Drug Abuse … The American Disease

Host: Richard D. Heffner
Guest: David F. Musto
Title: “Drug Abuse: The American Disease”
VTR: 11/4/90

I’m Richard Heffner, your host on THE OPEN MIND, and my guest today is Dr. David F. Musto, Professor of Psychiatry and the History of Medicine at Yale University.

Now The American Disease is the title of Dr. Musto’s own history of narcotics control in the United States, published by Oxford University Press and characterized by one reviewer as “a rich and significant story, enlivened by the foibles, myopia and hysteria of several generations of Americans, including this one”.

And it is about those foibles, that hysteria, and particularly about the damaging myopia that characterizes Americans’ historic response to drugs that we ought to talk today. Indeed, looking back at a perceptively critical Los Angeles Times Op-Ed piece Dr. Musto wrote in 1987 contrasting Ronald Reagan’s earlier heady rhetorical thrust toward creating “a drug-free generation” with the later reality of the President’s actual drastic budget-slashing in his so-called “war on drugs”, my guest identified his major concern about Americans’ traditional approach to drugs as “our failure to recognize that the drug problem does not have a time-line of a few years. It is a long-term struggle that requires predictable, sustained effort”. Consistent, well-planned actions, he means, not just words, words, words.

But, to start with, I want to ask Dr. Musto why he refers to The American Disease?

Musto: Well, thank you for asking that question because I forgot to put it in the book. The American Disease is what the New York City Health Commissioner called teenage heroin use among male gangs in New York City in 1918.

Heffner: Hmmm….

Musto: And it stuck in my mind as a, as both to remind people that we’ve had this for a very long period of time, that New York, this is the second time that New York has gone through the great heroin problems that it has, and also that Americans have looked upon drug use in a very curious way. They have often looked upon it as an inordinate desire, by Americans, for drugs. So, they…so we have at times looked upon it as an American disease. But this way of looking at it has alternated with blaming foreign countries for our drug problem. So we…

Heffner: The suppliers.

Musto: The suppliers. Before…World War I is the great watershed in this…before World War I we believed in treaties and, in fact, we started the world anti-narcotic movement. We called the Shanghai Opium Commission, we wrote the Hague Opium Convention in 1912 and we believed that we had this strange desire for drugs, and other countries perhaps could help us by controlling their supplies. After World War I, of course, we didn’t involve ourselves with the League of Nations and so, and we saw other nations as endangering us, each continent sending in its own special drug to subvert American democracy. And at that time our official position was that our appetite for drugs was a normal one, just average, in fact healthy, perhaps, but if, if it were not for these other countries sending in the drugs. So we’ve looked at…the drug problem in America is also old, I mean even the international one and the cocaine problem is a hundred years old, ah, that we’ve really taken different positions at different times. And depending on when you grew up in the United States, you could think of this as a drug-using country, like if you grew up in the 1880s or the 1970s. Or if you grew up in the 1940s or maybe in the 2010s, I don’t know, you would think of our country as being a very abstemious one in which drug use is terribly frowned upon. So we’ve gone back and forth. But we don’t have any memory of these big switches in attitude because every time we firmly fix one of these attitudes, the previous one seems so ridiculous that it is really not even allowed into our textbooks.

Heffner: Now are you suggesting, as some people sitting at this table do, whether we’re talking about political change or economic change, that we’re talking about something that is simply cyclical?

Musto: Well, it’s cyclical, but I don’t believe it has to be…cyclical. I, I don’t like the idea that we are somehow bound to be pro-drug and then anti-drug, followed several generations later by the opposite point of view. I think that you can understand the cyclical nature of drug use in America in the way in which we, we react to a high level of drug use. The way we react to it is…let’s say the way we reacted to cocaine and heroin use in…around World War I. By the 1930s we came to rely on three, three mainstays of national strategy. One was increasing penalties. So that penalties gradually rose from say around 1915, when they were sort of ordinary tax evasion penalties, to 1956, when we had the Federal death penalty for anyone over 18 providing heroin to anyone under 18. So the penalties rose gradually throughout this whole period, as drug use fell. It’s quite interesting. As drug use falls, the penalties become greater and greater.

Heffner: Now, wait a minute…

Musto: Yeah.

