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National Assembly: Drugs, Alcohol Abuse,
and the Criminal Offender
Tuesday, December 7, 1999

Drugs, Alcohol Abuse, and Crime:
A Historical Perspective on National Policies

David Musto, M.D., Professor
Child Psychiatry and History of Medicine
Yale University School of Medicine
New Haven, Connecticut

Summary of Proceedings

"Cocaine: a drug through which its stimulant properties can supply the place of food, make the coward brave, the silent eloquent, free the victims of alcohol and opium habits from their bondage and, as an antiseptic, render the sufferer insensitive to pain..."

—1885 booklet sent to physicians to
introduce cocaine

Providing a far-reaching historical perspective on national policies related to substance abuse, treatment, and drug-related crime in the United States, historian and professor Dr. David Musto of the Yale School of Medicine argued that perspectives on drugs have shifted radically throughout U.S. history, varying with prevailing cultural and political attitudes, and that insights into previous drug epidemics can inform current efforts to address drug abuse.

"The most important thing to know about our current drug epidemic is that it is not the first," said Musto, author of American Disease: Origins of Narcotic Control. From the early 1800s to the dawn of 2000, the United States has experienced several "epidemics" of alcohol and drug abuse with corresponding legislative attempts to control use through prohibition and punishment. Society's response to drug abuse can be viewed from one of two perspectives: either as an "anti-drug movement" or as a "health movement"—either as one "against drugs or alcohol" or as a search for "positive health."

"The broad outlines of earlier waves of drug use and its eventual decline are so like recent decades that it makes one wonder whether history truly repeats itself," Musto said.

In the 1830s and 1840s, a national anti-alcohol movement developed across the country, culminating in more than a dozen states prohibiting alcohol by 1850. These events, said Musto, set the stage for the18th amendment to the Constitution, which was ratified in 1920, and the national prohibition movement of the 1920s and early 1930s.

Musto described two major drug epidemics, the first beginning at the end of the 19th century. It began with cocaine, which became an "ideal tonic" in 1884 when Parke-Davis, along with other manufacturers, made the drug readily available. The result was widespread popular consumption. "You could get cocaine in 14 different easy-to-use forms, ranging from injection, sniffing, smoking, as a salve, or . . . in Coca Cola, which contained cocaine until 1900," Musto said. President William Howard Taft's message to Congress in 1910 described cocaine as "the most threatening of the drug habits that has ever appeared in this country."

The consumption of opium and its active ingredient, morphine, peaked in 1895, with an estimated 250,000 addicts. In 1898, heroin, a derivative of morphine, entered the commercial market as a cough suppressant marketed by the Bayer Company. At a time when vast numbers of people were dying from cough-related illnesses, it was very valuable to have a powerful cough medicine that would allow people to recover, Musto noted. By 1915, heroin had overtaken morphine as the leading cause of opiate-related admissions to New York City's Bellevue Hospital, prompting the city's health commissioner to call teenage heroin use "an American disease."

This first epidemic lasted four to five decades, during which there were many years of legal and easy access to drugs. The federal government made no attempt to control the flow because in the late 19th century, regulation of narcotics was regarded as beyond its jurisdiction. For example, licensing of physicians and pharmacists was rare at that time. What is more important, scholars of the time interpreted the Constitution's delineation of federal and state powers to prohibit the federal government from any regulation of the practice of medicine. It would have been "unthinkable," Musto noted, to pass any federal legislation mandating what drugs physicians and pharmacists could prescribe and dispense. The prevailing view was that only the states had such powers.

Did the eventual decline of drug use come from legislative mandates or "because Americans turned from drugs in disgust and fear?" The open market in drugs was stopped, Musto said, for both reasons: "You only have laws when the public turns against drugs." When the public has a favorable view or tolerance of drug use, there are few laws against narcotics.

By the 1920s, public sentiment in the United States was clearly against drug use and most anti-narcotic laws were in place, Musto observed. The U.S. Supreme Court's 1919 interpretation of the Harrison Narcotic Act of 1914, the first comprehensive federal anti-drug law, was an example of the legal changes reflected in public opinion. The Harrison Act prohibited the "maintenance of simple addiction" by pharmacists or physicians. The Supreme Court was "quite ingenious" in their decision to uphold this law while recognizing that the federal government had no right to control the "practice of medicine," Musto said. In a five to four decision, the court declared that the "maintenance of addiction was not the practice of medicine." Therefore, a prohibition of "addiction maintenance" could be sustained without infringing on the right of physicians to "practice medicine." This legal argument stood until the 1960s, providing the basis for future legislation.

