| Contents | Previous | Next |
The need to escape life's hardships has always been a human tendency, and so have drags.
One of the first recorded notations about the alcoholic syndrome was in the sixth century B.C. It was written that Cambyses, King of Persia, had man's oldest affliction. He was said to have been extremely cruel, and some accounts say he died by his own hand.
Diodorus Siclus, a Greek historian in 20 B.C., chastised the Gauls in writing for their excessive drinking. Another Roman author, Pliny, wrote in the first century a description of an alcoholic: "Pallor, pendulous cheeks, bloodshot eyes, tremulous hands which spill the full cup...sleep disturbed by the furies, the habit of drinking increases the appetite for it."
Beer was first made in Egypt around 3000 B.C. Winemaking formulas were recorded in Italy almost a century and a half B.C. The process of distillation was developed by an Arabian alchemist by the name of Rhazes about 800 A.D., and so the fall spectrum of alcoholic beverages was able to be experienced. People of many early cultures, including Egyptians, Greeks and Romans, made excessive use of alcohol.
By the Middle Ages, alcohol was used as a medicine. It was an antiseptic and an anesthetic and sometimes combined with other ingredients to make salves and tonics.
Homer mentioned opium in the ninth century B.C., as long as alcohol has been around. Availability leads to the selection of the drug of choice: hashish and marijuana from the cannibas in India, opium from the poppy in China, and cocaine from the coca leaf in the Peruvian Andes.
There are cultural favorites for intoxicating agents. The Irish like alcohol, the French and Italians like wine, and the Germans love beer.
Each culture has its own customs. The Orthodox Jewish family serves a sweet wine to all members of the family, particularly during ceremonies of religious holidays. A German child knows the taste of beer because it is served at meals and on social occasions. The Italian child is comfortable with wine as a food and accepts it as a social beverage rather than a drug for special effects.
In France, there are no controls on excessive drinking. Drinking in France, as in Ireland, is a matter of social obligation. A refusal to drink is an insult. A Frenchman may start drinking early in the morning and continue all day. So alcoholism is a problem.
Alcoholism is also a problem with the Irish. Drunkenness is tolerated and is a masculine thing to do. The Irish solve all problems by reaching for the bottle and think of alcohol as a health stimulant.
In cultures where there are low rates of alcoholism, the children are introduced to it gradually in small, diluted amounts on special occasions. Muslims and Mormons forbid the taking of drugs, so there is no problem of that kind in their culture.
Peru, a leading producer of the coca leaf, the raw material from which cocaine is obtained, has been economically hooked on the one-billion-dollar-a-year trade for years, but addiction by the populace to the drug is a relatively new phenomenon.
"Prolonged recession, widespread poverty and discrimination against Indians drive many Peruvians to drugs," said Maritza Rojas, head of the private Center of Information and Education for the Prevention of Drug Abuse (World News, June 1994). This center is financed by the U.S. Agency for International Development and deals with addiction to a wide range of drugs.
The histories of addicts at this center are similar. As children, they smoked marijuana with friends, then looked for stronger sensations in PBC (pasta basica de cocaine), which diminishes the appetite, takes away all notion of time, and eventually impairs speech and brain functions. PBC resembles crack, it is cheap and about 40 percent of male Peruvians have tried it. It costs 45 cents a cigarette. That is enough for a brief high. Many addicts smoke dozens of cigarettes a day, forcing the men to steal and the women to become prostitutes in order to support their habits.
As the cocaine consumption is declining and overproduction drives prices down, more cocaine will be dumped on the local market and the addiction rate will soar.
Meanwhile, under a bridge in an area of Lima called Amazonas, three filthy human wrecks sit smoking and staring wildly at nothing. "They're too far gone to even try rehabilitation," said a man who used to smoke with them, "they are just waiting to die."
It's hard to be a substance abuser if:
Social attitudes toward drinking pass from parents to children. When the rules are clear and widely agreed upon, when drunkenness is not tolerated, substance abuse is not a problem.