Heffner: …there will be those who will make the connection in a different way…

Musto: Yes.

Heffner: …because the penalties rose, the drug use declined.

Musto: Well, yes, you could try that except that some of the penalties that we had enacted in say ’51 and ’56, that is the ten and twenty year mandatory minimum sentences and so on, really affected very few people. We had such a low level of drug use that if you go back and you see why those laws were put into place, they were to prevent a recurrence of a drug epidemic. Actually our drug problem had reached a very low level by the 1950s. Cocaine had been practically expunged from the United States. Having started out as legal in the 1880s and 1890s, it became the most feared of all drugs.

Heffner: Do I understand correctly that one of the things you fear…

Musto: Yes.

Heffner: …is when there is a decreasing emphasis upon drugs in our national life that, in fact, that signals that there will be an increasing use because we no longer educate against drugs?

Musto: Well, that’s one of the great problems. The other two elements besides increasing penalties in the 30s were silence and exaggeration. I mean you…It might sound hard to have both at the same time, but we did manage to have it. Silence came about because as drug use declined in the 1920s into the 1930s national leaders, like the Commissioner of Narcotics, Harry Anslinger and others felt that since kids weren’t using drugs much any more, and it wasn’t much available any more, it was unwise to tell them about drugs. If you told them about cocaine, which had been so popular in 1900 and so on, they might want to experiment. So silence became a policy. For example, one of my favorite examples is the Motion Picture Association of America in 1934 adopted a Production code which did not allow even the showing of narcotics in motion pictures, which lasted, with one exception, to 1959, in any major motion picture. And that…so you couldn’t even show let’s say, drug dealers being caught. You couldn’t have any drugs whatsoever. So silence was one, and the other was exaggeration. And as Mr. Anslinger explained it to me as I interviewed him in the early 1970s, the goal was to describe drugs in so repulsive and disgusting a manner that a child would not be tempted to try it once. So if you…the great goal was to have no discussion of drugs and let the whole problem fade away from American life. But if you had to discuss it and describe the drugs, you had to describe them in such a way that on one would try them once.

Heffner: Now, I’ll bet…

Musto: Yes.

Heffner: …that on a common sense level there are an awful lot of people who are watching us talk today, who would say, “Well, of course”.

Musto: Oh, absolutely. This to me is the most natural response…I call it the parental quandary. Because it’s what a parent would do if a teenager came up and said, “Should I try cocaine once?”, and the parent, first of all would hope that the child would never, ever bring it up, which is silence, and then there’s also the possibility of severe punishment. And finally, the parent may feel impelled to describe the dangers of marijuana or cocaine in such an extraordinary manner that the child won’t try it once. So I look at these responses as being absolutely natural and human, which is one reason which I think which contributes to the cyclical nature of this. This is not some invocation of a peculiar law that was passed or some, you know, natural cataclysm at one particular time, but rather…drug use comes in, it is described as being almost harmless, but wonderful in various other ways. When cocaine came in in the 1880s it was described as the first anti-depressant, a wonderful tonic, a harmless, non-addictive stimulant. Sound very familiar.

Heffner: Right.

Musto: Sounds like the 1970s, but that’s how it was being described in the 1880s. And it was…it became the official remedy of the American Hayfever Association, for example.

Heffner: Ah, but you k now, I’m puzzled. You say “it sounds like the 1970s”…

Musto: Yes.

Heffner: …and I was very much aware of what you said earlier and of what you write in The American Disease, that you feel that in the 70s there was a national approval…

Musto: Yes, I think…

Heffner: That is hard for me to accept having lived through them.

Musto: Yes, well…

Heffner: Why do you characterize it as approval?

Musto: I would say that there was a very broad tolerance of drugs in the 1970s. I…and that was my experience that increasingly, especially young people, felt that drugs had some value, that if they knew how to use them correctly, they would get what the drugs offered them, either energy or insight, whatever it happened to be. That it did offer something for them, and that they were relatively safe. And I saw this very widespread in the country, and if you look at the attitudes revealed, let’s say in the longitudinal studies, either the Gallup Poll or the University of Michigan studies and so on, you can see,…especially among young people, that the feeling that marijuana was harmless grew gradually and steadily up to about 1978 or ’79.

Heffner: And now?

