Everything we have been told about drugs and drug addiction and how society should deal with them is wrong, says the British author and journalist Johann Hari. He chooses the best books on the War on Drugs.
Drug Addicts are Human Beings
by Henry Smith Williams
The Murderers: The Shocking Story of the Narcotic Gangs
by Henry Anslinger and Will Oursler
by Charles Bowden
The Globalization of Addiction: A Study in Poverty of the Spirit
by Bruce Alexander
In the Realm of Hungry Ghosts: Close Encounters with Addiction
by Gabor Maté
Everything we have been told about drugs and drug addiction and how society should deal with them is wrong, says the British author and journalist Johann Hari. He chooses the best books on the War on Drugs.
The war on drugs is a government policy that began exactly a hundred years ago in the United States and Britain. It’s the belief that the correct way to respond to drug use and drug addiction is to try, at least in theory, to wipe these chemicals from the face of the earth. The slogan of the UN General Assembly Special Session on the World Drug Problem was, ‘A drug free world – we can do it!’ When I started working on this book four years ago, I thought of myself as pretty well-informed on this issue. Partly that’s because I had a very personal reason to care about it: We had drug addiction in my family and one of my earliest memories is of trying to wake up one of my relatives and not being able to, and, as I got older, understanding why.
Four years ago, as we were coming up to this centenary, I realised there were still lots of basic questions that I didn’t know the answer to. Why did we go to war against drug users and addicts a hundred years ago? Why do we continue, when so many people think it doesn’t work? What, in practice, are the alternatives? What really causes drug use and drug addiction? Part of the problem, I felt, is that the way we discuss these issues is overly abstract, as if we are at a philosophy seminar discussing how the world should be. I didn’t want to talk about it that way. I wanted to go and sit with people whose lives had been changed, in one way or another, and relate them to the best social scientific evidence.
“Everything we’ve been told about this subject for the last century is wrong.”
So I ended up going on a much longer journey than I thought it would be at the start — 30,000 miles across nine different countries. I spent time with people, from a transsexual crack-dealer in Brownsville, Brooklyn, to one of the only people to ever make it out of the deadliest Mexican drug cartel and live to tell what it’s like on the inside, to the only country that’s ever decriminalised all drugs, from cannabis to crack — Portugal — with really extraordinary results.
The main thing I discovered is that almost everything we’ve been told about this subject for the last century is wrong. Drugs are not what we’ve been told they are, addiction is not what we’ve been told it is, the drug war is not what we’ve seen on our television screens, and the alternatives aren’t what we think they are. These books, amongst others, really helped me to understand that.
Your first book is Drug Addicts Are Human Beings by Henry Smith Williams. Its title reveals that it’s a polemic of some kind, as no one could possibly think that drug addicts aren’t human beings.
This is an eerily prophetic book that, as far as I can tell, has been completely forgotten since it was first published in the 1930s. The reason I discovered it is that there was a man called Harry Anslinger, who was the most influential person who no one’s ever heard of. He was the first person to use the phrase ‘war on drugs,’ it originates much earlier than most people think it does, many decades before Nixon used it. Anslinger was a government bureaucrat who took over the Department of Prohibition just as alcohol prohibition was ending. He inherited this big, corrupt, messy government department, and partly to give it something to do, came up with the war on drugs.
One of the people I noticed in his files, that he really hated and was obsessed with, was a doctor in California. His name was Henry Smith Williams. He had treated drug addicts when drugs were legal, before the ban was introduced and enforced. He was not a man who was particularly sympathetic to drug addicts, certainly at the start. He was a social Darwinian, and had rather annihilatory views towards drug addicts. At one point he says — I’m paraphrasing — that the world would be a better place if they had never been born. He is no bleeding heart liberal. But he noticed several striking things. When drugs were legal — which was for most of human history, but particularly in this period in California prior to the beginning of Prohibition — most people would get them by buying them at the local pharmacy. The most popular way of consuming opiates was ‘Mrs Winslow’s Soothing Syrup’. Coca tea was also very popular and Coca Cola really did contain the same extract as cocaine early on. Being an addict was certainly debilitating, like being an alcoholic, but addicts overwhelmingly had jobs and were no more likely to be poor than the rest of the population.
Then, after Prohibition really kicks in, what Henry Smith Williams sees is two massive crime waves. Firstly, drugs are transferred from people like him to armed criminal gangs. These gangs are violent and jack up the price massively — I think the figure is 1000% — because you have to pay people a premium to take the risk of going to prison in order to sell it. Then, to pay these massively inflated prices, you get the second crime wave, which is people who previously bought their drugs at low prices from pharmacies suddenly stealing or prostituting themselves to pay for it. He also notices a huge increase in the death rate among addicts. So all sorts of changes happen, and, having previously been very unsympathetic to addicts, he starts thinking, ‘We’re really destroying these people.’
