Mood modification through drugs—intoxication—is a standard cultural reality in American history, but possibly even more so today. Rather than hopelessly pursuing a drug-free country or world, a mature response demands that we ask: How can we successfully manage this reality?
As I discussed in Filter, the World Health Organization announced last year that the ideal amount of alcohol a human being should consume is… none. Somehow, I doubt that alcohol producers are panicking or anti-alcohol epidemiologists rejoicing in the wake of this pronouncement, which follows many similar ones. Americans will continue to drink and use other drugs, perhaps even more so.
After reviewing our much-maligned drug use of today, I’ll look back on how things used to be in America. Recognizing that far less has changed over the centuries than we might imagine is an important step toward arriving at sensible ways to reduce harms.
Contemporary trends in psychoactive substance use
Alcohol is a normal part of the lives of Americans: More than 86 percent of us have drunk in our adult lives, and 56 percent of us have done so within the past month—even if comparable rates in many European countries, for example, are higher.
Drinking rates are highest among well-off, educated Americans. Indeed, beverage alcohol is most often a high-end product, including prestige wines, local and imported small-batch spirits, and craft beers. When Elizabeth Warren appeared on Instagram Live in her run-up to seeking the presidency, she began by telling her audience, “I am going to get me a beer.”
It’s worth noting that Warren grew up in Oklahoma, after Utah our most Temperance-inclined state. Oklahoma got in on Prohibition early. Beverage alcohol was prohibited by the state’s constitution when OK was admitted to the union in 1907, beating national Prohibition by two decades. Following national repeal in 1933, Oklahoma okayed beer sales in1938. But it was only in 1958 that the state approved sales of bottled liquors, and not until 1984 that Oklahoma allowed sales of liquor by the drink.
Americans are accustomed to the idea of normal intoxication, even as they worry about it.
It seems safe to say that America is not poised to return to the kind of widespread prohibition and individual abstinence sought so ardently by some, and resisted with as much urgency by others, in the past.
Moving on, you may have heard that marijuana is commercially legal in 10 states, and legal for medical use in well over half the states. Meanwhile, a majority of Americans nationwide now support its legalization. It would be hypocritical if they didn’t: Most (52%) of us have used marijuana, and 44 percent of those who have tried it still use it.
Of course, just as there remains a substantial anti-alcohol movement in America, a backlash against marijuana has also formed. But just as drinking is in no danger of disappearing—or, in all likelihood, of diminishing—so too is legalized cannabis unlikely to be repealed where it already exists, and most likely will continue to expand. (Along with widespread public acceptance, of course, legal pot has become a multi-billion-dollar industry.)
So Americans are already accustomed to the idea of normal intoxication, and in many cases the experience of it, with alcohol and now marijuana, even as they worry about it.
Where do mood-modifying therapeutic drugs fit into this picture? Here is the trend line for antidepressants from 1999-2014:
Source: National Center for Health Statistics
Does this graphic suggest anything to you?
Then there are highly utilized drugs for other mental disorders: benzodiazepines (anti-anxiety drugs), antipsychotics and stimulants (used for ADHD and ADD)—all of which are used in large and growing quantities. Many—here Marcia Angell, former editor-in-chief of the New England Journal of Medicine, and here Zach Rhoads in a recent Filter interview with Johann Hari—ponder the co-occurrence of the modern epidemic of mental illness diagnoses and psychiatric drug proliferation.
And we still need to account, of course, for the use of opioids, consumed by many tens of millions of Americans—most of whom follow prescriptions and use the drugs safely, albeit with a small, high-risk minority who do not. Among the many data sources we might choose to illustrate this overall pattern of use, take this study of North Carolina’s prescription monitoring program: “Of 2,182,374 patients prescribed opioids, 478 overdose deaths were reported (0.022% per year).”
The limited but significant trend in destructive opioid-painkiller use, typically in dangerous combinations with other drugs, is the source of great, understandable alarm. But reducing prescriptions doesn’t reduce the death rate—or even halt its growth.
Before we move on from the landscape of modern drug use in America, I should mention rising stimulant use and cite the rapidly growing use of psychedelic drugs for therapeutic purposes—including psilocybin, ayahausca, ketamine et al. Meanwhile, many perfectly stable and responsible Americans—like best-selling author Michael Pollan, as he describes in How to Change Your Mind—are tripping in a search to expand their consciousness.
