole support of Virginia and North Carolina in colonial times. Coca was an important source of income for king and church in Bolivia and Peru under Spanish rule. Just before Prohibition, almost half of the revenue of the U.S. government came from taxes on alcohol. Today a good part of Great Britain's balance of trade depends on the export of Scotch whiskey, just as Britain's Indian empire depended on the export of opium 150 years ago. Major portions of the economies of whole countries are now given over to growing coffee and tea for export. As for the illicit drug market, farmers in Turkey, Iran, Afghanistan, and Burma depend on American heroin addicts for their income; the marihuana and cocaine traffic is transforming the economies and societies of Bolivia, Colombia, and Jamaica. Marihuana has become one of the most important cash crops in the United States itself, just as grain for whiskey was one of our most important crops in 1830. It is harder to eliminate drug use once it has become an integral part of the world economic system.

The legal control system also has some unexpected economic functions. Heroin addicts, for example, steal things and sell them to fences or to local people at far less than their retail price. People who despise heroin addicts and other fences will nevertheless buy from them, as slaveholders might feel contempt for slave traders or rich cocaine users for the people who sell them cocaine. Stores lodge inflated claims for the thefts, insurance companies raise their premiums, and manufacturers have a market for replacements (O'Connor et al. 1971). The overall effect is a redistribution of wealth toward the inner-city poor.

The moral of these interesting historical and sociological stories remains unclear. The cocaine traffic may be bad for Colombia and Bolivia, even if it does bring in a great deal of money, but that has nothing to do with the intrinsic properties of cocaine. Knowing how bananas affect the Honduran economy or how sugar affects the Cuban economy does not tell us whether bananas and sugar are good or bad. If many of the problems of Colombia, for example, are caused by a system of cash crop cultivation for export in an economy dominated by the United States, it makes just as much sense to denounce the legal traffic in coffee as the illicit traffic in cocaine. The cocaine traffic is more corrupt, violent, and obviously destructive in its social effects, but that is mainly because of its illegality.

The radical analysis takes into account both supply (the concern of the distribution of consumption theory) and demand (the concern of the alcoholism movement and the integration theory). On the supply side, it is an extension of the idea of hunting down the big traffickers, tile drug profiteers. Only instead of going after individual traffickers, radicals want to eliminate the economic context in which they (and all businessmen) operate. But the Soviet Union's attempt to ban vodka showed that this will not succeed if enough customers still want the drug. So the demand side must also be dealt with by eliminating the conditions that create drug abusers and alcoholics. It is something like diversion, greatly elaborated. Supply elimination and demand elimination correspond to the two faces of positive liberty — authoritarian and anarchist. At the start, suppliers are put out of business, but once the demand no longer exists, coercion will no longer be needed to cut off the supply. Demand will be eliminated not by a direct attack on the drug problem but by liberating the masses from exploitation and making life much better for everyone. The desire to abuse drugs fades as civilization advances and the new socialist humanity replaces the Old Adam — the Prohibitionist dream was similar. Lenin wrote that in the future socialist world, state coercion would be needed until everyone learned socially responsible habits. By then, humanity would have graduated from its tutelage, and social excesses would wither away along with the state. In this stateless utopia there would be no place for prescribed liberties of the kind advocated by Mill, and no need for them.

As the difficulty of turning diversion or the integration model into a conscious policy suggests, socialist revolutions have been more effective on the supply side than on the demand side. China apparently did away with its opium problem by long prison terms and executions and by disrupting the commerce — not by liberating addicts from their desire for opium through the thoughts of Mao. When the Old Adam has persisted after the revolution, socialists have not developed original solutions. The state that Lenin founded has tried to eliminate the capitalist milieu in which the alcohol trade used to be conducted (there is still a large black market in illicit spirits), but the alcohol problem remains about average for an industrial country (Trent 1975), and the people who study it find themselves falling back on most of the old explanations (only economic and social conditions can no longer be blamed). The official Soviet position is that prerevolutionary Russian cultural traditions are at fault. That is beginning to sound implausible now that sixty-five years have passed since ?he revolution and there is no sign of a decline in alcohol abuse. Otherwise, Soviet theories about the causes and treatment of alcoholism are not very different from those prevalent in capitalist societies. Alcoholism is associated with an underclass more than it is in the United States. Although the Soviet Union is still more moralistic than we are about alcoholism — drunks may be publicly humiliated by having their heads shaved — it is beginning to medicalize the problem. The explanation of cultural tradition is beginning to give way to biological theories. Group therapy techniques resembling those of AA are used; factories have compulsory alcoholism programs; liquor is heavily taxed. In short, the Soviet Union is facing the same problems and is trying more or less the same solutions as capitalist countries (Roman and Gerbert 1973). The Communist utopia without alcohol problems is not approaching, and the Soviet state, notoriously, shows no signs of withering away.