Another interesting thing he goes into in his book is that there was a loophole deliberately written into the 1914 law which first banned drugs. The loophole stated, quite clearly, that this new system should not apply to addicts. There was a ban on selling drugs to ordinary punters, but addicts were still meant to be able to go to the doctor to get them. And lots of doctors — including Henry Smith Williams and his brother, Edward, who was also a doctor — carried on prescribing drugs to addicts. They thought that it was better they get drugs from them than from a drug dealer who would sell them a contaminated, shitty product that was more likely to kill them. Then Anslinger arrives and starts a massive crackdown on doctors. This is a forgotten part of American history, but 17,000 doctors were arrested in the United States.
The drug war was hugely contested when it was introduced. The mayor of Los Angeles stood outside the heroin-prescribing clinic where Edward Smith Williams worked and said words to the effect of ‘You will not shut down this clinic, it does a good job for the people of Los Angeles.’ There were lots of people who said it would be a disaster, and the person who said it would be a disaster more than anyone else was Henry Smith Williams. His book, Drug Addicts are Human Beings, sees the whole drug war coming. Amongst other things he says — and I’m paraphrasing again, the exact words are quoted in my book — ‘If we continue with this policy for the next 50 years, 50 years from now we’ll have a five billion dollar smuggling industry in the United States.’ He was right — almost to the exact year.
The other fascinating thing about Drug Addicts are Human Beings is that he talks about why drugs were banned in California. The loophole of doctors being able to prescribe drugs to addicts is shut down state by state, and California was one of the last holdouts, partly because politicians there were quite brave. Henry Smith Williams reveals the story of why it was eventually shut down. I went and looked at the archives of the court case involved. It turns out the Chinese drug gangs in California were really pissed off, because in Nevada they had shut down medical prescription, and so drug addicts had to go to the drug gangs to get their drugs. In California they could still go to the doctor, so the drug gangs bribed the narcotics police to introduce the drug war in California. What this tells us is that, right at the start of the drug war, criminal gangs were paying for it to be introduced because they’re the only people who win from it. They’re the beneficiaries.
For me, it was fascinating seeing the same dynamic at the end of the drug war, when I interviewed the people who led the Colorado marijuana legalisation campaign. They would make the case that we should legalize marijuana because it would bankrupt the cartels. But Steve Fox, one of the leaders of the campaign, explained to me that people in Colorado were really scared, they thought the cartels would threaten them or even kill them if they made that argument publicly. It’s fascinating to see, both at the beginning and end of the drug war: Who wants it? Who wins from it? Who benefits from it? It’s armed criminal gangs. For everyone else, it’s a disaster.
Henry Smith Williams also thought the Mafia must have been bribing Anslinger to introduce the drug war, because he couldn’t understand why else anyone would be so foolish. That’s one big thing he was wrong about. But his book is still, I think, an absolutely crucial document.
Who do you think read it?
As far as I can tell, almost nobody. It had only one print run. It’s one of those tragic cries in the dark. To some degree, the debate was repressed by force in the United States. Some academics tried to sound warnings, and Anslinger literally had the police sent to warn their bosses that they were linked to organized crime. It’s extraordinary. He used the power of the state to intimidate people out of joining the debate. Henry Smith Williams’s brother Edward was one of the people arrested in the crackdown, and accused of being a drug dealer. He had his license suspended.
But surely there are good guys who want to close down drugs because they’ve seen the harm that they can do to individuals, to families, to friends? You’ve got Harry Anslinger as the devil incarnate in this story, because he’s initiated a war that he didn’t really fully understand the consequences of, but do you think his motivations were ultimately benevolent?
I’m not a believer in the ‘Great Man’ theory of history. I’m not saying this is the work of one man, that would be wrong. Harry Anslinger can only be what he was within the range of social forces that existed within the United States at that time. You can be a great surfer, but if you don’t catch a great wave, you aren’t going to amount to much. Anslinger’s story is important, partly because he was an influential figure, but also because he’s a way into understanding these much wider social forces.
One of the interesting things, to me, about the debate about drug prohibition, is that, unlike some of the other debates that I engage in, a lot of the impulses behind it are hugely admirable, and ones that I agree with. Most prohibitionists today are motivated by good and decent urges. Take, for example, Peter Hitchens, who’s probably the most prominent proponent of prohibition in Britain. He’s a conservative writer for the Mail on Sunday, and a very good writer. Peter Hitchens’s motivation in arguing for a much more extreme drug war in Britain is that he doesn’t want people to become addicted, he doesn’t want children to use drugs. Those are goals I entirely share with him, and I feel them very strongly. The only difference is that I think the evidence shows that the policies he supports actually make both those problems worse, while there are alternatives that are already in practice in various places in the world that could help.
What I would say about Anslinger, though, is that if we look at the motivations for the introduction of the drug war in the United States and in Britain — and this is something that surprised me. I assumed, before I started work on this, that they would be pretty much the reasons that we give now, that we don’t want kids to use drugs etc. but when I looked at the archives, I found those arguments were barely discussed.
