The best books on Drugs

Why have you chosen Paying the Tab? 

First of all because it involves the most important abused drug, which is alcohol. Secondarily, because it’s one of the most lucid and beautifully-written policy books I know, and because it makes a very straightforward point: which is that in the US, alcohol is far too cheap and far too loosely regulated and the resulting social costs are enormous. Cook calculates that if we double the alcohol tax, which would increase the average price of a drink by about ten per cent, that would prevent about 500 murders a year.

But prohibitions never work. 

Prohibitions do work: that’s why there’s less cocaine abuse than there is alcohol abuse. But badly implemented prohibitions can be terribly expensive.

But Cook isn’t talking about making alcohol unaffordable. He is just talking about raising the price a little so that people would drink a little less. The people who would use less alcohol would be two groups – people with not much money, like teenagers, and people who drink a lot. It would have very little impact on the ordinary drinker. Somebody who has a drink a day would end up paying $35 a year in tax – he’d barely notice it. But somebody who has five drinks a day would notice it.

How many alcohol-related murders are there in the US every year? 

There are about 16,000 murders a year and in more than half of them the victim or the perpetrator or both are drunk. Murdering someone generally doesn’t seem like a very good idea unless you’re drunk.

You’d have to be quite drunk for murdering someone to seem like a good idea. 

No. You could be a little bit drunk and insult somebody who would then kill you. But also you could be a little bit drunk and get into a fight where you didn’t intend to kill the other guy but you did. One third of all the homicides in the United States are committed either in a bar or within 50 feet of the door.

Now you’ve chosen to talk about the Boyum and Reuter analysis of the US drug policy. 

This is the best analysis of what we’re currently doing about drug abuse and what we could do about drug abuse. This is not in the Boyum and Reuter book, but I personally think that what we are doing is mostly we are putting a lot of people in prison and telling a lot of lies. Drug-prevention education is not notorious for its factual content.

Because it overstates or understates the dangers? 

It overstates the dangers and minimises the distinctions between drugs, and overemphasises the distinction between illegal and legal drugs. What we should do is to have law-enforcement that is designed to minimise the damage done by drug dealing, as opposed to trying to minimise drug supply. We should make people who are heavy drug users and active criminals stop using when they are on probation or on parole.

In terms of minimising the dangers done by drug dealing, do you mean, a kind of human security thing of protecting the people who aren’t involved? Or do you mean arresting the dealers rather than the users? 

I mean protecting the neighbourhood from the impact of drug dealing, which means focusing on the dealers who are the most violent. Not all dealers are equally violent and the current enforcement system actually creates advantages for the more violent over the less violent.

How? 

Witnesses are afraid to testify against people who are reputedly scary. It’s easier to make people testify against the dealers that nobody is scared of.

Is anyone taking any notice of this document? 

Well, it was certainly very well received and a lot of the things mentioned are now going on, but it definitely wasn’t a bestseller. It deserved to be.

Tell us about Help at Any Cost. 

This is an exposé of the juvenile drug-treatment racket and the cruelties that get practised in the name of tough love. They programmes are privately run or some are contracted by various government agencies, but they are mostly exploiting the fears of middle-class parents.

So, your son is smoking a few joints and you send him to some horrible rehab? 

Yes. They practise physical and psychological abuse against people who are not yet adults, and there is some sexual abuse, though obviously that’s not part of the programme. But deliberate degradation and humiliation is part of the programme.

Give me an example. 

They’re hauling them up and shouting at them, or the kids are required to wear a T-shirt that says ‘I’m a junkie’. Physical restraint, stress positions, hunger, sexual humiliation. I have somewhat blocked out the full horror of it. The book is survivors’ stories and analysis. Most of the kids don’t need to be in a residential treatment programme and, in any case, nobody is helped by being abused.

Are these kids who are using drugs in a way that lots of people might consider fairly normal in growing up? 

Some of them, yes. But some have real serious drug problems – but even for them their treatment problem is more serious than their drug problem.

Isn’t the addiction to whatever the substance is more of a symptom than a cause though? 

I think that’s a half-truth. There are people whose primary problem is that they got into a bad habit around some drug and if they didn’t have that bad habit then they’d be all right. But the primary problem is lack of self-command. They don’t have good control over their habits. Of course, they’re likely to be people who face other stresses that made drug abuse seem like an attractive escape, but many of them can stop using drugs under the right sort of persuasion, without fixing whatever their other underlying problems are.

In any case, most of their basic problems are probably not helped by taking amphetamines. So I have no objection to programmes designed to get people to stop using. But there ought to be some limit to the damage done in the process.

Why don’t we want people to take drugs? 

I don’t not want people to take drugs. I want people to not have bad habits and hurt themselves and other people as a result. There are lots of people whose drug use is bad for them, in ways that they mostly know. The problem is that the reward of using is now and the cost of using is later. I don’t regard drug use as mysterious in the way that some people do. I don’t think there is some fundamental disorder about using drugs. There are bad habits and some people have them.

Which leads us to Addiction: A Disorder of Choice by Gene Heyman. 

This is an attack on the ‘brain disease’ model of drug use. I mean, yes, if a disease is something abnormal, involuntary, and unwanted, then a bad habit is a disease and drug abuse is a bad habit. And the disorder obviously lodges in the brain and not in the elbow, so in that sense I don’t have a problem with saying that it is a brain disease. But imagining that brain imaging will tell us all about it is wrong. What Heyman is really attacking is the notion that drug consumption by people with bad drug habits is involuntary in the same way as the tic of Tourette’s or the tremor of Parkinson’s.