Musto: And then…since…it’s been steadily down since 1979. And actually the regular use of marijuana by, say, high school seniors has been more than cut in half since 1979 or ’80.

Heffner: Then how do we explain our contemporary concern for the drug problem. Every other headline one reads…

Musto: Yes.

Heffner: …concerns…

Musto: Yes. Well, there’s a, there’s a very important shift that takes place between the beginning of a drug epidemic and the end of the drug epidemic.

Heffner: You think we’re at the end of one.

Musto: No, no, we’re in the decline phase. I have to be very careful, because when I say “decline” I’m talking about…I’m talking as a historian. I’m not talking about that it’s all going to be over next summer. I’m talking about something that we’re facing for 10 or 15 more years. And I’m …I have to be very careful because when I say we’re in the decline phase, which I do believe we are, of this epidemic. It’s really looking at it from a long perspective. It’s a very gradual decline. Well, what happens between the beginning of a drug epidemic and the, and the decline side of the drug epidemic is we shift from seeing the drugs as being an instrument or a technology of our…for our health or wisdom or whatever we want.

Heffner: Good feeling?

Musto: An instrument.

Heffner: Yes.

Musto: I mean you just use it. It’s there. It’s there to be used. And we move to where we see any drug use as damaging ourselves. I bother words, in the first part if you take drugs you can be more than you would be otherwise. And now we’re in a stage where increasingly people see any drug use as reducing your potential to be something. This is an enormous sea change I guess you would call it, an attitude which happens very silently and quietly, but people start taking a very different point of view toward drugs. Now, if you believe that any drug use is bad, and extremely dangerous, your attitude toward any drug use is very different from what it was in the 70s in which you saw only excessive drug use, or stupid drug use as being…as dangerous. So even though much drug use is declining in our country, nevertheless, we’re more excited about it because we have changed our view of what any drug use is.

Heffner: Drug use then has become equated in our own time with drug abuse.

Musto: Yes, that’s correct. Whereas abuse in the 70s would be someone who had a very bad trip, or they got hooked on something they weren’t careful about, or they took two drugs when they shouldn’t have ten them together. There was some practical error that was made…or it was an idiosyncrasy of the person who took the drugs.

Heffner: Now, probably because of my age…advanced…

Musto: Yes…yes, I know. (Laughter)

Heffner: …it does seem to me that any drug use is drug abuse. How does it seem to you?

Musto: Well, I’m not in favor of drug use, and I suppose this has something to do with…although I’m not as advanced, perhaps, as you…

Heffner: Let me say that.

Musto: Yes…yes…okay. (Laughter) That I also, why I grew up in the time in which there essentially was no drug use, and to me, the idea that not using drugs is to me a very natural attitude towards these things. And I feel that we’re in general moving back toward that. But the problem that is faced in this is the one that was faced in the parental quandary and the parents’ movement has this problem now. It’s a…it’s a very interesting American problem. That is, once you decide drug use is bad, and you don’t want anyone to use drugs, you’re faced with how do you persuade people not to use any drugs whatsoever? Are you forced into an exaggeration of the characteristics of drugs, or the likelihood of your getting into trouble with drugs? And what happened in the previous time, in the 30s, and the 40s, and the 50s is that when young people got involved with drugs in the 60s and early 70s their experience simply did not fit the exaggerated descriptions of the Federal government previously. So the Federal government lost its credibility. I remember that time very well, and it turns out if you took marijuana, you did not become an instant raving maniac. That one use of heroin did not, inevitably, addict somebody, and so on. These things which had become clichés, almost, in, in what anti-drug education there was not…were…just simply lost the credibility of the Federal government and of teachers and so on.

Heffner: Would you dismiss them as clichés, too, as “merely clichés”?

Musto: Well, they were intentionally described in this way to dissuade young people from using drugs. And so, in a sense, they were a natural response to, to a personal responsibility. If you were…the drugs are…or something…how would you want to describe a drug? And I think you’d be led…it would be very difficult not to describe them in the most negative possible way. And I think that it’s very understandable how that happens. And if you think of the alternative, that is to say, maintaining a balanced drug education in the United States which sort of weights the pros and cons…no, well let’s say the negative and not-so-negative aspects of drugs, this becomes an impossible policy in a time of extreme negative attitude toward drugs. What we need to have, and it’s hard to imagine what it would be, is a policy that could be sustained through these extremes of attitude. But since these extremes of attitude really are composed of thinking drugs are very valuable, and thinking drugs are poison, you don‘t sort of average them out.

