NO BAD DRUGS

The Arbitrary Distinctions at the Root of Prohibition

High Society: How Substance Abuse Ravages America and What to Do About It,
by Joseph A. Califano Jr., New York: Public Affairs, 270 pages, $26.95

The Cult of Pharmacology: How America Became the World's Most Troubled Drug
Culture, by Richard DeGrandpre, Durham, N.C.: Duke University Press, 294
pages, $24.95

On the opening page of High Society, which aims to explain "how substance
abuse ravages America," Joseph Califano declares that "chemistry is chasing
Christianity as the nation's largest religion." Although it is not always
easy to decipher Califano's meaning in this overwrought, carelessly
written, weakly documented, self-contradictory, and deeply misleading
anti-drug screed, here he seems to be saying that opiates are the religion
of the masses. Americans, he implies, are seeking from psychoactive
substances the solace they used to obtain from faith in God, and better
living through chemistry is nearly as popular as better living through Christ.

That claim, like many Califano makes, is unverifiable, and it does not seem
very plausible.

Americans may be less religious than they used to be, but large majorities
still say they believe in God and identify with specific faiths, making the
U.S. much more religious than other Western countries, which tend to have
substantially lower drug use rates.

Although Americans have a bewildering array of psychiatric medications to
choose from nowadays (with permission from a doctor), they smoke a lot less
than they did in the 1960s and drink less than they did a century ago, when
they also could freely purchase patent medicines containing opium, cocaine,
and cannabis.

If the devout are less inclined than the doubters to use mood-altering
drugs, how is it that mostly Mormon Utah leads the country in
antidepressant prescriptions? And if chemistry and Christianity are locked
in competition, what are we to make of Jesus' water-into-wine miracle, or
of the Native American Church, Uniao do Vegetal, and other groups that
combine Christianity with psychedelic sacraments?

Already I have put more thought into the alleged connection between
faithlessness and drug use than Califano did. And so it is with the rest of
the book. A proper debunking would require more than the 186 pages of text
that Califano, a domestic policy adviser to Lyndon Johnson and secretary of
health, education, and welfare in the Carter administration, squeezes out
of conversations with politicians and old reports from the Center on
Addiction and Substance Abuse (CASA), the prohibitionist propaganda mill he
founded and heads.

Although CASA brags about its affiliation with Columbia University, the
school has less cause to be proud of that relationship, given the center's
sloppy research and hyperbolic rhetoric.

In a 2002 report that attracted wide publicity, CASA issued "a clarion call
for national mobilization" against "America's underage drinking epidemic,"
claiming that "Children Drink 25 Percent of Alcohol Consumed in the U.S."
Not only did these "children" include 18-to-20-year-olds (a.k.a. "adults"),
but it turned out CASA's estimate was off by a factor of more than two.

Yet Califano is worth taking seriously.

He is a leading exemplar of the moralistic pseudoscience that Richard
DeGrandpre dissects in The Cult of Pharmacology, an insightful,
historically informed critique of the ideas that guide the war on drugs.

DeGrandpre, an independent scholar with a Ph.D. in psychopharmacology and a
former fellow at the National Institute on Drug Abuse, decries "the modern
mythologizing of drugs as angels and demons" that underlies our
"bewildering and often brutal differential system of prohibition."
Califano, by contrast, is committed to defending the arbitrary distinctions
built into our drug laws.

Califano, who since his time in the Carter administration has railed
against cigarettes with all the zeal you'd expect from a former
three-pack-a-day smoker, is perceptive enough to recognize that legal drugs
are not necessarily angels.

When he talks about the promiscuous use of stimulants to control
inattentive, unruly schoolchildren or the routine prescription of
mood-altering drugs to smooth "the changing moods that mark human nature,"
he sounds a bit like DeGrandpre, who wrote a book called Ritalin Nation and
is unsparing in his criticism of the psychiatric profession and the
pharmaceutical industry.

What Califano fails to understand is that every drug, regardless of its
current legal status, is potentially an angel or a demon. DeGrandpre builds
upon the insights of the alternative medicine guru Andrew Weil, who first
made his name with books about drugs and altered states of consciousness.
"Any drug can be used successfully, no matter how bad its reputation, and
any drug can be abused, no matter how accepted it is," Weil wrote in his
1983 book From Chocolate to Morphine (co-authored by Winifred Rosen).
"There are no good or bad drugs; there are only good and bad relationships
with drugs." While Califano acknowledges the importance of context in
determining what constitutes abuse of alcohol and prescription drugs, he
insists that any use of currently illegal drugs is abuse by definition.
"Drugs are not dangerous because they are illegal," he says. "They are
illegal because they are dangerous."

