CHAPTER 10 Law and morality: some summary considerations

GIVEN THE LARGE HISTORICAL TREND IN WESTERN Civilization in the direction of increasingly humane treatment for physical and mental illnesses, it is an anomaly and an anachronism that drug addiction should today be treated with such passionate moral outrage, while in the nineteenth century the addicted were regarded with both sympathy and compassion. As noted earlier, we now would consider it barbaric to deny medical treatment to one suffering from a disease because of objection to the moral situation in which it was contracted. It is both humane and sensible to treat the physiological problem first, saving the moral question for later. Yet, because the psychological-physiological problem of addiction-habituation has been intertwined with the moralistic problem of willful sensual pleasure and flight from responsibility, the view and response to addiction has taken a moralistic form. The psychological interpretation of opiate addiction has led to a brutal conservatism in the conception and treatment of the problem. Current professional and common-sense theories of the "disorder" have come to rest on explanations of the psyche and what is seen as its retreat, its immaturity, and ultimately, its pleasure-seeking immorality. The addict is denied physical treatment for his suffering because of the moral judgment of the social meaning of addiction and drug use.

It is the moral condemnation of addiction per se that allows the Federal Narcotics Bureau to report with a sense of accomplishment that the number and proportion of addicts has decreased greatly since 1914. What gain is there in this when the present smaller number of addicts do far more damage to society and to themselves than all those addicted in 1914? What gain is there when the society has created a smaller population that is far more destructive than the larger population of an earlier more civil and humane period?
Americans have tied themselves into a circular knot on the drug problem because they have come to believe that the physical treatment of the addict with drugs is itself immoral.

To explain how this came about, several themes have been developed in this book. The analysis has consistently focused upon the various conceptions of moral behavior. Both individual moral action and claims for morality which transcend the community have been avoided in the task of explaining the emergence of communal moral judgment.

This has not been a diatribe against the use of a moral stance on the problem of the distribution and use of narcotics. (It is neither desirable nor possible to rid a society of moral judgment, for social structure is also moral order.) Rather, the position has been that the moral posture towards drugs should be assumed only after there is firm, adequate knowledge of the physical effects. If a drug destroys body tissues (e.g., alcohol), then a moral stand on the destruction of body tissue, not on the independent and isolated social meaning of taking a drink, should be forthcoming. If a drug dulls the senses and relieves anxiety, then a moral stand on whether that should be done under certain circumstances should be taken. Instead, in ignorance we have categorically defined heroin use as morally different from barbiturate use due to its social-legal base, not its physiological base. Grossly inconsistent, we listen with silent approval to radio advertisements for drugs that relieve anxiety and produce calm women's club presidents out of the previously distraught. We then revert to moral fervor to condemn for its social meaning what we define as the same quality act among addicts. For those who would bring the "deviant" back within the boundaries of "normal" society so that he can have some kind of relationship to it, it is self-defeating to stigmatize the deviant as though he were a totally different kind of person. In so doing, we guarantee that his deviance will simply take the form of the response that in some degree either (a) accepts that judgment of the self or (b) rejects that judgment, and in so doing, rejects other normal standards of the society that placed him there. The United States has taken the lead in treatment of the addict as a social deviant. Among all Western nations, it has had the largest problem with the illegal use of narcotics. It is now very alarming to note that the United States may be serving as a model for other industrial nations. The "drug problem" is becoming more evident in Western Europe, England, and japan. In England and Sweden, increasingly restrictive measures and the way of thinking about the problem have been inherited from America. A Swedish newspaper recently advised that Swedish physicians come to America to see first-hand how the Americans, "who have had a long experience with the problem," are handling it. Given certain indications that some of the rest of the world is moving in the direction of the total moralistic interpretation of the drug user, a public reassessment might prove fruitful.