Heffner: But you know, Dr. Musto, what puzzles me about that is when you say “a shift from thinking they’re valuable to thinking they’re dangerous…”

Musto: Yes.

Heffner: …weren’t you talking about two disparate, different groups in our society both of which maintain their separate attitudes, consistently throughout whatever period…

Musto: I…no…I don’t think so. I’m sure there are some people who continue to maintain that these various drugs are relatively harmless. But it’s a small…I think it’s a small group. I frequently ask people, when I go out to talk to them or when people come to talk to me…I ask them about their attitude toward drugs. And, I’m very impressed by how many people I meet, who were into drugs in the 70s and are very anti-drug now. In fact, I know an example of someone who was a well-known activist in the 60s and 70s who now has a personal nutritionist. I mean does no drugs whatsoever…it’s a matter of what is the most healthy thing possible. Actually we move toward…each of these anti-drug movements could also be described as a pro-health movement. There’s always been a strong health movement whenever there’s been an anti-drug movement. There’s also an anti-alcohol movement that accompanies these movements. We forget that they probably had cocaine prohibition and we also had alcohol prohibition at the same, at that same time. So we’re talking about something broader, I think, than just drugs. We’re thinking about changing our view of substances in the environment and what we take into our bodies. And we can either, you know, concentrate on say what’s an anti-alcohol movement or an anti-drug movement, but we could call it a pro-health movement just as well.

Heffner: Now, where does your sense, your knowledge of the history of the anti-drug…

Musto: Yes.

Heffner: …lead you when it is suggested that we make the penalties disappear and make drug-taking legitimate, legal?

Musto: Yes, well, to me this is the wrong…(laughter)…the timing for this is not…they’ve missed the timing for this. The ideal time to have moved for drug legalization was in the mid-seventies, and there was a move for drug legalization in the mid-seventies. As a matter of fact, many of the same people who are now arguing it again now, but from my analysis of it the country’s only becoming more anti-drug all the time and this is a trend which will continue on. And it’s extremely unlikely, in my view, I mean it’s almost unbelievable, that say five years from now the American public will say, “Well, we’ve changed our views on cocaine. We now think it’s quite a safe thing and five years ago we were very scared about it, but now we feel differently”. In my experience, looking over the history of attitudes toward drugs, that doesn’t happen. And a drug like cocaine gets, let’s say, 98% consensus in the public that it’s a dangerous substance and shouldn’t be tried once. There’s an interesting contrast with alcohol because alcohol has never gotten more than, I would say at the absolute maximum, 60% of Americans feeling that way about alcohol…maybe, maybe 52%. And so, with alcohol you have enough people persuaded of its danger to pass prohibitory laws, but not enough people against it in order to be successful in the prohibition, whereas with cocaine you have both the consensus and the laws.

Heffner: If you could pick you time…

Musto: Yes.

Heffner: …and that’s seldom given to us to do in life.

Musto: Yes.

Heffner: …but if you could pick your time, would you legalize drugs?

Musto: I don’t think that I would do that in the United States, especially in this, in the political climate and in the attitudes we now have toward drugs. You…if you wanted to sort of take a…the strangest scenario, I’ll put it this…of it, you would say that when we hit the low point of drugs, let’s say in 1940 or 1950, and cocaine had practically disappeared from the United States, and heroin was at, was at a very low, extremely low level, you might say from…on some basis, well that’s the time to legalize drugs. People are completely anti-drug. No one wants them. Why don’t we legalize them? But the political reality is that the reduction in demand for drugs is accompanied by this intense dislike and fear of drugs. That is what leads to the reduction in mass popular demand. So when you have come to see drugs as the most dangerous thing there is, and cocaine the most dangerous substance there is, at that same time to say, “I think we should now legalize it”, it’s a political impossibility. So I think we have to work within a concept of, of criminalization of drugs. One other point I would make is we had legal cocaine. We’re the only country that had absolutely available, legal cocaine in New York City and around the country in the 1880s and the 1890s, and it was also accompanied by many wonderful encomia about how great cocaine was. The result was that eventually, by about 1900, 1910, the American people demanded laws against cocaine. So we’ve actually had legal cocaine and the result was that people demanded laws against it. In fact in New York State the first major anti-cocaine law was the Al Smith anti-cocaine law of 1906, in which Al Smith, when he was just an Assemblyman, got though the first law controlling cocaine in New York State.

