ADDICTION AND ITS SCIENCES

doi:10.1111/j.1360-0443.2011.03723.x

Addiction and the science of history
David T. Courtwright
Department of History, University of North Florida, Jacksonville, FL, USA

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486..492

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

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

INTRODUCTION Historians do not usually think of themselves as scientists, let alone scientists allied to addiction researchers. Even so, history provides data, contextual knowledge and narrative syntheses for those who study addiction in more conventionally scientific disciplines. In some research areas, such as retrospective epidemiology or policy analysis, history is indispensible. Things are the way they are because they got that way, as any evolutionary biologist will attest. Understanding the present state of things requires understanding past events.

WHAT HISTORIANS DO Although historians gain knowledge about the past in many ways, their signature method is the location, close reading and interpretation of primary sources. Why, for example, did the US Supreme Court uphold the federal government’s position that the ambiguously worded 1914 Harrison Narcotic Act forbade maintenance, the long-term supply of addicts with prescribed narcotics? Part of the answer can be found by unearthing the briefs government attorneys prepared for two crucial 1919
© 2012 The Author, Addiction © 2012 Society for the Study of Addiction

cases. Both briefs exaggerated the prevalence of addiction and the threat it posed to the nation. Given that the Harrison Act’s extension of federal police power was controversial and constitutionally convoluted; that the Court had previously ruled against government attempts to block maintenance; and that the vote was five-to-four, it seems likely that the misinformation contributed to the outcome [1]. ‘It seems likely’ and ‘contributed to’ are modest and tentative formulations. This is necessarily so, because historians deal in retrodiction rather than prediction. They cannot test their findings experimentally. No time machine permits us to dial up 1919, substitute amended briefs, and then observe whether the justices’ votes change. No statistical program can run a regression equation through their minds, calculating causal weights for the many variables in their decision processes. What historians can do, however, is amass enough information to give themselves and their readers an understanding of how historical actors saw evolving situations, with all their peculiarities and ambiguities, and why they acted as they did. The evidence behind such empathic explanations is cumulative and, in an important sense, verifiable. How do we know that the justices
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readability and range. Stimulants. What is striking about this list is how well it corresponds to the findings of epidemiologists.Addiction and history 487 confronted ‘exaggerated’ claims? What evidence justifies that adjective? The answer is that several contemporaneous reports. Kathryn Meyer and Terry Parssinen. for example. his monumental study of how tobacco companies addicted tens of millions of people world-wide—and went on doing so after the emergence of damning health evidence. who introduced cannabis and smoking opium to new lands. contemporaries were not always aware of it. Consider again the question of maintenance. Richard Davenport-Hines and Griffith Edwards [6–10]. ‘I can examine his personal papers—the very contracts. medical and political actors. to the point that political elites began imposing market restrictions? The answer is complex. Although historians do not usually test theories in a formal way. rather than increasing. to gain. and letters that made him a reality’. Addiction. The tobacco litigation discovery process. Historical claims may not be experimentally verifiable. By 1920 most were lower. 