We will all have to learn to live with more compromise and ambiguity on drug issues. There is something absurd and irrelevant about the martial imagery often evoked: drugs versus society, a war on drugs. A drug-free society remains a mirage. We must learn to live with drugs in a way that, as Mill would say, promotes individuality, self-development, variety of human situations, the highest and most harmonious development of human powers. The complexity of modern society and the powers of modern technology make this harder to do. So does the growth of leisure time and disposable resources. And attempts to control drugs are subject to the conflicting influences of a decline in enforceable moral authority and a heightened consciousness of the need for public protection against common risks. If, as E. O. Wilson suggests, "Most and perhaps all of the prevailing characteristics of modern societies can be identified as hypertophic modifications of the biologically meaningful institutions of hunter-gatherer bands" (Wilson 1978, p. 95), it is not surprising that we have hypertrophied drug problems too.

But even societies that consider themselves plagued by drug and alcohol abuse do not handle the problem nearly so badly as is sometimes thought. In the United States today, despite easy availability of cheap alcohol, a third of the adult population does not drink at all, and another third drinks three times a week or less. Most people do not find it hard to exercise self-restraint in using drugs. Attitudes toward tranquilizers, for example, are very conservative in all racial, social, and economic groups, but especially among the poorest and least educated. People regard them as temporary palliatives that cure nothing; they believe that using them is a sign of weakness and may prevent real solutions to personal problems. Most people disapprove of using drugs to enhance normal functioning; by association, they tend to be suspicious of antidepressants and drugs for energy or alertness (Manheimer et al. 1973). Volunteers allowed to regulate their own intake of amphetamines for weight loss used les § than the amounts usually prescribed (Bigelow et al. 1978). The picture of drug abuse as a potentially uncontrollable epidemic is vastly overdrawn.

Drug problems are partly self-limiting. For example, in France, one of the hardest-drinking countries in the world, per capita alcohol consumption dropped from 6.8 gallons per year to 5.9 gallons between 1955 and 1972 (Moore and Gerstein 1981, p. 36). Drug problems also limit themselves biologically, since many of them belong to a certain stage of life. Like street crime, drug abuse is a symptom of the turmoil of late adolescence and early adulthood. Most people use less alcohol and almost no illicit drugs after the age of twenty-five or thirty. Even heroin addicts often "mature out" in their thirties (Winick 1962; Waldorf and Biernacki 1982).

Besides, overemphasizing safety may put unnecessary limitations on human possibilities and powers. Consider this comment by a man who was known for asceticism:

One may decide, with full knowledge, that what one is doing is worth the damage it inflicts on one's liver. For health is not the only thing that matters. . . . I doubt whether, on balance, even outright drunkenness does harm, provided it is infrequent — twice a year, say. The whole experience, including the repentance afterwards, makes a sort of break in one's mental routine, comparable to a weekend in a foreign country, which is probably beneficial. (Orwell 1968, p. 257)

Similar claims are made for occasional LSD use, including the bad trips. The point is that people sometimes have to be allowed to make these judgments for themselves. Some writers have promoted the ideal of a completely safe pleasure drug, as though it were something like the desirable ideal of a completely safe medicine. But it is more like the insipid ideal of a completely safe sport or adventure. Some risk, if only a risk of unpredictable change, is essential to the meaning of the activity. The completely safe pleasure drug resembles its utopian opposite, the completely drug-free society. Knowing that drug use can never be made perfectly safe, we can still afford to place more confidence in the judgment of the average person and the recuperative powers of society than we have been willing to show where drugs are concerned.