This line, popular among drug warriors, misconstrues an argument against
prohibition. The point is not that prohibition causes all the hazards
associated with drug use but that it compounds those hazards by exposing
users to the unreliable quality, unpredictable doses, and violence of the
black market (not to mention the risk of arrest). Leaving aside the
question of how prohibition makes matters worse, it is untenable to argue
that illegal drugs are uniquely dangerous, since every potential problem
they pose is also posed by alcohol, a substance that Califano says he does
not want to ban.

The argument that drugs "are illegal because they are dangerous" is
especially hard to make with respect to marijuana, which is by far the most
popular illegal intoxicant, one that half of American adults born after
World War II have tried.

The worst risk that marijuana smokers face is getting arrested, a fact
Califano tries to obscure through the time-honored prohibitionist tactics
of focusing on children, conflating correlation with causation, and
obscuring the distinction between short-term and long-term effects.

In the 1980s, Califano says, "we seemed to discover" (an odd but
appropriate way of putting it) "that marijuana might not be as benign as
kids and permissive parents thought." How could smoking pot be no big deal
in the '60s and '70s, when the baby boomers were in high school and
college, then suddenly become a big deal in the '80s and '90s, when their
children were? Might this shift reflect the natural tendency of parents to
be alarmed by their children's rebellious behavior, even when it's no worse
than what they themselves did without regret as teenagers?

Of course not. Califano wants parents to know there's a firm scientific
basis for their hypocrisy. "Today's teens' pot is not their parents' pot,"
he explains. "It is far more potent....The average levels of THC jumped
from less than 1 percent in the mid-1970s to more than 7 percent in 2005."
Since the potency threshold for distinguishing cannabis from a placebo in
experiments is roughly 1 percent, Califano is in effect asserting that
people who smoked pot in the '60s and '70s generally did not get high as a
result.

If so, it's hard to fathom how "pot was becoming the hottest high on
college campuses" by the end of the '60s, as Califano reports elsewhere in
the book. In fact, as sociologist Lynn Zimmer and pharmacologist John P.
Morgan show in their 1997 book Marijuana Myths, Marijuana Facts, claims
that Mom and Dad's pot was indistinguishable from ditchweed are based on
low-quality, nonrepresentative samples that probably lost their THC content
while in storage.

Even if average THC content has not risen seven-fold (or 30-fold, as drug
czar John Walters claimed in 2002), it no doubt has increased significantly
as marijuana growers, especially indoor growers in the U.S., have learned
to produce a better product.

The average THC concentration of seized cannabis tested by the University
of Mississippi's Potency Monitoring Project (which relies on "convenience"
samples that are not necessarily representative of the national supply)
more than doubled between 1983 and 2006, from a bit under 4 percent to 8.5
percent.

But the stronger pot is, the less people tend to smoke.

Since the possible respiratory effects of smoking are the most serious
health risk associated with marijuana, higher THC content makes marijuana
less dangerous, not more so.

But "today's marijuana is addictive," Califano says, warning that "10
percent of those who try it will get hooked at some point in their lives."
Even taking that number at face value, it is about one-third lower than the
lifetime addiction rate for alcohol, based on data from the National
Comorbidity Survey.

Implicitly conceding that cannabis itself is not very dangerous, Califano
makes much of marijuana's status as a "gateway drug," a substance that
people tend to try before they use other illegal intoxicants. According to
a CASA analysis of survey data from the early 1990s, he reports, "twelve-to
seventeen-year-old children who used marijuana were eighty-five times more
likely...to use cocaine."

That impressive-sounding "risk ratio" reflects the fact that people very
rarely use cocaine without trying marijuana first.

Although he repeatedly cites such numbers as a reason to prevent people
from trying marijuana, Califano concedes that "gateway statistical
relationships do not necessarily establish causality," and he quotes the
Institute of Medicine's take on the issue, which does not suggest that
marijuana pharmacologically causes people to seek "harder" drugs: "People
who enjoy the effects of marijuana are, logically, more likely to be
willing to try other mood-altering drugs than are people who are not
willing to try marijuana or who dislike its effects. In other words, many
of the factors associated with a willingness to use marijuana are,
presumably, the same as those associated with a willingness to use other
drugs."