The Proposal and the Argument

At some point, in some part of the body, all suffer some physical or organic illness. Most of these ailments do not get in the way of the daily management of affairs. When they do, organic treatment is now g generally accepted by almost all but a few very religious sect members. To be dependent upon organic treatment is no shame. We have come to the point where such dependence is not regarded as immoral. The successful professional who cannot sleep at night and who needs a strong dose of barbiturates may develop a "dependency." Here is a problem with a psychic base that is handled physiologically, and no imputation of immorality is made. Also, at some point, on some issue, all men probably suffer from some neurotically based inability to handle a problem. For most, it does not get in the way of the daily management of affairs. When it does, therapy is an alternative, either psychotherapy, some organic treatment, or the invoking of gods. No one argues that such treatment is itself morally wrong. The imputation is made when the psychic and the physical are intertwined, in the case of heroin use. As we have seen in this book, the answer lies partly in the fact that the kind of people who are known to use heroin are those in social categories most vulnerable to the charge of immorality. So long as an activity is engaged in predominantly by those in the "center" social categories, the likelihood of moral condemnation for the activity is miniscule, for it is the "center" of society which establishes the criteria for moral condemnation.'

Even when the stage is set and the conditions are ripe for the labeling of men and their behavior as immoral, the effectiveness of the law in bringing about changes in the behavior presents a basically different problem. It is the latter question which brings about lay assertions on the relationship between legislation and morality. Many believe that in certain areas (notably civil rights), the law cannot and should not precede and shape the moral order.

Americans invoke the cliche, "You can't legislate morality," but they are extremely inconsistent and apply the idea selectively to different kinds of behavior. They are typically very much in favor of legal sanctions to enforce strong moralistic feelings about the use of marijuana, and they have typically supported legislation that reinforces the current moral conception of appropriate sexual behavior. Prostitution in all forms and homosexuality in most forms are outlawed across the country. Moreover, almost everyone favors laws to protect the sexual exploitation of the very young. These are clearly areas where the law is used to buttress strong moralistic conceptions. This inconsistency is not faced directly and honestly. Instead of making reasoned and rational solutions to emotional commitments (as psychologists have long noted) we erect rational justification for our emotional proclivities. Thus, fear of "aliens" living in the same neighborhood is rationalized into the "inalienable right to property" (which, if not challenged by the prospective tenant, means his right to property is undermined) and the belief that you can't legislate morality. At the same time, fear of the drug addict is rationalized into more and more repressive legal measures against the addict with the unconscious commitment to the idea that we can, indeed, legislate the morality of young marijuana users.

However, the purpose of this work has not been to show that men are inconsistent—a commonplace and well-documented finding—but to demonstrate that a set of moral beliefs about the deviant (and the consequent behavior) creates, sustains, perpetuates, and exacerbates the deviance. It is time to reconsider the mindless assertions about heroin as ‘`our real concern being for the wasted manpower" and "the unthinkably immoral act of the community supporting an addict's habit." That is not the real concern. If it were, concern for the barbiturates would be much greater. If it were, we would ban certain commercials from the television and radio which peddle anxiety-reduction pills as a viable solution to problems. The moral beliefs upon which we have based our public policy are themselves founded on myths about both the physical effects of drugs and errors about the total quality of persons addicted.

We have seen the argument made that the apprehension and rehabilitation approach to addiction is bound to fail so long as the addict is viewed as morally different from others. However, there is a solution that is suggested by the very mechanisms which created the problem—namely, a legal change that alters the conditions of the addicted. Things began to move this way in 1914, when the law forced the most vulnerable social categories into the limelight as the publicly known users of the opium derivatives. It is by this means as well that a resolution can be effected.

