1 Introduction

"H" is for heaven; "H" is for hell; "H" is for heroin. In the life of the addict, these three meanings of "H" seem inextricably intertwined.

How and why does addiction happen? What, if anything, should be done about it? These are the basic questions to which this book is addressed. They are complex questions, not merely in the sense that many factors must be taken into account in answering them, but also in the sense that they reach beyond the borders of the intellect and the devices with which one ordinarily tries to find answers to intellectually challenging questions. Although we have attempted to approach these questions as behavioral scientists, bringing to bear many research and analytic techniques and trying to lay bare fundamental facts, we rather doubt that it is possible to answer them dispassionately.

When one tries to answer these questions, he finds himself profoundly implicated. The addict is not simply an alien specimen that can be placed under a microscope, coldly dissected, or otherwise displayed to our disinterested and detached observation. He is a human being; that, in itself, is enough to implicate us. No matter how offensive and destructive we may find his behavior, we cannot regard him as a merely noxious object, an insensate thing, or less than human creature without to some degree dehumanizing ourselves. Moreover, however insufficient the sheer fact of our common humanity may be as a basis of empathic communion, the addict stands before us as a stark model of what the rest of us might have made of ourselves; insofar as we sense in his life story a tragedy of temptation and fall, he serves as a bleak reminder of our own vulnerability to temptation and of our own desperate hope never to be cut off from all possibility of redemption.

Our own inner reverberations when confronted by such unpleasant potentialities of the human image—the arousal of our hidden guilts, fears, awareness of frailties, and, let us face it, our envy of the "freedoms" of irresponsibility and of the esoteric delights that we dare not permit ourselves—all of this may be difficult to bear. We may try to protect ourselves by turning outward and adopting a stance of witness to a drama of the implacable working out of retributive justice. Prometheus, having illicitly brought the heavenly fire to earth, is condemned to a millennium of being eaten alive; Tantalus, having stolen the ambrosia of the gods, suffers a fate that makes his name a symbol of an exquisite form of torture; Icarus, having soared to forbidden heights, suffers the inevitable consequence of plummeting to the depths; and the addict, having trespassed in heaven, has earned his hell.

Alas, it does not take much witnessing to learn that the great drama is nothing but a tawdry parody. Our Promethean-Tantalic-Icaric addict is not a heroic figure, but a miserable wretch. The heaven on which he has trespassed is not the heaven of a normal man's dreams, but an impoverished counterfeit. The hell that he suffers is not the inevitable consequence of impersonal forces or of the will of the gods, but a hell generated by human society. Our stance as witnesses turns out to be a pose designed to mask a petty, punitive, narrowly self-righteous superiority.

Be it a contemporary rendition or a shabby burlesque of the classical tragedy, we are all implicated in the life story of the addict. He is one of us. His character and actions have consequence for us, as ours do for him. As members of a common society, we share in the responsibility for the conditions that have helped make him what he is, insofar as these conditions are subject to human control. The dispositions we make for his treatment help to determine the consequences of his addiction. No matter how low he sinks, he cannot lose his right to justice; the lower he sinks, the greater is his claim to our concern.

There is thus ample occasion for passion in the discussion of addiction. It is not, however, the traditional role of the scientist to display his involvement in his subject matter. If he is involved, it is the style of scientific reporting to carefully conceal that fact. Sentences that would normally be expressed in the first person are, for instance, systematically translated into the third person, neuter gender, passive voice. This is his guarantee of objectivity. Yet, the closer his subject matter to areas of significant human concern, the more is that guarantee a pretentious sham. Or, if he is truly detached, the greater the reason to be suspicious of the quality of his observation; flatness of affect and detachment are common symptoms of psychopathology, and we do not normally trust the mentally sick to be the most accurate observers.

The true characteristics of scientific inquiry are in the steps taken to guarantee the accuracy of the observations, regardless of the state of one's feelings with regard to the outcome; to control for possible sources of error; and, in instances of failure to control, to make express acknowledgment of the failure and to take account of its possible effects. If the personal involvement of the scientist makes more tenable the hypothesis that he is in large measure merely observing that which he wants or expects to observe, then it is all the more his scientific responsibility to acknowledge his personal involvement, not to conceal it. It is his responsibility to keep his feelings from intruding into his determination of the facts; it is not his responsibility to deny himself as a human being by indifference to the facts, and it is only scientific irresponsibility to conceal from his readers the fact that he does have feelings.

