phr
Bluelighter
No Bad Drugs
Jacob Sullum
Reason
4.2008
High Society: How Substance Abuse Ravages America and What to Do About It, by Joseph A. Califano Jr., New York: Public Affairs, 270 pages, $26.95
The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture, by Richard DeGrandpre, Durham, N.C.: Duke University Press, 294 pages, $24.95
On the opening page of High Society, which aims to explain “how substance abuse ravages America,” Joseph Califano declares that “chemistry is chasing Christianity as the nation’s largest religion.” Although it is not always easy to decipher Califano’s meaning in this overwrought, carelessly written, weakly documented, self-contradictory, and deeply misleading anti-drug screed, here he seems to be saying that opiates are the religion of the masses. Americans, he implies, are seeking from psychoactive substances the solace they used to obtain from faith in God, and better living through chemistry is nearly as popular as better living through Christ.
That claim, like many Califano makes, is unverifiable, and it does not seem very plausible. Americans may be less religious than they used to be, but large majorities still say they believe in God and identify with specific faiths, making the U.S. much more religious than other Western countries, which tend to have substantially lower drug use rates. Although Americans have a bewildering array of psychiatric medications to choose from nowadays (with permission from a doctor), they smoke a lot less than they did in the 1960s and drink less than they did a century ago, when they also could freely purchase patent medicines containing opium, cocaine, and cannabis. If the devout are less inclined than the doubters to use mood-altering drugs, how is it that mostly Mormon Utah leads the country in antidepressant prescriptions? And if chemistry and Christianity are locked in competition, what are we to make of Jesus’ water-into-wine miracle, or of the Native American Church, Uniao do Vegetal, and other groups that combine Christianity with psychedelic sacraments?
Already I have put more thought into the alleged connection between faithlessness and drug use than Califano did. And so it is with the rest of the book. A proper debunking would require more than the 186 pages of text that Califano, a domestic policy adviser to Lyndon Johnson and secretary of health, education, and welfare in the Carter administration, squeezes out of conversations with politicians and old reports from the Center on Addiction and Substance Abuse (CASA), the prohibitionist propaganda mill he founded and heads. Although CASA brags about its affiliation with Columbia University, the school has less cause to be proud of that relationship, given the center’s sloppy research and hyperbolic rhetoric. In a 2002 report that attracted wide publicity, CASA issued “a clarion call for national mobilization” against “America’s underage drinking epidemic,” claiming that “Children Drink 25 Percent of Alcohol Consumed in the U.S.” Not only did these “children” include 18-to-20-year-olds (a.k.a. “adults”), but it turned out CASA’s estimate was off by a factor of more than two.
Yet Califano is worth taking seriously. He is a leading exemplar of the moralistic pseudoscience that Richard DeGrandpre dissects in The Cult of Pharmacology, an insightful, historically informed critique of the ideas that guide the war on drugs. DeGrandpre, an independent scholar with a Ph.D. in psychopharmacology and a former fellow at the National Institute on Drug Abuse, decries “the modern mythologizing of drugs as angels and demons” that underlies our “bewildering and often brutal differential system of prohibition.” Califano, by contrast, is committed to defending the arbitrary distinctions built into our drug laws.
Califano, who since his time in the Carter administration has railed against cigarettes with all the zeal you’d expect from a former three-pack-a-day smoker, is perceptive enough to recognize that legal drugs are not necessarily angels. When he talks about the promiscuous use of stimulants to control inattentive, unruly schoolchildren or the routine prescription of mood-altering drugs to smooth “the changing moods that mark human nature,” he sounds a bit like DeGrandpre, who wrote a book called Ritalin Nation and is unsparing in his criticism of the psychiatric profession and the pharmaceutical industry.
What Califano fails to understand is that every drug, regardless of its current legal status, is potentially an angel or a demon. DeGrandpre builds upon the insights of the alternative medicine guru Andrew Weil, who first made his name with books about drugs and altered states of consciousness. “Any drug can be used successfully, no matter how bad its reputation, and any drug can be abused, no matter how accepted it is,” Weil wrote in his 1983 book From Chocolate to Morphine (co-authored by Winifred Rosen). “There are no good or bad drugs; there are only good and bad relationships with drugs.” While Califano acknowledges the importance of context in determining what constitutes abuse of alcohol and prescription drugs, he insists that any use of currently illegal drugs is abuse by definition. “Drugs are not dangerous because they are illegal,” he says. “They are illegal because they are dangerous.”