It has been pointed out time and again that the moral posture toward a drug and subsequent legal implementation should be based upon the effect that the drug has upon the body. The depressant qualities of the opiates are known. These drugs do not evoke any hostile, aggressive, or destructive tendencies toward the self or toward the society. The morphine or heroin addict operating a daily life at a productive equilibrium is not a myth, but as the history of the late nineteenth century reveals, is very real. That is not to encourage heroin use, which is a separate moral problem worthy of more discussion. We might want to take up at some future time the question of to what extent a society ought to permit the depression of psychic and physical pain. My own view is that while many, if not most, psychic problems are best worked out without the use of drugs (e.g., social and personal solutions), some psychic and physical problems benefit most from the administration of drugs. This is not a question which a physician or psychiatrist is better equipped to answer than say, an attorney or a schoolteacher or a bricklayer. It relates to the moral order of the society and no profession can lay claim to being the most legitimate "moral entrepreneur."2 Experts in dealing with the mind and body are most capable of providing information that is to be used in the development of those stances. Solutions to the massive drug problems must begin with a reassessment of the social meaning of heroin and morphine use. The key to our correct handling of other problems such as marijuana, LSD, pep pills, and the barbiturates lies first with our reassessment of the opiates, for the opiates are the hard stuff that people fear most, and about which we are most irrational and self-defeating. The link between this reassessment and marijuana is clear, for the fiercest charge against marijuana is that it supposedly leads to the opiates. Marijuana cannot be discussed or explained calmly until basic questions about the opium derivatives are resolved. The link between this problem and LSD and other drugs is more subtle, but I would argue that just as cocaine colored all conceptions of the wild, aggressive "dope fiend" in the thirties, so the model of the willful, sensual, retreatest heroin addict of the sixties dominates public thought about the meaning of drug use. To undermine the basic myth is to allow reasonable pursuit of discussions about the actual physical effects of other drugs, and perhaps to provide a new climate for research upon those effects. In short, so long as the social and moral meaning of drug use is tied up with the dominance of heroin, other drugs are colored by common-sense notions of heroin use. The layman usually lacks even a sufficient knowledge of the various drugs to distinguish between amphetamines, marijuana, and LSD. In such a situation, it is only natural that "drugs" or "narcotics" are lumped together in his mind as a similar class of objects. The dominant theme in that class of objects revolves around the heroin addict, and the first breakthrough must come there. That is one of the reasons why most of the theoretical case presented here has rested on the heroin problem as strategic in this analysis of deviance. Reassessment and change must start here, but it would be utopian dreaming to leave the argument with a simple admonition neglecting guidelines to remedial action. A solution is suggested by the turn of events that brought about the problem.

Almost overnight, in 1914, thousands of addicts were driven by legal circumstances into underground and criminal activity. Just as quickly and dramatically, the law could create conditions which would point towards a possible viable relationship between the addict and the society. I refer to the dispensation of the opiate derivatives from clinics and from private physiciansge Once the society made its first move, the choice would be that of the addict, not the society. It would be the addict's choice, and it should be welcomed in that form. Able to decide whether to live a life with a physical-psychic dependency or without it, some will undoubtedly opt for the dependency, and we must be willing to face that as a possibility and even to see its positive side. Opium addicts are incapacitated neither physically nor mentally. Artists from Coleridge to Cocteau have been addicted, and they have made significant contributions of lasting merit far exceeding that of many "who just wouldn't darege" That argument is only specious insofar as one interprets it to coincide with a general advocacy of opium or a eulogy of its positive effects. It is neither. It simply points out that a society can expect return of inestimable worth from addicts allowed to live their lives without the stigma of moral deviance.

The Clinical System

Any clinical system for the dispensation of narcotics should be a supplement to the ability of private physicians to prescribe. Further, in keeping with the central theme of this work, the clinics should not be separate physical structures, but should be incorporated into existing community hospitals. We would go far to remove the stigma of the addict if we allowed him similar "moral" treatment to that accorded to others who have a physical-psychological dependency upon medicine. So long as the present attitudes toward drug addiction remain, it would be unwise to erect separate buildings as dispensing clinics. Those who became patients there would be identified in the community, only making their adjustment impossible.

As was pointed out in the first chapter, the clinics of 191 8- 1921 were not the failures that the propaganda of the Federal Narcotics Bureau leads one to believe. Rather, sensational newspaper accounts of abuses in only two of the scores of cities brought about strong public reaction and the demise of the clinics. It should be recalled that the clinics were set up after the authorities had recognized that many addicts had been cut off from a legal source, as they were unable to pay a private physician for individualized treatment. Thus the addict had already been stigmatized by 1919, and much of the public outrage was to be explained on these grounds. The early clinics then, did not "fail to solve the drug problem," they failed to operate long enough for that to be true.