As a matter of historical record, we had no axes to grind when we started our investigations, and we still do not have any in the sense of material advantages that might accrue to us or to any agencies with which we are associated from the defense of one position as against another. Neither our own statuses nor those of the agencies for which we work are at stake in the sheer fact of concluding one way or another.

We were also free of any expectations with regard to the substantive aspects of the problem, so that we could not be fairly said to have started with any particular bias. We had no idea whether all strata of society were equally vulnerable or whether some segments were more vulnerable than others. If we had to make a guess, it would have been in the direction of our findings, and we would probably have been surprised if it had turned out that all individuals are equally vulnerable; but we were open to the possibility that the only factor relevant to the spread of drug addiction is the prevalence of inducements to try the drugs and that, once one has partaken of them, there is, subject only to continuation of access, a physiologically inevitable course to addiction.

It was not until we were well into the problem that we began, at first vaguely, to distinguish between users and addicts; and it was not until this book was well under way that it dawned on us that even a person with a history of drug use and physiological dependence on the drug might conceivably not be an addict. Such a person might be lacking in what we now regard as an indispensable characteristic of a true addict—craving, that is, a powerful desire for the drug independent of the degree to which the drug has insinuated itself into the physiological workings of the body. It was not until we were well into the problem that we clearly realized that the factors responsible for drug use might be different from the factors responsible for addiction, given drug use. We started with the common belief that prolonged use of narcotic drugs is intrinsically devastating to the human being, physically and psychically, and it was not until we set to work to prepare a true-false test on information about narcotics that it was brought home to us how completely without any scientific foundation and contrary to fact such a belief is.

When we began our studies, we were, of course, aware that there were laws concerning the possession and sale—and, by implication, the use—of narcotics. We viewed the problem as a special case in the general area of crime and delinquency. We saw the law as setting the framework of the problem, but we did not start with any suspicion that the law might be in any way contributing to the existence of the problem. If we gave the matter any thought at all, we would probably have gone along with the common assumption that the law was a perfectly rational way of meeting a genuine need and with the common-sense view that, if people do something that is dangerous to society or morally reprehensible under the risk of arrest and prosecution, they will be all the more likely to do it if the risk is removed. It did not occur to us at that time to question the fundamental premise of the commonsense view, namely, that the motivation of such actions exists independently of the risk and of the conditions that make these actions risky. It did not occur to us to ask how much drug-taking behavior would not take place were it not for the challenge of the risk; the attractiveness of the forbidden; the glamor of defying authority; the power of self-destructive needs given a socially validated channel of expression; the drawing power of an illicit subsociety to lonely individuals alienated from the main stream and the lure of its ability to confer a sense of belonging, interdependence of fate, and common purpose to individuals who would otherwise feel themselves to be standing alone in a hostile world; and the inducements to drug use motivated by vast profits made possible by the very effectiveness of the law enforcement agencies and the operation of the economic law of supply and demand. We did not, then, have any notion that the most dangerous consequences of addiction to the individual were a direct outcome of the existence and enforcement of the law.

We did, however, eventually reach conclusions—in briefest version, that the problem of addiction is commonly viewed in the most violently distorted perspective and that the efforts of society to cope with the problem are models of irrationality. These are strong conclusions, bound to evoke strong reactions. If this is not enough to alert the reader to proceed with a critical eye, let us add that, although we have disclaimed any initial bias, we are conscious of the all-too-human tendency to develop a personal investment in one's conclusions. There is evidence that, once one has committed oneself to certain conclusions, there is a tendency to hold to them with all the more unshakable conviction, the less solidly they are based. In our own eyes, therefore, if only on this ground, our conclusions are not invulnerable.

If we have, nevertheless, already stated some bald conclusions, perhaps implied some others, and continue this chapter with a bare summary of some of our findings, it is only because such a statement helps to provide an integrative map of the rest of the book. This is where the reader is given a picture of the sort of things he is going to be asked to believe. It is the big picture. We have put it at the beginning rather than in the customary position at the end because this makes easier-the reader's job of checking the big picture. By the customary procedure, the reader must fix all of the details in mind before he knows what will be done with them, and it is relatively easy for him to go along with the authors in any distortions they may introduce in the summary, wittingly or unwittingly overlooking conflicting details, overemphasizing some details, and underemphasizing others. But, if he has the big picture clearly in mind at the outset, then jarring details, insufficiencies of evidence, and the like are more likely to strike him as he goes along. We believe that the big picture we present is faithful to its subject; but that is for the reader to judge.