That actually leads neatly to my second book, The Murderers by Harry Anslinger. I spent a lot of time in his archives. If you look at the reason why drugs are banned in the United States, and then in Britain, the real reason was a race panic. There’s a deep belief that African Americans and Chinese Americans are using drugs to attack white people, and therefore drugs have to be banned in order to put these ethnic minorities back in their place. A good example is in California. There was a Chinatown in San Francisco, and they wanted to forcibly relocate it and get the Chinese out. The Chinese Americans go to the California state-level Supreme Court, which rules they cannot be forcibly relocated. Immediately afterwards many Chinese Americans are arrested for running opium dens. Some of the racist quotes are really shocking, official statements like: ‘the cocaine nigger sure is hard to kill.’ There’s this belief that African Americans use cocaine and become superhuman.
You do have to understand this in the context of the failure of reconstruction after the Civil War. Michelle Alexander writes about it really well in her book, The New Jim Crow. There’s this promise to African Americans that they’ll become equal citizens. That doesn’t happen, they’re forcibly repressed, Jim Crow — the American system of apartheid — is introduced, and African Americans and Chinese Americans are understandably angry. Now, you can understand why white Americans didn’t want to see why they were angry, and would rather believe, “Oh, if we just got rid of these white powders and these potions, they’ll just go back to ‘their place.’’
You really see that with Anslinger. Anslinger’s books are fascinating. He co-wrote them with a guy called Will Oursler, who’s a brilliant writer. Anslinger loved the ‘true crime’ genre, and these books are written as sexy, thrilling, captivating stories of their time. Anslinger is right about one big thing, ahead of everyone else. It’s very hard to remember, but from the 1920s, right up to the early 1960s and the Bobby Kennedy hearings, the belief that the Mafia existed was regarded as a crazy conspiracy theory. Anslinger was one of the first government officials to believe in the existence of the Mafia. It was a real and significant achievement. The tragedy is he thought he was undermining the Mafia when, in fact, he was transferring one of the biggest industries in the world into their control.
In his book, there are his stories of tracking the Mafia. The story I tell in my book, Chasing the Scream, is how he was involved in the stalking and killing of Billie Holliday, the great jazz singer. It tells you a lot about what motivated Anslinger. In 1939, Billie Holliday stood on stage in New York City and sang ‘Strange Fruit,’ which, as many people know, is a song against lynching. Her goddaughter, Lorraine Feather, explained to me how unbelievably shocking it was at the time to have an African American woman standing in front of a white audience, in a hotel where she wasn’t even allowed to walk through the front door (she had to go through the service elevator), and sing a song against white supremacy. Someone referred to it later as the musical starting gun for the civil rights movement. That night, the Federal Bureau of Narcotics told Billie Holliday to stop singing that song.
When Harry Anslinger found out Judy Garland was a heroin addict he told her to take longer vacations and reassured the studio she was going to be fine. With Billie Holliday, he stalked her right up to her deathbed.
So, the book Anslinger wrote is The Murderers. Who are the murderers in the book?
The drug gangs. Of the two kind of sexy books Anslinger wrote, one is called The Murderers and the other The Protectors. They’re both fascinating. Firstly, they’re great reads, extremely well-written, good, pulpy, pleasurable, and extremely insightful. As far as I can tell, they’ve been out of print since they first came out, but they can be got hold of. Anslinger was obsessed with a guy called Lucky Luciano, who was an iconic gangster. There are some very revealing moments, for example when Anslinger talks about alcohol prohibition, and how he came to realise that it was a disaster, and caused more problems than alcohol itself. And you think, ‘Gee, Harry, can you think of anywhere else that applies?’ He also talks about the dynamic of prohibition — which is something I really saw in northern Mexico. One group of gangsters rises over the bodies of another group, and you get a Darwinian process where you get more and more extreme gangsters. Al Capone wouldn’t last five minutes in Juarez today. For as long as prohibition lasts, we’ll continue to have these horrendous mutations, it’s like the battle between antibiotics and bacteria. Of course, if we end prohibition, this dynamic ends.
Your third book also has murder in the title. There is clearly a connection between drugs and murder, murders that are done by gangs, murders that are done by people who are fuelled by drugs, murders that are done in order to get money to pay for drugs. There are definitely crimes around addiction, we can’t deny that. What’s the theme of Murder City?
To respond to the first part of what you just said: there’s an important study by a professor called Paul Goldsmith. He did a breakdown of every murder in New York City in 1986 that was described as drug-related. Some 2% were where an addict was committing a property crime to feed their habit, and it went wrong and they killed someone. Another 7% were where someone used drugs and committed an act of violence. And all the rest were armed criminal gangs killing each other to control their patch. It’s really important to understand this: the vast majority have nothing to do with drugs, they are to do with drug prohibition. In the same way, Al Capone wasn’t an alcohol-related killer, he wasn’t getting drunk and shooting people.
