history of drugs essay

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7.1 Drug Use in History

Learning objectives.

• Discuss the presence of drugs in ancient times.
• Summarize the use of drugs in the United States during the nineteenth century.
• Explain the racial basis for decisions to ban opium, cocaine, and marijuana in the United States.

Shakespeare once wrote that “what’s past is prologue.” This familiar phrase means that what happened in the past provides a context for, and can help to understand and predict, the future. To the extent that the past is prologue, the history of drug use provides a sobering lesson: Drug use has been common since ancient times and has been common in almost every society. As a recent book on drug policy states, “People have used chemicals to alter their state of mind since before there were written records” (Kleiman, Caulkins, & Hawken, 2011, p. xviii). If past is indeed prologue, then it is no surprise that drug use remains common in contemporary nations despite considerable efforts to reduce it.

One manifestation of the long history of drug use is that humans have used mind-altering plants since prehistoric times. “Early humans discovered that eating some plants gave a feeling of relaxation, happiness, drowsiness, or peace,” one scholar writes. “Some gave a feeling of increased energy, alertness, and stamina. And some caused strange sensations, terrifying visions, or a profoundly different awareness” (Gahlinger, 2004, p. 5).

Ancient Greeks drank poppy juice, which contained opium, around 300 BCE. Use of other drugs was also common in ancient times.

Tilemahos Efthimiadis – National Archaeological Museum, Athens, Greece – CC BY 2.0.

Examples of drug use thousands of years ago abound (Escohotado, 2010; Faupel, Horowitz, & Weaver, 2010; Goodman, Sherratt, & Lovejoy, 2007). Mead, an alcoholic drink made from fermented honey, was first used about 8000 BCE, and beer and berry wines were first used about 6000 BCE. The ancient Sumerians used opium starting about 5000 BCE. Ancient Egypt used alcohol in 3500 BCE, while ancient China used cannabis (the source of marijuana) around 3000 BCE. Ancient people in what is now Switzerland ate poppy seeds (the source of opium) in 2500 BCE. Coca leaves (the source of cocaine) have been chewed for thousands of years. Folk medicines made from plants and herbs have also been used since ancient times. People in ancient Palestine drank wine in 350 BCE. Ancient Greeks drank poppy juice in 300 BCE. In about the same period, South American tribes used a hallucinogen called cohoba , made from mimosa beans. The Chinese and other Asians were using opium regularly by 1000 CE. Native Americans used tobacco before being discovered by Columbus in 1492. The use of various drugs has also been common in the many societies that anthropologists have studied (Durant & Thakker, 2003; Page & Singer, 2010).

Sociologist Erich Goode (2008, p. 176) summarizes the history of drug use as follows: “Humans have been ingesting drugs for thousands of years. And throughout recorded time, significant numbers of nearly every society on earth have used one or more drugs to achieve certain desired physical or mental states. Drug use comes close to being a universal, both worldwide and throughout history.”

Drug Use in US History

This history of drug use includes the United States, where past is again prologue. During the colonial era, tobacco was a major crop in Virginia and other colonies thanks to slave labor. After being processed, it was commonly used by colonists and also exported to Europe in great quantities (Gately, 2001). From the earliest colonial days, alcohol was another drug used in great quantities, as “Americans were drinkers right from the start” (Genzlinger, 2011, p. C1). The Mayflower, the celebrated ship that brought the first Puritans to what eventually became the United States, was filled with barrels of beer. In colonial New England, rum manufacturing was a major industry, and rum drinking was common. During the early 1770s, New England had more than 140 rum distilleries, and rum consumption in the colonies averaged 7.5 million gallons annually. This massive drinking has led one author to call rum “the real spirit of 1776” (Williams, 2006). Rum was also a major export to Europe and elsewhere. In addition to rum, colonists routinely drank beer and hard cider.

During the nineteenth century, Americans began to use drugs other than alcohol in great quantities. One popular drug was coffee. Before the Civil War, Americans who drank coffee had to buy green (unroasted) coffee beans in bulk and roast their own coffee. Then in 1865, John Arbuckle, a Pittsburgh grocer, began selling roasted coffee inside a new invention—the paper bag. His bagged coffee was an instant hit across the nation, other coffee manufacturers followed suit, and coffee use by Americans greatly increased.

Alcohol also remained a very popular drug, and use of this drug during the 1800s was probably greater than during colonial America. Two reasons help account for this trend (Faupel et al., 2010). One reason was the western frontier. As the nation moved west, many of the explorers and settlers who led the way were men who were unmarried or, if married, men who had left their families behind. To put it mildly, they drank a lot, fought a lot, and gambled a lot. A second reason was that many Irish immigrants came to the United States during a great wave of immigration that began in the mid-nineteenth century. Although it might sound like a stereotype, the Irish drank a lot of alcohol back in their homeland, and they continued to do so once they reached the United States. Regardless of who was drinking, heavy alcohol use contributed greatly to poverty, to physical assaults and homicides, and to domestic violence and other family problems.

Three other popular drugs in this era were opium, cocaine, and marijuana. Use of these drugs was so common that nineteenth-century America has been called a “dope fiend’s paradise” (Brecher, 1973). A brief discussion of these drugs’ histories will underscore the widespread use of drugs in the American past and also racial issues that arose when laws were passed to ban these drugs (Musto, 1999).

During the decades before and after the Civil War, the use of opium was extremely common (Goode, 2012). Beyond making people feel good, opium is an effective painkiller and cough suppressant. Accordingly, it was a staple in many patent medicines, elixirs and tonics, sold back then in apothecaries, general stores, and other venues. Large numbers of people from all social backgrounds used these opium-laced medicines for problems such as depression, headaches, menstrual cramps, and toothaches. It is not much of an exaggeration to say that the United States was a nation of opium users during this period; an estimated 500,000 Americans were addicted to opium by the end of the century. As anthropologist Robert B. Edgerton (1976, pp. 57–58) summarizes the situation, “The use of opium was widespread in all segments of American society. Children were calmed with opium derivatives, women used many popular patent medicines which were liberally larded with opiates, and ‘opium dens’ were probably present in all cities and most towns as well.”

Opium was a common ingredient in nineteenth-century tonics and elixirs that were sold widely to the public.

camarelius – _DSC_5554 rot cr alt – CC BY-NC 2.0.

Attendance at opium dens (the equivalent of today’s bar or tavern, with opium the drug of choice rather than alcohol) was a popular activity for the Chinese immigrants who began coming to the United States during the 1850s to help build the nation’s railroads and perform other jobs. White workers feared their growing numbers as a threat to their jobs, and racial prejudice against the Chinese increased. Politicians, labor unions, and other parties began to focus on the Chinese habit of smoking opium at opium dens and warned that the Chinese were kidnapping little white children, taking them to the opium dens, and turning them into “opium fiends.” This campaign had two effects: it increased prejudice against the Chinese, and it increased public concern about opium. This rising concern led San Francisco in 1875 to become the first locality to ban opium dens. Other California cities did the same, and the state itself banned opium dens in 1881. Three decades later, the federal government banned the manufacture, sale, and use of opium (except for use with a physician’s prescription) when it passed the Harrison Narcotics Act in 1914.

Cocaine was another drug that was very popular in the nineteenth century, beginning in the 1880s, thanks in part to enthusiastic claims by Sigmund Freud and American physicians that cocaine could help relieve asthma, depression, hay fever, sexual impotence, toothache pain, and a host of other problems. Like opium, cocaine was a popular ingredient in the many patent medicines that people bought at various stores, and the US Army Surgeon-General advocated its medical use. It was a major ingredient in a new beverage introduced in 1886, Coca-Cola, which became an instant hit because people naturally felt so good when they drank Coke! During the next two decades, however, concern grew about cocaine’s effects. Some of this concern was fueled by the absurd belief that African Americans who used cocaine became extra strong, dangerous, and even invulnerable to bullets. Cocaine was heavily taxed by the 1914 Harrison Narcotics Act and later banned.

A third legal drug during the late nineteenth century was marijuana. It joined opium and cocaine in being a common ingredient in patent medicines, and it was a popular drug for problems like migraine headaches, menstrual cramps, and toothache pain. After the Mexican Revolution of 1910, Mexicans moved to the United States in increased numbers and brought with them their habit of marijuana use. Whites feared that Mexicans would take their jobs, and, similar to what happened with opium and Chinese immigrants during the 1870s, began to charge that Mexicans who used marijuana would become violent and more likely to rape and murder innocent white victims. This racially prejudiced claim increased concern about marijuana and helped lead to the federal Marijuana Tax Act of 1937 that banned its use.

This brief history shows that drug use has been part of the American culture ever since the nation began. If past is prologue, it should come as no surprise that drugs remain part of the American culture today, and it should also come as no surprise that efforts to reduce or eliminate drug use often meet with much resistance and little success. As the United States continues to try to deal with drug use, these basic facts must not be forgotten.

Key Takeaways

• Drug use has been common since ancient times.
• Alcohol was widely drunk in colonial America. During the latter nineteenth century, opium, marijuana, and cocaine were legal drugs that were also widely used.
• Racial prejudice played an important role in decisions during the late nineteenth century and early twentieth century to ban opium, marijuana, and cocaine.

For Your Review

• Were you surprised to read that mind-altering drug use has been common since ancient times? Why or why not?
• Were you surprised to read that racial prejudice helped lead to bans on opium, marijuana, and cocaine? Why or why not?

Brecher, E. M. (1973). Licit and illicit drugs . Boston, MA: Little, Brown.

Durant, R., & Thakker, J. (2003). Substance use and abuse: Cultural and historical perspectives . Thousand Oaks, CA: Sage Publications.

Edgerton, R. (1976). Deviance: A cross-cultural perspective . Menlo Park, CA: Cummings.

Escohotado, A. (2010). The general history of drugs (G. W. Robinette, Trans.). Valparasio, Chile: Graffiti Milante Press.

Faupel, C. E., Horowitz, A. M., & Weaver., G. S. (2010). The sociology of American drug use . New York, NY: Oxford University Press.

Gahlinger, P. (2004). Illegal drugs: A complete guide to their history, chemistry, use, and abuse . New York, NY: Penguin.

Gately, I. (2001). Tobacco: The story of how tobacco seduced the world . New York, NY: Grove Press.

Genzlinger, N. (2011, October 1). Bellying up to the time when America went dry. New York Times , p. C1.

Goode, E. (2008). Deviant behavior (8th ed.). Upper Saddle River, NJ: Prentice Hall.

Goode, E. (2012). Drugs in American society (8th ed.). New York, NY: McGraw-Hill.

Goodman, J., Sherratt, A., & Lovejoy, P. E. (Eds.). (2007). Consuming habits: Drugs in history and anthropology (2nd ed.). New York, NY: Routledge.

Kleiman, M. A. R., Caulkins, J. P., & Hawken, A. (2011). Drugs and drug policy: What everyone needs to know . New York, NY: Oxford University Press.

Musto, D. F. (1999). The American disease: Origins of narcotic control (3rd ed.). New York, NY: Oxford University Press.

Page, B., & Singer, M. (2010). Comprehending drug use: Ethnographic Research at the social margins . New Brunswick, NJ: Rutgers University Press.

Williams, I. (2006). Rum: a social and sociable history of the real spirit of 1776 . New York, NY: Nation Books.

Social Problems Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Introduction: A New Global History of Drugs

Paul Gootenberg is SUNY Distinguished Professor of History and Sociology at Stony Brook University. He is the author of Andean Cocaine: The Making of a Global Drug (2008) and co-editor of The Origins of Cocaine: Colonization and Failed Development in the Amazon Andes (2018). From 2011–14, he chaired the “Drugs, Security, and Democracy” (DSD) program of the Social Science Research Council and is 2021–23 President of the Alcohol and Drugs History Society (ADHS).

I thank my drug historian colleagues and comrades Haggai Ram, Miriam Kingsberg Kadia, and Isaac Campos for input on this Introduction, and Spencer Austin at Stony Brook and Nancy Toff at OUP for editorial assistance.

• Published: 18 March 2022
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This chapter reveals how a global “New Drug History” has evolved over the past three decades, along with its latest thematic trends and possible next directions. Scholars have long studied drugs, but only in the 1990s did serious archival and global study of what are now illicit drugs emerge, largely from the influence of the anthropology of drugs on history. A series of key interdisciplinary influences are now in play beyond anthropology, among them, commodity and consumption studies, sociology, medical history, cultural studies, and transnational history. Scholars connect drugs and their changing political or cultural status to larger contexts and epochal events such as wars, empires, capitalism, modernization, or globalizing processes. As the field expands in scope, it may shift deeper into non-Western perspectives, fluid historical definitions of drugs; environmental concerns; and research on cannabis and opiates sparked by their current transformations or crises.

Despite their widespread prohibition, illicit drugs such as opiates, cannabis, cocaine, amphetamines, and the myriad of psychedelics and synthetics are fundamental features of the modern world, with historical antecedents in virtually all human societies going back to prehistory. Today’s illicit global drug trade is among the world’s most lucrative revenue flows and affects tens of millions of consumers, abusers, or addicted users of mind-altering drugs across the planet. Even in early modern times, novel intoxicants such as tobacco sparked widespread controversy, but today drugs draw outsized attention in politics and culture because of the visible social and public health crises associated with their traffic and use (such as heroin overdoses and trafficking violence) and their globalizing threat to national boundaries. Illicit drugs also spark audible political debates about the failures or costs of twentieth-century United Nations-sanctioned global drug prohibitions, as well as mass culture industries that openly cater to popular fascination with forbidden drugs ( Weeds , Breaking Bad , and Narcos in the United States or the narco-novelas of Mexico and Colombia).

Despite the notoriety and ample interest in drug-related topics, most scholars, students, and the educated public have scant knowledge of the rich and deep history connecting human societies with drugs, or their global ubiquity. Ethnobotanists and anthropologists began researching mind drugs in the late nineteenth century, and by the 1960s the burgeoning “drug culture” let loose a long wave of journalistic, sociological, and medical writings about modern illicit drugs. Almost none of these publications were rooted in archival research or written by trained or professional historians. Amateur writers and journalists continue to dominate the always-vast marketplace of books about illicit drugs. Most of these writings are mythological, anecdotal, partisan, or retread versions of traditional sources, ideas, and legends about drugs.

However, starting in the 1990s, academic historians began to forge what is elsewhere termed the “new drug history.” 1 This was mainly an attempt to move the minuscule field beyond the domination of biomedical, legal, and journalistic perspectives. By the early twenty-first century, the drug history field had become largely professional, with new doctorates produced every year in the United States, Europe, and elsewhere. It is also highly global in scope and locale, with new drug historians actively working on the Americas writ large, Europe, Asia, and Africa. Drug historians have absorbed the sophisticated archival tools of the guild while adapting an array of innovative cross-disciplinary cultural and sociological methods. They converse with each other across borders in a number of thriving international professional associations, notably in the Alcohol and Drugs History Society (ADHS) and its expanding journal The Social History of Alcohol and Drugs ( SHAD ). 2 And many historians continue to productively study widely used licit stimulants and pleasures such as alcohol, tobacco, and caffeine, as well as the relationships of drugs to medical science and religious cultures.

Others are delving more systematically into the modern origins and elusive phenomena of criminalized drugs; their underworlds of users and dealers; their opaque social histories; their political, cultural, and environmental histories; and their legacies as banned pariah drugs. 3 Historians are commonly asking critical questions about how stimulants and inebriants began to connect the globe in the early modern age; how certain traditional and new drugs (and not others) became perceived as public menaces during the nineteenth century; how local and national medical regulations and treaty prohibitions developed on a world scale after 1909; and what roles race, gender, and class played in the construction of “addiction” or criminal user social types. 4 They investigate the place of colonialism and big-power politics in dispersing both drug use and drug restrictions, the consequences of a US-led global “war on drugs” that ramped up in the decades after the consolidation of the 1961 UN Single Convention on Narcotic Drugs; the rise of “harm reduction” and similar drug reform movements in Europe, Latin America, and at the state level in the United States; and recent conservative backlashes, like those in Russia and Africa against drug trafficking. Some of this research is deeply historical (e.g., studies of the centuries-old botanical or colonial origins of drug trades and cultures), while some speak in recent historical terms to growing global public concerns about drug and penal reform and regulating or normalizing our relationships with proscribed drugs (e.g., studies on the aftermaths of Cold-War drug politics and culture).

This Handbook is the first major attempt by historians of drugs to take stock of the progress and new directions of this field, on both a global and long-temporal scale. The thirty-five contributions prefaced here simultaneously survey what is known historically about drugs across the world, and how academic-trained historians are now approaching this still-fresh topic.

A Brief Historiography of Drugs in History

Drugs and their storied pasts have long fascinated people, but it was not really until the 1990s that (longer attention to alcohol aside) one can seriously speak of a “historiography” of drugs. 5 From the mid-nineteenth to early twentieth centuries, sundry botanists, medical men, anthropologists, pioneer psychopharmacologists, and enthusiasts penned histories and categorizations of narcotics and drugs. Some are classics, such as those by the mid-nineteenth-century “father” of ethnobotany Baron Ernst von Bibra ( Plant Intoxicants ), turn-of-the-century American surgeon W. Golden Mortimer ( History of Coca ), and Weimer-era pharmacologist Louis Lewin ( Phantastica ). 6 Educated amateurs still contributed tomes in the mid-twentieth century, such as banker-mycologist Gordon Wasson in search of the fabled ancient South Asian vision-drug Soma. 7 But the larger drug studies field was pioneered by anthropologists, their discipline long attuned to the roles of intoxicants, alcohol, and plant shamanism in small-scale societies. They were joined by ethnobotanists such as the Harvard drug explorer Richard Evans Schultes (a towering figure in the United States), as well as legal scholars, criminologists, and sociologists like Alfred Lindesmith and Howard S. Becker who challenged the punitive direction of evolving American drug policies. 8

The 1960s, and their aftermath of widespread entrenched recreational and illicit drug cultures, unleashed a torrent of writings on drug history. However, most of these were documentarian (including valuable reprints of drug classics) or synthetic in nature, depending on easily accessible published sources on drugs. 9 In the United States, most remained journalistic, sociological, legal, or medical in tone, not yet in sync with rising movements in academic history. Influential books in this genre (besides many serviceable collections of refurbished documents about “marihuana,” opiates, and cocaine) include Richard Bonnie and Charles Whitebread’s The Marihuana Conviction: A History of Marihuana Prohibition in the United States (1974), a legal scholars’ indictment of racial motives in the 1920s to ‘30s criminalization of pot. The prolific Lester Grinspoon, of Harvard Medical School, during the 1970s and beyond offered a slew of topical drug books (on cannabis, cocaine, amphetamines, psychedelics, and more) that deployed historical “background” on each drug to show shifting social attitudes toward their use and control. 10 Two such volumes with transformative impacts on the field were medical doctor David Musto’s The American Disease: Origins of Narcotic Control (1973), with serial republications that suggestively wove “America’s” long fascinations with drugs into the history of public health and racial panic; and Alfred McCoy’s The Politics of Heroin in Southeast Asia (1972), by a bona fide historian with a radical but alluring thesis that modern heroin trafficking was historically rooted in Cold-War US governmental complicity in Asian military conflicts, including Vietnam. McCoy’s work had its sights on accelerating global drug networks, yet most early work in the field was dominated by an Anglo-American historical axis, which likely affected its narrow choice of mostly institutional topics and methods. (A precocious exception was Franz Rosenthal’s deeply legal-textual 1971 study of hashish in medieval Sunni Muslim societies.) 11

The 1980s saw a number of professional historians digging deeper into archives to move beyond received narratives, joining and catching up with interdisciplinary movements like social history, oral history, and historical anthropology. It is intriguing to find that both David T. Courtwright and Virginia Berridge, of the United States and Britain respectively, published their deeply researched books on nineteenth- to early twentieth-century opiates in virtually the same years (1981–82), precursors to their later synthetic works influenced by the histories of medicine and global commodities. 12 Amid a heating up of the global war on drugs, diplomatic historians began revisiting the origins of global drug politics, for example, William Walker III for the United States and Latin America (1981), and later Anglo-America and China (1991), moving beyond the traditionally published apologetics of contemporaneous big-power diplomats and global elite participants in international drug diplomacy. 13 On the European scene, the Spanish philosopher Antonio Escohotado’s use of easily retrievable sources and mythologies for his encyclopedic Historia general de las drogas (1989) may make that work feel dilettantish today. But his was arguably the most widely read and republished book worldwide on drug history, given its attractive libertarian thesis normalizing drug use across time and cultures. Another European thinker, Wolfgang Schivelbush, who first published his provocative Tastes of Paradise: A Social History of Spices, Stimulants, and Intoxicants in 1980 (1992 in English), suggested a formative role for drugs (broadly conceived to include spices, coffee, tobacco, and alcohol) and institutions like the eighteenth-century coffeehouse and the nineteenth-century bar in the making of European cultural politics. 14

These kinds of influences, and particularly the blending of history and anthropology, came together in 1995 in what was probably the single-most transformative book for the academic history of drugs: Consuming Habits: Drugs in History and Anthropology (1995), edited by Jordan Goodman, Paul Lovejoy, and Andrew Sherratt. It is still well worth sampling the revisionist precis on the volume’s dustjacket:

The consumption of psychoactive substances is as ancient as human societies and characteristic of most cultures. The central purpose of this book is to establish that psychoactive substances are integral to the construction of cultures; that they are a rich analytical category for the study of historical and cultural processes; and that the labeling of these substances as “legal” or “illegal” has served only to divert attention away from understanding their cultural and historical role. 15

Coming on the heels of historical anthropologist Sidney Mintz’s groundbreaking 1985 volume Sweetness and Power: The Place of Sugar in Modern History, which introduced the hybrid study of “drug foods” (and in sync with anthropologist Arjun Appadurai’s 1986 volume The Social Life of Things ), the ten essays in Consuming Habits placed drug history squarely and dynamically in the rising global histories of consumption and culture. 16 Drug history had thus finally shed its mid-century amateur roots and caught up methodologically with the dynamic academic field of history. This history-anthropology synthesis has been the main driver of the expanding wave of drug history since the mid-1990s, though like most growing fields, it has now widely diversified its methodologies. By the 2000s, it went truly “global” from its initial Anglo-US-European base.

By the turn of the twenty-first century, dozens of scholars were seriously engaging archives about drugs across the world; drugs were no longer considered a “freakish” historical interest. An entire cottage industry arose, for example, of national histories of “addiction,” and the ways different polities and cultures personified and constructed the threat. 17 In 2001, Harvard University Press published the academic field’s first serious synthesis: Courtwright’s Forces of Habit: Drugs and the Making of the Modern World , a tour de force that brought facets of global commodity history, biomedical perspectives, and state-building processes together into one argumentative whole. Courtwright coined the term “Psychoactive Revolution” to describe the ways until then disparate world drug cultures (caffeine, tobacco, alcohol, opium, cannabis, coca-leaf, and so on) came together under European commerce and capitalism, some faster than others, to cross the globe and change human consciousness and habits. Likewise, a decade later Virginia Berridge’s Demons: Our Changing Attitudes to Alcohol, Tobacco, and Drugs (2013) emerged from across the pond to unpack the ways in which fundamental categories and representations of drugs, drink, and addiction have diverged and converged over time. 18 Gender politics, class, and distinctive public health traditions underlay the definitional shifts on dangerous “drugs” experienced distinctively in Britain and the United States since the nineteenth century.

Lest one think drug revisionism is too easily Eurocentric, Asian histories (and colonial histories generally) have also attracted innovating theses by major specialists in the field. For example, Frank Dikötter, Lars Laamann, and Zhou Xun’s Narcotic Culture: A History of Drugs in China (2004) rigorously challenged the old nationalist narrative (repeated every year with each new popular book on the “Opium War”) that China has been simply a victim civilization in the history of drugs, with no intricate drug history or agency of its own. Its thesis converged with Timothy Brook and Bob Wakabayashi’s Opium Regimes (2000) , which argued that rather than simply a destructive force, the imperial drug triangle between China, Japan, and the “West” contributed in various ways to the historical development of Asian states. 19 Closer studies of British colonialism and drugs, for example, by James Mills, suggested a more complex and active historical interplay between colonies like India and the metropole, beyond a one-sided imposition of either drugs or anti-drug ideologies and laws. Other studies, such as Miriam Kingsberg’s on modern Japan, decenter imperial drug regimes by showing the mutual entanglements and political wash-back of Japanese imperialism on Japanese drug culture and national identity. 20 By the 2010s, the number of solid monographs on drugs in China alone had skyrocketed, given the impulse and pace of Asian-based research. Latin American and Middle Eastern drug historians, more dispersed by modern nation-states, are not far behind, taking on with archival diligence traditionally dominant orientalized narratives as well as recent sensationalized representations of Third-World drug cultures and drug trafficking booms. 21

Drugs of Many Disciplines

As drug history has taken off and globalized its range since the 1990s, historians have implicitly or openly absorbed perspectives from a number of disciplines and traditions of drug studies. In “trespassing,” historians of drugs are no different from other contemporary historical currents that move from strictly archival or narrative pursuits to interdisciplinary methods (and running into the so-called history of the present). At the risk of overlap, a number of core influences are worth noting—to wit:

  Anthropology: As a discipline, anthropology has perhaps the longest-running association with drugs. Intoxicant and alcohol use exhibit extraordinary cultural, symbolic, and ritual roles and are central to many small-scale “shamanistic” societies throughout the world. Ethnobotany became an early recognized subset of the field, accumulating a wealth of knowledge about global human use of mind-altering plants. 22 The sister discipline of archaeology also lends a defined interest in drugs, including chemical analysis of alkaloidal traces in ancient sites, uniting the distant past to the ethnographic drug present. As anthropology moved toward history and “complex” societies after the 1970s, modern global “drug foods” became a burning concern. 23 Historians have absorbed both “relativism” from classical anthropology (societies treat intoxicants in fundamentally different and also changeable ways) and the varied recent fascinations with culture known as the “cultural turn.”