This line, popular among drug warriors, misconstrues an argument against prohibition. The point is not that prohibition causes all the hazards associated with drug use but that it compounds those hazards by exposing users to the unreliable quality, unpredictable doses, and violence of the black market (not to mention the risk of arrest). Leaving aside the question of how prohibition makes matters worse, it is untenable to argue that illegal drugs are uniquely dangerous, since every potential problem they pose is also posed by alcohol, a substance that Califano says he does not want to ban.
The argument that drugs “are illegal because they are dangerous” is especially hard to make with respect to marijuana, which is by far the most popular illegal intoxicant, one that half of American adults born after World War II have tried. The worst risk that marijuana smokers face is getting arrested, a fact Califano tries to obscure through the time-honored prohibitionist tactics of focusing on children, conflating correlation with causation, and obscuring the distinction between short-term and long-term effects. In the 1980s, Califano says, “we seemed to discover” (an odd but appropriate way of putting it) “that marijuana might not be as benign as kids and permissive parents thought.” How could smoking pot be no big deal in the ’60s and ’70s, when the baby boomers were in high school and college, then suddenly become a big deal in the ’80s and ’90s, when their children were? Might this shift reflect the natural tendency of parents to be alarmed by their children’s rebellious behavior, even when it’s no worse than what they themselves did without regret as teenagers?
Of course not. Califano wants parents to know there’s a firm scientific basis for their hypocrisy. “Today’s teens’ pot is not their parents’ pot,” he explains. “It is far more potent.…The average levels of THC jumped from less than 1 percent in the mid-1970s to more than 7 percent in 2005.” Since the potency threshold for distinguishing cannabis from a placebo in experiments is roughly 1 percent, Califano is in effect asserting that people who smoked pot in the ’60s and ’70s generally did not get high as a result. If so, it’s hard to fathom how “pot was becoming the hottest high on college campuses” by the end of the ’60s, as Califano reports elsewhere in the book. In fact, as sociologist Lynn Zimmer and pharmacologist John P. Morgan show in their 1997 book Marijuana Myths, Marijuana Facts, claims that Mom and Dad’s pot was indistinguishable from ditchweed are based on low-quality, nonrepresentative samples that probably lost their THC content while in storage.
Even if average THC content has not risen seven-fold (or 30-fold, as drug czar John Walters claimed in 2002), it no doubt has increased significantly as marijuana growers, especially indoor growers in the U.S., have learned to produce a better product. The average THC concentration of seized cannabis tested by the University of Mississippi’s Potency Monitoring Project (which relies on “convenience” samples that are not necessarily representative of the national supply) more than doubled between 1983 and 2006, from a bit under 4 percent to 8.5 percent. But the stronger pot is, the less people tend to smoke. Since the possible respiratory effects of smoking are the most serious health risk associated with marijuana, higher THC content makes marijuana less dangerous, not more so.
But “today’s marijuana is addictive,” Califano says, warning that “10 percent of those who try it will get hooked at some point in their lives.” Even taking that number at face value, it is about one-third lower than the lifetime addiction rate for alcohol, based on data from the National Comorbidity Survey.
Implicitly conceding that cannabis itself is not very dangerous, Califano makes much of marijuana’s status as a “gateway drug,” a substance that people tend to try before they use other illegal intoxicants. According to a CASA analysis of survey data from the early 1990s, he reports, “twelve- to seventeen-year-old children who used marijuana were eighty-five times more likely…to use cocaine.”
That impressive-sounding “risk ratio” reflects the fact that people very rarely use cocaine without trying marijuana first. Although he repeatedly cites such numbers as a reason to prevent people from trying marijuana, Califano concedes that “gateway statistical relationships do not necessarily establish causality,” and he quotes the Institute of Medicine’s take on the issue, which does not suggest that marijuana pharmacologically causes people to seek “harder” drugs: “People who enjoy the effects of marijuana are, logically, more likely to be willing to try other mood-altering drugs than are people who are not willing to try marijuana or who dislike its effects. In other words, many of the factors associated with a willingness to use marijuana are, presumably, the same as those associated with a willingness to use other drugs.”