Attitudes and beliefs regarding drugs are interwoven with cultural themes and lifestyles. Availability of the substance leads to the selection and development of customs that control its use.
America is a mixture of cultures, and the social view of substance abuse has changed over the years. Alcohol came to America with the colonists. Spanish missionaries brought grapevines, and winemaking was begun in California before the United States was a nation. Staten Island, New York was the site of the first distillery in the 1600s.
In the 17th and 18th centuries when men and women shared the hardships of the new world, alcohol was viewed as a medicine and elixir, and it was consumed by all. Also, the manufacture of liquor was important to the economy of the new nation. Jamaican rum was introduced, and the Irish and Scottish settlers in Kentucky and West Virginia produced whiskey.
During the Revolutionary War, the government issued every soldier a ration of brandy, rum or whiskey. This was in part to encourage the men to fight.
Drinking was mainly considered a masculine activity. If a woman drank, it was in secret. If she drank in public, she was considered a fallen woman. Some women did run the saloons in the West, which were hangouts for lonely and angry men. Finally, the provision of a free lunch reintroduced the idea that drinking should be associated with eating.
In 1785, Dr. Benjamin Rush, a physician from Philadelphia, one of the signers of the Declaration of Independence and surgeon general of the army, made the blunt statement that alcohol was a disease.
At the same time, Dr. Thomas Trotter, a British physician, wrote, "In medical language, I consider drunkenness to be a disease produced by a remote cause, and giving birth to actions and movements in the living body that disorder the functions of health."
So some people in the health field had an inkling about addiction, but it wasn't shared with the general public. It would be almost 200 more years before the problem would be addressed as a medical one, and solutions sought.
Opium was available in America as early as 1800. But opium dens were thought of as somewhere far away, in Shanghai, on the other side of the world.
Morphine was popular as a pain reliever and, with the advent of the hypodermic needle, was administered by injection directly into the bloodstream; the effects were powerful. Its extensive use during the Civil War made many people aware of its addictive nature, but they didn't know what to do about it except to stop taking the drug. To many, that really wasn't an option.
Self-medicating with alcohol and patent medicines contributed to narcotic intake. Physicians were not knowledgeable about many illnesses and infections and eagerly sought to treat the patient's anxiety.
The attitude of most people at that time was directed at social management. Local laws against the sale of liquor and morphine were enacted. Manufacturers of patent medicines resisted the attempts to require them to list the ingredients of the medication on a label.
Publicity, early regulatory laws in many of the states, and mostly public opinion forced the cessation of the use of opiates and cocaine in medications. It was the notion that the evils connected with the abuse of alcohol and drugs could be controlled through legislation.
Medicine and druggists were in the pursuit of forming professional organizations when they were caught in the middle of the issue of narcotic control. Drugs were dispensed freely and frequently. Movements to restrict habit-forming drugs focused on alcohol. The Temperance Movement condemned excessive drinking. Political action accelerated and the only possible way to stop excessive drinking was to enact a prohibition law.
In 1919, Congress passed the Eighteenth Amendment, making it illegal to sell or manufacture alcoholic beverages. Prohibitionists believed that a law could change the habits of most people. This amendment remained in effect until 1933. When it was repealed, the problem of alcoholism was still there.
Prohibition did reduce the number of people addicted to alcohol. Critics of the prohibition amendment claim that it ushered in an era of excess, centered in speakeasies. Alcoholism was linked to gangsterism; the Mafia controlled the manufacture and selling of alcohol. It became a time of corruption and immorality. Drinking patterns changed. People went to the speakeasy to get drunk. It made the act of going there an exciting adventure.
The American Medical Association was founded in 1847. Pharmacists organized the American Pharmaceutical Association in 1852. Both these organizations joined together for the good of the public and lobbied for strict narcotic laws.