  Commodity studies: There are many varieties of commodity studies, and many of them are used by drug historians. Treating drugs neutrally as “goods” was one strategy of dealing with the moralistic or passionate views that drugs evoke. Drugs could be researched via solid business and corporate histories, especially those like cocaine that began as modern pharmaceutical wonders. The post-1980s “social life of things” school portrayed commodities and their meanings as culturally pliable and has been applied to the changing “biographies” of drugs and their subjective effects and legitimacies. 24 The field is also inundated with bestselling single commodity studies (of opium, coffee, cannabis, cocaine, etc.), typically built around a good’s long-hidden history of worldly connections. Another branch of commodity studies, derived from economic sociology, is “commodity chains” analysis (tracing and tying the pathways of goods from distant areas of supply to areas of consumption). This found its way, in varied shapes, into drug studies, as a means of normalizing their study as global “goods” that integrate peoples and distant geographies. Courtwright’s influential global drug synthesis, Forces of Habit (2001) , starts from global commodity history, positing that the historic timing or wave of a drug’s incorporation into commerce, starting in the sixteenth century, largely determined its later probabilities as a profitable and legal drug (coffee, tobacco), versus proscribed and illicit drugs (opium, cocaine).

  Consumption studies: Key new historical studies (again, stimulated by Mintz’s mid-1980s study of sucrose) underscore the vanguard role that stimulants and intoxicant trades (and related drug foods like sugar and rum) had in opening the early modern Atlantic economy and beyond, or their roles as new labor and ritually assimilated goods. Changing or constructed tastes and politics of goods became as crucial as understanding their material supply chains. Drugs became a facet of modernized consuming and leisure regimes. 25 All this was joined to the burgeoning field, spurred by 1990s-era cultural studies, of consumption cultures and the growing trend of food histories. Spices and stimulants play pivotal roles and are key issues here, instructive for drug history in how certain foods became culturally assimilated into world cuisines, while others were rejected. A recent concept pertaining to drugs is “ingestible goods” which stresses the tactile, emotive, sensory impacts of goods, like drugs, that enter and affect the body. 26 Courtwright in his latest big synthesis, The Age of Addiction (2019) , is now vying to grasp drug consumption as just a subset of what he terms “limbic capitalism”: the mass exploitation of a connected series of wired-in human habits (drugs, gambling, junk food, pornography, video games) by modern corporate business strategies. 27

  Sociology: Sociology has contributed to drug histories via social history (subcultures of drug users); the linkage to state-building (vice and drug taxation); criminology (critical perspectives on deviance or crime networks); and drug ethnography, which observes contemporary user or dealing populations, free of penal or policing lenses. However, the core contribution here is the concept of the “social constructivism” of the drug experience, dating to Howard S. Becker in the 1950s, sometimes known as “labeling theory.” It suggests that rather than one fixed or predictable “chemical” effect, or addictive effect, mind-altering drugs are “learned” or acquire defined effects through their social environments, often termed in related psychological research as “set and setting.” 28 Some pharmacologists second this idea of the plasticity of mind drugs, skeptical of their own scientific “Cult of Pharmacology.” A drug’s history is, arguably, the largest set and setting in its social learning curve, so historians are starting to seriously integrate such constructionist ideas (beyond common sloganistic usage)—as in Isaac Campos’s book, Home Grown (2012) , about the shifting historical relationships between conceptions of cannabis and its bodily and sensory effects in Mexican history. 29

  Medical history: Drug history mostly originated as a subfield of medical history, or medical authorities lending their professional authority about drugs. The boundaries between medicine and other types of drugs are highly fluid and doctors and pharmacists themselves were prime actors in drug history. Most mind-altering drugs were first historically read in the pharmacopeia lens; many “escaped” from initial medical usage (e.g., cocaine) or had long overlap with healing or analgesic drugs (e.g., opiates everywhere). For example, drug discovery and epidemiology are the central concerns in many works about the “Age of Tranquilizers” or the “Anti-Depressant Era.” 30 As the history of medicine transformed itself in recent decades to a more “externalist” or critical view of medical science—medicine as an interdisciplinary object rather than a method of study per se—the prestige of purely medical approaches to drugs has waned. This is revealed in the history of “addiction,” where the many historians who have studied malleable concepts of “inebriation” and “habit” question its medical foundations. The “medicalization” of drugs becomes itself a subject of historical-cultural critique, an echo of the inquisitional views of drug policy voiced decades past by renegade psychiatrist Thomas Szasz (1974) . 31 The relationship of drugs to changing cultural concepts of “health” and “body” is also a pressing concern. However, a call to balance medical knowledge and insight back into drug history is also gaining ground, most vocally through Courtwright himself, including recent developments in neuroscience and brain imaging. 32 This brings drugs back to the broader rise of science and technology studies (STS) as an interdisciplinary pole, particularly knowledge production about drugs and technologies of making and taking mind-altering drugs.

  Cultural studies: Cultural studies is a catch-all term for the wave of cultural, literary, and discourse-centered theory that has deeply impacted interpretive fields like history since the 1990s. Drugs are a particularly compelling topic in cultural studies, given the passionate and contested cultural meanings that drugs provoke. Literature and art are also primary sources for understanding the intrinsic subjectivities of drug experience. Many cultural studies of drugs are trenchant analyses of official, policing, or medical “discourses” around drugs, sometimes inspired by a Foucauldian genealogy method. 33 If cultural studies now appears ephemeral to historians, its enduring mark was to bring essential topics explicitly into drug history: modernity, gender, race, sexuality, emotion, and pleasure, among them. For example, racial stereotyping, gendered anxieties, and cultural discrimination are long tagged as a source of drug panics, addiction threats, and prohibitions (Chinese migrants and opium; Mexicans and cannabis in the United States). The approach of cultural studies offers striking narratives of how drugs “produce” racial stigma and categorization, for example, in the wake of the US crack boom of the 1980s–‘90s. 34

  Globalization and transnationalism: Drug history took off in the 1990s precisely when social scientists and historians were at the crux of lively debates about globalization: what it meant and how it compared to earlier global connections, empires, or world systems. Do new fluid transnational methods transcend traditional bordered national units, articulated by diplomatic ties? Historians know that drugs have long been battering rams of globalization, such as early modern tobacco, arguably the first global commodity besides precious metals. Colonial powers aggressively “bio-prospected” the global tropics. Modern legal concepts of “illicit” drugs were produced by vanguard global reform institutions (i.e., the 1912 Hague Conventions); drug smuggling, an evermore researchable topic, is an ambiguous challenge to the regulatory power of nation-states. 35 A string of studies looks at how modern empires both disseminated colonial drugs (the nineteenth-century opium-for-tea nexus in Asia long the exemplar, but also regulatory and fiscal colonial opium monopolies) and the seeds in imperial backlash of what were to become modern restrictions on drugs in the metropole. 36 Needless to say, a multitude of methods inspire “international” and “global” histories, each now shaping drug research. One cutting-edge concern, for example, is the global and local environmental impact of spreading drug crops. 37

In sum, drug history not only has its own historiography but is deeply enriched by borrowings from other disciplines. Drug history is intrinsically interdisciplinary. It is gaining ground because drugs themselves are a uniquely rich medium in which the “realities” of drug use (who uses, commercial networks) merge with “representations” (essential to the construction, effects, and politics of drugs). Drugs both are, and are not, like other goods. Perhaps the central question of drug history raised repeatedly by interdisciplinarity is how the boundaries and separated definitions of drugs themselves change in history and travel over geography: good drugs, bad drugs, pharmaceutical drugs, recreational drugs, soft drugs, hard drugs, ritual drugs, hedonist drugs, legal drugs, illegal drugs. Why are certain drugs embraced at certain times and places but fall into disrepute and rejection elsewhere? Are individual drugs—like single commodity studies—still worthwhile for study over the long term? Or are drugs best compared and conglomerated in their relationships to medicine; alcohol (still the world’s most pervasive intoxicant); legal alkaloid stimulants like coffee, tea, and chocolate (from which they also diverged); to other “vices” and capitalist goods and habits; or say today’s commercial “new age” nostrums or “energy drink” cocktails?

Drug history has survived a fertile “incubation” period and is quickly expanding in many new directions. The question is, do historians really need or prefer a separate field of research on drugs history? Or rather, do the richest historical insights originate precisely from the ways in which drugs are integral to the multiple concerns and contexts of contemporary historians, social scientists, policymakers, and cultural critics?

New Directions in Drug History

Putting together this Handbook presents a timely opportunity to assess the progress and direction of this historical field, and perhaps suggests a response to that last question raised about the ultimate desirability of a new “drug history.” This field captures a rich diversity of themes, found clustered in these three dozen new historical surveys.

Most historians of drugs place their major transformations into the larger contexts of epochal events, including, above all, wars and imperial expansion or collapse, or more broadly, the social processes of state-building, modernization, national identities, mobility, and within the diverse waves of historical globalization since the sixteenth century. 38 These historical and social contexts, not the intrinsic properties of the drugs themselves, drive changes or expansion in drug use and regimes. Indeed, more and more, drugs are also used as an analytical tool or historical agent for exploring larger social and political processes, such as the formation of commercial and labor capitalism or of modern legal, racial, and state-building regimes. Similarly, premodern drug historians comfortably situate drugs into larger civilizational frames, though now mostly shorn of essentialist mythologies.

Such ancient and prehistoric drugs are still fundamentally interpreted in the realm of religious experience, whether deciphered textually, symbolically, or archaeologically in material culture. Perhaps this is a given, as religion and spirituality usually govern the cycles or textures of human life in preindustrial societies. Ancient drugs filled substrates of cultural usage and display discernible paths of drug succession. This continuing research interest deepens understandings of the ritual, ecstatic, emotional, or sensory dimensions of drugs, though early discernible power and social differentials are coming into analysis, for example, the differential roles of drugs in hierarchical or territorialized state systems versus egalitarian or mobile shamanistic societies. 39

What constitutes “drugs” remains a fluid and contested issue through virtually every period and place of known history, but is now related to changing (or distinctive) ideals of health, the body, medicine, religious ideals, and diversifying consumption or ingestion practices. On the ground, intermediaries such as pharmacists, botanists, shamans, or merchants, some of them subaltern or distant actors, appear essential in shifting the definitions and directions of drug trades. As elaborated below, this metamorphic definition of drugs—where history itself defines the various uses and kinds of drugs—continues to evolve.

Many histories (especially those set in South Asia and the Middle East) deliberately eschew the “Orientalism” and related European or colonial drug (and sometimes even anti-imperial) mythology that has long obscured their fields. Similarly, there is a growing ambivalence toward the romantic or “new age” celebration of ritual hallucinogenic use, notably in the Americas, with its structuralist lineage in shamanistic studies from anthropology. Hybrid culturally mixed, fluid meanings of modern drugs are quickly becoming a norm, rather than essentialized or static conceptions of their cultural place or impacts. If drugs are malleable in culture and politics, the same drug and its meanings may have likely changed a good deal through its history.

In terms of modern illicit drugs, criminological common sense—depicting traffickers as simply criminal actors, or users as uniformly deviants or passive victims—is fast fading. Whether viewed as addicts or casual consumers, drug users merit compassionate, nuanced, humane treatment by scholars. In many accounts they are emerging as “victims” of cruel or oppressive legal or carceral systems. While that change in tone represents a positive development, such labels must be applied to drug users with care so as not to condescendingly wipe away their human agency or the diversity of their experiences. The studies of those who deal drugs are likewise rife with new complications. Comparisons abound with legal consumer indulgence in intoxicants and stimulants or corporate drug marketers such as big tobacco or pharmaceutical firms. Historical trafficking networks and flows, now the subject of improving social-science analyses, appear anything but the monolithic and vertically organized “cartels” or set “connections” depicted by the media, journalistic writers, or international policing authorities. 40 Instead, they are generally reactive, flowing, dispersed, and highly adaptive to the global structures of drug prohibition, as well as to the local conditions of national politics.

Consumption phenomena remain pivotal for interpreting the drug experience; drug markets; the transformations of drug use forms; and their relationships to social, cultural, and political life. Modern recreational, exploratory, individualized, compulsive, or commodified drug consumption is still sharply differentiated from ancient or deeply socialized drug consumption. And the historical rise of world stimulant or intoxicant trades during and after early modern European commercial expansion, the crucible era of modern consumption practices, is read as a key precursor or foundation to later drug consumption, and drug conceptions, whether legal or not.

Historians today, after decades of engaging global perspectives, rarely make a zero-sum choice between nationally bounded studies of drugs (in national political cases like Germany, Japan, or Turkey) and far-flung transnational connective methods. In the modern nation-state era from the nineteenth century on, historians subtly pursue how national identity-making, political culture, and institution-building intersects with drug flows and cultural influx. Nor did seemingly imperious global forces (such as twentieth-century League of Nations or United Nations drug restrictive regimes) homogenize every nation-state’s or locale’s experience with drugs. Other historians fruitfully incorporate larger, interpenetrating, and shifting drug contexts, such as the global impacts of epochal events like European expansion, religious conflicts, the Cold War, cultural-civilizational perspectives, or drug flows that messily crisscross changing national spaces and boundaries.

Contemporary political debates about drugs indirectly impact and inform historians’ questions and thinking about drugs. These include the international critique of prohibition regimes and drug wars, burgeoning European- (and now Latin American-) style “harm reduction” and other drug reform movements, and controversies about the “carceral state” and racial incarceration crisis in the United States and beyond. Race is both a given in drug research but also subject to critical empirical research. In contrast to a previous era’s medicalization of drugs, drugs as an obvious public health problem, engaged perspectives appear skeptical about dangerous and medicalized drugs as given categories of analysis. Many historians are searching again for “evidence-based” historical instances or sites of harm reduction, or relative tolerance or safer social integration of drug consumption.

Most historians drawn to study drugs appear keenly interested in developing “drugs in history” in a broader sense, including so-called histories of the present. A separately defined field of “drug history” (including an artificial separation from alcohol or tobacco histories) may have helped to jump-start the field in the 1990s, but it is no longer the necessary or optimal way of understanding the illicit.

Historians typically beg off predicting future trends, as deciphering the past is challenge enough. However, from this perch, the decade of the 2020s certainly appears to be a tipping point toward a genuinely global drug history, as the number and kinds of historical studies multiply across the world. One may glimpse nascent trends of global drug history, distinctive from those just discussed that consolidated since its 1990s definition as an academic field.

First, we may expect an intensified globalism of drugs as scholarship pours in from and about Asia, Africa, and Latin America. These may change or even “decolonize” the dominant narratives that portray drug change, for example, as a byproduct of Western drug imperialism or later Anglo-American anti-drug political campaigns. Areas once thought bereft of strong drug history, such as Africa, may soon find pivotal roles, or regions like Latin America, once thought passive to US drug policies, look proactive instead. 41 Global regions of study themselves may be redefined by drug commerce or cultures, such as an interactive pan-Mediterranean basin, or Indian Ocean or Red Sea smuggling routes. Some of this new history (e.g., from China) may chafe at the consensus pointing to non-prohibitionist drug reform in the West.

Second, also continuing a trend, “drugs” seem to be evermore a concept in flux, an idea constantly traversing between medicine, culture, and law. In a step away from pathologized chemical addiction, a broader place for social pleasure and sensory intoxication is also redefining drugs. Many emerging studies point to the metamorphic qualities and experiential meanings of drugs—from the sixteenth-century slew of merchant “discoveries” of new drugs that coined the continuing term to the multiplicities of meanings around rapid twentieth-century laboratory discoveries. 42 And drugs themselves help to constitute new legal regimes rather than simply acquiring their status from laws. Therefore, “What are drugs?” will remain the field’s complexly protean central puzzle.

Third, the current wave of drug decriminalization in the Americas and Western Europe, albeit mostly about cannabis reform, will prompt new research questions and concerns. Cannabis, paradoxically, is the least studied of major world drugs, perhaps due to its recent “soft drug” or “stoner” status. 43 But nothing illustrates more dramatically than cannabis itself the rapid changeability of drug definitional status. In a few generations, “pot” went from a 1950s marker of deviant or dangerous outsider status, to a celebrated vehicle of 1960s middle-class rebellion and recreation, to a post-1990s medical panacea (including now non-intoxicant CBDs), to today’s massive commercial bonanza and social experiment in commercial or regulated consumption—changes experienced, to varying degrees, on a global stage. But reformers will want to know more about prior waves of medicalized cannabis (for example, of the late nineteenth century) and how its effects on consciousness and racial colorings were acquired and transformed over time and across borders. In many US states and localities, social justice concerns, including legal restitutions, are inscribed into liberalization campaigns, which require expert historical knowledge of users, drug markets, and prosecutorial regimes. Other places, for example Jamaica, will need to define what is “traditional” or religiously protected use.

In contrast to cannabis, opiates (heroin and pharmaceutical opioids like OxyContin and fentanyl) are the other and truly destructive drug “epidemic” since the early 2000s. This social crises is driving literally tens of thousands of overdose deaths annually is prompting a thorough rethinking of and new research into the opiate past and its failed litany of punitive, medical, overdose, and “treatment” regimes. 44 We are moving beyond traditional “opium wars” narratives that colored the historical imaginary of opiates. The changing interplay of ancient plant-based drugs and technological and market innovations is essential to this story. At the same time, the distance between “hard” and “soft” drugs seems further than ever, though with a new social twist. In the United States especially, the discernible shift from repressive and racial discourses about hard or addictive drugs (typical of the violence-prone 1980–‘90s “crack age”) is giving way to growing public concerns with the socially marginalized, often rural (i.e., white) drug user as the passive “victim” of social blight and predatory pharmaceutical corporations. This paradoxical shift is a precursor, perhaps, to deeper historical thinking about opiate drugs, enveloped in racial thought since the era of the migrant opium den and modern urban criminal addict. As David Herzberg argues, the opiate crisis can be historicized as the outcome of a century-long US divide between regulated “white” market drugs and illicit “black” market drugs, in which the shading also signals a deep racial divide. 45

As drug plants and drug wars spread into fragile global ecosystems, such as the western Amazon-Andes or the forests of northern California, a mounting concern is the environmental histories and impacts of alkaloidal and other particularly tropical drug plants. 46 Since the early modern Columbian exchange, caffeinated beverages and drugs-foods like coffee and tea, sugar, and tobacco deeply shaped and stressed natural environments (and massive labor systems including transatlantic slavery and coolie migration) across the planet’s tropical belt. The relationship of drugs-environmental transformation may date to the Neolithic transition, where research suggests the move to grain cultivation in the ancient Near East was, perhaps, for its fermenting festive possibilities. Historians moving from an anthropomorphic to an Anthropocene perspective (the revolutionary current epoch where humans shape planetary history) are already undertaking new research, including the impacts of peasant drug migrations, industrial drug processing, and modern chemical drug warfare on deforestation, biodiversity, and the socially marginalized growers of drugs. But this direction can also encompass our increasingly intrusive “built environments”: the networks and structures, say, of global port cities that adapted to connect legal or illicit drugs, the material cultures of drug production, or the complex social ecology of segmented urban drug markets and users in the twentieth century.

Finally, the researched history of the “global sixties” is finally coming into its own—as opposed to its anecdotal, partisan, or broadly remembered pasts. Historians will ask in new and rigorous ways how or if the 1960s (and 1970s–‘80s, when illicit consumption trends greatly ratcheted up in many parts of the globe) represented the cultural pivot point in modern drug history often imagined. How did rising consumption and trafficking—always so difficult to research—relate to the high modernist project of drug control, then only recently achieved on a world regime scale with the prohibitionist 1961 UN Single Convention on Narcotic Drugs? Did new radically mind-altering drugs like LSD or synthetic mescaline truly transform the culture? How was this rupture or wave felt in faraway places like “Psychedelic Chile”? 47

Whatever actually arises ahead in this expansive field, these are exciting times for scholars and readers alike of the “new drug history.”

  1.   Paul Gootenberg and Isaac Campos , “Towards a New Drug History of the Americas,” Hispanic American Historical Review 95, no. 1 (2015): 1–35 .

SHAD gradually grew in the 2000s before its recent (2019) adoption by the intellectual gold standard University of Chicago Press, a sure sign of the field’s professionalization and expanding scope.

Over 300 different drugs are banned in the current UN drug conventions, many of them “designer” synthetics covered since the 1980s.

4. Addiction remains a highly contested concept in drug history (hence the quotes): Is it primarily biological or pharmacological fact, or significantly shaped by social, political, and cultural factors, and by ever-changing historical or normative definitions of “habits,” health, and inebriation? See, for one example, Nancy D. Campbell , Discovering Addiction: The Science and Politics of Substance Abuse Research (Ann Arbor: University of Michigan Press, 2007) .

5. A huge caveat here: the growing analytical separation by the 1990s of the study of “drugs” from historical alcohol (already an established topic among social historians and anthropologists) could be another pivot in tracing the emergence of new drug history. But I’ve opted to stress, for economy of space, the 1990s convergence of disciplines instead. A different and thornier question is whether such a drugs-alcohol separation is intellectually or policy defensible or sustainable over the long term. For overarching and shifting alcohol-tobacco-drugs relationships, see Virginia Berridge , Demons: Our Changing Attitudes to Alcohol, Tobacco, and Drugs (Oxford: Oxford University Press, 2013) ; or provocatively, David T. Courtwright , “Mr. ATOD’s Wild Ride: What Do Alcohol, Tobacco, and other Drugs Have in Common?,” Social History of Alcohol and Drugs 20 (2005): 105–40 .

6. See, e.g., W. Golden Mortimer , History of Coca: “The Divine Plant” of the Incas (1901; repr., San Francisco: Fitz Hugh Ludlow Memorial Library, 1974) ; Ernst von Bibra , Plant Intoxicants (1855; repr., Rochester, VT: Healing Arts Press, 1995) ; Louis Lewin , Phantastica: Narcotic and Stimulating Drugs (1923; repr., Rochester, VT: Park St. Press, 1998) .

7.   Gordon Wasson , Soma: Divine Mushroom of Immortality (New York: Harcourt, Brace Jovanovich, 1972) .

8.   Richard Evans Schultes and Albert Hofmann , Plants of the Gods: Their Sacred, Healing and Hallucinogenic Powers (1979; repr., Rochester, VT: Healing Arts Press, 1992) ; Alfred Lindesmith , The Addict and the Law (Bloomington: Indiana University Press, 1965) ; Howard S. Becker , “Becoming a Marijuana User,” in Outsiders: Studies in the Sociology of Deviance, 41–58 (1953; repr., New York: The Free Press, 1963) .

9.   H. Wayne Morgan , Yesterdays’ Addicts: American Society and Drug Abuse, 1865–1920 (Tulsa: University of Oklahoma Press, 1974) ; David C. Andrews and David Solomon , comps., The Coca Leaf and Cocaine Papers (New York: Harcourt, Brace and Jovanovich, 1975) .

10.   Richard J. Bonnie and Charles H. Whitebread , The Marihuana Conviction: A History of Marihuana Prohibition in the United States (Charlottesville: University of Virginia Press, 1974) ; Lester Grinspoon and James B. Bakalar , Cocaine: A Drug and Its Social Evolution (New York: Basic Books, 1976) .

11.   David Musto , The American Disease: Origins of Narcotic Control , 3rd ed. (New Haven, CT: Yale University Press, 1987) ; Alfred McCoy , The Politics of Heroin: CIA Complicity in the Global Drugs Trade (1972; repr., Chicago: Lawrence Hill Books, 2003) ; Franz Rosenthal , The Herb: Hashish versus Medieval Muslim Society (Leiden: E. J. Brill, 1971) .