Perhaps sensing that the gateway argument is not generating enough alarm,
Califano warns that marijuana "adversely affects short-term memory, the
ability to concentrate, emotional development, and motor skills." By
throwing in "emotional development," he falsely implies that the memory,
concentration, and motor skill impairments, which are short-term effects of
intoxication, are permanent disabilities caused by smoking one joint too many.

Speaking of old prohibitionist tricks, Califano is not above scare tactics
reminiscent of the "reefer madness" claims that Federal Bureau of Narcotics
Director Harry J. Anslinger promoted in the 1930s. "Recent studies indicate
that marijuana use increases the likelihood of depression, schizophrenia,
and other serious mental health problems," Califano writes.

These studies do not show that smoking pot makes you crazy; they show that
people who smoke pot, especially if they do so at early ages and in large
amounts, are more likely to have "serious mental health problems." In other
words, these studies find associations, which, as Califano notes vis-a-vis
the data on gateway drugs, "do not necessarily establish causality." It
could be that people with psychological problems are especially attracted
to marijuana because it makes them feel better, or because they tend to act
out or take risks; early use of marijuana could be a marker for
psychological problems rather than a cause of them.

Having failed to explain why people should be arrested for producing,
selling, and possessing marijuana when they are free to produce, sell, and
possess alcoholic beverages, Califano goes on to note that all those
arrests (about 830,000 in 2006 alone) don't seem to have accomplished much.
"From 1993 to 2005," he writes, "a 107 percent increase in marijuana
arrests was accompanied by a 100 percent increase in marijuana users."
Califano concludes that "something more is needed": harsher penalties,
mandatory anti-drug classes, and forced "treatment" for pot smokers.

More generally, although he claims to be recommending a "dramatic shift,"
even a "revolution," in drug policy, Califano actually wants to maintain
the status quo, except with more drug treatment and better anti-drug
classes. (He correctly notes that DARE, the most popular such program in
American schools, "has been repeatedly found worthless.") Califano wants to
force "treatment" on people who use politically incorrect intoxicants even
though he concedes "there have been few independent systematic evaluations
of substance abuse treatment effectiveness." The techniques that have not
been proven effective through rigorous independent evaluations include the
religiously oriented 12-step programs that Califano nevertheless wants to
compel drug users to attend.

While Califano seems to favor mandatory treatment rather than jail for drug
users, he says people "who dealt drugs but didn't use them belong in
prison--and for a long time." Contrary to conventional wisdom in the drug
business, then, it may be a good idea to sample your own product, so you
can benefit from Califano's curiously compartmentalized compassion.

Lest you think that Califano, a big-spending liberal Democrat, favors
unproven demand-side measures at the expense of futile supply-side
measures, he can also sound like the most clueless get-tough Republican,
confident that we can seal our borders against the flow of drugs Americans
want if only we put our minds to it. "We must mount a far more effective
effort to block entry of illegal drugs into the United States and to
eliminate production within the country," he writes. "This under-taking
demands the kind of attention we have committed to keeping chemical,
biological, and nuclear weapons out of our nation.

Marijuana, cocaine, heroin, Ecstasy, and other illegal drugs have
demonstrated a far deadlier capability for mass destruction."

Califano, who worries that "sensational media coverage" causes "popular
concerns and parental fears about substance abuse" to "ricochet from drug
to drug," does not exactly strive for a restrained tone himself.

Blaming cocaine for inciting "paranoia and violence," he says the smokable
version "flooded inner-city neighborhoods and kicked off a harrowing
crack-related crime tsunami." To support this claim, he cites page 245 of
Paul Gahlinger's Illegal Drugs: A Complete Guide to Their History,
Chemistry, Use, and Abuse. But Gahlinger says nothing about a "harrowing
crack-related crime tsunami."

As DeGrandpre notes in The Cult of Pharmacology, Califano's image of
crack-crazed criminals was debunked more than a decade ago by the U.S.
Sentencing Commission. "The media and public fears of a direct causal
relation between crack and other crimes do not seem to be confirmed by
empirical data," the commission said in 1995. "Studies report that neither
powder nor crack cocaine excite users to commit criminal acts and that the
stereotype of a drug-crazed addict committing heinous crimes is not true
for either form of cocaine." So-called crack-related violence was in fact
prohibition-related violence, arising from conflicts among black-market
participants.