A natural human desire to alter consciousness is one of the reasons sometimes given for the use of drugs. But altering consciousness does not have to be conceived as something abrupt, unusual, and mysterious. Our primate curiosity makes us seek new things to see, feel, and think, and adventurousness implies some risk. Drug or alcohol use, within limits, can sometimes promote the development of human powers by heightening individuality and variety of experience, in accord with Mill's prescriptions as well as the more communitarian theories of positive liberty. Just as it would be a mistake to impose an impoverished conception of sexual naturalness and normality for the sake of what is alleged to be pubic morality, it can be a mistake to use what is thought to be public health or social cohesion as an excuse to impose an impoverished conception of naturalness and normality on the search for new experience by changing consciousness.

The special danger of drug use is that it may drastically reduce real variety and novelty in human experience. Even when there is no drug abuse in the ordinary sense, no danger to health or individual pathology, drug technology can be destructive to humanity — as in Huxley' s Brave New World. Soma at first seems to be the harmless pleasure drug that some have wished for, but as used in Huxley's dystopia, it is not harmless. It narrows rather than broadens the range of effective human choice. This example suggests why fears about drugs go deeper than any mere struggle for cultural dominance or classification into strange-sinister-theirs and familiar-benign-ours. Drugs are an intimate technology with the apparent power to distort our humanity, so the dangers that are called objective and those that are called symbolic, or the instrumental and expressive purposes of drug laws and antidrug movements, cannot always be distinguished at the deepest level.

The difficulty, even impossibility, of distinguishing so-called objective from so-called symbolic dangers is illustrated by the example of drug use in sports. As we noted in the last chapter, the common reasons given for banning drug use in sports would also justify banning many other practices and items of equipment that are considered quite acceptable. It would be hard to show that allowing athletes to use drugs is any more unfair than allowing them to use fiberglass vaulting poles, or any more dangerous than allowing them to drive automobiles at 180 miles per hour, or any more artificial than using Nautilus machines or, for that matter, running shoes. Nor is it easy to see why eyeglasses to correct defective vision have a normalizing effect but stimulants to correct defective enthusiasm and energy have an optimizing effect, or why painkillers are acceptable as a substitute for needed rest when stimulants are not.

We mentioned the medicalization of drugs as one reason for this distinction. The use of drugs can be banned for medical reasons, although blows to the head with a boxing glove or blows to the neck during a football tackle cannot. But medicalization is only a symptom of a deeper uneasiness. The runner Sebastian Coe has said that drug use has the capacity "to destroy sports, to chip away at the foundations" (Wallace 1982). No one has ever said that about the effect of blows from gloved fists on boxers' brains, because the threat of head injury is one of the foundations of boxing, one of the things that makes it exciting and defines the boxer's skills.

The charges of danger, unfairness, abnormality, and artificiality against drug use in sports are mainly ways of expressing our feeling that drug use is somehow inappropriate in an aesthetic or conventional sense that is hard to formulate clearly. The point is that some techniques and instruments seem to change the nature of a sport and others do not. Fiberglass vaulting poles are admitted, but a motorized pole or one containing a spring would presumably not be allowed — not because it would be dangerous, unfair, or artificial, and certainly not because the jumper's talent and training would no longer be important, but simply because the sport itself would no longer be pole vaulting as we now know it. We might even introduce motorized pole vaulting in addition to ordinary pole vaulting, just as we have both motorcycle and bicycle races, with the understanding that these are entirely different sports. Where the line should be drawn is a matter of form and propriety, the aesthetic shape of the game. Fiberglass does not change pole vaulting beyond recognition, but a motor or spring would.

It does not seem that drugs, at least the existing ones, change the shape of a game more than the fiberglass pole or the lively ball in baseball. And even if they did or could change things that much, we might allow an equivalent of the bicycle—motorcycle distinction — separate competitions for athletes who do not use drugs and for those who do. But obviously this proposition is hopeless, scandalous. Drugs today are regarded as a peculiar kind of equipment that destroys the aesthetic shape or form of any game by changing the nature of the athletes themselves. It is sometimes complained that training methods used in one country or another make its athletes into robots or mechanical men; not coincidentally, improper drug use is usually part of this charge. The implication is that sports become meaningless if the competitors are something both more and less than athletes — self-made robots whose freedom and humanity have been deliberately impaired for the sake of victory in a game. Fear of the athlete's transformation or degradation lies behind the suggestion of robotism in the word "artificial," as well as the charge that drug users are not winning by their own efforts. Talk of artificiality is just another way to express a feeling of inauthenticity or inappropriateness.