486–492 .5]. how medical researchers and pharmaceutical companies developed and marketed the drug. In 1880 most US addicts were middle-class women whose narcotic use was medical in origin. We can now see that the demographic transformation of the addict population was a necessary. the opening of new archives and the growth of secondary literature adds continuously to the store of insight. culture. economists and clinicians. as has the translation of such important works as Wolfgang Schivelbusch’s Das Paradies. gracefully written narrative that combines technology. His book serves double duty as the chronicle of a conflicted. The same graduate student would also learn something about addiction science. everything is connected to everything else. science and law with the decisions of key corporate. To those who say that ‘hindsight is always 20/20’. The perspective that comes with time. findings of social and natural scientists. They also look for litigation. but they are objective in the sense that they emerge from corroborative evidence that can be confirmed by others. William McAllister. in rare detail. der Geschmack und die Vernunft [Tastes of Paradise: A Social History of Spices. of the historical actors. anywhere in the world. Brandt wrote. gave Alan Brandt much of the material for The Cigarette Century (2007) [3]. What makes interwoven accounts possible is hindsight. but would minimally include the expanded production and export of cheap spirits. Because the change occurred gradually and arose from multiple independent causes. Why. ill-informed or otherwise. Addiction © 2012 Society for the Study of Addiction in origin. plans. in so far as legislators and judges had previously shown no interest in criminalizing drug use by elderly morphine addicts. It is now possible for an English-fluent graduate student in any discipline. did addiction become much more widespread during the 19th century. Historians look for patterns. but not a sufficient. ‘Efficiency’ seems an odd compliment to bestow on a 600-page book. the isolation and non-medical use of psychoactive alkaloids (morphine. price and mode of administration are crucial variables in the addiction process [13]. smoking cigarettes). historians have grasped that the accumulation of evidence from different sources after the fact will reveal processes beyond the control. knowledge of the history of addictive substances beyond all but the most sophisticated scholars of a generation ago. into a single. In good history. PROGRESS AND RECOGNITION Historical knowledge is thus cumulative. the one advantage that historians enjoy over deadline-pressed journalists and prediction-oriented scientists. and had been doing so for years [1]. of elite historical actors such as the Supreme Court justices [1]. such as those of indentured Indian and Chinese laborers. From Thucydides onwards. from laboratory reports to marketing studies. and convenient internet access. yet it affected policy. turning quotidian problems into ‘amphetamine-treatable medical conditions’ [2]. as well as correspondence between chagrined researchers. new means of consuming drugs (injecting narcotics. and sometimes corroborates. modernizing society and a history of drug use—a feat duplicated in Alan Baumler’s study of opium in the Chinese Republic and Robert Stephens’s account of the Hamburg counterculture. in a semester’s reading. which also arose from decisions. ‘Junkies’ were another matter. but Brandt distills thousands of scattered sources. Germans on Drugs [4. The Cigarette Century exemplifies three of narrative history’s cardinal virtues: efficiency. and Intoxicants] and Pierre-Arnaud Chouvy’s Les Territoires de l’Opium [Opium: Uncovering the Politics of the Poppy] [11. Intellectual property lawsuits over amphetamine gave Nicolas Rasmussen the opportunity to show. that exposure. showed the government estimates of 750 000–1 500 000 addicts to be impossibly high. making possible ambitious books such as Brandt’s or the international drug history and policy studies by Rudi Matthee. 107. ‘Rather than staring up at the Camel Man’. and global migrations. The emergence of English as a common academic language has facilitated access to the secondary literature. their research often applies. condition for the anti-maintenance policy.or working-class men whose use was non-medical © 2012 The Author. Prevalence had been declining. cocaine). the historian responds that there is nothing wrong with excellent vision.12]. namely. or even the knowledge.