It was an uphill battle because the drug habit was part of American life. Lawyers and preachers took cocaine to be more relaxed when speaking and to be "more persuasive." Physicians were addicted to morphine, and men in the army and navy were increasing their use of opium because of contact with natives overseas.
In 1884, Sigmund Freud recommended cocaine as a "cure-all" drug. He endorsed it for digestive ailments, asthma problems and as a cure for morphine addiction. In 1887, Freud, in his paper "Craving For and Fear of Cocaine," denounced the drug as a "dangerous enemy to health."
In 1906, the Pure Food and Drug Act limited the use of cocaine in elixirs and medications. Also in 1906, Congress adopted a pharmacy act in which pharmacists had to be licensed. Drugs, including cocaine, opium and its derivatives could be given only by written order of a licensed practitioner, and prescriptions could not be refilled.
The Ham son Act of 1914 made it impossible for the addict to obtain drugs regularly from legitimate sources, and so illicit traffic sprouted up.
Maintenance clinics were established to "cure" the addict. The surgeon general said, "the medical profession has awakened to the fact that addiction cannot be controlled by will-power." He was convinced that no satisfactory medical treatment existed for drug addiction. The clinics were the subject of much controversy and were considered social menaces. "They merely dispense morphine at a profit."
There was no help for the 19th Century drunkard. The person who overindulged was regarded as a person who was immoral and persisted in anti social behavior. Many were locked up in jails, mental hospitals or private sanitariums. Protestant churches that supported the Temperance Movement set up missions "to save the poor soul."
The Salvation Army volunteers' slogan was "Soap, Soup, Salvation." They were kind and helpful, but the alcoholic was more to be pitied than anything.
In 1935, Bill Wilson, an alcoholic who had been hospitalized many times for the problem of alcoholism, spoke with Dr. Bob, also a struggling alcoholic. He shared with Dr. Bob the discovery that when the compulsion to drink came over him, he found it useful to talk to someone who understood the desire.
Together, they formed an organization in Akron, Ohio, which became known as the Fellowship of Alcoholic Anonymous. This group developed a Twelve-Step Program for recovery from alcohol dependence, and it was the most successful method to help alcoholics up to that time. Members maintained their motivation by helping others. Their belief was that "only an alcoholic can help an alcoholic." Anonymity was and is closely guarded.
After the Second World War, in the '40s, social views changed again. When the men came home, most people were ready to relax. Men gathered in taverns to swap "war stories." They consumed large quantities of manufactured hard liquor. The taverns were owned by businessmen who were more concerned with profits than deportment. They advertised "Happy Hour" late in the afternoon, and food was served. Drinks were half price.
American culture accepted the "Beer Busts." The armed forces had them every Wednesday for their troops. A six-pack of beer was taken to the noontime football game. "Pep pills could improve the performance of athletes by as much as 40 percent under some conditions." Most women took diet pills or tranquilizers, or both.
Because of a reported rise in addiction between 1947 and 1950, mandatory sentences were enforced for narcotic offenders. Sentences for some offenses were raised to five years for the first offense. A jury could impose the death penalty on anyone over the age of 18 who sold heroin to a minor. These sentences were condemned later.
In 1960, there was a rapid rise in drug use in Great Britain. Heroin replaced morphine as the drug of choice. A black market flourished and the youth were snared.
Marijuana was popular in the United States. The Flower Children lived in a state of sublime euphoria, "stoned," it was called. "Peace," "love," "music" were the passwords.
In 1962, the Supreme Court declared drug addiction to be a disease, not a crime. President Ronald Reagan borrowed from President Johnson's slogan, "War on Poverty" and declared "War on Drugs." Nancy Reagan said, "Just say no." Every school child knew the slogan, but still drug abuse rose. The War on Drugs was unsuccessful.
Outpatient clinics established in the mid-60s for methadone maintenance were viewed as a favorable way to treat heroin abuse. Even though methadone is addicting, it can be used to stabilize lifestyles for those who cooperate with the treatment program.
