My friends Phil Cook (economics and public policy, Duke) and Peter Reuter (public policy and criminology, Maryland) have a very nice essay forthcoming in the journal Addiction, under the provocative title, “When is alcohol just another drug? Some thoughts on research and policy.” It addresses the question why, when people talk about abusable “drugs,” they mostly aren’t thinking of alcohol, and makes a strong case for considering alcohol and controlled substances together as a research topic: for example, taking clues from alcohol policies and problems about the likely consequences of legalizing cannabis.
The editors were so pleased by the essay that they asked some other people to write short commentaries. That is generally understood as an invitation to bloviate at will, and in any case I had nothing much to add to the Cook and Reuter thesis, which is solid, important, and tightly argued. So instead I indulged in a little bit of cultural and media criticism. The issue of Addiction containing this material won’t appear until June or July, but the editors have kindly permitted me to post my musings here, in the hopes that some readers will be motivated to look up the underlying paper when it appears. It should go without saying that neither Cook nor Reuter bears any responsibility for what appears below.
If you have substantive suggestions or literary corrections to offer, I still have time to make revisions. My email is kleiman (at) ucla (dot) edu.
Alcohol as a “Drug”: A Moral Revolution
“In terms of its effects on the human body and psyche, alcohol is simply another psychoactive substance.” That sentence, with which Cook and Reuter begin their very able essay, embodies a proposition that will be taken as a truism by most readers of this journal, but would be regarded as a fallacy, an outrage, and an insult by many, if not most, ordinary citizens.
Why is that claim controversial, and why does the rejection of that claim matter?
It is controversial, I would submit, because the mood in which the public, its elected representatives, and their appointed officials consider drugs, drug-taking, and drug policy has little to do with the calm, evidence-based, policy-analytic tone taken by Cook and Reuter. The two scholars do not recite, because they do not believe, the basic credo underlying the international drug control regime, as well as the drug policies of most countries: outside a strictly medical context, drugs are fundamentally evil, drug-taking is both harmful and morally culpable, and drug-takers require some mixture of treatment and punishment. It is this credo that is threatened by any attempt to treat alcohol as a “drug.”
By contrast with any of the controlled drugs, alcohol use is neither statistically nor legally deviant.
In particular, those who discuss drug policy (outside Islamic societies) have no obligation to pretend that they themselves are, nor any right to assume that their audiences are, abstinent from alcohol. Thus courtesy forbids even those who themselves do not drink, and disapprove of drinking, from referring to alcohol users generically as “drunkards” or “degenerates” or “slaves of the Demon Rum.” Problems with alcohol must therefore be treated, in Abraham Lincoln’s formulation, as “the abuse of a good thing,” not “the use of a bad thing.”
But if alcohol is a drug, then “drug use” is normal, and not all drug use is abuse. That undercuts the entire project of stigmatization underlying much of what passes for “drug abuse prevention.” If smoking cannabis, snorting cocaine, swallowing MDMA (“ecstasy”), or even injecting heroin, are not different in principle from having a glass of wine, then the moral basis for treating cannabis-smokers, cocaine-snorters, rave-goers, and heroin-injectors as carriers of a deadly plague is called into question, and even suppliers of those drugs might be seen as regulatory violators rather than hostes humani generis (enemies of humankind) the modern incarnation of a legal category that used to cover pirates and slave-traders.
Conversely, labeling alcohol a “drug,” given the nasty connotations that word has been so carefully given, calls into question the presumptive innocence and innocuousness of drinking by responsible, non-alcoholic adults, and of the industry that supplies them, as it also supplies children, alcoholics, and those who become violent and imprudent under the influence of drink. To the analytically-minded it seems perverse that the one-eighth or so of diagnosable substance abuse disorder (other than nicotine dependency) that relates to the controlled drugs should receive much more attention (whether measured by rhetoric or control resources) than the seven-eighths in which the problem substance is alcohol.
Back when the U.S. Office of National Drug Control Policy (the “drug czar’s” office) was new, I had a conversation with someone who was then a staffer and is now a senior official. When I suggested that the office ought to include alcohol among its targets, he fairly snarled, “Don’t change the subject!” Someone of a psychodynamic or cultural-critical turn of mind might be inclined to turn that response around, and consider the current social and political formulation of the “drug problem” as a massive displacement mechanism, an effort to “change the subject” from the one drug that claims the majority of the addicts and accounts for the vast bulk of drug-related deaths and drug-related violence
Thus what Cook and Reuter propose is nothing less than a moral revolution. If current attitudes overstate the evils of “drugs” and understate those of alcohol, if current policies are excessively harsh on “drug” users and dealers and excessively loose about the use and supply of alcoholic beverages, then that revolution might bring both sets of policies closer to their respective optima. But to the vast majority whose views the current laws reflect, treating alcohol as a “drug” would be not only an instance of moral confusion but also an invitation to policies both unduly lenient toward wrongdoing and unduly meddlesome about normal, innocent pleasures and comforts. That the proposed revolution reflects a scientific consensus would be, to that majority, at best a cold comfort.