In a present-day clinical system, addicts would be supplied on some periodic basis. There would be abuses in the first few years, and these must be expected due to the nature of the problem we have created. Some registered addicts would undoubtedly supply others not registered, or incapacitated, or even some novices, but this number would be far less than those youth who now by the scores of thousands can expect to enter a life of drugs. A major argument against such a program is that "the state should not give sanction to drug use," as a moral example. The fallacy of this position is that the state would no more be sanctioning such use than it would in any other sphere, where it simply regulates the supply and distribution of a drug, as in the case of the barbiturates. Does the state sanction barbiturates? Further, as a moral issue, why is the need for sleep a higher moral achievement than the physiological equilibrium? Those who would offer the glib response that the addict ought always to handle his problem psychologically must be prepared to say the same about other classes and forms of psychosomatic problems that men develop.

The advantages of a clinical system for the ambulatory treatment and supply of the addict are numerous. It is a system where most parties would gain, with the loss minimized. For the society, the gain would be in the drastic reduction of individuals who prey upon it daily for millions of dollars in theft to supply the addiction. The gain would also involve the undermining of the system of black-market controls that feed into the increased power of organized crime. These gains have been pointed out before by many other commentators on the drug question, but there is one gain that clinical dispensation would provide that is unique. This would be the slow but definite erosion of the moral stigma of being addicted, a gain of incalculable magnitude—for it would free a literal army of hundreds of thousands of abnormally intelligent and sensitive men to relate again to their society in a way that is not pathological.

Who can guess how many writers or artists or political thinkers there are among those denied a means for expression by the present situation around narcotics?

Some simple changes in the laws would accomplish a great deal. The present drug laws should be changed with respect to the opium derivatives so as to allow clinical dispensation. Based upon the best knowledge we have available about the effects of the drug, present marijuana statutes are ludicrously out of proportion. Marijuana is in a class with alcohol as a mind-transforming drug, and should get the same moral and legal treatment. As for LSD and the class of psychedelics, the paucity of research and the misinformation make recommendations impossible, except that we need to legally free the drug for more research. The amphetamines and the barbiturates are not now "morality-evoking" drugs, as the terms have been used. That is not necessarily a good thing. Based upon their physical effects, perhaps it should be reexamined whether or not these kinds of drugs deserve special treatment for distribution and control. Addiction to either class of drugs is a serious physiological problem, more serious, as noted earlier, than addiction to morphine or heroin.

There are not only positive gains from a legal change that would sanction clinical dispensation of the opiates, there are negative gains as well. Drug use is engaged in privately, not publicly, and there is no party to the act who has an interest in being the plaintiff. For these reasons, the law will not be effective in bringing about a change in the behavior or morality of the law violators. Thus, millions of dollars are spent in a fruitless attempt to stamp out the problem that could better be used upon some constructive program. At the very least, the negative gain would involve the elimination of the pursuit of an impossible task.

There will be objections to this suggestion, and they will predictably take two forms. First, the change touches upon a moral area where people are invested with strong feelings. Thus, even though the physical and psychic consequences of sustained heroin use are detailed in a dispassionate manner, Americans may still object to the legal dispensation to the addicted because it is "wrong." But there is already precedent for considering drug addiction as a sickness or disease. A joint report of the American Medical Association and the American Bar Association came to this conclusion in the early 196os.3 It is the right direction, though lam opposed to that conceptualization of the problem because in this instance it borders too closely to the charge of immorality. In any case, this precedent for viewing the problem in terms of illness means that a legal shift that permitted medical supervision of the addicted would not meet with such strong resistance. The legal and medical professions could provide a moral cloak for the addicts for a period long enough for an enlightened attitude to emerge, as was the case with epilepsy and certain forms of mental illness. There is no simple and direct move from a change in the law to a change in the moral order, but the law would change the social conditions and thereby the climate for a reinterpretation of the moral issues.

