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Drugs, Addiction, and Anti-Vice Activism: An Interview with David Courtwright

David Courtwright is a Presidential Professor Emeritus at the University of North Florida. He specializes in drug history, and is the author of the books such as Forces of Habit: Drugs and the Making of the Modern World, Dark Paradise: A History of Opiate Addiction in America. His most recent book, The Age of Addiction: How Bad Habits Became Big Business examines the link between corporate enterprises and the myriad forms of addiction plaguing the modern world.

Tucker Wilke: One theme in Forces of Habit is that drugs have long been a point of clash between economic forces and health and safety concerns. How has that conflict played out for a drug such as tobacco?

David Courtwright: Well, for most of history, it’s not about health and safety, it’s about money and power. Initially, drugs like tobacco do draw opposition from people who are horrified by the recreational use of these substances, but over time they become big money makers. They then  become tied into plantation agriculture and slavery, which are the means of raising revenue for overseas colonies. Essentially, in the 16th, 17th, 18th centuries, these plant drugs became global commodities, which trumped health and safety concerns.

Then, in the late 19th and the early 20th century, there were numerous technological refinements that made these drugs more potent and addictive. That’s really what happens with tobacco. Imagine someone smoking an occasional pipe of tobacco in the 17th century — sure, it’s not good for them, but compare it to smoking two packs of mass-produced cigarettes made with flue-cured tobacco in the 1920s. People realized for a long time that there were harms associated with tobacco, but it was when the morbidity and mortality associated with tobacco consumption became overwhelmingly obvious that policy started to shift. Thinking counterfactually, had the technology not changed and the harms not escalated, I don’t think we would have had this global campaign against combustible tobacco products. 

TW: How did alcohol seemingly avoid that global campaign?

DC: Well, let’s not forget, there was a global war against alcohol. Many nations, not just the United States, experimented with prohibition in the 1910s and the 1920s. One of the reasons is that alcohol became more dangerous, since it became very easy to produce oceans of cheap gin and other spirits. That was a problem in industrialized nations and in colonies where cheap gin was used as a trade good or as barter with indigenous populations. The late 19th century is also the age of medical statistics. It’s when people really start to understand the basic principles of epidemiology and they start calculating social costs, and they become much more aware of problems associated with these increasingly potent and increasingly cheap drugs.

These are significant changes, and they’re one of the reasons why there is this window of what I call “global anti-vice activism” in the late 19th and the early 20th centuries. There were, however, powerful countervailing corporate interests causing a long struggle which, in the case of Prohibition, eventually ended with more or less triumph of multinational alcohol industries. And now, personally, I think that alcohol is one of the most underregulated and undertaxed of all of the major psychoactive substances. 

TW: Who led this movement of global anti-vice activism?

DC: This push in the late 19th and the early 20th centuries to more strictly regulate or in some cases even prohibit certain kinds of drug use, comes from two places. First, it comes from religious people, especially protestant missionaries who are appalled by what they saw in China and in other parts of the world where native peoples are becoming heavily dependent on opium, and on imported alcohol. They see it as an impediment to God’s work. They want to win souls for Christ, and opium and alcohol are in the way. 

There are also people who are indifferent, if not hostile to religion, who are secular scientists and physicians who understand that these are toxic substances that have deleterious effects on individual and social health. Many of these people are also in favor of more regulation and in some cases even prohibition. It’s important to remember that in addition to changing drugs, technological advancements from the industrial revolution also created a very different public health environment. It’s one thing for somebody to have a drunken cousin who’s sort of stumbling around a field somewhere. It’s another thing to have a drunken railroad brake man or a drunken railroad engineer. For those reasons, certain types of corporations supported regulation and prohibition. 

The trick that the drug industry works is it makes people think that the impulse for prohibition comes exclusively from religious fanatics. If you look at political cartoons from the 1930s and the 1940s that harken back to the days of Prohibition, the stereotype of the prohibitionist is some guy who’s dressed like a Puritan at Thanksgiving. In reality, you had everyone from Mahatma Gandhi to protestant missionaries to European scientists all finding common ground when talking about the dangers of cheap spirits, morphine addiction, and tobacco. The PR people who work for these drug companies are very clever in rewriting the history so that it appears to be just this sort of epiphenomenon of religious fanaticism. In the case of alcohol, we turned them back in the 1930s and didn’t let them come back again. It’s a very clever mischaracterization of what was a strange bedfellows kind of movement. 

TW: In The Age of Addiction, you expand your discussion beyond just drugs. One phrase that plays a central role is “limbic capitalism.” What does that refer to?