In our view, grossly exaggerated estimates of the number of addicts is a numbers game. There seem to be two kinds of vested interest at work in establishing the exaggerated statistics as authentic—one benevolent, the other not so.

On the benevolent side are the agencies and individuals who are desperately trying to provide services for the addict. Treatment, rehabilitation, and research resources are so grossly inadequate, however, that these agencies and individuals find themselves in the situation of a person caught in a traffic jam who is trying to estimate the number of cars on the road. It may also be good politics to exaggerate the need in the hope that legislators and other controllers of funds may be moved to approach the level of need. On the whole, however, we think that these individuals are honestly reflecting what they see; it is merely that they are in no position to provide authentic figures. It is also our, perhaps naïve, opinion that it should not be necessary to exaggerate to be able to meet existing human needs. These are acute needs, and there has been scarcely a beginning in meeting them.

On the not-so-benevolent side there is what seems to be an occupational disease of law enforcement agencies. Such agencies are continually frustrated in the discharge of their proper functions by considerations of civil liberties. These frustrations are real, even though they are necessitated by the larger social good. The law enforcement agencies, however, are not charged with maintaining the larger social god, but with law enforcement, and they are quite naturally most concerned with establishing the conditions that will enable them to carry out their responsibilities most effectively. Moreover, the normal course of their relationships with law violators is such as to make it difficult for them to achieve a balanced view of criminals as human beings included among those whom the Bill of Rights was designed to protect. Their constant concern is to outwit and to keep from being outwitted; such a relationship can hardly be expected to generate a desire to protect the rights of others. Finally, there is a phenomenon similar to the traffic-jam effect mentioned in the preceding case; in the experience of the law enforcement agent, the world must be far more densely populated with malefactors than is actually the case.

What does all this have to do with the numbers game? If the addiction problem can be inflated to the proportion of a national menace, then, in terms of the doctrine of clear and present danger, one is justified in calling for ever-harsher punishments, the invocation of more restrictive measures, and more restrictions on the rights of individuals.

There seems to be a trend for law enforcement officials to accept the definition of addiction as a disease, but this trend does not entail much of a change in outlook. The argument goes something like this: The addict is mentally sick and irresponsible. We know that he will commit crimes. It is essential to protect society from his depredations. Therefore, he should be committed to a mental hospital.

No American law enforcement officer, to our knowledge, has ever dared suggest that a person be sentenced to jail for crimes he has not yet committed; but to sentence him to hospital servitude is, after all, thoroughly humanitarian and not a violation of the Bill of Rights at all. It takes panic to make this sort of logic palatable, and numbers are useful in generating panic.

Although we shall present, in later chapters, some data on other subgroups, we shall here limit ourselves to the subgroup we have most intensively studied, the sixteen-to-twenty–year–old male drug-user. All of our data are limited to cases in three boroughs of New York City—Manhattan, the Bronx, and Brooklyn.

From the information available to us, allowing for differences in specific statistics, it can be said that the picture is probably not much different from that of other subgroups and other large cities with large numbers of cases. The major exceptions in at least some important details are the so-called medically addicted cases—that is, individuals introduced to narcotics in the course of medical treatment—the majority of which (excluding terminal cancer cases) currently come from the rural areas of states which still permit nongraduates of medical schools to practice medicine and the cases of individuals addicted exclusively to barbiturates, to so-called tranquilizers, and to one or another of a variety of synthetic drugs.

Every year since 1949, about five hundred young men, give or take a hundred or so, who have not been previously known to be illicitly involved with narcotics have been coming to the attention of the courts, city hospitals, and other interested agencies. The great majority of these have used heroin; only a small proportion are nonusing sellers of heroin or involved exclusively with marijuana. How many of these become addicted is not known, especially since the word "addict" is not used in any standardized way. How many additional cases there might be which do not come to public attention is also not known, but it is unlikely that a habituated individual (that is, one who has been taking at least one daily dose for at least two weeks) can escape attention for long. The count probably includes nearly all those who, for some considerable period during the time span under consideration, may be considered habituated users.