12.   David T. Courtwright , Dark Paradise: Opiate Addiction in America before 1940 (Cambridge, MA: Harvard University Press, 1982) ; Virginia Berridge and Griffith Edwards , Opium and the People: Opiate Use in Nineteenth-Century England (London: Yale University Press, 1981) ; David T. Courtwright , Herman Joseph , and Don Des Jarlais , Addicts Who Survived: An Oral History of Narcotic Use in America, 1923–1965 (Knoxville: University of Tennessee Press, 1989) ; Terry M. Parssinen , Secret Passions, Secret Remedies: Narcotic Drugs in British Society, 1820–1930 (Philadelphia: Institute for the Study of Human Issues, 1983) .

13.   William Walker , Drug Control in the Americas (Albuquerque: University of New Mexico Press, 1981); Opium and Foreign Policy: The Anglo-American Search for Order in Asia, 1912–1954 (Chapel Hill: University of North Carolina Press, 1991) .

14.   Antonio Escohotado , Historia general de las drogas , 3 vols. (Madrid: Alianza Editorial, 1989) ; Wolfgang Schivelbush , Tastes of Paradise: A Social History of Spices, Stimulants, and Intoxicants (1980; repr., New York: Vintage Books, 1993) .

15.   Jordan Goodman , Paul Lovejoy , and Andrew Sherratt , eds., Consuming Habits: Drugs in History and Anthropology (London: Routledge, 1995) .

16.   Sidney W. Mintz , Sweetness and Power: The Place of Sugar in Modern History (New York: Viking Press, 1985) ; Arjun Appadurai , ed. The Social Life of Things: Commodities in Cultural Perspective (Cambridge: Cambridge University Press, 1986) . The anthropological trend was less pronounced in the same year’s other (more mainstream medical history inspired) drug collection: Roy Porter and M. Teich , eds., Drugs and Narcotics in History (Cambridge: Cambridge University Press, 1995) .

17.   Campbell, Discovering Addiction ; Caroline Jean Acker , Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control (Baltimore: Johns Hopkins University Press, 2002) ; Timothy Hickman , The Secret Leprosy of Modern Days: Narcotic Addiction and Cultural Crisis in the United States, 1870–1920 (Amherst: University of Massachusetts Press, 2007) ; Howard Padwa , Social Poison: The Culture and Politics of Opiate Control in Britain and France, 1821–1926 (Baltimore: Johns Hopkins University Press, 2012) .

18.   David T. Courtwright , Forces of Habit: Drugs and the Making of the Modern World . (Cambridge, MA: Harvard University Press, 2001) ; Berridge, Demons .

19.   Frank Dikötter , Lars Laamann , and Zhou Xun , Narcotic Culture: A History of Drugs in China (Chicago: University of Chicago Press, 2004) ; Timothy Brook and Bob Tadashi Wakabayashi , eds., Opium Regimes: China, Britain and Japan, 1839–1952 (Berkeley: University of California Press, 2000) .

20.   James H. Mills , Cannabis Britannica: Empire, Trade, and Prohibition (Oxford: Oxford University Press, 2003) ; Miriam Kingsberg , Moral Nation: Modern Japan and Narcotics in Global History (Berkeley: University of California Press, 2014) .

21. Gootenberg and Campos, “A New Drug History”; Paul Gootenberg , Andean Cocaine: The Making of a Global Drug (Chapel Hill: University of North Carolina Press, 2008) ; Isaac Campos , Home Grown: Marijuana and the Origins of Mexico’s War on Drugs (Chapel Hill: University of North Carolina Press, 2012) ; Rudi Matthee , The Pursuit of Pleasure: Drugs and Stimulants in Iranian History, 1500–1900 (Princeton, NJ: Princeton University Press, 2005) ; Ryan Gingeras , Heroin, Organized Crime, and the Making of Modern Turkey (Oxford: Oxford University Press, 2014) ; Haggai Ram , Intoxicating Zion: A Social History of Hashish in Mandatory Palestine and Israel (Stanford, CA: Stanford University Press, 2020) .

22.   Richard Rudgley , Essential Substances: A Cultural History of Intoxicants in Society (New York: Kodansha International, 1994) ; Schultes and Hofmann, Plants of the Gods .

  Mintz, Sweetness and Power .

  24.   Appadurai, Social Life of Things ; Joseph F. Spillane , Cocaine: From Medical Marvel to Modern Menace in the United States, 1884–1920 (Baltimore: Johns Hopkins University Press, 2000) .

25. For example, Robert P. Stephens , Germans on Drugs: The Complications of Modernization in Hamburg (Ann Arbor: University of Michigan Press, 2007) .

26.   Stacey Schwartzkopf and Kathyn E. Sampeck , eds., Substance and Seduction: Ingested Commodities in Early Modern Mesoamerica (Austin: University of Texas Press, 2017) ; Marcy Norton , Sacred Gifts, Profane Pleasures: A History of Tobacco and Chocolate in the Atlantic World (Ithaca, NY: Cornell University Press, 2008) . A new Oxford Handbook to the History of Consumption (and still another on food) attests to this wide field.

27.   David T. Courtwright , The Age of Addiction: How Bad Habits Became Big Business (Cambridge, MA: Harvard University Press, 2019) .

28.   Becker, “Becoming a Marijuana User” ; Andrew Weil , The Natural Mind: An Investigation of Drugs and the Higher Consciousness (Boston: Houghton Mifflin, 1972) ; Norman E. Zinberg , Drug, Set, and Setting: The Basis for Controlled Intoxicant Use (New Haven, CT: Yale University Press, 1984) .

29.   Richard DeGrandpre , The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture (Durham, NC: Duke University Press, 2006) ; Campos, Home Grown .

30.   Mickey C. Smith , A Social History of the Minor Tranquilizers (1985; repr., New York: Hayworth Press, 1991) ; David Healy , The Anti-Depressant Era (Cambridge, MA: Harvard University Press, 1997) ; Porter and Teich, Drugs and Narcotics .

31.   Marek Kohn , Narcomania: On Heroin (London: Faber and Faber, 1987) ; Timothy Hickman , The Secret Leprosy of Modern Days: Narcotic Addiction and Cultural Crisis in the United States, 1870–1920 (Amherst: University of Massachusetts Press, 2007) ; Thomas Szasz , Ceremonial Chemistry: The Ritual Persecution of Drugs (Garden City, NY: Anchor Books, 1974) .

32.   Courtwright, “Mr. ATOD’s Wild Ride” ; Courtwright, Age of Addiction ; cf. Timothy Hickman , “Target America: Visual Culture, Neuroimaging, and the ‘Hijacked Brain’ Theory of Addiction,” Past and Present 222, no. 9 (2014): 207–26 .

33.   Kohn, Narcomania ; David Lenson , On Drugs (Minneapolis: University of Minnesota Press, 1995) ; Curtis Marez , Drug Wars: The Political Economy of Narcotics (Minneapolis: University of Minnesota Press, 2004) .

34. E.g., Jimmie L. Reeves and Richard Campbell , Cracked Coverage: Television News, the Anti-Cocaine Crusade and the Reagan Legacy (Durham, NC: Duke University Press, 1994) .

35.   William B. McAllister , Drug Diplomacy in the Twentieth Century: An International History (London: Routledge, 2000) ; Londa Schiebinger , Plants and Empire : Colonial Bioprospecting in the Atlantic World (Cambridge, MA: Harvard University Press, 2007) ; Peter Andreas and Ethan Nadelmann , Policing the Globe: Criminalization and Crime Control in International Relations (University Park: Penn State University Press, 2006) ; Peter Andreas , Smuggler Nation: How Illicit Trade Made America (New York: Oxford University Press, 2013) .

36.   Mills, Cannabis Britannica (2003) ; William Jankowiak and Daniel Bradburd , eds. Drugs, Labor and Colonial Expansion (Tucson: University of Arizona Press, 2003) ; Stephen Rimner , Opium’s Long Shadow: From Asian Revolt to Global Drug Control (Cambridge, MA: Harvard University Press, 2018) ; Maziyar Ghiabi , ed., Power and Illicit Drugs in the Global South (Abingdon, UK: Routledge, 2019) .

  37. E.g., Nick Johnson , Grass Roots: A History of Cannabis in the American West (Corvallis: University of Oregon Press, 2017) .

See, for one example of drugs in larger historical forces, Peter Andreas, Killer High: A History of War in Six Drugs (New York: Oxford University Press, 2020).

See Schwartzkopf and Sampeck, eds., Substance and Seduction .

40. Thus, the majority of specialists on drugs carefully avoid or reject loose terms like “cartel”; see, e.g., analysis of political scientist Michael Kenney , From Pablo to Osama: Trafficking and Terrorist Networks, Government Bureaucracies, and Competitive Adaptation (University Park: Pennsylvania University Press, 2007) . For nuanced historical study of such criminal structures, see Stephen Snelders, Drug Smuggler Nation: Narcotics and the Netherlands, 1920-1995 (Manchester UK: Manchester University Press, 2021).

41. For a sterling example, see Chris S. Duvall , The African Roots of Marijuana (Durham, NC: Duke University Press, 2019) ; or shifting narratives in Campos, Home Grown ; or Rimner, Opium’s Long Shadow .

42.   Benjamin Breen , The Age of Intoxication: Origins of the Global Drug Trade (Philadelphia: University of Pennsylvania Press, 2019) ; Alexander S. Dawson , The Peyote Effect: From the Inquisition to the War on Drugs (Oakland: University of California Press, 2018) ; Lucas Richert , Strange Trips: Science, Culture, and the Regulation of Drugs (Montreal: McGill-Queens University Press, 2019) .

This neglect of cannabis by serious history is finally changing: see Lucas Richert and James H. Mills, eds., Cannabis: Global Histories (Cambridge MA: The MIT Press, 2021).

44. E.g., Nancy D. Campbell , OD: Naloxone and the Politics of Overdose (Cambridge MA: MIT Press, 2020) ; David Herzberg , White Market Drugs: Big Pharma and the Hidden History of Addiction in America (Chicago: University of Chicago Press, 2020) , and many others.

  Herzberg, White Market Drugs .

  Johnson, Grass Roots , and research of Daniel Weimer, April Merleaux, and others on environmental impacts of modern drug wars. For “beer before bread” hypothesis of the Neolithic revolution, see Courtwright summary in Age of Addiction , 19–22.

47. For Latin America alone, see Eric Zolov , “Introduction: Latin America in the Global Sixties,” The Americas 70, no. 3 (2014): 349–62 ; Patrick Barr-Melej , Psychedelic Chile: Youth, Counterculture, and Politics on the Road to Socialism and Dictatorship (Durham, NC: Duke University Press, 2017) ; Valeria Manzano , The Age of Youth in Argentina: Culture, Politics, and Sexuality from Perón to Videla (Chapel Hill: University of North Carolina Press, 2014) ; Lina Britto , Marijuana Boom: The Rise and Fall of Colombia’s First Drug Paradise (Durham, NC: Duke University Press, 2020) ; Mike Jay , Mescaline: A Global History of the First Psychedelic (New Haven, CT: Yale University Press, 2019) .

Appadurai, Arjun , ed. The Social Life of Things: Commodities in Cultural Perspective . Cambridge: Cambridge University Press, 1986 .

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Berridge, Virginia.   Demons: Our Changing Attitudes to Alcohol, Tobacco, and Drugs . Oxford: Oxford University Press, 2013 .

Brook, Timothy , and Bob Tadashi Wakabayashi , eds. Opium Regimes: China, Britain and Japan, 1839–1952. Berkeley: University of California Press, 2000 .

Campos, Isaac.   Home Grown: Marijuana and the Origins of Mexico’s War on Drugs . Chapel Hill: University of North Carolina Press, 2012 .

Courtwright, David T.   The Age of Addiction: How Bad Habits Became Big Business . Cambridge, MA: Harvard University Press, 2019 .

Courtwright, David T.   Forces of Habit: Drugs and the Making of the Modern World . Cambridge, MA: Harvard University Press, 2001 .

Dikötter, Frank , Lars Laamann , and Zhou Xun . Narcotic Culture: A History of Drugs in China . Chicago: University of Chicago Press, 2004 .

Escohotado, Antonio.   Historia general de las drogas . 3 vols. Madrid: Alianza Editorial, 1989. [Abridged English version: Antonio Escohotado , A Brief History of Drugs: From the Stone Age to the Stoned Age . Translated by Ken Symington . Rochester, VT: Park St. Press, 1999 .]

Goodman, Jordan , Paul Lovejoy , and Andrew Sherratt , eds. Consuming Habits: Drugs in History and Anthropology . London: Routledge, 1995 .

Gootenberg, Paul.   Andean Cocaine: The Making of a Global Drug . Chapel Hill: University of North Carolina Press, 2008 .

Herzberg, David.   White Market Drugs: Big Pharma and the Hidden History of Addiction in America . Chicago: University of Chicago Press, 2020 .

Matthee, Rudi.   The Pursuit of Pleasure: Drugs and Stimulants in Iranian History, 1500–1900 . Princeton, NJ: Princeton University Press, 2005 .

McCoy, Alfred.   The Politics of Heroin: CIA Complicity in the Global Drugs Trade . Chicago: Lawrence Hill Books, 2003 . First published by Harper and Row in 1972.

Mintz, Sidney W.   Sweetness and Power: The Place of Sugar in Modern History . New York: Viking Press, 1985 .

Musto, David.   The American Disease: Origins of Narcotic Control , 3rd ed. New Haven, CT: Yale University Press, 1987 . First published by Yale University Press in 1973.

Norton, Marcy.   Sacred Gifts, Profane Pleasures: A History of Tobacco and Chocolate in the Atlantic World . Ithaca, NY: Cornell University Press, 2008 .

Porter, Roy , and Mikuláš Teich , eds. Drugs and Narcotics in History . Cambridge: Cambridge University Press, 1995 .

Rudgley, Richard.   Essential Substances: A Cultural History of Intoxicants in Society . New York: Kodansha International, 1994 .

Schivelbusch, Wolfgang.   Tastes of Paradise: A Social History of Spices, Stimulants, and Intoxicants . Translated by David Jacobson . New York: Vintage, 1993 .

Schultes, Richard Evans , and Albert Hofmann . Plants of the Gods: Their Sacred, Healing and Hallucinogenic Powers . Rochester, VT: Healing Arts Press, 1992 . First published by McGraw-Hill in 1979.

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• Published: 29 June 2005

The evolutionary origins and significance of drug addiction

• Tammy Saah 1  

Harm Reduction Journal volume  2 , Article number:  8 ( 2005 ) Cite this article

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By looking at drug addiction from an evolutionary perspective, we may understand its underlying significance and evaluate its three-fold nature: biology, psychology, and social influences. In this investigation it is important to delve into the co-evolution of mammalian brains and ancient psychotropic plants. Gaining an understanding of the implications of ancient psychotropic substance use in altering mammalian brains will assist in assessing the causes and effects of addiction in a modern-day context. By exploring addiction in this manner, we may move towards more effective treatment early prevention, treating the root of the issue rather than the symptoms.

1. Introduction

As we find ourselves in the beginning of a new millennium, we are faced with challenges to our survival as a human population. Some of the greatest threats to our survival are sweeping epidemics that affect millions of individuals worldwide. Drug addiction, although often regarded as a personality disorder, may also be seen as a worldwide epidemic with evolutionary genetic, physiological, and environmental influences controlling this behavior. Globally, the use of drugs has reached all-time highs. On average, drug popularity differs from nation to nation. The United Nations Office on Drugs and Crime identified major problem drugs on each continent by analyzing treatment demand [ 1 ]. From 1998 to 2002, Asia, Europe, and Australia showed major problems with opiate addiction, South America predominantly was affected by cocaine addiction, and Africans were treated most often for the addiction to cannabis. Only in North America was drug addiction distributed relatively evenly between the use of opiates, cannabis, cocaine, amphetamines, and other narcotics. However, all types of drugs are consumed throughout each continent. Interpol reported over 4000 tons of cannabis were seized in 1999, up 20% from 1998, with the largest seizures made in Southern Africa, the US, Mexico, and Western Europe [ 2 ]. Almost 150 tons of cocaine is purchased each year throughout Europe and in 1999 opium production reached an estimated 6600 tons, the dramatic increase most likely due to a burst of poppy crops throughout Southwest Asia. This rapid increase in drug use has had tremendous global effects, and the World Health Organization cited almost 200,000 drug-induced deaths alone in the year 2000 [ 3 ]. The Lewin group for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism estimated the total economic cost of problematic use of alcohol and drugs in the United States to be $245.7 billion for the year 1992, of which $97.7 billion was due to drug abuse [ 4 ]. The White House Office of National Drug Control Policy (ONDCP) found that between 1988 and 1995, Americans spent $57.3 billion on drugs, of which $38 billion was on cocaine, $9.6 billion was on heroin and $7 billion was on marijuana.

Among the different approaches for diagnosis, prevention, and treatment of drug addiction, exploring the evolutionary basis of addiction would provide us with better understanding since evolution, personality, behavior and drug abuse are tightly interlinked. It is our duty as scientists to explore the evolutionary basis and origins of drug addiction so as to uncover the underlying causes rather than continuing to solely focus on the physiological signs and global activity of this epidemic. Too often the treatment of addiction simply works to alleviate the symptoms of addiction, dealing with overcoming the physiological dependence and working through withdrawal symptoms as the body readjusts to a non-dependent state of homeostasis. However, we must not only concentrate on this aspect of addiction when considering global treatments and preventative programs. We must take into consideration that it is not purely the physiology of addiction we are battling.

Drug addiction is thought of as an adjunctive behavior, or a subordinate behavior catalyzed by deeper, more significant psychological and biological stimuli. It is not just a pharmacological reaction to a chemical but a mode of compensation for a decrease in Darwinian fitness [ 5 ]. There are three main components involved in substance addiction: developmental attachment, pharmacological mechanism, and social phylogeny including social inequality, dominance, and social dependence [ 6 ]. Developmental attachment created by environmental influences, such as parental care or lack thereof, may influence children's vulnerability to drug addiction. Evolutionarily speaking, children that receive care that is more erratic may focus more so on short-term risks that may have proved to be an adaptive quality for survival in ancient environments. Compounding that attachment, the pharmacological mechanism describes the concept of biological adaptation of the mesolimbic dopamine system to endogenous substance intake. These factors combined with the influence of social phylogeny create a position for predisposition to drug addiction. They attribute to the common belief that many substances of abuse have great powers to heal, and that is often the driving motivation for overuse and addiction. Evolutionary perspective shows an intermediate and fleeting expected gain associated with drug addiction correlated with the conservation in most mammals of archaic neural circuitry [ 7 ], most often being a falsified sense of increased fitness and viability related to the three components of drug abuse [ 5 , 8 ]. The chemical changes associated with fitness and viability are perceived by mammals as emotions, driving human behavior.

Human behavior is mediated primarily by dopaminergic and serotonergic systems, both of ancient origins probably evolving before the phylogenetic splits of vertebrates and invertebrates [ 9 ]. 5-HT (serotonin), stimulated by a small range of drugs, mediates arousal. It is believed to be inhibited by hallucinogens and also helps control wanting for ethanol and cocaine consumption. The cortico-mesolimbic dopaminergic system, on the other hand, is believed to be the target of a wide range of drugs, including marijuana and cocaine, increasing the transmission of dopamine to the nucleus accumbens [ 10 ]. This system mediates emotion and controls reinforcement, and is the primary pathway acted on by antipsychotic drugs such as chlorprothixene and thioridazine. Problematic use of drugs develops into addiction as the brain becomes dependent on the chemical neural homeostatic circuitry altered by the drug [ 7 ]. No matter the theory of drug addiction, there remains one constant: withdrawal is inevitable. As a drug is administered continuously and an individual becomes addicted, the brain becomes dependent on the presence of the drug. With an absence of the drug, withdrawal symptoms are experienced as the brain attempts to deal with the chemical changes. There are believed to be evolutionary origins of drug addiction, which will be discussed further, as well as a link between physiological addiction and the evolution of emotion.

2. Drugs distribution and use in ancient environments

When examining the distribution of natural drugs in ancestral environment we see that there was often a limited amount of resources, meaning there was little overactivity of salient (wanting) behavior, causing no need for the adaptive development within the cortico-mesolimbic dopaminergic system of a built-in regulatory system of salience [ 6 , 11 ]. Genetic and environmental factors increasing substance abuse liability may have been of no consequence in ancestral environments due to their limitations. We originally relied on the limitations of ancient environments in that same manner, so when we are introduced to excessive amounts of salience in modern environment, we have no internal control. Basically, our ancient-wired bodies have not yet evolved to adapt to modern environment, leaving us vulnerable to addiction.

A common belief is that psychotropic plant chemicals evolved recurrently throughout evolutionary history [ 12 ]. Archaeological records indicate the presence of psychotropic plants and drug use in ancient civilizations as far back as early hominid species about 200 million years ago. Roughly 13,000 years ago, the inhabitants of Timor commonly used betel nut ( Areca catechu ), as did those in Thailand around 10,700 years ago. At the beginning of European colonialism, and perhaps for 40,000 years before that, Australian aborigines used nicotine from two different indigenous sources: pituri plant ( Duboisia hopwoodii ) and Nicotiana gossel . North and South Americans also used nicotine from their indigenous plants N. tabacum and N. rustica . Ethiopians and northern Africans were documented as having used an ephedrine-analog, khat ( Catha edulis ), before European colonization. Cocaine ( Erythroxylum coca ) was taken by Ecuadorians about 5,000 years ago and by the indigenous people of the western Andes almost 7,000 years ago. The substances were popularly administered through the buccal cavity within the cheek. Nicotine, cocaine, and ephedrine sources were first mixed with an alkali substance, most often wood or lime ash, creating a free base to facilitate diffusion of the drug into the blood stream. Alkali paraphernalia have been found throughout these regions and documented within the archaeological record. Although the buccal method is believed to be most standard method of drug administration, inhabitants of the Americas may have also administered substances nasally, rectally, and by smoking.

Many indigenous civilizations displayed a view of psychotropic plants as food sources, not as external chemicals altering internal homeostasis [ 12 ]. The perceived effects by these groups were tolerance to thermal fluctuations, increased energy, and decreased fatigue, all advantageous to fitness by allowing longer foraging session as well as greater ability to sustain in times of limited resources. The plants were used as nutritional sources providing vitamins, minerals, and proteins rather than recreational psychotropic substances inducing inebriation. Due to limited resources within ancient environments, mammalian species most probably sought out CNS neurotransmitter (NT) substitutes in the form of psychotropic allelochemicals, because nutrient NT-precursors were not largely available in the forms of food. Therefore, drugs became food sources to prevent decreased fitness from starvation and death. It is believed that early hominid species evolved in conjunction with the psychotropic flora due to constant exposure with one another. This may be what eventually allowed the above civilizations to use the flora as nutritional substances, therefore increasing both their fitness and viability.

Over time, psychotropic plants evolved to emit allelochemical reactivity to deter threats from herbivores and pathogenic invasions. These allelochemical responses evolved to imitate mammalian NT so as to act as competitive binders and obstruct normal CNS functioning. The allelochemical NT analogs were not anciently as potent as forms of abused substances used in modern environments, but instead were milder precursors that had an impact on the development of the mammalian CNS. The fit of allelochemicals within the CNS indicates some co-evolutionary activity between mammalian brains and psychotropic plants, meaning they interacted ecologically and therefore responded to one another evolutionarily. Basically, series of changes occurred between the mammalian brain and psychotropic plants allowing them affect one another during their processes of evolving. This would have only been possible with mammalian CNS exposure to these allelochemicals, therefore to ancient mammalian psychotropic substance use. The evidence for this theory is compelling. For example, the mammalian brain has evolved receptor systems for plant substances, such as the opioid receptor system, not available by the mammalian body itself. The mammalian body has also evolved to develop defenses against overtoxicity, such as exogenous substance metabolism and vomiting reflexes.

3. Evolutionary advantage of emotion

The evolution of brain systems brought about indicators of levels of fitness in the form of chemical signals perceived as emotion [ 7 , 8 , 11 , 13 ]. These emotions help direct physiology and behavior of an individual towards increasing Darwinian fitness. They essentially were tools chosen for by the mechanisms of natural selection. Positive emotions, such as euphoria and excitation, motivate towards increased gain and fitness state, whereas negative emotions, for instance anxiety and pain, evolved as defenses by motivating towards managing potential threats or decreases in fitness level.

Mammalian drive to escape danger is fueled by a capacity to feel negative emotions [ 14 ]. Negative emotions can be defenses, and in their suppression we may find ourselves unarmed and unprepared to deal with problems much more detrimental than the original warning emotions. Those individuals that lack the capacity to suffer, including the inability to experience pain, are unable to put up basic physiological and behavioral defenses and often find themselves dying at relatively young ages. Negative emotions (pain, fear, stress, anxiety, etc.) have evolved in mammals to allude to even the slightest, most harmless potential indicator of a more serious problem, leading to what may be known as a modern-day personality disorder. Personality disorders can be characterized as anything from over-anxiety to schizophrenia [ 13 ]. Many emotional disorders that drugs mask, such as anxiety disorders, develop from the ancient adaptive mechanisms expressed by the evolved mode of personality, and may in fact not be disorders but hypersensitive neural adaptations. Since personality evolved as an information gating mechanism to transmit culture among people, as well as within an individual from external environmental stimuli to internal neural circuitry for personal regulation, negative emotion may be simply transmitted and can be enhanced through personality [ 15 ].