Other Califano claims are absurd on their face. In his lexicon, if a single
teenager reports seeing a fellow student buy, use, or possess alcohol or
other drugs at his school, that is enough to render the school
"drug-infested." In a 1999 report CASA said "teens who smoke marijuana are
playing a dangerous game of Russian roulette," an activity in which there
is a one-in-six chance of instant death on each turn. Three years later it
likened underage drinking to "a deadly round of Russian roulette."

In High Society, Califano trots out the metaphor for another purpose.
"Russian roulette is not a game anyone should play," he informs readers,
just in case they were considering it as an alternative to checkers.
"Legalizing drugs not only is playing Russian roulette with children; it is
also slipping a couple of extra bullets into the chamber." Meaning that if
drug prohibition were repealed, half of America's children would die?

Califano is on even shakier ground when he suggests that the classical
liberal philosopher John Stuart Mill would have approved of drug
prohibition, since "Mill's conception of freedom does not extend to the
right of individuals to enslave themselves," and "drug addiction is a form
of enslavement." We can be pretty sure Mill would not have endorsed drug
prohibition on this ground, since he didn't. In fact, he vigorously opposed
alcohol prohibition as a clear violation of individual liberty.

But maybe Mill was wrong.

Could drug addiction really be a form of slavery? According to Califano,
it's actually a "chronic, relapsing disease" similar to "diabetes or high
blood pressure." Which is not to say that it's strictly a biochemical
phenomenon. Addiction research, Califano says, "is also psychological,
emotional, and spiritual research, since this complex disease has elements
of dysfunction in all these areas." Califano's fondness for Alcoholics
Anonymous and likeminded groups makes sense, since he, like them, views
drug abuse as a medical problem with a spiritual solution.

Does it matter that Califano chooses to call drug abuse a disease?

I think it does, since a disease is something that happens to people, not
something that they do. It follows that the choices made by people whom
others identify as addicts need not be respected, since they are not really
choices at all. DeGrandpre quotes Alan Leshner, a former director of the
National Institute on Drug Abuse, who declares "Addiction is not a
voluntary circumstance. It's not a voluntary behavior. It's more than just
a lot of drug use. It's actually a different state...a state of compulsive,
uncontrolled drug use."

DeGrandpre doesn't buy it. "The vast literature on careers in drug use
flatly contradicts this perspective," he writes in The Cult of
Pharmacology. He summarizes that literature, showing that addicts commonly
drift into and out of heavy use, stop or moderate their consumption on
their own, and "mature out" of supposedly permanent addictions. Even the
animal experiments prohibitionists cite to demonstrate the irresistible
power of certain chemicals, DeGrandpre notes, actually show that drug use
is "sensitive to the context in which it occurs." When lab animals are kept
in stimulating environments along with other animals, they are much less
inclined to consume drugs than when they are isolated in boring
environments and hooked up to a catheter.

Human drug use shows even more variation.

A patient in pain or a soldier at war can use a strong narcotic for
particular reasons and give it up without much trouble once those reasons
no longer apply.

A happy person can take or leave the same drug that a miserable person
turns to every day. A person who uses a drug to excess during an especially
troubled period may find that he can use it in moderation after his
situation improves.

Given these differences, it makes little sense to talk about a drug's
"addictiveness" as if it were a chemical property. "Used for different
reasons, taken in different forms, and at different doses, the same drug
can serve dramatically different ends," DeGrandpre observes. "Drugs, their
users, and the context of use all come together to produce drug outcomes."

Since expectations affect the drug user's experience, DeGrandpre
provocatively but plausibly argues, the belief that a substance is
powerfully addictive can become a self-fulfilling prophecy. "The massive
use of opiates in the nineteenth century did not translate into widespread
dependence and addiction," he notes, but that was before opiates,
especially heroin, acquired a reputation as irresistible and inescapable.
He suggests this "placebo script," together with prohibition and the
concomitant shift in the user population from middle-class women to young
men at the margins of society, made opiates look more addictive.

Likewise, says DeGrandpre, exaggerating the power of nicotine (as Califano
routinely does) "teaches [smokers] that it is impossible to quit."