It is not known, however, how many habituated users there are among sixteen-to-twenty–year–old males in the three boroughs on any given day; the number is undoubtedly far less than the total number of cases counted for the statistic cited at the beginning of the preceding paragraph. Some have discontinued use, if only temporarily, by virtue of finding themselves in custody; some have voluntarily, perhaps also temporarily, discontinued use for a variety of reasons; some have left town; many have graduated beyond their teens. It is also not known how many habituated users are to be found, let us say, today in the three boroughs who are known to have become involved there with narcotics prior to their twentieth birthdays; some have died, some have left the area, some have quit temporarily and are clear as of today, some have reduced their level of intake to less than that which we have designated as habituated use and others have never reached that level, and some may have quit permanently.

It is a virtual certainty that only a fraction—an unknown fraction, to be sure—of the 2,950 males in the sixteen-to-twenty age range whom we counted as having become involved with drugs in the period from January 1, 1949, through December 31, 1954, are still alive, residing in New York City, and habituated as of today. This fraction may be greater or smaller than the fraction of those truly addicted, in the sense earlier defined, as of today, since, on the one hand, not all habituated individuals are necessarily addicts and since, on the other, not all true addicts are necessarily habituated on a given day. To be sure, a habituated person with so long a history of continuous involvement with narcotics is very likely to be a true addict; but, for all we know to the contrary, there may be a substantial number of the same individuals who are today habituated but who have had no involvement at all in the interim.

Whatever the actual numbers of juvenile habituates and true addicts may be, drug use among juveniles is most frequently found in the most deprived areas of the city. In the early 1950's, 15 per cent of the census tracts in the three boroughs, containing less than 30 per cent of the sixteen-to-twenty–year–old boys, contributed over 80 per cent of the cases of involvement. The areas of high incidence of drug use are characterized by the high incidence of impoverished families, great concentration of the most discriminated against and least urbanized ethnic groups, and high incidence of disrupted families and other forms of human misery. There is no reason to suppose that this situation has materially changed since then.

The relation of drug use to crime and delinquency is not a simple one. The illegality of the possession of heroin and marijuana, of course, defines the user of these drugs as ipso facto a criminal, and he can only obtain the drugs by dealing with criminals. Moreover, the high market cost of heroin makes it impossible for ordinary habituated users, especially juveniles, to maintain their supplies by legitimately obtained financial resources. Habituated use demands financing by illegal means, participation in the sale of narcotics ("pushing") and in other forms of crime that promise cash returns. In areas of high drug use, the increase in the latter is accompanied by an increased proportion of potentially money-making juvenile crime. Still, the increase in drug use does not result in an over-all increase in juvenile crime when the direct violations of the narcotics laws are discounted. Drug use flourishes in areas of disproportionately high delinquency, but it is not the cause of the delinquency (again, of course, discounting the direct violation of the narcotics laws). The increase in crimes of profit is compensated for by a decrease in such crimes as rape, assault, automobile theft, and disorderly conduct. Nor is the prevalence of delinquency in an area a sufficient condition of its hospitabiity to the spread of drug use. The areas with the highest incidence of drug use are high delinquency areas, but they differ from equally high delinquency areas of much lower drug use in a greater concentration of the kinds and sources of human misery referred to in the preceding paragraph.

The juvenile street gangs that become involved in delinquent activities are not major agencies of the spread of drug use—even in the cases of gangs where the use of marijuana and heroin is more or less common. True, few gang members have strong feelings against the smoking of marijuana, and substantial numbers have no strong objections to moderate and controlled experimentation with heroin. In general, however, delinquent gangs seem to resist the spread of immoderate drug use in their midst. The considerations are not moral, but practical. Drug-users are considered unreliable "on the job," and it is believed that they can get the whole gang into trouble if arrested with others. Individuals with histories of habituated use get to be known to the police and remain under more-or-less continuous scrutiny, thus endangering their not-so-law-abiding associates. Moreover, there are laws of "constructive possession" that imperil the innocent; for instance, all individuals in a car in which narcotics are found are technically liable to prosecution. The interests of the regular users also tend to become limited and specialized so that they form cliques and thereby threaten the cohesiveness of the gang. In consequence, gang leaders who start to use drugs tend to lose or to yield their leadership positions. A gang member who is a pusher will not normally tempt a vulnerable fellow member, for example, a dehabituated addict returned from a period of custody in some hospital or jail; the pusher will, of course, have no hesitation about plying his wares among nonmembers and the members of other gangs.