There are two defined types of positive emotion [ 7 ]. The first includes feelings of anticipation and excitation induced by a promise of an increase in fitness (+ Positive Affect, or PA), while the second includes emotions of relief and security due to a removal of a threat to fitness (- Negative Affect or NA). + PA emotions fall into the behavioral activation system, or the BAS [ 16 ]. The BAS attempts to propagate positive emotions and appetitive conditioning, resulting in a motivation to reach goals and, essentially, the positive affect. – NA emotions fall into the behavioral inhibition system (BIS), which attempts to regulate and compensate for negative emotions and aversive conditioning. As mammals expose themselves to fitness-increasing situations and avoid fitness-decreasing situations, they tend to motivate towards pleasure-inducing, or + PA, stimuli that indicate these increases in fitness. Even if unrelated to fitness in modern environment, emotions continue to process events in the same archaic way. Many pleasant feelings may now not indicate an increase in fitness at all, but the evolutionary brain may still correlate the two.

Modern environments include medical and social technologies that bring comfort and longer living than was experienced in ancient environment, so much of modern human emotion does not serve the same function as was evolutionarily performed. As our emotions become less indicative of fitness and more superfluous, there comes to be confusion within the intended signals of emotion. The pursuit of "happiness" involves gain, and while evolutionarily these gains were increased fitness, the emotion of happiness is no longer directly related to fitness. While one may become happy due to a casual and pleasing relationship, the euphoric emotion may have evolutionarily corresponded with an indication of successful reproduction and therefore a gain in fitness and viability. This can also be applied to the euphoria associated with wealth, which in ancient environments may have been an indicator of increases in fitness due to plentiful food and water resources, but now may indicate status.

4. Effects of drugs on emotion

Psychoactive drugs induce emotions that at one point in mammalian evolutionary history signaled increased fitness, not happiness [ 11 ]. In ancient environments positive emotion correlated with a sign of increased fitness, such as successful foraging sessions or successful breeding. Mammals would feel euphoric only during times where fitness levels were high, the euphoria being indicative of survival and not a superfluous feeling of "happiness." Mammals would otherwise feel negative emotions when fitness levels were low. The effect of many psychoactive substances provided the same euphoric feeling, and may have had some increasing effects on fitness levels in ancient mammalian species. However, drug use today does not carry the same predicted increases in fitness, and in fact may act as a pathogen on neural circuitry. Yet, these same drugs continue to target archaic mechanisms of the brain with the intent of inducing positive emotion, essentially blocking many neurological defenses.

Drugs that stimulate positive emotion virtually mediate incentive motivation in the nucleus accumbens and the neural reward system [ 11 ]. Modern drug addiction fundamentally indicates a false increase of fitness, leading to increasing drug abuse to continue gain, even if the gain is realized as being false. This is the quintessential paradox among drug addicts. The motivation towards gain begins to take precedence over adaptive behaviors among addicted individuals. Some stimuli that simulate increased fitness may become greater priorities than true adaptive stimuli necessary for increased fitness, such as food and sleep [ 7 ]. Individuals can, in turn, decrease their fitness by ignoring necessary behaviors for survival and fitness and focusing on a false positive emotion. The appetite for a drug may also override the drive to consummate, causing a drastic decrease in viability. Their emotional systems are now concentrated on drug-seeking rather than survival.

In modern humans, drugs that may block negative emotions may be more useful than the endurance of ancient warnings of harm, like pain and fever [ 11 ]. Certain drugs can aid in pathology treatment, and while negative emotions may have been entirely necessary for the survival of ancient mammals, they may no longer be exclusively indicative of nociceptive or otherwise harmful stimuli [ 11 , 13 ]. Hypersensitivity of our bodies' defense mechanisms has evolved, leading to unnecessary negative emotions for non-nociceptive stimuli as preventative defense. When there is a threat towards an individual's fitness, the modern body often responds with several different warning signs, perhaps several different types of negative emotions (pain, fever, and hallucination, for example). Therefore, blocking a few of the negative emotions will ideally not disrupt the message. I emphasize the word "ideally" for this is not always the case. Frequently there are situations in which drugs that block these defenses, such as anxiolytics, may contribute to the decreases in fitness by temporarily removing a small negative emotions but leaving the individual vulnerable to a much larger harm [ 17 ].

Emotional disposition has shown to specifically correlate with problematic use of alcohol [ 16 ]. If the perceived emotion before alcohol consumption is negative, the individual most likely is drinking to cope, with less control over his/her own use. In the case of a positive disposition before consumption, the user is said to drink to enhance, with more greatly controlled use of the substance. Since alcohol consumption alters normally functioning cognitive processes, it does not prove to be equal to evolutionarily superior internal coping mechanisms. Instead, alcohol mediates not only negative feelings by their suppression, but also encourages the habituated continuance of positive emotion. Recovering alcoholics often document reasons of relapse surrounding the drive to compensate for negative feelings, resulting in a motivation to cope and therefore to drink.

5. Physiology of addiction and reward

Mammalian brains work heavily on a motivational system with two types of motivation: like and want [ 11 ]. Like is controlled by opioid and brain stem systems, and refers to pleasure upon receiving a reward, whereas want (salience), mediated by the cortico-mesolimbic dopaminergic system, is an anticipatory motivation to pursue reward. We receive "pleasure" through intracellular signaling of adaptive chemical pathways of a reward system that bring our attention to what we need. The nucleus accumbens (NAcb) and globus pallidus are involved in reward pathways for alcohol, opiates, and cocaine [ 18 ]. NTs involved in these pathways are dopamine (primarily within the NAcb and hippocampus), serotonin (hypothalamus), enkephalins (ventral tegmental area and NAcb), GABA (inhibitory – ventral tegmental area and NAcb), and norepinephrine (hippocampus). When there is a disturbance within the reward intracellular cascade, a chemical imbalance occurs that triggers negative emotions to be indicative of the disturbance. This is referred to as "reward deficiency syndrome," where the chemical imbalances within the intracellular cascade manifest themselves as behavioral disorders, indicating a deficiency within the adaptive reward pathway. Drug addiction may initially cause and then further proceed to exacerbate "reward deficiency syndrome."

Another theory of drug addiction, the "drugs for reward" theory, states that addiction is the malfunctioning collision of both motivational systems (like vs. want), stimulating pursuit of a substance that most probably no longer provides pleasure and in fact may be pathogenic [ 11 ]. Different drugs stimulate different types of positive emotion [ 7 ]. Opioids contribute to – NA states, while dopamine-releasing drugs contributes to + PA states. In this theory, dopamine is believed to mediate a state of addiction through the activation of the cortico-mesolimbic system passing through the ventral tegmental area to the nucleus accumbens, all regulating reward-seeking motivation. It is also involved in withdrawal from psychostimulants, as the sudden removal of a chemical drug stimulant from the body causes a massive alteration within the dopaminergic system, leading to negative emotions. Opioids are believed to mediate the consumption of reward, with opioid addiction following a well-defined route: 1) first ensues as a pleasure-seeking behavior, 2) tolerance to the opioid builds and pleasure resulting from drug use reduces, yet use is increased in an attempt to regain the hedonic pleasure, and 3) withdrawal may occur with a cessation of the opioid substance differing from withdrawal from psychostimulants, but also leading to negative emotions. With the "drugs for reward" theory, adaptive hard-wired (physiologically determined to serve a specific role) dopamine function is believed to induce a feeling of reward for a particular action that indicates an increase in the level of fitness of an individual [ 6 ]. It encourages the continuation of habit that increases dopamine release, therefore leading to a perception of increased levels of fitness (although often falsely when referring to drug use). Problems with this theory are encountered when we take into consideration that dopamine also signals negative reinforcement, not just positive reinforcement through reward. Dopamine is therefore referred to as simply altering an emotional state from one to another, even if it means going from positive emotion to negative emotion.

Dopamine is otherwise argued to be a mediator of salience [ 6 ]. Although dopamine is believed to control the cortico-mesolimbic system, it does not rule the consummatory/satiatory/seeking behavior in this particular theory. It instead mediates appetitive/approach behavior, placing an importance on things by demanding attention on either their strength (positive emotion) or their potential harm (negative emotion), then increasing the motivation to move towards an action to change, not to satiate (stop). If upregulated, a feeling of "wanting" is induced for a specific substance, leading to addiction with overuse [ 10 ]. This explains dopamine action as integrated activity rather than hard-wired function, and best explains how drug addiction is obsessively saliatory without ever reaching satiation. This concept is referred to as IS, or incentive salience. Earlier theories discussed unconditioned stimuli, such as a specific drug, as stimulants of an unconditioned response of neural regulation [ 19 ]. In this model, the drug is not the unconditioned stimulus causing guaranteed changes of the CNS, as was previously thought, but the chemical activity caused by the drug within the CNS is the unconditioned stimuli. The brain then becomes adapted to the chemical response of the drug, producing a salient conditioning response within the brain's association context. The prefrontal cortex directs associative context, in turn regulating the cortico-mesolimbic dopamine system to induce an amalgamation of abnormal behavior and salience; the individual is now driven by uncontrolled craving and wanting. We originally relied on the limitations of the ancestral environment to be the regulatory influences as we used drugs for food, and our bodies still remain adapted to ancestral environments in that aspect. Therefore, when we are introduced to excessive amounts of salience, we have no internal control.

Candidate gene polymorphisms within the above pathway receptors may contribute to substance abuse [ 20 ]. Substance abuse tendencies and liabilities (the vulnerability to a disease and the possibility of becoming affected due to genetic and environmental susceptibility) may be inherited through phenotypic liabilities. The expression of substance abuse is therefore dependent on this phenotypic liability and environmental influences. The phenotypic liability may be a result of a genetic polymorphism within the DRD2 dopamine receptor gene (A.sub.1 allele) [ 18 ]. The DRD2 dopamine receptors are targeted by antipsychotics [ 9 ]. This particular receptor gene polymorphism correlates with alcohol and substance addiction as well as obsessive compulsive disorders. The DRD4 dopamine receptor has documented polymorphisms within a 48 base pair variable number tandem repeat, and also correlates with substance addiction, for it is believed to be involved in reducing sensitivity to methamphetamines, alcohol, and cocaine. In Israeli and Arab heroin-dependent populations, there was data collected displaying a DRD4 gene polymorphism in exon 3 consisting of seven-repeat alleles not present in non-addicted control groups. This was also observed in a study of heroin-addicted Han Chinese. In a study done with Native American alcoholics, a linkage on chromosome 11 near the DRD4 gene was documented. With these phenotypic liabilities, an individual may be considered to be addicted to a substance after passing a threshold of which there is no diagnostic or solid definition. Dependence is often continued because of temporary positive effects with the denial of the more permanent, negative pharmaceutical effects. There have been documented significant relationships between drug and alcohol dependence and certain genetic factors, with the same genetic correlation to smoking, displaying a significant cohesion between different substance use disorders. Individuals addicted to substances may, therefore, be genetically predisposed to the situation and are then pushed past threshold by environmental stimuli.

6. Social-cultural impact

We have discovered that the nature of addiction is not solely based on free will to use, or an individual's conscious choice to use, but may have deeper influences. The nature of drug addiction is three-fold: biological, psychological, and social. Although humans may be biologically and psychologically predisposed to drug use and addiction, they may often be driven towards that state by social and cultural influences. To what extent environmental stimuli affect a person's vulnerability to addiction is unknown and may be varying. However, we cannot ignore the great impact of environmental and mental stimuli in the progression towards addiction. It has been found that certain environmental variables breed higher vulnerability [ 21 ]. Family dysfunction and disruption, low social class rearing, poor parental monitoring, and rampant social drug-use exposure may greatly contribute to an individual's movement from substance abuse predisposition to addiction. Both acute and chronic stresses have been linked with substance abuse as well, with acute stress being one of the main influences of relapse in rehabilitated drug addicts. The widespread availability of drugs in certain areas also may affect susceptibility [ 22 ]. This is exceptionally notable in low socioeconomic areas in which overcrowding and poverty have been associated statistically with increased substance abuse. In addition, repeated exposure to successful high-status role models who use substances, whether these role models are figures in the media, peers or older siblings, is likely to influence children and adolescents. Similarly, the perception that smoking, drinking or drug use is standard practice among peers also serves to promote substance abuse.

When examining drug addiction through this triple-perspective, we are forced as a global society to re-evaluate the criminalization of drug use and addiction throughout world. In general, social drug policies have been conservative and unyielding. Most often, addicts are left to feed their addiction through illegal means of acquiring drugs. As a result of conservative influence in national politics, a "tough on drugs" philosophy that stresses zero tolerance, law enforcement, and abstinence has been adopted. This philosophy neglects the need for medical and psychological treatment of substance addiction.

Columbia University's National Center on Addiction and Substance Abuse report over 75% of state penitentiary inmates require drug abuse treatment, but the disconcerting fact is that under 20% of those individuals actually are provided with proper treatment programs [ 23 ]. If treatment is provided, it is often times extremely short-term and non-intensive, and even less frequently offered to jail inmates. In addition, the Bureau of Justice Statistics stated that only 1 in 10 state prison inmates were provided drug abuse treatment in 1997, down from the 1 in 4 inmates offered treatment in 1991. This is astonishingly low, considering the correctional institution holds more substance abusers than any other national institution. Also commonly noted are the incredibly high comorbidity rates between mental illness and drug addiction within the prison system. It is vital to view substance addiction as a medical condition when dealing with criminal charges, making sure that addicts are provided with treatment for the root of their affliction rather than simply punishing the active symptoms of addiction.

7. Conclusion

Drug use and addiction seem to have been a part of mammalian society since ancient times. Researchers have evidence and reason to believe that the evolution of mammalian brains and psychotropic plants might be related to each other, connected by ancient drug use. Regardless of the possible co-evolution of drugs and mammalian brains, abuse of drugs inevitably causes long-term disadvantages. Drug addiction could be extremely detrimental for any individual, not only because of the various health problems involved, but also due to the fact that it abolishes negative emotions, such as pain, which in turn shuts off basic defense mechanisms against potential threats. While the origins for drug addiction may indeed be genetically founded, abuse is most likely caused by a combination of both external and internal stimuli. Although a person may be pre-disposed to addiction, environmental and emotional stimuli may act as a catalyst towards the state of actual substance addiction. It is suggested that the motivation towards drug abuse comes from reward systems within the mammalian brain causing an initial "like" for a substance and leading to the insatiable "want" that correlates with abuse. Although there has been a distinction made between a possibility of a reward-based abuse and a salience-based abuse, it may be possible to see a combined effort of the two proposed systems working towards eventual drug addiction.

More research spanning the evolutionary history of mammalian brains might give us a greater awareness of the physiological wiring of the mammalian brain. For example, is there a combined influence of the salience and reward systems? Are these systems in fact hard-wired, indicating a hard-wired and possibly genetic underlying origin of liability to drug abuse? What is the true reason all humans are vulnerable to drug abuse? Are these tendencies towards drug abuse preventable or simply treatable? These and other questions may, in turn, allow us a deeper understanding of how to effectively prevent and treat drug abuse without simply placing a bandage over it by relieving the superficial symptoms accompanying it. Essentially, we must investigate what may universally cause this internal affliction before we can move on to examine external environmental stimuli that may be associated with individual cases.

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Saah, T. The evolutionary origins and significance of drug addiction. Harm Reduct J 2 , 8 (2005). https://doi.org/10.1186/1477-7517-2-8

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Toward a New Drug History of Latin America: A Research Frontier at the Center of Debates

Paul Gootenberg studied at St. Antony's College, Oxford, and the University of Chicago, and he is SUNY Distinguished Professor of History and Sociology at Stony Brook University. He began his career as an economic historian of nineteenth-century Peru before turning to the history of drugs. He is the author of Andean Cocaine: The Making of a Global Drug (University of North Carolina Press, 2009) and editor of Cocaine: Global Histories (Routledge, 1999). He is currently helping the Beckley Foundation to coordinate an international report on cocaine's future possibilities and is starting on a new global commodity history of Latin America from 1500 to 2000.

Isaac Campos holds a PhD from Harvard University and is Associate Professor of History at the University of Cincinnati. His book, Home Grown: Marijuana and the Origins of Mexico's War on Drugs (University of North Carolina Press, 2012), which explored the development of drug policy and drug war ideology in Mexico between the sixteenth century and 1920, was awarded 2013's Best Book Prize from the New England Council of Latin American Studies. His current project examines the history of illicit drugs in Mexico and greater North America between 1912 and 1940.

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Paul Gootenberg , Isaac Campos; Toward a New Drug History of Latin America: A Research Frontier at the Center of Debates. Hispanic American Historical Review 1 February 2015; 95 (1): 1–35. doi: https://doi.org/10.1215/00182168-2836796

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This introduction brings the issue of Latin American drug trades and cultures into conversation with the region's historiography. Illicit drugs are now notoriously associated with Latin America and represent untold billions in exports, generating over the last three decades tremendous violence, instability, and public controversy. Yet historians are just starting to seriously research the topic. Psychoactive drugs, broadly conceived, have been central in Latin American history from pre-Columbian times to the present; this piece offers a long-term periodization of drugs to uncover and analyze their complex and often-surprising roles. Rather than fetishize drugs, the essay maintains that they can be productively woven into the largest contexts and problems of Latin American history. After analyzing three methodological concerns of drug history — issues of transnationality and scale, the place of drugs in commodity studies, and the social constructivist approach to drug meanings and effects — the special issue editors introduce three exemplary new essays on the history of drugs in Latin America.

“Drugs,” at least the criminalized, menacing kind, are everywhere in twenty-first-century dispatches about Latin America. The Andean region, despite decades of US-sponsored drug war, still exports some 600 metric tons of illicit cocaine a year. The yearly consumption value alone of drugs in the Western Hemisphere is guesstimated at around 150 billion dollars. Trafficker violence that not long ago blighted Colombia's cities has spread to Mexico, where tens of thousands have horrifically perished in the country's worst social meltdown since the Cristero revolt of the 1920s. Mexico remains a bustling cross-border supplier of illegal cannabis, heroin, methamphetamine, and cocaine to desirous consumers in the United States, though much of that trade, and its “cartels,” is shifting perilously to smaller Central American nations, notably Honduras and Guatemala. Governments and police already notorious for old-style graft are caught in a torrent of drug-induced corruption, including billions in drug profits laundered through Caribbean banks. And Latin America is taking drugs too: Brazil, for example, is now the world's second-biggest consumer of Andean cocaine after the United States, fueling fierce gang warfare in the favelas, while the Argentine and Chilean middle classes smoke marijuana at rates similar to those for disaffected European youth. Drug addiction, beyond problems with alcohol, is now recognized as a public health hazard across the region. Meanwhile, the prefix “narco” is attached to myriad cultural and political actors and has gained its own commercial and popular currency. And, for the first time, a diverse group of Latin American political elites are voicing fresh opinions about solving hemispheric drug problems, sometimes against the strict international prohibitionist system long advocated by Washington. Who has not heard of Bolivian president Evo Morales's passionate defense of the indigenous coca leaf, the mounting calls from Colombian officials to debate new strategies in the drug war, or Uruguay's recent experiment as the hemisphere's first pot-legal nation? 1

These issues are certainly topical, but we argue that drugs, broadly conceived, have long pervaded the social, economic, and cultural history of the Americas. In this special issue of HAHR , we, two archival historians who study that drug past, want to introduce a new drug history for the Americas, though admittedly, the old kind barely got a start. 2 We argue here that the fetishization of drugs by prohibitionists and enthusiasts alike has been no accident. Whether due to the resemblance between drug-induced and spiritually inspired ecstasy, or the way that drugs can undermine the razón on which Western civilization has supposedly hinged, or their life-and-death medicinal implications, these are no ordinary goods. Thus drugs also possess, we believe, extraordinary potential for expanding historical study. At the same time, drugs have been closely tied to fundamental themes and developments throughout Latin American history.

Here we will introduce these ideas in three parts. First, we offer a long-term periodization of drugs in Latin America that frames the big picture and problematizes present distinctions between licit and illicit drugs. Second, we propose a brief set of explicit suggestions on the methodological possibilities of drug history. Third, we present three new essays, focused specifically on the tumultuous long 1960s in Argentina, Colombia, and Mexico, that exemplify how drugs can open new frontiers at the center of our field.

• Defining Drugs

Drugs, as anthropologist Sidney Mintz taught us with his penetrating idea of “drug foods,” are far more than today's multibillion-dollar, illicitly trafficked cocaine, marijuana, and meth, and this wider scope helps to define their deeper place across the landscape of Latin American history. 3 The modern interdisciplinary field of drug studies favors such a broad-tent definition. Drugs include legal and soft stimulants like coffee, yerba mate , cacao, tobacco, and even, arguably, sugarcane-derived sucrose itself. They also include scores of Native American ritual hallucinogenic plant drugs such as peyote, “magic mushrooms” (usually psilocybin), ololiuqui (Mexico's sacred morning glory seed), Salvia divinorum , Amazonian ayahuasca vision vine (yajé), yopo snuff, San Pedro (a mescaline cactus of South America), and the countless datura and other alkaloid-rich Solanaceae species deftly employed by indigenous shamans in parts of Colombia and Ecuador. Drugs also properly include the many well-known alcoholic beverages that have arisen out of Latin American cultures and export zones: chicha, pulque, aguardiente, pisco, tequila, cachaça, Cuban, Puerto Rican, and Nicaraguan rums, Chilean wines, and the famously branded bottled products of the Mexican beer industry. The touristy margarita, for example, is a global signifier of good times a la mexicana . And in the very broadest definition, drugs also include the overlapping histories of myriad medical, herbal, and pharmaceutical products of the region. Antimalarial cinchona (Peru Bark), for example, was a result of the purposeful bioprospecting expeditions of early European colonial powers; native hallucinogens (and of course cannabis) are still thought to have hidden therapeutic potential. 4 Such botanic traditions have survived and been transformed over the centuries through internal colonization of national materia medica, in modernist developmental projects of the high-tech Mexican and Cuban pharmaceutical sectors, and today in New Age natural exports such as Andean uña de gato . The drug prospecting continues today with the patent mining of Central American rain forest knowledge by global pharmaceutical giants. 5

Drugs, in short, are everywhere in Latin American history, but that ubiquity has nonetheless produced some distinct contours that can be sketched within a long-term, four-part periodization: pre-Columbian, colonial, a long nineteenth century of national drugs, and today's globalized illicit drug circuits, which erupted in the mid-twentieth century. 6 In offering this framework, we hope to underscore how drugs provide a window for looking afresh at some of the biggest questions in Latin American history: the workings of pre-Columbian states, the imprint of colonialism, the rise of national identities and racialist civilization discourses, the regulation of a normalized body and consciousness, state formation, the rise of modernist biomedical sciences, and, most recently, the impacts of Cold War developmentalism, agrarian change, social violence, authoritarian regimes, and neoliberal globalization.

This, to be clear, is not an exhaustive historiography of the field, which remains too sparse and scattered for useful synthesis. 7 Noting the pioneering contributions of older drug history, we can say that its strong roots in hemispheric diplomatic history left certain starting biases: toward Anglophone publication and state-centered archives and around the twentieth-century dilemmas of US drug problems, policies, or trafficking, as well as a tacit acceptance of drug war–era distinctions in which drugs were by definition illicit, demonized substances and other intoxicants (alcohol, tobacco, coffee, etc.) were not “drugs.” A longer-term periodization shows how such distinctions were historically constructed while also demonstrating that not all drug history originates in Washington. This conceptual turn is at the heart of the new drug history and is, we believe, vital for historically problematizing the dramatic late twentieth-century drug war era. It also provides a sense of how much work remains to be done on drugs and how future work can inform key themes in Latin American history.