Perhaps sensing that the gateway argument is not generating enough alarm, Califano warns that marijuana “adversely affects short-term memory, the ability to concentrate, emotional development, and motor skills.” By throwing in “emotional development,” he falsely implies that the memory, concentration, and motor skill impairments, which are short-term effects of intoxication, are permanent disabilities caused by smoking one joint too many.
Speaking of old prohibitionist tricks, Califano is not above scare tactics reminiscent of the “reefer madness” claims that Federal Bureau of Narcotics Director Harry J. Anslinger promoted in the 1930s. “Recent studies indicate that marijuana use increases the likelihood of depression, schizophrenia, and other serious mental health problems,” Califano writes. These studies do not show that smoking pot makes you crazy; they show that people who smoke pot, especially if they do so at early ages and in large amounts, are more likely to have “serious mental health problems.” In other words, these studies find associations, which, as Califano notes vis-à-vis the data on gateway drugs, “do not necessarily establish causality.” It could be that people with psychological problems are especially attracted to marijuana because it makes them feel better, or because they tend to act out or take risks; early use of marijuana could be a marker for psychological problems rather than a cause of them.
Having failed to explain why people should be arrested for producing, selling, and possessing marijuana when they are free to produce, sell, and possess alcoholic beverages, Califano goes on to note that all those arrests (about 830,000 in 2006 alone) don’t seem to have accomplished much. “From 1993 to 2005,” he writes, “a 107 percent increase in marijuana arrests was accompanied by a 100 percent increase in marijuana users.” Califano concludes that “something more is needed”: harsher penalties, mandatory anti-drug classes, and forced “treatment” for pot smokers.
More generally, although he claims to be recommending a “dramatic shift,” even a “revolution,” in drug policy, Califano actually wants to maintain the status quo, except with more drug treatment and better anti-drug classes. (He correctly notes that DARE, the most popular such program in American schools, “has been repeatedly found worthless.”) Califano wants to force “treatment” on people who use politically incorrect intoxicants even though he concedes “there have been few independent systematic evaluations of substance abuse treatment effectiveness.” The techniques that have not been proven effective through rigorous independent evaluations include the religiously oriented 12-step programs that Califano nevertheless wants to compel drug users to attend.
Jacob Sullum
Reason
4.2008
High Society: How Substance Abuse Ravages America and What to Do About It, by Joseph A. Califano Jr., New York: Public Affairs, 270 pages, $26.95
The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture, by Richard DeGrandpre, Durham, N.C.: Duke University Press, 294 pages, $24.95
On the opening page of High Society, which aims to explain “how substance abuse ravages America,” Joseph Califano declares that “chemistry is chasing Christianity as the nation’s largest religion.” Although it is not always easy to decipher Califano’s meaning in this overwrought, carelessly written, weakly documented, self-contradictory, and deeply misleading anti-drug screed, here he seems to be saying that opiates are the religion of the masses. Americans, he implies, are seeking from psychoactive substances the solace they used to obtain from faith in God, and better living through chemistry is nearly as popular as better living through Christ.
That claim, like many Califano makes, is unverifiable, and it does not seem very plausible. Americans may be less religious than they used to be, but large majorities still say they believe in God and identify with specific faiths, making the U.S. much more religious than other Western countries, which tend to have substantially lower drug use rates. Although Americans have a bewildering array of psychiatric medications to choose from nowadays (with permission from a doctor), they smoke a lot less than they did in the 1960s and drink less than they did a century ago, when they also could freely purchase patent medicines containing opium, cocaine, and cannabis. If the devout are less inclined than the doubters to use mood-altering drugs, how is it that mostly Mormon Utah leads the country in antidepressant prescriptions? And if chemistry and Christianity are locked in competition, what are we to make of Jesus’ water-into-wine miracle, or of the Native American Church, Uniao do Vegetal, and other groups that combine Christianity with psychedelic sacraments?
Already I have put more thought into the alleged connection between faithlessness and drug use than Califano did. And so it is with the rest of the book. A proper debunking would require more than the 186 pages of text that Califano, a domestic policy adviser to Lyndon Johnson and secretary of health, education, and welfare in the Carter administration, squeezes out of conversations with politicians and old reports from the Center on Addiction and Substance Abuse (CASA), the prohibitionist propaganda mill he founded and heads. Although CASA brags about its affiliation with Columbia University, the school has less cause to be proud of that relationship, given the center’s sloppy research and hyperbolic rhetoric. In a 2002 report that attracted wide publicity, CASA issued “a clarion call for national mobilization” against “America’s underage drinking epidemic,” claiming that “Children Drink 25 Percent of Alcohol Consumed in the U.S.” Not only did these “children” include 18-to-20-year-olds (a.k.a. “adults”), but it turned out CASA’s estimate was off by a factor of more than two.