But when was the last time you heard a scientist apologize for not being a historian? When was the last time you saw a © 2012 The Author. when the ATHG renamed itself the Alcohol and Drugs History Society (ADHS). simplistic? [23] Or. Historians. They have described the rise of addiction as a medical and scientific field [20. the great intellectual divide in the addiction field is between the reductivists and the nonreductivists. not only history PhDs—have also turned their attention to addiction research and treatment. generally don’t feel comfortable making scientific claims at all. . have since become active in ADHS. Like most social scientists. which raises another fundamental difference between historians and scientists: addiction as a pathological frame. will have little or no immediate use for the idiographic history that sociologists. Like research into consciousness. Courtwright Historians—I include all serious researchers who apply the methods and insights of the discipline. Addiction © 2012 Society for the Study of Addiction . where developments are occurring rapidly and issues of etiology and treatment remain tangled and complex. They have recorded. there are still some significant tensions. at best. There was a smaller but near-simultaneous revival of the historical study of narcotics and street drugs such as cannabis and cocaine. CPDD has also honored journalist Michael Massing and economist Peter Reuter. are monolingual in their modern language—and blissfully unaware that it. All this prize-giving is of little moment to bench scientists working in wet laboratories and imaging centers. they really don’t like it when historians try to make scientific ones. lucid surveys of basic science in the field [25]. Brandt and other academic historians. which was itself part of a larger wave of new social history in the late 1960s and 1970s. 486–492 TENSIONS Whatever common ground historians and addiction scientists have found. whose 2011 conference was expansively entitled ‘The Pub. Veteran researchers such as Michael Kuhar have simplified the task by providing. 107. the name of their international association makes no mention of addiction. are multi-lingual in the classical languages of addiction. and when we do we generally do so with a lot of apologies—disqualifiers of the ‘now.’ type. at least in my experience. The informal alliance between the two groups of researchers became formal in 2004. not something cobbled together from memory. One involves an unspoken double standard.488 David T. The College on Problems of Drug Dependence (CPDD) has returned the flattery in the form of media awards for Nancy Campbell. Specialists in licit psychoactive drugs. Historians. They have profiled such seminal figures as Marie Nyswander and Jerry Jaffe [18. I’m not a neuroscientist . historians study alcohol and other drugs in contexts other than those of addiction or disease. will gain credibility and insight by adding the new language of addiction neuroscience to the familiar languages of paradigms past. the organization grew from a renaissance of historical studies of alcohol. erroneous. will pass into the classics under the pressure of revision. Founded in 1979 as the Alcohol and Temperance History Group (ATHG). . Tellingly. who are interested mainly in the synchronic elaboration of the current paradigm. Attention from historians is. like imitation. for their part. in that addicts have long accounted for a disproportionate share Addiction. They have given us classic accounts of the origins of the concept of alcoholism [14. both of whose works are deeply informed by history. a sincere form of flattery. who are interested in the diachronic development of multiple scientific approaches. ADHS members are concerned with addiction. To avoid appearing foolish. transcribed and provided internet access to interviews with many of the field’s leading figures [22]. They have described the development of alcohol and drug treatment [16. scientist exhibit any awareness at all that the historical claims they were making were. crosses the line from irritation to unconscious disciplinary insult [24]. Such surveys are especially useful in addiction. historians should do their best to understand the latest dispensation.15]. which historian Joseph Gabriel described with unusual candor: Scientists often feel free to make historical claims—and in fact they often feel somewhat compelled to—but. The words ‘etiology’ and ‘treatment’ connote disease. pain or mental illness (broadly considered). in interdisciplinary conferences and journals. Those who are concerned only with nomothetic brain research. economists and other social scientists find valuable. ethnographers. At some point the number and casualness of historical misstatements in a purportedly scientific book. scientists need to understand that history is the fruit of disciplined research. yet the trend towards preserving and articulating the history of addiction science and treatment shows that there are at least some areas of common interest and potential collaboration between those in white coats and those in tweed. oral tradition and prefaces from old journal articles. such as historian David Herzberg [26]. laboratory researchers. The problem has a time-honored solution: hard work and accuracy.19]. such as receptor pharmacology in experimental animals. for our part. Historians. too. Even so. at worst. such as Solomon Snyder’s Brainstorming.17]. the Street. and the Medicine Cabinet’.21].