• Latin American Drugs through Four Eras

As often noted by ethnobotanists, the pre-Columbian Americas hosted by far the world's richest and most diverse uses of mind-altering drugs: the so-called “American drug complex,” with hot spots in Mesoamerica and western Amazonia. The hundreds of types of mind-altering intoxicants embraced by indigenous peoples have been tied to the filtering of ancient Asian shamanistic vision traditions across the Bering Strait and to the relatively rapid explosion of New World agriculture, which kept foragers toying with the tropics' wildly diverse flora. 8 Unlike in premodern Europe, however, in Latin America fermented beverages (although known) did not drown out other inebriants. The first era of Latin American drug history is thus pre-Latin. More study is needed to understand the concrete ways that sacred, ecstatic, or healing drug cultures became subsumed in or regulated by the more stratified societies and militant state systems that emerged after 500 CE in both Mesoamerica and the central Andes. What ways, for example, did hallucinogens — the “plants of the gods” such as teonanácatl  — permeate and legitimate the religious, aesthetic, or state cosmologies of Mayans or Aztecs? How did officially sacred and regulated coca leaf tie the Incan state, Tawantinsuyu, with ordinary ayllu peasants? 9

Whatever the answers, this first drugs era clearly ended with the Spanish and Portuguese conquest, an event that irrevocably changed the history of drugs worldwide. David T. Courtwright dubs this shift the “psychoactive revolution” of the early modern world, and a rising historical literature now explores both the intricate relations of European colonialism to novel drug commodities — such as cacao, tobacco, teas, and coffee — and the role of drugs in auspicious social and cultural revolutions among European consumers, even, some argue, the birth of the capitalist ethos. 10 Portuguese mariners were vital agents of the new global medicinal and spice drugs trade connecting Asia, Africa, Europe, and the Indies, while Spain rigorously catalogued the medicinal plants of its conquered realms and made lucrative colonial goods out of cacao and tobacco, the one truly Pan-American preconquest drug. 11 Latin America was, in short, at the epicenter of these global shifts.

In broad strokes, American drugs moved in four directions under colonialism, though each category raises the historical question of why this drug over others. Some drugs, such as tobacco or cacao (both notable in pre-Columbian exchange), became widely creolized, commercialized, and even state-sponsored mercantilist goods by the late sixteenth century, though as Marcy Norton brilliantly shows in her recent study of Atlantic cultural networks, this does not mean that Europeans stamped out these products' American indigenous roots and spiritual connotations. 12 Other drugs, like Andean coca leaf, mate , and indigenous brews, were for various reasons imperfectly or only locally commodified. For example, in the case of mate, the Jesuits created a largely closed circuit of southern South American production and trade. In coca's case, initially Spanish authorities feared its ingrained religious, neo-Incan, or subversive nativist meanings and, after intense early ecclesiastical debates, sought to ban it. But, after 1570, it was officially tolerated in order to stimulate the global silver bonanza at Potosí, becoming a regional commodity circuit of the Andes — to cite another Courtwright concept — and, by the end of the colonial era, a cultural marker of Peru's degraded “Indian” caste. 13 Coca was in fact among the first drugs critical to colonial labor regimes and to evolving colonial representations of natives.

A third diverse group of drugs, primarily comprised by what we classify today as hallucinogens (cacti, fungi, ololiuqui, even frog toxins), were deemed fully heretical and subject to extirpation by local authorities. It is indeed hard to imagine these drugs' sensory effects and ascribed divinatory powers as even potentially acceptable to Christian authorities. Their use either moved underground — in an early preview of today's prohibition and illicit drug cultures — or became associated with indigenous myth, madness, and mayhem, as in scattered trace New Spanish references to preconquest tlápatl or tzitzintlápatl . Indeed, so marginalized and secretive were some of these practices that up to the mid-twentieth century most experts regarded them as extinct or mythical — until rising postwar drug seekers encountered the coming out of mushroom shamans such as the now iconic Mazatec Indian María Sabina. 14 Most of these ritual psychedelics (to use a more recent term) survived along tropical or other frontiers, as with, for example, the drugs used by the remote and stateless clan groups in the Colombian Amazon.

The final form of colonial drugs inspired major global capitalist complexes in which expanding metropolitan demand for intoxicants was fitted to the labor and ecosystems opened by colonialism. One dramatic example is Caribbean rum, which in imperial rivalries articulated the vanguard sugarcane plantation industry to the African slave trade, New England merchant smugglers, Atlantic sailors, and European imbibers of spirits. Another was coffee, an East African plant cultivated extensively by the French in Saint-Domingue before making a dramatic late colonial economic march across Portuguese Brazil. 15

Here, in the transition from the colonial period to our next major drug era, we see perhaps most clearly the close relationship between drugs, drug foods, and empire. While the Spanish Bourbons used lucrative tobacco and alcohol monopolies to try to preserve an overextended empire, the Haitian Revolution propitiously brought a late eighteenth-century sugar boom to Cuba. A new colonial compact built on sugar and slavery then helped preserve Spanish rule there for another century. The same revolution helped spur coffee cultivation in Brazil, where the move from one drug food — sugar — to another — coffee — played a key role in prolonging the vitality of both slavery and empire. But by the 1880s, ironically, by shifting the nation's political geography, coffee eventually helped to bring these same national institutions down. 16

These developments were symptomatic of the larger trends that define our third major historical era for Latin American drugs: a long nineteenth century, stretching from roughly the time of Alexander von Humboldt's travels and other Bourbon-era botanical expeditions down to World War II. The period saw the emergence of global mass markets for a number of key drug commodities as well as the “rebranding” of others into invented national traditions. For example, coffee, freed from the restraints of mercantilism, continued a striking, globalizing path of exponential growth. Brazil's nineteenth-century transformation into the global coffee superpower — with all its forward developmental impact — was also closely tied, as Steven Topik shows, to the birth of mass-market capitalism in the United States. In different ways, by 1900 the states and fates of Colombia and virtually all the nations of Central America also became tied to the global taste for a single stimulant, caffeine, which in the eighteenth century became the drug of choice for Europe's “industrious revolution” and which is still the world's most widely used intoxicant. 17 National drug cultures also consolidated in novel forms. For example, Southern Cone sociability and sensibilities became synonymous with taking stimulants in the form of regionally specific mate tea in gauchoesque fashion. In Mexico, one regionally specific form of mescal (distilled blue agave cactus) was elevated into tequila, along with a complex of Jaliscan customs (such as mariachis) that colored constructions of lo mexicano . Chilean elites became proud of their respectable viticulture — after all, Chilean reds are actually the sole survivors of grape blights that decimated classic European vineyards in the late nineteenth century. Imperial rum routes splintered into revered national spirits and cocktails, such as Cuban rum and mojitos. Each Latin American nation, usually thanks to German migrants, industrialized “national” beers, mostly pilsners. Even the lowly Andean coca leaf underwent a kind of nationalist resuscitation in the late nineteenth century, lifted by local Peruvian science, modern botany, and the German discovery of the miraculous cocaine alkaloid in the 1860s. A national modernizing cocaine industry (centered on central Andean Huánuco) dominated global production of the drug by 1900. Exuberance for coca even made it, through a new and sinuous overseas export route, into the secret (1886) formula of the soon emblematic North American soft drink Coca-Cola. 18

These licit and often-celebrated drug developments evolved concurrently with the less conspicuous consolidation of new regional or subaltern drug cultures and the stigmatizing, marginalizing, and sometimes even criminalizing response to them by civil society and authority. In Mexico, for example, the European import cannabis, after an obscure colonial history, was transformed into the supposedly indigenous marihuana , becoming synonymous with insanity, violence, and desperately oppressed groups such as Porfirian prisoners and soldiers. Hygienic anticannabis discourses and restrictions came into play, duly noted in the making of the reformist 1917 constitution, and began seeping into the United States, where they provided the foundation for 1930s “reefer madness” campaigns and marijuana's belated US prohibition (in 1937). Meanwhile, in the Caribbean a confluence of African slave and (East) Indian indentured laborers formed the “ganja complexes” of Jamaica and Trinidad, making cannabis into a rural workers' salve and, eventually, a significant element in the protonationalist, Garveyesque Rastafarian religious movement of the 1950s and beyond. 19 Brazil's African-inflected maconha cannabis culture, still largely unstudied, also emerged from the ashes of slavery, while Chinese migrants, shopkeepers, and laborers — “coolies” — in Peru, Cuba, and northern Mexico became synonymous with the use and sale of opium. Local cultivation of opium poppy, in part medicinal, emerged alongside this — sometimes, as in Peru, regulated as a state monopoly. Overall, as in the United States and Europe, by 1910 opiates had become infused with Orientalist, racist, degenerative, and gendered discourses that helped fuel later prohibitions. Though, to be clear, some bohemian elites sampled them (along with recreational cocaine, cannabis, absinthe, and ether), while, at least in Mexico, ordinary folk demonstrated as much or more prejudice against these drugs and their users as the political classes (“everyday” views of drug use in other parts of Latin America have yet to receive much scholarly attention). 20

There is no doubt, however, that eugenics and related strains of medical thought made drug use, especially alcoholism, a mark of lower-class decay from Chihuahua to Patagonia. In the Andes, for example, coca went from briefly heroic to an Indian “addiction.” We need to know more about these precursory regionalized drug cultures, for they would have surprisingly significant futures. Furthermore, modernizing elite responses to them reveal much about the anxieties, prejudices, and intellectual influences of the day. Each case seems to have reworked neocolonial civilizational and puritanical discourses, with drugs becoming symbolically potent markers for a kind of inward-directed “Orientalism.” Indeed, cannabis and opium, historically the two “Oriental” drugs par excellence, helped consummate the comparison between Latin America's supposedly degenerate Indians and the teeming Asian masses of nineteenth-century Orientalist fantasy. Each kind of drug became laden with cultural and capitalist contradictions, too — for example, as to whether drug use stimulated or enervated the willingness of peasants or plantation laborers to work. 21

These developments spurred Latin America's zigzag insertion into restrictive world drug-control regimes by the 1930s, a process that capped the region's long nineteenth century of drugs. Clearly the key process here is the twentieth-century construction of strong illicit drug categories in which the newly prohibited ultimately help to erase the memory of previous arrays of drugs, with many traditional intoxicants no longer categorized as drugs at all (as in the ubiquitous but redundant phrase “drugs and alcohol”). Here also big questions remain: Were global drug prohibitions imperially pushed onto weak Latin American nations, or were there, as new research demonstrates for Mexico, also deeper local inspirations for antidrug crusades? 22 Were there any alternative conceptions or practices about drugs, such as medicalization or regulated state sales and monopolies, that might have emerged instead of complete prohibition and criminalization? 23 There was, we submit, a surprisingly complex midcentury interplay of Latin American drug politics and US and global antidrug imperatives. For one thing, a number of countries had their own specific drug restrictions in place well before the United States got directly involved. There is plenty of work to do in Latin American archives on the usually quiet emergence of these policies around the region. The birthing process of drug prohibitions was rarely on the front page of contemporary newspapers, yet the consolidation of these policies by the 1950s laid the foundation for today's massive illicit drug export bonanza.

Which brings us to our fourth and final period in Latin American drug history — the development, starting roughly in the 1940s, of the highly profitable, commercially dynamic, and now spectacularly violent illicit drug export markets of the late twentieth century: the era of global illicit drugs. A plethora of often-lurid journalistic accounts aside — the narco-libros that clutter airport bookstores from Mexico to Colombia — we know little so far from archival research about recent drug history. 24 Did outside drug authorities move in to contain quietly spiraling midcentury smuggling trades, or, conversely, did the criminalization of once licit economic and recreational activities lead to the intensification, expansion, and “cartel”-ization of the trade, as well as, eventually, escalating violence along these illicit routes? Do the social geographies of illicit production and distribution zones — in the remote eastern Andes, northwestern Mexico, and transit sites like Colombia, Paraguay, and many more — truly map onto belts of political and social marginalization, as is often asserted? Or did they sometimes represent, as in the cases of Havana and Medellín, hotbeds of middle- and upper-class Latin entrepreneurialism? Is there, as some assert, a rustic outlaw culture among drug-growing peasants or trafficking groups that will impel us to classify them as social banditry or even as social movements? Have illicit actors fostered social breakdown, resistance, or community in their locales? How did Cold War politics and the waning of earlier national social reforms, such as land redistribution, and the frustrating politics of modernizing development — at their peak as drug trades took off — lead into the era of drug capitalism? Does drug smuggling share social affinities and practices with neoliberal free-trade mentalities? The looming question for economic historians of a region long marked by cyclical export booms is why the largest boom of the late twentieth century — with prohibition-inflated revenues topping 100 billion dollars annually — developed in spheres of illicit commerce. Why — and here as well the process is problematically circular — has the drug war, escalated with US policies after 1970, been utterly unable to contain this quintessentially Latin-controlled business? How much can we blame on the well-studied and oft-criticized contradictions of supply-side drug war policy, and how much of this paradox is peculiar to the region's history? 25

These are all questions that invite fine-grained historical analysis. Historians are beginning to flesh out some of these issues by carefully tracing the genealogies and geographies of the illicit flows and networks of people involved. One consistent hot spot is of course Mexico, which has long been a purveyor of myriad illegal mind-altering substances along the borderlands with the United States: patent medicines and vials of the first illegal drugs in the 1910s, booze during Prohibition, opiates during and after World War II, marijuana by the sixties (when it was branded as oaxaqueño or Acapulco gold), transshipments of high-margin cocaine during the neoliberal 1980s and 1990s, and by 2000 amphetamines and counterfeit pharmaceuticals. Historians may ponder if these border smuggling waves are episodic or are structurally tied to Mexican politics and the complex regional aftermaths of, say, the centralizing and agrarian policies of the Mexican Revolution. New research into the longer origins of the Sinaloa Cartel and its spread and fragmentation during the 1980s might answer such questions. 26 The reappearance from the shadows of Mexico's indigenous drug cornucopia (i.e., peyote- and mushroom-using peoples and villages) also relates to modern politics and has a complex cultural resonance with both the rights discourse of indigenismo and the impact of transnational social movements such as hippies and wealthier New Age niche cultures.

In the Andes, by contrast, the illicit flows have been dominated by cocaine, still the most lucrative and violence-enveloped drug export in the Americas. As new scholarship demonstrates, the nineteenth-century discovery of cocaine (first as a medical good) had much to do with reworking long-standing Andean coca traditions as well as the technical and business innovations of Peruvians themselves. 27 The same holds true when cocaine reemerged as a locally made illicit drug after 1947 and was first exported north mainly by Chilean and Cuban smuggling rings, though Bolivian “chemists” and peasants also proved critical to forging cocaine capitalism in the 1950s and 1960s. On the other hand, Colombia, while surely an avid nation of smugglers (much like the United States, as Peter Andreas reminds us), had little to do with drug trafficking save for cigarettes and nationally branded coffee until the 1970s. 28 Arising apart from a Caribbean-rim La Guajira marijuana boom (the iconic Colombian gold of the 1960s and 1970s), global cocaine traffic was utterly transformed in 1970s Colombia. Drugs also transformed Colombia, as a result of geopolitical shocks to the cocaine trade formed, since its early Cold War criminalization, in the eastern parts of Peru and Bolivia. We still lack a researched account of the rise of the misnamed, highly entrepreneurial Colombian “cartels,” but by the mid-1980s, Colombia swiftly adapted its own peasant coca capitalism to feed the expansive trade. 29 This was a key chapter in the agrarian transformation, via intensive peasant migration, of the lowland tropical Andes, where coca emerged by the 1990s as this vast region's most strategic crop, with notable social, environmental, and political impacts from Colombia to Bolivia. Equally underdeveloped is the modern history of coca leaf in Bolivia and Bolivia's incubation, starting in the revolutionary 1950s, of illegal cocaine routes north. The indigenous, cultural, and international ethnographic revalorization (after 1970) of national herbal coca leaf in Bolivia cries out for historical research, perhaps as the foil to globalizing illicit cocaine.

A final area for study in this most recent period of Latin American drug history involves the myriad transit zones, which for political geography or entrepreneurial verve became critical to drug exports. Such spaces (along with northern Mexico) are perhaps best seen as borderland territories in the larger story of imperial friction, overlap, and border making. 30 Panama, where the Canal Zone cut and demarcated new spheres of illicit and licit commerce, has long served as a smuggler's paradise for cross-border vice, including all sorts of drugs. Viewed in terms of US informal empire, it was comparable to “offshore” sin cities such as Tijuana, Mexicali, and Havana from the 1920s to the 1950s. George H. W. Bush's 1989 invasion to oust former US ally and drug kingpin President Manuel Noriega was a high point but not an end point to the isthmus as a hot spot of strategic transshipments and money laundering. Meanwhile, Cuba's prerevolutionary tourist- and mafia-fostered drug scene was nurturing a new Latin-inflected taste for cocaine throughout the Americas during the 1950s. As counterrevolutionary exiles swept across the hemisphere, including Miami, some of these same gangsters professionalized and internationalized the burgeoning cocaine trades of the 1960s and 1970s, keeping it a largely Latin American (rather than a global mafia) enterprise, as it still is today. 31 Historians may note that Cold War conflicts, politics, and ideologies, in their broadest senses (including modernization projects and transforming visions of indigenous cultures), had much to do with the shifting early routing of drugs — a politics that exploded by the 1980s in various accusations, against both Left and Right, of drug trafficking during the Reagan-era Central American civil wars and the purposeful (and persistent) labeling of local insurgencies as “narco-terrorist.” Drugs as a factor in such 1980s struggles needs serious, nonconspiratorial evaluation: Were drugs genuine socially rooted “conflict goods” or mostly ideological ammunition inflaming a polarized region? 32 Other transit sites include Caribbean drug-stopover and profit-cycling zones from Haiti and Jamaica (where a national drug culture in ganja drew outside fascination and even drug tourism) to the Bahamas and other Anglophone laundering centers. The scattering of drug trades under pressure is now entering a stage of wider dispersal across places such as the Dominican Republic, Puerto Rico, Guatemala, Honduras, Ecuador, and Venezuela as well as, with the rapid globalization of Latin American illicits, Europe and Asia through Brazil (via Africa) and now Argentina. 33 Historians will no doubt ask different questions than, say, criminologists and international police officials as to why certain routes rise rather than others and what determines their relative propensity for violence and mayhem.

Modern trafficking flows surged in tandem with states, politics, and larger power relations and thus are the growing subject of concern for political and other social scientists. For example, some analyze the comparative place of narco-trafficking and social violence in the regional and state-building processes of Colombia and Mexico. State elites and organized crime appear as often in cahoots as in conflict, depending on the historical balance of forces, and these relationships (going beyond easy labels like “corruption”) have a lot to do with the ability to contain the violent underbellies of illicit trades. 34 For example, a common assumption about Mexico — just now being seriously plumbed in archives — is that informal pacts reigned among postrevolutionary elites and the army, especially in distant border areas, to regulate illicit activities such as drugs or to funnel them into the political system. In this scenario, the strong-state Partido Revolucionario Institucional (PRI) was able to control the havoc, as well as rustic Sinaloan peasants, until the late 1980s, when Mexican cartels proved ungovernable (or indeed captured parts of the state) as the exceptional power of the PRI waned. The horrific drug war violence of the twenty-first century is read against this unique political past. Historians are beginning to enter these debates by questioning how monolithic and all-encompassing the PRI's state-building power really was while looking back at ongoing historical sources of Mexican social violence and entropy. 35 In sharp contrast, Colombia is usually read as a case in which regional power and entrepreneurial autonomy prevailed against an unusually weak central state — until the civil war–scale violence of the 1980s (as traffickers like Pablo Escobar sought to break into politics) forced the country, heavily assisted by the United States, to build up its state, security apparatus, and services to tame its unruly illicit businesses, cities, and peasantry. Historians can bring their own longer lens to these big issues of power and politics in which drugs played a dynamic role.

In a different vein, there are also plenty of drugs to study in terms of domestic consumption, without making a strict dichotomy between export and national drug cultures. Most countries of Latin America lack national drug histories for the twentieth century. 36 We know that cocaine and opiates had become early recreational drugs in urban music scenes and in clubs (especially in Brazil and Argentina), brothels, and sailor hot spots in many parts of the Americas, evident by the 1910s. 37 At midcentury, foreigners ranging from Harvard ethnobotanists to bohemians such as William S. Burroughs often ventured to exotic locales of Latin America as precocious drug tourists and then published on what they found. During the long 1960s, urban middle-class youth in Brazil, Argentina, Mexico, Peru, Colombia, the Dominican Republic, and elsewhere joined the rebellious drug cultures associated with global rock music, cannabis smoking, and other youth movements. This must have sparked many peculiar transnational encounters in a region where Afro-descendants and Indians had rich stocks of accumulated drug knowledge. In a striking example, modern jipis (hippies) from Mexico City, along with foreign kin, decamped to places like Huautla de Jiménez, Oaxaca, for close encounters with the “authentic,” sometimes lionized psychedelic pioneers: shamans of local rural indigenous folk. 38 The history — and politics — of these encounters has yet to be fully written. That these drug scenes germinated under authoritarian regimes, and along the edges of rising illicit drug corridors, may have lasting implications, given the new sets of national norms and laws that drug use and scares generated and the growing spillover, after 1980, of massive cocaine and cannabis exports into urban shantytowns and impoverished peasant hinterlands. For one thing, these Cold War political encounters may have something to do with the long tendency (just now receding) of Latin American elites to support the global drug war, despite its ineffectiveness and flagrant collateral damage — skyrocketing violence, corruption, rights abuses — at home.

In sum, this overview has served to show the many ways that drugs, in their broadest sense and well before the notorious narco-trafficking of the late twentieth century, have been integral to many of the pivotal developments in Latin American history. This long history, in turn, is a key to knowing how illicit and licit drug cultures divided in the twentieth century and how massive trafficking was born. Deeper research is just beginning. However, drugs also offer a new prism for looking in fresh, surprising ways at the cultural, social, and political history of the Americas. We will now turn to some new methodological possibilities offered by the new drug history.

• Thinking about Methods

Beyond the historiographical questions just raised, many with contemporary resonance, drugs present exciting methodological opportunities. Of course there are considerable challenges in historical drug research: uncovering and interpreting the often invisible, covert, charged, or ineffable worlds that surround illicit or mind-altering goods, or, when thinking about drugs, the pitfalls of received official discourse, biases, and categories. Each of these challenges requires critical awareness and caution to transcend but are not, we believe, qualitatively different problems from those surrounding other demanding recent historical topic areas such as, for example, subaltern history. Drug history is beginning to thrive as a theme of research on many parts of the world — notably in the history of opiates across Asia 39  — but for Latin Americanists the topical possibilities remain wide open, marked largely by empirical gaps. It is true that drugs are sometimes exceedingly hard to find in the archive, save for taxed legal exports like coffee, or in institutions, such as a few official opium sales monopolies. But precisely for that reason, and for our skill at detectivesque research that prizes, finds, and pieces together many types of scattered, fragmentary sources, historians have much to contribute in terms of new narratives and interpretations.

Drug history can and is fruitfully combined with a laundry list of historical subfields: social and cultural history; policy, diplomatic, and imperial history; Atlantic and world history; commodity and business history; ethnohistory and archaeology; the “deep history” of the brain and the senses; agrarian, subaltern, gender, and race history; legal and criminological history; the history of science and medicine; and environmental and ethnobotanical history. 40 Indeed, because drugs themselves are by their nature defined in many biological, social, cultural, and political dimensions, it is hard to conceive of drug history without intrinsically cross-disciplinary content.

That said, many of the choices for drug historians reduce to a simple interpretive divide: Does one stress the power and agency of individual drugs themselves? Or does it make more sense to weave drugs into the fabric of economic, cultural, political, and other histories — for example, looking at drugs through shifting filters of modernity? Histories of particular drugs are fruitful, though they also run the risk of what is variously termed the “pharmaco-centric fallacy” or the “cult of pharmacology” — ascribing to particular drugs (or to specific compounds within them such as morphine, THC, or cocaine) an essential, irresistible chemical power to transform or overpower people and whole societies. 41 Modern (and highly contestable) medical discourses of “addiction,” as well as most big conspiracy theories regarding the untold power of “cartels” and other undergrounds (like those about the connection between the Central Intelligence Agency and crack), suffer equally from this misleading magical fetish about the powers of drugs. 42 Drugs are mystified as the lead culprit for many social ills imagined and real. As we think our own work demonstrates, historians can usefully focus on a single drug commodity through time. But we also believe it crucial to avoid the pharmaco-centric fallacy, something made possible by integrating drug histories into larger questions, contexts, and currents of historical practice. This contextualizing strategy also helps, as elaborated below, to clarify some of the passions about drugs and their potential for bodily or social harm.

Indeed, for special reasons — for example, for being commodities that can directly alter thought processes and the senses and thus excite public emotions — drugs are an inviting site for cross-disciplinary analysis, in particular for the mixing of materialist and cultural methods, or, put differently, approaches that blend the realities and representations of drug worlds. Here, for fellow Latin American historians, we will articulate three core interdisciplinary methodological possibilities (though there are doubtless more): questions of transnationalism and scale, the wide field of commodity studies, and the sociocultural constructivism of drug experience.

