Book Review Forces of Habit – U/Massachusetts Medical School

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The immediately-preceding section “Participant Comments” contains, inter alia, The First Short Quiz entitled “Titillating Treasure-Hunt Tidbits” which starts with an explanation --

“[‘Treasure Hunt’ because most of the answers are contained in the immediately-following ‘Reference Materials’ Section of www.ReadingLiberally-SaltLake.org for our July 8 meeting.]”

The initial set of postings in this section from which the answers might have come are --

Re “Age of Addiction” by David Courtwirght (Harvard U Press 5/6/2019) -- our focus book --

1. Book Review of “Age of Addiction” from the Washington Free Beacon

2. An interview of our author, Prof. David Courtwright, about “Age of Addiction” by www.vox.com

Re: “Dark Paradise: A History of Opiate Addiction in America” by David Courtwright (Harvard U Press – a 2001 newly-enlarged edition of the original 1982 version) --

3. New York Times Editorial on 4/21/2018 entitled “An Opioid Crisis Foretold” giving full credit to David Courtwright’s “Dark Paradise”

4. Book Review of “Dark Paradise” in the Johns Hopkins Bulletin Of History Of Medicine (Vol 77 No 1 – Spring 2003) by Prof. Nancy D. Campbell, Chairman of the Department of Science and Technology Studies at Rensselaer Polytechnic Institute

Re: “Forces of Habit: Drugs and the Making of the Modern World” by David Courtwright (Harvard U. Press 1/1/2001) --

5. Book Review in Psychology Today Magazine 7/1/2001

6. Book Review published by The University of Massachusetts Medical School upon the paperback release of “Forces of Habit” in 2009

Miscellaneous – Historical Review

7. Article by David Courtwright in The New England Journal of Medicine 11/26/2015 entitled “Preventing and Treating Narcotic Addiction – A Century of Federal Drug Control”

NB: The first of David Courtwright’s four opuses (or should that be “opi”) was “Addicts Who Survived: An Oral History of Narcotics Use in America” -- which, like “Dark Paradise” has two versions dated 1982 and 2001, has two versions dated 1989 and 2012.
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Book Review Forces of Habit – U/Massachusetts Medical School

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David T. Courtwright. Forces of Habit: Drugs and the Making of the Modern World, Harvard University Press, 2001. Reviewed by Harvey Fenigsohn.
Review by Harvey Fenigsohn – 2009 – University of Massachusetts Medical School


"The obese Marquis de Sade was obsessed with [chocolate] in all forms. From prison, he badgered his wife for ground chocolate, crème au chocolat, chocolate pastilles, and even cacao butter suppositories to soothe his piles. 'I asked ... for cake with icing,' he wrote in 1779, 'but I want it to be chocolate and black inside from chocolate as the devil's ass is black from smoke'" (p. 23).

Chocolate is just one of the psychoactive substances David T. Courtwright discusses in Forces of Habit, Drugs and the Making of the Modern World, the source of the above colorful quotation. Is chocolate a drug? For Courtwright, most certainly, yes, as the author considers a drug to be "any psychoactive substance, licit or illicit, mild or potent, deployed for medical and non-medical purposes" (p. 2). He includes alcoholic and caffeinated beverages, chocolate, coca, cannabis, and tobacco as well as so called hard drugs such as morphine, heroin, cocaine, methamphetamine, and other mind-altering substances, synthetic or semi-synthetic. Courtwright acknowledges that the sheer number of different drugs makes it impossible for him to discuss them all.

The author terms the most widespread drugs, alcohol, tobacco, and caffeine, "The Big Three," (p.9), and he labels the next three most important but less often consumed drugs, opium, cannabis, and coca, "The Little Three" (p. 31). He also considers many other psychoactive substances including those confined to small areas such as kava in East Africa and the betel nut in Papua New Guinea. He notes that scholarship on drug history tends to focus on particular drugs in particular settings, such as mescal in Mexico or ganja in Jamaica.

Courtwright's range envelops the globe as he traces the ancient and modern origins of numerous habituating substances, considers their use and abuse over the centuries, and analyzes their significance as determined by trade, politics, and culture. Viewing the subject with an expansive lens, he also zooms in, concentrating on illustrative case histories such as the story of James Duke and the cigarette industry, the struggle to control alcohol abuse in India, and the debilitating effects of opium in China.