Yet Califano is worth taking seriously. He is a leading exemplar of the moralistic pseudoscience that Richard DeGrandpre dissects in The Cult of Pharmacology, an insightful, historically informed critique of the ideas that guide the war on drugs. DeGrandpre, an independent scholar with a Ph.D. in psychopharmacology and a former fellow at the National Institute on Drug Abuse, decries “the modern mythologizing of drugs as angels and demons” that underlies our “bewildering and often brutal differential system of prohibition.” Califano, by contrast, is committed to defending the arbitrary distinctions built into our drug laws.
Califano, who since his time in the Carter administration has railed against cigarettes with all the zeal you’d expect from a former three-pack-a-day smoker, is perceptive enough to recognize that legal drugs are not necessarily angels. When he talks about the promiscuous use of stimulants to control inattentive, unruly schoolchildren or the routine prescription of mood-altering drugs to smooth “the changing moods that mark human nature,” he sounds a bit like DeGrandpre, who wrote a book called Ritalin Nation and is unsparing in his criticism of the psychiatric profession and the pharmaceutical industry.
What Califano fails to understand is that every drug, regardless of its current legal status, is potentially an angel or a demon. DeGrandpre builds upon the insights of the alternative medicine guru Andrew Weil, who first made his name with books about drugs and altered states of consciousness. “Any drug can be used successfully, no matter how bad its reputation, and any drug can be abused, no matter how accepted it is,” Weil wrote in his 1983 book From Chocolate to Morphine (co-authored by Winifred Rosen). “There are no good or bad drugs; there are only good and bad relationships with drugs.” While Califano acknowledges the importance of context in determining what constitutes abuse of alcohol and prescription drugs, he insists that any use of currently illegal drugs is abuse by definition. “Drugs are not dangerous because they are illegal,” he says. “They are illegal because they are dangerous.”
This line, popular among drug warriors, misconstrues an argument against prohibition. The point is not that prohibition causes all the hazards associated with drug use but that it compounds those hazards by exposing users to the unreliable quality, unpredictable doses, and violence of the black market (not to mention the risk of arrest). Leaving aside the question of how prohibition makes matters worse, it is untenable to argue that illegal drugs are uniquely dangerous, since every potential problem they pose is also posed by alcohol, a substance that Califano says he does not want to ban.
The argument that drugs “are illegal because they are dangerous” is especially hard to make with respect to marijuana, which is by far the most popular illegal intoxicant, one that half of American adults born after World War II have tried. The worst risk that marijuana smokers face is getting arrested, a fact Califano tries to obscure through the time-honored prohibitionist tactics of focusing on children, conflating correlation with causation, and obscuring the distinction between short-term and long-term effects. In the 1980s, Califano says, “we seemed to discover” (an odd but appropriate way of putting it) “that marijuana might not be as benign as kids and permissive parents thought.” How could smoking pot be no big deal in the ’60s and ’70s, when the baby boomers were in high school and college, then suddenly become a big deal in the ’80s and ’90s, when their children were? Might this shift reflect the natural tendency of parents to be alarmed by their children’s rebellious behavior, even when it’s no worse than what they themselves did without regret as teenagers?
Of course not. Califano wants parents to know there’s a firm scientific basis for their hypocrisy. “Today’s teens’ pot is not their parents’ pot,” he explains. “It is far more potent.…The average levels of THC jumped from less than 1 percent in the mid-1970s to more than 7 percent in 2005.” Since the potency threshold for distinguishing cannabis from a placebo in experiments is roughly 1 percent, Califano is in effect asserting that people who smoked pot in the ’60s and ’70s generally did not get high as a result. If so, it’s hard to fathom how “pot was becoming the hottest high on college campuses” by the end of the ’60s, as Califano reports elsewhere in the book. In fact, as sociologist Lynn Zimmer and pharmacologist John P. Morgan show in their 1997 book Marijuana Myths, Marijuana Facts, claims that Mom and Dad’s pot was indistinguishable from ditchweed are based on low-quality, nonrepresentative samples that probably lost their THC content while in storage.