Transnationalism and Scale

Most illicit drugs are concentrated substances, or are refined into such, that easily enter into cross-regional or cross-border flows. This geographic mobility marked even pre-Columbian cacao, tobacco, and the vast vertical ecological exchange of Andean coca. Scales then broadened when colonialism turned stimulants into pioneering items of globalizing imperial commerce. Seventeenth-century American tobacco, for example, was (along with silver and gold) one of the first truly global commodities; reciprocally, the nineteenth-century global demand for coffee helped solidify, and globalize, the fiscal, ideological, and bureaucratic foundations of several Latin American states. International legal regimes that began (for complex reasons) to regulate, restrict, and thus sharply delineate drugs after 1909, as well as the imperious cultural and political influences often behind them, are also formative transnational forces in the world of drugs. Birthed by these legalistic distinction regimes, the criminalized drugs of the latter twentieth century are among the most rapid-moving, powerfully driven, and globally sensitive economic enterprises. Of course, ironically, they came into being precisely because of political, legal, spatial, and cultural borders. By the 1990s, given their scale, these invisible criminal flows began to be analyzed as the predictable or rational mirror image of licit commodity traffic — the alleged dark side of contemporary neoliberal globalization. 43

Thus drugs present many of the same methodological challenges and choices that epitomize other major themes in the history of Latin America — historically a globalized, hybridized region — but more so. How to balance and integrate local, national, and global forces? The dynamic interplay between external power and local agency? Dependency versus autonomy? Traveling or transcultural meanings, discourses, and power? Cross-border identities and networks? And how can historians effectively connect in their narratives zones of production, commercial webs, and often-faraway sites and forms of consumption? Even amid the rage for transnational history, there is no one method to best address questions of scale. We believe, however, that drugs make an excellent topic to examine with what social scientists call relational and multiscalar analyses — those that closely connect different levels and geographies of power. 44 In this way, new studies not only fill gaps in drug history but also inform and advance new approaches to thorny problems in the field as a whole.

Commodity Studies

Commodities are of course vital in Latin American history, a history that is often interpreted as one damn commodity after another. 45 From one perspective, regarding drugs as essentially market goods makes perfect sense, since they are highly marketable, heavily traded, historically branded, and perhaps even addictive in their demand. Moreover, purposely reducing drugs to commodity status is a commonly adopted research strategy to neutralize the political distortions, social attitudes, and labels (“good,” “bad,” “alien,” “soft,” “hard,” “dangerous,” “recreational”) that often surround drugs.

There are two (and perhaps more) major developments in commodity studies since the 1980s to highlight for historical research on drugs. The first is the growing interest, especially among anthropologists, in the so-called “social life of things” or “cultural biography” of goods. These perspectives critically interrogate the genesis of what we think of as commodities, their meanings and value, changeability, and cultural relativity across time, cultures, and borders. The consumption, phenomenology, semiotics, and power of goods are paramount. This perspective, pioneered by Arjun Appadurai, was immediately applicable to drugs, which carry so much symbolic import and baggage, meanings that have changed radically over the centuries. For example, compare cocaine's initial role as a heroic, modern miracle drug of the late nineteenth century to both its celebrity and menacing roles today. The scale of such shifting meanings has also expanded to what Appadurai later called global “scapes.” Finally, new political ecology views commodities as key mediators between landscapes and peoples, another potentially fruitful optic for studying the social and political lives of plant drugs. 46

A second useful tool of commodity studies is the concept of global commodity chains, originally part of the grand political economy apparatus of 1970s Wallersteinian world-systems theory. The method (or perhaps metaphor) of the commodity chain — concertedly tracing the spatial, social, and political pathways and networks of goods across the globe, from producers to suppliers, distributors, and final consumers — is now familiar to Latin American historians studying export economies. Like the “social life of things,” this idea was quickly adopted by scholars to examine the border crossings of drugs, and it relates to global-local scale and to critiques of global market analysis as ungrounded, unpeopled, apolitical abstractions. Gootenberg uses this concept to map together the vast “glocal” connections of cocaine since the 1850s. However, in historical fashion, commodity chains expand from markets to include the reciprocal and frictional flows of ideas, law, medicine, people, and politics surrounding the drug. In the end, cocaine's history demonstrates that the licit commodity chain dynamics of the late nineteenth and early twentieth centuries helped to determine the formation of illicit chains after World War II. 47 Both these major approaches to commodity studies — the social life of goods and commodity chains — are useful for insulating research from the heated passions and labels that are so often attached to drugs, while at the same time facilitating the reflexive study of those same meanings and passions as they evolved over time.

Sociocultural Constructionism

One way to bring the passions and the experiential side of drugs fully into their materiality and politics is through what sociologists call social constructionism, a concept that enjoys a rich lineage in scientific drug studies. 48 Starting in the 1930s, psychopharmacologists and sociologists studying drug-using populations discovered that many of the supposed effects of drugs were to a large degree learned, imagined, or constructed by the expectations of the user. This finding, known as “set and setting,” suggests that drug experiences or even drug addiction become malleable according to the social contexts of users, an idea counter to standard biomedical determinism and medical “addiction” paradigms. Kindred perspectives have come out of the anthropology of shamanistic drug use, which highlights the active role played by group expectation; powerful hallucinogens are safely used in such guided or constructed contexts. On a societal scale, pharmacologist Richard DeGrandpre has coined the term “placebo texts” for this phenomenon: drugs are, and do, what our internalized social or political expectations narrate. 49 Historians can add a crucial temporal dimension to this dynamic. Tracing the way drug narratives shift over time may be key to understanding the largest setting of all: historical context. A dramatic example is cannabis. In nineteenth-century Mexico, medical elites perceived “marihuana” use not only as a deviant, subaltern practice but also as one, following both local and external Orientalist discourses, that literally caused “madness” and outbreaks of random violence among its users. For more obscure reasons, ordinary Mexicans maintained similar views of the drug and its effects. The power of this narrative, according to Campos, probably sparked actual mad outbursts and violence (later referred to as “reefer madness” in the United States), thus reinforcing the prohibitionist discourses that originally fueled the provocative behavior. 50 Here one sees how the “placebo text” might produce self-fulfilling prophecies on the ground (the “junkie,” the “crackhead,” the “ marihuano ”). Certainly marijuana's apparent effects in Mexico a century ago were quite different than the mellow and recreational hue of the drug championed by countercultural American youth during and after the 1960s or the rising discourse and politics of medical marijuana as tonic today.

Change over time is the area in which our expertise as historians creatively informs larger understandings of drugs. This perspective also contributes to getting at how some drugs become socially integrated as “soft drugs” with a minimum of social harms while other drugs are constructed into “hard drugs” that (market and political forces aside) are often socially uncontained and thus do in fact wreak much social havoc and harm. All this — drugs, “placebo texts,” and related self-fulfilling prophecies — might also help explain why prohibitionist policies have long been so attractive, even addictive, for drug-fighting bureaucrats. Thus, historical constructivism may help in the task of forging alternative understandings and responses to our punitive prohibitionist regimes, which are now both failing and losing political credibility throughout the Americas. The downside, however, is a penchant for concept abuse: the idea that everything, everywhere, is socially constructed is one of the academic clichés of our time. 51

Constructivism also brings us back to historical concerns with agency and, indirectly, the normative, present-tense politics surrounding hemispheric drugs. If historians contest the idea that drugs per se possess chemical or demonic agency, this returns the question to historical contexts and to the ways in which people and peopled power structures (such as movements, nations, or states) have shaped drugs. In the global politics of drugs, blame prevails: on Colombian cartels or Mexican drug culture or, alternatively from the Left or Latin American critics, imperialist US drug policies or an insatiable American demand for pleasure drugs. Constructivism may help restore a balanced sense of historical agency and interaction instead of one-sided blame. Clearly it has been the interaction of specific conditions throughout the Americas that has spurred the growth and persistence of both drug trafficking and consumption. This vast and largely unexamined past may reveal negotiated outcomes, lost alternatives, or opportunities for change. As historical knowledge, these may inform the present conjuncture, in which governments around the hemisphere — Bolivia, Uruguay, Colombia, Colorado — are constructing new and perhaps decisive forms of global drug reform.

The three essays that follow here exemplify a few of the main historiographical and methodological trends of the new drug history. They are offered in that invitational spirit, rather than being fully representative of the wide variety of drugs, historical eras, or forms of drug history possible for Latin America. Indeed, these three essays come together in their focus on modern drug scenes and drug politics rather than the longer-term panorama just seen of drugs in the Americas.

As in the United States, and elsewhere, the long 1960s represent a pivotal moment in the configuration of Latin American drug use, trafficking, and politics. Within the larger field of Latin American history, the period has also become the focus of exciting cultural and political historical research, with the transnational Cold War at its core, along with the era's spiraling political and cultural conflicts. 52 Drugs, however, remain conspicuously absent in this historiography. Yet this was exactly the period when Latin American actors (from the eastern Andes to northern Mexico) first joined en masse in the trafficking of illicit drugs to meet the rising demands of users to the north. These developments were hardly incidental to the marginalized rural poor or the disaffected regional entrepreneurs swept aside by 1960s US-led “modernization” drives, nor were they unaffected by Cold War realignments and ideological strife about internal subversion, modern lifestyles, and national values.

The major landmarks of postwar Latin American drug history are already visible: we know that Mexican drug cultures helped fuel the psychedelic turn of the sixties; we know that the Cuban Revolution and the Chilean coup helped to scatter drug traffickers to other parts of Latin America; we know that the postwar baby boom in the United States combined with a repressive Cold War atmosphere to spawn a drug-celebrating counterculture and, more generally, a spike in recreational drug use; and we know that the subsequent Nixon-era drug war crackdown and new agencies like the Drug Enforcement Administration (1973) ended up fueling the growth of new illicit supply chains of unprecedented scale and profitability. But there is much left to be clarified. For example, how did the particular rural, political, and developmental histories of forgotten zones like Peru's Huallaga Valley or Mexico's Sierra Madre feed into intensified trafficking? What distinctive imprint did the predominantly white, middle-class, recreational, and permissive youth culture of cannabis smoking (fashioned in the United States and Western Europe) mean for the politics of poorer but mobilized urban youth in such distinct and socially conservative places as Mexico, the Dominican Republic, or Argentina? Did Latin American authorities take advantage of the alien symbolism of drugs (as representative of “Indians” or even gringo hippies) to justify broader crackdowns on dissent? How did the United States use the newly escalated drug war to redeploy or camouflage its counterinsurgency politics in the aftermath of the Cuban Revolution? And, on the other side of the coin, how did Latin American leaders exploit public concern about drugs to justify their embrace of US political and diplomatic incursions? In all the current passion for the memory and cultural politics of this era, the roles of drug politics and drug experience are still largely forgotten.

Valeria Manzano's “The Creation of a Social Problem: Youth Culture, Drugs, and Politics in Cold War Argentina” begins to fill some of these empirical gaps. Here she explores how authoritarian Cold War military politics helped to construct a drug problem in modern Argentina. In contrast to Mexico or Colombia, the country did not significantly produce or transship internationally defined illegal drugs. As a result, more political controversy surrounded urban culture and the politics of emerging forms of drug consumption. During the 1960s, youth in rising counterculture movements began to use marijuana and amphetamines, which previously had barely raised the alarm of medical and judicial authorities. In 1970, Buenos Aires also became the first South American capital to host an office of the US Bureau of Narcotics and Dangerous Drugs, and soon thereafter the Argentine Federal Police, the media, and politicians across the ideological spectrum began to talk of an emerging problem. As Manzano's essay shows, it was a problem that they were in fact actively helping to manufacture, entwined with the larger construction of the infamous Cold War subversive enemy within. Promoted by a motley array of new experts — doctors, psychiatrists, judges, police chiefs, military intelligence services, and journalists — that campaign helped forge a connection between youth, deviance, and subversion, leading Argentina to enact newly punitive drug laws that allowed the Argentine Federal Police to monitor broad areas of youth sociability such as schools, social clubs, and public plazas. One paradox — like the tension between Mexican jipis, shamans, and authorities seen below — is that most of Argentina's actual militant or armed groups abhorred what they saw as decadent, casual middle-class drug use. This drug-related repression reached its peak (but not end) during the 1976–1981 Videla dictatorship. Manzano shows the political as much as social or symbolic processes of building a drug regime and uncovers their authoritarian origins and fallout in places like Argentina. 53

Lina Britto's “Hurricane Winds: Vallenato Music and Marijuana Traffic in Colombia's First Illegal Drugs Boom” emerges from her work on the Greater Magdalena marimberos , the shadowy pioneers of Colombian drug trafficking pre-Escobar. The potential of drug history is exemplified in how Britto's essay contributes to the history of vallenato and its adoption into the modern Colombian nationalist imaginary, while demonstrating the tangible sociocultural impacts of traffickers. Marimberos sprang from the most marginalized and excluded rural and urban sectors of the northern Santa Marta region. When drug war crackdowns in Mexico spiked demand for marijuana in the United States, these upstarts took advantage of their region's long coastline, many navigable ports, and proximity to the market. Their humble backgrounds made them eager to advertise their suddenly heightened economic status at a moment when the area's traditional cotton-growing elites were simultaneously attempting to win the region a more prominent place on the national stage. In the middle of this was the regional music, vallenato, which had long been disdained by local and national elites as the coarse accordion music of dark-skinned country bumpkins. Cotton growers took advantage of the moment to rebrand the region in part through an annual vallenato music festival, while the previously humble marimberos, with a defined taste for vallenato, began using the same music to advertise their wild exploits and sudden wealth. As these processes overlapped, drug money began financing vallenato, and musicians returned the favor with increasingly narco-related subject matter and thinly veiled trafficker panegyrics. All this fueled the music's meteoric rise to national prominence. These outlaw origins of now celebrated vallenato are largely laundered from the national consciousness, but Britto's deeper history of Santa Marta golden helps recover them.

Finally, Alexander Dawson's essay “Salvador Roquet, María Sabina, and the Trouble with Jipis ” sheds light on the complex, sometimes ironic intersections of indigeneity, drugs, Western medicine, and law in late twentieth-century Mexico. Unlike in Argentina or even Colombia, the presence of strong indigenous traditions in Mexico had a mirror effect on the emergence of drug cultures during the 1960s. Drugs connected, sometimes paradoxically, uneven layers of modernizing Mexico's cultures and raise tricky questions about forms of cultural appropriation. In the late 1960s, Salvador Roquet, a highly respected doctor with the Mexican Ministry of Health, began treating psychiatric problems (notably addiction) by tapping into the burgeoning counterculture. Psychedelics, particularly peyote and psilocybin mushrooms, seemed to offer an alternative, fast-acting therapy. The well-connected Roquet, who collaborated with the state against countercultural leftist youth in 1968, opened a clinic in the tony neighborhood of La Condesa, where he eventually treated more than 1,000 (mostly wealthy) patients, many of them counterculture refugees. Ironically, Roquet saw indigenous drugs, and the therapies that he developed after observing Mazatec curanderos at work, as an ideal means of getting the “Indian” out of the jipis. Meanwhile, the press and the mainstream psychiatric community condemned the jipis as developmentally stunted, drug-addicted failures of Mexico's materialist middle class. As the line blurred between jipi dropouts and student movement revolutionaries, Roquet mostly agreed with this assessment, as did his now famous collaborator, the Mazatec shaman María Sabina. Rather than an externally driven drug conflict in Mexico, indigenous drugs, symbolically and pharmacologically potent, reveal the sharpest contradictions of Mexican society and revolutionary nationalism.

We hope that HAHR readers, after taking in these essays, will fully appreciate the ways in which drug history can open a new lens on many of the central questions and themes of Latin American history. For better or worse, drugs permeate the Latin American present and in some cases dominate inter-American relations. The drug past of the Americas needs to be brought into the story, not only for intellectual clarification but also because stronger historical work around it can help guide us as we seek ways to better live with these drugs in the future.

1. On the value of drugs produced in Latin America, see Organization of American States, General Secretariat, Drug Problem . On generally inflated drug value statistics, see the critique by Reuter, “Political Economy”; or, generally, Andreas and Greenhill, Sex, Drugs, and Body Counts .

2. Gootenberg, Andean Cocaine ; Campos, Home Grown . See note 7 below on the broader historiography.

3. Mintz, Sweetness and Power ; or Mintz's suggestive “Forefathers of Crack.” For broader definitions of drugs, see, for example, Weil and Rosen, From Chocolate to Morphine ; Goode, Drugs ; or a more recent iteration, Kleinman, Caulkins, and Hawken, Drugs and Drug Policy , esp. chapter 1, “Why is ‘Drug’ the Name of a Problem?” (1–14).

4. Pierce and Toxqui, Alcohol . On the relation between intoxicating drugs and medicine, see Mann, Murder ; Schiebinger and Swan, Colonial Botany . For an exemplary study of twentieth-century pharmaceuticals, see Soto Laveaga, Jungle Laboratories .

5. Hayden, “From Market”; Greene, “Indigenous People.”

6. This periodization is partly inspired by Bauer, Goods, Power, History .

7. Until the 1990s, the sole dedicated historian of drugs in Latin America was the intrepid US diplomatic historian William Walker III, whose drugs-related publications include his foundational Drug Control in the Americas as well as Drug Control Policy and Drugs in the Western Hemisphere . Around 1990, a number of new contributions began to appear, some in the form of historically minded political science such as González and Tienda, Drug Connection ; and Toro, Mexico's “War . ” Other scholars, some of them historians, began pioneering domestic drug histories as well, notably in Mexico, Colombia, and Peru. See, for example, Astorga A., El siglo ; Pérez Montfort, “El veneno ‘faradisíaco’ ”; Gutiérrez Ramos, “La prohibición”; Pérez Gómez, Historia de la drogadicción ; Pérez Gomez, Sustancias psicoactivas ; Gagliano, Coca Prohibition . Since then, as noted in the footnotes throughout this essay, the literature has been slowly advancing, if still fragmented. For a summary of existing historiography, yet still drawing heavily from literatures in politics, anthropology, and investigative journalism, see Gootenberg, “Drug Trades.”

8. La Barre, “Old and New World”; Schultes and Hofmann, Plants of the Gods ; Furst, Flesh of the Gods . For the popularization of ethnobotanical currents, see Devereux, Long Trip . See also the special issue “Alucinógenos del México prehispánico.”

9. Guzmán, “Hallucinogenic, Medicinal”; Dobkin de Rios, “Plant Hallucinogens and the Religion”; Dobkin de Rios, “Plant Hallucinogens, Sexuality”; Stahl, “Hallucinatory Imagery.” Obviously, this is a truncated summary of the pre-Columbian drug literature.

10. Courtwright, Forces of Habit , 9–30; Schivelbusch, Tastes of Paradise ; Goodman, “Excitantia.”

11. Schiebinger and Swan, Colonial Botany ; Schiebinger, Plants and Empire ; Varey, Chabrán, and Weiner, Searching for the Secrets .

12. Norton, Sacred Gifts . See also Goodman, Tobacco in History ; Coe and Coe, True History ; Foster and Cordell, Chilies to Chocolate ; Courtwright, Forces of Habit , 31–66.

13. Courtwright, Forces of Habit , 59–64.

14. For colonial traces of rituals, see Guzmán, “Hallucinogenic Mushrooms”; Campos, Home Grown , 39–65; Gagliano, Coca Prohibition , 47–98. On mate, see Folch, “Stimulating Consumption”; Estrada, Vida de María Sabina ; Feinberg, Devil's Book . On renewed interest in these plants after World War II, see Stevens, Storming Heaven , 47–87; or among bohemians, see Burroughs and Ginsberg, Yage Letters .

15. Smith, Caribbean Rum ; Ortiz, Cuban Counterpoint ; Nater, “Colonial Tobacco.” The historiography on Latin American coffee is vast: start with Roseberry, Gudmundson, and Samper Kutschbach, Coffee, Society, and Power . See also Clarence-Smith and Topik, Global Coffee Economy .

16. For sugar in Cuba, see McGillivray, Blazing Cane ; Scott, Slave Emancipation ; or the classic on two drugs, Ortiz, Cuban Counterpoint . On coffee's political impact in Brazil, see Andrews, Blacks and Whites , 33–34.

17. See Topik and Samper Kutschbach, “Latin American Coffee”; Clarence-Smith and Topik, Global Coffee Economy ; de Vries, Industrious Revolution .

18. Whigham, La yerba mate ; Gootenberg, Andean Cocaine , 15–102; Valenzuela-Zapata and Nabhan, ¡Tequila! ; Pozo, Historia del vino ; Smith, Caribbean Rum ; Sánchez Santiró, Cruda realidad .

19. Campos, Home Grown ; Rubin, Cannabis and Culture ; Angrosino, “Rum and Ganja.”

20. Hutchinson, “Patterns of Marihuana Use”; Astorga A., El siglo ; Gutiérrez Ramos, “La prohibición”; Meagher, Coolie Trade ; Campos, Home Grown , 123–54; Henman and Pessoa, Diamba sarabamba .

21. Gagliano, Coca Prohibition , 119–63; Fischer, “ ‘¿Culturas de coca?’ ”; Campos, Home Grown , 123–54; Jankowiak and Bradburd, Drugs, Labor, and Colonial Expansion .

22. Campos, Home Grown .

23. Walker, Drug Control in the Americas , chronicles this process and a few alternatives; see Gootenberg, Andean Cocaine , 143–88, on local control projects. On global prohibition regimes, see McAllister, Drug Diplomacy ; or, for a more critical take, McCoy, “Stimulus of Prohibition.” As a variety of US economic imperialism in Latin America, see Reiss, “Policing for Profit.”

24. Some initial archival research includes Astorga A., Drogas sin fronteras ; Astorga A., Mitología del “narcotraficante” ; Carey, “ ‘Selling’ ”; Mottier, “Drug Gangs”; Gootenberg, “ ‘Pre-Colombian’ ”; Sáenz Rovner, Cuban Connection . Some journalistic accounts help; for example, see Osorno, El cártel ; Grillo, El Narco .

25. The United Nation's annual World Drug Report is the general source for such rough drug-market estimates; see also Organization of American States, General Secretariat, Drug Problem . For a methodological critique of aggregate revenue numbers, see Reuter, “World Drug Report.” For one of many devastating critiques of repressive policy, see Bertram et al., Drug War Politics .

26. Astorga A., Drogas sin fronteras ; Astorga A., “Mexico”; Recio, “Drugs and Alcohol”; Mottier, “Drug Gangs.” A nuanced rural sociology of drug zones is Maldonado Aranda, “Stories of Drug Trafficking.” A dissertation in progress by Froylán Enciso (History, Stony Brook University) explores Sinaloan origins.

27. Gootenberg, Andean Cocaine .

28. González-Plazas, Pasado y presente ; Andreas, Smuggler Nation ; Sáenz Rovner, “La ‘prehistoria.’ ” On trafficking routes and the early Cold War, see Gootenberg, “ ‘Pre-Colombian.’ ”

29. There are, however, convincing biographies of figures such as Pablo Escobar, including Salazar J., La parábola ; Mollison, Memory . See also the analysis of trafficking in Kenney, From Pablo to Osama .

30. Adelman and Aron, “From Borderlands to Borders”; Bender, Run for the Border . This topic is ethnographically approached by Campbell, Drug War Zone ; or through transnational lives in Carey, Women Drug Traffickers .

31. Gootenberg, “ ‘Pre-Colombian’ ”; Sáenz Rovner, Cuban Connection ; Cirules, Mafia in Havana ; Scott and Marshall, Cocaine Politics ; Marcy, Politics of Cocaine ; Dinges, Our Man ; Scalena, “Illicit Nation.”

32. Paul Collier, “Economic Causes of Civil Conflict and Their Implications for Policy,” last modified Apr. 2006, accessed 19 Aug. 2013, http://users.ox.ac.uk/~econpco/research/pdfs/EconomicCausesofCivilConflict-ImplicationsforPolicy.pdf ; Cooper, “Conflict Goods.” On the “narco-terrorism” label, see Scott and Marshall, Cocaine Politics , 23–50.

33. On latest routes, see Organization of American States, General Secretariat, Drug Problem .

34. For a peek at this exploding literature, see Snyder and Durán Martínez, “Drugs, Violence”; Bailey and Taylor, “Evade, Corrupt, or Confront?”; Aguilar Rivera, Las bases sociales . One of the first to stress such pacts was Lupsha, “Drug Lords.” Or see Astorga's take in “Drug Trafficking.”

35. Smith, “Rise and Fall”; Knight, “Narco-Violence.” An early study is Sandos, “Northern Separatism.”

36. Exceptions include Campos, Home Grown ; Sáenz Rovner, “La ‘prehistoria’ ”; Pérez Montfort, “El veneno ‘faradisíaco’ ”; Weissmann, Toxicomanías ; Venâncio and Carneiro, Álcool e drogas ; Pérez Gómez, Sustancias psicoactivas ; Pérez Gómez, Historia de la drogadicción ; Fernández Labbé, Drogas en Chile .

37. Resende, Cocaína ; Guy, Sex and Danger , 148–50; Schwartz, Pleasure Island ; Scalena, “Illicit Nation.”

38. Zolov, Refried Elvis , 106–11. On drug adventurers in Latin America, see note 14 above; an ethnobotanist's account is Davis, One River .

39. For example, Dikötter, Laamann, and Xun, Narcotic Culture ; Brook and Wakabayashi, Opium Regimes ; Kingsberg, Moral Nation .

