Overview of Addiction in America

Just two years after the United States was formed, its first law to regulate a psychoactive drug—an excise tax on alcohol—was enacted; however, passage of this law appears to have been motivated primarily by the Federal government’s desire to establish its taxation authority over the territories west of the Appalachian Mountains. Protection of the public health and welfare, the stated rationale for governmental regulation of alcohol, probably was a secondary concern.

Despite this early law, both the use and sale of psychoactive substances (including such potent ones as narcotics) were unregulated throughout much of the country’s history. Eventually, however, health and social problems produced by substance abuse led to shifts in public opinion and resulting political changes that precipitated increased governmental regulation.

The rise of substance abuse in this country has been attributed to a variety of causes. One factor that has been implicated was the importation of large numbers of Chinese laborers into the United States during the 1850s, many of whom brought with them the practice of smoking opium. Smoking opium, even in small quantities, can be addictive, because doing so produces a pleasurable, dreamlike state that can last for hours. The practice quickly spread, and opium dens (public establishments where opium could be obtained and smoked) were established in cities on the West Coast such as San Francisco. These establishments functioned legally and were not subject to governmental regulation.

The use of opium and its more potent derivatives, morphine and heroin, was a major factor that eventually led to governmental regulation of drug use in the United States. Flowever, factors other than the smoking of opium by Chinese workers were more directly responsible for the abuse of opioids. For instance, in the 1800s, physicians, who by modern standards had a limited number of interventions to apply, often prescribed opium derivatives for their patients, particularly to treat ailments causing pain. Moreover, the introduction of the hypodermic syringe into the United States in 1856 made it possible for physicians to administer fast-acting dosages of morphine.

The Civil War created a great need for medical intervention, and morphine was used extensively to treat both pain and dysentery (diarrhea). As a consequence, following the war, many veterans were addicted to the very drugs that had been medically administered to them. To make matters worse, physicians used heroin (a newly discovered derivative of morphine) to treat morphine addictions. Originally, it was thought that heroin was not addicting, or at least much less addicting than morphine—a belief that later proved to be quite erroneous.

The factor that is probably most directly responsible for the sharp increase in substance abuse in this country was the widespread use of patent medicines during the late 1800s and early 1900s. These substances sometimes contained large quantities of potent drugs such as alcohol, morphine, and cocaine, as well as various toxins.

They were concocted by individuals or corporations who touted them as treatments for various physical or mental ailments and were available to anyone who had the asking price. In fact, patent medicines became quite popular, with sales increasing from $3.5 million in 1859 to $74 million in 1904. As a result, a sizable proportion of the population of the United States is believed to have been addicted to drugs by the turn of the century.

The problems resulting from the uncontrolled use of addicting substances prompted increasing governmental regulation. In 1906, the Pure Food and Drug Act was passed, which required that products containing addictive drugs such as alcohol, morphine, opium, cocaine, heroin, or marijuana to be clearly labeled. One aim of this law was to deter the false therapeutic claims of manufacturers of patent medicines. In 1914, the Harrison Narcotics Act was passed, which for the first time required dealers and dispensers of opiates and cocaine to register with the government and pay a small fee.

Physicians, dentists, and veterinary surgeons were designated as the lawful distributors of these substances. The Harrison Act made it more difficult for drug addicts to legally obtain the drugs to maintain their addiction. Hence, many historians believe that its net effect was to drive the distribution of drugs “underground,” with very serious consequences. Specifically, an illegal drug traffic arose that centered around organized crime.

Compared with other psychoactive drugs, alcohol has generally been more readily available and less regulated. This may be related to the fact that ordinary food substances, especially fruits and grains, can be used to produce alcohol through fermentation. The earliest attempts to regulate alcohol use in the United States were initiated by conservative religious groups.

Combining their religious ideologies with the theme of self-reliance, hard work, and striving for personal accomplishment (the pioneer ethic of the early United States), these groups at first encouraged people to moderate their intake of alcohol. However, when alcohol abuse became widespread and social problems associated with it mounted (especially among impoverished urban factory workers), both religious and secular elements of the society advocated total abstinence from alcohol. The temperance movement gained political momentum, leading eventually to legal prohibition of alcohol from American society.

In 1851, Maine was the first state to pass a law restricting the sale and use of alcohol. Other states followed suit, so that by 1917 64% of the population of the United States lived in “dry” areas. In 1920, the Eighteenth Amendment to the United States Constitution, which prohibited the sale and transportation of alcoholic beverages throughout the United States, became effective; however, the Prohibition Amendment did not eliminate alcohol problems from American society.

There were unforeseen difficulties with enforcing the law, and an illegal industry, run largely by organized crime, was developed to supply that segment of the society that chose to continue to drink. In fact, because of the widespread disregard for the law and the profitable involvement of organized crime in the sale of alcohol, the Eighteenth Amendment was eventually repealed by the Twenty-First Amendment, which became effective in 1933.

Since World War II, social and political trends have significantly affected patterns of substance use and abuse in this country. The end of the war brought a general feeling of optimism among the American public that was accompanied by a period of relative affluence. During this time, the use of opioids was at a low level, except among poor people living in urban areas. However, during the late 1960s and early 1970s, there were reactions against political and social conservatism, and a “counterculture” developed where psychoactive drugs such as cannabis (marijuana and its derivatives) and hallucinogens were widely used.

More recently, American society has again become relatively conservative, with a resulting reduction in the use of cannabis and hallucinogens. Concurrently, however, the use of cocaine and its derivatives has increased sharply, as has the number of people addicted to these drugs. Moreover, the production and consumption of alcoholic beverages has significantly increased. Alcohol remains the most widely abused drug in the United States. Surveys conducted in the 1980s indicate, in fact, that approximately 13% of the adult population of the country have experienced significant problems with alcohol at some time during their lives.

Patterns of substance use and governmental regulation of it are partly determined by the philosophy of drug addiction that prevails in a particular society. Some societies consider substance abuse a moral problem that should be controlled through criminal penalties. Other societies view addiction as a medical problem and the addict as someone in need of treatment or other rehabilitation. In the United States, both philosophies have been supported, although greater emphasis has been placed on criminalizing the use of psychoactive drugs than has been the case in certain other countries.

For example, in Great Britain, physicians can legally prescribe narcotics for heroin addicts, whose drug use might be maintained for many years, sometimes with minimal attempts to eliminate the addiction. Interestingly, both the rate of narcotic addiction and the social problems associated with it (e.g.. theft, organized crime, prostitution) are considerably lower in Great Britain than in the United States.

This observation has prompted some people in the United States to propose a method to regulate the use of opioids that is similar to the one used in Great Britain. Others contend, however, that such an approach would result in rampant drug abuse in the United States. Hence, a consensus about an optimal solution to the current drug abuse problems in the United States has not been reached.