The best way to explain it is like this: if you or I go to the local off-license [liquor store], and try to steal the beer or vodka, the owner will just call the police. He doesn’t need to be violent or intimidating. If we go up to the local coke dealer or the local weed dealer and try to steal their product, they can’t call the police, because the police will arrest them. So they do have to be violent and intimidating. The sociologist Philippe Bourgois says that prohibition creates a culture of terror. Charles Bowden, who wrote Murder City, talks about the war on drugs creating a war for drugs. Because drug dealers have no recourse to the law, they have to establish a reputation for being intimidating and violent, so that no one will dare to take them on. This massively increases the murder rate, as they have to establish and maintain their patch by force. Milton Friedman, the Nobel prize-winning economist, calculated there were an additional 10,000 murders each year in the United States because of this dynamic.
I spent a lot of time with Chino Hardin, a transsexual crack dealer in Brownsville, Brooklyn and he explained the dynamic to me extremely well. People think, ‘oh drugs cause violence,’ and clearly there are some genuinely drug-related killings, as we just saw – but they are a tiny minority of the killings described as ‘drug-related’, and vastly outweighed by the killings caused by prohibition itself. If we banned milk, and people still wanted milk, the milk market would become extremely violent, because it’s the nature of a prohibited market.
The best way to test that is to ask, where are the violent alcohol dealers today? Does Oddbins go and blow up the drinks aisle in Sainsbury’s? Do they go and shoot the people that work in the Sainsbury’s aisle in the face? Does the head of Guiness send people to go and torture the head of Smirnoff? No. But under alcohol prohibition, there were a huge number of violent alcohol dealers. Nothing’s changed about alcohol, the drug remains the same. The method of how you sell it has changed, and therefore the murder rate massively fell. Jeffrey Miron, a professor at Harvard, does a brilliant graph in his book, Drug War Crimes, just looking at the murder rate in the United States through the twentieth century. It massively spikes in the 1920s during alcohol prohibition, then falls when alcohol is legalised, and only massively rises again with the huge intensification of drug prohibition in the 1970s.
Murder City is by a journalist called Charles Bowden, who sadly died last year, and it’s a study of Ciudad Juarez, where I also went. It’s a city in northern Mexico on the border with the United States. El Paso, which is on the Texas side, and Juarez, which is on the Mexico side, used to be the same city. One of the things we know about the drug war is that the route of supply from the poor countries that grow the drugs, to the rich countries that consume them, will always take the path of least resistance. This is called the ‘balloon effect.’ If you imagine a balloon half full of air, if you push down on the air somewhere, it will pop up somewhere else. That’s basically what happens with drugs. If you think about the 80s, one of the main supply routes was up from Colombia, through the Caribbean and into Florida. That was the Miami Vice period. They cracked down massively there, so it started to go through Mexico. If you have a massive crackdown in Mexico, it will go somewhere else. What never happens is fewer drugs getting through. We know that because there would be a price rise if there were fewer drugs getting through, and that doesn’t happen.
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Juarez is this city where, in the early 90s, there’s this huge torrent of illegal drugs. 70% of the economy is in the hands of armed criminal gangs, I was shown around by Julian Cardona, who is the brilliant Reuters correspondent there. He kept introducing me to families of people who’d been killed by the police. At some point I said, “Julian, I’ve got to get stories about people who have been killed by the cartels.” His just laughed, and explained that they’re not separate forces. If the cartel wants to kill someone, they employ the police to do it. That was the moment when I realised how really scary the situation is there. Murder City is a great analysis of what has happened to Juarez, and why, at the time that Charles Bowden was there, it was the deadliest city in the world.
One mild criticism of the book I would raise is that there is a tendency with people who go to Juarez to get slightly drunk on apocalyptic rhetoric, because what’s happened there is so extreme. I think when Charles Bowden was there, it was 20 murders a day, while the murder conviction rate was 2% – and those 2% didn’t do it, they were people who were framed by the police. It really is a nightmarish landscape. It’s particularly peculiar because in many ways it feels like a normal American city. There’s a KFC, you can go to the mall and buy a flat screen TV. And, yet, murder has effectively been legalised.
One of the most surreal things I did there was go out with a group of evangelical Christian teenagers. Anyone there who has ever protested against anything has been systematically murdered — journalists, politicians, civil society — and this group were just appalled that when bodies were dumped in the street, no one even stopped to look at them anymore because they were so scared. So they decided to do this mad thing: They dress up as angels. They wear these incredibly elaborate costumes, they paint themselves silver, and they’re really, freakishly effective. They stand on stools with robes flowing down from them, so it looks like they’re eight feet tall, and hold signs over the bodies that say things like, ‘Chapo Guzman, God is watching you’, or ‘Corrupt police, Jesus can see you.’
I was with them when they went and stood in the street, and people really reel back. They say, cynically, ‘Oh someone will kill the angels.’ But no one has yet, I think because they’re actually a bit superstitious. Who wants to be the person who shot an angel?