There is a second objection to this proposal that is predictable; and that has to do with the implementation upsetting and undermining strongly vested interests in the present way of handling the problem. Organizations, agencies, bureaus, and centers established to handle a problem employ men, and place some in high positions. These men develop what Veblen termed a "vested" interest in the maintenance of the organization or agency. The longer such organizations persist and the more permanent the funding of their operation, the more entrenched become the interests of those in higher echelon occupational roles. One reason for this is that careers develop around a special competence or a particular bit of expertise. Either a massive reorganization or a scuttling of the whole venture of the organization poses a serious threat to those whose careers have been narrowly defined by the pursuit laid down by the original interest. Lindesmith has voiced his concern as it relates to the establishment of more and more centers and organizations for the handling of the drug problem.4 He cites this as an important force of conservatism and resistance to reforms in the laws relating to the punishment of drug offenders. One can expect strong opposition from these quarters, but the merit of the arguments should be examined critically, beyond earshot of entrenched fortresses.

In the beginning of this work, I touched upon some relationships between legal change and moral order that deserve exploration. During the course of the development of the problems around the deviance of drug use, some of these relationships have been clarified. A summary statement of some of the relationships that have been thrown into sharper focus is in order. We know that people who materially benefit most from the status quo tend to see their societies as basically just and legitimate. However, even those who stand to gain from a redistribution of the wealth and power often justify the perpetuation of that order. Without that belief on the part of the subordinate, there could be no "right" of the privileged to exist the way they do. The prevailing conditions in a society are not simply things to be dealt with, they have moral force in the community.

For example, since everyone goes to elementary school, it soon becomes a part of the moral order that everyone ought to go. As ‘`everyone" goes off to form his own nuclear family, people begin to think that so ought everyone. As "everyone" marries for a romantic conception of love, so ought everyone, and so forth. It is equally true that matters of social deviance obtain their moral imperatives from a reading of the existing conditions: As males do not express affection toward each other, so ought they not. As females do, so should it be. A change in the morals of men does not come about from a"a change of heart," but from some alteration of the conditions in which they live.

Men did not suddenly decide to give women the right to vote because of a change in their morality—the conditions changed before men changed. So it is with deviance. Drug addiction became immoral because the social conditions revolving around it changed and, as I have tried to demonstrate, peculiarly lent itself to such a moralistic interpretation.

Many factors operate to alter the conditions, and they are so numerous and complex that it would be fruitless to begin to name them —though technological change is clearly the most dramatic and far-reaching element that could be identified. A second element that is prime among these factors is the law.

It is difficult to regulate such things as the rate of technological change and development, for it is dependent upon such matters as the distribution of skills and the economic base. The law, however, is relatively within control of a designated group at a given time. Because legal changes can alter the way in which police and other authorities behave towards a deviant group, they can alter the conditions of their existence and thus, as I have argued, the moral interpretation of that existence. The essential features of the drug addict's life, which make others impute to him unconscionable morality, are his associations with criminal activity, the belief that he leads an "unproductive and wasteful life," and the imputations of psychic weakness. Each of these could be dealt a death blow by legal changes that destroyed their basis. It has been pointed out by dozens of writers who have commented on the drug problem that the black market and the criminal tieups with drugs would be undermined by legal clinical dispensation of narcotics.The other advantages of the kind of legalization advocated here are more long range and less dramatic, but are no less important. The view that drug users are not productive can be dispelled better by eradicating the invidious distinctions between addicts and nonaddicts than by demonstrating that some addicts, like morphine-using physicians, can be and are productive. In the latter case, the disbelievers simply have recourse to the idea that those are the exceptional cases, and addicts aren't really like that. Thus, no claim is made that in changing the law we would demonstrate that individuals can be productive while addicted. We know that already. Rather, legal dispensation would go far in eliminating the socially arbitrary immorality attributed to selected kinds of drug use. It would do this by freeing the addict to participate in what others could clearly see as life as usual. It must be clearly pointed out that this is not a proposal to designate the addict and then let him reveal how he can be "normal." (This would be the equivalent of confronting a bigot with a member of an ethnic minority who would be acceptable in the bigot's terms. This would merely be treated as the exceptional case once again, while generic bigotry remained.) The point to be made is that the addict, supplied a drug without stigmatization, would make the case that has been presented: that he cannot be identified among "normal" men without a chemical test, and could therefore lead that kind of social life which would negate the charge of psychic weakness. It was not an issue in 1895 when there were proportionately so many more opiate addicts in the population, and it would not be an issue today if the circumstances were conducive.