Punitive legislation designed to address drug abuse in the first epidemic gave policymakers "an exaggerated view of the power of the laws," which were seen as the main reason drug use declined. But in fact, drug use decreased, laws were passed, and drug use continued to decrease, Musto noted.

This misunderstanding of the relationship between legislation and actual drug use was illustrated in the 1950s, when strong laws were enacted in response to a rise in heroin use. Mandatory minimum sentences were put in place in 1951. Minimum mandatory sentences were doubled in 1956. The death penalty was imposed for supplying heroin to anyone under 18. Thus, when the next wave of drug use began, the United States had on the books the most severe narcotics penalties in the nation's history and yet, a major drug epidemic still developed in the 1960s. Public opinion tended to reflect these facts, as the general public came to believe that laws do not seriously affect drug use, the opposite of the public's perception in the early part of the 20th century.

Musto also spoke about the public's perception of the relationship between drugs and crime as the second epidemic gathered momentum. From 1965 to 1980, the rise in property crimes often was attributed to increasing drug use. There were several proposals to legalize drugs or to develop heroin maintenance systems that would alleviate the need for addicts to steal. None of these was adopted, and by 1980 public opinion had shifted again as states and the federal government imposed stiffer drug penalties. Property crimes also began to decrease and have fallen steadily for 20 years, a decline that some have attributed to the new laws.

Musto emphasized "the symbolic power that drugs acquire in our society, so that it may be difficult to deal with drugs realistically." For the counterculture of the 1960s and 1970s, drug use represented rejection of traditional family/societal values, lifestyles, and politics, as well as membership in a special group. He noted that around 1970 it was commonplace for drug enthusiasts to claim that "the entire nature of society would be changed for the better by regular drug use." In contrast, one might adhere to a different symbolism, choosing to reject drugs because of a commitment to "health and wisdom," he said. Thus, drug rejection can define our identity as much as drug taking, and any campaign against drugs must operate at the symbolic as well as the scientific levels.

In the decline phase of the two drug epidemics in the United States, specific subpopulations have tended to be stereotyped inaccurately with the use of a specific drug. In the 1930s, for example, Chinese immigrants were linked to opium and Mexican immigrants were linked to marijuana. Similarly, the alcohol prohibition movement was aimed in part against Catholic and European immigrants. These unfair stereotypes tend to shift over time, Musto noted. In the early 1900s, heroin tended to be thought of as a "white" drug and cocaine as a "black" drug. By the 1970s, these stereotypes had been reversed.

The drug explosion of the 1960s appeared to be a unique event in part because of society's "collective loss of consciousness" regarding the lessons learned from past drug epidemics, Musto said. "Our loss of memory of the earlier epidemic contributed to the great similarity between the two waves of drug use, then and now. In each case, many of the same drugs entered a nadve and inexperienced American society that had little understanding of their actual short- or long-term effects."

To regain our "collective consciousness," we need to educate the public about the actual effects of drug use, and those efforts need to be sustained over time. Musto recalled a drive to educate the public about the evils of drug abuse throughout the 1920s, when 46 states adopted anti-narcotic education campaigns. However, by the 1930s, these efforts started to decline because many believed that "things had gotten so much better, so why bother students with this information."

Silence about drug abuse was the hallmark of the 1940s and 1950s and even was codified in the film industry's production code, which "didn't allow the depiction of narcotics in motion pictures," Musto said. This lack of education left us unprepared in the 1960s to respond appropriately to the increase in drug use.

"The effect of enforcing anti-drug laws has been to fill prisons with drug offenders, whether or not we are sending too many to prison who could be dealt with otherwise," Musto said. He noted a similar tendency in the decline phase of the first epidemic. "The decline phase of a drug epidemic is marked by good and bad characteristics: an aroused public turns against drugs and supports stronger law enforcement." Changed attitudes and legal restraints encourage drug use decline, he said. However, the country must provide comprehensive, ongoing education about the effects of drug abuse and guard against the real dangers of "scapegoating minorities, abandoning the drug user, and legislating excessive penalties."


Last Updated: March 4, 2002

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