So I understand why Charles Bowden does feel apocalyptic in Juarez. It’s a superb piece of reporting and I strongly recommend it. But there’s an element of playing up the apocalypticism, rather than the slightly more prosaic truth – which is that, actually, this would happen anywhere on the supply route that worked in the same way. If you put Oslo between Mexico and the United States and had 70 percent of the economy in the hands of armed criminal gangs, the same thing would happen. The specific manifestations would be different — maybe in Oslo they would dress as Vikings rather than angels, I don’t know enough about Oslo to be sure — but the kind of violence, the insanity, would be the same. There’s a degree to which we can play up Mexican exoticism of it, but actually it’s much more a standard product of the drug war.
Are you saying that this Hobbesian world where you have to get them before they get you is part of the structure of criminalised drugs?
It is directly created by prohibition. It is the only way the system can work, once you’ve banned them. I interviewed Rosalio Reta, who was a hitman for the deadliest Mexican drug cartel, the Zetas, from when he was 13 to when he was 17. He butchered around 70 people, and I interviewed him in prison in Texas where he’s in constant solitary confinement because whenever they let him out, someone stabs him immediately. He helped me to understand this, and then looking at the sociology of Philippe Bourgois was a help as well.
It’s tempting, when you look at this violence, to think it’s like Fred West or Jeffrey Dahmer, just psychosis, and clearly there is a degree of that. But, actually, it’s the functional effect of prohibition, because in a culture of terror where there’s a war for drugs, if you are the person who’s prepared to go a little bit further in violence than the other guys, you gain a brief competitive advantage. So, if you’re the first person who says, we’re not just going to kill the other side, we’ll kill their pregnant wives, you get a brief competitive advantage. If you’re the person who says, we won’t just kill their pregnant wives, we’ll put it on Youtube, you gain a brief competitive advantage. If you say, we’ll cut off their faces, sew their faces onto a football and send the football to their families — this is a real thing that happens — you get a brief competitive advantage.
The structure of prohibition, and the nature of the prohibited market, means that whoever is prepared to push that boundary a little bit further, gains a market advantage for a brief period, until the other guys start to do it, and then of course it gets worse. Most of this violence — not all of it — is to do with the nature of prohibition. Referring back to Jeffrey Miron’s statistics, if we just look at what happened to the murder rate after the end of alcohol prohibition, it just fell off a cliff.
Prohibition may have bad effects, but they vary from country to country, because clearly we haven’t got people operating at that extreme in Britain. Also, I have children. The decriminalisation of drugs would worry me in that, presumably, it would make it easier for people to get hold of drugs, and bring the price down. There are many currently proscribed drugs I don’t think a teenager should be experimenting with.
We have the same dynamics in Britain – a lot of the stabbings in London are rival teenage gangs fighting for control of their patch – but it is much less extreme because much less of our economy is dominated by it. In Juarez, as I say, the best estimate is that 70 percent of the economy is the illegal drug trade. Even on the roughest estates in Britain – say, Easterhouse, which my mum used to live near – it’s not going to be anything like that. If Britain was in the middle of a supply route between a massive drug grower and a massive drug buyer, the same dynamic would happen here.
On kids, I absolutely agree with you. My book is dedicated to my nephews who are all teenagers, and to my niece, who is a bit younger. One of my strongest motives for supporting drug reform is precisely that I want to deny them access to drugs. There are all sorts of reasons why teenage brains can be seriously damaged, including by cannabis.
I don’t support legalization in spite of that desire. I support legalization because of that desire. In Camden, New Jersey, I interviewed a guy called Fred Martens, who was a right-wing cop. He reminded me of the Clint Eastwood character in ‘Dirty Harry.’ He is no one’s idea of a liberal, but in the 1970s he had an epiphany. He was in a carpark in Wayne, New Jersey, and he was staking out a drug dealer. He was in plain clothes, and a young teenager came up to him and said something like, ‘Hey Mister, will you do me a favour, will you go into that liquor store and buy me some booze because I’m too young to buy it?’ and Fred said ‘No, get out of here!’ So the kid went up to the drug dealer and bought drugs from him instead, because drug dealers don’t check I.D.
“We gave it a fair shot: 100 years and a trillion dollars.”
What we have at the moment is a system of anarchy. Unknown criminals sell unknown chemicals to unknown users, all in the dark. Legalisation is a way of imposing regulation on that, currently completely deregulated market, and one of the things you can do when you regulate drugs is put barriers between people. So, for example, no one in my nephews’ school is selling Jack Daniels or Budweiser, but there are loads of people selling weed and pills. There was a study in the United States that found that teenagers find it easier to get hold of marijuana than they do to get hold of alcohol, precisely because drug dealers don’t check I.D. So, if your main motivation when approaching the drug war, and it’s a very good one, is to say you do not want your teenagers to have access to drugs, that’s one of the strongest arguments I know for legalisation.
So, your fourth book, The Globalisation of Addiction. Addiction is what we’re talking about mostly here, and we haven’t really addressed what addiction is. You said at the beginning that you think most of us have been misinformed about addiction, or have an inaccurate view of what addiction is. What’s this book about?