40. Smith, Sensing the Past ; Smail, On Deep History , 157–89.

41. DeGrandpre, Cult of Pharmacology ; Morgan and Zimmer, “Social Pharmacology.” For explicit discussions of methods in drug history, see Gootenberg, “Scholars on Drugs”; Campos, Home Grown , 7–38; Sherratt, “Introduction.”

42. For a drug history critique of contemporary “disease model” theories of addiction, see Hickman, “Target America.”

43. Schendel and Abraham, Illicit Flows ; versus the more policy-oriented take in Stares, Global Habit ; and Gilman, Goldhammer, and Weber, Deviant Globalization . See related discussion in Gootenberg, “Introduction,” 8–9. See Peter Andreas, “Gangster's Paradise: The Untold History of the United States and International Crime,” Foreign Affairs (New York), Mar.–Apr. 2013, pp. 22–28, for a critique of exoticizing illicit trades.

44. Again, anthropology advances historical debates: i.e., Burawoy, “Introduction”; Escobar, Territories of Difference . See also geographers such as Smith, Uneven Development ; or sociologists such as Kahn, Framing the Global .

45. Topik, Marichal, and Frank, From Silver . On commodities in Latin American economic history, see Bulmer-Thomas, Economic History .

46. Appadurai, “Introduction”; Kopytoff, “Cultural Biography”; Appadurai, Modernity at Large , 48–65; Robbins, Political Ecology .

47. Hopkins and Wallerstein, “Commodity Chains”; Bair, Frontiers ; Topik, Marichal, and Frank, From Silver , esp. Topik, Marichal, and Frank, “Introduction”; and Gootenberg, “Cocaine in Chains.”

48. Sometimes called constructivism. A pioneering work was Becker, “History.” See also Weil, “Adverse Reactions”; Zinberg, Drug, Set, and Setting . An early constructivism is summarized in Goode, Drugs , 17–20.

49. DeGrandpre, Cult of Pharmacology , 103–37. See also Harner, Hallucinogens .

50. Campos, Home Grown .

51. Hacking, Social Construction .

52. The best new overview of this work is Zolov, “Latin America.” For recent examples, see Manzano, Age of Youth ; Dunn, Brutality Garden ; Langland, Speaking of Flowers ; Franco, Decline and Fall ; Sorensen, Turbulent Decade . See also Joseph and Spenser, In from the Cold ; Grandin and Joseph, Century of Revolution .

53. In August 2009, the Supreme Court of Argentina voided most drug possession laws from the dictatorship as unconstitutional. Transnational Institute, “Argentina's Supreme Court ‘Arriola’ Ruling on the Possession of Drugs for Personal Consumption,” Drugs and Democracy (blog), 1 Sept. 2009, http://www.tni.org/article/argentinas-supreme-court-arriola-ruling-possession-drugs-personal-consumption . On the depenalization movement rapidly unfolding across the region, see Youngers, “Drug Policy Reform,” esp. 6–7.

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Historical and cultural aspects of man's relationship with addictive drugs

Aspectos históricos y culturales de la relación entre el hombre y las drogas adictivas, aspects historiques et culturels de la relation entre l'homme et les substances addictives, marc-antoine crocq.

Centre Hospitalier, Rouffach, France

Our taste for addictive psychoactive substances is attested to in the earliest human records. Historically, psychoactive substances have been used by (i) priests in religious ceremonies (eg, amanita muscaria); (ii) healers for medicinal purposes (eg, opium); or (iii) the general population in a socially approved way (eg, alcohol, nicotine, and caffeine). Our forebears refined more potent compounds and devised faster routes of administration, which contributed to abuse. Pathological use was described as early as classical Antiquity. The issue of loss of control of the substance, heralding today's concept of addiction, was already being discussed in the 17th century. The complex etiology of addiction is reflected in the frequent pendulum swings between opposing attitudes on issues that are still currently being debated, such as: is addiction a sin or a disease; should treatment be moral or medical; is addiction caused by the substance; the individual's vulnerability and psychology, or social factors; should substances be regulated or freely available.

En los primeros registros humanos hay testimonios de nuestro gusto por sustancias psicoactivas adictivas. Históricamente las sustancias psicoactivas han sido utilizadas por: 1) sacerdotes en ceremonias religiosas (ej. amanita muscaria), 2) curanderos con propósitos medicinales (ej. opio) ó 3) la población general de una manera socialmente aceptada (ej. alcohol, nicotina, cafeína). Nuestros antepasados retinaron compuestos más potentes e idearon vías más rápidas de administración, que contribuyeron al abuso. El uso patológico ha sido descrito desde la Antigüedad Clásica. El tema de la pérdida del control de la sustancia, precursor del concepto actual de adicción, ya fue discutido en el siglo XVII. La compleja etiología de la adicción está reflejada en las frecuentes oscilaciones del péndulo entre actitudes opuestas en temas que actualmente siguen siendo debatidos como: si la adicción es un pecado o una enfermedad; si el tratamiento debe ser moral o médico; si la adicción es causada por la sustancia, la psicología y la vulnerabilidad del individuo o por factores sociales; y si las sustancias deben ser reguladas o estar disponibles libremente.

Le goût de l'être humain pour les substances psychotropes addictives est attesté par les sources historiques les plus anciennes. Historiquement les substances psychotropes ont été employées 1) par des prêtres, dans des rituels religieux (p. ex., l'amanite tue-mouches), 2) par des guérisseurs, à des fins thérapeutiques (p. ex., l'opium), ou 3) par la population générale, d'une façon sanctionnée socialement (p. ex., l'alcool, la nicotine et la caféine). L'homme a modifié les substances disponibles pour intensifier leurs effets et accélérer leur absorption, ce qui a favorisé l'abus de ces produits. Des modes de consommation pathologiques sont décrits dès l'Antiquité classique. La question de la perte du contrôle sur la substance, à l'origine du concept actuel de dépendance, est déjà analysée au XVIIe siècle. L'étiologie complexe des addictions se traduit au cours des siècles par des oscillations entre des attitudes opposées, toujours débattues aujourd'hui : les addictions sont-elles un péché ou une maladie, et le traitement doit-il être moral ou médical?; l'addiction est-elle causée par la substance, ou par la vulnérabilité de l'individu et par des facteurs psychologiques et sociaux?; l'accès aux drogues doit-il être libre ou bien régulé?

This paper endeavors to discuss (i) the cultural history of man's relationship with addictive drugs; and (ii) the historical roots of the science of addiction. The first part deals with addictive substances and their “normal” patterns of use across different epochs. The second part is about the recognition of pathological use and the appearance of the science of addiction, the definition of drug use as a disease and its inclusion in the medical constituency, and the evolution of views on etiology and intervention.

Our early ancestors lived as hunter-gatherers and- as shown by the culture of human groups who retained this lifestyle (eg, Australian aborigines, Amazon Indians, or Kalahari desert Bushmen) - they undoubtedly collected considerable information on pharmacological plants. Ötzi, the man whose frozen body was recovered in the Alps in 1991, lived about 3300 years BC, and carried in his pouch a travel pharmacy including a polypore fungus with antibacterial and hemostatic properties. After adopting a pastoral lifestyle, humans may have observed the effects of psychoactive plants on their flocks. Tradition has it that Ethiopian priests started roasting and boiling coffee beans to stay awake through nights of prayer after a shepherd noticed how his goats were frolicking after feeding on coffee shrubs.

Addictive substances and cultural patterns of use

Schematically, psychoactive substances have been used (1) in religious ceremonies by priests; (ii) for medicinal purposes; or (iii) massively, as staple commodities, by large segments of the population in a socially approved way. Dominant patterns of use varied according to epochs and places. An important parameter was the degree of a drug's acculturation. For instance, New World plants such as tobacco (nicotine) and coca (cocaine) are relative newcomers to the Old World. Conversely, poppy (opium) and hemp (cannabis) originated in Eurasia. 1 In contrast, alcohol can easily be produced by the action of yeast on a variety of plants containing starch or sugar, and has been used by virtually all cultures. 2 Surprisingly, however, alcohol was largely unknown throughout much of North America before the arrival of Europeans. The sudden destructive impact of alcohol on North American native cultures might be explained by the fact that traditional patterns of use had not been established; another possible factor may be the lack of previous genetic selection operating on vulnerable subjects over millennia.

Religions use

Priests or shamans have ingested plants for millennia to induce states of dissociative trance. Such substances are sometimes termed “entheogenic” (from the Greek roots “en” [inside], “theo” [god], and “gen” [create]). The mushroom Amanita muscaria, commonly known as fly agaric, has been at the center of religious rituals in Central Asia for at least 4000 years. Children know this beautiful white-spotted red mushroom from the illustrations of fairy tales and Christmas cards. Amanita muscaria had a religious significance in ancient India, and travelers recorded its use as late as the 18th century in Northeastern Siberia. It was an ingredient of Soma, a sacred beverage in the Rigveda in ancient India, and also of Haoma, a sacred beverage mentioned in the Avesta, the ancient scriptures of Zoroastrianism. 3 , 4 Etymologically, soma and haoma are the same words. It has long been thought that muscarine, a cholinergic substance discovered in 1869 in Amanita muscaria (hence the name), was the hallucinogenic compound. In fact, the hallucinogenic compounds are ibotenic acid and muscimol. In Central America, psilocybe mushrooms were used for the same purposes. Mushrooms of this genus contain the psychoactive compounds psilocin and psilocybin. Indigenous people in pre-Columbian Mexico, and also the Navajo in the southwestern United States, used peyote (Lophophora williamsi) to trigger states of spiritual introspection. This cactus contains psychoactive alkaloids, notably mescaline.

Medicinal use

Some drugs have been used as medications for most of human history. For instance, the medicinal use of opium is described from the earliest written records. Nepenthes pharmakon is mentioned in the 9th century BC in Homer's Odyssey (4, 221). It is written that the beautiful Helen of Troy had received this potion from an Egyptian queen and that she used it to treat the Greek warriors (“presently she cast a drug into the wine of which they drank to lull all pain and anger and bring forgetfulness of every sorrow”). Since the 18th century, most exegetes have thought that this potion was prepared from opium. Interestingly, this preparation is qualified as a pharmakon, ie, a medication, in the Greek original. According to etymology (ne: no, and penthes: grief, sorrow), nepenthes would be an anxiolytic or an antidepressant in today's parlance. There is general agreement that the Sumerians cultivated poppies and isolated opium from their seed capsules at the end of the third millennium BC; they called opium “gil” (joy), and the poppy “hul gil” (the joy plant). 5 The Ebers papyrus (c. 1500 BC), one of mankind's oldest medical documents, describes a remedy to prevent excessive crying in children using grains of the poppy plant, strained to a pulp, passed through a sieve, and administered on 4 successive days. Homer's nepenthes was perhaps similar to laudanum, an opium tincture attributed to Paracelsus in the 16th century. In the 19th century, laudanum was extensively used in adults and children, for numerous indications (insomnia, cardiac and infectious diseases). The working class largely consumed laudanum because it was cheaper than gin or wine, since it escaped taxation. In the early 20th century, encyclopedias in Western countries still stated that persons in good mental and physical health could use opium without risk of dependence. Griesinger (1817-1868), a German psychiatrist, one of the founders of modern psychiatry, recommended the use of opium in the treatment of melancholia. 6

Recreational use

Some potentially addictive drugs have been used by a significant proportion of the population on a regular basis, to the point that they have been considered staple commodities. Alcohol, nicotine, and caffeine, being palatable for their mild psychotropic properties, are examples of widely consumed drugs. As licit psychoactive drugs, they are used mostly by “normal” people, in contrast to illicit “hard drugs,” which are traditionally viewed as the province of the deviant. 7 Alcohol, nicotine, and caffeine have permeated our culture, serving as vehicles for social interaction, shaping our urban landscape, from the Japanese teahouse to the British pub, stimulating the opening of international trade routes. Similarly, hashish (cannabis) has been largely consumed - eaten and later smoked - in Islamic cultures. All these substances have a long history, intricately interwoven with myth, bearing witness to man's predilection for psychoactive substances. The oldest seeds of cultivated vines so far discovered and carbon dated were found in Georgia and belong to the period from 7000 to 5000 BC. 8 According to Jewish and Christian tradition, one of Noah's first actions after coming out of the Ark was to plant a vineyard; he drank some of its wine and became drunk (Genesis 9, 20-21). Coffee was largely used throughout the Islamic world at the end of the 15th century. Its use spread rapidly in Europe, and Europeans introduced coffee plants into their colonies. Tea's history is much older, since the plant was already being harvested in China in the 3rd century BC.

These staple commodities have long been the object of official attention, for the purpose of collecting excise tax rather than controlling abuse. In order to extract revenues, rulers in Ancient Egypt and Babylon established production or sales monopolies. 9 Ordinances limiting consumption have coexisted and alternated with free supply, in close temporal and geographic proximity. Temperance movements led to a clear decrease in liquor use in Western Europe in the early 20th century, culminating with prohibition in the United States (from 1920 to 1933) and in a few Nordic countries. In preceding centuries, tobacco and cannabis had also known prohibition. Smokers ran the risk of having their lips cut under the first Romanov tsar, Michael Fiodorovich, or of being beheaded under the Ottoman sultan Murad IV. In 1378, the Ottoman emir in Egypt, Soudoun Sheikhouni, was determined to stamp out hashish use: farmers growing hashish were imprisoned or executed, and those found guilty of consuming were said to have their teeth pulled out. 10

Devising more potent compounds

In the course of history, many psychotropic plants have been refined and administered through new routes, allowing faster access to the brain in higher concentrations. The fermentation of cereals containing starch produces beer with an alcoholic content of around 5%, whereas the same process with grape sugar yields wine containing up to 14% alcohol Distillation made it possible to obtain beverages with a much higher alcohol content. People could drink alcohol with strength of 50% and more, making it easier to become drunk. The construction of stills, associating an alembic to distill a liquid with arrangements to condense the vapor produced, seems to have started only in the 11th or 12th century around the medical school of Salerno in Italy. 11 Distillation, though it did not create the problems with alcohol, could intensify them. 12 The “water of life,” as it was called in many languages (Latin aqua vitae) conquered Europe with great speed. That name still survives, as in the Danish akvavit and through the Gaelic uisge beatha to the English whisky. In England, drunkenness was to become connected with distilled spirits, especially gin, as dramatically pictured in Hogarth's Gin Lane. Alcohol without liquid (AWOL) is a more recent process that allows people to take in liquor (distilled spirits) without actually consuming liquid. The AWOL machine vaporizes alcohol and mixes it with oxygen, allowing the consumer to breathe in the mixture. Vaporized alcohol enters the bloodstream faster, and its effects are more immediate than its liquid counterparts, producing a euphoric high. Traditionally, coca leaf is chewed in the regions of production in Southern America, for instance by Andean miners to diminish fatigue. At the other pharmacokinetic extreme, the smoking of crack cocaine produces short-lived and intense effects that are felt almost immediately after smoking. Opium is another example of a substance whose pattern of use changed in the last centuries, from a medication used for pain relief and anesthesia to a substance associated with abuse and dependence. Opium's capacity to induce dependence was probably bolstered by the recent purification of morphine, and the synthesis of heroin, more potent compounds that are available for injection. Similarly, cigarettes, which allow nicotine to be rapidly absorbed into the bloodstream and to reach the brain in a few seconds, were associated with more dependence than previous modes of tobacco use (snuff, cigars, chewing) which did not promote deep inhalation into the lungs.

The historical roots of addiction medicine

Chronological milestones.

Abnormal patterns of substance use have been described since antiquity, at least since Alexander the Great's deathin 323 BC was precipitated by years of heavy drinking. Aristotle recorded the effects of alcohol withdrawal and warned that drinking during pregnancy could be injurious. 13 The Roman physician Celsus held that dependence on intoxicating drink was a disease. 14 The birth of addiction medicine in modern times is sometimes credited to Calvinist theologians who offered explanations for the phenomenon of compulsive drinking, which were later accepted by physicians. 15 Dr Nicolaes Tulp, a Dutch physician depicted in Rembrandt's painting “The Anatomy Lesson,” adapted theological models to explain the loss of control over various types of behavior (1641). In this process, what was considered sinful behavior was given medical explanations. A few decades later, one of Tulp's colleagues, Cornelius Bontekoe, applied his teaching to the progressive loss of willful control over alcohol intake. With the colonial era, industrial revolution, and international trade, addiction became a global public health problem. In the 18th century, opium's addictive potential was recognized when a large number of Chinese people became addicted, and the Chinese government tried to suppress its sale and use. In Europe, the working classes were threatened by alcoholism. 16 At that time, psychiatry had matured into a scientific discipline, established nosological classifications, and taken stands on societal issues. The American physician Benjamin Rush, writing in the 18th century, maintained that compulsive drinking was characterized by a loss of self-control, and that the disease was primarily attributable to the drink itself and not the drinker. His remarks concerned only strong liquors; wine and beer, in his view, were salutary thirstquenchers. 17 In German-speaking countries, the most influential physician was Constantin von Brühl-Cramer, who is credited with coining the term “dipsomania” ( “Über die Trunksucht und eine rationelle Heilmethode derselben” [1819]). Dedicated medical journals were created in the 19th century. The Journal of Inebriety appeared in the United States in 1876, while the British Journal of Addiction was first published in 1884. Emil Kraepelin, the physician who exerted the greatest influence on the shaping of modern psychiatry, fought alcohol with extreme dedication. 18 He published the first psychometric data on the influence of tea and alcohol in the early 1890s. As a result of his research, he came to the conclusion that chronic alcoholism provoked cortical brain lesions that led to a permanent cognitive decline. Drawing from personal consequences, Kraepelin became a teetotaler in 1895. Before that, he had been a moderate drinker, recognizing alcohol's relaxing and mood-elevating effects, as in this letter to the psychiatrist August Forel in December 1891: “...I have often found that, after great exertion, and also after severe mood depression, alcohol has had a clearly beneficial effect on me....” 19 Kraepelin was particularly concerned about the social and genetic consequences of alcohol. Sigmund Freud, a contemporary of Kraepelin, laid the ground for the psychological approach to addiction. Freud wrote in a letter to Fliess in 1897: “...it has dawned on me that masturbation is the one major habit, the ”primal“ addiction and that it is only as a substitute and replacement for it that the other addictions - for alcohol, morphine, tobacco, etc - come into existence.” 20 A consequence of the psychological approach is that the addiction to different substances (alcohol, opiates, etc) and even to certain types of behavlor, such as gambling, have been gathered together under a common denominator, and regarded as different expressions of a single underlying syndrome. Interestingly, the Qur'an warns against both wine (khamr) and gambling (maisir) in the same sura (2,219). In the 20th century, addiction medicine has been enriched by (i) diagnostic classifications and (ii) neurobiological and genetic research. Louis Lewin published his influential classification in 1924, distinguishing between stimulants (nicotine; caffeine-containing compounds such as coffee, tea, mate); inebriants (alcohol, ether); hallucinogens (lysergic acid diethylamide [LSD], peyote); euphoriants (cocaine; opium derivatives such as morphine, codeine, heroin); and hypnotics. Also, animal research and functional brain imaging studies in humans have led to the current influential hypothesis that all drugs of abuse share a common property in exerting their addictive and reinforcing effects by (i) acting on the brain's reward system and (ii) conditioning the brain by causing it to interpret drug signals as biologically rewarding or potentially salient stimuli comparable to food or sex. Cues associated with morphine, nicotine, or cocaine activate specific cortical and limbic brain regions. This conditioning involves the prefrontal cortex and glutamate systems. However, in rats, this pattern of activation displays similarities to that elicited by conditioning to a natural reward-highly palatable food such as chocolate. 21 Confronted by cues that serve as drug reminders, the individual experiences craving, and the degree of voluntary control that he or she is able to exert may be impaired. This hypothesis is partly derived from Pavlov's conditioning paradigm, where food is equated to cocaine, the animal's salivation to cocaine craving, and the bell to the drug cue. 22 Family, adoption, and twin studies have demonstrated the intervention of genetic factors in addiction, 23 notably in alcohol abuse and dependence. Genetic factors interact in a complex way with the environment. 24 - 26

Addiction - history of a word

The definition of addiction has evolved over time. Today, addiction is defined by the characteristic features that are shared by a variety of substances: (1) the pattern of administration can progress from use, to abuse, to dependence and (ii), as discussed in the previous paragraph, a common feature of several substances is that they induce pleasure by activating a mesolimbic dopaminergic reward system, and dependence by mechanisms involving adaptation of prefrontal glutamatergic innervation to the nucleus accumbens.

The term “addiction,” in its current medical meaning, was used first in English-speaking countries, and then passed on to other languages that had used other terms previously. For instance, addiction has displaced the words toxicomanie or assuétude in French. Interestingly, the word assuétude (from the Latin assuetudo [habit]) had originally been introduced into French in 1885 to translate the English addiction. 27 German uses non-Latin roots, such as Abhängigkeit (dependence), Sucht (addiction), and Rausch (intoxication). In Roman law and in the Middle Ages, addiction was the sentence pronounced against an insolvent debtor who was given over to a master to repay his debts with his work. Thus, the addictus was a person enslaved because of unpaid debts. According to the Oxford English Dictionary, the term “addict,” in the meaning of “attached by one's own inclination, self-addicted to a practice; devoted, given, inclined to” has been used since the first part of the 16th century. However, addiction, in its current medical meaning of “state of being addicted to a drug; a compulsion and need to continue taking a drug as a result of taking it in the past” has been in widespread use only since the 20th century In medical English, addiction replaced older terms, such as “inebriety.”

The difference between the terms dependence and addiction has long been debated. The meaning of these terms among public health professionals can only be understood in the light of their historical development. Addiction is defined as “strong dependence, both physiologic and emotional” in Campbell's psychiatric dictionary 28 In 1964, the World Health Organization recommended that the term drug dependence replace addiction and habituation because these terms had failed to provide a definition that could apply to the entire range of drugs in use. Historically, the archetypal model of addiction was opiates (opium, heroin), which induce clear tolerance (the need to increase doses), severe physical withdrawal symptoms when use is discontinued, and have serious consequences for the social, professional, and familial functioning of users. The spread of the concept of addiction to other substances, notably nicotine, occurred only in recent decades. 29 The diagnosis of tobacco dependence or addiction did not exist in the Diagnostic and Statistical Manual of Mental Disorders, 2nd ed (DSM-II, American Psychiatric Association in 1968). 30 In the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-W) 31 this diagnostic category was called “nicotine” dependence instead of “tobacco” dependence. A similar historical evolution was observed with the International Classification of Diseases (ICD), the World Health Organization's Classification of Diseases: the ICD-10 Classification of Mental and Behavioral Disorders. Clinical descriptions and diagnostic guidelines (ICD-10, published in 1992,) 32 contains a category for tobacco dependence, whereas the previous classification, the International Classification of Diseases, 9th Revision ( ICD 9), 33 devised in the mid 1970s, had no such specific category and offered only a category for nicotine abuse. The current labeling of “dependence” in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed,Text Revision (DSM-IV-TR) 34 is confusing. During the preparation of the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised. (DSM-III-R), 35 committee members disagreed as to whether “addiction” or “dependence” should be adopted. A vote was taken at a committee meeting and the word “dependence” won over “addiction” by a single vote! As pointed out by O'Brien, the term “addiction” can describe the compulsive drug-taking condition and distinguish it from “physical” dependence, which is normal and can occur in anyone taking medications that affect the brain. 36 For instance, pain patients requiring opiates become dependent, but are not automatically addicted.

Conclusion - a complex illness

Cultural history suggests that our relationship with drugs is more complex than the paradigm of the laboratory rat that is trained to self-administer cocaine. In most cases, we actively seek addictive drugs, and are not passive vietims. History illustrates that our relationship with substances is shaped by multiple factors, including culture, society, religion and beliefs, individual psychology (addictive, anxious, antisocial personalities), cognition (addiction as a “learned” behavior), neurobiology, and genetics. Addictive behavior results from the conjunction of a substance and a personality. Addiction is not only a substance, but the way a person uses it. In other words, it is not only the drink, but also the drinker, as illustrated by the following dialogue in Shakespeare's Othello (Act 2, Scene 3): Cassio - “O thou invisible spirit of wine, if thou hast no name to be known by let us call thee devil” ... Iago- “ Come, come. Good wine is a good familiar creature, if it be well used. ” The etiological complexity of addiction is illustrated by a history of pendulum swings of social and medical opinion. There is no resting equilibrium on unanimous beliefs. It has been common to observe, at the same time and in the same place, the confrontation of opposing attitudes on issues such as: strict vs broad definition of addiction (eg including gambling or not); laissez-faire or prohibition; punishing or treating the addict; and individual responsibility.

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19 The Rise of Fentanyl

Dylan DePersia

Introduction

First developed in the 1960s as a numbing agent and pain reliever, fentanyl is a powerful opioid contributing significantly to the opioid epidemic. The recent rise in prevalence of fentanyl is compounded by the dramatic impact that the drug has had on the increasing number of overdoses in the U.S..

