New Book About the War on Drugs

aaaaaaaaaaaaaaaaaaaaaaaaChasing-the-Scream

I’ve got a great new book to recommend to anyone interested in the U.S.’s failed war on drugs. It’s “Chasing the Scream: The First and Last Days of the War on Drugs,” by Johann Hari. Published in 2015, I heard about this book at an Addiction Medicine conference when it was highly recommended by one of my colleagues.

As the title implies, the first part of the book describes how the war on drugs was initiated, not by the Reagans, but by Harry Anslinger, our first drug war general, back in the 1930’s. Anslinger is portrayed as an arrogant man, close-minded, filled with hubris, and lacking in compassion. He played on the public’s worst prejudices in order to get draconian drug laws passed, and showed no mercy enforcing them. He fanned the flames of public fears of drug-intoxicated minorities in order to expand his scope of power and prestige. His statements, preposterous from a medical point of view, still echo in the mouths of politicians today.

The author says Anslinger helped to create U.S.’s first drug lord, Arnold Rothstein, who is only the first of many ruthless gangsters to follow. Demand for drugs in the face of strict drug laws creates irresistible opportunities for criminals. The book describes how the war on drugs re-incarnated Anslinger and Rothstein with each generation; the names change but the tactics and destruction remain the same.

It’s an interesting concept.

Part Two of the book describes the lives of drug addicts. The author shows how people with addiction are forced to behave like sociopaths in order to maintain their supply of drugs. For example, many addicts deal drugs on a small scale to help finance their own drug use, an action they would be unlikely to undertake without the strong motivation of their own addiction.

The author goes on to illustrates how police crackdowns on drug dealers actually lead to increased gang violence. When top drug-dealing gang members are jailed, it creates a power vacuum, which leads to increased violence as rival gang members jockey for positions of power. Ultimately, the amount of drug dealing remains the same.

His reasoning does make sense, and is backed by interviews from urban bystanders in the violence of drug wars, both in the U.S. and Mexico.

This section of the book also discusses the inequalities of the drug war. The war on drugs is really a war on people who use drugs, and minorities are much more likely to targets of the drug war. Black drug dealers are more likely to be arrested than white dealers. People with money and influence aren’t targeted, while police go after the downtrodden, less likely to mount legal defenses if treated unfairly. Police do this in order to meet arrest quotas with less trouble from those targeted.

I could believe this, but then in the same section, the author also accuses police of expanding their budgets by confiscating high-dollar cars and homes from the rich people caught in the drug wars. So that was a little contradictory.

The author points out how a youngster who gets arrested for a drug offense is unemployable for the rest of his life, and how he can’t get student loans or public housing. To me that sounded a little overblown, since I know people who have managed to go to school, get their GED, then get a college education and even an advanced degree. I’m sure having a crime in one’s background makes this more difficult, but not impossible. That makes me question the accuracy of the author’s other assertions. For example, I have no idea if a drug charge eliminates all possibility of public housing.

Part three of the book is hard to read. In it, the author describes inhumane treatment of addicts who have been jailed. Arizona is noted for being a particularly brutal state for addicted inmates.
Inmates in general in the U.S. are treated horribly but no one seems to care, since few people have compassion for criminals.

This same section of the book also describes the horrible violence in Mexico brought about by the U.S. demand for illicit drugs. With so much profit to be made, drug cartels become ruthless. The author says in order to make sure other potential rivals stay in fear, dealers must engage in ever-increasing violence and depravity.

The fourth section of the book presents interesting ideas. First of all, the author claims the desire to get high is nearly universal. Far from being a deviant desire, the author advances the theory that the desire for intoxication is found in all humans in all civilizations at all times of human existence. He questions the goal of eliminating all drug use, and says it isn’t realistic.

I agree with him. The desire for euphoria is hard-wired into humans. When that urge runs amok, we may seek to satisfy that desire incessantly with drugs or other destructive behaviors.

The author then describes how life events affect the risk of addiction as if this were something new, but we’ve known for years that stress affects addiction risk. People who have experienced abuse and deprivation as children are more susceptible. But then the book connects our society’s present method of dealing with addiction, which is to shame addicts and cause them more pain. This approach is, predictably, counterproductive.

He says the more drug addicts are stressed, forced to live in poverty, are ostracized and shamed, the less likely they are to be able to find recovery.

Then the book goes into a weird tangent, saying that opioid withdrawal really isn’t all that bad, and the withdrawal is mostly mental in nature. He quotes some scientists who say that people living interesting and productive lives don’t get addicted, because they are happy. The book implies that the biological model has been overblown and scientists ignore the psychosocial components that cause addiction.

He’s wrong. Experts in addiction and its treatment haven’t forgotten the psychosocial components of addiction. But for decades, people have argued addiction is just bad behavior. They say addicts need punishment, rather than coddling in treatment programs. These people completely denied scientific components of the disorder. As a result, scientists interested in treating addiction poured money, time, and energy into proving the scientific portion of the disease. But now the same people who said there was no science to support addiction as a disease complain that scientists ignore the role of psychosocial factors that cause addiction.