Bruce Alexander is a person I’ve got to know pretty well. I think he’s an extraordinary man, with an extraordinary mind. He really educated me, and transformed how I think about this. If you had said to me four years ago, ‘What causes heroin addiction?’ I would have looked at you as if you were a bit simple-minded, and said, ‘Heroin causes heroin addiction.’ We’ve been told that story about addiction for 100 years and we take it for granted as common sense. Certainly I did. We think that if you, me and the first 20 people to read this article all used heroin together for 20 days, on day 21, we’d all be heroin addicts because there are chemical hooks in the drug that our body would physically need at the end of it. That’s what addiction means.
The first thing that alerted me to the fact that that might be wrong is when it was explained to me like this: If, at the end of this interview, I step out onto the street and am hit by a car, and am taken to hospital with a broken hip, it’s quite likely I’d be given diamorphine, which is medically pure heroin. It’s much stronger than anything you’d ever get on the streets because it’s not contaminated by dealers. And it’s possible that I’ll be given it for a quite a long period of time. For anyone reading this in the developed world, there are people in hospitals near you being given a lot of heroin right now. If what we believe about addiction is right, what would happen to those people? Some of them, at least, would become addicts. They would leave and want to score on the street. That virtually never happens. That seemed so weird to me, that I didn’t know what to do with it until I read, and then interviewed extensively, Bruce Alexander.
Bruce explained to me that the ‘common sense’ view of addiction we have comes from a series of experiments that were done earlier in the twentieth century. They’re really simple experiments, readers can do them at home if they’re feeling a bit sadistic. You get a rat and put it in a cage and you give it two water bottles. One is just water, and one is water laced with either heroin or cocaine. If you do that, the rat will almost always prefer the drugged water and almost always kill itself. That’s our theory of addiction. Bruce comes along in the 1970s and says, ‘Hang on, we’re putting the rat in an empty cage, it’s got nothing to do except use this drug. Let’s do this differently.’ So he built Rat Park.
Rat Park is a cage that is like heaven for rats, it’s got loads of nice food, coloured balls, tunnels, and, crucially, loads of other rats: loads of friends, the rat can have loads of sex, whatever it wants. Again, they’ve got the water bottles: the normal water and the drugged water. But here’s the fascinating thing: In Rat Park, the rats don’t like the drugged water, they hardly ever use it. None of them ever overdose, or use it in a way that looks compulsive or obsessive.
There was a fascinating human parallel to Rat Park that was happening, by coincidence, at the same time. It was called the Vietnam War. 20% of troops in Vietnam were using heroin, and if we look at the news reports from the time, Americans were shitting themselves because they thought, ‘When the war’s over, we’re going to have hundreds of thousands of junkies on the streets of the United States.’ But studies that followed these troops discovered something really striking, which is that 95% of them just stopped when they got home. They didn’t go to rehab and they didn’t need any treatment. That doesn’t fit with the old theory of addiction, but, if you follow Bruce’s theory, it makes complete sense. If you’re taken out of a hellish pestilential jungle where you don’t want to be and could be shot at any moment, and go back to your nice life in Wichita, Kansas with your friends and family, will you want to be present in your life again? It’s the equivalent of being taken out of that first cage and put into Rat Park. You see this with lots of people who have addiction problems. If their lives can be turned around, if their environment can be radically improved, if they can be connected with sources of meaning, they don’t want to be out of it all the time.
What Bruce says this shows is that both the right-wing and left-wing theories of addiction are wrong. The right-wing theory is it’s a moral failing, you’re a hedonist, you indulge yourself. The left-wing theory is your brain gets hijacked, you get taken over. Bruce says, it’s not your brain, it’s not your morality, to a much larger degree than we’ve appreciated until now, addiction is an adaptation to your environment. Professor Peter Cohen talks about how we shouldn’t even use the term ‘addiction,’ we should use the term ‘bonding.’ Human beings have an innate need to bond, and when we’re happy and healthy, we will bond with each other, we will connect with other human beings. When we can’t do that because we’re isolated, or beaten down, or traumatised, we will bond with something that gives us some sense of relief. That could be gambling, it could be pornography or cocaine. But we will bond with something that gives us a sense of meaning.
Bruce’s book is a brilliant exposition of this, and there are huge implications. The implications for the drug war are obvious: we take people who are addicted because they’re isolated and traumatised, and then isolate and traumatise them further in the hope that it will make them stop. I went out in Arizona with a group of women who were made to go out on a chain gang wearing t-shirts saying ‘I was a drug addict’ and made to dig graves. This is an extreme example, but actually, all over the world — except in the places that have decriminalised, like Portugal, or legalised, like Switzerland — we take addicts and give them criminal records. We cut them off from society, and then we’re surprised that they don’t get better. Gabor Maté, who wrote the next book we’re going to talk about, said to me — I’m paraphrasing, the exact words are in my book — ‘If you wanted to design a system that would make addiction worse, you’d design the system we have now.’