Social and cultural influences are essential elements in the creation of the American drug problem. Focusing on law enforcement actually made the problem worse. Half the people in our prisons are drug offenders. The cost of providing prisons and upkeep runs into billions of dollars, and the epidemic continues.
Public demand for action against drug abuse has led to confusing regulations, and the real problems are hidden and not addressed. Each minority group has its own drug of choice. Eliminating one drug would disrupt the social harmony.
Increased border patrols and custom inspections uncover large shipments of illegal drugs and prevent them from entering the mainstream. There is a constant outcry for more border patrols to catch the smugglers. On the other hand, focusing on law enforcement cuts into the funds for programs to treat addicts.
What needs to be eliminated is the need people have for drugs. Professor Rod Green of Howard University, looking at the issue from an African-American perspective, scoffed at some of the programs proposed. "The issue in the inner city is economics," he explained. "The alternatives to violence and addiction are jobs and economic opportunities that are better than those offered by crime. Maybe we can never get to understand some people's needs. We can just hope to enlighten them."
The pain of some mothers whose children were killed on the street by intoxicated drivers, was turned into positive action with the formation of an organization called MADD (Mothers Against Drunk Drivers). The dedicated effort of these women has made the slogan "designated driver" part of our vocabulary. The power of these mothers and the success of this organization shows what can come about from the formation of a special interest group with a focused purpose.
An example of how the substance abuse of one person can affect many and the environment is the Exxon Valdez oil spillage in 1989. Joseph Hazelwood had a history of alcohol abuse, but he was hired by the Exxon Oil Company as captain of an oil tanker. One night while he was intoxicated, the tanker hit a charted reef and spilled nearly 11 million gallons of oil into prime Alaska fishing grounds. These fisheries are 3000 years old. It was the biggest environmental damage in United States history. Mr. Hazelwood's judgment was so impaired that he thought the tanker was 34 miles away from where it really was. This impairment caused by substance abuse affected birds, fish and 10,000 people.
Sometimes the federal government has to take drastic steps to correct a situation that is out of hand. There is a public assistance housing project in Chicago called Geneva Tower. Many tenants and visitors at the project were so criminally minded that "not even the cops would enter its doorway." Concerned housing agents decided to "lock it down," that is, they built a high security fence around the tower. Tenants have to enter and exit through a security room. The halls and garage are monitored by a television system. There are 60 armed guards who carry more fire power than average security guards. "But thugs carry more," is the explanation. They patrol the halls and keep the "bad element out." It is a safer place to live now, but the tenants say, "It doesn't feel like home." Children can now play in the yard where shootings used to take place. There are some who say these tactics just "push the crime up to the next block."
There is pain in the communities, and we are not dealing with it. Seventy percent of drug addicts in New York City come from only eight areas in the city. What is happening in these areas that fosters substance abuse?
The advocates for legalization of drugs say that the billions of dollars spent on police agencies, customs services and armed services in an attempt to stop the drugs from entering the United States is wasted.
Legalizing drugs will cut the jugulars of the drug barons by taking the profit out of it. The continued high rate of illegal drugs in our country, such as cocaine, allows the drug underworld to set street values so as to make a huge profit, which is used to underwrite other forms of crime.
Advocates for legalization say that marijuana has proven to be effective in the treatment of nausea which follows chemotherapy, and that physicians should be allowed to prescribe it.
Legalization of drugs is favored by people as diverse in their ideology and viewpoints as former Surgeon General Joycelyn Elders and writer-lecturer William F. Buckley.
Legalizing drugs would be a source of tax revenue, and the money could be spent for the treatment of addicts. The quality of the drugs could be controlled. It would free up our police officers to focus on other crimes.
Zurich, Switzerland, Liverpool, England and Canberra, Australia are experimenting with the controlled distribution of heroin in an effort to free people from the horrendous dependence on organized crime. These governments hope that addicts can lead "normal" lives without the pressure of having to find the next fix. They want to integrate them into society and treat them for the psychological reasons they are addicted. History has proven that legalization of drugs increases the number of addicts. We will watch the results of these programs.