The standard of genuineness and appropriateness that we are implicitly applying is a mixed one. It cannot be reduced to a simple moralistic formula, and it has not always been the same. The athletic establishment in 19Q0 did not feel the sense of impropriety in using stimulant drugs that we feel today. But more than convention and fashion have changed; our idea of what it means to be an athlete is different now. At this level convention touches on something deeper, something on the border between the aesthetic and the moral, or, in other terms, between the symbolic and the instrumental.

Whether the violated convention seems to be deep and important depends on what kind of game we think is being played. For example, the problem of stimulant use in football might be posed by asking whether it would be better to open up some positions for younger players by preventing drug use, or to allow more experienced older players to keep going a while longer. If we did that, the issue would become almost a technical one and would lose its flavor of scandal. We would no longer be looking for ways to cope with a "drug abuse problem" that enters football from outside and corrupts it; we would simply be asking what form we wanted the game to take.

But everyone knows that the question will never be seriously put in that form. By contrast, consider the ban on spitballs. It was introduced to make hitting easier and to clean up the image of baseball. No one claimed that the spitball was especially dangerous, unfair, or abnormal. The new rule was aimed at molding the shape of the game to make it more interesting and attractive, and, incidentally, more profitable. The rule is often violated but not strictly enforced, partly because throwing spitballs does not, after all, change the shape of baseball very much. Drug violations are taken more seriously. It somehow seems more terrible for an athlete to be hurt by a toxic reaction to a drug than hit by a spitball, even if the injury is no worse. Amphetamine dependence in a football player is more scandalous than brain damage in a boxer, because more or less severe brain damage is regarded as an unfortunate but natural effect of the way professional boxing is conducted, but we do not accept the possibility that more or less severe drug dependence might become one unfortunate but natural effect of the way professional football competition is conducted. Drug use somehow changes the nature of the game.

An analogy with language may be helpful. The grammar of a sport permits a risky and exciting display of human powers by disallowing many actions as inappropriate. We ask what the shape of the game requires, just as we ask what human communication in a given language requires. A spitball in baseball is like a solecism or a mild obscenity in tbe wrong place. Many people regard drug use in sports as analogous to talking gibberish; it takes the meaning out of what you are doing.

The distinctions made in sports are also made in broader contexts. Most drugs that are believed to optimize moods or mental states (pleasure drugs and performance enhancers) are prohibited; drugs thought to notmalize moods or mental states (medical or psychiatric drugs) are acceptable. Drugs are banned both in sports and in other settings because they are supposed to be dangerous and people are not supposed to know enough to avoid the dangers. They are also described as "artificial" paradises, which ought to be abandoned for "natural" highs. Only the charge of unfairness is not heard outside of sports, because there the standard form of the game is less rigidly defined by convention.

In his novel The Futurological Congress, Stanislav Lem imagines a society in which drug use has deprived life itself of its proper form (Lem 1974). In the "psychem society," as he calls it, the nearly intolerable living conditions produced by overcrowding and changes in climate are masked for the great majority of people by a variety of marvelously precise and efficient hallucinogenic drugs that make them think they are living in a paradise. They are not obviously suffering, and they are not benumbed or narcotized. In a sense, they are using drugs to normalize their condition by making it humanly bearable. A character in the novel, defending the system, even dares to use the analogy of eyeglasses. Instead of correcting defective vision, the psychem society corrects the vision of a defective world. One reason for our uneasiness about the use of stimulants in sports is that it might be justified using the same analogy.

The psychem society has institutionalized illusion and inauthenticity so comprehensively that human life becomes meaningless. The problem is not that this way of using drugs is dangerous (it may be, but so is life without it in the world of the novel) or abnormal (by what definition?). The trouble is that this is a deeply inappropriate way for human beings to live. It is not just that perceptions, feelings, and thoughts are being manipulated chemically; we do that every time we drink alcohol, and in any case, all of our mental activity is mediated by chemical neurotransmitters. The horror, as a character in the novel explains, comes from eliminating the very distinction between natural and manipulated feelings. In sports the parallel would be an elimination of the difference between victory by one's own efforts and victory by chemical manipulation. Considering the actual nature of athletic drug use, the imagery of mad sports engineers and their manipulated creatures may seem rather farfetched and melodramatic. But it expresses a genuine concern that drug use is somehow dehumanizing and aesthetically false, transgressing the formal limitations that make excellence possible — like writing a sonnet with the wrong rhymes and rhythms or, still worse, programming it on a computer.