Whose theory is that? 

The brain disease idea is actually the theory of Alan Leshner, who was director of the National Institute on Drug Abuse, and it is now pretty much dogma. Nora Volkow is the current director and has the same view. The theory is also that it is a particularly chronic and relapsing disorder, and Heyman produces the data to show that that is false. Drug abuse is one of the least chronic of the psychiatric disorders. The group of people today who meet diagnostic criteria for substance abuse or dependence is about eight per cent of the adult population. Three years from now two-thirds of those will not meet diagnostic criteria. The most typical course of drug abuse is a single incident that can last months or years and it resolves when that person decides to stop or someone else tells them they have to stop. Mostly they do recover, and not necessarily to abstinence. For alcohol it is often a return to normal drinking.

The idea of a chronic relapsing disorder comes from drug treatment programmes – if you are running a programme then the people who come to it are those with a chronic relapsing disorder, those people who didn’t recover on their own. Even then, the ones who recover after a single treatment episode don’t come back, so the clinic population winds up being dominated by people who keep trying and failing to get a grip on their drug-taking. So if you look at any drug-treatment programme you are going to see the people with the chronic relapsing disorders, but they are a minority of a minority. Most people who use drugs don’t get in trouble and most people who do get in trouble using drugs don’t have a chronic relapsing disorder.

Is there a class element to this? 

There’s a class elements in several ways. People with more to go back to are more likely to recover. So physicians who get caught dipping into the medicine cabinet and are told that if they keep using they’ll lose their licence have about a 75 per cent chance of being OK. They’ve got a lot to lose and also they got through medical school internship so they have some self-command. But there’s class all the way through it. Drug abuse is one good way to move down the SES spectrum.

The what?

Socio-economic status. Sorry, American academic jargon. We’re American so we can’t have class – it’s SES. If you look at the skid-row population, a lot of them weren’t poor growing up but they wound up on skid row through their drug abuse. Also, poor users are more likely to commit crimes they’ll get caught for to support their habits. And poor people have less privacy and live more of their lives in public spaces, meaning that their drug problem is more likely to become somebody else’s problem. There is also the opposite end – people who don’t have work to go to or anything to lose because they are too rich.

Finally, Cleansing The Doors of Perception. 

This is different from all the rest. Huston Smith deals with a class of drugs that we don’t normally discuss much in the course of thinking about drug policy, and that’s the hallucinogens or psychedelics. And he talks about benefit and not cost. His claim is that some people using psychedelics have extremely profound experiences, not distinguishable from a spontaneous spiritual-religious experience, and that if we had a social order that allowed more people to do that then we would be happier and better.

Does he give examples? 

Oh yes, and some historical analysis as well. The book is really a collection of essays written over a long period of time. He claims, for example, that kykeon, a drink that was at the heart of the Eleusinian Mysteries, the centre of Greco-Roman culture for a thousand years, was a hallucinogen. The followers went through a period of purification and then through a secret ceremony, which we don’t know much about, but it looks as if the potion they drank was a hallucinogen. It was regarded as a rebirth, and the Eleusinian initiates called themselves ‘the twice-born’, so when you see the bumper sticker that says ‘Born Again Pagan’, that’s them.

Do you agree? I think of people who have taken a lot of acid as completely brain-fried. 

Well, people who took a lot of acid… I think it was Alan Watts who said: ‘When you get the message, hang up the phone.’ These people who took it a lot probably didn’t get it right the first time. Most conditions under which psychedelics are taken aren’t very conducive to any sort of insight. But in a recent experiment at Johns Hopkins, they gave people a little bit of psycho-spiritual preparation and then a big dose of psilocybin, the active agent in mushrooms, and about two-thirds of them had a full-on mystical, spiritual experience.

So it’s the brainwashing prior to taking the drugs rather than the drugs? 

Not exactly brainwashing. It’s just a few hour-long sessions with a psychologist. There’s no doubt that the wisdom is not the drugs, but the fact that you can fairly reliably produce something that people spend their whole lives in monasteries trying to get to, seems to me a pretty exciting result.

It makes it sound quite inviting. Have you ever taken it? 

Not a question I answer. If you do what I do, which is write about drug policy, you’ve got a choice between admitting that you’re talking about stuff of which you have no experience or admitting that you are a law-breaker and a bad citizen. So, given those alternatives, I prefer a discreet silence.

The thing about this book is that it is not written by some whacked-out hippie. Here we have one of the most prominent scholars of comparative religion in the world saying: ‘What sometimes happens to people under psychedelics is what’s at the root of all the world’s religions.’ That moment of seeing yourself at one with the universe is where all the religions start – at the burning bush, on the road to Damascus, under the bodhi tree. And that experience is available on a quite democratic basis, according to Smith, and he wants us to pay attention to that very astounding fact.

I’m going to go out and get me some. 

Until fairly recently you could have. It’s only a few years ago that fresh magic mushrooms were banned in Britain.

Actually, I find the whole thing terrifying. I have enough problems clinging on to sanity as it is. 

Right. Anybody sane who thinks about doing this stuff wants to do it with preparation and with a guide. It’s not something you do alone.