Another controversy is the Crime Bill of 1995. Some of the provisions in the bill pertain to substance abuse and include a measure that would attempt to enlist behavioral medicine in the multibillion dollar search for effective prevention of some forms of violence. People are divided about the spending of so much money on prevention. These programs are called "social reforms." One mandate that most favor is the requirement that all federal prisons offer alcoholism and drug treatment to any inmate who wishes to participate. Today, only half of all federal prisons have an addiction treatment program in place. This bill would authorize the Federal Bureau of Prisons to spend "such sums as necessary" to meet the goal of enough treatment slots for every substance abusing prisoner by 1998.
This bill has the potential for involvement of behavioral health providers:
President Clinton is the first President to admit he was the adult child of an alcoholic, the first to admit using an illicit drug and the first to have firsthand knowledge of a drug treatment center. Clinton says that his involvement in his brother's recovery from cocaine addiction and his childhood experience of living with a violently alcoholic stepfather were important factors in shaping his personal values.
Another uphill battle will be the passage of the Clinton Administration Health Care Plan. As it stands now, there is a provision for mental health and substance abuse treatment. Coverage is limited, however. It offers 60 days a year for inpatient services and 120 days a year for hospital care, and copayments and deductibles. It does not have all the benefits that those who supported it wanted.
The wheels of progress turn slowly. There are so many opposing viewpoints and causes. Everyone presses to have their project accepted.
The Substance Abuse and Mental Health Services Administration reports that there were over 68,000 people on the treatment waiting list this past spring. There are some data to indicate that there may be as many as four to six million people needing treatment for drug and alcohol abuse, and most of them will not receive it.
This is a social disgrace. The financially needy, mentally ill, and the addicted are abandoned. It is time for those in the substance abuse field to make the general public aware of the problem and to lobby for sanctions.
Opponents of legalization of marijuana say there is no scientific evidence to support its medical use; that there are other legal medications just as effective in the treatment of nausea that follows chemotherapy.
If drug use were legal, it would sabotage significant progress that has been made against illegal drugs. Individuals would feel free to experiment with various dangerous drugs.
Those against legalization of drugs say that drug use would increase if it became legal. Legalizing alcohol has not stopped the hazards and problems created by this drug. The opportunities for people to self-destruct would be expanded beyond that which could be controlled.
In a surprise ruling, a high court in Bogota, Columbia, has legalized drug use in that country. Columbia is the world's main supplier of cocaine and the site of a drug war that has killed thousands of people. This ruling puts Columbia on a collision course with Washington, which has already accused the Bogota government of leniency toward drug traffickers and of having halted evidence sharing in drug cases.
Society's attitude has changed over the years. There is less tolerance for drunkenness. People used to laugh over the "funny drunk." Many comedians and singers built their act around the antics of a drunk person. Dean Martin, singer, always had a glass in his hand. Johnny Carson had a running joke about Ed McMahon's (his announcer) drinking. The public doesn't think that it's funny now.
Years ago, employers were more tolerant if they had an employee who drank. Today, competition is too keen and the costs of running a business too high to tolerate absenteeism or lateness. Loss of productivity is money and cannot be written off.
Driving while intoxicated is severely punished by fines or jail sentences. Antisocial behavior is dealt with immediately. Films no longer portray the hard-drinking hero in movies, and movie stars can no longer have a substance abuse problem in their private life. It is soon public news when someone goes "into treatment."
There are now signs in ladies' public bathrooms warning pregnant women not to drink or take drugs. In 1989 Surgeon General Koop asked for the practice of Happy Hour to be abandoned.
Woodstock 1994 was different from Woodstock 1969. All alcohol and drugs were confiscated, and a private security force patrolled the grounds. The promoters turned down sponsorships from such companies as Marlboro, Coors, Budweiser and Seagram's. They accepted sponsorship from Haagen-Daz, Apple Computer and Pepsi. The three-day event attracted over 255,000 people without major incidents.