Existing drugs do not really have the power to make athletes into robots or guinea pigs or supermen any more than they have the power to create precisely defined illusions that can be imposed by governments. The structure of the brain is too complicated for that. Even the most effective drugs are a clumsy and undirected form of interference in a complex interaction of organism and environment. But the psychem society is a powerful nightmare vision, because the primitive character of drug technology as an instrument for specific purposes is much less obvious than its capacity to produce enormous changes in consciousness very fast. As the poet A. E. Housman says, "Malt does more than Milton can/to justify God's ways to man." If the subjective effects of drugs could be directed toward specific forms of perception and belief as easily as the explosive force of a rocket engine is directed toward its target in space, we might be able to create a society in which our present conception of humanity would be seriously violated.

Imagine a species of extraterrestrial beings whose natural sensory world resembles Lem's psychem society. We can reliably change everything in our field of vision by turning our heads 180 degrees. These creatures could produce similar reliable changes by putting various substances into their mouths and swallowing them. The bizarre drugs described in Lem's novel would seem as ordinary to them as alcohol seems to us. If these creatures discovered alcohol, they might consider its relatively unpredictable and undirected effects to be as weird and terrifying as Lem's drugs appear to us. And that is the way we ourselves tend to regard new drugs. Unless a drug is as integral a part of traditional human life as alcohol is, we fear that it will create a strange and somehow distorted human environment. Lem's society seems a wrong way for people to live. Human life might take on a meaningless, inhuman shape if drug technology were allowed free rein.

In this borderland between the aesthetic and the moral, pornography supplies an analogy. Some of it is deeply offensive, even though there are no universally accepted standards of naturalness and normality in sexual display. It is even harder to achieve agreement on general matters such as the authentically and meaningfully human or the forms appropriate to human life. Most of us no longer believe in natural law. The standards are vague and subject to historical change, yet some uses of drugs seem deeply offensive or wrong. In the last hundred years, the rules against pornography have been relaxed, and we find less and less violation of propriety in more and more forms of public sexual display. But the rules against drugs have been tightened, mainly because they now seem to be a form of technology that, as Lem implies in his novel, has the power drastically to distort the shape of human life.

Unfortunately, the standards are so vague that it is often hard to say when they are being violated. We do not want to prevent desirable change by insisting on a historically, geographically, or culturally provincial notion of appropriateness. A drug that tripled the human life span or, worse yet, made us immortal could be regarded as either a wonderful new medical treatment or a sinister transformation of the conditions of life. We know very well that using a motor or a spring in vaulting poles, for example, would require a redefinition of the sport of pole vaulting. But it is hard to say what redefinition of humanity would be required if people became immortal.

By this standard most existing drugs are very feeble. The complexity of the human body and brain puts such engineering miracles as the immortalizing drug far beyond our present technical capacities. The threat to our notion of what it means to be a human being is symbolic, or at most potential rather than actual. The sense of inauthenticity or impropriety takes many forms. And however much it may be derided by sociologists of deviance as a response to symbols rather than reality, we cannot rid ourselves of it.

Denunciation of drug use by athletes covers an underlying confusion about the proper conduct of sports — about the kinds of risks that are permissible, the demands made on athletes, the purpose of sports medicine, and the suitability of training practices. Similar questions lie behind the argument about drug use in general. Which dangerous practices should be permitted and which ones forbidden? Are some demands or desires created by modern social conditions intolerable? What is the proper role of medicine? When does a new practice or innovation threaten our sense of what humanity should be? The focus on drugs may not be right, despite some historical fantasies and current propaganda (and many individual disasters). It is doubtful whether any society has ever been ruined by a drug; certainly no sport has been. But as technology becomes more effective and somehow more menacing, we become more suspicious of this peculiarly initimate and insidious kind of technology. Even if no drug has ruined a sport or a society so far, the symbolic threat remains, and we are not likely to relax our efforts to contain it.