Plus ça change…
Does it seem as though an awful lot of people are currently using a wide variety of substances to modify their feelings and consciousness? Surely this has never been true in the United States before!
But of course it has.
I described Oklahoma as a cutting-edge state in banning alcohol. But it was only one part of a national Temperance movement that began in the 1830s.
A movement from what?
Our founding national documents were written by intoxicated men.
Colonial America was soaked in alcohol. Protestant sects observed sacramental wine in church; the tavern was the center of family and community gatherings; alcohol was served during sessions of state legislatures.
Consider that drinks were doled out at the signing of the Declaration of Independence and throughout the Constitutional Convention—our founding national documents were written by intoxicated men!
A picture of drinking in Colonial America was presented in the 2015 National Archives exhibit, Spirited Republic: Alcohol in American History. In an interview titled, “The time when Americans drank all day long,” Bruce Bustard, senior curator of the exhibit, commented:
Early Americans took a healthful dram for breakfast, whiskey was a typical lunchtime tipple, ale accompanied supper and the day ended with a nightcap. Continuous imbibing clearly built up a tolerance as most Americans in 1790 consumed an average 5.8 gallons of pure alcohol a year.
Did you know that the framers of the Constitution organized a farewell party for Washington before signing off on the document? We still have the bar tab. The 55 attendees drank 54 bottles of Madeira, 60 bottles of claret, eight of whiskey, 22 of porter, eight of hard cider, 12 of beer, and seven bowls of alcoholic punch. That’s more than two bottles of fruit of the vine, plus a number of shots and a lot of punch and beer, for every delegate. It works out to perhaps 16-20 standard drinks each.
That was some party! How is such drinking humanly possible, let alone how our most prominent citizens actually behaved?
Bustard explains, as best as possible:
We think of that as an astounding amount—you would think people would be staggering around drunk, but most people were able to handle their alcohol because it was integrated into daily life.
This was also a period when most people were working in the fields which presumably didn’t require much focus. And living in a tight knit community meant people could keep an eye on each other and intervene if somebody was thought to be overdoing it. Even so, modern Americans look quite abstemious by comparison, consuming only two gallons of pure alcohol per year.
In 1830, on the eve of Temperance, consumption peaked at seven gallons per person per year, three-and-a-half times as much as the average American drinks today.
Addiction is not inherent in the properties of drugs, but is instead bound up in the difficult social and economic circumstances of people’s lives.
So intoxication is built into American culture. Whoa, you might say. “But then America embarked on a century-long abstinence binge, culminating in national Prohibition and continuing today in our ever-present ambivalence towards alcohol and other drugs.”
But Americans didn’t reject intoxication; they simply shifted its source.
In his classic book, Dark Paradise: A History of Opiate Addiction in America, David Courtwright details how 19th-century America was awash in opioids.
Laudanum (tinctured opium) was sold in drug stores without prescription, hawked as a miracle cure on street corners, and given to teething babies. Morphine was widely introduced during the Civil War, and heroin was developed by the Bayer company by the end of the century.
Courtwright compellingly describes the prevalence of opioids in the 19th century, but the title of his book is misleading. Widespread addiction to opioids was not evident in America until (as he himself describes) heroin became a street drug, typically purveyed among disadvantaged populations, after the turn of the 20th century.
In other words, addiction is not inherent in the properties of the drugs themselves (as Carl Hart has shown in High Price), but is instead bound up in the difficult social and economic circumstances of people’s lives.
Only when marginalized social groups began using opioids in ways perceived to match the addictive patterns that many modern Americans view as irresistible—and in particular, when opium was smoked by Chinese immigrants—did opioid use incur the wrath of middle-class America, leading finally in the 20th century to strict legal control of these drugs.
This is our past, present and future reality.
As we have seen, Americans have historically spent a considerable amount of time under the influence of intoxicants. Current trends merely see us returning to, or continuing, a rather long tradition.
This is our past, present and future reality—even as we exude anxiety about it. Yet there are sensible and largely safe ways for a society to accommodate the human penchant for intoxication, which I will describe in a future Filter article.
Mt. Rushmore photo via Wikimedia Commons