DC: Limbic capitalism is shorthand for a very sophisticated system that taps into the limbic region of your brain, which deals with many important things including long-term memory, motivation, and pleasure. It’s critical for your survival, but paradoxically, it’s now possible to commercially exploit that part of your brain in ways that are detrimental to your survival. In The Age of Addiction, I do an analysis of how many people have recently died in wars or through homicide, and how many people have died prematurely due to diseases that can be tied in one way or another to overeating, or drug use, or drinking too much, smoking, or similar causes. The ratio is about 30 to one. The real killers remain the products of limbic capitalism. 

TW: What makes limbic capitalism so dangerous?

DC: Well, there’s another very important term in the book: hormesis. Hormesis is a medical term that refers to substances that are benign or beneficial if you consume just a little bit of them, but become toxic if you consume a lot of them on a regular basis. In the book, I show that this is true not only of drugs, but of other behaviors or products that are drug-like in their effects, such as food addiction, gambling, or computer games. The logic of limbic capitalism is that by conditioning the limbic region of your brain and by making the behavior habitual, they get you to be a dependent, daily user of substance which if used sparingly and intermittently may in fact be good for you, but if used on a daily, heavy basis is the opposite. That’s why you get so much morbidity and mortality from this. 

That’s why we really need to think beyond drugs. We need to think about products that produce the burst release of dopamine in our brains and that, if we do that often enough, permanently alter neural structures in ways that lead us to heavy consumption, and in some cases, not all cases, but in some cases, outright addiction. 

TW: Some of these examples, such as gambling, have been considered addictive for a while. What has limbic capitalism done to make them a more urgent problem?

DC: I make essentially two arguments about gambling in terms of the larger global picture. One is that gambling became even more seductive when it was mechanized and now digitized. So it becomes easier and faster for people to gamble when you have something like slot machines. Now that it’s digitized, you can place a bet in the middle of a football game on whether the next play is going to result in a first down or not. There’s actual real-time betting, which is more and more seductive.

The second thing I came to realize is that it’s a mistake, historically and sociologically, to talk about something like gambling and its development by itself because a lot of gambling, from the 17th century on, has occurred in casinos. Casinos now have banks of blinking digitized slot machines, video poker, very expensive booze, they have discos, exotic entertainment, and easy access to drugs. This creates an intensified blending of seductive pleasures. It’s not just that gambling is now more seductive and more high tech, it’s that the whole Las Vegas experience is  this package of pleasures which is designed to draw in people who wouldn’t have been found dead in a casino a hundred years ago. 

TW: Your book also discusses internet usage and computer games, which are not traditionally thought of as addictive in the way that drugs and gambling are. Why do they fall under limbic capitalism?

DC: Well, they fall under limbic capitalism in the sense that people who are into these games are experiencing the release of dopamine. These games provide reward in the primitive neural substrates of the brain. That’s not to say they’re necessarily addictive, and not everybody who plays video games is addicted. To me, addiction is the endpoint of a spectrum, often defined by compulsion, a loss of control, regular heavy use, and harm to the individual and others. Unless you have those elements, I don’t think you want to call it addiction, and it’s silly to say that somebody who occasionally plays a video game is necessarily harming themselves or they’re doing anything other than enjoying an innocent pastime. 

The problem here is that you can’t make a lot of money from people who only occasionally use your product in relatively benign ways. This is based on the “Pareto” distribution from economics, which suggests that for most commodities there’s the significant few and the trivial many.  So with alcohol, you’ve got a relatively small percentage of drinkers who account for 80% of the consumption. If a corporation is going to make money, they need to move people in the direction of those dependent daily users because that’s where the profit is centered. Given the inherent nature of the products, some of those regulars are going to become addicts and they’re going to do harm to themselves and others. These companies, of course, are all aware of the addictive potential of these products, and I think in many cases they design the products to encourage heavy regular use. Look at what the recent Facebook whistleblower said – their model is to get the users hooked while they’re young, so that they’ll have them for life. 

TW: That’s a pretty grim picture. Do you see any way out of this?

DC: If you look around the world, there have been on both the left and the right people who have and are willing to fight back. 

I think the strongest inclination to fight back comes from nationalist groups, which is why I think it’s incredibly significant that China is starting to try to crack down on digital addictions. The Chinese government is now trying to limit the number of hours children can spend playing these computer games so they don’t interfere with their studies. They’re not kidding when they call it the opium of the mind. It looks a lot to me like the strong nationalist reaction against the opium trade in late Qing China and early Republican China, where the anti-opium cause was bound up in the desire for Chinese Independence, return of Chinese National sovereignty, and glory. I see that again in this incipient antilimbic capitalist movement in China. 

So it’s important to remember that history is not linear, and public policy is not linear. Even in the United States, it’s possible that people will rise up to regulate enterprises like Facebook. This is a really fascinating conversation because I think it’s happening right now. One of the very few things that both parties agree on in Congress is that we should have more regulation of the tech sector. We could be moving in that direction.

*This interview has been edited for length and clarity.