In a technological society, we have to live with the visions of Brave New World and the psychem society, as well as with the more commonplace dangers pf drugs. But that should not frighten us back into rigidity — into "standing stiffly in the position of flinging a gauntlet or uttering a battle cry," the image G. K. Chesterton used to describe prohibitionism. If a degraded uniformity in human life is one of the main dangers, trying to impose a single simple solution is another variant of the disease for which it pretends to be the cure. The utopian vision of religious drug use in Huxley's Island is not necessarily more implausible than the vision of Brave New World.

Since neither a drug-using utopia nor a drug-free society is now in prospect, circumstances have been forcing us into greater flexibility. When an illicit drug has been used by tens of millions of people, it can no longer be relegated to a small criminal or pathological category, and we have to start making distinctions among kinds of use and users. That implies a greater variety of controls, and more compromises between social reality and the demands of law enforcement. If the law and public language simplify and stereotype experience too much, they will defeat their own purposes. That is why public and private discourse about drugs has begun to converge.

On the other hand, public rules and public discourse are necessarily less ambiguous and contradictory — more rigid — than private sentiment, because they are less able to survive unresolved conflict (Williams 1979). Modern societies inevitably incorporate conflicting values, and we would lose something by reducing the conflict too much. We cannot expect perfect harmony, and a touch of something like hypocrisy may be unavoidable; the line between confusion or conflict of values and straightforward hypocrisy may be hard to draw. There is even a moral argument in favor of certain kinds of hypocrisy. The nineteenth-century utilitarian ethical philosopher Henry Sidgwick wrote:

. . it may be right to do and privately recommend under certain circumstances, what it would not be right to advocate openly; it may be right to teach openly to one set of persons what it would be wrong to teach to others; it May be conceivably right to do, if it can be done with comparative secrecy, what it would be wrong to do in the face of the world, and even, if perfect secrecy can be reasonably expected, what it would be wrong to recommend by private advice or example. (Sidgwick 1907, pp. 488-90)

An example would be giving a depressed student an unjustifiably high grade to lift his spirits and help him do better work. Recognizing the paradox of stating publicly that it is sometimes right to do secretly what a public ethical code condemns, Sidgwick added that the above opinion should itself be kept comparatively secret (Singer 1981, p. 166).

Ultimately, the problems surrounding drug use can be neither solved nor dissolved. Freud said that the palliatives needed to make human life bearable include intoxicants that render us insensitive to our miseries; for this purpose, he even put them on a par with art (a "substitute gratification") and science (a "powerful diversion"). Mencken said of the alcohol problem that between the distillers and saloonkeepers on one side and the prohibitionists on the other, "no intelligent man believes the thing is soluble at all." The alcohol problem might be more like the metaphysical problem of evil than like a treatable disease or an adjustable social conflict.

The confusion of attitudes about intoxicants is not just a modern one, even if it is heightened by contemporary conditions; it is in the nature of humanity and the drugs themselves. Baudelaire writes in his essay "On Wine and Hashish":

Wine is like man; we will never know to what extent it should be esteemed and scorned, hated and loved, nor how many sublime actions or monstrous misdeeds it is capable of. So let us not be more cruel to it than to ourselves, and let us treat it as our equal. (Baudelaire 1974, p. 72)

And he adds: "If wine disappeared . . . I believe that it would produce in the health and intellect of the world a void, an absence much more frightful than all the excesses and aberrations for which wine is held responsible" (p. 75). But hashish, he says, "makes neither warriors nor citizens," annihilates the will, isolates the user, and in the end proves useless and dangerous (pp. 92-3). In Les paradis artificiels, he adds that it "allows man to violate the laws of his constitution" in his taste for the infinite (p. 101). This distinction does not make sense. It cannot be right to embrace the contradictions in one case and reject them in the other. Chesterton said that the dipsomaniac and the abstainer both make the mistake of treating wine as a drug rather than a drink. But the truth is that alcohol is, among other things, a drug. All drugs produce their dipsomaniacs, their abstainers, and everything in between. If wine is like man, capable of sublime and monstrous deeds, so are other drugs. If we must be cruel to them, that does not mean we have to be so much more cruel than we are to ourselves.