Heffner: Now, I want to ask you a question…

Musto: Yes.

Heffner: You talk…you said in answer to my…

Musto: Yes.

Heffner: …question…

Musto: Right.

Heffner: …”not in America”, you wouldn’t legalize drugs in America. What differentiates us from…

Musto: That’s a, that’s a difficult question to answer, and all I can say, I can try to explain why I said, why I said it…I don’t have a full answer…but I have studied the drugs and alcohol situation in other countries, and let’s take, just take alcohol as an example here. The most successful anti-alcohol campaign that I know of in any Western country was in the Netherlands between 1890 and 1930 when the per capita consumption went from 14 liters per person to 1. I mean, in other words, right during our time of Prohibition, they were more successful than our Prohibition, even the most…the greatest advocates of Prohibition would ever claim they were, and they never had Prohibition.

Heffner: Education.

Musto: It was education. It became linked…if you want to stop people from using drugs, or to use drugs, you have to link them to a sense of your own identity or some larger gesture on your part. And in the Netherlands not drinking became linked with the development of the union movement and the workers’ movement. I won’t, won’t take any time to go into it, but I just wanted to say that it became a, a…it was symbolic if you didn’t drink. It was very significant that you didn’t drink. And it came up from the people, from the Volksburg and other, other Dutch organizations, and they were tremendously successful.

Heffner: Why aren’t we capable of…

Musto: That, well that’s an interesting question. We seem, we go from seeing drugs as, and this is an exaggeration; but it’s more like this…we go from seeing something like cocaine as being the most wonderful tonic imaginable, absolutely safe, wonderful thing, can’t understand why anyone would ever be against it. And we have many quotes from people in the 70s to that effect…to seeing a substance like cocaine as the worst, the most evil, the most dangerous substance you can possibly take. And this only took 15 years to move from this. We, we somehow go from one extreme to the other. It is very difficult for us to maintain an ambivalence about a substance. We tend to moralize or make an ethical issue out of health questions. And so something that starts out as just a health issue eventually becomes a moral imperative against it. And why do we do it? I mean is it our Puritan heritage? What is there about America that causes us to move from seeing alcohol as a, as a harmless, maybe even a beverage aiding productivity to seeing it as a poison that on one should even have a drop of, and then to go back again to the other attitude again…say a lifetime later? It, it’s very hard to explain that. I think the best I can do is describe that it’s happened. But to explain to a deepest feelings and characteristics of the American people is beyond my capacity.

Heffner: Now, we have about a half minute left.

Musto: Yes.

Heffner: What do you prophesize will be the course of Americans’ attitudes and actions?

Musto: Oh, yes, well, I’m very concerned about it because as we, as the drugs decline and we become more anti-drug all the time, we tend to simplify the problem, rely excessively on law enforcement, undercut research and treatment because they’re not…don’t seem important anymore, and we tend to scapegoat other groups in society such as, as we did in…with cocaine around 1900 with Blacks. And I see us doing the same thing again with the inner city, and writing off the inner city and giving us a justification for not supporting the people there who are trying to re-claim their homes and their playgrounds, and so on. So, actually I see, although I believe that drug use is gradually going to decline, I also believe that it’s a very natural thing for us to scapegoat, symbolize, over-simplify the problem.

Heffner: Dr. David Musto, thank you so much for coming to THE OPEN MIND and talking about this extraordinarily important question. Thank you for joining me.

Musto: Thank you.

Heffner: And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, today’s subject, please write to THE OPEN MIND, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $2.00 in check or money order. Meanwhile, as an old friend used to say, “Good night and good luck”.

Continuing production of this series has generously been made possible by grants from: The Rosalind P. Walter Foundation; The M. Weiner Foundation of New Jersey; The Mediators and Richard and Gloria Manney; The Edythe and Dean Dowling Foundation; The New York Times Company Foundation; The Richard Lounsbery Foundation; and, from the corporate community, Mutual of America.

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