I can believe with cocaine and heroin the rats might just be occasional users, but let’s take drugs I know from experience — caffeine, alcohol, and from family, nicotine — those all are physiologically addictive to a certain degree and people get withdrawal symptoms. It’s not simply a matter of being in the right environment because you take them on holiday and they have a lovely time, but they still want the alcohol, the coffee, and the nicotine.
I’m not saying that the chemical component of addiction plays no role: It does play a significant and real role, and we can actually measure how much and answer this. We can even measure it by looking at nicotine patches. In the early 90s, there was a broad scientific consensus that one of the most physically addictive drugs in our society is tobacco. We can isolate the physically addictive component in tobacco because we can test whether it causes withdrawal, and it’s nicotine. So, when nicotine patches were invented, there was a huge wave of optimism. People thought, ‘Ah great! We can give smokers the drug they’re addicted to without the filthy carcinogenic smoke. Brilliant!’ The U.S. Surgeon General conducted a very detailed study, and found that 17% of smokers with nicotine patches were able to stop, and the remaining 83% weren’t.
Now, 17% is a lot, it shows you a significant component of the addiction is a physical addiction. If you can stop 17% of tobacco addiction, that’s a huge deal. But it still leaves 83% that can’t be explained through chemical means. Given that we know that tobacco is one of the most physically addictive drugs, we would expect it to be a similar or smaller percentage with other drugs. A very important person here is Dr Carl Hart, a professor at Columbia University, who I interviewed extensively. Even if you look at meth, or crack, the vast majority of people don’t become addicted. That was really shocking to me, but the evidence is pretty robust. 90% of drug use, even according to the UN Office on Drugs and Crime — the main drug war body in the world — is non-problematic.
What we have to understand, and what Bruce and Gabor, the next person we’re going to talk about, are so good at explaining, is that for most of the 10% of people who are terribly damaged — and that includes people very close to me — the drug itself is not sufficient to explain the addiction. There are other aspects that are highly significant, and – crucially – they were there before the drug ever came along.
The best way to explain it is like this: you’ve got a glass of water in front of you, I’ve got a sparkling grape juice. Forget the drug laws for a second. We could both be drinking vodka right now, totally legally. We’ve probably both got enough money that we could do nothing but drink vodka for the next three months. The reason we’re not doing it is not because anyone’s stopping us, it’s because we’ve got something we want to be present for in our lives. We’ve got jobs we love, we’ve got people we love, we’ve got books we want to read, we’ve got stuff we want to do. If you look at addicts — clearly it’s a complex picture and there’s many factors — but the single biggest factor, and I think Bruce has demonstrated this very powerfully, is that addicts are people who can’t bear to be present in their lives. If we want to change that, and there are countries that have changed that, we have to make their lives better, not worse.
One thing we can say about the drug war is that we gave it a fair shot. We gave it 100 years and a trillion dollars. We can compare the results we got from that, to the results of countries where they’ve spent most of their money on turning addicts’ lives around. In Portugal, nearly 15 years ago, they decriminalised all drugs and spent the money on treatment for addicts, and turning addicts’ lives around, in particular through subsidised jobs. The results are that injecting drug users are down by 50%, overdoses are massively down, and HIV transmission among addicts is massively down. We can see how these models work, there’s nothing theoretical or abstract about this debate anymore, there are countries that have tried the prohibitionist approach, there are countries that have tried approaches based on compassion, and we can see the results.
As you brought that up, what has happened in Portugal?
In 2000, Portugal had one of the worst drug problems in Europe. 1% of the population was addicted to heroin, which is mind-blowing. Every year they tried the American way more: they arrested more people, had more people in prison and the situation just got worse. One day the prime minister and the leader of the opposition got together and said, ‘We can’t go on like this, what can we do?’ So they set up a panel of scientists and doctors to figure out what would genuinely solve the problem. They agreed in advance that they would do whatever the scientists recommended, because it took it out of politics.
The panel went away for a year-and-a-half and came back and said: Decriminalise all drugs, from cannabis to crack, but — and this is the crucial thing — take all the money we currently spend on arresting and imprisoning drug users, and spend it on the lessons of Rat Park. Let’s turn addicts lives around, let’s help them to reconnect. So, say you’re an addict who used to be a mechanic. They’ll go to a garage and say, ‘If you employ this guy for a year, we’ll pay half his wages,’ — just to make sure that every addict in Portugal had something to get out of bed for in the morning. 15 years later overall addiction is down, and one of the ways you know it succeeded is no one wants to go back. I interviewed João Figueira, who was the top drug cop in Portugal. He led the opposition to the decriminalisation. He said a lot of the things that people reading this will be thinking: ‘Surely it will be a disaster if you just decriminalise all drugs?’ He said to me words to the effect of: ‘Everything that I said would happen, didn’t happen, and everything the other side said would happen did.’ He talked about how he felt ashamed that he’d spent 20 years before the decriminalisation arresting and harassing drug users, and he hoped the whole world would follow Portugal’s example.