Congress now gives foreign aid only to countries whose drug control programs they approve of. Don't you think the federal government should stop funding the 78,000 drug addicts each month with Social Security disability income? Society has to work on this one.
Exercise is being sold as the great stress-reducer. Many people go to the gym regularly, and a fast-paced walk has become a way of life. Everyone owns a jogging outfit and a pair of Reeboks. The lunch hour is becoming the exercise hour at many large corporations.
College campuses post signs advertising their drug-free programs. Large corporations also have programs that support a drug-free lifestyle.
The problem with drug abuse is not going to be solved by the federal government. It is going to be taken care of by concerned parents, teachers and local police. The people in the community, the ones most affected, are joining together to stop this rampage.
Some communities have drug-free school zones. This is an area around the school grounds where no drugs are permitted. Any person who does not have legitimate business on the school grounds is asked to leave. There are guidelines for search and seizure procedures. The sale of alcoholic beverages is also not allowed in a radius around the school zone. Local taxes on the sale of alcoholic beverages can be raised.
The local offices of the Department of Alcoholic Beverage Control does frequent sweeps of places, including neighborhood bars, where alcoholic beverages are sold. Businesses caught selling to minors are cited for illegal sales and proprietors arrested.
Deputies say that a number of underage youths contacted were either in possession of or under the influence of alcohol.
Neighborhoods are also organizing together for "crimewatch." Citizen patrols who are residents of the neighborhood take pictures of any suspicious activity. The purpose is to let drug dealers know the neighbors are reclaiming their neighborhood.
Citizens also report any suspicious traffic. They jot down license numbers and describe people who appear active in illegal behavior. These programs have a powerful effect on reducing flagrant drug dealing. "Not in my neighborhood" is the theme. Street drug dealing brings with it crime and shootings, and citizens want it stopped.
Family Recovery Centers are being opened in various places. Women who are substance abusers can live at these centers with their children. "We want to get them off the streets and off drugs so they can lead a clean sober life." The centers take on the most severe cases of substance abusers and require the women to remain at the treatment home for nine months to a year. Clients pay for the treatment on a sliding scale based on income, but no one who qualifies for the program is turned away. In addition to undergoing treatment and counseling, the women are expected to perform daily chores such as cooking and cleaning.
"Every moment should be a learning experience," say the organizers of these centers, who claim their program can change the substance abuser's life. It gives the woman and her children the opportunity to live in a stable environment and encourages her to stay in recovery.
Most communities have banned alcohol at the beach. Local businesses are setting up strong antidrug policies which establish a set of values that affect everyone. Pre-employment drug testing has become the rule, and most applications for employment state that random testing may be done.
There is much communities can do to show they will not tolerate drugs on their beaches, in their parks, or at their places of business or anywhere in their neighborhoods.
Television and newspapers have an influence in shaping the attitude of the population. When an automobile accident has been caused by substance abuse, it is reported as a drug-related accident. This does not cover up the cause of the accident but brings to mind the connection of alcohol or drugs and accidents. As a result, people are turning off drugs because of the harm they cause.
There is a public announcement on television:
Parents who take drugs have children who take drugs.
This is a direct message to parents about their role in their children's choices. Media participation like this goes a long way in influencing the public's attitude about appropriate behavior and consequences.
The need to escape life's hardships has always been a human tendency. So have drugs.
Each culture has its own drug of choice. Some cultures have more problems with substance abuse than others.
We have written testimony about the effects of alcohol on man since the sixth century B.C.
Social attitudes toward drinking pass from parents to children. When the rules about drinking are clear and everyone agrees to them, then substance abuse is not a problem.
Availability of the substance leads to the selection of it; the development of customs controls its use.
Legislation about control of drugs is sometimes hard to enforce.
American culture tolerated substance abuse at one time, but that view is changing.