virtually any political or social subject can prompt an oppositional response. this paradigm currently dominates. Wayne Morgan. Imaging studies have shown that drug and behavioral addictions activate the same neural pathways. America’s punitive drug policy and high-profile addiction research programs have made for especially tempting targets. It seems irrelevant because it sheds no light on culturally specific phenomena. for that matter. OPPOSITIONAL SCHOLARSHIP The Cult of Pharmacology exemplifies what historiographers call ‘oppositional’ histories. seeking and use despite adverse consequences. Addiction. works that are highly critical of the status quo and that favor radical change. Addiction © 2012 Society for the Study of Addiction ignores that which cannot be illumined with positrons or studied in neurons. as well as on such critics as psychologist Bruce Alexander and physician-ethnobotanist Andrew Weil. relapsing brain disease with a social and genetic component. and a defining loss of control over drug craving. taxes and social costs. scientific work in the addiction field. In the NIDA paradigm all addiction is.e. However. Drawing selectively on history. long-term changes in brain structure and function visible in imaging studies. but they arise most often when the subject involves morally charged policy questions or claims about the biological determinants of behavior. compulsive users never made up more than a minority of all users. significant comorbidity with other mental and physical disorders. brothels and gambling parlors in the same teeming quarter. Then. historians such as David Musto. Although these works were accommodationist to a lesser or greater degree. Jill Jonnes. This is his term for the largely arbitrary. now routinely describe compulsive behaviors involving gambling. Timothy Hickman and Eric Schneider published new. the prestige of science to supply-side drug warriors bent on keeping everyone’s fragile brains out of the sizzling drug grease [27]. as they were once called. shopping and eating as ‘addictions’. The brain-disease paradigm appears to be an oldfashioned monistic pathology wearing the fashionable garb of neuroscience [30].28]. evidently by limiting these activities’ capacity to augment dopamine release. Researchers. Emanating from researchers at the National Institute on Drug Abuse (NIDA). and may one day unify. in absolute terms. Prostitutes and their customers drank liquor and snorted cocaine. DeGrandpre indicts the brain-disease model as a prop of ‘pharmacologicalism’. They lack the equivalent of a fellowship in addiction medicine. In a discipline in which left-liberal views are commonplace. Gamblers flocked to bars. Epidemiological and genetic studies have found that compulsive gamblers are more prone to alcohol and drug abuse. They also lack allegiance to ‘the NIDA paradigm’. Without addiction’s pathos and urgency. a stone’s throw from the pawnbrokers. Victorian reformers regarded vices as a ‘constellation’ of ruinous behaviors. Rufus King and Edward Brecher treated history as a sort of munitions dump where they might find the means of exploding prejudicial ideas and unjust policies [33–35]. sex. 486–492 . DeGrandpre has some angels and devils of his own. beginning in the 1970s. For much of the mid-20th century. 107. Alcohol and other drugs played multiple. talismans of faith—that had little to do with addiction. occasions of conviviality. The late Bob Schuster has wings. They occupy the left end of an ideological spectrum that runs from oppositional to ‘accommodationist’ (i. Historians have found much evidence that vices. historians are loath to concede the neural and genetic commonalities of these same behaviors. alcohol and drug history probably would not have coalesced into a specialty with its own organization and journal. It strikes them (and many other social scientists) as crudely reductive because it © 2012 The Author. Clinical studies have revealed that narcotic antagonists can reduce compulsive gambling and viewing of pornography. they provided empathic narratives based on primary sources. It seems threatening because it gains all the funding and media attention. Joseph Spillane. all of whom had graduate training in history. It seems intellectually reactionary because it evokes biological essentialism and naive positivism. Chinatown revelers found opium dens. were linked spatially and conceptually. inadvertently and despite the medicalizing intentions of its proponents. an acquired ‘malfunctioning of the brain’s reward center’ [27. common training. conservative) views [32]. mildly reformist) to ‘dominant’ (i. These claims are more than metaphorical. authors such as Alfred Lindesmith. assume neither a common interest in addiction nor. profits. ADHS members. However. in the words of psychiatrists Michael Bostwick and Jeffrey Bucci. often positive social roles—as markers of identity. whose meetings are conspicuously catholic affairs. Alan Leschner has horns [31]. all of which they sought to discourage or suppress [29]. Richard DeGrandpre marshals these grievances and more in his retelling of the story of ‘how America became the world’s most troubled drug culture’. and journalists who popularize their findings.e. conspicuously professional histories [36–41]. socially clueless and highly profitable division of the pharmacopeia into ‘angel’ drugs on which we spend billions for prescriptions and ‘devil’ drugs on which we spend billions for futile suppression. In The Cult of Pharmacology. shorthand for the scientific model of addiction as a chronic. Their authors.Addiction and history 489 of alcohol and drug consumption. Among former NIDA directors. It may even be politically reactionary because it lends.