Let’s go on to the last book, In the Realm of Hungry Ghosts. Great title.
It’s a great book. Gabor Maté was a baby when his mother was stranded in the Budapest Ghetto at the height of the Holocaust. She didn’t know it, but her parents had just been murdered in Auschwitz and she was convinced that the Nazis were going to come and kill her and her baby. One day she saw a Christian stranger in the ghetto and she handed her baby to him and said, ‘Please take my baby because I’m going to die here and I want my baby to survive,’ and the stranger did take her baby.
Gabor ended up, many years later, in Downtown Eastside in Vancouver as a doctor. This is a place notorious for having the worst concentration of drug addicts in North America, and Gabor was working with homeless, hardcore street addicts. He wanted to pioneer an approach where you talk to addicts and listen to them, which no one had ever tried to do, at least with this group. What Gabor noticed, when he talked about their lives, is that they had all had horrific childhoods. Either sexual abuse or extreme physical abuse or neglect. He began to wonder about this. At the same time, he noticed he was having this addictive impulse that he couldn’t control. He would abandon women in the middle of delivering babies, or his children in public places, and just go out and obsessively buy CDs that he wouldn’t even listen to. He would just obsessively spend, he didn’t understand it, and Gabor started to look into the role that childhood trauma can play in adult addiction.
He found something called the “Adverse Childhood Experiences Study” which had been conducted by the Center for Disease Control, the US public health body. In it, he discovered something extraordinary. It looked at ten categories of traumatic experience that can happen to a child, and how they correlate with adult addiction. It turns out that for every traumatic category of experience that happens to a child, they are two to four times more likely to grow up to be an injecting drug user. If you had had six of those traumatic categories of experience, you were 4,600% more likely to become an adult addict. It’s mind-blowing, and, of course, Gabor began to think about this in relation to himself. He’d obviously had this traumatic childhood, and that was partly why he had these problems. It also helped to explain the people around him.
There’s a psychoanalyst here in London called Sue Gerhardt who wrote a very good book called Why Love Matters, and she gives a partial explanation for this. When we’re babies, we internalise the way that our caregivers treat us. When you were upset, your caregiver reassured you and calmed you down. Over time, you learned to calm yourself and reassure yourself. If, when you were upset, your caregiver was angry or hostile, you will respond to your own upset by being angry or hostile, and, as you get older, you will be more likely to need external soothers, which may be drugs, or may be other things.
Gabor, who I interviewed a lot, is friends with Bruce Alexander. At first I thought these were contradictory theories, that childhood trauma and isolation is different. But actually I think they’re connected, and Gabor says this as well. If you have a very traumatic childhood, it’s harder to trust the world, it’s harder to believe the world will treat you well. You are more likely to grow up to be isolated and disconnected, and therefore you’re more likely to be like the rats in the first rat cage, and less like the rats in Rat Park. I think Bruce and Gabor’s books together really help us to understand how this issue needs to be reframed and thought about very differently.
There is a kind of liberal argument that it’s everybody’s free choice, they should do what they want and get on with it, and take the consequences. But you seem to be moving in the direction of a therapeutic approach to replace criminalization?
For the 90% of drug users who are not harmed by their drug use, even according to the UN, they should have liberty. I personally don’t use any drugs, I haven’t for years, I don’t ever want to use them again. I occasionally drink a glass of wine, that’s it, and even that, very rarely, although I do drink industrial quantities of caffeine. But it’s not for me to tell you what’s good for you. If you’re not harming anyone else, and you’re not harming yourself, that’s fine by me, crucially as an adult, of course.
If you are harming yourself and you are in a terrible state, as addicts are, clearly that’s a different matter. Most addicts feel an internal conflict. There’s a big part of them that wants help and wants to stop. For those people I would certainly advocate — I’d be wary of using the word ‘therapeutic,’ solely for one reason which is that the direction we have tended to go in when we talk about therapy of addicts is a very narrow model of residential rehab. I’m not against residential rehab, but we have to be honest. The results have been appalling. They have extremely poor success rates, because not all, but many, residential rehabs are based on the wrong theory of addiction. What they do is the equivalent of taking the rat out of the first cage, putting it into Rat Park for a while, and then putting it back into that first cage. Unsurprisingly, it fails. I think the rehab industry needs to be challenged and changed in all sorts of ways, although there are many people in it doing good and valuable work.
Rather than rehab, I would focus on reconnection. I would talk much more about what they do in Portugal, which is about connecting people with sources of meaning, and turning their lives around, rather than a model that’s just about physically separating people from the drug for a while, and then putting them back into a disastrous, addictogenic environment.
The evidence is clear: A system based on stigma and punishment and hatred doesn’t work. A system based on compassion and care and love does work. It turns people’s lives around. So now we have a choice. Do we want to have another century of charging off in the wrong direction? Or do we want to listen to the countries where they are trying the new approach, and it is having amazing results?
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