Fentanyl was first created with the goal of developing both a powerful and fast-acting pain reliever to be used for cancer-induced pain and as an analgesic after surgical procedures. However, it was not long before the illicit drug market began adding fentanyl to commonly used street drugs. Problems began to arise as individuals who believed they were using pure heroin were actually using a much stronger alternative, laced with fentanyl.

The result has been a dramatic uptick in overdose deaths across the country, rising to nearly 600,000 deaths in the U.S. between 1979 and 2016. In New York City alone, from 2015 to 2017, fentanyl-related deaths increased by a staggering 55% (Han et al., 2019).

Mechanism and Effects

Fentanyl is a semi-synthetic opioid created in laboratories, meaning it is similar but not directly from the poppy plant, although chemicals from the natural plant are used when making fentanyl. Fentanyl and its analogs affect many systems in the body ranging from the central nervous system to the pulmonary system. The drug attaches to fat molecules and plasma proteins inside the body, where it is then carried to the brain and primarily acts on receptors that play a role in how fentanyl can slow down breathing, which can lead to an overdose.

Many side effects on the body can last anywhere from two to 16 hours and range from migraines and dizziness to hallucinations (Han et al., 2019). Digestive symptoms can include nausea and vomiting, while the most notable effects of fentanyl are respiratory depression and bradycardia . This means that it can slow down a person’s breathing and heart rate to an extent that can kill them. Sometimes the heart can stop, or the user’s breathing decreases enough that the brain stops receiving oxygen. To highlight its danger, fentanyl can lead to lethal respiratory depression in just two minutes, whereas in a drug like heroin, an overdose-related death can take up to 20 minutes (Kuczynska et al., 2018). Some people choose to use fentanyl because of its strong relaxation and euphoria effects. The added drowsiness and overwhelming mind-altering effects often mask the sense of imminent danger and leave individuals at a higher risk for overdose.

From the Laboratory to the Street

The primary ways that fentanyl is known to hit the street drug market are from illicit production and from tampering with legal prescriptions (Kuczynska et al., 2018). Illicit production consists of making fentanyl illegally from underground sources, but fentanyl in the United States (US) has been found to be mostly sourced from other foreign countries, primarily from Asian laboratories. One report stated that in 2016 alone, 668 kg of fentanyl powder was seized in the US from China (Kuczynska et al., 2018). Although new Chinese drug classification and stricter exportation surveillance have been implemented to try to slow the shipments of fentanyl, manufacturers have found other routes into the US, such as through routes established by the Mexican drug cartels (Felbab-Brown, 2022).

The second method in which the illicit drug trade acquires fentanyl is by diverting legal, prescription fentanyl products. The most common forms are transdermal patches, lozenges, or even lollipops, usually prescribed for pain management and shown in the included image. Drug users can find a way to get their own prescription, but it is also routine for them to be stolen from family members, unsuspecting elderly patients, and garbage cans outside of hospitals and nursing homes (Kuczynska et al., 2018). Although the patches are believed to be completely used when thrown away, enough of the drug can sometimes linger for a few days. A lethal dose can still be contained in a thrown-away patch, but abusers often stack multiple patches at one time, increasing the likelihood of an adverse reaction or potential overdose. Unused patches can deliver high doses for as long as three days (American Addiction Centers, 2022). Sometimes individuals even eat or chew on the fentanyl patches, insert them into their rectums, or smoke them in foil or a pipe for quicker absorption into the bloodstream (Kuczynska et al., 2018).

Treatment and Prevention

The best way to reduce the risk of consuming fentanyl is through education and awareness. Some myths about fentanyl have been proven false, including that someone can overdose from simply touching fentanyl and that fentanyl is resistant to naloxone .  In reality, the drug must be introduced to the bloodstream to have an effect, and it will respond to naloxone in the event of an overdose (National Harm Reduction Coalition, 2021). With such a dangerous drug, there is often no information on how to use it safely. However, once a person has decided to use fentanyl, there are precautions that they can take to try to minimize risk. Starting with a small dose and using it slowly can be important, along with snorting or smoking instead of injecting. Hydrating, eating, and resting are also important in the excretion of fentanyl. Most important to note is the fact that fentanyl test strips are available and can correctly indicate whether the opioid is present in any form of other drugs (National Harm Reduction Coalition, 2021).

Fentanyl’s dangerous traits, including its strength, are the reason that it has contributed to the worsening opioid epidemic. It is much stronger than other available opioids and negatively affects many systems in the body. Whether made from underground resources or pulled from prescription patches, there are ways to reduce the risk of being harmed by fentanyl. Staying educated, using fentanyl testing strips, and taking any possible precautions will reduce the negative outcomes of this drug.

Review Questions

1. Fentanyl is classified as what type of drug?

b. Stimulant

c. Hallucinogen

d. Depressant

2. True or false: fentanyl was first created with the goal of developing both a powerful and fast-acting pain reliever to be used for cancer-induced pain.

3. Which of the following is NOT a common way to consume fentanyl?

a. Transdermal patches

b. Lollipops

c. Lozenges

d. Chewing gum

Felbab-Brown, V. (2022, November 7). China and synthetic drugs control: Fentanyl, methamphetamines, and precursors. The Brookings Institution.  https://www.brookings.edu/research/china-and-synthetic-drugs-control-fentanyl-methamphetamines-and-precursors/

National Center for Drug Abuse Statistics. (2022, May 3). Fentanyl abuse statistics .  https://drugabusestatistics.org/fentanyl-abuse-statistics/

Han, Y., Yan, W., Zheng, Y., Khan, M. Z., Yuan, K., & Lu, L. (2019). The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Translational Psychiatry , 9(1), 282. https://doi.org/10.1038/s41398-019-0625-0 .

Kuczyńska, K., Grzonkowski, P., Kacprzak, Ł., & Zawilska, J. B. (2018). Abuse of fentanyl: An emerging problem to face.  Forensic Science International , 289, 207–214. https://doi.org/10.1016/j.forsciint.2018.05.042 .

National Harm Reduction Coalition. (2021, May 24). Fentanyl resources . https://harmreduction.org/issues/fentanyl/ 

American Addiction Centers. (2022, September 15). The dangers of abusing fentanyl patches. https://americanaddictioncenters.org/fentanyl-treatment/dangers-of-abuse

proportion of a population with a disease or condition

a drug that is used to reduce pain

not permitted, unlawful

produced by chemical alteration of a natural starting material

a chemical compound that is structurally similar to another but differs slightly in composition (as in the replacement of one atom by an atom of a different element or in the presence of a particular functional group)

relatively slow heart action

a feeling or state of intense excitement and happiness

relating to, being, or supplying a medication in a form for absorption through the skin into the bloodstream

a synthetic potent antagonist of narcotic drugs

The Diversity of Drugs: History, Effects, and Everything in Between Copyright © by Dylan DePersia is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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History of Drug Trafficking

By: History.com Editors

Updated: June 10, 2019 | Original: May 31, 2017

Drug trafficking in the United States dates back to the 19th century. From opium to marijuana to cocaine, a variety of substances have been illegally imported, sold and distributed throughout U.S. history, often with devastating consequences.

Early Opium Trade in the United States

During the mid-1800s, Chinese immigrants arriving in California introduced Americans to opium smoking. The trading, selling, and distribution of opium spread throughout the region.

Opium dens, which were designated places to buy and sell the drug, began to crop up in cities throughout California and soon spread to New York and other urban areas.

Before long, Americans were experimenting with other opiates like morphine and codeine. Morphine was especially popular for use as a pain reliever during the Civil War , which caused thousands of Union and Confederate soldiers to become addicted to the drug.

The Harrison Act of 1914 outlawed the use of opium and cocaine for non-medical purposes, but the illicit drugs continued to circulate.

In 1925, a black market for opium opened up in New York’s Chinatown . At this time, there were about 200,000 heroin addicts in the United States.

The distribution of opiates continued during the Jazz Era of the 1930s and 1940s. Marijuana also became a popular recreational drug in some communities during this era.

Mafia Drug Smuggling

American Mafia families were caught smuggling and selling illicit drugs as early as the 1950s, in addition to gambling and other illegal activities. These organized groups paved the way for future drug cartels that focused on drugs for their revenue.

The Mafia’s participation in drug trade was sometimes known as the “French Connection” because smugglers in New York City would seize shipments of Turkish opium that arrived from Paris and Marseilles, France.

The Vietnam War and Drug Trafficking

The U.S. involvement in the Vietnam War led to a boost in heroin being smuggled into the United States between the years 1965-1970.

Drug use among Vietnam soldiers was widespread. In 1971, reports showed 15 percent of active soldiers were heroin addicts, and many more smoked marijuana or used other drugs.

The number of people dependent on heroin in the United States soared to 750,000 during these years.

Pablo Escobar and the Medellin Cartel

In the late 1970s, the illegal cocaine trade became a major moneymaking opportunity throughout the world. The Medellin Cartel, an organized group of drug suppliers and smugglers based in the city of Medellin, Colombia, began operating during this time.

In 1975, Colombian police seized 600 kilos of cocaine from a plane. Drug traffickers retaliated by killing 40 people during one weekend in what became known as the “Medellin Massacre.” The event triggered years of violence that led to assassinations, kidnappings and raids.

The Medellin cartel surged to power in the 1980s. It was run by brothers Jorge Luis, Juan David, and Fabio Ochoa Vasquez; Pablo Escobar ; Carlos Lehder; George Jung; and Jose Gonzalo Rodriguez Gacha.

During the peak of its reign, the Medellin cartel brought in up to $60 million a day in drug profits.

Importantly, the U.S. and Colombian governments ratified a bilateral extradition treaty in 1981. This treaty became a significant concern for Columbian traffickers.

Manuel Noriega and the Panamanian Drug Trade

In 1982, Panamanian General Manuel Noriega allowed Medellin drug lord Pablo Escobar to ship cocaine through Panama.

Around this time, Vice President George H.W. Bush created the South Florida Drug Task Force to combat cocaine trade through Miami, where violence involving traffickers was steadily increasing.

After learning of the Medellin cartel’s undertakings in Panama, a Miami federal grand jury indicted the group’s top leaders in 1984. A year later, U.S. officials found out that the Medellin cartel had a hit list that included American embassy members, their families, journalists and businessmen.

In 1987, the Colombian National Police captured Carlos Lehder and extradited him to the United States, where he was sentenced to life in prison without parole plus 135 years.

General Noriega surrendered to the Drug Enforcement Administration (DEA) in 1989 when the United States invaded Panama. He was eventually convicted and sentenced to 40 years in prison on eight counts of drug trafficking, money laundering and racketeering.

Also in 1989, Jose Gonzalo Rodriguez was killed by Colombian police during a raid.

The Ochoa brothers surrendered in 1990 but were released from jail in 1996. Fabio Ochoa Vasquez was arrested again for new crimes in 1999.

George Jung served nearly 20 years for drug-smuggling. He was released from prison in 2014 but was arrested again in 2016 for violating parole. Jung’s life story was portrayed in the 2001 movie Blow .

Pablo Escobar surrendered to the Colombian police in 1991, but escaped during a prison transfer a year later. Police relocated him in 1993, but he was killed as he tried to flee from authorities.

The Cali Cartel

When the Medellin cartel was brought down, the Cali Cartel stepped up. This organized operation emerged in the early 90s and was based in southern Colombia.

Its founding leaders included brothers Gilberto and Miguel Rodriguez Orejuela; Jose Santacruz Londoño (also known as “Chepe”); and Hélmer Herrera (also known as “Pacho”).

At the peak of the Cali Cartel, it was thought to have control over about 80 percent of the cocaine supplied to the United States. By the mid-90s, the organization became a multi-billion-dollar smuggling business.

In 1995, top Cali cartel members were captured and arrested. A year later, all of the Cali kingpins were behind bars.

El Chapo, Los Zetas and Mexican Drug Cartels

By the mid-1980s, the U.S.-Mexican border became the main transport route for cocaine, marijuana and other drugs into the United States. By the late 1990s, Mexican traffickers dominated drug distribution and introduced methamphetamine.

The Sinaloa Federation, which is still operating today, is perhaps the largest and most well-known Mexican drug cartel. It’s also known as the “Pacific Cartel,” the “Guzman-Loera Organization,” the “Federation,” and the “Blood Alliance.”

According to the U.S. Attorney General’s office, the Sinaloa cartel imported and distributed almost 200 tons of cocaine and large amounts of heroin between 1990-2008.

The infamous drug lord Joaquin “El Chapo” Guzman led Sinaloa beginning in 1989. In 2003, the United States Department of the Treasury considered Guzman the “most powerful drug trafficker in the world.”

After several arrests and escapes from prison, Guzman was recaptured by Mexican authorities in 2016. In early 2017, he was extradited to the United States to face criminal charges.

Los Zetas and the Gulf Cartel

Another Mexican cartel, known as Gulf, started in the 1920s but didn’t gain ground in the area of drug trafficking until the 1980s. Gulf became one of Sinaloa’s main rivals in the 2000s.

The Gulf Cartel worked with Los Zetas, a group made up of former elite members of the Mexican military. Representatives of Los Zetas essentially worked as hitmen for Gulf.

When the two groups split in 2010, a bloody fallout occurred that has been called the most violent period in the history of organized crime in Mexico .

Los Zetas had a reputation for ruthless violence that included leaving body parts in public places and posting killings on the Internet. The group’s former leader, Miguel Angel Treviño, was arrested in 2013.

The impact of Mexico’s drug cartel violence is still felt today. Newer cartels have emerged in recent years, and some have formed after breaking with old alliances.

According to the 2015 Congressional Research Service report, Mexican drug wars claimed more than 80,000 lives between 2006 and 2015.

CIA and Drug Trafficking

Over the years, journalists and writers have made claims that the CIA has been involved in various drug trafficking operations.

One of the most notorious accusations involved the CIA’s connection to the Nicaraguan Contra War during the presidency of Ronald Reagan . In 1986, the administration acknowledged that the Contras may have engaged in activity with drug traffickers but insisted that leaders of the rebels were not involved.

In 1996, a series of newspaper reports known as the Dark Alliance , which was written by journalist Gary Webb, claimed that the CIA may have offered the Contra smugglers support and protection. These claims are considered controversial and continue to be debated.

Drug Trafficking in Recent Years

Drug trafficking in the United States remains a significant concern.

Organizations in the Middle East, including the Taliban and al-Qaida, have become major players in the production and shipment of illegal drugs.

Mexican and Columbian cartels remain problematic for the U.S. government, in particular the DEA.

In 2013, six substances accounted for nearly all drug trafficking offenses: powder cocaine, methamphetamine, marijuana, crack cocaine, heroin, and oxycodone.

A 2014 report revealed Americans spent about $100 billion a year over the previous decade on illicit drugs.

While drug trafficking may never completely dissipate, government officials and agencies are currently working on new strategies to stop illegal substances from being brought into and transported throughout the United States.

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The history of Drugs

Drugs have been around for hundreds of years. Indians were known to have used Opium and other drugs for medical and various other purposes. During the 7th Century A. D. in China a drug emerged called Opium. Opium, the dry juice from immature seed pods of the opium poppy plant, is a narcotic drug that is very powerful in the relief of pain but is also very addictive. At the beginning Opium was like any other drug, but then people unaware of the harm it could cause began to use it more and more often.

During the 19th century in China there was a period called the Opium Wars where the use of Opium had become such problem the government tried to prohibit it. But by then no one could stop its growth. In 1803 the compound responsible for the painkilling effect was found and called Morphine. This discovery brought even more use of Opium. Finally in 1898 a chemist discovered diacetylmorphine or Heroin. Heroin was at first considered a safer, stronger but less addictive pain killer and was used by doctors everywhere. However doctors soon found out that it was more dangerous and even more addictive.

During the 70’s heroin reemerged as a powerful drug but many were afraid to use it. Throughout the 80’s strong anti-drug campaigns seemed to be winning the war on drugs . But, in 1996 people have become alert to the increase in Heroin addiction. Heroin use has doubled every year since 1992. What caused the use of heroin to increase? The growth of heroin abuse has increased in the United States because famous musicians and movie stars have been caught with the drug, because pop culture continues to make heroin seem glamorous, and because babyboomers have a relaxed view on drugs.

To begin with, the abuse of heroin has increased because famous usicians and movie stars have been caught with the drug or have been known to use it. Kurt Cobain , lead singer for Nirvana, openly admitted to abusing the drug and checked himself into a detox center weeks before his suicide. Kurt Cobain had chronic stomach problems and was always looking for something to ease the pain. During an interview with MTV he commented on his stomach pain with, “The pain in my stomach made me feel like a junky so if I was going to feel like a junky I might as well become one. Cobain’s stomach pains made him look, talk, and feel like a wrecked individual.

So he figured that if he was going to appear that way, he might as well be that way. Young fans of Kurt Cobain see his attitude on life and try to mimmick it by not caring what they do to their bodies. Many fans only saw Cobain in the spotlight were he seemed to be above everyone and everything, Cobain was one of the most successful musicians of the 90’s and everything he did was seen under a microscope. With his admission to drugs he brought heroin back out of the underground and into pop culture where many more kids could see it.

Also, Stone Temple Pilots frontman Scott Weiland as busted for possession of cocaine and heroin. Scott Weiland was different than Kurt Cobain. Weiland was not a misunderstood poet who rose from obscurity with the addiction, he was a clean cut pop-rock star when the drug found him. However, Weiland like Cobain was a major role model to the children of America. And as Karen Schoemer wrote in Newseek, “Since kids emulate rock stars, they’re liable to emulate their drug use”. Likewise, actor Robert Downey Jr. was arrested twice over the summer for possession of cocaine and heroin. Like Weiland, Downey Jr. as also a clean cut young man .

But, unlike Cobain or Weiland he was not a musician or artist, he was an actor. This broadened the awareness of drug abuse. The movie industry brings in a whole other group of kids who see their favorite actor get caught for possession of heroin and think if they do heroin they too can be as “cool” or “sophistcated” as movie stars. Many young people are using heroin because they see their idols use it. Second, pop culture makes heroin seem glamorous which adds to its use among young people. Movies like Pulp Fiction and Trainspotting make using heroin look appealing.

The main character in Pulp Fiction was a hitman played y John Travolta who did heroin at various times throughout the movie. Writer,Quentin Terantino, did not make heroin addictive or harmful but instead he made it look like a glamour drug that mellowed people out and made them feel good. Even though one scene did have the female role overdose, many more scenes showed how cool people were who do heroin. The movie Trainspotting deals with “Scotland’s junky underbelly” and is criticized by many for making heroin use seem attractive. But, despite criticism this film is one of the most hyped imports of the year.

The acceptance these movies have recieved show that people re also accepting the rise in heroin use, therefore teenagers will see nothing wrong with it. Next, fashion designers continue to hire “druggy looking” women to model their clothes. One designer, Jil Sander, was criticized for showing a “wasted” looking woman with one sleeve pushed up. The trend in the fashion industry is to hire skinny women with sunken faces to model their clothes. One model who recently kicked the habit, Zoe Fleischaur, said “They wanted models that looked like junkies, the more skinny and f—ed up you look, the more everybody thinks you’re fabulous.

One example of a “druggy-looking model” is Kate Moss who has based her entire career on being skinny and looking wasted. Young women see these models and want to be like them. This puts a lot of pressure on young people, especially women, to do heroin in order to fit the appearance that fashion designers project in their productions. Third, heroin abuse has increased because baby boomers have a relaxed view on drugs. Many parents used drugs as teenagers and do not see anything wrong with their children doing drugs. During the 60’s and 70’s many teenagers became caught up in the counter-culture movement led by people like Timothy Leary .

Timothy Leary viewed the use of drugs as a way to expand one’s mind. There are parents who still follow that philosophy with their children. They believe that expanding one’s mind is not wrong therefore doing drugs is not wrong. Moreover, children see their parent do illegal drugs and think that it is not wrong. It’s been proven that parents are one of the biggest contributors to a child’s value system. “Parents who do drugs have children who do drugs. ” reads a major slogan on the war on drugs. Teenagers see their parents values on certain drugs and contribute those values to harder drugs like heroin.

In addition, parents do not spend enough time telling their children what heroin and other hard drugs can do to their child’s body or future. During the 80’s there was a huge war against drugs. Many parents thought that the government was doing a good enough job of informing children of the risks about drugs and let their guard down. Obviously, the government did not do a good enough job of informing children of the dangers of drugs, recently there have been a number of studies showing that almost every illegal drug’s use among teenagers has risen dramatically since the early 90’s.

In conclusion, the use of heroin has grown because rock stars and actors have been caught with the drug, because the media glamorizes the use of heroin, and because some parents have a carefree view of drug usage. Almost everybody knows at least one person who has at one time done an illegal drug. Anybody can become hooked on drugs. Today the percentage of teenagers using drugs keeps rising just as it was in the sixties. Chances are in the future there will be another strong anti-drug campaign just like the one in the 80’s which will reduce the amount of drug abuse for future generations.

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History of Drug Use and Lessons Learnt Essay

Perhaps, the most important lesson that we should have learned from the history of drug use is that ban on drugs decreases their usage. A common misunderstanding regarding the prohibition of alcohol is that it increased alcohol use instead of leading to its decline (Goode, 2015). However, evidence shows that alcohol use reduced dramatically in the years before the prohibition and reached 1.96 gallons; during prohibition, it decreased even further, reaching 0.90 gallons (Goode, 2015). When prohibition ended, the consumption of alcohol began to rise gradually (Goode, 2015). This evidence demonstrates that making drugs illegal decreases their consumption. This is likely to happen because drugs become difficult to find and obtain, and drug users risk being punished for their use. Currently, the media sometimes appeals to people to oppose the legalization of drugs. For example, Rosenstein (2018) calls on the government to prohibit drugs because the rate of deaths from drug overdose increased from 2012 to 2016. If enacted, these measures are likely to lead to a decline in drug use, based on history.

Another lesson from history is that changing public attitudes toward drugs can lead to a decrease in drug use. Goode (2015) argues that before 1830, alcohol consumption was very high, and even children were allowed to treat alcohol. However, after Benjamin Rush, a physician, published his work explaining the negative effects of immoderate alcohol consumption, the temperance movement emerged, leading to a significant decrease in alcohol use (Goode, 2015). This example shows that healthcare professionals, as well as other prominent public figures, have the power of changing public attitudes toward drugs. The change in attitudes, in its turn, influences behaviors and can lead to a decrease in drug use.

Studying drug use trends is crucial to understanding cultural and historical changes in society because it shows public attitudes toward drug use over time and public responses to the rise or decline in drug use. Based on the evidence from the past, scholars can identify effective measures for reducing drug use rates and study the correlation between drug consumption and other social issues, such as crime rates.

Goode, E. (2015). Drugs in American society (9 th ed.). McGraw Hill Education.

Rosenstein, R. J. (2018). Fight drug abuse, don’t subsidize it. The New York Times .

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IvyPanda. (2022, July 26). History of Drug Use and Lessons Learnt. https://ivypanda.com/essays/history-of-drug-use-and-lessons-learnt/

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1. IvyPanda . "History of Drug Use and Lessons Learnt." July 26, 2022. https://ivypanda.com/essays/history-of-drug-use-and-lessons-learnt/.

Bibliography

IvyPanda . "History of Drug Use and Lessons Learnt." July 26, 2022. https://ivypanda.com/essays/history-of-drug-use-and-lessons-learnt/.

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Home — Essay Samples — Nursing & Health — Drugs — The Effects of Drugs on Our Society

The Effects of Drugs on Society: Health Problems

• Categories: Drugs Society

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Words: 1471 |

Published: Dec 3, 2020

Words: 1471 | Pages: 3 | 8 min read

Table of contents

Introduction, drugs in history, effects of drugs on society: health issues, works cited.

• Center for Substance Abuse Treatment. (2006). Substance abuse treatment for persons with co-occurring disorders. Substance Abuse and Mental Health Services Administration.
• Drug Enforcement Administration. (2019). Drugs of abuse: a DEA resource guide. US Department of Justice.
• Green, L. W., Kreuter, M. W., Deeds, S. G., & Partridge, K. B. (1980). Health education planning: A diagnostic approach. Mayfield.
• National Institute on Drug Abuse. (2021). Commonly abused drugs. National Institutes of Health.
• National Institute on Drug Abuse. (2021). DrugFacts: Understanding drug use and addiction. National Institutes of Health.
• Pinto, F. A., & Pinto, M. A. (2019). Health risks of addiction to illicit drugs. Advances in preventive medicine, 2019.
• Reuter, P., & Pollack, H. A. (2006). Drug war heresies: Learning from other vices, times, and places. Cambridge University Press.
• Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. US Department of Health and Human Services.
• The National Center on Addiction and Substance Abuse. (2010). Addiction medicine: Closing the gap between science and practice. Columbia University.
• World Health Organization. (2019). Substance abuse: Key facts. WHO.

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