A major thesis of this work has been that certain classes of persons in any society are more susceptible to being charged with moral inferiority than other classes of persons. The behavior in which persons indulge is often less important than the social category from which they come. In order to understand how certain acts get labeled deviant over time, and how other acts get the deviance label lifted from them, it is necessary to take into account the conditions under which persons in the "moral center" of society are publicly associated with a given behavior. Indeed, the thesis can be stated more categorically: When it is part of the public view that the predominant perpetrators of the act come from the moral center, that act cannot long remain "immoral" or deviant; it can become deviant again only under circumstances where the public conception is that the "morally susceptible" classes are those who are the primary indulgers.

I have tried to show how certain behavior (morphine and heroin use) was tolerated or ignored so long as it was more associated with "decent and respectable" elements of society than with any other part. Later, as the conditions changed so that the public viewed the unrespectable elements as the primary indulgers, the behavior came to be treated as deviant and immoral. The same point is made when we review what has happened to the moral status of alcoholic consumption in this last century. The point is the same, though the direction of the change was in reverse of the heroin problem. In the case of alcohol, it was an instance in which behavior once condemned by the moral center and associated in the public view as a vice of the vulnerable social categories later became acceptable, normal, and moral behavior due to conditional changes. These changes were of such a nature as to make it appear that respectable elements were associated with the behavior, thereby giving it a new, acceptable moral status.

From Gusfield's work on the temperance movement, we learn that its leaders were drawn from the professional and white-collar class from 1870 through Prohibition.5 As Gusfield argues, this was the primary source of its strength, for these proponents of abstinence spoke from within the society. The Pennsylvania Amish also favored abstinence from alcohol, but were an alien group who railed from without. The Women's Christian Temperance Union (WCTU) was a middle-class movement that took a benign posture toward the lower classes and the problems of poverty and failure. Abstinence was a panacea that would cure all ills; economic, social, political, psychological, and moral. In a word, temperance advocates could and did argue that abstinence was a virtue of the successful in the "moral center." (What then developed was just the opposite of what was to occur with morphine-heroin use.) In increasing numbers and proportions the middle-class began to indulge in the public arena. The Eighteenth Amendment, for alcohol, like the Harrison Act for heroin, made production and distribution illegal. There was one dramatic difference. The narcotics laws, as we have seen, made available to the middle classes a channel for a supply and made it seem as if only the lower classes were indulgers. The new alcohol law cut off the legal supply completely to all classes, and made violation the only alternative to those middle-class persons who insisted on imbibing. Such flagrant violations did occur, producing the conditions for a public reappraisal of the moral status of alcoholic consumption.

The historical development of a new morality around narcotics usage followed a different route to make the same point. Namely, a public reappraisal of the moral meaning of heroin use occurred when public identification of users shifted from the least vulnerable to the most vulnerable class.

One of the major purposes of this book was to develop some ideas that might serve to contribute to the sociology of deviance. We have already seen studies that have dealt with the cohesive consequences of deviance, the labeling and identification of deviance, and the life-styles of the deviant. The present work is an attempt to relate these themes with an additional explication of forces that produce and sustain select social categories of men for deviant careers. At the same time, it is insufficient to merely describe and analyze a phenomenon or problem of the magnitude of narcotics use without pointing to where that analysis might lead in the way of resolution. The first step to an empirical test of the theoretical propositions offered is to point where that analysis leads one to seek practical solutions. The opportunity now exists for a simultaneous contribution (I) to our understanding of some broader issues in the development and change of laws and morals, and (2) to a mundane solution to an important problem. A clinical system of dispensation with ambulatory treatment has the potential of accomplishing both. It is time we ended an anachronism that degrades men and refuses them assistance unless they comply with the prevailing middle-class moral interpretation of psychic health.