The historian's method entails carefully tracking a drug's movements across the globe and through time, analyzing the commercial, cultural, and psychological reasons for that drug's popularity. For instance, accounting for the prevalence of coffee, he follows the trail of the world's most popular, profitable caffeinated beverage, indigenous to Ethiopia, first extending to Arabia, then to other Islamic regions, and finally to Asia, Europe, the New World, and beyond: "Apollo 11 astronauts were drinking coffee three hours after landing on the moon" (p. 21).

The author reveals how market driven forces, hedonic reactions, and moral reasoning have affected a drug's use. He discloses why certain once illegal drugs are legal today, and why other formerly legal drugs are now strictly controlled, if not banned altogether—though often unsuccessfully, given their marketability and allure. Courtwright shows how national governments, unable or unwilling to suppress addictive drugs, tax toxic substances to enhance revenues despite the pernicious effects on its citizenry. As he observes, "The clash between opportunities for profit and concerns about health forms the central moral and political conflict running through the history of psychoactive commerce" (p. 91).

Courtwright contends that throughout history, political and capitalist elites found drugs highly useful in maintaining social control. Chinese coolies remained docile and less likely to rebel if numbed by opium, while the English working class stayed compliant if consoled by gin. The Romans soothed their soldiers with wine, and U.S. soldiers in World War II calmed their nerves with government issue cigarettes included in their K-rations. Courtwright notes, too, the fashionable attraction of a drug for certain social groups such as the snob appeal of chocolate for the Mayan and French aristocracies, and the mystique of LSD in the counter culture of the sixties.

Accounting for the global popularity of tobacco, Courtwright dazzles us with the enormity of the nicotine plant's popularity, despite its many proven health risks. He observes, "By the mid-90s, the world had an estimated 1.1 billion smokers- a third of the population over age 15- smoked 5.5 trillion cigarettes annually. That sum represented a pack a week for every man, woman, and child, smoker or non-smoker, on the planet" (p. 19). Tobacco smoking in this country has since been dramatically reduced, but prevails in other parts of the world as a cash crop and as a stimulant, despite earlier brutal attempts to suppress its use. "Russian smokers (once) suffered beatings and exile; snuff takers had their noses torn off. Chinese smokers had heads impaled on stakes …" (p. 16).

The author shows that relentless advertising and hype can make an American drug internationally fashionable, explaining the ways "Coca-Cola … a blend of the two most massive stimulants [caffeine and kola] known to pre-industrial cultures" (p. 26), gained global popularity. The soft drink became a national icon, once described by the company's CEO as the "sublimated essence of all America stands for, a decent thing honestly made, universally distributed, conscientiously improved through the years" (p. 26).

Courtwright acknowledges the beneficial results of powerful psychoactive drugs in enhancing life and relieving human misery, if they are used responsibly. He recognizes, for instance, that moderate drinking, such as a glass of wine a day, may provide protection against stroke, adultonset diabetes, and osteoporosis, and he endorses the psychological benefits of coffee. In tracing the arc of drugs through history, Courtwright also shows how drugs now considered addictive, such as tobacco, alcohol, and cocaine, were once viewed as medically beneficial. He explains, as well, how certain drugs once used medicinally have come to be severely abused, e.g. morphine, amphetamines, and barbiturates.

Having earlier listed the progression of official approaches to drugs from "pure prohibition" to "universal access" (p. 188), Courtwright ends by endorsing stronger governmental regulations, i.e., "restricting commerce and profit" through "regulatory laws and treaties" (p. 206). Unfortunately, he does not explain how we might better implement these measures beyond our present efforts, nor does he fully explore the nexus of international crime driving the drug trade, such as the influx of hard drugs into this country. Courtwright, as well, neglects any serious consideration of the libertarian view that the solution to the drug problem is to make more drugs legal. Strangely, too, though he provides a most interesting and complete history of marijuana use in this country, he does not address the issues raised by the movement to decriminalize cannabis for medical purposes.

Nevertheless, the countless achievements of the book far outweigh its few shortcomings. In a smooth, pithy style, sometimes humorous, always illuminating, the author cites an impressive variety of primary sources—official, private, scientific, literary. He commands an army of wellchosen facts to establish his expertise and supplies striking quotations to enliven his text for both general readers and academic specialists. In Forces of Habit: Drugs and the Making of the Modern World, David T. Courtwright presents a comprehensive study, thoroughly scholarly and refreshingly readable.

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