Also contrary to popular belief, the great majority of juvenile regular users are not initiated into drug use by an adult pusher; even those who are, are not necessarily persuaded by the adult pusher. Some boys seek out even their initial source on their own. Most take their first dose of heroin, free, in the company of one or more boys of their own age—in the home of one of the boys, on the street, on a roof, or in a cellar—rarely on school property. Frequently, the first occasion arises just before a dance or party, probably for the same reason that some of their peers and many adults brace themselves with one or more shots of alcohol, as a source of poise and courage. Ninety per cent or so of habituated users have become so within a year of their first dose.,,

Already by the eighth grade, about a fifth of the boys in highly deprived areas give evidence of having acquired what we have characterized as a "delinquent" orientation to life. This orientation consists of moods of pessimism, unhappiness, a sense of futility, mistrust, negativism, defiance, and a manipulative and "devil-may-care" attitude on the way to get something out of life. This orientation, particularly prevalent among the greatest social misfits, is generally favorable to experimentation with narcotics. In an area of extremely high drug use, however, the connection of this orientation to attitudes favorable to narcotics is especially marked. Moreover, this connection has two major strands, one emphasizing the dysphoric mood and the other the more active aspects of the delinquent orientation. The first of these strands is particularly tied to a wholesale rejection of many arguments for not taking heroin. In addition, there is, in this area, evidence of a pervasive polarization of attitudes among the eighth-grade boys, moreor-less independent of the issues of the delinquent orientation, that favor or disfavor drug use. That is, there must be a substantial number of individuals in this area whose attitudes are favorable to drug use even though they do not share fully in the delinquent orientation. This generally favorable attitude is also related to direct exposure to the use of narcotics. It does not follow, of course, that attitudes favorable to the use of drugs will be realized in action. If other conditions are also conducive, however, the likelihood of yielding is increased by that much.

The boys in the areas of high drug use who neither become delinquents nor drug-users are actively resistant to sociocultural pressures in these directions. They have a negative attitude toward the "other crowd" and dissociate themselves from it. In their own groups, they find a wider range of stimulating activities than the others ever do. They participate in more active sports, including hiking and camping. They discuss books and current events. Their daydreams are realistically oriented to future work and family life. They stay in school longer and appreciate the importance of learning new skills and improving their minds. They are likely to show interest in and participate in school government, newspapers, or magazines. They do not spend as much time as do the others at the local candy store, going to the movies, or just "goofing off." They are more likely to have stable and intimate friends among their peers.

These boys come from more cohesive families than do the users; but they are not more likely to come from such families than are delinquents who are not users. They are less likely to have confronted the developmental task of adjusting to new families in the course of their lives through the middle teens and are more likely to have continued living with their real fathers through these years. Their extended families are less likely to include individuals with police records, and their immediate families more likely to be regular churchgoers. Most have a father, a teacher, a minister, or priest to whom they can talk about personal matters that bother them. Insofar as they have an ideal which they would like to emulate, it is more likely to include the father; but, in any event, they are more likely to value their ideal for what he is (e.g., his courage or kindness) rather than for what he has (e.g., his wealth or skills).

The boys who become addicts are clearly related to the delinquent subculture. Even before they started using drugs regularly, most users have had friends who had been in jail, reformatory, or on probation. In their general activities, interests, and attitudes, they resemble the non-using delinquents and are quite unlike the group described in the preceding paragraphs. Their leisure is spent aimlessly, talking about having cars, expensive clothes, pocket money.

Their home life is conducive to the development of disturbed personalities, which they display in abundant measure. Relations between parents are far from ideal, as evidenced by separation, divorce, overt hostility, or lack of warmth. In almost half the cases, there was no father and no other adult male in the household during a significant portion of the boys' early childhood. As children, they tended to be overindulged or harshly frustrated. The parents were often unclear about the standards of behavior they wanted their sons to adhere to and tended to be inconsistent in their application of disciplinary measures. Their ambitions for their sons were typically unrealistically low, but in other instances they were unrealistically high. Although we had hoped to do some special studies of deviant cases—that is, of addicts coming from psychologically adequate homes and of nondelinquent nonusers coming from psychologically deficient homes—we were frustrated because we did not find such cases; on scales of psychological adequacy of the homes, there was virtually no overlap between the two distributions.

The evidence indicates that all addicts suffer from deep-rooted, major personality disorders. Although psychiatric diagnoses are apt to vary, a particular set of symptoms seems to be common to most juvenile addicts. They are not able to enter prolonged, close, friendly relations with either peers or adults; they have difficulties in assuming a masculine role; they are frequently overcome by a sense of futility, expectation of failure, and general depression; they are easily frustrated and made anxious; and they find both frustration and anxiety intolerable. To such individuals, heroin is functional; it offers relief from strain, and it makes it easy for them to deny and to avoid facing their deep-seated personal problems. Contrary to common belief, the drug does not contribute rich positive pleasures; it merely offers relief from misery.