In reality, both biologic AND psychosocial factors influence who becomes addicted. It isn’t either/or but both/and. It isn’t productive to argue about which is more important, because both types of causative factors need to be addressed in the disease of addiction.

The fifth part of the book is the most interesting. Chapters in this section describe the changes that occurred when drug addiction was treated more as a public health problem and less like a crime.

In a grass roots organization in Vancouver, Canada, a heroin addict managed to mobilize people to approach heroin addiction in a completely new way. This addict unified addicts and the people who care about them to create political pressure. This group attended town meetings, protested, and organized people who cared about the marginalized addicts of Downtown Eastside of Vancouver. Eventually, this organization managed to create such a stink that the mayor of Vancouver met with this addict-leader, and was so impressed by the insights and arguments that he authorized the establishment of a safe injection house.

Ultimately, Vancouver had one of the most progressive and harm-reduction oriented policies on drug addiction. Their overdose death rate plummeted. Health status of addicted people improved.

Similar harm reduction policies were enacted in Great Britain and in Switzerland, with similar reduction in overdose death rates and in improved health status for drug addicts. In Great Britain, physicians could legally prescribe heroin for opioid addicts for a period of time, from the mid-1980’s until 1995, when this program was ended. All of the health gains – reduced overdose deaths, reduced crime, reduced gang activity, and improved physical health for the addicts – were instantly reversed as soon as the program was stopped.

An entire chapter is dedicated to the changes seen in Portugal, where drugs are now decriminalized, but not legalized. This means thought drug use is not a crime, selling these drugs is still illegal. This chapter describes the changes that happened in Portugal, where harm reduction and public health strategies were enacted beginning in 2001. The nation has one of the lowest rates of illicit drug use in the world, though it’s important to understand that heroin has traditionally been the main drug of this country. Addicts’ lives are more productive and death rates are down. Crime rates dropped, and now the whole country supports these harm reduction strategies to the draconian drug laws that Portugal had in the past.

Near the end of the book is a chapter about what is happening in Uruguay, a small South American country where drugs are now not only decriminalized but legalized.

Anyone interested in the creation of a sound drug policy needs to read this book. It’s extensively researched, and the author spoke with many of the key individuals responsible for changes in drug policy all over the world. I haven’t critically researched all data he quotes in his book about the results of drug decriminalization and legalization, but he gives references for much of what’s contained in the book so that any interested reader can do so.

This book is uniquely interesting because the author combines data and statistics with personal stories of various addicts and their families. This technique combines the power of individual story with the facts of a more objective and detached view.

I don’t agree with all of the authors conclusions. For example, when he tries to say addiction is more about a person’s socioeconomic and emotional status rather than about the drugs…nah. Addiction is not all about the addictive nature of the drug itself, but it is a major factor. When you discount the euphoric attraction of opioids, cocaine, and the like, you risk misunderstanding a huge part of addiction. When a substance produces intense pleasure when ingested, it’s more likely to create addiction. After all, we don’t get addicted to broccoli…

It’s important to know this author has been in hot water in the past, accused of plagiarism. Knowing this made me a little distrustful of his interviews with people throughout the book, but I think the ideas illustrated by the interviews are still valid.

It’s a book filled with food for thought.

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7 responses to this post.

  1. Posted by Devin on June 28, 2015 at 6:42 pm

    I’ve already ordered this one I was told about it a couple weeks ago !!! I can’t wait !

    Reply

  2. I’m actually currently reading this one… I’m about half way through, and so far I would give it a rave review. It’s chalked full of history, but what I like is how he goes out and interviews folks that are on both sides of the “war on drugs” TODAY in addition to doing a fine job of laying out the history and personalities leading up to our current (failed) policy. It’s one that all folks in our field should read, hands down.

    Zac Talbott

    Reply

  3. I agree. Im so happy he published this. Its timely and a real call to action. The book’s website is also full of great info. You can google several video clips of him being interviewed about this topic.