DeGrandpre persuasively debunks "the two core ideas of the disease model:
that use leads inevitably to addiction and that addiction, without
'treatment,' guarantees lifelong use." But those two ideas can be
separated, as illustrated by the history of thinking about alcohol abuse.

As the sociologist Harry G. Levine noted in a 1978 Journal of Studies on
Alcohol article, "the idea that drugs are inherently addicting was first
systematically worked out for alcohol and then extended to other
substances. Long before opium was popularly accepted as addicting, alcohol
was so regarded." This was the idea that drove the temperance movement's
transition from moderation enforced by self-discipline to abstinence
enforced by law: If alcohol was inherently addicting, voluntary temperance
was a dangerous illusion.

After the repeal of Prohibition, the view of alcoholism as a disease caused
by alcohol gave way to a view of alcoholism as a condition that makes it
impossible for certain susceptible individuals to drink moderately.
Whatever its scientific weaknesses, this A.A.-promoted version of the
disease model does not demand abstinence from all and is therefore much
more compatible with a legal market in alcoholic beverages than the earlier
versions.

Califano seems to accept the A.A. model of alcoholism, which concedes that
most people are capable of drinking moderately. While "Just Say No" is the
message children should receive with regard to illegal drugs, he says, "The
message for alcohol use is more complex: No for children and teens,
moderation for adults." He never explains why "moderation for adults" is
not a valid approach to, say, marijuana.

The belief that certain drugs are irredeemably evil and that the current
version of the Controlled Substances Act has inerrantly identified them
betrays a lack of historical understanding. Heroin originally was sold as a
substitute for codeine and a cure for "morphinism." Cocaine was touted by
Sigmund Freud as a nonaddictive all-purpose tonic.

After these drugs were demonized, DeGrandpre notes, psychoactive
pharmaceuticals such as meprobramate (Miltown), amphetamines (Benzedrine,
Dexedrine, Methedrine), barbiturates (Ambutal, Nembutal, Seconal),
methaqualone (Quaalude), and the benzodiazepines (Librium, Valium, Xanax,
Ativan, Halcion) followed "the same cycle of medical hype, vast nonmedical
use, and new and 'unexpected' problems of dependency." DeGrandpre argues
that SSRI antidepressants such as Prozac are undergoing a similar
re-examination.

The government's own legal distinctions belie the idea that drugs can be
neatly separated into good and bad categories. "Even methamphetamine,
[which] drug czar Barry McCaffrey called 'the worst drug to ever hit
America,' was dispensed to children by prescription until the end of the
century," DeGrandpre notes.

Children diagnosed with attention deficit disorder (ADD) continue to
receive Ritalin, a drug whose pharmacological action is very similar to
cocaine's, as teenagers who crush and snort their friends' prescription
pills have discovered. "If Ritalin could legally be given to millions of
American children despite the fact that its effects were indistinguishable
from cocaine['s] when taken in comparable doses and via the same route of
drug administration, then popular and scientific beliefs concerning these
two drugs in the twentieth century were nonsensical," DeGrandpre writes.
"Either cocaine is not the inherent demon drug it was made out to be, or
Ritalin is incorrigibly evil and corrupting."

The story of pharmaceutical fashions that DeGrandpre tells highlights a
fact that the psychiatric iconoclast Thomas Szasz has long emphasized: Drug
prohibition is built on a foundation of mandatory prescriptions. Although
Califano seems to believe Ritalin is overprescribed, he presumably would
say that giving it to a child based on a valid ADD diagnosis is a
legitimate use, while snorting it for fun is not. Likewise, amphetamines
can legally be used with a doctor's prescription to treat obesity, relieve
depression, and keep narcoleptics and military pilots awake.

But in the government's view (and therefore in Califano's view), if people
use amphetamines on their own for essentially the same purposes--to lose
weight, boost their moods, or stay alert--they are guilty of drug abuse
(although I guess that was not true until 1954, when prescriptions were
first required for amphetamines). In such cases, the difference between use
and abuse lies not in the drug's chemical structure or even in the user's
goal. What matters is the spell scrawled by a government-appointed medicine
man who can transform demons into angels with the stroke of a pen.

Senior Editor Jacob Sullum is the author of Saying Yes: In Defense of Drug
Use (Tarcher/Penguin).