Let us pause, now, to ask a few questions. Assuming for the moment that the picture we have just drawn can be supported, do such findings support the premise that the paramount objective of the treatment of the addict is to get him off the drug? It seems clear to us that such a premise confounds a relatively minor symptom with the disease. Yet this is the major premise of all public policy in the United States with regard to the problem of addiction. Although some physicians and others have raised courageous voices in protest, it is a premise that dominates even the medical treatment of addiction.

What have we left out of the picture that might justify such a premise? Is it possible that the drug is so inherently dangerous as to make it the paramount consideration? Overdoses are clearly fatal, but whence comes the danger of overdosage? Apart from those addicts bent on suicide—and, needless to say, such people have many alternatives available to them—the big danger is a direct consequence of our public policy. On the illegal market, the drug does not come from quality-controlled manufacturers. The user, therefore, never knows what dosage he is actually getting, and he has no protection whatever from adulterants, many of them possibly more dangerous than the drug itself.

Is the drug dangerous in other ways? Strong habituation brings with it the danger of severe reactions (not as severe, however, as in cases of habituation to the readily available barbiturates) to abrupt discontinuance. But why should the addict have to confront the necessity of abrupt discontinuance? In any event, is the addict any worse off than is, say, the diabetic in his dependence on insulin? And, if the danger of abrupt discontinuance is our major concern, why is it that this is the treatment typically imposed on him?

Apart from the dangers of overdosage and abrupt discontinuance, there are a few other, relatively mild, medical disturbances (such as severe constipation) commonly associated with prolonged usage. Are these the dangers that justify the premise? This is, of course, to say nothing of the neglect of health and sanitary measures into which the addict is forced by his monomaniacal pursuit of continuance of his supply under present conditions.

Does, the drug sap the moral fiber of individuals and produce criminals? In the first place, the question confuses cause and effect. Drug addicts are not distinguished for their moral fiber prior to their first experience with drugs. People of high moral fiber do not take opiates except under medical instruction and supervision and, even if habituated under these conditions, do not continue as addicts once they have been detoxified. The fact that jails are crowded with individuals who have illicit drug experience proves that criminals are prone to such experience rather than that such experience per se disposes individuals to crime. Even so, under the conditions dictated by the major premise, the addict has no alternative to a criminal existence; even if he can afford the drugs at black market prices, which few can, his uncontrollable craving makes him a criminal because possession per se is defined as a crime. With all this, there is our own remarkable finding that, at least among teen-age boys, there is no net increase in the volume of crime, apart from the direct violations of the narcotics laws, accompanying a marked increase in drug use.

Is it possible, then, that the great danger justifying the major premise is that of the enormous spread of what, apart from the effects of the premise, would be a relatively minor disease? Even a relatively minor disease in epidemic proportions may be taken as a national peril. But is the premise necessary to defense against such a peril? No one, to our knowledge, advocates the utterly uncontrolled distribution of opiate drugs. Suppose, then, that the prescription of drugs were left to the total discretion of the individual physician in his treatment of the individual patient; do we have any reason to believe that the occasional abuse of such a privilege could not be controlled by the internal disciplinary processes of the medical profession? Do the police have to be brought in at all? Suppose, further, that there remains a hard core of addicts who refuse to abide by the discipline of medical control and that there remains a residual black market in opiate drugs; would we be worse off than we are now?

Just for the sake of argument, let us consider what would happen if anyone were free to purchase opiate drugs without presciption in an uninflated market. Would this bring with it the danger of epidemic? On the available evidence, the danger would be no greater than the prevalence of social and psychological pathology, and this is what should concern us rather than the possible danger of an epidemic of addiction. In any case, we need not speculate on the danger. Prior to the passage of the Harrison Act, there was precisely the condition we are now imagining, with the further complication that many proprietary medicines were loaded with opiates without warning to the user. The evidence, to be reviewed below, is that there were many addicts—most of them probably habituates rather than true addicts and, at that, habituates without any real awareness of their physiological dependence—but the numbers were not cataclysmic.

We are not suggesting that ridding ourselves of the major premise would solve all of our problems; we shall return to this issue. But is there not in all this occasion for anger?