    Reply

  4. Posted by Benjamin K Phelps on June 29, 2015 at 6:40 pm

    That he would discount heroin/opioid withdrawal as purely psychological or mental bothers me greatly. I, for one, happen to KNOW this is extremely false. While there is a mental angle to it – i.e. – we can psych ourselves out to think we’re worse off than we really are during withdrawal – that doesn’t mean that’s all there is to it. After all – I didn’t even KNOW you got sick when stopping opioids until I stopped heroin sniffing after 2 weeks & rolled all over the bed that night, groaning out loud, kicking & twisting my hands & feet, freezing cold, then burning hot, & couldn’t figure out why. I didn’t even THINK about heroin at that moment. It took me a day & a half to suddenly wonder if it had anything to do with how I felt. I called my “guy” & in 5 minutes after meeting up, I no longer felt like I was going out of my mind. You’re never going to convince me nor my parents that it’s all mental. They’ve seen what it does to me – I’m one of those who gets it HORRIBLE, & I don’t add much in the way of mental stuff to it when I’m in withdrawal. Sure, I’m scared while it’s happening b/c it hurts. But I don’t imagine it’s worse than it is. I just deal with what I’m feeling at that moment. The biggest problems FOR ME in w/d are 1) lack of sleep – it will drive you insane after a couple of days; and 2) the restless leg or akathesia thing. I can’t lie still. I twist & turn until I want someone to saw my appendages off b/c they hurt so bad. That’s not all b/c I think they should feel that way, I can promise you that. I’ve also found that anti-histamines like Benadryl, Phenergan, & Vistaril DO NOT help me sleep or calm down during w/d – they intensify it exponentially. I’ve found this out even when I didn’t KNOW I’d taken one. Before I knew meds well, I was given some of these & tri-cyclic anti-depressants, which are POTENT anti-histamines, & I didn’t know that fact either back then, & each time, I’d go so insane up & down, walking & sitting, lying down & kicking & twisting that people in my jail cell thought I was a crazy man until they wore off. Some were literally scared of me, & I’m a scrawny, skinny, white guy with no tattoos or scary looks about me. NOTHING about me says “you should be afraid to mess with me”, yet they were like “WHOA!!! This guy is NUTS! Stay away from him!” Then I had a doc in jail give me 3 meds that I knew NOTHING about at that time, but I rolled over & went to sleep after 5 days of methadone w/d’s. Guess what they were? 1) Valium 10mg (got rid of the leg problems & depressed my system that was running at super-high speed; 2) Lomotil 5mg diphenoxylate/.050 atropine – which is 2 tabs – (contains an opioid that DOES cross the blood-brain barrier, unlike Imodium, which is an opioid, but does not & therefore doesn’t control w/d’s or cause euphoria at all) for diarrhea & atropine to prevent abuse of it); & finally, Catapres (clonidine) .01mg for blood pressure, which is almost always given to heroin addicts in w/d’s b/c it’s the textbook “solution” docs learn if they learn anything about it in school. Clonidine may prevent a stroke if we get high blood pressure from w/d’s, but doc’s, PLEASE don’t be fooled – it does NOT make us feel any better whatsoever, I don’t care what the textbook says about how it identically suppresses certain activities in cells like heroin & therefore, helps us feel so much better. Now, at that time (1997), I knew NOTHING of Lomotil having opioid in it, or that Valium would suppress the leg kicking or help me sleep, etc, etc. But within 5 mins (on an empty stomach), I rolled over & fell asleep. No other time has that happened b/c no other time have I been given anything but clonidine, Phenergan, Elavil, Sinequan, Bentyl, Vistaril, & meds like these, which even before I knew better than to take them, they made me almost crazy during w/d’s. Now I know – I refuse ANY anti-histamine or tri-cyclic antidepressant in w/d’s, & if I have to, I have told them once that I was withdrawal also from alcohol so they’d dose me on a small decreasing dose of Librium or Ativan to calm the kicking & help me sleep. I won’t say I recommend lying, but I don’t feel bad about helping myself not be put through absolute HELL for no reason at all other than a doc who thought I was a bad person b/c I passed a fake script to try to not be sick & so I could go to work without having to call in & say I was too sick to work & make my bill money that day. If I could have gotten them any other way than that where I was, I would have. But I did the ONLY thing I could do. There was NO Suboxone at that time, & no clinic less than 2 hours in any direction at that time, either. There are now, thank goodness for those who live there. But they’re STILL an hour away, no matter which direction you go.

    This man makes other points I’d like to touch on, but I’ve said so much already that for now at least, I’ll leave it at this.

    Reply

  5. Posted by Joe L. on August 14, 2015 at 5:38 am

    Hello Dr.
    My name is Joe. I’ve been a follower of your blog for some months now and have almost finished “chasing The Scream” because you recommended it here. The information and ideology in this book is so important that I’m very sad it’s Mr. Hari disseminating the information. As a discredited, proven plagiarizing liar it’s easy to discount all the information in the book, though I think most of it is sound. There is plenty that is questionable, some outright wrong “…tobacco cigarettes are considerably more addictive than menthol cigarettes…”(p. 201) (Where the hell did he get that!?)
    It’s just really unfortunate. I also find too much of his editorializing in the work instead of a cleaner presentation of facts. Ultimately I believe in the goals of the book and am hopeful for the future; it’s just with Hari as the mouthpiece feels like steps backwards.It’s almost as bad as having Stephen Glass, formerly of The New Republic espousing these ideas. Just makes me question all his sources and interviews. I hope someone more reputable steps forward to take his place. Hari & his unfortunate history is no threat to the status quo.
    I do however love this blog, Dr Burson. I am a heroin addict currently in Methadone treatment here in the People’s Republic of Seattle. You & the important work you do in the ultra right wing bible infested south (I lived in VA & NC for over 12 years) are truly on the front lines. I have family in southern VA and would wager you are probably the closest MAT clinic to where they live, so if I can rectify my estrangement & visit them for any amount of time, I bet I may wind up visiting your clinic at some point in the future. Thank you for the work you do and this blog.
    Joe L.

    Reply

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