which is made more difficult by their imposition of prohibition regimes [53]. when oppositional social scientists evoke history.490 David T. and Places. the enemy of my enemy is my friend. they most often cite the works of oppositional historians with whom they are simpatico. Neuroscientists will dismiss historians—in fact. Thus Tom Decorte writes that ‘captive samples’ in prisons and treatment programs blind authorities to the extent of controlled drug use. The chance to put that knowledge together represents. Historians do not. The danger is that the addiction field will become a grotesque caricature of C. That would be an irony as well as a shame. the more a historian doubts or qualifies the extent of past addiction and other drug-related harms. Addiction. Declaration of interests None. as books such as those of DeGrandpre [31] or Arthur Benavie [43] continued to roll off the presses. not improved. Broadly speaking. As in Middle Eastern politics. an ungrasped intellectual opportunity. for—this is the nub of my essay—both of their enterprises have flourished in the last four decades. however. Griffith Edwards’s Matters of Substance [10]. Unsurprisingly. 107. perhaps more for historians and social scientists than for bench-bound researchers. Acknowledgements The author thanks Nancy Campbell.50]. Times. a widely read hybrid of comparative policy analysis and history that used past experience of vice regulation to guardedly support such ‘heresies’ as cannabis depenalization [42]. We know more than ever about addictive processes that occur inside the brain. Virginia Berridge’s Opium and the People [44] and Alex Mold’s Heroin [45] are straightforward narratives. a dozen can color the perception of an entire field: guilt by association. 486–492 . Joseph Spillane and Nicolas Rasmussen for commenting on a preliminary draft. Recent drug-history literature in the United Kingdom follows a similar pattern. If it is natural for controversial subjects such as drug policy to produce oppositional scholarship. Here the stakes are particularly high. They condemn as counterproductive (and sometimes murderous) the 20th-century drug wars inflicted within and without China. who deny that China was ‘Patient Zero’ in a global drug plague [49. Lars Laamann and Zhou Xun. Shelby Miller. I worry that mutual distrust and incomprehension will end the tenuous cross-fertilization between scientists and historians concerned with addiction. measured in tone. We know more than ever about addictive processes. Anthropologist Phillipe Bourgois describes vividly the self-destructive behavior of homeless street addicts. Snow’s ‘two cultures’ [55]. all non-quantitative social scientists—as naive leftists and neurochemical Luddites. is more explicitly accommodationist. Although he concedes that Qing China had many underlying problems. (Social psychologist Robert MacCoun and economist Peter Reuter displayed similar circumspection in Drug War Heresies: Learning from Other Vices. but presents them as victims of social neglect and structural change whose lives are worsened. as all historians agree that the Chinese opium situation motivated international efforts to curtail the drug traffic in the late 19th and early 20th centuries. While we have not yet reached such an impasse. Claire Clark. The same is true of social scientists. if not quite harmless. that occur outside the brain. The compliment will be returned in renewed charges of scientific arrogance and indifference to the addictions’ real-world contexts. Opium was. argues that opium enabled Europeans to create a vast empire and to exploit Asian consumers and laborers. physicians and diplomats who sought to suppress the traffic. The same could not be said of Frank Dikötter. who uses words such as ‘plague’ or ‘bane’ to describe the drug’s impact in China and other Asian lands. his ‘damage narrative’ is consistent with that of the nationalists. multi-purpose drug used in social contexts other than compulsion and degradation—an interpretation consistent with work by Richard Newman [51] and Zheng Yangwen [52]. Gargi Bhattacharyya’s Traffick [46] and Toby Seddon’s Foucauldian A History of Drugs [47] are all frankly oppositional works. the more likely he or she is to criticize ‘prohibitionist’ regimes. The same spectrum runs throughout Chinese drug history. The value of history to policy analysts and addiction scientists—or even the likelihood that they will bother to read it—diminishes in proportion to their perception that it is politicized or dismissive of cutting-edge research. While a single polemic can be bracing. it is also natural for such scholarship to breed a measure of distrust and confusion.) The new accommodationist scholarship merely counterbalanced the older polemical tradition. missionaries. save that oppositional scholars in disciplines such as sociology or criminology argue typically that current drug problems are © 2012 The Author. then a popular. Addiction © 2012 Society for the Study of Addiction exaggerated and/or by-products of suppression. a medical and historical tour d’horizon with a coda of policy suggestions. agree on how serious the Chinese problem was or whether it warranted strong prohibitory medicine. by law enforcement [54]. P. Davenport-Hines’s The Pursuit of Oblivion [9]. Andrew Courtwright. past and present. Courtwright ground no axes. or none so conspicuous that readers might doubt their selection and handling of evidence. It did not replace it. Carl Trocki [48].

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