Even if average THC content has not risen seven-fold (or 30-fold, as drug czar John Walters claimed in 2002), it no doubt has increased significantly as marijuana growers, especially indoor growers in the U.S., have learned to produce a better product. The average THC concentration of seized cannabis tested by the University of Mississippi’s Potency Monitoring Project (which relies on “convenience” samples that are not necessarily representative of the national supply) more than doubled between 1983 and 2006, from a bit under 4 percent to 8.5 percent. But the stronger pot is, the less people tend to smoke. Since the possible respiratory effects of smoking are the most serious health risk associated with marijuana, higher THC content makes marijuana less dangerous, not more so.
But “today’s marijuana is addictive,” Califano says, warning that “10 percent of those who try it will get hooked at some point in their lives.” Even taking that number at face value, it is about one-third lower than the lifetime addiction rate for alcohol, based on data from the National Comorbidity Survey.
Implicitly conceding that cannabis itself is not very dangerous, Califano makes much of marijuana’s status as a “gateway drug,” a substance that people tend to try before they use other illegal intoxicants. According to a CASA analysis of survey data from the early 1990s, he reports, “twelve- to seventeen-year-old children who used marijuana were eighty-five times more likely…to use cocaine.”
That impressive-sounding “risk ratio” reflects the fact that people very rarely use cocaine without trying marijuana first. Although he repeatedly cites such numbers as a reason to prevent people from trying marijuana, Califano concedes that “gateway statistical relationships do not necessarily establish causality,” and he quotes the Institute of Medicine’s take on the issue, which does not suggest that marijuana pharmacologically causes people to seek “harder” drugs: “People who enjoy the effects of marijuana are, logically, more likely to be willing to try other mood-altering drugs than are people who are not willing to try marijuana or who dislike its effects. In other words, many of the factors associated with a willingness to use marijuana are, presumably, the same as those associated with a willingness to use other drugs.”
Perhaps sensing that the gateway argument is not generating enough alarm, Califano warns that marijuana “adversely affects short-term memory, the ability to concentrate, emotional development, and motor skills.” By throwing in “emotional development,” he falsely implies that the memory, concentration, and motor skill impairments, which are short-term effects of intoxication, are permanent disabilities caused by smoking one joint too many.
Speaking of old prohibitionist tricks, Califano is not above scare tactics reminiscent of the “reefer madness” claims that Federal Bureau of Narcotics Director Harry J. Anslinger promoted in the 1930s. “Recent studies indicate that marijuana use increases the likelihood of depression, schizophrenia, and other serious mental health problems,” Califano writes. These studies do not show that smoking pot makes you crazy; they show that people who smoke pot, especially if they do so at early ages and in large amounts, are more likely to have “serious mental health problems.” In other words, these studies find associations, which, as Califano notes vis-à-vis the data on gateway drugs, “do not necessarily establish causality.” It could be that people with psychological problems are especially attracted to marijuana because it makes them feel better, or because they tend to act out or take risks; early use of marijuana could be a marker for psychological problems rather than a cause of them.
Having failed to explain why people should be arrested for producing, selling, and possessing marijuana when they are free to produce, sell, and possess alcoholic beverages, Califano goes on to note that all those arrests (about 830,000 in 2006 alone) don’t seem to have accomplished much. “From 1993 to 2005,” he writes, “a 107 percent increase in marijuana arrests was accompanied by a 100 percent increase in marijuana users.” Califano concludes that “something more is needed”: harsher penalties, mandatory anti-drug classes, and forced “treatment” for pot smokers.
More generally, although he claims to be recommending a “dramatic shift,” even a “revolution,” in drug policy, Califano actually wants to maintain the status quo, except with more drug treatment and better anti-drug classes. (He correctly notes that DARE, the most popular such program in American schools, “has been repeatedly found worthless.”) Califano wants to force “treatment” on people who use politically incorrect intoxicants even though he concedes “there have been few independent systematic evaluations of substance abuse treatment effectiveness.” The techniques that have not been proven effective through rigorous independent evaluations include the religiously oriented 12-step programs that Califano nevertheless wants to compel drug users to attend.
